GILES B

Question 1

A physical therapist performs the Thessaly test to a patient with a suspected meniscal tear. This testing procedure would require the therapist to:
A. Passively medially rotate the patient’s tibia and extend the knee
B. Cup the patient’s heel and allow the knee to extend from a fully flexed position
C. Grasp the patient’s hands in standing to promote balance
D. Passively flex and extend the patient’s knee while feeling for “popping”

Answer 1

Grasp the patient’s hands in standing to promote balance

Correct Answer: C
The Thessaly test for a meniscal tear occurs in single leg stance by having a patient rotate the femur on the tibia medially and laterally three times. A positive test is indicated by joint line discomfort, catching or locking in the
knee.

The therapist grasp the patient’s hands in standing during the Thessaly test to provide additional balance which allows the patient to perform the necessary medial and lateral rotation of the femur on the tibia.

Question 2

2. A physician orders electromyography for a patient with a brachial plexus injury to objectively determine the extent of pathology. Which of the following responses is MOST indicative of a normal muscle at rest?
   A. Electrical silence
   B. Spontaneous potentials
   C. Polyphasic potentials
   D. Occasional motor unit potentials

Answer 2

Electrical silence

A normally innervated muscle is electrically silent at rest. Once the insertion activity (caused by the trauma of needle insertion) resolves, there should be no action potential on the oscilloscope.

Question 3

A patient being treated in physical therapy experiences a syncopal event. A review of the patient’s medical record indicates that the patient has had oth diarrhea and vomiting within the last 24 hours. The MOST likely cause associated with the syncopal event is:
A. Anemia
B. Dehydration
C. Orthostatic hypotension
D. Pregnancy

Answer 3

Dehydration

Dehydration refers to a lack of sufficient fluids in the body. The loss of fluids from bodily processes such as diarrhea and vomiting can lead to dehydration and cause syncope. The fact that the patient has experienced diarrhea and vomiting within the last 24 hours makes dehydration the most probable cause.

Question 4

A physical therapist prepares to treat a patient currently undergoing active treatment for an osteosarcoma.
Which statement BEST describes this condition?
A. A malignant growth affecting the long bones
B. A malignant growth affecting the flat bones
C. A benign growth affecting the long bones
D. A benign growth affecting the flat bones

Answer 4

A malignant growth affecting the long bones

Osteosarcoma is a malignant bone growth (i.e., tumor) affecting the long bones of the body. It is most commonly diagnosed in the distal femur, followed by the proximal tibia, and the proximal humerus.

Question 5

A physical therapist treats a patient diagnosed with posterior tibial tendon dysfunction. When observing the posterior aspect of the patient’s lower leg and ankle in standing, the MOST probable finding is:
A. Forefoot adduction
B. Hindfoot valgus
C. Hypertrophy of the gastrocnemius
D. Swelling in the lateral ankle region

Answer 5

Hindfoot valgus

The hindfoot consists of the talus and the calcaneus. Posterior tibial tendon dysfunction is most often characterized by a valgus deformity of the hindfoot due to a flattening of the medial longitudinal arch.

Question 6

A physical therapist is informed that a patient was diagnosed with a Lisfranc injury after returning from a physician visit. The patient was originally diagnosed with a minor lateral ankle sprain, however, returned to the physician after falling to make progress. Which bone would be LEAST likely to be impacted with this type of injury?
A. Calcaneus
B. Cuboid
C. Second cuneiform
D. Navicular

Answer 6

Calcaneus

The calcaneus is a quadrangular bone at the back of the tarsus. The bone articulates with the cuboid and the talus. The calcaneus is considered part of the hindfoot.

Question 7

A physical therapist completes a sensory assessment on a 61-year-old female diagnosed with multiple sclerosis. As part of the assessment the therapist examines stereognosis, vibration, and two point discrimination. What type of receptor is primarily responsible for generating the necessary information?
A. Deep sensory receptors
B. Mechanoreceptors
C. Nociceptors
D. Thermoreceptors

Answer 7

Mechanoreceptors

Mechanoreceptors are sensory receptors that respond to mechanical deformation of the area surrounding a receptor. They are responsible for sensations of touch, pressure, itch, tickle, vibration, and discriminative touch.

Question 8

A physical therapist completes a developmental assessment on an infant. At what age should an infant begin to sit with hand support for an extended period of time?
A. 6-7 months
B. 8-9 months
C. 10-11 months
D. 12-15 months

Answer 8

6-7 months

Sitting for a prolonged period of time with upper extremity support usually occurs at 6-7 months of age. The infant will also bring objects to midline, hold a bottle with two hands, and roll to prone.

Question 9

A patient rehabilitating from congestive heart failure is examined in physical therapy. During the examination the patient begins to complain of pain. The MOST immediate physical therapist action is to:
A. Notify the nursing staff to administer pain medication
B. Contact the referring physician
C. Discontinue the treatment session
D. Ask the patient to describe the location and severity of the pain

Answer 9

Ask the patient to describe the location and severity of the pain

Having the patient describe the location and severity of the pain is the most immediate action of the physical therapist should take. The information can be collected in a timely manner and may be useful to determine the relative seriousness of the patient’s subjective repost of pain.

Question 10

A patient demonstrates a significant loss of strength when trying to grasp a cup. However, the patient has much less difficulty when holding onto a pencil. This type of clinical scenario is consistend with pathology affective the:
A. Median nerve
B. Suprascapular nerve
C. Musculocutaneous nerve
D. Ulnar nerve

Answer 10

Ulnar nerve

The ulnar nerve controls flexion of the ulnar digits and would therefore be involved primarily in power grips. The ulnar nerve innervates some muscles of the thumb, therefore it would have a small effect on precision grips, though this effect would be limited in comparison to power grips which rely on the ulnar side of the hand.

Question 11

A patient presents with ape hand deformity secondary to a peripheral nerve injury. Which of the following findings would MOST likely be noted on examination?
A. Decreased strength with thumb opposition
B. Fixed flexion of the metacarpophalangeal joints
C. Fixed hyperextension of the metacarpophalangeal joints
D. Wasting of the hypothear eminence

Answer 11

Decreased strength with thumb opposition

Ape hand deformity is characterized by wasting of the thenar eminence, which results in weakness with thumb flexion and opposition. The patient’s thumb may fall back in line with the other digits since the pull of the thumb extensors is stronger than the thumb flexors.

Question 12

A physical therapist reviews a research study that examines knee flexion range of motion two weeks following arthroscopic surgery. Assuming knee flexion range of motion is a normally distributed variable, what percentage of patients in the population would achieve a goniometric measurement value between the mean and one standard deviation above the mean?
A. 14%
B. 34%
C. 48%
D. 68%

Answer 12

34%

34% is the approximate area under the normal curve bounded by 1 standard deviations above or below the mean.

Question 13

An entry in a patient’s medical record indicates that the patient has recently received viscosupplementation.
This type of procedure is MOST commonly performed to treat:
A. Arrhythmias
B. Bursitis
C. Osteoarthritis
D. Spasticity

Answer 13

Osteoarthritis

Osteoarthritis is a condition characterized by the loss of articular cartilage within a joint secondary to mechanical stresses. Viscusupplementation is commonly used in the treatment of osteoarthritis as the improved lubrication within the joint can help reduce joint stresses and reduce the progression of cartilaginous destruction. The befits of viscosupplementation are relatively transient.

Question 14

A patient recently visited a podiatrist and was told to purchase a heel lift for one of their shoes. Which condition would be LEAST likely to benefit from the use of the heel lift?
A. True leg length discrepancy
B. Achilles tendonitis
C. Achilles tendon repair
D. Calcaneal bone spur

Answer 14

Calcaneal bone spur

A calcaneal (or heel) bone spur is an area of abnormal bone growth that occurs as a result of excess stress on the bone. Calcaneal spurs can be located on the posterior calcaneus or the inferior calcaneus. A heel lift would not be effective at managing the symptoms of a calcaneal spur. A heel cushion would be more effective at lessening pressure on the spur and thus reducing symptoms.

Question 15

A physical therapist collects data as part of a preseason athletic screening program designed to identify individuals susceptible to heat illness. Which of the following measures would be the MOST valuable to collect?
A. Heat
B. Weight
C. Percent body fat
D. Vital capacity

Answer 15

Percent body fat

Patients with a higher percent body fat are more susceptible to heat illness since the larger the person is, the more difficulty it will be to dissipate excess heat. In addition, research has revealed that overweight individuals may generate up to 18% greater heat production than underweight individuals.

Question 16

A physical therapist employed in an acute care hospital works with a patient on bed mobility activities. The therapist would like to incorporate a strengthening activity for the hip extensors that will improve the patient’s ability to independently reposition in bed, however, the patient does not have adequate strength to perform bridging. The MOST appropriate exercise activity is:
A. Anterior pelvic tilts
B. Heel slides
C. Straight leg raises
D. Isometric gluteal sets

Answer 16

Isometric gluteal sets

An isometric gluteal set is an appropriate precursor to bridging since the activity incorporates the hip extensors.

Question 17

A patient with a transtibial amputation is performing gait training. After 15 minutes of training, the patellar tendon bearing prosthesis is removed and the skin is inspected. Redness is noted on multiple areas of the residual limb. Which area of redness would be the GREATEST concern?
A. Patellar tendon
B. Fibular shaft
C. Gastrocnemius muscle
D. Distal anterior tibia

Answer 17

Distal anterior tibia

The distal anterior tibia is not a pressure tolerant area, as it is covered by a thin layer of skin and has little to no adipose tissue to distribute the transmitted forces. If redness is noted in this area, it is necessary to verify that socks and liners are being worn appropriately prior to contacting a prosthetist.

Question 18

A physical therapist uses a self-care assessment to examine change over time in rehabilitation programs.
The assessment uses a seven point scale to examine 18 items. The collected information is based on observations of patient performance. This type of assessment MOST closely describes the:
A. Functional Independence Measure
B. Functional Status Index
C. Physical Self-Maintenance Scale
D. Katz Index of Activities of Daily Living

Answer 18

Functional Independence Measure

The Functional Independence Measure (FIM) tests a subject in multiple areas to determine the overall degree of disability experienced by an adult rehabilitation patient. A seven-point scale is utilized to examine 18 areas, which include self-care, sphincter control, transfer, locomotion, communication, and social cognitive activities. The FIM is commonly used to examine changes in disability status that occur over time.

Question 19

A physical therapist working on a pulmonary rehabilitation unit works with a patient on therapeutic positioning. The patient has experienced a lengthy inpatient hospitalization and was only recently referred to physical therapy. The patient has significant weakness of the diaphragm and is hypertensive. The MOST appropriate patient position to initiate treatment is:
A. Prone
B. Supine
C. Trendelenburg position
D. Reverse trendelenburg position

Answer 19

The reverse trendelenburg position

The reverse Trendelenburg position is recommended to reduce hypertension and facilitate movement of the diaphragm by using gravity to reduce the weight of the abdominal contents on the diaphragm.

Question 20

A physical therapist works with a patient who is HIV positive and has been admitted to an acute care hospital for a course of intravenous antibiotics. The patient’s medical record states that he has had a persistent cough producing bloody sputum for four weeks and that airborne precautions should be observed.
The MOST likely rationale for this level of precaution is to:
A. Decrease the risk of exposing the ummunocompromissed patient to pneumonia
B. Decrease the risk of exposing the immunocompromised patient to active tuberculosis
C. Decrease the risk of staff and visitor exposure to pneumonia
D. Decrease the risk of staff and visitor exposure to active tuberculosis

Answer 20

Decrease the risk of staff and visitor exposure to active tuberculosis

Airborne precautions are typically instituted to protect staff and visitors from contracting an infection spread through airborne transmission. There is a significant prevalence of tuberculosis among patients who are HIV positive and the reported persistent cough and bloody sputum are consistent with the clinical presentation of the disease.

Question 21

A physical therapist determines that a patient’s cadence is 120 steps per minute. How long would it take the patient to complete 120 full strides?
A. 30 seconds
B. 60 seconds
C. 120 seconds
D. 240 seconds

Answer 21

120 seconds

A period of 120 seconds would be necessary to complete 120 strides since the patient can currently complete 120 steps in 60 seconds. In 120 full strides or 240 half strides based on a cadence of 120 steps per minute.

Question 22

A patient is referred to physical therapy with a diagnosis of temporomandibular joint pain. After completing the examination, the physical therapist suspects that the patient may actually be experiencing referred visceral pain. Which organ is MOST likely involved?
A. Heart
B. Liver
C. Diaphragm
D. Pancreas

Answer 22

Heart

Pathology of the heart can result in referred pain to the shoulder, neck, upper back or TMJ.

Question 23

A physical therapist reviews risk factors for the development of pressure ulcers. Which patient would be
MOST at risk for a pressure ulcer?
A. A 55-year-old Caucasian male with diabetes
B. A 60-year-old African American female with a C7 spinal cord injury
C. An 80-year-old African American male with chronic obstructive pulmonary disease
D. A 65-year-old Caucasian female status post total knee arthroplasty

Answer 23

A 60-year-old African American female with a C7 spinal cord injury

This patient would be at the greatest risk for the development of a pressure ulcer due to her race (i.e., African American), gender (i.e., female), and medical condition (i.e., spinal cord injury). Patients with spinal cord injuries are often immobile, which places them at high risk for developing pressure ulcers.

Question 24

A physical therapist treats a patient wearing a shoe that incorporates a rocker bottom. This type of modification would be the MOST beneficial for a patient diagnosed with:
A. Achilles tendonitis
B. Hallux rigidus
C. Plantar fasciitis
D. Posterior tibial tendonitis

Answer 24

Hallux rigidus

Hallux rigidus refers to degenerative arthritis due to bone spurring that affects the first metatarsophalangeal joint. Patients with this condition often experience pain and stiffness with walking, standing or bending. A rocker bottom shoe could be potentially beneficial by reducing extension of the hallux during normal gait. This type of modification may assist the patient to experience decreased pain and allow for an increased activity level.

