PEAT #2 Flashcards

Question

A patient reports vertigo and nausea after rolling in bed. The symptoms last for 30 seconds. The patient has a positive response on the Hallpike-Dix test. To decrease symptoms, which of the following interventions would be MOST effective? 1.Habituation exercises 2.Brandt-Daroff exercises 3.Gaze stabilization treatment 4.Canalith repositioning treatment

Answer 1

1. The patient has symptoms that are consistent with benign paroxysmal positional vertigo due to canalithiasis (p. 332). Habituation exercises are most effective in patients who have vestibular hypofunction, not benign paroxysmal positional vertigo. (pp. 399-400). 2. The patient has symptoms that are consistent with benign paroxysmal positional vertigo due to canalithiasis (p. 332). Although Brandt-Daroff exercises are appropriate for the treatment of benign paroxysmal positional vertigo, they are nonspecific and the outcome is not as good as with the canalith repositioning for benign paroxysmal positional vertigo (p. 341). 3. The patient has symptoms that are consistent with benign paroxysmal positional vertigo due to canalithiasis (p. 332). Gaze stability exercises would be effective for patients with vestibular hypofunction resulting in impairments in gaze stability (pp. 397-399). *4. The patient has symptoms that are consistent with benign paroxysmal positional vertigo due to canalithiasis, specifically, nausea and vertigo with movement, symptoms lasting 30 seconds or less, and a positive result on the Hallpike-Dix test (p. 332). Canalith repositioning treatment is the most appropriate evidence-based intervention for canalithiasis (pp. 332-335).*CORRECT ANSWER

Answer 2

1. Slipping of the iliopsoas tendon over the osseous ridge of the lesser trochanter or anterior acetabulum is the most common cause of internal snapping. It occurs at approximately 45° of flexion when the hip is moving from flexion to extension, especially with the hip abducted and laterally (externally) rotated. *2. A tight iliotibial band riding over the greater trochanter of the femur may cause an external snap that tends to be felt more laterally during hip flexion and extension, such as occurs when running, especially if the hip is in medial (internal) rotation.*CORRECT ANSWER 3. Acetabular labral tears can also cause a snapping hip sensation. There is generally sharp pain into the groin and anterior thigh, especially with pivoting movements. In this scenario, the snapping is felt over the lateral hip, so an acetabular labral tear is less likely. The pain can be reproduced passively when an extended hip is adducted and laterally (externally) rotated. 4. Internal snapping may be caused by the Iliofemoral ligament slipping and riding over the femoral head. This occurs at approximately 45° of flexion when the hip is moving from flexion to extension, especially with the hip abducted and laterally rotated.

Answer 3

*1. 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.*CORRECT ANSWER 2. Modifications to help manage symptoms of gastroesophageal reflux disease includes avoiding items such as caffeinated coffee. Dairy foods do not have an effect on reflux. 3. Modifications to help manage symptoms of gastroesophageal reflux disease includes avoiding fried and fatty foods. High-sugar foods do not have an effect on reflux. 4. Dairy and high-sugar foods do not have an effect on reflux.

Answer 4

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).*CORRECT ANSWER 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).

Answer 5

1. Although data from small case series are very useful, subjects in these series are not randomly assigned to experimental and control groups, thereby limiting the generalizability of the data (pp. 314, 317). 2. Clinical case reports are nonexperimental. Findings from clinical case reports are not sufficient to conclude that a treatment approach is valid. (p. 317) *3. Clinical observation is a preliminary step used to formulate a theory, which then can be used to design formal research (p. 310). Clinical observation is not as generalizable as a randomized controlled trial.*CORRECT ANSWER 4. The research method that is best suited to determine efficacy is the randomized controlled trial, in which researchers control for a variety of factors that would interfere with an understanding of the impact of the treatment of interest (p. 49).

Answer 6

1. The School Functional Assessment is used to assess and monitor the performance of children in functional tasks and activities in elementary school social and academic settings. It does not have a section on caregivers' need for assistance. *2. The Pediatric Evaluation of Disability Inventory (PEDI) is a 197-item inventory that is used to detect the functional limitations on participation of the patient and the need for assistance by the caregivers.*CORRECT ANSWER 3. The Bruininks-Oseretsky Test of Motor Proficiency is a test of fine motor control, manual coordination, body coordination, strength, and agility. It does not have a section on caregivers' need for assistance. 4. The Peabody Developmental Motor Scale can be used to assess changes in gross and fine motor skills and is appropriate for children up to age 5 years. It does not have a section on caregivers' need for assistance

Answer 7

*1. Anemia is a significant hematologic problem associated with chronic kidney disease due to decreased erythropoietin production, decreased red blood cell lifespan, and reduced iron absorption (Goodman, Pathology, p. 969; Goodman, Differential Diagnosis, pp. 214, 365).*CORRECT ANSWER 2. Leukopenia is a reduction of leukocytes and can occur in many forms of bone marrow failure such as after chemotherapy or radiation or as a result of severe infections and autoimmune diseases. It is not associated with chronic kidney disease. (Goodman, Differential Diagnosis, pp. 217-218, 365) 3. Neutropenia can be congenital or acquired and is associated with decreased circulating neutrophiles. Acquired neutropenia may be caused by medications, infectious agents, and carcinomas (Goodman, Pathology, p. 720). Neutropenia is not associated with chronic kidney disease. 4. Polycythemia is a myeloproliferative disorder in which bone marrow stem cells produce excessive red blood cells. Decreased, not increased, red blood cell production is associated with chronic kidney disease. (Goodman, Differential Diagnosis, pp. 215, 365)

Answer 8

*1. A hiatal hernia occurs when the stomach protrudes through the cardiac or lower esophageal sphincter (pp. 867-868).*CORRECT ANSWER 2. The esophagus is normally above the lower esophageal sphincter and is not entrapped in a hiatal hernia (pp. 867-868). 3. Intestines are more often involved in femoral, umbilical, or incisional hernias (p. 899). 4. Intestines are more often involved in femoral, umbilical, or incisional hernias (p. 899).

Answer 9

*1. Pain and paresthesias, especially with overhead activity, are consistent with thoracic outlet syndrome (Dutton). The special test described in the stem is the Adson Test; the result indicates that the patient has thoracic outlet syndrome (Magee, p. 344). Roos Test will rule in thoracic outlet syndrome (Magee, pp. 345-346).*CORRECT ANSWER 2. The Clunk Test is performed to confirm a tear of the glenoid labrum (Magee, p. 299). The special test described in the stem is the Adson Test; the result indicates that the patient has thoracic outlet syndrome (Dutton; Magee, p. 344). 3. The Speed Test is performed to confirm biceps tendinitis or partial rupture of the tendon (Magee, p. 299). The special test described in the stem is the Adson Test; the result indicates that the patient has thoracic outlet syndrome (Dutton; Magee, p. 344). 4. The O'Brien Test is performed to identify superior labral tears or proximal biceps impairment (Magee, p. 299). The special test described in the stem is the Adson Test; the result indicates that the patient has thoracic outlet syndrome (Dutton; Magee, p. 344).

Answer 10

1. Children with autism spectrum disorders respond best with a high degree of structure and predictable routines. *2. The child demonstrates the signs of autism spectrum disorder. Young children with autism spectrum disorder have been shown to prefer and thrive in structured, predictable environments.*CORRECT ANSWER 3. While it is important to allow for free movement and improvisational activities, children who have autism spectrum disorders respond best with a high degree of structure. For low-functioning children (as described in the stem), more prompting may be required to optimize outcomes. 4. Odd or exaggerated responses to sensory stimuli are common in autistic children. Too much sensory stimulation may be overwhelming.

Answer 11

*1. Clonus is characteristic of upper motor neuron syndrome (p. 377).*CORRECT ANSWER 2. Severe muscular atrophy is characteristic of lower motor neuron syndrome (p. 378). 3. Fasciculations and fibrillations are characteristic of lower motor neuron syndrome (p. 378). 4. Hypoactive deep tendon reflexes are characteristic of lower motor neuron syndrome (p. 378).

Answer 12

1. Incentive spirometry is commonly performed by postoperative patients to reduce the incidence of respiratory complications. This patient is not post surgery, and incentive spirometry does not address the increased respiratory rate. *2. Pursed-lip breathing slows the respiratory rate. The patient has a rapid respiratory rate and overuse of the inspiratory accessory muscles and would, therefore, benefit from techniques to slow down respiration.*CORRECT ANSWER 3. Segmental breathing is used to augment localized lung expansion. Although this patient has signs and symptoms of respiratory distress, segmental breathing will not address the elevated respiratory rate. 4. Glossopharyngeal breathing is used in patients who have high-level tetraplegia to improve respiratory capacity and increase vital capacity. This patient does not have a loss of vital capacity, but rather has an increased respiratory rate and overuse of the accessory inspiratory muscles.

Answer 13

1. A C5 radiculopathy can present with neurological symptoms from the superior aspect of the shoulder to the lateral aspect of the arm. The patient may also have decreased strength of the deltoid muscle with a potential loss of the brachioradialis reflex. (pp. 1282, 1288, 1313) 2. In medial epicondylalgia, pain will be in the anterior medial elbow region, there will be pain with pronation and wrist flexion, and there is no numbness or tingling (pp. 740-741, 760). *3. The symptoms described in the stem are classic signs of cubital tunnel syndrome, which is entrapment of the ulnar nerve. This condition results in symptoms of tingling in the ring and little fingers (4th and 5th digits). (p. 738)*CORRECT ANSWER 4. Olecranon bursitis would likely cause pain and swelling in the posterior aspect of the elbow (p. 740).

