SUSIEG 2018 A Flashcards
An elderly patient with hypothyroidism is recovering from a fall and is referred to physical therapy to increase exercise tolerance and safety. The patient complains to the therapist of significant muscle pain in both lower extremities. What additional musculoskeletal effects should the therapist examine for?
A. Distal muscle weakness
B. Proximal muscle weakness
C. Joint laxity
D. Decreased deep tendon reflexes
Correct Answer: B
Hypothyroidism can have numerous musculoskeletal effects, including myalgia (muscle pain) and proximal muscle weakness.
A patient is referred to a woman’s health clinic with moderate to severe uterine prolapse.
What symptoms should the therapist examine for?
A. Absent perneal sensation
B. Bowel leakage
C. Low back pain and perineal discomfort aggravated by prolonged standing
D. Low back pain and perineal discomfort aggravated by lying down
Correct Answer: C
Low back pain and perineal discomfort aggravated by prolonged standing are common with uterine prolapse.
A child experienced a superficial partial-thickness burn from a scalding pot of water affecting 26% of the thorax and neck. On what should the therapist’s INITIAL plan of care focus?
A. Return to preborn function and activities of daily living
B. Pain management
C. Infection management
D. Chest wall mobility and prevention of scar contracture
Correct Answer: D
Prevention of scar contracture and preservation of chest wall mobility and normal neck range of motion (ROM) are the initial major goals to focus on with this patient.
A patient with coronary artery disease has been doing regular aerobic exercise on a treadmill. If the patient fails to comply in taking prescribed beta-blocker medication and continues to exercise, what potential rebound effect could result?
A. Increase in blood pressure and decrease in heart rate during exercise
B. Decrease in blood pressure and heart rate during exercise
C. Increase in blood pressure and heart rate during exercise
D. Decrease in blood pressure and increase in heart rate during exercise
Correct Answer: C
Beta-blockers affect the beta-1 adrenergic receptors. Blocking these inhibits the sympathetic response. However, when abruptly terminated, they cause a reflexive opposite response. This patient will demonstrate increased contractility, blood pressure (BP), and heart rage (HR) as a result.
A patient has persistent midfoot pain with weight bearing. The injury occurred during a soccer match when an opposing plaver stepped on the patient’s right foot when it was planted and cutting to the left. Patient locates the pain where laces are tied. Upon examination there is splaving of the first metatarsal and increased pain when passively stressing the foot with plantarflexion and rotation. What injury should the therapist suspect the patient has sustained?
A. Lisfranc injury
B. Turf toe
C. Calcaneocuboid joint subluxation
D. Hallux rigidus
Correct Answer: A
The Lisfranc injury (also known as the Lisfranc fracture, tarsometatarsal injury, or simply midfoot injury) is an injury of the foot in which one or all of the metatarsal bones are displaced from the tarsus. Direct Lisfranc injuries are usually caused by a crush injury, such as when a heavy obiect falls onto the midfoot, or when landing on the foot after a fall from a significant height. The injury often occurs when an athlete has his or her foot plantar flexed and another player lands on his or her heel.
A patient is referred to physical therapy with a 10-vear history of rheumatoid arthritis (RA).
What are possible extra-articular complications?
A. Disc degeneration
B. Psoriatic skin and nail changes
C. Vasculitis
D. Conjunctivitis and iritis
Correct Answer: C
Rheumatoid arthritis is a progressive autoimmune disease affecting primarily joints and synovial tissue. Extra-articular complications of the disease can include vasculitis.
A physical therapist is instructing an elderly patient how to perform bed mobility following a total hip replacement. The therapist should carefully consider the effects of aging that relate to skin. What is one such effect?
A. Increased perception of pain
B. Impaired sensory integrity
C. Increased skin elasticity
D. Increased inflammatory responsiveness
Correct Answer: B
Changes in skin composition associated with aging include decreased sensitivity to touch, decreased perception of pain and temperature, and increased risk of injury.
What would a therapist who is examining the breathing pattern of a patient with a complete (ASIA A) C5 spinal cord injury expect to observe?
A. Asymmetric lateral costal expansion due to ASIA A injury.
B. An increased subcostal angle due to air trapping from muscle weakness.
C. No diaphragmatic motion since the diaphragm is below the level of the lesion.
D. Rising of the abdomen due to no abdominal muscle tone on the abdominal viscera.
Correct Answer: D
The abdominal musculature provides external stability to the abdominal viscera. Without this, the viscera are displaced with respiration.
Men are at high risk for development of metabolic syndrome if they exhibit which of the following symptoms?
A. An HDL level lower than 45mg/dL
B. A waist size greater than 40 inches
C. Triglyceride levels greater than 100mg/dL
D. Fasting blood glucose less than 100mg/dL
Correct Answer: B
Criteria for diagnosis of metabolic syndrome include abdominal obesity (waist circumference
>40 inches in men or > 35 inches in women).
During an examination, the limitations of ultrasound imaging include which of the following?
A. Inability to clearly see cartilate in infants
B. Disruption of cardiac pacemakers
C. Difficulty penetrating bone and therefore visualizing internal structure of bones
D. Inability to give a clear picture of tendons and therefore diagnose tendon tears
Correct Answer: C
Ultrasound has difficulty penetrating bone. Ultrasound images are typically used to help diagnose tendon tearsm such as tears of the rotator cuff in the shoulder or Achilles tendon in the ankle; abnormalities of the muscles such as tears; bleeding or other fluid collections within the muscles, bursae, and joints; benign and malignant soft tissue tumors; early changes of rheumatoid arthritis; fluid in a painful hip joint in children; lumbs in the neck muscles of infants; and soft tissue masses (lumps/bumps) in children.
A patient with a body mass index (BMI) of 37 is referred to physical therapy for exercise conditioning. What are additional clinical manifestations associated with the BMI that this patient might exhibit?
A. Hyperpnea and hyperpituitarism
B. Hypertension and hyperinsulinism
C. Hormone-related cancer
D. Hypolipoproteinemia and hypotension
Correct Answer: B
Obesity is associated with hypertension, dyslipidemia, hyperinsulinemia (type 2 diabetes), and hyperglycemia. The presence of these comorbidities increases risk, resulting in the need for additional medical screening before exercise testing.
When visually examining active abduction of the arm to 150 degrees, what is the normal composition of the motion a therapist would expect?
