MUST know

Question 1

Loose Pack position of Joint

Answer 1

The loose-packed position for the hip joint is 30° of flexion The resting position of the hip is flexion of 30° and abduction of 30°
2. The loose-packed position for the glenohumeral joint is 55° of abduction (Hoogenboom, p. 344). The resting position is abduction of 55° and horizontal adduction of 30°
3. Tibiofemoral joint placed in 25° of flexion will be in the resting or loose-packed position
4. The loose-packed position for the humeroulnar joint is 70° of flexion

Question 2

gastroesophageal reflux disease- foods to not eat

Answer 2

Modifications to help manage symptoms of gastroesophageal reflux disease includes avoiding eating large meals that can distend the stomach and avoiding items such as chocolate, peppermint, alcohol, caffeinated coffee, and fried and/or fatty foods.

Question 3

TMJ Mob to improve limitation of Mouth Opening

Answer 3

Distraction with anterior glide to the temporomandibular joint is best for improving a patient’s ability to achieve greater opening of the mouth.
Posterior glide is not the appropriate arthrokinematic motion to assist with mouth opening. Posterior glides are appropriate for improving mouth closing.

Question 4

terms BEST describes the extent to which an intervention produces a desired outcome under usual clinical conditions

Answer 4

Effectiveness is the extent to which an intervention produces a desired outcome under usual clinical conditions.

Question 5

Effect size

Answer 5

The effect size is the magnitude of the difference between two mean values.

Question 6

Efficacy

Answer 6

Efficacy is the extent to which an intervention produces a desired outcome under ideal conditions.

Question 7

required to wear a surgical face mask

Answer 7

1. Airborne precautions, including wearing a particulate respirator, should be used when working with patients who have rubeola.
2. Particulate respirators are recommended when working with patients who have tuberculosis.
3. Airborne precautions, including wearing a particulate respirator, should be used when working with patients who have varicella zoster virus.
4. Droplet precautions, including wearing a face mask, should be used when working with patients who have bacterial pneumonia.

Question 8

M.S & Overflow incontinence caused by an underactive detrusor muscle

Answer 8

1. The symptoms fit the description for overflow incontinence. In patients who have multiple sclerosis, overflow incontinence is usually the result of a hypotonic or underactive detrusor muscle.

Question 9

Stress incontinence caused by

Answer 9

Stress incontinence is due to weak pelvic floor muscles, internal urethral sphincter failure, hypermobility of the ureterovesical junction, or damage to the pudendal nerve and would not be caused by anxiety in a patient who has multiple sclerosis

Question 10

A patient sustained an injury to the cerebellar cortex. Which of the following functions would MOST likely be diminished?

Answer 10

1. Difficulty with initiation of movement occurs in basal ganglia lesions, not cerebellar lesions (p. 195).
2. Motor information is processed in the primary motor cortex and is located in the precentral gyrus of the cerebral cortex. Damage to the cerebellum would not be likely to cause diminished strength. (pp. 190-191)
3. Sensory information is processed in the primary somatosensory cortex, which is located in the postcentral gyrus of the cerebral cortex. Damage to the cerebellum would not be likely to cause diminished sensation. (pp. 86-87)
4. Rapid alternating arm movements test for dysdiadochokinesia, the term used to indicate impaired ability to perform these movements. Patients who have cerebellar lesions would be most likely to experience this impairment. (p. 194)

Question 11

1. Frequency of 35 pps, duration of 50 microseconds
2. Frequency of 35 pps, duration of 150 microseconds
3. Frequency of 50 pps, duration of 250 microseconds
4. Frequency of 150 pps, duration of 50 microseconds

Answer 11

1. The lower pulse frequency is appropriate for promoting muscle strength, but the pulse duration is too short and would be more appropriate for pain control
2. Frequency of 35 pps and duration of 150 microseconds would be more appropriate for strengthening a small muscle group. The quadriceps are one of the largest muscle groups in the body
3. For a large muscle group with intact innervation, the most effective parameters for promoting increased muscle strength are a frequency of 35-80 pps and a pulse duration of 200-350 microseconds
4. Frequency of 150 pps and duration of 50 microseconds would be more appropriate for influencing pain and not as effective for promoting muscle strength

Question 12

An adult patient who reports a new onset of back pain had a radiograph that identified wedging of the L1 vertebral body. Which of the following muscle groups would be MOST appropriate to stretch?

Answer 12

2. The symptoms and radiographic bony changes suggest osteoporosis. Compression fractures are commonly associated with trunk flexion, and symptoms are provoked with flexion activities. Stretching of the antagonist muscles, such as the shoulder horizontal adductors and medial (internal) rotators, hip flexors and medial (internal) rotators is recommended for patients who have compression fractures of the vertebral bodies secondary to osteoporosis.

Question 13

Slipped capital femoral epiphysis

Answer 13

Slipped capital femoral epiphysis generally occurs in adolescents. Symptoms include antalgic gait and pain in the groin, knee, or medial thigh. This disorder is more likely to present with antalgic gait and a laterally (externally) rotated lower extremity. When the onset is acute, the adolescent will be unable to bear weight on the affected extremity. Obesity is often a factor in the development of this condition

Question 14

Legg-Calvé-Perthes disease

Answer 14

The clinical picture of Legg-Calvé-Perthes disease is a typical occurrence between the ages of 3 to 13 years, most commonly in physically active, yet small, boys. The etiology of the disease is unknown. It is an avascular necrosis that disrupts blood flow to the capital femoral epiphysis, progresses through four well-defined stages, and is ultimately self limiting. Children who have Legg-Calvé-Perthes disease often are smaller in stature and may have limb length discrepancies

Question 15

Osgood-Schlatter disorder

Answer 15

Osgood-Schlatter disorder is an overuse injury that presents with anterior knee pain. It typically appears between the ages of 9 to 15 years in children who are physically active. The chief symptoms are an ache in the anterior knee and a clear tenderness of the apophysitis upon direct palpation. Muscle contraction will also produce pain. The application of strengthening exercises should not provoke symptoms

Question 16

Developmental hip dysplasia

Answer 16

Undetected childhood developmental hip dysplasia can result in a form of avascular osteonecrosis as early as adolescence or in adulthood. Symptoms typically are hip or groin pain, gluteus minimus gait, limited hip range of motion for medial (internal) rotation, flexion, and abduction, and tenderness to palpation over the hip joint. The femoral head is the most common site of the disorder. Symptoms, when they appear, may be mild initially and increase over time

Question 17

Kidney

Answer 17

The kidneys are located in the region of the costovertebral angle. Pain upon percussion of this region is common in kidney involvement. Pain associated with the kidneys usually refers to the ipsilateral flank and groin.

Question 18

Spleen

Answer 18

. The spleen is located near the left costovertebral angle but not in close association, compared with the kidney. In this case, it is the right side that is involved. Left upper quadrant and left shoulder pain would be associated with injury to the spleen.

Question 19

Which of the following arthrokinematic motions occurs during open-chain knee flexion?

Answer 19

During open-chain knee flexion, the femur is stationary. According to the concave-convex rule of arthrokinematics, when the concave surface of the tibia is flexing on the convex surface of a fixed femur, the tibia both rolls and glides posteriorly on the relatively fixed femoral condyles.

Question 20

A patient’s skin distal to the mid-calf is darker than the skin proximal to the mid-calf. Which of the following examination techniques would MOST efficiently screen for the expected dysfunction

Answer 20

1.Capillary refill is a test of surface arterial blood flow and would not provide information about venous insufficiency
2. The patient presents with hemosiderin staining, which is a sign of venous insufficiency. A venous filling time test can indicate that a patient has venous insufficiency if the venous filling time is less than 15 seconds If the test result is positive for venous insufficiency, further testing can be recommended for verification and examination of the extent of the condition.
3. Diminished dorsalis pedis pulse would be expected with arterial insufficiency, not venous insufficiency
4. Sensory filament testing is a test for detecting peripheral sensation, not for venous insufficiency

Question 21

A patient who has rheumatoid arthritis is referred to a physical therapist for exercise prescription. Which of the following considerations is MOST important when prescribing exercise for the patient?

1. Include low-load, prolonged stretching activities.
2. Give a low priority to pain as an indicator of exercise tolerance.
3. Modify exercise according to the phase of the disease process.
4. Increase the duration of exercise while decreasing the frequency.

Answer 21

1. Soft tissue structures may be weakened by the rheumatic process, and stretching would increase risk of injury to the tissues
2. Fatigue and increased pain should be recognized as indicators of exercise intolerance, and the type and intensity of exercise should be varied depending on symptoms
3. The clinician should consider the stage (acute versus chronic) of rheumatoid arthritis when designing an exercise program, and the patient must be taught to modify the program to match the stage of the illness
4. Longer duration exercise is incorrect because a principle of joint protection and energy conservation is to use frequent but short episodes of exercise

Question 22

A patient reports feeling light-headed when moving from sitting to standing position. Which of the following patient instructions would be MOST appropriate?

1. Sit down and perform ankle pumps.
2. Remain standing with the eyes closed.
3. Remain standing with the eyes open.
4. Return to supine position and discontinue the session.

Answer 22

1. The patient is most likely experiencing orthostatic hypotension. This is due to a rapid change in body position that causes blood to pool in the abdomen and lower extremities because of gravity. The reduction in venous return leads to a reduced stroke volume and cardiac output, resulting in a lowering of blood pressure and feelings of light-headedness. The most appropriate course of action is to have the patient return to sitting position and perform ankle pumps to increase venous return and ultimately increase blood pressure.
2. The patient is most likely experiencing orthostatic hypotension. Having the patient remain standing with eyes closed will increase feelings of light-headedness.
3. The patient is most likely experiencing orthostatic hypotension. Having the patient remain standing with eyes open will increase feelings of light-headedness.
4. The patient is most likely experiencing orthostatic hypotension. Although having the patient return to supine position is a good option; discontinuing therapy session should only occur if sitting and performing ankle pumps does not relieve the symptoms.

Question 23

During an examination, a physical therapist observes that a patient has difficulty concentrating, refuses to participate in certain examination procedures, and appears reactive and fearful to touch. Which of the following strategies would be MOST appropriate during screening of the patient?

1. Ask direct questions about substance abuse.
2. Ask indirect questions about substance abuse.
3. Ask direct questions about violence or abuse.
4. Ask indirect questions about violence and abuse.

Answer 23

1. An individual with a substance use disorder may have cognitive impairments that affect judgment and impulse control as well as demonstrate mood swings, social withdrawal, and belligerent or confrontational interactions. Indications of substance abuse warrant discussion with the patient and referral to either a physician or mental health professional. The behaviors of the patient described in the clinical scenario do not correlate with behavior indicative of suspected substance abuse. (pp. 104-105)
2. An individual with a substance use disorder may have cognitive impairments that affect judgment and impulse control as well as demonstrate mood swings, social withdrawal, and belligerent or confrontational interactions. Indications of substance abuse warrant discussion with the patient and referral to either a physician or mental health professional. The behaviors of the patient described in the clinical scenario do not correlate with behavior indicative of suspected substance abuse. (pp. 104-105)
3. Asking direct questions about violence during routine social screening and safety questions is recommended. The therapist may suspect violence or abuse if a patient has injuries to the head and trunk (areas usually out of sight), lacerations, fractures, contusions, and/or black eyes. Burns, knife wounds, and joint injuries are also common. Victims of violence and abuse may appear excessively reactive and fearful of touch. Patients may use vague descriptions of pain and mechanism of injury, and even appear evasive. Patients may confide in health care providers that they feel isolated or alone. (p. 43)
4. Asking direct questions about violence during routine social screening and safety questions is recommended. It is essential to establish a safe environment where the therapist can open a dialogue with the client, listen carefully, and document conversations. Good communication skills are of the utmost importance to develop rapport and a sense of trust. (p. 43)

Question 24

A physical therapist is educating a patient on the use of a moist hot pack for home treatment. For the patient to prevent burns and still receive the benefits of superficial heat, which of the following heat application time frames is MOST appropriate?

1. 5-10 minutes
2. 20-30 minutes
3. 45-60 minutes
4. 70-90 minutes

Answer 24

1. Five to 10 minutes is an insufficient amount of time for therapeutic heating effects.
2. The ideal amount of time for therapeutic heating effects varies from 15-30 minutes.
3. Forty-five to 60 minutes is too long a period of time and could increase the risk of developing a burn.
4. Seventy to 90 minutes is too long and could increase the risk of developing a burn.

Question 25

Which of the following clinical manifestations would MOST likely be associated with right ventricular failure?

