TherapyEd A

a therapist is planning on using percussion and shaking for assisting airway clearance with a patient diagnosed with COPD. what major precaution might curtail selection of of this form of intervention? 1. a platelet count of 20,000 2. dyspnea when in Trendelenburg position 3. SaO2 range of 88-94% on room air 4. FIM score of 4

1. a platelet count of 20,000 a patient with platelet count of 20,000 is at increased risk of bleeding, percussion could cause microtraumas and increased bleeding risk

what is pain and tenderness with palpation over McBurney's point associated with? 1. acute appendicitis 2. hiatal hernia 3. acute cholecysitis 4. GERD

1. acute appendicitis pain and tenderness over McBurney's point is associated with acute appendicitis, McBurney's point is half the distance from the ASIS and the umblicus in the right lower abdominal quadrant

capsular tightness has limited a patient's ability to full extend the left knee. what joint mobilization technique should be used to restore joint motion? 1. anterior glide and external rotation of the tibia 2. anterior glide and internal rotation of the tibia 3. posterior glide and external rotation of the tibia 4. posterior glide and internal rotation of the tibia

1. anterior glide and external rotation of the tibia ER is required for full extension

a physical therapist is treating a patient with active infectious hepatitis B. in addition to wearing a protective gown when in patient's room, what precautions should be taken to avoid transmission of the disease? 1. avoid direct contact with the patient's blood or blood contaminated equipment by wearing gloves 2. avoid direct contact with any part of patient 3. have the patient wear a mask to minimize droplet spread of organisms from coughing 4. provide tissues and no touch receptacles for disposal of tissues

1. avoid direct contact with the patient's blood or blood contaminated equipment by wearing gloves hep B is transmitted in blood, body fluids, and body tissues, precautions should include avoiding direct contact with blood or blood contaminated equipment

a patient presents with hemosiderin changes and increased LE edema. what diagnosis are these changes consistent with? 1. chronic venous insufficiency 2. acute venous insufficiency 3. acute arterial insufficiency 4. chronic arterial insufficiency

1. chronic venous insufficiency LE edema is usually due to incompetent valves which causes the edema, long standing edema causes staining of the legs because of increased iron from pooling blood -LE edema can be caused by acute venous insufficiency there is not any time for staining -acute arterial insufficiency would cause significant pain, pale or cyanotic skin, and decreased or absent pulses -chronic arterial insufficiency would cause pain, decreased or absent pulses, and dependent rubor with trophic changes (nail changes, loos of hair, pale, shiny skin)

what is the expected hemodynamic response for a patient on beta-adrenergic agents during exercise? 1. heart rate to be low at rest and rise minimally with exercise 2. heart rate to be low and rise continuously to expected levels as exercise intensity increases 3. systolic BP to be low at rest and not rise with exercise 4. systolic BP to be WNL at rest and progressively fall as exercise intensity increases

1. heart rate to be low at rest and rise minimally with exercise beta blockers decrease sympathetic response to activity, decreasing HR at reast and blunting HR response to activity

What activity would help break up obligatory LE synergy patterns in a patient with hemiplegia? 1. high kneeling position, ball throwing 2. standing, alternating marching in place with hip and knee flexion, and hip abduction 3. sitting, alternate toe tapping 4. sitting foot slides under the seat

1. high kneeling position, ball throwing -kneeling with hip in extension and knees flexed to 90 is an out of synergy position -all other options are in synergy

a patient with degenerative joint disease of the right hip complains of the right hip complains of pain the anterior hip which is aggravated by weight bearing. there is decreased ROM and capsular restriction. right gluteus medius weakness is evident during ambulation and there is decreased tolerance of functional activities including transfers and LE dressing. in this case a capsular pattern of joint motion should be evident by which of the following? 1. hip flexion, abduction, internal rotation 2. hip flexion, adduction, and internal rotation 3. hip extension, abduction, and ER 4. hip extension, abduction, and ER

1. hip flexion, abduction, internal rotation capsular pattern is limitation of flexion/internal rotation with some limitation of abduction

A patient has persistent midfoot pain when weight bearing. the injury occurred during a soccer match when an opposing player stepped on the patient's right foot when it was planted and cutting left. patient locates the pain where the laces are tied. upon examination there is splaying of the first metatarsal and increased pain when passively stressing the foot with plantar flexion and rotation. what injury should the therapist suspect the patient has sustained? 1. lisfranc injury 2. turf toe 3. calcaneocuboid joint subluxation 4. hallux rigidus

1. lisfranc injury - Lisfranc: Midfoot crush injury caused when plantar flexed and having another player step on mid foot. - Turf Toe: Hyperextension of big toe (Sprint) - Calcaneocuboid Joint Subluxation: Irritates surrounding joints. - Hallux Rigidius: Degenerative arthritis causes stiffening of the big toe.

an adult is seen in a PT clinic one day after sustaining an ankle inversion injury. the lateral aspect of the ankle is swollen. the patient is having difficulty bearing weight on the involved LE. therapist is concerned for possibility of fracture. what other physical exam finding would indicate need for ankle radiographs? 1. palpation tenderness at the distal lateral malleolus 2. inability to dorsiflex the ankle 3. positive anterior drawer test 4. weak and painful resisted eversion

1. palpation tenderness at the distal lateral malleolus palpation tenderness of either malleoli is one of the criteria of the ottawa ankle rules used to determine when to order an xray with an acute ankle injury, the ottawa ankle rules are highly sensitive and accurately rule out fracture following an acute ankle injury, all other choices are not on the ottawa ankle rules

a soccer player with a Q angle of 30 degrees exhibits abnormal patellofemoral tracking. while playing soccer what is the MOST often used orthotic device to address this problem? 1. patellar stabilizing brace with a lateral buttress 2. patellar stabilizing brace with a medial buttress 3. neoprene sleeve with patellar cutout 4. derotation brace

1. patellar stabilizing brace with a lateral buttress an increased valgus deformity can result in greater lateral displacement force on the patella, which can disrupt patella tracking and could even lead to subluxation. the theory behind the lateral buttress brace is that it provides support to help prevent subluxation and tries to maintain normal patellar tracking -medial butress would be on the wrong side, neoprene sleeve would be helpful for painful arthritic knee, derotation brace is designed for rotary instabilities secondary to cruciate injuries

a women is referred to PT with diagnosis of pelvic floor weakness after delivering a baby. proper instructions for pelvic floor exercises would NOT include which of the following? 1. stop and start the flow of urine every time you go to the toilet 2. squeeze the muscles around the vagina, imagining you are stopping the flow of urine, hold for 5-10 seconds, then relax 3. repeat the exercises ten times, 3x day 4. start in supine position and progress to sitting and standing practice

