PT365 Daily Questions Flashcards
A PT observes that a patient with chronic venous insufficiency is wearing stockings with 20 mmHg of pressure despite being prescribed stockings with 40 mmHg of pressure. Which clinical finding would be MOST anticipated?
1) edema
2) loss of sensation in the feet
3) angina pectoris
4) hyporeflexia
1) Answer: edema
1) Chronic venous insufficiency typically effects the distal LE’s. So a person with decreased venous return and is wearning stockings with insufficient pressure is likely to experience symptoms of chronic venous insufficiency, including edema.
2) You won’t lose sensation in feet if you have venous insufficiency
3) This is a heart condition
4) Hyporeflexia refers to a diminished or absent response to tapping of a tendon. This is a reflex arc issue / neuron issue. Reflexes would NOT be impacted much based on this change in stocking pressure.
Recent diagnostic imaging identified the presense of a glenoid labral tear. Which diagnostic imaging method would have MOST likely been used to identify this condition?
1) arthrogram
2) x-ray
3) doppler ultrasound
4) bone scan
ANSWER: 1 arthrogram
1) It is an xray that uses an injected dye to visualize joint structures. Dye is injected into the joint for images to be taken. You can see fluid leakage if there is a tear in any part of joint cavity. This is used in most major joints.
2) xrays are NOT as good with labrum, better with bone
3) This ultrasound is typically used to view blood flow in major veins, arteries, and cerebrovascular system. It wouldn’t be used for labrum tear
4) Bone scan uses radioactive isotopes to identify areas of bone that have high bone mineral turnover. Bone scans view for bone diseases, not for labrum tear.
1) A PT treats a pt diagnosed with lateral epicondylitis using iontophoresis. The PT uses dexamethasone with a current intensity of 3mA for 20 mins. How often during the treatment session should the therapist check the skin?
1) every minute
2) every 3-5 mins
3) every 20 mins
4) at the conclusion of treatment session
2) What is iontophoresis
- Why is checking the skin SO important during ionto
Answer: 2 (every 3-5 mins)
2) Process of applying meds to injured area through e-stim.
- PT’s should check the skin frequently during treatment to assess skin for sensitivity reactions.
1) A PT working in a rehab hosptal plans to assess a pt’s risk for developing pressure sores using the Braden Scale. When using this scale, which risk factor would the therapist NOT need to consider?
a) sensory perception
b) level of mobility
c) nutrition status
d) cognitive status
2) What is the Braden Scale
- What does it assess?
3) Scoring scale for Braden Scale … is a higher score better or worse?
- Highest score you can get?
- Mild / Mod / High / Severe scores?
Answer d
2) The Braden scale is a scoring system used to assess a pt’s risk for developing pressure sores or pressure injuries.
- sensory perception, level of mobility, exposure to moisture, activity level, nutrition status, and exposure to friction/shear.
3)
- Each item is scored 1-4, with HIGHER numbers being better.
- 23 is highest score you can get
- Mild Risk: 15-18
- Moderate Risk: 13-14
- High Risk: 10-12
- Severe Risk: <9
A PT observes a pt complete hip abduction and adduction exercises in standing. Which axis of movement is utilized with these particular motions?
a) frontal
b) vertical
c) anterior-posterior
d) longitudinal
1) Explain it:
Answer: c (anterior-posterior)
1) Remember the PLANES of motion are sagittal, frontal/coronal, and transverse. But these are NOT the same as the axis of movement. Motions are described as occuring around the planes yes, but movement in the planes occur around three corresponding axes (anterior-posterior, medial-lateral, vertical).
*** THE AXIS IS PERPENDICULAR TO IT’S PLANE
(So frontal plane has an anterior-posterior axis; sagittal plane has a medial-lateral plane; transverse plane has a vertical axis).
1) A PT assesses a pt’s present pain level and concludes that the current patient-controlled analgesia protocol is not adequate. The MOST appropriate action is to:
a) modify the allowable medication dosage
b) eliminate the lockout interval
c) contact the patient’s nurse
d) page the patient’s referring physician
Explain:
Answer: c (contact pt’s nurse)
Explain: Some pt’s are allowed to control their own pain meds (called: patient controlled analgesia). Done through IV.
1) A PT completes a developmental assessment on a five-month old infant. If the therapist elects to examine the infant’s palmar grasp reflex, which of the following stimuli is the MOST appropriate:
a) contact the ball of the foot in upright standing
b) maintained pressure on the palm of the hand
c) noxious stimulus to the palm of the hand
d) sudden change in the position of the head
Answer: b (maintain pressure in palm of hand)
REVIEW PRIMITIVE REFLEXES … AND WHEN THEY INTEGRATE (integration is when reflex is NO longer present). Failure to have a reflex integrate can lead to impaired movement and function.
1) A PT determines that a patient is able to generate 120 ft-lbs of knee extensor force on the involved extremity at 240 degrees per second. Which value would BEST estimate the amount of knee extensor force generated at 60 degrees per second:
a) 75 ft-lbs
b) 105 ft-lbs
c) 135 ft-lbs
d) 165 ft-lbs
Explain
Answer: d, 165 ft-lbs
Explain: Isokinetic testing is a strength test with leg in motion. The velocity of muscle shortening during concentric exercise is inversely proportional to the force exerted by the muscle. So the faster the speed, the less force needed (and visa versa). Thus, in this ?, since you reduce the speed significantly, you’d increase the force significantly.
1) A patient rehabing from a SCI informs a therapist that he will walk again. Which type of injury would make functional ambulation the MOST unrealistic
a) complete T9 paraplegia
b) posterior cord syndrome
c) Brown-Sequard’s syndrome
d) Cauda equina syndrome
Explain:
Answer: a (complete T9)
Explain:
a) T9 injury means you have UE and partial trunk control, but NO LE sensory or motor control. Very hard to walk with this.
b) Posterior cord SCI injures the DCML, so fine touch and proprioception would be lost, but not motor.
c) Brown-Sequard is usually incomplete, and only half (one sided / hemi) of spinal cord. So pt would lose fine touch/sensory on same side, and pain/temp from contralateral side (due to decussation of tracs)
d) Cauda equina is below L2 area. It is also a LMN injury, so flaccidity, areflexia. This patient would have difficulty walking as well, but they have L1/L2.
1) A patient with cardiac arrythmias has been prescribed beta-blockers. What is the MOST effective way to monitor the patient’s activity tolerance?
a) rating of perceived exertion
b) visual analog scale
c) palpation of radial heart rate
d) assessment of telemetry strip
Explain:
Answer: a (rating of perceived exertion)
Explain: Beta blockers slow down HR, and open air ways. It is given to those with ischemia, HTN, arrythmias. Beta blockers also decrease O2 demand by decreasing sympathetic response/input to heart.
a) RPE or Borg scale is a way to coorelate exertion to an objective rating (6 = 60bpm, 13 = 130 bpm).
b) VAS is a pain scale based on visually looking
c) Remember heart rate is lowered on beta blockers, so this would be ineffective
d) Telemetry is an electrocardiogram monitoring system that provides real time electrocardiogram results through radiofrequency transmission of ECG signals to a monitor. These are used to study the electrical activity of the heart, to identify arrythmias.
1) A PT records the parameters of an electrical stimulation treatment in a pt’s medical record. The standard unit of measure when recording alternating current frequency is:
a) volt
b) hertz
c) coulomb
d) pulses per second
Explain:
Answer: b (hertz)
Explain:
a) volts relates to electrical forces moving charged particals through a conductor between 2 points
b) Hertz is the unit of measure describing number of cycles per second when using alternating current
c) A coulomb is the amount of electrical charge transported in one second by a steady current of one ampere
d) Pulses per second is utilized to describe the frequency of pulsed current.
1) A PT performs a circulatory screening on the LE’s. In order to assess the posterior tibial artery pulse, the PT must palpate the:
a) medial aspect of the arm midway between the shoulder and elbow
b) Posterior aspect of the medial malleolus
c) posterior aspect of the knee
d) dorsal aspect of the foot between the first and second metatarsals
Answer: b (posterior aspect of medial malleolus)
*** MUST REVIEW where to check for all the major pulses in UE and LE. Examples: Brachial (medial elbow); Radial (distal wrist); Carotid (neck); femoral (groin); popliteal (posterior knee); posterior tibial (medial malleolus); dorsalis pedis (dorsal/top of foot).
Compare one extremity to the other to determine strength of pulse, coloring, etc. If issue / injury is suspected, check the distal pulse(s).
1) A PT palpates the bony structures of the wrist and hand. Which of the following structures would NOT be identified in the distal row of carpals?
a) capitate
b) hamate
c) triquetrum
d) trapezoid
Explain:
Answer: c (triquetrum)
Explain: So long the pinky, here comes the thumb. Trapezium is the thumb (um = umb).
A PT is evaluating a pt that is seven months pregnant for an exercise program. The therapist positions the patient in a hooklying position and asks the pt to raise their head from the plinth. The therapist notes a bulge in the central abdominal area. This observation should be noted as:
a) de Quervain’s disease
b) diastasis recti
c) thoracic outlet syndrome
d) piriformis syndrome
Explain:
Answer: b (diastasis recti)
Explain: Diastasis recti is a seperation of the rectus abdominis muscle along the linea alba. It can tear during pregnancy, or seperate due to hormonal changes. It is diagnosed when it is more than 2 finger width’s length apart. A test (crunch) during pregnancy to monitor this is important in pregnant women. Pregnant women should continue with exercises at a moderate rate during pregnancy (50-60% max heart rate). Abdominal activities should be avoided until healing has reduced the seperation.
A PT implements an exercise program for a pt that is 27 weeks pregnant. Which position would be the MOST desirable for exercise activities based on the patient’s current status?
a) quadraped and sitting
b) supine and hooklying
c) sitting and trendelenburg
d) Trendelenburg and quadraped
Answer: a (quadraped and sitting)
A PT performs a formal systems review as part of an examination. As part of the systems review the PT measures the patient’s height and weight. The collected information is important for:
a) estimating blood pressure
b) calculating the body’s composition
c) calculating the patient’s BMI (body mass index)
d) predicting the pt’s functional exercise capacity
Answer: c (BMI)
A PT reviews the medical record of a pt entering a cardiac rehab program. The pt is status post (s/p) myocardial infarction and was recently placed on propanolol (beta blocker) by his PCP. The PT would expect the medication to:
a) lower the pt’s heart rate response to exercise
b) increase the pt’s oxygen saturation during exercise
c) increase the pt’s heart rate response to exercise
d) lower the pt’s level of dyspnea during submaximal levels of exercise
Answer: a (lower HR)
A PT observes that a pt often exhibits toe drag during the swing phase of gait. Which objective finding would be LEAST likely to contribute to this gait deviation:
a) flaccidity of the dorsiflexors
b) inadequate dorsiflexion ROM
c) weakness of dorsiflexors
d) spasticity of dorsiflexors
Answer: d (spasticity of DF’s)
A PT examines differences in lung volumes based on gender. Which lung volume would the therapist anticipate having the largest difference between males and females:
a) tidal volume
b) inspiratory reserve volume
c) expiratory reserve volume
d) residual volume
Answer: b (inspiratory reserve volume)
KNOW:
- Males have total lung capacity of about 6,000mL, while Females have about 4,200mL. Males and females Tidal Volume is about the same for each (500mL). Inspiratory reserve volume is max air you can breathe in, and accounts for 50% of lung capacity, so it is larger in males.
A PT works with a pt with an obstructive lung condition characterized by permanent widening and distortion of the medium sized airways. The pt presents with a cough, copious amounts of purulent sputum, and recurrent pulmonary infections. The description is MOST characteristic of:
a) bronchiectasis
b) idiopathic pulmonary fibrosis
c) chronic bronchitis
d) emphysema
Answer: a (bronchiectasis)
Explain:
- Lung conditions are either obstructive or restrictive. Obstructive is when things obstruct air getting in/out, like COPD or emphasema or bronchitis. Restrictive is when your lungs just can’t move due to pregnancy, fibrosis, broken rib, accessory muscle weakness, etc.
- Symptoms of an obstructive disease are: chronic cough, mucus, wheezing, and dyspnea
- Bronchiectasis is a condition where there is permanent damage to bronchi and bronchioles elastic compenents breaking down.
- Idiopathic pulmonary fibrosis is a RESTRICTIVE lung condition where aveolar walls are destroyed.
- Chronic bronchitis is narrowing of airways and production of mucus, but is NOT permanent destruction of bronchioles like in Bronchiectasis
- Emphysema is more permanent enlargement of airways, not bronchioles, but don’t produce large amounts of sputum
A PT inspects a burn obtained as a result of iontophoresis. The PT describes the burn as an acidic reaction. If the PT is correct, the pH of the skin would MOST likely be:
a) 2
b) 4
c) 6
d) 8
Answer: a (2)
Explain: Ionto utilizes a current which moves ions through body tissues, and that alters pH of the skin (so pt’s can become suseptible of burns). Usually pH is about 7.0, and less than 7.0 = acidic, and above 7.0 = alkaline. Skin’s normal pH is 3-4, so ionto makes it more acidic, so taking it down to 2. A 4 is normal range of pH for skin, and anything above 4 is alkaline reaction.
