PEAT 3 Flashcards
During pregnancy, which of the following exercises is CONTRAINDICATED?
A. Curl-ups
B. Bridging
C. Double leg lifts
D. Deep breathing with forced expiration
C. During pregnancy and postpartum, the stretched abdominal muscles are unable to stabilize the lower back as the legs are raised. Attempting to perform double leg lifts can overwork the abdominal muscles and cause damage to spinal joints.
A target heart rate is determined for individuals entering a training program in order to:
A. regulate exercise intensity.
B. estimate energy expenditure
C. control blood pressure at a specific heart rate.
D. ensure that participants exercise at maximal capacity.
A. Exercise intensity can be expressed as oxygen uptake during activity. Heart rate and oxygen uptake have a relatively linear relationship. Therefore, utilizing a target heart rate will ensure that the appropriate exercise intensity is being achieved. Estimation of energy expenditure requires measurement of oxygen consumption that is then calculated into calories metabolized during the activity. Blood pressure cannot be controlled at specific heart rates. Exercising at maximal capacity does not achieve aerobic training benefits and is unsafe for the majority of patient populations.
For a child with Duchenne muscular dystrophy, the MOST appropriate physical therapy goal is:
A. prevention of contractures and determination of the best method of mobility
B. preservation of strength and muscle tone.
C. inhibition of abnormal muscle tone and facilitation of normal movement and postural reactions
D. facilitation of normal movement and improvement of strength.
A. Goals of PT intervention for a child with Duchenne muscular dystrophy are to retard the development of contracture and muscle weakness, which could lead to functional limitations, and thus, disability. The physical therapist would also play a role in determining the appropriate use of assistive devices that could help maintain the child’s mobility such as wheelchairs, walkers and orthoses. Muscle tone changes and declines in strength cannot be prevented since they are results of the disease process.
Outcomes of a prenatal exercise program would NOT include
A. improved body mechanics.
B. application of relaxation techniques.
C. improved ligamentous flexibility.
D. strengthened pelvic-floor musculature
C During pregnancy, the ligaments soften due to hormonal influences, and allow some degree of separation between the joint surfaces. Additional stretching of the ligaments could result in joint instability or injury, and would not be a goal of treatment. The remaining options are all appropriate interventions.
A patient has limited ankle dorsiflexion following open reduction and internal fixation of the distal tibia. Radiographs reveal that the fracture is well healed. Treatment with passive mobilization should include:
A. posterior glide of the talus on the tibia.
B. lateral glide of the calcaneus on the tibia.
C. posterior glide of the tibia on the talus.
D. anterior glide of the talus on the tibia.
A
The trochlea of the talus is convex. Therefore, during dorsiflexion of the ankle, the talus moves posteriorly relative to the tibia. To facilitate the movement of dorsiflexion one would need to perform a posterior glide of the talus on the tibia.
A patient who has recently and successfully completed a 12-week program of Phase III cardiac rehabilitation will MOST likely demonstrate a decrease in:
A. carbon dioxide elimination in maximal work
B. cardiac output in maximal work.
C. stroke volume at a given level of submaximal work.
D. heart rate at a given level of submaximal work.
D
Aerobic conditioning that occurs during the 12 weeks of cardiac rehabilitation will result in a decrease in heart rate both at rest and with exercise. CO2 elimination and cardiac output would both increase with maximal work. The stroke volume would increase during submaximal work.
Redness on the inferior aspect of the patella upon removal of a patellar-tendon-bearing prosthesis indicates that the residual limb:
A. is not far enough into the prosthesis, and fewer socks should be worn
B. is not far enough into the prosthesis, and additional socks should be worn
C. has slipped too far into the prosthesis, and fewer socks should be worn.
D. has slipped too far into the prosthesis, and additional socks should be worn
D The residual limb is pistoning up and down because the socket diameter is too large or the suspension system is inadequate, resulting in skin friction. The addition of more socks will enhance the fit.
A physical therapist is evaluating a patient with an acute lumbar disc protrusion and a right lateral shift of the thoracic spine. Which of the following findings is the BEST indicator that the symptoms will respond positively to physical therapy intervention?
A. The pain is referred only into the buttock and not the thigh
B. The patient prefers standing and walking to sitting.
C. There is a decrease in lumbar lordosis
D. Repeated backward bending centralizes the pain
D The fact that backward bending is centralizing the pain is an indicator that the nucleus of the disc is being moved centrally, and the pressure is being taken off of the nerve root. Centralization of the pain is also a good indicator for physical therapy intervention.
A physical therapist evaluates a patient who has lateral epicondylitis. The patient reports a subjective pain rating of 8/10. The patient also reports pain and shows weakness with resisted wrist extension. The therapist decides to use ice massage as an intervention. The MOST appropriate length of time for the ice massage is:
A. 10 minutes.
B. until the area turns red, and the patient reports a burning sensation
C. until the patient reports that the area feels numb
D. no longer than 5 minutes.
C Ice massage is usually applied to control pain, edema, or inflammation. In this case, the ice would be used for pain relief and to reduce inflammation, if present. The dosage for ice massage is determined by the patient’s response, and is usually applied until the patient experiences analgesia or reported numbness over the area of the massage. Although 5 to 10 minutes may be a usual time for the response to occur, the dosage depends on the patient’s response, not on an exact time. The patient will usually feel the following, sequential sensations during the massage: cold, burning, aching and then finally numbness. The desired effect is numbness, not aching. The skin may turn white; however, the desired effect is numbness or pain reduction and not skin color.
To conduct an experimental study on pain in postsurgical orthopedic patients, a physical therapist randomly assigns patients into 2 groups. One group is treated with transcutaneous electrical nerve stimulation, heat, and exercise; the second receives heat and exercise only. In this experimental design, transcutaneous electrical nerve stimulation is the:
A. continuous variable.
B. dependent variable
C. discrete variable
D. independent variable.
D The independent variable can be thought of as the cause or treatment and the dependent variable can be thought of as the effect or response. In this case the TENS is the treatment or independent variable. Continuous and discrete variables are methods of quantifying variables
It is important to perform cool-down exercises immediately following a general aerobic exercise program PRIMARILY in order to prevent:
A. venous pooling.
B. cardiac arrhythmia.
C. decreased body temperature
D. muscle tightening.
A During aerobic exercise, there is vascular dilation that occurs in order to optimize blood flow and the venous system relies on muscular pumping in order to return blood back to the heart.
Without a cool-down period, there would be no muscular pumping and therefore blood would pool in the venous system. Cardiac arrhythmia may occur as well, but is less likely in someone without cardiac disease. Cessation of activity by itself would result in a gradual decrease in body temperature and specific exercises are not necessary. Muscle tightening may occur as a result of metabolites accumulating in the circulatory system, but this would occur as a result of the venous pooling
The intervention for a patient who has right sciatic pain caused by piriformis compression should
NOT include:
A. instruction in mild self-stretching in sitting with the right hip and knee flexed and pressure applied in the medial direction to the distal thigh with the left upper extremity.
