NPTE mini
A 22 year old patient complains of a gradual onset of thoracic and sacroiliac pain. Lumbar ROM is limited to 50%. Patient reports his stiffness is worse in the morning and gradually improves. He recently started a new job at Comcast and has been sitting for long periods of time. Which of the following would you MOST likely suspect? Select one: a. Pectoral muscle adaptive shortening b. Ankylosing spondylitis c. Thoracic hypomobility d. Spinal tumor
B. Ankylosing spondylitis Rationale: Ankylosing spondylitis is a rheumatic disease characterized by chronic inflammation of ligaments in the lumbar spine, sacroiliac joint, thoracic spine, and shoulders that usually occur in the teenage years and 20's. Radiographs will show a bamboo spine.
A therapist is observing a patient with a transtibial prosthesis and notices "drop off" during the late stance phase of gait. Which of the following prosthetic/anatomical causes would be the LEAST LIKELY cause of this gait deviation? Select one: a. Keel too short b. Socket too far posterior c. Knee flexion contracture d. Insufficient plantarflexion
B. Socket too far posterior Rationale: An early knee flexion during the late stance phase of gait is also known as "drop off". It occurs due to the following causes: Prosthetic causes: High shoe heel, Insufficient plantar flexion, Keel too short, Dorsiflexion stop too soft, Socket too far anterior, Socket excessively flexed, Cuff tabs too posterior. Anatomical causes: Knee flexion contracture. A socket placed too far posterior would cause delayed knee flexion.
Which of the following is LEAST LIKELY to be present in a patient with congestive heart failure? Select one: a. Weight gain b. Orthopnea c. Peripheral edema d. Weight loss
D. Weight Loss Rationale: Weight gain, orthopnea (shortness of breath in the supine position) and peripheral edema are all signs consistent with Congestive heart failure.
While assessing a patient with a R CVA, the therapist asks the patient to fold a piece of paper into half and notices that the patient does not use the L hand at all. On asking the patient what is wrong with the L hand, she says that she slept funny so the hand is not moving for now and that it should be moving by the end of the day. Which of the following is the MOST LIKELY medical diagnosis for this presentation? Select one: a. Anosognosia b. Right-left discrimination disorder c. Ideational apraxia d. Somatoagnosia
A. Anosognosia Rationale: Anosognosia is the denial or lack of awareness of the presence or severity of one's paralysis. Right-left discrimination is the inability to identify the right and left sides of one's own body. Somatoagnosia is a lack of awareness of the body structure and relationship of body parts to oneself or to others. Ideational apraxia is the inability to perform a task on motor or on command.
A physical therapist while assessing a patient noticed that the patient winced in pain when the arm was in the position as shown in the picture below. Which of the following is the MOST LIKELY cause of this presentation? arm flexed, elbow flexed to 90, forearm pronated. horizontal front of body IR Select one: a. Impingement at the shoulder b. Ulnar nerve entrapment c. AC joint instability d. Anterior subluxation of the shoulder
A. Impingement of shoulder Rationale: The therapist is performing the Hawkins-Kennedy Test by forcibly medially rotating the humerus with the arm flexed to 90 degrees. It is considered to be positive if the test causes pain and is indicative of impingement at the shoulder joint.
A 24 y.o. male was training for baseball and hurt his finger while trying to catch the ball. He experienced a sudden sharp pain in his finger, and his finger was swollen immediately. He finished his training and went to the ER with the following presentation. Which of the following deformities does this patient MOST LIKELY have? Select one: a. Zig-Zag deformity b. Mallet finger deformity c. Claw finger deformity d. Trigger finger deformity
B. Mallet Finger deformity Rationale: Option A: There is flexion at the carpometacarpal joint and hyperextension at the metacarpophalangeal joint. The deformity is associated with rheumatoid arthritis and is usually seen in the thumb. Option B - A mallet finger deformity is the result of a rupture or avulsion of the extensor tendon where it inserts into the distal phalanx of the finger. The distal phalanx rests in a flexed position option D: This deformity is the result of a thickening of the flexor tendon sheath (Notta's nodule), which causes sticking of the tendon when the patient attempts to flex the finger. Option C: This deformity results from the loss of intrinsic muscle action and the overaction of the extrinsic (long) extensor muscles on the proximal phalanx of the fingers. The metacarpophalangeal joints are hyperextended, and the proximal and distal interphalangeal joints are flexed.
