SUSieg 2015 Set A Only Flashcards

Question

During a finger-to-nose test, a patient demonstrates hesitancy in getting started and is then unable to control the movement. The moving finger slams into the side of the face and misses the nose completely. The therapist documents these findings as moderate impairment in: a. Dyssynergia b. Dysmetria c. Response orientation d. Dysdiadochokinesia

Answer 1

Correct Answer: B Dysmetria refers to impaired ability to judge the distance or range of movement. Incorrect Choices: Response orientation refers to the ability to select the correct movement in response to a stimulus. Dysdiadochokinesia refers to impaired ability to perform rapid alternating movements. Dyssynergia refers to impaired ability to associate muscles together for complex movement (decomposition of movement).

Answer 2

Correct Answer: A The patient with complete C6 tetraplegia will lack triceps (elbow extensors), and should be taught to lock the elbow for push-up transfers by using shoulder external rotators and extensors to position the arm; the anterior deltoid locks the elbow by reverse actions (all of these muscles are functional). Incorrect Choices: Triceps are not functional in this patient. Pectoral muscles cannot be used to stabilize the elbows in extension

Answer 3

Correct Answer: B It is within the surgeon’s scope of practice to discuss the indications and problems that could arise from this surgical procedure Incorrect Choices: It is not within the PT’s scope of practice to be the expert that discusses problems associated with surgery. Referral should be made to the physician, not another therapist.

Answer 4

Correct Answer: D The patient is most likely suffering from a supraspinatus tear or impingement. Acute PT intervention should focus on reduction of pain and inflammation. During the early subacute phase, active assistive pulley exercises would be indicated to promote healing of the supraspinatus muscle and maintain AROM of the glenohumeral joint. ncorrect Choices: Performing a superior glide of the glenohumeral joint would not be beneficial to improve elevation of the arm. Use of modalities is not the focus at this point of intervention. Resistance exercise would be too difficult and not beneficial to promote healing of the injured tissues.

Answer 5

Correct Answer: C The stated hematocrit value is within the normal range for both males and females, and indicates the fecal blood loss is not significant at treatment time. Incorrect Choices: The other choices (leukocyte count, platelet count, and ESR) are not indices of Gl bleeding

Answer 6

Correct Answer: D Patients should be educated about proper lifting techniques and precautions against heavy lifting Incorrect Choices: Closed-mouth breathing during lifting is contraindicated, due to increased risk of intra-abdominal pressure with Valsalva's maneuver. Avoiding excessive staining is important. Turning in bed and sitting are part of daily functions.

Answer 7

Correct Answer: C Gestational carpal tunnel syndrome (CTS) is not an unusual phenomenon, and results from extra fluid retention. The most effective intervention would be to place the wrists in a neutral position in splints. The carpal tunnel Is, therefore, not compromised by poor hand positioning while at work. Incorrect Choices: Modalities that use steroids are contraindicated for pregnant women. Although ice packs may relieve discomfort, they do little to correct the source of the problem.

Answer 8

Correct Answer: C Not tolerating being touched would signal a possible sensory integration issue that is common in children with autism. Although a referral for autism diagnosis should have additional information, this would be the most important factor from the choices given. Incorrect Choices: Since this was the initial evaluation it is not uncommon for a child this age to be quiet, shy and fearful of the PT. This behavior may not have anything to do with autism, but that of being wary of strangers. A delay in gross motor skills does not necessarily indicate autism. This child could have mild cerebral palsy or just be delayed for no apparent reason. Responsive to most commands would be a positive outcome when dealing with a 2-year-old child. A child with autism may not respond to commands due to issues with cognition, lack of focus, or verbal deficits.

Answer 9

Correct Answer: A Because of the long-term, continuous use of TENS, the sensory receptors accommodated to the continuous current, and no longer responded to the stimuli. Changing to modulation mode (i.e., burst modulation), which periodically interrupts the current flow, does not allow accommodation to occur. Incorrect Choices: None of the other choices decreases accommodation. Low-rate TENS is a motor level stimulation, not sensory. Increasing treatment frequency would result in accommodation occurring more quickly. Decreasing the pulse duration would require increasing the intensity to get a response, and the patient has already maximized the intensity.

Answer 10

Correct Answer: A Work involving increased wrist deviation from a neutral posture in either flexion/extension or radial/ulnar deviation has been associated with increased reports of CTS and other wrist and hand problems. Incorrect Choices: Increasing wrist flexion or extension can be harmful. Adding armrests does not solve the wrist position problem.

Answer 11

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Answer 12

Correct Answer: B During the stance phase of gait, the hip abductors of the support limb are activated to maintain the pelvis in a relatively horizontal position. This allows the opposite foot to clear the floor during swing. Incorrect Choices: Stimulation of the right abductors throughout swing or the left hip abductors during swing or stance would not compensate for the weakness of the right hip abductors during the support period.

Answer 13

Correct Answer: D Children with Down syndrome typically present with generalized hypotonicity. The low tone is best managed by weight-bearing activities in antigravity postures. Typical responses include widened base of support and co-contraction to gain stability. Verbal cueing for redirection is generally the best form of feedback to use, along with visually guided postural control Incorrect Choices: Proprioceptors are not in a high state of readiness, and the child may be slow to respond to proprioceptive facilitation techniques (i.e., stretch, resistance, rhythmic stabilization). With developmental delay, this child is not ready for intensive locomotor training. Rolling is probably not age appropriate for this child. The child should already possess this skill since most children with Down syndrome walk at 24 months of age.

Answer 14

Correct Answer: A Signs and symptoms of anabolic steroid use include rapid weight gain, elevated BP, acne on the face and upper back, and changes in body composition with marked muscular hypertrophy, especially in the upper body. Additional signs include frequent bruising, needle marks, male breast enlargement, or In females, secondary male characteristics and menstrual irregularities. With prolonged use, jaundice or changes in personality (mood swings, rages) may develop Incorrect Choices: The other choices are not characteristic of anabolic steroid use.

Answer 15

Correct Answer: B Facet joint dysfunction is exacerbated with sustained positions, and eases with movement. Progressive increase in activity intensifies the pain Incorrect Choices: Stress fracture pain is worse when weight- bearing, and is not necessarily worse in the morning. Nerve root involvement would cause radiating pain to the extremity. The spinal cord has no innervation and is not a source of pain

Answer 16

Correct Answer: A The test position would consist of right cervical side-bending with extension. This shortens the upper trapezius and stresses the right cervical facets. When a pathological cervical facet is provoked, the result will cause pain in the ipsilateral cervical region, with referred pain to the ipsilateral scapular region. The test might also compress the nerve root, creating radicular signs, but only on the right side. Incorrect Choices: This test would shorten the upper trapezius so it will not cause tightness in the muscle. Radicular pain would be consistent with dysfunction of a spinal nerve, not a facet joint syndrome. Referred pain to the left midscapular region would be caused by a test that was applied to the structures on the left side.

Answer 17

Correct Answer: B An obstructive pattern on pulmonary function tests includes increased total lung capacity, caused by destruction of alveolar walls. This same destruction causes an increased residual volume, with a resulting increased functional residual capacity and decreased vital capacity. The GOLD (global Initiative for Obstructive Lung Disease) classification of an FEV1/FVC ratio below 70% is indicative of COPD. Incorrect Choices: The other choices are all increased with COPD.

Answer 18

Correct Answer: B This patient is experiencing delayed-onset muscle soreness (DOMS) as a result of vigorous exercise or muscular overexertion. It typically begins 12-24 hours after exercise, peaks in 24-48 hours, and can last up to 5-7 days. ncorrect Choices: DOMS is usually greater after muscle engthening or eccentric exercise. It can be essened by gradually increasing intensity and duration of exercise, and not starting at 80% of maximal intensity.

Answer 19

Correct Answer: A Common problems in MS include fatigue and heat intolerance. Exercise intensity should be reduced, and a distributed practice schedule should be used, in which rest times equal or exceed exercise times. Incorrect Choices: A massed practice schedule in which the exercise time exceeds the rest time is contraindicated as is a warm environment or warm pool, which can increase fatigue.

Answer 20

Correct Answer: C Continuous positioning in spinal extension Increases symptoms in patients with spinal stenosis. Activities such as swimming using a crawl stroke place the spine in this position. Incorrect Choices: All other activities described do not require the patient to maintain a continuous extended spinal position.

Answer 21

Correct Answer: A In an A-B-A-B single-subject design, A represents multiple baseline measurements, and B represents multiple posttreatment measurements. If the hypothesis is accepted, the pain-rating scores will be lower following treatment compared with the baseline measurements. Incorrect Choices: Any choice in which B is equal to or greater than A Is incorrect. That would indicate that there was no change in pain or that it increased after treatment.

Answer 22

Correct Answer: D A patient with a BMI of 33 kg/m is obese (BMI >30 kg/m) and is at increased risk for hyperthermia during exercise (as well as orthopedic injury). Incorrect Choices: Weight loss is the result of a complex interplay between diet and exercise, and not the result of exercise alone. A balanced program of exercise and diet will produce effects over time, not just in the initial weeks. An appropriately prescribed exercise program should decrease anxiety and depression. Hypothermia is not typical with obesity.

Answer 23

Correct Answer: B Obesity is consistently reported as a predictor of lymphedema after modified radial mastectomy for breast cancer. Weight management should be an integral part of patient education. Incorrect Choices: Diuretics are sometimes used, and even though they do not change the accumulation of protein in the interstitial spaces, they are not a predictor of lymphedema. Diet is thought to be very important, but there are no recommended diets except one that is healthy and low in sodium; it is not predictive, however. It is common to have strength loss after a surgery, and although strength loss is associated with lymphedema in the more advanced stages, it is not predictive of lymphedema.

Answer 24

Correct Answer: B Prolonged mechanical stretching involves a low-intensity force (generally 5 to 15 |b) applied over a prolonged period (30 minutes to several hours). It is generally the most beneficial way to mange long-standing flexion contractures. Incorrect Choices: Manual passive stretching and tilt-table standing are shorter-duration stretches that are not likely to be as effective in this case. Hold-relax techniques can be used to improve flexibility in the presence of shortening of muscular elements, but are not likely to be effective in this case because of the short duration and long-standing contracture affecting connective tissue elements.

Answer 25

Correct Answer: A The combined signs and symptoms of absent breath sounds, sudden onset of chest pain and shortness of breath indicate a pneumothorax, especially in an adolescent (growth spurt) with pathological changes of ung tissue. This is an emergency situation. ncorrect Choices: The other interventions (continuing treating reposition the patient) do not adequately address the emergency nature of this situation, given the symptoms presented. Potential harm can come to this patient.

Answer 26

Correct Answer: B Intensity of exercise is prescribed using HR and RPE and monitored using HR, RPE and signs of exertional intolerance. For post-Ml patients, an RPE < 13 (6-20 scale) and a HR < 120 beats/min (or HR resting plus 20 bpm) Is recommended. Incorrect Choices: HR plus 30 beats/min is recommended for postsurgery patients. Signs and symptoms for an upper limit of exercise intensity include choices 1 and 3 along with onset of angina, and ECG disturbances (ventricular arrhythmias, second-or third-degree atrioventricular block, atrial fibrillation, etc). (Source: American College of Sports Medicine, guideline for exercise testing and prescription.)

