620 FInal

30. You are a PT in an inpatient rehab setting. When doing a chart review you note that your patient is listed as Rachos Los Amigos LCFs Level 7. Which of the following behaviors might you expect from this patient? B

Automatic, robotic responses; able to carry out steps of familiar routines

15. You are instructing your older patient with complete paraplegia in wheelchair propulsion. You recall that there are many different propulsion strategies you can choose from and you struggle to remember if one is superior to another when first instruction. Which of the following might best drive your decision? A

Choose a single or double looping pattern after proper wheelchair fitting that allows for efficient and effective propulsion and avoids excessive shoulder extension or elevation

40. When working with a patient who is having difficulty with the execution of their sit to stand transfers, showering weakness in midrange, which of the following techniques would be MOST appropriate at this level? D

Combination of isotonics, working in the weak range

54. When evaluating an individual s/p severe traumatic brain injury, which of the following provide you with the best evidence for prediction of outcome in patients with a TBI? Choose all that apply.B + D

Duration of coma or unconscious state and Their GCS score

28.Which of the following interventions for SCI would focus primarily on compensatory strategies instead of recovery of function? C

Exercises to enhance tenodesis and focusing on the head-hip relationship while teaching transfers from wheelchair to/from mat

6. A patient sustained a CVA involving the right parietal hemisphere, exhibiting SEVERE unilateral hemisensory and hemispatial neglect. Which of the following interventions is the BEST choice for the PT to select? C

Explicitly (verbally), repetitively call attention to the left extremities during all interactions and interventions

29. Based upon the most current evidence, what are the minimum requirements for cardiorespiratory fitness and muscle strengthening in patients with SCI, specifically relative to the type and does of 1). Fitness and 2). Strengthening? (open ended)

For cardiorespiratory fitness and muscle strength benefits, adults with SCI should engage in at least 20 mins of moderate to vigorous intensity aerobic exercise 2x per week AND 3 sets of strength exercises for each major muscle group, at a moderate to vigorous intensity, 2x per week

26. A patient presents s/p fall with a head injury. On arrival his eyes open to painful stimuli, he is confused and withdraws to pain. What is the GCS severity of injury and prognosis for the patient? B

GCS is most consistent with a score of 10, a head injury of moderate severity, and a poor prognosis for full recovery

52. A diabetic patient with hemiplegia and hemisensory loss, bilateral edema, and limited distal lower extremity active motor recovery, requires recommendation of appropriate orthotic prescription at discharge. What recommendation is most appropriate to make to the rehabilitation team prior to discharge?

Graphite AFO

10. A patient post CVA presents with a reported change in status. The family reports increased assistance required for basic ADL sequences, increased confusion, increased assistance required for walking safety because of poor balance, and a new onset of incontinence. This cluster of symptoms MOST suggest which of the following? C

Hydrocephalus

14. You are working in an acute inpatient rehabilitation setting on the TBI floor. Your next patient is a Ranchos Los Amigos LCF's Level V. Which of the following tests would be MOST appropriate for this evaluation? CHOOSE ALL THAT APPLY C+D

Moss Attention Rating Scale+ Agitated Behavior Scale

21. Working as an outpatient PT, you are about to evaluate a patient s/p TBI who is Ranchos Los Amigos LCFs Level 7. According to the chart this patient is having difficulty with functional activities, postural control and becomes easily frustrated when tasks are too difficult. Using what you know about LCF's Level 7 and what you learned from their chart, which group of tests would be your PRIORITY for this first visit? A

Moss Attention Rating Scale, Berg Balance Scale, 10M walk test

24. The following represents the theory underlying the various neuromuscular reeducation techniques available to a PT within the intervention toolbox. Please select the MOST appropriate matching answer

NDT/Bobath - Normalize tone, inhibit primitive patterns of movement....etc Brunnstrom - Synergies, primitive reflexes, and other abnormal movements...etc PNF - Stimulation of nerve, muscle, and sensory receptors through manual...etc Rood - Modify muscle tone and motor activity using cutaneous sensory input...etc

5. A PT evaluates an individual 2 days post CVA. The patient demonstrates return of active upper extremity motor including all shoulder and elbow motions against gravity, with initiation of wrist extension and extension of three of four digits. Which of the following prognostic statements is the MOST appropriate for the PT to share with the patient given these findings? C

Patient can expect complete upper extremity recovery

17. Chart review of the barlum Swallow test results from this morning reveal moderate severe dysphagia with mild aspiration. Entering the hospital room, the patient is found slouched/fallen down in the bed, laterally flexed forward toward the hemiplegia side. Which of the following actions should be the FIRST for the PT to perform as part of their session? A

Physical therapist contacts speech pathology for intervention assistance

48. A patient recovering from traumatic brain injury (TBI) is unable to bring the right foot up onto the step during stair training after multiple attempts, demonstrating a progressive increase in extensor tone and frustration. The BEST training activity is to: A