You are assessing a patient in the ICU who opens eyes to pain, has an abnormal flexion response to motor stimuli, and is oriented verbally. You would MOST likely categorize this patient on the Glasgow Coma Scale as having what type of brain injury? Select one: a. Mild b. Moderate c. Very severe d. Severe
B. Moderate Rationale: This patient would score a 10 on the Glasgow Coma Scale. A score of less than 8 is considered a severe brain injury, 9-12 is considered a moderate brain injury, and a score of 13-15 is considered a mild brain injury. Eye opening -spontaneous 4 - to speech 3 - to pain 2 - no response 1 Best Motor response - follows command 6 - localizes 5 - withdraws 4 - abnormal flexion 3 - extensor response 2 - no response 1 Verbal - oriented 5 - confused conversation 4 - inappropriate words 3 - in comprehensive 2 - no response 1
A physical therapist is teaching a patient an exercise in standing with the patient's right side of the body next to the wall and the patient's right arm resting on the wall for support. The patient is told to place the right leg behind the left in the extended, adducted and externally rotated position with the pelvis shifted to the right and a slight trunk lean to the left. Which of the following tests was MOST LIKELY positive for the therapist to recommend this intervention? Select one: a. Ely's test on the right b. Ober's test on the right c. Phelp's test on the left d. Piriformis test on the left
B. Ober's test on the right Rationale: The intervention described is a stretch of the ITB/tensor fascia lata on the right. Ober's test is used to assess the tightness/contracture of the tensor fascia lata. Ely's test is for a tight rectus femoris and Phelp's test is positive in the case of a tight gracilis muscle.
You are treating a patient in inpatient rehabilitation with deficits in pupillary light reflex in the right eye and a failure to look at the nose with the right eye. When testing lateral deviation of the eye, the patient is able to follow the stimulus. No deficits noted in chewing. Which anatomical location is MOST likely affected? Select one: a. Cerebellum b. Pons c. Midbrain d. Medulla
C. Midbrain Rationale: Cranial nerves IV and III are located in the midbrain. Cranial nerve III is the oculomotor nerve, and damage to the oculomotor nerve causes ptosis (drooping eyelid), dilation of the pupil, and loss of accommodation of the light reflex. Cranial nerve IV is the trochlear nerve. The trochlear nerve's motor innervation is to the superior oblique muscle which is responsible for rotating the eye down and in.
A physician is assessing how well a baby is doing immediately after birth and how well the newborn is doing outside the womb. Which of the following findings indicate the BEST result? Select one: a. Crying baby, HR<100 bpm, some muscle tone, grimacing present, pink body with blue extremities b. Entire body is pink, active motion of extremities, grimacing present, HR <100, Irregular and slow respiration c. Crying baby, HR< 100 bpm, pink body, flexed arms and legs, grimacing present and a cough d. Crying Baby, HR >100 bpm, pink body with blue extremities, prompt response to stimulus, active movements of extremities
D. Crying Baby, HR >100 bpm, pink body with blue extremities, prompt response to stimulus, active movements of extremities Appearance, pulse, grimace, activity, respiration grade 2-0 Option A- 2+1+1+1+1=6/10 Option B-2+2+1+1+1=7/10 Option C: 2+1+2+1+2=8/10 Option D: 2+2+1+2+2=9/10
A patient complains of gradual onset of dyspnea with exertion. He is a teacher by occupation and noticed that he needs to take frequent breaks while teaching/talking because he gets fatigued easily. He has been a smoker for over 30 years and reports an increase in cough with expectoration. He is suspected to have obstructive pulmonary disease. Which of the following will most likely NOT be associated with this condition? Select one: a. Obliteration of Lovibond angle b. Bluish discoloration of the mucous membrane c. Hypertrophy of accessory muscles of respiration d. Increase in the amount of exhalation in 1 sec
D. Increase in the amount of exhalation in 1 sec Rationale: The symptoms of COPD include: Hypertrophy of accessory muscles of ventilation, pursed-lip breathing, cyanosis (bluish discoloration of skin or mucous membrane), and digital clubbing (obliteration of Lovibond angle is grade 2 of stages of clubbing). Spirometry is the GOLD standard test for diagnosis of COPD which indicates a decrease in the expiratory flow rates (especially FEV1 which is the amount of air exhaled in 1 sec).
A patient complains of frequent episodes of tingling on the medial aspect of the calf and ankle especially on forward flexion. On evaluation, the knee jerk is found to be weak along with weakness of tibialis anterior and extensor hallucis muscles and a limited straight leg raise with negative prone knee bend. A disc herniation at which of the following levels would cause these symptoms? Select one: a. L5-S1 b. L2-L3 c. L4-L5 d. L3-L4
D. L3-L4 Rationale: L3 would have sluggish knee jerk, a positive prone knee bend and pain on full flexion. Paresthesias would be present on inner knee and anterior lower legL4 lesions would be associated with weakness of tibialis anterior, extensor hallucis along with paresthesias in the medial aspect of calf and ankle, weak knee jerk and a limited straight leg raise.L5 lesions would be associated with weakness of extensor hallucis, peroneals, gluteus medius, ankle dorsiflexors, hamstrings along with paresthesias on the lateral aspect of leg, medial three toes with decreased ankle jerk and painful crossed straight leg raise.S1 lesions would cause paresthesias along the lateral two toes, lateral foot, lateral leg to knee, plantar aspect of foot along with weakness of the calf and hamstrings, wasting of gluteals, peroneals, plantar flexors and limited straight leg raise.L4 nerve root is affected in this case.At the lumbar level between L3-L4:Nerve root exiting- L3Nerve affected in stenosis- L3But with herniation, it is the L4 nerve root that is involved. Because of the course of the nerve root as it exits, the L4 disc (between L4 and L5) only rarely compresses the L4 nerve root; it is more likely to compress the L5 nerve root. (Image attached for better understanding).In this case the symptoms aggravated on forward bending- indicating it was a disc pathology. So for L4 to be affected, the herniation should have taken place at L3-L4 level.