Answer 27

Correct Answer: B A patient with homonymous hemianopsia needs to be made aware of the deficit and instructed to turn the head to the affected left side (a compensatory training strategy). Incorrect Choices: Initial strategies include placing items on the right (unaffected side), not the left side, so that the patient can successfully interact with the environment. Later, as there is ability to compensate, items can be moved to midline, and finally to the affected left side.

Answer 28

Correct Answer: B Dyskinesias (involuntary movements) are caused by an adverse effect of prolonged use of dopamine. Other changes include gastrointestinal disturbances (nausea, vomiting) and mental disturbances (restlessness, general overactivity, anxiety, or depression). Medication adjustment may reduce some of these effects and improve function. Incorrect Choices: Although the symptoms described in the other choices may also occur with pharmacological management of PD, they do not adequately explain the presence of adventitious or involuntary movements. Selegiline is used in early PD; its main adverse effects include nausea, dry mouth, dizziness, anxiety, and hallucinations. Failure to notify the physician of these documented adverse effects can jeopardize the patient's functional outcomes and safety.

Answer 29

Correct Answer: C Hemosiderin staining is indicative of venous insufficiency. It is characterized by dark pigmentation (bluish-red color) and result from leakage of hemosiderin (the by-product of red cell hemolysis) in the presence of blood stasis and incompetent valves. Incorrect Choices: The other choices are not characteristic of stasis dermatitis secondary to venous insufficiency. Red, oozing crusting rash; erosions; exudate; and pruritic vesicles are characteristic of eczema.

Answer 30

Correct Answer: A According to the American College of Sports Medicine, women can continue to exercise regularly (three times a week) at mild to moderate intensities throughout pregnancy if no additional risk factors are present. After the 1st trimester, women should avoid exercise in the supine position because this position is associated with decreased cardiac output. Prolonged standing with no motion should also be avoided. Incorrect Choices: Non-weight bearing exercise (swimming) is an acceptable alternative to walking or jogging. However, this patient's interests and skills are with jogging, making it the most appropriate choice. Exercise prescription should be specific to the individual. Using a target HR of 140 or a target date of the fifth month of pregnancy does not allow for this

Answer 31

Correct Answer: B In a positive Romberg test, the patient demonstrates instability during the eyes closed (EC) condition but not during the eyes open (EO) condition; commonly seen in dorsal column disease. Incorrect Choices: In a negative Romberg test, the patient would be able to maintain balance equally well under both conditions (EQ and EC). The Dizziness Handicap Inventory is a scale of self-perceived handicap as a result of vestibular disorders. An ataxic posture can be seen in cerebellar disease and refers to instability and increased postural sway, present during the EO and EC condition.

Answer 32

Correct Answer: C A CVA affecting the middle cerebral artery will result in symptoms of contralateral hemiparesis and hemisensory deficits with greater involvement of the arm than the leg. Incorrect Choices: The findings presented in choices 1 are characteristic of a CVA affecting the posterior cerebral artery syndrome (central territory). The findings presented in choice 3 are characteristic of a CVA affecting the vertebral artery, and posterior inferior cerebellar artery (lateral medullary syndrome). The findings presented in choice 4 are characteristic of a CVA, affecting the anterior cerebral artery.

Answer 33

Correct Answer: A Because like charges are repelled, the positively charged medication would be forced into the skin under the positive electrode (anode). A continuous, unidirectional current flow is very effective in repelling ions into the skin. Procaine is a positive medicinal ion, and will be repelled from the anode (positive pole). Incorrect Choices: A pulsed, interrupted or bidirectional current generates less propulsive force owing to the discontinuous nature of the current. The cathode is not an appropriate choice to administer this medication

Answer 34

Correct Answer: A Foot drop is a swing phase deficit. Stimulation of the dorsiflexor muscles during the swing phase places the foot in a more neutral position and prevents the toes from contracting the ground and interfering with the gait pattern Incorrect Choices: Plantarflexors are active from heel strike to foot-flat, and from heel-off to toe-off

Answer 35

Correct Answer: C It is important to be supportive of a patient who is experiencing losses and resentment. Allow the patient to fully verbalize feelings and frustrations. Incorrect Choices: Ignoring the patient's responses or encouraging denial will not allow for healing and acceptance. In an emotional state, the patient may be unable to give an accurate history.

Answer 36

Correct Answer: B This patient is receiving systemic corticosteroids to suppress inflammation and the normal immune system response during an MS attack. Chronic treatment leads to adrenal suppression. Numerous adverse reactions/side effects can occur. Those affecting the patient's capacity to exercise include muscle wasting and pain, weakness and osteoporosis. Weight loss is common (anorexia) with nausea and vomiting. ncorrect Choices: Adrenal suppression produces hyperglycemia, not hypoglycemia. Spontaneous fractures are not typical. Hyperkinetic behavior is not an expected adverse effect.

Answer 37

Correct Answer: D Resistance training is typically initiated after patients have completed 4-6 weeks of supervised cardio respiratory endurance exercise. Lower intensities are prescribed. Careful monitoring of BP is necessary because BP will be higher and HR lower than for aerobic exercise. Patients should demonstrate an exercise capacity greater than 5 METs without angina symptoms or ST segment depression. Incorrect Choices: The common use of a percentage of 1 RM (repetition maximum) estimates intensity, and should be used only as a general guideline. Intensity should be assessed using perceived intensity. Exercise should be terminated at a rate of perceived exertion (RPE; Borg Scale 6-20) of 15-16. During resistance training. HR response is disproportionate to oxygen consumption and should not be used as a measure of intensity. Resistance training is not restricted to phase 3 programs, as long as proper guideline are followed.

Answer 38

Correct Answer: C Rotation of the tibia on the femur is influenced by sagittal knee position. Rotation of the knee increases with increasing flexion up to 90°. After 90°, the soft tissues behind the knee restrict further increases in rotation at the knee. Incorrect Choices: Placing the knee in 30°, 45°, or 60° of flexion will not allow for maximal tibiofemoral rotation.

Answer 39

Correct Answer: D Common abnormal postural findings consistent with anterior knee pain in an adolescent female include pes planus, lateral tibial torsion, and genu valgum. These are compensatory changes that occur when the femur is in excessive medial rotation. Incorrect Choices: Abduction is associated with coxa valga (an increase in the angle of the femoral head to the neck ), which is not commonly associated with knee pain. Lateral femoral rotation is commonly observed with genu varum. Retroversion of the hip is an abnormally small angle between the femoral neck and the condyles, and is not affected by posture.

Answer 40

Correct Answer: B The surface appearance of a superficial partial-thickness burn is characterized by intact blisters and moist, weeping or glistening surface when blisters are removed. Incorrect Choices: A dry surface with no blisters is characteristic of a superficial burn. A wet surface with broken blisters is characteristic of a deep partial-thickness burn. Parchment-like, leathery, and dry surface is characteristic of a full-thickness burn.

Answer 41

Correct Answer: C Because the epiphyseal plates do not close until the end of puberty, US energy should be applied with caution around the epiphyseal area due to its potential to cause bone growth disturbances. However, there is no documented evidence that US creates any direct untoward effects on the growth plates, especially if applied at low dosage. Incorrect Choices: Electrical stimulation or deep thermotherapy would have no deleterious effects on the epiphyseal plates because no mechanical effects on hard tissue are associated with their use.

Answer 42

Correct Answer: B Very often, patient with chronic pulmonary disease have been managed using corticosteroid therapy. Long-term steroid use has the catabolic effects of osteoporosis, weakened supporting joint structures and muscle wasting, making joint mobilization contraindicated. Incorrect Choices: There would not be any increase in reflex muscle guarding in a patient with pulmonary disease over that in other patient populations. Inhalation therapy, even with a corticosteroid, has minimal systemic uptake of the drug and, therefore, would not be a contraindication to performing joint mobility. A functionally limited thorax may be considered when deciding on the starting body position for joint mobility, but will not change the stability to perform the task.

Answer 43

Correct Answer: A Based on the arthrokinematic convex- concave rules of motion, ankle joint dorsiflexion is described as occurring through a combination of anterior roll and posterior translation of the talus within the mortise joint. Dorsal glide of the talus would be utilized to improve ankle joint dorsiflexion if posterior translation of the talus is limited. Incorrect Choices: Posterior glide of the talus is not a technique to improve subtalar joint motions or distal tibiofibular joint extensibility.

Answer 44

Correct Answer: C When the electrodes are close together, the likelihood of detecting undesired motor unit activity from adjacent muscles (crosstalk) decreases. By setting the sensitivity (gain) ow, the amplitude of signals generated by the hypertonic muscles would decrease and Keep the EMG output from exceeding a visual or auditory range. ncorrect Choices: The other choices do not achieve these goals. The wider the spacing of electrodes, the more volume of the muscle is monitored. Thus, when targeting a specific muscle, a narrow spacing should be used. When the focus is not on a specific muscle but instead to encourage a generic motion such as shoulder elevation, then a wider spacing of electrodes can be used. In addition, when working with weakness of a muscle where there is a decreased ability to recruit motor units or a decrease in the size and number of motor units, then a wider spacing and a high sensitivity would be used in order to create an adequate visible signal.

Answer 45

Correct Answer: D During the cocking phase, the arm is taken into the end-range of humeral external rotation. At that point, the anterior aspects of the capsule and labrum are acting as constraints to prevent excessive anterior glide of the humerus. Incorrect Choices: The other phases of the throwing motion do not place the same degree of strain on the anterior labrum and capsule.

Answer 46

Correct Answer: B An agitated patient with dementia does not process information easily. A calm and supportive approach with low-level commands (one or two actions) provides the best approach for this patient. Incorrect Choices: Establishing rules, confrontation and making unrealistic promises that cannot be kept may Increase agitation. Guided movements may help, but communication should be maintained.

Answer 47

Correct Answer: D A positive Noble's compression test is an indication of an indication of an iliotibial band friction disorder Incorrect Choices: A Negative FABERE test can rule out Sl joint dysfunction. A negative grind test eliminates DJD at the hip. There were no findings to implicate the LS nerve root.

Answer 48

Correct Answer: C In order to maintain the center of gravity over the base of support, the subtalar joint must pronate, and the entire lower quarter must medially rotate. Incorrect Choices: Because the expected compensation is pronation of the ankle the medial rotation of the tibia, the responses with dorsiflexion and/or external rotation are incorrect.

Answer 49

Correct Answer: D Hypertrophy is the increase in muscle size as a result of resistance training and can be observed following at least 6-8 weeks of training. Individual muscle fibers are enlarged, contain more actin and myosin and have more, larger myofibrils. Incorrect Choices: The other choices are too brief a time interval to show demonstrable changes. Some strengthening can occur, but no obvious hypertrophy.

Answer 50

Correct Answer: D Most men with chronic prostatitis have tenderness and tightness of the striated muscles of the pelvic floor. The goal of manual therapy compression techniques is to relax and lengthen those muscles, as well as to relieve the pain associated with palpable tender points (trigger points). Striated muscles of the pelvic floor that are frequently tight and painful in men with chronic prostatitis are the pubococcygeus. Obturator internus, and piriformis. The perineal body and bulbospongiosus muscle are also frequently tender. Incorrect Choices: The gluteus medius, which appears in three of the answers, is not a pelvic floor muscle. It does attach to the external surface of a pelvic bone (ilium), but it is not by definition a part of the pelvic floor. Interestingly, tender points of this mucle are a common finding in men with chronic prostatitis.