1. Pulmonary edema
2. Jugular venous distention
3. Paroxysmal nocturnal dyspnea
4. Muscular weakness and fatigue

Answer 25

1. Pulmonary edema is most associated with left ventricular failure (pp. 592-593).
2. In patients who have right ventricular failure, the right side of the heart is unable to adequately pump fluid through the pulmonic valve. This fluid backs up into the jugular vein through the superior vena cava. (pp. 593-595)
3. Inability of the left ventricle to adequately distribute oxygenated blood through the body may result in disruptions in mechanisms of respiratory control (p. 593).
4. Insufficient cardiac output to working muscles by the left ventricle may result in tissue hypoxia and inability to remove metabolic waste (p. 593).

Question 26

Which of the following interventions is MOST appropriate for a 12-year-old child who has a history of progressive idiopathic scoliosis and a Cobb angle of 45°?

1. Orthotic management
2. Postural correction
3. Surgical intervention
4. Spinal stabilization exercises

Answer 26

1. Orthotic management is typically indicated for children who have idiopathic scoliosis and who are skeletally immature and have a Cobb angle of 25° to 45°.
2. Postural correction is not sufficient to manage a curve of 45°.
3. The major indication for spinal fusion is a documented, progressive idiopathic curve and a Cobb angle greater than 40°.
4. Exercise alone is not sufficient to manage a curve of 45°.

Question 27

When conducting a 10-meter walk test, appropriate procedure includes which of the following elements?

1. The patient is permitted to use an assistive device.
2. The patient is instructed to walk with feet heel-to-toe.
3. The patient begins the assessment in a seated position.
4. The patient walks until reaching a marker, then turns around.

Answer 27

1. Assistive devices are permitted and should be used for safety if the patient usually uses one.
2. The test should be conducted with the patient using the patient’s usual walking pattern.
3. The seated position is the beginning position for the Timed Up and Go test, not an assessment of gait speed. For the 10-meter walk test, the timing starts when the patient reaches the first marker of the 10-meter walk test.
4. This option describes a condition of the Timed Up and Go test. Gait speed should not include the time it takes for a patient to turn around. Gait speed should be measured over a straight course.

Question 28

A family physician refers a patient to physical therapy for treatment of chronic low back pain. The patient is currently receiving treatment from a massage therapist for the same problem. Which of the following actions is MOST appropriate for the physical therapist?

1. Ask the patient to discontinue the massage therapy.
2. Treat the patient on days the patient is not seen by the massage therapist.
3. Gain permission from the patient to contact the massage therapist to discuss the plan of care.
4. Discontinue the patient’s physical therapy.

Answer 28

1. Asking the patient to discontinue massage therapy may alienate the patient and may deny the patient access to appropriate treatment therapy.
2. Without knowledge of what other treatment the patient is receiving, treating the patient on days the patient is not seen by the massage therapist may be counterproductive.
3. Obtaining the patient’s permission to contact the massage therapist allows communication between healthcare providers and provides the most appropriate treatment for the patient.
4. Discontinuing physical therapy would not allow for the best care for the patient.

Question 29

A patient has pain in the mid lower abdominal area and low back that is not of musculoskeletal origin. Which of the following diagnoses is MOST likely?

1. Enlarged liver
2. Inflamed pancreas
3. Ruptured gallbladder
4. Dissecting aortic aneurysm

Answer 29

1. Liver pain is referred to the right shoulder, upper back, and chest and would not be consistent with the lower abdominal pain (p. 352).
2. While pancreatic pain can refer to the middle or lower back, it tends to be in the epigastric and left upper quadrant region, not in the lower abdomen (p. 321, 329).
3. Gallbladder pain refers to the right shoulder, chest, and upper back regions and would not be consistent with the lower abdominal pain (p. 351).
4. Pain in the abdominal and lower back region can be referred by a dissecting aortic aneurysm (p. 265).

Question 30

Which of the following scenarios BEST describes the effect of climatic conditions on an individual who has exercise-induced asthma?

1. Bronchospasm is facilitated by exercise in a humid environment, compared with a dry environment.
2. Bronchospasm is facilitated by exercise in a warm environment, compared with a cold environment.
3. Bronchospasm is blunted when exercising in a humid environment, compared with a dry environment.
4. Bronchospasm is blunted when exercising in a cold environment, compared with a warm environment.

Answer 30

1. Exercise-induced asthma or bronchospasm is exacerbated in cold and dry environments, not humid environments.
2. Exercise-induced asthma or bronchospasm is exacerbated in cold and dry environments, not warm environments.
3. Exercise-induced asthma or bronchospasm is exacerbated in cold and dry environments and is blunted when exercising in a humid environment.
4. Exercise-induced asthma or bronchospasm is exacerbated in cold environments.

Question 31

Which of the following muscles should be strengthened in a patient who has an anterior trunk lean during the foot flat (loading response) phase of gait?

1. Tibialis anterior
2. Iliopsoas
3. Quadriceps
4. Triceps surae

Answer 31

1. Ankle dorsiflexion weakness can result in inadequate dorsiflexion control during the foot flat (loading response) phase of gait (p. 308).
2. Hip flexor weakness typically results in gait deviations in the swing, not stance, phase of gait (p. 308).
3. Anterior trunk bending is commonly used to bring the line of force in front of the knee to compensate for weak knee extensors (p. 307).
4. Triceps surae weakness can result in inadequate knee extension in stance (p. 308).

Question 32

Which of the following medications for pain is MOST likely to increase risk of peptic ulcer disease?

1. Codeine
2. Morphine
3. Ibuprofen (Motrin)
4. Acetaminophen (Tylenol)

Answer 32

1. Codeine is not a type of nonsteroidal antiinflammatory drug and will not increase risk of peptic ulcer disease (p. 600).
2. Morphine is not a type of nonsteroidal antiinflammatory drug and will not increase risk of peptic ulcer disease (p. 203). A headache is the most likely problem, not light-headedness.
3. Ibuprofen is a type of nonsteroidal antiinflammatory drug that impairs the gastric protective mechanism against corrosive acids (p. 225).
4. Acetaminophen is not a type of nonsteroidal antiinflammatory drug and will not increase risk of peptic ulcer disease (p. 232).

Question 33

After discussing with the physical therapist the benefits of therapy and the risks of refusing intervention, a patient refuses physical therapy. The patient acknowledges that without intervention, there is a high probability that this condition will worsen. Which of the following is the MOST appropriate response?

1. Respect the patient’s decision to decline the therapy.
2. Continue discussions with the patient on why therapy is the best option.
3. Begin treatment, starting with a very easy exercise.
4. Refer the patient to another therapist who may be able to establish a better rapport.

Answer 33

1. Every adult of sound mind has a right to refuse treatment.
2. If the patient has made an “informed refusal,” the right of the patient to make autonomous medical decisions should be respected.
3. If the patient refuses a treatment and informed consent is not obtained, then continuing treatment can result in legal action.
4. If the patient has made an “informed refusal,” the right of the patient to make autonomous medical decisions should be respected.

Question 34

A patient who has an L2 radiculopathy with motor weakness would MOST likely demonstrate which of the following ipsilateral gait abnormalities?

1. Pelvic drop during the swing phase of gait
2. Hip lateral (external) rotation during the swing phase of gait
3. Genu valgum during the stance phase of gait
4. Posterior trunk bending in the stance phase of gait

Answer 34

1. A pelvic drop during the swing phase of gait is indicative of gluteus medius weakness and is known as Trendelenburg gait (Lippert, p. 392). The gluteus medius is innervated by L4–S1 (Lippert, p. 309).
2. A patient with an L2 radiculopathy would demonstrate weakness in the hip flexors. The iliopsoas is innervated by L2–L4, which would cause the patient’s hip flexion to be weak and allow muscle substitution to occur. Lateral (external) rotation may be used to facilitate hip flexion in swing phase, using the adductors as flexors, if the true hip flexors are weak. (Levine, p. 73, Lippert, p. 304; O’Sullivan)
3. Dynamic genu valgum during the stance phase of gait can occur due to weakness of the ipsilateral gluteus medius (Kisner, p. 794). The gluteus medius is innervated by L4–S1 (Lippert, p. 309).
4. Posterior trunk bending indicates a weakness of the hip extensors and is known as gluteus maximus gait or rocking horse gait (Lippert, pp. 391-392). The gluteus maximus is innervated by L5–S2 (Lippert, p. 307). A posterior trunk lean from initial contact to loading response is the result of either hip extensor weakness, hip flexor contracture, or inadequate hip flexion in the swing limb. Therefore, a posterior trunk bend during stance suggests either the ipsilateral gluteus maximus is weak or the contralateral hip flexors are weak. (Dutton, p. 292) The stem asks for ipsilateral.

Question 35

Use of a pneumatic compression pump in the lower extremity is CONTRAINDICATED for a patient who has which of the following findings?

1. Ankle-brachial index of 0.9
2. Hypoproteinemia measured at less than 2 g/dL
3. Resting blood pressure of 140/90 mm Hg
4. Fasting blood glucose value of 118 mg/dL (6.5 mmol/L)

Answer 35

1. Compression is generally contraindicated in patients who have severe peripheral arterial disease, as indicated by an ankle-brachial index of less than 0.6 (Cameron, p. 415).
2. Hypoproteinemia less than 2 g/dL is a contraindication for compression as this intervention can increase intravascular fluid thus further lowering serum protein concentration, which can adversely affect cardiac or immunologic function (Cameron, p. 416).
3. Uncontrolled hypertension is a precaution for the use of compression on a patient. Compression can be used as long as the patient’s blood pressure is monitored during use and does not exceed the physician’s recommended parameters (Cameron, p. 416). This patient’s hypertension may be controlled with medication, in which case close monitoring of blood pressure before and after treatment would help determine tolerance to the intervention (Bellew, p. 250).
4. Although impaired sensation is a precaution for the use of compression on a patient (Cameron, p. 416), a fasting glucose value of 118 mg/dL (6.5 mmol/L) is considered pre-diabetes and does not necessarily mean a patient has peripheral neuropathy (ACSM).

Question 36

Which of the following substitution patterns should be prevented when measuring active forearm pronation?

1. Shoulder medial (internal) rotation and shoulder abduction
2. Shoulder medial (internal) rotation and shoulder adduction
3. Shoulder lateral (external) rotation and shoulder abduction
4. Shoulder lateral (external) rotation and shoulder adduction

Answer 36

1. Shoulder abduction and medial (internal) rotation should be avoided when measuring forearm pronation (p. 168).
2. Shoulder abduction and medial (internal) rotation should be avoided when measuring forearm pronation (p. 168). Shoulder adduction should be avoided when measuring forearm supination (p. 163).
3. Shoulder abduction and medial (internal) rotation should be avoided when measuring forearm pronation (p. 168). Shoulder lateral (external) rotation should be avoided when measuring forearm supination (p. 163).
4. Shoulder abduction and medial (internal) rotation should be avoided when measuring forearm pronation (p. 168). Shoulder lateral (external) rotation and adduction should be avoided when measuring forearm supination (p. 163).

Question 37

The presence of which of the following devices would MOST likely limit mobility activities during physical therapy?

1. Ventilator
2. Tracheostomy tube
3. Temporary pacemaker
4. Intracranial pressure monitor

Answer 37

1. Although activity may result in sounding of ventilator alarms, patients who have mechanical ventilation can participate in activities (Johansson, p. 76). For patients who demonstrate adequate strength and medical stability to ambulate, a portable ventilator may be used (Hillegass).
2. Although excessive head and neck movement should be avoided by patients who have a tracheostomy tube, mobility is feasible (Johansson, p. 75).
3. Although it may be a life-threatening situation if the pacemaker becomes disconnected, patients with temporary pacemakers are able to participate in exercise and physical activity (Johansson, p. 71).
4. An intracranial pressure monitor is the correct option because it takes very little to disrupt the values and interfere with the readings, such as changing the bed height. Therefore, mobility activities are significantly limited for patients who have an intracranial pressure monitor. (Johansson, p. 77)

Question 38

A patient has acute bilateral trapezius spasm. Which of the following types of transcutaneous electrical nerve stimulation is MOST appropriate for pain relief for this patient?

1. Burst
2. Acupuncture
3. Conventional
4. Low-frequency

Answer 38

1. Burst transcutaneous electrical nerve stimulation is similar to acupuncture mode in its setting, mechanism of action, and use, and is more appropriate for chronic pain conditions (Cameron).
2. Acupuncture transcutaneous electrical nerve stimulation produces a painful noxious stimulus to release endorphins and may not be tolerated by a patient with acute symptoms (Cameron; O’Sullivan).
3. Conventional transcutaneous electrical nerve stimulation produces sensory-level stimulation and is most likely to be tolerated by a patient in acute pain (Cameron; O’Sullivan).
4. Low-frequency transcutaneous electrical nerve stimulation releases endorphins by providing a noxious stimulus and may not be tolerated by a patient with acute symptoms (Cameron; O’Sullivan).

