GILES A Flashcards
A physical therapist performs a manual muscle test on a patient with unilateral lower extremity weakness. The physical therapist should test the patient’s hip adductors with the patient positioned in:
A. Prone
B. Sidelying
C. Standing
D. Supine
Correct Answer: Sidelying
The hip adductors include the adductor longus, adductor brevis, adductor magnus, and gracillis
A. A prone position would not be utilized to test the hip adductors, however, would be an appropriate position to test the hamstrings and gluteus maximus muscles.
B. The strength of the hip adductors is assessed with the patient positioned in sidelying with the test leg closest to the surface in an adducted position. The physical therapist should apply pressure to the distal aspect of the femur, pushing downward in an attempt to abduct the lower extremity.
C. Standing would not be an appropriate position to test the hip adductors since it would be extremely difficult to adequately stabilize the body and prevent substitution. In addition, the activity would not be considered against gravity.
D. A supine position would not be utilized to test the hip adductors, however, would be an appropriate position to test the Sartorius and the tensor fasciae late muscles.
A patient reports feeling tenderness and sensitivity to pressure in an area of the hand consistent with the marking in the image. This subjective finding is MOST consistent with:
A. Carpal tunnel syndrome
B. Dupuytren’s contracture
C. De Ouervain’s disease
D. Ulnar nerve entrapment
Correct Answer: Dupuytren’s contracture
Medical conditions often have several characteristic signs and symptoms that can help distinguish the condition from other similar conditions. Knowledge of this information can assist physical therapists to develop appropriate plans of care and maximize patient outcomes.
A. Carpal tunnel syndrome (CTS) is a peripheral nerve entrapment injury that occurs as a result of compression of the median nerve where it passes through the carpal tunnel. A patient with CTS will initially present with sensory changes and paresthesias along the median nerve distribution in the hand. The sensory changes and paresthesias may also radiate into the upper extremity, shoulder, and neck.
B. Dupuytren’s contracture is a contracture of the palmar fascia of the hand which results in a flexion deformity of involved metacarpophalangeal and proximal interphalangeal joints. This deformity most commonly affects the fourth and fifth digits.
The condition is characterized initialy by nodules and thickened tissue near the distal palmar crease in the palm region below the ring finger and little finger. This area is often tender and sensitive to pressure.
C. De Quervain’s disease refers to inflammation of the sheath that surrounds the abductor pollicis longus and extensor pollicis brevis tendons at the wrist. This condition is likely to produce pain or discomfort in the area of the distal radius.
D. Ulnar nerve entrapment occurs due to compression, injury or irritation of the ulnar nerve. A patient with ulnar nerve entrapment at the wrist will often report weakness and numbness in the ulnar nerve distribution, but would be less likely to experience tenderness and sensitivity to pressure. This condition is more common at the elbow than the wrist.
A physician completes a physical examination on a 16-year-old male who injured his knee while playing in a soccer contest yesterday. The physician’s preliminary diagnosis is a grade I anterior cruciate ligament injury. Which of the following diagnostic tools would be the MOST appropriate in the immediate medical management of the patient?
A. Bone scan
B. Computed tomography
C. Magnetic resonance imaging
D. X-ray
Correct Answer: X-ray
A grade II anterior cruciate ligament injury most often presents with moderate pain and swelling, minimal instability of the joint and decreased range of motion. The physician would make the diagnosis based on the patient’s clinical presentation and the results of ligamentous testing such as the Lachman test, lateral pivot shift maneuver or anterior drawer test.
A. A bone scan is a diagnostic test that utilizes radioactive isotopes to identify areas of bone that are hypervascular or have an increased rate of bone mineral turnover. Bone scans are most commonly used to detect bone disease or stress fractures.
B. Computed tomography produces cross-sectional images based on x-ray attenuation. A computerized analysis of the changes in absorption produces a detailed reconstructed image. The test is commonly used to diagnose spinal lesions and in diagnostic studies of the brain.
C. Magnetic resonance imaging is a non-invasive diagnostic test that utilizes magnetic fields to produce an image of bone and soft tissue. The test is valuable in providing images of soft tissue structures such as muscles, menisci, ligaments, tumors, and internal organs. The test would be the most beneficial to confirm the presence of an anterior cruciate ligament injury, however. due to the cost of the diagnostic test and the availability of the testing units it is unlikely that the test would be used in the immediate medical management.
D. X-ray is a radiographic photograph commonly used to assist with the diagnosis of musculoskeletal pathology such as fractures, dislocations, and bone loss. An x-ray is a relatively cost effective diagnostic test often utilized in the immediate medical management to rule out the possibility of an associated fracture.
A physical therapist performs goniometric measurements on a 38-year-old female rehabilitating from an acromioplasty. The therapist attempts to stabilize the scapula while measuring glenohumeral abduction. Failure to stabilize the scapula will lead
to:
A. Downward rotation and elevation of the scapula
B. Downward rotation and depression of the scapula
C. Upward rotation and elevation of the scapula
D. Upward rotation and depression of the scapula
Correct Answer: Upward rotation and elevation of the scapula
Normal glenohumeral abduction is 0-120 degrees. When measuring glenohumeral abduction, the axis of the goniometer should be placed over the anterior aspect of the acromion process. The stationary arm should be positioned parallel to the midline of the anterior aspect of the sternum and the moveable arm should be positioned on the medial midline of the humerus. Failure to stabilize the scapular will result in the obtained range of motion value being greater than the actual amount of glenohumeral abduction available.
A. Glenohumeral abduction requires upward rotation of the scapula and not downward rotation.
B. Glenohumeral abduction requires upward rotation and elevation of the scapula and not downward rotation and depression
C. Failure to stabilize the scapula when measuring and elevation of the scapula. When measuring should complex abduction, the thorax should be stabilized to prevent lateral flexion of the trunk.
D. Glenohumeral abduction requires elevation of the scapula and not depression.
A physical therapist performs an examination on a 46-year-old male patient diagnosed with piriformis syndrome. The patient indicates he has experienced pain in his low back and buttock region for the last three weeks. Which motions would you expect to be weak and painful during muscle testing based on the patient’s diagnosis?
A. Abduction and lateral rotation of the thigh
B. Abduction and medial rotation of the thigh
C. Adduction and lateral rotation of the thigh
D. Adduction and medial rotation of the thigh
Abduction and lateral rotation of the thigh
Correct Answer: A
Piriformis syndrome refers to a condition in which the piriformis muscle irritates the sciatic nerve causing pain in the buttock and referred pain along the course of the sciatic nerve. The piriformis muscle originates on the anterior surface of the sacrum and the sacrotuberous ligament and inserts on the greater trochanter of the femur. The muscle is innervated by the sacral plexus.
A. The patient would likely present with pain and weakness with resisted abduction and lateral rotation of the thigh since the motions are consistent with the action of the piriformis muscle.
B. The patient would likely present with pain and weakness with resisted abduction of the thigh, however, would not with resisted medial rotation.
C. The patient would not likely experience pain and weakness with resisted adduction, however, may with lateral rotation.
D. The patient would not likely experience pain and weakness with resisted adduction or medial rotation of the thigh since the motions are the exact opposite of the piriformis muscle’s action.
A physical therapist assesses a patient’s upper extremity deep tendon reflexes as part of a screening examination. The MOST appropriate location to elicit the brachioradialis reflex is the:
A. Radial tuberosity
B. Antecubital fossa
C. Biceps tendon
D. Stvloid process of the radius
Stvloid process of the radius
Correct Answer: D
The brachioradialis muscle is innervated by the radial nerve via C5-C6 nerve root, however, the reflex is largely a function of C6. The brachioradialis muscle is the only muscle in the body that extends from the distal end of one bone to the distal end of another.
A. The radial tuberosity is an oval projection from the medial surface of the radius, immediately distal to the neck. The biceps brachi tendon inserts on the radial tuberosity.
B. The antecubital fossa is a triangular cavity of the elbow that contains the tendon of the biceps, the median nerve, and the brachial artery.
C. The biceps reflex (CS-C6) is tested by tapping over the biceps tendon of the thumb of the therapist placed directly over the biceps tendon in the antecubital fossa.
D. The brachioradialis reflex is tested by tapping the brachioradialis tendon at the distal end of the radius with the flat edge of the reflex hammer.
A physical therapist completes a respiratory assessment on a patient in an acute care hospital. The examination reveals decreased breath sounds and decreased fremitus. This finding is MOST indicative of:
A. Pleural effusion
B. Pulmonary edema
C. Consolidation
D. Atelectasis
Pleural effusion
Correct Answer: A
Decreased breath sounds and decreased fremitus are most likely caused by pleural effusion or pneumothorax. Pulmonary edema, consolidation, and atelectasis are often associated with decreased breath sounds and increased fremitus.
A. Pleural effusion is an accumulation of fluid between the layers of the membrane that lines the lungs and the chest cavity.
Abnormal lung pressures secondary to congestive heart failure often cause transudative pleural effusion. Exudative effusion results from inflammation of the pleura caused by lung disease.
B. Pulmonary edema is an accumulation of fluid in the alveolar spaces. The condition is most often associated with decreased breath sounds and increased fremitus.
C. Consolidation refers to an area of the lung that is filled with fluid. The fluid may be edema, inflammatory exudate, pus, water or blood. The condition is most often associated with decreased breath sounds and increased fremitus on the side of the consolidation.
D. Atelectasis is the absence of gas in part or all of a lung due to a collapse of the lung tissue. The condition is most often associated with decreased breath sounds and increased fremitus.
A physical therapist performs gait training activities with an eight-year-old child who utilizes a reciprocating gait orthosis.
Which medical diagnosis is MOST often associated with the use of this type of orthotic device?
A. Cerebral palsy
B. Down syndrome
C. Legg-Calve-Perthes disease
D. Spina bifida
Spina bifida
Correct Answer: D
A reciprocating gait orthosis is a type of hip-knee-ankle-foot orthosis that incorporates a cable connecting the two hip joint mechanisms. The device assists the child to advance the lower extremities during ambulation.
A. Cerebral palsy is an umbrella term used to describe a group of non-progressive movement disorders that result from brain damage. Clinical presentation includes motor delays, abnormal muscle tone and motor control, reflex abnormalities, poor postural control, and balance impairments.
B. Down syndrome (trisomy 21) occurs when there is an error in cell division. Clinical manifestations include hypotonia, flattened nasal bridge, Simian line (palmar crease), epichantal folds, enlargement of the tongue, developmental delay.
C. Legg-Calve-Perthes disease is the name given to idiopathic osteonecrosis of the capital femoral epiphysis of the femoral head. Clinical presentation includes short limb, high greater trochanter, quadriceps atrophy, and adductor spasm. Bracing using a Scottish-Rite brace may be used in an attempt to contain the femoral head in the acetabulum.
D. Spina bifida is a congenital neural tube defect that generally occurs in the lumbar spine, but can also occur at the sacral, thoracic, and cervical levels. Classifications include occulta, meningocele, and myelomeningocele. Since the impairments associated with some of the classifications of spina bifida can include motor and sensory loss below the vertebral defect, a reciprocating gait orthosis is often used.
A physical therapist instructs a patient rehabilitating from thoracic surgery how to produce an effective cough. Which patient position would be the MOST appropriate to initiate treatment?
A. Standing
B. Sitting
C. Sidelying
D. Hooklying
Sitting
Correct Answer: B
An effective cough requires an inspiration greater than tidal volume, followed by closure of the glottis, abdominal muscle contraction, and sudden opening of the glottis for the forceful expulsion of the inspired air.
A. Although it is possible to perform a maximal inhalation needed for an effective cough, the standing position would not be the most appropriate position to initiate treatment after thoracic surgery.
B. Sitting upright will maximize all the steps needed to produce an effective cough
C. The sidelying position does not promote the maximal inhalation needed for an effective cough.
D. Hooklying refers to a position where the patient is lying in supine with their hips and knees bent and the feet flat on the floor with the arms positioned at their side. The hooklying position does not promote the maximal inhalation needed for an effective cough.
A physical therapist provides pre-operative instructions for a patient scheduled for hip arthroplasty surgery. As part of the session, the therapist discusses the importance of preventing deep vein thrombosis following surgery. Which finding is the BEST indicator that the patient is at minimal risk of acquiring a deep vein thrombosis?
A. Ability to perform ankle pumps and muscle setting exercises
B. Ability to ambulate on a frequent schedule
C. Ability to achieve full hip range of motion within the allowable limits
D. Ability to utilize pneumatic compression devices and elastic stockings
Ability to ambulate on a frequent schedule
Correct Answer: B
Deep vein thrombosis results from the formation of a blood clot that becomes dislodged and is termed an embolus. This is a serious medical condition since the embolus may obstruct a selected artery. Patients are often at risk for acquiring a deep vein thrombosis after surgery. Other risk factors include advanced age, obesity, infection, tobacco, and air travel.
A. Ankle pumps and muscle setting exercises are beneficial, but would not produce the magnitude of muscle pumping action compared to an activity such as ambulation since the exercises tend to involve muscles working in relative isolation.
B. The ability to ambulate on a frequent schedule requires a significant amount of muscle pumping action generated from contraction of the lower extremity muscles. The initiation of this activity signifies that the patient is progressing toward a more dynamic state which significantly decreases the risk of acquiring deep vein thrombosis.
C. Range of motion is a desirable activity following surgery since it requires muscle activity and promotes circulation, however, the intensity of the activity is relatively low when compared to ambulation.
D. Pneumatic compression devices and elastic stockings are often utilized following surgery since they can help to prevent coagulation and the formation of a thrombus. The interventions are less desirable than an activity like ambulation, however, can be successfully integrated into a comprehensive program to prevent deep vein thrombosis.
A group of physical therapists design a research study which examines the reliability of the Functional Independence
Measure. To measure reliability the therapists utilize a test-retest design. What is the MOST significant source of error with this type of research design?
A. Sampling error
B. Tendency to rate too strictly or leniently
C. Change in test forms due to sampling of items
D. Change in subject situation over time
Change in subject situation over time
Correct Answer: D
The repeatability of scores on the Functional Independence Measure (FIM from one test administration to another provides evidence of test-retest reliability.