A PT works with a pt diagnosed with fibromyalgia syndrome. The pt reports significantly reduced activity levels due to pain flares and the PT suspects the pt is exhibiting fear-avoidance behaviors. Which of the following strategies would likely be the MOST beneficial to utilize with this pt.
a) Use the McGill pain questionaire to further assess the pt’s pain behaviors
b) Initiate the use of modalities to help control pain before starting exercises
c) Have the pt choose an activity goal and teach pacing techniques
d) Educate the pt to take prescribed pain meds 30 mins prior to exercise
Answer: c
Explain: Fibromyalgia is a rheumatology syndrome where there is pain in multiple areas/joints/muscles. It is chronic pain and no curable
- Use of modalities for chronic pain pt’s should be avoided ***
- Focussing on activity goals serves as positive reinforcement for pt with chronic pain
A pt rehabing from a fractured acetabulum is referred to PT for ambulation activities. The pt has been on bed rest for 3 weeks and appears to be somewhat apprehensive about weight bearing. The MOST appropriate device to use when initiating ambulation activities is:
a) parallel bars
b) walker
c) axillary crutches
d) straight cane
Answer: a (parallel bars)
Explain: Given the place of injury and how long they’ve been on bed rest, the pt will be very weak and have poor muscle control and balance. GOAL ON BOARD and as a PT is to be SAFE, SAFE, SAFE. Parallel bars are safer initially.
A PT administers the BERG balance scale with a pt status post right CVA prior to d/c from a rehab facility. The pt scored a total score of 39. The PT should conclude:
a) the pt will require a low burden of care once d/c’d home
b) the pt will have difficulty independently reaching for objects
c) the pt is at significant risk of multiple or recurrent falls
d) the pt will require assistance during ambulation
Answer: c (at risk of falling)
Explain: The BERG balance scale is for assessing balance, not gait. The BERG is out of 56, and lower than 45 (or 40) is ROF.
- The “Burden of Care” is not assessed by the BERG, that is the FIM which is done in the acute setting. FIM is on 18 categories to assess level of function and burden of care upon d/c.
- Barthel index is designed to measure the amount of assitance needed to perform 10 different ADL’s and mobility activities.
A PT works with a pt rehabing from a recent hospitalization. Which activity would be MOST likely associated with the development of syncope?
a) transferring from supine to sitting position
b) riding a stationary bicycle at 50 revolutions p/min
c) performing a leg exercise with ankle weights in supine
d) walking at 3 miles/hour on a treadmill
Answer: a (transfer from supine to sitting)
Explain: Syncope refers to a loss of consciousness often resulting from insufficient blood flow to the brain. The condition comes on fast, like orthostatic hypotension.
- Going from supine to sitting would bring on syncope as blood flow is decreased in brain.
- Yes riding a bike and walking would be taxing, but wouldn’t bring on syncope since it is usually brought on by positional changes
A note in a pt’s medical record indicates that they are taking oral potassium chloride for an acid-base disorder. Which acid-base disorder is MOST likely based on the prescribed medication?
a) respiratory acidosis
b) respiratory alkalosis
c) metabolic acidosis
d) metabolic alkalosis
Answer: d (metabolic alkalosis)
Explain: Oral potassium chloride is often administered when potassium levels are extremely low and need to be replenished, as well as, in pt’s with ongoing potassium loss. Acid-base disorders are often related to respiratory and/or metabolic issues.
- Respiratory acidosis is when pH is low due to hypoventilation, respiratory alkalosis is when pH is high
A pt rehabing from multi-trauma injuries sustained in a motor vehicle accident is not a candidate for patient-controlled analgesia. Which finding may have been MOST relevant when making this determination?
a) surgical contraindications
b) cognitive impairments
c) functional limitations
d) gastrointestinal distress
Answer: b (cognitive impairments)
- Explain: Patient controlled analgesia allows pt to control pain meds via IV. Pt needs to have cognition intact to do this.
A PT performs strength testing on members of a high school football team as part of a preseason assessment. The majority of players are between ages of 14 and 16 yrs old. Which age-related phenomenon would NOT be characteristic of this period of development:
a) increase in muscle mass
b) increase in the number of muscle fibers
c) Increase in muscle fiber size
d) increase in muscle strength
Answer: b (increase in number of muscle fibers)
- Explain: Puberty aged adolescents have rapid acceleration in strength and performance. They will increase in muscle mass (which is from an increase in muscle fibers) which equates to an increase in muscle strength. BUT, the actual number of muscle fibers does NOT change (hyperplasia does not happen, but hypertrophy can).
A note in a pt’s medical record indicates that laboratory testing identified an elevated hematocrit. Which condition would most likely be associated with this condition?
a) anemia
b) dehydration
c) leukemia
d) nutritional deficiency
Answer: b (dehydration)
Explain: Hematocrit refers to % of RBC’s in blood. A LOW hematocrit may indicate anemia and/or blood loss. A high hematocrit may indicate dehydration, or polycythemia vera (which is an overproduction of RBC’s). Normal hematocrit is 38-45 ish.
- If you are dehydrated, your fluids will be low, so RBC count is higher. Dehydration happens due to lack of water/fluid consumption or diarrhea, vomiting, or use of diuretics.
- Leukemia is cancer of blood when leukocytes change into malignant cells. Often leukemia results in lowered hematocrit levels.
- Lower vitamin and mineral levels also result in lowered hematocrit levels.
A PT treats a pt with right homonymous hemianopsia. The pt is positioned in sitting in the middle of a small table. When reaching for objects placed at different locations around the table, the pt would have the MOST difficulty retrieving objects:
a) placed at the top center of the table
b) placed to the left side of the table
c) place to the right side of the table
d) placed at the bottom center of the table
Answer: c (right side)
Explain: Homonymous hemianopsia is a condition where the visual field is damaged due to damage to MCA (middle cerebral artery). Often happens with a Right sided CVA and may accompany visual neglect.
- So homonymous means both eyes, and hemi means one sided. So RIGHT sided blindness means you can’t see right sided visual objects.
A PT treats a pt recently diagnosed with blood cancer. What type of blood cancer specifically involves the plasma cells?
a) leukemia
b) lymphoma
c) multiple myeloma
d) Hodgkin’s disease
Answer: c (multiple myeloma)
Explain: Blood cancers affect production of blood and function of blood cells. Blood is produced in bone marrow, so most cancers originate there. 3 major blood cancers are: leukemia, lymphoma, and myeloma.
- Leukemia is when leukocytes (WBC’s) become cancerous. These cancerous cells affect bone marrow, where they are made, and then travel to lymph nodes, liver, spleen, etc.
- Lymphoma is cancer in lymph system. This is Hodgkins or Non-Hodgkins lymphoma where abnormal lymphocytes collect in lymph nodes and impair the immune system.
- Multiple myeloma is cancer of PLASMA cells. Abnormal plasma cells accumulate in bone marrow and effect body’s immune system.
- Hodgkin’s is type of lymphoma, and is one of the most curable cancer’s.
A PT examines a pt with a past medical history that includes a transient ischemic attack. Which variable MOST differentiates a transient ischemic attack from a stroke?
a) presence of an aura
b) magnitude of the initial symptoms
c) time for resolution of symptoms
d) extent of speech and vision problems
Answer: c (time of resolution of symptoms)
Explain: A TIA is usually linked to atherosclerotic thrombosis which causes a temporary interruption to blood flow to brian. TIA’s are most common, and often occur in carotid and vertebrobasilar arteries. A TIA does NOT cause permanent neurological damage, but it is an indication of future risk, thus pt should get medical help and blood thinner meds.
- Aura’s are experienced with migraines
- Initial symptoms of a stroke and TIA are similar (F.A.S.T … face, arm, slurred speech, vision, confusion, etc.) … BUT SYMPTOMS and EFFECTS of a TIA RESOLVE MUCH MORE QUICKLY. Thus, any speech or vision issues with a TIA would resolve quickly.
A PT reads in the medical record that a pt has recently been diagnosed with DM (diabetes). Which of the following entries in the medical record would be MOST consistent with DM 1 but rarely seen in DM II:
a) high level of ketones in the blood
b) presence of retinopathy
c) end-stage renal disease
d) loss of sensation in the feet
Answer: a (high levels of keytones).
Explain: DM I is when pancreas fails to produce enough insulin. It is usually found in children. Type II is often diagnosed past age 45. Type II they can still produce insulin, just not enough to clear out all the excess sugar.
- In type I, not enough insulin can get glucose to cells, so it breaks down fat as a result to get energy, leading to high levels of keytones.
A pt presents with Poor Plus (2+/5) strength of the R LE and Good Plus (4+/5) strength of the R UE. Sensory loss is also noted to be greater in the R LE than the R UE and the pt is demonstrating abulic aphasia. Occlusion of which of the following arteries is the MOST likely cause of the pt’s impairments:
a) middle cerebral
b) vertebral-basilar
c) posterior cerebral
d) anterior cerebral
Answer: d (anterior)
Explain: Brain’s blood supply consists of two internal carotid a’s and two vertebral a’s. Branches of these form the Circle of Willis. Blood supply when cut off can effect different areas of body and functions depending on where the occlusion happened, and how big the occlusion was.
- MCA: Most CVA’s are in the MCA, and produces contralateral weakness and sensory loss in UE’s and Face (LE’s not impacted as much). Broca’s and Wernicke’s will also be impacted.
- Vertebral-Basilar artery damage results in locked-in syndrome, coma, or vegetation
- Posterior: Results in BLINDNESS
- ACA: LE’s most impacted (weakness and sensation), and frontal lobe changes like personality.
A PT performs a cranial nerve test by assessing a pt’s ability to distinguish sour and bitter substances by taste when placed on the posterior third of the pt’s tongue. Assuming the pt is unable to accurately identify the tasted substances, which of the following cranial n’s is MOST likely damaged:
a) facial
b) vagus
c) glossopharyngeal
d) hypoglossal
Answer: c (glossopharyngeal)
Explain:
- Facial nerve 7 has both motor and sensory, but on ANTERIOR part of the tongue, and facial m’s.
- Glossopharyngeal will detect taste on POSTERIOR tongue
- Hypoglossal nerve 12 does tongue movement
A PT plans to apply ultrasound over an extremity irregular body surface area. Which method of ultrasound administration would be the MOST ideal?
a) direct contact with a gel coupling agent
b) direct contact without a gel coupling agent
c) water immersion with a gel coupling agent
d) water immersion without a gel coupling agent
Answer: d (water immersion without a gel coupling agent).
Explain: Ultrasound waves do NOT travel through air, so a coupling agent is required. A coupling agent can be gel, water, lotion, oil
- Normally direct contact with a coupling gel would work, but irregular body surfaces are hard with ultrasound, so you can use water (but don’t need gel + water).
A physician’s order in the medical record indicates that a pt has been placed on hold from PT due to a suspected pulmonary embolism. Which diagnostic test would be the MOST valid method to confirm a suspected pulmonary embolism?
a) magnetic resonance imaging
b) pulmonary angiography
c) bronchoscopy
d) ultrasonography
Answer: b (pulmonary angiography)
Explain: Remember a pulmonary embolism is when some thrombus breaks off somewhere else and travels to pulmonary arteries. s/s of pulmonary embolism are: dyspnea, coughing, hypoxic, chest pain, and may look like a MI.
- An MRI can see an embolism, but is usually used to look at soft tissue: muscle, tendon, ligament, tumor, organs
- Pulmonary angiography looks at blood flow specifically through the lungs. Test of choice for pulmonary embolisms
- Bronchoscopy looks specifically at bronchial tree to look for foreign bodies, tumors, bleeding in airways. Not usually used for finding a pulmonary embolism.
- Ultrasonography just shows images of internal organs … usually used to detect DVT, but not pulmonary embolisms.
A PT elects to use a communication board with a pt in an acute care setting. Which of the following pt’s would MOST likely benefit from the use of the item shown in the image (the image had yes, no, turn on lights, turn on tv, need to take a bath, need to eat, etc.)
a) 45 yr old who speaks limited English
b) 60 yr old with hemianopsia
c) 75 yr old with Broca’s aphasia
d) 88 yr old with end stage dementia
Answer: c (Broca’s)
Explain: Communication boards are just boards that allow a pt to point to a picture to communicate what they want/need. It has pics for: yes, no, turn on lights, turn on tv, need to take a bath, need to eat, etc. Usually used for those with verbal impairments.
- Yes, this board would help someone who can’t speak English, but usually a hospital would provide an interpreter for them.
- Someone with Broca’s (expressive aphasia) can comprehend, but can’t produce language.
- Those with dementia have cognitive, memory, and speaking deficits. They lose ability to communicate, but also to respond. Maybe early stage dementia might benefit, but end-stage probably would not.
A pt with suspected pulmonary embolism is referred for additional diagnostic testing. Which of the following patient’s would be at the GREATEST risk for developing this medical condition?
a) 35 yr old obese female who is sedentary and on oral contraceptive
b) 45 yr old male two weeks post tibial fracture requiring internal fixation
c) 70 yr old female 3 weeks post closed reduction of a Colles’ fracture
d) 50 yr old male one week post tibial plateau fracture in a long leg cast
Answer: a (35 yr old female who is obese and sedentary)
Explain:
- It said most pulmonary embolii occur 2-10 post surgery (not weeks later). Thus the sedentary woman who is inactive is most suseptible. And typically pulmonary embolii occur due to thrombus forming in LE’s not UE’s (so Colles’ fracture is out).