A. 150 degrees of the glenohumeral motion and O degrees of scapulothoracic motion
B. 110 degrees of the glenohumeral motion and 40 degrees of scapulothoracic motion
C. 75 degrees of the glenohumeral motion and 75 degrees of scapulothoracic motion
D. 100 degrees of the glenohumeral motion and 50 degrees of scapulothoracic motion
Correct Answer: D
Elevation of the arm into abduction involves coordinated motions involving the scapulothoracic and glenohumeral joints (along with movements at the sternoclavicular and acromioclavicular joints). While there is some variability in the precise timing and amounts during the early, middle, and late phases, motion at the glenohumeral and scapulothoracic joints generally occurs at an overall 2 to 1 ratio. Given this ratio, 150 degrees of active abduction would be a result of 100 degrees of glenohumeral and 50 degrees of scapulothoracic motion.
13.To prepare a patient with a cauda equine lesion for ambulation with crutches, what upper-quadrant muscles would be the most important to strengthen?
A. Upper trapezius, rhomboids, and levator scapulae.
B. Deltoid, coracobrachialis, and brachialis.
C. Middle trapezius, serratus anterior, and triceps.
D. Lower trapezius, latissimus dorsi, and pectoralis major.
Correct Answer: D
The muscles needed for crutch use include the shoulder depressors and extensors along with
elbow extensors.
What will a patient with a significant right thoracic structural scoliosis demonstrate on examination?
A. Decreased breath sounds on the right
B. Decreased thoracic rib elevation on the right
C. Increased lateral costal expansion on the right
D. Shortened internal and external intercostals on the right
Correct Answer: C
With a right thoracic scoliosis, the convex side is on the right. This would allow for increased aeration and mobility on that side.
A therapist has been treating a patient over a period of 4 months for decreased shoulder elevation and a loss of external rotation. Recovery has been good; however, the patient still complains of being unable to reach the upper shelves of kitchen cabinets and closets. To help the patient achieve this goal, what should be the focus of manual therapy?
A. Superior glide
B. Inferior glide
C. Anterior glide
D. Grade II oscillations
Correct Answer: C
Anterior glide would help increase external rotation (ER), which is a component of full elevation. Performing anterior glides to improve ER and late flexion will help increase overhead reach since ER of humerus occurs with flexion.
Which activity would help break up obligatory lower extremity synergy patterns in a patient with hemiplegia?
A. High kneeling position, ball throwing
B. Standing, alternate marching in place with hip and knee flexion and hip abduction
C. Sitting, alternate toe tapping
D. Sitting, foot slides under the seat
Correct Answer: A
Kneeling positions with the hip in extension and the knee flexed to 90 degrees, is an out-of-synergy position. Balance training activities (e.g., reaching, ball throwing) enhance postural control while engaging cognitive control on the added activity (ball throwing).
17.A patient recovering from stroke reports lack of feeling in the more-affected hand. Light touch testing reveals lack of ability to tell when the stimulus is being applied (only 1 correct response out of 10 tests). What addition sensory tests should the therapist perform?
A. Test for pain and temperature
C. Test for two-point discrimination
B. Test for two-point discrimination
D. Test for barognosis
Correct Answer: A
Testing for pain and temperature can be performed as these sensations are carried in different pathwavs (anterolateral spinothalamic pathways); light touch is carried in dorsal column-lemniscal pathways.
In managing the residual limb of an elderly patient with a transfemoral amputation, what is the MOST IMPORTANT factor the therapist should consider?
A. Contracture of hip musculature
B. Residual limb shape
C. Muscle atrophy
D. Residual limb healing
Correct Answer: D
All are important considerations. However, wound healing is most important to prevent infections and possible revision surgery or further amputation
Three months ago a patient experienced a traumatic injury to the hand that resulted in surgical tendon repair and fracture stabilization. The therapist is planning a treatment program to address tightness of the lumbricals. What exercises would be BEST in order to increase range of motion of the hand?
A. Both the MCP and IP joints are moved into flexion
B. Both the MCP and IP joints are moved into extension
C. The MCP joints are extended and the IP joints are flexed
D. The MCP joints are flexed and the IP joints are extended
Correct Answer: C
Lumbrical action is extension of the interphalangeal (P) joint and simultaneous flexion of the metacarpophalangeal (MCP) joint of the second through fifth digits. Therefore, the opposite motion of MCP joint extension and IP joint flexion would stretch the lumbricals.
20.A patient with a long history of cigarette smoking has been admitted to the hospital and presents with tachycardia, signs of lung infection, abnormal breath sounds in both lower lobes, and dullness to percussion. What should the therapist’s initial intervention focus on with this patient?
A. Getting the patient to quit smoking
B. Breathing reeducation to increase efficiency of ventilation
C. Airway clearance and secretion removal
D. Graded inspiratory muscle training
Correct Answer: C
The patient has signs and symptoms consistent with pneumonia. It is most important to assist with secretions clearance to assist with recovery from the infection and to improve gas exchange.
A patient has adhesive capsulitis of the glenohumeral joint. What is the expected greatest limitation of motion when performing shoulder ROM?
A. Flexion
B. Abduction
C. Medial rotation
D. Lateral rotation
Correct Answer: D
Adhesive capsulitis is diagnosed by numerous physical characteristics, including a thickening of the synovial capsule, adhesions within the subacromial or subdeltoid bursa, adhesions to the biceps tendon, and/or obliteration of the axillary fold secondary to adhesions. Adhesive capsulitis is commonly associated with other systemic and nonsystemic conditions. By far the most common is the comorbid condition of diabetes mellitus. The common capsular pattern of limitation has historically been described as diminishing motions with external (lateral) shoulder rotation being the most limited, followed closely by shoulder flexion and internal rotation.
During a home visit an adult patient asks the physical therapist assistant to see the physical therapy progress notes in the medical record. What should the physical therapist assistant do?
A. Refuse to let the patient see the record
B. Allow the patient to see the notes
C. Let the patient see the notes only with the permission of the physical therapist
D. Contact the patient’s physician and explain the situation
Correct Answer: B
The law requires a health care provider, except in limited circumstances, to supply a patient, upon request, complete and current information the provider has about the patient’s diagnosis, treatment, and prognosis. The provider must also notify a patient of any test results in the provider’s possession or requested by the provider for purposes of diagnosis, treatment, or prognosis.
A chest tube gets dislodged during physical therapy treatment. If the therapist fails to cover the defect, what could the patient develop?
A. Pulmonary embolism
B. Pulmonary edema
C. Pneumothorax
D. Aspiration pneumonia
Correct Answer: C
With the removal of the chest tube, there is an increased positive pressure on the lung tissue.
The lung is not able to inflate, and it succumbs to the pressure and therefore collapses.
Following a motor vehicle accident, a patient with chest trauma developed atelectasis. What is the LEAST Appropriate intervention to help with the immediate management of atelectasis?