B. contract-relax exercises to the hip external rotators performed with the patient sidelying on the left and the right hip and knee positioned in 90° of flexion
C. active resistive strengthening exercises to the piriformis with the patient prone and the knee flexed.
D. application of cold to the area of sciatic nerve irritability.
C The piriformis muscle functions as an external rotator of the hip, and it is thought that a tight piriformis muscle may compress the sciatic nerve causing pain. Passive internal rotation and resisted external rotation may be painful. Intervention would call for stretching of the piriformis muscle, not strengthening it. Modalities such as ice may also be helpful to decrease the inflammation.
A physical therapist is assigned the planning and implementation of physical therapy service for all members of a community. The therapist’s FIRST step should be to:
A. develop a brochure for distribution to the community.
B. organize a health fair to provide screening for the community.
C. evaluate existing services and community resources.
D. initiate contacts in the medical community to establish prescriptive relationships.
C The most appropriate first step (pre-planning) would be to evaluate existing services within the community and work out a budget for the project. Options A and B, although important, are things that would most likely be done after the practice is up and running. Option D may be done early on in the planning process, but would follow Option C.
A patient is referred to physical therapy reporting severe pain in the right hip and groin area, which increases during walking. The patient reports tenderness when the therapist palpates the area over the right greater trochanter. The MOST likely cause of the patient’s signs and symptoms is:
A. sacroiliac joint derangement.
B. a hip fracture.
C. a strain of the adductor longus muscle.
D. hip bursitis.
D Signs and symptoms of hip bursitis include the following: severe pain over the bursa area, with pain aggravated by active motion including activities such as walking. Signs and symptoms of a sacroiliac joint derangement include pain directly over the region of the joint and in the low back, in addition to pain with walking. Signs and symptoms of a hip fracture will include the following: severe pain in the groin area and tenderness occurs in the area anterior to the femoral neck. An adductor longus muscle strain would not cause tenderness over the greater trochanter
When working with neurological patients to ensure that physical therapy services are adequately documented, it is MOST important to record changes in:
A. muscle tone.
B. functional abilities.
C. cognitive status.
D. quality of movement.
B All documentation about PT services should readily translate the physical findings (impairments) into functional abilities/limitations.
A patient has right hemiparesis resulting from a traumatic brain injury. When assessing motor control in the right lower extremity with the patient standing, the physical therapist finds that the patient cannot extend the hip while flexing the knee or flex the hip while extending the knee. In which of the following functional activities will this problem be MOST apparent?
A. Shifting weight while standing
B. Walking sideways
C. Walking backward
D. Moving from a sitting position to a standing position
C Of the four options, backward walking is the only one that requires hip extension with concurrent knee flexion and hip flexion with knee extension
A physical therapist examining wrist-joint play finds restriction in the direction indicated by the arrow. To address the restriction, the therapist should include an intervention to increase which motion of the index finger (2nd digit)?
A. Flexion
B. Extension
C. Abduction
D. Rotation
A The therapist is shown performing a volar glide, which is the same, joint motion used for finger flexion. Limited motion in this direction indicates limited ability to perform finger flexion.
In which of the following conditions is a nerve conduction velocity test MOST appropriate?
A. Carpal tunnel syndrome
B. Cerebrovascular accident
C. Myotonia
D. Duchenne muscular dystrophy
A Nerve conduction velocity testing is most useful in the evaluation of peripheral nerve or lower motor neuron status. Therefore, since carpal tunnel syndrome is the only one of the conditions that directly involves a peripheral nerve; it would be the most appropriate choice. A cerebrovascular accident is an upper motor neuron disorder. Both myotonia and Duchenne muscular dystrophy are primary muscle disorders
A patient with leukemia has developed thrombocytopenia following a bone-marrow transplant.
Which of the following measures are indicative of the status of the thrombocytopenia?
A. Ta lymphocyte count
B. Red blood cell count
C. Platelet count
D. White blood cell count
C Thrombocytopenia is an acute or chronic decrease in the number of platelets in the circulation. The Ta lymphocyte count is used to assess immune status in patients with HIV or AIDS. The red blood cell count is utilized to assess for presence of anemia and the white blood cell count would be examined to determine presence of infection or degree of immunosuppression
For a patient with insulin-dependent diabetes who is completing a cardiovascular fitness program, what change in diabetic management is MOST likely to be instituted as fitness increases?
A. Switching to oral rather than injected medication
B. Decreasing caloric intake for 2 to 3 hours following exercise sessions
C. Decreasing the amount of insulin taken daily
D. Increasing the amount of insulin taken daily
C Exercise has been shown to increase sensitivity of the insulin receptors therefore leading to a decrease in the amount required. Administration of medication is dictated by tolerance and efficacy of the medication and would not necessarily be altered by exercise. In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 to 48 hours after exercise, therefore increasing caloric intake, particularly carbohydrates, would be essential
An elderly patient presents with a sacral pressure ulcer measuring 6 in x6 in (15 cm x 15 cm). The wound has moderate serous fluid drainage and is loosely covered with necrotic and fibrotic tissue, although there are no indications of infection present. The BEST method of debridement is:
A. daily vigorous scrubbing of the wound.
B. wet-to-dry dressings with normal saline 2 times/day.
C. daily wet-to-dry dressings with 1:1 diluted povidone-iodine (Betadine).
D. whirlpool jet agitation 2 times/day.
B Wet-to-dry dressings are indicated for necrotic tissue needing debridement. The moderate amount of drainage would require more frequent (i.e., bid) dressing changes. Vigorous scrubbing of the wound could damage friable tissue. Betadine can be cytotoxic. Whirlpool would not be effective in removing necrotic tissue.
A patient has disuse atrophy of the anterior compartment muscles following cast removal after a fracture of the tibia. The patient has Poor (2/5) strength in the ankle dorsiflexors. Electrical stimulation is to be used to enhance dorsiflexor strength in conjunction with exercise. Initially, which of the following waveform characteristics are MOST appropriate to stimulate the muscles?
A. Monophasic pulse with a frequency of 100 pps and an on/off cycle ratio of 3:1
B. Biphasic pulse with a frequency of 30 ps and an on/off cycle ratio of 1:5
C. Direct current waveform with an on/off ratio of 1:1
D. Interferential waveform with a beat frequency of 1 pps
B The most efficient stimulus would be one that causes tetany in the muscles) without causing fatigue. The biphasic waveform at 30 ps best fits this stimulus. The 100 ps stimulus rate may cause fatigue, which would be undesirable. The interferential waveform at a frequency of 1 pps is too low and the direct current would not be appropriate because it would not cause tetany. In addition an on/off cycle of 1:5 would allow adequate recovery time for the muscles between successive contractions.
