SUSIEG 2018 C Flashcards
After an uncomplicated acute myocardial infarction (MI), under what circumstances should a patient be administered a graded exercise test (GXT) before hospital discharge?
A. Symptom-limited GXT at 10 days post MI.
B. Low level GXT at 4 to 6 days post MI.
C. GXT to 85% age predicted maximum HR 3 to 5 days post MI.
D. GXT to 75% age predicted maximum HR 4 to 6 days post MI.
Answer: B
Submaximal GXT can be administered before hospital discharge at 4 to 6 days post acute MI.
Low-level exercise testing provides data for recommendations for ADL and early ambulatory exercise therapy. This amount of activity doesn’t place too much demand on the healing myocardium (ACSM guidelines for Exercise Testing and Prescription, 8’ ed.).
A newborn is examined at birth using the APGAR test. Which of the following APGAR results is a likely indicator of potential neurological complications?
A. 3 at 10 minutes
B. 9 at 1 minute.
C. 8 at 1 minute.
D. 8 at 5 minutes.
Answer: A
The APGAR score is based on heart rate (HR), respiration, muscle tone, reflex irritability (grimace), and color (appearance). APGAR scores are routinely assigned at 1 and 5 minutes and occasionally at 10 minutes postbirth.
APT requested that a physical therapy assistant (PTA) perform ultrasound (US) to the shoulder of a patient. During the treatment session, the patient experienced an electrical shock. In which situation would the PT be responsible for any injury the patient might receive?
A. Faulty circuitry.
B. The PTA failing to use a ground fault interrupter (GFI).
C. The patient touching the US device during treatment.
D. The PT having instructed the PTA to use a device that had malfunctioned on the previous day.
Answer: D
The PT in this case correctly delegated the US treatment to the PTA. Every individual (PT, PTA) is liable for their own negligence; however, supervisors may assume liability of workers if they provide faulty supervision or inappropriate delegation of responsibilities (not evident in this case). PTs are liable for use of defective equipment if they contributed to its malfunction or continued to have it used in treatment without having it checked.
A patient with coronary artery disease received inpatient cardiac rehabilitation after a mild myocardial infarction (MI). The patient is now enrolled in an outpatient exercise class that utilizes intermittent training. What is the BEST initial spacing of exercise/rest intervals to safely stress the aerobic system?
A. 5:1
B. 1:1
C. 10:1
D. 2:1
Answer: D
Presuming that the exercise goals for inpatient cardiac rehabilitation are met, an exercise/rest ration of 2:1 can be used with this patient to begin exercise in an outpatient setting in a safe
manner.
What is the BEST initial intervention to improve functional mobility in an individual with a (stable humeral neck fracture?
A. Isometrics for all shoulder musculature.
B. Heat modalities
C. Active resistive range of motion (ROM)
D. Pendulum exercises.
Answer: D
This individual will typically be immobilized with a sling for a period of 6 weeks. After 1 week, the sling should be removed to have the patient perform pendulum exercises to prevent shoulder stiffness.
A patient with unilateral spondylolysis at L4 is preferred for physical therapy. The patient complains of generalized lower back pain when standing longer than 1 hour. Which (strengthening exercise is BEST fot the subacute phase of this patient’ rehabilitation?
A. Multifidi working from neutral to full extension
B. Abdominals working from neutral to full flexion.
C. Multifidi working from full flexion back to neutral.
D. Abdominals working from full extension to full flexion.
Answer: C
Performing strengthening exercise to the multifidi from flexion to neutral will not stress the pars defect.
A patient has fixed forefoot varus malalignment. What possible compensatory motion or posture might occur?
A. Excessive subtalar pronation.
B. Ipsilateral pelvic external rotation.
C. Hallux varus.
D. Genu recurvatum.
Answer: A
Possible compensatory motions or postures for forefoot varus malalignment include excessive midtarsal or subtalar pronation or prolonged pronation; plantarflexed first ray; hallux valgus; or excessive tibial; tibial and femoral; tibial, femoral and pelvic internal rotation; and/or with contralateral lumbar spine rotation.
A patient presents with fingertips that are rounded and bulbous. The nail plate is more convex than normal, These changes are the likely result of which condition?
A. Psoriasis.
B. Chronic hypoxia from heart diease.
C. Inflammation of the proximal and lateral nail folds.
D. Trauma to the nail bed.
Answer: B
Chronic hypoxia from heart disease or lung cancer and hepatic cirrhosis leads to clubbing of the fingers, characterized by fingertips that are rounded and bulbous and a nail plate that is more convex than normal.
The PT is examining a patient for right neck pain and spasms. Several inflamed submandibular nodes are noted. The nodes are approximately 1.0 cm in size, tender, and erythematous. The patient has no known history of cancer or metabolic diseases. What is the FIRST action the therapist should take?
A. Question the patient regarding impact of neck pain and emotional distress.
B. Question the patient regarding any recent dental or throat infections.
C. Have another therapist confirm the findings before implementing treatment.
D. Apply superficial heat and begin manual lymphatic drainage.
Answer: B
Typically, lymph nodes are not palpable, but they can become palpable in the presence of infection or metastases. Past medical history is instrumental to identifying when follow-up is required by the physician. Recent infections (especially dental or pharyngeal) can make the lymph nodes swollen, tender, erythematous, and/or firm. Medical referral is necessary.
10.A PT is reviewing a medical record prior to examining a patient for the first time. The suspected diagnosis is multiple sclerosis. On the neurologist’s note, the therapist finds the following: deep tendon reflex (DTR); right quadriceps is 2+, left quadriceps is 4+. What is the correct interpretation of these findings?
A. The right DTR is normal, the left is abnormal.
B. Both DTRs are abnormal and indicative of hyporeflexia.
C. The right DTR is exaggerated, the left is clearly abnormal.
D. Both DTRs are abnormal and indicative of upper motor neuron (UMN) syndrome.
Answer: A
DTRs are graded on a 1-4 scale. Scores include 0 (no response); 1+ (present but depressed; 2+ (normal); 3+ (increased, brisker than average; possibly but not necessarily); and 4+ (very brisk, hyperactive, with clonus, abnormal). In this case, the right DTR is normal; the left is abnormal and consistent with strong hypertonicity.
11.A patient has an episode of syncope in the physical therapy clinic. The therapist attempts to rule out orthostatic hypotension as the cause of the fainting. What is the BEST test protocol to use?
A. Palpate the carotid arteries and take resting HR and BP in the supine position.
B. Take resting HR and BP in supine, then in sitting, then in standing after 1 minute.
C. Take resting HR and BP in supine after 5 minutes, then in semi-Fowler position.
D. Take resting HR and BP in sitting and after 3 and 5 minutes of cycle ergometry exercise.
Answer: B
Orthostatic hypotension is a fall in BP with elevation of position; thus responses to movements (HR and BP) are tested from supine to sitting or sitting to standing. A small increase or no increase in HR upon standing may suggest baroreflex impairment. An exaggerated increase in HR upon standing may indicate volume depletion.