Question 39

An 82-year-old female patient has a sudden onset of muscle aching and stiffness. The patient reports fatiguing quickly and having difficulty ascending stairs. The patient denies recent illness or significant worsening of symptoms over the last week. The physical therapist notes an oral temperature of 99.9°F (38°C). Which of the following conditions is MOST consistent with this presentation?

1. Multiple sclerosis
2. Myasthenia gravis
3. Polymyalgia rheumatica
4. Guillain-Barré syndrome

Answer 39

1. Multiple sclerosis is an inflammatory demyelinating disease that is more common in women, but the disease generally appears in women age 20-50 years. It can present with weakness and fatigue, but it generally is not accompanied by aching muscles. Although fever is possible, it would be a secondary complication. (pp. 452-453)
2. Myasthenia gravis tends to affect women in the 20-30 year range. After age 50 years, the disorder is more common in men. It is characterized by muscle fatigue and weakness, but the symptoms generally affect the muscles of eye movement, chewing, swallowing, and facial expression. It is not generally associated with a fever or reports of stiffness. (pp. 454-455)
3. Polymyalgia rheumatica is a systemic rheumatic inflammatory disorder that is more prevalent in persons over age 80 years and more common in women. Typical clinical presentation includes muscle aching and stiffness, low-grade fever, weakness, fatigue, and malaise, as well as possible headache, weight loss, depression, or vision changes. It is not necessarily associated with a recent illness. (pp. 442-444) Normal oral temperature is 96.8°F to 99.5°F (36°F to 37.5°C). (p. 161)
4. Guillain-Barré syndrome is an acute autoimmune disorder characterized by demyelination of the peripheral nervous system. It can affect all ages, and incidence is not related to gender. The presentation is acute, with progressive weakness, and can include fever. As the patient denies any significant worsening in the previous week, this condition is less likely. The patient also did not report a recent illness prior to the development of the symptoms, which is characteristic of Guillain-Barré syndrome. (p. 454)

Question 40

A patient sustained a compression injury to the axillary nerve. Which of the following actions is MOST likely to be difficult for the patient to perform?

1. Elbow extension
2. Shoulder flexion
3. Forearm pronation
4. Shoulder medial (internal) rotation

Answer 40

1. The radial nerve innervates the elbow extensors, which would not be affected by an injury to the axillary nerve (p. 82).
2. The axillary nerve innervates the deltoid muscle, which is involved with active shoulder flexion (p. 81).
3. The median nerve innervates the forearm pronators, which would not be affected by an injury to the axillary nerve (p. 83).
4. The muscles involved with shoulder medial (internal) rotation include the subscapularis, pectoralis major, teres major, and latissimus dorsi. These muscles are not innervated by the axillary nerve. The subscapularis nerve innervates the subscapularis, the medial and lateral pectoral nerves innervate the pectoralis major, the lower subscapular nerve innervates the teres major, and the thoracodorsal nerve innervates the latissimus dorsi. (p. 77, 592)

Question 41

Which of the following interventions is MOST appropriate for treatment of a patient who has functional incontinence?

1. Developing a voiding schedule
2. Removal of clutter within the bathroom
3. Abdominal activation exercises in supine position
4. Rhythmic contractions of the pelvic floor

Answer 41

1. A voiding schedule will not improve balance and mobility, which would help most with functional incontinence. A voiding schedule is most often recommended for bladder retraining as part of the treatment for urge incontinence. (Kauffman, p. 416)
2. Removing clutter in the bathroom will improve the speed of ambulation to the toilet. Functional incontinence is defined as the loss of urine because of gait and locomotion impairments. (Kauffman, p. 416)
3. Abdominal activation exercises increase abdominal pressure and may cause an increase in urinary incontinence if there is weakness in the pelvic floor musculature (Bo). This patient has functional incontinence, which is due to gait and locomotion problems (Kauffman, p. 416).
4. Rhythmic contractions of the pelvic floor are indicated to strengthen the pelvic floor muscles. This does not affect the gait and locomotion impairments associated with functional incontinence. (Kauffman, pp. 416-417)

Question 42

Which of the following scenarios MOST likely indicates that a patient has a unilateral lesion of the semicircular canals on the right side?

1. The patient is able to maintain gaze on a target when the head is flexed to 30° and manually rotated quickly to the left side.
2. The patient is able to maintain gaze on a target when the head is flexed to 30° and manually rotated quickly to the right side.
3. The patient is unable to maintain gaze on a target when the head is flexed to 30° and manually rotated to quickly the left side.
4. The patient is unable to maintain gaze on a target when the head is flexed to 30° and manually rotated quickly to the right side.

Answer 42

1. A patient who has a unilateral lesion or a pathological condition of the central vestibular neurons will not be able to maintain gaze when the head is rotated quickly toward the side of the lesion.
2. A patient who has a unilateral lesion or a pathology of the central vestibular neurons will not be able to maintain gaze when the head is rotated quickly toward the side of the lesion.
3. A patient who has a unilateral lesion or a pathology of the central vestibular neurons will not be able to maintain gaze when the head is rotated quickly toward the side of the lesion, which is the right side for this patient.
4. The head thrust test is used to examine semicircular canal (SCC) function. A patient who has a unilateral lesion or a pathology of the central vestibular neurons will not be able to maintain gaze when the head is rotated quickly toward the side of the lesion.

Question 43

When using electrical stimulation to cause a contraction of innervated muscles, which of the following nerve fibers are activated FIRST?

1. Small diameter nerve fibers
2. Large diameter nerve fibers
3. Nerve fibers that innervate the slow-twitch muscle fibers
4. Nerve fibers that innervate the type I muscle fibers

Answer 43

1. The large diameter fibers are activated first during electrically stimulated contraction, and the smaller nerve fibers are activated first during a physiologically initiated muscle contraction.
2. The larger diameter nerve fibers are activated first during an electrically stimulated muscle contraction.
3. Slow-twitch muscle fibers are innervated by small diameter nerve fibers, which are not activated first.
4. Type I muscle fibers are the same as the slow-twitch muscle fibers, and these are innervated by small diameter nerve fibers, which are not activated first.

Question 44

A patient who recently received a new wheelchair reports frequent forward loss of balance and difficulty propelling the wheelchair. Assessment results for the patient are unchanged from previous physical examinations, except for redness over bilateral scapula. The physical therapist should suspect a problem with which of the following components of the wheelchair?

1. Seat height
2. Rear wheel position
3. Seat angle
4. Back height

Answer 44

1. Although improper seat height can interfere with propulsion and trunk balance, redness over the scapulae implicates the back height, not the seat height (Fairchild, pp. 139-140).
2. The rear wheel position relative to the patient’s upper limbs can affect the ease of propulsion; however, it does not explain the redness over the scapulae (Cifu).
3. Seat-to-back angles are primarily adjusted to correct pelvic tilt. For this patient, angling forward would increase loss of balance and angling posteriorly would increase scapular pressure, but both issues would not occur at the same time. (Palisano)
4. The irritation over the scapulae indicates that a problem with the back height exists. The excessively high back height can prevent the patient from leaning adequately backward and contribute to a forward loss of balance. (Fairchild, p. 140)

Question 45

A patient has surgery to repair an injury to the right knee. On postoperative day 1, the patient has a body temperature of 102.3°F (39°C), significant effusion in the right knee, and increased pain. Which of the following actions is MOST appropriate for a physical therapist to take?

1. Inform the surgeon of the new symptoms and hold physical therapy until the physician sees the patient.
2. Write a note in the medical record about the patient’s symptoms and apply some form of cryotherapy to the joint.
3. Inform the nurse of the patient’s condition and apply compression to the joint.
4. Document the reason for holding physical therapy and check on the patient the next day.

Answer 45

1. Rapid postoperative effusion with an elevated body temperature is indicative of a potential infection (Fruth). Findings that are outside the scope of the physical therapist should be relayed to the surgeon for appropriate and timely medical management (Pagliarulo).
2. Although cryotherapy might be appropriate for the usual postoperative effusion, the elevated temperature indicates possible infection, which requires more aggressive medical intervention (Fruth). The patient’s condition should be documented, but the physician should be verbally alerted as well (Pagliarulo).
3. The elevated temperature indicates possible infection, which requires more aggressive medical intervention (Fruth). Informing the nurse does not guarantee that the information will be communicated to the surgeon in a timely manner.
4. The physical therapist should take active steps to ensure that the physician receives the information about the change in the patient’s condition (Pagliarulo), especially when early intervention is paramount to patient safety (Fruth).

Question 46

An otherwise healthy patient has advanced osteoarthritis in the medial compartment of the right knee. Which of the following gait deviations is MOST likely to be observed during stance phase on the right lower extremity?

1. Left trunk lean
2. Right trunk lean
3. Forward trunk lean
4. Backward trunk lean

Answer 46

1. A left trunk lean would shift more external load onto the medial compartment and increase medial compartment pressure in a patient who has advanced osteoarthritis in the medial compartment of the knee (pp. 573-574).
2. Patients who have advanced osteoarthritis in the medial compartment of the knees frequently lean ipsilaterally, bringing the center of mass laterally. This transfers load more to the lateral compartment of the knee and promotes an external frontal plane knee moment that is more valgus, which also unloads the medial compartment of the knee. (pp. 573-574)
3. Although a forward trunk lean can decrease the compressive load on the whole knee through decreasing the external knee flexion moment and transferring it to the hip, it does not unload the medial compartment more than any other compartment of the knee and also is not seen as frequently as an ipsilateral lean with unicompartmental arthritis of the medial compartment of the knee (pp. 573-574).
4. A backward trunk lean shifts the center of mass backward, which increases the external knee flexion moment and increases the load on the entire knee. This deviation is not likely to be seen in a patient whose symptoms are aggravated by any knee joint compressive force. (pp. 694-695)

Question 47

A patient is able to repeat the movement depicted in the photographs a maximum of five times (heel raise). Which of the following manual muscle test grades would MOST likely be assigned to the muscles being tested?

1. Poor (2/5)
2. Fair (3/5)
3. Good (4/5)
4. Normal (5/5)

Answer 47

1. An individual who is able to perform a heel raise one time in standing position is given a grade of at least Fair (3/5). Manual muscle testing to obtain a grade of Poor (2/5) for the gastrocnemius and soleus muscles would be performed in prone position.
2. To confer a grade of Fair (3/5) an individual must be able to perform one heel raise correctly. A grade of Good (4/5) is conferred when the patient completes between two and 24 correct heel rises.
3. The photograph depicts an individual performing heel rises in standing position. This is the standard manual muscle test to examine the strength of the gastrocnemius and soleus muscles. A grade of Good (4/5) is conferred when the patient completes between two and 24 correct heel rises.
4. A grade of Normal (5/5) is given when an individual is able to repeat a heel rise a minimum of 25 times.

Question 48

Which of the following ASIA Impairment Scale levels is MOST appropriate to assign to a patient who has a C7 spinal cord injury with only intact anal sensation?

1. A
2. B
3. C
4. D

Answer 48

1. A patient who has intact anal sensation cannot be considered to have an ASIA Impairment Scale A spinal cord injury.
2. ASIA Impairment Scale B is the appropriate classification for a patient’s spinal cord injury if the patient has anal sensation.
3. ASIA Impairment Scale C is the appropriate classification for a patient’s spinal cord injury if the patient has a muscle strength grade of Fair (3/5) or less for more than one-half of the key muscles below the level of the lesion.
4. ASIA Impairment Scale D is the appropriate classification for a patient’s spinal cord injury if the patient has a muscle strength grade of Fair (3/5) or more for one-half of the key muscles below the level of the lesion.

Question 49

A patient demonstrates excessive pronation from midstance to terminal stance (heel off). Which of the following muscles is MOST likely weak?

1. Tibialis posterior
2. Extensor digitorum
3. Fibularis (peroneus) longus
4. Extensor hallucis longus

Answer 49

1. Excessive pronation during midstance to terminal stance (heel off) can be caused by a weak tibialis posterior muscle. Pronation occurs with hindfoot eversion. The tibialis posterior muscle produces ankle inversion, which can counteract ankle eversion. (p. 300)
2. The extensor digitorum extends the MTP and IP joints of the lateral four digits and is not a key mover of the ankle into plantarflexion and inversion (p. 1121). Weakness of this muscle would not be expected to contribute to excessive pronation during gait.
3. Contraction of the fibularis (peroneus) longus produces eversion, which this patient is already displaying. Therefore, weakness of this muscle is not likely to be contributing to excessive pronation. (p. 1120)
4. The extensor hallucis longus produces extension at the MTP and IP joints of the great toe and is not a key mover of the ankle into inversion and eversion. Weakness of this muscle would not be expected to cause excessive pronation. (p. 1121)

Question 50

A patient has a boutonnière deformity that is being treated nonsurgically. To maintain the maximum amount of hand function, which of the following exercises should be performed?

