SUSIEG 2015 Flashcards
A patient has undergone surgery and subsequent immobilization to stabilize the olecranon process. The patient now exhibits an elbow flexion contracture. In this case, an absolute CONTRAINDICATION for joint mobilization would be:
a. Empty end-feel
b. Soft end-feel
c. Springy end-feel
d. Firm end-feel
Correct Answer: A
An empty end-feel (no real end-feel) may be indicative of severe pain and muscle guarding associated with pathological conditions
A PT is instructing a student in proper positioning to prevent the typical contractures in a patient with a transfemoral amputation. The PT stresses positioning the patient in:
a. Side-lying on the residual limb
b. A wheelchair with a gel cushion and adductor roll
c. Prone-lying with the residual limb in neutral rotation
d. Supine-lying with the residual limb
resting on a small pillow
Correct Answer: C
The typical contractures with a transfemoral amputation are hip flexion (typically from too much sitting in a wheelchair). The residual limb also rolls out into abduction and external rotation. When in bed, hip extension should be emphasized (e.g., prone-lying). When sitting in the wheelchair, neutral hip rotation should be emphasized (e.g., using an abductor roll). Time in extension (prone, supine, or standing) should counterbalance time sitting in a wheelchair
In treating a patient with a diagnosis of right shoulder impingement syndrome, the FIRST intervention the PT should consider is to:
a. Instruct the patient in proper postural alignment
b. Complete AROM in all shoulder
motions
c. Implement a stretching program for the shoulder girdle musculature
d. Modulate all pain
Correct Answer: A
Without regaining normal postural alignment and scapular-humeral rhythm, the patient will continue to impinge the supraspinatus and/or biceps tendon at the acromion and never regain normal function of the shoulder
A patient with Parkinson’s disease (PD)
demonstrates a highly stereotyped gait pattern characterized by impoverished movement and a festinating gait. The intervention that would be MOST beneficial to use with this patient is:
a. Locomotor training using a motorized treadmill and body weight support harness
b. Braiding with light touch-down support of hands
c. Standing and reaching with a body weight support harness
d. Locomotor training using a rolling walker
Correct Answer: A
The patient with PD typically presents with postural deficits of forward head and trunk, with hip and knee flexion contractures. Gait is narrow-based and shuffling. A festinating gait typically results from persistent forward posturing of the body near the forward limits of stability. Task-specific training using body weight support and treadmill training (BWSTT) is the best choice
A patient is experiencing sensory changes secondary to left CVA. Upon testing, the patient is unable to detect pin prick or temperature in the right hand, leading to disuse and increased safety risk. These changes are BEST documented as “Patient is experiencing”:
a. Allodynia
b. Abarognosis
c. Anesthesia
d. Analgesia
Correct Answer: D
Analgesia refers to a complete loss of pain sensibility (in this case).
A patient is on the cardiac unit following admission for CHF and a history of an MI.
The patient is currently compensated by pharmacological management and is comfortable, alert and oriented at rest with a normal HR and BP. The telemetric
ECG depicts the rhythm shown in the figure. The PT’s appropriate interpretation and action is: (PICTURE)
a. ST segment depression; alert emergency medical personnel
b. Ventricular tachycardia; alert emergency medical personnel
c. Normal sinus rhythm; continue to monitor during activity progression
d. ST segment depression; check medical record for baseline ECG
Correct Answer: D
The ECG shows ST segment depression. If ST segment depression is present during comfortable, stable rest in a patient with a history of an MI, it likely represents the presence of a nontransmural MI and is the patient’s baseline ECG. However, this should be confirmed to rule out silent ischemia
A 14-year-old girl complains of subpatellar pain after participation in an aerobic exercise program for 2 weeks.
The PT’s examination shows a large Q angle, pain with palpation at the inferior pole of the patella and mild swelling at both knees. The BEST intervention for this situation is:
a. Hamstring strengthening
b. Vastus medialis (VM) muscle strengthening
c. Vastus lateralis (VL) strengthening
d. Taping to increase lateral patellar tracking
Correct Answer: B
Q angles of greater than 15° could be indicative of abnormal lateral patellar tracking. VM muscle strengthening can reduce the tendency for the patella to track laterally.
A patient is referred to a physical therapist with a diagnosis of Bell’s palsy. Which cluster of examination findings below would the PT expect to find?
a. Decreased sensation to the forehead, cheek and jaw; absence of a gag reflex; and deviation of the tongue to one side
b. Posis, weakness in the temporalis and masseter muscles and deviation of the tongue to one side
c. Ptosis, decreased abduction of the eye and excessive tearing
d. Decreased closure of one eye, drooping of the mouth, and inability to raise the eyebrow
Correct Answer: D
Decreased function of the facial nerve (cranial nerve VIl) is associated with motor weakness of the muscles of facial expression, which could result in a decreased ability to close the eye tightly, raise the eyebrow, and raise the corner of the mouth as in a smile. Other functions of the facial nerve include taste to the anterior tongue, tearing, salivation, and dampening sound.
The cardiac rehabilitation team is conducting education classes for a group of patients. The focus is on risk factor reduction and successful lifestyle modification. A participant asks the PT to help interpret cholesterol findings. Total cholesterol is 220 mg/dL, high-density lipoprotein (HDL) cholesterol is 24 mg/dL and low-density lipoprotein (LDL) is 160 mg/dL. Analysis of these values reveals:
a. The levels of HDL, LDL and total cholesterol are all abnormally low
b. LDL and HDL cholesterol levels are within normal limits, and total cholesterol should be below 200 ma/dL
c. The levels of HDL, LDL and total cholesterol are all abnormally high
d. The levels of LDL and total cholesterol are abnormally high, and HDL is abnormally low
Correct Answer: D
Increased total blood cholesterol levels (>
200 mg/dL) and levels of LDLs (>130 mg/dL) increase the risk of coronary artery disease
(CAD); conversely, low concentrations of HDLs (<40 mg/dL for men and <50mg/dL for women) are also harmful. The link between
CAD and triglycerides is not as clear.