Question 25

A patient following total hip arthroplasty using a posterolateral surgical approach experiences hip instability. Which finding would BEST explain the reason for the instability?
A. Trabecular bone erosion
B. Femoral nerve paralysis
C. Posterior capsule damage
D. Hip abductor weakness

Answer 25

Posterior capsule damage

A total hip arthroplasty using a posterior surgical approach penetrates the posterior capsule. As a result, it is associated with a high post-surgical dislocation rate. To prevent posterior dislocation of the femoral head component, the patient should avoid excessive hip flexion greater than 90 degrees, hip adduction, and hip medial rotation.

Question 26

A 68-year-old male is referred to physical therapy after being diagnosed with primary osteoarthritis. The associated articular changes are MOST likely attributed to:
A. Age-related changes
B. Trauma from previous injuries
C. Congenital bony abnormalities
D. Underlying inflammatory processes

Answer 26

Age-related changes

Primary OA is diagnosed when there is no clinical or medical history present to support the initiation of the condition. The idiopathic articular changes are attributed to normal aging and typically occur in older populations.

Question 27

A patient with diabetes insipidus is being treated with exogenous administration of antidiuretic hormone
(ADH). Which potential side effect of ADH is MOST likely?
A. Increased blood pressure
B. Decreased blood pressure
C. Hypovolemia
D. Constipation

Answer 27

Increased blood pressure

ADH administration can promote increases in blood pressure secondary to stimulation of smooth muscle contraction of the vascular system. ADH may also have an effect on the coronary arteries which can result in angina or myocardial infarction.

Question 28

A physical therapist reviews a patient’s medical record and identifies an entry that indicates the patient was recently prescribed an emetic agent. The PRIMARY purpose of this pharmacological agent is to:
A. Promote defecation
B. Induce vomiting
C. Minimize gastrointestinal irritation
D. Reduce diarrhea

Answer 28

Induce vomiting

Emetic agents are used to induce vomiting usually after ingestion of a toxic substance. Side effects include dehydration, electrolyte imbalance, and gastrointestinal erosion with prolonged use. Examples of emetic agents include Apomorphine and Ipecac.

Question 29

A 48-year-old female patient is referred to physical therapy after being diagnosed with patellofemoral pain syndrome. As part of the session, the patient describes a number of exercises that she was instructed to perform by her personal trainer. Which exercise would likely be the MOST problematic?
A. Terminal knee extension in standing
B. Mini-squats from 0-30 degrees of knee flexion
C. Long are quads from 0-45 degrees of knee flexion
D. Quadriceps setting in terminal knee extension in supine.

Answer 29

Long are quads from 0-45 degrees of knee flexion

In contrast to closed-chain activities, the patellofemoral joint reaction forces for open-chain activities are their lowest at 90 degrees of flexion. The joint reaction forces increase as the knee moves closer to full extension. Therefore, open chain exercises between 0 and 45 degrees of knee flexion are not recommended.

Question 30

A patient with a T3 spinal cord injury exercising on a treatment table in supine begins to exhibit signs and symptoms of autonomic dysreflexia including a dramatic increase in blood pressure. The MOST immediate action to address the patient’s blood pressure response is to:
A. Elevate the patient’s legs
B. Call for assistance
C. Sit the patient upright
D. Check the urinary drainage system

Answer 30

Sit the patient upright

The physical therapist should immediately position the patient in sitting to address the autonomic nervous system response and reduce the patient’s elevated blood pressure. After the patient has been positioned in sitting, the urinary drainage system should be checked since a blocked catheter is a common noxious stimulus that triggers the sympathetic response.

Question 31

A patient rehabilitating from a traumatic head injury is lethargic since being placed on Phenobarbital. The PRIMARY purpose of the medication is to:
A. Decrease agitation
B. Prevent seizures
C. Reduce spasticity
D. Limit arrhythmias

Answer 31

Prevent seizures

Phenobarbital is classified as a barbiturate and is prescribed most often to prevent adult seizures. Side effects include sedation, vitamin deficiencies, nystagmus, and ataxia.

Question 32

A patient with a transtibial amputation ambulates in the physical therapy gym. The patient exhibits an extended knee throughout early stance phase on the prosthetic side. The MOST appropriate action to resolve the patient’s difficulty is:
A. Plantar flex the foot
B. Soften the heel wedge
C. Move the foot anteriorly
D. Dorsiflex the foot

Answer 32

Dorsiflex the foot

A prosthetic foot that is set in slight dorsiflexion will present with an increased flexion moment and assist with knee flexion during stance and when advancing the prosthesis.

Question 33

A physical therapist examines a patient diagnosed with carpal tunnel syndrome. As part of the examination the therapist assesses end-feel. The therapist classifies the end-feel associated with wrist extension as firm.
The MOST logical explanation is:
A. Tension in the dorsal radiocarpal ligament and the dorsal joint capsule
B. Contact between the ulna and the carpal bones
C. Contact between the radius and the carpal bones
D. Tension in the palmar radiocarpal ligament and the palmar joint capsule.

Answer 33

Tension in the palmar radiocarpal ligament and the palmar joint capsule.

A firm end-feel with wrist extension can result from tension in the palmar radiocarpal ligament and the palmar joint capsule. Tension in the ulnocarpal ligament can also contribute to the firm end-feel.

Question 34

A physical therapist examines a patient diagnosed with patellofemoral syndrome. As part of the examination the therapist elects to measure the patient’s Q angle. Which three bony landmarks are used to measure the Q angle?
A. Anterior superior iliac spine, superior border of the patella, tibial tubercle
B. Anterior superior iliac spine, midpoint of the patella, tibial tubercle
C. Anterior superior iliac spine, inferior border of the patella, midpoint of the patella tendon
D. Greater trochanter, midpoint of the patella, tibial tubercle

Answer 34

Anterior superior iliac spine, midpoint of the patella, tibial tubercle

The most accurate measure of the angle of quadriceps muscle force (i.e., Q angle) utilizes the origin and insertion of the quadriceps muscle and the midpoint of the patella.

Question 35

A physical therapist positions a patient as shown prior to testing for clonus, The MOST appropriate action to complete the test is:
A. Provide a quick stretch to the plantar flexors
B. Provide a quick stretch to the dorsiflexors
C. Provide a quick stretch to the plantar flexors while extending the knee
D. Provide a quick stretch to the dorsiflexors while extending the knee.

Answer 35

Provide a quick stretch to the plantar flexors

Clonus is evaluated by supporting the knee in a partially flexed position, encouraging the patient to relax, and passively moving the foot. The therapist provides a quick stretch into dorsiflexion and observes any rhythmic oscillations between plantar flexion and dorsiflexion.

Question 36

A physical therapist examines a patient with multidirectional instability fo the shoulder. Which position would be the MOST appropriate when assessing posterior instability of the shoulder?
A. Abduction to 90 degrees with neutral rotation
B. Abduction to 90 degrees with full external rotation
C. Flexion to 90 degrees with full internal rotation
D. Arm at the side in neutral rotation

Answer 36

Flexion to 90 degrees with full internal rotation

Flexion to 90 degrees with full internal rotation describes the position used when testing for posterior shoulder instability. These motions both move the humeral head posteriorly in the joint and place stress on the posterior capsule. During the jerk test, the patient is placed in this position and the therapist applies an axial load through the elbow in a posterior direction. The therapist can then horizontally adduct the shoulder to place further stress on the posterior capsule.

Question 37

A physical therapist employed in a busy outpatient orthopedic clinic attempts to determine a schedule for calibration and maintenance of an ultrasound unit. The MOST important factor for the therapist to consider when determining an appropriate schedule is:
A. Beam nonuniformity ration
B. Frequency of use
C. Cost associated with calibration and maintenance
D. Availability of qualified personnel to inspect the unit

Answer 37

Frequency of use

The frequency of use of an ultrasound device is extremely important when determining a schedule for calibration and maintenance. Ultrasound units used frequently may be calibrated several time a year, while a unit used sparingly would likely warrant a longer interval.

Question 38

A physical therapist positions a patient as shown in order to assess their claim of complete paresis of the right lower extremity. The therapist instructs the patient to perform a rapid straight leg raise with their left lower extremity. Which finding would BEST dispute the patient’s claim?
A. The patient is unable to lift their left heel from the therapist’s hand
B. The patient experiences radiating pain into the right lower extremity.
C. The patient exerts a downward force into the therapist’s hand with their right heel.
D. The patient reports severe pain while performing the straight leg raise.

Answer 38

The patient exerts a downward force into the therapist’s hand with their right heel.

A rapid straight leg raise of the left (uninvolved) lower extremity should result in the patient exerting a downward force into the therapist’s hand with the right (involved) heel. This action would be considered a normal response due to the effort associated with performing the straight leg raise, therefore disputing the patient’s claim of complete paresis of the right lower extremity.

Question 39

A patient is treated using pulsed wave ultrasound at 1.2 W/cm? for seven minutes. The specific parameters of the pulsed wave are 2 msec on time and 8msec off time for one pulse period. The duty cycle should be recorded as:
A. 10%
B. 20%
C. 25%
D. 50%

Answer 39

20%

The question indicates that the parameters of the pulsed wave are 2 sec on time and 8 msec off time for one pulse period. As a result, duty cycle = 2 msec / (2 msec + 8 msec) = .20 (100) = 20%

Question 40

A physical therapist examines the output form a single lead electrocardiogram of a patient with first degree atrioventricular hear block. The defining characteristic of this condition is a/an:
A. Inverted T wave
B. Prolonged PR interval
C. Bizarre QRS complex
D. ST segment depression

Answer 40

Prolonged PR interval

The normal duration of the PR interval is 0.12 to 0.20 seconds. A prolonged PR interval (> 0.20 seconds) is the defining feature of first-degree atrioventricular block.

Question 41

A patient diagnosed with ankylosing spondylitis exhibits a forward stooped posture. As part of the patient’s care plan the physical therapist selects a number of active exercises that promote improved posture. Which proprioceptive neuromuscular facilitation pattern would be the MOST appropriate to achieve the therapist’s objective?
A. D1 extension
B. D1 flexion
C. D2 extension
D. D2 flexion

Answer 41

D2 flexion

The command for D2 flexion would be to open your hand and pull up and away from your body. The pattern emphasizes shoulder flexion, abduction, and lateral rotation which would facilitate improved standing posture.

Question 42

A physical therapist completing a balance assessment positions a patient in standing prior to administering the Romberg test. When administering the Romberg test it would be MOST important for the therapist to determine:
A. The width of the base of support necessary in order to maintain standing
B. The amount of time the patient is able to maintain the test position
C. The amount of sway present during the testing period
D. The complexity of tasks the patient is able to perform with eyes open and eyes closed

Answer 42

The amount of sway present during the testing period

The amount of sway present during the testing period determines whether the Romberg test is positive or negative. A positive test is characterized by a patient being able to stand with no more than minimal sway with the eyes open, but presents with increased instability or falls with the eyes closed.

Question 43

A physical therapist reviews the medical record of a patient diagnosed with peripheral arterial disease prior to initiating treatment. Which objective finding would MOST severely limit the patient’s ability to participate in an ambulation exercise program?
A. Signs of resting claudication
B. Decreased peripheral pulses
C. Cool skin
D. Blood pressure of 165/90 mm Hg

Answer 43

Signs of resting claudication

Claudication pain is a symptom of ischemia of the lower extremity muscles caused by peripheral arterial disease. Resting claudication pain is typically considered a contraindication to exercise with peripheral arterial disease and may be an indication that the disease process is more advanced.

Question 44

A seven-year-old boy sitting in the physical therapy waiting area suddenly grasps his throat and appears to be in distress. The boy slowly stands, but is obviously unable to breathe. The physical therapist recognizing the signs of an airway obstruction should administer:
A. Abdominal thrusts
B. Chest thrusts
C. Rescue breathing
D. Finger sweep

Answer 44

Abdominal thrusts

Abdominal thrust (Heimlich maneuver) can be used on a child until the object is expelled or the victim becomes unresponsive. The American Red Cross recommends back blows in combination with abdominal thrusts. Abdomina thrusts are not recommended for infants (less than one year of age) because of an increased risk of injury.

Question 45

A patient reports significant discomfort in the lower leg during ultrasound treatment. The therapist believes the discomfort is caused by periosteal pain from the ultrasound. Which scenario is MOST likely associated with the patient’s subjective report of discomfort?
A. An ultrasound unit with a high beam nonuniformity ratio
B. An ultrasound unit with a low beam nonuniformity ratio
C. A transducer with a large effective radiating area
D. A transducer with a small effective radiating area

Answer 45

An ultrasound unit with a high beam nonuniformity ratio

A high beam nonuniformity ratio produces a less uniform beam and therefore places the patient at greater risk for undesirable side effects such as periosteal pain or hot spots.

Question 46

A physical therapist participates in a research study that examines body composition as a function of aerobic exercise and diet. Which method of data collection would provide the physical therapist with the MOST valid measurement of body composition?
A. Anthropometric measurements
B. Bioelectrical impedance
C. Hydrostatic weighing
D. Skinfold measurements

Answer 46

Hydrostatic weighing

Hydrostatic weighing calculates the density of the body by immersing a person in water and measuring the amount of water that becomes displaced. This measurement technique is considered the criterion or gold standard for determining body composition.

Question 47

A physical therapist reviews the surgical report of a patient that sustained extensive burns in a fire. The report indicates that at the time of primary excision, cadaver skin was utilized to close the wound. This type of graft is termed:
A. Allograft
B. Autograft
C. Heterograft
D. Xenograft

Answer 47

Allograft

An allograft is a temporary skin graft taken from another human, usually a cadaver, in order to cover a large burned area. A homograft is synonymous with the term allograft.

Autograft - tissue from the same patient
Heterograft - aka Xenograft; skin from an animal

Question 48

A patient classifies the intensity of exercise as a 16 using Borg’s (20-point) Rating of Perceived Exertion
Scale. This classification BEST corresponds to:
A. 40 percent of the maximum heart rate range
B. 60 percent of the maximum heart rate range
C. 70 percent of the maximum heart rate range
D. 85 percent of the maximum heart rate range

Answer 48

85 percent of the maximum heart rate range

A rating of 16 (very hard) on the 20-point RPE scale corresponds to 85% of the heat rate range.