1. Flexion of the DIP joint with the PIP joint supported in extension
2. Extension of the DIP joint with the PIP joint supported in extension
3. Flexion of the PIP joint with the DIP joint supported in flexion
4. Flexion of the PIP joint with the DIP joint supported in extension

Answer 50

1. A boutonnière deformity is a contracture involving PIP joint flexion and DIP joint extension usually due to a central slip; therefore, maintaining active DIP flexion is important for function. The disruption of the central slip causes the lateral bands to slip volarly to the PIP joint axis of motion, creating flexor forces on the PIP joint. The imbalance results in hyperextension of the DIP joint. With this DIP posture, the oblique retinacular ligament is at risk of becoming tight. Maintaining active DIP flexion is essential for functional activities such as grip and manipulation of small objects.
2. A boutonnière deformity is a contracture in which the DIP joint is hyperextended; therefore, extension of the DIP joint would not be helpful.
3. A boutonnière deformity is a contracture involving PIP joint flexion and DIP joint extension; therefore, performing additional PIP flexion is not helpful and may worsen the contracture.
4. A boutonnière deformity is a contracture in which the DIP joint is hyperextended; therefore, flexion of the PIP joint with the DIP joint in extension would not be helpful.

Question 51

A patient who has Bell palsy would benefit MOST from strengthening of which of the following muscles?

1. Masseter
2. Temporalis
3. Lateral pterygoid
4. Frontalis

Answer 51

1. The masseter is a masticatory muscle that is innervated by the trigeminal nerve (CN V) (p. 238). A facial nerve (CN VII) injury will have no effect on the masseter.
2. The temporalis is innervated by the trigeminal nerve (CN V) (p. 238). A facial nerve (CN VII) injury will have no effect on the temporalis.
3. The lateral pterygoid is innervated by the trigeminal nerve (CN V) (p. 238). A facial nerve (CN VII) injury will have no effect on the lateral pterygoid.
4. Bell palsy involves paralysis of the facial nerve (CN VII) (pp. 136-137). A facial nerve (CN VII) injury will impair the strength of the frontalis, because the frontalis is innervated by the temporal branch of the facial nerve (CN VII) (p. 128).

Question 52

Patients who exhibited generalized weakness participated in an exercise program that included aerobic conditioning and resistive exercises for the lower extremities. Researchers found that this group of patients walked faster than patients who participated in an exercise program that included balance and functional retraining. The BEST extrapolation of these findings is that aerobic and resistive training of the upper extremities may increase the speed with which patients perform which of the following tasks?

1. Propelling a manual wheelchair
2. Rolling from supine position to prone position
3. Performing dressing activities
4. Completing a sliding board transfer

Answer 52

1. Since aerobic conditioning and resistive exercises of the lower extremities increased speed of performance during a cyclical, continuous task (walking) in individuals with weakness, it is possible that similar activities of the upper extremities will result in similar findings for another cyclical, continuous task (pushing a manual wheelchair).
2. In spite of the ballistic nature of rolling, it is still a discrete task, with a set beginning (supine position) and ending (prone position). The factors that dictate the success of a discrete motor task are different from those of a cyclical, continuous task and may not improve with increased aerobic fitness or strength.
3. A serial task, such as dressing, is composed of a series of discrete movements that are combined in a particular sequence. The factors that dictate the success of a serial motor task are different from those of a cyclical, continuous task and may not improve with increased aerobic fitness or strength.
4. Sliding board transfers are serial motor tasks. The factors that dictate the success of a serial motor task are different from those of a cyclical, continuous task and may not improve with increased aerobic fitness or strength.

Question 53

A patient has restricted left rotation at the C5–C6 level. When performing a unilateral posterior-anterior joint mobilization, placement of the physical therapist’s hand at which of the following locations is MOST likely to increase left rotation?

1. Left posterior articular pillar at C5
2. Left posterior articular pillar at C6
3. Right posterior articular pillar at C5
4. Right posterior articular pillar at C6

Answer 53

1. Mobilization with hand placement at the left posterior articular pillar at C5 would produce an increase in right rotation at C5–C6.
2. Mobilization with hand placement at the left posterior articular pillar at C6 would produce an increase in right rotation at C6–C7.
3. Anterior mobilization at the C5 posterior aspect of the articular pillar would produce rotation of the C5 vertebra to the left, increasing left rotation at C5–C6.
4. Mobilization with hand placement at the right posterior articular pillar at C6 would produce increased left rotation at C6–C7.

Question 54

Which of the following options BEST represents a typical respiratory rate for a child who is 1 year old?

1. 15 breaths/minute
2. 30 breaths/minute
3. 45 breaths/minute
4. 60 breaths/minute

Answer 54

1. A rate of 15 breaths/minute is below the normal range for respiratory rate for a child who is 1 year old.
2. The normal respiratory rate for a child who is 1 year old is between 25 and 35 breaths/minute.
3. A rate of 45 breaths/minute is above the normal range for respiratory rate for a child who is 1 year old.
4. A rate of 60 breaths/minute is above the normal range for respiratory rate for a child who is 1 year old.

Question 55

During examination of a 30-year-old female patient, a physical therapist palpates an enlarged thyroid gland. The patient appears nervous, has a rapid pulse rate, and has a thin build. Which of the following symptoms would the therapist expect to be associated with the enlarged thyroid?

1. Weight gain
2. Heat intolerance
3. Constipation
4. Irregular or heavy menses

Answer 55

1. Hyperthyroidism is associated with weight loss.
2. Graves disease, which is a condition of hyperthyroidism, is more common in women between 20 and 40 years old. In this condition, the thyroid can enlarge, secreting more thyroid hormone. Heat intolerance is a common symptom of hyperthyroidism. Excessive thyroid hormone creates a generalized elevation of body metabolism.
3. Hyperthyroidism is associated with diarrhea.
4. Hyperthyroidism is associated with amenorrhea.

Question 56

The BEST way to test if a patient has sufficient protective sensation in the foot to prevent skin breakdown is to use:

1. a feather and brush lightly over the bottom of the foot.
2. monofilaments and test areas exposed to high weight-bearing.
3. a sharp pin prick and test for a painful response.
4. a hot/cold discrimination test and test heat and cold tolerance.

Answer 56

1. Use of a feather to test sensation with a brushing stroke will test a larger area and would not be point specific. Use of a feather may inform the therapist of a touch awareness deficit but will not determine if a patient has protective sensation. (p. 93)
2. Protective sensation can be reliably measured utilizing monofilaments. Protective sensation in the foot is considered absent if an individual cannot feel the 5.07 monofilament. (pp. 93, 548)
3. In a foot with decreased skin integrity and suspected decreased sensation, the sharp pin may cause an additional wound. The pin prick may inform the therapist of a deficit but will not yield a qualitative result to determine if a patient has protective sensation. (p. 93)
4. Decreased thermal sensation may be an area of concern, but wounds were most likely caused by pressure on a weight-bearing area. Intact thermal sensation may not prevent a neuropathic wound. (p. 93)

Question 57

Which of the following methods is MOST appropriate for handling a 1-year-old child who has cerebral palsy and who exhibits strong extensor tone in the trunk and extremities?

1. Carrying the child in sitting position
2. Carrying the child over one’s shoulder
3. Keeping contact with the back of the child’s head
4. Picking the child up under the upper extremities

Answer 57

1. The sitting position promotes visual attending, use of the upper extremities, and social interaction (Martin, pp. 98-100). A flexed posture is preferred so the shoulders are forward. A child who exhibits extensor posturing should be carried in a symmetric position that does not allow axial hyperextension and keeps the hips and knees flexed (Palisano).
2. Carrying the child over one’s shoulder would inhibit visual attending and social interaction. It is better to carry the child in such a way that allows the child to look around and see what is ahead. (Martin, p. 101)
3. Carrying positions should accentuate the strengths of the infant and should avoid as much abnormal posturing as possible. The infant should be allowed to control as much of his or her body as possible for as long as possible before external support is given (Martin, p. 148). Contact to the back of the child’s head may facilitate extensor posturing. When carrying a child, one should encourage as much head and trunk control as the child can demonstrate. The child should be carried so that the neck and trunk muscles are used to maintain the head and trunk upright against gravity. This allows the child to look around and see what is ahead. (Martin, p. 101)
4. Picking the child up under the upper extremities would be more likely to facilitate extensor posturing. The legs stiffen into extension and may even cross or scissor. (Martin, pp. 98, 100)

Question 58

A 54-year-old patient has pain in the lateral shoulder rated at 9/10 intensity. The pain is of insidious onset and began 1 week ago. The patient is unable to lift the arm into abduction. Which of the following conditions is the MOST likely cause of these findings?

1. Biceps tendinopathy
2. Supraspinatus calcific tendinopathy
3. Adhesive capsulitis
4. Full-thickness rotator cuff tear

Answer 58

1. The signs and symptoms associated with biceps tendinopathy are pain in the anterior arm radiating to the elbow, pain with activities requiring supination such as opening a jar, and repetitive stress (p. 102).
2. The symptoms associated with calcific tendinopathy are generally very severe subacromial lateral shoulder pain with more sudden onset in patients who are middle aged (p. 102).
3. In the initial freezing stage of adhesive capsulitis, patients usually report mild, poorly localized shoulder pain that develops more gradually than calcific tendinopathy (pp. 158-159).
4. For a full-thickness rotator cuff tear, there is generally a causative event with pain in the subacromial region. Pain is generally less severe. (pp. 100-101)

Question 59

Which of the following cervical motions places the LEAST amount of compression on the vertebral artery as it courses through the cervical spine?

1. Flexion
2. Extension
3. Contralateral rotation
4. Contralateral side flexion

Answer 59

1. The vertebral artery is vulnerable to compression as it courses through the transverse foramen of C6–C1. The order of cervical positions that put the most to least stress on the artery are rotation-extension-traction, rotation-extension, rotation alone, side flexion alone, extension alone, and flexion alone. Flexion is the least stressful on the vertebral artery.
2. The vertebral artery is vulnerable to compression as it courses through the transverse foramen of C6–C1. The order of cervical positions that put the most to least stress on the artery are rotation-extension-traction, rotation-extension, rotation alone, side flexion alone, extension alone, and flexion alone. Extension is not the least stressful on the vertebral artery.
3. The vertebral artery is vulnerable to compression as it courses through the transverse foramen of C6–C1. The order of cervical positions that put the most to least stress on the artery are rotation-extension-traction, rotation-extension, rotation alone, side flexion alone, extension alone, and flexion alone. Rotation is more stressful than flexion on the vertebral artery.
4. The vertebral artery is vulnerable to compression as it courses through the transverse foramen of C6–C1. The order of cervical positions that put the most to least stress on the artery are rotation-extension-traction, rotation-extension, rotation alone, side flexion alone, extension alone, and flexion alone. Side flexion is more stressful than flexion on the vertebral artery.

Question 60

A patient has paresthesias in the areas marked in the photograph. Which of the following interventions is MOST appropriate to perform FIRST? (pic: Median Nerve distribution pattern to hands)

1. Resistance exercises for the wrist flexors
2. Putty exercises for tip-to-pad prehension
3. Tendon-gliding exercises for the wrist and finger flexors
4. Stretching exercises for the wrist and finger extensors

Answer 60

1. Resistance exercises put excessive compression on the carpal tunnel and median nerve and would not be initiated until symptoms have resolved (Kisner, p. 406).
2. Putty exercises are not indicated for patients who have carpal tunnel syndrome until symptoms are no longer provoked (Kisner, p. 406).
3. The photograph depicts the median nerve distribution that is associated with carpal tunnel syndrome. Flexor tendon gliding and a series of gentle median nerve mobilization techniques are indicated for this patient. The patient should progress through the series until median nerve symptoms are mildly provoked (tingling). (Kisner, pp. 406-407)
4. Stretching of the wrist extensors simulates the reverse Phalen test for carpal tunnel syndrome and would create compression of the median nerve, increasing symptoms (Dutton).

Question 61

A patient walks on the lateral edge of the foot and demonstrates diminished heel off (terminal stance) during gait. Which of the following nerves is MOST likely compromised?