A. Pain reduction techniques
B. Segmental breathing
C. Incentive spirometry
D. Paced breathing
Correct Answer: D
In order to reverse atelectasis, the patient needs a technique to facilitate deep breathing. Paced breathing controls the rate of breathing, not the depth of breathing, and will therefore be ineffective.
Following a reattachment of the flexor tendons of the fingers. the patient is in a splint. One physical therapy goal is to minimize adhesion formation. What should the physical theranist teach the patient to perform after 72 hours post-surgery?
A. Passive extension and active flexion of the interphalangeal joints
B. Active extension and flexion of the interphalangeal joints
C. Active extension and passive flexion of the interphalangeal joints
D. Gentle passive extension and flexion of the interphalangeal joints
Correct Answer: C
Severe edema increases tendon drag and likelihood of rupture. Therefore, wait until 48 to 72 hours postop prior to initiating range of motion (ROM therapy. This patient is a few days postop and can begin passive finger flexion with caution so as not to disrupt the repair. Begin by blocking the metacarpophalangeal (MCP) in full flexion and actively extend interphalangeal (IP) joints, followed by passive proximal interphalangeal (PIP) flexion and active extension.
26.A patient with a transtibial amputation of 2 months’ duration complains of an intense burning pain that seems to emanate from the heel. This phantom pain mirrors the patient’s preoperative pain. What is the most likely previous source of this pain?
A. Dorsalis pedis artery obstruction
B. Popliteal artery obstruction
C. Damage to the superficial peroneal (fibular) nerve
D. Damage to the tibial nerve
Correct Answer: D
Although the limb is no longer there, the nerve endings at the site of the amputation continue to send pain signals to the brain that make the brain think the limb is still there. Sometimes, the brain memory of pain is retained and is interpreted as pain regardless of signals from injured nerves. In addition to pain in the phantom limb, some people experience other sensations such as tingling, cramping, heat, and cold in the portion of the limb that was removed. The question describes pain in the heel. Nerve supply to the heel is by the calcaneal branch of the tibial nerve.
A patient’s plan of care includes use of iontophoresis for the management of calcific bursitis of the shoulder. To administer this treatment using the acetate ion, what current characteristics and polarity should be used?
A. Monophasic twin-peaked pulses using the positive pole
B. Monophasic twin-peaked pulses using the negative pole
C. Direct current using the positive pole
D. Direct current using the negative pole
Correct Answer: D
The acetate ion has a negative charge, and thus a negative pole will be needed to repel the drug into the tissue. Direct current will continuously drive the acetate into the tissue during the treatment time.
A snowmobile left the trail and struck a tree. The driver’s left knee was flexed approximately 90 degrees and the tibia impacted with the inside front of the snowmobile. What would this mechanism of injury MOST LIKELY result in?
A. Dislocated patella
B. Sprained or ruptured posterior cruciate ligament (PCL)
C. Sprained or ruptured anterior cruciate ligament (ACL)
D. Rupture of the popliteal artery
Correct Answer: B
The above scenario describes one of the most common mechanisms of injury of the PCL, the
“dashboard iniury.” This occurs when the knee is flexed, and an object forcefully strikes the proximal anterior tibia and displaces it posteriorly. It is called a “dashboard injury” because it can occur in automobile collisions when the tibia forcefully hits the dashboard. The PCL attaches from the lateral aspect of the medial femoral condyle to just posterior to the posterior horn of the medial meniscus. It is the primary restraint to posterior displacement of the tibia on the femur.
The interview with an 18 year-old female cross-country runner elicits a history of stiffness and diffuse ache in her right knee that is aggravated by prolonged sitting. Going down stairs is also painful. Based on this information, what is the LIKELY diagnosis that should serve as a focus for the physical examination?
A. Iliotibial band friction syndrome
B. Osgood-Schlatter disease
C. Meniscal tear
D. Patellofemoral syndrome
Correct Answer: D
Patellofemoral syndrome (“runner’s knee”) is the most common overuse iniury among runners.
It occurs due to mistracking of the patella within the intercondylar groove. It generallv occurs in younger, recreational runners and is more common in women The main symptom of patellofemoral pain syndrome is knee pain, especially when sitting with knee flexion. This is known as the theater sign or movie-goer’s knee. Squatting, jumping, or using the stairs (especially going down stairs) will also be painful. There may also be occasional buckling of the knee.
Following mastectomy with axillary Ivmph node dissection, a patient developed 4+ edema in the ipsilateral arm. A compression garment was ordered. What is the primary reason this garment decreases edema?
A. It decreases the osmotic pressure of the capillaries
B. It increases the capillary permeability
C. It exceeds the internal tissue hydrostatic pressure
D. It equals the fluid outflow from the capillaries
Correct Answer: C
The external pressure caused by the compression garment essentially increases the amount of pressure on the tissue. This causes a relative increase in the hydrostatic pressure in the extravascular space compared with the intravascular space.
A patient presents with a chronic restriction of the temporomandibular joint (TMJ). The physical therapist observes the situation seen in the picture during mouth-opening range of motion (ROM) assessment. What is the BEST intervention if the patient has a classic TMJ unilateral capsular restriction?
A. Left TMJ, superior glide manipulation
B. Left TMJ, inferior glide manipulation
C. Right TMJ, superior glide manipulation
D. Right TMJ, inferior glide manipulation
Correct Answer: D
Right TMJ, inferior glide. In the photo, the chin has deviated to the right at terminal opening.
The active range of motion (AROM) will be limited with ipsilateral opening and a lateral deviation to the side of restriction for patients with a TMJ capsular pattern of restriction.
A patient in the late stages of Parkinson’s disease exhibits episodes of akinesia while walking. What should the therapist examine?
A. Primary involvement of the head and trunk
B. Associated dyskinesias
C. Primary involvement of the hips and knees
D. Triggers that precipitate the freezing episodes.
Correct Answer: D
Freezing of gait (episodes of akinesia) is typically associated with a trigger (e.g., turning, changing direction or speed, doorways). Identification of triggers is helpful in developing the plan of care.
A patient is referred to physical therapy for balance and gait training following two falls in the home in the past month. The therapist notes in the medical record that the patient has adrenal insufficiency. What are the metabolic abnormalities associated with adrenal insufficiency?
A. Hypokalemia
B. Hyponatremia
C. Hyperglycemia
D. Alkalosis
Correct Answer: B
Metabolic abnormalities seen in adrenal insufficiency include hyponatremia (decreased sodium concentration in the blood) secondary to renal loss of sodium ions. A decrease in cortisol results in an inability to regulate potassium and sodium.
A physical therapist is treating a patient with active infectious hepatitis B. In addition to wearing a protective gown when in the patient’s room, what precautions should be taken to avoid transmission of the disease?