Question 49

A male patient rehabilitating from a lower extremity injury is referred to physical therapy for gait analysis.
The physical therapist begins the session by observing the patient at free speed walking. The normal degree of toe-out at this speed is:
A. 3 degrees
B. 7 degrees
C. 14 degrees
D. 21 degrees

Answer 49

7 degrees

The degree of toe-out during free speed walking is approximately 7 degrees

Question 50

A patient diagnosed with patellofemoral syndrome discusses his past medical history with a physical therapist. The patient reports having anterior ruciate ligament reconstruction surgery on his right knee two years ago, however, the therapist is not able to identify a scar over the anterior surface of the right knee.
Assuming the surgeon utilized an autograft for the reconstruction, which of the following would be the MOST likely graft site?
A. Semitendinosus and semimembranosus
B. Semitendinosus and gracilis
C. Semimembranosus and gracilis
D. Semitendinosus and biceps femoris

Answer 50

Semitendinosus and gracilis

The semitendinosus and gracillis tendons are commonly used together as a graft for anterior cruciate ligament reconstruction. The grafts result in a decreased incidence of post-operative patellofemoral knee pain, however, provide weaker initial fixation. The gracillis functions as a hip adductor and is innervated by the obturator nerve (L2-L4).

Question 51

A physical therapist observes the gait of a child with spastic cerebral palsy. The therapist notes that the child exhibits excessive lordosis during ambulation. Which surgical procedure would BEST address this postural deformity?
A. Hamstring tendon lengthening
B. Adductor longus tendon lengthening
C. Iliopsoas tendon lengthening
D. Lumbar laminectomy

Answer 51

Iliopsoas tendon lengthening

Contracture of the iliopsoas causes an excessive anterior pelvic tilt, which results in increased lordosis of the lumbar spine. Lengthening of the iliopsoas reduces the anterior pull on the pelvis and corrects the lordosis.

Question 52

A physical therapist completes a series of resisted movements on a patient with a lower extremity injury.
The patient denies pain initially, but complains of increasing pain after performing a number of repetitions.
This scenario is MOST consistent with:
A. Complete rupture of a tendon
B. Intermittent claudication
C. Ligamentous laxity
D. Emotional hypersensitivity

Answer 52

Intermittent claudication

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. Pain tends to progressively worsen with increasing activity.

Question 53

A physical therapist treats a patient with right medial epicondylitis. When positioning the patient’s ulnohumeral joint in the loose packed position, the therapist should allow for:
A. Full extension
B. 70 degrees flexion, 10 degrees supination
C. 70 degrees flexion, 35 degrees supination
D. Full extension, full supination

Answer 53

70 degrees flexion, 10 degrees supination

Placing the ulnohumeral joint into 70 degrees flexion and 10 degrees supination is the correct placement to obtain the open packed position of this joint. This position is commonly used when assessing joint play of the ulnohumeral joint.

Question 54

Members of a community health task force evaluate a proposal for a new adolescent screening program. Several members of the task force raise questions as to the validity of the screening instrument. Which measure of validity examines the instrument’s ability to identify diseased persons by comparing true positives?
A. Adaptability
B. Selectivity
C. Sensitivity
D. Specificity

Answer 54

Sensitivity

Sensitivity is a measure of the validity of a screening test, based on the probability that the screening test will be positive in someone with the disease or target condition (i.e., true positive).

Question 55

A physical therapist attempts to quantify a patient’s endurance level by administering a maximal exercise test. What is the PRIMARY limitation of a maximal exercise test?
A. Maximal exercise testing requires participants to exercise to the point of volitional fatigue
B. Maximal exercise testing does not typically allow a steady state heart rate at each work rate.
C. Maximal exercise testing is not useful in diagnosing coronary artery disease.
D. Maximal exercise testing requires progressive stages of increasing work intensities without rest intervals.

Answer 55

Maximal exercise testing requires participants to exercise to the point of volitional fatigue

The primary limitation of a maximal exercise test is that it requires the individual to exercise to the point of volitional fatigue. Some subjects terminate the exercise test due to fatigue or exercise intolerance before reaching their physiological maximum. This reduces the sensitivity of the estimate of maximum oxygen uptake.

Question 56

A physical therapist prepares to complete a sensory examination on a patient rehabilitating from a lower extremity burn. Which of the following would serve as the BEST predictor of altered sensation?
A. Presence of a skin graft
B. Depth of burn injury
C. Percentage of body surface affected
D. Extent of hypertrophic scarring

Answer 56

Depth of burn injury

It is possible to predict the relative extent of sensory alteration based on the depth of the burn. For example, a superficial partial-thickness burns characterized by extreme pain and significant sensitivity to temperature change, while a full-thickness burn is characterized by an absence of pain and ability to identify temperature change.

Question 57

A physical therapist would like to minimize the likelihood of a burn when using iontophoresis. Which action would be the MOST consistent with the therapist’ objective?
A. Increase the size of the cathode relative to the anode
B. Decrease the space between the electrodes
C. Increase the current intensity
D. Decrease the moisture of the electrodes.

Answer 57

Increase the size of the cathode relative to the anode

Increasing the size of the cathode relative to the anode serves to decrease current density and therefore reduces the probability of a burn when using iontophoresis. The cathode refers to the negatively charged electrode in a direct current system and the anode refers to the positively charged electrode. The accumulation of positively charged ions in a small area creates an alkaline reaction that is more likely to create tissue damage. As a result, it is desirable to increase the size of the cathode.

Question 58

A physical therapist reviews a patient coverage form that lists the parameters used during a recent ultrasound treatment to the right anterior shoulder: 1.5 W/cm2, pulsed 20%, 1 MHz, 6 minutes. Assuming the objective of the ultrasound was to increase tissue temperature, which parameter would be the MOST critical for the therapist to alter?
A. Time
B. Duty cycle
C. Frequency
D. Intensity

Answer 58

Duty cycle

Duty cycle is defined as the ratio of the on time to the total time. When ultrasound is used in a pulsed mode with a 20% or lower duty cycle, the heat produced ruing the on time of the cycle is dispersed during the off time and as a result there is no measurable net increase in temperature. To increase tissue temperature it would be necessary to significantly increase the duty cycle or use a continuous mode.

Question 59

A physical therapist attempts to assess the integrity of the vestibulocochlear nerve by administering the Rinne test on a patient with a suspected upper motor neuron lesion. After striking the tine of the tuning fork to begin vibration, which bony prominence should the therapist utilize to position the stem of the tuning fork?
A. Midline of the skull
B. Occipital protuberance
C. Inion
D. Mastoid process

Answer 59

Mastoid process

The mastoid process refers to a protruding bony area in the lower part of the skull situated behind the ear. This structure is used while performing the Rinne test.

Question 60

A physical therapist prepares to apply a topical antibiotic to a small portion of the upper arm of a patient with a deep partial-thickness burn. When applying the topical antibiotic, the therapist should utilize which form of medical asepsis?
A. Gloves
B. Sterile gloves
C. Sterile gloves, gown
D. Sterile gloves, gown, mask

Answer 60

Sterile gloves

Topical antibiotics are applied directly to the burn and therefore require the use of sterile gloves. Failure to use sterile technique increases the probability of contamination.

Question 61

A physical therapist examines a patient with coordination deficits presenting with excessive involuntary and extraneous movements including hemiballismus. This clinical presentation is MOST consistent with damage to the:
A. Cerebellum
B. Basal ganglia
C. Frontal lobe
D. Medulla oblongata

Answer 61

Basal ganglia

The basal ganglia are gray matter masses located deep within the white matter of the cerebrum and include the caudate, putament, globus pallidus, substantia nigra, and subthalamic nuclei. In addition to hemiballismus, other basal ganglia deficits include choreoathetosis, hyperkinesis, rigidity, and bradykinesia.

Question 62

A patient with Addison’s disease suffers from fatigue and extreme weight loss. The MOST likely cause of this patient’s symptoms is:
A. Decreased production of cortisol
B. Hyperfunction of the thyroid gland
C. Decreased absorption of nutrients within the intestines
D. Hyperfunction of the adrenal gland

Answer 62

Decreased production of cortisol

The adrenal glands are responsible for the production of cortisol and aldosterone. Decreased production of these hormones results in fatigue and weight loss. Addison’s disease can be treated by the administration of exogenous cortisol.

Question 63

A physical therapist observes a patient complete a standing arm curl with a dumbbell using the starting and ending positions shown in the image. Which scenario would produce the MOST power?
A. A 2 pound dumbbell lifted in two seconds
B. A 2 pound dumbbell lifted in three seconds
C. A 4 pound dumbbell lifted in one second
D. A 4 pound dumbbell lifted in four seconds

Answer 63

A 4 pound dumbbell lifted in one second

A 4 pound dumbbell lifted in one second would produce the greatest amount of power since the weight lifted is the heaviest of the presented options and the amount of time to complete the repetition (i.e., one second) is the shortest.

Question 64

A physical therapist examines a patient with a suspected injury to the thoracodorsal nerve. Which objective finding would be consistent with this injury?
A. Shoulder medial rotation weakness
B. Shoulder extension weakness
C. Paralysis of the rhomboids
D. Paralysis of the diaphragm

Answer 64

Shoulder extension weakness

The latissimus dorsi is innervated by the thoracodorsal nerve (C6, C7, C8). Weakness of the latissimus dorsi would produce impaired strength during shoulder extension resistive testing despite the fact that several other muscles also function to extend the shoulder. These muscles include the posterior deltoid and teres major.

Question 65

A physical therapist works with a patient using a flotation device positioned vertically in the deep end of a pool. Which area of the patient’s body would experience the GREATEST amount of hydrostatic pressure?
A. Shoulders
B. Torso
C. Hips
D. Feet

Answer 65

Feet

When positioned vertically, the feet would experience the greatest amount of hydrostatic pressure since they are the deepest immersed body part.

Question 66

A physical therapist prepares to treat a patient two days following total hip arthroplasty using a posterolateral surgical approach. Which muscle experiences the GREATEST trauma with this surgical procedure?
A. Gluteus maximus
B. Gluteus medius
C. Piriformis
D. Vastus lateralis

Answer 66

Gluteus maximus

Access to the hip using a posterolateral surgical approach occurs by splitting the gluteus maximus muscle in line with the muscle fibers. This type of surgical approach penetrates the posterior capsule resulting in potential post-operative joint instability. In order to prevent dislocation of the femoral head component, the patient should avoid excessive hip flexion greater than 90 degrees, hip adduction, and medial rotation.

Question 67

A physical therapist completes an examination on a patient diagnosed with Parkinson’s disease. Results of the examination include 4/5 strength in the lower extremities, 10 degree flexion contracture at the hips, and exaggerated forward standing posture. The patient has difficulty initiating movement and requires manual assistance for gait on level surfaces. The MOST appropriate activity to incorporate into a home program is:
A. Prone lying
B. Progressive relaxation exercises
C. Lower extremity resistive exercises with ankle weights
D. Postural awareness exercises in standing

Answer 67

Prone lying

Prone lying is a static positioning activity designed to stretch the hip flexors. If the patient was unable to tolerate prone lying, the physical therapist could plce one or more pillows under the patient’s hip and gradually remove pillows over time as the patient improves their flexibility

Question 68

The medical record indicates a patient has been diagnosed with chronic respiratory alkalosis. The MOST consistent laboratory finding with this condition is:
A. Elevated arterial blood pH. Low PaCO2
B. Low arterial blood pH, elevated PaCO2
C. Elevated arterial blood pH, elevated PaCO2
D. Low arterial blood pH, low PaCO2

Answer 68

Elevated arterial blood pH. Low PaCO2

Elevated arterial blood pH and low PaCO2 are consistent with respiratory alkalosis. This condition can be caused by alveolar hyperventilation due to dizziness or syncope.

Question 69

A patient involved in a motor vehicle accident sustains a proximal fibula fracture. The fracture damaged the motor component of the ommon peroneal nerve. Ankle dorsiflexion and eversion are tested as 2/5. The MOST appropriate intervention to assist the patient with activities of daily living would be:
A. Electrical stimulation
B. Orthosis
C. Exercise program
D. Aquatic program

Answer 69

Orthosis

The use of an orthosis would ensure adequate foot clearance and stability during activities of daily living. This form of intervention would have an immediate impact on the patient’s ability to perform activities of daily living.

Question 70

A physical therapist instructs a patient with pulmonary pathology in energy conservation techniques. Which of the following techniques would be the MOST effective when assisting a patient to complete a selected activity without dyspnea?
A. Diaphragmatic breathing
B. Pacing
C. Pursed-lip breathing
D. Ventilator muscle training

Answer 70

Pacing

Pacing is an integral component of energy-saving techniques used by patients who present with dyspnea during activity. Pacing refers to dividing an activity into component parts so that the patient does not exceed the limits of their breathing capacity throughout each portion of the task. For example, climbing upstairs is performed only on exhalation and by taking only one or two steps at a time.

Question 71

During an examination, a physical therapist notes a yellow discoloration of the patient’s skin and sclera of the eye. This discoloration would be LEAST likely observed with:
A. Cholecystitis
B. Ulcerative colitis
C. Pancreatitis
D. Hepatitis

Answer 71

Ulcerative colitis

Ülcerative colitis is an inflammation and ulceration of the inner lining of the colon and rectum. Signs and symptoms include rectal bleeding, diarrhea, nausea, vomiting, weight loss, and fever. Jaundice is not a symptom typically seen with this condition.

Question 72

A physical therapist consults with the teacher of a nine-year-old child with dyspraxia. Which of the following school-based activities would be the MOST challenging for the child?
A. Maintaining upright sitting posture in a classroom chair
B. Negotiating a crowded halfway between classrooms
C. Opening and closing a locker
D. Writing their name

Answer 72

Negotiating a crowded halfway between classrooms

A child with dyspraxia will have difficulty maintaining their balance in environments with changing surfaces and many obstacles, such as in a crowded hallway. To accommodate for this, a student may be allowed to leave class a few minutes early in order to transition between classrooms in a less crowded hallway.

