Ortho: knee treatment board questions

A patient explains to a physical therapist assistant that she was instructed to bear up to five pounds of weight on her involved extremity. The patient's weight bearing status would be BEST described as: A. Non-weight bearing B. Toe touch weight bearing C. Partial weight bearing D. Weight bearing as tolerated

Partial weight bearing

A Cho-Pat Straps are commonly prescribed for patients with which of the following conditions at the knee joint? A. ACL injuries B. MCL injuries C. Lateral tracking patella D. Patellar tendinitis

Patellar tendinitis

A physical therapist assistant works with a patient diagnosed with anterior cruciate ligament insufficiency. The physician referral specifies closed kinematic chain rehabilitation. Which exercise would not be appropriate based on the physician order? A. exercise on a stair machine B. limited squats to 45 degrees C. walking backwards on a treadmill D. isokinetic knee extension and flexion

isokinetic knee extension and flexion

A college volleyball player complains of moderate pain resulting from a left hamstring strain four weeks ago. The focal point of pain and tightness is noted where a hematoma developed initially. The specific massage technique that would be MOST beneficial in this case is: A. Stroking B. Kneading C. Tapotement D. Friction

Friction

As the result of blunt trauma to the quadriceps femoris muscle, a patient experiences loss of knee function. Early PT interventions should stress: A. Gentle AROM exercises in weight bearing B. Aggressive soft tissue stretching to remove blood which has accumulated in soft tissues C. Aggressive open-chain strengthening of the quads to regain normal lower extremity strength D. Gentle PROM exercises in non-weightbearing to regain normal knee motion

Gentle AROM exercises in weight bearing

A physical therapist assistant observes a physical therapist perform joint mobilizations on a patient rehabilitating from a knee fracture. The large amplitude movement is directed parallel to the joint surfaces and is designed to increase periarticular extensibility. This type of mobilization best describes: A. Grade III Traction B. Grade III Glide C. Grade IV Traction D. Grade IV Glide

Grade III Glide

A physical therapist assistant performs graded oscillation techniques in an attempt to reduce a patient's knee pain. Which grades of oscillation would be the most appropriate based on the stated objective? A. I, II B. I, III C. II, III D. III, IV

I, II

A 10 y/o boy with hemophilia fell and injured himself while skateboarding. He was admitted to a pediatric acute care facility and a therapist sees him that afternoon. Examination reveals a hemarthrosis in his left knee. The BEST initial intervention for this patient is: A. Instruct the patient in crutch use to protect the joint and assist in early return to walking B. A pool program to maintain ROM and strength while he is non-weightbearing C. A hot pack for the knee, splint and instruction in non-weightbearing exercises D. Ice, elevation and a splint for the limb

Ice, elevation and a splint for the limb

A seventeen y/o healthy female athlete is being treated for tendonitis of the right patellar tendon. The supervising PT believes that it is time to enhance her strength by introducing appropriate therapeutic exercises. The exercise principle that would most likely promote rapid strength development would be to: A. Increase the size of the muscle belly through repeated bouts of exercise B. Begin repeated bouts of sub-maximal isometric exercise C. Increase the recruitment of motor units through increased resistance D. Instruct the athlete to ingest greater amounts of protein in her diet

Increase the recruitment of motor units through increased resistance

The primary physical therapist asks you to perform patellar joint mobilizations on a patient 5 weeks s/p knee surgery. If the primary goal was to assist in gaining limited knee flexion the direction of the mobilization should be placed in which of the following directions? A. Superior B. Inferior C. Medial D. Lateral

Inferior

Following a total knee replacement [TKR], continuous passive motion [CPM] is initiated. One of the main objectives in using CPM in this case is to facilitate: A. Active knee extension B. Passive knee flexion C. Passive knee extension D. Active knee flexion

Active knee flexion

You are manually stretching a patient's hamstring muscle in the supine position by performing a passive straight leg raise. The therapeutic goal is to improve long-term flexibility of the hamstring muscle. The physiological changes that you are trying to produce are: A. Elastic changes in the musculotendinous components B. Elastic changes in the ligamentous components C. Plastic changes in the ligamentous components D. Plastic changes in the musculotendinous components

Plastic changes in the musculotendinous components

A PTA is required to train a 71 y/o patient to ascend and descend stairs. The patient presents with a fractured left tibia and is weight bearing as tolerated. There is moderate weakness in the involved lower extremity secondary to the fracture. The most appropriate instructions are: A. "One step at a time, right foot first to ascend and to descend the stairs" B. "Step over step slowly" C. "One step at a time, left foot first to ascend and to descend the stairs" D. "One step at a time, right foot first to ascend the stairs and left foot first to descend the stairs"