A PT observes in the medical record a physician’s order to hold PT, along with an order for a D-dimer blood test on a pt who is four days post total knee arthroplasty. Based on the presented information, concern for which of the following conditions is the MOST likely reason for temporarily holding PT:
a) Post operative infection
b) Thrombocytopenia
c) Post-surgical anemia
d) DVT (Deep vein thrombosis)
Answer: d (DVT)
Explain: A D-dimer blood test helps determine if there is a blood clot. It helps rule in/out a thrombos
A PT suspects that a pt’s UE ROM limitation may be the result of a fear-based pyschological response. Which of the following examination findings would be MOST consistent with the PT’s hypothesis?
a) Decreased PROM; weak but pain-free resistive testing
b) Decreased AROM; strong but painful resistive testing
c) Decreased AROM and PROM; strong and pain-free resistive testing
d) Decreased AROM; decreased effort with resistive testing
Answer: D. Pain can be certainly related to psychological processes, and pain is a subjective experience. So pain is a very psychological process, and thus fear-based response during movement is common. Thus PT’s should be aware of the psychological effects of ROM limitations.
- It says PROM would not be limited, but AROM would, and they’d be fearful of strength testing.
A pt exhibits limited and pain-free active shoulder ER, however, passive ER is normal. Resistive testing of shoulder ER is weak and pain-free. Which of the following is MOST consistent with this pt’s presentation:
a) Adhesion of the anterior joint capsule
b) Fear-related psychological response
c) Grade III strain of infraspinatus muscle
d) Grade I strain of shoulder ER’s
Answer: c (Grade III)
Explain: If AROM is limited, but PROM is normal, it is usually MUSCLE involved.
- Adhesion of joint capsule would impact both AROM and PROM
- Grade III is full rupture, so would be pain free after acute phase of injury is over, and infraspinatus is primary ER of shoulder.
- Grade I tear would be painful
A pt reports being unable to drive to work due to difficulty reaching forward to grasp the steering wheel secondary to weakness. Which of the following conditions would MOST likely be associated with this type of activity limitation?
a) Rotator cuff impingement
b) Peripheral nerve entrapment
c) Adhesive capsulitis
d) Cervical facet impingement
Answer: b (peripheral nerve entrapment)
Explain: Nerve injury results in paresthesias, pain, and weakness.
- RC impingement is when RC m’s get impinged under acromion. A painful arc of motion or overhead arm elevation are signs of RC impingement. Reaching forward to the steering wheel is not really arm elevation, so this is probably more nerve related.
- If a nerve is entraped it will cause pain and weakness, so can’t reach forward and grasp steering wheel. Nerve damage can cause muscles to atrophy (weak)
A pt exhibits a compensatory contralateral step-to-gait pattern and persistent left knee pain. Which of the following conditions would MOST likely result in this type of long-term compensatory gait pattern?
a) Degenerative joint disease
b) Anterior cruciate ligament sprain
c) Osgood-Schlatter disease
d) Patellofemoral syndrome
Answer: a (degenerative joint disease)
Explain:
- OA causes damage to cartilage, and thus pain results on mvmt and during weight bearing. Then bone gets bone spurs and pain increases, and function decreases. Deviated gait results.
- Key here is “long-term” … ACL will create antalgic gait pattern yes, but OA is a long term result of change in gait pattern.
- Osgood-Schlatter happens at tibial tuberosity and effects young kids in sports that run, jump, etc. Anatalgic gait may occur, but not long term (it has a good prognosis)
- Patellofemoral syndrome is when the patella doesn’t track properly between femoral condyles. Same as above where it won’t be a long term gait pattern change.
A PT treats a pt diagnosed with lateral epicondylitis using ionto. The therapist uses dexamethasone with a current intensity of 3 mA for 20 mins. How often during the treatment session should the therapist check the skin:
a) every minute
b) every 3-5 mins
c) every 20 mins
d) at the conclusion of the treatment session
Answer: b (3-5 mins)
Explain: Ionto is applying medication to a superficial area through a patch where estim pushes it to effected area. PT’s must check skin for any irritation frequently.
A PT performs a manual muscle test on a pt's affected R LE with the following findings: - hip flexors: 4/5 - hip extensors: 3+/5 - hip abductors: 3-/5 - knee extensors: 3/5 Assuming the contralateral limb exibits normal strength, which of the following gait deviations would MOST likely occur during midstance on the R LE: a) posterior trunk lean b) anterior trunk lean c) lateral trunk lean to the left d) lateral trunk lean to the right
Answer: d (lateral to right)
Explain:
- Posterior trunk lean would be observed during early stance due to weakness of hip extensors
- Anterior trunk lean would be due to weak knee extensors
- Lateral trunk lean to left means L hip abductors are weak (but this says R is weak, and L is strong)
- Lateral trunk lean to right means R hip abductors are weak (which ? said they were)
A PT consults with a speech-language pathologist regarding a pt who has abulic aphasia. Based on the type of presenting aphasia, which of the following impairments would be MOST anticipated?
a) delayed response time to questions
b) impaired repetition and naming skills
c) inability to understand questions being asked
d) inability to produce or comprehend language
Answer: a (delayed response time to ?s)
Explain: Aphasia is impairment of processing for receptive and/or expressive language. It is a result of brain injury, head trauma, cerebrovascular accident, tumor, infection, etc. Abulic aphasia is a finding associated with occlusion of the anterior cerebral artery, along with mutism
- Most common sign is reduced spontaneous speech and delayed response time to questions. Abulic means lack of motivation or passive. So reduced social interactions and reduced interest are common.
- Impaired naming skills = Broca’s
- Inability to understand = Werneke’s
- Inability to produce or comprehend language = global aphasia
A PT uses a floor scale to educate a pt on their current weight bearing status following a LE injury. Assuming the pt weighs 250 lbs and has been cleared for 30% weight bearing, what would be the most appropriate amount of weight transmitted through the involved LE:
a) 50 lbs
b) 75 lbs
c) 100 lbs
d) 175 lbs
Answer: b (75)
A pt performs an isometric contraction of the quadriceps in supine by pushing the knee into a towel positioned under the posterior surface of the knee. Which modification would be the MOST appropriate to assist with regaining hyperextension:
a) Reposition the patient in long sitting
b) Increase the force of the muscle contraction
c) Place a rolled towel under the ankle
d) Add an ankle cuff weight to the distal tibia
Answer: c (place towel under ankle)
A PT classifies a pt’s deep tendon reflexes as hyperreflexive. Which medical condition would MOST likely contribute to this clinical finding?
a) Addison’s disease
b) Ankylosing spondylitis
c) Cushing’s syndrome
d) Graves’ disease
Answer: d (Grave’s)
Explain:
- Addison’s is from adrenal dysfunction where adrenal cortex is in hypofunction. So there is a decrease in cortisol and aldosterone, so weakness, but would NOT effect reflexes.
- Ankylosing spondylitis is a systemic condition of inflammation of spine (and other joints). Symptoms are back pain, morning stiffness, and impaired spinal extension. This would NOT impact reflexes.
- Cushing’s syndrome is adrenal dysfunction of hyper function of adrenal gland, so excessive amounts of cortisol get produced. Would NOT impact reflexes.
- Grave’s disease is an autoimmune disease of dysfunction of thyroid gland. It causes hyperreflexia
A PT applies a hold-relax technique to a pt in prone in order to increase knee extension ROM. Where should the PT’s hands be placed when administering this type of intervention?
a) Stabilize the pelvis and apply resistance to the posterior surface of the distal tibia
b) Stabilize the pelvis and apply resistance to the anterior surface of the distal tibia
c) Stabilize the distal femur and apply resistance to posterior surface of the distal tibia
d) Stabilize the distal femur and apply resistance to the anterior surface of the distal tibia
Answer: c (stabilize distal femur, resist posterior tibia)
A pt performing a prone knee hang using a one pound cuff weight reports pressure and discomfort in the patellofemoral region. Which of the following actions would be the MOST appropriate to address the pt’s comment and still maintain the goal of the exercise:
a) Place a folded towel under the pt’s distal femur
b) Scoot the pt’s body further up on the treatment table
c) Decrease the amount of weight in the ankle weight
d) Apply ice to alleviate any discomfort during the stretch
Answer: a (place towel under)
A pt presents with a small, round, partial thickness wound on the lateral malleolus with distinct wound edges. Upon examination, the wound bed is a grey color without evidence of granulation tissue and appears to be dry. The wound is extremely tender to palpation and the pt reports calf pain during walking. These findings are MOST associated with which of the following ulcers:
a) venous statis
b) neuropathic
c) arterial
d) decubitus
Answer: c (arterial)
Explain:
- Venous statis ulcers result from venous insufficiency due to impaired functioning of venous system resulting in inadequate venous return. Venous ulcers are typically shallow, irregular in shape, have a lot of exudate, and are usually in lower limb proximal to medial malleolus. There is edema around it and tropic changes.
- Neuropathic ulcers are secondary complications of iscemia and neuropathy. Usually you see these in pt’s with DM II. These wounds are commonly on plantar side of foot where shear of weight bearing cause ulcer where pt can’t see or feel.
- Arterial ulcers are from arterial insufficiency from inadequate circulation and O2 / oxidation to tissues. Could be from atherosclerosis. These ulcers are smaller, dry, round edges, distinct margins, lacks granulation and blood supply. They are typically on distal limb and foot / toes, on dorsal side of foot or around lateral malleolus.
- Decubitus ulcers = pressure ulcers. From sustained/prolonged pressure on tissues with no movement. Around bony prominences
A PT employed in an acute care hospital works with a pt with a known latex allergy. Which of the following items would be LEAST likely to contain latex:
a) gloves
b) surgical masks
c) intravenous tubing
d) gowns
Answer: gowns
A PT observes a pt perform a STS transfer. The pt struggles to initiate the movement of scooting forward and rising from the chair and performs all movements very slowly. Based on the pt’s impairments during the STS transfer, which of the following structures is MOST likely damaged?
a) Cerebellum
b) Medulla oblongata
c) Hippocampus
d) Basal Ganglia
Answer: d (basal ganglia)
Explain:
- Bradykinesia is movement that is very slow, and commonly found in conditions like Parkinson’s. Initiation and execution of mvmt is slow and difficult.
- Cerebellum deficits would be manifested in posture, balance, rapid alternating movements, coordination
- Medulla oblongata is below the pons and above spinal cord. It controls nervous activity like: respiration, HR, vomitting, coughing, sneezing
- Hippocampus: In temporal lobe, responsible for memory
- Basal Ganglia: Gray matter responsible for voluntary mvmt, so Parkinson’s will lose this area (substantia nigra)
After observing a pt rehabing from a LE injury on a stationary bike, a PT elects to raise the seat height. Which lower extremity motions would this modification MOST promote?
a) hip extension and knee extension
b) hip flexion and knee extension
c) hip extension and knee flexion
d) hip flexion and knee flexion
Answer: a (hip ext and knee ext)
Explain:
- Raise the seat and you get MORE hip ext and knee ext. Lower seat and you get more hip flex and knee flex
A PT places a pt in supine with their legs elevated after the pt experienced the s/s of orthostatic hypotension during a treatment session. A pt with which of the following conditions would MOST likely experience difficulties in this recovery position?
a) Lumbar spinal stenosis
b) Chronic venous insufficiency
c) Graves’ disease
d) Congestive heart failure
Answer: d (CHF)
- Explain: Orthosatic hypotension is when systolic BP decreases more than 20 mmHG (or diastolic decreases more than 10 mmHG) when going from supine to sitting).
- Laying with legs elevated puts pt with spinal stenosis in more lumbar flexion, which would feel GOOD to pt with spinal stenosis
- Venous insuff is a condition when valves in veins are damaged and can’t get blood back to heart. Compression stockings and elevation of legs will help this pt and decrease swelling.
- Graves’ disease is hyperactive thyroid condition when autoimmune disease attacks thyroid. Laying supine won’t impact this pt.
- CHF is when heart can’t meet metabolic demands of body. Pt’s with CHF will have pulmonary edema, dyspnea, orthopnea, SOB, etc. Elevating this pt’s legs will push more fluid to the heart, which is problematic.
A PT reviews the medical record of a pt recently involved in a MVA. A note in the medical record indicates that the pt uses a halo-vest cervicothoracic orthosis. What is the MOST likely medical diagnosis for this pt.:
a) spinal fracture
b) acute myofascial pain syndrome
c) traumatic brain injury
d) herniated nucleus pulposus
Answer: a (spinal fracture)
Explain:
- A halo vest cervicothoracic orthosis is for spinal fractures. It will significantly limit ROM
- Pt with TBI usually doesn’t have a brace or halo unless cervical structures were also damaged
- A herniated disc may or may not require an orthodic, but not a halo vest.
