NPTE Exam 2 Review

A patient with evidence of nerve root involvement at the L4-L5 level would MOST likely have which of the following signs and symptoms? 1. Weak knee flexors, diminished Achilles tendon reflex, and paresthesia at the lateral aspect of the lower extremity 2. Weak foot intrinsics, diminished patellar tendon reflex, and paresthesia at the medial aspect of the knee 3. Weak ankle dorsiflexors, diminished patellar tendon reflex, and paresthesia at the medial calf and ankle 4. Weak ankle plantar flexors, diminished Achilles tendon reflex, and paresthesia at the lateral border of the foot

1. A decreased Achilles tendon reflex implicates S1. Paresthesias at the lateral aspect of the lower extremity involve L5-S1. 2. Foot intrinsics are innervated at the S1-S2 level. 3. The L4 nerve root exits at the L4-L5 level. Weak ankle dorsiflexors, diminished knee jerk, and paresthesias along the medial calf and ankle are the only combination of signs and symptoms listed that could all be a result of L4 nerve root compromise. 4. This combination of signs and symptoms would occur with nerve root involvement at the S1-S2 level.

A home health patient who recently had a three-vessel coronary artery bypass graft describes experiencing bilateral lower extremity swelling, leg pain, and shortness of breath, especially when lying down. The patient MOST likely has which of the following diagnoses? 1. Deep vein thrombosis 2. Myocardial infarction 3. Pulmonary embolism 4. Heart failure

1. A deep vein thrombosis corresponds to the leg pain and possibly swelling, but symptoms would typically be unilateral. 2. A myocardial infarction corresponds to shortness of breath but typically does not result in swelling acutely. A myocardial infarction could result in the development of heart failure, which would result in these symptoms, but this is a secondary result, not a primary result. 3. A pulmonary embolism would result in shortness of breath, usually not changed by position, and typically cardiac arrest. 4. Typical signs of heart failure include dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and peripheral edema.

A patient reports low back pain that radiates down one leg below the knee. The patient also reports numbness and tingling in the middle dorsum of the foot. Which of the following examination findings is MOST likely? 1. Diminished knee reflex 2. Diminished ankle reflex 3. Weakness of the gastrocnemius 4. Weakness of the extensor hallucis longus

1. A diminished knee reflex is indicative of a herniated disc at the L4 level, which would not be consistent with the symptoms reported by the patient (Agur, p. 367). 2. A diminished ankle reflex is indicative of a herniated disc at the S1 level, which would not be consistent with the symptoms reported by the patient (Agur, p. 367). 3. A weak gastrocnemius is indicative of a herniated disc at the S1 level, which would not be consistent with the symptoms reported by the patient (Agur, p. 367). 4. The patient's symptoms are indicative of a herniated disc at the L5 level, which causes compression of the 5th lumbar nerve root. Sensory deficits extend on the dorsolateral foot as indicated in the photograph. Subsequent motor weakness involves the extensor hallucis longus. (Dutton, pp. 141, 1463; Agur, p. 367)

A patient is seen in physical therapy after an arthroscopic debridement of the knee. Which of the following describes the optimal parameters for electrical stimulation to address an extensor lag noted during the examination? 1. Duty cycle of 50%; current intensity high enough to produce 40% of maximal voluntary isometric contraction; 20 minute total treatment time 2. Duty cycle of 20%; current intensity high enough to produce 40% of maximal voluntary isometric contraction; 20 minute total treatment time 3. Duty cycle of 20%; current intensity high enough to produce 60% of maximal voluntary isometric contraction; 10 minute total treatment time 4. Duty cycle of 50%; current intensity high enough to produce 60% of maximal voluntary isometric contraction; 10 minute total treatment time

1. A duty cycle of 50% is too high, the current intensity is too low, and the treatment time is too long (Bellew, pp. 382-383; Cameron, pp. 247-249). 2. The duty cycle is correct (20%), but the current intensity is too low and the treatment time is too long (Bellew, pp. 382-383; Cameron, pp. 247-249). 3. For strengthening with electrical stimulation the current intensity should be maximal, so 60% is the better answer when compared with 40% of maximal voluntary contraction. Also, the duty cycle should allow for the rest period to be 5 times as long as the hold cycle, so a 20% duty cycle is best. One treatment session should include at least eight contractions, so a 10-minute treatment time is best. (Bellew, pp. 382-383; Cameron, pp. 247-249) 4. The duty cycle is too high in this example; more rest time is needed for muscle recovery (Bellew, pp. 382-383; Cameron, pp. 247-249).

Which of the following home programs is MOST appropriate for a patient who has chronic lateral epicondylalgia? 1. Using a forearm cuff to increase loading on the extensor tendons 2. Performing exercises for wrist strength and stretching 3. Administering iontophoresis with dexamethasone (Decadron) and lidocaine (Xylocaine) 4. Doing friction massage of the brachioradialis tendon

1. A forearm cuff is thought to decrease the muscle loading (p. 756). 2. Lateral epicondylalgia is caused by overuse of the wrist extensors that originate on the lateral epicondyle of the humerus, especially the extensor carpi radialis brevis. If the lateral epicondylalgia is at a chronic stage, conditioning of the extensor muscles and sustained grip activities will be most effective in long-term management. (p. 756) 3. Iontophoresis would not be appropriate for a home program and is more appropriate for acute lateral epicondylalgia (p. 755). 4. Friction massage of the brachioradialis would not be appropriate since the extensor carpi radialis brevis muscle is usually the muscle that is affected.

A patient who has severe bilateral hip and knee flexion contractures requires the assistance of two people for bed-to-chair transfers. The patient demonstrates normal dynamic sitting balance and Normal (5/5) upper body strength. The patient lives at home with one caregiver. The physical therapist's FIRST intervention should be to teach which of the following transfers? 1. Use of a mechanical lift operated by the caregiver 2. Sliding-board transfer performed by the patient with assistance from the caregiver 3. One-person lift transfer performed by the caregiver 4. One-person stand pivot transfer performed by the patient with assistance from the caregiver

1. A mechanical lift will promote total dependence for the patient, which should not be necessary in this case. 2. With normal sitting balance and normal upper body strength, this patient should be able to participate significantly with transfers, thereby easing much of the strain on the caregiver and allowing transfers to be done with assistance of only one person. 3. A one-person lift transfer performed by the caregiver does not allow the patient to participate by using existing abilities. 4. The description of the patient's lower extremities indicates that the patient is not likely to be a good candidate for a stand pivot transfer.

A patient with diabetes had a right transtibial amputation 5 days ago. An advantage of a rigid removable dressing versus bandaging is that the rigid dressing: 1. allows for early weight bearing. 2. requires less monitoring. 3. allows applied pressure to be varied. 4. is less costly.

1. A rigid dressing allows for early fitting of a prosthesis and weight-bearing and helps alleviate edema and pain, which is an advantage. 2. A rigid dressing requires more (not less) supervision because there is no access available to the incisions and the dressing is fabricated by the surgeon or prosthetist. As the residual limb heals, sutures are removed, and the limb changes shape, a new cast must be made. 3. Pressure cannot be varied when using a rigid dressing, unlike bandaging with an elastic wrap or shrinker. 4. A rigid dressing requires careful application by a skilled individual and, therefore, may be more costly. An elastic shrinker is a less expensive option.

During auscultation of the chest wall, a physical therapist notes an area of decreased breath sounds. Which of the following additional findings would support the suspicion of consolidation? 1. Tympanic sound with percussion 2. Increased fremitus 3. Hypertrophy of accessory muscles 4. High-pitched wheezes

1. A tympanic sound with percussion may be heard over a hyperinflated chest (Frownfelter, p. 212). 2. Increased fremitus is palpated in the presence of an increase in secretions (Frownfelter, p. 212). 3. A person with chronic obstructive pulmonary disease might exhibit increased muscle activity in the respiratory accessory muscles (Frownfelter, p. 212). This would not typically be observed in a person with an increase in secretions. 4. The adventitious sound associated with consolidation would be crackles, not wheezing (McCance, p. 1273).

Appropriate knee positioning when strength testing the hamstrings in the prone position will minimize: 1. active insufficiency of the hamstrings and rectus femoris. 2. active insufficiency of the rectus femoris and passive insufficiency of the hamstrings. 3. active insufficiency of the hamstrings and passive insufficiency of the rectus femoris. 4. passive insufficiency of the hamstrings and rectus femoris.

1. Active insufficiency occurs when the agonist is shortened actively to a point that the actin and myosin do not have optimal contact for maximal contraction. When testing the hamstrings with the patient in prone position, the hamstrings would have the tendency to become overly shortened (active insufficiency) because the hip is blocked from flexing. The quadriceps would be stretched over both the hip and knee joints (passive insufficiency). 2. Active insufficiency occurs when the agonist is shortened actively to a point that the actin and myosin do not have optimal contact for maximal contraction. Passive insufficiency occurs when the actin and myosin are overstretched, preventing optimal contraction. When testing the hamstrings with the patient in prone position, the hamstrings would have the tendency to become overly shortened (active insufficiency) because the hip is blocked from flexing. The quadriceps would be stretched over both the hip and knee joints (passive insufficiency). 3. Active insufficiency occurs when the agonist is shortened actively to a point that the actin and myosin do not have optimal contact for maximal contraction. Passive insufficiency occurs when the actin and myosin are overstretched, preventing optimal contraction. When testing the hamstrings with the patient in prone position, the hamstrings would have the tendency to become overly shortened (active insufficiency) because the hip is blocked from flexing. The quadriceps would be stretched over both the hip and knee joints (passive insufficiency). 4. Passive insufficiency occurs when the actin and myosin are overstretched, preventing optimal contraction. When testing the hamstrings with the patient in prone position, the hamstrings would have the tendency to become overly shortened (active insufficiency) because the hip is blocked from fle

A 41-year-old patient sustained a grade II injury to the right medial collateral ligament of the elbow 3 weeks ago. A systems review reveals normal cardiopulmonary, integumentary, and neuromuscular status. Which of the following is MOST likely the status of the healing tissue? 1. Well organized and gaining in tensile strength 2. Well organized and capable of withstanding high tensile forces 3. Disorganized but able to withstand high tensile forces 4. Disorganized and unable to withstand high tensile forces

1. Although the repair is gaining in tensile strength, 3 weeks is not enough time for a grade II injury to fully organize. 2. A longer period of time is needed for a well-organized repair in a grade II injury. 3. A disorganized repair is not able to withstand high tensile forces. 4. A grade II ligament injury requires significant repair, and, although the tissue is beginning to organize at 3 weeks, it is not fully organized and is deficient in tensile strength.

A physical therapist should anticipate that an abnormal lymph node will feel: 1. soft and nonmobile and have an increased skin temperature. 2. firm and nontender and have an increased skin temperature. 3. firm, mobile, and tender or nontender. 4. soft, mobile, and tender or nontender.