Question 73

A physical therapist works with a nine-year-old child with Down syndrome. The therapist determines that the patient has abnormalities in muscular tone consistent with the diagnosed condition. Which technique would be the MOST beneficial when treating the patient’s tone abnormalities?
A. Quick stretch
B. Deep pressure
C. Prolonged icing
D. Neutral warmth

Answer 73

Quick stretch

Providing a quick stretch to a muscle helps activate muscle spindles and results in enhanced muscular contraction. For patients with low tone, this technique may help facilitate increased activity in affected muscles.

Question 74

A physical therapist treats a patient diagnosed with osteonecrosis of the femoral condyle. Which patient profile if MOST typical with this medical condition?
A. A 42-year-old female with osteonecrosis fo the lateral femoral condyle
B. A 64-year-old female with osteonecrosis fo the medial femoral condyle
C. A 46-year-old male with osteonecrosis of the medial femoral condyle
D. A 68-year-old male with osteonecrosis of the lateral femoral condyle

Answer 74

A 64-year-old female with osteonecrosis fo the medial femoral condyle

Females are three time more likely than males to experience osteonecrosis of the femoral condyle with peak incidence occurring in women who are over 60 years of age. The medial femoral condyle is more likely to be affected than the lateral femoral condyle due to increased weight bearing forces caused by the center of gravity being medial to the knee.

Question 75

A physical therapist employed in a rehabilitation hospital treats a patient status post traumatic brain injury. During the treatment session the therapist notices that the patient’s toes are discolored below a bivalved lower extremity cast. The cast was applied approximately five hours ago in an attempt to reduce a plantar flexion contracture. The MOST appropriate therapist action is to:
A. Discontinue the use of the anterior portion of the cast
B. Contact the staff nurse and request that the cast is removed
C. Refer the patient to an orthoptist
D. Remove the cast

Answer 75

Remove the cast

A physical therapist possesses the requisite skills and training to remove the bivalved cast.

Question 76

A physical therapist treats a patient rehabilitating from a traumatic brain injury by applying approximation to the pelvis to increase bilateral lower extremity weight bearing. The patient exhibits significant hypertonicity and the presence of the positive support reflex. The therapist is MOST likely using the therapeutic ball to:
A. Avoid a mass extensor pattern in standing
B. Encourage active assistive range of motion
C. Allow the patient partial weight bearing through the ball
D. Limit range of motion at the shoulder

Answer 76

Avoid a mass extensor pattern in standing

In this particular scenario, the patient uses the therapeutic ball to allow for supported trunk flexion when standing. This avoids a mass extensor response and allows for weight bearing and weight shifting through the lower extremities

Question 77

A physical therapist asks a patient who has been inconsistent with his attendance in physical therapy, why he is having difficulty keeping scheduled appointments. The patient responds that it is difficult to understand the scheduling card that lists the appointments. The therapist’s MOST appropriate action would be to:
A. Contact the referring physician to discuss the patient’s poor attendance in therapy
B. Make sure the patient is given a scheduling card at the conclusion of each session.
C. Write down the patient’s appointments on a piece of paper in a manner that the patient can understand
D. Discharge the patient from physical therapy.

Answer 77

Write down the patient’s appointments on a piece of paper in a manner that the patient can understand

The physical therapist can improve the patient’s understanding of the scheduling card by writing the appointments in a more understandable format.

Question 78

A physical therapist treats a patient status post right cerebrovascular accident with resultant left hemiplegia for a colleague on vacation. A note left by the primary therapist indicates that the patient exhibits “pusher syndrome.” When examining the patient’s sitting posture, which of the following findings would be MOST likely?
A. Sitting with increased lean to the left along with increased weight bearing through the left buttocks
B. Sitting with increased lean to the right along with increased weight bearing through the right buttocks
C. Sitting with increased weight bearing through the right buttocks and the head rotated to the right; unresponsive to stimuli on the left
D. Sitting with unequal weight bearing and the head rotated to the left; unresponsive to stimuli on the right

Answer 78

Sitting with increased lean to the left along with increased weight bearing through the left buttocks

A patient with right CVA (left hemiplegia) with pusher syndrome would typically exhibit a lateral lean to the left in sitting with increased weight bearing on the left buttocks.

Question 79

A physical therapist working in a school system develops long-term goals as part of an individualized Educational Plan for a child with Down syndrome. The MOST appropriate timeframe to attain these goals iS:
A. One month
B. Four months
C. Six months
D. One year

Answer 79

One year

Federal legislation mandates the review of an IEP on a one year basis. Goals relate to improving a child’s education experience. IDEA also provides for children 0-5 years of age through early intervention programs.

Question 80

A two-year-old with T10 spina bifida receives physical therapy for gait training. Initially, the preferred method to teach a child how to maintain standing is with the use of:
A. Bilateral hip-knee-ankle-foot orthoses (HKAFO) and forearm crutches
B. Parapodium and the parallel bars
C. Bilateral knee-ankle-foot orthoses (KAFO) and the parallel bars
D. Bilateral ankle-foot orthoses (AFO) and the parallel bars

Answer 80

Parapodium and the parallel bars

The parapodium is a HKAFO with a thoracolumbar orthosisthat supports the trunk and lower extremities. It has a large base of support and is used with or without an assistive device. This would be ideal for a patient with T10 spina bifida to initiate standing within the parallel bars.

Question 81

A physical therapist works on weight shifting activities with a patient sitting over the edge of a mat table with their feet positioned on the floor. The therapist facilitates an anterior weight shift through facilitation of the pelvis. What pattern of activity would be required for the patient to maintain an upright posture?
A. Spinal extension resulting from concentric contraction of the spinal extensors
B. Spinal flexion resulting from concentric contraction of the spinal flexors
C. Spinal extension resulting from eccentric contraction of the spinal extensors
D. Spinal flexion resulting from eccentric contraction of the spinal flexors

Answer 81

Spinal extension resulting from concentric contraction of the spinal extensors

When a patient initiates an anterior weight shift through the pelvis, spinal extension must occur in order to maintain an upright posture in sitting. Concentric contraction of the spinal extensors is required to produce spinal extension

Question 82

A physical therapist observes a patient running on a treadmill at an intensity of approximately 75% of their estimated maximum oxygen consumption. What is the PRIMARY source for the adenosine triphosphase (ATP) produced during this activity?
A. Amino acids
B. Carbohydrates
C. Fats
D. Proteins

Answer 82

Carbohydrates

As exercise intensity increases (e.g., greater than 70% of maximum oxygen consumption), carbohydrates are responsible for the vast majority of ATP production. The transition from the use of fats to carbohydrates as the primary fuel source is referred to as the “crossover” concept. The rate of oxidation during exercise is a function of the rate of carbohydrate utilization and the availability of circulating fatty acids. If activity lasts for a long period of time (e.g., greater than one hour), fats play a greater role in energy metabolism.

Question 83

A physical therapist examines several pathological reflexes on a patient with a suspected upper motor neuron disease. Which stimulus would be the MOST appropriate when assessing Hoffman’s reflex?
A. Tapping the nail of the middle finger
B. Stroking the inner thigh
C. Stroking the plantar aspect of the foot
D. Rapidly dorsiflexing the foot

Answer 83

Tapping the nail of the middle finger

Hoffman’s reflex is assessed by tapping or snapping the nail of the middle finger. An abnormal response consists of flexion of the first finger and thumb.

Question 84

A physical therapist attempts to assess the integrity of the L4 spinal level. Which deep tendon reflex would provide the therapist with the MOST useful information?
A. Lateral hamstrings reflex
B. Medial hamstrings reflex
C. Patellar reflex
D. Achilles reflex

Answer 84

Patellar reflex

The patellar reflex is innervated at the L3-L4 spinal level.

Question 85

A patient receiving physical therapy services in an outpatient clinic explains that he has felt nauseous since having his methotrexate medication level altered. The MOST appropriate physical therapist action is to:
A. Explain to the patient that nausea is very common when altering medication levels
B. Ask the patient to stop taking the prescribed medication
C. Request that the patient make an appointment with the physician
D. Request that the patient contact the physician’s office

Answer 85

Request that the patient contact the physician’s office

A patient should contact the physician’s office whenever they experience side effects that may be associated with prescribed medication. Direct contact with the physician is an immediate response which makes the physician aware of the patient’s present status and allows them to potentially modify or discontinue medication.

Question 86

A physical therapist examines a patient diagnosed with cerebellar degeneration. Which of the following clinical findings is NOT typically associated with this condition?
A. Athetosis
B. Dysmetria
C. Nystagmus
D. Dysdiadochokinesia

Answer 86

Athetosis

Athetosis is characterized by extraneous and involuntary movements, slowness of movement, and alterations in muscle tone. Athetoid movements may look “wormline” with a rotator component evident.

Question 87

A physical therapist examines a 36-year-old female referred to physical therapy after experiencing back pain two weeks ago. The patient identifies the majority of pain in the buttock and lateral thigh and denies any referred pain down the posterior leg. Presently she rates the pain as a “3” on a 0-10 scale, however, indicates that the pain is a “6” or a “7” during activity or at night. This description MOST closely resembles:
A. Sacroillitis
B. Iliolumbar syndrome
C. Piriformis syndrome
D. Trochanteric bursitis

Answer 87

Trochanteric bursitis

Trochanteric bursitis refers to inflammation of the trochanteric bursa, which is a pad-like sac that protects the soft tissue structures that cross the posterior portion of the greater trochanter. The patient is often extremely sensitive to palpation over the bursa and may experience lateral thigh pain that is exacerbated by activity or periods of prolonged rest.

Question 88

A physical therapist treats a patient with a suspected rupture of the patellar tendon. Which objective finding would be MOST indicative of this condition?
A. Marked tenderness along the anterior surface of the knee joint
B. Inability to actively extend the knee against gravity
C. Limited ability to complete range of motion due to hemarthrosis
D. Resistive isometrics are strong and painful for knee extension.

Answer 88

Inability to actively extend the knee against gravity

A functioning patellar tendon is essential tosuccessfully extend the knee. When the quadriceps contract, the force is transmitted through the patellar tendon using the patella as a fulcrum. Any lack of continuity in this tendon would significantly influence a patient’s ability to actively extend the knee against gravity.

Question 89

A patient experiences a proximal humerus fracture that is non-displaced. Which clinical finding would provide the BESt support for the patient being cleared to perform active-assisted exercise?
A. Hematoma formation
B. Diminished pain
C. Callus formation
D. Remodeling

Answer 89

Callus formation

Callus formation is one of the first indications that healing has occurred. The presence of a callus identified through diagnostic imaging allows the patient to progress to active-assistive exercise.

Question 90

A physical therapist reviews the medical record of a patient recently admitted to the intensive care unit. A note from the patient’s physician indicates an order for arterial blood gas analysis six times daily. Which type of indwelling line would be used to collect the necessary samples?
A. Intravenous line
B. Arterial line
C. Central venous line
D. Pulmonary artery line

Answer 90

Arterial line

An arterial line consists of a catheter inserted through the skin into an artery connected to pressure tubing, a transducer, and a monitor. The device can be used for continuous direct blood pressure readings and to sample arterial blood for arterial blood gas analysis. The radial and brachial arteries are the most common sites for an arterial line.

Question 91

A physical therapist performs an examination on a patient diagnosed with thoracic outlet syndrome.
During the examination, the therapist initiates a special test as shown in the image. Which of the following would be considered a positive finding when performing the special test?
A. Inability to maintain the test position for three minutes
B. Subjective report of fatigue in the arms
C. Absence of a radial pulse after one minute
D. Failure of the hands to regain their normal color after 30 seconds

Answer 91

Inability to maintain the test position for three minutes

A positive Roos test is indicated by an inability to maintain the test position, weakness of the arms, sensory loss or ischemic pain.

Question 92

A physical therapist inspects a patient’s wheelchair and identifies that the wheel axle is aligned further posterior than it typically would be in a standard wheelchair. This type of alignment would likely result in:
A. Decreased rolling resistance
B. Increased ability to perform a “wheelie”
C. Decreased turning radius
D. Increased energy required for propulsion

Answer 92

Increased energy required for propulsion

The posterior alignment of the wheel axle increases the amount of energy required for propulsion which serves to decrease the patient’s ability to propel the wheelchair.

Question 93

A physical therapist works with a patient on gait training using bilateral axillary crutches. The right axillary crutch is modified with a platform attachment. What is the MOST likely reason for the modification?
A. The patient has a radial nerve injury
B. The patient has a proximal humeral fracture
C. The patient has impaired balance and coordination
D. The patient has a transhumeral amputation

Answer 93

The patient has a radial nerve injury

A patient with a radial nerve injury would have significant weakness of the triceps muscle and be unable to extend the elbow. The platform modification would be necessary since the patient would be unable to produce elbow extension and would instead need to bear weight through the albow and forearm.

Question 94

A physical therapist works with patient on wheelchair mobility. The patient has a history of cerebrovascular accident with right-sided hemiparesis. Which of the following wheelchair adaptations would be MOST beneficial for the patient to ensure safety during stand pivot transfers?
A. Anti-tip tubes
B. Pull-to wheel lock with brake extensions
C. Elevating leg rests
D. Removable full-length armrests

Answer 94

Pull-to wheel lock with brake extensions

A pull-to wheel lock allows for closer access to surface during transfers. Brake extensions on the right side allow the patient to reach with the uninvolved upper extremity to lock the wheelchair prior to transferring. The patient’s ability to use the right hand to lock the brakes is most likely limited due to the right-sided hemiparesis.

Question 95

A patient is limited in passive ankle dorsiflexion when the knee is extended, but is not limited when the knee is flexed. The MOST logical explanation is:
A. The gastrocnemius is responsible for the limitation
B. The soleus is responsible for the limitation
C. The popliteus is responsible for the limitation
D. The gastrocnemius and soleus are both responsible for the limitation

Answer 95

The gastrocnemius is responsible for the limitation

The gastrocnemius is a two-joint muscle that crosses both the knee and ankle joints. When the knee is flexed, the muscle is placed on slack which allows for normal ankle range of motion. A limitation in ankle range of motion when the knee is extended may indicate a restriction in the gastrocnemius and possibly the plantaris.