12.An impatient with a grade III diabetic foot ulcer is referred for physical therapy. Panafil has been applied to the necrotic tissue BID. The wound has no foul smell; however, the therapist notes a green tinge on the dressing. What is the BEST action for the therapist to take?
A. Fit the patient with a total contact cast.
B. Document the finding and contact the physician immediately.
C. Begin a trial of acetic acid to the wound.
D. Document the finding and continue with treatment.
Answer: D
In this case, the therapist should document the findings and continue with treatment. Panafil is a keratolvtic enzyme used for selective debridement. A greenish or yellowish exudate can be expected.
13.A PT receives a referral to examine the fall risk of an elderly patient with Parkinson’s disease who lives alone and has had two recent falls. Which activity is the MOST common reason for falls in the elderly?
A. Walking with a roller walker with hand brakes.
B. Climbing on a step stool to reach overhead objects
C. Turning around and sitting down in a chair.
D. Dressing while sitting on the edge of the bed.
Answer: C
Most falls occur during normal daily activity. Getting up or down from a bed or chair, turning, bending, walking, and climbing/descending stairs are all high-risk activities.
14.A patient with Addison’s disease is referred for physical therapy following a hip fracture.
Which of the following is a cardinal symptom of Addison’s disease?
A. Weight gain
B. Tremors
C. Asthenia
D. Diarrhea
Answer: C
The cardinal symptom of Addison’s disease is asthenia. The weakness is slowly progressive and debilitating.
15.A2-month-old child with bilateral hip dislocations is being discharged from an acute pediatric facility. The PT has developed a home exercise program and now needs to instruct the patients. What is the MOST important item for the therapist to assess before instructing the parents?
A. Their degree of anxiety and attention.
B. Their knowledge of the etiology of the hip dislocations.
C. The home environment.
D. The financial reimbursement plan.
Answer: A
A needs assessment should include a determination of the level of anxiety and ability to attend to the instructions given, If anxiety is high and the parents are unable to attend to the therapist’s instructions, risk of failure to perform the home exercises correctly is high.
16.A PT receives a referral for a young child that had been swung around while being held from the wrists. The referral reads, “functional disuse following nursemaid’s elbow.” Which of the following commonly results from a forceful longitudinal pull of the forearm of a child?
A. Superior subluxation of the radial head from the annular ligament.
B. Inferior subluxation of the ulna from the annular ligament.
C. Superior subluxation of the ulna from the annular ligament
D. Inferior subluxation of the radial head from the annular ligament.
Answer: D
The inferior subluxation of the radial head from the annular ligament typically occurs with a forceful longitudinal pull of the forearm in a child. It is also known as “baby sitter’s elbow.
17.Which is typical early clinical manifestation of cystic fibrosis (CF)?
A. Increase in secretions of the endocrine system.
B. Frequent recurrent urinary tract infections.
C. Excessive appetite and weight loss.
D. Increased FEV: (forced expiratory volume in 1 sec) during pulmonary function testing.
Answer: C
CF is an inherited disorder affecting the exocrine glands of the hepatic, digestive, and respiratory systems. The patient with CF is prone to chronic bacterial airway infections and progressive loss of pulmonary function from progressive obstructive lung disease. Early clinical manifestations include an inability to gain weight despite an excessive appetite and adequate caloric intake.
Which of the following activities demonstrates an infant’s integration of the asymmetrical tonic neck reflex?
A. Turns head to one side and brings opposite hand to mouth.
B. Can turn head to either side with extended arms.
C. Turns head to one side and brings hand to mouth on the same side.
D. Turns head to one side and looks at the extended arm on that side.
Answer: C
ATNR causes extension of upper extremity on the side the head is turned toward. Bringing the hand to the mouth would not be possible with an obligatory reflex.
19.A Physical therapy aide is cleaning a mat table with a new product supplied by the housekeeping department. The spray from the cleaning agent contact the skin resulting in irritation, redness, and some swelling. The symptoms were minor and abated within 20 minutes. Later, the aide informed the physical therapy supervisor of this situation. What action should the supervisor take?
A. Initiate first aid by rinsing the affected area with a skin cleanser and applying cortisone cream for the inflammation.
B. Inform housekeeping to immediately cease using the cleaning agent.
C. Fill out an incident/occurrence report and have the aide examined by employee health or their own primary care physician.
D. Fill out an incident/occurrence report and review the Material Safety Data Sheet (MSDS) from occupational Safety and Health Administration (OSHA) with the aide on how to properly handle the cleaning agent.
Answer: D
Material Safety Data Sheets are mandated by OSHA of the U.S Department of Labor, Thses sheets give employees information about potentially hazardous materials in the workplace and how to protect themselves. An incident/occurrence report is used to document situations that involve patients or staff that could have resulted in potential long-lasting or permanent harm and are part of an internal quality improvement program. The use of this cleaning agent may have some specific directions in method of application and precautions needed to be observed by the user. The MSDS would make this clear.
20.During surgery an apical lung tumor, the long thoracic nerve was injured. Muscle testing of the serratus anterior demonstrates its strength to be 3+/5. What is the BEST initial exercise for this patient?
A. Standing wall push-ups.
B. Standing arm overhead lifts using hand weights.
C. Supine arm overhead lifts using weights.
D. Sitting arm overhead lifts using a pulley.
Answer: A
The long thoracic nerve supplies serratus anterior muscle. With a muscle grade of 3+/5, the patient can then begin functional strengthening using standing wall push-ups, with resistance (provided by the patient’s own body.
21.A PT examination reveals posterior superior iliac spine (PSIS) is low on the left; anterior superior iliac spine (ASIS is high on the left; standing flexion test shows that the left PSIS moves first and farthest superiorly; Gillet’s test demonstrates that the left PSIS moves interiorly and laterally less than right; long sitting test shows that the left malleolus moves short to long; and the sitting flexion test is negative. Based on these findings, what is the therapist’s diagnosis?
A. Left upslip
B. Iliac inflare on the left
C. Left posterior rotated innominate
D. Left anterior rotated innominate
Answer: C
A posterior rotated innominate is a unilateral iliosacral dysfunction. The question outlines positive physical findings, both static and dynamic, found with this dysfunction. One of these positive findings alone does not confirm the diagnosis of left rotated posterior innominate.
22.A patient recovering from a burn on the back of the hand is referred to physical therapy for mobilization exercises. The therapist observes a 14-em irregular area that is thick and pink.
How should the therapist document this finding?