A. Sampling error refers to the differences between samples drown from the same population due to chance. This is not an issue in test-retest design for reliability because the same individuals are tested each time.
B. In a test-retest design for reliability, the therapists rating the patients use the same scoring rules on each occasion.
C. In a test-retest design for reliability, the FIM would be administered both times, therefore the form of the test would not change.
D. Because test-retest design necessitates an interval of time between test administrations, a real change in the patient’s function during this time would adversely affect the reliability score.
A physical therapist treats a patient status post femur fracture with external fixation. While monitoring the patient during an exercise session, the therapist observes clear drainage from a distal pin site. The MOST appropriate therapist action is:
A. Discontinue the exercise session and contact the referring physician
B. Use a gauze pad to absorb the drainage and notify nursing
C. Use a gauze pad to absorb the drainage and continue with the exercise session
D. Document the finding and discontinue the exercise session
Use a gauze pad to absorb the drainage and continue with the exercise session
Correct Answer: C
External fixation devices provide stabilization to fracture sites through the use of pins that are inserted into bone fragments
Clear drainage from a pin site is not uncommon and should not be viewed as a sign of infection or any other serious medical complication.
A. Clear drainage from a distal pin site would not warrant discontinuing the exercise session or contacting the referring physician. If the scenario offered compelling data suggestive of infection, it would be appropriate to notify the referring physician and/or the nurse.
B. The gauze pad is an acceptable method to absorb the drainage. The observation of clear drainage from a distal pin site is relative common and therefore would not require consultation with nursing.
C. The exercise session can continue after the drainage has been absorbed. The physical therapist may be required to use multiple gauze pads throughout the session, however, this should not impact the overall exercise routine.
D. Documenting the observation would be acceptable, however, the presented scenario does not provide adequate justification for discontinuing the exercise session.
A physical therapist is scheduled to treat a patient requiring droplet precautions. What type of protective equipment would be necessary prior to entering the patient’s room?
A. Gloves
B. Mask
C. Gloves and mask
D. Gloves, gown, and mask
Mask
Correct Answer: B
Droplet precautions are designed to prevent transmission of infectious agents through close respiratory or mucous membrane contact. Droplets are most often deposited on the host’s nasal mucosa, conjunctivae or mouth. Examples of diseases requiring droplet precautions include pertussis, influenza, and diphtheria.
A. Gloves would be required for contact precautions, but would not be required for droplet precautions.
B. Droplet precautions require individuals coming within three feet of the patient to wear a mask, however, it is prudent to wear the mask upon entering the room of a patient on droplet precautions to avoid any inadvertent exposure.
C. A mask is required when working with a patient with droplet precautions, however gloves are not.
D. Only a mask is required when treating a patient with droplet precautions. Gloves, gown, and mask are typically required with direct contact with a patient with contact precautions.
A physical therapist collects data as part of a research project that requires direct observation of children performing selected gross motor activities. The therapist is concerned about the influence of an observer on the children’s performance.
The MOST effective strategy to control for this source of error is to:
A. Provide initial and refresher observer training
B. Increase observer awareness and influence of their background
C. Have an observer spend time with the children before direct observation
D. Ask the children to ignore the presence of the observer
Have an observer spend time with the children before direct observation
Correct Answer: C
A research project should be designed to eliminate as many extraneous variable as possible. Failure to eliminate or at least reduce the potential impact of an observer on the children’s performance would be a significant limitation of the study.
A. Observer training would be beneficial in order to provide the observers with a better sense of their purpose, role, and actions. This action would be desirable, but would not address the nuance of the observer for the children.
B. An individual’s background can influence their observations particularly when the date collected is open for interpretation.
This option also focuses on the observer and not the children.
C. Spending time with the children prior to direct observation will allow the children to feel more at ease and as a result their performance may be more reflective of their current abilities.
D. Asking the children to ignore the presence of the observer would likely serve to bring additional attention to the observer and therefore influence behavior.
A physical therapist discusses the importance of proper posture with a patient rehabilitating from back surgery at the L3-L4 spinal level. Which body position would place the MOST pressure on the lumbar spine?
A. Standing in the anatomical position
B. Standing with 45 degrees of hip flexion
C. Sitting in a chair slouching forward
D. Sitting in a chair with reduced lumbar lordosis
Sitting in a chair slouching forward
Correct Answer: C
A study by Nachemson examined intradiskal pressure in the lumbar spine (L3 disk) as they relate to specific body positions.
The order of body positions from the lowest total load to the greatest total load is as follows: lying in supine, sidelying, standing in the anatomical position, standing with 45 degrees of hip flexion, sitting in a chair with reduced lumbar lordosis, and sitting in a chair slouching forward
A. Standing in the anatomical position resulted in a greater total load than the load associated with lying in supine or sidelying.
B. Standing with 45 degrees of hip flexion resulted in a greater total load than the load associated with lying in supine, sidelying, and standing in the anatomical position.
C. Sitting in a chair slouching forward resulted in a greater total load than any of the other five body positions measured.
D. Sitting in a chair with reduced lumbar lordosis had the greatest total load of the positions measured with the only exception being sitting in a chair slouching forward.
A physical therapists works on transfer activities with a patient diagnosed with a complete C5 spinal cord injury. Which of the following muscles would the patient be able to utilize during the training session?
A. Brachioradialis
B. Pronator teres
C. Extensor carpi radialis brevis
D. Latissimus dorsi
Brachioradialis
Correct Answer: A
A Patient with C5 tetraplegia would be able to utilize muscles innervated at or above the C5 spinal level.
A. The brachioradialis is innervated by the radial nerve (C5-C6) and acts to flex the elbow joint and assists in pronating and supinating the forearm when these movements are resisted.
B. The pronator teres is innervated by the median nerve (C6-C7) and acts to pronate the forearm and assists in flexion of the elbow 1oint.
C. The extensor carpi radialis brevis is innervated by the radial nerve (C6, C7, C8) and acts to extend the wrist and assists in wrist abduction.
D. The latissimus dorsi is innervated by the thoracodorsal nerve (C6, C7, C8) and with the origin fixed acts to medially rotate, adduct and extend the shoulder joint.
A physical therapist assesses the deep tendon reflexes of a patient as part of the lower quarter screening examination. The therapist determines that the right and left patellar tendon reflex and the left Achilles tendon reflex are 2+, while the right Achilles tendon reflex is absent. The clinical condition that could BEST explain this finding is:
A. Cerebral palsy
B. Multiple sclerosis
C. Peripheral neuropathy
D. Intermittent claudication
Peripheral neuropathy
Correct Answer: C
A reflex is a motor response to a sensory stimulation that can be used to assess the integrity of the nervous system. Deep tendon reflexes (DIR) elicit a muscle contraction when the muscle’s tendon is stimulated. A grade of 2+ would be considered a normal response.
A. Cerebral palsy is a neuromuscular disorder of posture and controlled movement, however, the clinical presentation is highly variable based on the area and extent of central nerveous system damage. It is unlikely that a reflex would be absent in an upper motor neuron disorder such as cerebral palsy.
B. Multiple sclerosis is a chronic autoimmune inflammatory disease of the central nervous system characterized by demyelination of the myelin sheaths that surround nerves within the brain and spinal cord. Symptoms can include visual problems, paresthesias and sensory changes, clumsiness, weakness, ataxia, balance dysfunction, and fatigue. Deep tendon reflexes would not typically be absent with multiple sclerosis since it is an upper motor neuron disorder.
C. Peripheral neuropathy is a broad term that describes a lesion to a peripheral nerve. Patients with peripheral neuropathy may exhibit motor, sensory, and autonomic changes including extreme sensitivity to touch, loss of sensation, muscle weakness, and loss of vasomotor tone. Deep tendon reflexes may be asymmetrical based on the location of the involved peripheral nerve and usually present as diminished or absent.
D. Intermittent claudication occurs as a result of insufficient blood supply and ischemia in active muscles. Symptoms most commonly include pain and cramping in muscles distal to the occluded vessel. Deep tendon reflex would not typically be affected
A patient is directed to reach for an object beyond their arm’s length during therapeutic activities emphasizing core training and balance activities as depicted in the image. The desired response with this activity would be:
A. Left trunk elongation, left weight shift, right hip hiking
B. Right trunk, elongation, right weight shift, right hip hiking
C. Left trunk elongation, left weight shift, left hip hiking
D. Right trunk elongation, right weight shift, left hip hiking
Right trunk elongation, right weight shift, left hip hiking
Correct Answer: D
A. A patient that presents with left
trunk elongation, left weight shift, and right hip hiking is likely reaching for an object just beyond their reach at shoulder height or higher on their left side.
B. A patient that presents with right trunk elongation and right weight shift would typically be reaching for an object beyond arm’s length at shoulder level or higher on their right side. They would, however, present with left hip hiking, not right hip hiking.
C. A patient that presents with left trunk elongation and left weight shift would typically be reaching for an object beyond arm’s length at shoulder level or higher on their left side. They would, however, present with right hip hiking, not left hip hiking.
D. A patient that presents with right trunk elongation, right weigh shift, and left hip hiking is likely reaching for an object just beyond reach at shoulder height or higher on their right side.
A physical therapist attempts to palpate the tibialis posterior tendon. To facilitate palpation of this structure the therapist should:
A. Ask the patient to invert and plantar flex the foot
B. Ask the patient to evert and dorsiflex the foot
C. Ask the patient to invert and dorsiflex the foot
D. Passively evert and plantar flex the foot
Ask the patient to invert and plantar flex the foot
Correct Answer: A
A tendon is a band of dense fibrous tissue forming the termination of a muscle which attaches the muscle to a bone. A tendon becomes more prominent when the associated muscle is active. The tendon of the tibialis posterior can be palpated posterior and inferior to the medial malleolus.
A. The tibialis posterior originates on the interosseous membrane, lateral portion of the posterior surface of the tibia, and proximal two thirds of the medial surface of the tibia, and proximal two thirds of the medial surface of the fibula. The muscle acts to invert the foot and assists with plantar flexion of the ankle joint. As a result, the tendon is more prominent with active inversion and plantar flexion.
B. Eversion and dorsiflexion are opposite of the action of the tibialis posterior. As a result, the active moment would not facilitate palpation of the muscle’s tendon.
C. The tibialis anterior acts to dorsiflex the ankle joint and assists with inversion of the foot. As a result, the tendon is more prominent with active dorsiflexion and inversion. The tendon of the muscle is easily palpated where it crosses the ankle joint to its insertion on the medial aspect of the base of the first metatarsal and medial cuneiform bone.
D. Passive movement would not be as desirable as active movement to facilitate palpation of the tendon since muscular activity is necessary to make the tendon prominent. In addition, the tibialis posterior inverts the foot and assists with plantar flexion of the ankle joint.
A physical therapist participating in a research project uses a simple random sample to draw a sample from the population.
By selecting this type of sample, the therapist ensures:
A. The data collected from the sample will be normally distributed
B. The sample size will be large
C. The sample will have proportional representation from all parts of the population
D. That every member of the population has an equal opportunity of being chosen
That every member of the population has an equal opportunity of being chosen
Correct Answer: D
Probability samples are created through a process of random selection. Each selection is independent and every member of the population has an equal chance of being selected for the sample.
A. Simple random sampling does not ensure that the date collected will be normally distributed. The shape of the distribution of the date collected from the sample is independent of the type of sample.
B. Simple random sampling does not determine the size of the sample
C. To ensure that the sample will have proportional representation from all parts of the population, the therapist would create a proportional stratified sample.
D. A simple random sample is unblased; each member of the population has an equal chance of being chosen.
A physical therapist examines the heart sound of a 48-year-old female status post coronary artery bypass graft. When auscultating, the therapist identifies the heart sound associated with closing of the mitral and tricuspid valves. This heart sound BEST describes:
A. S1
B. S2
C. S3
D. S4
S1
Correct Answer: A
The heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. The therapist uses a stethoscope to listen for these sounds, which provide important information about the condition of the heat
A. The first heart sound, SI (the lub of the lub-dub), is associated with the closing of the mitral and tricuspid valves, corresponding to the onset of ventricular systole.
B. The second heart sound, S2, (the dub of the lub-dub), is associated with the closing of the aortic and pulmonary valves, corresponding to the onset of ventricular diastole.
C. A third heart sound, S3, occurs early in diastole while the ventricle is rapidly filling. The sound occurs immediately after S2 (lub-dub-dub). The S3 sound may occur in healthy children and young adults, and is referred to as physiologic third heart sound. It also indicated a loss of ventricular compliance in the presence of heart disease or heart failure. In this case, it is called a ventricular gallop.
D. A fourth heart sound, S4, occurs late in diastole just before S1 (la-lub-dub) and is associated with atrial contraction and an increased resistance to ventricular filling. The heart sound is required to as an atrial gallop. The sound is common in patients with hypertension, a history of myocardial infarction or coronary bypass surgery.
During a balance assessment of a patient with left hemiplegia, it is noted that in sitting the patient requires minimal assistance to maintain the position and cannot accept any additional challenge. The physical therapist would appropriately document the patient’s sitting balance as:
A. Normal
B. Good
C. Fair
D. Poor
Poor
Correct Answer: D
Sitting balance can be graded in an objective manner by using a scale that ranges from poor to normal. A patient that requires assistance to maintain a sitting position would be graded as having poor sitting balance.
A. A grade of normal is indicative of a person that is able to sit unsupported, move in and out of the base of support, and accept maximal challenge without loss of balance.
B. A grade of good is indicative of a person that is able to sit unsupported, move in and out of the base of support, and accept some challenge without loss of balance.
C. A grade of fair is indicative of a person that is able to maintain their balance in sitting unsupported, but cannot accept any challenge or go outside of their base of support without loss of balance.
D. A grade of poor is indicative of a person that is unable to maintain their balance in sitting without external support or assistance.
