Exam B
Pt with left hemiplegia is able to recognize wife after she is with him for awhile and talks to him but is unable to recognize faces of his children when they come to visit. The children are upset. What is the BEST explanation to his problem?
Visual agnosia - inability to recognize familiar objects despite normal function of eyes and optic tracts
Therapist suspects pt recovering from MCA stroke, exhibiting pure hemianopsia. What test should be used to confirm the hemianopsia?
Visual confrontation test with a moving finger - visual field is examined using confrontation test
PT should be alert to recognize signs and symptoms associated with onset of aspiration pneumonia. Which patient diagnosis is MOST susceptible to develop aspiration pneumonia?
ALS with dysphagia and diminished gag reflex
UE function in pt with TBI examined using finger-to-nose testing. Movements are irregular, not easily reversed. As speed is increased movement becomes more disorganized. What are these findings indicative of?
Cerebellar dysfunction
Pt 5 weeks post-MI is participating in cardiac rehabilitation program. Therapist monitoring responses to increasing exercise intensity. What finding is an indication that exercise should immediately be terminated?
1.5mm of downsloping ST segment depression - representative of myocardial ischemia
Lachman's tests the integrity of what structure?
ACL
PT conducting study to determine optimal placement of electrodes for producing peak quadriceps femoris muscle torque. Four different electrode site placements are being investigated. Which statistical tool must be used to determine if there is a significant different in torque output based on electrode placement?
ANOVA - used to determine differences among 3 or more groups
New staff PT on oncology unit of large medical center receives referral for strengthening and ambulation of a woman with ovarian cancer undergoing radiation therapy after surgical hysterectomy. Current platelet count is 17,000. What intervention is indicated?
AROM exercises and ADLs (platelets <20,000) Exercise testing and training is contraindicated in patients with cancer whose platelets are <50,000, WBC <3000, Hemoglobin <10g/dL
Therapist investigated pulse oximetry during exercise; correlational analysis measured strength of relationship between two types of ear probe. Investigator found measured arterial oxyhemoglobin saturation (%HbO2) levels have a correlation of .89 at high saturation but only .68 at low saturation levels. How should therapist interpret these results?
Accuracy of measurements increases at higher saturation levels
What is MOST effective intervention to regain biceps brachii strength if muscle is chronically inflamed and has painful arc of motion?
Active eccentric contractions in pain-free range
Pt has hx of angina pectoris and limited physical activity. Pt participates in second exercise class, PT suspects angina is unstable and may be indicative of preinfarction state. What s/sx would therapist use to determine presence of unstable angina?
Angina of increasing intensity that is unresponsive to nitroglycerin or rest
Pt presents with acute sprain of R ankle. According to pt, this has occurred fairly frequently over past 5 years. What clinical test should therapist use to examine integrity of ATFL?
Anterior drawer test - talar tilt: CFL - morton's test: presence of stress fracture or neuroma in forefoot - Thompson's test: assess integrity of achilles tendon
High-risk medications with possible adverse effects can result in falls and fall injuries in adults >65. Which accurately describes potential adverse side effects associated with meds listed?
Antidepressants (i.e. Imipramine/tofranil) can result in sedation and hyponateremia (independent risk factor fo falls) Antipsychotics (haldol) can increase risk of falls due to dizziness, lightheadedness., drowsiness, impaired motor function Narcotics (oxymoron ever) can result in confusion, dizziness, orthostatic hypotension and fast, irregular HR Diabetes meds (glucophage) can result in hypoglycemia due to increased insulin or low blood sugar
During exam of C/S of client for C5 radiculopathy, small groupings of nevi are noted near superior angle of left scapula. What is NEXT action therapist should take
Ask pt about hx of moles/examine closely -asymmetry, border irregularities, color, diameter (>6mm)
Cerebellar infarct likely to demonstrate?
Ataxia
Congenital condition in which there is development of non-progressive contractures affecting one or more areas of body prior to birth?
Athrogryposis congenita multiplex
Therapist is treating 1 year old with Down syndrome at home notices decreasing strength in extremities with neck pain and limited neck motion. UE DTR are 3+. These signs and symptoms are a hallmark of what diagnosis?
Atlanto-axial subluxation with spinal cord impingement - ligamentous laxity is hallmark of DS and can lead to AA instability with spinal cord impingement, which is a medical emergency - increased DTRs with decreased strength are signs of dislocation from loss of cord function
Pt sprained L ankle 4 days ago. Pain 4/10, moderate swelling getting worse. Which intervention would be BEST to use?
Cold/intermittent compression combined with limb elevation
Pt is receiving mobilizations to regain normal mid thoracic extension; after 3 sessions, pt complains of localized pain persisting > 24 hours. What is the therapists BEST option?
Change mobilizations to gentle, low amplitude oscillations to reduce joints and soft tissue irritation
Elderly pt with severe COPD, GOLD stage 4. Which of following findings would therapist expect to find?
Barreled chest with decreased thoracic excursion - pt with COPD GOLD 4 will have lost much of elastic recoil properties of lung. Usual elastic properties of lung tissue help to pull thorax into normal chest wall configuration. Without these elastic recoil properties, pt's thorax will "barrel" in appearance, meaning it is larger and rounder than what you would normally expect. As thorax has moved into inspiratory position at rest, there is less movement available, so a decreased thoracic excursion would be expected.
PT and colleague examining pt who complains of numbness over lateral aspect of shoulder. PT convinced pt has C5 radiculopathy, while other colleague believes it is an axillary nerve lesion. Result of UE DTR equivocal. Weakness in which muscle would support C5 nerve root problem > axillary nerve lesion?
Biceps brachii - not innervated by axillary nerve, strong C5 muscle
Elderly adult pt presents with history of and subjective complaints consistent with lumbar central spinal stenosis. What is most appropriate clinical test to differentiate spinal stenosis from intermittent vascular claudication?
Bicycle (Van Gelderen's) Test
Before liver transplantation, pt has BMI of 17, generalized muscle atrophy and completed 6MWT with 65% of age-predicted distance. Surgery was 10 days ago, pt is able to complete bed mobility with overhead trapeze, walk independently for short distances with a rolling walker, complete deep breathing and LE AROM for 2x10 reps. Pt being discharged home w/family. Home care scheduled to begin in 1 week. What is BEST choice for pt's discharge HEP?
Breathing exercises, ambulation with walker, AROM LE
Pt with L CVA exhibits R hemiparesis and strong and dominant hemiplegic synergies in LE. What activity would be BEST to break up synergies?
Bridging, pelvic elevation; combines hip extension with knee flexion to break up synergies
Pt with recent trauma presents with restricted R hand movement. Decreased motion of third R PIP joint. To differentiate as to whether it is a joint restriction or not, what examination procedure should you do?
Bunnel-littler test - determines if there is intrinsic or joint capsule restriction at PIP joints
Pt dx with bulging disc at R L5-S1 spinal level without nerve root compression. What is impairment MOST likely to be documented?
Centralized gnawing pain with loss of postural control during lifting activities
Glossopharyngeal
CN IX, tase over posterior tongue
Hypoglossal
CN XII, strength of tongue protrusion
Pt seen in PT 2 days after MVA. Chief complaints are headaches, dizziness, neck pain with guarding, and a sensation of lump in throat. XRAYS were negative. What should therapist refer pt for?