A. Hypertrophic scarring
B. An excoriation
C. Atrophic scarring
D. A scale
Answer: A
Hypertrophic scars are thick (raised) and pink (or red).
23.A patient presents with partial-and full-thickness burns on the chest and neck regions, The therapist decides to apply transcutaneous electrical nerve stimulation (TENS) before debridement to modulate pain. Which TENS mode should provide the BEST relief?
A. Acupuncture-like (low-rate) TENS
B. Brief intense TENS
C. Modulated TENS
D. Conventional (high-rate) TENS
Answer: B
Brief intense TENS is used to provide rapid-onset, short-term relief during painful procedures.
The pulse rate and pulse duration are similar to conventional TENS; however, the current intensity is increased to the patient’s tolerance.
24.A patient recovering from traumatic brain injury (TBI) demonstrates difficulties in feeding resulting from an unstable posture while sitting, The therapist determines that modification is necessary to ensure optimal function. What is the first body segment or segments that the therapist should align?
A. Trunk
B. Pelvis
C. Head
D. Lower extremities
Answer: B
Modification of the pelvic position in a neutral posture promotes good lumbar and trunk alignment. Many postural problems are correctable by aligning the pelvis first and achieving a stable base.
25.A patient demonstrates some out-of-synergy movements in the right upper extremity indicative of stage 4 recovery after a left cerebrovascular accident (CA). Which proprioceptive neuromuscular facilitation (PNF) pattern represents the BEST choice to promote continued recovery of the right upper extremity?
A. Bilateral symmetrical D2F and D2E, elbows straight
B. Chop, reverse chop with right arm leading
C. Lift, reverse lift with right arm leading
D. Bilateral symmetrical D1 thrust and reverse thrust
Answer: B
Both chop and reverse chop patterns move the affected arm out-of-synergy
26.An elderly individual has limited endurance as a result of a sedentary lifestyle. There is no history of cardiorespiratory problems. An exercise tolerance test was negative for coronary heart disease. What is the BEST initial exercise prescription for this individual?
A. 40%-50% HR max
B. 35%-50% of VO2max
C. 60%-90% HR max
D. 30%-50% HRmax
Answer: C
An appropriate initial exercise prescription for an asymptomatic elderly individual with general deconditioning is 60%-90% of HRmax which is equivalent to 50%-85% of HR reserve (Karvonen’s formula). This is within the established intensity guidelines for adults for aerobic exercise training. Duration should be discontinuous, and exercise should be performed most days of the week (ACSM guidelines for Exercise Testing and Prescription, 8’ ed.).
27.A patient is admitted to a coronary care unit with a mild myocardial infarction (MI). after 2 days, the patient is referred to physical therapy for inpatient cardiac rehabilitation. During an initial exercise session on the unit, the patient reports chest pain, appears anxious and wants to go back to bed to rest. What is the therapist’s BEST initial course of action?
A. Assist the patient back to bed and contact the charge nurse on the floor.
B. Sit the patient and monitor vital signs carefully during the rest period.
C. Assign the PTA to assist the patient back to bed and monitor vital signs carefully
D. Terminate the exercise and contact the attending physician immediately
Answer: B
If the chest pain (angina) is exercise induced, this is an indication to stop the exercise session and provide a period of rest during which time the patient is closely monitored. Recovery is expected after a period of rest.
28.A patient with a 10-year history of sIcleroderma is referred for physical therapy to improve functional status and endurance. The patient was recently treated with corticosteroids for a bout of myositis. Examination findings reveal limited ROM and fibrotic soft tissue along with hyperesthesia. What is the BEST choice for initial intervention?
A. Treadmill walking using body weight support at an intensity of 40% HRmax
B. Active range of motion (AROM) exercises and walking in a therapeutic pool
C. Closed-chain and modified aerobic step exercises
D. Soft tissue mobilization and stretching
Answer: B
Scleroderma (progressive systemic sclerosis) is a chronic, diffuse disease of connective tissues causing fibrosis of skin, joints, blood vessels, and internal organs. Patient typically demonstrate symmetrical skin thickening and visceral involvement of the gastrointestinal tract, lungs, heart, and kidneys along with hypersensitivity to touch. The BEST choice for initial intervention is to exercise in the pool. The warmth and buoyancy of the water will enhance the patient’s movements and decrease pain.
29.A patient is referred to physical therapy after a fall injury (fractured left hip with operative reduction, internal fixation [ORIF]). Medical history reveals a diagnosis of mild Alzheimer’s type dementia (AD). Given this stage of AD, which change should not be evident in this patient?
A. Profound communication deficits
B. Memory loss
C. Anxiety and irritability
D. Difficulty concentrating
Answer: A
Profound communication deficits (inability to speak), global deterioration of mental functions (delusions, hallucinations, fragmented memory), agitation, and pacing (sundowning) are all characteristic of later stages of AD.
30.A patient recovering from stroke with minimal lower extremity weakness and spasticity is able to walk without an assistive device. The therapist observes that as the patient walks there is noticeable hip hiking on the more affected side during swing phase. What is the BEST initial intervention?
A. Bridging exercises progressing to sit-to-stand training.
B. Marching while sitting on a therapy ball.
C. Standing and marching with manual pressure applied downward on the pelvis
D. Partial wall squats using a small ball held between the knees.
Answer: B
Hip hiking is a compensatory response for weak hip and knee flexors or extensor spasticity.
Active exercises for the hip and knee flexors (marching) is the most appropriate intervention.
The therapist is instructing a patient with traumatic brain injury (TBI) how to lock the brakes on a wheelchair. The patient is right-handed, and the right upper extremity is more affected than the left. What is the BEST motor learning strategy to use with this patient?
A. Have the patient practice brake locking using the left hand to assist the right.
B. Guide the patient’s right hand through the locking motions, then the left.
C. Verbally talk the patient through the locking motions, practicing with both hands simultaneously.
D. Have the patient practice locking the brakes first with the left hand and then with the right.
Answer: D
Using the motor learning strategy of transfer of training is best to use with this patient. Practice is performed with the less affected extremity first and then progressed to use of the more affected extremity.
32.In neural tension testing, what position will BEST bias the tibial nerve?
A. Straight leg raise with plantarflexion and eversion
B. Straight leg raise with dorsiflexion and inversion
C. Straight leg raise with plantarflexion and inversion
D. Straight leg raise with dorsiflexion and eversion
Answer: D
A straight leg raise with dorsiflexion and eversion will best bias the tibial nerve. This is the optimal position for neural tissue provocation of the tibial nerve. Neural tension techniques are used to decreaseadverse mechanical tension on the nerves. Peripheral nerves can often become trapped within the tissues, where there can be a pull on the nerve with movement. This technique frees up the nerve so that it can slide in its sheath.