Answer 14

1. An exposed bone or tendon that is visible or directly palpable describes a Stage 4 pressure injury. 2. A shallow open ulcer with a red or pink wound bed without slough describes a Stage 2 pressure injury. *3. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed in a Stage 3 pressure injury. In this stage, there is full-thickness tissue loss. The bone/tendon is not visible or directly palpable.*CORRECT ANSWER 4. A purple localized area of discolored intact skin or a blood-filled blister due to damage to the underlying soft tissue from pressure and/or shear describes a suspected deep tissue injury.

Answer 15

*1. Every adult of sound mind has a right to refuse treatment.*CORRECT ANSWER 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

Answer 16

1. Myocardial ischemia is the result of an acute coronary syndrome or the blockage of blood in the coronary arteries. It presents with chest pain that worsens with activity and refers to the shoulder, neck, and jaw. It is typically associated with nausea, sweating, and apprehension. (p. 871) *2. Heartburn is the principal symptom of gastroesophageal reflux disease. Other common symptoms can include difficult and painful swallowing. Gastroesophageal reflux disease is due to transient relaxation of the lower esophageal sphincter causing (acidic) gastric contents to flow back up into the esophagus and causing irritation to the mucosal lining and, hence epigastric pain. It can be exacerbated by ballistic activities, such as running, and although it can be associated with nausea, it is not associated with shoulder pain thus making this the most correct answer. (p. 871)*CORRECT ANSWER 3. Peptic ulcer disease presents with epigastric pain and nausea or vomiting. Pain is not usually referred however occasionally, ulcer pain radiates to the midthoracic back and right upper quadrant, including the right shoulder (p. 878). Peptic ulcer disease is not always associated with an increase in activity. 4. Cholelithiasis presents with right upper quarter pain or epigastric pain and usually with nausea or vomiting (p. 871).

Answer 17

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)*CORRECT ANSWER 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.

Answer 18

1. Although the hamstrings must be sufficiently long to allow 100° of straight leg raise, individuals who have tetraplegia benefit from having tight lower trunk muscles to improve sitting stability. 2. Although individuals who have tetraplegia will benefit from tightness in the lower trunk muscles, the hamstrings must be sufficiently long to allow a 100° straight leg raise to improve the ability to sit in long sitting position and to dress the lower extremities. 3. Individuals with tetraplegia benefit from tightness of the lower trunk muscles to improve stability in sitting position. Hamstring length to allow 100° straight leg raise improves the ability to long sit and dress lower extremities. *4. Individuals who have tetraplegia benefit from having tight lower trunk muscles to improve stability in sitting position and hamstring length to allow 100° of straight leg raise to improve the ability to sit in long sitting position and to dress the lower extremities.*CORRECT ANSWER

Answer 19

*1. Joint effusion contributes to capsular pattern range of motion loss. In the glenohumeral joint, the capsular pattern of range of motion loss is maximum loss of lateral (external) rotation, moderate loss of abduction, and minimal loss of medial (internal) rotation.*CORRECT ANSWER 2. A capsular pattern of loss is expected with joint effusion; therefore, abduction loss is expected to be worse than medial (internal) rotation loss. 3. A capsular pattern of loss is expected with joint effusion; therefore, lateral (external) rotation loss is expected to be worse than losses in medial (internal) rotation and abduction. 4. A capsular pattern of loss is expected with joint effusion; therefore, lateral (external) rotation and abduction losses are expected to be worse than medial (internal) rotation loss.

Answer 20

1. Although type 2 diabetes contributes to both arterial and venous disease (p. 512), it is the sensory changes and repeated stress/pressure on insensate areas that causes ulceration (pp. 515-516). Diabetic ulcers are typically round and deep and have minimal drainage (p. 642). The stem states that the wound is irregular in shape, heavily exudating, and superficial. *2. Venous wounds are typically irregular in shape and highly exudative and frequently develop at the medial distal leg (pp. 642, 655-656).*CORRECT ANSWER 3. Arterial ulcers are typically round in appearance and dry (p. 642). The stem indicates that this wound is irregular in shape and heavily exudating. 4. Wounds that develop as a result of progressive secondary lymphedema are usually a result of cracking of dry skin from chronic fibrosis (p. 682). This wound is irregular in shape and heavily exudating

Answer 21

1. Jogging is among the activities considered to be associated with medium or higher risk for patients who have lymphedema, regardless of the pace (Goodman; Zuther). *2. Swimming is among the beneficial forms of exercise with low risk for patients who have lymphedema (Goodman; Zuther).*CORRECT ANSWER 3. Tennis is considered a high-risk activity for patients who have lymphedema. Tennis involves ballistic movements of the upper and lower extremities. (Goodman) 4. Use of a stair-stepper machine is considered a higher risk activity that can exacerbate lymphedema (Goodman)

Answer 22

1. Forearm pronation is performed by the pronator teres. This muscle originates from the medial epicondyle of the humerus and attaches to the upper portion of the radius (Dutton, pp. 716-717). The pronator teres has no anatomical connection to the labrum at the shoulder. Therefore, resisted forearm pronation has no effect on the repaired labrum tear. *2. Resisted forearm supination is performed by active contraction of the biceps brachii and supinator muscles (Dutton, p. 718). The long head of the biceps brachii has firm attachments to the superior labrum of the shoulder (Dutton, p. 595). Resisted contraction of the biceps brachii during the first 3-6 weeks post surgery, when the labrum tear has not yet fully healed, can place excessive strain on the labrum and can cause severe damage to the repaired labrum. Therefore, resisted forearm supination should be avoided during the first 6 weeks, which is the time needed for proper healing of the labrum (Dutton, pp. 653-654).*CORRECT ANSWER 3. Scapular retraction is performed by the middle trapezius, rhomboids, and lower trapezius muscles (Magee, pp. 272, 279). None of these muscles have any anatomical connections to the labrum at the glenohumeral joint. Therefore, resisted shoulder retraction has no effect on the repaired labrum tear at the shoulder joint. 4. Resisted scapular protraction occurs at the scapulothoracic joint and has no direct effect on the labrum within the glenohumeral joint (Magee, p. 272).

Answer 23

1. The recommended functional position of the wrist is from neutral to 30° of extension, but the proximal and distal interphalangeal joints should be in extension while the metacarpals are in slight flexion. 2. The recommended position would be elbow extension and the forearm in supination or neutral position. *3. Shoulder abduction and lateral (external) rotation is the recommended position because it promotes stretching of the axillary region of the shoulder, which often becomes contracted following a burn.*CORRECT ANSWER 4. Shoulder abduction and lateral (external) rotation would be a better position for this patient.

Answer 24

1. Although passive trunk extension is indicated for individuals who have an acute lesion and an extension bias (such as a herniated lumbar disc), trunk extension is contraindicated in spondylolisthesis (pp. 455, 462, 473). 2. High-velocity manipulation is contraindicated for patients who have a herniated disc, as well as for patients who have spondylolisthesis (pp. 464, 473). 3. Although trunk flexion is indicated for individuals who have spondylolisthesis, active trunk flexion is contraindicated for patients who have an acute disc lesion, such as a herniated disc (pp. 464-465, 473). *4. Spinal stabilization exercises are indicated to increase trunk stability for patients who have an acute herniated disc and for patients who have spondylolisthesis (pp. 465, 473).*CORRECT ANSWER

Answer 25

1. S1 is a normal sound heard when mitral and tricuspid valves close. 2. S2 is a normal sound heard when aortic and pulmonic valves close. *3. S3 is normal in children and young adults, but is abnormal if heard in those over the age of 40 years. In patients who have heart failure, it is indicative of ventricular failure or lack of ventricular compliance.*CORRECT ANSWER 4. S4 is an abnormal sound that may occur with cardiomyopathies and coarctation of the aorta but not with left ventricular failure.

Answer 26

1. Pectoral strengthening would not address the instability of the glenohumeral joint (pp. 647-648). *2. A positive sulcus sign is indicative of inferior glenohumeral instability (p. 645). Rotator cuff strengthening will increase the stability of the glenohumeral joint and the ability of the humeral head to stay in the glenoid fossa (pp. 669-672).*CORRECT ANSWER 3. Acromioclavicular joint mobilization would not address the instability of the glenohumeral joint (pp. 647-648). 4. Joint mobilization of the sternoclavicular joint would not address the instability of the glenohumeral joint (pp. 647-648).

Answer 27

1. Significant drainage and edema are more characteristic of venous insufficiency. 2. Significant edema is more characteristic of venous insufficiency. *3. A wound due to arterial insufficiency is typically associated with intermittent claudication, absent pedal pulses, and a deep wound bed due to decreased oxygenated blood flow in the area or limb.*CORRECT ANSWER 4. Significant drainage is more characteristic of venous insufficiency.

Answer 28

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)*CORRECT ANSWER

Answer 29

1. Latex allergy is a common problem in patients who have myelomeningocele (73%), but symptoms generally include watery and itchy eyes, sneezing, hives, and rash (Tecklin, pp. 286-287). 2. Tethered cord is a common development in patients who have myelomeningocele, but symptoms typically include spasticity, increased tone, buttock pain, increasing scoliosis, and weakened leg musculature (Tecklin, pp. 285-286). *3. At least 85% of children who have myelomeningocele have hydrocephalus, and 80% to 90% will require a shunt, especially those with high-level lesions. Shunt dysfunction is common, and therapists should be familiar with signs and symptoms for early detection. Early warning signs include the clinical manifestations described in the stem. (Palisano; Tecklin, p. 259)*CORRECT ANSWER 4. Although Chiari II malformation is commonly the cause of hydrocephalus, 2% to 3% of children who have myelomeningocele show significant impairment from Chiari II malformation (Tecklin, pp. 249-250). Symptoms associated with Chiari malformation generally include stridor, apnea, swallowing difficulty, and ataxia but could also include seizure (Tecklin, p. 250).