1. stop and start the flow of urine every time you go to the toilet Kegel exercises (pelvic floor exercises) should not include the stopping and starting the flow of urine every time one goes to the toilet. -all other choices are part of directions for Kegels

A patient recovering from a stroke reports lack of feeling in the more affected hand. light touch testing reveals lack of ability to tell when stimulus is being apply (only 1 correct response out of 10 tests). what additional sensory tests should the therapist perform? 1. test for pain and temperature 2. test for two point discrimination 3. test for stereognosis 4. test for barognosis

1. test for pain and temperature -Testing for pain and temperature can be performed as these sensations are carried in different pathways (anterolateral spinothalamic) where as light touch and the other options all use the dorsal column lemniscal pathway - Anterolateral: Pain & temperature - Dorsal Column: Monofilament, vibration, and joint proprioception.

A patient with a BMI of 37 is referred to PT for exercise conditioning. what are additional clinical manifestations associated with the BMI that this patient may exhibit? 1. hyperpnea and hyperpituitarism 2. HTN and hyperinsulism 3. hormone related cancer 4. hypolipidproteinemia and hypotension

2. HTN and hyperinsulism -obesity is associated with HTN, dyslipidemia, hyperinsuliemia (type II diabetes), and hyperglycemia -the other choices are not associated with obesity

A patient is seen in a PT clinic for a traumatic knee injury. the patient sustained the injury by falling "up the stairs" in their house and striking the proximal tibia directly against the edge of a step. during the examination of the patient, therapist notes diffusing bruising around the tibial tuberosity. what structure was most likely injured? 1. ACL 2. PCL 3. medial patellofemoral ligament 4. popiteal artery

2. PCL the scenario describes a common MOI for PCL injury, knee flexion with an object forcefully striking the anterior tibia and displacing it posteriorly

during ausculation, the therapist hears S1 and S2 heart sounds. during early diastole the therapist hears a low frequency sound of turbulence. what suspected sound should the therapist record this as? 1. S4 sound 2. S3 sound 3. heart murmur 4. pericardial friction rub

2. S3 sound -S3 is an abnormal third heart sound due to poor ventricular compliance and turbulence. it is heard as a low frequency sound during early diastole -S4 is due to exaggerated atrial contraction and subsequent turbulence, low frequency, heard during late diastole -heart murmur: swishing sound during systole, diastole, or both systole or diastole -pericardial friction rub: leathery sound during systole

Men are at risk for development of metabolic syndrome if they exhibit which of the following symptoms? 1. an HDL level lower than 45 mg/dL 2. a waist size > 40 inches 3. triglycerides greater than 100 mg/dL 4. fasting glucose less than 100 mg/dL

2. a waist size > 40 inches -criteria for diagnosis include abdominal obesity (>40 inches for men, > 35 for women) -other criteria includes elevated triglycerides (>150 mg/dL), low HDL (<40 mg/dL), and fasting plasma glucose of > 110 mg/dl

During a home visit, an adult patient asks the PTA to see the PT progress notes in the medical record. what should the PTA do/ 1. refuse to let the patient see the record 2. allow the patient to see the note 3. let the patient see the notes only with permission of the PT 4. contact patient's physician and explain the situation

2. allow the patient to see the note by law patient is allowed to access their complete medical record. the PTA does not need to ask for PT or MD permission to release the record to the patient

a patient suddenly falls and lands on a piece of equipment left on the floor. a severe laceration with spurting blood is noted in the area of the lateral distal right thigh. to help control bleeding, where should the PT apply pressure in addition to directly over the wound? 1. behind the knee at the popliteal fossa 2. at the femoral triangle 3. at the antecubital fossa 4. at midthigh, directly over the profunda femoris artery

2. at the femoral triangle the patient is experiencing an arterial bleed most likely affecting the descending branch of the lateral circumflex femoral artery, pressure should be applied over the wound and more proximally over the femoral artery

a patient is diagnosed with BPPV. what intervention should the plan of care emphasize for this patient? 1. gaze stability exercises using horizontal head rotation 2. canalith repositioning treatment 3. postural stability exercises in sitting using a therapy ball 4. habituation exercises using provocative positions and movements

2. canalith repositioning treatment gaze stability and postural stability is for UVH or BVH habituation is for UVH with continual complaints of dizziness, can also be used for central vestibular lesion

the vertebral artery test is performed with patient supine and head supported off the table. the examiner passively moves head and neck into extension, lateral flexion, and ipsilateral rotation. the position is maintained for 30 seconds and repeated on both sides. which of the following is a positive test? 1. sensory changes occur in the face along with visual changes 2. dizziness and nystagmus occurs, indicating that opposite side artery is being compressed 3. hearing difficulties and facial paralysis occur 4. dizziness or nystagmus occur, indicating same side artery is being compressed

2. dizziness and nystagmus occurs, indicating that opposite side artery is being compressed

a patient with a complete tetraplegia (ASIA A) at the C6 level is initially instructed to transfer using a transfer board. with the shoulders externally roatted, how should the remaining UE joints be positioned? 1. forearms pronated with wrists and fingers extended 2. forearms supinated with wrist extended and fingers flexed 3. forearms pronated with wrists and fingers flexed 4. forearms supinated with wrists and fingers extended

2. forearms supinated with wrist extended and fingers flexed the patient with C6 tetraplegia does not have triceps to assist in transfers. independent transfers can be achieved by using muscle substitution and positioning to lock the elbow. hands are positioned anterior to hips. shoulders in ER, with elbows and wrist extended, forearms supinated, and fingers flexed. strong contraction of the anterior deltoid, shoulder ERs, and clavicular portion of the pec major flexes and adducts the humerus causing elbow to extend -fingers are always flexed to preserve tenodesis grasp

a patient is referred to PT for balance and gait training following two falls in the home in the last month. the therapist notes in the medical record that the patient has adrenal insufficiency. what are the metabolic abnormalities associated with adrenal insufficiency? 1. hypokalemia 2. hyponatremia 3. hyperglycemia 4. alkalosis

2. hyponatremia -metabolic abnormalities seen in adrenal insufficiency include hyponatremia (decreased sodium concentration in the blood) secondary to renal loss of sodium ions. decrease in cortisol results in an inability to regulate potassium and sodium -patients with adrenal insufficiency would be hyperkalemic, hypoglycemic, and have acidosis

