PT Practice Test I Remediation

1. When the dominant temporal lobe is involved, receptive aphasia may be present. The magnetic resonance imaging (MRI) shows a lesion in the parietal and temporal areas. (p. 1514)

On the basis of the magnetic resonance imaging data shown in the photograph, which of the following findings is MOST likely to be found during examination of a patient who is left-handed? (right temporal lobe involvement) 1. Receptive aphasia 2. Executive function changes 3. Bilateral ataxia observed with intentional movement 4. Lower extremity involvement greater than upper extremity involvement

3. The stem describes a case of suspected slipped capital femoral epiphysis. Signs and symptoms are typically found in adolescent patients (10-16 years old) and include leg shortness, knee pain, and pain when the hip is medially (internally) rotated. Groin pain will be triggered with the anterior impingement test (hips flexed to 80° to 90° and medially [internally] rotated with adduction) if slipped capital femoral epiphysis exists. (pp. 1580-1581)

A 13-year-old patient reports moderate knee pain persisting more than 3 weeks, with no trauma noted. The patient exhibits an out-toeing gait pattern, leg length discrepancy, and restriction in medial (internal) rotation of the involved leg. Which of the following test findings would MOST likely be present? 1. Pain with palpation of the trochanteric region 2. Pain and instability during the application of valgus stress to the knee in full extension 3. Pain in the groin region with hips flexed 80° to 90° and then medially (internally) rotated with adduction 4. Pain in the gluteal region with combined movements of hip flexion to 45° to 60°, abduction, and lateral (external) rotation

3. The signs exhibited by the patient described in the stem are indicative of anorexia nervosa, which can occur frequently in this population (p. 93).

A 14-year-old high school wrestler is participating in a conditioning program. Proximal muscle weakness, swelling of the hands and feet, and clubbing of the fingers are evident. The physical therapist should be MOST concerned with which of the following conditions? 1. Ulcerative colitis 2. Celiac disease 3. Anorexia nervosa 4. Irritable bowel syndrome

4. Right ventricular failure results in backup of blood into the systemic venous circulation, manifested by edema systemically, including jugular venous distention, ascites, and bilateral pedal edema (p. 143t).

A 62-year-old patient has ascites and bilateral pedal edema. The patient's pulse rhythm is regular. The patient's history is negative for any liver, kidney, or metabolic disease. Which of the following conditions is MOST likely present? 1. Hypotension 2. Hypertension 3. Left ventricular failure 4. Right ventricular failure

4. Athetoid cerebral palsy is characterized by slow, involuntary, writhing, twisting, "wormlike" movements. Some muscles demonstrate tone that is too high, and others demonstrate tone that is too low.

A child who has athetoid cerebral palsy is MOST likely to exhibit which of the following characteristics? 1. Sustained limb posturing 2. Low frequency tremor 3. Rapid, jerky motions 4. Mixed muscle tone

2. Culturally and linguistically appropriate services require professional translators with knowledge of the patient's language and knowledge of medical terms.

A non-English-speaking patient is accompanied to physical therapy by her young English-speaking grandson. The patient does not understand or speak enough English to fully participate in an initial examination. To provide the MOST appropriate services, the therapist should take which of the following actions? 1. Ask the grandson to translate and proceed with the examination. 2. Use a professional translator and proceed with the examination. 3. Ask a same-language-speaking member of the hospital's staff to translate and proceed with the examination. 4. Use gestures, pictures, and simple terms in order to proceed with the examination.

3. Hydrocolloids are indicated for wounds that have low to moderate amounts of drainage and that need protection from bacteria or other contaminants (pp. 312, 314).

A partial-thickness wound that has been treated for 10 days is currently debrided of all devitalized tissue, but granulation tissue is still not apparent. The wound is draining a minimal amount of serous fluid. Which of the following interventions would be MOST appropriate? 1. Enzymatic agent 2. Calcium alginate dressing 3. Hydrocolloid dressing 4. Nonwoven gauze dressing

3. Patients who have diabetes potentially have a lack of insulin secretion or effectiveness, leading to disruption of glucose metabolism. Results of acute metabolic changes related to glucose metabolism include hyperglycemia (high blood glucose), electrolyte disturbances that are manifested by acidosis that triggers an increased respiration rate, irregular heart rate, and increased fatty acid metabolism resulting in acetone breath. (p. 522)

A patient displays an irregular heart rhythm, increased respiratory rate, and acetone-like breath odor after performing 15 minutes of intense exercise. Which of the following conditions is MOST likely present? 1. Thyroid hypersecretion 2. Pituitary hypersecretion 3. Pancreatic hyposecretion 4. Adrenal hyposecretion

1. Muscle setting isometric exercises are begun immediately to prevent adhesions of the tendon to the sheath or surrounding tissues and to promote alignment of healing tissue.

A patient had a biceps femoris tendon repair 3 days ago. After the initial postsurgical assessment, the physical therapist should FIRST initiate which of the following interventions? 1. Gentle isometric strengthening 2. Closed kinetic chain exercises 3. Passive end-range stretching 4. Concentric exercises with gentle resistance

1. Jaundice, darkened urine, and ascites are all clinical signs of liver disease. Asterixis, or liver flap, is also likely to be present as a result of ammonia imbalance, which causes this neurologic symptom. (Goodman, p. 341)

A patient has jaundice, dark urine, and ascites. Which of the following findings is MOST likely to be present during the physical therapy examination? 1. Asterixis 2. Pronator drift 3. Hoffman 4. Rebound tenderness

2. Individuals who have lymphedema in any stage (Stage 0 or risk for other stages) should protect the skin and avoid any activities that could pierce the skin tissue.