A PT decides to discontinue a scheduled PT session to a suspected pulmonary embolism and requests further consultation from the attending physician. Which of the following clinical findings BEST supports the PT’s hypothesis:
a) Partial pressure of O2 (PaO2) of 85mmHg
b) Resting respiratory rate of 14 bpm
c) Resting HR of 100 bpm
d) Increased cough with presence of hemoptysis
Answer: d (increased cough with blood)
Explain:
- A pulmonary embolism occurs when a thrombus in LE detaches and travels to lungs (pulmonary artery). s/s of pulmonary embolii is: SOB, dyspnea, coughing, hypoxic, chest pain
- Normal range of PaO2 is 80-100, so 85 is NORMAL
- Normal RR is 12-20 bpm
- Tachycardia is HR over 100 bpm
- Cough with blood is common sign of pulmonary embolism
A PT observes a pt on a stationary bike laterally flex the trunk to the left when the right knee is at the top of the pedal cycle. Which ROM impairment would most likely associated with this type of deviation:
a) Right knee extension
b) Right knee flexion
c) Left knee flexion
d) Left ankle DF
Answer: b (right knee flexion)
Explain:
- Impairments in knee extension would be seen when foot/peddal is at the bottom. Knee flexion impairments would be seen when foot/peddal is at top of the cycle.
Remember Deanne - pt who hip hiked
A PT prepares to apply a heating agent to a pt recently referred to PT. Which heating agent would require the PT to use the GREATEST temperature:
a) diathermy
b) paraffin
c) ultrasound
d) whirlpool
Answer: b (paraffin)
Explain:
- Diathermy: a medical and surgical technique involving the production of heat in a part of the body by high-frequency electric currents, to stimulate the circulation, relieve pain, destroy unhealthy tissue, or cause bleeding vessels to clot.
- Paraffin: Needs to be about 113-126 degrees F.
- Ultrasound: doesn’t require specific temperature, uses sound waves
- Whirlpool: temps are usually 99-104 degrees F (temps greater are more risky for burns)
A PT completes LE ROM activities with a pt status post SCI. While performing PROM, the PT notices that the pt’s urine is extremely dark and has a distinctive foul smelling odor. Which of the following is the MOST appropriate action:
a) verbally report the observation to the pt’s physician
b) verbally report the observation to the pt’s nurse
c) document and verbally report the observation to the pt’s nurse
d) document and verbally report the observation to the director of rehab
Answer: c
PT’s should report any changes to the pt’s urine color through documentation and to nursing staff.
A PT treats a pt with multiple sclerosis (MS). The pt does not have a history of seizures, however, has been prescribed an anticonvulsant medication to assist in the treatment of neuropathic pain. This form of treatment would BEST be described as:
a) adjuvant medication
b) immunomodulating medication
c) interventional medicine
d) alternative medicine
Answer: a (adjuvant)
Explain:
- Anticonvulsant meds such as gabapentin and carbamazepine have been found effective with treatment of neuropathic pain. Neuropathic pain includes conditions like: MS, DM, Shingles, cancer.
- An adjuvant analgesic is a medication that is not primarily designed to control pain but can be used for this purpose. Some examples of adjuvant drugs are medications like antidepressants and anticonvulsants. They may also be called coanalgesics.
- Immunomodulating meds assist with modifying the body’s immune responses. They don’t help with neuropathic pain.
- Interventional meds will manage pain like: nerve blocks, injections, etc.
- Alternative medicine is different than Western medicine. Examples: homeopathy, acupuncture, dry needling, tai chi, etc. Don’t help those with MS.
A PT performs a pain assessment on a pt recently referred to PT. The pt responds with clear proportional pain that is consistently produced with movement and testing to the targeted area. This type of pain is BEST classified as:
a) nociceptive: deep somatic pain
b) nociceptive: visceral pain
c) nociceptive: superficial pain
d) central neurogenic pain
Answer: c (nociceptive: superficial pain)
Explain:
- Somatic pain is when there is damage to muscle, bone, ligament, connective tissue, etc. This pain can refer.
- Visceral pain is pain from organs. This pain can refer.
- Pain to skin (cutaneous) is localized. This pain does NOT refer, and is localized.
- Central Neurogenic pain is damage to spinal cord or CNS.
A PT concludes that it is necessary to elongate the long head of the triceps brachii as part of a passive range of motion assessment of the elbow. Which positioning of the arm would assist the therapist to meet the stated objective:
a) elbow extension and shoulder extension
b) elbow extension and shoulder flexion
c) elbow flexion and shoulder extension
d) elbow flexion and shoulder flexion
Answer: d
The tricpes is a 2 jt muscle. It extends shoulder and elbow. Elbow flexion and shoulder flexion are both opposite the action of the triceps and therefore would elongate both ends of the muscle
A PT administers superficial heat to the low back of a pt using hydrocollator pack. Assuming the PT uses six towel layers, the MOST appropriate duration for the intervention is:
a) 10 mins
b) 20 mins
c) 30 mins
d) 40 mins
Answer: b (20 mins)
Explain:
- You always need 6-8 layers of towels, and will heat tissues superficially up to 2 cm.
- 10 mins isn’t long enough, hot packs require 15-20 mins to get an effect, and anything longer is too long and heat would be lost from hot pack
A pt that required a mechanical ventilator for 2 weeks following a near drowning incident is cleared to gradually decrease use of the device. Which measured cardiovascular value would indicate a sign of distress during weaning of the vent?
a) respiratory rate of 38 bpm
b) Tidal volume of 350 mL
c) Pulse Oximetry measured at 91 %
d) HR change of 10 bpm over baseline
Answer: a
Explain:
- 38 breaths per min is WAY high = tachypnea, and can’t wean from vent at this rate.
- 350 mL of tidal volume is not too concerning during weaning process. Less than 325 is when distress sets in.
- Pulse Ox reading lower than 90 is when you get concerned
- The HR would have to go 20 over baseline to be concerning
A PT treats a pt with Parkinson’s disease using whole-body vibration. Which symptom associated with Parkinson’s disease would this intervention MOST influence:
a) dysphagia
b) Tremor
c) Akinesia
d) Cognitive acuity
Answer: b (tremor)
Explain:
- Whole body vibration consists of transferring vibration of varying frequencies to the body as a whole in one or multiple planes. Vibration training can be utilized as an intervention to improve muscle strength, power, flexibilty, and coordination.
- Dysphagia: inability to swallow properly. Whole body vibration isn’t used for dysphagia
- Whole body vibration has been found to decrease tremors and rigidity in Parkinson’s pt’s. Vibrations impact input to muscle spindles / muscle length
- Akinesia refers to inability to INITIATE movement
- Whole body vibration won’t impact cognition
A PT works with a pt with hemiparesis who uses a hemiplegic chair for mobility. Which activity would become more challenging for the pt based on the prescribed wheelchair?
a) Reaching for objects outside the base of support
b) Performing a standing transfer
c) Performing independent pressure relief
d) Propelling the wheelchair
Answer: b (performing a standing transfer)
Explain:
- A hemiplegic chair incorporates a seat that is approximately two inches lower than a standard chair to enable the user to use the LE to propel the chair. The pt typically uses one handrim and one or both feet to help propel and steer the w/c. One or both front riggings on the w/c are removed to provide the feet with necessary space for propolsion.
- A hemiplegic chair won’t limit someone reaching out of BOS
- Performing a standing transfer will be harder due to the lower seat
- Performing pressure relief would be same in this chair or any w/c
- Propelling this w/c is easier - it is designed as a hemiplegic chair to help those with a stroke propel it easier.
A PT examines the posture of a pt from a lateral view using a plumb line. Which structural condition would be MOST likely to cause the plumb line to fall further anterior to the knee joint compared to normal postural alignment.
a) genu recurvatum
b) genu valgum
c) genu varum
d) patella baja
Answer: a (genu recurvatum)
Explain: Plumb line is the line of ideal posture (through ear, acromion, hip, lateral knee, malleoli, etc.).
- Genu recurvatum is knee hyperextension (so knees are posterior to plumb line)
- Genu valgum is knocked knees (knees touch and ankles apart). Can’t see as well in lateral view. *** Valgus will increase compression of LATERAL tibial condyle and increase stress to medial structures.
- Genu varum is bow legged (knees apart, ankles closer). Also can’t see as well in lateral view. Varum will increase compression of MEDIAL tibial condyle and increase stress to lateral structures.
- Patella baja is a lower patella (not viewed from lateral view). Patella Alta is a higher patella.
Prior to working with a pt in the hospital setting, a health care provider should verify the identity of the pt by:
a) checking the pt’s chart
b) asking the pt’s caregiver
c) confirming with the pt’s PCP
d) checking the pt’s wrist band
Answer: d (check pt’s wrist band)
Explain: Checking the pt’s chart allows the health care provider to access medical info, but not verify pt’s identity.
But checking the wristband is most reliable method to verify the patient’s identity in the hospital. And you can ask pt to tell you their first and last name and DOB to verify.
A PT works with an infant that was born prematurely and is demonstrating the absence of several primitive reflexes. Which reflex would be the MOST important for allowing the baby to breastfeed:
a) palmar grasp reflex
b) Moro reflex
c) rooting reflex
d) symmetrical tonic neck reflex
Answer: c (rooting)
Explain: Review the primitive reflexes. They all integrate (go “away”) at varying stages. Absent primitive reflexes indicate CNS issue which will also result in later developmental delays.
A PT reviews clinical features and diagnostic criteria associated with various types of osteogenesis imperfecta. Which of the following is included in the criteria used to delineate specific types of this condition:
a) fracture frequency
b) genetic inheritance
c) age of diagnosis
d) anticipated life expectancy
Answer: b (genetic inheritance)
Explain: Osteogenesis Imperfecta, also known as brittle bone disease, is a group of genetic disorders that mainly affect the bones. It results in bones that break easily. OI can vary widely depending on which of the 4 types is diagnosed.
- The frequency of fractures may be more or less often depending on the type of OI pt is diagnosed with. But, fracture frequency may also just be a result of the pt’s activity level, so thus isn’t determined to diagnose the disease.
- Genetic testing is best way to get info regarding specific types of OI and thus prognosis. You could have a dormant or recessive type, and that will greatly impact prognosis/mortality.
- Age is not considered when making diagnosis
- Life expectancy can vary widely, based on the type of OI.
A PT measures elbow flexion while a pt grasps the handgrip of a walker in standing. The PT records elbow flexion as 35 degrees. Which statement BEST describes the height of the walker:
a) the walker height is too low for the pt
b) the walker height is too high for the pt
c) the walker height is appropriate for the pt
d) not enough information is given to assess walker height
Answer: b (walker height is too high)
Explain: Proper fitting by measure is usually ulnar styloid process, but if doing it by degree, it should be 20-25 degrees of elbow flexion for an AD. This degree amount is for optimal function during ambulation.
A patient discusses a number of recommended dietary changes following a physician visit. Which medical condition would MOST warrant an increase in the amount of dietary fiber?
a) Crohn’s disease
b) diverticulitis
c) irritable bowel syndrome
d) malabsorption syndrome
Answer: b (diverticulitis)
Explain:
- Crohn’s Disease: is a specific form of inflammatory bowel disease in which the lining of the GI tract becomes abnormally inflammed. Treatment for Crohn’s disease includes medication to reduce intestinal inflammation and to manage flare ups.
- Diverticulitis refers to possessing inflammed or infected diverticula. Treatment for diverticulitis includes diet modification, controlling infection, and lowering colonic pressure through increased fiber intake. 20-35 grams of fiber is recommended per day.
- Irritable bowel syndrome (IBS) is when colon isn’t functioning properly. Pt’s should avoid large meals, wheat, rye, barley, alcohol, and caffeine.
- Malabsorption syndrome is a condition characterized by a group of pathologies where there is reduced intestinal absorption and inadequate nutrition.
A pt diagnosed with patellofemoral syndrome reports significant pain in the involved knee when descending stairs. Which scenario is MOST likely responsible for the pt’s subjective report of knee pain?
a) concentric activity of the quadriceps muscle group
b) eccentric activity of the quadriceps muscle group
c) concentric activity of the hamstrings muscle group
d) eccentric activity of the hamstrings muscle group
Answer: b
Explain: Patellofemoral syndrome is a general term for describing pain or discomfort in the anterior knee. The condition is a repetitive overuse disorder resulting from increased force at the patellofemoral joint. s/s are anterior knee pain, pain with prolonged sitting, swelling, crepitus, and pain going up/down stairs.
- The quads act CONCENTRICALLY doing knee extension, so going UP stairs. The quads act ECCENTRICALLY going down stairs to control the amount of knee flexion (and this causes increased pressure in knee joint).
A PT observes that the back height of a w/c extends above the pt’s inferior angle of the scapula. Which finding would provide the MOST appropriate justification for the described w/c fit:
a) patient exhibits poor sitting tolerance due to pelvic obliquity
b) patient has fair trunk control, but is able to independently propel a w/c
c) patient requires mild to moderate lateral support due to listing or scoliosis
d) patient is unable to perform weight shifting activities in sitting due to extensor tone
Answer: b (pt has fair trunk control but is able to ind propel w/c)
Explain:
- Back height of a w/c is determined by measuring from the seat of the chair to the floor of the axilla with the pt’s shoulder flexed to 90 degrees (and then subtract 4 inches). Normal back height is 16 inches. Normally back height is below inferior angle of scapula, so higher back height is for increased trunk control (due to poor trunk control).