Practice components of stair climbing inside the parallel bars using a 3-inch step

3. When working with a patient that is s/p moderate TBI, the patient begins to become agitated and refuses to do any more work during your session. You allow the patient to return to their room. During your next session, how can you modify the session to remove the agitating antecedent? A

Raise the height of the surfaces they are transferring from

50. You are treating a patient that is s/p TBI with severe spasticity and tightness in the trunk and lower extremities. You have chosen slow lower trunk rotation in a hook lying position with the goal of: D

Reciprocal inhibition to achieve relaxation of the LE extensors

43. A therapist is working with a patient recovering from TBI. Rancho Los Amigos levels of cognitive functioning Level 4. This is the patients first time in the PT gym. While the therapist attempts to work with the patient on transfers, the patient becomes agitated and combative. Which strategy is the BEST choice in this situation? D

Remove the patient to a quiet environment and provide support and calming stimuli

53. In a well designed physical therapy intervention for neuromuscular reeducation of a task or movement, which of the following represents the most common way in which cortical representation (cortical or brain map) is changed in a patient following cerebrovascular accident. D

Repetitive task specific practice

49. An individual post CVA demonstrates early return of active upper extremity motor including all shoulder and elbow motions against gravity, with initiation of wrist extension and extension of three of four digits. Which of the following interventions is the MOST appropriate for the physical therapist to prescribe given these examination findings? B

Repetitive, task-specific functional movements of the affected UE

36. Which of the following is the MOST important protocol for preventing common secondary impairments in comatose or vegatative states after brain injury? D

Reposition patients every 2 hours to decrease likelihood of skin breakdown

13. A patient that is considered in a coma likely has damage to which structure of the brain? B

Reticular formation

23. You are working as an inpatient rehab PT. While working with a new patient that is s/p severe TBI after falling 15 feet from a roof, he reports that the first thing he remembers following his injury is seeing his wife as his bedside 2 weeks after he fell from the roof. What type of memory deficit is this patient demonstrating? A

Retrograde amnesia

51. While working with your new patient that is s/p C6 SCI ASIA C, your evaluation has shown he has poor postural control and sitting balance. He is currently able to sit on the edge of the mat with bilateral upper extremity support. He requires max assist when unsupported. Which of the following therapeutic activities would be MOST appropriate to begin with for balance training? A

Rhythmic stabilization in sitting with BUE support to activate trunk muscles

8. A patient post CVA presents with urinary incontinence. List two important patient risks or complications associated with the presence of urinary incontinence.

Skin breakdown and Fall risk

2. Which of the following personal factors in the review of systems of an adult client is of GREATEST association with risk of stroke and may require referral and patient education? A

Smoking and blood pressure >165/95 mmHg

9. You are preparing to complete education on a bladder program with your 19 yr old male patient that is s/p T2 SCI, ASIA A. Which of the following would be the BEST technique to teach? A

Tactile stimulation to the suprapubic area, this injury causes a reflexive bladder

41. A patient with a moderately severe TBI made gradual improvements over two months but then developed a shuffling gait and has stopped initiating conversations. What is the most likely diagnosis? B

Temporal lobe seizure

18. After you evaluated a patient with a foot drop, you decided to use a functional electrical stimulation to address the issue during gait. Using a manual trigger, which of the following statements BEST describes the timing that you turn on/off the stimulation to the dorsiflexor muscles? A

Turn the stimulation on during the initial swing phase, turn the stimulation off during the initial to mid-stance phase

11. A patient with a recent severe TBI has no purposive cognitive or communicative engagement but occasionally smiles or cries. What is the MOST appropriate classification of altered state of consciousness if the patient manages basic cardiorespiratory and homeostatic functions, tracking some of the PT's movements in the room, but is not able to reliable execute purposive movement of muscle groups? C

Unresponsive wakefulness state

12. Postural hypotension can be a major concern post SCI. Which of the following interventions would be BEST to help improve your patients tolerance to the upright position? D

Use of a tilt table while monitoring BP, issuing an abdominal binder

22. Which of the following activities would be MOST appropriate for Ranchos Los Amigos LCFs Level V? C

Using on compensatory strategies to roll in bed, using short, simple commands, having caregiver training to maximize carryover

37. Which of the following levels of SCI would you expect could BEST independently manage a manual wheelchair in the community? C

C6-7

25. Minimal contact assistance is provided for imbalance to ensure safe transfer for a patient from sit to stand and bed to wheelchair. These results are BEST documented by the PT as which of the following? C

03. Partial/moderate assistance

1. Gait training an individual following stroke, the physical therapist observes genu recurvatum on the hemiparetic side following initial contact to midstance. Which of the following causes should be the MOST LIKELY intervention focus for the physical therapist to improve stance control?

A - Hip extensor and adductor spasticity paired with combined with quadriceps weakness at weight acceptance limits progression from mid to terminal stance

33. A patient post CVA is on anti-hypertensive agent, specifically a beta-blocker. Which of the following side effects is of GREATEST concern to the PT during interventions?