A patient who has Stage 0 lymphedema should be educated to AVOID which of the following activities? 1. Prolonged air travel 2. Running barefoot 3. Aquatic activities 4. Stationary cycling

2. The L4 nerve root is the main segmental innervation to the tibialis anterior. The L4 nerve root is also the myotome for ankle dorsiflexion. Impingement of the L4 nerve root would result in foot slap. (Magee, p. 585; O'Sullivan, p. 239)

A patient with low back pain has L4 nerve root impingement. The patient will MOST likely demonstrate which of the following gait deviations? 1. Trendelenburg gait 2. Foot slap 3. Posterior thrust of the trunk at heel strike (initial contact) 4. Toe walking

2. Velocity increases and cadence decreases as gait develops.

As a child ages from 1 to 7 years, which of the following factors indicate maturing gait? 1. Velocity decreases and cadence increases. 2. Velocity increases and cadence decreases. 3. Single-leg stance time decreases and step length increases. 4. Single-leg stance time increases and step length decreases.

1. The photographs show the modified Thomas test. This test is used to assess iliopsoas complex flexibility. The extreme position of abduction should raise suspicion of possible tensor fasciae latae shortness. To confirm possible shortness of the tensor fasciae latae, the modified Ober test would be appropriate as a follow-up examination. (pp. 916-918)

At the completion of the test in the photographs, the patient's right lower extremity has the position shown in photograph B. Which of the following tests would be MOST appropriate for follow-up? (modified Thomas test) 1. Modified Ober test 2. Prone hip extension 3. Prone knee flexion 4. Supine straight leg raise

3. Chondromalacia is a roughening of the cartilage behind the kneecap, and relaxin causes an increase in tendon and ligament laxity, exacerbating any friction between the patella and the femur (p. 1062).

Changes in the level of which hormone are MOST likely to contribute to development of chondromalacia patella in a pregnant woman? 1. Calcitonin 2. Progesterone 3. Relaxin 4. Insulin

2. The myotome associated with L5 is toe extension/dorsiflexion. The dermatome associated with L5 is the lateral leg and dorsum of the foot.

Examination of a patient's right lower extremity reveals weakness in great toe extension and decreased sensation along the lateral leg and dorsum of the foot. Which of the following nerve roots is MOST likely contributing to these findings? 1. L4 2. L5 3. S1 4. S2

3. Children who have Down syndrome are extremely flexible (p. 433).

Exercises to improve flexibility would be LEAST appropriate to include in a physical fitness program for children with which of the following diagnoses? 1. Spastic cerebral palsy 2. Juvenile rheumatoid arthritis 3. Down syndrome 4. Muscular dystrophy

2. Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Continuous mode (or 100% duty cycle) produces thermal effects, compared to pulsed mode (p. 185). Research indicates that a frequency of 3 MHz results in a higher maximal temperature than 1 MHz despite delivering a lesser depth of penetration (p. 175). Furthermore, higher intensities produce higher temperature increases in tissues (p. 175).

If treatment time and surface area are kept constant, which of the following ultrasound parameters would MOST likely deliver the GREATEST amount of energy through tissues? 1. 0.5 W/cm2 in continuous mode at 1 MHz 2. 0.8 W/cm2 in continuous mode at 3 MHz 3. 1.0 W/cm2 in 50% pulsed mode at 1 MHz 4. 1.2 W/cm2 in 25% pulsed mode at 3 MHz

2. Use of an abdominal corset in patients who have weak abdominal muscles can compensate for laxity and can improve respiratory function (Nichols-Larsen).

In a patient who has weak oblique, rectus abdominis, and transversus abdominis muscles, which of the following interventions is MOST likely to improve the mechanical efficiency of the diaphragm? 1. Use of a rigid trunk support 2. Use of an abdominal binder 3. Assuming an erect sitting position 4. Assuming a forward leaning sitting position

3. A muscle has maximal ability to generate force (or tension) when the muscle is contracted at its optimal length. Finger flexors involved in grip cross the wrist, so wrist position affects the length of the finger flexors and consequently also affects the ability of the flexors to generate force. The optimal length of the finger flexors is maintained when the wrist is held at approximately 30° of extension.

In which of the following wrist positions would maximal grip strength MOST likely be generated? 1. 0° (neutral) 2. 15° of flexion 3. 30° of extension 4. 60° of extension

1. Herpes zoster (shingles) is a painful, blistering skin rash caused by the varicella-zoster virus. The first symptom is usually one-sided pain, tingling, or burning followed by development of a rash that usually involves a narrow area from the spine around to the front of the chest or abdomen. A typical location for occurrence of shingles rash is the T11-T12 dermatome along the iliac crest. The location of the rash, postsurgical onset, and symptoms of pain all suggest herpes zoster. (Goodman, p. 177)

One day after lumbar laminectomy surgery, a patient refuses to wear a thoracolumbosacral orthosis because of a painful and itching rash that extends in a narrow path from the central low back along the iliac crest to the right lateral trunk. Which of the following conditions is MOST likely present? 1. Herpes zoster 2. Infected surgical incision 3. Contact dermatitis 4. Allergic response to medication

1. Ocular torticollis may result from a lesion to the trochlear nerve. Damage to the trochlear nerve results in diplopia. Patients will frequently compensate for the diplopia by tilting the head anteriorly and laterally toward the side of the normal eye. (pp. 1080-1081)

Palsy of which of the following cranial nerves would MOST likely lead to the presentation of torticollis in a child? 1. Trochlear nerve (CN IV) 2. Facial nerve (CN VII) 3. Vestibulocochlear nerve (CN VIII) 4. Hypoglossal nerve (CN XII)

2. Recent head trauma is a contraindication for postural drainage.

Postural drainage for the posterior segments of the lower lobes would be CONTRAINDICATED for which of the following patients? 1. A patient who has a pleural effusion. 2. A patient who had a recent head trauma. 3. A patient who had a recent total knee arthroplasty. 4. A patient who has a history of pulmonary embolism.