- Pelvic obliquity would need a custom molded seat
- Increased back height helps give more back control
- Lateral support for scoliosis might help back, but not the lateral support they need.
- Extensor tone pt’s need more of a solid tilt-in-space frame
A PT instructs a pt to change his wound dressing daily between weekly visits to the wound center. At the next visit, the pt reports that he instead changed the dressing only when it was soaked through in an effort to conserve supplies. As a result, the surrounding skin would MOST likely be described as:
a) Infected
b) Gangrenous
c) Macerated
d) Indurated
Answer: c (macerated)
Explain: It wouldn’t get infected as a result, and certainly not gangrene. But would become wet (macerated = wet).
A PT reviews the medical record of a pt with an arthritic condition. Which piece of information would be MOST useful to definitively diagnose rheumatoid arthritis:
a) pain profile
b) joint symptoms
c) blood tests
d) age of onset
Answer: c (blood tests)
Explain: RA is an autoimmune disease with unknown etiology. Blood test is best way to rule in RA (since OA and RA could have similar pain and s/s). High levels of RF (rheumatoid factors) indicate autoimmune disease like RA.
A PT is performing gait training with a pt who suddenly reports that they can no longer walk and appears to be in distress. The pt demonstrates severe shaking and trembling of the legs and significantly altered balance. Which of the following actions is the MOST immediate for the PT:
a) communicate the observed info to another PT
b) provide verbal encouragement and grasp the gait belt tighter
c) walk the pt to a chair and assess the pt’s vital signs
d) slowly lower the pt to the floor and monitor pt closely
Answer: D
Explain: This is a SAFETY question. Think of what is safest. Initially I thought getting pt to a chair is best, but what if chair is far away. If their legs are shaking, get them down quickly for safety. It is clear the pt is in distress, so get pt down and safe fast. Walking the pt to the chair may take time and pt may collapse in the process. Assessing vital signs is appropriate, but get them down and safe first so they don’t collapse.
A pt who collapsed in the PT gym fails to exhibit a pulse. Upon viewing the pt’s mouth, it becomes obvious that the pt has dentures. The PT is hesitant to remove the dentures since they seem secure, however, does not want them to interfere with rescue breathing. Which of the following actions should the PT take:
a) leave the dentures in place
b) loosen the dentures
c) remove the dentures
d) perform compressions only
Answer: a (leave dentures in place)
Explain: Cardiopulm resuscitation (CPR) is done on pt’s with no pulse. You need to act quickly. If the dentures are secure, leave them, and give them breath and compressions ASAP, don’t waste time getting the dentures out. Only remove them if they are loose and you can’t get a good seal, and it is quick to remove them.
- And you should do compressions and ventilations
A PT observes a pt completing a low-level exercise test on a treadmill. Which of the following measurement methods would provide the PT with an objective measurement of endurance:
a) facial color
b) facial expression
c) rating on a perceived exertion scale
d) respiration rate
Answer: d (RR)
Explain: All others are subjective. RR is only objective option.
The medical record indicates that a 51-year-old male had a subacromial decompression approximately four weeks ago. Which special test would MOST likely have been positive prior to the surgical procedure?
a) drop arm test
b) glenoid labrum tear test
c) neer impingement test
d) upper limb tension test
Answer: c (impingement)
A PT prepares to auscultate the lungs as part of an examination. When performing this procedure correctly, the therapist should:
a) listen to at least 3 breaths in each bronchopulmonary segment
b) ask the pt to breathe deeply through an open mouth
c) hear tubular quality sounds over distal portions of the lung in a person without lung disease
d) hear adventitious breath sounds over portions of the tracheobronchial tree that are clear of secretions
Answer: b (pt breathe through an open mouth)
- One breathe, not 3 is usually sufficient
- Breathing deeply through an open mouth increases turbulence in the airways making it easier to hear the sounds
- In pt’s without lung disease, tubular lung sounds, or bronchial breath sounds, are normally found over the trachea. Vesicular breath sounds are normally found over the distal portions of the lung in a person without lung disease.
- Adventitious breath sounds are abnormal breath sounds. These are wheezes, rhonchi, crackles, rales, pleural friction, etc. Wheezes and crackles often mean secretions in the airways.
A PT works with a 65-year-old male with a diagnosis of CHF and hypertension. Which pharmacological agent would MOST likely be prescribed based on the pt’s medical status:
a) diuretics
b) inhaled corticosteroids
c) mucolytics
d) bronchodilators
Answer: a (diuretics)
Explain: CHF occurs when heart can’t contract, so cardiac output decreases, and fluid builds up and backs up into pulmonary and systemic circulation.
- Diuretics are for CHF and HTN to reduce preload
- Inhaled corticosteroids are to reduce inflammation in airways
- Mucolytics are used to improve the expectoration of bronchopulmonary secretions in pt’s with chronic bronchopulmonary diseases
- Bronchodilators work to relieve bronchospasm in pt’s with COPD be relaxing smooth muscle of bronchi.
A PT assesses a pt with a TBI using the Glasgow Coma Scale (GCS). The pt can open their eyes in response to speech and can make incomprehensible sounds. If the pt receieved a total score of 10, what would be the pt’s motor response?
a) withdraws arm away from pain source
b) localizes and moves toward the pain source
c) extension of elbow in response to pain
d) flexion of elbow in response to pain
Answer: b (localizes and moves towards pain source)
Explain: GCS is used to assess pt’s consciousness following injury. It is scored based on verbal response, motor response, and ability to open their eyes. A pt that opens eyes in response to speech is given a 3, and a pt who makes incomprehendible sounds would be given a 2.
- Motor subscale is scored 1-6. A pt who withdraws their arm away from the source of pain would be given a 4, therefore, the total score would be 9.
- A pt who can localize the source of pain and move their hand toward it would be given a score of 5, therefore, a total score of 10.
- A pt who extends elbow in response to pain is given a 2, so total score is 7
- A pt who flexes elbow in response to pain is given 3, therefore, total score of 8
A 29-year-old female status post Colle’s fracture is referred to PT. The pt has moderate edema in her fingers and the dorsum of her hand and complains of pain during AROM. The MOST appropriate method to quantify the pt’s edema is:
a) volumetric measurements
b) circumferential measurements
c) girth measurements
d) anthropometric measurements
Answer: a (volumetric)
Explain: Volumetric measurements are often used to quantify the presence of edema in the wrist and hand by examining how much water is displaced. You can compare bilaterally to non-involved hand in terms of water displacement.
- Circumferential measurements use a tape measure. It is good, just not as accurate.
- GIRTH = CIRCUMFERENTIAL (synonymous)
- Anthropometric measurements are height, weight, BMI, waste to hip ratio, % of body fate. These measurements are then referenced against norms for that person’s age.
A PT assesses a pt with suspected unilateral hearing loss using the Rinne Test. With the tuning fork on the pt’s skull, the pt reports that the sound disappears after 15 seconds. Assuming the pt’s sense of hearing is normal, how long should the pt hear the sound when the tuning fork is later placed next to the ear:
a) 15 secs
b) 30 secs
c) 45 secs
d) 60 secs
Answer: b (30 secs)
Explain: Rinne test is when PT holds a tuning fork against the mastoid process until the sound is no longer heard by the pt. Then PT holds tuning fork 1-2 cm away from auditory canal until they can’t hear the sound. The duration of time it takes until pt can’t hear sound is recorded in each position. Normal ratio is 2:1 (conduction of air being longer than bone conduction)
- So 2:1 (air:bone) is normal. So if both were 15 seconds, that would be 1:1, which is not normal (so probably hearing impairment)
- If pt hears air for 30 secs, it would be 2:1 ratio, which is normal for air:bone conduction
- If it is 45 seconds, that means the ratio would be 3:1, which is not normal
A PT assesses the functional strength of a pt’s hip extensors while observing the pt move from standing to sitting. What type of contraction occurs in the hip extensors during this activity?
a) concentric
b) eccentric
c) isometric
d) isokinetic
Answer: b (eccentric)
Explain:
- When sitting down, the hip extensor m’s (gluts and HS’s) will work eccentrically to control the motion. Standing up will kick in hip extensors to work concentrically.
- Concentric = shortening of involved muscle. Eccentric = lengthening of involved muscle. Typically eccentric contractions happen to SLOW down a motion.
A PT participates in a community fitness program by conducting anthropometric measurements designed to determine percent body fat. Which site is NOT typically utilized when measuring skinfolds?
a) suprailiac
b) subscapular
c) triceps
d) lateral calf
Answer: d (lateral calf)
Explain: Measuring skin folds helps determine amount of subcutaneous fat which will help you know total fat. This technique is actually better than height, weight, and circumference. But, hydrostatic weighting is even better.
- Suprailiac site, triceps, and below inf. border/angle of scapula are all sites used. Lateral calf site is not used, but medial calf is used
A PT uses a subjective pain scale to assess pain intensity in a pt with multiple sclerosis. The pain scale consists of a 10cm line with each end anchored by one extreme of perceived pain intensity. The pt is asked to mark on the line the point that best describes their present level of pain. The type of scale is BEST termed:
a) Descriptor Differential Scale
b) Verbal Rating Scale
c) Visual Analogue Scale
d) Numerical Rating Scale
Answer: c (VAS)
Explain: There are a variety of pain scales used in PT.
- The Descriptor Differential Scale consists of 12 descriptor items each centered over 21 horizontal dashes. At the extreme left dash, a minus sign and at the extreme right is a plus sign. Patients are asked to describe their pain based on each descriptor.
- Verbal pain scale asks pt to use certain words like: agonizing, fair, unpleasant, etc.
- VAS is a 10 cm line with NO PAIN at left and WORSE PAIN on right.
- Numerical Rating Scale asks the pt to rate their pain on a scale of 0-10 (or 0-100)
A PT listens to the lung sounds of a 56-year-old male with chronic bronchitis. The pt was admitted to the hospital two days ago after complaining of shortness of breath and difficulty breathing. While performing auscultation, the therapist identifies distinct lung sounds with a high constant pitch during exhalation. This type of sound is MOST consistent with:
a) crackles
b) rales
c) rhonchi
d) wheezes
Answer: d (wheezes)
Explain:
- Wheezes are HIGH pitched adventitious (abnormal) breath sounds as air moves through airway (weeeeee is HIGH pitched). Wheezes are often heard with asthma and bronchitis.
- Crackles are adventitious (abnormal) sounds due to fluid accumulation in airways
- Rales are synonymous with crackles
- Rhonchi are LOWER pitched adventitious sounds during breathing
A PT working in a high school setting has an athlete come into the treatment room complaining of a headache, fever, and painful neck. The PT positions the athlete in supine and flexes the hip to 90 degrees. When the PT attempts to extend the knee in this position, the pt complains of significant pain. This is indicative of a:
a) positive Kernig’s sign
b) negative Kernig’s sign
c) positive Brudzinski’s sign
d) negative Brudzinski’s sign
Answer: a (positive Kernig’s sign)
Explain: The athlete is presenting with s/s of meningitis which can be fatal if not treated immediately. Meningitis refers to the inflammation of the meninges of the brain and spinal cord and can occur through bacteria or viral forms.
- A positive Kernig’s sign is when pt is in supine and can NOT tolerate hip flexion and knee extension (which puts meninges on stretch). This is positive for meningitis. Refer immediately.
- A positive Brudzinski’s sign occurs when a pt placed in supine experiences pain with passive flexion of the neck. Passive neck flexion will also produce hip and knee flexion since the pt will try to decrease neural tension of the meninges. Brudzinski’s is also another special test to help rule in meningitis.
A PT assesses the mobility of a pt’s left scapula as part of a range of motion assessment. Which patient position would be MOST appropriate to conduct the assessment:
a) left sidelying
b) right sidelying
c) quadraped
d) supine
Answer: b (right sidelying)
Explain: Scapula mobility should assess scapula elevation and depression, protraction and retraction, and upward and downward rotation. The passive assessment proceedure requires the pt to be in a position where the PT can gain access to the scapula to perform the required manual movements, yet relax the surrounding muscles.
A PT reviews the results of a pulmonary function test (PFT). Assuming normal values, which of the following measurements would you expect to be the GREATEST:
a) vital capacity
b) tidal volume
c) residual volume
d) inspiratory reserve volume
Answer: a
Explain: Just go to the chart and review this. There will absolutely be some question on the boards from this chart. Remember, they may not ask this question, but they will ask some other question related to it, so know all values.
A PT treats a pt diagnosed with epilepsy that is taking an anticonvulsant medication. The physician hypothesizes that the medication may be responsible for the pt’s recent cardiac arrhythmia’s. What anticonvulsant medication would be MOST likely to produce this type of side effect:
a) Dilantin
b) Tegretol
c) Klonopin
d) Neurontin
Answer: b (Tegretol)
Explain: PT’s must be aware of common side effects of commonly prescribed medications. Anticonvulsant medications generally attempt to inhibit firing of certain cerebral neurons through various channels. Side effects of anticonvulsants are: drowsiness, dizziness, fatigue, sedation, nausea, and cardiac arrythmias.