Answer 30

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)*CORRECT ANSWER 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)

Answer 31

1. The Dix-Hallpike Test is the most common test to confirm benign paroxysmal positional vertigo. Nystagmus will be provoked when the affected ear is inferior. The left ear is in a superior position in this case and would not be implicated. During the right Dix-Hallpike Test, there would be no nystagmus if the person had a left posterior canal benign paroxysmal positional vertigo. 2. During the right Dix-Hallpike Test, there could be horizontal nystagmus, but it would be impossible to see upbeating torsional nystagmus with the head to the right if the person did not have horizontal canal benign paroxysmal positional vertigo. In patients who have horizontal canal benign paroxysmal positional vertigo, the Dix-Hallpike Test may not provoke vertigo and nystagmus. The best maneuver would be one that moves the patient's head in the plane of the horizontal canal, which is done during the roll test, but not during the Dix-Hallpike Test. *3. The Dix-Hallpike Test is the most common test to confirm benign paroxysmal positional vertigo. The right posterior canal would be identified with symptoms of upbeating and right torsional nystagmus. Lowering the head backward and to the side allows the debris in the posterior canal to fall to its lowest position, activating the posterior canal and resulting in eye movement and vertigo.*CORRECT ANSWER 4. During the right Dix Hallpike Test, there could be horizontal nystagmus, but it would be impossible to see upbeating torsional nystagmus to the right if the person did not have right posterior canal benign paroxysmal positional vertigo. In patients who have horizontal canal benign paroxysmal positional vertigo, the Dix-Hallpike Test may not provoke vertigo and nystagmus. The best maneuver would be one that moves the patient's head in the plane of the horizontal canal, which is done during the roll test, but not during the Dix-Hallpike Test.

Answer 32

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.*CORRECT ANSWER 3. Hyperthyroidism is associated with diarrhea. 4. Hyperthyroidism is associated with amenorrhea.

Answer 33

1. The examination findings are normal. Normal examination findings would not help determine the presence of calculi. (Paz; Goodman, pp. 201, 633) *2. Percussion to the kidneys should produce a thud-like sound; pain or tenderness is a sign or symptom of distention or inflammation (Paz). If the test produces a thud and the person feels no pain, the test result is negative for renal involvement (Goodman, pp. 201, 633).*CORRECT ANSWER 3. The kidneys present with sharp or dull pain with palpation or percussion if they are inflamed or distended; therefore, a thud-like sound would not be the expected (Paz). If pain is caused with percussion, the kidneys are possibly inflamed (Goodman, p. 201). 4. Kidney transplants are often located in the abdomen. The therapist should not percuss or palpate the kidneys of anyone with chronic renal disease or organ transplant. (Goodman, p. 201)

Answer 34

1. It is unsafe for patients at risk for osteoporotic fracture to repeatedly flex the spine forward during daily activities (Bonder, p. 235). Stretching tight hip flexors and pectoral muscles would be more appropriate (Goodman, p. 1223). *2. Patients who have osteoporosis and who want to prevent a spinal compression fracture should perform daily exercise to increase muscular endurance in spinal extensors (Bonder, p. 235).*CORRECT ANSWER 3. The aging process modifies normal postural alignment into a predominantly flexed posture (Bonder, p. 163). Exercises that decrease the lumbar lordosis further would not be appropriate (Bonder, pp. 164-165). 4. Improving posture and biomechanics is important (Goodman, p. 1226). Instructing the patient to carry loads in front of the body is incorrect. The patient should be instructed to push, pull, or roll loads when possible to reduce compressive forces. If the patient must carry a load, it should be held in the position that keeps it closest to the patient's body (Fairchild).

Answer 35

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.*CORRECT ANSWER

Answer 36

*1. Mallet finger is a resting DIP flexion contracture due to a loss of active extension at the DIP joint.*CORRECT ANSWER 2. A Z-deformity of the wrist is a pattern of deformity in the rheumatoid arthritic hand. It also causes a swan-neck deformity of the fingers. 3. Deformity from flexor digitorum superficialis paralysis presents as PIP hyperextension and slight flexion of the DIP (swan-neck deformity of the fingers). 4. A middle phalanx dislocation can cause the central slip to be torn and result in a boutonnière deformity, which presents as PIP joint flexion and DIP joint hyperextension.

Answer 37

1. Experimentation with movement strategy occurs during early learning. *2. Ability to focus on a secondary task occurs during late learning.*CORRECT ANSWER 3. Inconsistent performance occurs during early learning. 4. Fast improvement occurs during early learning.

Answer 38

1. Ulnar nerve involvement does not impact sensation of the thumb and index finger (1st and 2nd digits) (p. 483). 2. Radial nerve involvement does not impact flexor pollicis brevis function or sensation of the thumb and index finger (1st and 2nd digits) (p. 416). 3. Deep posterior interosseus nerve involvement does not impact flexor pollicis brevis function or have a sensory component (p. 416). *4. Median nerve involvement can produce motor weakness of the flexor pollicis brevis, sensory loss in the thumb and index finger (1st and 2nd digits), and weakness in grip strength (p. 483).*CORRECT ANSWER

Answer 39

*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.*CORRECT ANSWER 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.

Answer 40

1. The diastolic response described in the stem is an excessive increase and is considered abnormal. *2. A normal systolic blood pressure response is a linear increase with workload. A normal diastolic blood pressure response to exercise is an increase or decrease within 10 mm Hg or no change at all. Given the increase in workload, the 20 mm Hg increase is a normal response for systolic but abnormal for diastolic pressure.*CORRECT ANSWER 3. The systolic change is within normal limits. The diastolic response is an excessive increase and considered abnormal. 4. The systolic change is within normal limits.

Answer 41

*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.*CORRECT ANSWER 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.

Answer 42

*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).*CORRECT ANSWER 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)

Answer 43

*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).*CORRECT ANSWER 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.

Answer 44

1. Blood gas analysis is crucial in the assessment of acid-base balance, ventilation, and oxygenation. Arterial blood gas analysis is used frequently to monitor the condition of patients in critical care to modify respiratory interventions. It is not used for diagnosing or monitoring chronic obstructive lung disease. (p. 352) 2. Although the chest radiograph/x-ray is the predominant test to determine anatomic abnormalities and pathologic processes within the chest, it is not the best diagnostic test. The classic findings associated with chronic obstructive pulmonary disease are typically not seen until the condition is severe. Thus, a chest radiograph is of limited value in diagnosing chronic obstructive pulmonary disease. (p. 338) *3. Pulmonary function testing, i.e., spirometry, is used to diagnose and monitor the progression of chronic obstructive lung disease. Pulmonary function testing provides information regarding the volume of air the lung contains and information on the different lung capacities. Two forced spirometry measures that can be followed over time include forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC); the ratio of these values decreases as the severity of lung obstruction increases. (p. 191)*CORRECT ANSWER 4. Exercise testing is the single most important noninvasive procedure used in the diagnosis and management of patients who have coronary artery disease. A maximal exercise test may be used to measure functional capacity and to diagnose coronary artery disease, not pulmonary disease, although it can be used to provide information on exercise prescription. (p. 279)

Answer 45

1. Resistance training through weight lifting using low resistance and a high number of repetitions is safe and beneficial for patients who are obese or have joint pain as long as the arc of motion does not aggravate the pain (Brody, p. 323; Goodman, p. 39) *2. Individuals who are obese are at higher risk for the development of knee osteoarthritis (Goodman, p. 37). Aerobic programs should be designed to minimize joint stress and impact in this population (Brody, p. 324). Step aerobics is the least appropriate intervention of those listed.*CORRECT ANSWER 3. Non-weight-bearing aerobic activity, such as aquatic exercise, will reduce joint compression, so this would be an appropriate intervention for this patient (Goodman, p. 39). 4. Bicycling is a low-impact aerobic exercise that can reduce stress in joints, so it is an appropriate activity both for individuals who are obese and for individuals who have knee pain (Goodman, p. 39).

Answer 46

*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)*CORRECT ANSWER 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)

Answer 47

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.*CORRECT ANSWER 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

Answer 48

1. A nasoenteric tube does not interfere with upright patient mobility. *2. Risk of aspiration is increased when the head of the bed is lowered below 30° when feeding is occurring using a nasoenteric feeding tube.*CORRECT ANSWER 3. Unlike peripherally inserted central catheter lines, a nasoenteric tube is not affected by pressure on the chest wall or axilla. 4. Unlike intraventricular catheters, a nasoenteric tube is not sensitive to height.

Answer 49

1. While the family's role is important, the patient's needs come first, based on the plan set in place. 2. The value system of the patient should take priority over reimbursement issues related to the patient's end-of-life care. *3. The patient's value system is the first component to be considered. Religious and cultural needs should be addressed. Specific activities will vary from person to person, influenced by personal preferences and ethnic, religious, or other beliefs.*CORRECT ANSWER 4. Evidence-based practice is a tertiary concern and should be implemented as appropriate.