33.A therapist is examining a patient with chronic obstructive pulmonary disease (COPD)
GOLD stage III. What would be a clinical finding that the therapist would expect for this patient?
A. Decreased anteroposterior to lateral chest ratio.
B. Muscle wasting.
C. Use of supplemental oxygen.
D. Weight gain.
Answer: B
Muscle wasting is a common manifestation of COPD. The cause of muscle wasting is not clear, but it is not simply a malnutrition problem. The results of this muscle wasting are peripheral weakness, impaired functional abilities, poor quality of life, and a poor prognostic sign.
34.What muscle length test for the tensor fascia lat is recommended in a patient with decreased muscle length of the rectus temoris?
A. Modified Ober test (knee extended).
B. FAIR (flexion, adduction, internal rotation) test.
C. Ober test (knee flexed).
D. Ely’s test.
Answer: A
The modified Ober test is performed with the knee extended, which allows the patient to attain the necessary hip extension required to assess the tensor fascia lata.
35.During a postural screen for chronic shoulder pain, the therapist observes excessive internal rotation of the shoulders and winging of the scapula during overhead motion, What is the BEST choice for exercise intervention?
A. Strengthening of rhomboids and stretching of upper trapezius.
B. Strengthening of pectoral muscles and stretching of upper trapezius.
C. Strengthening of upper trapezius and stretching of pectoral muscles.
D. Strengthening of middle and lower trapezius and stretching of pectoral muscles.
Answer: D
Abnormal posture that produces excessive internal rotation of the shoulders may result in chronic shoulder impingement syndrome due to a loss of scapular stability with overhead motion. Shoulder pain is likely to continue until a balance between anterior and posterior trunk musculature is achieved. The anterior chest muscles (pectorals) are shortened and need stretching and posterior trunk muscles (middle and lower trapezius) are stretched and need strengthening.
36.Examination of a patient with a dermal ulcer over the coccyx reveals a wound exposing the deep fascia. There is no necrotic tissue, exudate is minimal, and the borders of the ulcer are diffusely covered with granulation tissue. Previous treatment has included wet-to-dry dressings with normal saline. What is the BEST choice for intervention?
A. Hydrogel dressings and whirlpool immersion
B. Continuation of the same treatment
C. Wound irrigation with pressures below 15 psi
D. Calcium alginate dressings
Answer: C
Low -pressure wound irrigation helps to decrease colonization and prevent infection.
37.Based on the spinal defect shown in the diagram, what lumbar spinal motion should be avoided?
A. Rotation
B. Extension
C. Lateral flexion
D. Flexion
Answer: B
With spondylolisthesis, there is typically an anterior slippage of one vertebra on the vertebra below. Because of the anterior shearing forces acting at the vertebra caused by the wedge shape of the vertebra and gravity, spinal extension positions should be avoided.
38.A computer specialist is unable to work because of weakness and altered sensation in the dominant right hand. The patient complains of pain and tingling of the thumb, index finger, long finger, and radial half of the ring finger. The therapist observes thenar weakness and atrophy. Strength, reflexes, and sensation are within normal limits throughout the remainder of the right upper extremity. These signs and symptoms are characteristic of what diagnosis?
A. Ulnar nerve compression
B. Carpal tunnel syndrome
C. Pronator teres syndrome
D. Cervical root compression
Answer: B
The pattern of motor and sensory loss corresponds to the median nerve distribution in the hand.
The most likely cause is carpal tunnel syndrome.
39.A patient presents with rapidly progressive symmetrical weakness that started in the distal lower extremity muscles but now has ascended to include proximal trunk and upper extremity muscles. The motor segments of the lower cranial nerves are also showing impairment. The patient complains of abnormal sensations of tingling and burning of the affected extremities. Consciousness, cognition, and communication are all normal. These signs and symptoms are characteristic of what diagnosis?
A. Multiple sclerosis
B. Guillain-Barre syndrome
C. Amyotrohic lateral sclerosis
D. Postpolio syndrome.
Answer: B
These signs and symptoms are characteristic of Guillain-Barre syndrome, a peripheral neuropathy in which there is inflammation and demyelination of peripheral motor and sensory nerve fibers, Early in its progression, either upper or lower motor signs may predominate.
40.A patient recovering from surgery for triple coronary artery bypass grafts is scheduled to begin a phase III cardiac rehabilitation program. During the resistance training portion of the circuit training program, the therapist instructs the patient to avoid the Valsalva maneuver.
What are the expected adverse effects of the Valsalva maneuver?
A. Slowing of pulse and increased venous pressure are possible.
B. The decreased return of blood to the heart can lead to pitting edema.
C. Heart rate (HR) and blood pressure are likely to be elevated.
D. A cholinergic or vagal response can occur.
Answer: A
The Valsalva maneuver results from forcible exhalation with the glottis, nose, and mouth closed. It increases intrathoracic pressures and causes slowing of the pulse, decreased return of blood to the heart, and increased venous pressure. Although Valsalvas occur during normal daily activities (breath holding, straining), they can be dangerous for patients with cardiovascular disease. On relation, blood rushes to the heart and can overload the cardiac muscle, resulting in cardiac arrest:
41.A patient experiences color changes in the skin during position changes of the foot. During evaluation, pallor develops. When the limb is then positioned in the seated hanging position, hyperemia develops. What do these changes indicate?
A. Lymphedema
B. Arterial insufficiency
C. Deep vein thrombophlebitis
D. Chronic venous insufficiency
Answer: B
Arterial insufficiency can be determined by skin color changes during position changes of the foot (termed rubor of dependency test).
42.An elderly and frail adult is referred to physical therapy for an examination of balance. The patient has a recent history of falls (two in the last 6 months). Based on knowledge of balance changes in the elderly and scoring of standardized balance measures, which of the following test results BEST indicates increased fall risk?
A. Tinetti Performance Oriented Mobility Assessment (POMA) score of 27
B. Functional Reach of inches
C. Timed Get UP & GO (GUG) test result of 13 seconds.
D. Berg Balance score of 50
Answer: B
All of these instruments can be used to examine functional balance and fall risk. A functional
Reach score of <10 is indicative of increased fall risk.
43.During an examination, a patient complains of right upper quadrant pain and tenderness. The PT percusses over the costal margin at the point where the lateral border of the rectus muscle intersects with the costal margin. The patient complains of acute pain and stops inspiratory effort. What does this patient’s response indicate?
A. Hernia
B. Acute cholecystitis
C. Irritation of the psoas muscle by an inflamed appendex
D. Peritoneal inflammation
Answer: B
Percussion for costovertebral tenderness that reveals a sharp increase in tenderness with a sudden stop in inspiratory effort is a positive Murphy’s sign and is indicative of acute cholecystitis.