3. Raynaud syndrome is listed as a contraindication for use of superficial cooling (p. 133).

Superficial cooling is CONTRAINDICATED in which of the following situations? 1. For a patient with an injury near the location of the fibular nerve 2. For a patient who has a blood pressure of 176/90 mm Hg 3. For a patient who has periodic vasoconstriction in the fingers 4. For a patient who has a Mini-Mental State Examination score of 20/30

1. The device shown in the photograph is a chest tube collection device. Removal of a chest tube may result in pneumothorax. A radiograph of the chest is needed to rule out pneumothorax prior to mobilization of the patient. (p. 439)

The device shown in the photograph has been removed from a patient. Which of the following tests is required prior to mobilizing the patient? (chest tube collection device) 1. Radiograph 2. Electrocardiogram 3. Pulmonary function test 4. Computed tomography scan

2. Hands are placed over the anterior chest with the thumbs over the costal margin so the tips of fingers almost meet at the xiphoid process. This is the proper position to palpate the diaphragm, which is located anatomically in the inferior aspect of the thorax. (p. 527f)

The photographs indicate locations for hand placement to assess various aspects of breathing. Which of the photographs indicates the MOST appropriate hand placement for assessing movement of the diaphragm? 1. A- Hands are placed over the anterior portion of the first four ribs with the fingertips extended over the upper trapezius 2. B- Hands are placed over the anterior chest with the thumbs over the costal margin so the tips of fingers almost meet at the xiphoid process 3. C- Hands are positioned with fingers over the trapezius with palms on the posterior aspect of the thorax 4. D- Hands are placed over the lower ribs

4. Criterion-related validity of a new tool is tested by using practical and objective comparisons to a reliable/valid (gold) standard measure already in use.

What form of validity is measured by comparing results obtained with a test to results obtained using an already well-established and validated tool? 1. Face 2. Construct 3. Content 4. Criterion-related

3. Stage 3 pressure injuries are characterized by full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia (deep crater with or without undermining).

When examining a patient's pressure injury, a physical therapist notes that in the area of the wound, the patient has complete loss of skin and intact underlying fascia. The therapist should recognize this as a: 1. Stage 1 wound. 2. Stage 2 wound. 3. Stage 3 wound. 4. Stage 4 wound.

1. For best biofeedback results, electrode placement should be as close to the muscle as possible (Prentice). Hook grasp requires finger flexion (Lippert, p. 215). The finger flexors are located proximal to the anterior forearm (Lippert, pp. 201-202).

Where on the forearm should a physical therapist place electrodes for biofeedback therapy in order to facilitate hook grasp? 1. Proximal anteromedial 2. Proximal posterolateral 3. Distal anteromedial 4. Distal posterolateral

3. Stretching of the hamstring muscles prevents overstretching of the back during long sitting. Passive low back muscle tightness is important to develop for passive trunk stability. Straight leg raises less than 100° to 110° in long sitting put a passive pull on the pelvis, resulting in posterior pelvic tilt and stretching of the low back. (O'Sullivan, p. 894)

Which of the following interventions is MOST appropriate to improve stability in long sitting for an individual with a complete T4 spinal cord injury? 1. Stretch the gluteus maximus to 90° of hip flexion. 2. Strengthen the abdominal muscles to grade Fair (3/5). 3. Stretch the hamstrings to 110° of straight leg raising. 4. Strengthen the erector spinae muscles to grade Good (4/5).

2. Flexion at 30° results in greater separation of the posterior structures, which include the facet joints and the intervertebral foramina. Cervical flexion in supine position allows for more patient comfort and muscle relaxation than cervical flexion in sitting position.

Which of the following interventions would be BEST for a patient who has cervical stenosis and right upper extremity radicular symptoms? 1. Supine cervical traction in 10° of flexion 2. Supine cervical traction in 30° of flexion 3. Sitting cervical traction facing toward the door 4. Sitting cervical traction facing away from the door

2. High-pitched wheezes are continuous musical sounds of variable pitch and duration that are heard on inspiration, expiration (most common), or both and are usually caused by narrow airways or stenosis (Main; O'Sullivan, p. 449).

Which of the following lung sounds heard during auscultation would BEST be described as continuous musical sounds during exhalation for a patient who has difficulty breathing and who has an increased respiratory rate? 1. Stridor 2. High-pitched wheezes 3. Pleural rub 4. Crackles (rales)

2. For the cremasteric reflex text, the patient lies in supine position while the examiner strokes the inner side of the upper thigh with a pointed object. The test result is negative if the scrotal sac on the tested side pulls up. Unilateral absence of this response indicates a lower motor neuron lesion between L1 and L2.

Which of the following options BEST describes a normal response to the cremasteric reflex test? 1. Skin tenses in the gluteal area. 2. Ipsilateral scrotum elevation 3. Contraction of the anal sphincter muscles 4. Umbilicus moves down and toward area being stroked.

3. The process by which increasing numbers of nerve fibers are activated by increasing the amplitude or the duration of the stimulus is called fiber recruitment.

Which of the following parameters of electrical stimulation control the recruitment of peripheral axons during therapeutic electrical stimulation? 1. Current density 2. Symmetry of waveform 3. Duration of stimulus 4. Duty cycle

1. The photograph depicts the median nerve distribution, which is commonly disrupted in carpal tunnel syndrome. Tapping the anterior wrist describes the Tinel sign at the carpal tunnel.

Which of the following provocative maneuvers is MOST likely to elicit symptoms in the area highlighted in the photograph? (The photograph depicts the median nerve distribution, which is commonly disrupted in carpal tunnel syndrome) 1. Tapping the anterior wrist moving from proximal to distal 2. Applying direct pressure to the base of the thumb (1st digit) 3. Palpating along the pronator teres 4. Compressing the cervical spine with ipsilateral rotation and extension

2. With chronic ischemia due to arterial insufficiency, a cardinal sign is that the skin in the lower extremities becomes thin, scaly or shiny, and transparent due to inadequate blood flow.

Which of the following signs would be MOST indicative of a patient who is experiencing chronic lower limb ischemia? 1. There is an increase in the hair growth in the lower extremities. 2. The skin of the lower extremities has become transparent and appears dehydrated. 3. The nail beds of the toes have become thin and supple in texture and strength. 4. There is an increase in skin temperature in the lower extremity.

