PEAT #1 Flashcards

Question

Which of the following options BEST describes a normal response to the cremasteric reflex test? 1.Skin tenses in the gluteal area. 2.Ipsilateral scrotum elevation 3.Contraction of the anal sphincter muscles 4.Umbilicus moves down and toward area being stroked.

Answer 1

1. Tensing of the skin in the gluteal area is due to the gluteal reflex, which is evoked by stroking the back. The gluteal reflex comes from nerve roots of L4–L5, S1–S3. 2. For the cremasteric reflex text, the patient lies in supine position while the examiner strokes the inner side of the upper thigh with a pointed object. The test result is negative if the scrotal sac on the tested side pulls up. Unilateral absence of this response indicates a lower motor neuron lesion between L1 and L2. 3. Contraction of the anal sphincter muscles is due to the superficial anal reflex. The examiner tests the superficial anal reflex by touching the perianal skin. A normal result is shown by contraction of the anal sphincter muscles. This reflex comes from the S2–S4 nerve roots. 4. Movement of the umbilicus down and toward the area being stroked is due to the superficial abdominal reflex. The examiner uses a pointed object to stroke each quadrant of the abdomen of the supine patient in a triangular fashion around the umbilicus. Absence of the reflex (movement of the skin) indicates an upper motor neuron lesion; unilateral absence indicates a lower motor neuron lesion from T7–L2, depending on where the absence in noted, as a result of segmental innervation.

Answer 2

1. Frequent feedback is detrimental when learning a skill and would not be done first when teaching a new skill (p. 263). 2. Massed practice is less effective than distributed practice and would not be done first (p. 255). 3. It may be best to tailor written instructions to fit the patient's learning needs (p. 212). 4. It is best to identify and use the patient's preferred learning style (p. 24).

Answer 3

1. Patients who have a history of long-term nonsteroidal antiinflammatory drug use should be monitored for signs and symptoms of bleeding. Pain occurring within 1-3 hours of eating is typical in duodenal ulcers. The pain occasionally radiates to the mid thoracic back and right upper quadrant, including the right shoulder. Right shoulder pain alone may occur as a result of blood within the peritoneal cavity. Melena (dark, tarry stools) and coffee-ground vomitus are indicative of bleeding. Referral to a physician is warranted. (pp. 877-878) 2. Although gastritis is a common adverse effect of nonsteroidal antiinflammatory drugs and is associated with epigastric pain and loss of appetite, pain is much less common than with ulcer disease. Coffee-ground vomitus is not typically associated with gastritis. (pp. 875-876) 3. Irritable bowel syndrome typically presents with prolonged abdominal pain that is relieved by bowel movements. Changes in stool associated with irritable bowel syndrome include hard, loose, or watery stool, rather than melena (dark, tarry stools), alterations in stool frequency, or difficulty in having a bowel movement. Left lower quadrant pain with constipation and diarrhea are commonly associated with this condition. (p. 891) 4. An inflammation of the appendix typically presents with a classic sequence of abdominal pain with vomiting (not coffee-ground vomitus, which is indicative of bleeding), low-grade fever, anorexia, and nausea. Pain associated with appendicitis is constant and may shift within 12 hours to the right lower quadrant at the McBurney point. Melena (dark stools) and pain referred to the right shoulder are not typically associated with appendicitis. (pp. 904-905)

Answer 4

1. Use of a hip strategy is more appropriate for activities such as tandem and single limb stance (Umphred). 2. Use of a hip strategy is more appropriate for activities such as tandem and single limb stance (Umphred). 3. Small perturbations backward (anterior to posterior) would create a forward weight-shift, then a return to midline in response (O'Sullivan). 4. The ankle strategy is appropriate for small perturbations on a stable surface (Umphred). Small perturbations forward (posterior to anterior) would create a backward weight-shift, then a return to midline in response (O'Sullivan).

Answer 5

1. Advanced ankylosing spondylitis would cause loss of chest wall excursion, which compromises breathing. Aerobic exercise done consistently would be most important in order to optimize efficiency of oxygen transport and maintain cardiopulmonary function. (pp. 1333, 1337) 2. Balance exercises would likely be used for a patient who has ankylosing spondylitis, but they would not be as important as maintaining cardiopulmonary function in those who have advanced stages of this disease. In addition, activities requiring high levels of balance might need to be avoided to reduce risk of falls. (p. 1337) 3. Stretching and aerobic exercise would be more important than light resistance exercise for a patient who has advanced ankylosing spondylitis and likely fusion of involved joints. Energy conservation would also take precedence over resistance exercise. (p. 1337) 4. High-intensity and high-impact exercise should be avoided by a patient who has advanced ankylosing spondylitis, because intense exercise can potentially exacerbate the inflammatory process and be potentially harmful. Low-intensity aerobic exercise is recommended instead. (p. 1337)

Answer 6

1. The stem describes a patient who recently developed psoriasis (pp. 449-450). Bluish discoloration of the digits with cold exposure is associated with Raynaud disease (p. 255). 2. The stem describes a patient who recently developed psoriasis (pp. 449-450). The dermal effects associated with systemic lupus erythematosus include a major skin reaction often resulting from exposure to sun. This may include a red, scaly rash. (p. 445). 3. The stem describes a patient who recently developed psoriasis, a systemic disease hallmarked by silver scaled papules and plaques in the scalp, elbows, knees, back, and buttocks. It is a systemic disease that can result in erosive arthritis, particularly in the DIP joints of the hands. (pp. 449-450) 4. The stem describes a patient who recently developed psoriasis, a systemic disease hallmarked by silver scaled papules and plaques in the scalp, elbows, knees, back, and buttocks. It is a systemic disease that can result in erosive arthritis, particularly in the DIP joints of the hands. Hip joints typically are not involved in psoriasis. (pp. 449-450)

Answer 7

1. Debris in the right posterior semicircular canal produces symptoms of transient upbeating nystagmus and/or right ocular torsion. 2. Debris in the right superior semicircular canal produces symptoms of persistent downbeating nystagmus and/or right ocular torsion. 3. The canalith repositioning maneuver for the left posterior semicircular canal is performed to move free-floating debris in the posterior semicircular canal back into the vestibule, thus resolving the signs and symptoms of nystagmus and dizziness. Debris in the left posterior semicircular canal produces symptoms of transient upbeating nystagmus and/or left ocular torsion. 4. Debris in the left superior semicircular canal produces symptoms of persistent downbeating nystagmus and/or left ocular torsion.