A patient is referred to physical therapy with a 20° knee flexion contracture following arthroscopic knee surgery 1 month ago. All of the following interventions are appropriate EXCEPT:
A. stretching of the semimembranosus muscle
B. strengthening of the vastus medialis.
C. inferior gliding of the patella.
D. mobility of the posterior capsule of the knee joint.
C A 20° knee flexion contracture means that the knee is unable to complete the last 20° of extension. This limitation of motion can be caused by several factors including tightness of the hamstrings (semimembranosus), restriction in the posterior capsule of the knee, and weakness of the quadriceps femoris muscles (vastus medialis). Restriction of patellar movement may also be a factor, however the proper glide technique to increase knee extension would be a superior (not inferior) glide of the patella.
During an evaluation, a patient lacks 10° of passive ankle dorsiflexion. The same degree of limitation is present whether the knee is flexed or extended. The muscle MOST likely contributing
to this restriction is the
A. gastrocnemius.
B. tibialis anterior.
C. plantaris.
D. soleus.
D The soles originates on the tibia and fibula and inserts onto the calcaneus, crossing only the ankle joint. Therefore, it will have an effect on the ankle whether the knee is flexed or extended. The gastrocnemius and plantaris both have origins on the femur and insert onto the calcaneus crossing both the knee and ankle joints. Therefore, they will be placed on stretch with the knee extended and will potentially limit ankle dorsiflexion to a greater extent with the knee extended. The tibialis anterior is a dorsiflexor of the ankle and while weakness in this muscle may limit active dorsiflexion, it would not affect passive dorsiflexion.
A patient sustained a severe brain stem injury 1 week ago and has demonstrated minimal change since the incident. The patient’s cognitive status is MOST likely to include:
A. a decreased level of arousal
B. a decreased level of intelligence
C. an increased level of agitation
D. an increased level of impulsivity
A A state of alertness to the internal and external environment must be maintained for motor or mental activity to occur. The brain stem reticular activating system brings about this state of general arousal. To proceed from a state of general arousal to one of “selective attention” requires the communication of information to and from the cortex, the thalamus, and the limbic system and its modulation over the brainstem and spinal pattern generators.
To maximize continuity of patient care, the physical therapist should begin discharge planning
when the:
A. physician refers the patient for discharge
B. therapist makes the discharge evaluation of the patient
C. discharge planner requests information pertinent to the patient’s discharge status.
D. therapist performs the initial evaluation of the patient.
D The Standards of Practice for Physical Therapy state that the physical therapist is responsible for establishing a plan of care for the patient based on the evaluation of the examination data and patient needs. The plan of care includes plans for discharge. The implication is that the long-term goals for the patient (discharge plans) are determined when the therapist first sees the patient. It is anticipated that modifications of the plan of care is to be expected depending on the response of the patient to the intervention.
A manual muscle test of a patient who sustained a gunshot wound just superior to the elbow joint reveals specific muscle weakness from a partial median nerve injury. The physical therapy intervention for this patient should include strengthening activities for wrist flexion, forearm:
A. pronation, finger flexion, and thumb adduction.
B. pronation, finger flexion, and thumb opposition.
C. supination, finger abduction, and thumb opposition
D. supination, finger flexion, and thumb extension.
B The median nerve innervates the following muscles in the forearm: (1) pronator teres and quadratus, (2) flexor digitorum superficialis, (3) flexor digitorum profundus (index and middle fingers), (4) thenar muscles (abductor pollicis brevis, opponens pollicis, flexor pollicis brevis).
Therefore, a lesion of the median nerve would affect those muscles and their accompanying actions: forearm pronation, finger flexion and thumb opposition. Thumb adduction is accomplished by the adductor pollicis (ulnar nerve). Finger abduction is performed by the dorsal interossei (ulnar nerve). Forearm supination is the action of the supinator (radial nerve) and biceps brachii (musculocutaneous nerve).
A measurable objective for a community education program on proper exercise techniques would be for participants to:
A. understand the importance of a sufficient warm-up period.
B. list 5 stretching techniques that can be used when warming up
C. overcome lower extremity problems and adhere to a regular exercise program.
D. appreciate the effects of increasing intensity of exercise on heart rate.
B
Objectives must be measurable and the specific behavior expected should be stated.
Understanding, overcoming, and appreciating elude tangible measurement, while listing five techniques is an activity that can be documented and is therefore measurable.
During manual muscle testing of the hip flexors in the sitting position, a patient exhibits lateral (external) rotation with abduction of the thigh as resistance is applied. The physical therapist should suspect muscle substitution by the:
A. sartorius.
B. tensor fascia late.
C. adductor longus.
D. semimembranosus.
A The sartorius flexes, externally rotates and abducts the hip joint. With resisted hip flexion, the sartorius will be recruited to perform all three actions giving the observed substitution pattern.
The tensor fascia late is a medial (internal) rotator and flexor of the hip, so substitution by it would involve medial (internal) rotation and abduction. The adductor longs would adduct the hip.
Substitution by the semimembranosus would cause hip extension.
A physical therapist is treating a patient who has lymphedema in the right lower extremity. The therapist decides to use mechanical, intermittent pneumatic compression as an intervention, using a sleeve that covers the foot, leg, and thigh. The therapist measures the patient’s blood pressure at 135/85 mm Hg. At the first treatment session, the MOST appropriate inflation pressure for the sleeve is:
A. 20 mm Hg.
B. 60 mm Hg.
C. 100 mm Hg.
D. 140 mm Hg.
B The recommended dosage for mechanical, intermittent pneumatic compression pressure is between 30 and 80 mm Hg, (higher for the lower extremities than upper extremities). It is also recommended that the pressure be below the diastolic pressure. Pressures below 30 mm Hg are not considered to be effective. Pressures above diastolic can be used with caution. For the first treatment, it would be most appropriate to use a pressure, which is considered effective, yet not so high as to cause potential problems for the patient. If the patient responds positively to the intervention, a higher pressure could be instituted.
A physical therapist receives a telephone call from a woman who identifies herself as a friend of one of the therapist’s patients. She wants to know how the patient is doing and if he will be able to go up and down the stairs, because she wants to take him home for a weekend visit. Which of the following actions is MOST appropriate for the therapist to take
A. Discuss the patient’s program and functional status with the caller.
B. Invite the caller to observe the patient’s next therapy session.
C. Refuse to discuss the patient, unless the patient’s permission is obtained
D. Refer the caller to the patient’s social worker.
C According to the Guide to Physical Therapist Practice, “Information relating to the physical therapist/patient relationship is confidential and may not be communicated to a third party not involved in that patient’s care without the prior written consent of the patient.” Option C is the only one that fits these criteria.
The parents of a 1 month-old child with myelomeningocele report that the child has been increasingly irritable and has changed sleeping patterns over the past 3 days. The child has also been vomiting. Which of the following actions is MOST appropriate for the therapist to take?