CT scan
Pt presents with decubitus ulcer of 3 months on lateral ankle. Ankle is swollen, red, painful with moderate to high amount of wound drainage (exudate). What is BEST choice of dressing for this wound?
Calcium alginate dressings - wounds with moderate to high exudate benefit from calcium alginate. Dressings absorb large amounts of exudate (up to 20x their weight) and form a gel, to maintain moist wound environment while maintaining good permeability to oxygen
Elderly person has lost significant funcitonal vision over past 4 years and complains of blurred vision and difficulty reading; pt frequently makes mistakes of images directly in front of her, especially in bright light; able to identify environment in peripheral vision to both sides; what is the visual condition pt is MOST likely experiencing?
Cataracts - gradual loss of vision; central vision lost first, then peripheral; causes clouding of lens
College cross-country runner referred to PT with anterolateral leg pain. Pt reports pain has progressively worsened since an increase in training over past 2 weeks. Symptoms appear at later stages of runs and persist for 2-3 hours after completion of a run. Pt denies LE paresthesias. Tib A is tender and taut on palpation. Resisted DF is strong but reproduces pain. What is MOST LIKELY diagnosis?
Chronic exertional compartment syndrome - result of transiently elevated anterior compartment pressure that restricts blood flow to muscles; pts tender in anterolateral leg region with tautness of anterior compartment; rearfoot strike running may be associated with this due to increased muscle activity of Tib A.
Elderly man complains of LBP referred to PT at extended care facility. During history, pt describes urgent and painful urination and pain around base of penis and behind scrotum. Symptoms have been fluctuating over past few months but pain is severe, 7/10. Therapist suspects which of the following?
Chronic prostatitis
Pt sustained valgus stress to L knee while skiing. Orthopedist found positive McMurray's test and positive Lachman's stress test. Pt has been referred to PT for conservative management of problem. BEST intervention for subacute phase of rehabilitation?
Closed-chain functional strengthening of quadriceps femoris and hamstrings, emphasizing regaining terminal knee extension - closed chain exercises emphasized in subacute phase to enhance functional control of muscles surrounding knee
Soccer player sustained grade II inversion ankle sprain 2 weeks ago; what is BEST intervention to use in early subacute phase of rehab?
Closed-chain strengthening and proprioceptive exercises
PT treating patient with diabetic peripheral neuropathy. Pt recently began taking Lyrica (pregabalin). During monofilament exam of feet therapist notices circumferential marks bilaterally at level of malleoli after socks are removed. Pt is complaining of increased difficulty ambulating long distances. In this situation, what is the therapist's BEST course of action?
Contact physician about possible development of CHF
Pt experiencing persistent vertigo with increasing symptoms over past week, including mod to severe headaches over past 48 hours; spinning (vertigo) is so bad it prevents walking > few feet at a time. Persistent and sustained down-beating nystagmus that occurs with lateral gaze, head thrust, and Dix-Hallpike during exam. What is BEST treatment option?
Contact referring provider secondary to concerns of CNS pathology and need for further testing
Pt recovering from open heart surgery (sternotomy and CABG); PT is supervising outpatient exercise program at 7 weeks post surgery. What guidelines should be followed regarding use of moderate to heavy weights during resistance training?
Contraindicated in the first 2 months; restricted to 5-8 pounds for the first 5-7 weeks Once cleared; initial loads UE: 30-40% 1RM, LE: 50-60% 1RM
Pt with no significant PMHx now presents with bacterial pneumonia in R anterior base would present with which of the following exam findings?
Crackles on inspiration only at R anterior base, decreased SaO2, and productive cough x 3 days Pneumonia interferes with transport of oxygen from alveoli to pulmonary capillaries, PaO2 and SaO2 would be lower than expected; crackles common finding in pneumonia
PT is treating elderly, deconditioned pt in private room at long-term care facility; pt dx with C. diff and is referred for exercise to improve LE strength and ability to move STS. Therapist elects to use light resistance using cuff weights. What precautionary steps need to be taken?
Cuff weights and other exercise apparatus should be disinfected immediately on removal from pt's room
Pt presents with bluish discoloration of skin and nail beds of fingers and toes; palms are cold and moist. What is most likely cause of these changes?
Cyanosis
Elderly female pt taking Raloxifene for estrogen-like effects on the body in management of osteoporosis. What side effect should be monitored?
DVT
Elderly pt has history of two MIs and one episode of recent CHF. Pt has claudication pain in R calf during exercise tolerance test. What is the BEST initial exercise prescription for this patient?
Daily walking, using interval training for 10-15 minute periods
Pt with stage II primary lymphedema or R LE has increased limb girth with skin folds/flaps present. Important component of lymphedema management is MLD. Which describes a cardinal principle of MLD management?
Decongesting proximal portions of limb first and working distally
During US treatment, pt flinches and states a strong ache is felt in treatment area. What is BEST course of action?
Decrease US intensity
Pt recovering from GBS started attending supervised outpatient exercise program; pt failed to show up for follow-up sessions. Pt reported increased muscle pain and being too weak to get out of bed for past 2 days; pt is afraid to continue with exercise class. What is therapist's BEST course of action?
Decrease intensity and duration, but maintain frequency of 3x/week -clinical manifestations of GBS include myalgias, weakness as well as excessive fatigue with minimal activity; general conditioning is indicated
Pt with pain in left lateral face and head found to have limited active and passive mouth opening ROM. Passive lateral deviation is full to both sides. What is likely reason for limitation in mouth opening ROM?
Decreased flexibility of muscles of mastication on the left -unilateral capsular and intraarticular restrictions of TMJ would result in deflection of mandible toward side of restriction with opening and would limit lateral deviation away from side of restriction due to decreased anterior translation of mandibular condyle. Anterior disc displacement with reduction would not limit mouth opening.
Pt referred to PT for functional gait difficulties. Unable to take normal step, drags L foot. Examination reveals muscle weakness with fasciculations of L LE. What other signs/symptoms would most likely be present?
Decreased tone and hyporeflexia (LMN lesion) (hypotonia, flaccidity, hyopreflexia or areflexia and neurogenic atrophy)
PTA assigned to ambulate pt with 10 year history of PD. What should PT instruct PTA to watch for?
Decreased trunk rotation with shorter steps
Elderly and frail resident of nursing home developed stage III pressure ulcer. Wound is open with necrosis of subcutaneous tissue down to fascia. What are age-related changes expected in this pt when compared to a younger pt?
Decreased vascular and immune responses resulting in impaired healing (also will have decreased elasticity, eccrine sweating, vascular responses, and dec scarring)
Elderly pt referred to PT after fall and ORIF for fracture of R wrist. During initial exam, therapist observes pt's skin and eyes with a yellowish hue. What is therapist's BEST course of action?
Document findings, consult with primary physician immediately after treatment (jaundice/liver dysfunction)
Pt being examined for impairments after stroke. When tested for 2 point discrimination on R hand pt is unable to tell whether PT is touching with one or two points. Which ares of CNS can be impaired with these findings?
Dorsal column/lemniscal pathways and somatosensory cortex (DCML - discriminative touch, proprioception, vibration; faciculus cuenatus for UE, faciculus gracilis for LE)
Pt presents with complaint of neck pain on R. During AROM examination, PT observes these osteokinematic neck motions: full L SB, full L rot, full flex, limited and painful ext, limited and pain R SB, limited and painful R Rot; what is the arthrokinematic restriction?