Answer 8

1. This is a normal response in a patient who has chronic obstructive pulmonary disease and as such would not require discontinuation of the exercise session. Since elevated heart rates with increased hypoxemia are an expected compensatory response in patients who have pulmonary disease, there is no reason to cease exercise unless some other type of medical emergency exists. 2. During acute exercise, patients who have chronic obstructive pulmonary disease experience elevated heart rates and blood pressures with incremental exercise. The patient's response is an expected compensatory response, and exercise can continue as prescribed with continued monitoring of vital signs. 3. Since elevated heart rates with increased hypoxemia are an expected compensatory response in patients who have pulmonary disease, there is no reason to refer the patient back to the physician unless there is some other type of medical emergency. 4. This is an expected compensatory response in a patient who has chronic obstructive pulmonary disease and as such would not require discontinuation of the exercise session. There is no reason to refer the patient to the emergency department unless there is some other type of medical emergency.

Answer 9

1. External validity is the degree to which the results of a study can be generalized to another situation. In this option, the only change in the procedure is the model of the electrical stimulation machine. External validity should be maximized in this situation. 2. The generalizability (external validity) of the findings is only high for patients from the same population (those who have acute disc herniation). 3. The generalizability (external validity) of the findings is only high for patients from the same population (those who have acute disc herniation). 4. The generalizability (external validity) of the findings is only high for patients from the same population (those who have acute disc herniation).

Answer 10

1. A lesion of the right middle cerebral artery, which affects the right parietal lobe, typically produces impairment of spatial perception (p. 600). 2. Ataxia involving the limbs and gait occurs with damage to the cerebellum, involving the vertebrobasilar arteries (p. 603). 3. Visual agnosia occurs with damage to the left occipital lobe from a lesion of the posterior cerebral artery (p. 601). 4. A memory defect is a characteristic of damage to the inferomedial area of the temporal lobe either bilaterally or only on the dominant side of the brain (usually the left side). Damage to the posterior cerebral artery is implicated. (p. 601)

Answer 11

1. Axial extension or chin retraction may assess the mobility of the upper cervical spine but not the function of the deep neck flexors. Axial extension causes excessive shear in the mid-cervical spine. 2. The longus colli and longus capitis are deep neck flexors. The craniocervical flexion test or the deep neck flexor endurance test is included in the examination of these muscles. 3. The cervical compression test is used to stress the ability of the neck to tolerate passive loading; it is not a test of muscle strength. 4. Neck flexion range of motion is not specific for the deep neck flexors and can be achieved with gravity assist (in sitting position) or with the superficial neck flexors such as the sternocleidomastoid.

Answer 12

1. Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Continuous mode (or 100% duty cycle) produces thermal effects compared to pulse mode (p. 185). Research indicates that a frequency of 3 MHz results in a higher maximal temperature than 1 MHz despite delivering a lesser depth of penetration (p. 175). Furthermore, higher intensities produce higher temperature increases in tissues (p. 175). 2. Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Continuous mode (or 100% duty cycle) produces thermal effects, compared to pulsed mode (p. 185). Research indicates that a frequency of 3 MHz results in a higher maximal temperature than 1 MHz despite delivering a lesser depth of penetration (p. 175). Furthermore, higher intensities produce higher temperature increases in tissues (p. 175). 3. Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Pulsed mode (less than 100% duty cycle) produces nonthermal effects, compared to continuous mode (p. 185). 4. Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Pulsed mode (less than 100% duty cycle) produces nonthermal effects, compared to continuous mode (p. 185).

Answer 13

1. Trace (1/5) strength in the anterior tibialis indicates the ankle is unable to move into dorsiflexion, resulting in foot drop (Avers, pp. 284-285). The posterior leaf spring is designed to help lift the foot for adequate clearance during the swing phase of gait (O'Sullivan, p. 1293). 2. A floor (ground) reaction orthosis has an anterior shell that provides a posteriorly directed force to resist knee flexion during stance phase (O'Sullivan, p. 1296). This patient does not need assistance with knee control because the patient has weakness of the tibialis anterior, which affects dorsiflexion of the ankle (Avers, p. 284). 3. A patellar tendon-bearing orthosis is designed to lessen the load on the foot (O'Sullivan, p. 1296). This patient requires assistance with ankle dorsiflexion due to tibialis anterior weakness (Avers, p. 284). 4. A solid ankle-foot orthosis limits all foot and ankle motion (O'Sullivan, p. 1294). This patient requires only assistance with ankle dorsiflexion due to tibialis anterior weakness (Avers, p. 284).

Answer 14

1. Resistance training is an essential component of an exercise program for a patient who has osteoporosis (Moore) and is lacking from this option. Balance training, although helpful in preventing falls, is not most beneficial for maintaining bone density. 2. This question presents two comparisons and asks which is better: 1) treadmill walking or swimming and 2) resistance or balance training. The correct answer is treadmill walking and resistance training. Walking is a beneficial weight-bearing aerobic activity. Resistance training is important to maintain bone mineral density or prevent loss of bone mineral density. (Moore) 3. Swimming, because of the lack of a weight-bearing component, has limited value for a person who has osteoporosis (Goodman). Balance training, although helpful in preventing falls, is not most beneficial for maintaining bone density. 4. Swimming, because of the lack of a weight- bearing component, has limited value for a person who has osteoporosis (Goodman).

Answer 15

1. Transient synovitis is most likely to occur in children younger than the patient described in the stem. Transient synovitis is associated with an active antalgic gait and with pain that is aggravated by medial (internal) rotation but also by abduction, unlike the pattern found with anterior labral tears. (p. 1580) 2. Trochanteric bursitis is more likely to be associated with lateral hip/thigh pain aggravated by lying on the involved side. This condition is more likely to occur in patients age 40-60 years, not in the demographic group of the patient described in the stem. Pain often is enhanced with passive hip adduction and resisted lateral (external) rotation, abduction, and extension. (pp. 945-947) 3. The clinical presentation of anterior acetabular labral tears most often includes pain on passive adduction, flexion, and medial (internal) rotation. The description of mechanism of injury and clinical presentation in the stem are most typical of this injury. (pp. 936-938) 4. Femoral head stress fractures present with a pain pattern similar to the pattern presented in the stem, but pain is increased with weight-bearing. Examination results are often negative except for an empty end-feel with hip rotation and a noncapsular pattern. (p. 952)

Answer 16

1. Pain from urinary calculi results from the ureter contracting in the attempt to dislodge the calculi. 2. Pain from urinary calculi is more likely to result from obstruction in the ureter than from obstruction in the urethra. 3. Pain from urinary calculi results from obstruction in the ureter, not the bladder. 4. Pain from urinary calculi results from obstruction in the ureter, not the kidneys.