A physical therapist is treating a patient with a head injury who begins to perseverate. In order to refocus the patient and achieve the desired therapeutic outcome, the therapist should
A. Focus on the topic of perseveration for a short period of time in order to appease the patient
B. Guide the patient into an interesting new activity and reward successful completion of the task
C. Take the patient back to his room for quiet time and attempt to resume therapy once he has stopped perseverating
D. Continue with repetitive verbal cues to cease perseveration
Guide the patient into an interesting new activity and reward successful completion of the task
Correct Answer: B
Perseveration is the continued repetition of a word, phrase or movement. Initiating a new activity during therapy may allow the patient toredirect attention and subsequently receive positive reinforcement for attending to the selected task.
A. It is not necessary to attempt to appease the patient since the patient cannot independently move beyond whatever they are perseverating on. Staying with the topic will not assist in moving forward.
B. Patients with a lesion in the premotor or prefrontal cortex often exhibit perseveration. Since the patient typically continues the repetition of a word, phrase or movement after the cessation of the original stimulus, the best intervention would be to redirect the patient away from the current activity.
C. The patient will not benefit from “quiet time” since the patient is not perseverating due to a behavioral issue. Redirecting the patient may successfully alow the patient to move forward and continue with therapy without interruption.
D. Verbal cueing is not an effective technique to cease perseveration. The patient typically requires a redirection of their attention to another activity or environment.
A male physical therapist examines a female diagnosed with subacromial bursitis. After taking a thorough history, the therapist asks the patient to change into a gown. The patient seems very uneasy about this suggestion, but finally agrees to use the gown. The MOST appropriate course of action would be to:
A. Continue with treatment as planned
B. Attempt to treat the patient without using the gown
C. Bring a female staff member into the treatment room and continue with treatment
D. Offer to transfer the patient to a female physical therapist
Bring a female staff member into the treatment room and continue with treatment
Correct Answer: C
The physical therapist should be sensitive to the patient’s apparent discomfort with the situation, however, must also take appropriate steps to manage their relative risk. Physical therapist must be willing to modify their approach with each patient encounter based on the unique presented circumstances.
A. The patient’s original reluctance to wear the gown makes it prudent to have a witness present during treatment. The decision to continue with treatment without any formal action places the physical therapist at unnecessary risk.
B. Failure to wear the gown may make it more difficult for the physical therapist to treat the patient or depending on the chosen intervention, could risk damaging or soiling the patient’s clothes.
C. The male physical therapist should bring a female staff member into the treatment room. The presence of a witness is a form of risk management that protects the physical therapist in the event of any alleged misconduct and may make the patient more comfortable.
D. It would be impractical to transfer a patient to another physical therapist simply because the patient seemed to be uncomfortable when asked to change into the gown. In addition, the female physical therapist may have similar concerns which would still require another staff member to be present.
A physical therapist treats a patient status post CVA. Which action would be MOST likely to facilitate elbow extension in a patient with hemiplegia?
A. Turn the head to the affected side
B. Turn the head to the unaffected side
C. Extend the lower extremities
D. Flex the lower extremities
Turn the head to the affected side
Correct Answer: A
Patients status post CVA are likely to exhibit abnormal tonic reflexes. Eliciting the reflexes will produce sustained posturing and abnormal movement patterns.
A. The asymmetrical tonic neck reflex produces extension of the affected upper extremity when the patient’s head is turned toward the affected side. The upper extremity on the skulls ide will flex.
B. If the patient’s head is turned toward the unaffected side, the unaffected upper extremity will extend and the affected upper extremity will flex due to the influence of the asvmmetrical tonic neck reflex (ATNR)
C. The symmetrical tonic labyrinthine reflex (STLR) promotes a tendency for extension when a patient is in supine and reduced extensor influence when the patient is in prone. STLR would not facilitate elbow extension in isolation as noted with ATNR.
D. Flexion of the lower extremities does not have a direct influence on upper extremity flexion or extension.
A physical therapist examines a patient three days following shoulder surgery. The patient complains of general malaise and reports a slightly elevated body temperature during the last twenty-four hours. Physical examination reveals an edematous shoulder that is warm to the touch. A small amount of yellow fluid is observed seeping from the incision. The MOST appropriate therapist action is:
A. Send the patient to the emergency room
B. Communicate the information to the referring physician
C. Document the findings in the medical record
D. Ask the patient to make an appointment with the referring physician
Communicate the information to the referring physician
Correct Answer: B
Physical therapists must be aware of any signs or symptoms of infection, particularly in patients following surgery. Common signs of infection include elevated body temperature, purulent exudate, swelling, edema, and redness.
A. The patient’s presentation requires the physical therapist to take formal action, but would not be indicative of an emergent condition that requires the patient to be seen in the emergency room.
B. The possibility of infection in a patient three days status post surgery warrants immediate consultation with the referring physician.
C. the Subjective and objective information gathered by the physical therapist should be documented in the medical record, however, this action would not address the primary issue which is the possibility of an infection.
D. Asking the patient to make an appointment with the physician is not an appropriate action since it places the burden solely on the patient. The physical therapist is responsible for communicating any potential change in a patient’s medical status to the physician in a timely manner.
A patient with an acute burn is referred to physical therapy less than 24 hours after being admitted to the hospital. The patient’s burns range from superficial partial-thickness to deep partial thickness and encompass approximately 35 percent of the patient’s total body surface area. Which of the following findings would be MOST predictable based on the patient’s injury?
A. Increased oxygen consumption
B. Hypernatremia
C. Increased intravascular fluid
D. Decreased core temperature
Increased oxygen consumption
Correct Answer: A
An acute burn produces hypermetabolism that results in increased oxygen consumption, increased minute ventilation, and an increased core temperature. Intravascular, interstitial, and intracellular fluids are all diminished.
A. Pulmonary function is affected by the presence of a burn injury. In addition to increased oxygen consumption, the patient can also experience increased minute ventilation up to five times the normal value.
B. Hyponatremia or low sodium concentration, initially occurs (within the first 36 hours) secondary to extracellular changes from the increased cellular permeability. In patients that sustain burns above 20% of the total body surface area, fluid and electrolyte replacement is a component of immediate medical management in order to control the hypermetabolic cycle that results from the burn.
C. Intravascular-fluid will decrease due to the increased vascular permeability and overall hematologic changes. Cardiac output can decrease secondary to a combination of an increase in blood viscosity, decrease in intravascular fluid, and an overall increase in peripheral resistance.
D. A patient with significant burn injury is at risk for an increased core temperature due to the increased metabolic and catabolic activity. The one to two degree increase occurs secondary to the “recalibrating” of the hypothalamic temperature centers in the brain. Patients that have sustained extensive burns require a warmer ambient temperature in order to reduce their metabolic rate. Average room temperature will create continued heat loss and perpetuate the hypermetabolic state.
A patient sustains a deep partial-thickness burn to the anterior surface of the right upper extremity and a superficial partial-thickness burn to the anterior surface of the trunk. According to the “rule of nines,” the patient has burns over:
A. 13.5 percent of the body
B. 22.5 percent of the body
C. 27.0 percent of the body
D. 36.0 percent of the body
22.5 percent of the body
Correct Answer: B
The “rule of nines” is commonly utilized to assess the percentage of the body surface affected by a burm. Each area of the body has a specific percentage allocated to it in order to approximate the total percentage of the body surface affected. The values are as follows: head (95), each upper extremity (9%), the trunk (36%), each lower extremity (18%), and the genital area (1%).
A. A value of 13.5% is less than the percentage of body surface affected. A candidate may gave generated an answer of 13.5 by allocating only 9% for the anterior trunk instead of 18% and then adding 4.5% for the anterior surface of the upper extremity.
B. The anterior surface of the right upper extremity equals 4.5% and anterior surface of the trunk equals 18% (4.5% + 18% =22.5%)
C. A value of 27% is greater than the percentage of body surface affected in the described scenario. A candidate may have generated an answer of 27% by incorrectly allocating 9% for the anterior surface of the right upper extremity and then adding 18% for the anterior surface of the trunk.
D. The entire trunk is valued at 36% of the body using the “rule of nines.”
A physical therapist examines the posture of a patient from a lateral view using a plumb line. Which medical condition would be LEAST likely to result in the external auditory meatus being anterior to the plumb line?
A. Ankylosing spondylitis
B. Grave’s disease
C. Osteoporosis
D. Parkinson’s disease
Grave’s disease
Correct Answer: B
When assessing a patient’s posture, a plumb line can be used as a line of reference to determine areas of abnormal posture and the extent of these abnormalities. In normal posture, the stationary plumb line runs through the external auditory meatus.
A. Ankylosing spondylitis is a systemic condition that is characterized by inflammation of the spine and largert peripheral joints. Symptoms include back pain, morning stiffness, and impaired spinal extension. The tendency of a patient with ankylosing spondylitis to exhibit a forward flexed posture would result in the external auditory meatus being anterior to the stationary plumb line.
B. Grave’s disease is an autoimmune disease in which certain antibodies produced by the immune system stimulate thyroid gland causing it to become overactive. Symptoms are consistent with hyperthyroidism including mild enlargement of the thyroid gland (goiter), heat intolerance, nervousness, tremor, and palpitations. Graves’ disease is not typically associated with postural changes.
C. Osteoporosis is a metabolic condition that presents with a decrease in bone mass that subsequently increases the risk of fracture. Symptoms include compression and other bone fractures, loss of lumbar lordosis, deformities such as kyphosis, and postural changes. The tendency of a patient with osteoporosis to exhibit a forward flexed posture would result in the external auditory meatus being anterior to the stationary plumb line.
D. Parkinson’s disease is a movement disorder caused by the progressive degeneration of the dopamine-producing cells in the basal ganglia. Symptoms include difficulty initiating and stopping movement, festinating, and shuffling gait. The tendency of a patient with Parkinson’s disease to exhibit a forward flexed posture would result in the external auditory meatus being anterior to the stationary plumb line.
A patient with complete paraplegia discusses accessibility issues with an employer in preparation for her return to work.
The patient is concerned about her ability to navigate a wheelchair in certain areas of the building. What is the MINIMUM space required to turn 180 degrees in a standard wheelchair?
A. 32 inches
B. 48 inches
C. 60 inches
D. 72 inches
60 inches
Correct Answer: C
The Americans with Disabilities Act was designed to provide a clear and comprehensive national mandate for the elimination of discrimination. Title III provides information on public accommodations including minimum accessibility standards.
A. Thirty-two inches is the minimum required width of a doorway for wheelchair clearance, however, this space would not be adequate to turn 180 degrees in a standard wheelchair.
B. Forty-eight inches would be 12 inches less than the minimum required space to turn 180 degrees in a standard wheelchair
C. Sixty inches is the minimum required width to turn 180 degrees in a standard wheelchair according to the Americans with Disabilities Act.
D. Seventy-two inches would be adequate to turn 180 degrees in a standard wheelchair, however, this value exceeds the minimum required space by 12 inches.
A physical therapist treats a 12-year-old with spastic diplegia that recently underwent an iliopsoas tendon release. The MOST likely associated finding with this surgical procedure is:
A. Crouched gait
B. Lower limb scissoring
C. Equinovarus deformity
D. Knee flexion contracture
Crouched gait
Correct Answer: A
The treatment of spasticity will follow a continuum from conservative to aggressive based on the degree to which the spasticity interferes with overall function. Surgical procedures may be appropriate for patients that have been unsuccessful with more conservative treatment. Goals of surgery include lengthening of muscles and tendons, improving function, increasing range of motion, and correcting deformity.
A. A crouched gait result from spasticity in the hip flexors and is associated with compensatory hip and knee flexion as well as lumbar hyperlordosis. The iliopsoas tendon is released from the lesser trochanter while maintaining its capsular attachments
This will effectively weaken the iliopsoas and decrease crouching.
B. Lower limb scissoring results from spasticity of the hip adductors. A partial obturator neurectomy is performed if contracture is not the cause of the gait deviation. This will effectively weaken the hip adductors and decrease the scissoring during gait.
C. Equinovarus deformity is the most common deformity of the lower extremity and results from spasticity of the gastrocnemius, soleus, and anterior tibialis. A split anterior tibialis tendon transfer (SPLATT) procedure is performed to create an eversion force in an attempt to rebalance the forefoot deformity.
D. A knee flexion contracture results from spasticity of the hamstrings. The distal hamstrings muscles are released along with a transfer of the distal hamstrings insertion if necessary.
A physical therapist prepares to treat a patient diagnosed with impingement syndrome with iontophoresis directly over the insertion of the supraspinatus muscle, What bony landmark BEST corresponds to this site?
A. Less tubercle of the humerus
B. Greater tubercle of the humerus
C. Supraspinatous fossa of the scapula
D. Deltoid tuberosity of the humerus
Greater tubercle of the humerus
Correct Answer: B
Impingement syndrome is a commonly used term describing mechanical impingement of the rotator cuff tendon beneath the anteriorinferior portion of the acromion. Symptoms of impingement syndrome include difficulty reaching up behind the back, pain with overhead use of the arm, and weakness of the shoulder muscles.
A. The subscapularis muscle originates on the subscapular fossa of the scapula and inserts on the lesser tubercle of the humerus. The muscle is innervated by the subscapular nerve.
B. The supraspinatus muscle inserts on the greater tubercle of the humerus. The muscle is innervated by the suprascapular
nerve.
C. The supraspinatus muscle originates on the supraspinous fossa of the scapula. The question asks about the insertion of the muscle.
D. The deltoid tuberosity is the insertion point for the three heads of the deltoid. The anterior deltoid originates on the lateral third of the clavicle, the middle deltoid originates on the acromion process, and the posterior deltoid originates on the spine of the scapula. The deltoid is innervated by the axillary nerve.
A physical therapist examines the breath sounds of a 55-year-old male diagnosed with pulmonary disease. The therapist identifies crackles during both inspiration and expiration. This finding is MOST representative of
A. Pleural effusion
B. Pulmonary fibrosis
C. Impaired secretion clearance
D. Localized stenosis
Impaired secretion clearance
Correct Answer: C
Auscultation of the lungs with a stethoscope is an examination procedure physical therapist use to identify abnormalities in lung sounds. Abnormal lung sounds may suggest problems with ventilation or airway clearance.
A. Pleural effusion is the accumulation of fluid in the pleural space. Lung sounds are usually decreased, but a pleural friction rub may be heart if the pleural surfaces are inflamed.