A patient is positioned in sidelying on a mat table. The pt is asked to prop up on their elbow and lift the pelvis off the mat while maintaining the lower foot in contact with the mat (ie: side plank). This type of stabilization exercise is often used to target the:
a) erector spinae
b) internal obliques
c) multifidus
d) quadratus lumborum
Answer: d (quadratus lumborum)
Explain:
- Erector spinae (3 m’s) primarily extend the back and help laterally flex back
- Internal obliques help bilaterally flex trunk and help do lateral bending/rotation of spine
- Multifidi is mainly around sacrum and lower lumbar region to stabilize lower spine and help distribute weight off lower lumbar discs.
- Quadratus lumborum goes from iliac crest to 12th rib and is a primary stabilizer of the spine. Strongest activation of this muscle is a side plank.
During an examination a PT attempts to determine a pt’s general willingness to use an affected body part. What objective information would be the MOST useful for the therapist?
a) bony palpation
b) active movement
c) passive movement
d) sensory testing
Answer: b (active movement)
A PT observes a pt attempt to walk on their heels as part of a lower quarter screening. This activity would BEST assess the:
a) L4 myotome
b) L5 myotome
c) S1 myotome
d) S2 myotome
Answer: a (L4)
A PT performs goniometric measurements for elbow flexion with a pt in supine. In order to isolate elbow flexion the therapist should stabilize the:
a) distal end of the humerus
b) proximal end of the humerus
c) distal end of the ulna
d) proximal end of the radius
Answer: a (distal end of humerus)
Explain: It said stabilizing proximal end of humerus was too far away to adequately stabilize the joint, so you go closer to the joint to stabilize.
A PT reviews the medical record of a pt diagnosed with Guillain-Barre Syndrome. A recent lumbar puncture helped confirm the diagnosis. Which of the following findings in the cerebrospinal fluid sample would MOST likely have been present to confirm the medical diagnosis?
a) elevated levels of leukocytes
b) elevated protein levels
c) elevated levels of gamma globulin
d) low glucose levels
Answer: b (elevated protien levels)
Explain: GBS is a temporary inflammation and demyelination of myelin sheaths over peripheral nerves. It can be diagnosed through CSF (cerebrospinal fluid) sample that contains high protein levels without an increase in leukocytes. You’ll also see slowed nerve conduction. If there are high levels of leukocytes, probably means they have some infection.
- The HIGH protein levels are high levels of albumin in the CSF to confirm GBS. Most common finding to confirm GBS is high levels of albumin (proteins) in CSF withOUT an increase in leukocytes.
- It is MS (Multiple Sclerosis) where you will find elevated levels of gamma globulin
A PT has been treating a pt who has lateral epicondylitis. The pt informs the therapist that they are now taking a seven-day course of an antibiotic that their physician prescribed for a severe sinus infection. Which of the following classes of antibiotics warrants the MOST caution by the therapist when determining the intensity and appropriate progression of resistive exercises?
a) Penicillins
b) Tetracyclines
c) Macrolides
d) Fluoroquinolones
Answer: d
A PT plans to begin exercises with a pt diagnosed with GBS 10 days ago. The pt currently has poor plus (2+/5) strength in LE’s. Which of the following types of lower extremity strengthening exercises would be the MOST appropriate in this early stage of treatment for GBS:
a) gluteal and quad sitting exercises and AROM
b) Aquatic resistance exercises with foam weights
c) AAROM and gravity minimized exercises
d) PROM, bridging, and long arc quad sets
Answer: c (AAROM)
During a patient interview, a PT discovers that a pt is 2 weeks post vertebroplasty. The PT should recognize that this procedure was MOST likely performed for which of the following medical conditions:
a) disc herniation
b) compression fracture
c) spinal instability
d) spondylolysis
Answer: b (compression fracture)
Explain: Vertebroplasty is a minimally invasive proceedure used to stabilize vertebral compression fractures (usually in osteoporosis pt’s). The surgeon uses fluoroscopy to locate the fractured vertebrae and injects some bone cement into the fracture site. The cement hardens, and provides stability while the bone then heals (reducing pain and improving mobility).
*** Kyphoplasty is a proceedure to place a balloon type object in between vertebrae that have lost height due to osteoporosis to get pt out of kyphotic posture.
- With disc herniations, conservative treatment is tried first, then cortisone shot, then eventually surgery called microdiscectomy.
- Osteoporosis creates thin and weak bones that fracture easily. This compression fracture is corrected through vertebroplasty (cement into fracture site), and then PT works on weight bearing and stabilization activities.
- Spinal fusion is another surgery that can be done is portions of vertebrae or disc were removed.
- Spondylolysis is a stress fracture through the pars portion of vertebrae (usually in lower lumbar area)
A PT observes that a pt has an exaggerated heel strike on the left during ambulation activities. Which term is MOST consistent with heel strike using Rancho Los Amigos nomenclature:
a) terminal swing
b) loading response
c) initial contact
d) midstance
Answer: c (initial contact)
Explain: Review phases of gait and nomenclature/terminology. Rancho Los Amigos terminology specifically refers to what action happens at certain time frames during gait.
- Standard terminology includes: heel strike, foot flat, midstance, heel off, toe off, acceleration, midswing, and deceleration.
- Rancho Los Amigos terminology includes: initial contact, loading response, midstance, terminal stance, pre-swing, initial swing, midswing, and terminal swing.
A pt appears to be somewhat anxious after learning her treatment will include soft tissue massage. The MOST appropriate massage stroke to begin treatment is:
a) effleurage
b) vibration
c) petrissage
d) tapotement
Answer: a (effleurage)
Explain: Massage is a manual therapy technique that produces physiologic effects in the tissue. Different types of strokes include: stroking, rubbing, and pressure.
- Effleurage is a light touch that generates relaxation. Performed at beginning and end of treatment to get pt to relax.
- Vibration is a technique is where therapist uses hands to vibrate pt
- Petrissage is a technique like kneading where the muscle is squeezed and rolled under the PT’s hand.
- Tapotement is a technique is rappid movements like tapping, hacking, cupping, slapping, etc.
A PT gathers a variety of equiptment prior to administering a series of sensory tests. Which form of sensation would be examined by utilizing a tuning fork?
a) joint position
b) vibration
c) stereognosis
d) barognosis
Answer: b (vibration)
Explain: tuning fork will provide a fixed tone when struck. The base of it is placed on a bony prominence after being struck and the pt percieves the vibratory stimulus. If vibration sense is intact, the patient will percieve the vibration. If there is impairment, pt will be unable to distinguish between vibration and no vibration.
- Joint position awareness = proprioception. There are specific proprioceptive tests to assess joint position (or proprioception)
- Vibration is assessed using a tuning fork
- Stereognosis refers to ability of a pt to identify objects placed in the hand without visual assistance (your ability to feel what something is without seeing it). It could be a pen, comb, pin, anything.
- Barognosis refers to the recognition of weight. The patient is asked to identify the comparative weights of similar sized objects.
A PT works with a nine year old child with cystic fibrosis. The age which BEST approximates the median age of survival for a pt with cystic fibrosis is:
a) 15 yrs old
b) 25 yrs old
c) 35 yrs old
d) 50 yrs old
Answer: c (35 yrs old)
Explain: Cystic fibrosis is an inherited disease of the exocrine glands of the lungs. Pt’s can get anit-inflammatory meds, do chest PT, nutrition, etc. to help improve life expectancy, but it has low age mortality.
A PT treats a patient with suspected bicipital tendon pathology. Which special test would be LEAST likely to confirm the suspected diagnosis:
a) Ludington’s test
b) Speed’s test
c) Yergason’s test
d) Drop Arm test
Answer: d (drop arm)
Explain:
- Ludington’s test is performed having the pt positioned in sitting and asking pt to clasp both hands behind the head. The pt is then asked to alternately contract and relax the biceps muscles. A positive test is indicated by the absense of movement in the biceps muscle and may indicate a biceps tendon rupture.
- Speed’s is basically a biceps RSC (of shoulder flexion with arm straight)
- Yergason’s is RSC of supination
- Drop arm test is for RC tear
A PT examines a six-month-old with Down Syndrome. Which of the following medical problems is MOST likely to further delay gross motor development in this population:
a) congenital heart defects
b) seizure disorder
c) atlantoaxial instability
d) obesity
Answer: a (congenital heart defects)
Explain: Congenital heart defects are common in infants with Down Syndrome. These can delay gross motor development.
- Congenital heart defects are found in 2/3’s of kids with DS. These kids will need additional time in NICU and surgeries.
- Seizures can delay gross motor development, but they are uncommon in kids with DS
- Atlantoaxial instability is common in kids with DS, but gross motor development isn’t impacted
- Obesity alone does not impact gross motor development, but because these kids are very inactive, they often become obese (but it won’t delay gross motor development)
A patient diagnosed with schizophrenia has been taking haloperidol (haldol) following an acute pysychotic episode. The PT should be alert for which of the following side effects MOST commonly associated with this type of medication:
a) Lip smacking and choreoathetoid movements
b) Significant weight gain and elevated serum lipids
c) Constipation and urinary retention
d) Agitation and tachycardia
Answer: a (lip smacking …)
A PTA is working on balance activities and gait training with a patient who has Parkinson’s disease. The therapist is attempting to schedule home therapy visits based on the timing of the patient’s levodopa medication. The therapist should coordinate home visits with which of the following dosing schedules to maximize the effects of treatment?
a) 30 mins following the lunch dose
b) One hour following the lunch dose
c) 30 mins following breakfast dose
d) One hour following breakfast does
Answer: D (hour after b-fast)
Explain: Parkinson’s is degenerative disease where dopamine production decreases in substantia nigra. Levodopa is dopamine replacement therapy to reduce symptoms of Parkinson’s (bradykinesia, tremors, rigidity).
PEAK performance is 1 hour after dose was taken, and the patient will have more energy in the morning.
A PT works on gait training with a pt and observes an ataxic gait pattern. Which of the following medications would be the MOST likely to influence balance during gait activities:
a) Prednisolone (Pediapred)
b) Methotrexate (Rheumatrex)
c) Lorazepam (Ativan)
d) Levodopa (Sinemet)
Answer: C (lorazepam)
Explain: Medications do have side effects and can impact treatment/interventions. Benzodiazepines are antianxiety meds so will have a calming effect on a pt. Drugs reach peak effectiveness typically an hour or 2 (or 3) after oral injestion, so keep that in mind.
- Prednisolone (Pediapred) would not impact balance
- Methotrexate (Rheumatrex) is for RA and wouldn’t impact balance
- Lorazepam (Ativan) is a sedative used for anti-anxiety, so has a GABA effect, so they are more relaxed and sedated (thus impacting balance).
- Levodopa is for Parkinson’s pt’s
A patient with atrial flutter suddenly becomes extremely lightheaded while exercising and appears to lose consciousness. Which scenario would BEST explain the change in the patient’s status:
a) increased filling of the ventricles
b) increased system congestion
c) decreased atrial depolarization
d) decreased blood traveling to the brain
Answer: D (decreased blood to brain)
Explain: A flutter is common heart arrythmia (rapid atrial tachycardia). This rapid rate creates decreased filling of ventricles, so less ejection fraction, so less blood out to body.
- With answer A: you’d get less filling of ventricles
- With answer B: you get congestion with CHF
- ** With answer C - it would be INCREASED atrial depolarization
After being discharged from an acute rehab hospital, a pt diagnosed with complete L4 paraplegia is referred to outpatient PT. The pt’s primary goal is to ambulate community distances using crutches. Which orthotic will the pt MOST likely require to meet this goal?
a) ankle-foot orthotic
b) knee-ankle-foot orthotic
c) drop lock knee-ankle-foot orthotic
d) hip-knee-ankle-foot orthotic
Answer: A
A PT completes a lower quarter screening examination on a pt diagnosed with hip pathology. Assuming a normal end-feel, which of the following classifications would be MOST consistent with hip extension:
a) soft
b) firm
c) hard
d) empty
Answer: B
Explain: End-feels are the type of resistance you feel when passively taking someone to end ROM.
- Soft: Soft end-feels are like knee or elbow flexion where muscle/fat prevents further movement
- Firm: Most end feels are firm due to ligament / tendon / capsule strain not allowing further movement.
- Hard: Bone on bone (like elbow extension, knee extension)
- Empty: this is when pain prevents getting to end range so resistance is not even felt
A pt is admitted to an acute care hospital following a motor vehicle accident. The pt is presently in a state of unconsciousness without arousal, eye opening or sleep-wake cycles. The pt does possess intact brainstem reflexes upon examination. This pt is MOST likely diagnosed with:
a) brain death
b) coma
c) vegetative state
d) locked in syndrome
Answer: C (coma)
Explain: Someone in an abnormal state of consciousness can be termed many things: delirium, stupor, dementia, vegetative state, coma, locked-in syndrome, brain dead, etc. But each are different:
- Brain dead: loss of function of entire cerebrum, brain stem, etc. Pt is in a coma, can’t breathe independently. Only reflexes that remain are deep tendon, withdrawl, plantar flexion. Recovery doesn’t happen.
- Coma: unresponsive so pt can not be aroused and does not respond to stimulation. Recovery can happen, but depends on extent of injury to brain.