A physical therapist is instructing an elderly patient how to perform bed mobility following a total hip replacement. the therapist should carefully consider the effects of aging that relate to skin. what is one such effect? 1. increased perception of pain 2. impaired sensory integrity 3. increased skin elasticity 4. increased inflammatory responsiveness

2. impaired sensory integrity -changes in skin composition associated with aging included decreased sensitivity to touch, decreased perception of pain and temperature, and increased risk of injury -all other choices are decreased (perception of pain, skin elasticity) or attenuated (inflammatory response)

a teenager is receiving outpatient PT for a shoulder injury sustained during football practice. during today's visit, he is complaining of nausea, malaise, and abdominal pain that started in his mid abdomen but is not predominantly in RLQ. the therapists suspects acute appendicitis and wants to elicit the obturator sign, what is the the correct method of performing this special test? 1. extension of the right hip with patient lying on the left side 2. internal rotation of the right hip with hip and knee flexed to 90 degrees 3. application of pressure in the left lower quadrant which elicits pain in the right lower quadrant 4. have patient stand on his toes and drop to his heels suddenly

2. internal rotation of the right hip with hip and knee flexed to 90 degrees above is how to perform the obturator sign, the obturator muscle may come in contact with an inflamed appendix eliciting pain, which helps substantiate a possible diagnosis of appendicitis

the therapist is treating a patient with chronic lyme disease of more than 1 year's duration. what joints are likely to demonstrate more arthritic changes and therefore should be the focus of PT interventions? 1. small joints of the hands and feet 2. large joints of the body, esp. the knee 3. axial joints, esp. the lumbosacral spine 4. axial joints, esp. the cervical and thoracic spine

2. large joints of the body, esp. the knee Stage 3 lyme disease (late or chronic lyme disease) is characterized by intermittent arthritis with marked pain and swelling, esp. in the large joints

what is an acceptable modified position to drain the posterior basal segment of the left lower lobe in a patient with pulmonary congestion? 1. side lying on right, with pillow under right hip and bed flat 2. prone with a pillow under the hips and bed flat 3. side lying with pillow between legs and foot of bed elevated 18 inches 4. prone, with pillow under the hps and head of the bed elevated 18 inches

2. prone with a pillow under the hips and bed flat prone with a pillow under the hips and bed flat will raise the posterior basal segments up to facilitate drainage sidelying will drain the lingula more than posterior basal segments, bed elevated or head of bed elevated will not facilitate drainage

An elderly patient with hypothyroidism is recovering from a fall and is referred to PT to increase exercise tolerance and safety. the patient complains of significant muscle pain in both LEs. what additional MSK effects should the therapist examine for? 1. distal muscle weakness 2. proximal muscle weakness 3. joint laxity 4. decreased DTRs

2. proximal weakness Myalgia and proximal muscle weakness are associated with hypothyroidism.

during examination of the right shoulder of teenage with anterior shoulder pain, the PT notices an excessive amount of scapular abduction during both shoulder flexion and abduction. full GH ROM is achieved at the ends of flexion and abduction. the axillary border of the scapula protrudes laterally beyond the thorax much more on the right than on the left. what muscle(s) would be associated with excessive lengthening during movements of shoulder flexion and abduction? 1. serratus anterior 2. rhomboids 3. teres major 4. levator scapulae

2. rhomboids the primary scapular adductors acting eccentrically to control excessive scapular abduction include the rhomboids and trapezius muscles groups. inadequately controlled lengthening of the rhomboids could contribute to hyperabduction of the scapula during the mid and later phases of should flexion and abduction.

the physical therapist is examining the muscle length of the patient's left hip and knee. how should the therapist interpret the muscle length test shown in the picture (pg 584)? 1. shortness of one joint and two joint hip flexors 2. shortness of one joint hip flexor with normal two joint hip flexors. 3. normal one joint hip flexors with tightness of two joint hip flexors 4. normal one joint and two joint hip flexors

2. shortness of one joint hip flexor with normal two joint hip flexors. the posterior thigh does not touch the table and the knee can be flexed to as many degrees as the hip is flexed. the thomas test is utilized for hip flexor length and to distinguish between one joint and two joint hip flexor tightness. with low back and sacrum flat on the table, a normal one joint hip flexor length would be with thigh flat on the table, normal two joint hip flexor length would be 80 degrees of 80 of knee flexion

a therapist is treating a child with spastic diplegia. what intervention can be used to promote relaxation? 1. rhythmic stabilization 2. slow rocking on a therapy ball 3. spinning in a hammock 4. rolling and spinning on a scooter board

2. slow rocking on a therapy ball relaxation can be achieved using slow rocking (slow vestibular stimulation) rhythmic is a PNF technique for postural stability, spinning and rolling can increase mobility based on fast vestibular stimulation

idiopathic scoliosis is suspected in a 12 year old girl. during the physical examination, what is the standard screening test for this condition? 1. longsitting, forward bend test 2. standing, forward bend test 3. sitting, rotation test to the right and left 4. standing, backward extension test

2. standing, forward bend test screening test for scoliosis includes bending forward with feet together, knees straight, arms hanging freely. therapist observes child from the back looking for a difference of the shape of the ribs on each side. a spinal deformity is most noticeable in this position

a client with stage I lymphedema of the RLE is referred to PT. the therapist considers a program of complete decongestive therapy (CDT). an important component of CDT is manual lymph drainage. how should the therapist BEST perform this procedure? 1. starting at the distal portion of the limb and working proximally to move the lymph toward the right lymphatic duct 2. starting at the proximal portion of the lymph and working distally to move lymph toward the thoracic duct 3. following application of intermittent pneumatic compression at right LE 4. by performing deep tissue friction massage for several minutes on fibrotic areas prior to CDT

2. starting at the proximal portion of the lymph and working distally to move lymph toward the thoracic duct because of very low forces present in the lymph system, lymph lode in the proximal areas must be relieved prior to progressing where lymphedema is present. proximal to distal approach maximizes benefits that may occur from the treatment technique. also anatomy of lymph system requires movement of LE lymph to thoracic duct, only upper quarter lymph will be directed to the lymphatic duct

while gait training with a patient following a stroke, the therapist observes the knee on the hemiparetic side going into recurvatum during stance phase. what is the most likely cause of this deviation? 1. severe spasticity of the hamstrings or weakness of the gastroc soleus 2. weakness or severe spasticity of quadriceps 3. weakness of the gastroc soleus or spasticity of the pretibial muscles 4. weakness of both the gastroc soleus and pre-tibial muscles