A. Avoid direct contact with the patient’s blood or blood-contaminated equipment by wearing gloves
B. Avoid direct contact with any part of the patient
C. Have the patient wear a mask to minimize droplet spread of the organisms from coughing
D. Provide tissues and no-touch receptacles for disposal of tissues
Correct Answer: A
Hepatitis B is transmitted in blood, body fluids, or body tissues. Precautions should include avoiding direct contact with blood or blood-contaminated equipment.
Idiopathic scoliosis is suspected in a 12-vear-old girl. During the physical examination, what is the standard screening test for this condition?
A. Longsitting, forward bend test
B. Standing, Adam’s forward bend test
C. Sitting, rotation test to the right and left
D. Standing, backward extension test
Correct Answer: B
Screening is most commonly done on adolescents. Females achieve adolescence about two years before males and are afflicted with scoliosis requiring treatment three to four times more frequently than males. The adam’s forward bend test is the standard screening test for scoliosis. During the test, the child will bend forward with feet together, knees straight, and arms hanging free. The therapist observes child from the back. Looking for a difference in the shape of the ribs on each side. A spinal deformity is most noticeable in this position.
A patient had anterior cruciate ligament (ACL) reconstructive surgery 2 weeks ago. During the initial examination, the physical therapist noticed marked edema around the knee and calf Knee passive range of motion (PROM was limited form -5 degrees extension to 90 degrees of flexion. Hip PROM was within normal limits. Ankle dorsiflexion was limited to 0 degrees because of pulling pain in the calf. Marked tenderness to superficial palpation to anterior knee and posterior calf and increased temperature were also noted. The patient is experiencing calf pain and discomfort when standing during partial weight-bearing ambulation. Upon completion of the examination, what is the BEST intervention at this time?
A. Isometrics and PROM for the knee
B. Massage to knee and calf to help alleviate the expected postsurgical edema
C. Ice and interferential current to alleviate edema and facilitate movement
D. Immediate referral to the surgeon
Correct Answer: D
The patient may have a deep vein thrombosis (DVT) based on increased swelling, temperature, tenderness, and pain in the calf with weight bearing 2 weeks after surgery, so referral to the surgeon is the best intervention at this time.
Use of continuous ultrasound at 1.5 watts/cm2 can increase which of the following?
A. Local metabolic rate
B. Rate of muscle hypertrophy
C. Stiffness of collagen tissue
D. The resolution of acute inflammation
Correct Answer: A
Continuous ultrasound (US) is used for its thermal effects, and the higher the intensity, the greater the probability of causing a tissue temperature rise that would result in an increased metabolic rate in the area applied.
During observation of bilateral active straight leg raising in a supine position, the patient demonstrates progressively increasing lumbar lordosis during lowering of the limbs with each successive lift. What is the MOST LIKELY cause of the observed excessive lordosis during the bilateral straight leg activity?
A. Muscle imbalance between the rectus femoris and the Sartorius muscles.
B. Weakness of both quadratus lumborum muscles.
C. Fatigue weakness of the rectus abdominis and oblique muscle groups
D. Excessive elastic shortening of the ipsilateral hamstring muscle group
Correct Answer: C
During a dynamic activity such as the performance of a bilateral active straight leg raise, the weight of the limbs lifted produces an anterior torque on the pelvis. During this dynamic activity, excessive lordosis typically is associated with excessive anterior pelvic rotation.
Normally muscles that control anterior pelvic rotation (posterior pelvic rotators) act to counter the anterior torques produced by the mass of the lower limbs lifted off the table, helping to prevent unwanted sagittal plane movements of the lumbar spine. Contractile activities of the anterior trunk muscles (rectus and obliques) provide a posterior rotation movement on the pelvis, helping to stabilize the pelvis. Fatigue weakness of the anterior trunk muscles in this patient could result in poor control of sagittal plane rotation of the pelvis, leading to the observed increasing lumbar lordosis.
The therapist is treating a patient with chronic Lyme disease of more than I vear’s duration.
What joints are likely to demonstrate more arthritic changes and therefore should be the focus of physical therapy interventions?
A. Small joints of the hands and feet
B. Large joints of the body, especially the knee
C. Axial joints, especially the lumbosacral spine
D. Axial joints, especially the cervical and thoracic spine
Correct Answer: B
Stage 3 Lyme disease (late or chronic Lvme disease is characterized by intermittent arthritis with marked pain and swelling, especially in thelarge joints) Permanent joint damage can occur.
During auscultation of the heart, the therapist hears S1 and S2 heart sounds. During early diastole the therapist also hears a low frequency sound of turbulence. What suspected abnormal sound should the therapist record this as?
A. S4 sound
B. S3 sound
C. Heart murmur
D. Pericardial friction rub
Correct Answer: B
S3 is an abnormal third heart sound due to poor ventricular compliance and turbulence, It is heard as a low frequency sound during early diastole.
A physical therapist observes a full-term infant in the neonatal intensive care unit (NICU) just after birth. In the supine position, the shoulders are abducted and externally rotated, elbows and fingers are flexed, hips are abducted and externally rotated, and knees are flexed.
What would this posturing be an indication of?
A. Upper extremity tone is abnormal
B. Lower extremity tone is abnormal
C. Tone is abnormal in both upper and lower extremities
D. Tone is normal in both upper and lower extremities
Correct Answer: D
A full-term infant in the NICU can have low Apgar scores, respiratory distress, or any one of a number of specific diagnoses (none listed in this case). Initial tone and posturing involve some flexion of the limbs. At 1 month, decreased flexion can be expected.
A patient with type 1 diabetes mellitus has generalized osteoporosis. What is the BEST exercise to include in this patient’s plan of care?
A. Bilateral quadriceps presses against resistance in sitting
B. Aquatic exercises
C. Running on a treadmill
D. Partial squats in standing
Correct Answer: D
Extensor stabilization exercises in weight-bearing postures provide the best stimulus to bone (e.g., standing, holding against resistance, standing partial squats).
A patient suddenly falls and lands on a piece of equipment left on the floor. A severe laceration with spurting blood is noted in the area of the lateral distal right thigh. To help control bleeding, where should the physical therapist apply pressure in addition to directly over the wound?
A. Behind the knee at the popliteal fossa
B. At the femoral triangle
C. At the antecubital fossa
D. At mid-thigh, directly over the profunda femoris artery
Correct Answer: B
This patient is experiencing an arterial bleed most likely affecting the descending branch of the lateral circumflex femoral artery. Pressure should be applied over the wound and more proximally over the femoral artery, which is palpable in the femoral triangle just inferior to the inguinal ligament.