Answer 50

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.*CORRECT ANSWER 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.

Answer 51

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.*CORRECT ANSWER 4. Mobilization with hand placement at the right posterior articular pillar at C6 would produce increased left rotation at C6–C7.

Answer 52

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)*CORRECT ANSWER 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)

Answer 53

1. Hypertonicity is expected with upper motor neuron disease. Guillain-Barré syndrome is a lower motor neuron disease and is characterized by flaccidity. 2. Clonus is expected with upper motor neuron disease. Guillain-Barré syndrome is a lower motor neuron disease and is characterized by hyporeflexia. *3. Guillain-Barré syndrome is a lower motor neuron disorder. Diminished reflexes are expected with lower motor neuron disease.*CORRECT ANSWER 4. Ataxia would be much more common with cerebellar disorders.

Answer 54

1. The Ortolani Test indicates the presence of a dislocated hip and is not associated with femoral anteversion (p. 719). *2. The Ortolani Test is used to detect the presence of a dislocated hip. The Ortolani Test elicits the sensation of the already dislocated hip. A "clunk" is felt as the dislocated femoral head reduces into the acetabulum. (p. 719)*CORRECT ANSWER 3. Metatarsus adductus occurs at the foot and not the hip (p. 910). The Ortolani Test is used to detect the presence of a dislocated hip. 4. Talipes equinovarus is clubfoot, which occurs at the foot and not the hip (p. 906). The Ortolani Test is used to detect the presence of a dislocated hip.

Answer 55

*1. Cervical myelopathy is an injury to the spinal cord that would present with upper motor neuron symptoms, including ataxic gait with a wide base of support, as well as headaches. Symptoms would also not follow a straight nerve root dermatome/myotome pattern. (Magee, pp. 157, 159-160)*CORRECT ANSWER 2. Cervical radiculopathy would indicate a nerve root lesion. Symptoms would include pain with cervical range of motion; however, upper motor neuron symptoms related to gait and headaches would not be present with a nerve root lesion. (Magee, p. 160) 3. A brachial plexus injury would not result in any changes to gait, and there would be no pain present in the neck. Symptoms would be more isolated to the shoulders. (Magee, p. 160) 4. A transient ischemic attack could result in neurological symptoms in the hand as well as impairments in balance and ataxic gait. However, cervical range of motion would not be limited or painful with a transient ischemic attack. (Umphred, pp. 713, 715-716)

Answer 56

1. A psoas abscess would be painful in the right or left lower quadrant and refer pain to the low back (p. 313). 2. Constipation and diarrhea are symptoms related to the colon, which, when painful, presents in the mid abdomen and refers pain to the sacrum, buttocks, or thighs (p. 307). 3. An abdominal aortic aneurysm would likely cause severe low back pain and would not change with eating nor would it cause epigastric pain (p. 242). *4. A high percentage of hospitalizations of the aging population who have gastrointestinal problems are due to the effects of nonsteroidal antiinflammatory drugs. This patient may be taking this class of drugs for the pain and inflammation in the knees. Because the pain changes with food intake, the gastric region as a source is implicated. (pp. 306-307)*CORRECT ANSWER

Answer 57

*1. Neck pain radiating to a unilateral arm along with a positive result on the Spurling neck compression test and pain with right cervical side bending are signs and symptoms consistent with cervical radiculopathy (p. 1313). It is recommended that cervical traction be used for patients with acute neck pain that is radiating to the upper limb in order to relieve compression on the nerve (p. 1302).*CORRECT ANSWER 2. Although patients should be encouraged to maintain joint mobility as tolerated, avoidance of symptom-provoking positions and immediate control of pain and symptoms may be the most appropriate intervention in the acute stage (p. 371). 3. Although strengthening of the deep cervical flexors is a recommended intervention in the subacute stage of healing for individuals who have neck pain (p. 1303), control of pain symptoms is the most appropriate intervention in the acute stage (p. 371). 4. Ice, not heat, is typically used in the acute phase of healing for analgesia and inflammation reduction (p. 372).

Answer 58

*1. Blood glucose levels of 300 mg/dL (16.6 mmol/L) or higher indicate that the blood glucose level is too high to exercise safely, putting the patient at risk for ketoacidosis. Muscle cramping, lethargy, and elevated blood glucose levels are signs of diabetic ketoacidosis. These signs and symptoms necessitate immediate referral to the physician.*CORRECT ANSWER 2. Blood glucose levels of 300 mg/dL (16.6 mmol/L) or higher put the patient at risk for ketoacidosis. Muscle cramping, lethargy, and elevated blood glucose levels are signs of diabetic ketoacidosis. These signs and symptoms necessitate immediate referral to the physician. The patient should not wait to see if symptoms worsen. 3. Blood glucose levels of 300 mg/dL (16.6 mmol/L) or higher put the patient at risk for ketoacidosis. Muscle cramping, lethargy, and elevated blood glucose levels are signs of diabetic ketoacidosis. These signs and symptoms necessitate immediate referral to the physician, not at the conclusion of the physical therapy session. 4. Blood glucose levels of 300 mg/dL (16.6 mmol/L) or higher put the patient at risk for ketoacidosis. Muscle cramping, lethargy, and elevated blood glucose levels are signs of diabetic ketoacidosis. These signs and symptoms necessitate immediate referral to the physician, not at the conclusion of the physical therapy session.

Answer 59

1. The Rehabilitation Act of 1973 mandates that access must be established in all federally funded buildings and transportation facilities and is not related to education, just access to federal buildings and transport (O'Sullivan). 2. The Americans with Disabilities Act (ADA) guarantees civil rights protection and equal opportunity in the areas of government services, employment, public transportation, telephone services, and public accommodations. It is not specific to education. (O'Sullivan) *3. The Individuals with Disabilities Education Act mandates that all children have access to a free and appropriate public education (Palisano).*CORRECT ANSWER 4. The Architectural Barrier Act of 1968 mandates that buildings financed by federal funds be designed and constructed to ensure physical access (O'Sullivan).

Answer 60

*1. The patient's presentation is consistent with autonomic dysreflexia. One of the common irritants or causes is tight or restrictive clothing below the level of the lesion. It is important to loosen any restrictive clothing if a patient presents with autonomic dysreflexia.*CORRECT ANSWER 2. The patient's presentation is consistent with autonomic dysreflexia, which results in acute hypertension. It is important to sit the patient up if the patient is lying down to try to decrease the patient's blood pressure. 3. The patient's presentation is consistent with autonomic dysreflexia. One of the common irritants or causes is a blocked urinary catheter, because it results in bladder distention. It is important to check the urinary drainage system and clear any blockages if a patient presents with autonomic dysreflexia. Clamping the urinary catheter would work against this principle and be contraindicated. 4. The patient's presentation is consistent with autonomic dysreflexia. One of the common irritants or causes is tight or restrictive clothing below the level of the lesion. It is important to loosen any restrictive clothing if a patient presents with autonomic dysreflexia. Applying an abdominal binder would work against this principle and be contraindicated.

Answer 61

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.*CORRECT ANSWER

Answer 62

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.*CORRECT ANSWER 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.

Answer 63

*1. The dorsal roots are purely afferent nerves with no motor component (Kisner).*CORRECT ANSWER 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).

Answer 64

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%.*CORRECT ANSWER 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%.

Answer 65

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.*CORRECT ANSWER

Answer 66

1. Placing both crutches on the next step first is incorrect. The patient should lead with the uninvolved leg first. *2. The patient should place the uninvolved, stronger leg up on the step first to elevate the body onto that step, then raise the weaker leg with the crutches up onto the step.*CORRECT ANSWER 3. The uninvolved lower extremity is needed to lift the body up onto the higher step; therefore placement of the uninvolved leg should happen first. 4. Bringing the right lower extremity up first to lift the body up would not be safe, especially due to the weight-bearing status. The uninvolved lower extremity is needed to lift the body up onto the higher step, therefore placement of the uninvolved leg should happen first.

Answer 67

1. Resistance training, even at low intensities, is not appropriate for a patient who has amyotrophic lateral sclerosis due to the increased risk of overuse weakness in patients with a manual muscle test grade less than Fair (3/5). With a grade of Poor plus (2+/5), the most appropriate interventions are active range of motion, passive exercises if a restriction exists, or submaximal aerobic exercises. (O'Sullivan, pp. 739-740) 2. Resistance training at this intensity for a patient who has amyotrophic lateral sclerosis is not appropriate given the high likelihood of overuse weakness. Moderate resistance training would be appropriate (60% of the one-repetition maximum) if the muscle grade was greater than Fair (3/5). (O'Sullivan, pp. 739-740) 3. The patient has normal passive shoulder flexion (175°) (Dutton). Active range of motion exercises, not passive, would be appropriate to promote functional return and slow further strength loss (O'Sullivan, p. 739). *4. Because the patient has Poor (2+/5) muscle strength and a diagnosis of amyotrophic lateral sclerosis, it is likely that strength training will not improve muscle strength. Exercise that overstress a muscle in a patient who has amyotrophic lateral sclerosis has a high likelihood of causing overuse weakness and further decline. Sidelying shoulder flexion promotes range of motion in the functional pattern needed in an antigravity position and is the most appropriate exercise for this patient, since it is not likely to induce unwanted secondary complications. (O'Sullivan, pp. 739-740)*CORRECT ANSWER