"One step at a time, right foot first to ascend the stairs and left foot first to descend the stairs"

A patient demonstrates quadriceps weakness (4-/5) and difficulty descending stairs. The BEST intervention to regain functional strength in the quadriceps is: A. Isokinetic exercise, at 36 degrees/second B. Partial squats progressing to lunges C. Progressive resistance exercises, 70% 1 RM, 3 sets of 10 D. Maximum isometric exercise, at 45 and 90 degrees of knee extension

Partial squats progressing to lunges

A patient is referred to physical therapy 24 hours after a total knee replacement. What exercise would be the most appropriate to begin treatment? A. Quadriceps sets B. Short arc quads C. Standing leg curls D. Straight leg raises

Quadriceps sets

A patient with patellar tracking dysfunction is referred to physical therapy. A note from the examination indicates diminished vastus medialis obliquus activity. The most appropriate method to selectively train the vastus medialis obliquus is: A. Short arc terminal extension with manual resistance B. Quadriceps setting exercises and biofeedback C. Straight leg raises with leg weights D. Multiple angle isometric exercises

Quadriceps setting exercises and biofeedback

Following surgery, a patient has effusion of the right knee joint and is unable to initiate quadriceps setting exercises. To facilitate the exercise, the best method to use would be: A. TENS stimulation to the thigh B. Quick icing to the quadriceps muscle C. Joint approximation at the knee D. Firm pressure on the patellar tendon

Quick icing to the quadriceps muscle

A patient with iliotibial band friction syndrome is seen in physical therapy for instruction in stretching of the iliotibial band and tensor fascia latae. The most appropriate way to teach this stretch is to position the patient: A. Sidelying on the involved side with the upper leg supported while the patient flexes, adducts and externally rotates the involved hip B. Supine while the patient extends, abducts and internally rotates the involved hip C. Sidelying on the uninvolved side while the patient extends, internally rotates and adducts the involved hip D. Standing with legs adducted, flexing and laterally rotating the trunk towards the involved side

Sidelying on the uninvolved side while the patient extends, internally rotates and adducts the involved hip

A patient diagnosed with left patellofemoral pain is referred to physical therapy. The patient reports the onset of pain in the left knee occurs when she runs for more than six miles. The physical examination of the left knee reveals mild edema along the medial joint line, diminished patella medial glide, and mild vastus medialis atrophy. The MOST appropriate treatment option is: A. Medial patella glides and squats to 90 degree knee flexion with hip adduction. B. Open chain knee extension in short sitting C. Squats to 30 degrees knee flexion with a resistance tube and medial patella glides D. Phonophoresis and retro- walking on a treadmill.

Squats to 30 degrees knee flexion with a resistance tube and medial patella glides

A PTA is treating a patient status post knee surgery. The patient is presently using a straight leg immobilizer that maintains the knee in an extended position. The decision to discontinue the knee immobilizer would be MOST influenced by the patient's: A. edema B. active range of motion C. quadriceps control D. pain

quadriceps control

A patient status post open knee meniscectomy is referred to physical therapy for neuromuscular electrical stimulation. The most beneficial frequency of treatment to promote strengthening is: A. three times per week B. one time per week C. two times per week D. once every two weeks

three times per week

A PTA reviews an exercise program for a patient rehabilitating from ACL reconstruction. Which of the following treatment options would place the least amount of stress on the reconstructed ligament? A. Walking B. Stationary cycling C. Slow running on a level surface D. Fast running on a level surface

Stationary cycling

A patient 2 weeks post anterior cruciate ligament reconstruction using a patellar tendon autograft is referred to physical therapy. The supervising physical therapist indicates that the patient's rehabilitation program should avoid activities that place shearing stress on the reconstructed ligament. Which exercise would be the least desirable to include in the exercise program? A. Straight leg raises in supine from 0-60 degrees of hip flexion B. Standing hamstrings curls from 0-90 degrees of knee flexion C. Gravity assisted knee extension in supine D. Supine short arc quadriceps exercises using a bolster

Supine short arc quadriceps exercises using a bolster

A patient two weeks s/p ACL reconstruction using a patellar tendon autograft is referred to physical therapy. The supervising physical therapist indicates that the patient's rehabilitation program should avoid activities that place shearing stress on the reconstructed ligament. Which exercise would be the least desirable to include in the exercise program? A. Straight leg raises in supine from 0-60 degrees of hip flexion B. Standing hamstrings curls from 0-90 degrees of knee flexion C. Supine short arc quadriceps exercises using a bolster D. Gravity assisted knee extension in supine