While gait training a patient following a stroke, the therapist observes the knee on the hemiparetic side going into recurvatum during stance phase. What is the MOST LIKELY cause of this deviation?
A. Severe spasticity of the hamstrings or weakness of the gastrocnemius-soleus
B. Weakness or severe spasticity of the quadriceps
C. Weakness of the gastrocnemius-soleus or spasticity of the pretibial muscles
D. Weakness of both the gastrocnemius-soleus and pretibial muscles
Correct Answer: B
Weakness of severe spasticity of the quadriceps is the most likely cause of genu recurvatum.
This picture depicts a clinician assessing for Stemmer’s sign. The clinician is examining for what condition?
A. Bunion
B.Hammer toe
C. Lymphedema
D.Fracture of the second toe
Correct Answer: C
Stemmer’s sign is assessed by pulling up on the skin at the base of the second toe or finger, which the clinician is doing in this picture. If the skin is unable to be pulled up, then it is a sign of lymphedema, usually primary but also advanced secondary.
A child with spastic diplegia is becoming independent in using a walker. Additional goals desired by the physical therapist include improving posture and increasing the child’s energy efficiency and velocity while ambulating. In this case, which walker is most likely to help improve these goals?
A. A standard anterior walker with no wheels
B. An anterior rollator walker with two wheels
C. A posterior rollator walker with two wheels
D. A posterior rollator walker with four wheels
Correct Answer: D
A posterior rollator walker with four wheels is the best choice to improve upright posture, energy efficiency, and velocity.
What is pain and tenderness with palpation over McBurney’s point associated with?
A. Acute appendicitis
B. Hiatal hernia
C. Acute cholecystitis
D. GERD
Correct Answer: A
Pain and tenderness with palpation over McBurney’s point are associated with acute appendicitis. McBurney’s point is located half the distance between the anterior superior iliac spine (ASIS) and the umbilicus in the right lower abdominal quadrant.
What is the expected hemody namic response for a patient on a beta-adrenergic blocking agent during exercise?
A. Heart rate to be low at rest and rise minimally with exercise
B. Heart rate to be low at rest and rise continuously to expected levels as exercise intensity
increases
C. Systolic blood pressure to be low at rest and not rise with exercise
D. Systolic blood pressure to be within normal limits at rest and progressively fall as exercise intensity increases.
Correct Answer: A
A beta-blocker will decrease the sympathetic response to activity. This will decrease the heart rate at rest and will blunt the heart rate response to activity.
A neonate’s Apgar score at 1 minute after birth is 8; at 5 minutes it is 9. Based on this score and expected heart rate, what can the therapist conclude about this infant?
A. The infant would have a heart rate of less than 100 beats per minute with slow and irregular respirations and not require resuscitation
B. The infant would require extensive resuscitation efforts including intubation
C. The infant would require some resuscitation and administration of supplemental oxygen
D. The infant would have a heart rate of greater than 100 beats per minute with good respiration and not require resuscitation
Correct Answer: D
Early signs receiving the top Apgar score of 2 each include heart rate over 100 bpm, good respiration and cring, active movements, cough or sneeze, and pink color (total of 10). Apgar scores of 8 to 10 at 1 minute are considered normal.
With the patient supine, the vertebral artery test is performed by passively moving the head and neck into extension and side flexion, then rotation to the same side and holding for 30 seconds. Which of the following indicates a positive test?
A. Sensory changes occur in the face along with visual changes
B. Dizziness or nystagmus occurs, indicating that the opposite side artery is being compressed
C. Hearing difficulties and facial paralysis occur
D. Dizziness or nystagmus occurs, indicating that the same side artery is being compressed
Correct Answer: B
The test is positive if dizziness or nvstagmus occurs, indicating that the opposite side artery is affected. Current evidence demonstrates some limitations in use of this test; however, not performing it prior to cervical manual therapy could be considered a breach of the standard of care.
A young adult who is comatose (Glasgow Coma Scale score of 3) is transferred to a long-term care facility for custodial care. On initial examination, the therapist determines the patient is demonstrating decerebrate posturing. Which limb or body position is indicative of this?
A. The upper extremities in flexion and the lower extremities in extension
B. Extreme hyperextension of the neck and spine with both lower extremities flexed and the heels touching the buttocks
C. All four limbs in extension
D. All four limbs in flexion
Correct Answer: C
With decerebrate posturing (decerebrate rigidity), the upper and lower extremities are held rigidly in extension.
A patient is recovering from a mild stroke with trunk weakness and postural instability. The patient complains of severe heartburn. What is the BEST choice to maximize stroke recovery and improve trunk stabilization while minimizing heartburn?
A. Perform trunk stabilization exercises with the patient in the semi-Fowler position
B. Begin with bridging exercises progressing to sitting holding
C. Perform resisted holding in sitting using rhythmic stabilization
D. Take antacids before physical therapy
Correct Answer: C
Heartburn is a common symptom of gastrosophageal reflux disease (GERD) and can be aggravated by positioning in supine, prone, or bridging. Modifying the patient’s position to upright can alleviate the symptoms and demonstrate to the patient the therapist’s concern.
To prevent contractures in a newly admitted patient with anterior neck burns, it would be best to position the neck in which of the following’
A. Hyperflexion
B. Slight flexion
C. Neutral
D. Slight extension
Correct Answer: D
Positioning the head/neck in slight extension will counteract the expected pull of the head into flexion with contracture development.
A therapist wishes to examine the balance of an elderly patient with a history of falls. The
Berg Balance Test is selected. Which area isNOT examined using this test?
A. Sit-to-stand transitions
B. Functional reach in standing
C. Turning while walking
D. Tandem standing
Correct Answer: C
The Berg Balance Test (BBT is a test of static and dynamic balance in sitting and standing, includes transitional items of sit-to-stand and stand-to-sit. It does not include items or
gait. Turning while walking is an item on both the Tinetti Performance-Oriented Mobility
Assessment and the Dynamic Gait Index.
The physical therapist is instructing a new mother to perform range of motion and stretching for her newborn who has a clubfoot. In what directions should the therapist advise her to carefully stretch?
A. Plantarflexion and inversion
B. Plantarflexion and eversion
C. Dorsiflexion and inversion
D. Dorsiflexion and eversion
Correct Answer: D
The term “clubfoot” (talipes equinovarus) refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club. It describes a range of foot abnormalities usually present at birth in which the infant’s foot is twisted into an equinovarus deformity. Stretching should be opposite the direction of the deforming position; therefore, stretch is into dorsiflexion and eversion.
Pursed lip breathing as part of the treatment regimen would be MOST appropriate for a patient with which condition?