1. An abnormal lymph node would not feel soft, and an elevated skin temperature is not expected. 2. An abnormal lymph node may feel firm and nontender, but an elevated skin temperature is not an expected accompanying feature of an abnormal lymph node. 3. An abnormal lymph node can range in feeling from firm to hard, be mobile or nonmobile, and be tender or nontender. 4. An abnormal lymph node would not feel soft.

Which of the following glenohumeral joint mobilization techniques is MOST appropriate for increasing the motion required to scratch the back at the T9 level? 1. Distraction with inferior glide 2. Anterior glide with abduction 3. Superior glide with approximation 4. Distraction with posterior glide

1. An inferior glide will increase abduction. 2. An anterior glide will increase lateral (external) rotation. 3. A superior glide with approximation would not increase joint range of motion. 4. To scratch the back at the T9 level requires a person to reach behind the back, with the shoulder moving into medial (internal) rotation. Posterior glide of the humerus will increase medial (internal) rotation.

A patient sustained a C6 spinal cord injury (ASIA Impairment Scale B) 2 weeks ago. Which of the following techniques would be MOST effective to reduce the risk of deep venous thrombosis in the lower extremities? 1. Ankle pumps 2. Compressive stockings 3. Standing in a standing frame 4. Gastrocnemius-soleus stretch

1. Ankle pumps are an effective technique for reducing venous stasis and blood clots, but a patient with an ASIA Impairment Scale B injury would have sensory, but not motor function preserved below the neurological level and would be unable to actively perform active ankle pumps due to paraplegia (p. 922). 2. Compressive stockings are the most effective device to use for a patient with a cervical spinal cord injury who is unable to move the lower extremities and will have venous stasis due to the lack of "muscle pumping" action. The compressive stockings decrease the venous stasis and blood pooling and reduce the risk of blood clotting. (p. 901) 3. A standing frame would be useful for the prevention of osteoporosis and bone density loss. It is also useful for improving respiratory function but would not be the best method for preventing the development of deep venous thrombosis. (p. 902) 4. Gastrocnemius-soleus stretch may aide in some movement of blood in the lower extremities but is not the most effective means of reducing deep venous thrombosis formation (p. 901).

A physical therapist examines a right-handed patient who demonstrates a rounded upper back and protracted shoulders. The patient may be at INCREASED risk for developing which of the following conditions in the left upper extremity? 1. Thoracic outlet syndrome 2. Carpal tunnel syndrome 3. Paresthesia in an ulnar nerve distribution 4. Lateral epicondylalgia

1. Anterior scalene or pectoralis minor tightness from this posture can impinge the neurovascular bundle, causing thoracic outlet syndrome (p. 331). 2. Overuse injury of the wrist is unrelated to this postural presentation (p. 835). 3. The ulnar nerve is well protected above the elbow. Injury most often occurs at the elbow or wrist. (pp. 761-762, 853) 4. Overuse injury of the elbow is unrelated to this postural presentation (p. 755).

When instructing a patient with rheumatoid arthritis in a home exercise program, the physical therapist should advise the patient to rest: 1. after the onset of joint pain. 2. after one hour of exercise. 3. when fatigued. 4. before becoming fatigued.

1. Any exercise that increases joint pain should be modified or avoided. 2. Pain and/or fatigue should be the limiting factor in an exercise program, not duration. 3. Undue fatigue after exercise indicates a need to further modify the exercise program. 4. An exercise program for a patient who has rheumatoid arthritis should be able to be performed without pain and fatigue.

Which of the following findings is MOST likely a negative prognostic indicator for surgical wound healing? 1. Bloody discharge on postoperative day 1 2. Clear and watery discharge on postoperative day 3 3. Purulent discharge on postoperative day 5 4. No discharge and a raised suture line on postoperative day 10

1. Bloody discharge on postoperative day 1 is a normal response for a healing surgical wound. 2. Clear and watery discharge on postoperative day 3 is a normal response for a healing surgical wound. 3. A purulent exudate from a surgical wound site is an indication of infection and is a negative prognostic indicator for healing. 4. No discharge and a raised suture line on postoperative day 10 are consistent with a normal response for a healing surgical wound.

Which of the following changes in cardiopulmonary function is MOST likely to occur in a pregnant woman in her third trimester of pregnancy? 1. Increase in oxygen consumption 2. Decrease in respiratory rate 3. Decrease in cardiac output 4. Decrease in heart rate

1. Cardiac output increases 30% to 60%, and oxygen consumption increases 15% to 20% during pregnancy. 2. Respiratory rate does not change during pregnancy. 3. Cardiac output increases 30% to 60%, and oxygen consumption increases 15% to 20% during pregnancy. 4. Heart rate increases during pregnancy.

A female patient had a radical mastectomy with axillary node removal. Which of the following signs would indicate initial development of lymphedema in the patient? 1. Increased blood pressure 2. Numbness in the antecubital fossa 3. Atrophy of the brachioradialis muscle 4. Decreased flexibility of the digits of the hand

1. Changes in blood pressure are not an initial sign of lymphedema (Goodman, pp. 682-683). 2. Numbness of the affected body part is a possible symptom of lymphedema, but the antecubital fossa is not the most likely location (Goodman, p. 680; Drake, pp. 140-141) 3. Muscular atrophy, conceivably due to nerve compression from lymphedema, is an unlikely initial sign of lymphedema (Goodman, p. 680). 4. Decreased finger flexibility may be an initial sign of peripheral lymphedema (Goodman, p. 680)

A physical therapist is examining a patient who has emphysema and no acute symptoms. During auscultation of the lungs, the therapist will MOST likely observe which of the following findings? 1. Wet crackles (rales) 2. Friction rub 3. Low-pitched wheezes (rhonchi) 4. Diminished breath sounds

1. Crackles are present with secretions in peripheral airways (Goodman, p. 774). 2. A friction rub is associated with a large pleural effusion rather than with emphysema (Hillegass, p. 8). 3. Low-pitched wheezes are associated with obstruction, such as bronchospasm (Goodman, p. 774). 4. Diminished breath or absent breath sounds are present with emphysema (Hillegass, p. 194).

A patient who had a cerebrovascular accident 1 year ago walks independently using a standard cane. During heel strike (initial contact), the forefoot makes contact with the floor first. Which of the following reasons BEST explains this gait pattern? 1. Increased reciprocal movements 2. Excessive activity of the plantar flexors 3. Overactivity of the muscles in the lateral compartment 4. Noncontractile tissue tightness in the anterior aspect of the lower leg

1. Excessive activity of the plantar flexors would position the foot into plantar flexion, which would result in a forefoot contact (O'Sullivan, p. 264). Increased reciprocal movements would not be a likely cause for this pattern. The velocity of the hemiparetic leg is usually decreased (Gillen, p. 200). 2. Excessive activity of the plantar flexors would position the foot into plantar flexion, which may result in a forefoot contact (O'Sullivan, p. 264). Other causes for this gait include weak dorsiflexors, a decreased ability to perform fast reciprocal movements, and noncontractile soft tissue limitations of the plantar flexors (Gillen, p. 200). 3. Overactivity of the muscles in the lateral compartment (the fibularis [peroneal] muscles) would result in increased eversion, not forefoot contact (Hislop, p. 265). 4. Tightness would be in the posterior (not anterior) aspect of the lower leg (i.e., plantar flexors) (O'Sullivan, p. 264; Gillen, p. 201).

A patient with an incomplete C8 spinal cord injury reports of burning in the buttocks when sitting in a wheelchair. Which of the following problems with the patient's wheelchair would be MOST likely to contribute to the burning? 1. Footplates are too high. 2. Footplates are too low. 3. Seat is too narrow. 4. Seat is too deep.

1. Footrests that are too high shift the patient's weight posteriorly onto the buttocks, leading to pressure and pain (p. 1419). 2. Footrests that are too low shift weight forward onto the thighs. Although this would cause problems due to pressure on the thighs, it would not lead to pain in the buttocks. (p. 1419) 3. A narrow seat will lead to pressure and pain on the lateral pelvis and thighs, not in the buttocks (pp. 1413, 1429). 4. A long seat will lead to pressure and pain behind the knees, not in the buttocks (pp. 1413, 1429).

A patient with normal urine control reports not being able to reach the toilet in time due to muscle weakness and joint pain. Which type of incontinence BEST describes the patient's condition? 1. Functional 2. Stress 3. Urge 4. Overflow

1. Functional incontinence occurs in people who have normal urine control but who have difficulty reaching a toilet in time because of muscle or joint dysfunction (p. 987). 2. Stress incontinence is the loss of urine during activities that increase intraabdominal pressure such as coughing, lifting, or laughing (p. 988). 3. Urge incontinence is the sudden unexpected urge to urinate and the uncontrolled loss of urine. Urge incontinence is often related to reduced bladder capacity or detrusor instability. (p. 988) 4. Overflow incontinence is the constant leaking of urine from a bladder that is full but unable to empty (p. 991).

Which of the following conditions is a CONTRAINDICATION for mechanical traction of the cervical spine? 1. Muscle spasm 2. Rheumatoid arthritis 3. Hypomobility of the spine 4. Decreased upper extremity sensation

1. Gentle intermittent traction may assist in decreasing muscle spasm and the resultant spinal compressive forces. 2. Joint capsules, ligaments, and bones are fragile in patients with rheumatoid arthritis (RA). A patient with RA is subject to atlantoaxial subluxation or to developing instability next to areas of hypomobility. 3. Longitudinal traction force provides a gliding separation of the facets, general capsular stretch, and opening of the intervertebral foramen. Traction can improve range of motion. 4. Reduction of neurological deficits may result from improved conduction in large-diameter myelinated afferent and efferent nerve fibers. Mechanical traction can release pressure on nerve fibers, thereby increasing nerve conduction.

A patient positioned in prone has difficulty initiating hip extension with the knee bent. Which of the following muscles will MOST likely need strengthening? 1. Hamstrings 2. Gluteus maximus 3. Lumbar erector spinae 4. Gluteus medius

1. Hamstrings are primarily knee flexors. They can be secondary hip extensors but would be tested with the knee extended, not flexed. (p. 242) 2. The gluteus maximus is the primary hip extensor muscle tested in this manner (p. 216). 3. Lumbar erector spinae extend the trunk on the legs. They do not attach on the femur and have no impact on hip extension. (pp. 43-44) 4. Gluteus medius weakness would be assessed by testing hip abduction in sidelying position (p. 223).