Supine short arc quadriceps exercises using a bolster

A PTA provides pre-operative instruction for a patient scheduled for anterior cruciate ligament reconstructive surgery. During the treatment session, the patient expresses to the therapist a sincere fear of dying during surgery. The therapist's most appropriate response would be: A. This surgery is done many times every day B. I have never had a patient die yet C. You will be back to athletics before you know it D. Surgery can be a very frightening thought

Surgery can be a very frightening thought

A physically active 27-year-old male receives preoperative instruction prior to anterior cruciate ligament reconstruction. The patient's past medical history includes a medial meniscectomy of the contralateral knee eight months ago. The most likely functional level of the patient following rehabilitation is: A. able to return to previous functional level B. able to participate in light recreational activities C. able to participate in all recreational activities D. able to return to recreational and competitive athletic activities with a de-rotation brace

able to return to previous functional level

A physician instructs a 26-year-old male to utilize a knee de-rotation brace for all athletic activities. Which condition would most warrant the use of the de-rotation brace? A. medial meniscus repair B. anterior cruciate ligament reconstruction C. posterior cruciate ligament reconstruction D. anterior cruciate ligament insufficiency

anterior cruciate ligament insufficiency

A patient successfully completes ten anterior lunges. The physical therapist assistant would like to modify the activity to maximally challenge the patient in the sagittal plane. Which of the following modifications would be the most appropriate? A. anterior lunge with concurrent bilateral elbow flexion to 45° with five pound weights B. anterior lunge with concurrent unilateral shoulder flexion to 90° with a five pound weight C. anterior lunge with concurrent bilateral shoulder flexion to 90° with five pound weights D. anterior lunge with concurrent bilateral shoulder abduction to 45° with five pound weights

anterior lunge with concurrent bilateral shoulder flexion to 90° with five pound weights

A physical therapist assistant attempts to select assistive device for a 46-year-old female that is partial weight bearing on the right lower extremity. Which of the following assistive devices permits weight bearing and requires the patient to exhibit significant coordination? A. axillary crutches B. bilateral canes C. single cane D. walker

axillary crutches

A physical therapist assistant implements an exercise program consisting of closed-chain activities for a patient rehabilitating from a medial meniscus repair. An appropriate closed-chain exercise to include in the rehabilitation program is: A. bilateral mini-squats in standing B. submaximal velocity spectrum isokinetic exercise C. short-arc terminal knee extension D. prone leg curls with a two pound cuff weight

bilateral mini-squats in standing

A patient two days status post arthroscopy of the knee completes a quadriceps setting exercise while lying supine on a mat table. During the exercise the patient begins to experience severe pain. The most appropriate physical therapist assistant action is: A. have the patient perform the exercise in sidelying B. have the patient flex the knee prior to initiating the exercise C. place a pillow under the ankle D. discontinue the exercise

discontinue the exercise

A patient rehabilitating from a motor vehicle accident completes a series of closed kinetic chain exercises. One of the exercises requires the patient to perform a mini-squat in an erect position the center of gravity placed directly over the knee joint. If the physical therapist assistant modifies the activity by asking the patient to move the buttocks posteriorly in relation to the knees, what muscle group is the therapist attempting to emphasize? A. knee extensors B. hip extensors C. knee flexors D. hip flexors

hip extensors

A patient scheduled for posterior cruciate ligament reconstruction in two weeks is seen in physical therapy. The patient has diminished quadriceps strength and walks with a noticeable limp. The involved knee has mild edema and a 15 degree flexion contracture. The most appropriate treatment priority is: A. improve quadriceps strength B. improve range of motion C. improve fluidity of gait D. reduce edema

improve range of motion

A patient rehabilitating from a knee injury completes an isokinetic test. The patient produces 88 ft./lbs. of torque with the hamstring at 120° per second. Assuming normal quadriceps/hamstrings ratio, which of the following MOST accurately reflects the predicted quadriceps value? A. 67 ft./lbs. B. 109 ft./lbs. C. 136 ft./lbs. D. 183 ft./lbs.

136 ft./lbs.