44.A 72-year-old patient is walking on a treadmill in the physical therapy department while vital signs and pulse oximetry are being monitored. It is noted that the patient’s arterial oxygen saturation (SpOz) drops from 95% to 92%. What is the therapist’s BEST response to this change?
A. Place a 40% Oz face mask on the patient for the remainder of the exercise session.
B. Not use supplemental Oz
C. Place 2 L of Oz by nasal cannula on the patient for the remainder of the exercise session
D. Place a 100% O2 face mask on the patient for the remainder of the exercise session.
Answer: B
A 72-year-old patient would likely have a resting SpO2 of 95% from the changes associated wit aging alon. There is no need to supplement oxygen in this case.
45.The therapist is evaluating the needs of a young child who is diagnosed with myelodysplasia at the T10 level. What is the therapist’s BEST choice of mobility device for this child to use in the school environment?
A. Bilateral knee-ankle-foot orthosis (KAFO)
B. Parapodium
C. Bilateral hip-knee-ankle-foot orthosis (HKAFO)
D. Lightweight wheelchair
Answer: D
The lightweight wheelchair is the MOST beneficial choice for this child. It provides effective and efficient mobility.
46.A patient has limited right rotation caused by left thoracic facet joint capsular tightness at
T6-7, what arthrokinematic glide would MOST effectively improve right rotation in sitting?
A. Superior and anterior glide on the right T7 transverse process.
B. Superior and anterior glide on the left T7 transverse process.
C. Superior and anterior glide on the right T6 transverse process.
D. Superior and anterior glide on the left T6 transverse process.
Answer: D
Because the left thoracic facet joint capsule is restricting movement, motion that would stretch the capsule would facilitate improved right rotation. With right rotation, the left superior facets move upward (opening the joint and stretching the capsule) and the right facets move downward (closing the joint and putting the capsule on relative slack).
47.Which muscles provide fairly continuous activity during quiet standing when measure by
EMG?
A. Quadriceps femoris and anterior tibialis
B. Posterior tibialis and intrinsic foot muscles
C. Anterior tibialis and peroneals
D. Soleus and gastrocnemius
Answer: D
The soles and gastrocnemius muscles oppose the dorsiflexion moment that exists at the ankle as a result of the line of gravity, which falls slightly anterior to the lateral malleolus. This fairly continuous activity is crucial for maintaining balance during quiet standing.
48.A patient falls while walking in the parallel bars. The therapist is required to fill out an incident report of te event. In addition to the names of those involved, what information is required in an incident report?
A. A description of the event, where the patient was injured, and the corrective actions to be taken.
B. Witness reports and therapist’s opinion as to the cause
C. What occurred, when and where it occurred, and witness statements.
D. The cause of this fall and cross-references to others who gave fallen in the parallel bars
Answer: C
The typical information included on an incident report are the names of those involved, inclusive of witnesses, what occurred, when it occurred, and where it occurred.
49.A therapist is beginning manual lymphatic drainage for a patient recently diagnosed with secondary lymphedema in the left upper extremity following a radical mastectomy. What is the BEST choice for initial bandaging of the limb?
A. Long-stretch compression wrap (Ace wrap).
B. Custom-made low-elastic garment
C. Gauze wrap
D. Short-stretch compression wrap (comprilan®)
Answer: D
A short-stretch wrap has a low resting pressure and high working pressure. This means it has enough pressure to enhance lymphatic return at rest, improve the activity of the lymphangion (contractile unit of the lymphatic system), and facilitate increased return during muscle pumping activities.
50.An elderly individual was found unconscious at home and was hospitalized with a diagnosis of cerebrovascular accident (CVA). Examination by the PT reveals normal sensation and movement on the right side of the body with impaired sensation (touch, pressure, proprioception) and paralysis on the left side of the body. The left side of the lower face and trunk are similarly impaired. What is the MOST likely location of the CVA?
A. Left parietal lobe
B. Right parietal lobe
C. Left side of brain stem
D. Spinal cord
Answer: B
This patient demonstrates involvement of the long tract (sensory and motor) indicative of involvement of the contralateral cerebral cortex, parietal lobe.
51.The loss of sensory function in peripheral neuropathy is often among the first noticeable symptoms. With large fiber damage, what is the typical pattern of the sensory loss?
A. Allodynia of the feet accompanied by pronounced dorsiflexor weakness
B. Band-like dysesthesias and paresthesias in the hips and thighs
C. Paresthesias affecting primarily the proximal limb segments and trunk
D. Stocking and glove loss of light touch and position sense
Answer: D
Symmetrical involvement of sensory fibers, progressing from distal to proximal, is the hallmark of polyneuropathy. It is termed “stocking and glove distribution” and is the result of the dying back of the longest fibers in all the nerves from distal to proximal. Sensory symptoms include decreased sensation and pain, paresthesias, and dysesthesias (abnormal sensations such as numbness, tingling, or prickling).
52.The PT is supervising a phase II cardiac rehabilitation class of 10 patients. One of the patients, who is being monitored with radiotelemetry, is having difficulty. Which change would be a criterion for terminating this exercise session?
A. An increase in systolic BP to 150 and diastolic BP to 90
B. 1-mm ST segment depression, upsloping.
C. A second-degree atrioventricular (AV) heart block
D. An increase in HR 20 beats/minute above resting
Answer: C
Criteria for reducing exercise intensity or termination according to the American College of Sports Medicine include (1) onset of angina and other symptoms of exertional intolerance; (2) systolic BP≥ 240 mm Hg, diastolic BP ≥ 110 mm Hg; (3) > 1-mm ST segment depression, horizontal or downsloping; (4) increased frequency of ventricular arrhythmias; and (5) second-degree or third-degree AV block or other significant electrocardiogram (ECG) disturbances.
53.A patient presents with severe claudication that is evident when walking distances greater than 200 feet. The patient also exhibits muscle fatigue and cramping of both calf muscles.
Upon examination, the PT finds the skin is pale and shiny with some trophic nail changes.
What is the BEST choice for this patient’s initial exercise program?
A. Avoid any exercise stress until the patient has been on calcium channel blockers for at least 2 weeks.
B. Begin with an interval walking program, exercising just to the point of pain.
C. Utilize non-weight-bearing exercises such as cycle ergometry.
D. Utilize a walking program of moderate intensity, instructing the patient that some pain is expected and to be tolerated.
Answer: B
This patient is exhibiting classic signs of peripheral artery disease (PAD). Rehabilitation guideline for arterial disease include using an intermittent walking program of moderate intensity and duration, 2-3 times/day, 3-5 days/wk. the patient should be instructed to exercise to the point of claudication pain within 3-5 minutes, not beyond.
54.A patient is hospitalized with diabetes and a large stage I plantar ulcer located over the right heel. The patient has been non-weight bearing for the past 2 weeks as a result of the ulcer.