Downglide of facet on R
Pt presents to clinic with pain and decreased function of R shoulder. Full tear of R rotator cuff is suspected. Which special test provides most valid and reliable information confirming this diagnosis?
Drop arm test
Pt presents with neck pain, result of MVA. To determine function of deep cervical flexors, PT decides to perform muscle function test utilizing cranio-cervical flexion test. What are expected findings when test is normal?
During active chin tuck, pressure in stabilizer cuff increases to 22, pt can hold position for 10 seconds
Pt with long-=standing TBI comes into outpatient clinic using standard wheelchair. Pt demonstrates sacral sitting with rounded, kyphotic upper back. What is MOST likely cause for this posture?
Excessive leg length from seat to foot plate - results in sliding forward in wheelchair to reach foot plate causing posterior tilt of pelvis and sacral sitting
Pt presents with large sacral decubitus ulcer that is purulent and draining. Therapist needs to take a representative sample of infected material in order to obtain lab culture. What is BEST source to obtain culture sample from wound?
Exudate in the wound - must be collected from wound site with minimum contamination from adjacent tissues
PFT findings with severe obstructive lung disese
FEV1 markedly reduced (<40%) FEF 25-75% low (indicating difficulty getting air out of small airways) TLC high (indicating air trapping) RV is increased - demonstrating significant air trapping Lung hyperinflation on a chest film is a hallmark sign in obstructive lung disease
67 yo pt with neck pain seen by PT; after examination, therapist consults with referring provider and recommends XR should be ordered to r/o C/S fracture. Which of the following examination findings prompted recommendation for XR?
Fall from 4-foot step ladder (Cspine rules, >65, dangerous MOI)
Pt with SCI is having difficulty learning how to transfer from mat to wheelchair. PT cannot seem to coordinate the movement. What is the MOST effective use of feedback during early motor learning?
Focus on knowledge of results and visual inputs - learners benefit from seeing the whole task performed correctly with dependence on visual inputs; developing reference of correctness (knowledge of results) is critical for early skill acquisition and cognitive mapping
Associative stage of motor learning
Focus on proprioceptive inputs is important (delayed feedback used in later learning)
Pt strained lower back muscles 3 weeks ago, now complains of pain (6/10); upon examination, therapist identifies BIL muscle spasm T10-L4. Therapist elects to apply IFC to help reduce pain and spasm; what is the BEST electrode configuration in this case?
Four electrodes, with current flow diagonal to the spinal column - allows greater area to be treated - current interference to occur b/w frequencies of two circuits because of diagonal pattern
Anosognosia
Frank denial, neglect, or lack of awareness of presence or severity of one's paralysis
Therapist wishes to use behavior modification techniques as part of plan of care to help shape the behavioral responses of a patient recovering from TBI. What intervention is BEST to use?
Frequent reinforcements of all desired behaviors Negative behaviors should be ignored, not reprimanded; self-correction is not a form of behavior modificaiton
Pt with ALS referred to PT; has mild to moderate weakness (2/5 to 4/5 MMT) and fasciculations in various muscles below knees and right hand. Which of following is BEST choice for initial intervention strategies?
Functional training activities with AD as needed to support independence
Outpatient PT is examining a pt who underwent TKA 2 weeks ago. Pt reports entire leg started swelling in past 2 days. Pitting edema through lower leg and foot with tenderness throughout mid calf. Girth measurements reveal 3.5cm increase in size of symptomatic leg. What recommendation should PT make?
GO immediately to ER - possible DVT
Pt referred for posterior thoracic pain; MSK exam finds no cause for symptoms. What anatomical structure may refer pain to thoracic region?
Gallbladder
Pt complains of 7/10 pain in shoulder region secondary to acute subdeltoid bursitis. Therapist elects to use TENS during acute phase. What BEST identifies the modulating properties of this?
Gate control mechanism
Pt with T10 ASIA A resulting from SCI is ready to begin community wheelchair training. Therapist's goal is to teach how to do wheelie in order to manage curbs. BEST training strategy?
Grasp handrims posteriorly, pull forward abruptly and forcefully
Following THA with posterior approach, what precautions are there?
HIp flexion > 90, adduction past midline, IR
Therapist instructing pt with a stroke in gait training. Therapist determines that learning is going well because pt's errors are decreasing and overall endurance is improving. What is BEST strategy to promote continued motor learning at this point?
Have pt practice walking in varying environments
Pt with diabetes and normal blood glucose prior to exercising reports feeling weak, dizzy, somewhat nauseous after 1 hour of exercising in your clinic. Therapist notices pt is also sweating profusely and is unsteady when standing; what is the BEST immediate course of action?
Have pt sit down, administer orange juice for hypoglycemia Hypoglycemia results from too much insulin; requires assessment of symptoms and prompt intervention with an oral sugar
What is MOST appropriate functional goal for 5 year old child with high lumbar lesion (myelomeningocele, L2) and minimal cognitive involvement?
Household ambulation with reciprocating gait orthosis (RGO) and Lofstrand crutches - able to ambulate household distances; benefits= improved cardiovascular and musculoskeletal functions
During an examination, pt demonstrates large-amplitude, sudden flailing motions of the arm and leg on one side of the body with primary involvement of axial and proximal joint muscles. What clinical term BEST describes the patient's behaviors?
Hemiballismus - refers to sudden, jerky, forceful, and flailing involuntary movements on one side of the body
Pt with 2 inch stage II decubitus ulcer over left lateral malleolus referred to PT. Therapist notes greenish, pungent exudate at wound site. Decides to do e-stim. What is the BEST treatment choice?
Hi volt pulsed monophasic current with anode over silver dressing placed in wound - evidence is strong for use of hi-volt pulsed monophasic current for reduction of infection, promotion of granulation and epithelialization; guidelines recommend anode (+ pole) used over silver dressing in wound if infection present
Pt presents with difficulty with fast movement speeds and fatigues easily. Therapist decides on strength training program to specifically focus on improving fast-twitch muscle fiber function. What is the optimal exercise prescription to achieve this goal?
High intensity workloads for short durations (low intensity, slow contraction speeds = type 1/slow twitch fibers)
Pt referred for outpatient care after tendon transfer of extensor carpi radialis longus. Muscle strength poor (2/5) in spite of previous intensive therapy. Therapist elects to apply biofeedback to assist in progressively increasing active motor recruitment. What is BEST choice for initial EMG protocol?
High-detection sensitivity with recording electrodes placed far apart over muscle belly
Phase 2 outpatient cardiac rehabilitation program uses circuit training with different exercise stations for 50 minute program. One station uses arm ergometry; for arm exercise compared with leg exercise, at a given workload, what can therapist expect?
Higher HR and systolic/diastolic BP
Overweight adult pt complains of R anterior hip and knee pain while walking, especially when weight bearing on R. Lumbar AROM normal and pain free. R hip AROM and PROM limited compared to L . Right knee AROM and PROM are full/pain free. No pain with resisted testing at R hip or R knee. Scour test reproduces pt's hip and knee symptoms. Hip joint distraction relieves symptoms. MOST likely diagnosis?
Hip DJD
Hyperthyroidism
Hyper metabolic state associated with exercise intolerance and impaired cardiopulmonary function; symptoms include dyspnea, fatigue, tachycardia, arrhythmia; in older adults there is increased risk of aggravating preexisting heart disease
Pt complains of diffuse joint and muscle pain; recent med history includes kidney stones. Pt appears drowsy and takes unusually long time to process info & answer questions. Which disorder is most likely explanation?