2. weakness or severe spasticity of quadriceps weakness or severe spasticity of the quadriceps is the most likely cause of genu recurvatum. spasticity of hamstrins or pretibial muscles would cause knee to buckle, weakness of gastroc would cause lack of push off, and weakness of pretibial muscles would cause drop foot

an infant has been diagnosed with complete rupture of C8 and T1 resulting in Klumpke's paralysis. which movement can be expected to be impaired? 1. shoulder elevation 2. wrist flexion 3. elbow extension 4. elbow supination

2. wrist flexion klumpke's paralysis involves muscles muscles innervated by the lower roots of the brachial plexus (C8-T1). Paralysis affects the intrinsic hand muscles (interossei, thenar, hypotenar muscles), flexors of the wrist and fingers (flexor carpi ulnaris, ulnar half of the flexor digitorum profundus), and forearm pronators, shoulder and elbow movements are not impaired with Klumpke's paralysis

following cast immobilization for a now heeled supracondylar fracture of the humerus, the patient's elbow lacks mobility. to increase elbow ROM, joint mobilization in the maximum loose packed position should performed at what position? 1. full extension 2. 90 degrees flexion 3. 70 degrees flexion 4. 30 degrees flexion

3. 70 degrees flexion loosed packed position of humeroulnar joint is 70 degrees of flexion.

A patient is referred to a women's health clinic with moderate to severe uterine prolapse? what symptoms should the therapist examine for? 1. absent perianal sensation 2. bowel leakage 3. LBP and perianal discomfort aggravated by prolonged standing 4. LBP and perianal discomfort aggravated by lying down

3. LBP and perianal discomfort aggravated by prolonged standing LBP and perianal discomfort aggravated by prolonged standing are common with uterine prolapse. - Perianal sensation is not decreased, patient will likely feel a sensation of heaviness or pulling on the pelvis - Pain is often relieved by lying down - Constipation and bowel movement are common

a patient diagnosed with MS experiences sudden electric like shocks spreading down the body elicited by the a manuever in the picture (pg 571), this is known as which of the following? 1. head jolt test 2. Kernig's sign 3. Lhermitte's sign 4. tinel's test

3. Lhermitte's sign lhermitte's sign is sudden, transient, electric like shocks spreading down the body when the head is flexed forward. occurs chiefly in MS but can also be seen with compression disorders of the cspine (tumor, cervical spondylitic myelopathy)

Following reattachment of the flexor tendon of the fingers, the patient is in a splint. one physical therapy goal is to minimize adhesion formation. what should the PT teach the patient to perform after 72 hours post surgery? 1. passive extension and active flexion of the IP joints 2. active extension and flexion of the IP joints 3. active extension and passive flexion of IP joints 4. gentle passive extension and flexion of IP joints

3. active extension and passive flexion of IP joints -there should be no active flexion of involved digits for weeks 1-3. passive extension of fingers should not be done until there is adequate strength of the repair

A patient with a long history of cigarette smoking has been admitted to the hospital and presents with tachycardia, signs of lung infection, abnormal breath sounds, and dullness to percussion? what should be the therapists INITIAL intervention focus on with this patient? 1. getting the patient to quit smoking 2. breathing reeducation to increase efficiency of smoking 3. airway clearance and secretion removal 4. graded inspiratory muscle training

3. airway clearance and secretion removal patient has signs and symptoms of pneumonia,it is important to assist with secretion clearance with recovery from the infection and improve gas exchange

a young adult who is comatose (Glasgow coma scale score of 3) is transferred to a long term care facility for custodial care. on initial examination, the therapist determines the patient is demonstrating decerebrate posturing. which limb or body positioning is indicative of this? 1. UEs in flexion and and LEs in extension 2. extreme hyper extension of the neck with both LEs flexed and heels touching the buttocks 3. all four limbs in extension 4. all four limbs in flexion

3. all four limbs in extension decerebate posturing is UE and LE both held rigidly in extension -decorticate UEs are in flexion, LEs in extension -opisthotonos: extreme hyperextension of the neck and spine, with both LEs flexed and heels touching the buttocks

a patient experienced a right CVA 2 weeks ago. the patient has motor and sensory impairments primarily in the LLE. the LUE shows only mild impairments. there is some confusion and perseveration. based on these findings, what time of stroke syndrome does the patient present with? 1. posterior cerebral artery stroke 2. internal carotid syndrome 3. anterior cerebral artery syndrome 4. middle cerebral artery syndrome

3. anterior cerebral artery syndrome signs and symptoms are characteristic of ACA syndrome with contralateral hemiplegia and LEs more affected than UEs

A therapist has been treating a patient over a period of 4 months for decreased shoulder elevation and a loss of ER. recovery has been good however patient still complains of being unable to reach the upper shelves of kitchen cabinets and closets. to help patient achieve the goal, what should the focus of manual therapy be? 1. superior glide 2. inferior glide 3. anterior glide 4. grade II oscillations

3. anterior glide -anterior glide would help increase ER which is a component of full ER, performing anterior glides to improve ER and late flexion will help increase overhead reach since ER of humerus occurs with flexion

During an examination, limitations of ultrasound imaging include? 1. inability to clearly see cartilage 2. disruption of cardiac pacemakers 3. difficulty of penetrating bone and therefore visualizing internal structure of bones 4. inability to give a clear picture of tendons and therefore diagnose tendon tears

3. difficulty of penetrating bone and therefore visualizing internal structure of bones -ultrasound has difficulty penetrating bone -ultrasound is usually used to diagnose tendon tears, abnormalties of muscles (such as tears), fluid collection within muscles, bursae, and joints, benign and malignant soft tissue tumors, early changes in RA, fluids in a painful hip in children, lumps in neck muscles of infants, and soft tissue masses in children

during observation of bilateral active SLR in supine, the patient demonstrates progressively increasing lumbar lordosis during lowering of limbs with each successive lift. what is the MOST LIKELY cause of the observed excessive lordosis during the bilateral SLR activity? 1. muscle imbalance between rectus femoris and sartorius muscles 2. weakness of both the quadratus lumborum muscles 3. fatigue weakness of the rectus abdominis and oblique muscle groups 4. excessive elastic shortening of the ipsilateral hamstring muscle group