Answer 51

Correct Answer: C This patient is demonstrating signs and symptoms of a venous ulcer: irregular, dark pigmentation; usually shallow, and appearing on the distal lower leg (medial malleolus is the most common area). There is little pain associated with venous ulcers. Incorrect Choices: Arterial ulcers also have irregular edges, but are not typically dark. They are painful, especially if the legs are elevated, and are common in the distal lower leg (toes, feet lateral malleolus, anterior tibial area). Diabetic ulcers are associated with arterial disease and peripheral neuropathy. They appear in locations where arterial ulcers appear, and are typically not painful. Signs and symptoms of arterial insufficiency include decreased or absent pulses and pale color. Intermittent claudication is common in early disease, whereas in late stages, patients exhibit rest pain and ischemia.

Answer 52

Correct Answer: A The gravity-independent area of the lung in the upright sitting position refers to the apices of the lungs, which house the most air at resting end expiratory pressure (REEP). The gravity-dependent area of the lungs in the upright sitting position refers to the bases of the lungs, which will house the most pulmonary perfusion. The relative increase in blood in the pulmonary capillaries around the alveoli in the bases results in less room for air in those alveoli. Because there is a relative decrease in blood in the pulmonary capillaries around the alveoli in the apices, there is more room for air. Incorrect Choices: The apices of the lungs in that position have the least perfusion because of the effects of gravity on blood flow. The apices also have the smallest change in ventilation during the respiratory cycle because they are the most full at rest, and that area has the least ROM of the thorax. The apices of the lung have the highest oxygenation and lowest carbon dioxide content as a result of the small blood volume that passes by these alveoli. Therefore, a relatively small amount of oxygen is extracted from the alveolar air, and a relatively small amount of carbon dioxide is given off into the alveolar air.

Answer 53

Correct Answer: A Gastric contents reflux into the esophagus in GERD. Scheduling therapy at least 90 minutes after eating reduces the possibility of food remaining in the stomach and aggravating the esophagus during therapy. Incorrect Choices: Concentric abdominal exercises (sit-ups) are contraindicated in recent thoracic compression fractures. Eating right before a therapy session may aggravate GERD. Recommending a medication change is outside the scope of a PT.

Answer 54

Correct Answer: A The primary motions of the talocrural and first metatarsophalangeal joints are plantarflexion and dorsiflexion in the sagittal plane. Normal forward progression of the ankle and foot during late stance period (terminal stance and preswing) requires ankle and great toe dorsiflexion. Incorrect Choices: The primary motions of the talonavicular and subtalar joints are pronation and supination in the frontal plane. Although important for normal gait, deficits in the fronal plane do not limit forward progression.

Answer 55

Correct Answer: C A shrinker is a suitable alternative to elastic wraps. It is important to select the right size shrinker to limit edema and accelerate healing. Incorrect Choices: An Unna’s paste dressing is applied at the time of initial surgery. Use of a temporary prosthesis should be a prosthetic team decision and is based on additional factors such as age, balance, strength, cognition, and so forth. Continuing to teach elastic bandage wrapping may be inefficient and ultimately fruitless, since the patient is elderly.

Answer 56

Correct Answer: B Lymphedema after surgery and radiation is classified as secondary lymphedema. Stage 1 means that there is pitting edema that is reversible with elevation. The arm may be normal size first thing in the morning, with edema developing as the day goes on. It can be effectively managed by external compression and extremity elevation. Manual lymph drainage (massage and PROM) are also appropriate interventions. Incorrect Choices: Exercise and positioning alone would not provide the needed lymph drainage; Isometric exercise is contraindicated.

Answer 57

Correct Answer: A ALS is a progressive degenerative disease that affects both upper and lower motor neurons. An important early goal of physical therapy is to maintain the patient's level of conditioning while preventing overwork damage in denervated muscle (lower motor neuron injury). Incorrect Choices: Myalgia is common in lower motor neuron lesions. It can be ameliorated but not prevented. Ataxia and radicular pain are not associated with ALS.

Answer 58

Correct Answer: D The DGI is an instrument designed to evaluate and document a patient's ability to modify gait in response to changing task demands (e.g., gait speed, head turns, pivot turns, step over and around obstacles, steps). Incorrect Choices: The DGl is a clinical test of mobility. It is not used in the community environment nor was it developed to obtain information about gait in the home environment. It is used to evaluate adaptability of gait, not consistency.

Answer 59

Correct Answer: C The muscles of the foot and ankle move the long lever of the body forward and backward (ankle strategy). The gastrocnemius-soleus moves the body backward, and the anterior tibialis moves the body forward. Post-stroke, spasticity of the gastrocnemius-soleus and weakness of the anterior tibialis are common. Incorrect Choices: Action of the hip extensors would result in a backward lean, with the center of motion occurring at the hip (hip strategy). Contracture of the hamstrings increases knee flexion and forward trunk lean. Spasticity occurs in lower extremity antigravity extensor muscles, not the anterior tibialis.

Answer 60

Correct Answer: B The distal tibiofibular joint must separate slightly with ankle dorsiflexion in order to allow the wider anterior aspect of the talus to pass between the articulating surfaces of the malleoli. Incorrect Choices: None of the other joints contribute significantly to ankle dorsiflexion range of motion.

Answer 61

Correct Answer: C With advanced age, the capacity of the individual to break down and convert drugs diminishes (secondary to decreased liver and Kidney function, reduced hepatic and renal blood flow, etc.). Some drugs additionally slow metabolism (e.g., calcium channel blockers like verapamil and diltiazem or antigout drugs like allopurinol). NSAIDs are associated with potential gastrointestinal (Gl) effects (stomach pain, peptic ulcers, Gl hemorrhage), peripheral edema and easy bruising and bleeding. NSAIDs can also lessen the effects of antihypertensive drugs. Central nervous system (CNS) effects can include headache, dizziness, lightheadedness, insomnia, tinnitus, confusion, and depression. Incorrect Choices: The other choices are not expected adverse reactions.

Answer 62

Correct Answer: A Physical therapists and physical therapist assistants are obligated to report any caregivers that engage in sexual activity with their patient or clients. It is unethical and unlawful for a PT or PTA to have such a sexual relationship, even if consensual. The human resources department would be able to gather pertinent information and perhaps confront the therapist involved to have the relationship immediately cease and determine if the therapist knew it was illegal or unethical to carry out such an affair. The PTA fulfilled the obligation of reporting the situation Incorrect Choices: The PTA could have submitted a complaint to the state licensing board. There could be a time delay before the investigative arm of the board got around to the case. The evidence may have only been hearsay. Meanwhile, the relationship might have continued. If the human resources department had corroborated the situation it is possible that the therapist might have been fired and human resources (HR) could file a complaint with the board. Approaching the supervisor by the PTA could open a can of worms for the PTA. The supervisor could just say it was none of her business or even make some other threatening comments. Standard 4 of the Guide for Conduct of the Physical Therapist Assistant makes it clear that the PTA must take some action in this situation. It is not necessarily wrong to approach the supervisor; however, is it the BEST thing to do?

Answer 63

Correct Answer: D Venous ulcers typically present with minimal pain (dull aching). Venous congestion and aching are relieved by leg elevation. Chronic venous insufficiency is also characterized by thickening, coarsening and brownish pigmentation of the skin around the ankles. The skin is usually thin, shiny, and cyanotic. Incorrect Choices: Arterial insufficiency typically presents with severe pain (claudication and in severe cases rest pain). The forefoot typically exhibits dependent rubor and pallor with decreased or absent pulses on elevation. Skin is typically cool, pale, and shiny.

Answer 64

Correct Answer: C Seventy percent of mean after a radial lymph node resection for prostate cancer will develop lymphedema in one or both lower extremities and potentially the genitals. Early changes include a perception of heaviness of the limb and an inability to wear old socks or shoes due to tightness. These are often precursors to clinically significant swelling. Incorrect Choices: Although circumferential measurements are important, they are not sensitive to small accumulations of lymphedema. Significant accumulation of lymphedema is recognized by greater than a 2.0 cm difference at one measurement point between upper extremity (UE) limbs and 1.0-1.5 cm difference between lower extremity (LE) limbs. Use of alkaline soaps will result in loss of normal pH of skin (slightly acidic), drying of the skin, and increased risk of bacterial infection due to breaks in skin. Use of compression pumps at pressures higher than 60mm Hg can cause damage to the lymphatic vessels.

Answer 65

Correct Answer: A To assist with venous return and decrease edema, pain, and clot extension, compression stockings are used. Early ambulation is permitted after adequate anticoagulation with low-molecular-weight heparin (LMWH). Incorrect Choices: The other choices do not adequately address the patient's problem. The patient should not be kept on strict bed rest nor should treatment be deferred (both choices contribute to venous stasis). ADL in sitting is permitted but does not address the central problem of lower extremity venous stasis.

Answer 66

Correct Answer: B Meta-analysis refers to pooling of data of RCTs to yield a larger sample. Meta-analysis provides a mechanism for quantitative systematic review. Incorrect Choices: Non-RCTs (case-control studies, case reports) are excluded. The Cochrane Collaboration is one source of meta-analysis reviews. Critically evaluating systematic reviews is a separate process.

Answer 67

Correct Answer: D Spontaneous fibrillation potentials and positive sharp waves present on EMG 2-3 weeks after injury are evidence of denervation. This occurs with axonotmesis, a class 2 peripheral nerve injury (PNI) with axonal damage and Wallerian degeneration distal to the lesion. Incorrect Choices: Polyphasic motor units of low amplitude and short duration are evidence of reinnervation. Neurapraxia is a class 1 PNI with local compression or blockage. EMG typically reveals no spontaneous activity.

Answer 68

Correct Answer: B The Q-angle is a static postural alignment measure commonly assessed in patients with PFPS. Increased hip adduction and femoral internal rotation during the test is associated with increased risk for PFPS. Incorrect Choices: Patella baja and patella alta have weak associations with PFPS. The hop test is most commonly used following ACL rupture or repair. Genu recurvatum and performing a heel raise or single leg stance may all provide useful information related to lower extremity and knee biomechanics but are not the primary test and measures associated with PFPS.

Answer 69

Correct Answer: D The most appropriate strategy is to hold a conference with the physician and family and discuss the patient's questions. Everyone interacting with this patient should be answering questions in the same way. A direct and honest approach is best, but must be consistent with the parents’ wishes because this patient is a minor child. Incorrect Choices: The other choices in this scenario do not address the issue at hand effectively or respect the patient's or parents’ concerns.

Answer 70

Correct Answer: A Exercise at low to moderate intensities is the heneral rule for patient with muscular dystrophy. Because of the young age of this child, exercise should be fun. Recreational exercise (swimming) satisfies this requirement and should be helpful in maintaining functional level as long as possible. At 6 years of age, wheelchair confinement is not usual. Incorrect Choices: Muscle with grades of 3 or less will not benefit from active or resistive exercise. Progressive resistance strength training (choices) and circuit training (choice 2) can be harmful at high intensities, producing overwork injury. Wheelchair sports (choice 4) Is not applicable for a 6-year-old child.