1. Plantar nerve
2. Posterior tibial nerve
3. Deep fibular (peroneal) nerve
4. Superficial fibular (peroneal) nerve

Answer 61

1. The patient’s impaired ability to evert and plantar flex the foot at heel off (terminal stance) implicates the fibularis (peroneus) longus muscle, which is innervated by the superficial fibular (peroneal) nerve. Impairment would result in walking on the outside of the foot. Plantar nerves supply innervation to the intrinsics of the foot and are not related to the actions at the ankle.
2. The patient’s impaired ability to evert and plantar flex the foot at heel off (terminal stance) implicates the fibularis (peroneus) longus muscle, which is innervated by the superficial fibular (peroneal) nerve. The posterior tibial nerve innervates the posterior lower leg muscles; it does not innervate the medial/lateral stabilizers.
3. The patient’s impaired ability to evert and plantar flex the foot at heel off (terminal stance) implicates the fibularis (peroneus) longus muscle, which is innervated by the superficial fibular (peroneal) nerve. The deep fibular (peroneal) nerve innervates the tibialis anterior, an inverter and dorsiflexor.
4. The patient’s impaired ability to evert and plantar flex the foot at heel off (terminal stance) implicates the fibularis (peroneus) longus muscle, which is innervated by the superficial fibular (peroneal) nerve.

Question 62

A patient who has been burned has lost the ability to detect light touch, temperature, and sharp/dull sensations. Vibration and pressure sensation are intact. Based on the sensory findings, what is the MOST likely classification of the burn?

1. Epidermal
2. Superficial partial-thickness
3. Deep partial-thickness
4. Full-thickness

Answer 62

1. An epidermal burn would only impact superficial free nerve endings, which correspond to pain and itch sensation. Temperature detection, sharp/dull discrimination, pressure, and vibration would all be intact (p. 1053).
2. A superficial partial-thickness burn would impact the epidermis and the papillary layer of the epidermis. The patient will have extreme pain and be highly sensitive to temperature changes and light touch (pp. 1053-1054).
3. A deep partial-thickness burn would include damage through the epidermis and the papillary layer of the dermis but the deep reticular layer of the dermis that holds the Pacinian corpuscles would be intact. Damage to the epidermis and papillary layer of the dermis would destroy the sensory receptors for pain, itch, superficial touch, warmth, and cold but would spare the sensory receptors for vibration and pressure, which are located deeper in the reticular dermis (p. 1054).
4. With a full-thickness burn the epidermis and dermis layers are destroyed, and there is some damage to the subcutaneous fat layer. All nerve endings will be destroyed and the burn will be insensate (p. 1055).

Question 63

When differentiating between Stage 1 and Stage 2 lymphedema, which of the following procedures would be MOST appropriate for the physical therapist to perform?

1. Checking if the skin is warm and discolored
2. Checking if the skin indents or pits when pressed
3. Checking for changes in extremity girth and circumference
4. Checking for decreased strength and sensation

Answer 63

1. Normally, the skin would not be discolored in Stage 1 or Stage 2 lymphedema, unless there is a comorbidity such as chronic venous insufficiency.
2. At Stage 1, lymphedema presents as pitting edema, and it presents as nonpitting edema at Stage 2. It is most appropriate in this case to check for pitting by pressing the skin.
3. With both Stage 1 and Stage 2 lymphedema, girth and circumference would change or increase, so this is not the best way to differentiate between Stage 1 and Stage 2 lymphedema.
4. Strength and sensation are normally not affected by lymphedema. Clinicians may see decreased range of motion and lowered ability to lift the upper or lower extremities, mainly due to increased girth and weight.

Question 64

Which of the following test results is MOST consistent with a T1 spinal cord injury (ASIA Impairment Scale B)?

1. Intact sensation on the apex of the axilla, active movement of the elbow flexors against gravity, and absence of anal sensation
2. Intact sensation on the medial side of the antecubital fossa, palpable muscle activity of the little finger (5th digit) abductors, and presence of anal sensation
3. Intact sensation on the dorsal surface of the proximal phalanx of the middle finger (3rd digit), palpable muscle activity of the wrist extensors, and absence of anal sensation
4. Intact sensation on the dorsal surface of the proximal phalanx of the thumb (1st digit), active movement of the wrist extensors against gravity, and presence of anal sensation

Answer 64

1. Sensation on the apex of the axilla represents preserved sensation at T2. The muscle grade exhibited by the patient during flexion of the elbow indicates preserved motor function at C5. The presence of anal sensation is necessary for the injury to be considered incomplete (ASIA Impairment Scale B).
2. This is the correct answer. The intact sensation on the medial side of the antecubital fossa and contraction of finger abductors is consistent with the T1 dermatome and myotome. In order for an injury to be considered incomplete (ASIA Impairment Scale B), either deep anal sensation or some sensation in the anal mucocutaneous junction must be present.
3. Sensation on the dorsal surface of the proximal phalanx of the middle finger (3rd digit) is through C7, and the muscle grade exhibited by the patient during extension of the wrist with the forearm is through C6. In addition, motor or sensory findings must be present in S4–S5 in order for the injury to be classified as incomplete (ASIA Impairment Scale B).
4. The presence of anal sensation indicates that the injury is incomplete (ASIA Impairment Scale B). Sensation on the dorsal surface of the proximal phalanx of the thumb (1st digit) and the muscle grade exhibited by the patient during extension of the wrist would indicate an incomplete C6 spinal cord injury.

Question 65

An adult patient has burns over the anterior and posterior surfaces of the left lower extremity. According to the rule of nines, what percentage of the total body surface area is MOST likely involved?

1. 9%
2. 18%
3. 24%
4. 36%

Answer 65

1. Using the rule of nines, the total body surface area would be approximately 18%, not 9%.
2. Using the rule of nines, the total body surface area would be approximately 18%.
3. Using the rule of nines, the total body surface area would be approximately 18%, not 24%.
4. Using the rule of nines, the total body surface area would be approximately 18%, not 36%.

Question 66

A patient who sustained a superficial abrasion and a fracture to the left thumb (1st digit) 2 months ago reports constant pain over the thumb and medial hand. The thumb is red, swollen, and hypersensitive. There is excessive sweating over the medial hand. Which of the following conditions is MOST likely present?

1. Infection
2. Arthrofibrosis
3. Osteoarthritis
4. Complex regional pain syndrome

Answer 66

1. Signs and symptoms of infection typically include dramatic tissue warmth, sudden increased pain, and stiffness, but not the hyperhidrosis described in the stem (Magee, p. 18).
2. Arthrofibrosis involves loss of joint motion due to dense proliferative scar formation with intra- and extraarticular adhesions. Pain may be present, but hyperhidrosis would not be expected. (Dutton, pp. 1044-1045)
3. Degenerative changes associated with osteoarthritis can include pain and stiffness, but not inflammation. Hyperhidrosis is not characteristic of osteoarthritis. (Dutton, pp. 843-844)
4. Complex regional pain syndrome is characterized by an exaggerated response to injury in a limb, with intense prolonged pain, vasomotor disturbance, delayed functional recovery, and trophic changes. Symptoms described in the stem should alert the clinician to the possibility of complex regional pain syndrome. (Magee, p. 435)

Question 67

Which of the following endocrine glands has the MOST immediate effect on the nervous system?

1. Thyroid
2. Parathyroid
3. Adrenal
4. Pituitary

Answer 67

1. The thyroid most immediately affects metabolic rate and protein synthesis (p. 483).
2. The parathyroid’s most immediate effect is to regulate calcium and phosphate metabolism (p. 494).
3. The adrenal medulla secretes epinephrine and norepinephrine, which exert widespread effects on the nervous system (p. 497).
4. The pituitary’s most immediate effect is to regulate other glands; it has no direct effect on the nervous system (p. 479).

Question 68

A physical therapist will MOST likely hear which of the following sounds when auscultating the lungs of a patient who is having an exacerbation of asthma?

1. Deep snoring sound
2. High-pitched crowing sound
3. Rattling or bubbling sound
4. Continuous whistling sound

Answer 68

1. Snoring sounds are created in the upper airway caused by partial obstruction by secretions.
2. A high-pitched crowing sound is more indicative of an upper airway obstruction, which would be common with a tracheal or glottis problem.
3. Rattling/bubbling sounds (rales) are caused by secretions in the lung common in patients who have heart failure.
4. Asthma is a restrictive airway disease with a hallmark wheezing sound on auscultation. The wheezing is often described as a whistling sound.

Question 69

A patient’s posterior superior iliac spines are at the same height as the anterior superior iliac spines. Which of the following tests would be MOST appropriate for further investigation of this finding?

1. Measurement of leg length
2. Muscle length testing of the hip flexors
3. Muscle length testing of the hamstring muscles
4. Measurement of lumbar flexion range of motion

Answer 69

1. Leg length discrepancy will lead to uneven changes from side to side. The anterior superior iliac spine and the posterior superior iliac spine will be higher on the long leg. (pp. 1035, 1040)
2. Anterior pelvic tilt would indicate tight hip flexors. This would be seen as the anterior superior iliac spines being much lower than the posterior superior iliac spines (greater than 30°) (pp. 1039, 1041-1042).
3. The normal pelvic angle is 30°. The posterior superior iliac spines should be slightly higher than the anterior superior iliac spines (pp. 1036-1039). A decreased pelvic angle indicates a posterior pelvic tilt, which is associated with decreased hamstring muscle length (p. 1025).
4. Forward trunk flexion can assist with detecting scoliosis, a condition which would present with one pelvis being higher on one side, thus involving both the posterior superior iliac spine and the anterior superior iliac spine (p. 1029).

Question 70

A patient has limited movements throughout the arc of forearm supination and pronation due to moderate to severe pain. Which of the following manual therapy techniques to the proximal radioulnar joint is MOST appropriate to perform initially?

1. With the patient positioned in 5° of supination and 90° of elbow flexion, perform small-amplitude mobilizations at the beginning of the available range of motion.
2. With the patient positioned in 10° of supination and 70° of elbow flexion, perform large-amplitude mobilizations at the end of the range of motion.
3. With the patient positioned in 35° of supination and 70° of elbow flexion, perform large-amplitude mobilizations in the middle of the range of motion.
4. With the patient positioned in full supination and full elbow extension, perform small-amplitude mobilizations at the end of the range of motion.

Answer 70

1. Small amplitude mobilizations performed at the beginning of the available range of motion are used for pain relief and to induce an analgesic effect. However, it is best to mobilize a joint with a pain-dominant condition in an open-packed position. A position of 5° of supination and 90° of elbow flexion is the closed-packed position for the radiohumeral joint and mobilization in this position would likely increase pain.
2. Large-amplitude movement in the middle of the range is used for pain relief. It is best to mobilize the joint in a pain-dominant condition in an open-packed position. A position of 10° of supination and 70° of elbow flexion is the open-packed position for the ulnohumeral joint, not the proximal radioulnar joint. Large amplitude movement at the end of range of motion is moving into resistance, possibly creating more pain.
3. Small-amplitude mobilizations performed at the beginning of the available range of motion and large-amplitude movement in the middle of the range of motion are used for pain relief and to induce an analgesic effect. This patient has a pain-dominant joint condition. It is best to mobilize a joint with a pain-dominant condition in an open-packed position, which is 35° of supination and 70° of elbow flexion for the proximal or superior radioulnar joint.
4. Small-amplitude mobilization performed at the beginning of available range of motion, not at the end of the range of motion, are used for pain relief and induce an analgesic effect. It is best to mobilize a joint in a pain-dominant condition in an open-packed position. Full supination and full elbow extension is the open-packed position for the radiohumeral joint, not the proximal radioulnar joint.

Question 71

A patient who has a 5° plantar flexion contracture is MOST likely to demonstrate which of the following gait deviations?

1. Foot slap
2. Early heel rise
3. Knee buckling during midstance
4. Contralateral pelvic drop

Answer 71

1. Foot slap is caused by weakness of the ankle dorsiflexors, not by a plantar flexion contracture (p. 239).
2. A plantar flexion contracture will not allow the patient’s trunk to progress from behind the ankle to in front of the ankle as normally occurs in midstance (p. 239).- correct
3. Tight heel cords would pull the knee into recurvatum, not cause the knee to buckle. Closed-chain knee flexion is associated with increased dorsiflexion. (p. 239)
4. A contralateral pelvic drop at midstance is a compensation for a weak gluteus medius on the stance leg (p. 243).

Question 72

A patient reports complete sensation loss in the C6 dermatome, but has Normal (5/5) muscle strength in all upper extremity muscles. The patient MOST likely has a lesion in which of the following locations?

1. Dorsal root ganglia of C6
2. Ventral root ganglia of C6
3. Posterior interosseous nerve
4. Medial antebrachial cutaneous nerve

Answer 72

1. The dorsal roots are purely afferent nerves with no motor component (Kisner).
2. The ventral root ganglia of C6 contains purely efferent nerves with no sensation component (Kisner).
3. Injury to the posterior interosseous nerve would result in motor loss without sensory loss (Dutton, pp. 762-763).
4. The medial antebrachial cutaneous nerve of the forearm is innervated by C8–T1, not C6 (Dutton, p. 75).