3. fatigue weakness of the rectus abdominis and oblique muscle groups during this activity excessive lordosis is associated with excessive anterior pelvic tilt, normally muscles that control anterior pelvic rotation (posterior pelvic rotators) act to counter the anterior torques produced by the mass of the lower limbs lifted off the table, helping unwanted sagittal plane movements of the lumbar spine. contractile activities of he anterior trunk muscles (rectus and obliques) provide a posterior pelvic rotation moment on the pelvis, helping to stabilize the pelvis, fatigue weakness of the anterior trunk muscles in this patient could result in poor control of sagittal plane rotation of the pelvis leading to the observed lumbar lordosis

A patient with coronary artery disease has been doing regular aerobic exercise on treadmill. if the patient fails to comply with in taking prescribed beta-blocker medication and continues to exercise what potential rebound effect could result? 1. increased in BP and decrease in HR during exercise 2. decrease in BP and HR during exercise 3. increase in BP and HR during exercise 4. decrease in BP and increase in HR during exercise

3. increase in BP and HR during exercise Beta-blockers affect the beta-1 adrenergic receptors. blocking these inhibits the sympathetic response. however if abruptly terminated they cause a reflexive opposite response. this patient will demonstrated increased contractility, BP, and HR as a result

What will a patient with significant right thoracic structural structural scoliosis demonstrate during examination? 1. decreased breath sounds on right 2. decreased thoracic rib elevation on the right 3. increased lateral costal expansion on the right 4. shortened internal and external intercostals on right

3. increased lateral costal expansion on the right -in right thoracic scoliosis, the convex side is on the right. this would allow for increased aeration and mobility on that side -ribs would elevate normally or more on the right side -the left side would have shortened muscle length and aeration making answers 1 and 4 incorrect

Following mastectomy with axillary lymph node disection, a patient developed 4+ edema in ipsilateral arm. a compression garment was ordered. what is the primary reason this garment decreases edema? 1. it decreases osmotic pressure of capillaries 2. it increases the capillary permeability 3. it exceeds the internal hydrostatic pressure 4. in equals the fluid outflow from the capilaries

3. it exceeds the internal hydrostatic pressure the external pressure of the compression garment essentially increases the amount of pressure on the tissue. this causes a relative increase in hydrostatic pressure in the extravascular space compared with the intravascular space

a therapist is examining a patient with an ulcer in the lower leg/ankle and suspects it is arterial rather than venous. one of the factors the therapist uses to to detemine this is based on the location of the ulcer. what is the typical location of an arterial ulcer? 1. medial malleolus 2. posterior tibial area 3. lateral malleolus 4. medial distal tibia

3. lateral malleolus arterial ulcers: distal lower leg (toes, foot), LATERAL malleolus, anterior tibial area venous: distal lower lower, MEDIAL malleolus

this picture (pg 550) depicts a clinician assessing for stemmer's sign. the clinician is examining for what condition? 1. bunion 2. hammer toe 3. lymphedema 4. fracture of the second toe

3. lymphedema stemmer's sign is a sign of lymphedema

an elderly patient with degenerative joint disease is seen by a PT 3 days following a total knee replacement. which of these findings would be an indication for the therapist to contact the surgeon? 1. patient is noncompliant when learning to transfer properly 2. patient cannot ambulate at least 50 ft with standard walker 3. patient fails to recognize the therapist on the 3rd consecutive post op visit 4. patient complains of soreness at incision site

3. patient fails to recognize the therapist on the 3rd consecutive post op visit patient is demonstrating signs of postoperative delirium which is a safety concern.

a patient is recovering from a mild stroke with trunk weakness and postural instability. the patient complains of severe heartburn. what is the BEST choice to maximize stroke recovery and improve trunk stabilization while minimizing heart burn? 1. perform trunk stabilization exercises with the patient in the semi-fowler position 2. begin with bridging exercises progressing to sitting holding 3. perform resisted holding in sitting using rhythmic stabilization 4. instruct patient to take antacids right before PT

3. perform resisted holding in sitting using rhythmic stabilization heart burn is aggravated by supine, prone, or bridging, modifying patient's position to upright can alleviate the symptoms -semi-fowler position (supine, head, and torso elevated 30 degrees) is not an effective position to work on trunk stabilization -bridging would aggravate heartburn -prophylatic use of antacids before PT is not indicated and with severe heartburn the patient would be on an proton pump inhibitor instead

A chest tube gets dislodge during PT treatment. if a patient fails to cover the defect, what could the patient develop? 1. pulmonary embolism 2. pulmonary edema 3. pneumothorax 4. aspiration pneumonia

3. pneumothorax -with removal of the chest tube, there is an increased positive pressure on the lung tissue. the lung is not able to inflate and it succumbs to the pressure and therefore collapses -chest tube does not affect the other options

A patient presents to physical therapy with a complaint of 7/10 ankle pain after an inversion injury earlier in the day. the patient does not want to bear weight on the involved side due to pain. there is slight eccymosis observed over the lateral ankle and foot with significant swelling. the patient is also tender to palpation on the tip of the lateral malleolus and area of the ATFL. in this case what would the therapists INITIAL action? 1. ice and cross friction massage to the ATFL 2. ice and compression wrap of both the foot and ankle 3. refer for radiography of the ankle 4. perform an anterior drawer test

3. refer for radiography of the ankle patient is unable to bear weight and has tenderness at lateral malleolus, indications for radiograph to rule out fracture

which of these findings is characteristic of boutonniere deformity of the finger? 1. flexion of the DIP 2. contracture of the extensor digitorum tendon 3. rupture with volar slippage of the lateral bands 4. hyperextension of the PIPs

3. rupture with volar slippage of the lateral bands injury involves volar slippage, DIP is in extension not flexion, PIPs will be in flexion

a physical therapist is examining a patient who has a recent history of falls on level surface. interaction with patient indicates that cognition is unaffected. which tests should be performed next once it has established that cognition is not impaired? 1. static balance activities 2. locomotor tests 3. sensory testing 4. dynamic balance tests

3. sensory testing sensory testing should be assessed before any of the other balance tests are performed

a physical therapist is performing an examination of an elderly patient who is confined to bed in a custodial care facility. a large ulcer is observed on the right heel as shown in the picture (p 582). based on the staging of pressure ulcers, how would this ulcer be classified? 1. stage I ulcer 2. stage II ulcer 3. stage III ulcer 4. stage IV ulcer