You are evaluating a 37 y.o. secretary in an outpatient clinic who presents with right upper extremity pain shooting into the hand. On examination, the therapist performed the test as shown in the image and the patient complained of pain, weakness, and tingling in the hand. To confirm the diagnosis, the therapist can perform which of the following additional tests? Select one: a. Positive Roos test b. Positive Neer's test c. Positive Anterior Apprehension test d. Positive Adson's test
D. Positive Adson's test The test shown in the image is Roos test which is used for the diagnosis of thoracic outlet syndrome. To confirm the diagnosis, the therapist can perform Adson test which is one of most common methods of testing for thoracic outlet syndrome. Anterior apprehension test is used for anterior shoulder instability; Neer's test is used for impingement.
A physical therapy student is studying about falls and objective measures to assess balance and mobility. Which of the following scores represents a higher risk of falls in the elderly? Select one: a. Score of 18 seconds on Timed Up and Go Test b. Score of 25 on Functional Gait Assessment c. Score of 49 on Berg Balance scale d. Score of 18 on Performance-Oriented Mobility Assessment
D. Score of 18 on Performance-Oriented Mobility Assessment Rationale: Performance-Oriented Mobility Assessment: 25-28 = low fall risk 19-24 = medium fall risk < 19 = high fall risk Timed Up and Go Test: Most adults can complete the test in <10 seconds. 11-20 seconds is considered within normal limits for all frail elderly individuals. Scores > 30 seconds are indicative of impaired functional mobility. Berg's Balance Scale: 41-56 = low fall risk 21-40 = medium fall risk 0 -20 = high fall risk. Score of < 45 indicates a greater risk of falling Functional Gait Assessment: Scores of <22/30 are effective in predicting falls in community-dwelling older adults.
A patient with a diagnosis of Parkinson's Disease is referred to an outpatient PT clinic. He is beginning to show signs of bilateral involvement, but has had no falls so far. Which of the following is the MOST APPROPRIATE stage of Hoehn-Yahr classification? Select one: a. Hoehn and Yahr stage I b. Hoehn and Yahr stage II c. Hoehn and Yahr stage III d. Hoehn and Yahr stage V
b. Hoehn and Yahr stage II Rationale: Symptoms of rigidity and postural instability are cardinal symptoms of Parkinson's disease. Parkinson's disease is classified with the Hoehn and Yahr scale. Hoehn and Yahr Level II indicates minimal bilateral or midline involvement with no balance impairment.
The following EKG pictured below MOST LIKELY demonstrates which cardiac condition? Select one: a. Atrial fibrillation b. This is a normal electrocardiogram, there is no pathology present c. Ventricular tachycardia d. Supraventricular tachycardia
c. Ventricular tachycardia Rationale: Increased Periventricular contractions puts stress on the ventricular musculature. PVC's that are present as a triplet or more are considered ventricular tachycardia.
You are assessing a patient with Parkinson's disease in the hospital. The patient complains of difficulty turning around and reports he has had 3 falls, with the most recent one occurring while getting up off the toilet at home. The patient is classified as a Hoehn and Yahn III. Which of the following is the MOST appropriate intervention for the initial treatment session? Select one: a. Sit to stand with emphasis on anterior weight shifting b. Dynamic balance on foam to improve balance reactions c. Standing on an even surface with eyes closed and feet together d. Gait training emphasizing starting and stopping
A. Sit to stand with emphasis on anterior weight shifting Rationale: A Hoehn and Yahn stage III would include impaired righting reflexes, unsteadiness when turning or rising from a chair and the patient can live independently. The patient's most recent fall was rising from the toilet. An appropriate intervention would be to improve the patient's ability to sit to stand.
A PT student is studying the effects and characteristics of ultrasound. Which of the following statements regarding therapeutic ultrasound is true? Select one: a. A 40% duty cycle would have an off time of 4msec and an on time of 6msec b. A 40% duty cycle would have an off time of 10msec and an on time of 4 msec c. A 40% duty cycle would have an off time of 6msec and an on time of 4msec d. A 40% duty cycle would have an off time of 4msec and an on time of 10msec
C. A 40% duty cycle would have an off time of 6msec and an on time of 4msec Rationale: Duty cycle is the fraction of time the US energy is on over one pulse period (time on + time off). Duty cycle= Duration of pulse/Pulse period x 100 Therefore, a 40% duty cycle would have an on time of 4msec and on off time of 6msec.
A physical therapist is assessing a patient with a sudden onset of dizziness two days ago. Upon performing the Roll Test, the patient had geotropic nystagmus, stronger on the right side as compared to the left. Which of the following is the MOST APPROPRIATE intervention for this patient? Select one: a. Semont maneuver for canalithiasis with side lying on the L b. Semont maneuver for cupulolithiasis with side lying on the R c. Bar-B-que roll maneuver for canalithiasis starting on the R d. Bar-B-que roll for cupulolithiasis maneuver starting on the R
C. Bar-B-que roll maneuver for canalithiasis starting on the R Rationale: Patient presents with horizontal canal BPPV (Canalithiasis) on the R side since the geotropic nystagmus is stronger on the R. The most appropriate intervention for canalithiasis is the bar-b-que roll with the head turned to the involved side first.