4. Secondary prevention involves early detection of disease and health conditions through regular screening.

Which of the following statements is the BEST description of a physical therapist's role in secondary prevention of disease? 1. Stopping the process that leads to the development of disease. 2. Providing education to give people greater control over their own health. 3. Limiting the degree of disability and improving function in patients who have chronic disease. 4. Performing early detection of disease and health conditions through regular screening.

4. The biceps brachii and brachioradialis flex the elbow and supinate the forearm. The cast position would shorten both muscles.

A patient sustained a nondisplaced midshaft radial and ulnar fracture 12 weeks ago. The patient was casted in mid-range elbow flexion with the forearm in a neutral position. Which of the following muscle pairs would MOST likely demonstrate contractile tissue shortening following the cast removal? 1. Brachialis and flexor pollicis longus 2. Brachioradialis and triceps 3. Biceps brachii and triceps 4. Biceps brachii and brachioradialis

1. Excessive foot pronation during midstance to toe off is the result of a compensated rearfoot (or forefoot) varus deformity.

A patient walks with excessive foot pronation during midstance through toe off (preswing). What is the MOST likely cause of the patient's gait deviation? 1. Compensated rearfoot varus deformity 2. Compensated forefoot valgus deformity 3. Uncompensated lateral (external) rotation of the tibia 4. Uncompensated pes cavus

4. The main function of the tibialis posterior is to plantar flex and invert the foot as well as support the medial arch. The tendon courses under the medial malleolus, causing pain and inflammation in this area when the tendon is dysfunctional. With a heel raise, the tendon becomes stressed due to its actions of plantar flexion and inversion. Finally, a finding of the "too many toes sign," which is the hallmark sign of this diagnosis, is due to forefoot abduction and hindfoot valgus. (Neumann)

A patient exhibits swelling and pain in the medial aspect of the ankle. During examination, the patient demonstrates rearfoot pronation in standing position and inability to perform a heel raise on the affected side. The patient demonstrates forefoot abduction when observed from behind. Which of the following conditions is MOST likely present? 1. Eversion ankle sprain 2. Retrocalcaneal bursitis 3. Tarsal tunnel syndrome 4. Posterior tibial tendon dysfunction

2. The patient depicted presents with a step-off deformity, which would be considered a type III disruption. Initially, the arm should be put in a sling. The patient will return to activity in about 6 weeks. The second degree of subluxation requires at least 6 weeks to return to activity, although the patient will have good structural strength at about 3 weeks.

A patient fell 1 day ago, sustaining the injury shown in the photograph. What is the MOST appropriate intervention and expected number of weeks for the patient to return to activity? (The patient depicted presents with a step-off deformity- AC joint) 1. Immobilization at night for 3 weeks; 3 weeks to return to activity 2. Immobilization for 3 weeks; 6 weeks to return to activity 3. Active assistive range of motion exercises; 6 weeks to return to activity 4. Active abduction and lateral (external) rotation exercises; 12 weeks to return to activity

4. A patient who has the risk factors described in the stem, including diabetes and placement of a Foley catheter, is at risk for a urinary tract infection. Urinary tract infections can result in sepsis. The signs and symptoms of sepsis include fever and confusion. (pp. 364-365)

A patient has a Foley catheter, diabetes mellitus, a decline in appetite and fluid intake, confusion, and an oral temperature of 101°F (38.3°C). The signs and symptoms are MOST consistent with which of the following diagnoses? 1. Insulin shock 2. Renal failure 3. Heart failure 4. Sepsis

2. A pink, shiny, shallow wound without slough on the heel associated with bed rest is consistent with a Stage 2 pressure injury.

A patient has a pink, shiny, shallow wound without slough on the heel after 3 weeks of bed rest following a motor vehicle accident. Which of the following classifications BEST represents the wound? 1. Stage 1 2. Stage 2 3. Stage 3 4. Stage 4

1. With arthrogryposis, children develop severe contractures. It is unlikely that a child with arthrogryposis would be able to stand, and, if so, joint stiffness and lack of muscle development would affect the joints of the foot and hip most. This would result in difficulty maintaining balance through the use of a hip strategy. (pp. 207-208)

A patient who has which of the following conditions is MOST likely to have difficulty performing the action demonstrated in the video? (child coordinating a hip strategy) 1. Arthrogryposis 2. Sever disease 3. Freiberg disease 4. Spondylolisthesis

4. A right thoracic rib hump is associated with a right thoracic rotoscoliosis. Scoliosis is an abnormal lateral curve that can be structural or functional. Structural scoliosis is a fixed deformity that persists during forward bending. Functional scoliosis is a changeable adaptation that is not present when fully forward flexed. The abnormal lateral curve is associated with rotation to the convex side of the curve. The rotation causes the transverse processes of the vertebrae to move posteriorly on the ipsilateral side, and the attached ribs follow to create a rib hump. In this example, the rib hump is on the right, so the rotation is to the right. The rotational component of scoliosis most frequently occurs to the convex side of the curve, so this example most likely involves left side bending.

A patient has a thoracic right rib hump that is present when the patient is standing but disappears upon forward bending. Which of the following conditions is MOST likely present? 1. Structural scoliosis involving left thoracic rotation and right side bending 2. Structural scoliosis involving right thoracic rotation and left side bending 3. Functional scoliosis involving left thoracic rotation and right side bending 4. Functional scoliosis involving right thoracic rotation and left side bending

3. Ankle-brachial index is a ratio of the systolic blood pressure at the ankle and the brachial systolic pressure. The normal value of the ankle-brachial index is 1.0, indicating similar blood flow in the ankle and brachial arteries. An ankle-brachial index greater than 1.1 relates to arterial calcification in the leg. With arterial calcification, the artery cannot be fully compressed for valid measurement of arterial pressure at the ankle. An ankle-brachial index greater than 1.1 is mostly found in patients who have diabetes. (p. 645)

A patient has an ankle-brachial index (ABI) of 1.5. Which of the following conditions affecting the lower extremity should a physical therapist suspect? 1. Arterial aneurysm 2. Arterial thrombosis 3. Arterial calcification 4. Arterial occlusive disease

1. Vertebral (basilar) arteries supply the brainstem and cerebellum. Lesions of these arteries usually manifest as unilateral or bilateral weakness of extremities and loss of vibratory sense, two-point discrimination, and position sense. Diplopia, homonymous hemianopsia, dysphagia, dysarthria, nausea, and confusion may also occur.