- Locked-in syndrome: lesion in brainstem. Pt is conscious and aware of surroundings (can even move eyes), but voice and physical function is lost.
A PT treats a pt with hypoparathyroidism. Which symptom would be MOST likely based on the pt’s medical condition:
a) tetany
b) weight loss
c) hypercalcemia
d) moon-shaped face
Answer: A (tetany)
Explain: Hypoparathyroidism results from a decrease in secretion of parathyroid hormone by parathyroid glands, so you get decreased calcium levels in blood (hypocalcemia).
- Tetany is sustained muscular contraction and is a result of hypoparathyroidism
- Weight loss is more commonly associated with hypoadrenalism which is undersecretion of hormones by adrenal cortex. Addison’s disease would be weight loss.
- Hypercalcemia is opposite of what would happen in hypoparathyroidism
- Moon shaped face (fat in face) is a result of hyperadrenalism
A PT treats a pt status post myocardial infarction. The physician prescribes moderate exercise activities no greater than 5 METs. This can be interpreted as an activity that requires:
a) five times the breaths per minute at rest in order to perform the activity
b) five times the energy expended at rest in order to perform the activity
c) five times the forced expiratory volume at rest in order to perform the activity
d) five times the tidal volume at rest in order to perform the activity
Answer: B
Explain: A MET is the amount of O2 consumed while sitting at rest (3.5mL O2/kg/min). METs are critically useful since they tell you how much energy is expended (or energy cost) for particular activities.
A PT interviews a pt recently involved in a MVA. The pt sustained multiple LE injuries as a result of the accident and appears to be very depressed. In an attempt to encourage active dialougue the PT asks open-ended questions. Which of the following would NOT be considered an open-ended question:
a) how does your knee feel today?
b) What are your goals for PT
c) Do you have trouble sleeping at night
d) Tell me about your present condition
Answer: C
While participating in a soccer game, a player complains of gradually increasing shortness of breath and eventually begins to experience wheezing and dyspnea. The player is removed from the game so that they can take medication to control their asthma attack. Which type of medication was MOST likely administered:
a) mucolytics
b) antihistamines
c) beta-adrenergic agonist
d) antitussives
Answer: C
Explain: Asthma is an obstructive respiratory condition characterized by airway inflammation, bronchospasm, and mucus plugging. Symptoms include SOB, wheezing, coughing. Triggers include: exercise, allergens, pollution, stress.
- Mucolytic drugs are used to treat secretion build up in airways. These can be used for CHRONIC asthma pt’s to reduce mucus buildup, though they would not be effective in treating symptoms of an ACUTE asthma attack.
- Antihistamines are used to treat allergic attacks/reactions. Antihistamines block the binding of histamines to receptor sites in airways, to reduce symptoms of an allergic reaction.
- Beta adrenergic agonists are used to reduce bronchospasm that you’d get in an ACUTE asthma attack. They create smooth muscle relaxation to bronchodilate airways.
- Antitussives are used to suppress coughing associated with common cold
A PT treats a pt with LE tightness. When the therapist evaluates the length of the tensor fascia latae, the MOST appropriate special test to perform is:
a) Ely’s
b) Phelp’s
c) Ober’s
d) Thomas
Answer: C
Explain:
- Ely’s is for quad tightness (Rectus Femoris)
- Phelp’s is when pt is prone with knees extended. The hips are first abducted maximally, then the knees are flexed. If there is further hip abduction after flexing the knees, the test is positive for shortening of the gracilis muscle.
- Ober’s is for TFL / IT Band
- Thomas is for hip flexors
A PT assesses a pt with a diabetic foot ulcer. Using the Wagner Ulcer Grade Classification System, the therapist grades the ulcer as a score of 4. What would be the MOST appropriate intervention for this type of wound:
a) pulsed lavage
b) total-contact casting
c) oral antibiotics
d) surgical amputation
Answer: D . (surgical amputation)
Explain: Wagner scale is grading foot ulcers based on depth, infection, gangrene. It is a 6 point grading scale, from 0-5, higher scores indicating greater wound involvement and severity. A grade 4 is presense of partial gangrene.
- Pulsed lavage: more used for necrotic tissue that requires debridement.
- Total contact casting is casting designed to relieve pressure to plantar portion of foot. Used for superficial ulcers (grade 1) or pre-ulcerative lesions to allow better healing. Not used for gangrene.
- Oral antibiotics may help fight infection, and typically used when it is grade 3 where bone has become infected, or grade 2 where skin is exposed.
- Grade 4 is partial gangrene, and if it is gangrene, it needs to be amputated.
A pt reports brief episodes of significant dizziness when standing during the last 24 hours. The pt states that her symptoms began in conjunction with a change in diuretic medication she takes for her CHF. The MOST likely rationale for this new symptom is:
a) hypertension due to a decrease in blood plasma volume
b) hypertension due to an increase in blood plasma volume
c) hypotension due to a decrease in blood plasma volume
d) hypotension due to an increase in blood plasma volume
Answer; C
Explain: Diuretics remove fluid from body to reduce symptoms of CHF. It thus reduces blood plasma volume (more water excreted), so the pt gets orthostatic hypotension.
A PT treats a six-month-old infant that has a rough, slightly protruding reddish-purple lesion on the right lower side of their face. This type of marking is BEST termed:
a) dermatitis
b) hemangioma
c) nevus
d) rosacea
Answer: B (hemangioma)
Explain:
- Dermatitis is a rash (accompanyed by pruritus and erythema)
- Hemangioma is benign tumor that appears like a red-purple birthmark. Often found in newborns
- Nevus is a mole. Small dark skin growth
- Rosacea is an inflammatory skin disorder that causes facial erythema. You’ll see flushing and erythema.
A patient returns to PT after completing medical testing using Doppler ultrasonography. The pt is MOST likely presenting with:
a) peripheral neuropathy
b) intermittent claudication
c) cardiac arrythmias
d) bursitis
Answer: B (intermittent claudication)
Explain: Doppler ultrasound is a noninvasive instrument used to assess arterial blood flow. *** It uses sound waves to show blood moving. As velocity of blood flow changes, the pitch or sound wave bouncing back changes. So it helps show blood movement through a vessel.
- Nerves are tested with nerve conduction velocity testing
- Cardiac arrythmias wold be assessed over EKG
- Bursitis can be seen via ultrasound, but typically diagnosed using radiography
A PT administers phonophoresis to a pt rehabing from medial epicondylitis. Which action BEST explains the effectiveness of ultrasound in drug delivery?
a) changes in systemic blood flow
b) changes in pH of the skin
c) changes in permeability of the skin
d) changes in the temperature of the skin
Answer: C (permeability of skin)
Explain: Phonophoresis is using ultrasound to deliver medication through skin to injured area (superficial area). It gets drugs to a specific localized spot. Ultrasound increases the ability for a drug to penetrate the skin, so permeability of stratum corneum layer (outer layer) changes and allows more diffusion.
A PT is asked to assist in administering a graded exercise test to a pt referred to a phase II cardiac rehab program. WHich of the following objective findings would MOST warrant the termination of the test?
a) diastolic blood pressure rising to 100 mmHg
b) systolic blood pressure rising to 200 mmHg
c) multifocal premature ventricular contractions
d) sustained ventricular tachycardia
Answer: D (v-tach)
Explain: Absolute indications to terminate exercise include v-tach, angina, ST elevation, no Q waves, cyanosis, ataxia, dizziness, pt requests to stop, etc.
- Diastolic BP would have to be 120+
- It said it needed to be 250 mmHg for you to stop exercise for systolic (I’d do 200, but it says 250)
- PVC’s are not good, but may still do light exercise constantly monitoring EKG’s
- V-tach you STOP exercise
** REVIEW ANATOMY of vertebrae. Remember that the pedicles are from vertebral body out to lamina. Lamina is from pedicles to spinous process. Spinal nerves exit under/over pedicles … they form the intervertebral foramen.
OK
A PT assesses a pt’s level of independence using the FIM. If the pt needs only supervision when bathing, the therapist should score this as a:
a) 7
b) 5
c) 3
d) 1
Answer: B (5)
Explain: FIM is 18 item assessment to assess person in acute setting to assess physical, psychological, social function. 7 is totally independent, and 1 is totally dependent. 7 - Independent 6 - Modified Ind (use AD) 5 - Supervision 4 - Min A 3 - Mod A 2 - Max A 1 - Total A 0 - Couldn't complete
What diagnosis would you do large movements as interventions
Parkinson’s
These pt’s you do BIG training (large body movements). These pt’s have trouble initiating or stopping movements due to low dopamine levels in basal ganglia (substantia nigra). Gait, posture, balance are all impaired. They are rigid, have tremors, freeze on gait.
A PT intends to use compression therapy as part of a patient’s plan of care. The use of compression therapy is LEAST likely for which of the following patients?
a) a 68-year-old male with LE edema due to CHF
b) a 56-year-old female status post TKA
c) a 14-year-old male who sustained burn injuries to his legs three months ago
d) a 78-year-old female with a recent transfemoral amputation
Answer: A (CHF)
Explain: Compression therapy is used to improve fluid flow/balance in body to improve circulation, prevent skin breakdown, prevent wounds, etc. You would use compression therapy for control of edema, lymphedema, post surgery, prevent DVT’s, treat venous stasis, after amputation, burn patients, etc.
- You do NOT do compression for CHF, cause that will send more fluid to the heart, and the heart is failing and should NOT get more fluid.
- Compression following TKA helps prevent DVT’s and help with blood flow as their muscles aren’t working as pumps for venous return
- Burn patients benefit by not getting too much scar formation
- Compression helps amputees to shape residual limb, help limb fit into prosthesis, and control edema
A PT treats a pt rehabing from a LE injury with a cryotherapeutic agent. Which finding is MOST accurate when using this type of intervention:
a) increased spasticity
b) increased pain threshold
c) increased nerve conduction velocity
d) increased metabolic rate
Answer: B (increased pain threshold)
Explain: Cryotheraputic agents are ice packs, ice massage, cool whirlpool, cold sprays, etc. There are physiological effects … blood vessels narrow, thus blood is restricted to area to reduce inflammation. Also, gate control theory applies to reduce pain … THUS increasing pain threshold.
- Cryotherapy decreases spasticity and muscle spasm
- It increases pain threshold (gate control theory), by reducing sensation of pain
- Cryotherapy decreases nerve conduction velocity of both sensory and motor nerves
- Cryotherapy decreases metabolic reactions in body
1) If a pt walks on their heels during a LQS, what nerve root are you assessing?
2) Are you assessing a dermatome or myotome?
3) What is difference between dermatome and myotome
4) Toe walking assesses what myotome
5) Great toe extension assesses what myotome
1) L4
2) Myotome
3) Dermatome is area of skin that nerve root innervates, myotome is muscles that nerve root innervates
4) S1
5) L5
A PT performs a chart review for a pt admitted to the hospital after sustaining an acute myocardial infarction. A recent note in the medical record indicates that the pt has experienced frequent arrhythmia. Which lab value abnormality would be MOST likely to contribute to the arrythmia:
a) potassium
b) hemoglobin
c) hematocrit
d) platelet count
Answer: A (K+)
Explain: Cardiac arrythmia is a disturbance in heart rate and rhythm as a result of abnormal electrical conduction system in the heart. Dysrhythmias are common complications of MI because of the interruption to the cardiac conduction system.
- Potassium (K+) is a major ion responsible to generate action potential in the heart. Hypokalemia (low K+ levles) and hyperkalemia (high K+ levels) can result in arrythmias.
- Hemoglobin is protein that O2 binds to to get O2 to cells. Normal ranges for men is 12-16 ish, women is 12-15 ish
- Hematocrit is % of RBC’s in total blood volume. Elevated hematocrits means you are dehydrated, low hematocrit means you are anemic. Normal amounts is 39-49 ish. Lower than 25% is concerning (don’t exercise)
- Platelets are for blood clotting. 150,000-400,000 is normal. Less than 20,000 is very concerning and they can bleed.
A PT examines a pt with fibromyalgia. The pt reports that contact with the bed sheets produces pain when he tries to sleep at night. This is an example of:
a) allodynia
b) hyperalgesia
c) hyposthesia
d) analgesia
Answer: B (hyperalgeisa)
Explain:
- Allodynia: pain produced by a stimulus that does NOT usually provoke pain. Pt’s with fibromyalgia, migraine HA’s, and neuropathies are at greater risk to experience allodynia. It is pain from a NON-noxious stimulus.
- Hyperalgesia is an exaggerated or heightened reaction to a painful stimulus that normally is not that painful. It is heightened pain to a noxious stimulus.
- Hyposthesia is a decreased sensitivity to sensory stimuli. The pt has a diminished capacity for physical sensation.
- Analgesia: absence of pain in response to a stimulation (noxious) that should normally be painful.
A PT assesses a pt with a diabetic foot ulcer. Using the Wagner Ulcer Grade Classification System, the PT grades the ulcer as a score of 4. What would be the MOST appropriate intervention for this type of wound:
a) pulsed lavage
b) total-contact casting
c) oral antibiotics
d) surgical amputation
Answer: D (amputation)
Explain: Wagner Ulcer System grades foot ulcers. It assesses depth of wound, presense of infection, presense of gangrene, etc. It is a 6 point grading scale (from 0-5).