Which of the following patient activities will BEST facilitate the goal of a posterior glide mobilization of the talus? 1. Performing heel raises while seated 2. Walking on tiptoes on level surfaces 3. Performing single limb stance activities 4. Ascending and descending stairs with a reciprocal pattern

1. Heel raises would augment plantar flexion, bringing the ankle only to neutral dorsiflexion (Loudon, pp. 324, 326). 2. Walking on tiptoes would emphasize plantar flexion motion rather than dorsiflexion (Loudon, pp. 324-325). 3. Single limb stance activities would not require dorsiflexion (Loudon, p. 325). 4. The photograph illustrates a posterior glide mobilization of the talus. This mobilization is intended to improve dorsiflexion at the ankle (Brody, p. 168). Therefore, the mobilization would be best augmented by exercises emphasizing active/passive dorsiflexion. Stair climbing requires dorsiflexion and plantar flexion movement. Normal dorsiflexion is 0° to 20°, and normal plantar flexion is 0° to 50°. Therefore, ascending and descending stairs is the best option. (Loudon, pp. 324-326)

A physical therapist plans to use autolytic debridement to treat a patient's shallow, dry, partly necrotic leg wound. Which of the following dressings is MOST appropriate for this wound? 1. Hydrofiber dressing 2. Transparent film 3. Enzymatic agent 4. Foam dressing

1. Hydrofibers are alginate-like in appearance and are activated by moisture in the wound. They are used for wounds with heavy exudate. The wound described is dry. (Sussman, p. 511) 2. A dry wound will be best autolytically debrided by using a transparent film dressing (Sussman, p. 446). 3. Enzymes are not used in autolytic debridement (Sussman, p. 442). 4. A foam dressing is best used for a moist, draining wound (Myers, p. 141).

During examination of a patient, a physical therapist notes bradycardia. The patient reports constipation and cold intolerance. Which of the following conditions is the MOST likely cause of the sign and symptoms? 1. Hypothyroidism 2. Hyperthyroidism 3. Hyperparathyroidism 4. Hypoparathyroidism

1. Hypothyroidism is consistent with signs and symptoms of bradycardia, constipation, and cold intolerance. 2. Hyperthyroidism causes diarrhea, rather than constipation. 3. Hyperparathyroidism is not associated with bradycardia. 4. Hypoparathyroidism is associated with arrhythmias and either constipation or diarrhea.

A patient has a comminuted femoral fracture with an external fixator. There is no sign of quadriceps contraction with electrical stimulation. Which of the following is the MOST likely cause? 1. A lesion in the femoral nerve 2. A contusion of the quadriceps muscle 3. An unstable fracture site 4. A lesion in the L4-L5 nerve roots

1. If a muscle becomes denervated, a contraction cannot be produced by neuromuscular electrical stimulation (Cameron, p. 246). 2. A contusion is a bruise, which is characterized by swelling, discoloration, and pain. Innervation of the muscle is typically intact, and, therefore, electrical stimulation would produce a contraction in the quadriceps. (Mosby, pp. 436-437) 3. If the nerve is intact at the fracture site, a muscle contraction may be produced by neuromuscular electrical stimulation (Cameron, p. 240). 4. The quadriceps are innervated by the femoral nerve, which is derived from spinal nerves L2-L4. A lesion in the L4-L5 nerve roots would still leave innervation in the quadriceps, and, therefore, electrical stimulation would produce a contraction in the quadriceps. (Moore, p. 547)

The parent of a 2-year-old child reports that while holding the child's hand when walking down a street, the child fell down. The parent tried to hold the child up while the child regained balance. The child now holds the arm at the side with the palm facing down. Which of the following conditions is MOST likely present? 1. Radial tunnel syndrome 2. Necrosis of the capitellum 3. Valgus extension overload syndrome 4. Partial slippage of the annular ligament

1. In radial tunnel syndrome, there is pain over the extensor muscle mass of the forearm distal to the lateral epicondyle. In addition, long finger extension testing would produce pain, and there could be weakness of finger and thumb (1st digit) extensors and the extensor carpi ulnaris. Typically, this syndrome results from overuse and not from a traumatic event. 2. Necrosis of the capitellum typically affects the dominant elbow of children, mainly boys, between the ages of 5 and 10 years. It is a diagnosis that is often associated with throwing in a young child (i.e., little-league elbow). 3. It is highly unlikely that a 2-year-old child would have valgus extension overload syndrome, because it typically is seen in throwing athletes in whom the repetitive stresses of throwing lead to progressive changes within the elbow joint, which cause pain and athletic impairment. Findings include pain and tenderness around the tip of the olecranon, pain with forced passive elbow extension, and increased valgus laxity. 4. A diagnosis of partial slippage of the annular ligament is made from the history with a report of longitudinal traction on an extended elbow, as with a child whose arm is pulled by a parent when walking. This injury typically occurs in children age 2-3 years.

Which of the following examination findings MOST likely indicates a favorable prognosis for a patient who has a posterior lumbar disc herniation? 1. Centralization and ability to restore extension mobility 2. Proximal symptoms and ability to restore flexion mobility 3. Peripheralization with flexion and a positive straight leg raise result 4. Leg pain with extension and a negative crossed straight leg raise result

1. Individuals who have centralization of symptoms and have the ability to restore extension of the spine demonstrate a good prognosis. 2. Proximal symptoms are suggestive of a good prognosis; however, flexion mobility is not a predictor of a good prognosis for patients who have a disc herniation. 3. Neither of these options have been found to have a predictive value in the prognosis of patients who have a disc herniation. 4. Although a negative result on the crossed straight leg raise is favorable, leg pain reproduced with extension is predictive of a poor prognosis.

A physical therapist is teaching a patient who has hemiplegia to perform overhead reaching activities. Which of the following teaching methods is MOST likely to encourage retention of the skill? 1. Provide instructions while demonstrating the activity. 2. Have the patient perform multiple repetitions of the activity. 3. Demonstrate movements that should be avoided during the activity. 4. Passively move the patient's limb through multiple repetitions of the activity.

1. Instructions and demonstration assist the patient in learning what to do (p. 20). 2. When active movement is the desired outcome, active limb movement should be practiced repeatedly. This is the preferred strategy for better learning and retention in the associative stage of learning. (p. 21) 3. Practicing incorrect movement patterns can lead to negative learning (p. 25). 4. Continued guidance may result in the patient becoming dependent on the physical therapist (pp. 20-21).

Iontophoresis should be used with precaution for a patient who has which of the following conditions? 1. Peripheral neuropathy 2. Raynaud disease 3. Degenerative joint disease 4. Chronic edema

1. Iontophoresis should be used with precaution in patients who have conditions involving decreased sensation (Cameron, p. 268; Bellew, p. 323). 2. Raynaud disease is not a precaution or contraindication for iontophoresis (Cameron, p. 268). 3. Degenerative joint disease may be associated with joint pain and inflammation, both of which could be indications for iontophoresis (Bellew, p. 319). 4. Chronic edema may be an indication for iontophoresis (Bellew, p. 319).

During gait evaluation, a physical therapist notes that a patient demonstrates a shorter left step length and excessive left knee flexion during the left midstance phase. Which of the following problems is the MOST likely the cause of the gait dysfunction? 1. Left hamstrings contracture 2. Right iliopsoas weakness 3. Left hip flexion contracture 4. Right quadriceps weakness

1. Left hamstrings contracture is a fixed, mechanical limitation. It is the most likely cause of the gait impairment, because it directly affects both the knee joint during the midstance phase and the step length. It is the only option that can contribute to both of the gait impairments. (p. 1013) 2. Hip flexor weakness is more likely to result in a posterior lurch to facilitate right limb swing (p. 1013). 3. A left hip flexor contracture would result in decreased step length on the right limb due to limited left hip extension (pp. 1007-1008). 4. Quadriceps weakness would be more likely to result in an anterior lurch at midstance to create a knee extension moment (p. 1014).

When providing patient education in cardiac rehabilitation, which of the following signs and symptoms of exertional intolerance should the physical therapist emphasize? 1. Anginal pain, insomnia, sudden weight gain, leg stiffness 2. Persistent dyspnea, dizziness, anginal pain, sudden weight gain 3. Persistent dyspnea, anginal pain, insomnia, weight loss 4. Anginal pain, confusion, leg numbness, weight loss

1. Leg stiffness is not a sign/symptom associated with exercise intolerance among patients undergoing cardiac rehabilitation. 2. The signs and symptoms listed in this option are associated with exercise intolerance among patients undergoing cardiac rehabilitation. 3. Weight loss is not a sign associated with exercise intolerance among patients undergoing cardiac rehabilitation. However, angina and dyspnea are important signs of exercise intolerance. 4. Leg numbness, confusion, and weight loss are not associated with exercise intolerance. However, angina is important to note in the patient who has cardiac dysfunction.

A patient with an excessive anterior pelvic tilt will usually have which of the following associated conditions? 1. Weak lumbar extensors 2. Weak hip flexors 3. Piriformis flexibility deficits 4. Iliacus flexibility deficits

1. Low back extensors are typically short and strong in a patient who has an excessive anterior pelvic tilt. 2. Hip flexor muscles are typically short and strong in a patient who has an excessive anterior pelvic tilt. 3. The piriformis attaches from the pelvis to the greater trochanter. Therefore, an excessive anterior pelvic tilt would not be associated with a tight piriformis; the sacral-femoral position is more likely to be related to piriformis flexibility deficits. 4. Hip flexor muscles (iliacus/iliopsoas) are short and strong in a patient who has an excessive anterior pelvic tilt.

A patient reports a burning sensation along the medial aspect of the knee and lower leg. The sensation is increased during resisted hip adduction and knee flexion. The patient MOST likely has which of the following conditions? 1. Meralgia paresthetica 2. Neuropathy of the obturator nerve 3. Complex regional pain syndrome 4. Neuropathy of the saphenous nerve

1. Meralgia paresthetica is described as burning pain along the anterolateral aspect of the thigh that increases with hip extension (not hip adduction as described in the stem) (Dutton, p. 951). 2. The obturator nerve has no cutaneous innervation to the lower leg (Moore, pp. 537-538). Pain would reside in the adductor thigh compartment (Dutton, p. 951). 3. Complex regional pain syndrome of the lower extremity typically involves the foot and ankle. There are multiple characteristics present, such as pain, allodynia, hyperalgesia, abnormal vasomotor response, and abnormal sudomotor (sympathetic nervous system) activity. (Dutton, p. 273) 4. The saphenous nerve is cutaneous and supplies skin on medial aspect of leg and foot (Moore, pp. 537-538). Entrapment can cause pain at the medial side of knee. The pain is described as burning pain that increases with knee flexion and hip adduction. (Dutton, p. 979)

A patient has impaired sensory and motor function of the left limbs and the left side of the face. The patient is unable to sit independently. In which of the following regions of the nervous system is the lesion MOST likely located? 1. Cerebrum 2. Brainstem 3. Spinal cord 4. Peripheral nerve

1. Motor and sensory deficits are entirely on the left side of the body. The lower half of the face, the trunk, and both limbs are involved, indicating damage to vertical tract neurons. Facial signs indicate a lesion above the lower midbrain, because a spinal cord lesion would not affect the face and a lesion in most areas of the brainstem would have facial signs contralateral to the limb signs. The most likely location is the cerebrum. 2. A lesion in most areas of the brainstem would have facial signs contralateral to the limb signs. 3. A spinal cord lesion would not affect the face. 4. Motor and sensory deficits are entirely on the left side of the body. The lower half of the face, the trunk, and both limbs are involved, indicating damage to vertical tract neurons. Peripheral nerve lesion signs and symptoms are specific to the nerve injured and would not encompass entire limbs and the face.