B. Pulmonary fibrosis is a type of restrictive lung dysfunction characterized by changes to the alveoli and lung architecture from an inflammatory process. The inflammatory changes cause scarring and fibrotic lesions in the lungs which result in decreased lung compliance, lung volumes, diffusing capacity, increased pulmonary arterial pressure, and work of breathing Auscultation often reveals decreased breath sounds.
C. Crackles or rales are abnormal breath sounds heard during auscultation of the lungs with a stethoscope. Crackles are extra sounds caused by the “popping open” of small airways blocked by secretions or fluid and may be heard during both the inspiratory and expiratory phases of the breathing cycle.
D. Localized stenosis is not a term associated with breath sounds.
The components of a clinical question posed in order to search the literature for information about the effectiveness of a therapy include:
A. Subjective, objective, assessment, plan (S.O.A.P.)
B. Patient or problem, intervention, comparison, outcome (P-I-C-O)
C. Validity, reliability, applicability
D. Diagnosis, prognosis, intervention
Patient or problem, intervention, comparison, outcome (P-I-C-O)
Correct Answer: B
Asking a patient-centered clinical question is the first step in searching the literature for information about the effectiveness of a therapy.
A. Subjective, objective, assessment, and plan (S.O.A.P.) refer to the elements commonly used for recording daily notes of a patient’s physical therapy sessions.
B. The acronym P-I-C-O helps to focus on the appropriate pieces of information needed to search the literature for information about the effectiveness of a therapy. The P refers to the target population or characteristics of the patient or problem of interest. The I refers to the intervention being considered. The C refers to the comparison or control condition that may be considered along with the intervention and is most appropriate when the need is to compare the effectiveness of two or more interventions. The O refers to the outcomes or measurements that will be relevant to understanding the effect of the interventions.
C. Validity, reliability, and applicability are properties of measurements.
D. Diagnosis, prognosis, and intervention are elements of the patient/client management models as described in the Guide to Physical Therapist Practice, along with examination, and evaluation.
A physical therapist completes a developmental assessment on a seven-month-old infant. Assuming normal development, which of the following reflexes would NOT be integrated?
A. Asymmetrical tonic neck reflex
B. Moro reflex
C. Landau reflex
D. Symmetrical tonic neck reflex
Landau reflex
Correct Answer: C
Integration of a reflex refers to the period of time when a reflex is no longer present despite an appropriate stimulus.
A. The asymmetrical tonic neck reflex is stimulated when the head is turned to one side. The response is a fencing posture (arm and leg on face side are extended, arm and leg on scalp side are flexed). The normal age of a response is from 28 weeks of gestation to 5 months.
B. The Moro reflex is stimulated when an infant’s head is suddenly dropped into extension for a few inches. The response is that the arms abduct with fingers open, then cross the trunk into adduction; often followed immediately by crying. The normal age of the response is from 28 weeks of gestation to 5 months.
C. The Landau reflex is an equilibrium response that occurs when a child responds to prone suspension by aligning their head and extremities in line with the plane of the body. Although the response begins around three months of age, it is not fully integrated until the child’s second year.
D. The symmetrical tonic neck reflex is stimulated by the head moving into flexion or extension. When the head is in flexion, the arms are flexed and the legs are extended. When the head is in extension, the arms are extended and the legs are flexed.
The normal age of the response is from 6-8 months.
A physical therapist examines a patient with limited cervical range of motion. As part of the examination, the therapist attempts to screen the patient for possible vertebral artery involvement, but is unable to position the patient’s head and neck in the recommended test position. The MOST appropriate action is to:
A. complete the vertebral artery test with the head and neck positioned in approximately 50 percent of the available cervical range of motion
B. complete the vertebral artery test as far Into the available cervical range of motion as tolerated
C. avoid completing the vertebral artery test until the patient has full cervical range of motion
D. avoid all direct cervical treatment techniques until the vertebral artery test can be assessed at the limits of normal cervical range of motion
complete the vertebral artery test as far Into the available cervical range of motion as tolerated
Correct Answer: B
The vertebral artery test is performed with the patient positioned in supine. The therapist places the patient’s head in extension, lateral flexion, and rotation to the ipsilateral side. A positive test is indicated by dizziness, nystagmus, slurred speech or, loss of consciousness and may be indicative of compression of the vertebral artery.
A. The vertebral artery test should be administered using the available cervical range of motion and as a result it would not make sense to utilize only a portion of the available range of motion.
B. The physical therapist should perform the test and clear the patient’s vertebral artery for their available range of motion. As the patient gains additional range of motion the test can be readministered.
C. The vertebral artery test can be performed on patients that possess less than full cervical range of motion.
D. Direct cervical treatment techniques are often employed on patients with less than full cervical range of motion. In many cases it is still necessary to clear the vertebral artery using the patient’s available cervical range of motion.
A 30-year-old female is seen in physical therapy secondary to benign paroxysmal positional vertigo. Which of the following physical therapy treatments would MOST benefit this patient?
A. Dix-Hallpike maneuver
B. canalith repositioning maneuvers
C. singular neurectomy
D. gaze stability exercises
canalith repositioning maneuvers
Correct Answer: B
Benign paroxysmal positional vertigo (BPPV) is an intense and intermittent vertigo that occurs in relation to rapid movement of the head in a particular direction and is believed to be a mechanical disorder of the labyrinths. Canaliths develop and float into the semicircular canals causing the brain to interpret their presence as an intense rotation of the head.
A. Dix-Hallpike maneuver is not a treatment for BPPV but rather a diagnostic tool. A patient that presents with BPPV will have torsional nystagmus when performing this maneuver. The patient moves from an upright posture to supine with the head hanging over the surface extended and rotated to 45 degrees. Nystagmus will occur in this position when the affected ear is toward the floor and should fatigue within 60 seconds.
B. Canalith repositioning maneuvers are a highly effective treatment for BPPV and are designed to dislodge the provoking canaliths. This treatment technique attempts to move the canalith debris out of the affected semicircular canal and back to the otolith. Canalith repositioning maneuvers begin in the Dix-Hallpike position to provoke vertigo. Repeated head rolling utilizes gravity to assist with movement of the debris. Treatment continues until no further nystagmus is noted.
C. A singular neurectomy is a surgical procedure that can assist with BPPV, but is rarely performed. This is not a physical therapy treatment but rather a selective surgical transaction of the nerve supply to the posterior canal.
D. Gaze stability exercises are frequently used in the treatment of unilateral vestibular hypofunction with the goal of improving the vestibuloocular reflex and other systems that provide gaze stability while the head is in motion.
A physical therapist inspects the static wrist and hand position of a patient with advanced rheumatoid arthritis. Which positioning is MOST likely based on the medical diagnosis?
A. radial deviation of the radiocarpal joint and radial deviation of the fingers
B. radial deviation of the radiocarpal joint and ulnar deviation of the fingers
C. ulnar deviation of the radiocarpal joint and radial deviation of the fingers
D. ulnar deviation of the radiocarpal joint and ulnar deviation of the fingers
radial deviation of the radiocarpal joint and ulnar deviation of the fingers
Correct Answer: B
Rheumatoid arthritis is a systemic autoimmune disorder of unknown etiology. The disease presents with a chronic inflammatory reaction in the synovial tissues of a joint that results in erosion of cartilage and supporting structures within the capsule.
Rheumatoid arthritis is diagnosed based on the clinical presentation of involved joints, the presence of blood rheumatoid factor, and radiographic changes.
A. Patients with advanced rheumatoid arthritis tend to exhibit radial deviation of the radiocarpal joint, however, the fingers would tend to be positioned in ulnar deviation.
B. Patients with advanced rheumatoid arthritis tend to exhibit radial deviation of the radiocarpal joint and ulnar deviation of the fingers. The radiocarpal changes include a distinct loss of joint space and erosive bone changes. Ulnar displacement of the extensor tendons and an increased ulnar approach of the flexor tendons contribute to the ulnar deviation of the fingers.
C. Patients with advanced rheumatoid arthritis tend to exhibit radial deviation of the radiocarpal joint and ulnar deviation of the fingers. This option is opposite of the typical positioning of a wrist and hand affected by rheumatoid arthritis.
D. Patients with advanced rheumatoid arthritis tend to exhibit radial deviation of the radiocarpal joint. They would, however exhibit ulnar deviation of the fingers.
A physical therapist instructs a patient in a self-stretching activity using the FABER position. This position would be
MOST useful to stretch the:
A. hip abductors
B. hip flexors
C. hip external rotators
D. hip Internal rotators
hip Internal rotators
Correct Answer: D
The FABER or figure-4 position occurs with the patient assuming a supine position with the involved leg flexed, abducted, and externally rotated at the hip so that the ankle is resting on the opposite leg. FABER stands for flexion, abduction, and external rotation.
A. The hip abductors are stretched when the hip is positioned in adduction. The FABER position requires the hip to be in abduction.
B. The hip flexors are stretched when the hip is positioned in extension. The FABER position requires the hip to be in flexion.
C.The hip external rotators are stretched when the hip is positioned in internal rotation. The FABER position requires the hip to be in external rotation.
D. The hip internal rotators are stretched when the hip is positioned in external rotation. The FABER position requires the hip to be in external rotation.
As a component of a cognitive assessment, a physical therapist asks a patient to count from one to twenty-five by Increments of three. Which cognitive function does this task MOST accurately assess?
A. Attention
B. constructional ability
C. abstract ability
D. orientation
Attention
Correct Answer: A
Attention is defined as the capacity of the brain to process information from the environment or from long-term memory. The complexity and familiarity of the task determines the degree of attention required to complete the task.
A. Attention can be assessed by asking a patient to count from one to twenty-five by increments of three. The task should be relatively easy for most individuals, however, it requires the person to exert a sustained, consistent effort. Attention deficits are common with many neurological disorders including brain injury, stroke, and dementia.
B. Constructional ability can be assessed by asking a person to copy figures consisting of varying sizes and shapes or to draw a known item such as a clock.
C. Abstract ability can be assessed by asking a person to interpret a common proverb or to describe similarities or differences between two obiects.
D. Orientation can be assessed by asking a person to identify time (e.g, day, month, season), person (e.g., name), and place (e.g., city, state).
A physical therapist treats a patient that sustained an acute wound to the anterior surface of the forearm. Which cell component would have been the FIRST to arrive at the injury site immediately following the incident?
A. endothelial cells
B. fibroblasts
C. leukocytes
D. platelets
platelets
Correct Answer: D
Normal wound healing occurs as damaged tissues move through distinct yet overlapping phases of repair. The phases of repair occur in a predictable sequence with complex cellular activity and chemical reactions occurring at each phase.
A. Endothelial cells stimulate the production of new blood vessels as well as transport oxygen and nutrients into the wound environment. Endothelial cells are most active in the proliferative phase of wound healing.
B. Fibroblasts produce a wound matrix that consists of collagen elastin, and proteoglycans. Fibroblast activity is facilitated by macrophages that are present from the inflammatory phase. Fibroblasts are most active in the proliferative phase of wound
healing.
C. Leukocytes (i.e., white blood cells) arrive at the wound site in response to the coagulation cascade. Leukocytes include both monocytes and granulocytes. Leukocytes are most active in the inflammatory phase of wound healing, however, they arrive at the wound site after the platelets.
D. Platelets are the first cells to arrive at the wound site. The cells attach to exposed collagen at the injury site and release chemicals that attract more platelets. Collectively the platelets form a platelet plug to temporarily stop the bleeding.
Platelets are most actlive in the hemostasis phase of wound healing.
A physical therapist reads in the medical record that x-rays confirmed the presence of a reverse Hill-Sachs fracture. Which injury would MOST likely be associated with this type of fracture?
A. anterior glenohumeral dislocation
B. posterior glenohumeral dislocation
C. rotator cuff tear
D. biceps tendon rupture
posterior glenohumeral dislocation
Correct Answer: B
A reverse Hill-Sachs fracture (i.e., reverse Hill-Sachs lesion) is an impaction fracture of the anterior medial humeral head
Management of this injury is primarily based on the size of the impression defect.
A. A Hill-Sachs fracture, sometimes referred to as a Hill-Sachs lesion, is characterized as an impaction fracture of the posterior superior humeral head and is frequently diagnosed in patients who have repeatedly sustained anterior glenohumeral dislocations. Approximately 95% of dislocations occur in an anterior direction.
B. A reverse Hill-Sachs fracture is typically associated with a posterior glenohumeral dislocation. Patients with a posterior glenohumeral dislocation typically present holding their arm medially rotated and adducted and may exhibit flattening of the anterior shoulder and a prominent coracoid process.
C. A fracture of the greater tuberosity can result in a rotator cuff tear, however, this is not associated with a reverse Hill-Sachs fracture.
D. A biceps tendon rupture is an injury that occurs to the biceps tendon causing the attachment to separate from the bone. The biceps may rupture proximally (i.e., shoulder) or distally (i.e., elbow). A biceps tendon rupture is rarely associated with a fracture.
A physical therapist uses the Modifiled Ashworth Scale when assessing a patient status post stroke. Which of the following assessment procedures would be the MOST appropriate when using the Modified Ashworth Scale?
A. strength testing
B. deep tendon reflex testing
C. active range of motion
D. passive range of motion
passive range of motion
Correct Answer: D
The Modified Ashworth Scale (MAS) is an instrument that is used to assess muscle spasticity. The MAS uses ordinal scoring, with a grade of “O” indicating the absence of spasticity and a grade of” 4” indicating the presence of rigidity.
A. Strength testing may be used for patients who have had a stroke to determine which muscles have been affected as a result of the neurological damage. However, strength testing would not provide valuable information when using the MAS since the instrument is used to assess spasticity
B. Deep tendon reflex testing may be used for patients who have had a stroke to determine if the patient has hyporeflexia or hyperreflexia as a result of the neurological damage. However, deep tendon reflex testing would not provide valuable information when using the MAS since the instrument is used to assess spasticity.
C. Active range of motion may be used for patients who have had a stroke to determine the patient’s functional use of their extremities. However, active range of motion would not provide valuable information when using the MAS since the instrument is used to assess spasticity, which requires a passive assessment.