A. Circumferential thoracic burns
B. Asbestosis
C. Rib fracture
D. Emphysema
Correct Answer: D
Pursed lip breathing gives increased resistance to the airwavs on exhalation. The resistance causes increased pressure, which helps to prevent airway collapse (likely sequelae given the pathophysiology of emphysema). This occurs via collateral ventilation through pores of Kohn and canals of Lambert.
A patient has normal quadriceps strength but unilateral weakness (3/5) of the hamstring muscles on the right. What might the therapist observe during swing phase of gait?
A. Excessive compensatory hip extension on the sound side
B. Decreased hip flexion followed by increased knee flexion on the weak side
C. Excessive hip extension followed by abrupt knee extension on the weak side
D. Excessive hip flexion followed by abrupt knee extension on the weak side
Correct Answer: D
The hamstring muscles primarily control the forward swing of the leg during terminal swing.
Loss of function may result in abrupt knee extension and increased hip flexion.
Following cast immobilization for a now healed supracondvlar fracture of the humerus, a patient’s elbow lacks mobility. To increase elbow range of motion, joint mobilization in the maximum loose-packed position should be performed at what position?
A. Full extension
B. 90 degrees of flexion
C. 70 degrees of flexion
D. 30 degrees of flexion
Correct Answer: C
The loose-packed position of the humeroulnar ioint is 70 degrees of flexion. The loose-packed position for the radiohumeral oint is 70 degrees of flexion, 35 degrees of supination. The loose-packed position is basically the resting position where the joint capsule and ligaments are most relaxed.
A patient with a complete tetraplegia (ASIA A) at the C6 level is initially instructed to transfer using a transfer board. With shoulders externally rotated, how should the remaining upper extremity (UE) joints be positioned?
A. Forearms pronated with wrists and fingers extended
B. Forearms supinated with wrist extended and fingers flexed
C. Forearms pronated with wrists and fingers flexed
D. Forearms supinated with wrists and fingers extended
Correct Answer: B
The patient with tetraplegia at the C6 level does not have triceps to assist in transfers.
Independent transfers can be achieved using muscle substitution and positioning to lock the elbow. The hands are positioned anterior to the hips; the shoulders are externally rotated with elbows and wrists extended, forearms supinated, and fingers flexed. Strong contraction of the anterior deltoid, shoulder external rotators, and clavicular portion of the pectoralis major flexes and adducts the humerus, causing the elbow to extend.
Upon removing the dressing covering a decubitus ulcer located on the heel of an elderly patient, the physical therapist observes copious amounts of a foul-smelling, yellow-green discharge. How should the therapist document this finding in the patient’s medical record?
A. There is likelihood of a staphylococcus aureus infection
C. Wound exudate is purulent
B. Maceration of the wound is evident
D. Wound exudate is serosanguinous
Correct Answer: C
Wound exudate (drainage) is purulent (containing pus) on the basis of the yellow-green discharge.
During examination of the right shoulder of a teenager with anterior shoulder pain, the physical theranist notices an excessive amount of scapular abduction during both shoulder flexion and abduction. Full range of glenohumeral (GH) motion is achieved at the ends flexion and abduction. The axillary border of the scapula protrudes laterally beyond the thorax much more on the right as compared to the left. Which muscle(s) would be associated with excessive lengthening during the movements of shoulder flexion and abduction?
A. Serratus anterior
B. Rhomboids
C. Teres major
D. Levator scapula
Correct Answer: B
During the motions of flexion and abduction, concentric muscle activity of the serratus anterior occurs, providing upward scapular rotation. However, concentric activity of the serratus anterior would also induce abduction of the scapula due to its line of action. Excessive scapular abduction can be controlled through muscle actions from those that can provide scapular adduction. The primary scapular adductors acting eccentrically to control excessive scapular abduction include the rhomboid and the trapezius muscle groups. Inadequately controlled lengthening of the rhomboids could contribute to hyperabduction of the scapula during the mid and later phases of shoulder flexion and abduction.
A competitive gymnast is examined by the physical therapist. The chief complaint is nagging, localized pain in the anterior left lower leg that is consistently present at night and increases during activity with swelling. What are these complaints MOST characteristic of?
A. Bone tumor
B. Anterior compartment syndrome
C. Shin splints
D. Stress fracture
Correct Answer: D
Symptoms of a stress fracture may include pain and swelling, particularly with weight bearing on the injured bone. Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. The differential diagnosis varies based on location but commonly includes tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome.
Four days following open-heart surgery, a patient is ambulating with a physical therapist in the hallway. The patient complains of some chest discomfort during the activity and wishes to return to his or her room. What should the therapist do?
A. Sit the patient down and call the physician immediately
B. Complete the treatment and have an aide transport the patient to the room as some discomfort is expected
C. Call the nurse and check to see if the discomfort is ongoing
D. Sit the patient down, take vital signs, and inform nursing services of the patient’s complaint
Correct Answer: D
It is important to determine etiology of the pain. If it is angina. having the patient stop will reduce the myocardial demand. Gathering timely vital signs will help determine if the patient was maintaining his or her cardiac output. If not, the demand of the activity may have been too great.
A group of institutionalized elderly was examined for balance instability and fall risk using a standardized test, the Performance-Oriented Mobility Assessment (POMA). The test-retest reliability fo total test (POMA-T) and the subtests, balance subtest (POMA-B) and gait subtest (POMA-G) varied between 0.77 and 0.86 the interrater reliability values ranged from 0.80 to 0.93. what is the therapist’s correct interpretation of these findings?
A. Overall, the test demonstrated moderate reliability
B. The test demonstrated moderate reliability for test-retest and good reliability for interrated comparisons
C. The test demonstrated poor reliability for test-retest and moderate reliability for interrater comparisons
D. Overall, the test demonstrated good reliability
Correct Answer: D
Reliability coefficients above 0.75 lemonstrate good reliability. This test demonstrated good reliability both for test-retest and interrater comparisons.
A patient presents with hemosiderin changes and increased lower extremity edema. What diagnosis are these changes consistent with?
A. Chronic venous insufficiency
B. Acute venous insufficiency
C. Acute arterial insufficiency
D. Chronic arterial insufficiency
Correct Answer: A
Lower extremity edema is usually due to incompetent valves. which causes the edema. Longstanding edema causes staining of the legs because of increased iron from pooling blood.
A patient experienced a cerebrovascular accident (right CA) 2 weeks ago. The patient has motor and sensory impairments primarily in the left lower extremity; the left upper extremity shows only mild impairment. There is some confusion and perseveration. Based on these findings, what type of stroke syndrome does this patient present with?