A patient has diplopia, dysphagia, and bilateral weakness of the lower extremities. The patient also has loss of vibratory sense, two-point discrimination, and position sense. There are no signs of personality changes or aphasia. Which of the following arteries is MOST likely affected? 1. Basilar 2. Anterior cerebral 3. Middle cerebral 4. Posterior cerebral

4. Emphysema has the features of higher than normal residual volume (because of destroyed alveolar walls and enlarged air spaces), absent or mucoid sputum (as opposed to sputum with a lot of neutrophils), and spirometry measures that are unimproved with bronchodilators (unlike asthma, which improves with bronchodilators) (Hillegass, pp. 192-193, 197).

A patient has higher than normal residual volume, absent or mucoid sputum, and spirometry measures that are unimproved with bronchodilators. The patient MOST likely has which of the following conditions? 1. Asthma 2. Pneumococcal pneumonia 3. Chronic bronchitis 4. Emphysema

1. Motor learning principles suggest that psychomotor skills are best learned when practice conditions allow errors to occur, when performers are encouraged to engage in active sensory encoding and retrieval processes, and when knowledge of results is used minimally. The conditions within this choice do not create variations within the task.

A patient is practicing moving from seated to standing position. Which of the following transfers to standing position would BEST facilitate motor learning of the task? 1. From a single chair at a self-selected speed, with minimal feedback of results 2. From a single chair at a variety of speeds, with maximum feedback of results 3. From a variety of chairs at a single speed, with maximum feedback of results 4. From a variety of chairs at a variety of speeds, with minimal feedback of results

1. The video depicts a swan neck deformity. This is a result of the strong pull of the contracted intrinsics, through the lateral bands which subsequently sublux dorsal to the axis of rotation of the PIP joint. The resultant deformity is one of hyperextension at the PIP joint and flexion at the DIP joint. If an individual were to have a contracture, it would likely be associated with the intrinsic muscles. (p. 155)

A patient presenting with a swan neck deformity MOST likely has a contracture of which of the following structures? 1. Intrinsic muscles 2. Oblique retinacular ligament 3. Extensor digitorum communis 4. Volar plate

3. Lymphedema is usually unilateral with typical presentation distally on the extremity (dorsum of the foot or hand) (Goodman, Differential Diagnosis; Goodman, Pathology, pp. 680-682).

A patient reports an insidious onset of swelling of 1 month's duration on the dorsum of the left foot. Which of the following conditions is the MOST likely cause? 1. Heart failure 2. Chronic venous insufficiency 3. Lymphedema 4. Lipedema

3. The person is pulling the car rear hatch door shut. Forceful downward rotation of the upper limb is necessary to perform the pictured activity. The latissimus dorsi primarily performs this task, with medial (internal) rotation, adduction, and extension of the shoulder. The rhomboids adduct and elevate the scapula, rotating it so the glenoid faces downward.

A patient reports difficulty, but no pain, when performing the task in the photograph. Which of the following muscles MOST likely require strengthening in the patient? (pulling the hatch door of a car shut) 1. Anterior and middle deltoid 2. Levator scapulae and serratus anterior 3. Rhomboids and latissimus dorsi 4. Upper and lower trapezius

1. Entrapment of the ulnar nerve as it courses through the hook of the hamate and the pisiform can lead to paresthesia along the ulnar side of the hand into the volar (palmar) aspect in the little finger (5th digit) and medial half of the ring finger (4th digit). It will also lead to weakness of the hypothenar muscles, making it difficult to perform gripping activities, such as opening jars or turning doorknobs. Common etiologies include repetitive gripping as occurs with knitting, tying knots, or using pliers and staplers. (p. 409)

A patient reports numbness and tingling in the medial aspect of the hand. The patient reports having used a stapler on 100 packets of paper last week for a presentation. Which of the following syndromes is MOST likely present? 1. Ulnar tunnel 2. Carpal tunnel 3. Thoracic outlet 4. Complex regional pain

2. The patient has signs and symptoms consistent with a diagnosis of a lateral ankle (inversion) sprain. A grade 2 lateral ankle sprain is characterized by localized swelling and more diffuse lateral tenderness (Dutton, p. 1151). Gentle posterior talocrural joint mobilizations should be performed in the acute stage of healing to maintain mobility and inhibit pain.

A patient who fell while running 3 days ago reports diffuse lateral ankle pain with active movement. The patient exhibits localized swelling distal and anterior to the lateral malleolus. Minimal laxity is noted with an anterior drawer test. Which of the following interventions would be MOST appropriate for the patient at this time? 1. Gastrocnemius-soleus stretching 2. Posterior talocrural joint mobilizations 3. Stationary cycling for up to 30 minutes 4. Active range of motion to end-range

2. Flexion synergy of the upper extremity includes scapular retraction/elevation or hyperextension. In the upper extremity, correct passive range of motion techniques require careful attention to lateral (external) rotation and distraction of the humerus, especially as ranges approach 90° of flexion or more. The scapula should be mobilized on the thoracic wall with an emphasis on upward rotation and protraction to prevent soft tissue impingement in the subacromial space during overhead movements of the arm.

A patient who had a cerebrovascular accident exhibits a flexion synergy of the left upper extremity. To promote good upper extremity movement, a physical therapist should mobilize the patient's scapula toward which of the following directions? 1. Upward rotation and retraction 2. Upward rotation and protraction 3. Downward rotation and retraction 4. Downward rotation and protraction

1. Limiting the knee flexion to 90° for the first 4 to 6 weeks is recommended to limit the shear stress to the healing meniscus. Flexion beyond 90° introduces shear to the meniscus and joint, damaging the repaired and healing meniscus.

A patient who had a medial meniscus repair 1 week ago has limited knee flexion. Which of the following interventions is MOST appropriate for the patient at this time? 1. Limit knee flexion to 90°. 2. Perform full knee flexion as tolerated. 3. Perform sit-to-stand transfers from a low chair. 4. Perform gluteus bridges with knee flexion at 100°.