A patient is unable to reach behind the low back during activities of daily living. Muscle performance testing is pain-free, normal, and symmetrical. What is the MOST likely problem contributing to this functional impairment? 1. Subscapularis disorder 2. Pectoralis minor stiffness 3. Posterior capsular stiffness 4. Acromioclavicular joint arthrosis

1. Muscle performance testing is normal, thus subscapularis disorder is not likely (p. 476). 2. Stiffness of the pectoralis minor would lead to impairments in activities requiring upward rotation and posterior tilting of scapula (p. 474). 3. Posterior capsular stiffness would decrease medial (internal) rotation, which is required for reaching the hand behind the back (p. 612). 4. Acromioclavicular joint arthrosis is most likely to limit horizontal adduction and overhead motions (p. 675).

Which of the following functions is MOST likely to be impaired in a patient who has a pontine infarct? 1. Jaw movement 2. Eyelid elevation 3. Tongue movement 4. Pharyngeal swallowing

1. Observed jaw deviation during mastication results from an insult to the trigeminal nerve (CN V), which originates in the pons (p. 134). 2. Impaired eyelid elevation (ptosis) results from an insult to the oculomotor nerve (CN III), which originates in the midbrain, not the pons (p. 134). 3. Impaired tongue movement results from an insult to the hypoglossal nerve (CN XII), which originates in the medulla, not the pons (p. 135). 4. Difficulty swallowing (dysphagia) results from an insult to the vagus nerve (CN X), which originates in the medulla, not the pons (p. 135).

A 4-year-old child who has an L1 myelomeningocele has developed scoliosis over the past 2 years. The curve currently measures 25°. Which of the following recommendations is MOST appropriate for scoliosis management? 1. Continue to monitor the scoliosis, with no intervention at this time. 2. Begin a home program of stretching exercises for trunk rotators. 3. Refer to an orthopedic surgeon for evaluation for spinal fusion. 4. Fit the child with a thoracolumbosacral orthosis.

1. Orthotic intervention, usually with a thoracolumbosacral orthosis, is helpful in maintaining improved trunk position for functional activities. For children with progressive spinal deformities, orthotic intervention is continued until the child reaches a sufficient age (10+ years) to allow surgical fusion of the spine. (Palisano, pp. 547-548) 2. Stretching programs have not been found to halt or improve scoliosis. If stretching exercises are performed, they should focus on the iliopsoas and low back extensors and lateral trunk flexors on the concave side of the curvature. (Goodman, pp. 1167-1168) 3. This child is too young for surgery for scoliosis. The ideal minimum age for spinal fusion is 10 to 11 years old in girls and 12 to 13 years old in boys. Long spinal fusions before the skeletal age of 10 result in greater loss of trunk height and an increased frequency of instrumentation failure. (Palisano, pp. 547-548) 4. Orthotic intervention, usually with a thoracolumbosacral orthosis, is helpful in maintaining improved trunk position for functional activities. For children with progressive spinal deformities, orthotic intervention is continued until the child reaches a sufficient age (10+ years) to allow surgical fusion of the spine (Palisano, pp. 547-548) and is indicated for a curvature 25° to 45° (Goodman, p. 1167).

A patient reports a 2-day history of a hot, swollen, first metatarsophalangeal joint. This complaint is MOST common in: 1. osteoarthritis. 2. polymyositis. 3. gout. 4. rheumatoid arthritis.

1. Osteoarthritis is typically characterized by dull, achy pain in weight-bearing joints (e.g., hips, knees, etc.) (pp. 1304-1306). 2. Polymyositis presents as symmetric proximal muscle weakness with malaise and weight loss. There is no joint involvement. (p. 1247) 3. Gout's typical presentation is severe joint pain, occurring at night, typically in the first metatarsophalangeal joint. Signs and symptoms also include erythema, warmth, and extreme tenderness and hypersensitivity of the affected joint. (p. 1345) 4. Rheumatoid arthritis presents with symmetrical joint inflammation and pain with subluxations (pp. 1319-1322).

A physical therapist is designing a rehabilitation program for a patient who has a recent diagnosis of ankylosing spondylitis. The therapist should anticipate that as the disease progresses, the patient is MOST likely to require: 1. special precautions for osteoporosis. 2. a wheelchair for community mobility. 3. spinal surgery. 4. bilateral ankle-foot orthoses.

1. Osteoporosis is a skeletal complication associated with long-standing ankylosing spondylitis. 2. Requiring a wheelchair is incorrect because the patient should still be able to walk, even with advanced stages of ankylosing spondylitis. 3. Spinal surgery has a very limited role in the treatment of ankylosing spondylitis. 4. Peripheral nerve dysfunction is not characteristic of ankylosing spondylitis. Orthoses to manage foot drop would not be expected in the plan of care for a patient who has ankylosing spondylitis

A patient sustained a T10 complete spinal cord injury. Which of the following wheelchair-to-bed transfer techniques is MOST appropriate for the patient? 1. Sit pivot 2. Sliding board 3. Standing pivot 4. Mechanical lift

1. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They may initially use a sliding board to assist transfers, but in the long term they should be able to independently perform a sit pivot transfer. 2. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They should be able to independently transfer and not need a sliding board in the long term. 3. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They would not have adequate lower extremity strength to perform a standing pivot transfer. 4. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They should be able to independently transfer and not need a mechanical lift.

Which of the following strategies for transfer training is MOST likely to be successful for a patient who has apraxia? 1. Give frequent and detailed verbal commands. 2. Provide the patient with written instructions. 3. Teach one component of the transfer at a time. 4. Have the patient practice transfers in a variety of settings and contexts.

1. Patients with apraxia will not be able to use verbal cues or commands to make corrections. The physical therapist should use the shortest possible sentences, not detailed or complex commands. 2. Patients with apraxia have a great deal of difficulty following written or verbal instructions for movement. 3. When teaching a new task to a patient with apraxia, the task should be broken down into its component parts. One component is taught at a time, and the patient is physically guided through the task if necessary. 4. Patients with apraxia benefit from repetition of the task using the same approach in the same environment. It is helpful to use as normal an environment as possible.

Which of the following interventions is MOST appropriate for an individual who has multiple sclerosis? 1. Submaximal exercise performed in the morning 2. Swimming exercises performed in a heated indoor pool 3. Resistance exercise alternating each day between upper and lower body workouts 4. Maximal exercise to the point of fatigue with several days of rest between training sessions

1. Persons with multiple sclerosis are susceptible to fatigue and heat intolerance. Submaximal exercises at moderate intensity (50% to 70%) are tolerated well. In addition, exercising in the morning is recommended because the body's core temperature is lowest at this time. 2. Persons with multiple sclerosis should take precautions to manage core body temperature and prevent overheating. Swimming in a heated pool could result in overheating and an increase in fatigue. 3. Because persons with multiple sclerosis are susceptible to fatigue, circuit training alternating work between upper and lower extremities is recommended during one training session. Performing upper extremity resistance exercise one day followed by lower extremity resistance exercise is more likely to result in increased fatigue. 4. Persons with multiple sclerosis are susceptible to fatigue. Submaximal exercises at moderate intensity (50% to 70%) are more appropriate.

Which of the following skeletal conditions is NORMAL in a newborn infant? 1. Pes cavus 2. Genu varum 3. Genu valgum 4. Talipes equinovarus

1. Pes cavus is an atypically high arched foot type, common in neuromuscular conditions such as Charcot-Marie-Tooth disease. It is not typical in the newborn infant. (Magee, pp. 910-911) 2. At birth, an infant's knees are bowlegged (genu varum) to accommodate for the flexed position in utero. The legs and hips gradually straighten until they reach a neutral alignment between the first and second years. (Palisano, p. 105) 3. At birth, an infant's legs are bowlegged to accommodate for the flexed position in utero. If infants were in genu valgum, it would not allow sufficient hip and knee flexion to attain the flexed posture. With genu valgum, the femur lies in relative medial (internal) rotation and adduction. (Palisano, p. 105) 4. Talipes equinovarus, also referred to as "clubfoot", is a congenital deformity of the foot seen in newborns. It is not a normal condition. The foot appears smaller due to the hypoplastic skeletal features of the bones. Surgical intervention or serial casting is required to correct this condition. (Palisano, pp. 307-308)

A patient has a cavernous wound on the sacrum. Which of the following data collection methods is MOST appropriate to identify the wound volume? 1. Take a photograph of the wound. 2. Measure the length and width using a disposable ruler. 3. Trace the wound onto an acetate measuring guide. 4. Measure the amount of hydrogel that fills the wound without spillage.

1. Photographing the wound will give an accurate assessment of the wound size (length and width) but not its depth (p. 119). 2. Measuring the area of the wound will not give volumetric information (p. 109). 3. Tracing the wound gives an indication of the size but not the depth of the wound (p. 110). 4. Filling the wound with hydrogel or water is used to determine the volume of the wound (p. 111).

After a kidney transplant, a patient develops a Stage 3 pressure injury over the sacrum and is referred to physical therapy for wound care. Which of the following is the MOSTappropriate agent to use initially on this wound? 1. Povidone-iodine solution 2. Sterile normal saline 3. Silver sulfadiazine (Silvadene) cream 4. Zinc oxide cream

1. Povidone-iodine is usually used as a skin preparation to prevent surgical site infection. It can be used in acute traumatic wounds. A Stage 3 pressure injury is an example of a chronic wound. (Sussman, p. 518) 2. Sterile normal saline is the appropriate initial agent used to clean a wound (Sussman, p. 518). 3. Use of silver sulfadiazine may be indicated if infection is present. However, it is not indicated in the initial treatment. (Sussman, p. 513) 4. Zinc oxide is used in dental fillings and in local surface treatment for various skin disorders but not for chronic pressure injuries (Mosby's, p. 1913).