A. Refer for immediate medical follow-up.
B. Instruct the parents to monitor head circumference daily
C. Advise the parents to watch the child for worsening symptoms.
D. Take head circumference measurements to compare at subsequent visits
A Sixty percent of children with myelomeningocele develop hydrocephalus after surgical closure of their lesion. Early warning signs of hydrocephalus include irritability; changes in sleep patterns, and changes in appetite and weight. Eighty to ninety percent of children who acquire hydrocephalus will require a cerebrospinal fluid shunt. These children require ongoing follow-up by a physician. Given the seriousness of this child’s symptoms, the child should be immediately referred for medical follow-up.
A physical therapist is developing a gait training program for a patient following a total hip arthroplasty of the right hip done via an anterolateral approach 2 weeks ago. The proper instructions and rationale for crutch training utilizing 1 crutch include holding the crutch in the:
A. right hand to decrease activity in the right hip abductors.
B. right hand to facilitate activity in the right hip abductors.
C. left hand to decrease activity in the right hip abductors
D. left hand to facilitate activity in the right hip abductors
C
With an anterolateral approach, the gluteus medius is reflected or the trochanter is taken down. Post operatively, these structures need time to heal and will not be healed only 2 weeks after surgery. The abductors should not be aggressively strengthened with exercise.
A right-handed woman is being examined by a physical therapist for right-sided weakness in her upper and lower extremities. Her muscle tone is hypotonic and she is ataxic during walking. She has a history of hypertension and alcoholism. Passive range of motion is normal with deep tendon reflexes showing hyporeflexia. She has an intention tremor when she tries to pick up an object from a table and exhibits difficulty in performing the finger to nose test. What is the location of the MOST probable area of the lesion?
A. Right side, cervical spinal cord
B. Left side, cerebral hemisphere
C. Left side, substantia nigra
D. Right side, cerebellar hemisphere
D This patient’s signs and symptoms are reflective of a right-sided cerebellar hemisphere lesion. That is, cerebellar lesions commonly produce hypotonia, hyporeflexia, ataxia and an intention tremor. Cerebellar lesions also produced ipsilateral signs and symptoms in the extremities. A right-sided lesion of the spinal cord (Brown-Sequard syndrome) would produce weakness with spasticity and hyperreflexia. A left sided cerebral hemisphere lesion would present similar to a right-sided cervical spinal cord lesion. A lesion of the substantia nigra would produce signs and symptoms like as those seen with Parkinson’s disease with rigidity and a resting tremor
A patient received a gunshot wound to the distal posterior thigh that resulted in complete severance of the common fibular (peroneal) nerve. Which of the following exercises is necessary in the early rehabilitation period to prevent contracture formation?
A. Active plantarflexion, inversion, and toe extension
B. Passive dorsiflexion, eversion, and toe extension
C. Active dorsiflexion, eversion, and toe flexion
D. Passive plantarflexion, eversion, and toe flexion
B
The common peroneal nerve innervates the following muscles: peroneus longs and brevis, tibialis anterior, extensor digitorum longs and brevis, peroneus tertius and extensor hallucis longus. Because of the complete nerve severance, all of those muscles would be affected and would not be able to actively contract until regeneration has taken place. Therefore, the patient would completely lose ankle dorsiflexion, eversion, and toe extension. Those motions would have to be performed passively in order to maintain range of motion. Option B is the only one that contains all of the correct actions
A patient with a mild closed head injury and bilateral femur fractures requires instruction in a lower extremity exercise program. To plan the most effective teaching methods for this patient, what is MOST critical to assess at the initial visit?
A. Comprehension of written, verbal, and demonstrated instructions
B. Short-term memory capacity
C. Auditory and visual status
D. Any personality changes compared to the patient’s premorbid status
A
Option A is the best answer. In Option B, if the patient does not initially understand the information, then having short-term memory is irrelevant. For Option C, hearing and vision are obviously important, but the most critical component is comprehension. Option D is irrelevant to the scenario.
For a patient with a bilateral transfemoral amputation to maximize balance in a wheelchair, the rear wheels should be positioned more:
A. laterally.
B. posteriorly.
C. anteriorly.
D. inferiorly.
B The center of gravity of a person with bilateral above-knee amputations is more posterior than the center of gravity of a person with their lower extremities intact. Setting the back wheels more posteriorly will make the patient more stable in the chair. This adjustment prevents the wheelchair from tipping backward.
On day 4 of physical therapy treatment, a patient who has had an open reduction and internal fixation for a hip fracture develops a large ecchymosis over the unaffected hip. The patient has MOST likely developed
A. a hemangioma.
B. a complication of anticoagulant therapy.
C. a hematocele.
D. deep vein thrombophlebitis
B Anticoagulation therapy inhibits the synthesis and function of clotting factors and can lead to bruising (ecchymosis) or more severely hemorrhage. A hemangioma is a benign liver tumor.
Deep vein thrombophlebitis would result in redness, swelling and warmth in the effected area and most commonly occurs in the calf muscle, not the hip region. A hematocele is a blood cyst.
A patient who is exercising on a bicycle ergometer in the cardiac rehabilitation unit is being monitored with electrocardiogram leads. During the exercise, the ST segment becomes depressed by 2 mm. If the cardiologist has given no specific guidelines, the physical therapist should
A. terminate the session immediately.
B. reduce the resistance load.
C. instruct the patient to slow down
D. direct the patient to continue as before.
A An ST segment depression of greater than 1 mm is indicative of myocardial ischemia.
Continuing the exercise session could place the patient at serious risk for continued ischemia, which could ultimately lead to myocardial infarction. Therefore, the best response for the therapist would be to stop the exercise session immediately and inform the cardiologist of the patient’s response. All of the other options would continue to place the patient at risk
Prior to starting an exercise training program, a patient with cardiac problems who is receiving beta-blocking medication should receive an explanation of the:
A. greater benefits from cardiovascular exercise to be achieved at lower rather than at higher metabolic levels.
B. need to use measures other than heart rate to determine intensity of exercise
C. need for exercise training sessions to be more frequent but of shorter duration
D. need for longer warm-up periods and cool-down periods during exercise sessions.
B The patient taking beta-blocking medication will experience a lower heart rate and blood pressure response during exercise as compared to a patient who is not taking this medication.
Since the heart rate is lower than anticipated, using heart rate to monitor exercise intensity may not be as accurate. Another measure, such as the Borg Scale (rating of perceived exertion) would be more beneficial. However, even though heart rate and blood pressure would be lower, the patient actually achieves the same metabolic levels during exercise and therefore altering the frequency or duration of exercise is unnecessary. The time for warm-up and cool-down exercises does not need to be altered.
A physical therapist places electrodes on a patient to monitor surface electromyographic activity.
The electrode placement shown in the photograph is MOST appropriate to monitor which of the following muscles?
A. Tensor fasciae late
B. Sartorius
C. Rectus femoris
D. Gluteus minimus
A The electrode placement in the photograph is the best placement for the tensor fascia late.
The electrodes are placed over the muscle belly and lined up parallel to the muscle fibers. The sartorius is found more distal and medial and following the direction of the muscle fibers. The rectus femoris is found more distal and central to the thigh. The gluteus medius is a deep muscle that is not monitored directly by surface electromyography easily.