A PT in treating a patient with a diagnosis of lower cervical level spinal cord injury. While the PT was performing passive hip stretching, the PT noticed that the patient had started sweating profusely and had goosebumps. On checking the vitals, the patient's HR had dropped and BP was higher than normal. Which of the following is the MOST APPROPRIATE intervention for this patient? Select one: a. Keep the patient in the supine position and start CPR b. Stop the treatment and let the patient rest for at least 2 hours before starting the treatment again. c. Bring the patient to sitting position and clamp the catheter d. Bring the patient to a sitting position and remove the abdominal binder
D. Bring the patient to a sitting position and remove the abdominal binder Rationale: Patients with a T6 or higher level of injury are at a risk of Autonomic Dysreflexia (AD) in the presence of a noxious stimuli. The symptoms of AD include profuse sweating, increased spasticity, hypertension, bradycardia, headache, piloerection, blurred vision, etc. The onset of these symptoms should be treated as a medical emergency and in order to lower the BP, the patient must be brought to a sitting position, noxious stimuli, tight clothing and abdominal binder must be removed, and the catheter must be unclamped.
You are testing a patient's deep tendon reflexes during an evaluation for low back pain in outpatient physical therapy. Which of the following is MOST likely to be consistent with a false negative patellar reflex? Select one: a. 2+ reflex and the patient has a confirmed L4 nerve root syndrome b. 1+ reflex and the patient has a confirmed S1 nerve root syndrome c. 3+ reflex and the patient has a confirmed L4 nerve root syndrome d. 2+ reflex and the patient does not have L4 nerve root syndrome
a. 2+ reflex and the patient has a confirmed L4 nerve root syndrome Rationale: 2+ reflexes are considered normal according to the reflex grading system. A false negative indicates that the test is normal but the patient has pathology. The correct answer states that the reflexes are normal but the patient has a pathology that affects the L4 nerve root.
A fireman was brought to the ER with burns on his anterior chest and trunk, anterior right arm, and bilateral anterior legs. Which of the following accurately describes the area of distribution of the burn? Select one: a. 40.5% b. 20.5% c. 54% d. 36%
a. 40.5% Rationale: According to rule of nines: anterior chest and trunk= 18%, right arm anteriorly= 4.5%, anterior legs= 9%+9%= 18%
You are treating a 35 year old patient with the following Electrocardiogram in inpatient rehabilitation. Which cardiac condition is MOST LIKELY represented below? Select one: a. Second degree AV block b. Atrial fibrillation c. Third degree AV block d. Ventricular tachycardia
a. Second degree AV block Rationale: This EKG shows a second degree AV block, and the following EKG strip details how the p-wave is not conducted through the AV node. There is a progressive increase in the PR interval until the beat drops.
You are evaluating a 30 year old patient with right elbow pain radiating into the forearm. The patient works as a bagger at a grocery store and reports his pain began 6 months ago after carrying a heavy box at work. The patient reports his pain is located on the medial side of the elbow and is worsened with prolonged gripping and carrying grocery bags. Which of the following diagnoses is MOST likely to be accurate for this patient? Select one: a. Tendinopathy of the wrist flexors b. Lateral epicondylalgia c. Biceps tendinopathy at distal insertion d. Biceps tendinopathy at proximal insertion
a. Tendinopathy of the wrist flexors Rationale: The patient's pain is in the medial elbow which is the anatomical location of the flexor tendon. Flexor tendinopathy is also known as "golfers elbow" and is caused by repetitive wrist flexion. Lateral epicondylalgia is a tendinopathy of the extensor tendon and biceps tendinopathy would be incorrect secondary to the location of pain specified in the question.
A pediatric PT is evaluating a 2 month old child. The PT pulls the child from a supine to seated position using the child's forearms. The child extends the trunk in response to this stimuli. Which of the following statements is the MOST accurate? Select one: a. The child has an abnormal traction reflex b. The child has an normal traction reflex c. The child has an abnormal moro reflex d. The child has a normal moro reflex
a. The child has an abnormal traction reflex Rationale: This question describes the traction reflex. The traction reflex is tested by pulling a child from supine to sit. A normal response is to fully flex and grasp. An extensor response would be considered abnormal.
A physical therapist is assessing a patient in a skilled nursing facility with RLE Lymphedema. The patient has a past medical history of cardiac arrhythmia. Objective assessment reveals fibrosis of the RLE, frequent infections, and a positive Stemmer's Sign. Which of the following is MOST likely true? Select one: a. The patient is in stage 2 lymphedema b. The patient is in stage 4 lymphedema c. The patient is in stage 0 lymphedema d. The patient has congestive heart failure
a. The patient is in stage 2 lymphedema Rationale: The patient is in stage 2 lymphedema. Stage 2 lymphedema is spontaneously irreversible lymphedema and is characterized by a + Stemmers Sign and brawny edema. Patients in this stage have fibrosis.