3. stage III ulcer stage III ulcer is categorized by full thickenss skin loss with damage or necrosis of subcutaneous tissue, presents clinically as a crater

a therapist is instructing the family of a 9 year old boy with Duchenne's muscular dystrophy. what should be the main focus of the plan of care for maintaining function in the LEs? 1. strengthening the knee extensors and plantar flexors 2. strengthening the plantar flexors and stretching the hip extensors 3. stretching the hip flexors and plantar flexors 4. strengthening the hip flexors and knee extensors

3. stretching the hip flexors and plantar flexors stretching of hips, knees, plantar flexors and IT band is important to prevent contractures. strenuous exercise and strengthening may cause breakdown of muscle fibers

Three months ago a patient experienced a traumatic injury to the hand that resulted in surgical tendon repair and fracture stabilization. the therapist is planning a treatment program to address tightness of the lumbricals. what exercises would be BEST in order to increase ROM of the hand? 1. both MCP and IP joints into flexion 2. both MCP and IP joints are moved into extension 3. the MCP joints are extended and IP joints are flexed 4. the MCP joints are flexed and the IP joints are extended

3. the MCP joints are extended and IP joints are flexed Action of lumbricals in MCP flexion, IP extension so MCP extension, IP flexion would stretch the muscle

a patient complains of excessive UE and LE muscle aching, cramping, and right upper quadrant pain when exercising. patient has a history of chronic alcoholism and was placed on atorvastin (a statin drug) 2 months ago. the therapist should refer the patient to primary care physician for what reason? 1. for an exercise test to determine right exercise intensity 2. to rule out cirrhosis of the liver 3. to rule out liver and muscle dysfunction from statin 4. to rule out gallstones that may be obstructing the bile duct

3. to rule out liver and muscle dysfunction from statin a small percentage of patients (< 5% ) who take statins experience myalgia, cramps, stiffness, spasms, or weakness affecting exercise tolerance. patient needs to see PCP to have the dose or medication changed

a therapist wishes to examine the balance of an elderly patient with a history of falls. the Berg balance test is selected. which area is NOT examined during this test? 1. sit to stand transitions 2. functional reach in standing 3. turning while walking 4. tandem standing

3. turning while walking Berg is a test of static and dynamic balance in sitting and standing. it does not include items on gait, turning while walking is on the Tinetti and DGI

the primary contribution of a physical therapist member of a facility emergency/disaster preparedness committee in formulating a disaster plan is descibing the role of physical therapists in providing which of the following? 1. triage and basic life support during the disaster 2. evaluation of soft tissue injuries and rendering appropriate care 3. unique preparedness concerns needed for people with disabilities or special needs 4. emotional distress management of victim or patients during crisis situations

3. unique preparedness concerns needed for people with disabilities or special needs the PT's unique contribution to the team is in addressing the concerns of individuals with disabilities or special needs

A patient is referred to PT with a 10 year history of RA? what are the possible extra-articular complications? 1. disc degeneration 2. psoriatic skin and nail changes 3. vasculitis 4. conjunctivitis and iritis

3. vasculitis - Inflammation of the blood vessels - RA is a degenerative autoimmune disease that effects primarily joints and synovial tissue. Extraarticular complications that can occur with RA include vasculitis, all others are not associated with RA.

upon removing the dressing covering a decubitus ulcer located on the heel of an elderly patient, the PT observes, copious amounts of foul-smelling, yellow-green discharge. how should the therapist document this finding in the patient's medical record? 1. there is a likelihood of a Staphylococcus aureus infection 2. maceration of the wound is evident 3. wound exudate is purulent 3. wound exudate is serosanguinous

3. wound exudate is purulent purulent based on he yellow-green discharge, without a wound culture you cant know what bacteria it is, serosanguinous exudate is bloody, macerated skin is softened skin, drained of its pigment, and is white in appearance

When visually examining active abduction of the arm to 150 degrees, what is the normal composition of motion the therapist would expect? 1. 150 degrees of GH motion, 0 degrees scapulothoracic 2. 110 degrees of GH motion, 40 degrees ST 3. 75 degrees GH motion, 75 degrees ST 4. 100 degrees GH motion, 50 degrees ST

4. 100 degrees GH motion, 50 degrees ST 2:1 GH to ST ratio, 100 GH, 50 ST only choice that fits this ratio

The interview with an 18 year old female cross country runner elicits a history of stiffness and diffuse ache in her right knee that is aggravated by prolonged sitting. going down stairs is also painful. based on this information what is LIKELY the diagnosis that should serve as a focus for the physical examination? 1. IT band friction syndrome 2. Osgood Schlatter disease 3. Meniscal tear 4. Patellofemoral syndrome

4. Patellofemoral syndrome patellofemoral pain syndrome is common in young, running females, includes pain with sitting and going down stairs

during pregnancy, the presence of the hormone relaxin can lead to abnormal movement and pain. which joints are typically affected? 1. GH joint 2. hip joint 3. lumbosacral joint 4. SI joint

4. SI joint

while ambulating a patient in the parallel bars, a therapist loses control and patient falls, hitting her head on the bar. patient lies motionless on teh floor between the bars bleeding heavily from a scalp laceration. what is the first thing the therapist should do? 1. apply a thick gauze and manual pressure to the scalp wound 2. check for responsiveness 3. call EMS 4. immediately determine the patient's HR and BP

4. administer vigorously once every 2 hours

a patient with cystic fibrosis has been admitted to the hospital in acute respiratory failure as a result of an infection. what is the BEST use of airway clearance techniques? 1. do not administer since it is contraindicated in acute respiratory failure 2. administer 2x/day to patient's tolerance 3. administer according to the patient's correct home regimen 4. administer vigorously once every 2 hours

4. administer vigorously once every 2 hours given the pathology of CF, it is important to clear secretions as often as possible to assist with clearing of the infection, it will also assist with maximizing gas exchange

confirmation of a diagnosis of spondyT can be made when viewing an oblique radiograph of the spine, what is the relevant diagnostic finding? 1. posterior displacement 2. bamboo appearance of spine 3. compression of the vertebral bodies of L5 and S1 4. bilateral pars interarticularis defects

4. bilateral pars interarticularis defects SpondyT is forward translation of a vertebral body with respect to the vertebral body below, spondylol is a break in the pars interarticularis and may or may not be associated with SpondyT, if the pars defect is bilateral it may allow slippage of the vertebrae, typically L5 on S1 resulting in spondyT -posterior displacement is the wrong direction, bamboo spine is seen with ankylosing spondylitis -compression of vertebral bodies would be a compression fracture and not result in forward slippage