Answer 17

1. Restricting fluid intake would result in dehydration, which is not a viable treatment option for incontinence. 2. The time intervals between voiding should be increased to suppress urges. 3. The detrusor muscle should be relaxed or inhibited in patients who have urge incontinence. 4. The patient is describing signs of urge incontinence with possible detrusor contractions. Relaxation training is helpful to decrease bladder contractions.

Answer 18

1. The patient is struggling to show improvements, and the therapist's assessment is that the patient will have deficits that will prevent the patient from becoming more independent with mobility. Continuing treatment for 2 more weeks is not a good use of resources. 2. Recommending transfer back to the hospital is inappropriate because the patient does not show any significant decline warranting a hospital admission. The patient is struggling to show improvements, and the therapist's assessment is that the patient will have deficits that will prevent the patient from becoming more independent with mobility. 3. A revision in the plan of care is indicated if the patient progresses more slowly than expected. Each modification must be evaluated in terms of overall effect on the plan of care. Family and caregiver education/training is a component of effective discharge planning. The caregiver should understand the proper use of any relevant assistive equipment and appropriate transfer and guarding techniques and should use correct body mechanics. 4. The family/caregiver and patient may be at risk for possible injury if not instructed in the proper body mechanics and transfer techniques.

Answer 19

1. Traction is contraindicated in the presence of instability, which is implied by the diagnosis of a labral tear (p. 378). 2. Ultrasound with a 3-MHz frequency will only penetrate superficial tissue and will only cover a small area; therefore, it is not appropriate to treat the injury in question (p. 184). 3. Cryotherapy reduces chemical mediators being released in order to modulate pain. Ice packs are helpful in the initial, or acute, stage of healing but are not as effective in later stages of healing. (p. 4). 4. Sensory-level electrical stimulation can cover a large area and is effective for treating chronic pain (p. 7).

Answer 20

1. An annular disc tear is more common in an older population and more common in the lumbar region. 2. A compression fracture is more likely in older patients who have osteoporosis. 3. The stem describes the presentation of Scheuermann disease, which typically affects the T7–T10 region. 4. Spondylolisthesis may be present in the lumbar spine, but it is rare in the thoracic spine.

Answer 21

1. Stage 1 pressure injuries are characterized by nonblanchable erythema of intact skin. In this scenario, the skin is not intact. 2. Stage 2 pressure injuries are characterized by partial-thickness skin loss involving the epidermis, dermis, or both (e.g., abrasion, blister, or shallow crater). 3. Stage 3 pressure injuries are characterized by full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia (deep crater with or without undermining). 4. Stage 4 pressure injuries are characterized by full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon or joint capsule).

Answer 22

1. Blood pressure of 140/83 mm Hg is an incorrect answer because the total change in systolic pressure from baseline is less than 15 mm Hg and the change in diastolic pressure is less than 10, which are both acceptable changes (Hillegass, pp. 546-547). 2. Mean arterial pressure (MAP) of 60 mm Hg is the correct answer because a patient with a MAP this low will be unable to perfuse vital organs. This finding would be MOST concerning (Malone, p. 95). 3. Blood glucose of 95 mg/dL is an incorrect answer because blood glucose of 95 mg/dL is a normal finding and would not be concerning (Malone, p. 79). 4. Presence of a S2 heart sound is an incorrect answer because an S2 heart sound is a normal finding and would not be concerning (Malone, p. 203).

Answer 23

1. Wall sits are performed in an upright position and would not exacerbate a hiatal hernia. 2. An overhead press is typically performed in seated, semireclined, or standing position and would not exacerbate a hiatal hernia. 3. Individuals who have a hiatal hernia should avoid supine position and avoid the Valsalva maneuver. Bilateral leg lifts must be performed in supine position and require strong contractions of the stomach muscles, encouraging the Valsalva maneuver, which would worsen the hiatal hernia. 4. Hamstring stretching can be modified to be done in a position other than supine to avoid exacerbating a hiatal hernia.

Answer 24

1. There is no evidence of a change in ventilation-perfusion ratio with pursed-lip breathing. 2. There is no evidence of a change in partial pressure of arterial oxygen (PaO2) with pursed-lip breathing. 3. The increase in exhalation time creates a decrease in respiratory rate. 4. There is no evidence of a change in strength of the ventilatory muscles with pursed-lip breathing.

Answer 25

1. Excursion is decreased in patients who have chronic obstructive pulmonary disease due to hyperinflation of the chest and a resultant flattened diaphragm. Normal excursion of the diaphragm is 1.2 to 2 inches (3 to 5 cm); therefore, 0.4 to 0.8 inch (1 to 2 cm) would be below the normal excursion value. 2. Excursion is decreased in patients who have chronic obstructive pulmonary disease due to hyperinflation of the chest and a resultant flattened diaphragm. 3. Normal excursion of the diaphragm is 1.2 to 2 inches (3 to 5 cm). 4. Excursion is decreased in patients who have chronic obstructive pulmonary disease due to hyperinflation of the chest and a resultant flattened diaphragm.

Answer 26

1. Face validity is based on the validation of a test without comparison to an already validated test. 2. Construct validity is based on abstract concepts and is not observable or measurable. 3. Content validity of a test is measured to determine the extent of coverage of a concept. It is not determined by comparison with a reliable/valid (gold) standard. 4. Criterion-related validity of a new tool is tested by using practical and objective comparisons to a reliable/valid (gold) standard measure already in use.