A - Hypotension

45. Your next patient is s/p traumatic brain injury 2 days ago with moderate intracranial edema present. The patient is currently ventilated and is being medically sedated. You have been cleared to do positioning and passive range of motion with this patient. When treating this patient, which of the following are MOST important to monitor during your session? Choose all that apply. A, B, C, D, F

ALL EXCEPT "PAIN"

20. As a PT in an inpatient setting you are assigned to work with a patient that is classified as LEVEL VI on LCF's Which of the following compensatory strategies would be MOST appropriate to supplement your therapy sessions? B

Activities to improve way-finding

4. For a patient post CVA, the therapeutic goal is to reduce genu recurvatum using an appropriate orthosis. Which of the following orthotics would be the MOST appropriate choice to achieve this goal? B

An AFO with ankle set in 5 deg dorsiflexion

44. You are currently working with a 45 year old male who was involved in a motor vehicle accident 2 months ago with resulting bi-frontal subdural hematomas, LCFS Level IV. This is the first physical therapy session in the acute rehabilitation hospital. When you approach, he is in his wheelchair and is complaining that he wants to go home and he can't understand why he is seeing you. He starts to yell and curse and is threatening to leave. Which of the following responses are best to communicate with this patient?

B - Calmly support and listen to his complaints, redirecting him by playing his favorite music and/or remove him from the source of agitation if possible

46. After a complete spinal cord injury affecting S2-S4, a bladder that cannot be emptied is which of the following?

B - Flaccid and paralyzed

42. You are treating an individual s/p TBI (closed) in the inpatient rehab setting. Please provide TWO autonomic nervous system symptoms/complications that you may encounter with this patient that would be concerning and negatively affect your treatment session. PICK TWO

Blood pressure changes. Vomiting

7. Which of the following is TRUE of brain injury? A

Diffuse axonal injury is a frequent cause of a vegetative state

19. A PT plans to facilitate controlled mobility of pre-gait for a patient who sustained a pontine CVA with resultant truncal ataxia. Which of the following neuromuscular activities would BEST be included in the treatment plan within this stage of motor control?

C - Tall kneeling, rhythmic stabilization of scapula/pelvis in stance position

27.Which of the following patients with spinal cord injury is MOST likely to regain some level of ambulation via neurological motor recovery? A

C3, AIS C, tetraplegia

47. A patient with complete spinal cord injury at the level of T11 is on a bowel program. The PRIMARY methodology of bowel training in this case is use of: B

Digital stimulation of intact defecation reflexes

38. Why do people with high thoracic spinal cord injuries have decreased expiratory pressure and ineffective coughs? C

Due to the inactivity of abdominal muscles

34. Your patient presents with muscle weakness in the hamstring and ankle plantarflexors. Which of the following BEST describes your hand placement for manual facilitation during body weight supported treadmill training?

D - Back of the knee during the swing phase and back of the ankle during stance phase

32. A PT selects CIMT to improve arms function in a patient with hemipariesis s/p parietal subdural hematoma with evacuation. Which of the following types of sensory motor recovery does the choice of CIMT BEST represent?

D - Experience-based cortical reorganization

55. You are treating a patient with a moderate traumatic brain injury. You notice during the current activity that the patient's respiration rate is increasing, they are beginning to fidget and their overall attention to this task is rapidly declining. Which of the following is the BEST response? Choose all that apply. A+B+D

Decrease the level of input and/or stimulation to the patient Decrease the level of difficulty of the task. Decrease the complexity of the environment

31. Analyze the postural alignment and control of the individual in the above picture. List and discuss the potential secondary impairments within/across three body systems and provide relevance.

Impaired ventilation - pulmonary system - will decrease ability to participate in PT treatment. Impaired muscle flexibility (hamstring length) - musculoskeletal system - biases pelvis to a posterior tilt leading to decrease in effectiveness of thoracic expansion and decreased oxygenation. Increased skin breakdown - integumentary system - limits ability to participate in PT treatment and enhances risk for infection

35. Which of the following is a sympathetic nervous system response that is MORE likely to be present after TBI? A

Increased heart rate

16. Review the above graphic. Define the principle and outline its relevance to your client, specifically their treatment plan, and impact on outcomes. (open ended)

Inverted U principle. This allows you to determine when the most appropriate time to treat your patient will be because you can schedule to see them when they are at optimal arousal and performance. This will promote better outcomes due to increased effectiveness and patient participation during treatment.

39. As an outpatient therapist, you are working with a patient that you have been seeing for 2 months for balance dysfunction. They have been steadily improving and you are getting ready for discharge next week. Today they report to therapy with a new onset of headache, confusion drowsiness and they report being very nauseous. After speaking with the patients caregiver you come to find they fell over the weekend ( 3 days ago) and the patient has been acting like this since this morning, and it seems to be getting worse. What is your differential diagnosis and immediate response? C

This is a subdural hematoma, call patient's MD