Hyperparathyroidism - moans, groans, stones, and bones: mental problems such as drowsiness, depression, confusion, poor memory (moans); arthralgia, myalgia, gout, abdominal pain (groans); kidney stones, renal calculi (stones); decalification of bones, pathologic fractures (bones)
Pt presents with T10 paraplegia complete. Extensive neurological workup failed to reveal specific cause for paraplegia. Physician determined dx of functional neurologic disorder. What is BEST choice of intervention?
Initiate functional training consistent with level of injury; treat this patient the same as any pt with SCI with similar functional deficits; early intervention is critical
Pt with type 2 diabetes is referred to PT for exercise conditioning; what is pathological cause of type 2 diabetes?
Impaired ability of tissues to use insulin and insulin deficiency
Somatognosia
Impairment in body scheme
Neer's test
Impingement of shoulder
Ideational apraxia
Inability to perform purposeful motor act, either automatically or upon command
With respect to a worker's sitting posture, which change provides greatest reduction in L/S compression forces?
Increasing chair backrest-seat angle to between 90 and 110 degrees Maximal reduction of lumbar disc pressures achieved between 90 and 110 degrees, using armrests for support, adding lumbar support or combining all for best solution.
Drop arm test
Integrity of rotator cuff
Pt with moderate to severe aortic valve stenosis presents to outpatient cardiac rehabilitation for aerobic conditioning. Which intensity of exercise program is MOST appropriate for this patient?
Interval walking program at 50% age predicted HR max - low intensity exercise should be prescribed due to risk of adverse events with higher intensity exercise/activities
Intention tremor
Involuntary oscillatory movements that occur during voluntary movement
Pt recovering from TBI demonstrates impaired cognitive function (Rancho Level VII). What training strategy should be therapist's focus?
Involve pt in decision making and monitor for safety
Infant dx with Erb's paralysis (brachial plexus injury). What would PT examination of infant MOST LIKELY reveal?
Involvement of muscles innervated by C5-6 nerve roots
Therapist treating pt with Brown-Sequard syndrome that resulted from gunshot wound. Which of following would therapist expect to find during examination?
Ipsilateral loss of motor function, light touch, and proprioception; contralateral loss of pain and temperature
Athlete sustained twisting injury of knee while playing basketball. PT suspects meniscal injury. BEST choice of special tests to confirm diagnosis?
Joint line tenderness and Thessaly test (CPG for meniscus injuries recommends Thessaly and McMurray tests); along with palpable joint tenderness yields good diagnostic utility for ruling in meniscal tear (high SP, positive likelihood ratios)
Middle-aged woman referred to woman's clinic with stress incontinence; reports loss of control that began with coughing or laughing but now occurs when she exercises aerobically 3x/week. What is BEST intervention for this patient?
Kegel's exercises several times/day
After treating pt for trochanteric bursitis for 1 week, pt has no resolution of pain and is complaining of problems with gait; therapist finds weakness of quadriceps femoris and altered sensation of greater trochanter. What is MOST likely cause of problem?
L4 nerve root compression
Pt presents to PT with primary complaint of LBP and R LE radicular symptoms extending distally to calf of 2 weeks duration. Current pain intensity is 2/10 at rest and 5/10 during lumbar extension movements. What is strongest prognostic indicator of not achieving a favorable clinical outcome?
LE radicular symptoms; presence of radicular symptoms in pts experiencing LBP is a strong prognostic indicator for not achieving good clinical outcomes
Pt seen in PT clinic after sustaining deep laceration of right buttock. During standing portion of physical examination, the therapist observes a positive Trendelenburg sign. What did the therapist see?
Left side of pelvis dropped when left foot was lifted off the ground
After MI, pt placed on meds including a beta-adrenergic blocking agent. When monitoring response to exercise, what changes in HR are expected?
Low at rest, rise very little with exercise
PT examines adult referred with acute ankle and foot pain. Dorsal and lateral aspects of foot and ankle are markedly swollen. Pt denies trauma; therapist notes swollen area is warm to touch, diffusely tender with palpation. Small, healed cut on dorsum of foot. Therapist suspects cellulitis. Which finding would help corporate dx of cellulitis?
Low grade fever -cellulitis is rapidly spreading, acute infection of skin and subcutaneous tissues; small breaks in skin allow organisms to invade the dermis and hypodermics; often presents with fever, chills, local swelling, tenderness, erythema, warmth. Lymphatic system if often first observed as a red streak under skin radiating from infection site in direction of regional lymph nodes.
Independent community ambulation as a primary means of functional mobility is a realistic functional expectation for some patients with complete SCI (ASIA A). What level would allow for this?
Low lumbar (L4-5)
Pt presents with LBP of insidious onset; based on history and subjective complaints, pt appears to have dysfunction of lumbar facet joint. What clinical test used to confirm diagnosis?
Lumbar quadrant test
Pt developed right throbbing shoulder pain after painting kitchen. Passive and active GHJ motions increase pain. What is suspected dx and BEST initial intervention?
Manual therapy techniques and therapeutic modalities to reduce pain as result of subdeltoid bursitis - bursitis is likely due to pain with AROM and PROM
Pt demonstrates postpartum sacral pain. Pt complains that pain is increased with prolonged walking, ascending or descending stairs, and rising from STS. What intervention would be MOST beneficial for this pt?
Manual therapy techniques of SIJ to provide relief of symptoms and therapeutic exercise to restore normal function of pelvic girdle
Pt with long term postural changes exhibits excessive forward head and complains of pain and dizziness when looking upward. What is MOST effective PT intervention?
Manual therapy techniques to provide pain relief and postural reeducation
Pt with 5 year history of AIDS and poor compliance with meds dx with HIV encephalopathy. What impairments should therapist expect to find during initial exam?
Memory loss, confusion, disorientation
Child with moderate CP is being treated; having difficulty learning to sit independently. Child does well with sitting most of time, but loses balance resulting in a fall backwards. You are worried primitive reflexes have not been integrated. Which of these reflexes or reactions would be MOST important to assess?
Moro and Startle reflex - occur if child looks up quickly with neck extension, shoulders abducted and elbows extended (Moro); startle results in same response but a result of loud noise, sudden movement in visual field or bright light; both could cause backward fall
Elderly pt suffered cerebral thrombosis 4 days ago, presents with: decreased pain and temperature sensation of ipsilateral face, nystagmus, vertigo, nausea, dysphagia, ipsilateral Horner's syndrome, contralateral loss of pain and temp. What is MOST likely location of thrombosis?
PICA (posterior inferior cerebellar artery) - presents with lateral medullary (wallenberg) syndrome; involves descending tract and nucleus of CN V, CN IX, CN X, cuneate and gracile nuclei and spinothalamic tract
Home care PT receives referral to evaluate fall risk potential of elderly community-dweller with chronic CAD. Pt has fallen 3x in past 4 months, no hx of all injury except for minor bruising. Pt currently taking number of meds. What is the drug most likely to contribute to dizziness and increased fall risk?
Nitroglycerin - dizziness/weakness due to postural hypotension
Elderly pt hospitalized for 3 weeks after surgical resection of carcinoma of colon. Pt is very weak, currently receiving PT to improve functional ambulation. During initial sessions, pt complains of pain in L shoulder that is aggravated by weight bearing using walker. What action should therapist take?