A patient with chronic adhesive capsulitis of the shoulder is to be treated with joint mobilization to increase joint range of motion. Which of the following is the MOST appropriate to increase shoulder abduction?
A. Distraction with inferior glide
B. Anterior glide with internal rotation
C. Superior glide with approximation
D. Distraction with posterior glide
A Since most of the joint contracture/adhesion forms in the anterior-inferior portion of the capsule, treatment to mobilize that portion of the capsule is of primary concern. Inferior glide would stretch the inferior portion of the capsule.
An 8 year-old child who has juvenile rheumatoid arthritis is developing bilateral knee flexion contractures. Which of the following is LEAST appropriate?
A. Exercises to increase joint mobility
B. Ultrasound to the hamstring insertions to increase tissue extensibility
C. Progressive weight-bearing by walking in a therapeutic pool to increase endurance
D. Exercise to increase quadriceps strength
B
Options A, C, and D are acceptable interventions for this patient. The epiphyseal areas (growth areas of bones) in children should not be exposed to ultrasound. The application of ultrasound over the knee joint (hamstring insertion) could expose the epiphyseal areas to the ultrasound
A physical therapist is screening a young adult patient for a possible right thoracic, left lumbar structural scoliosis. The postural deviation commonly seen with this diagnosis is:
A. spinous processes of thoracic spine rotated to the right
B. high left shoulder.
C. posteriorly protruding scapula on the left.
D. prominent right posterior rib cage.
D Scoliosis deformities are named relative to the convexities of the curves, with the apex of the curve defining the vertebral level. In a right thoracic, left lumbar structural scoliosis, there is a convex curve to the right in the thoracic spine and a convex curve to the left in the lumbar spine.
In the thoracic spine, the body of the vertebrae rotates to the right (convex side) and the spinous processes rotate toward the left (concave side). Along with this rotation, the ribs rotate posteriorly on the convex side causing the scapula to become more prominent on the convex side and causing the shoulder to be elevated on the convex side.
An exercise program for a patient with Parkinson’s disease would MOST likely include exercises to:
A. decrease movement of the upper extremities and trunk.
B. increase trunk flexor strength.
C. improve balance reactions and reciprocation
D. stretch the back extensor muscles
C Patients with Parkinson’s disease are characterized by rigidity, bradykinesia, tremor, lack of associated movements, impaired balance reactions and a flexed posture (kyphosis). Therefore, intervention should be directed toward full range of motion and correction of kyphotic posture through back extensor strengthening exercises, balance exercises, and exercises that promote reciprocal movement. Option C is the only one that includes appropriate exercises.
If a transtibial prosthesis has an excessively firm heel wedge, the patient is MOST likely to walk with:
A. excessive knee flexion in foot flat (loading response).
B. premature knee flexion in heel off (terminal stance).
C. insufficient knee flexion in foot flat (loading response).
D. excessive knee flexion in heel off (terminal stance).
A
Upon heel contact, the heel section compresses, partially absorbing the ground impact and thus permitting a controlled plantarflexion. If the heel is too stiff, upon initial contact, the knee flexes too soon and excessively on initial contact. An excessively firm heel wedge would not be a factor in late stance.
A physical therapist is planning a patient education program for a group of patients with chronic low back pain. To increase the likelihood that the patients will utilize the proper body mechanics at the work site, the therapist should:
A. ask the patients to demonstrate use of proper body mechanics.
B. provide a reference list of articles describing body mechanics
C. ask the patients to describe actions they do that increase their back pain.
D. provide information on the frequency of low back injuries due to improper body mechanics
A Evaluation of the patient’s retention of the information presented in the program can be enhanced by asking the patients questions about the program information, having the patients ask questions about the program, having the patients demonstrate what they have learned and testing the patient about the program material. Option A is the only one that utilizes one of these techniques. The other options do not require active participation by the patients, and they do not address specific interventions
A patient presents with hemiparesis and demonstrates a foot drop during the swing phase of gait.
It is MOST appropriate to administer functional electrical stimulation to the tibialis anterior and the:
A. gastrocnemius.
B. tibialis posterior.
C. extensor digitorum longus.
D. peroneus longus.
C
During the swing phase of gait, the foot is dorsiflexed to clear the floor. Muscles active during this phase of gait are the tibialis anterior, extensor hallucis longus, and the extensor digitorum longus. The gastrocnemius, tibialis posterior and peroneus longus are active during stance phase of gait. Therefore, of the muscles listed, the extensor digitorum longs is the best choice. If only the tibialis anterior was stimulated the foot would go into inversion and dorsiflexion, which could cause the patient to land on the lateral side of the foot at initial contact causing them injury. Addition of the extensor digitorum longs would bring the foot up into more dorsiflexion and avoid excessive inversion.
A physical therapist is treating a patient with iontophoresis. If the current is set at 4 mA, the duration at 15 minutes, and the dexamethasone (Decadron) solution at 0.04%, with an electrode area of 4 cm’, how should the therapist record the current dosage in the patient’s chart?
A. 0.16 mA-mg
B. 16 mA/cm?
C. 0.60 mg/min
D. 60 mA-min
D
The current dosage for ontophoresis is calculated by multiplying the current (4 mA) by the duration (15 minutes). In this case the calculation would yield a value of 60 mA-min. None of the other options use the correct values.
An elderly patient has a diabetic neuropathy. Upon examination, the patient shows marked mediolateral instability of the left ankle while walking. The patient also has fluctuating edema and glove-and-stocking sensory loss in both of the lower extremities. The MOST appropriate orthotic aid is:
A. a double-upright metal ankle-foot orthosis.
B. high-top shoes.
C. a prefabricated plastic solid ankle-foot orthosis
D. a spiral ankle-foot orthosis.
A
The double upright metal ankle foot orthosis (AFO) would provide the best support for the mediolateral instability and would allow for changes in leg volume. The plastic, solid AFO would not provide as much mediolateral support and because of its conformation to the leg it would not be advisable for patients who are experiencing changes in leg volume due to the edema. High top shoes would not provide enough support. The spiral AFO would not provide needed stability to the ankle and the design would not be indicated when a patient has fluctuating edema in the leg.
A 25 year-old patient with cystic fibrosis has been experiencing successful mobilization of thickened secretions by standard percussion and postural drainage. During the current treatment session, the patient coughs up sputum that has a small, brownish streak of blood. The physical therapist should:
A. percuss more vigorously in an attempt to clear out any other blood that is present in the airwavs
B. perform postural drainage in upright positions for this type of patient only.
C. continue treatment with little modification, unless more blood is noted.
D. stop the treatment and send the patient to the emergency room.
C Hemoptysis or the coughing up of blood can be benign or severe and can be a common occurrence in the cystic fibrosis population secondary to the pathophysiological processes in their pulmonary system. In general, a small amount of hemoptysis that occurs occasionally or is non-persistent hemoptysis is benign. The “brownish” color indicates either venous blood or old blood. In this situation, if the hemoptysis does not persist, then it is appropriate to continue treatment without modification. If the blood was larger in amount and fresher (denoted by a bright red color), then the treatment should be discontinued. The presence of blood in the sputum should not warrant more vigorous chest percussion, until it is deemed appropriate to continue with the session. Since this situation is a benign scenario, alteration of the drainage position is not necessary, and there is no need to send the patient to the emergency room.