Answer 27

1. Weakness in the gastrocnemius-soleus muscle results in excessive knee flexion during stance phase (Dutton, pp. 977-978). 2. Excessive ankle eversion during stance is most frequently associated with marked weakness of inverters such as the tibialis anterior and tibialis posterior (Dutton, p. 309), which may result from a malalignment such as a forefoot or rearfoot varus/valgus (Magee). Other causes of excessive eversion include plantar flexion contracture, fibular (peroneal) hypertonicity, and valgus deformity (Dutton, p. 314). A manual muscle test of the tibialis anterior and tibialis posterior muscles would best determine if these muscles are weak and in need of strengthening (Dutton, pp. 1136-1137). 3. The Modified Ashworth Test is used to examine spasticity (Umphred). However, excessive activation of the tibialis posterior muscle during walking (as would occur with spasticity) results in excessive inversion. The case describes excessive foot eversion. 4. The Modified Ashworth Test is used to examine spasticity (Umphred). Excessive activation of the tibialis anterior muscle during walking (as would occur with spasticity) results in excessive inversion. The case describes excessive foot eversion.

Answer 28

1. Mixed red-white coloring is evident with deep partial-thickness burns because the dermis is almost completely destroyed. 2. Marked edema is present with deep partial-thickness burns because of broken blisters and leakage of plasma fluid. Capillary destruction is marked. 3. Intact blisters are the most common sign of superficial partial-thickness burns. Damage is through the epidermis and into the papillary layer of the dermis. 4. Eschar is evident with full-thickness burns. It is a hard, devitalized tissue consisting of coagulated plasma and necrotic cells. Full-thickness burns destroy all of the epidermal and dermal layers and possibly the subcutaneous fat layer.

Answer 29

1. Spinal cord lesions at the level of S2 and below lead to bladder areflexia and dysfunction of the external sphincter. Surgical interventions for neurogenic bladder exist; sacral nerve modulation is used for incomplete lesions. (Goodman, pp. 991-992) The patient has a complete lesion. 2. Spinal cord lesions at the level of S2 and below lead to bladder areflexia and dysfunction of the external sphincter (Goodman, p. 991). S2–S4 innervate muscles in the perineum and external sphincter; therefore, complete loss of innervation would lead to paralysis of the respective musculature (Moore). Biofeedback is for muscle identification would be an inappropriate intervention for this patient. 3. Spinal cord lesions at the level of S3 and below lead to bladder areflexia and dysfunction of the external sphincter (Goodman, p. 991). S2–S4 innervate muscles in the perineum and external sphincter; therefore, complete loss of innervation would lead to paralysis of the respective musculature (Moore). Strengthening exercises would be an inappropriate intervention for this patient. 4. Spinal cord lesions at the level of S2 and below lead to bladder areflexia and dysfunction of the external sphincter. Bladder tone is preserved, but bladder compliance decreases with time. Catheterization is a commonly employed intervention to avoid excessive bladder distention. (Goodman, p. 991)

Answer 30

1. Water displacement has been regarded as the most sensitive and accurate standard for volume measurement. 2. Circumference measurements taken at various points of a body part are used most frequently to quantify lymphedema, but several problems exist, including limitations for acceptable differences between repeated circumferential measurement of the normal adult and control of intra- and interrater reliability. Circumferential measurement, although used clinically, is not considered a reliable/valid (gold) standard. 3. Single frequency bioelectrical impedance has become more frequently used in the clinical setting to measure limb fluid, but it is not considered the reliable/valid (gold) standard. 4. Optoelectronic volumetry calculates limb volume by using infrared light and has been conceptualized as a continuous variable, supporting a more robust test of the severity of lymphedema, but it is not considered a reliable/valid (gold) standard.

Answer 31

1. Use of tuning forks and vibrators would facilitate reeducation of vibratory sense. This sensory function is related to the dorsal column/medical lemniscus system and may not be affected in this patient. 2. Active movement with visual feedback would facilitate reeducation of proprioceptive sense. This sensory function is related to the dorsal column/medical lemniscus system and may not be affected in this patient. 3. Sensory reeducation focuses on all sensory modalities, but these techniques would emphasize reeducation of discriminative touch functions. These sensory functions are related to the dorsal column/medical lemniscus system and may not be affected in this patient. 4. With lesions to the anterolateral system, a patient may exhibit sensory deficits in both light touch and hot/cold discrimination. Failure to distinguish extremes in temperature could result in the patient sustaining thermal injuries. Instruction in techniques to protect against these injuries would be of primary importance.

Answer 32

1. Culturally and linguistically appropriate services require professional translators with knowledge of the patient's language and knowledge of medical terms. The patient's grandson should not be assumed to be an appropriate translator due to the sensitive topics to be covered. 2. Culturally and linguistically appropriate services require professional translators with knowledge of the patient's language and knowledge of medical terms. 3. Culturally and linguistically appropriate services require professional translators with knowledge of the patient's language and knowledge of medical terms. Although the person is a member of the hospital staff, the person may not have adequate knowledge of the medical terms involved in the patient's care. 4. Use of gestures, pictures, and simple terms by the physical therapist may help avoid confidentiality issues but does not provide satisfactory communication between the therapist and the patient.

Answer 33

1. This is the incorrect answer because this measure is designed to assess lower extremity power of the lower extremities. The patient has had repeated falls and would benefit from an appropriate falls outcome measure. The patient does not necessarily need power in the lower extremities to cross a street safely (Avers, p. 148). 2. This is the incorrect answer because the six minute walk test is a submaximal measure of aerobic capacity. The patient is having the most difficulty with balance and gait. The patient is a household ambulator and will likely not be able to complete the Six Minute Walk Test and will not provide valuable information to help the patient cross the street safely (Avers, p. 149). 3. This is the incorrect answer because the Fullerton is a balance test for higher-functioning older adults and would likely be too challenging for this patient as the patient is a household ambulator who uses a cane for mobility (Avers, p. 155). 4. This is the correct answer because a score of 12 on the DGI indicates a fall risk in older adults. The patient also has a history of recurrent falls. A self-report specific balance measure would be beneficial to gain a better understanding of when and why falls are occurring. (Avers, p. 144).