A patient had a brainstem stroke 2 months ago and is currently able to independently walk 65 ft (20 m) over level surfaces with a straight cane and ascend stairs with minimum assistance. Which of the following activities would MOST appropriately challenge this patient's balance during a physical therapy session? 1. Ascending stairs using a single handrail 2. Standing on one leg with eyes closed 3. Walking over uneven terrain 4. Walking 130 ft (40 m) with a straight cane

1. Practice ascending stairs addresses impaired ability to transfer weight onto a stance limb and lift the opposite dynamic limb (p. 242). Although dynamic balance is involved in this activity, ascending stairs using a single handrail is not more difficult than an activity the patient is currently able to perform and would not be challenging to the patient. 2. Static balance challenges will benefit static postural control (p. 195). 3. Walking over uneven terrain is a good example of an impairment-based, task-specific, functional activity that will improve the patient's dynamic balance (p. 233). 4. Increasing the duration of walking by progressing to longer distances primarily progresses endurance, not balance (p. 244).

During patellar reflex testing, the patient demonstrates hyperreflexia. What is the MOST likely cause of this finding? 1. A spinal cord tumor at L1 2. A herniated nucleus pulposus at L4 3. Femoral nerve impingement 4. A cauda equina lesion

1. Pressure on the spinal cord at L1 would cause signs of upper motor neuron lesions below this level. A sign of upper motor neuron lesion is hyperreflexia. (p. 1494) 2. A weak or absent patellar reflex is expected with nerve root L4 compression (p. 1494). 3. Peripheral nerve injuries, such as a femoral nerve impingement, would result in a diminished patellar reflex (pp. 96-97). 4. Peripheral nerve injuries, such as a cauda equina lesion, would result in a diminished patellar reflex (p. 134).

Which of the following patient positions would be the MOST appropriate treatment for atelectasis of the lower lobes, lateral basal segment? 1. Prone position with the bed flat 2. Long-sitting position, leaning back 30° 3. Supine position with the head down 15° 4. One-quarter turn from prone position with the head down 30°

1. Prone with bed flat is best used to drain the superior segments of the lower lobes (p. 314). 2. Long sitting, leaning back 30° is best used for involvement in the upper lobes, apical segments (p. 314). 3. Supine with head down and the patient rotated one-quarter backward is best used to drain the lingula (p. 314). 4. Treatment of atelectasis is directed at reversing the underlying contributing mechanism whenever possible. Atelectasis resulting from prolonged static positioning and monotonous tidal ventilation is managed with mobilization and manipulating body positions (i.e. postural drainage) to optimize alveolar ventilation and alveolar volume (p. 475). Lower lobe atelectasis may be cleared with the patient positioned on the uninvolved side, one-quarter turn from prone with the head down 30°. (p. 315)

Which of the following clinical features is a CONTRAINDICATION to intermittent compression? 1. Past history of deep vein thrombosis 2. Impaired sensation 3. Local infection 4. Peripheral neuropathy

1. Recent or acute deep vein thrombosis is a contraindication, but a past history or having a predisposition to deep vein thrombosis is not. 2. Impaired sensation is a precaution. 3. Infection may spread as a result of compression, and, therefore, infection is a clear contraindication. 4. Peripheral neuropathy is not a contraindication; it is a precaution.

An adult patient requests feedback on his health and wellness exercise program. The patient reports a weekly weight loss of 4.4 lb (2 kg)/week for the last 2 months and is utilizing a dietary intake of 900 kcal/day over the same time period. The BEST advice for the physical therapist to provide to this patient is to: 1. decrease dietary intake further to improve ability for greater weight loss. 2. keep intake and weight loss targets the same. 3. increase dietary intake and target a weight loss of no more than 2.2 lb (1 kg)/week. 4. increase dietary intake and exercise to preserve weight loss at 4.4 lb (2 kg)/week.

1. Reducing the patient's intake further would result in daily caloric intake below the minimal required daily caloric intake and would, therefore, be detrimental to overall health. 2. The patient's current rate of weight loss is than recommended, and the current caloric intake is lower than recommended. 3. Dietary intake should be adequate to allow weight loss of no more than 1 kg/week. 4. Weight loss of 2 kg/week is greater than recommended.

A patient is referred to physical therapy for right shoulder pain. Which of the following findings suggests that physical therapy intervention may not be appropriate? 1. Pain that subsides with right sidelying 2. Tenderness to palpation at the origin of the biceps tendon 3. Trigger points at the right rib 2-3 intercostal space 4. Pain with resisted shoulder lateral (external) rotation

1. Right sidelying often increases musculoskeletal pain but may decrease pleural friction/irritation and thus may decrease visceral pain (Goodman, p. 694). 2. Musculoskeletal pain is often tender to palpation or pressure (Magee, pp. 8-9, 61). 3. Trigger points are the most common musculoskeletal cause of chest pain (Goodman, p. 694). 4. Resisted testing or contraction of the involved muscle may increase pain of a musculoskeletal origin (Goodman, p. 694).

A physical therapist performs heart auscultation as part of a patient's cardiac systems review. The therapist hears a longer sound in-between S1 and S2. This sound is BEST described as a: 1. systolic murmur not considered to be normal. 2. normal heart sound occurring during systole. 3. diastolic murmur not considered to be normal. 4. normal heart sound occurring during diastole.

1. S1 represents closure of the mitral and tricuspid valves, while S2 represents closure of the aortic and pulmonary valves. These are the only two heart sounds that should occur normally. Sounds occurring between S1 and S2 are considered systolic murmurs. 2. S1 represents closure of the mitral and tricuspid valves, while S2 represents closure of the aortic and pulmonary valves. These are the only two heart sounds that should occur normally. 3. Sounds occurring between S2 and S1 are known as diastolic murmurs. The illustration does not show the sound occurring between S2 and S1. 4. S1 represents closure of the mitral and tricuspid valves, while S2 represents closure of the aortic and pulmonary valves. These are the only two heart sounds that should occur normally.

A patient presents with moderate pain in the elbow after a fall. The radiograph is negative for a fracture. Which of the following mobilizations is MOST appropriate for decreasing the pain? 1. Small-amplitude oscillations before the onset of tissue resistance 2. Small-amplitude oscillations into tissue resistance 3. Large-amplitude oscillations into tissue resistance 4. Large-amplitude oscillations at the end of tissue resistance

1. Small-amplitude oscillations before the onset of tissue resistance are appropriate for pain modulation. 2. Small-amplitude oscillations into tissue resistance are more appropriate for joint stiffness, not pain. 3. Large-amplitude oscillations into tissue resistance are more appropriate for joint stiffness. 4. Large-amplitude oscillations at the end of tissue resistance are for end range joint restrictions and are too aggressive for patients who have pain.

Rate pressure product is MOST indicative of which of the following cardiac factors? 1. Stroke volume 2. Cardiac output 3. Pulse amplitude 4. Myocardial oxygen demand

1. Stroke volume is the amount of blood ejected from the left ventricle during each heartbeat. Stroke volume (SV) and heart rate (HR) are components of cardiac output (CO) (CO=SV x HR). (Frownfelter, p. 38) 2. Cardiac output is calculated by multiplying heart rate by stroke volume and is representative of the amount of blood pumped by the heart in 1 minute (Paz, p. 17). 3. Pulse amplitude is an assessment of the quality of the pulse determined by the pulse taker. The quality of the pulse being taken is classified as absent, diminished, normal, moderately increased, or markedly increased. (Paz, p. 22) 4. Rate pressure product is calculated by multiplying heart rate by systolic blood pressure. It is an indication of myocardial oxygen demand. (Paz, p. 43)

A patient reports constant bilateral posterior calf pain with itching. The examination reveals a body temperature of 98.8°F (37.1°C), normal temperature of the lower extremities, and tenderness to palpation and crusting of the skin in the affected areas. Which of the following conditions is MOST likely present? 1. Dermatitis 2. Cellulitis 3. Atrophie blanche 4. Superficial venous thrombosis

1. Symptoms of dermatitis include lack of fever, itching, normal temperature of the lower extremities, inflammation, tenderness to touch, presence of vesicles and crusting, and either unilateral or bilateral distribution (Bryant, pp. 178, 211). 2. Although the patient's limb is painful, the other reported findings are not consistent with cellulitis. Signs of cellulitis include fever, elevated temperature of the lower extremities, erythema, inflammation, tenderness, one or a few bullae, no lesions, and unilateral distribution. (Bryant, p. 237; Sussman, p. 376) 3. Atrophie blanche is characterized by white, scar-like areas associated with pain at rest and when standing (Sussman, p. 376). Affected areas present as smooth white plaques (Bryant, p. 210). 4. Superficial venous thrombosis is characterized by pain and tenderness along the affected vein, usually the saphenous vein. Crusting of the skin is not a feature of this condition. (Goodman, pp. 647, 649)

A patient who sustained an avulsion of the right C5 and C6spinal nerve roots will show functional loss of right: 1. distal thumb flexion. 2. ulnar wrist deviation. 3. elbow extension. 4. shoulder abduction.

1. The C8-T1 nerve roots form the median nerve (anterior interosseus), supplying the flexor pollicis longus muscle. A patient who has an avulsion of the C5 and C6 spinal nerve roots will be able to perform distal thumb (1st digit) flexion. (Dutton, p. 83; O'Sullivan, p. 154) 2. The C7-C8 nerve roots form the ulnar nerve and radial nerve (posterior interosseus), supplying the flexor and extensor carpi ulnaris. Therefore, a patient who has an avulsion of the C5 and C6 spinal nerve roots will be able to perform wrist ulnar deviation. (Dutton, pp. 83, 86; O'Sullivan, p. 154) 3. The C5-C8 and T1 nerve roots form the radial nerve, supplying the triceps brachii. Avulsion of the C5 and C6 nerve roots will result in weakness but not functional loss of elbow extension. (Dutton, pp. 81-82; O'Sullivan, p. 154) 4. The C5-C6 nerve roots form the axillary nerve, supplying the deltoid and teres minor. Avulsion of these nerve roots will result in decreased right shoulder abduction. (Dutton, p. 80; O'Sullivan, p. 154)

During a symptom-limited graded exercise test, a patient exhibits wide QRS complex and absent P wave . This pattern is indicative of which of the following phenomena? 1. ST segment elevation 2. Premature ventricular contractions 3. Acute first-degree atrioventricular block 4. Normal response to exercise

1. The ST segment is not elevated in the photograph of the electrocardiogram (p. 331). 2. Premature ventricular contractions are present in the photograph of the electrocardiogram, as evidenced by the wide QRS complex and absent P wave(p. 325). 3. Acute first-degree atrioventricular block would be represented by a prolonged PR interval, which is not shown in this photograph (p. 323). 4. This electrocardiogram is not consistent with a normal response to exercise, because premature ventricular contractions are present (pp. 312-313).