A PT student is working on her research project to study the effects of strengthening hamstring muscles along with core muscle strengthening in patients with low back pain. For the study to be ethical and unbiased, which of the following is the MOST APPROPRIATE way to randomize the subjects into control and experimental groups? Select one: a. PT asks the subject's family which group the subject should be in but does not tell the patient b. Have the patients choose an envelope which will determine which group they will be placed in but do not inform the patient which group they are in c. SPT divides the patients into groups based on the severity and chronicity of the back pain with the experimental group consisting of more chronic LBP patients d. SPT asks the subject which group he/she prefers to be in
b. Have the patients choose an envelope which will determine which group they will be placed in but do not inform the patient which group they are in Rationale: Blinding and randomization are essential in randomized control trials (RCT). Having the patient, PT, or family member choose which group the subject should be in is not true randomization and creates a bias. Having a patient choose an envelope with a pre-determined group will be more appropriate for randomization, and it will not be biased.
A 59-year old teacher who is right hand dominant complains of stiffness in the neck and right hand (especially in the 1st CMC) upon waking in the morning. It subsides within thirty minutes as she moves around the house and performs some household chores. There is no associated history of other systemic symptoms, although she has noticed some bumps on her DIP joint. The presence of outgrowths can be documented as which of the following? Select one: a. Neurofibromatosis b. Heberden's nodules c. Bouchard's nodules d. Rheumatoid nodules
b. Heberden's nodules Rationale: The patient's age and symptoms indicate OA. Nodules on the DIP are called Heberden's nodules and nodules on the PIP are called Bouchard nodules. Absence of systemic systems and morning stiffness lasting less than sixty minutes rule out rheumatoid arthritis, and thus rule out rheumatoid nodules. With neurofibromatosis, the nodules would not be restricted to the DIP joints.
On assessment, the therapist notices redness on the skin as pictured below. Which of the following is the MOST APPROPRIATE description of this finding? Select one: a. Xanthoma b. Herpes zoster c. Rosacea due to H. Pylori d. Maculopapular rashes
b. Herpes zoster Rationale: A: Xanthomas are benign fatty fibrous yellow plaques, nodules, or tumors that develop in the subcutaneous layer of skin, often around tendons. The lesion is characterized by the intracellular accumulation of cholesterol and cholesteryl esters. B: Shingles is an outbreak of a rash or blisters on the skin that may be associated with severe pain. The pain is associated with the involved nerve root and associated dermatome and generally presents on one side of the body or face in a pattern characteristic for the involved site. Early signs of shingles include burning or shooting pain and tingling or itching. The rash or blisters are present anywhere from 1 to 14 days. C: Rosacea is a chronic facial skin disorder seen most often in adults between the ages of 30 and 60 years. Features include erythema, flushing, telangiectasia, papules, and pustules affecting the cheeks and nose of the face. D: Maculopapular rashes are associated with secondary syphilis. They appear as a pink, dusky, brownish-red or coppery, indurated, oval or round lesion with a raised border. These are referred to as "copper penny" spots. The lesions do not bleed and are usually painless. They usually appear scattered on the palms or the bottom of the feet but may also present on the face.
A patient with subluxation of the shoulder presents to the PT clinic. During evaluation, the therapist notices atrophy of the flexor surface of the upper arm along with weakness of elbow flexion with a supinated forearm. Which of the following findings will MOST LIKELY be associated with this finding? Select one: a. Loss of 2-point discrimination on the posterior aspect of the arm b. Loss of 2-point discrimination on the lateral aspect of the forearm c. Loss of 2-point discrimination on the posterior aspect of the forearm d. Loss of 2-point discrimination on the lateral aspect of the upper arm
b. Loss of 2-point discrimination on the lateral aspect of the forearm With an injury to the musculocutaneous nerve, the patient is unable to flex the elbow with the forearm supinated and may have some instability in the shoulder with atrophy of the flexor surface of the upper arm. The sensory supply of the musculocutaneous nerve is to the lateral aspect of the forearm.
A patient presents to the clinic with a chief complaint of pain on the sole of the foot. The patient's symptoms were gradual in onset with no history of trauma. Weight-bearing on the affected extremity and hyperextending the great toe aggravate the symptoms. Tenderness is present in the web spaces of the toes with pressure. The patient has full pain-free AROM and 5/5 strength with no increase in symptoms during testing. Which of the following is the MOST LIKELY diagnosis for this condition? Select one: a. Plantar fasciitis b. Morton's neuroma c. Retrocalcaneal bursitis d. Midfoot sprain
b. Morton's neuroma Rationale: Morton's Neuroma is gradual in onset with no known cause. The symptoms include pain on the sole of the foot which increases with WB with overpressure into toe extension during passive ROM. AROM is full and pain free with intact strength. The foot may be pronated with low arches with pain present in the web spaces of the toes. Morton's test is usually positive i.e. squeezing the metatarsal head reproduces the pain. Pain in plantar fasciitis is present on the insertion of the plantar fascia on the calcaneus and weak intrinsic muscles of the foot. Retrocalcaneal bursitis pain is usually just above the insertion site of the Achilles tendon on the calcaneus. Midfoot sprain involves a history of trauma or high-impact activity with generalized pain on the midfoot.