Answer 34

1. This is the incorrect answer because stridor indicates an upper airway obstruction (food particle in airway or acute airway inflammation). The patient is showing signs of possible acute congestive heart failure (Malone, p. 278). 2. This is the incorrect answer because diminished or absent breath sounds are consistent with an infection such as pneumonia, or a lung pathology such as fibrosis. The patient in this question is experiencing signs consistent with possible congestive heart failure (Frownfelter, pp. 207-208). 3. This is the correct answer because the patient is showing signs consistent with possible acute congestive heart failure (bilateral lower extremity edema, dyspnea, and dyspnea in supine). Patients with heart failure can have a S3 heart sound (Frownfelter, pp, 79-80, 209). 4. This is the incorrect answer because the S4 heart sound signifies rapid ventricular filling after atrial contraction and is consistent with a presentation of systemic hypertension, cardiomyopathy or coarctation of the aorta (Frownfelter, p. 209). The patient in this question is experiencing symptoms most likely related to congestive heart failure due to the bilateral lower extremity edema.

Answer 35

1. This is the incorrect answer because therapists want to recommend the least restrictive assistive device. The patient lives alone and would benefit from continued independence and safe walking to reduce mortality and morbidity (Avers, p. 208). 2. This is the correct answer because the patient has been having frequent falls with the straight cane and needs more stability. The patient also has spinal stenosis which favors spinal flexion. A rolling walker will provide the patient with some degree of spinal flexion (Avers, p. 208, Dutton, Chapter 28). 3. This is the incorrect answer because although the aim is to provide the least restrictive assistive device, the patient is having frequent falls and has a low DGI score. Continued use of the straight cane could result in more falls (Avers, p. 208). 4. This is the incorrect answer because the patient is having frequent falls and scored low on the DGI. The patient most likely needs a more supportive assistive device to lower fall risk and maintain independence (Avers p. 208).

Answer 36

1. Step aerobics is a high-risk activity for patients who have lower extremity edema. The patient is also at high risk for falls, and, therefore, this is not the best choice. (Zuther, p. 270) 2. This is not the best answer because the patient is a household ambulator and has a risk of falls (based on history and DGI) and will likely tire quickly on the treadmill (Avers). 3. Use of a recumbent bike encourages a flexed posture, which is beneficial for individuals with spinal stenosis. A recumbent bike also encourages higher positioning of the legs, which is better for lower extremity edema. Biking will stimulate diaphragmatic breathing, which promotes the return of lymph and venous fluid to the blood circulation. Biking is likely to be able to be performed by the patient. (Zuther, pp. 269-270) 4. This is a plausible answer as the hydrostatic pressure from the pool can provide compression and unweight heavy legs. However, the patient has spinal stenosis and would likely not tolerate the prone position as this increases spinal extension, which can exacerbate symptoms. (Dutton)

Answer 37

1. Unilateral gaze preference is associated with unilateral neglect and results from the lesion itself, not patient positioning. A patient with visual unilateral neglect often avoids crossing the midline visually (p. 1198). This condition is much more common in patients who have left hemiplegia than in patients who have right hemiplegia (p. 1198). 2. Hemiplegic shoulder pain is a common complication after stroke. Poor positioning of the more affected upper extremity has been implicated in producing joint microtrauma and pain. Prolonged soft tissue injury can result in complex regional pain syndrome. (pp. 646-647) 3. Sidelying on the right side should produce elongation of the trunk on the right, not shortening of the trunk. 4. Risk factors for skin breakdown include decreased sensation and abnormal patterns of movement, neither of which should be present on the less involved (left) side in this case (pp. 622-623).

Answer 38

1. A patient who has a C6 spinal cord injury retains full use of the diaphragm but lacks innervation to abdominal and intercostal musculature. The patient will display outward, not inward, motion of the abdomen and inward motion of the upper chest. 2. A patient who has a C6 spinal cord injury retains full use of the diaphragm but lacks innervation to abdominal and intercostal musculature. The patient will display outward, not inward, motion of the abdomen and inward, not outward, motion of the upper chest. 3. A patient who has a C6 spinal cord injury retains full use of the diaphragm but lacks innervation to abdominal and intercostal musculature. The patient will display outward motion of the abdomen and inward motion of the upper chest. The outward motion of the abdominal area is caused by the diaphragm contracting and pushing abdominal contents forward and outward, and the inward motion of the upper chest is due to the lack of structural support from paralyzed thoracic musculature. 4. A patient who has a C6 spinal cord injury retains full use of the diaphragm but lacks innervation to abdominal and intercostal musculature. The patient will display outward motion of the abdomen and inward, not outward, motion of the upper chest.

Answer 39

1. Jaundice, darkened urine, and ascites are all clinical signs of liver disease. Asterixis, or liver flap, is also likely to be present as a result of ammonia imbalance, which causes this neurologic symptom. (Goodman, p. 341) 2. Pronator drift is more likely to be observed in the presence of an upper motor neuron disorder. Upper motor neuron signs/symptoms are associated with central nervous system conditions, such as cerebrovascular accident, spinal cord injury, and multiple sclerosis. (Fruth, pp. 397, 400) 3. A positive result on the Hoffman Test, or Hoffman sign, is associated with corticospinal tract disorders. A positive result may be found contralateral to the area of a brain lesion or bilaterally in the presence of injury or compression of the spinal cord. (Fruth, p. 402) 4. Jaundice, ascites, and darkened urine are common clinical signs of liver disease. Rebound tenderness is most likely to be associated with appendicitis and peritonitis. (Goodman, pp. 319-320)

Answer 40

1. Also known as thyrotoxicosis, thyroid hypersecretion is associated with an enlarged thyroid gland, also known as a goiter. Patients exhibit hypermetabolism and sympathetic overactivity. Patients report fatigue, tremor, heat intolerance, increased sweating with warm moist skin, weight loss, palpitation with tachycardia, diarrhea, and muscle weakness and atrophy. They do not display an abnormal vital sign response to exercise, nor do they have acetone breath. (pp. 484-486) 2. Giantism and acromegaly can result from excessive secretion of growth hormone. This can result from a pituitary tumor or from a hypothalamic abnormality that leads to increased growth hormone release (pp. 479-480). Pituitary hyperactivity does not result in an abnormal vital sign response to exercise and does not cause the acetone breath associated with ketoacidosis. 3. Patients who have diabetes potentially have a lack of insulin secretion or effectiveness, leading to disruption of glucose metabolism. Results of acute metabolic changes related to glucose metabolism include hyperglycemia (high blood glucose), electrolyte disturbances that are manifested by acidosis that triggers an increased respiration rate, irregular heart rate, and increased fatty acid metabolism resulting in acetone breath. (p. 522) 4. People who have hyposecretion of adrenal hormones have Addison disease. Addison disease is characterized by the inability to withstand food deprivation, hyperpigmentation, dehydration, and postural hypotension (p. 498). A patient who has adrenal insufficiency should not exhibit any of the signs or symptoms described in the stem.