Which of the following should be recommended for a patient following a medial meniscectomy, if the physical therapy plan is to exercise the quadriceps femoris against accommodating resistance?
A. Knee bends through half of the range
B. Knee extension with a sandbag at the ankle
C. Knee extension on an isokinetic exercise device
D. Straight-leg raising with a sling suspension
C
Isokinetic exercise devices utilize accommodating resistance throughout the range of motion. The other exercises are not forms of accommodating resistance.
A physical therapist is examining a patient who has difficulty making a fist. Results of the patient’s muscle tests show the following: Flexors of the index, middle, ring, and little fingers (2nd to 5th digits) at the proximal interphalangeal joint are Normal (5/5). Flexors of the index finger (2nd) and middle finger (3rd digit) at the distal interphalangeal joint are Normal (5/5). Flexors of the ring finger (4th digit) and little finger (5th digit) at the distal interphalangeal joint are Poor (2/5). These findings are consistent with a lesion of the:
A. median nerve C8-T1.
B. median nerve C5-C6.
C. ulnar nerve C5-C6.
D. ulnar nerve C8-T1.
D The weakness is in the flexors of the fourth and fifth digits at the distal interphalangeal joint (2/5). The other fingers show normal strength (5/5). This weakness would indicate a problem with the flexor digitorum profundus, since the distal joints are involved. The flexor digitorum profundus is innervated by both the median and ulnar nerves. The flexor digitorum profundus muscles flexing the index and middle fingers are innervated by the median nerve. The flexor digitorum profundus muscles flexing the ring and little fingers are innervated by the ulnar nerve.
Therefore, since the ring and little fingers are involved, the lesion would have to be involving the ulnar nerve. The flexor digitorum profundus to the fourth and fifth fingers is innervated by the ulnar nerve roots C8 and T1.
An elderly man who lives alone fell in his home, sustaining a hip fracture, which necessitated a total hip arthroplasty. The patient was previously able to perform all activities of daily living independently. He has been admitted to a skilled nursing facility for rehabilitation. The patient’s goal is to return home. His family believes he should be admitted to a long-term care facility for his own safety once acute rehabilitation is completed. The physical therapist’s MOST appropriate action is to:
A. advise the family that the patient should determine his own discharge environment.
B. recommend a team conference with the patient and his family to discuss discharge plans.
C. schedule a home visit to determine if home modifications are needed before discharge.
D. implement a treatment plan with a long-term goal of discharge to home.
B The best answer would be for the therapist to recommend a team conference. That conference would bring together members of the health care team as well as the patient and family members, to arrive at joint decision as to the placement of this patient. The best time for such a meeting would be prior to discharge, because after discharge it is difficult to arrange such meetings. Allowing the patient to determine his own discharge environment may be fine if there are no safety concerns, however a decision whether or not the patient is competent to make that decision must be made first. Scheduling a home visit or the implementation of a treatment plan for home care would be premature until a decision on placement has been made.
During lower extremity exercise, a patient with incomplete C6 quadriparesis reports a new onset of tingling and numbness in both hands. A manual muscle test reveals that overall strength has decreased by 1 grade. In this situation, the MOST appropriate action for the physical therapist to take is to:
A. modify the exercise program to accommodate the change in strength.
B. apply an ice massage prior to exercise
C. continue the lower extremity therapeutic exercise and use facilitation techniques to stimulate more activity.
D. discontinue all exercise and notify the physician immediately.
D Sudden tingling or the hands and weakness of muscle groups are alarming signs of cord compression. The concern is that the spinal cord is sustaining further injury. The exercise may be exacerbating or causing these signs. This is considered a medical emergency and the physician should be immediately advised.
A physical therapist is treating a patient with moderately well-controlled type 1 diabetes. One of the goals is to help the patient regulate insulin dosage through exercise. In establishing an exercise program, the therapist should be aware that regular exercise will generally:
A. lower blood glucose levels and decrease the amount of insulin required.
B. lower blood glucose levels and increase the amount of insulin required
C. raise blood glucose levels and decrease the amount of insulin required
D. raise blood glucose levels and increase the amount of insulin required.
A In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 to 48 hours after exercise. Exercise has been shown to increase sensitivity of the insulin receptors therefore leading to a decrease in the amount of insulin required.
A physical therapist recognizes that departmental patient education materials are written on a reading level that is too difficult for some of the patients. The physical therapist can help the patients to better understand the materials by:
A. including illustrations and a larger print.
B. including illustrations and a simpler sentence structure.
C. reducing the number of syllables and lengthening the sentences.
D. using a large print format to present specific medical terminology
B
A larger print will not simplify the meaning, nor will lengthening the sentences. Only Option
B, the choice of illustrations and a simpler sentence structure, is correct.
During inspiration, a patient demonstrates increased upper chest expansion with retraction of the epigastric area. The physical therapist should suspect weakness of the:
A. scalene muscles.
B. diaphragm.
C. rectus abdominis.
D. intercostal muscles.
B
Normally, as the diaphragm descends with inspiration, it places increased pressure on the abdominal contents with a resultant distension of the epigastric area. Weakness of the diaphragm would decrease the distension and may result in a compensatory increase in upper chest expansion to improve ventilation. The scalene muscles act to elevate or stabilize the clavicle during inspiration. The rectus abdominus is a stabilizer during inspiration and assists with forced expiration. The intercostal muscles act to stabilize the thoracic cage during ventilation.
A patient with low back pain has been undergoing treatment for 2 sessions. The patient tells the physical therapist that today the pain is centralizing with the extension exercises, but is as intense as it was at the first treatment session. The patient is frustrated by this reaction. The MOST appropriate response of the therapist is to :
A. continue with the present program.
B. eliminate the extension exercises
C. consult the patient’s physician about the situation
D. progress to trunk flexion exercises
A
With an extension exercise program, centralization indicates that the patient is improving, even though the pain may be just as intense as it was. Even though the patient may feel frustrated, he is actually improving; and therefore the therapist should continue with the extension exercise program. There is no need to call the physician at this point, since the centralization is perfectly normal. Although trunk flexion may be used later in the intervention, it would not be indicated at this point because extension is working.
An attorney calls the physical therapy department seeking information on the status of his client, a patient who is undergoing rehabilitation following total knee surgery. The patient’s physical therapist should:
A. refer the attorney to the patient’s insurance carrier.
B. describe the patient’s current status.
C. require written authorization from the patient to release information.
D. obtain verbal permission from the patient to release information
C Information relating to the physical therapist/patient relationship is confidential and may not be communicated to a third party not involved in that patient’s care without the prior written consent of the patient. Option C is the only one that fits these criteria.