Question 96

A physical therapist completes a coordination assessment on a 67-year-old patient with central nervous system involvement. After reviewing the results of the assessment, the therapist concludes the clinical findings are indicative of cerebellar dysfunction. Which finding is NOT associated with cerebellar dysfunction?
A. Dysmetria
B. Hypertonia
C. Ataxia
D. Nystagmus

Answer 96

Hypertonia

Cerebellar dysfunction would typically be associated with hypotonia and not hypertonia. Hypotonia causes the patient to have difficulty fixating the limb, leading to incoordination with movement.

Question 97

A physical therapist classifies an obtained sputum sample as purulent. Which medical condition would
MOST likely be associated with this type of sputum?
A. Asthma
B. Lung abscess
C. Pulmonary edema
D. Tuberculosis

Answer 97

Lung abscess

A lung abscess refers to necrosis of pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by infection. Sputum associated with a lung abscess is most often described as purulent.

Question 98

A physical therapist participates in a research study to determine the effect of noise level on the ability to perform a physical skill. In the study, noise is the:
A. Independent variable
B. Dependent variable
C. Criterion variable
D. Extraneous variable

Answer 98

Independent variable

Noise level is the independent variable because it is the condition or characteristic that the researcher will manipulate to see how it changes physical skill.

Question 99

A patient with a C6 spinal cord injury is examined in physical therapy. Which objective finding would be the strongest indication the spinal cord injury is NOT complete?
A. Intact sensation on the lateral portion of the shoulder
B. Absent triceps reflex
C. Diminished sensation over the hypothenar eminence
D. Weakness of the biceps muscle

Answer 99

Diminished sensation over the hypothenar eminence

The dermatome that corresponds to the hypothenar eminence is at the C8 level. As a result, the finding of diminished sensation (not absent) at a level below the level of injury (i.e., C6) indicates that the injury is incomplete.

Question 100

A physical therapist reviews the medical record of a 77-year-old patient that was prescribed nonsteroidal anti-inflammatory medications (NSAIDS) for pain following arthroscopic surgery. If toxicity is a concern, the physician would have likely prescribed an analgesic that possesses:
A. Fa short half-life
B. A long half-life
C. Minimal biotransformation
D. Limited clearance

Answer 100

Fa short half-life

Half-life is defined as the amount of time required for fifty percent of the drug remaining in the body to be eliminated in general, elderly patients do not metabolize medications as quickly as younger patients which creates higher plasma levels. As a result, the elderly are at a higher risk for toxicity or adverse effects. Medications with a short half-life reduce these risks.

Question 101

A mysical therapist examines the reflex status of a patient. The therapist should use which technique to assess the patient’s superficial reflexes?
A. Brushing the skin with a light, feathery object
B. Passive joint range of motion
C. Stroking the skin with a non-cutting, but pointed object
D. Tapping over a muscle tendon

Answer 101

Stroking the skin with a non-cutting, but pointed object

The plantar reflex (S1, S2) is an example of a superficial reflex. The reflex is elicited by stroking the lateral aspect of the foot from the heel to the ball of the foot with a blunt object. A normal response is indicated by flexion of the great toe, while an abnormal response is indicated by extension of the great toe with fanning of the four other toes (Babinski sign). The Babinski sign is often associated with upper motor neuron damage.

Question 102

A patient returns to an outpatient physical therapy clinic two hours after a physical therapy session complaining of increased back pain. The patient has been in physical therapy for three previous visits and has had little difficulty with a program consisting of palliative modalities and pelvic stabilization exercises.
The patient was referred to physical therapy after injuring his back two weeks ago. The MOST appropriate physical therapist action is:
A. Contact the referring physician to discuss the patient’s care plan
B. Instruct the patient to discontinue the pelvic stabilization exercises and re-examine the patient at his next visit
C. Refer the patient to the emergency room of a local hospital
D. Instruct the patient to cancel existing physical therapy visits and schedule an appointment with the physician

Answer 102

Instruct the patient to discontinue the pelvic stabilization exercises and re-examine the patient at his next visit

The physical therapist should have the patient discontinue any activities that increase their pain. The therapist can re-examine the patient at the ent scheduled visit and determine an appropriate course of action based on the findings.

Question 103

An older adult patient complains of persistent pain, weakness, and stiffness affecting their shoulders and pelvis. Additionally, the patient has a higher than normal erythrocyte sedimentation rate (ESR). What medical condition is MOST consistent with the described presentation?
A. Pesudogout
B. Gout
C. Polymyalgia rheumatic
D. Systemic lupus erythematosus

Answer 103

Polymyalgia rheumatic

Polymyalgia rheumatic is a systemic inflammatory condition that is experienced primarily by older adults. Patients with this condition exhibit a high erythrocyte sedimentation rate (ESR) and pain is most commonly experienced in the pelvic and shoulder girdles.

Question 104

A patient exhibits pain and sensory loss in the posterior thigh, lateral calf, and dorsal foot. Extension of the hallux is poor, however, the Achilles reflex is normal. What spinal level would you expect to be involved?
A. LA
B. L5
C. SI
D. S2

Answer 104

L5

L5 nerve root:
Dermatome - buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes.
Myotome - extensor halluces, peroneals, gluteus medius, dorsiflexors, hamstrings, plantar flexors
Reflexes - medial hamstrings, posterior tibial

Question 105

When is it considered acceptable for a clinical trial to include a non-treatment control group as a basis for comparison with a new experimental therapy?
A. When there is no known effective form of therapy to treat the patient’s condition
B. When the experimental therapy has shown positive results in animal studies
C. When the study is reviewed by the facility’s Institutional Review Board (IRB)
D. When subjects are randomly assigned to a group

Answer 105

When there is no known effective form of therapy to treat the patient’s condition

A non-treatment control group may be used in clinical conditions for which no treatments have been effective.

Question 106

A physical therapist treats a patient diagnosed with spinal stenosis. As part of the treatment program the patient lies prone on a treatment plinth with a hot pack draped over the low back. The MOST effective method to monitor the patient while using the hot pack is:
A. Check on the patient at least everyten minutes
B. Supply the patient with a bell to ring if the hot pack becomes too hot
C. Instruct the patient to remove the hot pack if it becomes too hot
D. Select an alternative superficial heating modality

Answer 106

Supply the patient with a bell to ring if the hot pack becomes too hot

Supplying the patient with a bell to ring if the hot pack becomes too intense provides a form of instant communication with the therapist. The use of a bell does not negate the need for the physical therapist to formally check on the patient frequently.

Question 107

A patient employed in a machine shop is referred to physical therapy with a diagnosis of carpal tunnel syndrome. The patient indicates that he is scheduled for a diagnostic test that may help to confirm the diagnosis. Which of the following electrodiagnostic tests would be the MOST appropriate?
A. Electroencephalography
B. Evoked potentials
C. Nerve conduction velocity
D. Electromyography

Answer 107

Nerve conduction velocity

Nerve conduction velocity refers to the speed by which an action potential travels down a peripheral nerve. The measure is recorded in meters per second. Nerve conduction velocity can be used to diagnose conditions such as carpal tunnel syndrome, peripheral neuropathy, and Gullain- Barre syndrome.

Question 108

A physical therapist performs a goniometric measurement of the wrist on a patient diagnosed with carpal tunnel syndrome. Based on the presented image, which value would be MOST anticipated assuming the patient has normal wrist range of motion?
A. 0-20 degrees
B. 0-30 degrees
C. 0-40 degrees
D. 0-70 degrees

Answer 108

0-20 degrees

A measurement of 0-20 degrees is consistent with normal wrist radial deviation.

Question 109

A physical therapist performs the talar tilt test on a 22-year-old female rehabilitating from an inversion ankle sprain. Which ligament does the talar tilt test examine?
A. Anterior talotibial
B. Calcaneofibular
C. Deltoid
D. Posterior talotibial

Answer 109

Calcaneofibular

The calcaneofibular ligament is a round cord that passes posteroinferiorly from the tip of the lateral malleolus to the lateral surface of the calcaneus. The integrity of the ligament can be assessed using the talar tilt test.

Question 110

A patient referred to physical therapy with chronic low back pain has failed to make any progress toward meeting extablished goals in over three weeks of treatment. The physical therapist has employed a variety of treatment techniques, but has yet to observe any sign of subjective or objective improvement in the patient’s condition. The MOST appropriate action would be to:
A. Transfer the patient to another therapist’s schedule
B. Re-examine the patient and establish new goals
C. Continue to modify the patient’s treatment plan
D. Alert the referring physician to the patient’s status

Answer 110

Alert the referring physician to the patient’s status

Formal communication should occur with the referring physician when a patient falls to make progress in physical therapy. This is particularly relevant in the described scenario since the physical therapist has employed a verity of treatment techniques and has not observed any sign of subjective or objective improvement.

Question 111

A 38-year-old female was referred to physical therapy after having a cyst removed from her larynx two days ago. The patient’s speech sound very rough and hoarse. This type of abnormal sound would BEST be described as:
A. Dysphonia
B. Dysarthria
C. Dysphasia
D. Diplopia

Answer 111

Dysphonia

Dysphonia is a disorder of vocalization characterized by an abnormal production of sounds form the larynx. The principal complaint of dysphonia is hoarseness ranging from mild roughness of the voice to an inability to produce sound.

Question 112

A physical therapist treats a patient with a diagnosis of gouty arthritis. This medical condition would be
MOST likely to produce subjective reports of pain affecting the:
A. Hip
B. Knee
C. Ankle
D. Toe

Answer 112

Toe

The peripheral joints of the feet are the sites most commonly affected by gouty arthritis. The metatarsophalangeal joint of the great toe is affected in 90% of the cases of gouty arthritis.

Question 113

A physical therapist employed in a subacute rehabilitation facility works on community re- integration prior to discharging a 72-year-old patient to their home. Which aspect of gait should be focused on during training to ensure the patient’s ability to safely cross the street?
A. Step length
B. Velocity
C. Cadence
D. Heel strike

Answer 113

Velocity

Velocity is the rate of forward progression. It is defined as the distance traveled per unit of time. Gait velocity, or gait speed, is the most important measure of a patient’s ability to safely cross the street.

Question 114

A physical therapist treats a patient receiving supplemental oxygen using a nasal cannula with a flow rate of three liter per minute. Which value BEST approximates the percentage of oxygen delivered to the patient?
A. 25%
B. 29%
C. 33%
D. 37%

Answer 114

33%

An oxygen flow rate of three liters per minute would result in approximately 33% oxygen delivered

Question 115

A physical therapist attempts to monitor exercise intensity during an exercise session with a patient after cardiac transplantation. The MOST appropriate method is:
A. Metabolic equivalents
B. Perceived exertion scale
C. Pulmonary function tests
D. Target heart rate range

Answer 115

Perceived exertion scale

Patients can utilize a perceived exertion scale, such as Borg’s Rating of Perceived Exertion (RPE) Scale, as a subjective means of rating the intensity of exercise. This is particularly useful following cardiac transplantation since the transplanted heart fails to respond normally to sympathetic nervous stimulation resulting in an abnormal heart rate response to exercise.

Question 116

A patient is referred to physical therapy with a diagnosis of left shoulder impingement. During the examination, the physical therapist begins to suspect a systemic cause for the patient’s pain. Which of the following symptoms would BEST support this hypothesis?
A. Pain has been present for years
B. Pain is alleviated with the use of cryotherapy
C. Pain is aggravated by cervical rotation
D. Pain remains unrelieved with rest

Answer 116

Pain remains unrelieved with rest

Pain that has a systemic cause is difficult to reproduce. Symptoms are usually unrelieved by rest or a change in position.

Question 117

A physical therapist reads a recent entry in a patient’s medical record that indicates aspiration was performed in the elbow region. This scenario is MOST commonly associated with:
A. Dorsal ganglion cyst
B. Lateral epicondylitis
C. Medial epicondylitis
D. Olecranon bursitis

Answer 117

Olecranon bursitis

Olecranon bursitis is characterized by pain, redness, and swelling around the olecranon caused by inflammation of the elbow’s bursa. Aspirating the excess bursa fluid is often performed to relieve the inflammation and prevent further accumulation of fluid. An excessive amount of fluid in this region can inhibit range of motion and functional use of the elbow. The aspirated fluid is often cultured and evaluated for crystals to rule out infection or gout.

Question 118

A patient recently admitted to an acute care hospital is referred to physical therapy. The physical therapist documents the following clinical signs: pallor, cyanosis, and cool skin. These clinical signs are
MOST consistent with:
A. Cor pulmonale
B. Anemia
C. Hypertension
D. Diaphoresis

Answer 118

Anemia

A decrease in the number of red blood cells that carry oxygen in the blood results in a variety of symptoms including, pallor, cyanosis, cool skin, vertigo, weakness, headache, and malaise.

Question 119

A physical therapist instructs a patient in a home stretching program that includes the pictured stretch.
The MOST likely structure targeted is the:
A. Gluteus medius
B. Iliotibial band
C. Piriformis
D. Rectus femoris

Answer 119

Piriformis

The piriformis muscle originates on the sacrum and inserts on the greater trochanter. The muscle acts to laterally rotate the femur, however, with the hip flexed more than 60 degrees, the piriformis medially rotates the femur.

Question 120

A physical therapist receives a referral for a two-month-old infant diagnosed with osteogenesis imperfecta. After completing the examination, the therapist discusses the physical therapy plan of care with the infant’s parents. The PRIMARY goal of therapy should be:
A. Improve muscle strength and diminish tone
B. Facilitate protected weight bearing
C. Promote safe handling and positioning
D. Diminish pulmonary secretions

Answer 120

Promote safe handling and positioning

A patient with osteogenesis imperfect is extremely susceptible to fractures during even basic activities such as being carried or bathing. As a result, safe handling and positioning would be the primary goal. This information would be critical to convey to all caregivers, perhaps most notably, the infant’s parents.

Question 121

A physical therapist elects to utilize the Six-Minute Walk Test as a means of quantifying endurance for a patient rehabilitating from a lengthy illness. Which variable would be the MOST appropriate to measure when determining the patient’s endurance level with this objective test?
A. Perceived exertion
B. Heat rate response
C. Elapsed time
D. Distance walked

Answer 121

Distance walked

The test requires the therapist to measure the distance the patient walks within a six minute period with rest period permitted as necessary.