Notify physician immediately; risk of metastatic disease is present.
PT examines adult that recently suffered stroke involving right internal capsule. In addition to hemiparesis of contralateral extremities, pt also exhibits facial palsy. Which muscles would MOST likely be affected?
Only muscles on lower half of left side of face -stroke of internal capsule results in supranuclear palsy; affects contralateral lower half of face; (corticobulbar pathway contains UMN that project from motor cortex to facial nerve nucleus in brainstem; muscles in upper half of face spared because both R and L cerebral cortex project to LMNs in facial nucleus)
Pt with MRSA infection has been discharged from isolation with open wound of buttocks. Now returning to PT outpatient. Therapist should adhere to which precaution?
Open wound must be contained within a dressing; therapist should be gloved for any direct contact; all equipment cleaned with agent before and after use
Female underwent TKA 2 weeks ago, seen for first PT session to regain locomotor mobility. In addition to post-op knee pain, pt is upset and complains of considerable LBP since surgery; no previous hx of LBP; reports bloating and passing small amounts of liquid stool (not usual); PMHx includes hypertension, hyperlipidemia, osteoarthritis, type II diabetes. BMI is 32. Only med change is oxycodone for pain; what is MOST likely cause of back pain?
Opioid-induced constipation
Pt with congestive heart failure (CHF) is on regimen of diuretics (Chlorothiazide). Potential adverse effects of this medication that PT should be alert for?
Orthostatic hypotension and dizziness
Pt with cancer has been taking oral corticosteroids along with chemotherapy for the past year. What is an expected adverse effect of prolonged use of corticosteroids?
Osteoporosis -steroid medications have major effects on metabolism of calcium, vitamin D, and bone; prolonged use associated with bone loss, osteoporosis, fracture commonly reported in spine and ribs
Female pt complains of intermittent pain in R SIJ. Insidious onset appx 4 months ago. Pain gradually worsened and is now fairly constant, does not vary much with activity or movement. Active motion and overpressure of L/S at end range for all directions is normal without pain. SI provocation and lumbar mobilization tests are negative. Pt has diffuse and mild tenderness over R SIJ. What is MOST likely dx for this patient?
Ovarian cyst - all ovarian cysts can refer pain to sacroiliac region and is more likely to cause constant pain that does not vary much with activity; sx are not likely to be reproduced with musculoskeletal examination
2 year old child referred to PT for assessment due to concerns regarding delayed development of gross motor skills. Which would be the MOST appropriate developmental tool to use?
PDMS-2 - standardized tool to assess gross motor/fine motor development for children 0-5 years
Pt presents with pain and paresthesia over first two met heads of R foot. Pain worse after prolonged periods of weight bearing. Typically wears shoes with 3 inch heels and pointed toes. What is BEST intervention?
Pad placed proximal to met heads - elevates the transverse (anterior) arch and separates the metatarsals
After completing an examination of pt with shoulder pain, PT concludes cause is subscapularis tendinitis. Which clinical finding is supportive of this conclusion?
Pain provoked with passive GH ER or active IR
What is best intervention to improve left-sided neglect in pt with left hemiplegia?
Rolling, supine to sidelying on R, using PNF lift pattern - incorporate L side into crossing midline activity is best
Pt is reffered for postoperative rehabilitation following Type II SLAP repair performed 1 week ago. What is therapist's BEST choice of intervention during early rehabilitation?
Perform careful ROM of shoulder IRs - IRs will not peel back mechanism that increases stress to repair
Pt presents with weakness in R LE 3 weeks after MVA; complains of spontaneous twitching in muscles of lower leg. Muscle bulk is reduced on involved right limb with girth measurements 1 in difference; DTR diminished. What is MOST likely cause of weakness?
Peripheral nerve injury (LMN signs - hypotonia, hyporeflexia, paresis, neurogenic atrophy)
During course of PT treatment in ICU, radial artery line gets pulled (comes out of artery). What is first action PT should take?
Place BP cuff on involved extremity and inflate cuff until bleeding stops - not considered cardiac emergency; call for help once bleeding is stopped
Pt burned over 40% of body in an industrial accident and has full-thickness burns over anterior trunk and neck and superficial partial thickness burns over shoulders. In order to stabilize this pt out of positions of common deformity, what orthotic device would be greatest benefit?
Plastic cervical orthosis and Axillary splints utilizing an airplane position - stresses abduction, flexion and ER of shoulders
Therapist examining pt with vestibular dysfunction; pt asked to assume long sitting position with head turned to left side; therapist quickly moves pt backward so head is extended over end of table apprx 30 deg below horizontal. Causes severe dizziness and vertigo. Repeat to R side was negative. What is the BEST way to document this?
Positive L dix-hallpike test
Pt with fibromyalgia is experiencing symptoms of widespread pain, multiple trigger points, fatigue, sleep disturbances, and depression for the past 10months and describes significant limitations in daily activities; therapist wants to increase pt's activity level with aerobic conditioning. Which is the BEST choice for an initial exercise prescription for this patient?
Pool walking, slow walking, 30 min/session, 2-3x/week Low impact aerobics are best; pool walking has been shown to dec pain and stiffness while increasing cardiovascular conditioning and strength
PT and physician at odds regarding ordering a power wheelchair for 3-year old child. What factor precludes the use of a power wheelchair?
Poor head and fine motor control - most power wheelchairs require good head control to use a head rest control system or good fine motor skills to use a joy stick; this is a good reason to NOT recommend a power wheelchair
During therapy, pt with past history of seizures and TBI loses consciousness and presents with tonic-clonic movements involving all four extremities. Seizure lasts about 4 minutes before patient slowly becomes responsive. What is the therapists BEST immediate course of action?
Position pt in side-lying with mouth pointing to the ground during seizure
PT examines adult with significant swelling in R LE. Client reports she recently had radical hysterectomy for stage II cervical cancer. Lymphedema is expected. What is an important finding to corroborate dx?
Positive stemmer sign - highly specific for lymphedema; positive test if skin cannot be lifted or separated from underlying tissue
Knee capsular tightness has limited pt's ability to attain full flexion; Initial intervention a physical therapist can employ to restore joint motion should emphasize sustained mobilization in loose-packed positions; which of the following is the BEST choice to us?
Posterior glide and IR of tibia to achieve full flexion (Anterior glide and ER of tibia is for full extension)
Pt with bacterial pneumonia has crackles and wheezes in left lateral basal segment and decreased breath sounds throughout. Pt is on 4L of oxygen by nasal cannula with a resulting oxygen saturation (SaO2) of 90%. RR is 28. What is most beneficial intervention for this case?
Postural drainage, percussion, shaking over appropriate area on left lateral thorax for secretion removal Postural drainage for left lower lobe is in side-lying with head of bed tipped in full trendelenburg position
Retired bus driver experienced increasing frequency of LBP over past 10 years; pt states NSAIDs help to relieve symptoms, but there is always a nagging-type pain. Pt reports significant stiffness in the morning that dissipates by noon after exercising and walking. Pain is exacerbated with frequent lifting and bending activities, as well as sitting for long periods. What should PT plan of care emphasize?
Postural education, soft tissue mobilizations, dynamic stabilization This is a long term degenerative and postural dysfunction that is manageable with medication and proper physical activity; emphasize postural alignment and functional ADLs
Pt with hx of heart failure is taking Lasix (furosemide) to reduce volume overload. Which lab value is important to assess when treating pt who is taking Lasix?