An elderly patient is being treated for depression following the death of her husband. She is currently taking a tricyclic antidepressant medication (amitriptyline) and has a recent history of a fall. The PT suspects the precipitating cause of the fall is the medication because it can cause:
a. Hyperalertness
b. Postural hypotension
c. Dyspnea
d. Hypertension
Correct Answer: B
Most tricyclic antidepressants have significant anticholinergic and sedative properties and may cause lethargy, sedation, arrhythmias, hypotension and blurred vision, thus increasing fall risk. The elderly are particularly susceptible to adverse drug effects because of a multitude of factors
11.As the result of blunt trauma to the quadriceps femoris muscle, a patient experiences loss of knee function. The BEST choice for early physical therapy intervention is:
a. Gentle AROM exercises in weight bearing
b. Aggressive soft tissue stretching to remove blood that has accumulated in soft tissues
c. Aggressive open-chain strengthening of the quadriceps femoris to regain normal lower extremity strength
d. Gentle PROM exercises in non-weight bearing to regain normal knee motion
Correct Answer: A
Gentle weight-bearing AROM exercises to patient’s tolerance will minimize the chance of myositis ossificans and promote improved function.
A patient with active tuberculosis (TB) is referred for physical therapy. The patient has been hospitalized and on appropriate antituberculin drugs for 3 weeks. During treatment, what precautions should the therapist observe?
a. The patient must be treated in a private, negative-pressured room
b.The therapist must wear personal protective equipment at all times
C.The patient can be treated in the PT gym, without precautions
d. The patient must wear a tight fitting mask at all times
Correct Answer: C
Primary disease lasts approximately 10 days to 2 weeks. Two weeks on appropriate antituberculin drugs renders the host noninfectious. The patient can be safely treated in the PT gym without precautions. Medication is taken for prolonged periods (9-12 months).
With a traction injury to the anterior division of the brachial plexus, the PT would expect to see weakness of the elbow flexors, wrist flexors, and forearm pronators. The PT would also expect to find additional weakness in:
a. Wrist extension
b. Thumb abduction
c. Forearm supination
d. Lateral rotation of the shoulder
Correct Answer: B
Thumb abductors are innervated by the median nerve, primarily by the C6 nerve root.
The anterior divisions contribute to the nerves that primarily serve flexors and, in this case, the thumb.
A patient complains of right buttock pain after slipping. The right hip had been forced into internal rotation. Lumbar active motion testing is full and pain free. Neurological findings are unremarkable.
S1 provocation testing is unremarkable.
Passive hip internal rotation is limited with pain and pulling noted in the right buttock region. Resisted external rotation produces pain in the same region. Based on these finding, the MOST LIKELY diagnosis would be:
a. Piriformis strain
b. Quadratus lumborum strain
c. Lumbar disc herniation at L5/S1
d. Sacroiliac sprain/strain
Correct Answer: A
Forceful hio internal rotation would overstretch and potentially strain the piriformis muscle. Limited passive hip internal rotation would reproduce symptoms from a tight or tense piriformis. Pain with resisted external rotation would suggest a contractile problem with the piriformis.
A patient with MS demonstrates strong bilateral lower extremity extensor spasticity in the typical distribution of antigravity muscles. This patient would be expected to demonstrate:
a. Skin breakdown on the ischial tuberosities and lateral malleoli
b. Sitting with both hips abducted and externally rotated
c. Sacral sitting with increased extension and adduction of lower extremities
d. Sitting with the pelvis lateraly tilted and both lower extremities in windswept position
Correct Answer: C
Spasticity is typically strong in antigravity muscles. In the lower extremities, this is usually the hip and knee extensors, adductors, and plantarflexors: Strong extensor tone results in sacral sitting with the pelvis tilted posteriorly. This results in a rounded upper spine (kyphotic) and forward head.
16.A computer programmer with no significant past medical history presents to the emergency room with complaints of fever, shaking chills, and a worsening productive cough. Complaints of chest pain over the posterior base of the left thorax are made worse on inspiration. An anteroposterior x-ray shows an infiltrate on the lower left thorax at the posterior base. This patient’s chest pain is MOST LIKELY caused by:
a. Inflamed tracheobronchial tree
b. Angina
c. Trauma to the chest
d. Infected pleura
Correct Answer: D
The case is supportive of a pulmonary process as evidenced by radiography and history. Because the radiographic findings and the pain are in the same vicinity and worsen with inspiration, the likelihood is that this pain is pleuritic in origin.
The posture of a patient’s forefoot is an inverted position relative to the rearfoot while in subtalar neutral. What is the PT’s BEST choice to document this finding?
a. Forefoot varus
b. Medial column equinus
c. Metatarsus abductus
d. Forefoot valgus
Correct Answer: A
When observing the position of plantar aspect of the forefoot relative to the neutral posture of the rearfoot (subtalar neutral), an inverted forefoot is described as a forefoot varus.
- During a sensory examination, a patient complains of a dull, aching pain and is not able to discriminate a stimulus as sharp or dull. Two-point discrimination is absent. Based on these findings, the pathway that is intact is the:
a. Dorsal columns/neospinothalamic svstems
b. Anterior spinothalamic tract
c. Fasciculus gracilis/medial lemniscus
d. Lateral spinothalamic tract
Correct Answer: B
Sensations interpreted as dull, aching pain travel in the anterior (paleo) spinothalamic tract.
A patient is hospitalized in an intensive care unit following a traumatic SCI resulting in C3 tetraplegia (ASIA A). the patient is receiving endotracheal suctioning, following development of significant pulmonary congestion. The recommended time duration for endotracheal suctioning is:
a. 1-5 seconds
b. 10-15 seconds
c. 5-10 seconds
d. 15-20 seconds
Correct Answer: B
The recommended time duration for endotracheal suctioning is 10-15 seconds.
A patient presents with pronounced muscle weakness and wasting in the lower extremities, hypertension and a moon-shaped face with truncal obesity.
The PT recognizes these symptoms as characteristic of:
a. Hypoparathyroidism
b. Type II diabetes
c. Addison’s disease
d. Cushing’s syndrome
Correct Answer: D
Cushing’s syndrome causes a variety of signs and symptoms including hypoglycemia, hypokalemia, hypertension, muscle weakness, and wasting. Abnormal fat distribution (moon-shaped face, truncal, or central obesity) is a visible clinical feature.