Question 73

While using continuous ultrasound on a patient who has an upper trapezius muscle spasm, a physical therapist adjusts the intensity from 1.5 W/cm2 to 2.0 W/cm2. Which of the following changes will MOST likely occur?

1. Decrease in the depth of tissue penetration
2. Decrease in the amount of heating energy delivered
3. Increase in the depth of tissue penetration
4. Increase in the amount of heating energy delivered

Answer 73

1. The depth of penetration for ultrasound is determined by the ultrasound frequency. This clinical scenario describes a change in ultrasound intensity, which would have no effect on depth of penetration.
2. A change from 1.5 W/cm2 to 2.0 W/cm2 would increase the intensity and, therefore, increase the amount of heating energy being delivered, not decrease the amount of heating energy delivered.
3. The depth of penetration for ultrasound is determined by the ultrasound frequency. This clinical scenario describes a change in ultrasound intensity, which would have no effect on depth of penetration.
4. Intensity is the rate at which the energy is being delivered per unit area. An increase from 1.5 W/cm2 to 2.0 W/cm2 would increase the intensity and, therefore, increase the amount of heating energy being delivered.

Question 74

The test position shown in the photograph produces symptoms of dizziness, slurred speech, and confusion. The patient MOST likely has which of the following conditions?

1. Ménière disease
2. Vertebral artery compression
3. Benign paroxysmal positional vertigo
4. Unilateral vestibular hypofunction

Answer 74

1. Ménière disease is diagnosed symptomatically through fullness in the ear and tinnitus as well as episodic vertigo (O’Sullivan, pp. 942-943). Ménière disease can cause unilateral vestibular hypofunction, which would be diagnosed with the Romberg test, tandem Romberg test, single leg stance, changes in gait, and head turns, as well as the head-shaking-induced nystagmus test (O’Sullivan, pp. 926, 930). It would not be best diagnosed with the head position in the photograph.
2. The head position in the photograph, which is that of cervical extension and rotation, may cause vertebral artery compression. The symptoms of vertebral artery compression include dizziness, slurred speech, and confusion. If benign paroxysmal positional vertigo or unilateral hypofunction is present, slurred speech and confusion would not be present. (Herdman, p. 372)
3. Benign paroxysmal positional vertigo (BPPV) is assessed with the Dix-Hallpike test where the clinician rotates the patient’s head to one side while the patient is in sitting position and then brings the patient to a lying position with the neck extended up to 20° off the table (O’Sullivan, p. 929). While a patient with BPPV would report dizziness in the position in the photograph, slurred speech and confusion are not expected symptoms and would more likely point to vertebral artery compression (Herdman, p. 372).
4. Unilateral vestibular hypofunction would be diagnosed with the Romberg test, tandem Romberg test, single leg stance, changes in gait, and head turns, as well as the head-shaking-induced nystagmus test (O’Sullivan, pp. 926, 930). It would not be best diagnosed with the head position in the photograph.

Question 75

A patient who had a lumbar spinal fusion 2 days ago has developed increased secretions in the left lower lobe. Which of the following postural drainage strategies is MOST effective for clearing the secretions?

1. Left sidelying with the head lower than the feet
2. Left sidelying with the head lower than the feet, with percussion
3. Right sidelying with the head lower than the feet
4. Right sidelying with the head lower than the feet, with percussion

Answer 75

1. Placing the patient in left sidelying position will drain the right lower lobe (p. 543).
2. Placing the patient in left sidelying position will drain the right lower lobe (p. 543). Percussion is often used in conjunction with postural drainage to dislodge secretions in the underlying lung segment; however, percussion is contraindicated in patients who have a recent spinal fusion (p. 544).
3. The postural drainage position for the left lower lobe is right sidelying with the head lower than the feet (p. 543).
4. The postural drainage position for the left lower lobe is right sidelying with the head lower than the feet (p. 543). Percussion is often used in conjunction with postural drainage to dislodge secretions in the underlying lung segment; however, percussion is contraindicated in patients who have a recent spinal fusion (p. 544).

Question 76

Following multiple rib fractures on one side and an ipsilateral pneumothorax, which of the following pulmonary function tests is MOST effective to measure the patient’s improvement in ventilation?

1. Alveolar ventilation
2. Inspiratory capacity
3. Minute ventilation
4. Total lung capacity

Answer 76

1. Alveolar ventilation refers to the volume of air that participates in gas exchange. Unlike inspiratory capacity, alveolar ventilation is not a lung volume test and is not the most effective way to measure improvement in ventilation. Alveolar ventilation measurements should be confirmed by an arterial blood gas test, which can be invasive. (Paz, p. 71).
2. The patient has a restrictive extrapulmonary condition that will most likely impair lung expansion and the amount of air being mobilized in each ventilation cycle. Inspiratory capacity refers to the largest volume of air that can be inspired in one breath from the resting expiratory level, and it can easily be measured with an incentive spirometer. (Paz, p. 71; Hillegass)
3. Minute ventilation refers to the total volume of air inspired or expired in 1 minute without discrimination between lung expansion or increase in respiratory rate. In this case, the patient could maintain a good minute ventilation by increasing the respiratory rate, which would increase the ventilation effort. (Paz, p. 394) Therefore, minute ventilation would not accurately reflect an improvement in lung expansion in a patient who has the lung condition described in the stem.
4. The total lung capacity refers to the volume of air contained in the lung at the end of maximal inspiration. It requires special equipment to be calculated. (Paz, pp. 70-71)

Question 77

A physical therapist is assessing a patient’s orientation to gravity while the patient is in a prone stander. The therapist should be aware that the orientation to gravity:

1. affects the perception of sensation.
2. is a measure of function.
3. determines the degree of ROM available.
4. influences muscle tone throughout the trunk and extremities.

Answer 77

1. There is no reason to expect sensation to be altered by gravitational forces.
2. Orientation to gravity is not a measure of function.
3. Range of motion does not change based on orientation to gravity because range of motion is a static measure.
4. Tone presentation can vary depending on patient position and interaction of tonic reflexes.

Question 78

A patient ambulates with an absent heel strike (initial contact) on the left. Range of motion assessment reveals a loss of left ankle dorsiflexion. Which of the following modality and treatment interventions would be MOST appropriate?

1. Moist heat application followed by stretching into dorsiflexion
2. Cryotherapy application while stretching into dorsiflexion
3. Continuous ultrasound while stretching into dorsiflexion
4. Continuous ultrasound followed by stretching into dorsiflexion

Answer 78

1. The hot pack provides the effects of heating to the posterior lower leg but does not penetrate as deeply as the ultrasound does. Also, stretching together with heat is the most effective way of increasing muscle length. (pp. 175-176)
2. A cold pack can reduce the amount of spasticity in the muscle after application for a long period of time, up to 30 minutes. If this application were to be used to increase muscle length, the cold pack should be applied first and then stretching and other manual techniques should occur afterward to get the most effective results. (p. 132)
3. Continuous ultrasound along with stretching is the best way to increase soft tissue extensibility, thereby reducing soft tissue shortening and increasing joint range of motion. Ultrasound is best used because it can penetrate into the muscle and has been shown to be better than when stretching is used alone. (p. 176)
4. Ultrasound along with stretching is the most effective way of increasing joint range of motion by stretching (p. 176).

Question 79

During an outpatient physical therapy appointment, a patient reports lethargy, confusion, and excessive thirst. The patient should be referred to the appropriate professional to be examined for the presence of which of the following conditions?

1. Hypoglycemia
2. Hyperglycemia
3. Hypothyroidism
4. Hyperthyroidism

Answer 79

1. Hypoglycemia is marked by pallor and shakiness but not usually by excessive thirst (p. 408).
2. The symptoms listed are all characteristic of hyperglycemia in the context of diabetes. Although lethargy and confusion are common in other conditions, the excessive thirst should cause one to suspect diabetes over and above other conditions. (p. 408)
3. Hypothyroidism is marked by a puffy face, muscle weakness, and edema of the extremities but not usually by excessive thirst (pp. 395, 397).
4. Hyperthyroidism is marked by exophthalmos, weight loss, and sweating palms but not usually by excessive thirst (pp. 395-396).

Question 80

Which of the following descriptors BEST differentiates a child who has autism spectrum disorder from a child who has developmental coordination disorder?

1. Decreased muscle tone
2. Impaired motor coordination
3. Restricted, repetitive behaviors
4. Decreased participation in organized sports

Answer 80

1. Hypotonia occurs in individuals who have autism spectrum disorder (Palisano, p. 584) and in individuals who have developmental coordination disorder (Palisano, p. 400; Tecklin).
2. Impaired motor coordination is present in individuals who have autism spectrum disorder (Palisano, p. 585) and in individuals who have developmental coordination disorder (Palisano, p. 400).
3. Children who have autism spectrum disorder and children who have developmental coordination disorder share some impairments, functional limitations, and participation restrictions. Restricted or repetitive behaviors is a specific impairment that is listed for autism spectrum disorder but not listed for developmental coordination disorder. (Palisano, p. 584)
4. Decreased participation in organized sports is observed in individuals who have autism spectrum disorder (Palisano, p. 591) and in individuals who has developmental coordination disorder (Palisano, p. 400).

Question 81

A patient has weakness of the muscle being tested in the video. Which of the following nerves is MOST likely involved?

1. Common fibular (peroneal)
2. Tibial
3. Saphenous
4. Sural

Answer 81

1. This answer is correct because video demonstrates manual muscle test for extensor hallucis longus that is supplied by the common fibular nerve (Dutton p. 98).
2. The video demonstrates manual muscle test for extensor hallucis longus that is supplied by the common fibular nerve and not tibial nerve. Tibial nerve supplies ankle plantar flexors (Dutton, p. 95).
3. The video demonstrates manual muscle test for extensor hallucis longus that is supplied by the common fibular nerve and not saphenous nerve. Saphenous nerve is sensory only branch of the femoral nerve (Dutton, p. 87).
4. The video demonstrates manual muscle test for extensor hallucis longus that is supplied by the common fibular nerve and not sural nerve. Sural nerve is sensory only branch of the tibial nerve (Dutton, p. 95).

Question 82

If a patient has a positive result on the test shown in the photograph, which of the following muscles should be considered weak?

1. Teres major
2. Rhomboids major
3. Latissimus dorsi
4. Serratus anterior

Answer 82

1. A positive result for the test shown in the photograph implies weakness of the scapular control muscles: serratus anterior and lower trapezius (Magee). Teres major creates movement in the humerus, not the scapula. It is involved in humeral adduction and internal (medial) rotation (Moore, p. 705).
2. A positive result for the test shown in the photograph implies weakness of the scapular control muscles: serratus anterior and lower trapezius (Magee). Rhomboids major are scapular retractors and downward rotators. They are minimally involved in scapular elevation, not upward rotation (Moore, pp. 702-703).
3. A positive result for the test shown in the photograph implies weakness of the scapular control muscles: serratus anterior and lower trapezius (Magee). Latissimus dorsi is a depressor and primarily a downward rotator of the scapula, not an upward rotator like the serratus anterior or lower trapezius (Moore, p. 702).
4. The physical therapist in the photograph is performing the scapular assistance test. Decrease in symptoms from the scapular assistance test implies weakness of the scapular control muscles: serratus anterior and lower trapezius (Magee). Both of these muscles are upward rotators of the scapula in arm elevation (Moore, pp. 701-702).

Question 83

Which of the following forms of weight-shifting represents the MOST effective form of unloading to minimize the potential for skin breakdown?

1. Chair push-ups
2. Full forward lean
3. Partial forward lean
4. Lateral weight-shifts

Answer 83

1. The chair push-up completely lifts the buttocks off the chair, providing for pressure relief and reperfusion of tissue that has been compressed. This lift is considered the most effective method for completely unloading the buttocks.
2. A full forward lean will shift the weight forward to unload the posterior portion of the buttocks and ischial tuberosities but will not unload the area completely.
3. Placing the elbows on the knees can reduce the load on the buttocks but will not completely unload the buttocks.
4. Lateral leans only unload one side at a time and must be followed by leaning to the opposite side. Most patients are unable to lean far enough to completely unload the buttocks.

Question 84

Primary lymphedema is MOST likely to result from which of the following causes?