Potassium -Lasix is not a potassium sparing diuretic and pts taking potassium are at risk for eliminating too much potassium; low potassium can lead to muscle cramps, fatigue, and cardiac arrhythmia
Pt recovering from stroke and at 4 months is ambulating with straight cane for household distances. During OP PT, therapist has pt practice walking with no AD. Recurvatum is observed that worsens with continued walking. What is BEST choice for intervention?
Practice isolated small-range quadriceps eccentric control work in standing and continue with straight cane
Elderly and frail older adult has low vision. Recently returned home from 2-week hospitalization for stabilization of diabetes. PT's goal is to mobilize pt and increase ambulation level and safety. What is BEST intervention strategy for pt?
Practice walking in areas of high illumination and low clutter
Pt in chronic renal failure is being seen in PT for deconditioning and decreased gait endurance. Therapist needs to schedule pt's sessions around dialysis, which is received 3 mornings a week. What guidelines should therapist follow when taking pt's BP?
Pre and post-activities, using nonshunt arm
Pt recovering from incomplete SCI at L3 (Asia D) ambulate s with bilateral Lofstrand crutches. Pt reports great difficulty going down ramps with unsteady, wobbly knees. What is BEST intervention to use?
Progressive resistance training for quadriceps - L3 affects knee extensors/ Asia D indicates half key muscles > 3/5.
Pt with MS presents with dysmetria in both UE. Which of the following interventions is BEST choice to deal with this problem?
Proprioceptive neuromuscular facilitation (PNF) patterns using dynamic reversals with carefully graded resistance -Adding manual resistant with PNF can assist pt in slowing down movement and achieving better control
2-week old infant born at 27 weeks gestation with infant respiratory distress syndrome referred to PT; nursing reports child desaturates to 84% with handling and has minimal secretions present. What is the therapist's BEST course of action?
Provide suggestions to nursing for positioning for optimal motor development; excessive handling of premature infant can cause oxygen desaturation; it is best to limit number of handlers
Older adult received cemented THR 2 days ago. What is initial priorty?
Pt education regarding positions and movements to avoid
Therapist has elected to use continuous inductive coil short wave diathermy (SWD) as one intervention in managing hip pain. Use of thermal or electrical modalities were either contraindicated or ineffective. Which pt would be a candidate for SWD?
Pt with ankylosing spondylitis on high doses of NSAIDS and DMARDS -ankylosing spondylitis is a form of arthritis primarily affecting the spine and other joints including the hip. Pain, stiffness, and inflammation can result; deep heating for muscle relaxation followed by stretching, posture management, and other exercises indicated. SWD is preferred as it penetrates more deeply than capacitive SWD. Morbidly obese patient: collagen, fat, bone have low conductivity, excessive amounts of fat in hip could result in selective overheating of adipose tissue Type 1diabetic with insulin pump: contraindicated due to implanted device 11y.o. Boy with slipped capital femoral epiphysis: contraindicated (open, growing epiphyses); diathermy can alter rate of closure
Under HIPAA rules, to whom is it ILLEGAL to release PHI without patient consent?
Pt's spouse
Optic nerve
Pupillary reflexes, CN II
Pt in ICU is referred to PT and presents with significant SOB. Notable deviation of trachea to L. Which of following processes would account for such finding?
R hemothorax - blood in pleural space takes up space in R hemithorax, shifting trachea to the L
Pt with asthma is taking beta-2 agonist (sympathomimetic), albuterol (ventolin); what is the mOST important effect of this medication?
Reduces airway resistance by reducing bronchoconstriction - Sympathomimetrics: mimics effects of stimulation of body organs and structures by SNS; Albuterol: primary action of reducing airway resistance by decreasing bronchospasms - no effect on volume or consistency of airway secretions
Team of researchers investigate use of CIMT on patients with chronic stroke (>1 year post stroke) using multi center RCT. What are the characteristics of this type of research design?
Random assignment to experimental or control group for the study
Chorea
Rapid, irregular, jerky involuntary movements
PT is treating child with spastic cerebral palsy who is 3 years old cognitively but 6-month old gross developmental level. What is an appropriate treatment activity for this child?
Reaching for a multicolored object while in an unsupported, guarded sitting position Multicolored object is appropriate for 3-year-old cognitive level > black and white
Sports PT is working with high school hockey player with hx of Crohn's disease. He has hx of small bowel resection. Sports PT knows he is at highest risk for what type of arthritis?
Reactive arthritis (Reiter's syndrome) - body's immune system mistakenly attacks the joints and causes an inflammatory response, causing joint pain and stiffness as well as deformity; usually affects larger joints and can also affect lower spine, especially sacroiliac joints
To reduce elderly individual's chronic forward head posture in standing and sitting, what muscles are likely shortened and stretched?
Rectus capitis posterior major and minor
PT decides to exercise pt with LE lymphedema using aquatic therapy. Hydrostatic pressure exerted by the water can be expected to do which of the following?
Reduce LE fluid retention and assist venous return - pressure exerted by water on an immersed object is equal on all surfaces (pascal's law); depth of immersion increases, so does hydrostatic pressure; Increased pressure limited edema/extremity fluid retention, assists venous return, and can induce bradycardia
Pt recovering from surgical resection of acoustic neuroma presents with dizziness, vertigo, horizontal nystagmus, and postural instability. To address these problems, what should PT POC incorporate?
Repetition of movements and positions that provoke dizziness and vertigo - habituation training will encourage vestibular system to recalibrate.
child with developmental disability continues to be a no show for PT scheduled appointments; when child does arrive to PT family is usually late; HEP is not being done and child is regressing quickly. After PT discusses this with parents they get angry and stop bringing child for treatment. What is therapist's BEST course of action?
Report family for neglect of child; withholding necessary medical care fits the definition of neglect
Pt is recovering from deep partial-thickness burns over posterior thigh and calf (now healed). Therapist exam reveals local tenderness with swelling and pain on movement in hip area. Therapist detects mass. What is BEST course of action?
Report findings to physician
Pt recovering from cardiac transplantation for end-stage heart failure is referred to exercise training. What guidelines should the therapist follow when implementing an exercise program for this patient?
Require longer periods of warm-up and cool-down - physiological responses to exercise and recovery take longer
Therapist is reading recent report of arterial blood gas analysis: PaO2: 53 mmHg FiO2: .21 PaCO2: 30 mmHg pH: 7.48 HCO3: 24 mEq/L What state do these findings indicate?
Respiratory alkalosis pH higher than normal (7.35-7.45) = alkalosis HCO3 normal (not metabolic, must be respiratory) PaCO2 low (38-42 mmHg) = alkalosis, respiratory
Pt presents with chronic TMJ dysfunction. Limited lateral movement of mandible to R as result of muscular tightness. Which muscles should be focus of inhibitory or soft tissue lengthening techniques?
Right medial pterygoid
Therapist tests pt's hearing by holding a vibrating tuning fork on mastoid process then in front of ear. Comparison is made by asking pt which is louder. What is the name of the test?