A physical therapist assistant employed by a home health agency visits a patient status post total knee arthroplasty. The patient was discharged from the hospital yesterday and according to the medical record had an unremarkable recovery. The physician orders include the use of a continuous passive motion machine. The MOST appropriate rate of motion would be: A. 2 cycles per minute B. 4 cycles per minute C. 6 cycles per minute D. 8 cycles per minute

2 cycles per minute

A patient diagnosed with infrapatellar tendonitis completes a series of functional activities. After completing the activities the physical therapist assistant instructs the patient to use ice massage over the anterior surface of the knee. The MOST appropriate treatment time is: A. 3-5 minutes B. 5-10 minutes C. 10-15 minutes D. 15-20 minutes

5-10 minutes

A patient two months status post total knee replacement is referred to physical therapy for range of motion and strengthening exercises. Which treatment technique would be inappropriate for this patient? A. Active stretching using the contract-relax technique B. Joint mobilizations to increase joint play C. Exercise on a stationary bicycle against mild resistance D. Performing SLR's, SAQ's, and knee flexion exercises using ankle weights

Active stretching using the contract-relax technique

A therapist is treating a patient status post left knee replacement with goals of general conditioning and independence for household mobility. Which component of the patient's treatment program would be the most appropriate to delegate to a physical therapy aide? A. Stair training B. Progressive gait training with a straight cane C. Patient education regarding the surgical procedure D. Ambulation with a walker for endurance

Ambulation with a walker for endurance

A patient demonstrates a deficit in terminal knee extension following knee surgery due to capsular tightness. To assist the patient in gaining this last 10-15 degrees of knee extension you should perform which of the following? A. Pure posterior glides B. Posterior glides with medial rotation C. Anterior glides D. Anterior glides with lateral rotation

Anterior glides with lateral rotation

A college soccer player sustained a hyperextension knee injury when kicking the ball with his other lower extremity. The patient was taken to the emergency room of a local hospital and was diagnosed with "knee sprain". He was sent to physical therapy the next day for aggressive rehabilitation. As part of the examination to determine the type of treatment plan to implement, the therapist conducts the test shown in the figure (Page 621). The type of exercise that is indicated in the acute phase of treatment if a positive test is found includes: A. Agility exercises B. Open-chain terminal knee extension exercises C. Plyometric functional exercises D. Closed chain terminal knee extension exercises

Closed chain terminal knee extension exercises

A patient sustained a valgus stress to his left knee while skiing. Special tests found a positive McMurray's and Lachman's test. He has been sent to physical therapy for conservative treatment. The sub-acute phase of physical therapy intervention should emphasize: A. Open-chain strengthening of the quadriceps femoris and hip adductors to inhibit anterior translation of the tibia on the femur. B. Closed-chain functional strengthening of the quadriceps femoris and hip abductors to promote regaining terminal knee extension. C. Open-chain exercises of the hip extensors and hamstrings to inhibit anterior translation of the femur on the tibia. D. Closed-chain functional strengthening of the quadriceps femoris and hamstrings emphasizing regaining terminal knee extension.

Closed-chain functional strengthening of the quadriceps femoris and hamstrings emphasizing regaining terminal knee extension.

A 10 y/o boy who plays catcher on his baseball team complains of bilateral knee pain which is exacerbated with forceful quadriceps contraction. He has also noticed pain and swelling at the distal attachment of the patellar tendon. Effective early intervention should include: A. Decreased loading of the knee by the quadriceps femoris muscle B. Modalities to decrease inflammation C. AROM exercises to prevent contracture D. Casting followed by decreased loading of the knee

Decreased loading of the knee by the quadriceps femoris muscle

A patient status post medial meniscus repair is referred to physical therapy. Which of the following would be the responsibility of the physician post-operatively? A. Determine weight bearing status B. Specify the parameters for superficial modality application C. Specify the frequency and duration of range of motion exercises D. Select an appropriate resistive exercise program

Determine weight bearing status

A patient is receiving physical therapy following an ACL repair. After 4 weeks of treatment the patient still complains of pain and instability even though he reports he has been faithful with his home exercise program and wearing his orthosis. The original referral was for 7 to 8 weeks of physical therapy. The therapist's BEST course of action is to: A. Recommend to the Pt. that he get a second medical opinion as the surgery seems unsuccessful B. Discontinue the treatment; and discuss the situation with the supervising physical therapist C. Complete the full 8 weeks of treatment and carefully document his lack of improvement to ensure full insurance coverage D. Re-examine the patient and implement a modified therapy program

Discontinue the treatment; and discuss the situation with the supervising physical therapist

A physical therapist assistant works with a patient diagnosed with anterior cruciate ligament insufficiency. The physician referral specifies closed kinematic chain rehabilitation. Which exercise would NOT be appropriate based on the physician order? A. Exercise on a stair machine B. Limited squats to 45 degrees C. Walking backwards on a treadmill D. Isokinetic knee extension and flexion