D. The MAS is an assessment tool that is used to grade spasticity. Spasticity is defined as increased resistance to passive stretch that is velocity-dependent, therefore, passive range of motion would be the most appropriate method for measuring spasticity.
A physical therapist treats a patient with lower extremity weakness due to a laceration injury to the tibial nerve. Which movement would MOST likely be unaffected by the nerve injury?
A. plantar flexion of the ankle
B. extension of the great toe
C. flexion of the great toe
D. flexion of toes 2-5
extension of the great toe
Correct Answer: B
The tibial nerve is a branch of the sciatic nerve that supplies innervation to the muscles of the posterior lower leg. In the foot, the tibial nerve branches into the medial and lateral plantar nerves.
A. Ankle plantar flexion is performed by several muscles that are innervated by the tibial nerve, including the gastrocnemius, soleus, plantaris, tibialis posterior, flexor hallucis longus, and flexor digitorum longus. A patient with a tibial nerve injury would have significant difficulty performing ankle plantar flexion.
B. Extension of the great toe is performed by the extensor hallucis longus and extensor hallucis brevis. These muscles are innervated by the deep peroneal nerve, which is a branch of the common peroneal nerve. A patient with a tibial nerve injury would have no difficulty performing extension of the great toe.
C. Flexion of the great toe is performed by the flexor hallucis longus and flexor hallucis brevis. These muscles are innervated by the tibial nerve. A patient with a tibial nerve injury would have significant difficulty performing flexion of the great toe.
D. Flexion of toes 2-5 is performed by the flexor digitorum longus and flexor digitorum brevis. These muscles are innervated by the tibial nerve. A patient with a tibial nerve injury would have significant difficulty performing flexion of toes 2-5.
A patient’s job requires him to move boxes weighing 35 pounds from a transport cart to an elevated conveyor belt. The patient can complete the activity, however, is unable to prevent hyperextension of the spine. The MOST appropriate physical therapist action is to:
A. implement a pelvic stabilization program
B. design an abdominal strengthening program
C. review proper body mechanics
D. use an elevated platform when placing boxes on the belt
use an elevated platform when placing boxes on the belt
Correct Answer: D
Physical therapists often perform work site evaluations and make recommendations to modify existing work activities.
A. A pelvic stabilization program may be helpful to improve core stability, however, the question provides ample evidence that the problem is more likely related to the height of the elevated conveyor belt.
B. An abdominal strengthening program would also improve core stability, but would not accommodate for the height of the elevated convevor belt.
C. Reviewing proper body mechanics may be desirable however, the question states that the patient is unable to prevent hyperextension of the spine. Failure to prevent hyperextension of the spine is more likely to occur because of the height of the conveyor belt rather than lack of knowledge of proper body mechanics.
D. In order to eliminate hyperextension of the spine it may be necessary to modify the workstation. The most reasonable modification would be to utilize an elevated platform in order to minimize the height of the conveyor belt. In many instances, it is possible to modify a work site without utilizing large amounts of resources (e.g. time, money).
A 21-year-old male patient informs a physical therapist that additional therapy visits will not be covered by his medical insurance provider. The patient is 12 weeks status post anterior cruciate ligament reconstruction and has had an unremarkable post-operative progression. The MOST appropriate therapist action is:
A. otter to treat the patient pro bono
B. devise an affordable payment plan
C. request additional visits from the third party payer
D. discharge the patient with a home exercise program
discharge the patient with a home exercise program
Correct Answer: D
Physical therapists should discharge patients from physical therapy when the anticipated goals or expected outcomes have been achieved or the patient is no longer benefitting from physical therapy services.
A. Physical therapists are not permitted to offer pro bono services to selected patients based on factors such as reimbursement or the ability to pay. Therapists should strive to treat all patients equitably.
B. A payment plan permits a patient to pay for incurred physical therapy services in a gradual manner. This may be a more desirable option when a patient requires ongoing physical therapy services, but does not have adequate financial resources.
C. Requesting additional physical therapy visits from the third party payer is a possible option, however, based on the patient’s diagnosis and post-operative progression additional visits may not be warranted.
D. A patient 12 weeks status post anterior cruciate ligament reconstruction that has experienced an unremarkable recovery should be able to function independently using a well designed home exercise program. The program should incorporate activities such as jogging, strengthening, and agility drills.
A physical therapy program designs a study that uses performance on the Scholastic Aptitude Test as a predictor of grade point average in a physical therapy academic program. The results of the study identify that the overall correlation between the variables is 0.87, which statement is MOST accurate based on the results of the study?
A. A high grade point average in a physical therapy programs caused by a high score on the Scholastic Aptitude Test.
B. Students in a physical therapy program with high scores on the Scholastic Aptitude Test tend to have high grade point averages.
C. There is no relationship between grade point average in a physical therapy program and performance on the Scholastic
Aptitude Test.
D. There is an inverse relationship between grade point average in a physical therapy program and performance on the
Scholastic Aptitude Test.
Students in a physical therapy program with high scores on the Scholastic Aptitude Test tend to have high grade point averages.
Correct Answer: B
Correlation coefficients quantitatively describe the strength and magnitude of the relationship between two variables. The symbol “r” denotes the Pearson product-moment correlation coefficient which is used to evaluate the strength and direction of the linear relationship between two continuous variables on the interval or ratio scales. The Pearson “” can take values ranging from - 1.00 (a perfect negative relationship) to 1.00 (a perfect positive relationship).
A. Correlation does not imply a causal relationship between two variables. A strong relationship between X and Y does not suggest that X causes Y or that Y causes X. Therefore, it cannot be said that the r-0.87 suggests that a high score on the Scholastic Aptitude Test causes a high grade point average.
B. A r-0.87 indicates a good to excellent relationship between the Scholastic Aptitude Test (SAT) and grade point average
(GPA). That is, low scores on the SAT tend to be associated with low GPAs and high scores on the SAT tend to be associated with high GPAs.
C. No relationship between grade point average and performance on the Scholastic Aptitude Test would be indicated by a
1=0.0
D. Ar-0.87 indicates a positive or direct relationship between grade point average in a physical therapy program and performance on the Scholastic Aptitude Test. A negative correlation coefficient would indicate an inverse relationship.
A patient is referred to physical therapy with a C6 nerve root injury. Which of the following clinical findings would NOT be expected with this type of injury?
A. diminished sensation on the anterior arm and the index finger
B. weakness in the biceps and supinator
C. diminished brachioradialis reflex
D. paresthesias of the long and ring fingers
paresthesias of the long and ring fingers
Correct Answer: D
Involvement of a specific nerve root often results in predictable impairments including diminished sensation, muscle weakness impaired reflexes, and paresthesias.
A. Diminished sensation on the anterior arm and index finger is characteristic of a C6 nerve root injury and is assessed using light touch from a cotton ball.
B. Weakness in the biceps and supinator muscles is characteristic of a C6 nerve root injury and is assessed through resistive testing as part of an upper quarter screening examination and/or specific manual muscle testing.
C. A diminished brachioradialis reflex is characteristic of a C6 nerve root injury and is assessed by striking the blunt end of a reflex hammer at the distal end of the radius with the patient’s elbow flexed to 90 degrees and the upper extremity supported by the therapist.
D. Paresthesias of the long and ring fingers are commonly associated with the C7 nerve root. Other findings of a C7 nerve root injury include weakness of the triceps and wrist flexors, and a diminished triceps reflex.
A 22-year-old male status post traumatic brain injury receives physical therapy services in a rehabilitation hospital. The patient is presently functioning at Rancho Los Amigos level VI. The patient has progressed well in therapy, however, has been bothered by diplopia. Which treatment strategy would be the MOST appropriate to address diplopia?
A. provide non-verbal instructions within the patient’s direct line of sight
B. place a patch over one of the patient’s eyes
C. ask the patient to turn his head to one side when he experiences diplopia
place a patch over one of the patient’s eyes
Correct Answer: B
Diplopia refers to double vision resulting from defective function of the extraocular muscles that is typically caused by damage to the brain. A patient with diplopia is often instructed to wear a patch alternately over one of their eyes. Specific strengthening exercises of the extraocular muscles can serve to improve the patient’s vision.
A. Verbal instruction is often more desirable than non-verbal instruction since double vision would tend to minimize the effectiveness of non-verbal instruction.
B. A patient with diplopia will actually see two sets of the environment. If wearing the patch over the alternate eye does not resolve the problem, the patient may require prism glasses.
C. The patient will not alleviate diplopia through positioning of the head. Double vision can result from damage to the brain and requires strengthening and the use of an eye patch.
A physical therapist directs a patient in a stretching maneuver as part of a home exercise program. Based on the depicted image, which muscle is being stretched?
A. rectus femoris
B. biceps femoris
C. gastrocnemius
D. soleus
soleus
Correct Answer: D
When prescribing exercises
designed to increase muscular flexibility, the physical therapist
must be aware of a muscle’s attachment sites and orientation to maximize the effectiveness of a stretch. The physical therapist must also consider the differences in technique required when stretching a one-joint muscle versus a two-joint muscle.
A. The rectus femoris originates from the anterior inferior iliac spine and inserts into the tibial tuberosity. It is responsible for producing hip flexion and knee extension, therefore, the patient would have to extend the hip and flex the knee to maximally stretch this muscle. The depicted-image does not include hip extension.
B. The biceps femoris originates from the ischial tuberosity and inserts into the fibular head and lateral tibia. It is responsible for producing hip extension and knee flexion, therefore, the patient would have to flex the hip and extend the knee to maximally stretch this muscle. The depicted image does not include knee extension.
C. The gastrocnemius originates from the femoral condyles and inserts into the calcaneus. It is responsible for producing knee flexion and ankle plantar flexion, therefore, the patient would have to extend the knee and dorsiflex the foot to stretch this muscle. The depicted image does not include knee extension.
D. The soleus originates from the proximal tibia and fibula and inserts into the calcaneus. Because the soleus is a one-joint muscle, it is only responsible for producing ankle plantar flexion. To maximally stretch the muscle, the patient must dorsiflex the ankle. By performing the stretch with the knee in flexion, the influence of the two-joint gastrocnemius is eliminated.
A physician orders an electrocardlogram (ECG) for a patient diagnosed with congestive heart failure. The medical record indicates the patient is currently taking digitalis. What effect would you expect digitalis to have on the patient’s ECG?
A. sinus tachycardia
B. lengthened PR Interval
C. lengthened QT interval
D. elevated ST segment
lengthened PR Interval
Correct Answer: B
Digitalis is a medication given to increase the force of myocontractility and is often prescribed for patients with heart failure.
Increased contractility increases cardiac output and decreases preload, cardiac workload, and myocardial oxygen demand, thus reducing the clinical effects of congestive heart failure
A. Sinus tachycardia is a fast heart rate (greater than 100 bpm) that has its origin in the SA node.
B. Digitalis prolongs the PR interval on the ECG by increasing conduction time through the AV node.
C. The QT interval measures the depolarization and repolarization time of the ventricles and extends from the beginning of the
QRS complex to the end of the T wave. Digitalis may produce shortening of the QT interval.
D. The ST segment represents the beginning of ventricular repolarization and is generally isoelectric. The ST segment is elevated in an acute myocardial infarction, however, digitalis may produce sagging in the ST segment.
A physical therapist completes an examination on a five-year-old boy diagnosed with Duchenne muscular dystrophy. The referral indicates that the boy was diagnosed with the disease less than one year ago. Assuming a normal progression, which of the following findings would be the FIRST to occur?
A. distal muscle weakness
B. proximal muscle weakness
C. impaired respiratory function
D. inability to perform activities of daily living
proximal muscle weakness
Correct Answer: B
Duchenne muscular dystrophy is an inherited disorder, characterized by rapidly worsening muscle weakness that starts in the proximal muscles of the lower extremities and pelvis, and later affects all voluntary muscles
A. Distal muscles are affected later in the course of the disease process.
B. Muscle weakness and atrophy begin in the proximal muscles of the lower extremities and pelvis, then progress to the muscles of the shoulders and neck, followed by loss of upper extremity muscles and respiratory muscles.
C. The muscles of respiration are not initially affected in patients with Duchenne muscular dystrophy.
D. As the condition progresses, weakness begins to interfere with activities of daily living.
A physical therapist obtains an x-ray of a 14-year-old female recently referred to physical therapy after experiencing an increase in back pain following activity. The patient previously participated in competitive gymnastics, however, states that her back was unable to tolerate the intensity of training. Based on the presented x-ray, the therapist would expect the patient’s medical diagnosis to be:
A. Spondylitis
B. Spondylolysis
C. Spondylolisthesis
D. spondyloptosis
Spondylolisthesis
Correct Answer: C
There are a variety of commonly
encountered medical conditions that significantly impact the lumbar spine. Physical therapists should be familiar with the clinical presentation and management of these medical conditions
A. Spondylitis refers to inflammation of a vertebra.
B. Spondylolysis refers to a defect in the pars interarticularis or the arch of the vertebra. This is most common in the L5 vertebra, but can also occur in other lumbar or thoracic vertebrae.
C. Spondylolisthesis refers to the forward displacement of one vertebra over another. The x-ray involves spondylolisthesis at the L5-S1 level. Individuals involved in physical activities such as weight lifting, gymnastics or football are particularly susceptible to this condition. The severity of the spondylolisthesis is classified on a scale of 1-5 based on how much a given vertebral body has slipped forward over the vertebral body beneath it.
D. Spondyloptosis refers to the condition where a vertebral body has shifted completely off of the adjacent vertebral body (grade 5).
A physical therapist treats a nine-year-old child diagnosed with cystic fibrosis. As part of the treatment session the therapist attempts to improve the efficiency of the patient’s breathing. The MOST appropriate technique to encourage full expansion at the base of the lungs is:
A. manual percussion over the posterior portion of the ribs with the patient in prone
B. manual contacts with pressure over the lateral borders of the ribs with the patient in supine
C. manual vibration over the lateral portion of the ribs with the patient in sidelying
D. manual cues over the epigastric area with the patient in supine
manual contacts with pressure over the lateral borders of the ribs with the patient in supine
Correct Answer: B
Applying direct pressure with the hands on the lateral borders of the ribs with the patient in supine can promote a more efficient breathing pattern. Physical therapy management for a child with cystic fibrosis may include postural drainage techniques, chest percussion, vibration, and suctioning.