What is the BEST choice for this patient’s initial intervention?
A. Wash the foot and apply skin lubricants followed by a transparent film dressing.
B. Clean and bandage with a sterile gauze dressing.
C. Refer the patient for a surgical consult
D. Clean and debride the wound and apply a hydrogel dressing.
Answer: D
A stage II ulcer (deep ulcer) involves a partial-thickness skin with involvement of epidermis, dermis, or both; it is reversible. Intervention should be directed toward improving perfusion and relieving localized pressure. The wound should be cleaned with an antimicrobial agent, debrided of necrotic tissue, and covered with a sterile dressing. Hydrogel dressings maintain moisture in the wound bed, soften necrotic tissue, and support autolytic debridement. Pressure relief is also an important consideration. Techniques of protective foot care should be taught.
55.A PT is prescribing a wheelchair for a patient with left hemiplegia who is of average height (5 feet 7 inches). Which of the following is the BEST choice to improve the patient’s function?
A. Desk armrests
B. A 20-inch seat height
C. A 17.5-inch seat height
D. Elevating leg rests.
Answer: C
A hemi-or low-seat wheelchair has a seat height of 17.5 inches. The lower seat height permits the patient to propel and steer the wheelchair using the sound right upper and lower extremities.
A patient who is participating in a cardiac rehabilitation program suddenly collapses and falls to the floor. The PT is the lone rescuer on site. The therapist checks for a response and finds the patient unresponsive. After activating the emergency response system (phone 911), what is the BEST action for the therapist to take?
A. Use the automated external defibrillator (AED to shock the patient after 3 minutes of cardiopulmonary resuscitation (CPR)
B. Begin CPR and attach and use the AED as soon as possible
C. Give 100 chest compressions per minute.
D. Give two rescue breaths followed by 15 chest compressions, repeating the cycle for at least 2 minutes.
Answer: B
guideline from the American Heart Association (2010) concerning Basic Life Support and CPR specify that the first responder call 911 for unresponsive adults, get an AED (if available), and return to the victim to provide CPR and defibrillation, if needed. Trained HCs can use ventilations (1 breath every 8 seconds) with chest compressions (at least 100/minute.
57.A patient who was caster for 3 weeks after a grade III right ankle sprain has been referred to physical therapy for mobility exercises. Examination shows a loss of 10° of dorsiflexion.
Which activity will be the MOST difficult for the patient?
A. Ambulating over rough surfaces
B. Descending stairs
C. Ambulating barefoot
D. Descending a ramp
Answer: B
Loss of dorsiflexion will make descending stairs most difficult because the ankle must have dorsiflexon during the single-limb support phase during descent.
What is the torque output produced in the sitting position during isokinetic exercise involving the hamstring muscle?
A. Higher than the torque actually generated by the contracting hamstrings.
B. Lower because of resistance of the quadriceps.
C. Higher because of eccentric assistance of the quadriceps.
D. Lower than the torque actually generated by the hamstrings
Answer: A
Gravity-produced torque adds to the force generated by the hamstrings when they contract, giving a higher torque output than is actually produced by the muscle (gravity-assisted exercise). Testing values may be misleading; software is available to correct for the effects of gravity.
59.Which is the BEST choice of manual therapy technique to correct a closing restriction of T5 on T6?
A. Unilateral posteroanterior (PA) pressure at a 60° angle on the left transverse process of
T6 while stabilizing T5.
B. Central PA pressure at a 60° angle on the spinous process of T6 while stabilizing T5
C. Unilateral PA pressure at a 45° angle on the right transverse process of T6 while stabilizing T5
D. Central PA pressure at a 45° angle on the spinous process of T5 while stabilizing T6
Answer: B
In a closing restriction, the inferior facets of the superior vertebrae will not inferiorly glide on the superior facets of the inferior vertebra. Therefore, T5 inferior facets will not caudally glide on the superior facets of 6. Stabilizing T5 and application of pressure to T6 localizes the cephalad movement of the superior facets T6 on T5 bilaterally. The angle of the thoracic facets is 60°; therefore, the application of force should be at the same plane.
60.A patient presents with an acute onset of vertigo overnight. Symptoms worsen with rapid change in head position. If the head is held still, symptoms subside usually within 30-60 seconds. What is the MOST likely cause of these symptoms?
A. Meniere’s disease
B. Benign paroxysmal positional vertigo (BPPV)
C. Bilateral vestibular neuritis
D. Acoustic neuroma
Answer: B
BPPV is characterized by acute onset of vertigo and is positional, related to the provoking stimulus of head movement.
61.A patient with a significant history of coronary artery disease is currently taking atropine.
Based on knowledge of this medication, what are the expected effects?
A. Increased HR and contractility at rest.
B. Increased myocardial ischemia.
C. Palpitations at rest and with exercise.
D. Orthostatic hypotension.
Answer: A
Atropine is an anticholinergic agent (it blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the central nervous system). It produces an increase in HR and contractility and is used to treat symptomatic sinus bradycardia and exercise-induced bronchospasm.
62.A patient recovering from stroke is taking warfarin (Coumadin). What potential adverse reactions are associated with this medication?
A. Hematuria and ecchymosis
B. Palpitations and edema
C. Edema and dermatitis
D. Cellulitis and xeroderma.
Answer: A
Warfarin sodium (Coumadin) is an anticoagulant indicated in the prophylaxis and treatment for venous trombosis, pulmonary embolism, and thromboembolic disorders. Potential adverse reactions include hematuria and ecchymosis (skin discoloration and hemorrhaging). Serious bleeding is possible with drug toxicity.
63.The PT review the laboratory results of a patient admitted to the acute care hospital
yesterday: Hematocrit 45%, fasting blood glucose 180 mg/dL, and cholesterol 180 mg/dL.
Based on these laboratory results, what condition is MOST likely?
A. Polycythemia vera
B. Hyperglycemia of diabetes
C. Anemia
D. Hyperlipidemia
Answer: B
Normal fasting blood glucose for adults is 65-99 mg/dL. A fasting blood glucose level of 180mg/dL is abnormal and indicative of hyperglycemia of diabetes.
64.A patient recovering from a stroke is having difficulty with stair climbing. During ascent, the patient is able to position the more involved foot on the step above but is unable to transfer the weight up to the next stair level. What is the BEST exercise intervention to remediate this problem?
A. Bridging, holding.
B. Standing, side steps.
C. Standing, partial wall squats
D. Plantigrade, knee flexion with hip extension
Answer: C
The quadriceps muscle is responsible for most of the energy generation needed to transfer up stairs to the next level. Partial wall squats are the BEST choice to strengthen these muscles (closed-chain exercise). During forward continuance (corresponding to mid-stance), the ankle plantarflexors assist. Hip extensors are also active concentrically, assisting these actions.