Question 122

A patient reports a chronic history of widespread muscular pain, multiple tender points throughout her body, and excess fatigue. Upon examination, the therapist observes that the patient’s tender points are distributed throughout the body and do not refer pain when pressure is applied. What diagnosis would be MOST accurate for this patient?
A. Myofascial pain syndrome
B. Chronic regional pain syndrome
C. Fibromyalgia
D. Systemic lupus erythematosus

Answer 122

Fibromyalgia

Fibromyalgia is a condition characterized by widespread muscular pain with localized tender point that are sensitive to pressure. For a patient to have a diagnosis of fibromyalgia, they must have tender points in multiple different areas of the body. Patients with fibromyalgia typically report sleep disturbances and fatigue.

Question 123

A physical therapist prepares to complete an assisted standing pivot transfer with a patient that requires moderate assistance. In order to increase a patient’s independence with the transfer, which of the following instructions would be the MOST appropriate?
A. I want you to help me perform the transfer
B. Try to utilize your own strength to complete the transfer
C. Only grab onto me if it is absolutely necessary
D. Pretend you were home alone and needed to complete the transfer.

Answer 123

Try to utilize your own strength to complete the transfer

The statement, “try to utilize your own strength to complete the transfer, “ is a direct statement that explains the exact expectations of the patient during the transfer.

Question 124

A patient presents to the emergency room with multiple burns on their upper extremity and chest. The wounds all appear dry, but vary in size and are poorly defined. Examination reveals significant irregularity in the patient’s cardiac rhythm. What was the MOST likely source of the patient’s injury?
A. Friction burn
B. Chemical burn
C. Electrical burn
D. Radiation burn

Answer 124

Electrical burn

An electrical burn occurs when an electrical current passes through the body. These burns are often spread over a larger area since they contain an entrance wound (i.e.. at the site of contact) and several poorly defined exit wounds (i.e., where the current leaves the body). Electrical burns often appear dry, which likely occurs secondary to the electrical cauterization of the blood vessels. If the electrical current passes through the heart, it can also result in the development of cardiac arrhythmias.

Question 125

A physical therapist periodically measures a patient’s blood glucose level as they exercise on a treadmill. After ten minutes of exercise, the patient’s blood glucose measurement is 60 mg/dL. Which symptom would this patient MOST likely experience?
A. Polyuria
B. Hyperventilation
C. Excessive thirst
D. Headache

Answer 125

Headache

Headache is a symptom commonly associated with a hypoglycemic state. The low level of glucose circulating in the blood results in less glucose reaching the brain. Since the brain uses glucose as its primary source of energy, a lack of glucose can result in a headache.

Question 126

Echocardiographic testing revealed a significant decrease in a patient’s anticipated cardiac output.
Which variable would MOST likely contribute to this finding?
A. Increase in heart rate
B. Increase in preload
C. Increase in afterload
D. Increase in stroke volume

Answer 126

Increase in afterload

Afterload is the force the left ventricle must generate during the systolic phase and is directly related to the resistance in the aorta and peripheral arteries. As afterload increases, stroke volume (and thus cardiac output) will decrease.

Question 127

A physical therapist performs crutch training with a patient following total hip arthroplasty. The patient has orders for partial weight bearing. Which of the following gait patterns would be the MOST appropriate?
A. Four-point gait
B. Two-point gait
C. Three-point gait
D. Swing-to gait

Answer 127

Three-point gait

A three-point gait pattern is used when one limb is affected, such as after joint arthroplasty. This pattern is used when the weight bearing orders are for non-weight bearing or partial weight bearing. Three points of support contact the floor with weight borne through each crutch and the uninvolved lower extremity. The crutches are advanced followed by the affected lower extremity, then the unaffected lower extremity.

Question 128

Prior to initiating an ultrasound treatment, a physical therapist formally measures the target area as 12 cm2. Based on the therapist’s measurements, the MOST appropriate size soundhead to utilize during the treatment is:
A. 1 cm2
B. 3 cm2
C. 5 cm2
D. 8 cm2

Answer 128

5 cm2

A soundhead 5 cm2 is slightly less than half the size of the target area. This size soundhead would allow the therapist to achieve the desired therapeutic affects within a reasonable amount of time.

Question 129

A physical therapist attempts to identify a patient’s risk factors for coronary artery disease as part of a health screening. The patient’s heart rate is recorded as 78 beats per minute and blood pressure as 110/70 mm Hg. A recent laboratory report indicates a total cholesterol level of 170 mg/dL with high-density lipoproteins reported as 20 mg/dL and low-density lipoproteins as 100m/dL. Which of the following values would be considered atypical?
A. Heart rate
B. Blood pressure
C. High-density lipoproteins (HDL)
D. Low-density lipoprotein (LDL)

Answer 129

High-density lipoproteins (HDL)

A HDL cholesterol level of 20 mg/dL is very low and is associated with an increased risk of coronary artery disease. The patient would likely be treated by their physician with pharmacological and non-pharmacological therapies to raise the HDL cholesterol level.

Question 130

A physical therapist works with a patient in an acute care hospital to treat a painful, slow healing wound on the medial lower leg. The patient’s leg is swollen and appears dark red/purple in color with thickened skin. Which of the following conditions MOST likely contributed to this type of wound?
A. Diabetes
B. Arterial insufficiency
C. Venous insufficiency
D. Prolonged pressure

Answer 130

Venous insufficiency

Wound as a result of venous insufficiency occur when the venous system is not functioning properly, leading to poor nutrition to the tissues. Tissue damage results, eventually leading to tissue death and ulceration. These painful wounds often present on the medial malleolus. Hyperpigmentation of the skin and edema are present on the affected leg. The wound bed is shallow, the edges are irregular, and substantial drainage occurs.

Question 131

A physical therapist performs palpation with a patient positioned in standing as part of a respiratory assessment. Which assessment procedure would be performed with the therapist positioned behind the patient?
A. Mediastinum motion
B. Upper chest wall motion
C. Middle chest wall motion
D. Lower chest wall motion

Answer 131

Lower chest wall motion

The lower chest wall expansion is evaluated with the patient’s back to the therapist and the therapist’s fingers wrapped around the anterior axillary folds with the tips of the thumbs together at the vertebral spines.

Question 132

A group of physical therapists conducts scoliosis screenings on adolescents as part of physical therapy week. The MOST appropriate action after identifying an adolescent with a moderate scoliotic curve is to:
A. Refer the adolescent for further orthopedic assessment
B. Educate the adolescent as to the cause of the scoliosis
C. Devise an exercise program for the adolescent
D. Instruct the adolescent in the importance of proper posture

Answer 132

Refer the adolescent for further orthopedic assessment

Scoliosis is a condition that will respond to treatment best when detected early. Common postural findings with scoliosis include increased spacing between the elbow and trunk during standing, leg length discrepancy, uneven shoulder and hip heights, and prominence on one side of the pelvis or breast (due to rotation of the curve).

Question 133

A physical therapist attempts to secure a wheelchair for a patient with an incomplete spinal cord injury.
The patient is a 28-year-old female that is very active and relies on a wheelchair as her primary mode of transportation. Which type of wheelchair design would be the MOST appropriate for the patient?
A. Standard chair with a rigid frame
B. Lightweight chair with a rigid frame
C. Standard chair with a folding frame
D. Lightweight chair with a folding frame

Answer 133

Lightweight chair with a rigid frame

A lightweight wheelchair is easier to propel and maneuver. The chair is made from stainless steel or aluminum which also enhances durability. The rigid frame allows for strength and a smoother ride for the patient.

Question 134

A physical therapist attempts to select an assistive device for a patient rehabilitating from a traumatic brain injury. The patient is occasionally impulsive, however, has fair standing balance and good upper and lower extremity strength. Which of the following would be the MOST appropriate assistive device?
A. Cane
B. Axillary crutches
C. Lofstrand crutches
D. Walker

Answer 134

Walker

A walker is appropriate for patients of varying weight bearing levels. The device offers the greatest amount of stability due to its large base of support. The stability offered by the walker is necessary due to the patient’s fair standing balance and impulsivity. Proper supervision would be necessary based on the patient’s diagnosis.

Question 135

A physical therapist examines a 16-year-old male diagnosed with left knee anterior cruciate ligament insufficiency. During the examination a Lachman test is performed. Ideally, the therapist should perform the test with the knee in:
A. 20-30 degrees flexion
B. 30-40 degrees flexion
C. 40-50 degrees flexion
D. 80-90 degrees flexion

Answer 135

20-30 degrees flexion

20-30 degrees of knee flexion is generally accepted as the amount of knee flexion used for the Lachman test. The position approximates a functional position and all parts of the anterior cruciate ligament are relatively taut.

Question 136

A patient with cerebellar dysfunction exhibits signs of dysmetria. Which of the following activities would be the MOST difficult for the patient?
A. Rapid alternating pronation and supination of the forearms
B. Placing feet on floor markers while walking
C. Walking at varying speeds
D. Marching in place

Answer 136

Placing feet on floor markers while walking

Dysmetria occurs with cerebellar lesions and is defined as the inability to appropriately reach a target. An example of dysmetria would be the inability of a patient to place their feet on floor markers successfully while walking.

Question 137

A physical therapist examines a patient referred to physical therapy diagnosed with a medial collateral ligament sprain. During the examination the patient appears to be relaxed and comfortable, however, is extremely withdrawn. Which of the following questions would be the MOST appropriate to further engage the patient?
A. Is this the first time you have injured your knee?
B. Have you ever been to physical therapy before?
C. How long after your injury did you see a physician?
D. What do you hope to achieve in physical therapy?

Answer 137

What do you hope to achieve in physical therapy?

The question requires the patient to provide some level of insight towards their physical therapy goals and may provide a foundation for a meaningful exchange between the patient and the therapist. The information obtained by the therapist can be valuable when designing an appropriate plan of care.

Question 138

A physical therapy working in a wound clinic presents an inservice on the aging process and its effect on the skin. Which of the following skin changes is MOST likely to occur as a person ages?
A. Increase in skin elasticity
B. Decrease in skin turgor
C. Increase in sebaceous gland activity
D. Decrease in skin dryness

Answer 138

Decrease in skin turgor

As a person ages, skin turgor will decrease. Turgor refers to the resistance of skin to deformation. This can be assessed by pinching the skin and observing how quickly it returns to its resting position. The aging process results in thinning of the epithelial layers and results in a loss of turgor.

Question 139

A physician order compression garments for an ambulatory patient who has significant difficulty with lower extremity edema. How much pressure would typically be necessary to control lower extremity edema?
A. 10 mm Hg
B. 18 mm Hg
C. 25 mm Hg
D. 35 mm Hg

Answer 139

35 mm Hg

A pressure of 30-40 mm Hg is used to control edema in ambulatory patients.

Question 140

A physical therapist monitors the vital signs of a 52-year-old male during a graded exercise test. The patient was prompted to seek medical assistance two weeks ago after becoming short of breath on two separate occasions. When interpreting the data collected during the exercise test, which finding would serve as the BEST indicator that the patient had exerted a maximal effort?
A. Failure of the heart rate to increase with further increases in intensity
B. Rise in systolic blood pressure of 50 mm Hg when compared to the resting value
C. Rating of 12 on a perceived exertion scale
D. Rating of 2/4 on the dyspnea scale

Answer 140

Failure of the heart rate to increase with further increases in intensity

Failure of the heart rate to increase with further increase in exercise intensity is an objective indicator that the patient made a maximal effort during graded exercise testing.

Question 141

151. A patient status post stroke ambulates with a large base quad cane. The patient presents with left neglect and diminished proprioception. The MOST appropriate method to ensure patient safety is:
     A. Provide continuous verbal cues
     B. Utilize visual cues and demonstration
     C. Offer manual assistance on the left side
     D. Offer manual assistance of the right side

Answer 141

Offer manual assistance on the left side

The physical therapist should offer manual assistance on the patient’s left side during ambulation activities. The manual assistance can facilitate motor activity and weight bearing, as well as proprioception on the affected side. Manual contact significantly reduces the risk for fall or injury.

Question 142

A physical therapist employed in a rehabilitation hospital creates a professional development plan as part of his annual performance appraisal. Which of the following would be the MOST appropriate plan to facilitate the therapist’s development in his present practice setting?
A. Attend continuing education courses approved by the Federation of State Boards of Physical Therapy.
B. Attend continuing education courses featuring nationally recognized experts
C. Attend a minimum of two continuing education course annually
D. Attend continuing education course related to primary patient care responsibilities

Answer 142

Attend continuing education course related to primary patient care responsibilities

The physical therapist should attend continuing education courses that directly relate to their primary patient care responsibilities. Developing this particular skill set will allow the physical therapist to improve the quality of patient care within their current practice setting.

Question 143

A physical therapist works on balance reactions with a patient who has Charcot’s foot. The development of this medical condition is MOST likely related to:
A. Altered sensation
B. Muscular weakness
C. Ulcer formation
D. Pes cavus

Answer 143

Altered sensation

Charcot’s foot is most often seen in patients with diabetes secondary to peripheral neuropathy. The loss of sensation predisposes the joints of the foot to repetitive trauma and joint destruction.

Question 144

A patient being treated for general deconditioning explains to her physical therapist that she was diagnosed with metabolic syndrome. Which of the following signs or symptoms would the patient LEAST likely demonstrate?
A. Elevated triglyceride levels
B. Abnormal blood pH
C. Insulin resistance
D. Elevated blood pressure

Answer 144

Abnormal blood pH

Metabolic syndrome is not generally associated with abnormal blood pH since the syndrome represents only a collection of risk factors. However, if the risk factors associated with metabolic syndrome progressed to a specific pathology (e.g., diabetic ketoacidosis), abnormal blood pH would be more likely.