Answer 41

1. For best biofeedback results, electrode placement should be as close to the muscle as possible (Prentice). Hook grasp requires finger flexion (Lippert, p. 215). The finger flexors are located proximal to the anterior forearm (Lippert, pp. 201-202). 2. The proximal posterolateral forearm is the location of the finger extensors (Lippert, pp. 204-205). 3. No muscles originate from the distal anterior, medial forearm area (Lippert, pp. 201-206). 4. The distal posterolateral forearm is the location of thumb and index finger (1st and 2nd digit) extensors (Lippert, pp. 203-205).

Answer 42

1. Lateral (external) rotation and abduction with flexion is not the most likely position to dislocate the reverse total shoulder arthroplasty. Combined medial (internal) rotation and adduction with extension is more likely to cause dislocation. 2. Abduction and flexion are not most likely to cause dislocation. Combined medial (internal) rotation and adduction with extension is more likely to cause dislocation. 3. Lateral (external) rotation is not most likely to cause dislocation. Combined medial (internal) rotation and adduction with extension is more likely to cause dislocation. 4. Patients are most likely to dislocate a reverse total shoulder arthroplasty by performing medial (internal) rotation and adduction in conjunction with extension. This position allows the prosthesis to escape anteriorly and inferiorly.

Answer 43

1. Wearing the harness during rest only is inadequate. It should be worn 18–23 hours/day. 2. Wearing the harness during activity only is inadequate. It should be worn 18–23 hours/day. 3. Wearing the harness for 2–4 hours per day is inadequate. It should be worn 18–23 hours/day. 4. The harness must be worn 18–23 hours/day.

Answer 44

1. Having a patient find an object among similarly shaped objects is a better test for form discrimination rather than figure-ground discrimination as it assesses whether subtle differences in shape can be perceived (p. 1208). Finding a toothbrush amongst an array of utensils of various shapes and sizes would be a better test for figure-ground discrimination (p. 1208). 2. An impairment in figure-ground discrimination is the inability to visually distinguish a figure from the background in which it is embedded. A functional test that can be given to the patient to assess figure-ground discrimination is to ask a patient to point out a white button on a white shirt. Compensatory techniques to be used with patients who lack figure-ground perception are placing red tape over the Velcro strap of the shoe to aid the patient in locating it or using bright red tape to mark the edges on stairs. (pp. 1207-1208) 3. Tactile agnosia is the inability to recognize forms by handling them, although tactile sensation may be intact. If a patient is handed an object while the patient's vision is occluded, the patient will fail to recognize the object. This would not be the best test for an impairment of figure-ground discrimination. (p. 1213) 4. A patient who has depth and distance perception problems may have difficulty grasping an object. The impaired patient will overshoot or undershoot the object. This would not be the best test for an impairment of figure-ground discrimination. (pp. 1210-1211)

Answer 45

1. The purpose of humeroulnar distraction is to increase flexion (or extension) of the elbow joint. 2. The purpose of humeroradial posterior glide is to increase extension, not flexion, of the elbow joint. 3. The purpose of radioulnar anterior glide is to increase supination of the forearm, not elbow joint flexion. 4. The purpose of radioulnar posterior glide is to increase pronation of the forearm, not elbow joint flexion.

Answer 46

1. Direct current is indicated with a maximum safe amplitude of 4 milliamperes. 2. Direct current is indicated, but an amplitude of 8–10 milliamperes is too high. 3. Pulsed current is not the correct type of electrical current to use with iontophoresis. Direct current should be used. 4. Pulsed current is not the correct type of electrical current to use with iontophoresis. Direct current should be used. The amplitude of 8–10 milliamperes is too high.

Answer 47

1. Vancomycin-resistant Enterococcus (VRE) requires contact precautions. Contact precautions require a gown. A mask is not needed unless droplet precautions are necessary. 2. Contact precautions are followed for vancomycin-resistant Enterococcus (VRE). A gown is needed for contact precautions. 3. Vancomycin-resistant Enterococcus (VRE) requires contact precautions. A gown is needed for contact precautions. 4. A gown is appropriate; however, the therapist should follow contact precautions, not droplet precautions.

Answer 48

1. The first step in dealing with an angry patient who is not disruptive or a security risk is to validate the patient's feelings by listening and by acknowledging the patient's anger over the situation. This may diffuse the anger, allowing the therapist to carry on with the examination. 2. Attempting to change the direction of the questions is better used for a patient who is emotionally labile or excessively talkative. It does not acknowledge the patient's anger and thus may not diffuse the patient's anger. 3. Leaving the area would be appropriate if a patient is disruptive and appears to have violent intent. Stepping out of the area does not acknowledge the patient's anger. 4. Explaining the importance of collecting the same information may be an appropriate second step, but it does not acknowledge the patient's anger and thus may not diffuse the situation.

Answer 49

1. Most activities of daily living are performed at 50° of pronation and supination. Pronation and supination limited to 65° on the right would not delay return to work. (Magee, pp. 451-452) 2. One of the complications after an upper extremity trauma is the advent of complex regional pain syndrome. This complication often presents with burning pain with any movement of the body part, excessive sensitivity to light touch or minor stimulation, temperature changes, localized sweating, localized changes of the skin, or trophic changes of the skin, hair, and nails. Of the four options, this complication would result in longest delay in recovery and return to work. (Dutton) 3. The functional position of the wrist is between 20° and 35° of wrist extension, which this patient has (Magee, p. 445). The patient's pain is at end-range of wrist motion, and the patient should not have to push the wrist to end-range for most functional activities. 4. The grip strength on the right is 90% of the grip strength on the left. Although the right hand remains 10% weaker, this is an adequate strength for activities of daily living. (Magee, p. 455)

Answer 50

1. Trendelenburg gait is attributed to weakness in the gluteus medius muscle or L5 nerve root involvement (Magee, pp. 585, 1009). 2. The L4 nerve root is the main segmental innervation to the tibialis anterior. The L4 nerve root is also the myotome for ankle dorsiflexion. Impingement of the L4 nerve root would result in foot slap. (Magee, p. 585; O'Sullivan, p. 239) 3. Backward trunk lean reduces demands on a weakened stance limb gluteus maximus (O'Sullivan, p. 242). The gluteus maximus is innervated by the inferior gluteal nerve (L5–S2) (Magee, pp. 585, 1008-1009). 4. Causes of toe walking include a tight Achilles tendon, clubfoot, cerebral palsy, or limb length discrepancies (Magee, p. 1009; O'Sullivan, p. 239). It is not associated with L4 impingement.