Answer 71

Correct Answer: C This patient is demonstrating early signs of complex regional pain syndrome (CRPS) type | (formerly known as reflex sympathetic dystrophy). These changes typically begin up to 10 days after injury. Passive manipulation and ROM of the shoulder can further aggravate the patient's sympathetically maintained pain. Incorrect Choices: In type | CRPS, all of the other treatments can be used.

Answer 72

Correct Answer: C Transferring objects from one hand to another is a task developmentally appropriate for an 8-or 9-month-old. Incorrect Choices: A fine pincer grasp is an 11-month skill and stacking 2 blocks is a 12-15 month skill, while stacking 6 blocks is a 16-24 month skill. Holding a cup by the handle while drinking usually occurs by 12 months of age.

Answer 73

Correct Answer: B This patient is exhibiting signs and symptoms of slipped capital femoral epiphysis, characterized by a gluteus medius gait. Closed-chain exercises with weight bearing to tolerance will help regain or maintain functional muscular strength and normal motion. Incorrect Choices: The signs and symptoms are consistent with slipped capital femoral epiphysis and not any of the other conditions. Avascular necrosis of the femoral head (osteochondritis dissecans) involves the necrosis and separation of a small segment of the subchondral bone from the femoral head (epiphysis). The hip is painful upon weight bearing. Legg-Calve- Perthes disease (osteochondrosis of the femoral head) produces a painful hip with limited motion in abduction and internal rotation. Deformity (flattening) of the femoral head is a complication. Femoral anteversion occurs when the femoral neck is directed anteriorly when the knee is directed anteriorly.

Answer 74

Correct Answer: B This is a full-thickness burn wound. It is characterized by white (ischemic) and black (charred) areas. Skin is parchment-like, leathery, and dry. Full-thickness burns heal with skin grafting and scarring. Incorrect Choices: Partial-thickness burns are bright pink or red with a wet surface and blisters. This injury extends beyond the superficial skin (pink or red burn with no blisters). Superficial burns heal with minimal to no scarring. There is no indication that this burn extends down to the bone.

Answer 75

Correct Answer: D This individual is demonstrating signs and symptoms of dehydration (inadequate fluid intake) and hypovolemic shock. Pulse and respirations are increase; blood pressure (BP) may decline. Restlessness, anxiety, and confusion may al be present. Incorrect Choices: Hypervolemia is an abnormal increase in the volume of circulating blood. Anaphylactic shock is a severe hypersensitivity (allergic reaction) to a substance with symptoms of local allergen-antibody interaction (hives, edema, warmth, erythema) as well as systematic symptoms of flushing, wheezing, dyspnea, and anxiety. Septic shock (sepsis) Is a systematic inflammatory response to Infection characterized by fever, tachycardia, tachypnea, and organ failure.

Answer 76

Correct Answer: A Open motor skills are movement skills that can be performed in a variable, changing environment. Externally paced skills must comply with timing demands from the environment (e.g., walking through a revolving door). Incorrect Choices: Closed motor skills are movement skills that are performed in a stable, nonchanging environment. Serial skills are movements that combine a series of discrete elements, with a specific order of elements. Continuous skills are movement skills that appear to have no recognizable beginning or inherent beginning and end.

Answer 77

Correct Answer: A The correct measure for seat height in a wheelchair is 2 inches clearance between the floor and the foot plate, measured from the lowest point on the bottom of the footplate. Incorrect Choices: Leg measurement from the popliteal fossa to heel with customary footwear in place is used to determine footrest length on the wheelchair, not correct seat height. Clearance of 4 inches is too high

Answer 78

Correct Answer: C The basal ganglia functions to convert general motor activity into specific, goal- directed action plans. Dysfunction results in problems with motor planning and scaling of movements and postures. Patients benefit from initial guided movement and task- specific training. Proprioceptive, tactile, and verbal cues can also be used prior to and during a task to enhance movement. Incorrect Choices: The other listed deficits (choices) are not seen with basal ganglia disorders. Paralysis, hypertonicity and hyperreflexia occur with upper motor neuron lesions (corticospinal tract involvement). Problems with sensory organization and selection can occur with traumatic brain injury and stroke, and in children with cerebral palsy, Down syndrome, and learning disabilities.

Answer 79

Correct Answer: C Based on the information given, the NEXT thing the PT should do is determine what is causing the impairments so that the PT can target treatment to the tissue(s) at fault. Limitation of active shoulder flexion can be due to weakness (less than 3/5 strength) of any of the following muscles: deltoid, supraspinatus, serratus anterior and upper trapezius. However, the loss of active shoulder flexion could also be due to capsular restrictions. A patient who sustained a proximal humerus fracture and resulting immobilization would likely have a capsular restriction as well as muscle atrophy. One must determine the primary impairment in the limitation of active shoulder flexion. Performing passive shoulder flexion and glenohumeral accessory mobility testing will help determine the tissue(s) at fault. If full passive ROM is found, further testing of individual muscles is necessary to determine which muscles to strengthen. If there are restrictions in passive shoulder flexion and capsular restrictions, a program including joint mobilization is appropriate. Incorrect Choices: Manual muscle test of serratus anterior and rhomboids. Certainly, restricted shoulder flexion could be due to weakness in the serratus anterior. However, a weak serratus anterior would result in retraction of the scapula and possible winging, not protraction and upward rotation of the scapula. In addition, the rhomboids are downward rotators, retractors and elevators of the scapula. In this scenario, the scapula upwardly rotated and protracted, two actions that are antagonistic to rhomboid action. Therefore, weakness of the rhomboids would not be a concern. Manual resistance exercises for the supraspinatus and infraspinatus. This treatment would be appropriate for weakness of the rotator cuff. This is incorrect, since there is not enough information to begin treatment (no indication that the loss of ROM and excessive scapular motion are due to rotator cuff weakness). Large amplitude oscillations performed at the end-range of joint play for the glenohumeral inferior and posterior capsule. This treatment would be appropriate for capsular restrictions. This is incorrect, as there is not enough information to begin treatment (no indication that the loss of ROM and excessive scapular motion are due to capsular restriction).

Answer 80

Correct Answer: A Immediate effects of radiation include skin effects (erythema, edema, dryness. ltching, hair and fingernail loss, and loose skin). The PT should observe skin care precautions (avoid topical use of alcohol and drying agents and avoid positioning the patient directly on the radiated area). Exposure to heat modalities is also contraindicated. Incorrect Choices: Although postradiation patients are more susceptible to infection due to Immunosuppression, there is no evidence of infection in this patient (fever is often the 1st sign). Stretching exercises are important during and after radiation. Low-to-moderate- intensity aerobic exercise is appropriate.

Answer 81

Correct Answer: A In order to overcome the coefficient of friction of the body moving horizontally over the surface of a table, the traction force should be at least 25% of the body weight when using a split table, or 50% when using a non- split table. To achieve joint distraction, a force of 50% body weight is recommended. However, because it is the initial traction, a minimum of 25% for the 15! treatment is recommended to determine patient response. This would provide sufficient force to decrease muscle spasm and stretch the soft tissue, thereby decreasing the compressive force on the spine and allowing for greater ease of joint separation as the force is progressed. Incorrect Choices: Forces above 50% are generally not recommended for the lumbar spine.

Answer 82

Correct Answer: B Weakness or delayed contraction of the ankle dorsiflexors or spasticity in the ankle plantarflexors may cause foot drop during midswing. Incorrect Choices: Excessive extensor synergy would cause plantarflexion during stance. Decreased proprioception of the foot-ankle muscles would cause difficulties with foot placement and balance during stance. A strong flexor synergy can cause dorsiflexion with hip and knee flexion during swing.

Answer 83

Correct Answer: A In a PTB socket, relief is provided for pressure-sensitive areas: the anterior tibia and tibial crest, fibular head, and fibular (peroneal) nerve. Incorrect Choices: All the other choices are considered pressure-tolerant areas.

Answer 84

Correct Answer: A An insulin deficiency in a patient with diabetes leads to the release of fatty acids from adipose cells with a production of excess Ketones by the liver (diabetic ketoacidosis [DKA]). Signs and symptoms Include alterations in Gl function (anorexia, nausea and vomiting, abdominal pain), neural function (weakness, lethargy, malaise, confusion, stupor, coma, depression of vital functions), cardiovascular function (peripheral vasodilation, decreased HR, cardiac dysrhythmias), skin (warm and flushed) and increased rate and depth of respiration. The PT should report these changes immediately; the patient is in need of immediate intravenous insulin, fluid and electrolyte replacement solutions. Incorrect Choices: The other choices do not have a similar pattern of signs and symptoms. Respiratory acidosis is caused by inadequate ventilation and the retention of carbon dioxide. Renal acidosis is the result of kidney failure, with accumulation of phosphoric and sulfuric acids. Lactic acidosis is an accumulation of lactic acid in the blood due to tissue hypoxia, exercise, hyperventilation or some drugs.

Answer 85

Correct Answer: A The dysfunction observed on the x-ray is Osgood-Schlatter disease. The radiograph depicts epiphysitis of the continued explosive contractions of the quadriceps muscle complex during pubescent growth spurts. Patient education should focus on controlling knee-loading activities such as squatting and jumping. lonthophoresis using dexamethasone (a corticosteroid) provides a safe mechanism to deliver local anti- inflammatory medication. Incorrect Choices: Explosive contractions of the quadriceps complex should be avoided. Ambulation and AROM activities maintain mobility while the structure heals. Phonophoresis would be contraindicated because it may be painful to move the sound head over the affected area. In addition, US should be used with precaution over open epiphyses. Open-chain knee extension exercise may aggravate symptoms due to the increased load at the attachment of the patellar tendon to the tibial tuberosity.

Answer 86

Correct Answer: D The navicular drop test is a measurement of the difference in navicular height in millimeters from standing subtalar joint neutral to standing relaxed foot posture and Is used clinically as a composite measure (indicator) of excessive foot pronation. Collapse of the medial longitudinal arch is typically associated with excessive rearfoot and midfoot pronation. Incorrect Choices: The dorsal talonavicular ligament is a relatively thin, wide band attaching from the dorsal talar neck and running distally to the dorsal surface of the navicular bone. It supports the capsule of the talonavicular joint. There is no known clinical test to assess the integrity of the ligament. Midtarsal jointmotion along its descriptive longitudinal axis is thought to be primarily associated with Inversion and eversion motions in which the axis for this motion passes through the navicular bone. The navicular drop test is not utilized to assess midtarsal longitudinal motions. The tibialis anterior attaches to the dorsal surface of the first cuneiform and base of the 15t metatarsal and acts to dorsiflex the ankle and assists in inversion of the foot. While it potentially could offer some limited restraint to foot pronation, the navicular drop test is not utilized to test the integrity of the tibialis anterior tendon.

Answer 87

Correct Answer: C Stemmer’s sign is positive for lymphedema in the presence of a thickened cutaneous fold of skin over the dorsal proximal toes or fingers. There is an inability or difficulty lifting up or pinching the skin in this area. It appears in the late stages of lymphedema. Incorrect Choices: Pitting edema is present in early stage | (reversible) lymphedema, while during stage II pitting is difficult to induce due to the presence of fibrotic tissue. Dermal backflow refers to the movement of a tracer substance back down the limb during a lymphoscintigram. The scenario clearly rules out secondary edema since the history is indicative of primary lymphedema.