When evaluating wheelchair positioning of a child with cerebral palsy, the position of which of the following body parts should be examined FIRST? 1. Pelvis 2. Lower extremities 3. Head 4. Spine

1. The assessment of posture in a wheelchair begins with the pelvis and its relationship to its adjacent segments. 2. The pelvis, not the lower extremities, should be considered first when evaluating wheelchair seating. 3. The pelvis, not the head, should be considered first when evaluating wheelchair seating. 4. The pelvis, not the spine, should be considered first when evaluating wheelchair seating.

Which of the following activities would be MOST appropriate to practice to assist a 20-year-old patient who has Duchenne muscular dystrophy in maintaining independence? 1. Stair training using both handrails 2. Gait training using a rolling walker 3. Transfer training using a slide board 4. Power wheelchair training over various surfaces

1. The cessation of independent walking in boys with Duchenne muscular dystrophy typically occurs by age 10-12 (Palisano, pp. 250-251) or 13 years (Tecklin, p. 355). Therefore, stair climbing is not likely. 2. The cessation of independent walking in boys with Duchenne muscular dystrophy typically occurs by age 10-12 (Palisano, pp. 250-251) or 13 years (Tecklin, p. 355). Therefore, gait training is highly unlikely to be plausible. 3. The transition to adulthood marks a time of continued progressive disability. Assistance with transfers would be required at this stage. (Palisano, p. 254) 4. A 20-year-old patient with Duchenne muscular dystrophy is likely to require a power wheelchair for functional mobility due to the progressive nature of the disease (Tecklin, p. 362). Typically, by age 14 years, boys who have Duchenne muscular dystrophy are not ambulatory and require power-assisted mobility. The transition to adulthood marks a time of continued progressive disability with a greater reliance on assistive technologies such as a power wheelchair (Palisano, p. 254).

A patient reports insidious onset of pain and paresthesias on the lateral aspect of the right forearm and hand. The symptoms are reproduced with neck extension. Which of the following is the MOST likely diagnosis? 1. C6 radiculopathy 2. Ulnar nerve entrapment 3. Radial nerve entrapment 4. C8 radiculopathy

1. The dermatome for the C6 nerve root is the lateral aspect of the forearm and hand. Cervical extension with compression is a part of the foraminal compression test for nerve root involvement. 2. Injury to the ulnar nerve would result in sensory disturbance of the little and ring fingers (4th and 5th digits). 3. Injury to the radial nerve would result in sensory disturbance of the dorsum of the hand, thumb (1st digit), and fingers. 4. The dermatome for the C8 nerve root is in the medial hand and lower forearm.

A physical therapist is working with a patient who had a total knee arthroplasty 2 days ago. The patient's resting electrocardiogram shows a normal ECG. While gait training, the patient's electrocardiogram shows a 3-mm ST depression. Based on this finding, what is the BEST action for the therapist to take at this time? 1. Stop gait training and notify the nurse. 2. Continue gait training, because the heart rate is less than 100 bpm. 3. Stop gait training and allow the patient to sit down and rest. 4. Continue gait training, but allow the patient standing rest breaks.

1. The electrocardiogram change shows 3-mm ST depression, which is indicative of cardiac ischemia and is an indication to stop exercise and notify medical staff. 2. Continuing gait training would endanger the patient. 3. Stopping and resting is appropriate; however, the medical staff should be alerted to this situation first. 4. Continuing gait training, despite some standing rests, could allow the ischemia to progress and endanger the patient.

A patient who has an L1 spinal cord injury (ASIA Impairment Scale A) is working toward independent walking with knee-ankle orthoses and forearm crutches. When walking with crutches, the patient is unable to achieve neutral hip extension. Which of the following interventions would BEST address this problem? 1. Strengthening the hip extensors 2. Strengthening the back extensors 3. Stretching the hamstrings 4. Stretching the hip flexors

1. The gluteus maximus is innervated below L1 and could not be strengthened. 2. Strengthening the back extensors would not contribute to increased hip extension. 3. Stretching the hamstrings could contribute to increased hip flexion with knee extension, not increased hip extension. 4. Stretching the hip flexors will promote hip extension range of motion, which is necessary in order to ambulate over even surfaces.

During the examination of a patient who went on a hiking trip 1 week ago, a physical therapist notes neck stiffness and notices a red rash with partial central clearing on the patient's upper extremity. The therapist should suspect that the patient has which of the following conditions? 1. Meningitis 2. Herpes zoster 3. Lyme disease 4. Retropharyngeal abscess

1. The history of the patient is inconsistent with the classic history of meningitis (pre-existing respiratory infection)(p. 235). 2. Herpes zoster (shingles) occurs in a dermatologic distribution and is characterized by burning pain (p. 260). 3. The history of this patient (hiking trip), symptoms (neck stiffness), and findings (rash) are consistent with Lyme disease (p. 236). 4. Retropharyngeal abscess usually occurs in children younger than 4 years old or is the result of trauma or dental infection (p. 240).

When the Hawkins- Kennedy test is performed, the patient reports reproduction of pain. Which of the following functional activities is LEAST likely to cause pain in this patient? 1. Turning a doorknob 2. Reaching away from the side 3. Lifting overhead 4. Putting on a jacket

1. The image depicts the Hawkins-Kennedy test, a test for shoulder impingement (subacromial). Symptoms can be elicited by the combined movements of elevation, abduction, and medial (internal) rotation. Among all activities described, turning a doorknob is the activity that least requires these motions. 2. Reaching away from the side requires shoulder abduction, which can trigger impingement symptoms. 3. Lifting overhead requires shoulder elevation, which can trigger impingement symptoms. 4. Putting on a jacket requires abduction and medial (internal) rotation, which can trigger impingement symptoms.

Which of the following options BEST describes the mode of action of angiotensin-converting enzyme (ACE) inhibitors? 1. Reduction of heart rate and increase in cardiac contractility 2. Reduction of heart rate and decrease in cardiac contractility 3. Reduction of peripheral vascular resistance and increase in venous capacitance 4. Reduction of peripheral vascular resistance and decrease in venous capacitance

1. The mode of action described does not occur with angiotensin-converting enzyme inhibitors (p. 472). 2. The mode of action described is for beta-blockers, which are another medication used to treat hypertension (p. 470). 3. Angiotensin-converting enzyme inhibitors produce vasodilation, reduce peripheral vascular resistance, and increase venous capacitance (p. 472). 4. Angiotensin-converting enzyme inhibitors produce vasodilation, reduce peripheral vascular resistance, and increase venous capacitance (p. 472). Therefore this option is incorrect since it states an action is decreasing venous capacitance.

A patient demonstrates wrist drop and sensory loss in the region of the anatomical snuffbox. These signs are MOST likely due to an injury to what nerve? 1. Musculocutaneous 2. Median 3. Radial 4. Ulnar

1. The musculocutaneous nerve innervates the skin on the lateral side of forearm and the elbow flexors (pp. 378-380). 2. The median nerve innervates the skin on the anterior surface of the hand and posterior tips of the lateral three fingers and the wrist flexor muscles, not the extensors (p. 381). 3. The radial nerve innervates the skin on the posterior surface of the arm, forearm, and hand, including the snuffbox, and the elbow and wrist extensors. When the latter are weak, the patient has wrist drop. (pp. 378-379, 382) 4. The ulnar nerve innervates the skin of the medial two fingers and the wrist flexors and hand muscles (pp. 378-379, 381).

If the ulnar nerve tension test has positive findings, which of the following muscles is MOST likely affected? 1. Adductor pollicis 2. Pronator quadratus 3. Flexor pollicis longus 4. Abductor pollicis longus

1. The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393). The adductor pollicis is innervated by the ulnar nerve (nerve roots C7-C8, T1) (Magee, p. 399). 2. The pronator quadratus is innervated by the median nerve (Magee, p. 399). The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393). 3. The flexor pollicis longus is innervated by the anterior interosseous nerve, which is a branch of the median nerve (Magee, p. 450). The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393). 4. The abductor pollicis longus is innervated by the posterior interosseus nerve, which is a branch of the radial nerve (Magee, p. 399). The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393).

Which of the following blood pressure changes is an ABNORMAL response to increased exercise intensity and a reason to terminate exercise? 1. Decrease in diastolic blood pressure of 5 mm Hg 2. Increase in diastolic blood pressure of 5 mm Hg 3. Decrease in systolic blood pressure of 20 mm Hg 4. Increase in systolic blood pressure of 20 mm Hg

1. The normal blood pressure response to increased exercise intensity consists of a progressive increase in systolic blood pressure and no change or a slight decrease in diastolic blood pressure (ACSM, pp. 125, 128). 2. The normal blood pressure response to increased exercise intensity consists of a progressive increase in systolic blood pressure and no change or a slight decrease in diastolic blood pressure (ACSM, pp. 125, 128). A slight increase in diastolic blood pressure would not be cause for termination of exercise. 3. A drop in systolic blood pressure is considered an abnormal test response (ACSM, pp. 125, 127). Criteria for terminating exercise include exercise hypotension (drop in systolic blood pressure of 20 mm Hg or more) (Frownfelter, p. 280). 4. This is a normal response. A drop in systolic blood pressure is considered an abnormal test response (ACSM, pp. 125, 127).

A patient who is a waiter has hand pain when carrying trays overhead. Which of the following nerve tension tests is MOST likely to have a positive result? 1. Ulnar 2. Median 3. Radial 4. Musculocutaneous

1. The overhead positioning of carrying food trays is similar to the end position of the ulnar nerve tension test. The tension test for the ulnar nerve includes shoulder depression, abduction, and lateral (external) rotation; elbow flexion; forearm pronation or supination; and wrist and finger extension. 2. The median nerve tension test employs elbow extension, but the position of the waiter is more consistent with elbow flexion. 3. The radial nerve tension test employs elbow extension, and the position of the forearm is low by the side, not reaching overhead. 4. The musculocutaneous nerve does not innervate the hand.

An 18-year-old patient who has osteogenesis imperfecta has been receiving physical therapy services through the school system. The patient is independent in transfers, wheelchair mobility with a motorized wheelchair, and self-care and has been utilizing public transportation. Which of the following courses of action is MOST appropriate in planning for the patient? 1. Continue physical therapy services with a modified goal to maintain independence with mobility. 2. Continue physical therapy services under the care of a physical therapist assistant. 3. Recommend that the patient participate in a support group. 4. Refer the patient to vocational services.

1. The patient has achieved the goals necessary for independent mobility, so there is no need to continue with a mobility goal. 2. Continuing physical therapy services, even by a physical therapist assistant, is inappropriate when the patient has achieved the goals and expected prognosis at this stage of life. 3. There is no indication in this question that the person requires any social support. 4. This 18-year-old patient is independent for activities of daily living and is developmentally appropriate for the workforce or further academic study. A vocational counselor will provide the best guidance and support for the next setting/stage.