3. A patient who has a C6 spinal cord injury retains full use of the diaphragm but lacks innervation to abdominal and intercostal musculature. The patient will display outward motion of the abdomen and inward motion of the upper chest. The outward motion of the abdominal area is caused by the diaphragm contracting and pushing abdominal contents forward and outward, and the inward motion of the upper chest is due to the lack of structural support from paralyzed thoracic musculature.

A patient who has a C6 spinal cord injury (ASIA Impairment Scale A) is MOST likely to exhibit which of the following movement patterns during inhalation? 1. Inward motion of the abdomen and inward motion of the upper chest 2. Inward motion of the abdomen and outward motion of the upper chest 3. Outward motion of the abdomen and inward motion of the upper chest 4. Outward motion of the abdomen and outward motion of the upper chest

3. The presence of cervicogenic headaches is suggested by the patient's posture, pain distribution, and cervical joint hypomobility. Decreased strength in the deep cervical cranioflexors is associated with this condition; therefore, strengthening of the deep neck flexors would be appropriate. (Olson, p. 325; Dutton, pp. 1232-1233)

A patient who has a forward head posture reports right-sided headaches and neck pain. Assessment reveals stiffness of the right occipitoatlantal joint segment. The patient's goal is to decrease headache intensity and to improve cervical function. Which of the following muscles would be MOST appropriate to strengthen? 1. Neck extensors 2. Upper trapezius 3. Deep neck flexors 4. Sternocleidomastoid

1. In spastic bowel dysfunction, the level of cord injury occurs above S2-S4, leaving the spinal defecation reflexes intact.

A patient who has a spinal cord injury reports having spastic (reflex) bowel function. Which of the following descriptions BEST characterizes the patient's neurologic injury? 1. Injury above spinal segments S2-S4, leaving spinal defecation reflexes intact 2. Injury at or below spinal segments S2-S4, leaving spinal defecation reflexes intact 3. Injury above spinal segments S2-S4, abolishing spinal defecation reflexes 4. Injury at or below spinal segments S2-S4, abolishing spinal defecation reflexes

1. Stretching is a stimulus in the early healing stages for the proper alignment of healing collagen. Gentle stretching is performed to provide a stimulus for fiber orientation without disruption of the immature collagen. (p. 522)

A patient who has decreased tactile sensation due to diabetes mellitus is being treated for a mild Achilles tendon strain. Which of the following interventions is MOST appropriate to restore normal alignment of the healing collagen? 1. Gastrocnemius stretching 2. Ultrasound to the gastrocnemius 3. Cross-friction massage at the muscle belly 4. Hot pack to the gastrocnemius

1. The cognitive stage is the beginning of the learning process. Cues, instructions, and guidance are provided by the therapist, and demonstration is used.

A patient who has hemiparesis is learning to propel a manual wheelchair. Which of the following interventions is MOST appropriate for the cognitive stage of learning this task? 1. The physical therapist guides the patient with hand-over-hand cues and demonstrates the propulsion technique. 2. The patient propels the wheelchair with variable speed through an obstacle course with supervision from the physical therapist. 3. The physical therapist allows the patient to problem-solve when steering errors occur and does not provide feedback. 4. The physical therapist allows the patient to independently explore strategies for propulsion and steering during a specific propulsion task.

2. Hemiplegic shoulder pain is a common complication after stroke. Poor positioning of the more affected upper extremity has been implicated in producing joint microtrauma and pain. Prolonged soft tissue injury can result in complex regional pain syndrome. (pp. 646-647)

A patient who has right hemiparesis following a cerebrovascular accident is habitually positioned in right sidelying position. Which of the following problems may result from this positioning and should be of GREATEST concern to the physical therapist? 1. Left gaze preference 2. Chronic right shoulder pain 3. Trunk shortening on the right 4. Skin breakdown on the medial aspect of left knee

4. The liver removes bilirubin from the blood, conjugates it, and excretes this complex into the intestine. It is this conjugated bilirubin that darkens fecal material. Liver disease that limits bilirubin transport into the liver increases serum bilirubin (hyperbilirubinemia) and limits the amount of conjugated bilirubin entering the gut. Stools become light in color. This sign helps to distinguish jaundice caused by liver disease from jaundice caused by extrahepatic causes. (Goodman, Pathology; Goodman, Differential Diagnosis, pp. 340-341)

A patient who reports a history of liver damage exhibits signs of hyperbilirubinemia. Which of the following clinical manifestations is MOST likely present? 1. Pallor 2. Clear urine 3. Darkened stools 4. Light-colored stools

4. Exercise typically increases insulin sensitivity and enhances the effect of insulin. Therefore, glucose intake should be increased to counter the effects of exercise. Insulin intake could be decreased to counter the effects of exercise. During prolonged activity, a snack is recommended for every 30 minutes of activity.

A patient with type 1 diabetes is planning to begin an exercise program. Which of the following actions is MOST appropriate for the patient to perform? 1. Inject insulin just prior to starting an exercise session. 2. Avoid food consumption just prior to an exercise session. 3. Complete an exercise session within 1 hour of receiving an insulin injection. 4. Increase food intake prior to an exercise session.

2. The photograph depicts an anterior glide of the humerus, which helps improve glenohumeral extension, according to the concave-convex rule. Pulling a lawn mower cord is a movement into glenohumeral extension.

A physical therapist is MOST likely to perform the intervention shown in the photograph for a patient who has difficulty with which of the following functional activities? (anterior glide of the humerus) 1. Hanging clothes in a closet 2. Pulling the cord to start a lawn mower 3. Reaching across the body to scrub the back of the opposite shoulder 4. Bringing the arm out to the side and over the head

2. Contact precautions are followed for vancomycin-resistant Enterococcus (VRE). A gown is needed for contact precautions.