Answer 88

Correct Answer: B The PT should complete the examination of the patient, adequately document the findings, and determine the PT diagnosis. Although many states have direct access laws that permit physical therapy intervention without referral, most insurance companies, including Medicare (affecting the patient in this example), require a physician referral in order for services to be reimbursed. Thus, the PT needs to demonstrates stress incontinence, a problem that could be successfully treated with PT (e.g., Kegel's exercise and other interventions). Incorrect Choices: The other choices do not offer successful resolution for her problems. The PT is not being an active advocate for the patient in dealing with the incontinence.

Answer 89

Correct Answer: B Neurapraxia is a mild peripheral nerve injury (conduction block ischemia) that causes transient loss of function. Nerve dysfunctionis rapidly reversed, generally within 2-3 weeks. An example is a compression injury to the radial nerve from falling asleep with the arm over the back of a chair (Saturday night palsy). Incorrect Choices: If the nerve is cut, the distal part degenerates (wallerian degeneration). Regeneration (nerve growth and repair) is dependent upon intact Schwann cell and continuity of the nerve pathway. Regrowth is at the rate of 1-4 mm/d. in this case, the nerve injury was not severe enough to initiate regeneration.

Answer 90

Correct Answer: A Assess the needs of the patient and provide appropriate information. The PT is well qualified to provide information on the expected rehabilitation process. Incorrect Choices: Do not “pass the buck” unless the information is outside of the scope of the therapist's expertise. Refer the Guide for Professional Conduct, Appendix B, Chapter 12, Professional Judgment.

Answer 91

Correct Answer: D Metabolic syndrome (prediabetic state) is characterized by central obesity, insulin resistance, and dyslipidemia. Individuals with metabolic syndrome may develop hypertension and reactive hypoglycemia (as In this case) in response to exercise. Signs and symptoms of hypoglycemia include difficulty concentrating and speaking, confusion and developing incoordination. The therapist should sit the patient down and administer fruit juice immediately. Incorrect Choices: All other choices do not address the problem of hypoglycemia. Action should be taken immediately to stabilize glucose levels.

Answer 92

Correct Answer: C The uncinated processes (joints of Luschka) are located at the inferolateral aspect of the lower cervical vertebrae. Side-bending is lost with degenerative changes at the joint that the uncinated process makes with the vertebra below. Incorrect Choices: Other motion is restricted, but to a lesser degree. Review the joints of Luschka in the Review and Study Guide if necessary.

Answer 93

Correct Answer: A Normal fasting plasma glucose is less than 115 mg/dL, while a fasting plasma glucose level greater than 126 mg/dL on more than one occasion is indicative of diabetes. This patient is hyperglycemic with high glucose levels (= 250 mg/dL). Clinical signs that may accompany this condition include ketoacidosis (acetone breath) with dehydration, weak and rapid pulse, nausea/vomiting, deep and rapid respirations (Kussmaul’s respirations), weakness, diminished reflexes, and paresthesias. The patient may be lethargic and confused, and may progress to diabetic coma and death if not treated promptly with insulin. Physical therapy intervention is contraindicated; exercise can lead to further impaired glucose uptake. Coordination with the medical staff is crucial, so that the patient's blood glucose levels can be appropriately managed. Incorrect Choices: Ambulation is contraindicated. Postponing consultation with the medical staff is potentially dangerous for the patient.

Answer 94

Correct Answer: A The architectural standard for rise of a step is 7 inches (steps may vary from 7-9 inches). The recommended ratio of slope to rise is 1:12 (an 8% grade). For every inch of vertical rise, 12 inches of ramp will be required. A straight ramp will have to be 252 inches, or 21 feet, long. Incorrect Choices: The other choices do not adequately account for the 1:12 ratio (8% grade).

Answer 95

Correct Answer: B This patient is experiencing peripheral neuropathy, as evidenced by the paresthesias and distal weakness in both hands and feet. Incorrect Choices: Whereas myopathy may be a potential adverse effect of immunosuppression, it would not present as symmetrical distal weakness with paresthesias. Quadriparesis can also occur with immunosuppression, but would present with spasticity and more widespread paresis. Leukopenia is an abnormal decrease in the number of white blood cells, and can also occur with Immunosuppression.

Answer 96

Correct Answer: A With axillary dissection, the long thoracic nerve may be damaged. This leads to serratus anterior weakness and loss of scapular control. Gravity-assisted exercises to promote scapular control should be emphasized early in rehabilitation to help restore proper scapular humeral rhythm. Incorrect Choices: Because the dysfunction is associated with scapular control, the rotator cuff and deltoid muscles would not be involved. The rhomboids are important for scapular control, but they are innervated by the dorsal scapular nerve, which is not typically injured during the surgical procedure stated.

Answer 97

Correct Answer: C Forward advancement of the tibia from midstance to heel-off is controlled by eccentric contraction of the plantarflexors; from heel-off to toe-off, the plantarflexors contract concentrically. Either spasticity or contracture of the plantarflexors would limit this forward progression. Patients compensate by going right into swing, typically with a circumducted gait or with increased hip and knee flexion because there is no push-off. Incorrect Choices: Spasticity or contracture of the dorsiflexors is typically not seen, and could not cause this deficit. Weakness of the hip extensors would be evident at heel strike, with a backward lean of the trunk.

Answer 98

Correct Answer: C Ideational apraxia refers to an inability to perform a purposeful motor act, either automatically or upon command. lt is a failure in the conceptualization of the task. Incorrect Choices: Ideomotor apraxia refers to an inability to perform a purposeful motor act on command while retaining the ability to perform the task automatically. Dyssynergia refers to impaired ability to associate muscles together for complex movement (decomposition of movement). Cognitive inattention refers to an inability to select and attend to a specific stimulus while simultaneously suppressing extraneous stimuli.

Answer 99

Correct Answer: B Those with Ol (fragile bones) are very susceptible to fractures. PROM as well as traction to any long bones is contraindicated. Incorrect Choices: One can actively exercise those with MD; however, do not over-exercise these children because damage to muscle fibers can result In permanent damage and decline in function. PROM with children with arthrogryposis is indicated because contractures are one of their main issues. Limiting sensory input for some children with autism is appropriate; however, for others the treatment strategy that is best is to increase sensory inputs.

Answer 100

Correct Answer: A Because muscular dystrophy does not change the lung parenchyma, resting end expiratory pressure (REEP) will occur at the same point of equilibrium between lung recoil and thoracic outward pull. Therefore, functional residual capacity will not change. Incorrect Choices: Muscular dystrophy will alter the respiratory muscles’ ability to pull in air and blow out air; therefore, vital capacity, total lung capacity and FEV1 will be decreased.

Answer 101

Correct Answer: A Vigorous upper limb activities can cause inflammation of soft tissues surrounding the shoulder, resulting in compression of the long thoracic nerve and weakness of the serratus anterior. The serratus anterior stabilizes the scapula with greater than 90° of abduction Incorrect Choices: Supraspinatus tendinitis or weakness does not result in scapular winging. The supraspinatus muscle in concert with the deltoids initiates abduction in the upper extremity. Subdeltoid bursitis causes pain with all AROM and does not result in scapular winging.

Answer 102

Correct Answer: B This patient is presenting with classic signs and symptoms of unilateral vestibular dysfunction. An abnormal vestibular ocular reflex (VOR) produces nystagmus (involuntary cyclical movements of the eye), loss of gaze stabilization during head movements, and oscillopsia (an illusion that the environment is moving). Abnormal vestibulospinal function produces Impairments in balance and gait. Veering to one side is indicative of unilateral vestibular dysfunction (in this case, the left side). Incorrect Choices: BPPV is associated with episodic vertigo, nausea, blurred vision and autonomic changes that occur with head movement, and typically stop within 30 seconds once the head is static. Acoustic neuroma is a benign tumor affecting CN VIII, and is associated with progressive hearing loss, tinnitus and disequilibrium. Meniere's disease is associated with symptoms of nausea and vomiting, episodic vertigo, and fullness in the ear with low-frequency hearing loss.

Answer 103

Correct Answer: B The long head of the biceps is best exposed in shoulder lateral rotation and extension, due to its attachment at the supraglenoid tubercle of the scapula, which is at the medial aspect of the shoulder joint. Incorrect Choices: Medial rotation and abduction places the long head of the biceps deep to the anterior deltoid and pectoralis major muscles. The anterior surface of the shoulder, including the long head of the biceps, loses exposure with horizontal adduction.

Answer 104

Correct Answer: A Normally, radiographic evidence of healing is present within 2-6 weeks (soft callus phase). This radiograph represents a nonunion fracture. A nonunion is a fracture that will not heal, and there are no signs of bone repair over a period of 3 consecutive months (bridging and callus formation are absent). Typical causes of non-union fractures include infection, inadequate mobilization, poor blood supply, and muscle or some type of tissue interpositioned between the fractured segments. The distal tibia is more frequently the site of nonunion fractures in the long bones of the lower extremity, due to a sometimes inadequate blood supply. Incorrect Choices: If there were bridging or a callus formation, but less than expected, then it would be classified as a delayed union fracture. A delayed union is characteristic of a fracture that has not healed within the expected time frame, and there is evidence that it will heal given time and the right environment. In the case of delayed union, a bone stimulator, change in weight-bearing status and/or the use of an immobilizer boot for the leg may be needed. A fibular fracture typically does not restrict weight bearing status because this is a non-weight bearing bone. Reference image above: http://boneandspine.com/orthopaedic- Images/xray-union-shaft-fibula/

Answer 105

Correct Answer: B Paralysis of the upper limb typically results from a traction injury at birth, causing a brachial plexus injury. Variations include Erb- Duchenne or Erb’s paralysis (affecting C5-C6 roots), whole arm paralysis (affecting C5-T1 roots), and Klumpke's paralysis (affecting the lower plexus nerve roots, C8, and T1). Partial immobilization of the limb across the abdomen followed by gentle ROM is the best choice for initial intervention. Incorrect Choices: Mobilization in overhead motions is contraindicated. Splinting the shoulder in abduction leads to formation of abduction contractures and later hypermobility of the shoulder. Age-appropriate task training can follow after the initial treatment.

Answer 106

Correct Answer: A The ligamentum flavum becomes hypertrophied with lumbar spondylosis and may invade the intervertebral foramen, compressing the left LS spinal nerve root. Incorrect Choices: The supraspinous ligament and anterior longitudinal ligaments are unlikely to compress any neurological structures based on their anatomical locations. The posterior longitudinal ligament is so small and centrally located in the lower lumbar region that it is not able to compress a spinal nerve (actually more likely to compress the spinal cord [i.e., cauda equine]).

Answer 107

Correct Answer: B The TUG test records the time it takes for an individual to stand up, walk 3 m, turn, return to the chair, turn and sit down. Most adults can complete the test in 10 seconds; scores between 11 and 20 are normal for frail elderly; scores over 30 are indicative of impaired functional mobility and high risk for falls. Incorrect Choices: A score of 33 seconds is not low or moderately abnormal.