Answer 68

1. This question addresses external validity. External validity (applicability/ generalizability) is the degree to which results can be applied to other individuals and circumstances. (pp. 160-161) 2. This question addresses external validity. External validity (applicability/ generalizability) is the degree to which results can be applied to other individuals and circumstances. (pp. 160-161) 3. This question addresses external validity. External validity (applicability/ generalizability) is the degree to which results can be applied to other individuals and circumstances. (pp. 160-161) *4. Internal validity is the degree to which a change in the outcome can be attributed to the experimental intervention rather than extraneous factors (p. 145). Improperly calibrated instrumentation is a threat to internal validity (p. 204)*CORRECT ANSWER

Answer 69

1. Patients who have severe kidney disease often experience myopathy and loss of lean body mass. Therefore, mild to moderate intensity exercise, including isometric strengthening, is appropriate for this population (Goodman, p. 976). 2. Musculoskeletal changes such as osteomalacia, osteoporosis, and soft tissue calcification occur with severe kidney disease (Goodman, p. 975). Resistance training contributes to physiological adaptations to counteract these effects (Goodman, p. 977). 3. Fatigue and reduced work capacity secondary to reduced cardiac performance may occur in people who have severe kidney disease. Low to moderate intensity exercise can increase aerobic capacity and possibly improve the patient's blood pressure. (Goodman, p. 977) *4. Although aquatic therapy may be beneficial for patients who have mild to moderate renal failure (Goodman, p. 977), it is contraindicated for anyone who has severe kidney disease due to the patient's inability to adjust to fluid loss during immersion (Kisner).*CORRECT ANSWER

Answer 70

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)*CORRECT ANSWER 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)

Answer 71

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)*CORRECT ANSWER

Answer 72

1. The correct way of picking up an object from the floor is to put the unaffected extremity forward (not place both legs at the same level), and put body weight on the unaffected extremity (not both extremities) while bending and reaching for the object on the floor. 2. The correct way of picking up an object from the floor is to put the unaffected extremity forward and put the body weight onto the unaffected extremity while bending and reaching for the object on the floor. In this scenario, the affected extremity is being placed forward with weight-bearing. 3. The correct way of picking up an object from the floor is to put the unaffected extremity forward, and put body weight on the unaffected extremity while bending and reaching for the object on the floor. In this scenario, the patient is putting the wrong foot forward. *4. The correct way of picking up an object from the floor is to put the unaffected extremity forward and put body weight on the unaffected extremity while bending and reaching for the object on the floor.*CORRECT ANSWER

Answer 73

1. Taking time to contact emergency medical services would delay initiation of cardiopulmonary resuscitation. Checking airway should occur after providing chest compression. 2. The sooner cardiopulmonary resuscitation is started, the greater the chance of the patient's survival. A 13-year-old can be directed to contact emergency medical services, therefore there is no need for the therapist to delay initiating chest compressions. 3. This would be the correct response if the therapist was alone; however, a 13-year-old child has the ability to call emergency medical services. *4. The sooner cardiopulmonary resuscitation is started the greater chance of the patient's survival. A 13-year-old has the ability to initiate emergency medical services. Chest compressions are started first in cardiopulmonary resuscitation.*CORRECT ANSWER

Answer 74

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).*CORRECT ANSWER 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).

Answer 75

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.*CORRECT ANSWER

Answer 76

1. Confusion and disorientation are not clinical manifestations of a myocardial infarction (pp. 585-586). 2. Altered mental state is not a symptom of irritable bowel syndrome (p. 890). 3. These symptoms are not an expected clinical manifestation of emphysema (pp. 798-799). *4. A change in mental status, such as confusion and disorientation, is a potential symptom of a urinary tract infection (pp. 957-958).*CORRECT ANSWER

Answer 77

1. Loop diuretics decrease vascular volume and cause reflex tachycardia. (pp. 319-320) *2. Beta receptor antagonists cause negative chronotropic and dromotropic effects on the heart, clinically resulting in decreased heart rates at rest and during exertion. (pp. 320-321)*CORRECT ANSWER 3. Alpha-1 receptor antagonists cause vasodilation and a reflex tachycardia (pp. 321-322). 4. Angiotensin-converting enzyme inhibitors have no effects on heart rate at rest or during exertion (p. 326).

Answer 78

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 ANSWER 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).

Answer 79

1. A patient who has osteosarcoma of the lower leg would report deep pain with radiation that is not relieved with rest. A bone scan would be positive, not negative (p. 974). 2. A patient who has a tibial stress fracture would have acute, deep, and localized pain in the lower leg along with a positive bone scan (p. 974). *3. Compartment syndrome of the lower leg presents with diffuse pain and tightness, relief of pain with rest and increase in pain with activity. Stretching also increases the pain. Bone scans and radiographs are often negative (p. 974).*CORRECT ANSWER 4. A patient who has an Achilles tendon rupture will have sharp, acute pain. Plantar flexion muscle strength will not be normal (p. 940).

Answer 80

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).*CORRECT ANSWER 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).

Answer 81

*1. The patient is at risk for infection (postsurgical or urinary tract via catheter). The patient also has a white blood cell count that is high (greater than 11,000), so infection should be considered. Infection is typically accompanied by a fever. (Malone, pp. 66, 518-519)*CORRECT ANSWER 2. Excessive thirst is associated with diabetes and hypovolemia. The patient's laboratory test values are within normal range for hemoglobin A1C, hematocrit, and hemoglobin (mildly low), and the patient would be unlikely to experience excessive thirst. (Malone, pp. 64-66, 79) 3. Pallor is common with hypovolemia. The patient’s hematocrit is within normal range, and hemoglobin is mildly low. It would be unlikely the patient would exhibit pallor. (Paz; Malone, pp. 64-66) 4. The patient has a stable oxygen level and is not considered to be anemic (normal hemoglobin and hematocrit), which could lead to shortness of breath (Malone, pp. 64-66).

Answer 82

1. This is not the best answer because the patient would need to initiate the reach with the abdominal muscles which are weakened from pregnancy. The patient also needs to protect the cesarean incision in early stages of healing. A trapeze bar is typically used to get into the long sit or short sit position (Johansson, p. 306). 2. This is the incorrect answer because the patient just had a cesarean section and the incision needs to be protected. Further, the patient has weakened abdominal muscles from pregnancy (Malone, p. 486). *3. This is the correct answer because the patient needs to protect the right shoulder (from dislocation) and the abdominal region from cesarean section. Rolling onto the left side and pushing up with the left upper extremity is the best and safest option for the patient (Malone, p. 486).*CORRECT ANSWER 4. This is the incorrect answer because the patient should be able to roll onto her side and push with the left upper extremity while protecting the right shoulder and cesarean incision. Physical therapist should promote as much functional independence as possible (Malone, p. 486).

Answer 83

1. This is the incorrect answer because the patient is showing signs of supraventricular tachycardia which is known. The therapist should first instruct the patient to perform a cough or Valsalva maneuver to resolve. If the Valsalva does not work, then calling the nurse is warranted (Frownfelter; Hillegass). *2. This is the correct answer because the patient has known supraventricular tachycardia which causes the heart rate to go above 150 bpm (Frownfelter). Patients can attempt a Valsalva maneuver to reconvert to a normal rhythm (Hillegass).*CORRECT ANSWER 3. This is the incorrect answer because the patient is showing signs of supraventricular tachycardia which is known. The therapist should first instruct the patient to perform a cough or Valsalva maneuver to resolve. If the patient would become symptomatic (dizzy, syncope, etc.) then laying down is warranted (Frownfelter; Hillegass). 4. This is the incorrect answer because the patient is showing signs of supraventricular tachycardia which is known. The therapist should first instruct the patient to perform a cough or Valsalva maneuver to resolve. Continuing the standing exercise could be dangerous if the patient becomes symptomatic or has a syncope episode (Frownfelter; Hillegass).

Answer 84

1. This is a plausible answer because the patient only has current use of one extremity. However, a straight cane will not necessarily assist with pain management of the incision. The patient is also not at risk for falls and does not need to limit weight-bearing. (Dutton, pp. 308-309) 2. The patient has adequate hip strength and is not reporting pain related to the sacroiliac joint or hip. The belt is used to limit or control motion when instability or inflammation is present or with pelvic girdle pain. (Dutton, p. 1439) 3. The indications for a rolling walker are to limit lower extremity weight-bearing, address significant muscle weakness or balance deficits, and to assist in maintaining upright posture. The patient in this scenario will not be able to use a rolling walker because the right arm is in a sling. The patient does not have other indications for use of a rolling walker. (Dutton, pp. 308-309) *4. An abdominal binder is helpful to provide abdominal support and reduce pain after an abdominal/pelvic surgery (Malone).*CORRECT ANSWER

Answer 85

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.*CORRECT ANSWER 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.

Answer 86

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)*CORRECT ANSWER 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).

Answer 87

1. Complete rupture would result in weak (not strong) contraction and painless isometric testing. *2. A minor lesion of the quadriceps muscle or tendon will result in a strong and painful isometric contraction.*CORRECT ANSWER 3. Disorder in the nervous system will result in weak (not strong) and painless isometric testing. 4. Disuse atrophy will lead to weak and painless isometric testing.

Answer 88

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.*CORRECT ANSWER 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.

Answer 89

*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)*CORRECT ANSWER 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).