A patient who has emphysema reports a weight gain of 20 lb (9 kg) over the past month. There is 3+ pitting edema in both distal lower extremities. Which of the following tests is MOST important to identify the likely underlying condition? 1. Heart rate 2. Capillary refill 3. Heart auscultation 4. Ankle-brachial index

1. The patient has concerning symptoms suggestive of heart failure. Heart rate would not be most important measure because right ventricular heart failure is not associated with acute changes to heart rate. Right ventricular failure is due to the sustained elevation in pulmonary arterial hypertension. (Goodman, pp. 593-595) 2. Capillary refill is used to assess for surface arterial blood flow (Myers, p. 208). Edema is associated with venous insufficiency (Myers, p. 236). 3. The patient has concerning symptoms suggestive of heart failure. The classic signs include peripheral pitting edema, weight gain, jugular vein distention, diminished appetite, right upper quadrant discomfort, and a ventricular gallop (S3) heart sound (Hillegass, pp. 87, 98). Assessing the heart sounds would be of value for the medical diagnosis or for determining whether consultation with another health care professional is needed. 4. The ankle-brachial index is performed to assess for arterial disease and is designed to test the potential loss of profusion in the lower extremities (O'Sullivan, p. 586). Clinical manifestations of arterial disease include pain, pallor, paralysis, diminished pulses, hair loss, and thin shiny skin (Goodman, pp. 639-640). Venous insufficiency is represented by edema, hemosiderin staining of the skin, and normal arterial pulses (Goodman, pp. 655-656). The patient could have secondary venous issues, but the ankle-brachial index would not be indicated as an additional testing measure.

A person with bilateral pronation of the feet is asked to perform a bilateral squat. Based on the rearfoot position, which of the following will MOST likely be observed? 1. Genu varum with tibial medial (internal) rotation 2. Genu varum with tibial lateral (external) rotation 3. Genu valgus with tibial medial (internal) rotation 4. Genu valgus with tibial lateral (external) rotation

1. The patient in the photograph exhibits pronation of the feet. Pronation is associated with valgus, not varus, stress at the knee, and pronation of the subtalar joint results in or is caused by medial (internal) rotation of the tibia. 2. The patient in the photograph exhibits pronation of the feet. Pronation is associated with valgus deformity of the knee and medial (internal) rotation of the tibia. 3. The patient in the photograph exhibits pronation of the feet. Pronation is associated with medial (internal) rotation of the tibia and resulting genu valgus. 4. The patient in the photograph exhibits pronation of the feet. Pronation is associated with medial (internal), not lateral (external), rotation of the knee along with valgus stress.

When working with a patient who has tuberculosis, which of the following options BEST describes the appropriate location for treatment and type of personal protective equipment that a physical therapist should wear? 1. Therapy gym, N-95 respirator 2. Patient's room, N-95 respirator 3. Therapy gym, standard mask 4. Patient's room, standard mask

1. The patient should not be treated in the physical therapy gym because patients and others in the environment will be exposed to tuberculosis. Airborne precautions specify that the patient should stay in an airborne-infection-isolation room to prevent the spread of tuberculosis. (Minor, pp. 94-95) 2. Because of the nature if its transmission, tuberculosis necessitates airborne precautions. Airborne precautions require the health professional to wear an N-95 respirator (Fairchild, p. 35). Airborne precautions also specify that the patient should stay in an airborne-infection-isolation room to prevent the spread of tuberculosis through the facility's ventilation system (Minor, pp. 94-95). If a patient who has tuberculosis is treated in the physical therapy gym, others in the environment will be exposed to tuberculosis.

A home health physical therapist conducts an initial evaluation of a patient who sustained a tibial plateau fracture. The patient's status is non-weight-bearing, and the patient uses a walker. The patient lives alone, but has a neighbor who helps with meals. With which of the following aspects of the home environment should the therapist be MOST concerned? 1. Depth of the bathtub 2. Steps without a handrail 3. Width of the doorways 4. Height of the countertops

1. The patient will require a shower seat, so depth of bathtub is not the primary aspect of concern. 2. Ascending and descending stairs with a walker should be performed only when a handrail is available and all of the feet of the walker fit on the stair treads. Instruction without a handrail should be reserved for emergency situations only. 3. The walker can be used sideways through a narrow doorway. 4. Because the neighbor is helping with meals, the height of the countertop is not relevant.

Which of the following muscles is MOST active during a side-lying shoulder ER exercise? 1. Infraspinatus 2. Supraspinatus 3. Teres major 4. Rhomboid minor

1. The primary muscles that laterally (externally) rotate the glenohumeral joint are the infraspinatus, teres minor, and posterior deltoid (p. 74). 2. The action of the supraspinatus is primarily abduction of the arm (p. 73), which is not shown in the photograph. 3. The action of the teres major is adduction, medial (internal) rotation, and extension of the arm (p. 77), which is not shown in the photograph. 4. The rhomboid minor attaches to the medial border of the scapula, creating downward rotation and retraction of the scapula. It is not involved in movement of the humerus. (p. 65)

If the radial nerve tension test has positive findings, which of the following muscles is MOST likely affected? 1. Pronator teres 2. Adductor pollicis 3. Pronator quadratus 4. Abductor pollicis longus

1. The pronator teres is innervated by the median nerve (Magee p. 399). The nerve being stretched in the photograph is the radial nerve (Kisner, p. 393). 2. The adductor pollicis is innervated by the ulnar nerve (Magee p. 399). The nerve being stretched in the photograph is the radial nerve (Kisner, p. 393). 3. The pronator quadratus is innervated by the median nerve (Magee p. 399). The nerve being stretched in the photograph is the radial nerve (Kisner, p. 393). 4. The nerve being stretched in the photograph is the radial nerve (Kisner p. 393). The abductor pollicis longus is innervated by the radial nerve (nerve roots C5-C8, T1). When the abductor pollicis longus is affected, loss of thumb (1st digit) abduction could result (Magee, p. 399).

During manual muscle testing of the hip flexors in the sitting position, a patient exhibits lateral (external) rotation with abduction of the thigh as resistance is applied. The physical therapist should suspect muscle substitution by the: 1. sartorius. 2. tensor fasciae latae. 3. adductor longus. 4. semimembranosus.

1. The sartorius flexes, laterally (externally) rotates, and abducts the hip joint. With resisted hip flexion, the sartorius will be recruited to perform all three actions, giving the observed substitution pattern. 2. The tensor fasciae latae is a medial (internal) rotator and flexor of the hip, so substitution by it would involve medial (internal) rotation and abduction. 3. The adductor longus would adduct the hip. 4. Substitution by the semimembranosus would cause hip extension.

A patient who walks with an antalgic gait reports hip pain, loss of appetite, and night sweats. The patient has a low-grade fever. Which of the following tests is MOST important to perform to confirm the diagnosis? 1. Squat test 2. Patrick test 3. McBurney test 4. Iliopsoas muscle test

1. The squat test is a test to rule in or rule out a hip fracture. A patient who has a hip fracture will report increased pain with weight-bearing activities (p. 652). In addition to reporting hip pain, the patient has clinical signs and symptoms that indicate a psoas abscess (night sweats, low-grade fever). 2. The Patrick test is a test to rule in or rule out hip joint dysfunction (p. 642). In addition to reporting hip pain, the patient has clinical signs and symptoms that indicate a psoas abscess (night sweats, low-grade fever). 3. The McBurney test is a test for appendicitis. Pain resulting from appendicitis usually begins in the umbilical region and may be localized to the right lower quadrant. Pain is also generally accompanied by nausea, vomiting, and a low-grade fever. (pp. 340, 342) 4. The iliopsoas muscle test is a screening test for psoas abscess. A patient who has a psoas abscess will most likely have a low-grade fever, antalgic gait, and night sweats. (pp. 332-333)

While walking on a treadmill during Phase II cardiac rehabilitation following coronary artery bypass surgery, a patient reports the new onset of chest pain and dyspnea. The physical therapist should instruct the patient to: 1. continue walking while the therapist monitors the patient's vital signs. 2. continue walking at 50% slower speed while the therapist calls the physician. 3. cease walking while the therapist reassesses the patient's vital signs. 4. cease walking while the therapist activates the emergency medical system.

1. The symptoms should be regarded as indicators of a worsening or new condition. 2. These symptoms do not constitute a medical emergency but do indicate onset of a new condition. These are indications to terminate exercise and reassess vital signs. 3. The patient's symptoms indicate the onset of a new condition. These are indications to terminate exercise testing and reassess vital signs. 4. These symptoms do not constitute a medical emergency.

Which of the following lower extremity proprioceptive neuromuscular facilitation patterns is MOST appropriate to strengthen a patient's weak tibialis posterior? 1. Hip extension, abduction, and medial (internal) rotation, with ankle plantar flexion and eversion 2. Hip flexion, adduction, and lateral (external) rotation, with ankle dorsiflexion and inversion 3. Hip extension, adduction, and lateral (external) rotation, with ankle plantar flexion and inversion 4. Hip flexion, abduction, and medial (internal) rotation, with ankle dorsiflexion and eversion

1. The tibialis posterior plantar flexes and inverts the foot. Ankle plantar flexion and eversion would strengthen the fibularis (peroneus) longus and brevis. (pp. 213, 854) 2. The tibialis posterior plantar flexes and inverts the foot. Ankle dorsiflexion and inversion would strengthen the tibialis anterior. (pp. 212-214, 854) 3. The tibialis posterior plantar flexes and inverts the foot. Hip extension, adduction, and lateral (external) rotation, with ankle plantar flexion and inversion requires the specific action of that muscle. (pp. 212-214, 854) 4. The tibialis posterior plantar flexes and inverts the foot. Ankle dorsiflexion and eversion would strengthen the fibularis (peroneus) tertius. (pp. 212-214, 854)

A patient is referred to physical therapy with a diagnosis of adhesive capsulitis. During the initial evaluation, the patient is found to have limited shoulder range of motion, decreased tolerance to weight-bearing, recurrent night pain, and increased deep tendon reflexes. Which of the following courses of action is BEST for the physical therapist? 1. Contact the patient's referring physician. 2. Initiate small-amplitude oscillations performed at the beginning of the range of motion. 3. Perform pulsed ultrasound to the anterior aspect of the shoulder. 4. Delay therapy for 1-2 weeks until the pain decreases.

1. These measures do not fit with the diagnosis of adhesive capsulitis and might indicate a more serious pathological condition. Signs and symptoms of metastases include decreased tolerance to weight-bearing, change in deep tendon reflexes, and change in sleep habits. 2. Pain control mobilizations are not contraindicated, but it is more important to get the patient back to the physician for reevaluation. 3. Ultrasound should not be performed until a definitive diagnosis can be determined. 4. The physical therapist should take action to refer the patient the physician for reevaluation as soon as possible.