A physical therapist is assisting with bed mobility for a patient who is receiving antibiotics for vancomycin-resistant Enterococcus (VRE). Which of the following precautions and personal protective equipment are indicated for physical therapy intervention? 1. Contact precautions; the therapist should wear a mask. 2. Contact precautions; the therapist should wear a gown. 3. Droplet precautions; the therapist should wear a mask. 4. Droplet precautions; the therapist should wear a gown.

1. Droplet precautions are used to reduce the risk of droplet transmission of infectious agents such as viral influenza. Donning a face mask, gloves, and gown as shown in the video is recommended when treating patients with droplet precautions. (Johansson, pp. 97, 104; Paz, p. 332)

A physical therapist is doffing personal protective equipment after treating a patient. She is doffing gloves, gown, and mask. Which of the following infectious agents is the patient MOST likely carrying? 1. Influenza virus 2. Varicella zoster virus 3. Clostridium difficile 4. Myobacterium tuberculosis

2. The longus colli and longus capitis are deep neck flexors. The craniocervical flexion test or the deep neck flexor endurance test is included in the examination of these muscles.

A physical therapist is examining a patient who has a whiplash injury and a mid-cervical spine sprain. To determine the function of the patient's longus colli and longus capitis, which of the following assessments should be included in the examination? 1. Axial extension 2. Craniocervical flexion 3. Cervical compression test 4. Neck flexion range of motion

1. A white blood cell count of 16,000/mm3 exceeds the normal range of 4,500 to 11,000/mm3 (Hillegass, p. 268). This elevated count suggests infection, which may compromise exercise tolerances (Goodman).

A physical therapist is preparing to treat a patient in an acute care setting following a total hip arthroplasty. The patient's past medical history includes chronic obstructive pulmonary disease. Which of the following concomitant conditions MOST indicates that the therapist should defer treatment? 1. White blood cell count of 16,000/mm3 2. Oxygen saturation level of 92% with activity 3. Postoperative hemoglobin level of 15 g/dL (compared with a preoperative level of 18 g/dL) 4. Partial pressure of arterial oxygen (PaO2) of 80 mm Hg and partial pressure of arterial carbon dioxide (PaCO2) of 40 mm Hg

4. The patient's white blood cell count is within the normal range of 4500-11,000/mm3, so the infection has resolved.

A physical therapist is reviewing the laboratory report of a patient who received a diagnosis of pneumonia 2 weeks ago. The patient's white blood cell count is currently 9,000 cells/mm3. Which of the following conditions does this value indicate for the patient? 1. Anemia 2. Development of leukocytosis 3. Immunosuppression 4. Resolution of the pneumonia infection

4. The test shown in the photograph is the Phalen test, for which a positive result is indicative of carpal tunnel syndrome. A positive result of the carpal compression test is also indicative of carpal tunnel syndrome. (p. 474)

If the test shown in the photograph has a positive result, which of the following tests would MOST likely also have a positive result? (Phalen Test) 1. Allen test 2. Froment test 3. Piano keys test 4. Carpal compression test

3. The gate control theory of pain states that large-diameter fibers are activated with nonnoxious stimulation, such as transcutaneous electrical nerve stimulation. This will cause activation of the substantia gelatinosa, which will close the gate and block pain signals being sent by T-cells.

Low-intensity conventional transcutaneous electrical nerve stimulation is being used to control pain. Which of the following physiological responses is MOST likely to occur? 1. Activation of the A (large-diameter) fibers only 2. Activation of the C (small-diameter) fibers only 3. Activation of the A (large-diameter) fibers and substantia gelatinosa 4. Activation of the C (small-diameter) fibers and substantia gelatinosa

3. The area highlighted in the photograph is the C7 nerve root distribution. Absent sensation due to a nerve root lesion would cause muscles innervated by the C7 nerve root to be affected as well (p. 24). The triceps, which is innervated by the radial nerve (C7-C8), would most likely be affected as well (p. 24).

Sensation in the area highlighted in the photograph is absent due to a nerve root lesion. Which of the following muscles is MOST likely to be affected? (The area highlighted in the photograph is the C7 nerve root distribution- palmer aspect of 3rd digit) 1. Deltoid 2. Brachialis 3. Triceps 4. Supinator

3. When a client has a known hiatal hernia, the supine position and any exercise (such as posterior pelvic tilts) for which the patient might use the Valsalva maneuver should be avoided (pp. 901-902).

The physical therapy plan of care for a patient with low back pain includes posterior pelvic tilts performed in the supine position. Modification of the plan of care would be MOST needed if the patient were found to have which of the following conditions? 1. Irritable bowel syndrome 2. Duodenal ulcer 3. Hiatal hernia 4. Diverticulosis

4. The photograph shows a radial nerve glide (Kisner, p. 399). This maneuver is used to treat symptoms related to shoulder girdle depression, radial nerve distribution, and disorders such as tennis elbow (lateral epicondylalgia) and de Quervain syndrome (Kisner, pp. 399, 643).

The position demonstrated in the photograph is BEST used to treat a patient who has which of the following conditions? (radial nerve glide) 1. Cubital tunnel syndrome 2. Carpal tunnel syndrome 3. Medial epicondyle tendinopathy 4. Lateral epicondyle tendinopathy

4. Cervical rotation follows the same arthrokinematic motions as side bending; therefore, side bending to the right would be limited. Side bending mechanics include a superoanterior glide of the left superior facet and a posteroinferior glide of the right facet, which would be restricted with decreased cervical motion and translation of the mid cervical spine to the left. (p. 1268)

When performing active cervical rotation range of motion, a patient moves as shown in the photographs. Translation testing of the mid-cervical spine reveals no restrictions to the right and moderate restrictions to the left. Which of the following cervical motions will MOST likely be restricted in the patient? (limited cervical rotation to the left) 1. Forward bending 2. Backward bending 3. Side bending to the left 4. Side bending to the right