Answer 90

*1. Iontophoresis with dexamethasone is an appropriate and effective treatment for tendinitis in the shoulder (Cameron, pp. 275, 280; Bellew, pp. 318-319).*CORRECT ANSWER 2. Iontophoresis using acetic acid, not dexamethasone, would be most appropriate to treat calcium deposits in tendon (Cameron, pp. 275, 280). 3. Iontophoresis using zinc oxide is an effective treatment for a skin lesion (Bellew, pp. 318-319). 4. Iontophoresis using calcium chloride is an effective treatment for lumbar muscle spasm (Bellew, pp. 318-319).

Answer 91

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)*CORRECT ANSWER 4. Left torsion of the eye suggests left posterior semicircular canal involvement, not right semicircular canal involvement (p. 934).

Answer 92

1. To promote autonomy, the environment should be varied and challenging; therefore, distractions are introduced at this stage. 2. The ability to walk longer distances does not factor into autonomy of the movement. To be autonomous, the movement is largely automatic with little attention needed. Therefore, focusing on distance would not necessarily promote autonomy. *3. In the autonomous stage of motor learning, the person can perform the task with a minimal level of attention and can perform it in a changing, unpredictable environment. Training strategies include dual-tasking and varying the environment.*CORRECT ANSWER 4. A change of walking speed does not factor into autonomy of the movement. To be autonomous, the movement is largely automatic with little attention needed. Therefore, focusing on speed would not necessarily promote autonomy.

Answer 93

1. Climbing steps can be an easier task than walking for a person with Parkinson disease, due to the visual cues. The use of visual cues has been shown to help prevent freezing episodes but has little carryover (Umphred, p. 617). Therefore, although this task would be appropriate to practice with a patient who reports freezing, it would not be an effective intervention to improve a shuffling gait pattern. *2. Auditory cues have been shown to improve stride length and velocity in patients who have Parkinson disease. Rhythmic auditory stimuli, such as a metronome, have been shown to improve gait speed, cadence, and stride length. (O'Sullivan, p. 789)*CORRECT ANSWER 3. Treadmill training has been shown to be an effective treatment when combined with visual and/or auditory cues for increased step length (Umphred, p. 615; O'Sullivan, p. 796). This option, however, describes training without these cues and, therefore, would not be the best option for improving this patient's gait quality. 4. Braiding is a high-level task that is used to emphasize trunk rotation and side stepping movement (O'Sullivan, p. 796). This would not be an appropriate task to practice in order to increase step length.

Answer 94

1. Chronic pain syndrome is usually indicated by long-standing pain that persists beyond what would be expected for normal healing (p. 120). 2. Pool therapy would be indicated if the pain were of musculoskeletal origin; however, there are no clear indications of the source of the patient's pain (p. 114). 3. Transcutaneous electrical nerve stimulation is a modality for pain relief. However, the origin of the pain should first be determined when a musculoskeletal source of the pain is not identified. A medical evaluation may be necessary. (p. 25) *4. Pain that is unchanged by position along with a lack of significant objective musculoskeletal findings may indicate systemic disease; therefore, the patient may require medical evaluation (pp. 25, 124).*CORRECT ANSWER

Answer 95

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)*CORRECT ANSWER

Answer 96

1. Sitting is not a position used to test latissimus dorsi strength. 2. Extending the shoulder with lateral (external) rotation allows the long head of the triceps to substitute for the latissimus dorsi, so the palms should remain in the starting position. *3. The patient has demonstrated at least Fair (3/5) strength in the latissimus dorsi, so the physical therapist should add resistance to determine whether the patient has greater strength.*CORRECT ANSWER 4. This position is the gravity-eliminated position for testing the latissimus dorsi. The patient has already demonstrated sufficient strength to add resistance, so testing in the gravity-eliminated position would not be necessary.

Answer 97

*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.*CORRECT ANSWER 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.

Answer 98

1. Hypothyroidism results in cold intolerance, not heat intolerance (pp. 395-396). *2. People who have hyperthyroidism are at risk for heat intolerance due to hyperthermia secondary to accelerated metabolic rate (pp. 394-395).*CORRECT ANSWER 3. People who have hypoparathyroidism are not at risk for heat intolerance (pp. 400-401). 4. People who have hyperparathyroidism are not at risk for heat intolerance (pp. 399-400).

Answer 99

1. The principle of informed consent states that all primary health care providers have an ethical and legal duty to provide patients with all information necessary to make an informed and intelligent decision about whether to proceed with care. This does not fall under Health Insurance Portability and Accountability Act (HIPAA) of 1996. (p. 326) 2. Per the Omnibus Reconciliation Act of 1987, health care organizations must justify use of patient physical restraints and a written physician order must be obtained within 24 hours of applying the restraints (p. 85). 3. The withholding or withdrawal of life-sustaining treatment and support and do-not-resuscitate orders fall within the administration of the Patient Self-Determination Act. Patients can also sign a living will that can appoint individuals to make the decision to withdraw care depending on specifically outlined circumstances. (p. 455) *4. Per the Health Insurance Portability and Accountability Act (HIPAA), all patient medical records are protected for privacy and can only be shared with health care providers on a "need to know" basis. To copy a patient's medical records and use them for a school project is a direct breach of this privacy. (pp. 363-364)*CORRECT ANSWER

Answer 100

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.*CORRECT ANSWER 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.

Answer 101

1. There is no information present in the stem to indicate that the patient has diabetes. Neuropathic diabetic wounds would be more likely to occur on the weight-bearing, plantar aspect of the foot. (p. 75) 2. Arterial insufficiency wounds would present with thin, cool, shiny skin and usually occur at the distal digits (p. 75). *3. Venous insufficiency wounds tend to occur in the "gaiter" region proximal to the malleolus and tend to have hemosiderin staining, a woody texture, and a condition known as lipodermatosclerosis (pp. 75, 127).*CORRECT ANSWER 4. Pressure injuries initially present with nonblanchable redness over a bony prominence (p. 75).

Answer 102

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.*CORRECT ANSWER 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.

Answer 103

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).*CORRECT ANSWER 4. The minimal doorway width to allow standard wheelchair access is 32 inches (81 cm).

Answer 104

1. This is an incorrect answer for the following reasons: The Watson Test, also called the Scaphoid Shift Test, examines the dynamic stability of the wrist, in particular, the integrity of the scapholunate ligament. This test creates a subluxation stress on the scaphoid and will be positive if the scapholunate joint are unstable and the scapholunate ligament is torn (Magee, p. 532). The usual mechanism of injury that creates scapholunate instability is a hyperextension of the wrist during a fall on an outstretched hand. Patients frequently complain that the pain is aggravated by weight bearing on an extended wrist (Dutton, p. 806). While that is a similar feature to triangular fibrocartilage complex injuries, pain is typically centrally located (Magee, p. 487), not medial. Physical examination reveals limitation of wrist flexion with a springy end feel (Magee, p. 506) which is not present in this case. For these reasons, this is an incorrect answer. 2. This is an incorrect answer for the following reasons: First, the Flick Maneuver is a test for carpal tunnel syndrome (CTS). A positive test, indicating CTS, is the resolution of the paresthesia symptoms during or following administration of flicking the wrist (Dutton, p. 790). The initial characteristic features of CTS include intermittent pain and paresthesias in the median nerve distribution of the hand (Dutton, p. 812), which are not features of this case making this an incorrect answer. 3. This is an incorrect answer for the following reasons: This test is used to detect stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis known as de Quervain tenosynovitis (Magee p. 785). Pain along the radial aspect of the wrist and forearm is a common symptom for several pathoanatomical diagnoses, including de Quervain disease (Magee, p. 766). Since this patient does not have radial sided wrist pain, this is an incorrect answer. *4. This is the correct answer for the following reasons: The most likely diagnosis in this case is a tear of the triangular fibrocartilage complex (TFCC). Mechanisms of TFCC tears commonly include a fall on outstretched wrist in a supinated position, which occurs in this case. Moreover, patients with lesions of the TFCC complain of medial wrist pain just distal to the ulna, which is increased with end-range forearm pronation/supination and with forceful gripping. Clicking is also common (Dutton, p. 804). These findings are features of this case. The distal radioulnar joint is stabilized by the TFCC (Magee, p. 482). Pain or resistance to this test indicates a TFCC lesion (Dutton, Ch. 18, Forearm, Wrist, and Hand)*CORRECT ANSWER

Answer 105

1. This is an incorrect answer for the following reasons: Friction massage is applied to break up adhesions or minimize rough surfaces between tendons and their synovial sheaths. Friction massage is also used to increase the mobility of scar tissue in muscle as it heals. This form of connective tissue massage is a useful intervention for patients with restricted soft tissue mobility (Kisner, p. 112), which is not evident in this case. Since this individual has signs and symptoms consistent with a triangular fibrocartilage complex injury, such as medial wrist pain just distal to the ulna, which is increased with end-range forearm pronation/supination and with forceful gripping (Dutton, p. 804), cross friction massage is unlikely to be an efficacious or indicated intervention thus making this an incorrect choice. *2. This is the correct answer for the following reasons: The most likely diagnosis in this case is a tear of the triangular fibrocartilage complex (TFCC). Mechanisms of TFCC tears commonly include a fall on outstretched wrist in a supinated position, which occurs in this case. Moreover, patients with lesions of the TFCC complain of medial wrist pain just distal to the ulna, which is increased with end-range forearm pronation/supination and with forceful gripping. Clicking is also common (Dutton, p. 804). These findings are features of this case. The conservative invention for a TFCC injury, depending on the severity of symptoms, typically includes an ulnocarpal support attached to a soft wrist splint or a long-arm cast or splint fitted 6 weeks, if the TFCC is unstable (Dutton, p. 804).*CORRECT ANSWER 3. This is an incorrect answer for the following reasons: The distal radioulnar joint (DRUJ) is stabilized by the triangular fibrocartilage complex (TFCC) (Magee, p. 482). Injury to the TFCC creates increased mobility or instability at the TFCC (Magee, p. 532). Joint mobilization is contraindicated in hypermobile joints (Kisner, p. 133) making this an incorrect and contraindicated treatment in this case. 4. This is an incorrect answer for the following reasons: The distal radioulnar joint is stabilized by the triangular fibrocartilage complex (Magee, p. 482). If the tear is peripheral and acute, the highly vascular tissue is likely to scar together over a 4- to 6-week period with immobilization. Patients who have instability of the distal radioulnar joint may have to undergo ligament repair. (Magee and Zachazewski, p. 413). Thus, initial management should focus on structure healing and avoid movement. Thus, this is an incorrect answer.