A. Manual percussion over the posterior ribs with the patient in prone describes the postural drainage position and technique used for airway clearance, not expansion, of the posterior basal lung segments.
B. Direct pressure of the hands over the lateral ribs can facilitate expansion of the basal lobes of the lungs.
C. Manual vibration over the lateral portion of the ribs in sidelying describes the postural drainage position and technique used for airway clearance, not expansion, of the lateral basal lung segments.
D. The epigastric area refers to the upper central region of the abdomen. Manual cues on this area would not encourage expansion at the base of the lungs.
A physician discusses a patient’s plan of care with a physical therapist. The patient is a 29-year-old male that sustained deep partial-thickness burns to the anterior surface of his lower extremities. The physician discusses the possibility of discontinuing use of the topical antibiotic silver sulfadiazine after identifying an irregularity in the patient’s laboratory results. Which finding could be MOST related to the use of silver sulfadiazine?
A. Leukopenia
B. peripheral edema
C. hypokalemia
D. altered pH balance
Leukopenia
Correct Answer: A
Silver sulfadiazine is a topical antibiotic that works by interfering with bacterial nucleic acid production by disrupting folic acid synthesis in susceptible bacteria. The antibiotic is a broad spectrum agent that can be applied directly to the skin. Additional problems encountered with sulfa drugs include gastrointestinal of distress and allergic reactions
A. Silver sulfadiazine is a sulfa drug that can produce a decrease in the number of circulating white blood cells (leukopenia), usually below 5,000 mm?.
B. Peripheral edema refers to the swelling of tissues in the lower limbs due to the accumulation of fluid. Peripheral edema frequently is associated with heart failure, venous insufficiency, pregnancy, kidney disease, and selected pharmacological agents, however, it is not a side effect of silver sulfadiazine.
C. Hypokalemia refers to an abnormally low potassium concentration in the blood. The condition can be caused by vomiting, diarrhea, burns, uncontrolled diabetes mellitus, diuretic therapy, and steroid therapy, however, it is not a side effect of silver sulfadiazine.
D. The pH is a measure of the degree to which a solution is acidic or alkaline. A pH of 70 indicates neutrality, a pH of less than 7.0 indicates acidity, a pH of more than 7.0 indicates alkalinity. The body’s fluids are usually between 7.35- 7.45.
Topical agents such as mafenide acetate would be more likely to alter pH.
A physical therapist reviews the medical record of a patient with atrial flutter. Which characteristic of atrial flutter best differentiates this condition from atrial fibrillation?
A. the regularity of the atrial rhythm
B. the irregularity of the atrial rhythm
C. the rapid rate of atrial depolarization
D. the slow rate of atrial depolarization
the regularity of the atrial rhythm
Correct answer: A
Atrial flutter is a frequently occurring abnormal heart rhythm characterized by rapid atrial tachycardia. This rapid rate creates decreased filling time of the ventricles resulting in diminished amounts of blood being ejected from the heart. Atrial fibrillation is an arrhythmia characterized by erratic electrical conductivity within the atria.
A. In atrial flutter, the heart beats fast, but in a very regular rhythm producing sawtooth P waves. In atrial fibrillation, the heart also beats fast, however, the rhythm is irregular.
B. Atrial flutter is characterized by a rapid rate of atrial contraction (ie., 250-350 beats per minute) in a consistent and predictable rhythm. An irregularity of the atrial rhythm is characteristic of atrial fibrillation.
C. Both atrial flutter and atrial fibrillation are characterized by extremely rapid rates of atrial depolarization. This rapid rate creates decreased filling time of the ventricles resulting in diminished amounts of blood being ejected from the heart.
D. Both atrial fitter and atrial fibrillation are characterized by extremely rapid rates of atrial depolarization. A slow rate of atrial depolarization would be more characteristic of bradycardia which refers to a heart rate of less than 60 beats per minute.
A note in the medical record indicates that a patient was recently prescribed Lasix. Which condition is MOST commonly associated with the use of this medication?
A. atrial flutter
B. deep vein thrombosis
C. hyperlipidemia
D. congestive heart failure
congestive heart failure
Correct Answer: D
Lasix (furosemide) is a loop diuretic often used in the treatment of edema or hypertension. Lasix increases the excretion of sodium and chloride in the kidneys, thereby increasing urination and decreasing the volume of fluid that is retained within the body.
A. Atrial flutter is a type of cardiac arrhythmia characterized by a rapid contraction rate of the atria. Digoxin is an example of a medication that may be used to treat atrial flutter
B. Deep vein thrombosis is a condition where a blood clot forms in a vein, most commonly in the lower extremities.
Thrombolytic drugs would be administered to help break up an already existing blood clot.
C. Hyperlipidemia is a condition characterized by high levels of lipids (i.e., triglycerides, cholesterol) within the blood.
Atorvastatin (Lipitor) is an example of a medication that may be used to treat hyperlipidemia.
D. Congestive heart failure is a condition characterized by an inability of the heart to effectively pump blood to meet the metabolic demands of the body. Chronic heart failure can result in pulmonary edema or peripheral edema, depending on the side of the heart that is affected. Lasix is a medication that is commonly prescribed to help lessen the edema associated with chronic heart failure.
A physical therapist instructs a patient to expire maximally after taking a maximal inspiration. The therapist can use these instructions to measure the patient’s:
A. expiratory reserve volume
B. inspiratory reserve volume
C. total lung capacity
D. vital capacity
vital capacity
Correct Answer: D
Vital capacity is the maximum volume of gas that can be exhaled after a maximum inhalation
A. Expiratory reserve volume (ERV) is the additional volume of air that can be exhaled beyond the normal tidal exhalation.
ERV is one component of vital capacity.
B. Inspiratory reserve volume (IRV) is the additional volume of air that can be inhaled beyond the normal tidal inhalation. IRV is one component of vital capacity.
C. Total lung capacity is the maximum volume to which the lungs can be expanded. It is the sum of vital capacity and residual volume: TLC=VC + RV.
D. Vital capacity is the maximum volume of gas that can be exhaled after a maximum inhalation. It is equal to the sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume: VC= IRV + TV + ERV.
A patient’s medical record indicates the presence of a significant electrolyte imbalance. Which condition would MOST commonly be associated with an Increased risk of cardiac arrest if left untreated?
A. Hypercalcemia
B. Hyperkalemia
C. Hypermagnesemia
D. hypernatremia
Hyperkalemia
Correct Answer: B
Electrolytes play a critical role in maintaining homeostasis within the body. Examples of critical roles played by electrolytes include regulating cardiac function, fluid balance, acid-base balance, and neurologic activity. The most serious electrolyte imbalances involve abnormalities in the level of calcium, potassium, and sodium.
A. Hypercalcemia refers to an excessive level of calcium in the blood. Normal serum calcium is 8.4-10.2mg/DI. The condition is most commonly associated with hyperparathyroidism since excessive parathyroid hormone raises the level of circulating calcium above normal. Symptoms typically include constipation, pain, nausea, and vomiting.
B. Hyperkalemia refers to an excessive level of potassium in the blood. Normal serum potassium Is 3.5-5.0 mEq/L. Levels higher than 7 mEg/L can have significant hemodynamic and neurologic consequences, while levels exceeding 8.5 mEg/L can cause respiratory paralysis or cardiac arrest. Symptoms typically are related to abnormalities in muscular or cardiac function.
C. Hypermagnesemia refers to an excessive level of magnesium in the blood. Normal serum magnesium is 1.5-2.0 mEq/L.
This condition is relatively rare since the kidneys are able to eliminate excess magnesium by rapidly reducing its tubular absorption. Hypermagnesemia is most often caused by renal failure. Symptoms typically include hypotension and respiratory depression.
D. Hypernatremia refers to an excessive level of sodium in the blood. Normal serum sodium is 135-145 mEq/L. The condition results when there is a net water loss or a sodium gain and reflects too little water in relation to total body sodium and potassium. Hypernatremia is most often caused by impaired thirst or restricted access to water and can be facilitated by pathologic conditions with increased fluid loss. The primary symptom of this condition is thirst.
If the forced expiratory volume In one second (FEV1) test is negative for airway obstruction in 99% of individuals without lung disease, then the measurement of FEVi is:
A. Sensitive
B. Specific
C. Reliable
D. valid
Specific
Correct Answer: B
The validity of a diagnostic test, such as the FEV test, is evaluated by its accuracy in assessing the presence or absence of a target condition such as airway obstruction. A test is considered to be specific when the test is negative in persons who do not have the disease. A highly specific test will rarely be positive when a person does not have the disease.
A. Sensitivity is the probability of obtaining a positive test among individuals who have the disease. In this example neither condition was met: the test result was negative for airway obstruction and the individuals tested did not have lung disease.
B. Specificity is the probability of obtaining a negative test among individuals without the disease (who should test negative).
Since 99 of 100 individuals without lung disease had a negative FEV1 test for airway obstruction, the test is highly specific.
C. Reliability refers to the extent to which a test or measurement is consistent or yields the same result on repeated trials. In this example, there is no indication that the FEV, was administered more than once, therefore no estimate of reliability is possible.
D. Validity refers to the degree to which a test or measurement accurately reflects or assesses the specific concept the clinician is attempting to measure. Validity is concerned with the success at measuring what was set out to be measured. In this example, the data does not provide useful information for assessing the extent to which FEW, is a valid way to identify airway obstruction.
A physical therapist applies an automated external defibrillator (AED to a patient in cardiac arrest. In addition to ventricular fibrillation, what condition is capable of being identified and treated with the AED?
A. atrial fibrillation
B. premature atrial contractions
C. ventricular tachycardia
D. first degree ventricular heart block
ventricular tachycardia
Correct Answer: C
An AED is a portable electronic device that automatically diagnoses the potentially life-threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia. The electrical current potentially stops the abnormal rhythm and allows the heart to begin to beat normally by administering an electrical shock.
A. Atrial fibrillation is a common arrhythmia where the atria are depolarized between 350 and 600 times/minute. Atrial fibrillation occurs in healthy hearts and in patients with coronary artery disease, hypertension, and valvular disease.
B. Premature atrial contractions occur when an ectopic focus in the atrium initiates an impulse before the SA node. Premature atrial contractions are relatively common and generally benign.
C. Ventricular tachycardia refers to three or more consecutive premature ventricular contractions occurring at a ventricular rate of>150 beats/minute. Ventricular tachycardia longer than 30 seconds is a life-threatening arrhythmia and requires immediate medical intervention. This type of abnormal heart rhythm can be recognized and potentially treated by an AED.
D. First degree ventricular heart block is characterized by a PR interval that is longer than 0.2 seconds, but relatively constant from beat to beat. First degree ventricular heart block results in no associated symptoms or significant changes in cardiac function.
A physical therapist examines a patient with low back pain of unknown etiology. During the examination the therapist observes that the patient’s pain level remains unchanged with positioning in flexion and extension, however, is diminished with rest. This scenario is MOST consistent with:
A. facet joint irritation
B. spinal stenosis
C. disk herniation
D. neurogenic claudication
neurogenic claudication
Correct Answer: D
Physical therapists should be familiar with the unique characteristics of commonly encountered medical conditions. This knowledge should include information such as actions which improve or exacerbate a patient’s symptoms.
A. The facet joints are paired joints located on the posterior aspect of the spine at each spinal level. The facet joints provide stability to the spine and limit excess motion. Patients with facet joint irritation tend to experience less discomfort when in a flexed position since an extended position is consistent with the close packed position of the joint (i.e., maximal congruence between joint surfaces).
B. Spinal stenosis refers to narrowing of the spinal column and intervertebral foramen resulting in increased pressure an the spinal cord and associated nerve roots. Patients with spinal stenosis tend to experience less discomfort when in a flexed position since an extended position further narrows the size of the spinal column.
C. Disk herniation refers to a condition when the disk is pushed outside of its normal position between the vertebrae, often resulting in pressure being applied to adjacent spinal nerves. Patients with disk herniation tend to experience less discomfort when in an extended position and more discomfort when in a flexed position.
D. Neurogenic claudication is a common side effect of spinal stenosis where the spinal nerves become compressed by narrowing of the spinal column. The condition is characterized by weakness, cramping, and pain in the legs that is often exacerbated by activity. Patients with neurogenic claudication tend to experience less discomfort when at rest. Although a flexed position may also potentially relieve symptoms, the cessation of activity typically offers the greatest improvement in the patient’s condition.
A physical therapist observes a patient standing in a pool immersed in water to the level of the neck performing a number of upper extremity exercises. Which active movement would be MOST resisted by buoyancy with the patient starting with the arm positioned at the side and the elbow in 90 degrees of flexion?
A. elbow flexion
B. elbow extension
C. shoulder abduction
D. shoulder medial rotation
elbow extension
Correct Answer: B
Archimedes’ principle of buovancy states that there is an upward force on the body when immersed in water equal to the amount of water that has been displaced by the body. When an individual exercises in water, the buoyant force works in opposition to the gravitational force.
A. Elbow flexion is a sagittal plane motion that would best be classified as buoyancy assisted since the motion occurs in the same direction as the buoyant force. As a result, the buoyant force would make performing elbow flexion significantly easier for the patient.
B. Elbow extension is a sagittal plane motion that would best be classified as buoyancy resisted since the motion occurs in the opposite direction as the buoyant force. As a result, the buoyant force would make performing elbow extension more difficult for the patient.
C. Shoulder abduction is a frontal plane motion that would best be classified as buoyancy assisted since the motion occurs in the same direction as the buoyant force. As a result, the buoyant force would make performing shoulder abduction easier for the patient.
D. Shoulder medial rotation is a transverse plane motion that would best be classified as buoyancy supported since the motion occurs parallel to the bottom of the pool. The buoyant force would assist to support the arm, but would not be resisted by buoyancy.