Answer 51

1. Uveitis is commonly found in patients who have ankylosing spondylitis (p. 1134). 2. Urethritis is commonly found in patients who have Reiter syndrome (p. 1344). 3. Skin rashes, fever, fatigue, malaise, photosensitivity, dyspnea, cough, and peripheral neuropathies are all common findings in patients who have systemic lupus erythematosus (pp. 307-308). 4. Psoriasis is commonly seen in patients who have psoriatic arthritis (pp. 1341-1342).

Answer 52

1. This is the correct choice for the following reasons. The most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 20 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Additionally, there is tenderness to palpation with the elbow between 30°–60° of flexion, which is the correct position to palpate the ulnar collateral ligament (Dutton, p. 691). The Milking Maneuver Test is a special test for the medial collateral ligament of the elbow. The patient sits with the elbow flexed to 90° or more and the forearm supinated. The examiner grasps the patient’s thumb under the forearm and pulls it, imparting a valgus stress to the elbow. Reproduction of symptoms (apprehension, medial joint pain, gaping, and/or instability) indicates a positive test and a partial tear of the medial collateral ligament. Thus, the milking maneuver is likely to be positive in this case. 2. This is an incorrect test for the following reasons: While medial elbow tendinopathy (Golfer’s Elbow) is similar in presentation. This is an unlikely diagnosis in this case for the following reasons. While medial elbow tendinopathy may present with tenderness to palpation at the medial elbow, symptoms are typically exacerbated by either resisted wrist flexion and or pronation and passive wrist extension and/or supination (Dutton, p. 724). Both findings are not present in this case making medial elbow tendinopathy an unlikely diagnosis. The Golfer’s Elbow Test is typically performed for medial epicondylitis by passively extending the elbow and wrist (Magee, p. 453). In this case, the wrist and elbow active and passive range of motion are pain-free. Thus, this is the incorrect choice. 3. This is an incorrect test for the following reasons. The Varus Stress Test assess the lateral collateral ligaments of the elbow (Dutton, p. 691), not the medial collateral ligaments of the elbow. The most common mechanism of injury for the lateral collateral ligament is from a fall on outstretched hand (FOOSH) injury or from an elbow dislocation. Also, the patient may report painful catching, clicking or a feeling of instability during elbow flexion/extension particularly around 40° of elbow flexion with forearm supination (Dutton, p. 717). None of these features are present in this case and thus should not be considered a potential diagnosis to test for making this an incorrect choice. 4. This is an incorrect test for the following reasons: This test helps to determine if cubital tunnel syndrome is present (Magee, p. 456). Symptoms of cubital tunnel include paresthesia involving the fourth and fifth digits, accompanied by pain that may extend proximally or distally on the medial aspect of the elbow, pain or paresthesia worse at night; decreased sensation in the ulnar distribution of the hand; progressive inability to separate the fingers; loss of grip power and dexterity; and atrophy or weakness of the ulnar intrinsic muscles of the hand (late sign) are signs of cubital tunnel (Dutton, p. 725). Since none of these findings are present, this diagnosis of cubital tunnel, and a subsequent positive Elbow Flexion Test are unlike making this an incorrect choice.

Answer 53

1. This is an incorrect choice for the following reasons: First, the following structures are typically viewed on a lateral radiograph of the elbow: Olecranon, radius, distal humerus, and anterior fat pad (McKinnis, p. 568). Radiographs remain the initial imaging choice following traumatic elbow injuries to establish the initial injury, any associated fractures or displacement (Dutton, p. 705) which is an unlikely diagnosis in this case. Most fractures and dislocations at the elbow result from falls on an outstretched hand with or without an abduction or adduction component, or a force applied through a flexed elbow. Fractures of the radial and ulnar shafts are more often caused by direct trauma, often associated with violent blows, motor vehicle accidents, or falls from heights (McKinnis, p. 584). None of these mechanisms of injury are present in this case. While radiographs may reveal intra-articular loose bodies in the joint (McKinnis, p. 574), joint locking and twinges that typically indicate a loose body is moving within the joint are not present (Dutton, p. 170). Magnetic resonance imaging (MRI) is the most likely test reveal injuries to the ligament (McKinnis, p. 574). 2. This is an incorrect choice for the following reasons: Computed tomography (CT scan) may be indicated to identify occult fractures, osteochondral lesions, or the specific location of loose bodies or heterotopic ossification. Most fractures and dislocations at the elbow result from falls on an outstretched hand with or without an abduction or adduction component, or a force applied through a flexed elbow. Fractures of the radial and ulnar shafts are more often caused by direct trauma, often associated with violent blows, motor vehicle accidents, or falls from heights (McKinnis, p. 584). This mechanism of injury is not present in this case, and the MRI has been shown to be the most specific tool for diagnosing an ulnar collateral ligament injury (Dutton, p. 705) makings this an incorrect choice. 3. This is the correct choice for the following reasons. The most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 22 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Additionally, there is tenderness to palpation with the elbow between 30°–60° of flexion, which is the correct position to palpate the ulnar collateral ligament (Dutton, p. 691). Magnetic resonance imaging (MRI) has been reported to be highly specific (100% specificity, 57% sensitivity) for detecting ulnar collateral ligament tears (Dutton, p. 705). Indications for MRI of the elbow include suspected ligament injuries (McKinnis, p. 578). 4. This is an incorrect answer. A density dual-energy X-ray absorptiometry (DEXA) scan is used to detect osteopenia or osteoporosis (Goodman, p. 825). While Osteoporosis is a common condition in post menopausal females and half of women older than 50 years of age with osteoporosis will experience fractures due to loss of bone density, this individual does not appear to have signs of a fracture and is not of the most common gender and/or age range for suspected bone mineral density loss. Thus, the most pressing and overwhelming concern is the ulnar collateral ligament which is best visualized with an MRI (McKinnis, p. 578).