During which phases of the gait cycle would a PT expect to observe an everted posture of the calcaneus?
a. Terminal stance (heel-off) to preswing (toe-off)
b. Initial swing (acceleration) through midswing
c. From midstance through heel-off (toe-off)
d. From initial contact (heel strike) through loading response (foot-flat).
Correct Answer: D
Calcaneal eversion is a component of the triplanar motion described as rearfoot pronation. During the gait cycle, rearfoot pronation, caused by normal ground reaction forces, occurs from initial contact (heel strike) through loading response (foot-flat)
A patient with right hemiparesis has difficulty clearing the more affected foot during the swing phase of gait. An appropriate physical therapy intervention for the right lower extremity might include:
a. Pushing backward while sitting on a rolling stool
b. Sitting on a therapy ball, alternating lateral side steps and back to neutral
c. Assumption of bridging
d. Forward step-ups in standing, using graduate height steps
Correct Answer: D
Decreased foot clearance during swing may result from weak hip and knee flexors or from a drop foot (weak dorsiflexors or spastic plantarflexors). Step-ups represent the best choice to functionally strengthen the hip and knee flexion using task-specific training.
A researcher reviewed current literature related to moderate exercise for maintaining independence without accelerating disease progression in persons with amyotrophic lateral sclerosis (ALS). The search yielded nine studies:
two clinical case reports, two cohort studies, three single randomized controlled trials (RCT’s) and two multicenter RCT’s. According to levels of evidence, which studies provide the BEST evidence for support of exercise in persons with ALS?
a. Case series without controls
b. Multicenter RCTs
c. Single-center RCTs
d. Cohort/comparison studies
Correct Answer: B
According to recognized Levels of Evidence, multicenter RCTs (level I RCT) provide the best evidence
A sports PT is working with a local high school football team. During the game, a player is tackled violently and incurs a blow to the head. The PT determines that the player is unresponsive with normal respirations. The IMMEDIATE course of action should be to:
a. Stabilize the neck, and flip back the helmet face mask
b. Use the chin-lift method to improve
the airway
c. Summon Emergency Medical Services
d. Ask for help to log-roll the player onto his back, while stabilizing his neck
Summon Emergency Medical Services
During a finger-to-nose test, a patient demonstrates hesitancy in getting started and is then unable to control the movement. The moving finger slams into the side of the face and misses the nose completely. The therapist documents these findings as moderate impairment in:
a. Dyssynergia
b. Dysmetria
c. Response orientation
d. Dysdiadochokinesia
Correct Answer: B
Dysmetria refers to impaired ability to judge the distance or range of movement.
A patient with complete C6 tetraplegia
(ASIA A) should be instructed to initially transfer with a sliding board using:
a. Shoulder extensors, external rotators, and anterior deltoid to position and lock the elbow
b. Serratus anterior to elevate the trunk with elbow extensors stabilizing
c. Pectoral muscles to stabilize the elbows in extension and scapular depressors to lift the trunk
d. Shoulder depressors and triceps, keeping the hands flexed to protect tenodesis grasp
Correct Answer: A
The patient with complete C6 tetraplegia will lack triceps (elbow extensors), and should be taught to lock the elbow for push-up transfers by using shoulder external rotators and extensors to position the arm: the anterior deltoid locks the elbow b reverse actions (all of these muscles are functional).
A Pt has been treating a patient for chronic subluxation of the patella in the outpatient clinic. The patient is now scheduled for a lateral release and is worried about any complications of the surgical procedure. The patient asks the Pt to describe any potential complications. The PT’s BEST response I to:
a. Refer the patient to a physical therapy colleague who specializes in knee problems
b. Suggest that the patient speak with surgeon
c. Do an internet search and print out the information desired by the patient
d. Explain how previous patients that the therapist treated responded to the surgery
Correct Answer: B
It is within the surgeon’s scope of practice to discuss the indications and problems that could arise from this surgical procedure
A patient is unable to perform overhead activities because of a painless inability to reach past 80° of right shoulder abduction. The “empty can” test was positive. Early subacute physical therapy intervention should focus on:
a. Resistance exercises for the affected muscles
b. Modalities to reduce pain and
inflammation
c. Superior translatory mobilizations to increase glenohumeral arthrokinematics motion
d. Active assistive pulley exercises
Correct Answer: D
The patient is most likely suffering from a supraspinatus tear or impingement. Acute PT intervention should focus on reduction of pain and inflammation. During the early subacute phase, active assistive pulley exercises would be indicated to promote healing of the supraspinatus muscle and maintain AROM of the glenohumeral joint.
The PT is reviewing the medical history of a new patient being seen for balance deficits and general deconditioning. Prior to admission, the chief finding by the physician, 3 days ago, was a positive fecal blood test. Which laboratory value would confirm that the patient is safe for balance re-training activities?
a. Erythrocyte sedimentation rate (ESR)
7 mm/1 h.
b. Leukocyte count 7,000
c. Hematocrit 42%
d. Platelet count 70,000
Correct Answer: C
The stated hematocrit value is within the normal range for both males and females, and indicates the fecal blood loss is not significant at treatment time.
A middle-aged patient is recovering from surgical repair of an inguinal hernia and is experiencing persistent discomfort in the groin area. Patient education should focus on:
a. Avoiding sitting too long in any one position
b. Avoiding straining or turning in bed
c. Closed-mouth breathing during any lifting
d. Proper lifting techniques and precautions against heavy lifting
Correct Answer: D
Patients should be educated about proper lifting techniques and precautions against heavy lifting
A computer programmer in her second trimester of pregnancy was referred to physical therapy with complaints of tingling and loss of strength in both of her hands. Her symptoms are exacerbated if she is required to use her keyboard at work for longer than 20 minutes. The MOST beneficial physical therapy intervention is:
a. Ice packs to the carpal tunnel
b. Hydrocortisone iontophoresis to the volar surfaces of both wrists
c. Placing the wrists in resting splints
d. Dexamethasone phonophoresis to the carpal tunnel
Correct Answer: C
Gestational carpal tunnel syndrome (CTS) is not an unusual phenomenon, and results from extra fluid retention. The most effective intervention would be to place the wrists in a neutral position in splints. The carpal tunnel is, therefore, not compromised by poor hand positioning while at work.