A physician examines a 36-year-old male with shoulder pain. As part of the examination the physician orders x-rays. Which medical condition could be confirmed using this type of diagnostic imaging?
A. bicipital tendonitis
B. calcific tendonitis
C. supraspinatus impingement
D. subacromial bursitis
calcific tendonitis
Correct Answer: B
The greater the density of the tissue, the more visible it will appear on x-ray. The majority of inflammatory conditions of the shoulder would be formally diagnosed using magnetic resonance imaging.
A. Bicipital tendonitis is an inflammatory process of the tendon of the long head of the biceps. The condition is characterized by subjective reports of a deep ache directly in front and on top of the shoulder, made worse with overhead activities or lifting. Repeated full abduction and lateral rotation of the humeral head can lead to irritation that produces inflammation, edema, microscopic tears within the tendon, and degeneration of the tendon itself.
B. Calcific tendonitis Is often visible on x-ray due to the relative density of calcium. The greater the density of the tissue, the more visible it will appear on x-ray. The supraspinatus and infraspinatus tendons are common sites for calcific tendonitis.
C. Supraspinatus impingement is caused by an inability of a weak supraspinatus muscle to adequately depress the head of the humerus in the glenold fossa during elevation of the arm. The patient may experience a feeling of weakness and identify the presence of a painful arc of motion most commonly occurring between 60 and 120 degrees of active abduction.
D. Subacromial bursitis refers to inflammation of the subacromial bursa which lies between the deltoid muscle, supraspinatus tendon, and the fibrous capsule of the shoulder joint. The clinical presentation of the condition is very similar to the clinical presentation of supraspinatus impingement.
A physical therapist designs a research study that will examine the effect of high voltage galvanic electrical stimulation on edema following arthroscopic knee surgery. The MOST appropriate method to collect data is:
A. anthropometric measurements
B. circumferential measurements
C. goniometric measurements
D. volumetric measurements
circumferential measurements
Correct Answer: B
Physical therapists must utilize appropriate tests and measures to quantify the relative effectiveness of selected interventions. Therapists should carefully consider the reliability and validity of selected tests and measures when analyzing the collected data.
A. Common anthropometric measurements used for adults include height, weight, body mass index (BMI), waist-to-hip ratio, and percentage of body fat. These measures are then compared to reference standards to assess items such as weight status and the risk for various diseases.
B. Circumferential measurements using a flexible tape measure allow physical therapists to obtain a gross estimate of edema in the knee. Pre-test and post-test measurements provide information on the effect of the electrical stimulation on the edema
C. Goniometric measurements are obtained with a goniometer are designed to quantify available range of motion. If electrical stimulation is effective in reducing the edema, the patient may have improved range of motion, however, this would still not directly quantify the relative change in edema.
D. Volumetric measurements are often used to quantify the presence of edema in the wrist and hand by examining the amount of water displaced following immersion. Comparison with the uninvolved extremity provides a baseline measure. It would be impractical to attempt this type of measurement with the knee joint.
A 29-year-old male diagnosed with ankylosing spondylitis reports progressive stiffening of the spine and associated pain for more than five years. The patient’s MOST typical standing posture demonstrates:
A. posterior thoracic rib hump
B. flattened lumbar curve, exaggerated thoracic curve
C. excessive lumbar curve, flattened thoracic curve
D. lateral curvature of the spine with fixed rotation of the vertebrae
flattened lumbar curve, exaggerated thoracic curve
Correct Answer: B
Ankylosing spondylitis is a form of systemic rheumatic arthritis that is associated with an increase in thoracic kyphosis and loss of the lumbar curve. Ankylosing spondylitis occurs three times more often in males than females with a typical age of onset of
20-40 years.
A. A posterior thoracic rib hump is characteristic of scoliosis. The rotated vertebrae cause a rotation in the corresponding rib segments and result in posterior displacement of the rib cage.
B. The clinical presentation of ankylosing spondylitis initially includes recurrent and insidious onset of back pain, morning stiffness, and impaired spinal extension. Chronic inflammation causes destruction of the ligamentous-osseous junction with subsequent fibrosis and ossification. The patient may exhibit flexion at the hips, spinal kyphosis, fatigue, weight loss, and peripheral joint involvement. If the costovertebral joints are affected there may be impaired chest mobility, compromised breathing, and decreased vital capacity.
C. Excessive lumbar curve with a flattened thoracic curve is opposite from the typical clinical presentation of ankylosing spondylitis.
D. Lateral curvature of the spine with fixed rotation of the vertebrae is descriptive of scoliosis.
A physical therapist completes a developmental assessment on an Infant. Which pediatric reflex would the therapist expect to be integrated at the youngest age?
A. plantar grasp reflex
B. Moro reflex
C. Landau reflex
D. Galant reflex
Galant reflex
Correct Answer: D
Integration of a reflex refers to the period of time when a reflex is no longer present despite an appropriate stimulus.
A. The plantar grasp reflex is stimulated by placing pressure on the ball of the foot, generally in standing. The response is flexion and curling of the toes. The normal age of the response is from 28 weeks of gestation to nine months.
B. The Moro reflex is stimulated when an infant’s head is suddenly allowed to fall into extension. The action causes a “startled look” followed by upper extremity abduction with the fingers open, then crossing the trunk into adduction. The normal age of the response is from 28 weeks of gestation to five months.
C. The Landau reflex is an equilibrium response that occurs when a child responds to prone suspension by aligning their head and extremities in line with the plane of the body. Although the response begins around three months of age, it is not fully integrated until the child’s second year.
D. The Galant reflex is stimulated by touching the skin along the spine from the shoulder to the hip. The response is lateral flexion of the trunk to the side of the stimulus. The normal age of the response is from 30 weeks of gestation to two months.
A physical therapist treats a patient with a sacral pressure ulcer by applying a foam dressing Impregnated with charcoal
This type of dressing would be MOST beneficial in treating which type of wound?
A. a dry wound that is infected
B. a dry wound that has a fetid odor
C. a heavily exuding wound that is infected
D. a heavily exuding wound that has a fetid odor
a heavily exuding wound that has a fetid odor
Correct Answer: D
Foam dressings can be made up of a single layer or multiple layers and are usually made from a polyurethane material. These dressings are ideal for absorbing exudate and maintaining a wound bed with a normal moisture level. Foam dressings can be used as a primary or secondary dressing.
A. A foam dressing should not be used on a dry wound since it is a highly absorptive dressing. Other dressings may be more appropriate for dry wounds, such as hydrogels.
B. The charcoal impregnated into the foam dressing can be beneficial in treating wounds that have strong odors. However, a foam dressing should not be used on a dry wound due to its absorptive properties.
C. Foam dressings are useful in treating heavily exuding wounds since they have high absorbency. However, the charcoal would not be beneficial in treating infection. Dressings impregnated with silver may be more useful in treating infection secondary to the antimicrobial properties of silver
D. A foam dressing would be beneficial for treating a heavily exuding wound due to its absorptive properties. The charcoal in the dressing is beneficial for decreasing fetid odors associated with the wound.
A physical therapist examines a patient following a transtibial amputation. The patient resides in a retirement community and describes herself as socially active. She is presently using a temporary prosthesis consisting of a plastic socket, a pylon, and a solid ankle cushion heel (SACH) foot. The patient expresses concern that the permanent prosthesis will look awful and will be obvious to everyone. Which type of prosthesis would be the MOST appropriate for the patient?
A. endoskeletal shank and single-axis articulated foot-ankle assembly
B. endoskeletal shank and solid ankle cushion heel (SACH) foot
C. exoskeletal shank and single-axis articulated foot-ankle assembly
D. exoskeletal shank and solid ankle cushion heel (SACH) foot
endoskeletal shank and solid ankle cushion heel (SACH) foot
Correct Answer: B
An endoskeleton or modular shank is designed to incorporate a synthetic foam cover shaped like the opposite leg. As a result, the device is more cosmetically attractive and would likely make the patient more socially comfortable. A SACH foot is the most frequently prescribed foot-ankle assembly. It is considered to be a nonarticulated foot since it does not incorporate a mechanical joint at the ankle.
A. An endoskeletal shank would be an appropriate choice given the patient’s concerns, however, a single-axis articulated foot-ankle assembly would be heavier and requires more maintenance than the SACH foot. Since the patient is of retirement age and does not plan on heavy activity, this type of foot would not be appropriate.
B. Since the patient is of retirement age and expects low impact on the prosthesis, the endoskeletal shank and SACH foot will provide the patient with durability, low maintenance, and cosmesis.
C. An exoskeletal shank would not be appropriate for the patient since it is less cosmetically desirable and heavier with the hard, thermoplastic resin shell. The single-axis articulated foot-ankle assembly would also be heavier and requires more maintenance than the SACH foot.
D. An exoskeletal shank would not be as desirable for the patient as the endoskeletal shank. The SACH foot is appropriate for the patient.
A physical therapist observes a patient during gait training. The patient has normal strength and equal leg length. As the patient passes midstance he slightly vaults and exhibits early toe off. The MOST likely cause of this deviation is:
A. weakness of the dorsiflexors
B. weakness of the hip abductors
C. limited plantar flexion
D. limited dorsiflexion
limited dorsiflexion
Correct Answer: D
A patient with limited dorsiflexion may compensate with a vault or bounce through mid to late stance. Approximately ten degrees of dorsiflexion is required for late stance through toe off.
A. Weakness of the dorsiflexors will typically create a “steppage gait pattern.” The patient will present with foot slap at initial contact and compensate by lifting the knee higher than normal to clear the foot and avoid dragging the toe.
B. Weakness of the hip abductors (gluteus medius and minimus) will typically create a contralateral dip of the pelvis during the stance phase of the weak side, also known as a Trendelenburg gait pattern. The observed contralateral dip of the pelvis results from the inability of the weak hip abductors to stabilize the pelvis during contralateral swing phase.
C. Limited plantar flexion would not result in a vaulting gait pattern. The patient would require plantar flexion to vault (ascend onto the toes) during gait. Plantar flexion of 0-20 degrees is required for normal gait biomechanics with approximately 15 degrees during the loading response and 20 degrees during the pre-swing phase.
D. Limited dorsiflexion will typically result in premature elevation of the heel during midstance. The patient will appear to have a bounce during gait secondary to the gastrocnemius-soleus tightness.
A physical therapist treats a patient with Parkinson’s disease who has been recelving levodopa therapy for two years. Which side effect would MOST likely be present due to the chronic use of this medication?
A. Bradvkinesia
B. Choreoathetosis
C. shuffling gait
D. rigidity
Choreoathetosis
Correct Answer: B
Parkinson’s disease is a movement disorder caused by the progressive degeneration of the dopamine-producing cells in the basal ganglia. The disease is characterized by difficulties in planning, initiation, and execution of movement. Levodopa is a medication commonly used to improve motor function and general mobility in patients with Parkinson’s disease.
A. Bradykinesia (i.e., slowness of movement) is a common characteristic of Parkinson’s disease which would improve with the administration of levodopa.
B. Choreoathetosis is a type of dyskinesia characterized by uncontrolled, involuntary movements. The onset of dyskinesias can occur as soon as three months after first receiving levodopa therapy.
C. Shuffling gait is a common characteristic of Parkinson’s disease which would improve with the administration of levodopa.
D. Rigidity is a common characteristic of Parkinson’s disease which would improve with the administration of levodopa.
A physical therapist concludes that the Lachman test is negative in a patient with a suspected anterior cruciate ligament injury. Which finding would MOST likely contribute to a potential false negative?
A. moderate effusion of the knee joint capsule
B. 12 millimeters of anterior translation of the tibia on the femur
C. protective muscle guarding of the hamstring muscles
D. previous injury involving the anterior cruciate ligament
protective muscle guarding of the hamstring muscles
Correct Answer: C
The Lachman test is designed to assess the integrity of the anterior cruciate ligament. The test is performed with the patient positioned in supine with the knee flexed to 20-30 degrees. The therapist stabilizes the distal femur with one hand and places the other hand on the proximal tibia. The therapist applies an anterior directed force to the tibia on the femur. A positive test is indicated by excessive anterior translation of the tibia on the femur with a diminished or absent end-point. A false negative in this scenario refers to a negative Lachman test when there is in fact an anterior cruciate ligament injury.
A. Moderate effusion of the knee joint capsule would not likely contribute to a false negative when performing the Lachman test. A more dramatic change in the volume of fluid in the knee (i.e, hemarthrosis) would likely be necessary
B. Twelve millimeters of anterior translation of the tibia on the femur would be considered serious knee instability and
therefore would not likely contribute to a false negative when performing the Lachman test. Mild instability = 5 millimeters
or less; moderate instability = 5-10 millimeters; severe instability = greater than 10 millimeters.
C. The semitendinosus and semimembranosus insert on the posteromedial surface of the proximal tibia, while the biceps femoris inserts on the lateral condyle of the tibia and the head of the fibula. Protective muscle guarding of the hamstring muscles could limit the translation of the tibia on the femur and contribute to a false negative when performing the Lachman test.
D. A previous injury involving the anterior cruciate ligament would make a positive Lachman test more likely and therefore would not contribute to a false negative when performing this test.
A physical therapist observes an infant exhibiting a high guard position when in a sitting position. Which muscle would be the MOST essential for the Infant to maintain this position?
A. pectoralis major
B. rhomboids
C. serratus anterior
D. lower trapezius
rhomboids
Correct Answer: B
High guard position is characterized by the arms being held near shoulder level with retraction of the scapulae. The position increases midline trunk stability against the pull of gravity. High guard positioning may be observed in a number of different postures including sitting, tall kneeling, or erect standing.
A. The pectoralis major acts to adduct and medially rotate the humerus. The muscle receives dual motor innervation by the medial pectoral nerve and the lateral pectoral nerve. The pectoralis major would likely be active when assuming a high guard position, however, would not be as essential as the rhomboids.
B. The rhomboids act to adduct and downwardly rotate the scapula. The muscle originates on the nuchal ligaments and spinous processes of the C7-T5 vertebrae and inserts on the medial border of the scapula. The rhomboids are innervated by the dorsal scapular nerve. The rhomboids’ ability to adduct the scapula provides assistance to the trunk extensors when maintaining an upright posture.