Isokinetic knee extension and flexion

A patient with osteoarthritis in the right knee is referred to physical therapy. Examination reveals moderate inflammation in the involved knee and significant muscle weakness particularly in the quadriceps. The patient rates the intensity of pain in the knee as a 4 on a scale of 0 to 10. The most appropriate activity to address the muscle impairment is: A. Straight leg raises with ankle weights B. Limited range active knee extension in short sitting C. Avoid strengthening exercises until the patient is pain free D. Isometric quadriceps contraction

Isometric quadriceps contraction

A physical therapist assistant uses iontophoresis over the anterior knee of patient with patellar tendonitis. Assuming the established goal is to reduce the patient's present pain level, the MOST appropriate solution to utilize is: A. Acetic acid B. Lidocaine C. Sodium chloride D. Zinc oxide

Lidocaine

A 23 y/o male has sustained a left quadriceps strain while playing recreational volleyball two weeks ago. The supervising physical therapist has instructed you to begin a stretching program to promote a functional gain in range of motion. The patient has noted pain and discomfort with knee flexion greater than 80 degrees. The most appropriate treatment program for this patient would be: A. Moist heat followed immediately by ballistic stretching B. Moist heat followed immediately by static stretching C. Cryotherapy followed immediately by ballistic stretching D. Cryotherapy followed immediately by static stretching

Moist heat followed immediately by static stretching

A patient with left knee degenerative joint disease c/o knee pain of two months duration. He has been followed by outpatient PT for 3 weeks. The patient feels his condition is worsening as pain has increased during weight bearing activities and he can no longer fully extend his left knee. Re-examination findings include: increased swelling, decreased knee AROM into extension, and an antalgic gait. The PTA should: A. Continue therapy for another week to ensure that all interventions have been attempted and then return the patient to the referring physician. B. Continue physical therapy for another two weeks because there is uncertainty if the patient understands or is complying with the home exercise program. C. Tell the patient to see an orthopedic surgeon for possible immediate surgical intervention. D. Notify the primary physical therapist as to the ineffective treatment and document.

Notify the primary physical therapist as to the ineffective treatment and document.

A PTA is treating a 47 y/o female with diminished lower extremity ROM due to tight hamstrings. As part of the treatment program, the therapist attempts to identify an appropriate active exercise technique to improve ROM. Which objective finding would result in contract-relax being an undesirable treatment option? A. The limitation of movement is greater than 50% of the normal available range B. The limitation of movement involves multiple planes C. The limitation of movement is accompanied by pain D. The limitation of movement occurs in a non-capsular pattern

The limitation of movement is accompanied by pain

A physical therapist assistant treats a 47-year-old female with diminished lower extremity range of motion due to hamstrings tightness. As part of the treatment program, the therapist attempts to identify an appropriate active exercise technique to improve range of motion. Which objective finding would result in contract-relax being an undesirable treatment option? A. The limitation of movement is greater than 50% of the normal available range B. The limitation of movement involves multiple planes C. The limitation of movement occurs in a non-capsular pattern D. The limitation of movement is accompanied by pain

The limitation of movement is accompanied by pain

A fourteen-year-old girl complains of sub-patellar pain after participation in an aerobic exercise program for two weeks. The physical therapist's examination shows a large Q angle, pain with palpation at the inferior pole of the patella, and mild swelling at both knees. Physical therapy intervention should promote: A. Vastus medialis muscle strengthening B. Lateral patellar tracking C. Vastus lateralis strengthening D. Hamstring strengthening

Vastus medialis muscle strengthening

A physical therapist assistant prepares a patient education program for an individual with chronic venous insufficiency. Which of the following would NOT be appropriate to include in the patient education program? A. Wear shoes that accommodate to the size and shape of your feet B. Observe your skin daily for breakdown C. Wear your compression stockings only at night D. Keep your feet elevated as much as possible throughout the day

Wear your compression stockings only at night

A patient diagnosed with chronic osteoarthritis of his right knee and is referred to physical therapy. The patient reports his current pain as a 4 on a visual analog scale ranging from 0-10. The MOST appropriate goal when addressing the patient's pain is: A. prevent pain B. control pain C. manage pain D. alleviate pain

manage pain

A patient eight days status post anterior cruciate ligament reconstruction using a patellar tendon autograft is referred to physical therapy. Which of the following exercises would be the most appropriate based on the patient's post-operative status? A. limited range isokinetics at 30 degrees per second B. mini-squats in standing C. unilateral leg press D. active knee extension in short sitting

mini-squats in standing