A PT has decided to refer a 2-year-old child to a neurologist after the initial evaluation. The PT has concluded that the child may be autistic. The MOST PERTINENT factor to include in the referral is that the child is:
a. Delayed in gross motor skills
b. Quiet and did not want to separate from the mother
c. Defensive when touched
d. Responsive to most but not all commands
Correct Answer: C
Not tolerating being touched would signal a possible sensory integration issue that is common in children with autism. Although a referral for autism diagnosis should have additional information, this would be the most important factor from the choices given.
A patient was instructed to apply conventional (high-rate) transcutaneous electrical nerve stimulation (TENS) to the low back to modulate a chronic pain condition. The patient now states that the TENS unit is no longer effective in reducing the pain in spite of increasing the intensity to maximum. The PT should now advise the patient to:
a. Switch to modulation-mode TENS
b. Increase the treatment frequency
c. Decrease the pulse duration
d. Switch to low-rate TENS
Correct Answer: A
Because of the long-term, continuous use of TENS, the sensory receptors accommodated to the continuous current, and no longer responded to the stimuli. Changing to modulation mode (i.e., burst modulation), which periodically interrupts the current flow, does not allow accommodation to occur.
After performing an ergonomic examination of a computer programmer and workstation, the most appropriate recommendation for achieving ideal wrist and elbow positioning would be to:
a. Maintain the keyboard in a position that allows a neutral wrist position
b. Add armrests
c. Elevate the keyboard to increase wrist flexion
d. Lower the keyboard to increase wrist extension
Correct Answer: A
Work involving increased wrist deviation from a neutral posture in either flexion/extension or radial/ulnar deviation has been associated with increased reports of CTS and other wrist and hand problems.
An elderly patient receiving outpatient PT as a result of a stroke (cerebrovascular accident) presents with left hemiparesis.
The patient requires moderate assistance for ADL and transfers. The patient lives with and is cared for by a single adult daughter. The patient arrives for a physical therapy session and the PT notes multiple bruises on the patient’s face and arms. When asked about the bruises, the patient hesitates and says she does not know. Later in the session, the patient reports that her daughter is under a great deal of stress. In this case, what should the PT do?
a. Document and treat the bruises as necessary and assess whether the bruises are resolved at the next visit
b. Contact the appropriate jurisdiction and file a report for suspected abuse/neglect
c. Call the police and have the daughter arrested for elder abuse
d. Counsel the daughter on how to handle stress and advise her to hire a personal care attendant to help care for her mother and prevent falls
Contact the appropriate jurisdiction and file a report for suspected abuse/neglect
Following major surgery of the right hip, a patient ambulates with a Trendelenburg gait. Examination of the right hip reveals abductor weakness (gluteus medius 3/5) and ROM limitations in flexion and external rotation. As part of the intervention, the PT opts to include functional electrical stimulation to help improve the gait pattern. Stimulation should be initiated for the:
a. Left abductors during stance on the right
b. Right abductors during stance on the right
c. Left abductors during swing on the right
d. Right abductors during swing on the right
Correct Answer: B
During the stance phase of gait, the hip abductors of the support limb are activated to maintain the pelvis in a relatively horizontal position. This allows the opposite foot to clear the floor during swing.
An 18-month-old child with Down syndrome and moderate developmental delay is being treated at an Early Intervention Program. Daily training activities that should be considered include:
a. Locomotor training using body weight support and a motorized treadmill
b. Stimulation to postural extensors in sitting using rhythmic stabilization
c. Rolling activities, initiating movement with stretch and tracking resistance
d. Holding and weight shifting in sitting and standing using tactile and verbal cueing
Correct Answer: D
Children with Down syndrome typically present with generalized hypotonicity. The low tone is best managed by weight-bearing activities in antigravity postures. Typical responses include widened base of support and co-contraction to gain stability. Verbal cueing for redirection is generally the best form of feedback to use, along with visually guided postural control
A high school wrestler has been taking anabolic-androgenic steroids for the past 6 months to build muscle and improve performance. The PT working with the team suspects illegal drug use and examines the athlete for:
a. Rapid weight gain, marked muscular hypertrophy and mood swings
b. Rapid weight loss with disproportionate muscular enlargement
c. Changes in personality, including passivity and anxiety
d. Hypotension, edema, and rapid muscular enlargement
Correct Answer: A
Signs and symptoms of anabolic steroid use include rapid weight gain, elevated BP, acne on the face and upper back, and changes in bod composition with marked muscular hypertrophy, especially in the upper body.
Additional signs include frequent bruising, needle marks, male breast enlargement, or in females, secondary male characteristics and menstrual irregularities. With prolonged use, jaundice or changes in personality (mood swings, rages) may develop
While driving the ball during a golf match, a patient felt an immediate sharp pain in the right lower back. The following morning, the patient reported stiffness, with easing of pain after taking a shower.
Based on this information, the source of the pain is MOST LIKELY:
a. Diminished blood supply to the spinal cord
b. Facet joint impingement
c. A stress fracture
d. Nerve root compression
Correct Answer: B
Facet joint dysfunction is exacerbated with sustained positions, and eases with movement. Progressive increase in activity intensifies the pain
A PT is performing the maximal cervical quadrant test to the right with a patient with right C5-C6 facet syndrome. The patient would most likely complain of:
a. Pain in the right cervical region
b. Referred pain to the left midscapular region
c. Radicular pain into the right upper limb
d. Tightness in the right upper trapezius
Correct Answer: A
The test position would consist of right cervical side-bending with extension. This shortens the upper trapezius and stresses the right cervical facets. When a pathological cervical facet is provoked, the result will cause pain in the ipsilateral cervical region, with referred pain to the ipsilateral scapular region. The test might also compress the nerve root, creating radicular signs, but only on the right side.
A 62-year old patient has chronic, obstructive pulmonary disease (COPD).
Which of these pulmonary test results will
NOT be increased when compared with those of a 62-year-old healthy individual?
a. Functional residual capacity
b. FEV1/FVC (forced vital capacity) ratio
c. Total lung capacity
d. Residual volume
Correct Answer: B
An obstructive pattern on pulmonary function tests includes increased total lung capacity, caused by destruction of alveolar walls. This same destruction causes an increased residual volume, with a resulting increased functional residual capacity and decreased vital capacity. The GOLD (global Initiative for Obstructive Lung Disease classification of an FEV1FVC ratio below 70% is indicative of COPD.