Answer 108

Correct Answer: B According to the American College of Sports Medicine, an absolute indication for terminating an exercise bout is the onset of moderate to severe angina. Other absolute Indications include acute MI, a drop in systolic BP with increasing workload, serious arrhythmias (second-or third-degree heart blocks, sustained ventricular tachycardia or premature ventricular contractions, atrial fibrillation with fast ventricular response), unusual or severe shortness of breath, CNS symptoms (ataxia, vertigo, confusion), or patient's request. Incorrect Choices: The other choices (fatigue, 1.5 mm downsloping ST segment and supraventricular tachycardia) are considered relative indications and would require close monitoring

Answer 109

Correct Answer: D The anterior talofibular ligament (ATFL) provides the main restraint to anterior lateral translation of the talus within the mortise. Passive anterior translation of the talus is performed in 20° of plantarflexion. Excessive anterior translation of the talus during an anterior drawer test is considered indicative of significant laxity or rupture of the ATFL, and the test appears to be the most useful when performed within 4-7 days of the initial injury. Incorrect Choices: The calcaneofibular ligament acts as the primary restraint to inversion when the ankle Is in neutral or dorsiflexion and limits talar tilt. Testing of lateral talar tilt would be performed when attempting to examine integrity of the calcaneofibular ligament. The lateral talocalcaneal ligament is associated with stability of the talocalcaneal (subtalar joint) and would not offer significant restraint to motions of the talus within the mortise joint. The anterior tibiofibular ligament stabilizes the distal tibiofibular joint and would not offer restraint to anterior translation of the talus.

Answer 110

Correct Answer: B The patient with PD typically develops elbow flexion, shoulder adduction contractures of the upper extremities, along with a flexed, stooped posture. Bilateral symmetrical upper extremity PNF D2F patterns encourage shoulder flexion and abduction, with elbow extension and upper trunk extension (all needed motions). Incorrect Choices: Both quadruped and modified plantigrade positions encourage postural flexion. The patient needs exercises to improve postural flexibility and AROM, not strength of shoulder flexors

Answer 111

Correct Answer: B Psychotherapeutic drugs (e.g., tricyclic antidepressants such as Elavil) reduce alertness and slow central processing, thereby increasing fall risk. Other medications linked to increased risk of falls include antihypertensives (especially vasodilators), antiarrhythmics, diuretics, and analgesics (especially opiods).

Answer 112

Correct Answer: C Phonophoresis and education regarding consumption of only soft foot should help resolve the acute inflammatory process in the temporomandibular joint. Incorrect Choices: Application of an intraoral appliance occurs only when the acute inflammation is not resolved or buxism continues. Joint mobilization should not be attempted with an acute inflammation.

Answer 113

Correct Answer: A It is important to recall that functional resting position is slight wrist extension, supported fingers in natural slightly flexed position, and thumb partially opposed to promote proper joint position for recovery and future hand use. Incorrect Choices: The other choices do not place the hand in a functional position.

Answer 114

Correct Answer: D A hyperextended knee can be caused by extensor spasticity, quadriceps weakness (a compensatory locking of the knee), or plantarflexion contractures or deformity. The most likely cause in this case is extensor spasticity, which is consistent with strong obligatory synergies (stage 3 recovery). Incorrect Choices: Spasticity in dorsiflexors is atypical and would not cause knee hyperextension. Hip flexor and hamstring weakness would result In decreased lower extremity clearance during swing.

Answer 115

Correct Answer: D Clinical decisions should focus on reducing the environmental costs of exercising (change the time of day of the exercise class to reduce the heat stress) or reducing the overall metabolic costs of the activity (decrease the pace of exercise, add more rest periods). Incorrect Choices: Clinical decisions should focus on reducing the environmental costs of exercising (change the time of day of the exercise class to reduce the heat stress) or reducing the overall metabolic costs of the activity (decrease the pace of exercise, add more rest periods).

Answer 116

Correct Answer: D Patients should be educated to minimize certain positions for long periods. Symptoms resulting from Paget's disease are aggravated by positions in which the lumbar spine is in extension. Incorrect Choices: Because this is a chronic condition, modalities are not the most effective management strategy. Lumbar extension exercises decrease the space within the vertebral foramen, thereby increasing symptoms of pain associated with stenosis and Paget's disease. Strengthening exercises for the abdominal and back muscles do not affect the disease processes of slowly progressive enlargement and deformity of multiple bones.

Answer 117

Correct Answer: D Ober’s test is used to assess the extensibility of the tensor fascia lata and iliotibial band and is performed with the patient in a side- lying position with the lower leg flexed at the hip and the knee for stability. The upper leg Is passively abducted and slightly extended at the hip with the knee flexed to 90° (or extended). The examiner stabilizes the pelvis and allows the upper limb to slowly lower. The test is considered positive when the examined leg fails to lower beyond horizontal. The leg will remain abducted if the tensor fascia lata and iliotibial band are tight. Incorrect Choices: The ischiofemoral ligament limits internal rotation in flexion and extension and would therefore not be assessed with Ober’s test. The psoas is a flexor of the hip, and while it would be elongated with passive hip extension, it does not limit hip adduction, and therefore Ober's test would not be used to evaluate its extensibility. The posterior fibers of the gluteus maximus would be elongated during hip flexion and therefore not be assessed by Ober’s test.

Answer 118

Correct Answer: A Studies have shown that following a TKR, CPM significantly increases active knee flexion ability as compared with active knee extension or passive motions. The difference Is significant 2 weeks’ postsurgery. Incorrect Choices: The other choices are not the focus of, nor do they derive the same benefits of CPM use.

Answer 119

Correct Answer: C Following burns, edema and hypertrophic scarring can be effectively controlled with custom pressure garments. Pressure should be maintained 23 hours per day, often for 6- 12 months. Incorrect Choices: Surgery (surgical release) is an option of last resort. Compression wraps (elastic bandages) and occlusive dressings have no impact on hypertrophic scarring.

Answer 120

Correct Answer: A If a muscle were in a hypertonic state (muscle spasm), one would expect little change in cross-sectional area (CSA) since the exercise engages a muscle that is already contracting to some extent. Incorrect Choices: Normally, as a muscle concentrically contracts from its resting state, the CSA increases and the length decreases. A variety of factors can influence the CSA; e.g. longissimus invading the multifidus space), it may decrease or limit the CSA of the muscle being monitored; the angle of the transducer head can alter the dimensions of the muscle.

Answer 121

Correct Answer: B In a combination of knee extension and Internal rotation the menisci will move anteriorly during extension as they follow the tibia. In addition, the medial meniscus will move further anterior and the lateral meniscus will move posteriorly as they follow the femoral condyles during rotation. This specific combination will result in a tensile stress at the medial meniscus and a compressive stress at the lateral meniscus of a left knee. Incorrect Choices: Tensile lateral and compressive medial stresses result from a combination of flexion and internal rotation. The stresses placed in each meniscus cannot be the same given the direction of forces.

Answer 122

Correct Answer: B For the lumbar region, the oblique view will clearly demonstrate the pars interarticularis. Incorrect Choices: The anteroposterior and lateral views will not demonstrate the pars interarticularis. The lateral view may show anterior discplacement of the segment above a pars defect if the condition has progressed to a bilateral displaced fracture of the pars interarticularis (i.e., spondylolisthesis); however, the lateral view will not show the anatomy of the pars interarticularis.

Answer 123

Correct Answer: C Interrater reliability is the degree to which two or more independent raters can obtain the same rating for a given variable. In this case, two therapists obtained different FIM scores for the same group of patients, indicating a problem in interrater reliability. Incorrect Choices: Intrarater reliability is the consistency of an examiner on repeat tests. Issues of validity (Does the test measure what it says it measures?) are not relevant.

Answer 124

Correct Answer: B These are the tests to examine vagus nerve (CN X) function. Incorrect Choices: The trigeminal nerve (CN V) has both sensory and motor components. Sensory tests include pain and light touch to forehead, cheeks and jaw along with light touch (cotton wisp) to cornea. Motor function involves testing the temporal and masseter muscle (patient clenches teeth and holds against resistance). The facial nerve (CN 7) Is tested using motor tests: raise eyebrows, frown, show teeth, smile, close eyes tightly and puff out both cheeks. The hypoglossal nerve (CN 12) is testing using motor tests: tongue movements.

Answer 125

Correct Answer: B Pain at end-range of flexion, abduction, external rotation, and extension (FABERE test) is diagnostic for Sl joint dysfunction because it both gaps and compresses the joint. Incorrect Choices: Pain at the midrange into hip flexion, abduction and external/lateral rotation suggests hip joint pathology. Patient reported low back pain, and if the sartorius or the hip were involved, the complaint of pain would have been reported in the anterior and medial thigh. Renal pain is often referred to the costovertebral region, flank, or lower abdominal quadrant.

Answer 126

Correct Answer: D Patients with vascular insufficiency and claudication pain should be encouraged to walk daily, 2 to 3 times/day. Duration should be short. The patient should walk to the point of maximum tolerable pain, and be allowed to rest. Incorrect Choices: High intensity exercise (30- or 60-minute sessions, 3/week) is contraindicated. Twice- a-week sessions are too infrequent to be beneficial.

Answer 127

Correct Answer: C The practice of using supportive personnel falls under the Code of Ethics and under the individual practice acts of the states. Delegated responsibilities should be commensurate with the qualifications (experience, education and training) of the individual to whom responsibilities are being assigned. In this case, it is not reasonable to assume that an aide, newly arrived to the PT department, has the knowledge or skills to do this treatment. The PT should do the ROM exercises. Incorrect Choices: A brief orientation to ROM exercises is not adequate to ensure proper treatment. Deferral of the treatment or rescheduling does not address the concern about loss of ROM.

Answer 128

Correct Answer: C The purpose of postural drainage is to help remove retained secretions. If the amount of secretions diminishes, this might be an indicator that the treatment has been successful and that the frequency of treatment can be reduced. Incorrect Choices: The other choices indicate the patient's condition is worsening. Change of secretions from white to yellow (or green) suggests a developing pulmonary infection. An increase in temperature (febrile) also suggests infection (pulmonary, wound or urinary tract). If the patient reports an increase in postoperative pain, the patient would be unable to handle his/her secretions independent of the PT. All would be an Indication to maintain the PT intervention, not decrease it.

Answer 129

Correct Answer: B Large electrodes are used on large muscles In order to disperse the current (minimize current density under the electrode), enabling a more comfortable delivery of current. Widely spaced electrodes permit the current to travel deeper into the muscle to stimulate a greater number of deeper muscle fibers. Incorrect Choices: The other choices do not meet these guidelines. Utilizing small electrodes would cause the current to be concentrated over a smaller surface area, thus increasing the current density under the electrode. Exceeding the current density of an electrode can cause the patient discomfort, skin irritation, or a thermal burn. Close spacing of electrodes encourages superficial flow of current, rather than deeper flow.

Answer 130

Correct Answer: C Autolytic wound debridement allows the body's natural enzymes to promote healing by trapping them under a synthetic, occlusive dressing. Moisture-retentive dressings are applied for short durations (<2 weeks). Choices include transparent film dressings or hydrocolloid or hydrogel dressings. Incorrect Choices: The other interventions are wound management techniques; however, they are not autolytic.