A child experienced a superficial partial thickness burn from scalding pot of water affecting 26% of her thorax and neck. on what should the therapists POC focus? 1. return to preburn function and ADLs 2. pain management 3. infection management 4. chest wall mobility and prevention of scar contracture

4. chest wall mobility and prevention of scar contracture -chest wall mobility and prevention of scar contracture as well as normal neck ROM are initial major goals of therapy -return to preburn function and ADLs is important goal but not initial focus -pain and infection management are important goals but typically managed by the medical team

a physical therapist and PTA are conducting a cardiac rehabilitation session for 20 patients. the therapist is suddenly called out of the room. the physical therapist assistant should do which of the following? 1. terminate the exercises and have patients monitor their pulses until PT returns 2. have patients continue with the same exercise until therapist returns 3. have patient switch to a less intense exercise until the therapist returns 4. continued with the outlined exercise progression for that session

4. continued with the outlined exercise progression for that session the PT provided the exercise program and it is appropriate for the PTA to follow it

A patient with a transtibial amputation of 2 months duration complains of an intense burning that seems to emanate from the heel. this phantom pain mirrors the patient's preoperative pain. what is te most likely previous source of pain? 1. dosalis pedis artery obstruction 2. popliteal artery obstruction 3. damage to the superficial peroneal (fibular) nerve 4. damage to the tibial neve

4. damage to the tibial nerve -nerve supply to the heel is by the calcaneal branch of the heel -the artery choices are incorrect because phatom limb pain is the result of nerves being cut -the fibular nerve ends above the ankle by dividing into the medial and cutaneous branches, these nerves provide sensory innervation to the lateral and anterolateral skin of the distal leg and dorsum of the foot

initially a patient was seen by a PT in an outpatient clinic for 2 weeks. as it was difficult for the patient to arrange transportation, the therapist has decided to follow the patient by using telerehab. after 6 weeks, the therapist decides that the patient's exercise regime needs to be progressed. how should these exercise progressions BEST be implemented? 1. send the patient an app showing the exercise progression then watch the patient's performance using electronic means 2. have patient make a trip back to the clinic to be taught new exercise variations 3. describe exercise progressions over the phone, while simultaneously viewing their performance electronically. 4. demonstrate the exercises to the patient electronically and then view the patient's performance

4. demonstrate the exercises to the patient electronically and then view the patient's performance PT demonstration and pt performance is the best and most efficient way to progress the exercise routine, allows for an interactive 2 way communication, patient does not have to make another trip and promotes patient compliance

A patient's plan of care includes use of iontophoresis for management of calcific bursitis of the shoulder. to administer treatment using the acetate ion, what characteristics and polarity should be used? 1. monophasic twin peaked pulses using the positive pole 2. monophasic twin peaked pulses using the negative pole 3. direct current using positive pole 4. direct current using the negative pole

4. direct current using the negative pole -acetate has a negative charge requiring a negative pole to repel the drug into the tissue, direct current will continuously drive the acetate into the tissue during treatment time -monophasic is pulsed and does not have the ability to continuously drive the acetate into the tissue -a positive pole will not repel the acetate ion

a patient with a BMI of 32 kg/m^2 with excessive tissue mass in the hip area. what accommodations are need to the wheelchair prescription for this patient? 1. move the small front casters closer to the drive wheels to increase stability 2. add friction rims to increase hand grip friction 3. add an antitipping device to prevent falls going up curbs 4. displace the rear axle forward for more efficient arm push

4. displace the rear axle forward for more efficient arm push this patient is obese, a bariatric wheelchair with heavy duty, extra wide wheels is necessary. the rear axle is displaced forward compared to the standard wheelchair to allow for more efficient arm push -moving front casters close to the drive wheels will decrease stability -friction rims and anti-tipping devices are for patients with spinal cord injuries

the physical therapist is instructing a mother to perform ROM and stretching for her newborn who has clubfoot. in what directions should the therapist advise her to carefully stretch? 1. plantarflexion and inversion 2. plantarflexion and eversion 3. dorsiflexion and inversion 4. dorsiflexion and eversion

4. dorsiflexion and eversion stretching should be in the opposite direction of the deforming position therefore dorsiflexion and eversion

pursed lip breathing as part of the treatment regime woudl be most appropriate for a patient with which condition? 1. circumferential thoracic burns 2. asbestosis 3. rib fracture 4. emphysema

4. emphysema pursed lip breathing would have little to no effect on the other choices whereas pursed lip bearthing gives increased resistance to the airways on exhalation. increased pressure helps prevent airway collapse associated with emphysema

a male athlete sees a PT with a complaint of "right groin strain." examination of the MSK system in the groin is inconclusive, however, the therapist does detect swollen inguinal lymph nodes on the right side only. what should the therapist do next? 1. refer athlete to a primary care physician to rule out systemic disease 2. examine lymph nodes of neck which may be swollen if mononucleosis is suspected 3. ask the patient questions relating to possible STD as many symptoms are mistaken for other conditions 4. examine the right foot, leg, and hip for injury or infection

4. examine the right foot, leg, and hip for injury or infection the most common cause of unilateral lymph node swelling is injury or infection involving the distal foot, leg, thigh, or hip. abrasions in these areas, fairly routine for many athletes are potential sources as well as insect bites. -mono: common in young men but he doesnt have a sore throat or fatigue -asking about STDs and referral to PCP are both premature

a patient has normal quadriceps strength but unilateral weakness (3/5) of the hamstring muscles on the right. what might the therapist observe during swing phase of gait? 1. excessive compensatory hip extension on the sound side 2. decreased hip flexion followed by increased knee flexion on the weak side 3. excessive hip extension followed by abrupt knee extension on weak side 4. excessive hip flexion followed by abrupt knee extension on weak side

4. excessive hip flexion followed by abrupt knee extension on weak side hamstring muscles control forward sing of the leg during terminal swing. loss of function may result in abupt knee extension and increased hip flexion

a patient is walking on a motorized treadmill and is undergoing ECG monitoring. based on viewing this cardiac rhythm strip, what action should the PT take? 1. immediately call EMS 2. modify exercise based on past cardiac disease 3. modify exercise based on current cardiac disease 4. exercise the patient/client without any restrictions