A patient with a grade 2 quadriceps strain returns to physical therapy after the 1st exercise session, complaining of muscle soreness that developed later in the evening and continued into the next day.
The patient is unsure whether to continue with the exercise. The PT can minimize the possibility of this happening again by using:
a. Eccentric exercises, 3 sets of 10, with gradually increasing intensity
b. Concentric exercises, 3 sets of 10, with gradually increasing intensity
c. Eccentric exercises, 1 set of 10, lifting body weight (sit-to-stand)
d. Concentric exercises, 3 sets of 10, at 80% of maximal intensity
Correct Answer: B
This patient is experiencing delayed-onset muscle soreness (DOMS) as a result of vigorous exercise or muscular overexertion.
It typically begins 12-24 hours after exercise, peaks in 24-48 hours, and can last up to 5-7 days.
A patient with multiple sclerosis (MS)
exhibits moderate fatigue during a 30-minute exercise session. When the patient returns for the next regularly scheduled session 2 days later, the patient reports going right to bed after the last session. Exhaustion was so severe, the patient was unable to get out of bed until late afternoon of the next day. The PT’s BEST strategy is to:
a. Utilize a distributed practice schedule
b. Utilize a massed practice schedule
c. Treat the patient in a warm, relaxing environment
d. Switch the patient to exercising in a warm pool
Correct Answer: A
Common problems in MS include fatigue and heat intolerance. Exercise intensity should be reduced, and a distributed practice schedule should be used, in which rest times equal or exceed exercise times.
A patient has lumbar spinal stenosis encroaching on the spinal cord. The PT should educate the patient to avoid:
a. Use of a rowing machine
b. Bicycling using a recumbent cycle ergometer
c. Swimming using a crawl stroke
d. Tai chi activities
Correct Answer: C
Continuous positioning in spinal extension increases symptoms in patients with spinal stenosis. Activities such as swimming using a crawl stroke place the spine in this position.
A PT is performing clinical research in which a specific myofascial technique is applied to a patient with chronic back pain. She is using a single-case experimental design with an A-B-A-B format. Her research hypothesis states that pain-rating scores will decrease with the treatment intervention. Acceptance of this hypothesis would be indicated if:
a. B is less than A
b. B is greater than A at the 1.0 level
c. B is greater than A at the 0.05 level
d. B is equal to A
Correct Answer: A
In an A-B-A-B single-subject design, A represents multiple baseline measurements, and B represents multiple posttreatment measurements. If the hypothesis is accepted, the pain-rating scores will be lower following treatment compared with the baseline measurements.
An individual with a body mass index
(BMI) of 33 kq/m 2 is referred to an outpatient exercise program. The PT in charge of the program recognizes this patient is at increased risk for:
a. Increased anxiety and depression
b. Hypothermia during exercise
c. Rapid weight loss during the initial
Weeks
d. Hyperthermia during exercise
Correct Answer: D
A patient with a BMI of 33 kg/m-2 is obese
(BMI >30 kg/m-2) and is at increased risk for hyperthermia during exercise (as well as orthopedic injury).
47.A patient with a recent modified radial mastectomy for breast cancer is referred to physical therapy. The therapist recognizes that an important predictor for Ivmphedema after treatment for breast cancer is:
a. A diet low in sodium
b. Obesity
c. Mild strength loss in the affected extremity
d. Use of diuretics
Correct Answer: B
Obesity is consistently reported as a predictor of lymphedema after modified radial mastectomy for breast cancer. Weight management should be an integral part of patient education.
An elderly patient has been confined to bed for 2 months, and now demonstrates limited ROM in both lower extremities.
Range in hip flexion is 5°-115°, and knee flexion is 10°-120°. The MOST beneficial intervention to improve flexibility and ready this patient for standing is:
a. Hold-relax techniques followed by passive range of motion (PROM), 10 repetitions, two times per day
b. Mechanical stretching using traction and 5-Ib weights, 2 hours, two times per day
c. Manual passive stretching, 10 repetitions each joint, two times per day
d. Tilt-table standing, 20 minutes, daily.
Correct Answer: B
Prolonged mechanical stretching involves a low-intensity force (generally 5 to 15 lb) applied over a prolonged period (30 minutes to several hours. It is generally the most beneficial way to mange long-standing flexion contractures.
During a home visit, a PT is providing postural drainage in the Trendelenburg position to an adolescent with cystic fibrosis. The patient suddenly complains of right-sided chest pain and shortness of breath. On auscultation, there are no breath sounds on the right. The therapist
should:
a. Call emergency medical services because it may be a pneumothorax
b. Continue treating as it is possibly a mucous plug
c. Reposition patient with the head of the bed flat because the
Trendelenburg position is causing shortness of breath
d. Place the right lung in a gravity-dependent position to improve perfusion
Correct Answer: A
The combined signs and symptoms of absent breath sounds, sudden onset of chest pain and shortness of breath indicate a pneumothorax, especially in an adolescent (growth spurt) with pathological changes of lung tissue. This is an emergency situation.
A patient is 5 days’ postmyocardial infarction and is referred for inpatient cardiac rehabilitation. Appropriate criteria for determining the initial intensity of exercise include:
a. > 1 mm ST segment depression, horizontal or downsloping
b. HR < 120 bpm and rate of perceived exertion (RPE) < 13
c. Systolic BP < 240 mm Hg or diastolic
BP < 110 mm Hg
d. HR resting plus 30 bpm and RPE <
14
Correct Answer: B
Intensity of exercise is prescribed using HR and RPE and monitored using HR, RPE and signs of exertional intolerance. For post-MI patients, an RPE < 13 (6-20 scale) and a HR < 120 beats/min (or HR resting plus 20 bpm) is recommended.
A PT examines a patient with a right CVA and determines that the patient has a profound deficit of homonymous hemianopsia. The BEST INITIAL strategy to assist the patient in compensating for this deficit is to:
a. Provide constant reminders, printed notes on the left side, telling the patient to look to the left
b. Teach the patient to turn the head to the affected left side
c. Place items such as eating utensils on the left side
d. Rearrange the room so that while the patient is in bed, the left side is facing the doorway.