Answer 54

1. This choice is incorrect for the following reasons. First, there are no impairments in supination noted in the case. Second, the supinator has not been documented to have a stabilizing role at the medial elbow. Supination with a dowel or hammer strengthens the supinator (Kisner, p. 649), which does not provide an essential role in the rehabilitation of UCL injuries. Emphasis is placed on the forearm flexors, ulnar deviators, and pronators, in order to enhance their role as secondary stabilizers of the medial joint. Strengthening exercises for the following groups may be included: wrist curls and pronation (Dutton, p. 716). Thus this is not an efficacious choice for this case. 2. This choice is incorrect for the following reasons. First, there are no impairments in elbow flexion strength noted in the case. Second, the elbow flexor has not been documented to have a stabilizing role at the medial elbow. Elbow flexion with a dumbbell strengthens the elbow flexors (Kisner, p. 614), which does not provide an essential role in the rehabilitation of UCL injuries. Emphasis is placed on the forearm flexors, ulnar deviators, and pronators, in order to enhance their role as secondary stabilizers of the medial joint. Strengthening exercises for the following groups may be included: wrist curls and pronation (Dutton, p. 716). The most common clinical utility for resisted elbow flexion is for weakness of the elbow flexors (Kisner, p. 614). Thus this is not the most efficacious choice for this case. 3. This is the correct answer for the following reasons. First, the most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 20 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Additionally, there is tenderness to palpation with the elbow between 30°-60° of flexion, which is the correct position to palpate the ulnar collateral ligament (Dutton, p. 691). The most likely differential diagnosis for this case is medial elbow tendinopathy (Golfer’s elbow). This is an unlikely diagnosis in this case for the following reasons: While medial elbow tendinopathy may present with tenderness to palpation at the medial elbow, symptoms are typically exacerbated by either resisted wrist flexion and or pronation and passive wrist extension and/or supination (Dutton, p. 724). Both findings are not present in this case making medial elbow tendinopathy an unlikely diagnosis. Physical therapy treatment for UCL injuries includes the following: Rest and activity modification for about 2–4 weeks, range-of-motion exercises, modalities. Strengthening and stretching of the flexor carpi ulnaris, pronator teres, and flexor digitorum profundus are initiated once the acute inflammatory stage has subsided. Emphasis is placed on the forearm flexors, ulnar deviators, and pronators, in order to enhance their role as secondary stabilizers of the medial joint. Strengthening exercises for the following groups may be included: wrist curls and pronation (Dutton, p. 716). Thus, wrist curls is a prioritized intervention. 4. This choice is incorrect for the following reasons. First, there are no impairments in extension strength noted in the case. Second, the wrist extensor has not been documented to have a stabilizing role at the medial elbow. Eccentric wrist extension with a dumbbell strengthens the wrist extensors (Kisner, p. 650), which does not provide an essential role in the rehabilitation of UCL injuries. Emphasis is placed on the forearm flexors, ulnar deviators, and pronators, in order to enhance their role as secondary stabilizers of the medial joint. Strengthening exercises for the following groups may be included: wrist curls and pronation (Dutton, p. 716). The most common clinical utility for eccentric wrist extension is for lateral epicondylalgia. There is emerging evidence and moderate research support that suggests eccentric resistance training is effective in the treatment of lateral epicondylalgia (Kisner, p. 644). Thus this is not the most efficacious choice for this case.

Answer 55

1. This is an incorrect choice for the following reasons: The most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 20 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Additionally, there is tenderness to palpation with the elbow between 30°–60° of flexion, which is the correct position to palpate the ulnar collateral ligament (Dutton, p. 691). A wrist cock-up splint is indicated for a number of conditions including Posterior Interosseous Nerve Syndrome (Dutton, p. 728) and extensor tendon repairs (Magee, p. 399), but has no reported functional benefit in an injury to the ulnar collateral ligament making this an incorrect choice. 2. This is the correct choice for the following reasons. The most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 20 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Additionally, there is tenderness to palpation with the elbow between 30°–60° of flexion, which is the correct position to palpate the ulnar collateral ligament (Dutton, p. 691). The most effective brace to prescribe for this condition is a hinged elbow brace. During the inflammatory phase, the intervention includes immobilization of the elbow positioned at 90° of flexion in a well-padded posterior splint for 3–4 days followed by a hinged elbow brace initially set at 15°–90° (Dutton, p. 717). Thus, the hinged elbow brace is the correct choice for a patient with an ulnar collateral ligament injury. 3. This is an incorrect choice for the following reasons: While medial elbow tendinopathy (Golfer’s elbow) is similar in presentation. This is an unlikely diagnosis in this case for the following reasons. While medial elbow tendinopathy may present with tenderness to palpation at the medial elbow, symptoms are typically exacerbated by either resisted wrist flexion and or pronation and passive wrist extension and/or supination (Dutton, p. 724). Both findings are not present in this case making medial elbow tendinopathy an unlikely diagnosis. The Golfer’s elbow test is typically performed for medial epicondylitis by passively extending the elbow and wrist (Magee, p. 453). In this case, the wrist and elbow active and passive range of motion are pain-free. Thus, this is an unlikely diagnosis. The most likely brace prescribed for medial epicondylitis is a counterforce brace. A counterforce brace may be beneficial in patients who are rehabilitating but still involved in activities that may aggravate the symptoms (Magee, p. 307). The use of a counterforce brace is not indicated for an ulnar collateral ligament tear as there is no mechanism in which this brace could have a positive impact making this an incorrect choice. 4. This is an incorrect choice for the following reasons: A forearm-based wrist immobilization orthosis is fabricated with a to obtain a rigid support to be used during the proliferative stage of healing of an open reduction internal fixation. All forearm and wrist motions are significantly limited with this device (Chui, p. 386). The most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 20 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Immobilization of the wrist and forearm will not aid in this patient's recovery, thus this is an incorrect choice.