Question 145

A physical therapist employed in a skilled nursing facility works on balance reeducation activities to improve a patient’s independence with functional activities in the kitchen. Which of the following tests would provide the therapist with the MOST useful information on the patient’s ability to safely perform meal preparation?
A. Multi-Directional Reach Test
B. Timed Get Up and Go Test
C. Romberg Test
D. Tinetti Performance Oriented Mobility Assessment

Answer 145

Multi-Directional Reach Test

The Multi-Directional Reach Test measures the distance a patient can reach in a forward, backward or lateral direction. This test will provide the physical therapist with information on a patient’s ability to maintain their balance when reaching in and out of the base of support.

Question 146

A physical therapist attends an Inservice entitled “Principles of Exercise for the Obstetric Patient.” During the session, the speaker identifies several conditions that are considered to result in high risk pregnancies. Which of the following conditions would NOT be considered high risk?
A. Diastasis recti
B. Incompetent cervix
C. Pre-eclampsia
D. Multiple gestation

Answer 146

Diastasis recti

The etiology of diastasis recti is unknown, with separation greater than two centimeters considered significant. This condition is not considered high risk for pregnancy, however, can produce low back pain due to a limited ability of the abdominal muscles to stabilize the pelvis and lumbar spine.

Question 147

A physical therapist determines that a 67-year-old female is at an increased fall risk after being prescribed a new medication that tends to promote postural hypotension. The medication MOST consistent with the described scenario
A. ACE inhibitor agents
B. Antiepileptic agents
C. Anticoagulant agents
D. Antispasticity agents

Answer 147

ACE inhibitor agents

ACE inhibitor agents decrease blood pressure and afterload by suppressing the enzyme that converts angiotensin I to angiotensin II. Patients taking ACE inhibitors should avoid sudden changes in position due to the risk of dizziness and fainting from hypotension.

Question 148

A patient treated in an acute care hospital one day ago is not able to attend a scheduled physical therapy session due to suspected critical limb ischemia. Which symptom is MOST commonly associated with this condition?
A. Severe pain in the legs and feet at rest
B. Increased temperature in the lower leg and foot
C. Bounding lower extremity peripheral pulses
D. Flaking skin on the legs with brownish discoloration

Answer 148

Severe pain in the legs and feet at rest

Critical limb ischemia is characterized by severe pain in the logs and feet at rest. A patient often experiences the pain when in bed and may be able to diminish the intensity of pain by hanging the legs over the edge of the bed or getting up to walk around.

Question 149

A physical therapist prepares to apply a hot pack to the low back of a patient diagnosed with degenerative disk disease. When examining the patient the therapist identifies several blisters on the patient’s right side. The patient indicates they were caused by heat from a hot pack applied during the previous treatment session. The patient indicates he was hesitant to tell the therapist that the heat was too intense. The MOST appropriate therapist action is to:
A. Complete an incident report
B. Contact the referring physician
C. Modify the documentation from the previous treatment session
D. Avoid documenting the event since it occurred during the previous treatment session

Answer 149

Complete an incident report

The physical therapist must complete the incident report since they directly observed the blistered skin and heard the patient relate the cause of the burn to the hot pack.

Question 150

A physical therapist attempts to calculate the target heart rate range for a 40-year-old female with no significant past medical history. The patient’s resting heart rate is recorded as 60 beats per minute and the maximal heart rate is 180 beats per minute. Using the heart rate reserve method (Karvonen formula) and a range of 60-80% intensity, the patient’s target heart rate range should be recorded as:
A. 96-120 beats per minute
B. 132-156 beats per minute
C. 144-174 beats per minute
D. 164-185 beats per minute

Answer 150

132-156 beats per minute

Target heart rate range = [(180-60) 0.60 and 0.80] + 60 = [1200.60 and 120*0.80] + 60 = (72 + 60) and (96 + 60) = 132-156 beats per minute

Question 151

A 47-year-old patient with a diagnosis of CV A with left hemplegia is referred for orthotic examination.
Significant results of manual muscle testing include: hip flexion 3+/5, hip extension 3/5, knee flexion 3+/5, knee extension 3+/5, ankle dorsiflexion 2/5, and ankle inversion and eversion 1/5. Sensation is intact and no abnormal tone is noted. The MOST appropriate orthosis for this patient is a:
A. Knee-ankle-foot orthosis with a locked knee
B. Plastic articulating ankle-foot orthosis
C. Metal upright ankle-foot orthosis locked in neutral
D. Prefabricated posterior leaf spring orthosis

Answer 151

Plastic articulating ankle-foot orthosis

The patient’s strength at the hip and knee allows for an ankle-foot orthosis (AFO) to be used. A plastic AFo is appropriate since there is intact sensation and an articulating ankle joint is recommended to improve biomechanics during gait since there is an absence of tonal abnormalities.

Question 152

A patient with T10 paraplegia is discharged from a rehabilitation hospital following 12 weeks of intense rehabilitation. Which of the following pieces of equipment would be the MOST essential to assist the patient with functional mobility?
A. Ambulation with Lofstrand crutches
B. Ambulation with Lofstrand crutches and ankle-foot orthoses
C. Ambulation with Lofstrand crutches and knee-ankle-foot orthoses
D. Wheelchair

Answer 152

Wheelchair

A patient with T10 paraplegia will require a wheelchair for community ambulation due to the increased energy expenditure associated with ambulation. The lower abdominals and intercostals would be the lowest innervated muscles.

Question 153

A physical therapist instructs a patient’s spouse to remove and reapply a bandage. Which of the following instructional methods would be the MOST appropriate to ensure the task is performed appropriately?
A. Have the patient instruct the spouse how to remove and reapply the bandage
B. Provide written instruction on how to remove and reapply the bandage
C. Instruct the spouse to remove and reapply the bandage and observe her performance
D. Instruct the spouse to contact the physical therapy department if she has specific questions on how to remove or reapply the bandage

Answer 153

Instruct the spouse to remove and reapply the bandage and observe her performance

Patient and family education is a critical component of a comprehensive plan of care following amputation. Direct observation of the spouse’s performance is the best method to increase the probability that the activity will be performed correctly.

Question 154

A physical therapist treats a patient for a pressure ulcer on their ischial tuberosity and is concerned about the risk of infection caused by the patient’s weakened immune system. Which of the following patients would have the LOWEST risk for infection?
A. A 55-year-old patient with malabsorption syndrome
B. A 50-year-old patient with acquired immune deficiency syndrome
C. A 60-year-old patient receiving monthly cortisone injections
D. A 65-year-old patient with iron-deficiency anemia

Answer 154

A 65-year-old patient with iron-deficiency anemia

Anemia is a condition characterized by reduced oxygen carrying capacity of the blood. This condition is not associated with any change in immune system function. Though this patient is older than the other options (i.e., 65 years old), this small difference in age would not make up for the fact that this patient has no other risk factors for immunosuppression.

Question 155

A physical therapist applies a dressing to an area of skin on a patient’s heel. The therapist decided to use the dressing as a prophylactic measure to reduce the risk of skin breakdown in an area that was determined to be particularly susceptible. The MOST likely dressing used would be:
A. Calcium alginate
B. Hydrocolloid
C. Hydrogel
D. Transparent film

Answer 155

Transparent film

Transparent film dressings consist of thin membranes coated with a layer of acrylic adhesive. Since the film is transparent it allows for frequent assessment of the wound and offers some level of protection.
The films are oxygen permeable, however, are impermeable to microorganisms and moisture.

Question 156

A physical therapist receives a referral to instruct a patient in pelvic floor muscle strengthening exercises. Which of the following explanations would be the MOST effective to assist the patient to perform a pelvic floor contraction?
A. Tighten your muscles like you were trying to expel a large amount of urine in a very short amount of
time
B. Pull your muscles upward and inward as if attempting to stop the flow of urine
C. Tighten your abdominal muscles and anteriorly rotate your pelvis
D. Gently push out as if you had to pass gas

Answer 156

Pull your muscles upward and inward as if attempting to stop the flow of urine

The correct technique for pelvic floor exercises includes pulling the pelvic floor muscles up and in. Isometric contractions should be held for five to ten seconds with complete relaxation after each contraction. Five to ten contractions should be performed in a series and three to four series should be performed each day.

Question 157

According to proponents of evidence-based medicine, the BEST source of information upon which to make clinical decisions about therapy for an individual patient is a:
A. Cohort study
B. Randomized controlled trial
C. Systematic review
D. Case report

Answer 157

Systematic review

Systematic reviews are summaries of the medical literature that use explicit methods to perform a thorough literature search, a critical appraisal of individual studies, and statistical techniques to combine results. Systematic reviews are considered to provide the highest level of evidence for or against a therapy.

Question 158

A patient exercising in the physical therapy gym informs the physical therapist that he is experiencing chest pain. After resting for 20 minutes the patient’s condition is unchanged, however, he insists it is something that he can work through. The MOST appropriate therapist action is:
A. Allow the patient to resume exercise and continue to monitor the patient’s condition
B. Reduce the intensity of the exercise and continue to monitor the patient’s condition
C. Discontinue the treatment session and encourage the patient to make an appointment with his physician
D. Discontinue the treatment session and call an ambulance

Answer 158

Discontinue the treatment session and call an ambulance

If angina symptoms are not relieved by stopping exercise, or the use of three sublingual nitroglycerin tablets (one taken every five minutes), the patient should be transported to the nearest hospital emergency center.

Question 159

A physical therapist attempts to determine the number of known risk factors for coronary artery disease prior to initiating an aerobic exercise program for a 41-year-old male. Which piece of objective date would serve as the MOST relevant risk factor?
A. Blood pressure = 136/87 mm Hg
B. Waist-hip ratio = 1.15
C. Low-density lipoproteins = 96 mg/dL
D. Body mass index = 23.9 kg/m2

Answer 159

Waist-hip ratio = 1.15

Waist-hip ratio is the ratio of circumference of the waist to that of the hips. A waist-hip ratio of greater than 0.9 is an indication of central obesity and a risk factor for coronary artery disease. The patient’s value of 1.15 is well above this level.

Question 160

A physical therapist treats a patient with several injuries impacting the upper extremity including mallet finger. The therapist notes that the affected finger is immobilized using a static splint. Which position of the finger would be MOST essential when splinting?
A. 5 degrees of flexion at the distal interphalangeal joint
B. 5 degrees of flexion at the proximal interphalangeal joint
C. 5 degrees of hyperextension at the distal interphalangeal joint
D. 5 degrees of hyperextension at the proximal interphalangeal joint

Answer 160

5 degrees of hyperextension at the distal interphalangeal joint

Splinting in 5 degrees of hyperextension allows the extensor tendon to heal in an optimal position without becoming excessively lengthened. The amount of hyperextension shoupd be very slight since too much can cause ischemia to the skin. Splinting may be required for as long as 6-8 weeks.

Question 161

A physical therapist treats a patient with a peroneal tendon subluxation. To observe the subluxation, the therapist positions the patient in a prone position with the knee flexed to 90 degrees. Which action would be the MOST appropriate to reproduce the subluxation?
A. Active ankle plantar flexion and inversion
B. Active ankle dorsiflexion and eversion
C. Passive ankle plantar flexion and inversion
D. Passive ankle dorsiflexion and eversion

Answer 161

Active ankle dorsiflexion and eversion

Active ankle dorsiflexion and eversion often serve as the preferred action to reproduce the subluxation. Plantar flexion or circumduction may also be useful. Although reproducing the subluxation is not necessarily desirable, it is important for the therapist to initially observe the subluxation.

Question 162

A 20-year-old female patient with chronic edema in the extremities is told that she has a form of primary lymphedema. Which of the following conditions is an example of primary lymphedema?
A. Filariasis
B. Mastectomy
C. Milroy’s disease
D. Lymphadenitis

Answer 162

Milroy’s disease

Milroy’s disease is an inherited disease that presents during infancy and is characterized by lymphedema. Because the lymphedema is caused by developmental abnormalities of the lymphatic system, it is considered a form of primary lymphedema.

Question 163

A patient rehabilitating from hip surgery receives opioids through patient-controlled analgesia. Which objective finding would be MOST responsible for a decision to terminate opioid use?
A. Oxygen saturation rate of 94%
B. Respiratory rate of 9 breaths per minute
C. Resting pulse rate of 80 beats per minute
D. Body temperature of 99.4 degrees Fahrenheit

Answer 163

Respiratory rate of 9 breaths per minute

Opioids are central nervous system depressants that are commonly administered with patient-controlled analgesia. Opioids tend to decrease respiratory rate. A rate below 10 breaths per minute is typically used as a guideline to terminate opioid use. A normal resting respiratory rate in an adult is 12-20 breaths per minute.

Question 164

A physical therapist witnesses a motor vehicle accident in which a passenger is badly injured and appears to have suffered a partial amputation of the lower leg. The patients able to move their arms and legs, however, the therapist is concerned that the victim is experiencing symptoms of shock. What type of shock is MOST consistent with this scenario?
A. Septic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Hypovolemic shock

Answer 164

Hypovolemic shock

Hypovolemic shock occurs when severe blood loss results in decreased perfusion of the organs. The scenario states that the patient has a partial amputation of the leg and thus they have likely lost a high volume of blood.

Question 165

A physical therapist completes an upper extremity manual muscle test on a patient diagnosed with rotator cuff tendonitis. Assuming the patient has the ability to move the upper extremities against gravity, which of the following muscles would NOT be tested with the patient in a supine position?
A. Pronator teres
B. Pectoralis major
C. Biceps brachi
D. Middle trapezius

Answer 165

Middle trapezius

The middle trapezius is tested with the patient in a prone position. The test arm is abducted at the shoulder to 90 degrees with lateral rotation and elbow extension. The therapist provides pressure against the forearm in a downward direction.

Question 166

A physical therapist informs a patient that a ramp needed to assist the patient to enter their house with a wheelchair will require two separate sections with a landing area. What variable would have MOST likely influenced this decision?
A. Slope of the ramp
B. Angle of inclination of the ramp
C. Length of the ramp
D. Width of the ramp

Answer 166

Length of the ramp

The length of the ramp is the most critical variable to consider when determining the number of sections of a ramp. Any ramp with more than 30 consecutive feet of horizontal run would require more than one section and a transitional landing area.