Correct Answer: B
A patient with homonymous hemianopsia needs to be made aware of the deficit and instructed to turn the head to the affected left side (a compensatory training strategy).
A patient with a 10-year history of
Parkinson’s disease (PD) has been taking levodopa (Sinemet) for the last 5 years.
The patient presents with deteriorating function and is no longer able to walk independently due to constant and uncontrolled involuntary movements.
During the examination, the PT observes that the patient is restless, with constant dancing, hyperkinetic movements of his legs. The PT’s BEST course of action is to:
a. Complete the treatment session, focusing specifically on documenting the effects of rigidity
b. Document the observations and refer the patient back to the physician for possible medication adiustment
c. Examine for additional signs of chronic levodopa therapy, such as dizziness and headache
d. Talk to the spouse to see if the patient is taking any drugs with hallucinogenic effects, such as selegiline.
Correct Answer: B
Dyskinesias (involuntary movements) are caused by an adverse effect of prolonged use of dopamine. Other changes include gastrointestinal disturbances (nausea, vomiting) and mental disturbances (restlessness, general overactivity, anxiety, or depression). Medication adjustment may reduce some of these effects and improve function.
A patient with stasis dermatitis secondary to venous insufficiency is being examined by the PT. Visual inspection of the skin can be expected to reveal:
a. Extensive erosions with serous exudate
b. Pruritus, erythema and edema
c. Hemosiderin staining
d. Plaques with scales
Correct Answer: C
Hemosiderin staining is indicative of venous insufficiency. It is characterized by dark pigmentation (bluish-red color) and result from leakage of hemosiderin (the by-product of red cell hemolvsis) in the presence of blood stasis and incompetent valves.
A 24-year-old woman who is 12 weeks’ pregnant asks a PT if it is safe to continue with her aerobic exercise. Currently, she jogs 3 miles, three times a week, and has done so for the past 10 years. The Therapist’s BEST answer is:
a. Jogging is safe at mild to moderate intensities, whereas vigorous exercise is contraindicated
b. Jogging is safe as long as the target HR does not exceed 140 beats/min
c. Continue jogging only until the fifth month of pregnancy
d. Swimming is preferred over walking or jogging for all phases of pregnancy
Correct Answer: A
According to the American College of Sports Medicine, women can continue to exercise regularly (three times a week) at mild to moderate intensities throughout pregnancy if no additional risk factors are present. After the 1st trimester, women should avoid exercise in the supine position because this position is associated with decreased cardiac output. Prolonged standing with no motion should also be avoided.
A patient is able to stand feet together, unassisted, with eyes open. When asked to close the eyes, the patient immediately loses balance and has to take a step and grab onto the table to keep from falling.
The PT documents this finding as:
a. Ataxic posture
b. Positive Romberg test
c. Negative Romberg test
d. Positive Dizziness Handicap Inventory
Correct Answer: B
In a positive Romberg test, the patient demonstrates instability during the eyes closed (EC) condition but not during the eves open (EO) condition; commonly seen in dorsal column disease.
A patient is referred for rehabilitation after a middle cerebral artery stroke. Based on this diagnosis, a PT can expect that the patient will present with:
a. Contralateral hemiparesis and sensory deficits, with the leg more involved than the arm
b. Contralateral hemiplegia with central poststroke pain and involuntary movements
c. Contralateral hemiparesis and sensory deficits, with the arm more involved than the leg
d. Decreased pain and temperature to the face and ipsilateral ataxia, with contralateral pain and thermal loss of the body
Correct Answer: C
A CVA affecting the middle cerebral artery will result in symptoms of contralateral hemiparesis and hemisensory deficits with greater involvement of the arm than the leg.
57.A patient complains of pain (7/10) and limited range of motion (ROM) of the right shoulder as a result of chronic overuse.
The PT elects to use procaine hydrochloride iontophoresis as part of the intervention for this patient’s problems. To administer this substance, it would be appropriate to use:
a. Continuous monophasic current, with the medication under the anode
b. Continuous biphasic current, with the medication under the anode
c. Interrupted biphasic current, with the medication under the cathode
d. Continuous monophasic current, with the medication under the cathode
Correct Answer: A
Because like charges are repelled, the positively charged medication would be forced into the skin under the positive electrode (anode). A continuous, unidirectional current flow is very effective in repelling ions into the skin. Procaine is a positive medicinal ion, and will be repelled from the anode (positive pole).
A patient fractured the right mid tibia in a skiing accident 3 months ago. After cast removal, a severe foot drop was noted.
The patient wants to try electrical stimulation orthotic substitution. The PT would set up the functional electrical stimulation to contract the appropriate muscles during:
a. Mid swing
b. Late stance at push-off
c. Early stance at foot-flat
d. Late stance at toe-off
Correct Answer: A
Foot drop is a swing phase deficit.
Stimulation of the dorsiflexor muscles during the swing phase places the foot in a more neutral position and prevents the toes from contracting the ground and interfering with the gait pattern
A patient who is terminally ill with cancer is in tears, unable to cope with the changes in life and current
hospitalization. The PT has a referral for gait training so that the patient can be discharged to home under hospice care.
The BEST approach is to:
a. Encourage denial so the patient can cope better with life’s challenges
b. Ask the patient questions in order to obtain a detailed history
C.Take time now to allow the patient to express fears and frustrations
d. Ignore the tears and focus on therapy, but in a compassionate
manner
Correct Answer: C
It is important to be supportive of a patient who is experiencing losses and resentment.
Allow the patient to fully verbalize feelings and frustrations.
A patient with multiple sclerosis (MS) has been on prednisolone for the past 4 weeks. The medication is now being tapered off. This is the third time this year that the patient has received this treatment for an MS exacerbation. The PT recognizes that possible adverse effects of this medication are:
a. Weight gain and hyperkinetic behaviors
b. Muscle wasting, weakness and osteoporosis
c. Spontaneous fractures with prolonged healing or malunion
d. Hypoglycemia and nausea or vomiting
Correct Answer: B
This patient is receiving systemic corticosteroids to suppress inflammation and the normal immune system response during an MS attack. Chronic treatment leads to adrenal suppression. Numerous adverse reactions/side effects can occur. Those affecting the patient’s capacity to exercise include muscle wasting and pain, weakness and osteoporosis. Weight loss is common (anorexia) with nausea and vomiting.