Answer 131

Correct Answer: C Adolescents prefer to be treated as adults. It Is important to incorporate the patient's goals into the POC. Incorrect Choices: Too much structure limits trial-and-error learning, which is superior for retention of skills. Length of practice sessions should be determined by the difficulty of the skill and ability of the patient. The PT is often the least successful model to demonstrate motor skills. Use an individual with a similar disability who has mastered the required skill (rehabilitation graduate).

Answer 132

Correct Answer: B Myopathy and neuropathy can develop, indicating rejection in a patient with a solid organ transplant in either the acute or the chronic stage. Given the onset of the new symptoms, reporting the changes and securing medical follow-up are the most important actions for the therapist. Incorrect Choices: Although initiating an exercise program would be indicated, the stated balance exercises are at too low a level considering the Berg Balance score. Progressive resistance exercises would not be the exercise of choice due to possible rejection problems. Referral to a neurologist is not indicated.

Answer 133

Correct Answer: A An elderly patient with a cardiac history may present with initial symptoms of mental confusion, the result of oxygen deprivation to the brain. The shortness of breath and generalized weakness may be due to generalized circulatory insufficiencies coexisting with the developing myocardial infarction (Ml). Incorrect Choices: Early Alzheimer’s disease would not produce shortness of breath and generalized weakness. Chest pain would be evident with unstable angina. Hypertension is usually silent (asymptomatic). Occasionally, patients report headache.

Answer 134

Correct Answer: B Stress incontinence occurs when exercising, coughing, sneezing, or laughing as intra- abdominal pressures increase. Incorrect Choices: The pubourethral ligament maintains the relative position of the urethra to the urinary bladder; loosening of this ligament can result in bladder prolapse or herniation. A cystocele typically causes difficulty initiating voiding. Impaired sensation of the lower extremities reveals central or peripheral nerve dysfunction. Urge incontinence is the result of motor-detrusor instability.

Answer 135

Correct Answer: B Clinical decision-making in this case should focus on the patient's ability to mange in the home. Environmental modifications (the addition of a commode) and assistance of a home care aide should allow the patient to safely return home. Home physical therapy should focus on improving endurance to regain independence in the home. Treatment in the home is the most cost-effective in this case. Incorrect Choices: Postponing discharge or placing the patient In a skilled nursing facility is not necessary. Patient does not have the mobility and endurance to attend outpatient therapy.

Answer 136

Correct Answer: A The upper quadrant muscles that are most important to strengthen for crutch gaits include the lower trapezius, latissimus dorsi, and triceps. Shoulder depression and elbow extension strength are crucial for successful crutch gait. Incorrect Choices: The other choices include muscles not critical to swing-to or swing-through crutch gaits required by a patient with a complete SCI (ASIA A) at T12.

Answer 137

Correct Answer: C Excessive ischial pressure and redness from prolonged sitting require an aggressive approach. Arm push-ups, at least every 15 minutes, are indicated if redness is present. Incorrect Choices: High-density (not low-density) foam or gel cushions are used to relieve ischial pressure. ncreasing the arm rest height increases the neight of the push-up but does not address the frequency of push-ups needed. A tilt-in- space can relieve ischial pressure but is not typically ordered for SCI patients at the level of T10 unless mitigating factors prevent use of the upper extremities for pressure relief.

Answer 138

Correct Answer: C The most effective hand placement for mobilization into greater left rotation is at the posterior aspect of the right C7 articular pillar because it rotates the C7 vertebra to the left. ncorrect Choices: Hand placement on the left of C6 or C7 articular pillars will promote right rotation. Hand placement on the T1 spinous process will create a posteroanterior glide, which will promote flexion at the T1-2 segment and extension at the C7-T1 segment.

Answer 139

Correct Answer: C A positive slump test is indicated by a reproduction of the patient's symptoms in the test position that is reduced or relieved by reducing tension on the nervous systems through movement of a body segment not directly affecting the joints or muscles in the ocation of the symptoms. ncorrect Choices: The patient did not have complaints of umbar, buttocks, knee, or calf pain. Therefore, eliciting these symptoms during testing is not a reproduction of the patient's symptoms and cannot be considered a positive test.

Answer 140

Correct Answer: D With ideomotor apraxia, a patient cannot perform a task upon command but can do the task when on his/her own. Incorrect Choices: With ideational apraxia, a patient cannot perform the task at all. Unilateral neglect might lead the patient to ignore the can completely if positioned on his/her left side. Anosognosia is a more severe form of neglect, with lack of awareness and denial of the severity of one’s paralysis.

Answer 141

Correct Answer: B Cellulitis is an inflammation of the cellular or connective tissue in or close to the skin. lt is characterized by skin that is hot, red, and edematous. Fever is a common finding. Incorrect Choices: Dermatitis produces red, weeping, crusted skin lesions, but is not commonly accompanied by fever. Location on shins makes herpes an unlikely choice, and there are no skin eruptions or vesicles. Scleroderma is a collagen disease producing tight, drawn skin.

Answer 142

Correct Answer: C A maximum exercise tolerance test is a sign- or symptom-limited test. Dyspnea with a drop of 20 mm Hg in PaOz2 is an indication for stopping the test. Incorrect Choices: Achieving age-adjusted predicted maximum HR is not a sign or symptom, and therefore does not stop the test. HR is expected to increase with normal rhythm. ST segment depression, not a flat ST segment, reveals Ischemia and would be a reason to stop the test.

Answer 143

Correct Answer: C Left-sided heart failure is the result of the left ventricle failing to pump enough blood through the arterial system to meet the body's demands. It produces pulmonary edema and disturbed respiratory control mechanisms. Patients can be expected to demonstrate progressive dyspnea (exertional at first, then paroxysmal nocturnal dyspnea), fatigue and muscular weakness, pulmonary edema, cerebral hypoxia and renal changes. Incorrect Choices: Severe chest pain and shortness of breath are symptoms of impending myocardial infarction (MI). The other choices describe symptoms associated with right-sided ventricular failure.

Answer 144

Correct Answer: A These signs and symptoms could be the result of increased cerebral edema due to a clogged or infected shunt. Medical attention should be obtained immediately to avoid damage to the brain. Incorrect Choices: The other choices do not adequately respond to this emergency situation.

Answer 145

Correct Answer: B Active task-specific practice of stepping using a low step represents the best choice to ensure motor learning. Incorrect Choices: Passively bringing the foot up does not promote active learning. Marching in place and balance on stairs are appropriate lead- up skills to stair climbing, but are not task- specific practice.

Answer 146

Correct Answer: D The description of the wound is characteristic of a venous stasis ulceration, which is evident by the location (common site is superior to the medial malleolus), hemosiderosis (an accumulation of hemosiderin, a brown-colored pigment) and the liposclerosis (thickening of the tissue). Although this is a venous insufficiency wound, there could be a concomitant arterial disease, and before any type of compression therapy is applied (primary management for venous ulcerations), arterial perfusion must be assessed. The ABI is performed using a Doppler US and comparing the systolic pressure of the tibial or dorsalis pedis artery with that of the brachial artery. An ABI of 1 is normal. Incorrect Choices: An ABI of 0.5-0.8 indicates signs of decreased arterial perfusion are present, and any compression therapies will be contraindicated. Applying a four-layer bandage system (e.g., Profore) or an Unna boot is an appropriate compression therapy if arterial disease is absent. Debriding the wound in this case is not necessary (small amounts of fibrin deposits are normal), and whirlpool irrigation is harmful to granulation. In addition, placing the limb in a dependent position may further aggravate the condition.

Answer 147

Correct Answer: B Graves’ disease is caused by excess secretion of thyroid hormone (hyperthyroidism) and produces a number of clinical manifestations. Difficulty eating, mild facial edema, and abnormal protrusion of the eyes (exophthalmos) are classic signs. Other symptoms can include heat intolerance, nervousness, weight loss, muscle weakness and fatigue, tremor, and palpitations. Incorrect Choices: Chronic autoimmune thyroiditis (hashimoto’s disease) causes hypothyroidism. A number of clinical manifestations can occur, including muscle weakness and fatigue. Patients with fibromyalgia can also develop hypothyroidism. Exophthalmos is not seen with hypothyroidism. Hyperparathyroidism is caused by over activity of the parathyroid glands, leading to elevated serum calcium levels (hypercalcemia, increased bone absorption, hypercalciuria) and decreased serum phosphate levels.

Answer 148

Correct Answer: D In learning a psychomotor skill, the patient must be able to actively process information and self-correct responses. Occasional feedback provides the best means of allowing for introspection, and is appropriate for later practice (associated and autonomous phases of motor learning). Incorrect Choices: The other choices emphasize feedback more applicable to very early motor learning (cognitive phase).

Answer 149

Correct Answer: D Because the glossopharyngeal and vagus nerves mediate similar functions, they are tested simultaneously. The gag reflex is correct and is tested by swiping a tongue depressor at the back of the throat. Incorrect Choices: Swallowing is a complex function involving the combined actions of several cranial nerves (CN V, VII, IX, X, XI, and XII). Tongue protrusion is a function of the hypoglossal nerve (CN XIII). Rise and fall of the larynx during swallowing is a function of the cranial nerve root of the accessory nerve (XI).

Answer 150

Correct Answer: A Class lll heart disease is characterized by marked limitation of physical activity; the patient is comfortable at rest, but less than ordinary physical activity causes fatigue, palpitation, dyspnea or angina pain. Digitalis (digoxin) is frequently used to treat CHF (it slows HR and increases force of myocardial contraction). Adverse reactions/sde effects of digitalis can include fatigue, headache, muscle weakness, bradycardia and supraventricular or ventricular arrhythmias, including ventricular fibrillation, without premonitory signs. Incorrect Choices: The other choices are not expected adverse reactions of this medication.

Answer 151

Correct Answer: A Signs of increased intracranial pressure secondary to cerebral edema and brain herniation include decreasing consciousness with slowing of pulse and Cheyne-Stokes respirations. Cranial nerve dysfunction is typically noted in CN Il (papilledema) and CN lll (dilation of pupils). Incorrect Choices: The other choices are signs of meningeal irritation and CNS infection. All of the problems listed are serious, and can be life- threatening.

Answer 152

Correct Answer: C Initial exercise training should be performed at moderate intensity, defined as 40%-60% VO2max. Duration and frequency should start at 30 minutes per day most days of the week (ACSM guidelines). Incorrect Choices: High-intensity exercise (not moderate- intensity), is defined as (60-80% VO3) , and Is too intense for this patient, as is a 45- minute duration. A frequency of 2 days a week is too low to allow for adequate training effect.

Answer 153

Correct Answer: D Stage 4 recovery is characterized by some movement combinations that do not follow paths of either flexion or extension obligatory synergies. Knee flexion in standing is an out- of-synergy movement. Incorrect Choices: All other choices include some degree of in- synergy movements: the supine and sitting options are flexion synergy movements, and the other standing option focuses on knee and hip extension (extension synergy movements).

Answer 154

Correct Answer: B The therapist should initially teach this patient activity pacing and energy conservation techniques. It is important to balance rest with activity in order to not further weaken muscles affected by progressive postpolio muscular atrophy. Incorrect Choices: Resistance training, conditioning and aquatic therapy may be helpful in improving activity tolerance if kept at low to moderate Intensities (not evident in the incorrect choices). They should not be the therapist's initial priority.