Answer 106

1. Pressure in the inferior vena cava in supine position causes a decrease, not an increase, in venous return and cardiac output. This causes supine hypotensive syndrome, which presents as dizziness, nausea, and shortness of breath. 2. Pressure in the inferior vena cava rises, not decreases, in supine position. This causes supine hypotensive syndrome, which presents as dizziness, nausea, and shortness of breath. *3. Pressure in the inferior vena cava rises in late pregnancy, especially in supine position. This causes supine hypotensive syndrome, which presents as dizziness, nausea, and shortness of breath. Supine position causes a decrease in venous return and cardiac output.*CORRECT ANSWER 4. Pressure in the inferior vena cava rises, not decreases, in supine position. This causes supine hypotensive syndrome. which presents as dizziness, nausea, and shortness of breath.

Answer 107

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.*CORRECT ANSWER 4. Discontinuing physical therapy would not allow for the best care for the patient.

Answer 108

1. Freiberg disease, which commonly involves avascular necrosis of the second metatarsal epiphysis, leads to collapse of the osteochondrotic deformity. Symptoms include pain localized to the metatarsal head and exacerbated with activity, range of motion limitations, joint swelling, and occasional plantar callosity under the second metatarsal head. Neurological signs, such as those described in the stem, are not attributable to Freiberg disease (p. 274). 2. Patients who have anterior tarsal syndrome report deep aching pain in the medial and dorsal aspect of the foot, burning around the nail of the great toe, and pins-and-needles sensations that are exacerbated with plantar flexion. These symptoms are not consistent with the description in the stem (p. 1169). *3. The symptoms described in the stem are consistent with Morton neuroma, a mechanical entrapment neuropathy of the interdigital nerve (p. 1168).*CORRECT ANSWER 4. Sesamoiditis presents with pain on weight-bearing and swelling of plantar soft tissue. Passive dorsiflexion of the metatarsophalangeal joint while palpating the sesamoids exacerbates pain. Neurological signs, such as those observed in the patient described in the stem, are not commonly associated with this condition (p. 1167).

Answer 109

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°.*CORRECT ANSWER 4. Exercise alone is not sufficient to manage a curve of 45°.

Answer 110

1. A patient who has a new diagnosis of lymphedema would be classified in phase 1 of treatment for lymphedema, where short-stretch bandages would be the treatment of choice for compression. Long-stretch bandages would not provide the stretch and resting pressure of the short-stretch bandage. (Hillegass, p. 664) *2. This patient has a new diagnosis of stage 2 lymphedema (Hillegass, p. 660), which is an indication for phase 1 of treatment for lymphedema wherein bandages are the key component of compression. Short-stretch bandages are the bandages of choice for treating lymphedema because they are latex free and they stretch approximately 60% more than their original length. These bandages also provide a low resting pressure and high working pressure, which provides compression of the more superficial lymphatic and venous vessels (Hillegass, p. 664; Zuther, p. 404).*CORRECT ANSWER 3. Circular knit compression garments (stockings) are used for compression in phase 2 (Zuther, p. 399). The patient has a new diagnosis and is in phase 1 of treatment. A patient in phase 1 would have compression applied through use of short-stretch bandages but would not use a compression garment until phase 2 (Hillegass, pp. 664-667). 4. A flat knit compression garment would be used with a patient in phase 2 of treatment, and would not be indicated for a patient who is in phase 1 (new diagnosis). The flat knit compression garment would have a seam, cost more, and allow higher compression than the circular knit garment, but still would not be indicated for a patient in phase 1 of treatment (the intensive decongestive phase) (Hillegass, pp. 664-667).

Answer 111

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.*CORRECT ANSWER 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.

Answer 112

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 (pp. 246, 262). 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 (p. 246). *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 (p. 246).*CORRECT ANSWER 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 (p. 262).

Answer 113

1. A varus displacement at the elbow results in lateral collateral ligament instability but will not result in posterior movement of the coronoid process. 2. A valgus displacement at the elbow will result in a positive stress test for the medial collateral ligament. 3. An anterior displacement at the elbow occurs when the olecranon is displaced anteriorly. *4. Displacing the coronoid process inferior to the trochlea requires the ulna to be displaced posterolateral to the humerus.*CORRECT ANSWER

Answer 114

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)*CORRECT ANSWER 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)

Answer 115

1. Cardiac arrhythmia is not associated with Parkinson disease. *2. Erratic breathing is associated with Parkinson disease due to dyskinetic movement patterns of the muscles of respiration.*CORRECT ANSWER 3. Parkinson disease is characterized by restrictive lung dysfunction associated with rigidity and respiratory muscle weakness, both of which would produce decreased chest excursion and decreased inspiratory volume. 4. Cardiac arrhythmia is not associated with Parkinson disease.

Answer 116

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.*CORRECT ANSWER

Answer 117

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.*CORRECT ANSWER 4. Exercise-induced asthma or bronchospasm is exacerbated in cold environments.

Answer 118

1. Hip flexion up to 90° is permitted with total hip arthroplasty involving trochanteric osteotomy (p. 734). Active hip flexion within precautions is a common exercise in acute rehabilitation after total hip arthroplasty. *2. A transtrochanteric surgical approach for total hip arthroplasty involves osteotomy of the greater trochanter at the gluteus medius and minimus insertion, anterior capsulotomy and dislocation, and reattachment of the greater trochanter with wire. Abduction precautions are necessary while these structures heal (p. 730). After trochanteric osteotomy, no resisted abduction and no active isotonic hip abduction against gravity are allowed until the osteotomy has healed (p. 734).*CORRECT ANSWER 3. Hip extension to neutral is permitted with a total hip arthroplasty involving trochanteric osteotomy (p. 734). Assistance to support the lower extremity is important to minimize active hip abduction in the sidelying position. 4. Hip adduction to neutral is permitted with total hip arthroplasty involving trochanteric osteotomy (p. 734). This hip movement is functionally important for sit-to-supine transfers.

Answer 119

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).*CORRECT ANSWER 4. Triceps surae weakness can result in inadequate knee extension in stance (p. 308).

Answer 120

1. The heat-moldable healing shoe can be molded directly to the shape of the patient's foot and is commonly used after amputation or skin grafting. This type of shoe does not alleviate weight-bearing on the metatarsal heads. (Hamm, pp. 217-218) 2. The goal of off-loading is to reduce pressure and shear forces on the area of ulcers (Baranoski). Off-loading the heel would place more weight-bearing on the forefoot, which is where the ulcers are located. 3. A postoperative shoe, especially without a total contact molded insole, does not offload the metatarsals as well as a heel rocker shoe does (Hamm, pp. 219-220). *4. The heel rocker shoe is designed to provide extreme forefoot relief by transferring the patient's weight to the heel area. It can be used to facilitate wound healing for metatarsal and distal toe ulcers. (Hamm, p. 221)*CORRECT ANSWER

Answer 121

*1. Excessive midtarsal or subtalar supination is the common compensation for forefoot valgus (p. 1146).*CORRECT ANSWER 2. Rearfoot pronation is the compensatory motion for forefoot varus (p. 1146). 3. Medial (internal) tibial rotation is the compensatory motion for functional forefoot valgus (p. 328). 4. Increased ankle dorsiflexion would have no effect on the rotary component of forefoot varus or valgus. Primary motions of the talocrural joints are dorsiflexion and plantar flexion. The talocrural joint laterally (externally) rotates with supination and medially (internally) rotates with pronation. (pp. 1103-1105)

Answer 122

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).*CORRECT ANSWER

Answer 123

*1. Shoulder abduction and medial (internal) rotation should be avoided when measuring forearm pronation (p. 168).*CORRECT ANSWER 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).

Answer 124

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)*CORRECT ANSWER

Answer 125

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.*CORRECT ANSWER 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.

Answer 126

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).*CORRECT ANSWER

Answer 127

1. Lateral forefoot posting is used to correct forefoot valgus (Webster). The patient described in the stem has a limitation of first MTP extension, which would not be addressed by a lateral forefoot posting (Dutton, p. 1119). 2. Medial longitudinal arch support would be a correction for a pronated foot or decreased arch (O'Sullivan, p. 1290). *3. Passive metatarsophalangeal joint extension between 55° to 90° is necessary at heel off (terminal stance) (Dutton, p. 1119). The patient has limited first MTP joint extension. A metatarsal bar can reduce pressure on the MTP joint by transferring the stress to the metatarsal shaft. (O'Sullivan, p. 1292)*CORRECT ANSWER 4. Medial rearfoot posting is used to correct rearfoot varus (Webster), which is seen with a pronated foot (Dutton, p. 1143).