A patient is 4 weeks’ post-myocardial infarction (MI). Resistive training using weights to improve muscular strength and endurance is appropriate:
a. Only during post-acute phase 3 cardiac rehabilitation
b. During all phases of rehabilitation, if judicious monitoring of heart rate is used
c. If exercise intensities are kept below 85% maximal voluntary contraction
d. If exercise capacity is greater than 5 metabolic equivalents (METs) with no angina symptoms/ST segment depression
Correct Answer: D
Resistance training is typically initiated after patients have completed 4-6 weeks of supervised cardio respiratory endurance exercise. Lower intensities are prescribed.
Careful monitoring of BP is necessary because BP will be higher and HR lower than for aerobic exercise. Patients should demonstrate an exercise capacity greater than 5 METs without angina symptoms or ST segment depression.
To test for maximal passive tibiofemoral internal or external rotation the knee should be placed in:
a. 45° of knee flexion
b. 60° of knee flexion
c. 90° of knee flexion
d. 30° of knee flexion
Correct Answer: C
Rotation of the tibia on the femur is influenced by sagittal knee position. Rotation of the knee increases with increasing flexion up to 90°. After 90°, the soft tissues behind the knee restrict further increases in rotation at the knee.
An adolescent female is referred to physical therapy with a diagnosis of anterior knee pain. Positive findings include pes plans, lateral tibial torsion, and genu valgum. The position that the femur will be in is excessive:
a. Retroversion
b. Lateral rotation
c. Abduction
d. Medial rotation
Correct Answer: D
Common abnormal postural findings consistent with anterior knee pain in an adolescent female include pes plans, lateral tibial torsion, and genu valgum. These are compensatory changes that occur when the femur is in excessive medial rotation.
A therapist is examining a patient with superficial partial-thickness burns over
20% of the trunk. The correct identification of this burn type by surface appearance characteristics includes:
a. A dry surface with no blisters
b. Intact blisters and a moist, weeping surface if blisters are removed
c. A wet surface with broken blisters
d. Parchment-like, leathery, and dry surface
Correct Answer: B
The surface appearance of a superficial partial-thickness burn is characterized by intact blisters and moist, weeping or glistening surface when blisters are removed.
A 10-year-old presents with pain (4/10) and limited knee ROM (5°-95°) following surgical repair of the medial collateral ligament and ACLs. In this case, the modality that can be used with PRECAUTION is:
a. premodulated interferential current
b. continuous shortwave diathermy
c. low-dose ultrasound (US)
d. high-rate transcutaneous electrical stimulation
Correct Answer: C
Because the epiphyseal plates do not close until the end of puberty, US energy should be applied with caution around the epiphyseal area due to its potential to cause bone growth disturbances. However, there is no documented evidence that US creates an direct untoward effects on the growth plates, especially if applied at low dosage.
A CONTRAINDICATION to initiating extremity joint mobilization on a patient with chronic pulmonary disease may include:
a. Reflex muscle guarding
b. Long-term corticosteroid therapy
c. Concurrent inhalation therapy
d. Functional chest wall immobility
Correct Answer: B
Very often, patient with chronic pulmonary disease have been managed using corticosteroid therapy. Long-term steroid use has the catabolic effects of osteoporosis, weakened supporting joint structures and muscle wasting, making joint mobilization contraindicated.
Manual glide of the talus posteriorly within the ankle joint mortise can be used as a technique to increase:
a. Tibiotalar dorsiflexion motion
b. Talocalcaneal supination
c. Talocalcaneal pronation
d. Distal tibiofibular joint extensibility
Correct Answer: A
Based on the arthrokinematic convex-concave rules of motion, ankle joint dorsiflexion is described as occurring through a combination of anterior roll and posterior translation of the talus within the mortise joint. Dorsal glide of the talus would be utilized to improve ankle joint dorsiflexion if posterior translation of the talus is limited.
A patient with spastic hemiplegia is referred to physical therapy for ambulation training. The patient is having difficulty in rising to a standing position due to cocontraction of the hamstrings and quadriceps. The therapist elects to use biofeedback as an adiunct to help break up this pattern. For knee extension, the biofeedback protocol should consist of:
a. High-detection sensitivity, with electrodes placed far apart
b. High-detection sensitivity, with electrodes placed close together
c. Low-detection sensitivity, with electrodes placed close together
d. Low-detection sensitivity, with electrodes placed far apart
Correct Answer: C
When the electrodes are close together, the likelihood of detecting undesired motor unit activity from adjacent muscles (crosstalk) decreases. By setting the sensitivity (gain) low, the amplitude of signals generated by the hypertonic muscles would decrease and keep the EMG output from exceeding a visual or auditory range.
A baseball pitcher was seen by a PT following surgical repair of a SLAP (superior labral, anterior posterior) lesion of his pitching arm. In follow-up care, the therapist needs to pay attention to the pitching motion. The phase of the throwing motion that puts the greatest stress on the anterior labrum and capsule is:
a. Wind-up
b. Acceleration
c. Deceleration
d. Cocking
Correct Answer: D
During the cocking phase, the arm is taken into the end-range of humeral external rotation. At that point, the anterior aspects of the capsule and labrum are acting as constraints to prevent excessive anterior glide of the humerus.
A frail, elderly patient has recently been admitted to a skilled nursing facility following a fall-related injury (fractured hip with open reduction, internal fixation). The patient lived alone on the second floor and was unable to return home. The patient is extremely agitated over being in a nursing facility and demonstrates early signs of dementia, exclaiming to the PT,
“Leave me alone, I just want to get out of here!” An important approach to take while working with this patient is to:
a. Firmly state what the patient is expected to perform
b. Be calm and supportive, and use only one-or two-level commands
c. Minimize verbal communication and maximize guided movements
d. Promise anything to calm the patient down, as long as some walking
occurs
Correct Answer: B
An agitated patient with dementia does not process information easily. A calm and supportive approach with low-level commands (one or two actions) provides the best approach for this patient.