Answer 155

Correct Answer: C A hemiplegic chair has a low seat height (17 ¥2 inches as compared with the standard seat height of 19 2 inches) and is the best choice for this patient. The patient propels it with the sound right hand and leg. An elevating leg rest on the left is indicated for edema. Incorrect Choices: A one-arm drive wheelchair has both drive mechanisms located on one wheel. The patient can propel the wheelchair by using one hand. It is contraindicated in patients with cognitive or perceptual deficits (as in this case). The eleviric wheelchair with joystick might also work but is significantly more expensive and less transportable and would also require increased maintenance. The seat height of a standard height wheelchair (lightweight active duty wheelchair) would be too high to allow propulsion using the sound foot and hand.

Answer 156

Correct Answer: B Digitalis produces characteristic changes on the ECG: gradual downward sloping of ST segment with a flat T wave and shortened QT interval. These changes can be observed during initial telemetry monitoring. Incorrect Choices: HR is decreased (not increased). BP is unchanged (not decreased). Exercise capacity is increased (not reduced).

Answer 157

Correct Answer: B The injury was to the right hypoglossal nerve (CN XII), which innervates the hypoglossus, genioglussus, and styloglossus muscles and all intrinsic muscles of the tongue. Protruding or sticking the tongue out of the mouth is done primarily by contraction of the genioglossus muscle and involves a pushing movement. In the scenario above, when the individual sticks their tongue out, the stronger left side of the tongue will be unopposed and will essentially push the tongue to the right. With lower motor neuron injury, atrophy of the ipsilateral muscles of the tongue and deviation to the ipsilateral side occurs along with speech disturbance. Penetrating injury to the neck and skull base is a common cause. Incorrect Choices: Total paralysis and deviation to the contralateral side not possible with a unilateral peripheral nerve injury. Full and straight protrusion of the tongue is indicative of normal function.

Answer 158

Correct Answer: C Patients during recovery from stroke frequently exhibit problems with rate control during walking. They are able to move at slow speeds, but as speed of movement increases, control decreases. An isokinetic device can be an effective training modality to remediate this problem. Incorrect Choices: Both initiation of movement and reaction time may be impaired, but are not the likely cause of timing deficits during speed changes while walking.

Answer 159

Correct Answer: C The right sternocleidomastoid produces left ateral rotation and flexion of the cervical spine. The right sternocleidomastoid is in engthened position with the head turned to the right and the cervical spine extended. ncorrect Choices: The other positions do not effectively stretch the right sternocleidomastoid muscle. Right side-bending and left rotation stretches the left sternocleidomastoid muscle.

Answer 160

Correct Answer: D The spinal defect is spondylolisthesis as demonstrated by the anterior displacement of one vertebra upon the subadjacent vertebra. The figure shows the Scotty dog pars in an oblique view. Incorrect Choices: Ankylosing spondylitis (marie strumpell) is a progressive chronic inflammatory rheumatoid disease that primarily involves the spine and large peripheral joints. Spondylosis refers to degenerative arthritis of the vertebrae, If it affects the zygapophyseal joints, it could result in facet syndrome. There can also be pressure on nerve roots with resultant paresthesia or pain. Spinal stenosis is a narrowing of the spinal canal, intervertebral foramina or nerve root canals resulting in neurogenic claudication. None of these conditions were evident from the figure.

Answer 161

Correct Answer: B Intermittent claudication (leg pain) occurs with peripheral vascular disease (PVD). Exercising the extremity to the point of claudication results in the development of pain, along with increased pallor of the skin. Pulses may also be decreased or absent because of ischemia. The hallmark of claudication pain is that it is relieved with rest. Incorrect Choices: The other choices are all nonvascular causes of leg pain. Neurogenic claudication is associated with burning pain and dysesthesias. Peripheral neuropathy produces aching pain with sensory loss and numbness of the feet. It can progress to involve the hands (stocking and glove distribution). Motor weakness and muscle atrophy can occur (chronic sensorimotor neuropathy) along with autonomic changes (autonomic neuropathy). Restless leg syndrome is associated with “creeping” or “crawling” sensations in the legs that result in involuntary movements.

Answer 162

Correct Answer: B The anterior drawer test places the knee in 90° of flexion. In this position, the knee joint capsule is the primary constraint to movement, so performing this test may result in a false-negative determination. Incorrect Choices: The other tests are all appropriate tests to assess the integrity of the ACL.

Answer 163

Correct Answer: D Standard precautions specify that health care workers wear personal protective equipment (moisture-resistant gowns, masks) for protection from the splashing of blood, other body fluids or respiratory droplets resulting from direct body contact with the patient. Incorrect Choices: Although hand washing is important, it is not as important as wearing gloves when the health care worker comes in direct contact with blood or body fluids. The patient with risk of transmission of known or suspected infectious agents is typically isolated in a single-patient room and wears protective equipment (masks) only when being transported out of the room. Gowns or gloves are not typically worn.

Answer 164

Correct Answer: B Patients with diabetes are prone to silent Ischemia and therefore may not feel traditional angina symptoms. A 12-lead ECG will provide real-time information as to whether the patient is experiencing ischemia. Incorrect Choices: Angina is not a reliable indicator of ischemia In this case. Perceived exertion and age predicted heart rate do not provide enough specific information when monitoring a patient during an ergometer test with a combination of history of MI and diabetes.

Answer 165

Correct Answer: B The patient is exhibiting autonomic dysreflexia (an emergency situation). The therapist should first sit the patient up and check for irritating or precipitating stimuli (e.g., a blocked catheter). The next step is to call for emergency medical assistance. Incorrect Choices: Placing the patient supine can aggravate the situation. Continuing to monitor BP before calling for help causes an unnecessary delay IN emergency services.

Answer 166

Correct Answer: C The therapist was acting outside of her area of responsibility and did something that caused the patient harm. The therapist demonstrated negligence, defined as a failure to do what a reasonably competent practitioner would have done under similar circumstances, and as a result, the patient was harmed. Incorrect Choices: The therapist was not operating within standard protocols by changing the position of an unfamiliar patient, no matter how well meaning. The patient was naive about the effects of position changes, but may request a change. The therapist is not obligated to fulfill the patient's desires (especially a patient not being treated by the therapist) and, in this case, by doing so, caused harm. Consulting with a nurse, physician's assistant or other practitioner first would have been the wise course of action.

Answer 167

orrect Answer: repeat infections produce a chronic inflammatory state. Systemic effects Include low-grade fever, weight loss, malaise, anemia, fatigue, leukocytosis, and lymphocytosis. Incorrect Choices: Inflammatory activity can be detected by an elevated ESR, redness, warmth, swelling and pain are signs of acute inflammation. Fever, tachycardia and a hypermetabolic state are signs of the systemic effects of an acute inflammation.

Answer 168

Correct Answer: D Testing the joint mobility of the talocrual and distal tibiofibular joints would be indicated if a restriction in the arthrokinematic glide of the talocrual joint was present and therefore limiting the dorsiflexion range of motion. The other possibility would be decreased flexibility in the soleus. If this was the case when a finding of normal joint mobility would indicate that decreased soleus flexibility was the culprit. Incorrect Choices: Testing active and passive range of motion with the knee straight would add a potential influence from the gastrocnemius as this is a two-joint muscle crossing the ankle and the posterior aspect of the knee. Since the initial testing position with the knee flexed indicated restricted range of motion, adding the effect of the gastrocnemius would provide no additional useful information. The restricted range of motion was present both actively and passively, ruling out decreased muscle performance as a potential reason for the limitation in range of motion.

Answer 169

Correct Answer: A Several studies have shown the safe use of US over metal implants. The acoustical energy is dispersed throughout the metal, and is absorbed into the surrounding tissue. There is no significant heating within the implant. Incorrect Choices: The other choices are contraindications for the use of US.

Answer 170

Correct Answer: D Postural reeducation will help to prevent further increases in thoracic kyphosis, and costal expansion exercise will improve breathing efficiency. Incorrect Choices: Stretching of scapular stabilizers is not Indicated because the postural changes may already have overstretched these muscles. Pain management is usually not a factor in the early stages of the condition. Joint mobilization is not a successful intervention In this progressive disorder.

Answer 171

Correct Answer: C Normal Sa0:2 is 95%-98%. A 92% Sa0z2 is lower than normal but acceptable. Incorrect Choices: Unacceptable oxygen saturation rates during exercise are all other choices (85%, 82%, 75%)

Answer 172

Correct Answer: C This patient is exhibiting signs and symptoms of spinal cord compression with upper motor neuron signs (hyperreflexia), a positive Romberg sign, and sudden falls with loss of consciousness. This requires immediate immobilization and contact with the physician for further imaging. Some cervical lesions (nondisplaced dens fracture, rupture of the transverse ligament) require greater imaging detail than radiographs provide. This indificual also has rheumatoid arthritis, which Is often accompanied by erosion of the dens and facets and ligamental laxity (transverse). Immediately informing the physician is important, and if the client is exhibiting spinal cord compression, immediate stabilization is required. Incorrect Choices: Another series of radiographs is inadequate. More detailed imaging is required. An MRI is important, but would likely miss a fracture. Sometimes, MRIs can detect fractures indirectly via imaging bone marrow edema, peripheral edema or impingement of soft tissue structures. Because there are signs and symptoms of cord compression, it would be unwise to perform ligamentous laxity testing designed to exacerbate the symptoms. Provocation tests are performed only to clear the cervical spine of ligamental laxity, NOT when it is suspected. Upper cord signs require immediate stabilization and contact with the physician.

Answer 173

Correct Answer: D A patient with a C5 SCI will not have the abdominal musculature necessary to return the diaphragm to a high- fomed position during exhalation. Inspiration will be affected by the change in the diaphragm’s resting position. In the supine position, gravity will take the place of abdominals, holding the abdominal contents under the diaphragm, improving the zone of apposition, the height of the diaphragm dome and therefore, the ability to ventilate. Incorrect Choices: The other positions listed negate the positive effects of gravity acting on the abdomen to hold the abdominal contents under the diaphragm.

Answer 174

Correct Answer: D A patient with respiratory acidosis may present with many symptoms of increased carbon dioxide levels in the arterial blood. Significant acidosis may lead to disorientation, stupor or coma. Incorrect Choices: The other choices are signs and symptoms of respiratory alkalosis or a decrease of carbon dioxide in the arterial blood.

Answer 175

Correct Answer: B Implementation of an engineering control technique can be accomplished by designing or modifying the workstation, work methods and tools to eliminate/reduce exposure to excessive exertion, awkward postures, and repetitive motions. Incorrect Choices: The other choices do not fit the definition of an engineering control technique.

Answer 176

Correct Answer: D The medial collateral ligament is the primary restraint of valgus movement with the knee in 20°-30° flexion. ncorrect Choices: n less than 20° of knee flexion, the bony congruency of the knee and the cruciate igaments contribute significantly to resisting a valgus force. In greater than 30° of flexion, the joint capsule contributes significantly to resisting a valgus force.

SUSieg 2015 Set A Only Flashcards

(200 cards)