Answer 128

*1. Disc herniations are associated with acute pain in the back and leg (unilaterally) (Magee, p. 560). Lower extremity symptoms elicited with straight leg raise testing are suggestive of a lateral disc herniation (Magee, p. 604).*CORRECT ANSWER 2. A large central disc herniation would be more likely to reproduce pain in the back during the straight leg test. Lower extremity symptoms elicited with straight leg raise testing are suggestive of a lateral disc herniation. (Magee, p. 604). 3. Spinal stenosis is associated with an insidious, not acute, onset as well as bilateral, not unilateral, symptoms (Magee, p. 560). 4. Scoliosis is associated with insidious onset and would not be associated with a positive result for the straight leg test (Magee, p. 560).

Answer 129

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)*CORRECT ANSWER 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)

Answer 130

1. Involvement of the superior gluteal nerve would be needed if there were a reduction in the strength of hip abduction because of the lesion (p. 244). 2. Involvement of the superior gluteal nerve would be needed if there were a reduction in the strength of hip abduction because of this lesion (p. 244). 3. Involvement of the superior gluteal nerve would be needed if there were a reduction in the strength of hip abduction because of this lesion (p. 244). *4. The obturator nerve innervates the adductor longus, adductor brevis, adductor magnus, gracilis, and obturator externus, whose action is to adduct the hip. A lesion of the obturator nerve would not affect hip abduction (p. 252).*CORRECT ANSWER

Answer 131

*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).*CORRECT ANSWER 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).

Answer 132

*1. Stage 2 lymphedema, in which the Stemmer sign is positive, is identified primarily with tissue proliferation and subsequent fibrosis; the protein-rich swelling causes a progressive hardening of the tissues by Stage 2. The tissue over time becomes more indurated, and edema is difficult to reduce. (pp. 658, 660)*CORRECT ANSWER 2. Soft edema is more characteristic of the reversible stage or Stage 1. Pitting is readily induced with soft tissue pliability, but there are no fibrotic alterations. The Stemmer sign is not visible in Stage 1; it occurs in Stage 2 and may intensify in stage 3. (pp. 658, 660) 3. Decreased temperature of the distal extremities is associated most with diseased arteries (p. 297). This is not characteristic of lymphedema, which is associated with the Stemmer sign. 4. Decreased swelling with limb elevation is characteristic of Stage 1 lymphedema or the reversible stage. The Stemmer sign is characteristically seen in Stage 2 or the spontaneously irreversible lymphedema, where decreased swelling with limb elevation is not classically seen. (pp. 658, 660)

Answer 133

1. The thyroid most immediately affects metabolic rate and protein synthesis (p. 483). 2. The most immediate effect of the parathyroid 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).*CORRECT ANSWER 4. The pituitary's most immediate effect is to regulate other glands; it has no direct effect on the nervous system (p. 479).

Answer 134

1. Heart rate will be higher for upper extremity exercise and lower for lower extremity exercise. 2. Stroke volume will be higher for lower extremity exercise, compared to upper extremity exercise. 3. Systolic blood pressure will be higher for arm exercise, compared to leg exercise. *4. The rate pressure produce will be lower for leg exercise and higher for arm exercise due to the effect of higher heart rate and higher systolic pressure.*CORRECT ANSWER

Answer 135

1. The dorsal interossei are innervated by the ulnar nerve (p. 777). The ulnar nerve may be damaged by a distal humerus fracture but not by a mid shaft fracture (p. 685). 2. The flexor digitorum superficialis is innervated by the median nerve (p. 749). This nerve may be injured by a distal fracture of the humerus but not a mid shaft fracture (p. 685). 3. The pronator quadratus is innervated by the median nerve (p. 749). This nerve may be injured by a distal fracture of the humerus but not by a mid shaft fracture (p. 685). *4. The radial nerve is in direct contact with the shaft of the humerus and may be injured following a mid shaft fracture (pp. 684-685). The extensor carpi radialis longus is innervated by the radial nerve (p. 751).*CORRECT ANSWER

Answer 136

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.*CORRECT ANSWER 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.

Answer 137

*1. Shoulder lateral (external) rotation creates valgus stresses at the elbow. This should be avoided because valgus forces stress the ulnar collateral ligament.*CORRECT ANSWER 2. Active wrist motion is encouraged following ulnar collateral ligament reconstruction. 3. Gripping activities are encouraged in the early stages following an ulnar collateral ligament reconstruction. 4. The ulnar collateral ligament of the elbow does not attach on or near the scapula, and motion of the scapula does not load the ulnar collateral ligament of the elbow.

Answer 138

1. Arthritis would be associated with an empty end-feel, if the condition is significant in nature. *2. A boggy end-feel is produced by fluid or blood in the joint.*CORRECT ANSWER 3. Meniscal displacement would bring about a springy end-feel. 4. Patellofemoral syndrome would present with pain and possibly an empty end-feel.

Answer 139

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).*CORRECT ANSWER 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).

Answer 140

1. The coracohumeral ligament limits flexion and extension movements of the glenohumeral joint (Dutton, p. 583). It is the acromioclavicular and coracoclavicular ligaments that are disrupted with acromioclavicular joint injuries, not the coracohumeral ligament (Dutton, p. 587). *2. The coracoclavicular ligament, along with the acromioclavicular ligament, stabilizes the acromioclavicular joint (Dutton, p. 587). Injury to the acromioclavicular joint occurs from trauma, such as a fall on the shoulder, as in this patient's history (Neumann, p. 129). The acromioclavicular joint is stressed with passive shoulder horizontal adduction (Dutton, p. 588).*CORRECT ANSWER 3. The inferior glenohumeral ligament is under tension when the shoulder is positioned into abduction, extension, and/or lateral (external) rotation, not horizontal adduction (Dutton, p. 582). 4. The superior glenohumeral ligament stabilizes the shoulder against lateral (external) rotation as well as inferior and anterior translations of the humeral head (Neumann, p. 136). It is therefore not stressed with horizontal adduction.

Answer 141

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.*CORRECT ANSWER

Answer 142

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*CORRECT ANSWER

Answer 143

1. Rhythmic rocking is used to decrease postural tone, which is not indicated for this patient (p. 215). 2. Pressure is used to decrease postural tone, which is not indicated for this patient (p. 214). 3. Vibration is used to decrease postural tone, which is not indicated for this patient (p. 214). *4. Of the options listed, joint approximation is the most appropriate technique for improving low postural tone (pp. 827-828)*CORRECT ANSWER

Answer 144

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).*CORRECT ANSWER

Answer 145

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.*CORRECT ANSWER 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.

Answer 146

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)*CORRECT ANSWER 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).

Answer 147

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)*CORRECT ANSWER 4. Ultrasound along with stretching is the most effective way of increasing joint range of motion by stretching (p. 176)

Answer 148

1. Antalgic gait and lateral (external) rotation, not flexion, 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, not abduction, 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, not medial (internal) 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*CORRECT ANSWER

Answer 149

1. This is an incorrect answer for the following reasons: The primary stabilizer of the lunate is the scapholunate ligament (Neumann, p. 227). The usual mechanism of injury that creates scapholunate instability is a hyperextension of the wrist during a fall on an outstretched hand. While that is a similar feature to triangular fibrocartilage complex injuries, pain is typically centrally located with a scapholunate injury (Magee, p. 487), not medial. Physical examination reveals limitation of wrist flexion with a springy end feel in a scapholunate injury (Magee, p. 506) which is not present in this case. For these reasons, this is an unlikely answer. 2. This is an incorrect answer for the following reasons: The transverse carpal ligament serves as a primary attachment site for many intrinsic muscles located within the hand and the palmaris longus, a wrist flexor muscle. The transverse carpal ligament converts the palmar concavity made by the carpal bones into a carpal tunnel. The tunnel serves as a passageway for the median nerve and the tendons of extrinsic flexor muscles of the digits. Furthermore, the transverse carpal ligament restrains the enclosed tendons from “bowstringing” anteriorly and out of the carpal tunnel, most notably during grasping actions performed with a partially flexed wrist (Neumann, p. 221). Injuries to this ligament are likely to involve the median nerve (Dutton, p. 810). Flexion and sensation of the radial digits, important in precision grips, are controlled mainly by the median nerve (Dutton, p. 777). Since this case does not have any alterations in sensation or weakness in muscles innervated by the median nerve, this is unlikely structure to be involved in this case. 3. This is an incorrect answer for the following reasons: The extensor pollicis brevis (EPB) tendon is part of the first extensor compartment on the dorsum of the wrist and together form the radial border of the anatomic snuffbox. Tenderness over these tendons may indicate de Quervain tenosynovitis (Magee, p. 771). Pain along the radial aspect of the wrist and forearm is a common symptom for several pathoanatomical diagnoses, including de Quervain disease (Magee, p.766). Since this patient does not have pain on the radial side of the wrist, this is not a likely diagnosis and thus not a likely structure to be injured making this an incorrect answer. *4. Mechanisms of triangular fibrocartilage complex tears commonly include a fall on outstretched wrist in a supinated position, which occurs in this case. Moreover, patients with lesions of the triangular fibrocartilage complex report medial wrist pain just distal to the ulna, which is increased with end-range forearm pronation/supination and with forceful gripping. Clicking is also common (Dutton, p. 804). These findings are features of this case. Thus, the most likely structure that was injured is the triangular fibrocartilage complex.*CORRECT ANSWER

PEAT #2 Flashcards

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