Upon examining a patient with vague hip pain that radiates to the lateral knee, the PT finds a negative FABERE test, a negative grind test and a positive Noble’s compression test. The dysfunction is
MOST LIKELY due to:
a. DJD of the hip
b. SI joint dysfunction
c. Irritation of the L5 spinal nerve root
d. An iliotibial band friction disorder
Correct Answer: D
A positive Noble’s compression test is an indication of an indication of an iliotibial band friction disorder
What common compensatory postures would a PT expect for a patient diagnosed with fixed severe forefoot varus?
a. Toeing-in and lateral rotation of the femur
b. Excessive midtarsal supination and lateral rotation of the tibia
c. Subtalar pronation and medial rotation of the tibia
d. Excessive ankle dorsiflexion and medial rotation of the femur
Correct Answer: C
In order to maintain the center of gravity over the base of support, the subtalar joint must pronate, and the entire lower quarter must medially rotate.
A weight lifter exhibits marked hypertrophy after embarking on a strength training regime. Hypertrophy can be expected to occur following at least:
a. 3-4 weeks of training
b. 1-2 weeks of training
c. 2-3 weeks of training
d. 6-8 weeks of training
Correct Answer: D
Hypertrophy is the increase in muscle size as a result of resistance training and can be observed following at least 6-8 weeks of training. Individual muscle fibers are enlarged, contain more actin and myosin and have more, larger myofibrils.
74.A patient with a diagnosis of chronic prostatitis is referred for physical therapy.
As part of a multidisciplinar treatment program, the therapist considers performing manual therapy compression techniques applied to tender, tight pelvic floor muscles. Which of the following muscles should the therapist target in this case?
a. Piriformis, gluteus medius, and pubococcygeus
b. Pubococcygeus, gluteus medius, and
obturator interns
c. Obturator interns, gluteus medius, and piriformis
d. Obturator internus, pubococcygeus, and piriformis
Correct Answer: D
Most men with chronic prostatitis have tenderness and tightness of the striated muscles of the pelvic floor. The goal of manual therapy compression techniques is to relax and lengthen those muscles, as well as to relieve the pain associated with palpable tender points (trigger points). Striated muscles of the pelvic floor that are frequently tight and painful in men with chronic prostatitis are the pubococcygeus. Obturator interns, and piriformis. The perineal body and bulbospongiosus muscle are also frequently tender.
An elderly patient is being examined by the PT. The PT notes an irregular, dark-pigmented ulcer over the medial malleolus. The patient states this is not painful. The MOST LIKELY diagnosis is:
a. Arterial ulcer
b. Diabetic ulcer
c. Venous ulcer
d. Arterial insufficiency
Correct Answer: C
This patient is demonstrating signs and symptoms of a venous ulcer: irregular, dark pigmentation; usually shallow, and appearing on the distal lower leg (medial malleolus is the most common area). There is little pain associated with venous ulcers.
A patient with COPD is sitting in a bedside chair. The apices of the lungs in this position compared with other areas of the lungs in this position would demonstrate:
a. Increased volume of air at REEP
b. The highest changes in ventilation during the respiratory cycle
c. Increased perfusion
d. The lowest oxygenation and highest carbon dioxide content in blood exiting this zone
Correct Answer: A
The gravity-independent area of the lung in the upright sitting position refers to the apices of the lungs, which house the most air at resting end expiratory pressure (REEP).
The gravity-dependent area of the lungs in the upright sitting position refers to the bases of the lungs, which will house the most pulmonary perfusion. The relative increase in blood in the pulmonary capillaries around the alveoli in the bases results in less room for air in those alveoli. Because there is a relative decrease in blood in the pulmonary capillaries around the alveoli in the apices, there is more room for air.
An elderly patient is referred to physical therapy following a recent compression fracture at T8. The medical history includes osteoporosis and gastroesophageal reflux diease (GERD).
The patient is currently taking antacids.
Which of the following is MOST important for the therapist to consider in the POC?
a. Schedule therapy sessions at least 90 minutes after eating
b. Recommend an over-the-counter proton pump inhibitor (PP|) medication
c. Include sit-ups in supine to strengthen abdominals
d. Ensure that the patient eats a small snack before starting exercise
Correct Answer: A
Gastric contents reflux into the esophagus in
GERD. Scheduling therapy at least 90 minutes after eating reduces the possibility of food remaining in the stomach and aggravating the esophagus during therapy.
In a patient demonstrating early lift-off during the preswing phase of gait, the mobility of which joints of the ankle and foot are important for assessing the ability to maintain forward progression of the foot?
a. Talocrural and first metatarsophalangeal joints
b. Talocruaral and talonavicular joints
c. Subtalar and talonavicular joints
d. Subtalar and first matatarsophalangeal joints
Correct Answer: A
The primary motions of the talocrural and first metatarsophalangeal joints are plantarflexion and dorsiflexion in the sagittal plane. Normal forward progression of the ankle and foot during late stance period (terminal stance and preswing) requires ankle and great toe dorsiflexion.
An elderly patient with a transfemoral amputation is having difficulty wrapping the residual limb. The PT’s BEST course of action is to:
a. Apply a temporary prosthesis immediately
b. Consult with the vascular surgeon about the application of an Unna’s paste dressing
c. Use a shrinker
d. Redouble efforts to teach proper Ace bandage wrapping
Correct Answer: C
A shrinker is a suitable alternative to elastic wraps. It is important to select the right size shrinker to limit edema and accelerate healing.
80.A patient is being treated for secondary lymphedema of the right arm as a result of a radical mastectomy and radiation therapy. The resulting edema (stage 1) can BEST be managed in physical therapy by:
a. Isometric exercises, extremity positioning in elevation, and compression bandaging
b. Intermittent pneumatic compression, extremity elevation, and massage
c. AROM and extremity positioning in a functional arm/hand position
d. Isokinetics, extremity positioning in elevation, and massage
Correct Answer: B
Lymphedema after surgery and radiation is classified as secondary lymphedema. Stage 1 means that there is pitting edema that is reversible with elevation. The arm may be normal size first thing in the morning, with edema developing as the day goes on. It can be effectively managed by external compression and extremity elevation. Manual lymph drainage (massage and PROM) are also appropriate interventions.