1. Tumor obstruction
2. Radiation therapy
3. Chronic venous insufficiency
4. Lymphatic hypoplasia

Answer 84

1. Several conditions may cause secondary lymphedema, including radiation therapy (particularly post axillary lymph node dissection), infections, tumor obstruction (cancer), and chronic venous insufficiency (p. 145).
2. Several conditions may cause secondary lymphedema, including surgery, trauma, radiation therapy (particularly post axillary lymph node dissection), infections, tumor obstruction (cancer), and chronic venous insufficiency (p. 145).
3. Chronic venous insufficiency is a frequent cause of secondary lymphedema. The venous system becomes compromised and cannot accommodate the normal amount of venous flow. The lymphatic system will compensate but will likely become impaired with the increased demands, and the transport capacity will be unable to meet the increased fluid load. (pp. 151-152)
4. Primary lymphedema is believed to result from an abnormally developed lymphatic system that is congenital or hereditary, although the consequences may not be observed for several years. The three types of abnormalities (dysplasia) of the lymphatic systems include hypoplasia, hyperplasia, and aplasia. (pp. 145, 151)

Question 85

A physical therapist examines a patient with right shoulder pain unrelated to any specific activity. The patient has an 8-year history of alcohol abuse. When attempting right and left wrist extension, the patient demonstrates a high-amplitude tremor. The results of quadrant testing of the cervical spine are negative, and the patient demonstrates full range of motion of the right shoulder. The patient’s right shoulder pain is MOST likely the result of which of the following types of disorders?

1. Hematological
2. Hepatic
3. Musculoskeletal
4. Psychological

Answer 85

1. The signs and symptoms are consistent with a liver disorder associated with long-term alcohol abuse. There are no signs and symptoms associated with bleeding or a hematological disorder.
2. This scenario describes signs, symptoms, and clinical history consistent with a liver disorder: bilateral asterixis (flapping tremor), long-term alcohol abuse, and right shoulder pain unchanged with movement.
3. The presence of a tremor is an indicator that there is something other than a musculoskeletal problem, especially since there is normal range of motion in the neck and right shoulder.
4. There is evidence of a liver problem and no evidence of a psychological problem.

Question 86

A patient was struck from behind in a motor vehicle accident 2 days ago. The patient has cervical pain and limitations in right cervical rotation. Radiographs are unremarkable. In addition to use of a cervical collar, which of the following interventions would be MOST appropriate for the patient?

1. Use of modalities to diminish pain and guarding
2. Performance of exercise to address movement loss
3. Performance of mechanical cervical traction for pain management
4. Performance of cervical manipulation to address movement loss

Answer 86

1. The accident occurred 2 days ago, placing the timing of the injury in the acute stage of recovery. The primary goal in the acute stage is to diminish pain and muscle guarding, for instance with the use of modalities. (p. 1321)
2. The accident occurred 2 days ago, placing the timing of the injury in the acute stage of recovery. The primary goal in the acute stage is to diminish pain and muscle guarding, for instance with the use of modalities (p. 1321). If active range of motion exercise is initiated too early, it may lead to delays in healing due to the presence of continued myalgia and muscle guarding secondary to pain (p. 1322).
3. There is no evidence supporting the use of cervical mechanical traction for the treatment of whiplash associated disorders (p. 1322).
4. Although early manual therapy in the form of soft tissue mobilization may be beneficial to decrease pain in the acute stage, higher grade mobilization/manipulation should be initiated only when pain and muscle guarding has subsided (p. 1321).

Question 87

A patient who has vertigo is observed to have short-duration, upbeating nystagmus with left torsion during the Dix-Hallpike test. Which of the following interventions is MOST appropriate?

1. Liberatory maneuver to the left
2. Liberatory maneuver to the right
3. Canalith repositioning maneuver to the left
4. Canalith repositioning maneuver to the right

Answer 87

1. The liberatory maneuver is more appropriate for benign paroxysmal positional vertigo (BPPV) with cupulolithiasis (p. 934).
2. The liberatory maneuver is more appropriate for benign paroxysmal positional vertigo (BPPV) with cupulolithiasis, furthermore, left torsion of the eye suggests left posterior semicircular canal involvement, not right semicircular involvement (p. 934).
3. Transient nystagmus suggests benign paroxysmal positional vertigo (BPPV) canalithiasis. Left torsion of the eye suggests left posterior semicircular canal involvement (posterior semicircular canals are most often affected in BPPV). The canalith repositioning maneuver is designed to move free-floating debris out of the involved semicircular canal and into the vestibule. (pp. 933-934)
4. Left torsion of the eye suggests left posterior semicircular canal involvement, not right semicircular canal involvement (p. 934).

Question 88

A patient begins a 6-minute walk test and reports dyspnea and light-headedness after walking 100 ft (30.5 m). The patient is instructed to stop and stay in standing position for vital sign measurement; during this rest period, the patient’s dyspnea and light-headedness improve. The table depicts the patient’s physiological responses. Which of the following actions would be MOST appropriate for the physical therapist to perform NEXT?

1. Stop the exercise test and have the patient rest in sitting position.
2. Stop the exercise test and activate the emergency response system.
3. Continue the test and allow the patient to take rest breaks every 100 ft (30.5 m).
4. Continue the test and allow the patient unlimited rest breaks.

Answer 88

1. This patient’s heart rate response is higher than normal. With dynamic exercise, systolic blood pressure should increase in direct proportion to workload and diastolic blood pressure should remain within +/- 10 mm Hg. Systolic blood pressure that fails to rise or falls (greater than 10 mm Hg) is an abnormal response. This patient demonstrates an abnormal blood pressure response. Oxygen saturation as measured by pulse oximetry of 90% requires caution. A rating of perceived exertion of 13/20 is considered somewhat hard exertion and represents about 60% of the heart rate maximum. In addition to the patient’s abnormal systolic blood pressure response, dyspnea and light-headedness indicate marked exercise intolerance, and the test should be terminated.
2. This patient demonstrates an abnormal blood pressure response. Oxygen saturation as measured by pulse oximetry of 90% requires caution. In addition to the patient’s abnormal systolic blood pressure response, dyspnea and light-headedness indicate marked exercise intolerance, and the test should be terminated. The patient’s condition improved with rest, however; so emergency medical services are likely not warranted.
3. This patient demonstrates an abnormal blood pressure response. Oxygen saturation as measured by pulse oximetry of 90% requires caution. In addition to the patient’s abnormal systolic blood pressure response, dyspnea and light-headedness indicate marked exercise intolerance. Because this patient demonstrated an abnormal response to exercise and warning signs of limited exercise tolerance, the test should be terminated.
4. This patient demonstrates an abnormal blood pressure response. Oxygen saturation as measured by pulse oximetry of 90% requires caution. In addition to the patient’s abnormal systolic blood pressure response, dyspnea and light-headedness indicate marked exercise intolerance. Because this patient demonstrated an abnormal response to exercise and warning signs of limited exercise tolerance, the test should be terminated.

Question 89

A patient reports experiencing a spinning sensation when rolling to the right side in bed, looking up at a high shelf, or moving into supine position. Which of the following activities is MOST appropriate to include in the initial examination?

1. Performance of the Epley maneuver
2. Performance of the Dix-Hallpike maneuver
3. Completion of the Berg Balance Scale
4. Completion of the Dizziness Handicap Inventory

Answer 89

1. The Epley maneuver is a treatment, not an examination technique, for benign positional paroxysmal vertigo (Fell, p. 931).
2. The Dix-Hallpike maneuver is the standard examination for benign positional paroxysmal vertigo, which would be indicated with subjective reports of positional dizziness, such as a spinning sensation when rolling in bed to the right side, looking up at a high shelf, and moving into supine position (Fell, pp. 224-225).
3. Although the Berg Balance Scale is an objective measurement of balance and may be indicated for assessment of a patient who reports dizziness, it is a functional balance scale and not an examination specifically for vertigo (Umphred).
4. Although the Dizziness Handicap Inventory is an objective measurement of dizziness and may be indicated, it is a symptom survey completed by the patient and not an examination specifically for vertigo (Umphred).

Question 90

A physical therapist is treating a patient who has a primary lymphatic disorder of a lower extremity. Which of the following interventions would be MOST appropriate?

1. Elevation of the extremity
2. Manual drainage
3. Immobilization of the extremity
4. Thermotherapy

Answer 90

1. Primary lymphatic disorders are congenital or hereditary. Leg elevation may be inadequate to relieve swelling. The most effective intervention for lymphedema is a two-phase program of complete decongestive therapy, which involves manual lymphatic drainage.
2. Primary lymphatic disorders are congenital or hereditary. Treatment is done in two phases. Phase I involves skin care, manual lymphatic drainage, lymphedema bandaging, exercise, and use of a compression garment at the end of exercise. Phase II (self-management) includes skin care, use of a compression garment during the day, exercise, lymphedema bandaging at night, and manual lymphatic drainage as needed.
3. Primary lymphatic disorders congenital or hereditary. Treatment is done in two phases. Phase I involves skin care, manual lymphatic drainage, lymphedema bandaging, exercise, and use of a compression garment at the end of exercise. Phase II (self-management) includes skin care, use of a compression garment during the day, exercise, lymphedema bandaging at night, and manual lymphatic drainage as needed. Immobilization is not recommended.
4. Primary lymphatic disorders are congenital or hereditary. Treatment is done in two phases. Phase I involves skin care, manual lymphatic drainage, lymphedema bandaging, exercise, and use of a compression garment at the end of exercise. Phase II (self-management) includes skin care, use of a compression garment during the day, exercise, lymphedema bandaging at night, and manual lymphatic drainage as needed. Thermotherapy is not recommended.

Question 91

When reaching to grasp a glass of water, a patient overreaches and knocks the glass over. Upon further examination, the patient also displays difficulty with finger-to-nose touching. The patient’s condition is MOST likely caused by a lesion of which of the following neuroanatomical structures?

1. Spinocerebellum
2. Cerebrocerebellum
3. Vestibulocerebellum
4. Cerebellar peduncle

Answer 91

1. Spinocerebellar lesions result in a limb ataxia, such as dysmetria. Dysmetria is described as the inability to accurately move an intended distance, which would result in a patient overreaching for a target such as a cup. (pp. 294, 298-299)
2. The cerebrocerebellum helps control distal limb function including planning the timing, and coordination of voluntary movements. A lesion to this area would not result in limb ataxia such as dysmetria. (pp. 294, 298-299)
3. The vestibulocerebellum receives information from the visual and vestibular areas of the brain. A lesion to the vestibulocerebellum would impair eye movements and postural muscular control. (pp. 294, 298-299)
4. The cerebellar peduncles connect the brainstem with the cerebellum and have no regulatory effects. A lesion to this area would not result in a limb ataxic condition such as dysmetria. (p. 293)

Question 92

During the Clinical Test for Sensory Integration and Balance, a patient demonstrates increased sway when standing on a foam surface with eyes closed and when standing on foam with vision obscured by a dome. The sway is normal during all other conditions. Which of the following patient problems is the MOST likely reason for the findings?

1. Inability to effectively adapt sensory information
2. Inability to use vestibular input for postural control
3. Dependence on the visual system for postural control
4. Dependence on the somatosensory system for postural control

Answer 92

1. Patients who have a sensory selection problem and are unable to adapt will also exhibit increased sway when standing. Patients who are unable to use vestibular input for postural control are unable to resolve conflicts between vestibular and visual information on a firm surface with vision obscured and when standing on foam with eyes open.
2. Patients who exhibit increased sway when standing on foam with eyes closed and foam with obscured vision demonstrate a vestibular loss pattern.
3. Patients who are visually dependent will also exhibit increased sway when standing on a firm surface with eyes closed or with vision obscured.
4. Patients who are dependent upon surface information through the somatosensory system will also have increased sway when standing on foam with eyes open.

Question 93

A patient who is taking warfarin (Coumadin) has an international normalized ratio (INR) of 5. What is the MOST appropriate interpretation of this value?

1. This value is too low, indicating there is increased risk of excessive anticoagulation.
2. This value is too low, indicating the blood is too thick and there is increased risk for clots.
3. The value is too high, indicating there is increased risk of excessive anticoagulation.
4. This value is too high, indicating the blood is too thick and there is increased risk for clots.

Answer 93

1. An international normalized ratio value below 2 would be too low, because the goal is 2-3.5. This patient has a value of 5. This would mean the patient would need increased anticoagulants. They would not be at increased risk of excessive bleeding.
2. The goal range is 2 to 3.5. A value of 5.0 is too high, not too low.
3. International normalized ratio is used to assess the adequacy and effectiveness of anticoagulant therapies, such as warfarin (Coumadin). An acceptable ratio during anticoagulant therapy is 2-3.5. If a higher number is noted, then the patient is at risk for excessive bleeding. This can be dangerous and should be noted in individuals undergoing anticoagulation therapy.
4. This value is too high, but the patient is not at risk for clots. The patient is at risk for excessive bleeding or anticoagulation.

Question 94

A 13-year-old boy has a shorter lower extremity with ipsilateral thigh and hip pain. When walking, the patient is MOST likely to maintain the involved hip in which of the following positions?