After a stroke, a patient's visual field is as shown in the picture. Which of the following is the MOST LIKELY location of the lesion? Select one: a. R optic tract b. Optic chiasm c. L occipital lobe d. L optic nerve
b. Optic chiasm Rationale: The deficit shown in the image is bitemporal hemianopsia which is caused due to a lesion in the optic chiasm. L optic nerve damage would cause monocular vision. R optic tract lesion would cause C/L homonymous hemianopsia. Lesion in the L occipital lobe would cause C/L homonymous hemianopia with macular sparing.
You are treating a patient s/p total hip arthroplasty anterior approach 3 days post-op in inpatient acute care. The patient complains of 4/10 pain and pain in the anterior hip region. The patient's goal is to be able to navigate stairs to safely enter and exit the home. Which of the following is the LEAST appropriate intervention? Select one: a. AROM of knee and ankle joints of the affected extremity in sitting b. Stair climbing with UE support and a focus on hip hyperextension to improve reciprocal stair negotiation c. Standing marching on ground with UE support and emphasis on weight transfers d. Stair tapping with UE support to improve stair negotiation tolerance
b. Stair climbing with UE support and a focus on hip hyperextension to improve reciprocal stair negotiation Rationale: The patient had an anterior approach s/p hip replacement. Contraindications for the anterior hip approach are excessive hip extension and external rotation and hip flexion greater than 90 degrees. Options A, C, and D would all benefit the patient, only option B (hip extension with heel raises) would be contraindicated.
You are treating an 80 year old patient s/p total hip arthroplasty posterior approach. The patient complains of 8/10 pain in the gluteal region. The patient's goal is to be able to get up from a low toilet at home. Which of the following is the MOST appropriate intervention? Select one: a. Gait training to promote safe ambulation between rooms at home b. Toilet transfers with a raised toilet seat to improve functional tolerance c. Squats to a low toilet to improve toilet transfers at home d. Resisted squats to improve glute strength and toilet transfers
b. Toilet transfers with a raised toilet seat to improve functional tolerance Rationale: This patient had a posterior approach and has a goal of getting up from a low toilet. However, hip flexion greater than 90 deg, adduction and internal rotation is contraindicated with a posterior approach THA. Patients are advised to use a raised toilet seat so as to not break posterior hip precautions but promote functional independence.
You are treating a patient with spastic cerebral palsy in outpatient physical therapy clinic. The patient has difficulty with ambulation in the community and the patient's mother reports concern about falling. When quickly extending the right knee joint, there is a catch followed by minimal resistance through the rest of the remaining range (about 25% of the total range of motion). Which of the following statements is MOST ACCURATE? Select one: a. 3 on the Modified Ashworth Scale and increased tone in the quadriceps b. 1 on the Modified Ashworth Scale and increased tone in the quadriceps c. 1+ on the Modified Ashworth Scale and increased tone in the hamstrings d. 3 on the Modified Ashworth Scale and increased tone in the hamstrings
c. 1+ on the Modified Ashworth Scale and increased tone in the hamstrings Rationale: The Modified Ashworth Scale is a tool used to grade spasticity. A slight increase in muscle tone manifested by a catch, followed by minimal resistance throughout the remainder of movement (less than half of the range of motion) is classified as 1+.
A patient complains of the inability to slip the belt through the belt loops at the back of his pants. He is unable to reach his right hand to the left side on the back to complete the task. Which of the following mobilization techniques would be MOST APPROPRIATE to complete this task? Select one: a. Glenohumeral caudal glide b. Glenohumeral superior glide c. Glenohumeral posterior glide d. Glenohumeral anterior glide
c. Glenohumeral posterior glide Rationale: The shoulder joint follows the concave-convex rule. The convex humerus moves on the concave glenoid fossa. To be able to reach the back of the pant on the opposite side, the IR range has to be improved. Thus, posterior glide of the GH joint is appropriate. Anterior glide is used to increase extension or ER ROM. Caudal glide of GH is used to increase abduction of the GH joint.
A physical therapist is reading the lab report of a patient admitted in the hospital. In which of the following scenarios would the patient be advised to NOT exercise? Select one: a. Platelet count: 29,000/mm3; Hb: 8g/dL; Hematocrit: 30% b. Hematocrit: 25%; Platelet count: 20,000/mm3; WBC: 5200/mm3 c. Hb: 7g/dL; Hematocrit: 23%; WBC: 4800/mm3 d. Platelet count: 22,000/mm3; Hb: 9g/dL; WBC: 6000/mm3
c. Hb: 7g/dL; Hematocrit: 23%; WBC: 4800/mm3 Rationale: Guidelines for exercise based on laboratory values suggest no exercises for the following findings: WBC <5000/mm3; Hematocrit <25%; Hb <8g/dL; Platelets <20,000- AAROM or AROM but no antigravity or resisted exercise.