C. The serratus anterior acts to protract and upwardly rotate the scapula during humeral elevation. The serratus anterior is innervated by the long thoracic nerve. A high guard position requires retraction of the shoulder, not protraction.
D. The trapezius is a large superficial muscle that consists of three different components (ie, upper, middle, lower). The lower fibers depress and upwardly rotate the scapula and would not allow for the necessary adduction of the scapula required for the high guard position. The middle fibers of the trapezius would be a better option since they function to adduct the scapula. The middle fibers originate on the spinous processes of the first through fifth thoracic vertebrae and insert on the spine of the scapula.
A physical therapist employed in an outpatient orthopedic clinic examines a patient diagnosed with cerebral palsy. The therapist has limited experience with cerebral palsy and is concerned about his ability to provide appropriate treatment. The MOST appropriate therapist action is:
A. inform the patient of your area of expertise
B. co-treat the patient with another more experienced therapist
C. treat the patient
D. refuse to treat the patient
co-treat the patient with another more experienced therapist
Correct Answer: B
Physical therapists must make decisions that are consistent with their professional training. Since the therapist is concerned about his ability to provide appropriate treatment, he is in need of some form of external assistance.
A. Informing the patient of their area of expertise would likely make the patient question the therapist’s competence.
B. By co-treating the patient, the therapist receives external assistance and at the same time improves his skills with a particular patient population.
C. The question states that the therapist is concerned about his ability to treat the patient. This type of admission makes it inappropriate to simply treat the patient without utilizing available resources.
D. Refusing to treat the patient would not be necessary since the therapist has available resources to offer assistance.
A physical therapist compiles a table which identifies joint position at the hip, knee, ankle, and metatarsophalangeal joints for each subunit of the stance phase of gait. Which of the following is NOT accurate in describing normal joint position at the end of terminal stance?
A. 15 degrees of hip hyperextension
B. 0 degrees of knee extension
C. 0 degrees of ankle dorsiflexion
D. 10 degrees of metatarsophalangeal hyperextension
10 degrees of metatarsophalangeal hyperextension
Correct Answer: D
Rancho Los Amigos stages of gait include initial contact, loading response, midstance, terminal stance, pre-swing, initial swing, midswing, and terminal swing. Each stage requires a specific amount of available range of motion at each of the lower extremity joints. Terminal stance begins when the stance limb’s heel rises and ends when the other foot touches the ground.
A. The hip is in 10-20 degrees of hyperextension at the end of terminal stance.
B. The knee is in neutral (i.e., O degrees) at the end of terminal stance.
C. The ankle is in neutral (i.e., O degrees) at the end of terminal stance.
D. The metatarsophalangeal joints are in 30 degrees of hyperextension at the end of terminal stance.
A physical therapist monitors a patient’s vital signs while exercising in a phase I cardiac rehabilitation program. The patient is status post myocardial infarction and has progressed without difficulty while involved in the program. Which of the following vital sign recordings would exceed the typical limits of a phase I program?
A. heart rate elevated 18 beats per minute above resting level
B. respiration rate of 18 breaths per minute
C. systolic blood pressure decreased by 25 mm Hg from resting level
D. diastolic blood pressure less than 100 mm Hg
systolic blood pressure decreased by 25 mm Hg from resting level
Correct Answer: C
Physical therapists should closely monitor the response to exercise of patients in a phase cardiac rehabilitation program. Any abnormal responses observed during the cardiac rehabilitation program should be documented and shared with other members of the medical team.
A. An increase in heart rate of 18 beats per minute above resting heart rate is acceptable. Most guidelines for phase I cardiac rehabilitation recommend that heart rate not exceed 130 beats per minute or a heart rate more than 20 beats above resting for post myocardial infarction patients or a heart rate more than 30 beats above resting for post-surgical patients.
B. Dyspnea is a reason to terminate exercise during phase I exercise. However, a respiration rate of 18 breaths per minute is at the upper limit of the normal range and would not typically cause a patient to report a sense of dyspnea.
C. A decrease in systolic pressure of 25 mm Hg exceeds the 10 mm Hg limit allowed during exercise in a phase I cardiac rehabilitation program.
D. A diastolic blood pressure of 110 mm Hg is considered the upper limit for exercise in phase I cardiac rehabilitation. A diastolic pressure less than 110 mm Hg is acceptable.
A physical therapist is treating a patient in an acute care setting with a hematologic disorder. The MOST appropriate profile to monitor on a daily basis in order to ensure patient safety during physical therapy would be:
A. Hemoglobin
B. complete blood count
C. arterial blood gas
D. blood glucose
complete blood count
Correct Answer: B
When treating a patient with a hematologic disorder, a physical therapist should monitor a patient’s complete blood count (CBC) along with the coagulation profile to determine the potential risk for bruising, decreased oxygen carrying capacity at rest or with exercise, or thrombus formation. This information will allow a therapist to modify or defer physical therapy intervention if warranted secondary to abnormal lab values.
A. Hemoglobin is the iron-containing pigment in red blood cells that functions to carry oxygen in the blood. Low hemoglobin may indicate anemia or blood loss; elevated hemoglobin suggests polycythemia or dehydration. Hemoglobin is important to monitor, but not in isolation. A patient with a hematologic disorder requires monitoring of all components of a CBC to assess the patient’s status.
B. A CBC measures red blood cell count, total white blood cell count, white blood cell differential, platelets, hemoglobin, and hematocrit. A CBC is performed to assess health to diagnose and monitor a medical condition, and to monitor the effects of medical treatment. A patient with a hematologic disorder requires daily monitoring of a CBC to allow the therapist to determine trends and to recognize abnormal lab values that may require modification or deferment of services.
C. Arterial blood gases are collected to evaluate acid-base status (pH), ventilation (PaCO2), and oxygenation of arterial blood (Pa02). This profile is typically not affected by a hematologic disorder and therefore would not require daily monitoring in this scenario.
D. Blood glucose refers to sugar that is transported through the bloodstream to supply energy to all the cells. Daily monitoring of blood glucose is most appropriate for a patient diagnosed with diabetes mellitus. This is imperative to prevent the effects of hyperglycemia or hypoglycemia. This profile is typically not affected by a hematologic disorder and therefore would not require daily monitoring in this scenario.
A physical therapist treats a patient with a colostomy that is capable of producing solid stool on a fairly regular schedule.
Which type of colostomy would be MOST consistent with this description?
A. ascending colostomy
B. descending colostomy
C. sigmoid colostomy
D. transverse colostomy
sigmoid colostomy
Correct Answer: C
A colostomy is a surgical opening in the colon created for the elimination of feces. This type of procedure can be required when an injury or pathology prohibits the colon from functioning properly. There are several unique types of colostomies including ascending, transverse, descending, and sigmoid. The farther along the intestinal tract that fecal material travels, the more it resembles the consistency of normal stool.
A. The ascending colon, located on the right side of the abdomen, is the beginning portion of the large intestine. The ascending colon extends upward to a bend in the colon called the hepatic flexure. An ascending colostomy results in only a very short portion of the colon remaining active and as a result the output is primarily liquid containing many digestive enzymes.
B. The descending colon, located on the left side of the abdomen, follows the transverse colon and the splenic flexure. A descending colostomy results in a large portion of the colon remaining active and therefore the output is often firm, although tends to be somewhat irregular.
C. The sigmoid colon is the final portion of the large intestine and serves as a connection to the rectum. A sigmoid colostomy is the most common type of colostomy, located a few inches lower than a descending colostomy. As a result, this type of colostomy has additional working colon. A sigmoid colostomy produces normal stool consistency and discharge can be regulated.
D. The transverse colon, located across the upper portion of the abdomen, follows the ascending colon and the hepatic flexure.
The transverse colon ends with a bend in the colon called the splenic flexure. A transverse colostomy may produce soft or loose stool at infrequent intervals.
A physical therapist obtains a gross measurement of hamstrings length by passively extending the lower extremity of a patient in short sitting. The MOST common substitution to exaggerate hamstrings length is:
A. weight shift to the contralateral side
B. anterior rotation of the pelvis
C. posterior rotation of the pelvis
D. hiking of the contralateral hip
posterior rotation of the pelvis
Correct Answer: C
The hamstring muscles consist of the semitendinosus, semi- membranous, and biceps femoris. The semitendinosus and semimembranosus are considered the medial hamstrings since they insert on the medial surface of the tibia. The biceps femoris is considered the lateral hamstrings since the muscle inserts on the lateral surface of the tibia and the lateral surface of the head of the fibula.
A. Weight shifting to the contralateral side in short sitting without other compensatory movement would have minimal impact on measured hamstrings length.
B. Anterior rotation of the pelvis would tend to make the apparent hamstrings length shorter than the actual length due to the hamstrings origin on the tuberosity of the ischium.
C. Posterior rotation of the pelvis would tend to make the apparent hamstrings length longer than the actual length due to the hamstrings origin on the tuberosity of the ischium. Patients often attempt to posteriorly rotate the pelvis in short sitting by leaning backwards.
D. Hip hiking of the contralateral limb may cause the patient to weight shift toward the involved side. This adaptation would have minimal impact on measured hamstrings length
A physical therapist prepares to formally assess the balance of a patient with a neurological disorder. The MOST appropriate method to assess the vestibular component of balance would be:
A. assess cutaneous sensation
B. apply a perturbation to alter the body’s center of gravity
C. examine proprioception In a weight bearing posture
D. quantify visual acuity and depth perception
apply a perturbation to alter the body’s center of gravity
Correct Answer: B
Balance requires complex integration of the vestibular, visual, and somatosensory systems. Each system is responsive to specific stimuli and therefore can be assessed individually or collectively.
A. Cutaneous sensation is commonly assessed as part of a neurological examination, however, would not be directly associated with the vestibular system. Cutaneous sensory receptors include free nerve endings, Ruffini endings, hair follicle endings, and Meissner’s corpuscles.
B. The vestibular system reports information to the brain regarding the position and movement of the head with respect to gravity and movement. Assessment of the vestibular system often includes perturbations that require the body to make automatic adiustments that restore normal alignment.
C. The somatosensory system provides information about the relative orientation and movement of the body in relation to the support surface. Examining proprioception in a weight bearing posture would be a common method used for assessment of the somatosensory system.
D. The visual system allows individuals to perceive movement and detect the relative orientation of the body in space. Visual receptors allow for perceptual acuity regarding verticality, motion of objects and self, environmental orientation, postural sway, and movements of the head and neck. Visual acuity and depth perception contribute to the feedback gathered by the visual system
A physical therapist inspects a wound over the sacrum of a 58-year-old female. The therapist would MOST accurately classify the presented wound as:
A. stage I
B. stage II
C. stage III
D. stage IV
stage III
Correct Answer: C
The National Pressure Ulcer Advisory Panel pressure ulcer staging criteria was developed for use with pressure ulcers. The staging criteria range from I-IV.
A. A stage I ulcer is characterized by an observable pressure related alteration of intact skin whose indicators, as compared to an adjacent or opposite area on the body, may include changes in skin color, skin temperature, skin stiffness or sensation.
B. A stage II ulcer is characterized by partial-thickness skin loss that involves the epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, a blister, or a shallow crater.
C. A stage III ulcer is characterized by full-thickness skin loss that involves damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining adjacent tissue.
D. A stage IV ulcer is characterized by full-thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures (e.g., tendon, joint capsule).
A patient is referred to physical therapy following a modified radical mastectomy for treatment of associated soft tissue restrictions and pain. During the examination, the physical therapist becomes concerned since the surgical site is extremely warm to touch, tender, and discolored. Given the patient’s recent history, the MOST likely etiology is:
A. Dermatitis
B. Cellulitis
C. Mastitis
D. erysipelas
Cellulitis
Correct Answer: B
A modified radical mastectomy includes removal of all tissues of the affected breast including the areola, nipple, and most of the axillary lymph nodes. The local lymphatic disruption and resultant impairment of local immune responses increases the likelihood of post-operative cellulitis.
A. Dermatitis presents in numerous forms (e.g., contact, seborrheic, atopic), all of which involve some degree of general skin irritation. Although contact dermatitis may have a visible presentation similar to cellulitis, it would not typically be warm to touch nor is it consistent with the described clinical scenario.
B. Cellulitis tends to develop in areas where the skin’s protective barrier (e.g, surgical site, wound) and lymphatic flow (e.g., lymph node removal, excessive soft tissue, edema) have been disrupted. Cellulitis is a common post- operative complication of surgical breast cancer treatment.
C. Mastitis is an infection of the fatty breast tissue typically associated with breast feeding. The infection may present with an appearance similar to cellulitis, but is further characterized by painful lumps within the breast tissue.
D. Erysipelas is a specific form of cellulitis caused by streptococcal bacteria. Like cellulitis, the skin is typically warm and tender to the touch, however, it is much more defined in its appearance. Erysipelas is characterized by a raised, sharp demarcation of borders with an unmistakable bright red discoloration.
A physical therapist completes a series of upper extremity resisted tests on a patient with suspected cervical spine pathology. Which myotome would BEST be assessed using the test shown in the image?
A. C4
B. C5
C. C6
D. C7
C5
Correct Answer: B
Resisted isometric movements are designed to determine the role of contractile tissue in an injury. The therapist attempts to elicit a strong, static, voluntary muscle contraction. The therapist then classifies the movement as strong or weak and painful or pain-free.
A. The C4 myotome is commonly assessed by examining the diaphragm. The therapist uses a tape measure to quantify the amount of rib expansion that occurs with a deep breath. This measurement is then compared to the same measurement performed with the patient at rest.
B. The C5 myotome is commonly assessed by performing resisted isometric movements of the shoulder abductors or the shoulder external rotators. The image shows the therapist assessing the shoulder abductors by applying a downward force on the humerus while the patient resists the movement. The deltoid and supraspinatus muscles are the primary muscles active during this resisted test.
C. The C6 myotome is commonly assessed by performing resisted isometric movements of the elbow flexors or shoulder internal rotators.
D. The C7 myotome is commonly assessed by performing resisted isometric movements of the elbow extensors or wrist flexors.