65.An elderly patient has been hospitalized and on complete bed rest for 10 days. A physical therapy referral requests mobilization out of bed and ambulation. The patient complains of aching in the right calf. The therapist’s examination reveals calf tenderness with slight swelling and warmth. What is the BEST course of action for the therapist?
A. Begin with ankle pump exercises in bed and then ambulate.
B. Postpone ambulation and report the findings immediately.
C. Ambulate the patient with support stockings on.
D. Use only AROM exercises with the patient sitting at the edge of the bed.
Answer: B
The patient is exhibiting early signs of acute deep vein thrombophlebitis (DVT). These findings should be reported immediately.
66.A 9-year-old boy with Duchenne’s muscular dystrophy is referred for home care. How should the therapist begin the examination?
A. Ask the parents to outline the boy’s past rehabilitation successes.
B. Ask the child and his parents to describe the boy’s most serious functional limitations
C. Perform a complete motor examination
D. Perform a functional examination using the weeFIM
Answer: B
The child and his parents/caretakers play an important part in determining impairments, functional limitations, disability, and future interventions. Taking a thorough initial history is important in determining what other components of the examination would be appropriate.
67.During an examination of an adolescent female who complains of anterior knee pain, the PT observes that the lower extremity shows medial femoral torsion and toeing-in position of the feet. What pathology of the hip is commonly associate with medial femoral torsion and toeing-in’?
A. Retroversion
B. Anteversion
C. Medial/internal rotation
D. Lateral/external rotation
Answer: B
The pathology commonly associated with medial femoral torsion and toeing-in is hip anteversion due to an increase in the antetorsion angle (>15°) between the femoral condyles and the neck of the femur.
68.A patient with osteoporosis and no fractures complains of increased middle and lower back pain during breathing and other functional activities. What is the MOST beneficial exercise intervention for this patient?
A. Trunk flexion and rotation exercises
B. Trunk flexion and extension exercises
C. Trunk extension and abdominal stabilization exercises
D. Trunk rotation and abdominal stabilization exercises.
Answer: C
It is important to strengthen from the core to the floor as well as train in proprioception and balance enhancement techniques. Trunk extension and abdominal stabilization exercises are indicated.
69.A single 22-year-old woman who is 3 months pregnant arrives at a therapist’s private practice complaining of shoulder and leg pain. She has a black eye and some bruising at the wrists. The state in which the therapist practices has direct access. What is the BEST course of action for the therapist?
A. Examine the patient, and if abuse is suspected, report the findings to the appropriate authorities
B. Administer massage for bruising, TENS, and ice modalities for pain, as indicated by the examination findings
C. Direct the patient to the nearest ambulatory care center for physician evaluation
D. Refuse to examine the patient and send her to the nearest emergency room
Answer: A
According to the American Physical Therapy Association’s (APTA) Guideline for Recognizing and Providing Care for Victims of Domestic Violence, this patient falls into a category of high risk. Women between the ages of 17 and 28 years and women who are single, separated, or divorced or who are planning a separation or divorce are at high risk. Battered women usually have more than one injury. Most injuries occur in the head, face, neck, breasts, and abdomen.
According to the American Medical Association (AMA), battered women represent 23% of pregnant women who seek prenatal care. The victim may not volunteer information about her situation, but more often than not when asked will reveal it.
It is important for the PT to examine the patient and, if abuse is suspected, report the findings to appropriate authorities. The therapist should be familiar with resources available for victims of domestic violence and their own state reporting laws.
70.An elderly patient presents with stage III decubitus ulcer on the plantar surface of the right foot. After a series of conservative interventions with limited success, the therapist chooses to apply electrical stimulation for tissue repair. What is the BEST electrical current to administer in this case?
A. Medium-frequency burst current
B. High-volt monophasic pulsed current
C. Medium-frequency beat current.
D. Low-volt biphasic pulsed current.
Answer: B
Because high-volt pulsed current is a monophasic, unidirectional current, the unidirectional current would produce a therapeutic effect at the active (treatment) electrode. A negative charge (polarity) should be applied for a bactericidal effect or a positive charge given to promote wound healing.
71.A patient presents with pain radiating down the posterior hip and thigh as a result of a herniated disc in the lumbar spine. The therapist decides to apply mechanical traction. If the patient can tolerate it, what is the preferred patient positon?
A. Supine with one knee flexed
B. Prone with pillow under the abdomen
C. Supine with both knees flexed
D. Prone with no pillow
Answer: D
Placing the patient in the prone position would better align the spine so that the pull of the traction would be along the axis of the vertebral bodies.
72.A patient recovering from stroke demonstrates hemiparesis of the right upper extremity with moderate flexion and extension synergies (flexion stronger than extension). The therapist’s goal is to strengthen the shoulder muscles first to promote elevation of the arm. What is the BEST exercise intervention to achieve this goal?
A. Shoulder abduction with elbow flexion
B. Shoulder flexion with elbow extension
C. Shoulder horizontal adduction with elbow extension
D. Shoulder horizontal adduction with elbow flexion
Answer: B
Obligatory hemiplegic synergies are present and should not be reinforced. Shoulder flexion with elbow extension is the correct choice. It is an out-of-synergy combination that strengthens the shoulder flexors needed to stabilize the shoulder in an elevated functional position. In sitting, bending forward with elbow straight and hand touching floor is a good example of an early activity to promote this.
73.A physical therapist shines a light into a patient’s eye and observes the pupil of the eye.
Constriction of the pupil results. Which cranial nerve is being tested?
A. Abducens
B. Trochlear
C. Optic
D. Oculomotor
Answer: D
The pupillary reflex (constriction of the pupil) is a function of the efferent portion of the oculomotor nerve (CN III).
74.A patient is referred for physical therapy after a graded exercise test (GXT). The physician reports the test was positive and had to be terminated at 7 minutes. Which of the following criteria is an absolute indication for terminating exercise testing?
A. Mild angina and dyspnea with progressive increases in the treadmill speed and grade
B. A hypertensive response with blood pressure of at least 170/95.
C. ST segment depression from baseline of 3-mm horizontal or downsloping depression.
D. ECG changes from baseline of 1-mm ST segment elevation.
Answer: C
A positive GXT indicates myocardial ischemia with increasing exercise intensities. The optimal test duration is 8-12 minutes but can be terminated if symptoms of exertional intolerance are evident. The American College of Sports Medicine (ACSM) indicates these include ECG changes from baseline (> 2 mm horizontal or downsloping; ST segment depression, or > 2 mm ST segment elevation).