An acute care physical therapist is reading the reports of a patient with chronic kidney disease. The patient appears to be confused and lethargic. His body is warm to touch and he is in bradycardia. His lab findings are as follows: pH: 7.20; HCO3: 21mEq/L; PaCO2: 34 mm Hg. Which of the following is the MOST APPROPRIATE diagnosis for this patient? Select one: a. Uncompensated metabolic alkalosis b. Uncompensated metabolic acidosis c. Partially compensated metabolic acidosis d. Compensated metabolic acidosis
c. Partially compensated metabolic acidosis Rationale: Chronic kidney disease with renal failure results in acidosis because the failing kidney not only is unable to rid the body of excess acids but also cannot produce necessary bicarbonate. Normal values for pH = 7.35-7.45, PaCO2 = 35-45 mm Hg; and HCO3- = 22-26 mEq/L.
A patient presents to the clinic four weeks after a reverse arthroplasty of the right shoulder. Which of the following movements would you perform while treating the patient at this stage? Select one: a. Shoulder extension beyond 0 degree b. Shoulder IR up to 30 degree c. Shoulder elevation in scapular plane up to 90 deg d. Shoulder ER beyond 20 degree
c. Shoulder elevation in scapular plane up to 90 deg Rationale: Phase 1 of rehabilitation post reverse shoulder arthroplasty lasts for up to 6 weeks. The motions that are restricted during this period include:- No GH extension or internal rotation past neutral- No combined GH extension, adduction, and internal rotation- 0°-20° external rotation- Up to 90°-120° arm elevation in scapular plane
A PT student is assessing a patient with a chief complaint regarding the inability to completely raise the right arm. The student internally rotates the arm, slightly abducts, and brings the arm to 90 degrees of flexion. The student then asks the patient to resist the downward directed force on their arm. Which of the following responses would be MOST LIKELY if the patient is graded poorly on this test? Select one: a. Musculocutaneous nerve injury b. Long thoracic nerve injury c. Suprascapular nerve injury d. Radial nerve injury
c. Suprascapular nerve injury Rationale: The student is assessing the supraspinatus muscle by performing the Empty Can Test. The test is considered to be positive if there is weakness or pain while resisting flexion A positive finding is associated with a tear of the supraspinatus tendon or muscle, or injury to the suprascapular nerve.
Documenting the care provided to the patient is essential and must be completed in a timely manner. Which of the following is NOT appropriate with respect to documentation? Select one: a. Mistakes must be crossed out with a single line through the error, and then both initialed and dated by the therapist b. Medically approved symbols or abbreviations can be used for documentation c. When a charting error is made, use white-out material to correct the text d. When a charting error is made, it must be clearly indicated that a change was made without deleting the original record
c. When a charting error is made, use white-out material to correct the text Rationale: Documentation should be consistent with the Guidelines for PT Documentations, APTA. According to the Guidelines, white-out material must never be used to correct text in a medical record. All other statements are true.
A 65 year old patient with diabetic neuropathy presents to the clinic with a complaint of frequent falls especially at night. Which of the following conditions of the Sensory Organization Test is this patient MOST LIKELY to score poorly? Select one: a. Conditions 2 and 4 b. Conditions 4 and 6 c. Conditions 1 and 3 d. Conditions 5 and 6
d. Conditions 5 and 6 Rationale: Due to peripheral neuropathy, this patient is more dependent on their vision and vestibular systems. Patients depending on vision become unstable in conditions 2, 3, 5 & 6 where we either close the eyes, or have a conflict between vision and the vestibular system. With conditions 1 and 4, the patient will have the opportunity to rely on the visual system and maintain balance.
You are treating a patient with a cerebellar infarct that is affecting the UE. The patient has trouble coordinating rapid, alternating movements of the UE. Finger to nose testing reveals minimal aberrations, and toe tapping is within functional limits. What BEST describes the aforementioned symptoms? Select one: a. Resting Tremor b. Dysmetria c. Asthenia d. Dysdiadochokinesia
d. Dysdiadochokinesia Rationale: A resting tremor is observed when the patient is at rest and will diminish during movement. Dysmetria occurs when the patient is unable to perform activity with good accuracy; typically, they will overshoot or undershoot movement. Asthenia is fixation or position holding and is tested with application of manual resistance. Dysdiadochokinesia is tested with alternating movement and is what is affected in this patient.
A PT is assessing a patient with a chief complaint of low back pain and a diagnosis of L2-L3 nerve compression. Which of the following gait deviations at the hip and pelvis are NOT to be expected in this patient? Select one: a. Trunk lurches backward and toward the unaffected stance leg from heel off to mid swing b. Posterior tilt of the pelvis during initial swing c. Semicircle movement of the hip during swing—combining hip flexion, hip abduction and forward rotation of the pelvis d. Excessive hip flexion at initial and mid swing
d. Excessive hip flexion at initial and mid swing Rationale: L2-L3 nerve compression leads to weak hip flexors. Hence excessive hip flexion will not be seen at the initial and mid-swing phase of the gait cycle. Options A: Hip flexion is passively generated by a backward movement of the trunk Option B: Abdominals are used during initial swing to advance the swing leg Option C: Semicircular movement combining hip flexion, hip abduction, and forward rotation of the pelvis to compensate for hip flexor weakness.