0 - Foot at risk due to callus
1 - Superficial ulcer
2 - Deep ulcer (deep but not to bone, but could be infected)
3 - Absessed deep ulcers (deep to bone and infected, some necrosis)
4 - Limited gangrene
5 - Extensive gangrene
- Pulsed lavage is a light debridement of infected areas of a wound, so around a grade 2-3
- Total contact casting is designed to releive pressure so pt isn’t on wound (especially plantar side of foot). So these are used for grade 0, 1, or possible grade 2 ulcers
- Oral antibiotics are when ulcer is infected, so grade 3 ulcers (even grade 2)
- A grade 4 is partial gangrene, and gangrene always needs to be amputated off
A medical record indicates that a child’s oral temp. was recorded as 100.6 degrees Fahrenheit. Which value would be MOST expected if the pt’s rectal temp. was taken:
a) 98.6 deg F
b) 99.6 deg F
c) 100.6 deg F
d) 101.6 deg F
Answer: D (101.6)
Explain: 98.6 deg F is normal average BODY temp (body regulating homeostasis temp). + or - 1 degree from this value is normal. Rectal temp is typically a bit higher than an oral temp taken (usually 0.5 to 1 deg higher than whatever oral temp was taken).
A PT examines a six-month old with Down Syndrome. Which of the following medical problems is MOST likely to further delay gross motor development in this population:
a) congenital heart defects
b) seizure disorder
c) atlantoaxial instability
d) obesity
Answer: A (congenital heart defects)
Explain: Congenital heart defects are common in kids with down syndrome (as is ligament laxity and being overweight, but these 2 won’t cause developmental delays). But heart defects can delay gross motor development. Kids with Down Syndrome don’t typically get seizures though.
A PT assesses the pulse rate of a pt exercising on a treadmill. The therapist notes that the rhythm of the pulse is often irregular. The MOST appropriate action to ensure an accurate measurement of pulse rate is:
a) select a different pulse site
b) measure the pulse rate for 60 seconds
c) use a different stethoscope
d) document the irregular pulse rate in the pt’s medical record
Answer: B (measure for 60 secs)
Explain: An irregular pulse rate is feeling beats at varying intervals. This is abnormal. Because beats are irregular, it is hard to be accurate if you just check it for 15 seconds. So just count how many there are in a full 60 seconds to be more exact. You could check pulse at different artery, but you’ll get same information. And you’ll of course document it, but that won’t help you get a better measurement.
A PT prepares to administer the Thessaly test to a pt with a suspected meniscal tear in the right knee. Which activity would occur first when administering this test:
a) administer the test on the left extremity with the knee in 20 degrees of flexion
b) administer the test on the left extremity with the knee in 45 degrees of flexion
c) adminster the test on the right extremity with the knee in 20 degrees of flexion
d) administer the test on the right extremity with the knee in 45 degrees of flexion
Answer: A (opposite side first, 20 degrees)
Explain: Thessaly is the meniscus test where they stand on one leg and you spin/rotate with them to grind the meniscus. Meniscus tears are manifest by joint line discomfort, catching/locking/popping, unable to walk or weight bear, etc. First, try the test on the GOOD side to know what is normal. Test is done in 20 degrees of knee flexion to grind more of the meniscus
A PT reads in the medical record that a wound located near a pt’s ischial tuberosity was classified as ‘Black’ using the Red-Yellow-Black system. The MOST relevant finding associated with a ‘Black’ classification would be the presence of:
a) granulation tissue
b) exudate
c) slough
d) eschar
Answer: D (eschar)
Explain: Red-Yellow-Black system uses a wound’s surface color to direct treatment. Red is the best since it means granulation and healing. Yellow is slough or infection. Black is eschar or dead/necrosis tissue.
A PT attempts to transfer a dependent pt from a wheelchair to a bed. The Therapist is concerned about the size of the pt, but is unable to secure another staff member to assist with the transfer. Which type of transfer would allow the PT to move the pt with the greatest ease:
a) dependent standing pivot
b) hydraulic lift
c) sliding board
d) assisted standing pivot
Answer: B (hydraulic lift)
Explain: Hydraulic lifts are the best and safest when you have a dependent pt who needs help transferring and are overweight. Most times, it can be done with only ONE PT. Slide board would be next, but they’d need UE strength, trunk control, etc.
A PT concludes that a pt exhibits dysmetria after performing a number of specific tests. Which test would be LEAST helpful to confirm the therapist’s conclusion:
a) drawing a circle or figure 8
b) pointing and past pointing
c) placing the feet on markets while walking
d) walking with alterations in speed
Answer: D (walking with alterations in speed)
Explain: Dysmetria refers to an inability to modulate movement where patient’s will either overestimate or underestimate their targets. The cerebellum is normally responsible for the timing, force, extent, and direction of the limb movement in order to correctly reach a target.
- Drawing a circle or figure 8 requires the pt to connect a line to established end point (which they could under or over shoot)
- Pointing past something makes sense (they’d struggle with this)
- Placing feet on markers makes sense (they’d struggle with this)
- Walking with alterations in speed would confirm dysdiadochokinesia.
A PT requests that a physician supervise a submaximal graded exercise test. Which scenario would provide the BEST support for the therapist’s decision:
a) a 48 yr old female who is asymptomatic with no known risk factors for coronary artery disease (CAD)
b) a 36 yr old male who is asymptomatic with two known risk factors for CAD
c) a 42 yr old female who is asymptomatic with one known risk factor for CAD
d) a 28 yr old male who is symptomatic with no known risk for CAD
Answer: D (the one who is symptomatic)
Explain: You want to be SAFE. If someone has a heart condition and you want to be safe, you may get physician to monitor. Usually you’d do this if the pt has some symptoms and other risk factors of CAD. If they have risk factors but no symptoms, that is something to be cautious about and monitor, but if someone is symptomatic (with or without risk factors), you better watch them very closely.
A PT attempts to measure metacarpophalangeal abduction using a goni. The MOST appropriate location for the moveable arm when conducting the measurement is:
a) over the dorsal midline of the proximal phalanx
b) over the volar midline of the proximal phalanx
c) over the dorsal midline of the distal phalanx
d) over the volar midline of the distal phalanx
Answer: A (dorsal of proximal phalanx)
A PT transports a pt with multiple sclerosis to the gym for her treatment session. The pt is wheelchair dependent and uses a urinary catheter. When transporting the patient, the MOST appropriate location to secure the collection bag is:
a) in the patient’s lap
b) on the patient’s lower abdomen
c) on the wheelchair armrest
d) on the wheelchair cross brace beneath the seat
Answer: D
Explain: Collection bags should be LOWER allowing graity to help it collect and not cause some UTI.
A PT examines a pt with a C6 spinal cord injury. Which muscle would NOT be innervated based on the patient’s level of injury?
a) biceps
b) deltoid
c) triceps
d) diaphragm
Answer: C (triceps)
- Biceps is C5-C6, Deltoid is also C5-C5, Diaphragm is C3-C5 (3,4,5 keeps you alive). Triceps is C7.
A patient rehabilitating from a lower extremity injury is referred to PT for hydrotherapy treatments. The PT would like the pt to fully extend the involved lower extremity while sitting in the hydrotherapy tank. Which type of whirlpool would NOT allow the pt to extend the involved LE?
a) Hubbard tank
b) Highboy tank
c) Lowboy tank
d) Walk tank
Answer: B (highboy tank)
Explain: Whirlpools are tanks that hold water with a turbine that produces movement of the water. Some whirlpools are bigger (for bigger limbs), and some are smaller (for smaller limbs).
- Hubbard: is full body immersion. These are big
- Highboy: immerse larger body parts, but can’t fully extend leg. It is high, just not wide.
- Lowboy: is for immersing larger body parts, but pt can extend LE’s in these.
- Walk tank: allows near full body immersion in an upright posture to do functional activities.
A note in a pt’s medical record indicates that laboratory testing identified an elevated hematocrit. Which condition would MOST likely be associated with this condition?
a) anemia
b) dehydration
c) leukemia
d) nutritional deficiency
Answer: B (dehydrated)
Explain: Hematocrit is % of RBC’s to total blood. Thus if it is high, means your plasma level is low, so you are dehydrated, been vomitting, or have diahreah. Low hematocrit is when you are anemic or have blood loss. A high hematocrit could also be from polycythemia vera where the body produces too many new RBC’s.
A PT examines a 16 yr old soccer player in an OP clinic. The pt presents with reports of diffuse lateral knee pain that increases with running and climbing stairs. Ober’s test is positive. Which diagnosis is MOST likely based on the clinical presentation?
a) iliotibial band syndrome
b) prepatellar bursitis
c) patellar tendonitis
d) posterior cruciate ligament tear
Answer: A (IT band)
A PT gathers data to assist in differential diagnosis. The PT determines that the pt’s present pain is located primarily in the posterior shoulder region. This type of clinical presentation is MOST consistent with:
a) acromioclavicular joint arthritis
b) biceps tendinitis
c) cervical radiculopathy
d) rotator cuff tear
Answer: C (cervical radiculopathy)
Explain:
- A/C joint arthritis would be more likely to present with pain in the superior shoulder region. Pain during cross arm adduction where A/C joint is compressed.
There WILL be a question on the boards about respiratory acidosis/alkalosis or metabolic acidosis/alkalosis. MUST understand this concept and how to interpret numbers.
PaCO2 - partial pressure of dissolved CO2 in plasma
pH - degree of acidity or alkalinity in blood
HCO3- level of bicarbonate in the blood
% of SaO2 - % of the amount of hemoglobin sites that are filled (saturated) with O2 molecules
PaO2 80-100 mm Hg • below 80 mm Hg = hypoxemia. • 60-80 = mild hypoxemia • 40-60 moderate hypoxemia • <40 severe hypoxemia • *** Hyperventilation takes PaO2 over 100, and hypoxic event takes it below 80.
PCO2 / PaCO2 35-45 mm Hg
pH 7.35-7.45
HCO3 22-28 mEq/liter
Arterial Blood Gases PROCESS:
1) First, look at the pH. Is it between 7.35-7.45? Is it below or above (acidotic or alkalotic).
- If it is between 7.35-7.45 and all other values are in a
normal range, body is in homeostasis.
- If it is below 7.35, then determine if it is respiratory acidosis (the PaCO2 will be going UP since pH is going down), or is it metabolic acidosis (HCO3 will go down since pH is going down).
So, for respiratory: pH and PaCO2 move in opposite directions. For metabolic, HCO3 and pH move in the same direction.
Examples:
- If pH is 7.21 and PaCO2 is 63, this is respiratory acidosis since 7.21 is low pH and 63 is a high PaCO2 (moving in opposite directions).
- If pH is 7.21 and HCO3 is 12, they both are low, so must be metabolic acidosis. High pH and high HCO3 is metabolic alkalosis.
- If it is above 7.45, then determine if it is respiratory alkalosis (PaCO2 will be going DOWN since pH is going UP), or is it metabolic alkalosis (HCO3 will go UP since pH is going up).
- If however, the pH is in a normal range but other values are off – this is compensated. If pH is off and other values are off, this is uncompensated.
- How to know if it is compensated?
- To determine if the patient’s primary respiratory process has been compensated for by the renal system, look at HCO3.
- To determine if the patient’s primary metabolic process has been compensated for by the respiratory system, look at PCO2
- A high HCO3 in respiratory acidosis indicates compensated respiratory acidosis.
- A low HCO3 in respiratory alkalosis indicates compensated respiratory alkalosis.
GO REVIEW PRACTICE DOCUMENT
A PT discusses the importance of a well-balanced diet with a patient diagnosed with type 2 diabetes. The MOST appropriate action to emphasize the importance of diet is:
a) provide a handout from the American Diabetes Association which outlines an appropriate diet
b) ask other patients that have made dietary changes to speak to the pt
c) arrange for a consultation with a dietician
d) provide copies of recent research articles which cite the benefit of a well-balance diet
Answer: C (speak with dietician)
Explain: Giving handouts is good and won’t hurt, but better to be more proactive and actually do something difinitive to help this pt.
A patient diagnosed with T5 paraplegia is discharged from a rehab hospital following 16 weeks of therapy. Assuming a normal recovery, which of the following MOST accurately describes the status of the pt’s bathroom transfers:
a) independent with the presence of an attendent
b) independent with a sliding board
c) independent with bathroom adaptations
d) independent
Answer: C (ind. with bathroom adaptations)
Explain: T5 means they have full UE and some upper trunk control. A slide board is just adding an unnecessary risk. Adaptations like a grab bar or higher seat are appropriate.
A PT asks a pt several questions prior to administering cervical mechanical traction. During the questioning the pt indicates he is wearing dentures. The MOST appropriate action is to:
a) initiate traction using normal treatment parameters with the dentures in place
b) initiate traction using normal treatment parameters after removing the dentures
c) initiate traction using 50% of the normal recommended force with dentures in place
d) Avoid using traction since the intervention is contraindicated for the pt
Answer: A (keep dentures in)
Explain: If you remove the dentures, the alignment of the TMJ may be altered causing pressure through the mandible. Leave dentures in to help forces travel properly through c-spine, not TMJ