A. Posterior cerebral artery stroke
B. Internal carotid syndrome
C. Anterior cerebral artery syndrome
D. Middle cerebral artery syndrome
Correct Answer: C
These signs and symptoms are characteristic of anterior cerebral artery (ACA) svndrome, with contralateral hemiplegia and lower extremities more affected than upper extremities.
A patient is walking on a motorized treadmill and is undergoing ECG monitoring. Based on viewing this cardiac rhythm strip, what action should the physical therapist take?
A. Immediately call emergency medical services
B. Modify the exercise based on past cardiac disease
C. Modify the exercise based on current cardiac disease
D. Exercise the patient/client without any cardiac restrictions
Correct Answer: D
This is sinus bradycardia. There are no restrictions on proceeding with exercise in this patient.
A therapist is planning to use percussion and shaking for assisting airway clearance with a patient diagnosed with chronic obstructive pulmonary disease (COPD). What major precaution might curtail selection of this form of intervention?
A. A platelet count of 30,000
B. Dyspnea when in the Trendelenburg position
C. Sa02 range of 88% to 94% on room air
D. Functional Independence Measure (FIM) score of 4
Correct Answer: A
A patient with a platelet count of 30,000 is at increased risk for bleeding. Percussion may cause microtraumas and increased bleeding risk.
A patient with degenerative joint disease of the right hip complains of pain in the anterior hip and groin, which is aggravated by weight bearing. There is decreased range of motion and capsular restrictions. Right gluteus medius weakness is evident during ambulation, and there is decreased tolerance of functional activities including transfers and lower extremity dressing. In this case, a capsular pattern of joint motion should be evident by which of the following?
A. Hip flexion, abduction, and internal rotation
B. Hip flexion, adduction, and internal rotation
C. Hip extension, abduction, and external rotation
D. Hip flexion, abduction, and external rotation
Correct Answer: A
The two classical capsular patterns at the him are FAME and MEAL. FAME stands for loss of flexion, abduction, internal (medial) rotation, and extension. MEAL is loss of medial (internal) rotation, extension, and abduction. According to the American Physical Therapy Association (APTA) hip pain practice guidelines, patients were classified as having hip osteoarthritis (A) if they (1) reported experiencing hip pain and (2) present with either one of the following clusters of clinical findings: (a) hip internal rotation less than 15 degrees, along with hip flexion less than or equal to 115 degrees and age greater or equal to 15, along with pain with hip internal rotation, duration of morning stiffness of the hip less than or equal to 60 minutes, and age greater than 50 years.
Confirmation of a diagnosis of spondylolisthesis can be made when viewing an oblique radiograph of the spine, What is the relevant diagnostic finding?
A. Posterior displacement of L5 over S1
B. Bamboo appearance of the spine
C. Compression of the vertebral bodies of L5 and S1
D. Bilateral pars interarticularis defects
Correct Answer: D
Spondvlolisthesis is defined as forward translation of a vertebral body with respect to the vertebra below. Spondvlolvsis, a break in the vertebra typically in the region of the pars interarticularis, may or may not be associated with a spondylolisthesis. If the pars defect is bilateral, it may allow slippage of the vertebra, typically L5 on S1, resulting in spondylolisthesis. Most cases are thought to result from minor overuse trauma, particularly repetitive hyperextension of the lumbar spine.
A physical therapist and physical therapist assistant are conducting a cardiac rehabilitation session for 20 patients. The therapist is suddenly called out of the room. The physical therapist assistant should do which of the following?
A. Terminate the exercises and have the patients monitor their pulses until the therapist
returns
B. Have the patients continue with the same exercise until the therapist returns
C. Have the patients switch to a less intense exercise until the therapist returns
D. Continue with the outlined exercise progression for that session
Correct Answer: D
The physical therapist provided an exercise program, and it is appropriate for the PTA to continue to follow it.
A physical therapist is examining a patient who has a recent history of falls while ambulating on level surfaces. Interaction with the patient indicates that cognition is unaffected. Which tests should be performed next once it has been established that cognition is not impaired?
A. Static balancing tests
B. Locomotor tests
C. Sensory testing
D. Dynamic balance tests
Correct Answer: C
Sensory testing should be performed next, including somatosensations from the feet and ankles, visions, and visual proprioception, and vestibular sensations. Once the primary sensations have been tested, the clinical Test for Sensory Interaction in Balance can reveal valuable information about the patient’s ability to use sensory information under changing balance conditions.
A therapist wishes to study the progress of patients with paraplegia who are discharged from a rehabilitation setting. Starting with the patient’s discharge, and once a month for 3 years, the therapist will measure their joint range of motion of both hips and knees. Accurate analysis of this time series study is heavily dependent upon which of the following?
A. Random sampling
B. Interrater reliability
C. Intrarater reliability
D. Predictive validity of the measurements
Correct Answer: C
Accurate analysis will depend on the therapist’s ability to consistently measure ROM using standardized techniques on multiple measurement trials (intrarater reliability).
Which of these findings is characteristic of a boutonniere deformity of the finger?
A. Flexion of the distal interphalangeal joint
B. Contracture of the extensor digitorum communis tendon
C. Rupture with volar slippage of the lateral bands
D. Hyperextension of the proximal interphalangeal joint
Correct Answer: C
Finger position marked by extension of the metacarpophalangeal (MCP) and distal interphalangeal (DIP) joints with flexion of the proximal interphalangeal (PIP) joints. Through injury or disease, the central extensor tendon (extensor digitorum communis [EDC]) of the involved finger ruptures. The tendon then displaces palmarly relative to the PIP joint (volar slippage). The lateral bands become tight and are attached to the distal phalanx, extending it.
The flexor digitorum profundus (FPD) is now unopposed, and it pulls the PIP joint into flexion.
The result is a deformity that looks like a “buttonhole” or boutonniere in French.
A patient with chronic asthma has been admitted to the hospital for an acute exacerbation.
What is the MOST important information the therapist needs in order to determine the patient’s prognosis with physical therapy?
A. A current medication list
B. A previous history of the disease
C. The most recent chest x-ray results
D. The most recent pulmonary function test results
Correct Answer: D
Recent pulmonary function test results will give the therapist information regarding the severity of the lung disease. This information will assist in determining how much the patient will progress.
A therapist is examining the gait of a patient with a transfemoral prosthesis. The patient circumducts the prosthetic limb during swing. The therapist needs to identify the cause of the gait deviation. What is the MOST likely prosthetic cause?
A. Unstable knee unit
B. Inadequate socket flexion
C. Sharp or high medial wall or abducted hip joint
D. Inadequate suspension or loose socket
Correct Answer: D
Prosthetic causes of circumduction include a long prosthesis, locked knee unit, loose knee friction, inadequate suspension, small or loose socket, and plantar flexed foot.