4. The principle behind wound healing with electrical stimulation is galvanotaxis. The current's polarity introduced into the wound attracts cells that promote healing. Thus, a generator that has polarity must be used. High-voltage pulsed currents are polar currents. The other stimulators are not polar because they have a counter-pulse in the opposite direction that cancels out any polar effects. The negative electrode will attract neutrophils and is used in infected wounds. The positive electrode attracts macrophages and epidermal cells and is used in treating noninfected wound states. The frequency of 100 pps provides a continuous, comfortable current and has been demonstrated to promote healing. (pp. 271-272, 278)

When using electrical stimulation to treat a patient's nonhealing, infected wound, which of the following waveforms and parameters will be MOST helpful in facilitating wound closure? 1. Symmetrical biphasic waveform, 35 pps 2. Interferential current waveform, 100 beats/second 3. High-voltage pulsed current waveform, positive electrode in wound, 4 pps 4. High-voltage pulsed current waveform, negative electrode in wound, 100 pps

2. T-scores falling in the range -1.0 to -2.5 indicate low bone mass, which is osteopenia.

Which of the following T-scores for bone density indicates that the patient has osteopenia? 1. -3.0 2. -2.0 3. +2.0 4. +3.0

3. Skin rashes, fever, fatigue, malaise, photosensitivity, dyspnea, cough, and peripheral neuropathies are all common findings in patients who have systemic lupus erythematosus (pp. 307-308).

Which of the following conditions is MOST likely to be associated with systemic lupus erythematosus? 1. Uveitis 2. Urethritis 3. Photosensitivity 4. Psoriasis

4. This is a typical Cheyne-Strokes respiratory pattern, which is an irregular respiration pattern characterized by a period of apnea followed by gradually increasing depth and frequency of respirations (pp. 57-58). This breathing pattern is often observed with depression of the cerebral hemisphere (e.g., coma), in basal ganglia disease, and occasionally with congestive heart failure.

Which of the following descriptions BEST depicts the Cheyne-Stokes respiratory pattern? 1. Regular respiration pattern characterized by a rate of less than 10 breaths/minute 2. Regular respiration pattern characterized by a rate of more than 24 breaths/minute 3. Irregular respiration pattern characterized by highly variable respiratory depth and intermittent periods of apnea 4. Irregular respiration pattern characterized by a period of apnea followed by gradually increasing depth of respirations

2. An alginate dressing is best to use in this case because this type of dressing provides both hemostasis and is appropriate for use over an infected wound (pp. 565, 589).

Which of the following dressings is MOST appropriate to use with an infected wound that also requires hemostasis? 1. Foam 2. Alginate 3. Transparent film 4. Hydrocolloid

2. Patients who have diabetes should exercise regularly and consistently (Goodman; Porcari).

Which of the following exercise guidelines is MOST appropriate for a patient who has diabetes? 1. Exercise during peak insulin times. 2. Exercise at the same time each day. 3. Avoid exercise if the blood glucose level is less than 150 mg/dL (8.3 mmol/L). 4. Avoid exercise if the blood glucose level is greater than 200 mg/dL (11.1 mmol/L).

4. Research evidence supports that patients who possess active wrist and finger extension have improved upper extremity functional outcomes after a cerebrovascular accident.

Which of the following factors BEST predicts improvements in upper extremity functional outcomes for a patient following a cerebrovascular accident? 1. Family involvement in the patient's care 2. Use of blocked practice during intervention 3. Patient's cognitive understanding of the impairments and intervention program 4. Presence of active wrist and finger extension

1. Swelling that feels hard with palpation describes brawny edema. Brawny edema is associated with Stage 2 (spontaneously irreversible) lymphedema.

Which of the following findings is MOST associated with Stage 2 lymphedema? 1. Swelling that feels hard with palpation 2. Edema that forms a dimple when fingertip pressure is removed 3. Signs and symptoms that are improved with elevation of the limb 4. Skin on the dorsum of the foot that can be pinched in a fold

1. Excursion is decreased in patients who have chronic obstructive pulmonary disease due to hyperinflation of the chest and a resultant flattened diaphragm. Normal excursion of the diaphragm is 1.2 to 2 inches (3 to 5 cm); therefore, 0.4 to 0.8 inch (1 to 2 cm) would be below the normal excursion value.

Which of the following findings is MOST commonly associated with patients who have chronic obstructive pulmonary disease? 1. Below normal diaphragmatic excursion of 0.4 to 0.8 inch (1 to 2 cm) 2. Above normal diaphragmatic excursion of 0.4 to 0.8 inch (1 to 2 cm) 3. Below normal diaphragmatic excursion of 1.2 to 2 inches (3 to 5 cm) 4. Above normal diaphragmatic excursion of 1.2 to 2 inches (3 to 5 cm)

2. Extension and medial (internal) rotation of the shoulder puts the supraspinatus tendon in the most accessible position.

Which of the following positions of the humerus is BEST for application of an ultrasound treatment to the supraspinatus tendon insertion? 1. Flexion and lateral (external) rotation 2. Extension and medial (internal) rotation 3. Abduction and lateral (external) rotation 4. Flexion and medial (internal) rotation

4. When measuring forearm supination, lateral (external) rotation of the shoulder or adduction past 0° should be avoided (p. 92).

Which of the following substitution patterns should be prevented when measuring active forearm supination? 1. Shoulder medial (internal) rotation and shoulder abduction 2. Shoulder medial (internal) rotation and shoulder adduction past 0° 3. Shoulder lateral (external) rotation and shoulder abduction 4. Shoulder lateral (external) rotation and shoulder adduction past 0°

1. Water displacement has been regarded as the most sensitive and accurate standard for volume measurement.

Which of the following tests is MOST accurate for assessing volume reduction in a patient who has lymphedema? 1. Water displacement 2. Limb circumference 3. Bioelectrical impedance 4. Optoelectronic volumetry

4. Because peripheral neuropathy is a common secondary complication of diabetes, it is imperative for a physical therapist to assess a patient's ability to detect light touch and presence of protective sensation to determine risk of skin ulceration (Baranoski, pp. 381-382).

Which of the following tests or measurements is BEST to assess risk for skin ulceration in a patient who has diabetes? 1. Rate pressure product 2. Pulse pressure 3. Capillary refill 4. Light touch