75.A college soccer player sustained a hyperextension knee injury when kicking the ball with the other lower extremity. The patient was taken to the emergency room of a local hospital and was diagnosed with “knee sprain.” The patient was sent to physical therapy the next day for rehabilitation. As part of the examination, the therapist conducts the test shown in the figure. Based on a positive test, what type of exercise intervention is indicated during the acute phase of treatment?
A. Open-chain terminal knee extension exercises.
B. Closed-chain terminal knee extension exercises.
C. Plyometric functional exercises.
D. Agility exercises.
Answer: B
The test that was conducted was a Lachman’s test to determine integrity of the ACL. A positive test suggests laxity of the ACL. Closed-chain-terminal knee extension exercises are safe and effective secondary to the dynamic stability inherent with this type of exercise.
76.A patient with a grade III diabetic ulcer is being treated with a calcium alginate wound dressing. What are the primary indications for this type of wound dressing?
A. Provide semirigid support for the limb while maintaining a sterile field.
B. Facilitate autolytic debridement and absorb exudate.
C. Absorb exudate and allow rapid moisture evaporation.
D. Restrict bacteria from the wound while supporting the tissues.
Answer: B
Moisture-retentive occlusive wound dressings such as calcium alginate are recommended for use on exudating wounds (grade III ulcer). They maintain a moist wound environment, absorb exudate, provide autolytic debridement, reduce pain at the wound site, or promote faster healing (reepithelialization).
77.The PT receives a referral to treat a hospitalized patient with adhesive capsulitis. The patient is recovering from a recent hepatitis B infection. What precautions should the therapist observe?
A. Use of droplet transmission precautions
B. Use contact precautions
C. Ask the patient to wear gloves and avoid contact
D. Wear personal protection equipment (PPE) when transporting the patient to therapy.
Answer: B
Hepatitis B is a viral infection that is transmitted by close contact with the infected patient’s body fluids (nasopharyngeal exudate, saliva, sweat, urine, feces, semen, vaginal secretions) and blood and blood products. Health care workers should be vaccinated against the possibility of infection because they are in a high-risk category. Contact precautions should be observed to reduce the risk of microorganism transmission by direct or indirect contact.
78.A patient with a transtibial amputation is learning to walk using a patellar tendon-bearing
(PTB) prosthesis and is having difficulty maintaining knee stability from heelstrike to foot-flat. Which muscles are MOST likely weak?
A. Hip flexors
B. Back extensors
C. Knee extensions
D. Knee flexors
Answer: C
The knee extensors (quadriceps) are maximally active at heelstrike (initial contact) to stabilize the knee and counteract the flexion moment.
79.A Patient with a history of coronary artery disease and recent myocardial infarction (MI) is exercising in an impatient cardiac rehabilitation program. Because the patient is new, continuous ECG telemetry monitoring is being done. The therapist observes the following. What is the therapist’s BEST course of action?
A. Have the patient sit down, continue monitoring, and notify the physician immediately.
B. Activate the emergency medical response team
C. Have the patient sit down, rest, and then resume the exercise at a lower intensity.
D. Have the patient sit down and send him/her back to the room after a brief rest period.
Answer: A
This tracing shows premature ventricular contractions (PVCs) that are multifocal (originating from different irritable ventricular focus). These multiform PVCs pose a potential danger of deteriorating into ventricular tachycardia and ventricular fibrillation (cardiac standstill).
Because the heart is demonstrating a high degree of irritability, the BEST course of action is to stop the exercise, have the patient sit down, continue monitoring carefully, notify medical staff (attending physician) immediately.
80.A patient recovering from traumatic brain injury (TBI) is unable to bring the right foot up on the step during stair climbing training. What is the BEST choice to promote independent stair climbing for this patient?
A. Practice marching in place
B. Strengthen the hip flexors using an isokinetic training device before attempting stair climbing
C. Passively bring the foot up and place it on the 7-inch step
D. Practice stair climbing inside the parallel bars using a 3-inch step.
Answer: D
The most appropriate lead-up activity to promote the skill of stair climbing is practice using a 3-inch step in the parallel bars.
The picture depicts a patient who is learning to take her own pulse. What is the patient doing incorrectly?
A. Taking the pulse with the forearm supinated
B. Palpating the ulnar artery
C. Assessing the pulse with the thumb
D. Palpating the right arm as opposed to the more accurate left arm.
Answer: C
The thumb is pulsatile and cannot be used to assess a pulse.
The physical therapist is examining the muscle length of the patient’s left hip and knee.
What muscle length test is being shown in the picture below?
A. FABER test
B. Thomas test
C. Noble test
D. Ober test
Answer: B
The Thomas test is utilized to test for hip flexor length and to distinguish between one joint and two joint hip flexor tightness. Which low back and sacrum flat on the table, a normal one joint hip flexor length would be with thigh flat on the table. Normal two joint hip flexor length would be 80° of knee flexion.
The physical therapist is examining the patient’s left ankle. The test pictured below is testing the integrity of which structure?
A. Anterior tibiofibular ligament
B. Tibiotalar ligament
C. Calcaneofibular ligament
D. Anterior talofibular ligament
Answer: D
The special test being performed is the anterior drawer test of the ankle. This test is designed primarily to test for injuries to the anterior talofibular ligament. This is the most frequently injured ligament in the ankle. When the foot is in slight plantarflexion position the anterior talofibular ligament is perpendicular to the long axis of the tibia. A positive anterior drawer test may be obtained with a tear of only the anterior talofibular ligament, but anterior translation is greater if the calcaneofibular ligament is also torn. Ideally, the knee should be placed in 90° of flexion to alleviate tension on the Achilles tendon
The physical therapist is examining the muscle length of the patient’s right hip. What is the muscle length test pictured below?
A. Ober test
B. FABER test
C. Thomas test
D. Noble test
Answer: A
The Ober test is for tightness of the tensor fascia late and iliotibial band. With the pelvis stabilized and the hip kept in neutral rotation, the Ober test would be considered normal if the thigh drops slightly below horizontal.
- A patient is recovering from MI and is referred for supervised exercise training. While working out on a treadmill, the patient begins to develop mild shortness of breath.
Continuous telemetry monitoring reveals the following ECG rhythm. What is the correct interpretation of this rhythm?
A. Tachycardia with abnormal P waves
B. Sinus rhythm with upsloping ST segment depression
C. Sinus rhythm with sinoatrial blocks
D. Sinus rhythm with downsloping ST segment depression
Answer: B
This patient is exhibiting sinus rhythm with upsloping ST segment depression. An abnormal ECG response is defined as ≥ 1 mm of horizontal or downsloping at 80 sec beyond the J point. Associated clinical signs suggestive of myocardial ischemia include dyspnea and angina.
After a review of this patient’s exercise responses coupled with the ECG findings, the therapist correctly determines that the exercise session does not have to be terminated. The therapist should continue to closely monitor the patient’s responses.