1. Flexion
2. Abduction
3. Medial (internal) rotation
4. Lateral (external) rotation

Answer 94

1. Antalgic gait and lateral (external) rotation of the involved hip is likely to be observed in a patient who has a slipped capital femoral epiphysis which is described in the stem.
2. Antalgic gait and lateral (external) rotation of the involved hip is likely to be observed in a patient who has a slipped capital femoral epiphysis which is described in the stem.
3. Antalgic gait and lateral (external) rotation of the involved hip is likely to be observed in a patient who has a slipped capital femoral epiphysis which is described in the stem.
4. Slipped capital femoral epiphysis is the most common hip disorder of adolescents. Presentation is more common in males than females and occurs between the ages of 10-17 years. Pain is commonly reported in the thigh and hip with limited hip medial (internal) rotation, abduction, and flexion, and adductor spasm. Antalgic gait and lateral (external) rotation of the involved hip are likely to be observed.

Question 95

A patient has a raised area of skin with black coloration, regular borders, and a diameter of 0.12 inch (3 mm). These findings are MOST consistent with which of the following skin presentations?

1. Angioma
2. Melanoma
3. Basal cell carcinoma
4. Nevus

Answer 95

1. Angiomas are small, usually less than 3 mm in diameter and are usually bright red. They also have smooth borders. (p. 420)
2. Melanomas are primarily greater than 6 mm in diameter and have irregular borders even though they can be black in color (p. 437).
3. Basal cell carcinomas usually have irregular borders, and skin in the area will flake off. The coloration is usually not black (p. 433).
   4. If the lesion is less than 6 mm in diameter and has regular borders, it is more likely to be noncancerous (p. 431).

Question 96

The photograph shows the end-point of a Craig test performed on an adult patient. Which of the following conclusions is MOST appropriate?

1. Normal femoral anteversion
2. Excessive femoral anteversion
3. Normal femoral retroversion
4. Excessive femoral retroversion

Answer 96

1. The Craig test measures the point in prone hip medial (internal)/lateral (external) rotation where the greater trochanter is the most prominent. The photograph shows the patient in significantly more medial (internal) rotation than normal, indicating excessive femoral anteversion for an adult.
2. The Craig test measures the point in prone hip medial (internal)/lateral (external) rotation where the greater trochanter is the most prominent. The normal finding would be with the hip in medial (internal) rotation of approximately 8° to 15°. The photograph shows the patient in significantly more medial (internal) rotation, indicating excessive femoral anteversion for an adult.
3. The Craig test measures the point in prone hip medial (internal)/lateral (external) rotation where the greater trochanter is the most prominent. The photograph shows the patient in significantly more medial (internal) rotation than normal, indicating excessive femoral anteversion for an adult. Retroversion is not a normal position and would be a finding in a Craig test with the leg positioned in vertical or lateral (external) rotation.
4. The Craig test measures the point in prone hip medial (internal)/lateral (external) rotation where the greater trochanter is the most prominent. The photograph shows the patient in significantly more medial (internal) rotation than normal, indicating excessive femoral anteversion for an adult. Retroversion is not a normal position and would be a finding in a Craig test with the leg positioned in vertical or lateral (external) rotation.

Question 97

A patient wearing a transfemoral prosthesis is demonstrating lateral bending of the trunk to the prosthetic side from heel strike (initial contact) to midstance. Which of the following is the LEAST likely cause?

1. High medial wall
2. Weak hip abductors
3. Prosthesis that is too short
4. Prosthesis that is too long

Answer 97

1. The patient will lean away from the medial side so that the discomfort or pinching associated with a high medial wall is minimized.
2. Performing a lateral trunk lean toward the prosthetic leg in stance will compensate for weak hip abductors causing a Trendelenburg gait.
3. If the prosthesis is too short, the patient will demonstrate lateral trunk bending to the prosthetic side.
   4. A prosthesis that is too long would cause leaning of the trunk to the opposite side or circumduction of the leg.

Question 98

During lung auscultation, crackles (rales) are heard in the location directly under the physical therapist’s stethoscope shown in the photograph. Which of the following postural drainage positions is MOST appropriate for the patient?

1. Supine position with the head elevated to 30°
2. Right sidelying position with the trunk rotated to the left 45° and the head positioned 15° lower than the hips
3. Right sidelying position with the trunk rotated to the right 45° and the head positioned 15° lower than the hips
4. Sitting position with the patient leaning back on pillows at a 60° angle and the head flexed forward

Answer 98

1. Supine with the head elevated to 30° is the position for postural drainage of the anterior segments of the upper lobes. The location indicated in the photograph is the lingular segment of the left upper lobe.
2. The location indicated in the photograph is the lingular segment of the left upper lobe. The patient is positioned in right sidelying with the trunk rotated to the left 45° and the head lower than the hips for postural drainage of the lingular segment.
3. Right sidelying coupled with right rotation and the head lower than the hips does not place the lingular segment in the best position for postural drainage.
4. Sitting and leaning on pillows at a 60° angle with the head flexed forward is the position for postural drainage of the apical segment of the upper lobes. The location indicated in the photograph is the lingular segment of the left upper lobe.

Question 99

A patient who has peripheral arterial disease has an intact integument in the lower extremities. The patient reports posterior lower leg pain during walking but denies pain at rest. Which of the following ankle-brachial index values is MOST likely to be associated with these findings?

1. 0.3
2. 0.5
3. 0.8
4. 1.2

Answer 99

1. An ankle-brachial index (ABI) of 0.3 is considered an indication of severe ischemia in which pain will be present at rest.
2. An ABI of 0.5 indicates the presence of moderate peripheral arterial disease and is typically associated with lower extremity pain with walking and at rest.
3. An ABI of 0.8 is indicative of mild peripheral arterial disease and is typically associated with some form of intermittent claudication with walking but not at rest.
4. An ABI between 1.0 and 1.3 is considered normal, and patients who have an ABI in this range would be expected to be asymptomatic.

Question 100

An otherwise healthy young adult who has a C5 spinal cord injury (ASIA Impairment Scale A) is being examined by a physical therapist. Which of the following functional levels is the MAXIMUM that the patient can potentially achieve?

1. Dependent transfer to a wheelchair by using an overhead lift
2. Independent rolling side to side in bed
3. Independent community-level mobility with a manual wheelchair
4. Toilet transfer with a sliding board and assistance

Answer 100

1. A patient who has a complete injury to C5 still has innervation to the deltoids, biceps, and rhomboids and would potentially be able perform level surface transfers with assistance.
2. A patient requires innervation to the pectoralis major and teres major to be independent with rolling in bed. An individual who has a C6 spinal cord injury (ASIA Impairment Scale A) would be able to achieve this functional level, but not an individual who has a C5 spinal cord injury.
3. Although an individual with a C5 spinal cord injury (Asia Impairment Scale A) may be able to propel a manual wheelchair with rim projections on level surfaces, the high energy cost required for long-distance propulsion and maneuvering on unlevel surfaces and curbs in the community makes this functional level difficult to achieve.
4. A patient who has a C5 spinal cord injury (ASIA Impairment Scale A) can potentially assist with a sliding board transfer with the use of deltoids, biceps, and rhomboids, especially if normal strength is present in all innervated muscles.

Question 101

What is the MINIMUM width of a doorway that allows clearance for a standard wheelchair?

1. 28 inches (71 cm)
2. 30 inches (76 cm)
3. 32 inches (81 cm)
4. 36 inches (91 cm)

Answer 101

1. The minimal doorway width to allow standard wheelchair access is 32 inches (81 cm).
2. The minimal doorway width to allow standard wheelchair access is 32 inches (81 cm).
3. The minimal doorway width to allow standard wheelchair access is 32 inches (81 cm).
4. The minimal doorway width to allow standard wheelchair access is 32 inches (81 cm).

Question 102

hich of the following conditions is MOST likely to cause a left tracheal deviation?

1. Right pleural fibrosis
2. Right pleural effusion
3. Right lobar atelectasis
4. Right pneumonectomy

Answer 102

1. A tracheal shift occurs toward the side where there is less lung volume; fibrosis in the right lung will decrease lung volume and cause a right tracheal deviation.
2. A tracheal shift occurs away from the side of the abnormality when there is an increase in volume. A pleural effusion will cause an increase in volume. Therefore, a right pleural effusion will cause a left tracheal shift.
3. A tracheal shift occurs toward the side where there is less lung volume; atelectasis in the right lung will decrease lung volume and cause a right tracheal deviation.
4. A tracheal shift occurs toward the side where there is less lung volume; a right-sided pneumonectomy will decrease lung volume and cause a right tracheal deviation.

Question 103

A patient exhibits talocrural dorsiflexion that is limited both with the knee extended and with the knee flexed. Which of the following interventions would MOST appropriately address the limitation?

1. Anterior glide mobilization of the talus on the tibia and stretching of the soleus
2. Posterior glide mobilization of the talus on the tibia and stretching of the soleus
3. Anterior glide mobilization of the talus on the tibia and stretching of the gastrocnemius
4. Posterior glide mobilization of the talus on the tibia and stretching of the gastrocnemius

Answer 103

1. Anterior glide mobilization of the talus on the tibia and stretching of the soleus would not be the most appropriate intervention to address this limitation. An anterior glide is the incorrect direction for the glide.
2. The arthrokinematics of the ankle dictate that during dorsiflexion, the talus rolls anteriorly and slides posteriorly. Considering the arthrokinematics, the correct mobilization for restoration of dorsiflexion would be posterior glide of the talus on the tibia. (Kisner) The soleus crosses only the ankle joint. If the soleus is shortened, dorsiflexion of the ankle will be decreased regardless of the position of the knee. The gastrocnemius crosses both the knee and the ankle. If the gastrocnemius is shortened, dorsiflexion of the ankle will be decreased with the knee extended and be increased with the knee flexed. Therefore, posterior glide mobilization of the talus on the tibia and stretching of the soleus is the most appropriate intervention to address this limitation. (Dutton)
3. Anterior glide mobilization of the talus on the tibia and stretching of the gastrocnemius would not be the most appropriate intervention to address this limitation because anterior glide is the incorrect direction of glide and the gastrocnemius is not implicated as a limiter of motion in this scenario.
4. Posterior glide mobilization of the talus on the tibia and stretching of the gastrocnemius would not be the most appropriate intervention to address this limitation because the gastrocnemius is not implicated as a limiter of motion in this scenario.

Question 104

A physica therapist would like to implemetn NMES to strengthen the quadriceps of a 24year old soccer playe who recently underwent ACL repair. Which of the following is ideal dury cycle to aid in muscle strengthening for quads?

1. 1:4
2. 1:1
3. 2 sec
4. 5 sec

Answer 104

The suggested duty cycle for NMES for muscle strenghtening is 1:3 to 1:5, where 1:3 outlines an amplitude for 10 seconds followed by a rest period of 30sec.

Question 105

Median Nerve compression

Answer 105

Median nerve compression at the elbow will be responsible for weakness of wrist flexion,lateral two lumbricals, opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis. Additionally, median nerve compression may also affect sensory of hand atthe palmaraspect of the radial three and one half fingers and nail beds of radial three and one half fingers.

Question 106

A 74 year old woman is admitted to the acute care setting: Prior to seeing the pt thetherapist reviews these labs results:

Troponin: 0.1 ng/mL
Total cholesterol: 170mg/dL
Hematrocrit : 39%
Serum Creatinine: 4.0 mg/dL
Fasting blood Glucose: 105 mg/dL

What is the most likely diagnosis:
1. MI
2. Anemia
3. Renal Failure
4. DM

Answer 106

Creatine is filtered by the glomerulus when the kidnesya re functioning normallt. Therefore, creatine clearance indenactes renal failure. Nornal values are <1,5 mg/dL. Results of 4.0 mg/DL indecates severe renal failure

Troponin Normal value : <2.0 ng/mL, elevated troponin indicates cardiac injury

Hemocratic normal values for Female: 38-47%

Normal blood glucose levels is : 70-110 mg/dL

Question 107

A home health PT is treating a pt diagnosed with Parkinsons Disease. The therapist treatment includes using PNF patterns to assist with rolling and bed mobility for pressure relief due to repeated incidents of bed sores. The pt is MOST likely classified as what stage of Hoehn and Yahr Classification of diasbility scale?
1. Stage 1
2. Stage 3
3. Stage 4
4. Stage 7

Answer 107

Hoehn and Yahr Classification of Disability:

Stage I – Little to no disability; if disability is present, it has unilateral involvement
Stage II – Minimal disability; bilateral or midline involvement with no balance impairment
Stage III – Activity restrictions, balance deficits, and decreased righting reflexes; typically able to live and work independently
Stage IV – Severe disability; able to stand and walk with assistance
Stage V – Severe disability; confined to a wheelchair or is bed bound