You are performing a gait analysis of a patient whose primary complaint is right knee pain. The patient has a history of a right meniscectomy several years ago with minimal pain relief. Upon objective examination, the PT notes excessive dorsiflexion, eversion, and abduction of the right foot. Which of the following biomechanical adaptations is MOST likely to be true? Select one: a. Genu varum b. Coxa valga c. Genu recurvatum d. Genu valgum
d. Genu valgum Rationale: Excessive dorsiflexion, eversion and abduction are the triplanar components of pronation at the ankle. Patients with ankle pronation are likely to have genu valgum and coxa vara. Genu varum and coxa valga would be biomechanical compensations for a supinated foot.
A 62 year old male with a 20 year history of smoking, DM II, HTN stage 1 and COPD presents with cough and expectoration. On auscultation the therapist finds presence of crepitus. Which of the following lobes can be drained MOST EFFICIENTLY in the sitting position? Select one: a. R Apical Segments of Upper lobe and R Superior Segments of Lower lobes b. L Apical Segment of Upper lobe and R Middle lobe c. R Apical segment of Upper lobe and R Anterior segment of Upper lobe d. L Apical Segment of Upper lobe and R Posterior Segment of Upper lobes
d. L Apical Segment of Upper lobe and R Posterior Segment of Upper lobes Rationale: Apical and Posterior segments of the upper lobes can be drained in the sitting position. Anterior segment is drained in supine. Superior segment is drained in prone. R middle lobe is drained in the side lying position.
A 14 year old girl presents with a chief complaint of pain in the medial three fingers of the dominant hand, especially during gripping activities. The pain lasts for a while and subsides on its own after resting. She likes to play tennis on weekends but has a sedentary lifestyle otherwise. During postural assessment, the therapist noticed significant winging of the scapula on the same side. Strength of shoulder flexors: 4/5 and abductors is 4+/5 on the affected side. Strength of intrinsic muscles is intact. Which of the following nerves is MOST LIKELY involved? Select one: a. Axillary nerve b. Suprascapular nerve c. Median nerve d. Long thoracic nerve
d. Long thoracic nerve Rationale: Presence of scapular winging is indicative of serratus anterior weakness. The long thoracic nerve (C5-C7) is a motor nerve that supplies the serratus anterior muscle. The long thoracic nerve can be injured due to carrying heavy loads on the shoulder (e.g. backpacks) or when serving while playing tennis. Due to the weakness of scapular muscles, shoulder elevation may also be affected. Long thoracic nerve injury can be associated with inability/pain when fully flexing an extended arm. An axillary nerve injury would lead to weakness of shoulder abduction and ER with square shoulder deformity. The median nerve mainly supplies the forearm and hand muscles, which would not cause winging of the scapula. The suprascapular nerve supplies the supraspinatus and infraspinatus which function to abduct and ER the arm, respectively. It would also cause pain with cervical rotation to the opposite side.
A physical therapist who was working in an outpatient clinic is leaving the practice for better career opportunities. He is the only lymphedema certified specialist at that location and single-handedly manages all the patients with lymphedema. Which of the following will be the BEST course of action for the physical therapist toward patients requiring continued care? Select one: a. Find a replacement for the position before leaving b. Therapist is not allowed to terminate provider relationship if the patient requires continued care c. Discharge the patients before leaving d. Provide information to patients about alternative options to obtain care
d. Provide information to patients about alternative options to obtain care Rationale: Per the Code of Ethics for Physical Therapists: Principle #5: Physical therapists shall fulfill their legal and professional obligations. (Core Values: Professional Duty, Accountability). Physical therapists shall provide notice and information about alternatives for obtaining care in the event the physical therapist terminates the provider relationship while the patient or client continues to need physical therapist services.
You are assessing a patient with a CVA who presents with right sided body weakness, inability to understand commands, weakness of the R half of the face and homonymous hemianopsia. Which of the following will MOST LIKELY be absent in this patient? Select one: a. Limb-kinetic apraxia b. Loss of sensation on the right side of body c. Lack of fluency while talking d. Topographic disorientation
d. Topographic disorientation Rationale: The symptoms of weakness of R body and face, inability to understand commands (also known as Wernicke's Aphasia), and homonymous hemianopsia are suggestive of an L MCA infarct. With an L MCA infarct, Broca's aphasia, limb-kinetic apraxia and loss of sensation of the right UE and face are commonly seen. Topographic disorientation is usually seen with lesions involving non-dominant primary visual areas.
Joe presents to the clinic with a large burn on his forearm. When the therapist tries to touch it, he does not complain of pain on pressure or light touch. Which of the following is the MOST LIKELY presentation of this wound? Select one: a. Mixed red, waxy white appearance with blanching and slow capillary refill b. Erythematous pink with no blisters c. Erythematous with blanching and quick capillary refill d. White or tan with no blanching
d. White or tan with no blanching Rationale: Full thickness burns are white or tan and are usually anesthetic with poor circulation. A: Deep partial thickness burns have broken blisters and are sensitive to pressure but insensitive to light touch and blanch with slow capillary refill. B: Epidermal burns are erythematous with no blisters. C: Superficial partial thickness burns are erythematous and blanch with quick capillary refill.