Involving interdisciplinary team members in making decisions about continuity of patient care has all of the following benefits EXCEPT:
A. promoting each individual’s commitment to, and responsibility for, the decisions that have been made by the group
B. discouraging 1 or 2 team members from being in control and having all the authority.
C. enabling decisions regarding quality of care to be made quickly.
D. promoting quality of care by including several aspects of the patient’s care.
C Inclusion of all members of the health care team into decision-making is important for the patient and provides for continuity of care for the patient. However, the team approach has some pitfalls such as arranging meetings between team members, which may be a time consuming process. The team concept would also assume that the team reaches a consensus that requires more time than relying on individual decisions that can be made quickly. Therefore, Option C is the best answer to this question. The other three options are advantages of the team concept.
A physical therapist examines a patient with multiple sclerosis who is in a period of exacerbation.
The patient is independent with bed mobility, can sit unassisted at the edge of the bed, and requires physical assistance to stand with a walker. Which of the following activities of daily living is the MOST important for the initial intervention session?
A. Wheelchair propulsion up a 10-ft (3-m) ramp
B. Wheelchair transfers
C. Walking with an assistive device
D. Tub transfers
B
Physical therapy intervention should focus on helping the patient obtain maximal functional independence. Wheelchair transfers are the means to enable the patient to be independently mobile and will be a requirement before more difficult tasks are performed such as ascending a
10-foot ramp. The patient is presumably too weak to walk at this point in time. Tub transfers are important, but the wheelchair will be the best means to get the patient to the tub. Therefore, for the initial intervention session wheelchair transfers would be the most important
While examining a patient who had a baby 3 days ago by vaginal delivery, the physical therapist notices that the patient has a 2-cm diastasis of the rectus abdominis. To address this problem, the patient should:
A. perform partial sit-ups supporting her abdominal muscles with her hands, while lifting her head in the supine position.
B. not perform exercises, until the diastasis heals spontaneously.
C. perform sit-ups with the knees bent and arms behind the head.
D. perform partial sit-ups with legs straight and arms in front.
A Raising just the head activates only the recti muscles, and supporting the abdominal muscles with the hands provides external support to the stretched abdominal muscles. This is the optimal position to initiate abdominal strengthening following delivery for a patient with diastasis rectus abdominus. Doing no exercise would not be appropriate. With no support of the abdominal muscles, Options C and D would be too aggressive at this time.
When evaluating wheelchair positioning of a child with cerebral palsy, the physical therapist should FIRST examine the position of the child’s:
A. pelvis.
B. lower extremities.
C. head.
D. spine.
A The assessment of posture in a wheelchair begins with the pelvis and its relationship to its adjacent segments. The orientation and range of mobility of the pelvis in all three planes will in turn determine the alignment and support needed at the trunk, head, and extremities
For a patient with a right-middle-lobe pneumonia, the proper bronchial drainage position is supine with the body:
A. one-quarter turned to the left and the foot of the bed raised 14 in (35.6 cm).
B. one-quarter turned to the right and the bed flat.
C. three-quarters turned to the left and the head of the bed raised 14 in (35.6 cm).
D. three-quarters turned to the right and the foot of the bed raised 14 in (35.6 cm).
A
In order to place the right middle lobe in an optimal position to drain secretions, a patient would need to be positioned as stated in Option A. Another way this position may be stated is
“left sidelying with a quarter turn towards supine”. The other positions do not optimally drain this lobe.
To avoid the appearance of increased motion, what movement MUST be prevented during goniometric measurement of shoulder abduction?
A. Upward rotation of the scapula
B. Medial (internal) rotation of the shoulder
C. Lateral (external) rotation of the shoulder
D. Lateral flexion of the trunk to the opposite side
D
During measurement of shoulder abduction, the spine should be kept straight. If the patient is allowed to laterally flex the trunk it will give the appearance of increased shoulder abduction, but the motion would be occurring in the spine and not in the shoulder. Upward rotation of the scapula and lateral rotation of the shoulder would normally accompany the motion of shoulder abduction. Medial rotation of the shoulder would decrease the available abduction
A patient who received an organ transplantation 4 years ago demonstrates progressive weakness and is referred to physical therapy for strengthening exercises. In reviewing the medical history, the physical therapist learns that the patient takes prednisone Deltasone) and immunosuppressive drugs. Which of the following does the therapist need to consider?
A. Isokinetic strengthening will be preferable for this patient
B. The patient may have limited range of motion from increased bone mass.
C. The patient will need to be treated in an isolation room.
D. Muscle strengthening may be limited in this patient.
D An adverse side effect of prolonged prednisone use, in this case for 4 years, is muscle degeneration and therefore achieving increases in muscle strength may be limited. Since muscle strengthening may be limited, then isokinetic exercise would not necessarily be more beneficial.
Prednisone may lead to a decrease in bone density, not an increase. Four years after transplantation, the patient will have been out in the community and the need for an isolation room is unnecessary.
The results of a developmental screening of a 4 month-old infant indicate a possible right hip dislocation. The presence of which of the following is the MOST consistent with this diagnosis?
A. Pelvic obliquity, apparent pain on movement of the right hip, and decreased hip abduction on the left side
B. Asymmetrical gluteal folds, femoral telescoping, and limited hip abduction on the right side
C. Decreased active movement of the right hip, increased femoral neck retroversion, and atrophy of the gluteus maximus on the right side
D. Hip flexion contracture on the right side, apparent leg-length discrepancy, and inability to tolerate supported sitting
B Physical findings of congenital hip dislocation include asymmetric skin folds of the buttocks and adductor region; limitation of passive hip abduction; leg length inequality; and, telescoping of the flexed and adducted thigh on the pelvis.
A 14 month-old child with brachial nerve palsy has motor and sensory loss in the right upper extremity in the areas innervated by Cs and C.. Which of the following activities is MOST difficult for the child to accomplish with the affected upper extremity?
A. Pushing a wagon
B. Carrying a teddy bear in the crook of the arm
C. Holding a raisin in the palm of the hand
D. Grasping a cup
B The C5 and C6 myotomes include the biceps brachi, brachialis, brachioradialis, and deltoid muscles. The elbow flexors and supinators (C5-6) are used to carry a teddy bear in the crook of the arm. Pushing a wagon requires the use of the triceps (C7-8). Holding a raisin requires presence of wrist flexors (C6-8). Grasping a cup requires finger, thumb and wrist muscles (C6-8, T1).
A physical therapist is treating a patient who has been diagnosed with a nerve root impingement on his right side due to a narrowing of the intervertebral foramen between La and L§. The therapist decides to use mechanical, lumbar traction as an intervention. Which of the following positions, on a traction table, is MOST appropriate to relieve pressure on the nerve root?