Rinne's test If bone conduction (mastoid) is heard greater then air conduction (ear) pt is experiencing conductive deafness; if air conduction is > bone conduction, pt is experiencing sensorineural deafness
Pt complains of R shoulder pain since falling onto R shoulder 3 weeks ago. No dislocation, XR negative. AROM is 35 deg flexion and abduction with scapular elevation noted. Passive ROM nearly full with mild pain and muscle guarding at end range. Resisted abduction is weak, pain noted in anterior and lateral deltoid region. No atrophy. MOST Likely diagnosis?
Rotator cuff tear
Pt presents with s/sx consistent with SIJ dysfunction. What cluster of special tests/findings provides highest diagnostic criteria for SIJ dysfunction?
SI gapping, SI compression, thigh thrust, sacral thrust, Gaenslen's test
Elderly pt with diabetes and BIL LE amputation is to be discharged from acute care hospital 2 weeks post surgery; incisions on residual limbs not healed and continue to drain. Pt unable to transfer because venous graft sites into UE are painful and not fully healed. Endurance out of bed is limited. BEST choice of discharge destination for this patient?
SNF - pt continues to require nursing care for open wounds; initiation of PT can occur at SNF when pt is able
After MI, pt is a new admission to phase 2 hospital-based cardiac rehab program. During initial exercise session, pt's ECG responses are continuously monitored via telemetry. Therapist notices 4 PVCs in a row; what action should therapist take?
STOP EXERCISE, notify medical team immediately
Pt described sudden onset of back pain while trying to lift a heavy barrel; describes pani as constant, unremitting at 10/10 over past 3 days; unresponsive to pain meds. Pt is unable to work but is able to drive to clinic for treatment unaided. No hx of other back-related symptoms in past. Which of following is MOST likely causative factor?
Secondary gain
Pt has R pleural effusion post-operatives after R lower lobe wedge resection. Which treatment would be most effective for pt to complete 3x/day?
Segmental breathing while positioned in sitting, left side lying, 10 mins, 3x/day Breathing will help to increase aeration to potentially collapsed areas of lungs; changing positions will help aerate different segments of lung
Office worker complains of intermittent numbness and tingling in thumb, index finger, and middle finger of right hand. CTS suspected. What is the BEST physical examination item to corroborate this diagnosis?
Semmes-Weinstein monofilament testing - strong evidence to use this testing on pts with suspected CTS; assess middle finger using 2.83 or 3.22 monofilament threshold normal for light-touch sensation and static 2-point discrimination. Pts with moderate to severe CTS assess thumb or index finger with 3.22 monofilament as threshold for normal.
Elderly pt with ataxic gait, balance difficulty and a history of recent falls (two in the last 3 months) referred to PT for exam and evaluation. What should therapist examine first?
Sensory losses and sensory organization of balance
Adolescent basketball player complains of pain in tibial tubercle region with running and jumping. Pt was referred to PT with dx of Osgood-Schlatter disease. What is BEST therapeutic intervention for this pt?
Stretching of quadriceps femoris muscle PT should include flexibility exercises and activity modification to prevent excessive stress to inflamed site
Therapist examining pt recovering from stroke for expected pattern of spastic hypertonia in more involved UE. What muscles are typically spastic in hemiplegic UE during early to middle recovery?
Shoulder adductors, forearm pronators, flexors of elbow, wrist and hand.
Pt complains of increased pain and tingling in both hands after sitting at a desk for > 1 hour. Dx is TOS. Which treatment would be MOST effective intervention?
Stretching program for pectoralis minor and scalenes
R CVA 1 month ago, demonstrates moderate spasticity in L UE (predominantly increased flexor tone). Major problem is lack of voluntary movement control. Minimal active movement with 1/4 inch subluxation of shoulder. What initial treatment activity is BEST choice for this patient?
Sitting, weight bearing on extended L UE, weight shifting to help decrease flexor tone; also provides joint compression/approximation at the shoulder, which will help maintain shoulder position and stimulate stabilizing muscles
Athetosis
Slow, writhing, twisting involuntary movements
When using trans Tibial total surface bearing prosthesis, pt experiences excessive knee flexion in early stance. What is MOST likely cause of this problem?
Socket is aligned too far forward or tilted anteriorly
Ambulatory pt recovering from left CVA is wearing plastic AFO to stabilize his R foot. During gait analysis, therapist observes lateral trunk bending toward R as pt bears weight on R LE during midstance. What is BEST intervention to correct this problem?
Strengthen hip abductors on R side
Therapist determines pt is walking with a backward trunk lean with full weight on R LE. PT demonstrates great difficulty going up ramps. What is BEST intervention to remediate this problem?
Strengthen hip extensors through bridging - backward trunk lean = glute max gait; result of weak glute. Causes increased difficulty going up stairs/ramps. Functional training exercises such as bridging are indicated
Exercises, e-stim and biofeedback are MOST OFTEN employed by PT in management of which type of incontinence?
Stress incontinence
Pt presents with persistently downwardly rotated and addicted scapula during humeral elevation. POC includes stretching and strengthening to improve ROM. What muscles should be stretched and strengthened?
Stretch rhomboids and strengthen Serratus anterior muscle - rhomboids are downward rotators, scapular adductors, scapular elevators; insufficient length of rhomboids would limit upward scapular rotation, and stretching to restore proper length of these muscles would help to promote upward scapular rotation. - serratus is upward rotator and scapular abductor.
PT with two month hx of progressively worsening shoulder pain and stiffness without known injury or trauma to shoulder; currently unable to move UE above shoulder level while performing ADLs. After exam, PT concludes pt has adhesive capsulitis. What is BEST choice of PT interventions?
Stretching exercises
Pt has developed thick eschar secondary to a full-thickness burn; what is the antibacterial agent MOST effective for infection control for this type of burn?
Sulfamylon: penetrates through eschar and provides antibacterial control SIlver nitrate, nitrofurazone are superficial agents that attack surface organisms; pa fail is a keratolytic enzyme used for selective debridement
Baseball pitcher is referred tp PT with progressive posterior shoulder pain and weakness of shoulder abductors and lateral rotators. Therapist notices muscle wasting superior and inferior to scapular spine. Damage to which of the following structures is MOST likely cause?
Suprascapular nerve
Which muscle is tested during empty can test?
Supraspinatus - empty-can position puts supraspinatus muscle in its most effective position for contraction; weakness may be a result of inflammation, neuropathy or Suprascapular nerve, or tendon tear
Infant 39 weeks gestational age at birth now 3 weeks chronological age demonstrates colic. What is BEST intervention PT should teach mother?
Swaddling or wrapping - helps calm baby down especially when slowly rocked; neutral warmth provided is a calming stimulus
Elderly pt in ICU recovering from severe case of pneumonia. Pt is confused and disoriented. What criteria would allow therapist to determine disorientation is due to delirium rather than dementia?
Symptoms are intermittent
Elderly individual with hx of falls in home (4 in past 2 months with minor injury) is referred to PT. Which test is BEST to evaluate gait, strength, and dynamic postural stability/balance?
TUG
Elderly pt with hyperthyroidism referred to PT following period of prolonged bedrest. What should therapist be alert for when monitoring exercise of this pt?
Tachycardia and dyspnea
Possible ECG changes with exercise that can occur in patient with CAD and prior MI?
Tachycardia at relatively low intensity of exercise with ST segment depression - typical exercise ECG changes with CAD: tachycardia, ST depression (>1mm is significant); PVCs may appear
Pt currently being seen for LBP awoke one morning with drooping L facial muscles and excessive drooling. PT was recovering from cold and had experienced an earache in L ear during previous 2 days. Therapist suspects Bell's Palsy. What cranial nerve test can confirm dx?