A patient diagnosed with multiple sclerosis experiences sudden electric-like shocks spreading down the body elicited by the maneuver in the picture. This is known as which of the following?
A. Head jolt test
B. Kernig’s sign
C. Lhermitte’s sign
D. Tinel’s test
Correct Answer: C
Chermitte’s sign is sudden, transient. electric-like shocks spreading down the body when the head is flexed forward. It occurs chiefly in patients with multiple sclerosis but can also be seen in compression disorders of the cervical spine (tumor, cervical spondylitic myelopathy).
An elderly patient with degenerative joint disease is seen by a physical therapist 3 days following a total knee replacement. Which of these findings would be an indication for the therapist to contact the surgeon?
A. Patient is noncompliant when learning to transfer properly
B. Patient cannot ambulate at least 50 feet with a standard walker
C. Patient fails to recognize the therapist on the third consecutive postoperative visit
D. Patient complains of soreness at the incision site
Correct Answer: C
Postoperative adverse effects on the cardiac, pulmonary, and neuromuscular systems and on cognitive function are the main concerns for elderly surgical patient who are at high risk.
Postoperative delirium is characterized by incoherent thought and speech, disorientation, impaired memory, and attention. Elderly patients usually manifest delirium following a lucid interval of 1 postoperative day or more, a condition known as interval delirium, Symptoms are often worse at night. Alternatively, the condition can be silent and unnoticed, or misdiagnosed as depression. However, the effects of elderly postoperative delirium are evident in increased morbidity, delayed functional recovery, and prolonged hospital stay. Fortunately, the postoperative cognitive dysfunction is a reversible condition in the majority of elderly surgical patients. Preoperative risk factors of bilateral total knee arthroplasty are associated with a significantly higher incidence of acute delirium than unilateral total knee arthroplasty in patients over 80 vears.
Failing to recognize the therapist after three visits is an indication of a declining mental condition. This would definitely be a safety consideration as the patient may not be able to follow all the precautions and may also put himself or herself in danger by walking without an ambulatory aid, etc. Wound infection is also a consideration. Contacting the surgeon is necessary.
The primary contribution of a physical therapist member of a facility emergency/disaster preparedness committee in formulating a disaster plan is describing the role of the physical therapists in providing which of the following?
A. Triage and basic life support during the disaster
B. Evaluation of soft tissue injuries and rendering appropriate care
C. Unique preparedness concerns needed for people with disabilities or special needs
D. Emotional distress management of victims or patients during crisis situations
Correct Answer: C
The physical therapist’s unique contribution to the team is in addressing the concerns of individuals with disabilities or special needs.
Following a hard tackle, a football player exhibits signs of fractured ribs and a pneumothorax. When auscultating during inhalation over the injured area, what would the physical therapist expect to hear?
A. Soft, rustling sounds on inhalation
B. Decreased or no breath sounds crackles
C. Crackles
D. Wheezes
Correct Answer: B
The fractured ribs will cause the patient to have pain and therefore not take deep breaths. More importantly, the pneumothorax will cause an increasing positive pressure on the lung, not allowing it to inflate. The result will be minimal air movement and decreased or absent breath sounds.
A physical therapist is performing an examination of an elderly patient who is confined to bed in a custodial care facility. A large ulcer is observed on the right heel as shown in the picture. Based on the staging of pressure ulcers, how would this ulcer be classified?
A. Stage I ulcer
B. Stage II ulcer
C. Stage III ulcer
D. Stage IV ulcer
Correct Answer: C
A stage III ulcer is characterized by full-thickness skin loss with damage to or necrosis of subcutaneous tissue. It presents clinically as a crater.
The physical therapist is examining the muscle length of the patient’s left hip and knee. How should the therapist interpret the muscle length test shown in the picture?
A. Shortness of one joint and tow joint hip flexors
B. Shortness of one joint hip flexor with normal two joint hip flexors
C. Normal one joint hip flexors with tightness of two joint hip flexors
D. Normal one joint and two joint hip flexors
Correct Answer: B
The posterior thigh does not touch the table, and the knee can be flexed as many degrees beyond 80 degrees as the hip is flexed. The Thomas test is utilized to test for hip flexor length and to distinguish between one joint and two joint hip flexor tightness. With low back and sacrum flat on the table, a normal one joint hip flexor length would be with thigh flat on the table. Normal tow joint hip flexor length would be 80 degrees of knee flexion.
If the sign indicated by the picture is positive, intervention should focus on strengthening which of the following?
A. Left gluteus medius
B. Right gluteus medius
C. Left quadratus lumborum
D. Right quadratus lumborum
Correct Answer: A
This picture depicts a positive Trendelenburg sign. Weakness of the left hip abductors (gluteus medius) results in dropping of the pelvis on the opposite side. A normal response would be no dropping of the pelvis during the standing test.
A human bite injury resulted in laceration of the extensor tendons over the metacarpophalangeal (MCP) ioints. Following surgical repair, the patient was placed in a dorsal dynamic extension splint (as pictured). Therapy is initiated in the first 24 to 48 hours, with the therapist instructing the patient to move in which way?
A. Actively extend the wrist and passively flex the MCP joints
B. Actively extend the wrist and MCP joints
C. Passively extend the wrist and MCP joints
D. Passively extend the wrist and actively flex the MCP joints
Correct Answer: D
Goals during the first few weeks include preventing tendon rupture and promoting tendon healing as well as edema and pain control. For scar management, perform active range of motion (AROM) flexion, isolated joint and tendon gliding (hook and straight fist). Perform passive extension via elastic recoil of the dynamic splint, 10 to 20 reps hourly. Begin active MP flexion to 30 to 40 degrees (via flexion block on dynamic splint). Progress MP flexion as tolerated. Perform wrist and digit passive range of motion (PROM) in extension and tenodesis out of splint 10 repetitions hourly. Avoid making a full fist as this may place too much stress on the repair. The wrist is splinted in 40 to 45 degrees extension with 0-20 degrees of MP flexion and 0 degrees of IP flexion.
The picture shows the physical therapist examining the muscle length of the patient’s right hip. How can the muscle length test be interpreted?
A. Decreased length of the rectus femoris
B. Decreased length of the tensor fascia latae
C. Decreased length of the piriformis
D. Normal muscle length of the tensor fascia latae
Correct Answer: D
The Ober test is for tightness of the tensor fascia late and iliotibial band. With the pelvis stabilized and the hip kept in neutral rotation, the Ober test would be considered normal if the thigh drops slightly below horizontal. Some sources say that the thigh should drop below the horizontal to the table.