A. Supine with the hips and knees flexed
B. Supine with the hips and knees straight and laterally shifted to the right
C. Prone with the hips and knees straight
D. Sidelying on the right with a bolster between the table and patient
A In order to open up the intervertebral foramen, it would be best to flex or at least flatten the lumbar spine prior to applying the traction. Of the above options, positioning the patient supine with the hips and knees flexed would be the best way to do this. Laterally bending the trunk to the left would also open up the foramen, but this is not one of the options. Supine with hips and knees straight and then laterally shifted to the right would tend to close down the intervertebral foramen. Prone would also close the foramen. Sidelying with a bolster under the right lumber spine would also tend to close the foramen.
A patient who is transported to the physical therapy department in a wheelchair reports severe, bilateral lower extremity pain. A purple discoloration of both feet is observed. The pain is relieved when the patient’s feet are raised just above the horizontal plane. These signs are MOST indicative of:
A. arterial insufficiency.
B. intermittent claudication.
C. venous insufficiency.
D. a psychosomatic episode.
C With arterial insufficiency, elevation increases ischemia and therefore pain. Intermittent claudication is a phenomenon associated with metabolic demands exceeding the capability of the vascular system to supply adequate blood flow. Placing the limb in a dependent position increases swelling and therefore possibly pain with venous insufficiency. An objective sign such as purple discoloration rules out a psychosomatic episode.
A patient who completes a Phase | (in-hospital) cardiac rehabilitation program should be expected to achieve:
A. independence in self-monitored walking.
B. increased aerobic capacity to physical activity.
C. modification of risk factors.
D. increased blood pressure at a given workload.
A
The primary physical therapy goal of Phase I cardiac rehabilitation is to achieve a safe and independent level of activity that can be carried out at home. Increasing aerobic capacity cannot happen until Phase Ill, when cardiac tissue has healed fully. Modification of risk factors is a life-long process and will not be achieve during a short inpatient stay. Systolic blood pressure, when exercising, during the inpatient stay should only rise approximately 20 mm Hg above resting.
A physical therapist has been working with a patient who has a spinal cord injury. To document that the patient has been educated about skin care, the therapist should record that the patient:
A. is unable to tolerate more than 1 hour in a wheelchair.
B. is unable to tolerate more than 1 hour in a wheelchair.
C. is able to state 3 causes of skin breakdown.
D. is able to perform 10 push-ups in the wheelchair.
C Option C is the only one stated clearly in educational terms. The other options are objectives based on observations
A patient reports pain lateral to the coracoid process. When palpating the shoulder to assess the possible cause of the pain, starting at the coracoid process and moving laterally, the physical therapist should expect to find the following sequence of structures:
A. lesser tuberosity, biceps tendon, and greater tuberosity
B. greater tuberosity, biceps tendon, and lesser tuberosity.
C. lesser tuberosity, coracobrachialis tendon, and greater tuberosity
D. greater tuberosity, coracobrachialis tendon, and lesser tuberosity.
A
Starting at the coracoid process and moving laterally, one would palpate the following structures: (1) lesser tuberosity, (2) biceps tendon and (3) greater tuberosity. Any other order of structure palpation would be incorrect.
A factor that MUST be considered in designing an exercise program for a patient with angina pectoris is that when the arms are exercised:
A. angina occurs at a lower heart rate than when exercising the lower extremities.
B. heart rate and blood pressure rise more steeply in relation to workload than when exercising the lower extremities
C. pulmonary ventilation increases less rapidly than when exercising the lower extremities.
D. angina occurs at higher workloads than when exercising the lower extremities
B
Heart rate and systolic blood pressure responses are higher for any given workload when performed with the upper extremities as compared to the lower extremities. Angina is determined by a certain myocardial workload that is represented by the product of heart rate and systolic blood pressure. Therefore Option A cannot be a conclusive statement. Pulmonary ventilation has less definitive responses than the cardiac responses but in general would be similar in that upper extremity exercise would cause a greater ventilatory response than lower extremity exercise would. Since heart rate and blood pressure would be higher at any given workload with upper extremity exercise, then angina would most likely occur at a lower workload
A physical therapist is treating a patient for limitation of motion following knee surgery several weeks ago. The patient’s passive knee extension is lacking 15° from full extension, and knee flexion is limited to 95°. Both movements have a capsular end-feel. Which of the following mobilization techniques is MOST appropriate for increasing knee flexion?
A. Anterior glide of the tibia on the femur
B. Posterior glide of the tibia on the femur
C. Superior glide of the patella
D. Posterior glide of the femur on the tibia
B
During normal knee extension, the tibia moves posterior relative to the femur. Therefore, posterior gliding of the tibia would promote knee flexion. Superior glide of the patella could be used to increase knee extension. Posterior glide of the femur on the tibia would be used to increase knee extension
When considering special tests for orthopedic assessment of a client, the validity of a test is important because the:
A. results of the test can be standardized.
B. test measures what it is supposed to measure.
C. results of the test are reproducible
D. test can be accurately performed by someone else.
B Option B is the definition of validity. Options C and D refer to reliability measures. Results can be standardized even though they are not valid.
A patient sustained a Colles’ fracture 8 weeks ago and has been in a cast since that time.
Immediately after cast removal, it is MOST appropriate for the physical therapy intervention for the wrist and hand to include:
A. passive and active assistive range of motion exercises.
B. progressive resistive exercises.
C. grade-4 joint mobilization techniques.
D. return to prefracture level of activity.
A
The primary physical therapy goal at this time is to restore range of motion. Therefore, the most appropriate intervention for that goal is passive and active assistive ROM exercises.
Although gentle joint mobilization techniques may be indicated, grade 4 techniques at this time would not be. Progressive resistive exercises would come later in the plan of care. Although the long-term goal would be to return to normal activities, the short-term goal would not
A patient with a traumatic brain injury is receiving outpatient physical therapy. The physical therapist notices that the patient becomes agitated during therapy sessions. To which of the following professionals should the patient be referred for assessment and diagnosis?
A. Occupational therapist
B. Neuropsychologist
C. Vocational counselor
D. Speech-language pathologist
B Because the problem is a behavioral disorder, the most appropriate person to assess this patient would be a neuropsychologist. The neuropsychologist is trained to assess intellectual, emotional and coping functions of the patient as well as levels of depression and anxiety. They could also provide consultation to the rehabilitation team members as to how to deal with the problem.
During examination of the jaw-opening pattern of a patient with a temporomandibular joint problem, the therapist notes early protrusion of the mandible. Which of the following mandibular movements MOST likely causes the protrusion?
A. Condylar translation
B. Mandibular depression
C. Condylar rotation
D. Lateral glide
A The protrusion component involves the arthrokinematic movement of anterior condylar translation. Mandibular depression (jaw opening) involves both condylar rotation and anterior translation. However, this question is asking only about the protrusion component. Lateral glide involves anterior translation on the contralateral side and spin on the ipsilateral side.