Which of the following findings BEST describes an injury in the acute stage? 1. Collagen fibers reorient in response to stresses placed on connective tissue. 2. Collagen formation and granulation tissue development occurs at an increased rate. 3. During range of motion testing, the patient experiences pain synchronous with tissue resistance. 4. During range of motion testing, the patient experiences pain with movement and before tissue resistance.

1. This activity characterizes the chronic stage of healing, which involves tissue maturation and remodeling (p. 323). 2. This activity characterizes the subacute stage of healing (p. 320). 3. This response characterizes the subacute stage of healing (p. 317). 4. Pain on active movement is a hallmark of the acute stage of healing (p. 317).

A patient who has bicipital tendinopathy is MOST likely to experience pain with which of the following maneuvers? 1. Resisted shoulder flexion with the forearm supinated and the elbow flexed to 15° 2. Passive shoulder medial (internal) rotation and abduction with 90° of elbow flexion 3. Passive shoulder flexion greater than 90° with application of light pressure on the acromion 4. Resisted shoulder extension with the elbow extended and the shoulder abducted to 90° and medially (internally) rotated

1. This movement describes the Speed test, which is diagnostic of bicipital tendinopathy. 2. This movement describes the Hawkins test, which is diagnostic of impingement syndrome. 3. This movement describes the Neer test, which is diagnostic of impingement syndrome. 4. This movement describes the empty can test, which is diagnostic of supraspinatus tendinopathy.

A patient with no history of trauma has nonradiating low back pain. Lumbar flexion does not reverse the lordosis and is pain-free; lumbar extension increases the symptom. Palpation reveals a step-off in the lower lumbar region. The MOST appropriate treatment for this patient would be: 1. abdominal strengthening. 2. sustained prone positioning on elbows. 3. exaggerated lumbar lordosis in sitting. 4. grade III posteroanterior glide to L5.

1. This patient's signs and symptoms are consistent with spondylolisthesis. Abdominal muscle strengthening and stabilization are key to conservative management. 2. Extension activities are not indicated for a patient with spondylolisthesis. 3. Extension activities are not indicated for a patient with spondylolisthesis. 4. Extension activities are not indicated for a patient with spondylolisthesis.

A physical therapist is examining the posterior aspect of the heels of a patient who has darkly pigmented skin. Which of the following findings would indicate the presence of a Stage 1 pressure injury? 1. An intact area of the skin that is black and leathery 2. An intact area of the skin that is warm and purple 3. A shallow crater with a moist wound bed 4. An intact blister with a boggy feel

1. This presentation would indicate the presence of eschar. A pressure injury with eschar cannot be staged (p. 135). 2. This presentation fits the National Pressure Ulcer Advisory Panel's definition of a Stage 1 pressure injury. Warmth and color change indicate pressure damage. Damaged skin may look purple rather than red in people with darkly pigmented skin. Intact skin indicates that the pressure injury is not deeper than Stage 1. (p. 112) 3. A shallow crater with a moist wound bed is characteristic of a Stage 2 pressure injury (p. 135). 4. An intact blister with a boggy feel is characteristic of a Stage 2 pressure injury (p. 135).

A physical therapist is performing a manual muscle test of the shoulder abudctors in seated. If the patient is unable to achieve at least a grade of Fair (3/5), which of the following positions would be the BEST modification for the test? 1. Sitting against a wall for support 2. Lying sidelying 3. Lying supine 4. Lying prone

1. Upright sitting position does not eliminate the effects of gravity. If testing results in a grade below Fair (3/5), gravity should to be eliminated. 2. Sidelying is not a standard testing procedure for the deltoid/supraspinatus. Gravity will still be involved. If testing results in a grade below Fair (3/5), gravity should be eliminated. 3. Supine position allows the patient to slide the arm on the table. Gravity is eliminated in this position. This is the standard position to test the deltoid/supraspinatus for a grade of Poor (2/5). 4. Although prone position does minimize gravity, it is not the position of choice for the muscle group being tested.

A patient reports dizziness and frequent falls. Upon examination, the patient demonstrates constant vertical pendular nystagmus, abnormal smooth pursuit, and abnormal saccadic eye movements. The patient's symptoms are MOST likely caused by which of the following conditions? 1. Vertebrobasilar insufficiency 2. Central vestibular system lesion 3. Peripheral vestibular system lesion 4. Posterior semicircular canalithiasis

1. Vertebrobasilar insufficiency is associated with drop attacks, transient blindness, and dysarthria. 2. A patient who has a central vestibular system lesion, in particular a cerebellar lesion, may have pure vertical nystagmus that oscillates at equal speeds (pendular nystagmus). In addition, abnormal smooth pursuits and abnormal saccadic eye movements are symptoms associated with a central vestibular lesion. 3. Peripheral vestibular lesions are associated with intermittent nystagmus that will incorporate slow and fast phases (jerk nystagmus) and with normal smooth pursuit and saccades. 4. Peripheral vestibular lesions, including posterior semicircular canalithiasis, are associated with intermittent nystagmus that will incorporate slow and fast phases (jerk nystagmus) and with normal smooth pursuit and saccades.

During a gait training session, a patient who has Parkinson disease exhibits freezing episodes when attempting to negotiate turns. Which of the following training methods would be MOST beneficial for the patient? 1. Visual cue on the floor 2. Video of correct turning 3. Feedback at the end of the session 4. Blocked practice of turns

1. Visual stimuli have been shown to be effective in overcoming freezing episodes in patients who have Parkinson disease. Parkinson disease causes a deficit in proprioception for which visual cues may compensate. (Umphred, p. 617; Pfeiffer, p. 204) 2. Use of a video is not appropriate because patients who have Parkinson disease have difficulty in shifting attention and have selective attention due to a deficit of the frontal lobe (Umphred, p. 610). 3. Feedback at the end of the session is not appropriate because patients who have Parkinson disease are unable to quickly access working memory due to a deficit of the frontal lobe (Umphred, p. 610). 4. Blocked practice enforces procedural learning, which is impaired due to dysfunction of the basal ganglia in patients who have Parkinson disease (Umphred, pp. 606, 610-611).

A patient has difficulty with knee control while descending stairs. Which of the following exercises is MOST appropriate to improve function in this task? 1. Wall squats 2. Quadriceps setting exercises 3. Long arc knee extension with free weights 4. Concentric knee extension using an isokinetic dynamometer

1. Wall squats are a closed chain exercise that requires eccentric contraction of the quadriceps muscles in a pattern closely related to that used in descending stairs, making it the exercise most likely to lead to functional carry-over. 2. Quadriceps sets are isometric exercises that will strengthen the muscle but not in the same way needed to descend stairs. 3. Long arc knee extension exercises are an open chain exercise that will strengthen the muscle but not in the same way needed to descend stairs. 4. Exercises performed on an isokinetic dynamometer are open chain exercises that will strengthen the muscle but not in the same way needed to descend stairs.

A physical therapist is reviewing study findings summarized as follows: Patients with patellofemoral pain who received an experimental strengthening program plus a standard exercise program achieved improved outcomes, compared to patients who received only the standard exercise program (p = .001). The researchers had set the alpha level to .05 before the study began. Which of the following statements MOST accurately characterizes the results? 1. A statistically significant difference exists between the two interventions. 2. A small difference exists between the two interventions. 3. A large difference exists between the two interventions. 4. No difference exists between the two interventions.

1. When the p value is less than the alpha level, a statement can only be made that a significant difference exists. No statement can be made as to the magnitude of the difference. 2. When the p value is less than the alpha level, a statement can only be made that a significant difference exists. No statement can be made as to the magnitude of the difference. 3. When the p value is less than the alpha level, a statement can only be made that a significant difference exists. No statement can be made as to the magnitude of the difference. 4. The p value obtained is less than the alpha level, thus a statistical difference exists.

Following insertion of a chest tube, a patient displays scapular winging. The physical therapist should expect the patient to have the MOST difficulty: 1. scratching the low back area. 2. turning a doorknob. 3. holding a briefcase. 4. reaching forward for an object.

1. Winging of the scapula is caused by weakness of the serratus anterior (Hislop, pp. 82-83; Dutton, p. 591). Ability to scratch the low back area would not be affected by serratus anterior weakness. It would be affected by weakness of the medial rotators. (Hislop, pp. 133-137) 2. Winging of the scapula is caused by weakness of the serratus anterior (Hislop, pp. 82-83; Dutton, p. 591). Turning a doorknob would be most affected by weakness of the biceps and supinator (Hislop, pp. 147-150). 3. Winging of the scapula is caused by weakness of the serratus anterior (Hislop, pp. 82-83; Dutton, p. 591). Holding a briefcase would be affected by weakness of the flexor digitorum profundus, not by weakness of the serratus anterior (Dutton, p. 792). 4. Winging of the scapula is caused by weakness of the serratus anterior (Hislop, pp. 82-83; Dutton, p. 591). The serratus anterior abducts the scapula and rotates the interior angle laterally (Hislop, pp. 82-84). Weakness in this area would cause difficulty reaching forward for an object.

A patient's left eye is adducted at rest. During examination of extraocular eye movements, the patient is unable to move the left eye laterally. These findings MOST likely result from a lesion of which of the following nerves? 1. Oculomotor (CN III) 2. Trochlear (CN IV) 3. Trigeminal (CN V) 4. Abducent (CN VI)

1. With oculomotor nerve (CN III) injury, the affected eye would have ptosis and lateral deviation (pp. 330-331). 2. With a trochlear nerve (CN IV) injury, the person would have elevation of the involved eye during forward gaze (p. 331) and would not have difficulty with abducting the eye. 3. With trigeminal nerve (CN V) injury, the person would have impaired facial sensation, difficulty with jaw opening, and an impaired corneal reflex (pp. 336-338). 4. With a lesion of the abducent nerve (CN VI), the affected eye is adducted at rest and cannot be abducted (p. 331).

A patient reports audible clicking in the temporomandibular joint while chewing food. When a physical therapist is palpating the joint, which of the following pairs of active mandible motions would be MOST informative to confirm temporomandibular dysfunction? 1. Elevation and protrusion 2. Elevation and retrusion 3. Protrusion and retrusion 4. Depression and elevation

4. Reciprocal clicking with mouth opening and closing has good diagnostic utility in diagnosing temporomandibular conditions and in particular anterior disc displacement (p. 1353). Opening of the mouth, which is depression of the mandible, is the most revealing and diagnostic movement for temporomandibular dysfunction. Elevation of the mandible is mouth closing and primarily assesses the primary muscles that perform mouth closure (pp. 1360-1361). Protrusion of the mandible is used to assess tongue thrust conditions and for deviations during protrusion, which can be caused by muscle or disc problems; therefore, it is not a strongly discriminatory test. Retrusion of the mandible may be painful in patients with an intracapsular injury, but it not as useful as depression of the mandible in diagnosis of temporomandibular dysfunction