Question 167

An employee with a disclosed disability informs her employer that she is unable to perform an essential function of her job unless her workstation is modified. Which of the following would provide the employer with a legitimate reason for NOT granting the employee’s request?
A. The accommodation would cost hundreds of dollars
B. The accommodation would require an expansion of the employee’s present workstation
C. The accommodation would fundamentally alter the operation of the business
D. The accommodation would not address the needs of other employees

Answer 167

The accommodation would fundamentally alter the operation of the business

An accommodation that fundamentally alters the operation of a business would be considered an “undue hardship.”

Question 168

A patient with a lengthy medical history of cardiac pathology is referred to a phase I cardiac rehabilitation program. During th first session the physical therapist prepares to measure the patient’s blood pressure by inflating the cuff 20 mm Hg above the patient’s estimated systolic value. Which of the following values describes the MOST appropriate rate to release the pressure when obtaining the blood pressure measurement?
A. 2-3 mm Hg per second
B. 3-5 mm Hg per second
C. 5-7 mm Hg per second
D. 8-10 mm Hg per second

Answer 168

2-3 mm Hg per second

After inflating the cuff to 20 mm Hg above the estimated systolic pressure, the therapist should carefully unscrew (open) the valve and deflate the bladder no more than 2-3 mm Hg per second while listening for the Korotkoff sounds.

Question 169

A physically active 19-year-old male receives pre-operative instruction prior to anterior cruciate ligament reconstruction. The patient’s past medical history includes a medial meniscectomy of the contralateral knee eight months ago. The MOST likely functional level of the patient following rehabilitation is:
A. Able to participate in light recreational activities
B. Able to participate in all recreational activities
C. Able to return to recreational and competitive athletic activities with a derotation brace
D. Able to return to previous functional level

Answer 169

Able to return to previous functional level

A physically active, young patient should return to his previous functional level within 6-12 months following anterior cruciate ligament reconstruction.

Question 170

A patient involved in a motor vehicle accident sustains an injury to the posterior cord of the brachial plexus. Which muscle would NOT be affected by the injury?
A. Infraspinatus
B. Subscapularis
C. Latissimus dorsi
D. Teres major

Answer 170

Infraspinatus

The infraspinatus muscles is innervated by the suprascapular nerve (C4, C5, C6) that extends from the superior trunk of the brachial plexus.

Question 171

A physical therapist prepares a patient for a graded exercise test using an arm cycle ergometer instead of a treadmill due to a lower extremity injury. Which objective finding is MOST accurate when using the arm cycle ergometer instead of the treadmill?
A. The results of the testing will be more heavily influenced by patient motivation.
B. The obtained maximum oxygen consumption will be significantly lower.
C. The work level associated with the point of volitional fatigue will be greater.
D. The incremental work levels with be progressively shortened during testing.

Answer 171

The obtained maximum oxygen consumption will be significantly lower.

The obtained maximum oxygen consumption with arm cycle ergometry is typically 20-30% lower than the value obtained with treadmill testing. The lower maximum oxygen consumption with arm cycle ergometry is due to the smaller muscle mass of the arms compared to the larger muscle mass of the legs.

Question 172

A physical therapist assesses the vital signs of a patient with a blood disorder. The therapist records the patient’s blood pressure as 150/85 mm Hg. Which condition is MOST likely the cause of the abnormal blood pressure measurement?
A. Anemia
B. Thrombocytosis
C. Leukopenia
D. Polycythemia

Answer 172

Polycythemia

Polycythemia is defined as an increase in the number of red blood cells and concentration of hemoglobin. This condition results in increased blood viscosity and increased blood volume, thus resulting in elevated blood pressure measurements. Other signs and symptoms include fatigue, dyspnea, headache, dizziness, irritability, blurred vision, decreased mental acuity, and sensory disturbances.

Question 173

A physical therapist prepares to assess the blink reflex in a patient with suspected neurological involvement. Which cranial nerve components are assessed with this reflex?
A. Afferent cranial nerve V: efferent cranial nerve VII
B. Afferent cranial nerve VII; efferent cranial nerve V
C. Afferent cranial nerve IX; efferent cranial nerve X
D. Afferent cranial nerve X; efferent cranial nerve IX

Answer 173

Afferent cranial nerve V: efferent cranial nerve VII

The afferent cranial nerve V is associated with face sensation. The efferent cranial nerve VII is responsible for closing the eyes.

Question 174

A physical therapist designs a training program for a patient without cardiovascular pathology. The therapist calculates the patient’s age predicted maximal heart rate as 175 beats per minute. Which of the following would be an acceptable target heart rate for the patient during cardiovascular exercise?
A. 93 beats per minute
B. 135 beats per minute
C. 169 beats per minute
D. 195 beats per minute

Answer 174

135 beats per minute

135 beats per minute is within the recommended range for exercise intensity. 135 beats per minute corresponds to 77% of the maximum heart rate.

Question 175

A patient with complete C5 tetraplegia works on a forward raise for pressure relief. The patient utilizes loops that are attached to the back of the wheelchair to assist with the forward raise. Which muscles need to be particularly strong in order for the patient to be successful with the forward raise?
A. Brachioradialis, brachialis
B. Rhomboids, levator scapulae
C. Biceps, deltoids
D. Triceps, flexor digitorum profundus

Answer 175

Biceps, deltoids

The biceps (c5-C6) and deltoids (C5-C6) would both be innervated. The deltoids (anterior, middle, posterior) assist with all shoulder motions with the exception of adduction. The biceps act to flex the shoulder, flex the elbow, and supinate the forearm.

Question 176

A patient is referred to physical therapy for fall prevention training. The therapist determines that the patient has difficulty adapting their vision from low lighting to bright environments. What home modification intervention would be the MOST appropriate based on this information?
A. Use unfiltered direct lighting
B. Replace bathroom light bulbs with red bulbs
C. Use diffuse lighting
D. Use only dim lighting

Answer 176

Use diffuse lighting

Diffuse (filtered) lightning decreases sensitivity to glare and reduces the home adaptations that an individual needs to make when transitioning between rooms. It is recommended to use blinds and lampshades to help filter light in the home.

Question 177

A patient two weeks status post transtibial amputation is instructed by his physician to remain at rest for two days after contracting bronchitis. The MOST appropriate position for the patient in bed is:
A. supine with a pillow under the patient’s knees
B. supine with a pillow under the patient’s thigh and knees
C. supine with the legs extended
D. sidelying in the fetal position

Answer 177

supine with the legs extended

The supine position with the legs extended is the most appropriate position since it promotes lengthening of the hip flexors and hamstrings muscles and prevents the development of flexion contractures.

Question 178

A patient with T10 paraplegia is working with a therapist on how to react in the event of a backward fall. The patient is instructed to place one hand behind the head and the other across their lap as seen in the image. This directive will protect the head and:
A. Allow the patient to remain within the chair upon landing
B. Allow the patient to hold onto one armrest to stabilize the wheelchair.
C. Prevent the lower extremities from hitting the patient’s face
D. Allow the patient to secure the brake to slow the fall

Answer 178

Prevent the lower extremities from hitting the patient’s face

The primary goal of placing one arm across the lap is to limit the movement of the lower extremities with the forearm so that they do not fall into the patient’s face during the backward fall.

Question 179

A physical therapist makes a conscious effort to demonstrate particular kinds of behavior that are significant and attainable for an eight-year-old patient. This type of behavior therapy is termed:
A. Flooding
B. Operant conditioning
C. Role playing
D. Modeling

Answer 179

Modeling

Modeling refers to the process of learning by watching others. Learning often occurs through observation alone without any specific verbal direction from the therapist.

Question 180

A patient rehabilitating from knee surgery exhibits significant weakness in the involved extremity.
During the most recent therapy session the patient was able to complete an independent straight leg raise as shown. What muscles is emphasized in the exercise?
A. Vastus medialis
B. Rectus femoris
C. Vastus lateralis
D. Sartorius

Answer 180

Rectus femoris

The rectus femoris is the prime mover during s straight leg raise exercise. The muscles is a component of the quadriceps femoris muscle group and is innervated by the femoral nerve. The muscle is able to act on the hip as well as the knee due to the muscle originating on the anteroinferior iliac spine and the groove above the rim of the acetabulum.

Question 181

A physical therapist reviews a laboratory reports for a patient recently admitted to the hospital. The patient sustained burns over 25 percent of her body in a fire. Assuming the patient exhibits hypovolemia, which of the following laboratory values would be the MOST significantly affected?
A. Hematocrit
B. Erythrocyte sedimentation rate
C. Oxygen saturation rate
D. Prothrombin time

Answer 181

Hematocrit

Hematocrit is the volume percentage of red blood cells in whole blood. The hematocrit rises immediately after a severe burn and gradually decreases with fluid replacement.

Question 182

A physical therapist performs autolytic debridement in an attempt to remove nonviable tissue from a stage IV pressure ulcer. Autolytic debridement removes necrotic tissue by using:
A. A sharp instrument
B. An externally applied force
C. The body’s own mechanisms
D. A commercially prepared enzyme

Answer 182

The body’s own mechanisms

Autolytic debridement refers to using the body’s own mechanisms to remove nonviable tissue. Common methods of autolytic debridement include transparent films, hydrocolloids, hydrogels, and alginates.

Question 183

A physical therapist trats a 36-year-old male status post knee surgery. The therapist performs goniometric measurements to quantify the extent of the patient’s extension lag. Which of the following would NOT provide a plausible rationale for the extension lag?
A. Muscle weakness
B. Bony obstruction
C. Inhibition by pain
D. Patient apprehension

Answer 183

Bony obstruction

A bony obstruction would not produce an extension lag since passive range of motion and active range of motion would be equal. In essence, the obstruction would interfere with the ability to perform both passive and active knee extension.

Question 184

A physical therapist completes a developmental assessment on an infant. Which position would typically be the LAST to occur assuming normal development?
A. Modified plantigrade
B. Quadruped
C. Ring sitting
D. Bridging

Answer 184

Modified plantigrade

Modified plantigrade typically occurs at 10 months with an age range of 10-12 months. Modified plantigrade is characterized by lower extremity weight bearing in supported standing while leaning with upper extremity support on a table or weight bearing surface.

Question 185

A patient four weeks following anterior cruciate ligament reconstruction using a patellar tendon autograft informs her therapist that she is going on vacation for a week in a tropical location. Which advice would be the MOST beneficial for the patient to protect her scar from the sun?
A. Keep the scar covered when outside in the sun
B. Apply sunscreen with a minimum of 15 SPF directly to the scar
C. Apply sunscreen with a minimum of 30 SPF directly to the scar
D. Apply sunscreen with a minimum of 50 SPF directly to the scar

Answer 185

Keep the scar covered when outside in the sun

Keeping the scar covered when outside in the sun provides the best form of protection. This is particularly important in the presented scenario since it has only been four weeks since surgery and the scar is still maturing. Scars should be covered with clothing or a bandage that allows air to circulate. As scars mature, they typically fade in color and become softer, flatter, and less sensitive. Scars are considered to be mature in 12-18 months.

Question 186

A physical therapist is asked to provide a presentation on the dangers of anabolic steroid use to a group of adolescent male athletes. Which risk factor associated with steroids would be unique to the target audience?
A. Deepened voice
B. Growth cessation
C. Liver damage
D. Testicular atrophy

Answer 186

Growth cessation

Rising levels of testosterone and other sex hormones trigger the growth spurt associated with adolescence. When these hormones reach a specific level, they signify the conclusion of growth. Adolescents using anabolic steroids exhibit artificially increased levels of sex hormones that may trigger the cessation of bone growth prematurely.

Question 187

A patient successfully completes ten anterior lunges. The physical therapist would like to modify the activity to maximally challenge the patient in the sagittal plane. Which of the following modifications would be the MOST appropriate?
A. Anterior lunge with concurrent bilateral elbow flexion to 45 degrees with five pound weights
B. Anterior lunge with concurrent bilateral shoulder flexion to 90 degrees with five pound weights
C. Anterior lunge with concurrent unilateral shoulder flexion 90 degrees with a five pound weight
D. Anterior lunge with concurrent bilateral shoulder abduction to 45 degrees with five pound weights

Answer 187

Anterior lunge with concurrent bilateral shoulder flexion to 90 degrees with five pound weights

Bilateral shoulder flexion would create the largest forward movement and would therefore provide the greatest challenge for the patient due to the center of gravity moving forward outside the base of support.

Question 188

A physical therapist review the medical record of a 46-year-old female diagnosed with myasthenia gravis. A recent physician entry indicates that the patient is currently taking immunosuppressive medication.
Which laboratory test should be the MOST frequently monitored based on the patient’s medication?
A. Hematocrit
B. Hemoglobin
C. Patient count
D. White blood cell count

Answer 188

White blood cell count

The majority of immunosuppressive medications act non selectively and as a result the immune system is less able to resist infections and the spread of malignant cells. Leukopenia refers to a reduction in the number of leokocytes in the blood. The white blood cell count provides valuable information related to the degree of immunosuppression. It is essential for physical therapists to be aware of the patient’s most recent white blood cell count prior to initiating treatment.

Question 189

A physical therapist observes a patient’s postural strategies following a series of perturbations. Which strategy is BEST illustrated in the image?
A. Ankle strategy
B. Hip strategy
C. Suspensory strategy
D. Stepping strategy

Answer 189

Hip strategy

The presented image is an example of the hip strategy which is elicited by a greater force, challenge or perturbation. The hips will move (in the opposite direction from the head) in order to maintain balance. Muscle groups contract in a proximal to distal progression in order to counteract the loss of balance.

Question 190

A physical therapist works with a patient with left-sided hemiparesis as depicted in the image. As the therapist facilitates an anteriorly directed weight shift, the patient shifts weight onto the left lower extremity through:
A. Concentric activity of the left quadriceps and soleus
B. Eccentric activity of the left quadriceps and soleus
C. Concentric activity of the right quadriceps and soleus
D. Eccentric activity of the right quadriceps and soles

Answer 190

Eccentric activity of the left quadriceps and soleus

A patient positioned in half-kneeling as depicted in the image would use eccentric control of the left quadriceps and soles when weight shifting anteriorly. This activity also reinforces right hip extension with knee flexion and proximal control of the posterior extremity.