Taste over anterior tongue, have pt raise eyebrows and puff cheeks (Facial nerve, CN VII)
4 yo with newly diagnosed cystic fibrosis. What intervention should be considered for this patient?
Teach parents secretion removal techniques to all segments of all lobes of both lungs once or twice a day
Pt with 10 yr history of MS demonstrates 3+ extensor tone in both LE. Therapist needs to order wheelchair. What is BEST recommendation for this patient?
Tilt-in-space wheelchair with pelvic belt - strong extensor tone needs control over hips (pelvic belt) to maintain hips in flexion
Which of the following factors is likely to contribute to subluxation and shoulder pain in hemiplegia?
Traction acting on a depressed, downwardly rotated scapula
Pt with traumatic onset (MVA) of neck pain presents with subjective complaints of frank upper C/S instability. Which test would safely assist in identifying integrity of C1-2 articulation?
Transverse ligament stress test
Elderly, frail patient demonstrates history of recent falls (two in past 2 months) and mild balance instability. Therapist's referral is to examine pt and recommend an AD as needed. Based on pt's history, what device would be GREATEST benefit?
Two wheeled rolling walker - will provide added stability by increasing BOS and maintaining two standard legs on rear for increased control of walker motion; maintain gait as continuous movement sequence
Pt with hemiplegia and drop foot is referred for PT gait training; pt has pressure ulcer on R heel. Ulcer has dry eschar without edema, erythema, fluctuance or drainage. Pt is afebrile. What is BEST intervention?
Use AFO with heel pressure relief; helps to prevent plantarflexion contractures while heel relief will help prevent further damage to heel and promotes healing
Pt has 20 year history of diabetes; notable on exam: vascular insufficiency, diminished sensation of both feet with poor healing of superficial skin lesion; what recommendation is CONTRAINDICATED to include in pt care instructions?
Use daily hot soaks and moisturize skin
Pt complains of foot pain when first arising that eases with ambulation; therapist finds symptoms reproduced in weight bearing and running on treadmill; examination reveals pes planus and pain with palpation at distal aspect of calcaneus. What is BEST choice for early intervention?
Use of resting night splints - suggestive of plantar fasciitis; focus should be on decreasing irritation to plantar fascia; most effectively done with resting night splint
What is MOST appropriate intervention to correct for problem of a forward festinating gait in pt with PD?
Use of toe wedge - festinating gait is abnormal and is an involuntary increase in speed of walking in attempt to catch up with a displaced center of gravity due to forward lean; most appropriate intervention would be to use a toe wedge to help displace COG backward.
Older pt with hip OA undergone PT regimen of mobility and strengthening exercises. What outcome measure best determines improvement in pt's condition?
WOMAC - gold standard for measuring changes in pain, stiffness, function in pts with hip and knee OA
Pt referred to PT after an antero-inferior dislocation of R shoulder. What positive examination finding is expected as a result of this dislocation?
Weak deltoids - because of anatomical position of Axillary nerve, it can be damaged by an antero-inferior dislocation at the GHJ, resulting in weak deltoids
After ACL reconstruction, what is BEST weight bearing and mobility status within first week to decrease pain, increase ROM, and avoid adverse soft tissue responses?
Weight bearing as tolerated with ROM as tolerated
Pt with stroke demonstrates early recovery in RUE with moderate spasticity in biceps and finger flexors. Voluntary movement is evident in elbow flexors and shoulder abductors only through 1/2 range. What is BEST choice for initial exercise?
Weight bearing on extended RUE with wrist and fingers extended - early intervention focus on stretching and positioning RUE into extension with wrist and fingers extended to decrease development of flexor spasticity; weight bearing on limb promotes extensor activity in triceps and shoulder stabilizers
PT receives home care referral from nurse case manager; elderly man lost functional independence after recent death of wife. PMHx includes stroke with minimal residual disability; he no longer goes out of his house, rarely gets out of chair. During initial session, therapist suspects depression. What clinical signs/sx would lead to this determination?
Weight loss, social withdrawal
Elderly resident of community nursing home dx with Alzheimer's type dementia. What behaviors should the therapist consider when formulating plan of care?
Will likely be resistant to activity training if unfamiliar activities are used
Pt with traumatic injury to R hand had flexor tendon repair to fingers. When should PT intervention begin following this type of repair?
Within a few days after surgery to preserve tendon gliding; early passive and active assistive exercises promote collagen remodeling to allow free tendon gliding
CC: pain and swelling near base of thumb and lateral aspect of wrist. Condition aggravated with grasping and pinching activities. Therapist suspects De Quervain's tenosynovitis. Which special test is best to rule OUT the disorder?
Wrist hyper abduction test (WHAT): highest sensitivity (.99) for ruling out De Quervain's; pt flexes wrist while thumb is abducted against resistance
Pt arrives for outpatient cardiac rehab 10 weeks post CABG. Postoperative course complicated by A fib, which was controlled with meds. Pt's resting vital signs are HR = 90 in A fib, BP 116/74, RR = 14, and SpO2 99%. Is a symptom-limited exercise test appropriate at this time?
Yes, HR well controlled and cardiologist aware of arrhythmia
PT examines pt who sustained deep laceration to palm of dominant hand. Wound is near web space and therapist suspects pt lacerated deep ulnar nerve branch. PT performs strength test of intrinsic muscles, which of the of following is innervated by deep ulnar nerve?
adductor pollicis
Elderly pt with transfemoral amputation is being fitted with temporary prothesis containing SACH prosthetic foot. Which BEST characterizes the SACH foot?
allows limited sagittal plane motion with small amount of mediolateral motion
Rhomboid innervation
dorsal scapular nerve (C5); medial and posterior to shoulder joint
Hypoparathyroidism
hypocalcemia personality changes, cardiac arrhythmias, scaly skin, brittle fingernails/toenails
Elderly pt with CHF referred to PT for examination of functional mobility skills and safety in home environment. Family reports pt is demonstrating increasing forgetfulness and some memory deficits. During exam, what would therapist typically expect to find?
impairments in short term memory
Pt has pulmonary sarcoidosis and started pulmonary rehabilitation. Pt started walking program based on findings from 6-minute walk test. Which systemic signs or symptoms of sarcoidosis are MOST LIKELY to limit pt with walking program?
joint pain or swelling - bone and joint involvement can occur with sarcoidosis and could limit ability to walk long distances other symptoms with sarcoidosis that do not interfere with walking: increased salivation, skin lesions, liver involvement
AIMS
observational scale for screening gross motor milestones in infants from birth to 12 months of age (or independent walking)
Pt referred by orthopedist with dx of impingement syndrome of shoulder; initial PT examination reveals s/sx not consistent with this diagnosis and are more consistent with thoracic spine pain and dysfunction. PT did not communicate with referring physician. Months later, therapist is sued by pt's estate. Pt died of undiagnosed metastatic lung cancer. Therapist is:
responsible for not communicating PT exam results to referring physician
PT has been on bedrest for 4 days due to complications following triple CABG. During first therapy session, pt complains of tenderness and aching in R calf. For what clinical sign should therapist immediately examine?
swelling in calf or ankle
BOT-2
tests gross and fine motor develop of children 4-21 years
TIMP (Test of Infant Motor Performance)
used for premature infants from 32 weeks gestation to 3 1/2 months post-term