4. exercise the patient/client without any restrictions this is sinus bradycardia, there are not restrictions on proceeding with exercise in this patient as it is a normal rhythm

a patient had an ACL reconstructive surgery 2 weeks ago. during the initial examination, the PT noticed marked edema around the knee and calf. knee PROM was limited from -5 extension to 90 degrees flexion. hip PROM was WNL. ankle DF was limited to 0 degrees because of pulling pain in the calf. marked tenderness to superficial palpation to anterior knee and posterior calf and increased temperature were noted. the patient is experiencing calf pain and discomfort when standing during PWB ambulation. upon completion of the examination, what is the BEST intervention at this time? 1. isometrics and PROM for the knee 2. massage the knee and calf to help alleviate the expected postsurgical edema 3. ice and interferential current to alleviate edema and facilitate movement 4. immediate referral to the surgeon

4. immediate referral to the surgeon patient may have a DVT based on increased swelling, temperature, tenderness, and pain in the calf with weight bearing 2 weeks after surgery so referral to the surgeon is the best intervention at this time

a therapist is examining gait of a patient with a transfemoral prosthesis. the patient circumducts the prosthetic limb during swing. the therapist needs to identify the cause of the gait deviation. what is the most likely prosthetic cause? 1. unstable knee unit 2. inadequate socket flexion 3. high medial wall and abducted hip joint 4. increased knee flexion resistance

4. increased knee flexion resistance prosthetic causes of circumduction include a long prosthesis, locked knee unit, inadequate knee flexion, inadequate suspension, small or loose socket, plantar flexed foot -unstable knee unit would cause forward flexion during stance -high medial wall or abducted hip joint will result in abducted gait -inadequate socket flexion will result in lordosis during stance

a neonates APGAR score at 1 minute after birth is 8, at 5 minutes it is 9. based on this score and expected HR, what can the therapist conclude about this infant? 1. the infant would have a heart rate less than 100 bpm with slow and irregular respiration and not require resuscitation 2. the infant would require extensive resuscitation efforts including intubation 3. infant would require some resuscitation and administration of supplemental oxygen 4. infant would have a HR greater than 100 bpm with good respiration and not require resuscitation

4. infant would have a HR greater than 100 bpm with good respiration and not require resuscitation early signs of receiving top APGAR scoe of 2 each include heart rate over 100 bpm, good respiration, crying, active movements, cough, sneeze, and pink color (total of 10). Apgar scores of 8-10 at one minute are considered normal

A patient has adhesive capsulitis of the GH joint. what is the expected greatest limitation of motion when performing shoulder ROM? 1. flexion 2. abduction 3. medial rotation 4. lateral rotation

4. lateral rotation capsular pattern of GH joint is external rotation most limited

To prepare a patient with cauda equina lesion for ambulation with crutches, what upper quadrant muscles are most important to strengthen? 1. upper trapezius, rhomboids, levator scapulae 2. deltoid, corachobrachalis, brachialis 3. middle trapezius, serratus anterior, triceps 4. lower trapezius, latissimus dorsi, pec major

4. lower trapezius, latissimus dorsi, pec major -muscles needed to crutch include shoulder depressors and extensors, along with elbow extensors -all other choices enhance shoulder abduction or elevation

a patient with diabetes mellitus has had a stage III decubitus ulcer over the right ischial tuberosity for the past 5 months. the ulcer is infected with staphlococcus aureus, and necrotic tissue covers much of the wound. what therapeutic modality is contraindicated in this situation? 1. low voltage constant microamperage direct current 2. high voltage monophasic pulsed current 3. pulsed monophasic current 4. moist hot packs

4. moist hot packs both a moist environment and heat can accelerate bacterial growth, hot packs would be contraindicated in this case, all other options are not contraindicated and can aid in healing

a patient with chronic asthma as been admitted to the hospital with an acute exacerbation. what is the MOST important information the therapist needs to determine patient's prognosis with PT? 1. current medication list 2. previous history of the disease 3. the most recent chest xray 4. most recent pulmonary function test results

4. most recent pulmonary function test results recent pulmonary function test results will give the therapist information regarding the severity of the lung disease and will assist in determining how much the patient will progress

a patient was referred to PT with chief complaint of neck and posterior arm pain and paresthesias in thumb and index finger. a C6 radiculopathy is suspected. the therapist decides to treat patient with mobilizations to the lower cervical spine. which statement indicates a favorable response to the treatment? 1. neck pain improves and distal symptoms increase 2. neck pain improves, no change in distal symptoms 3. no change in neck pain, distal symptoms increase 4. no change in neck pain, distal symptoms decrease

4. no change in neck pain, distal symptoms decrease centralization occurs when patient's symptoms move from a more distal or peripheral area to a location closer to the spine

a group of institutionalized elderly was examined for balance instability and fall risk using a standardized test, the performance oriented mobility assessment (POMA). the test retest reliability of the total test (POMA-T) and subtests, balance subtest (POMA-B) and gait subtest (POMA-G) varied between 0.77-0.86. the interrater reliability values range from 0.80-0.93. what is the therapists correct interpretation of these findings? 1. overall the test demonstrated moderate reliability 2. the test demonstrated moderate reliability for test-retest and good reliability for interrater comparisions 3. the test demonstrated poor reliability for test-retest and moderate reliability for interrate comparisons 4. overall the test demonstrated good reliability

4. overall the test demonstrated good reliability reliability coefficients above 0.75 demonstrate good reliability, this test demonstrated good reliability in both test retest and interrater comparisions -poor reliability = <0.5, 0.5-0.75 moderate reliability

following a MVA, a patient with chest trauma developed atelectasis? which intervention is ineffective in the immediate management of atelectasis? 1. pain reduction techniques 2. segmental breathing 3. incentive spirometry 4. paced breathing

4. paced breathing -in order to reverse atelectasis, patient needs to facilitate deep breathing. paced breathing controls the rate of breathing and not the depth so therefore it would be ineffective -all other options would facilitate deep breathing and would be effective in reversing atelectasis

a patient with type I diabetes mellitus has generalized osteoporosis. what is the BEST exercise to include in this patient's POC? 1. bilateral quadriceps presses against resistance in sitting 2. aquatic exercises 3. running on a treadmill 4. partial squats in standing

4. partial squats in standing extensor stabilization exercises in weight bearing provide the best stimulus to bone (e.g. standing holding against resistance, standing partial squats) -high load short duration activities (jumping, running, weights) provide less stimulus to bone while posing increased risk of muscles strain and injury, buoyancy of water limits loard on bone during aquatic exercises

a patient presents with chronic restriction of TMJ. the PT observes a the situation seen in the picture (pg 541) during mouth opening ROM assessment. what is the best intervention if the patient has a classic TMJ unilateral capsular restriction? 1. left TMJ, superior glide manipulation 2. left TMJ, inferior glide manipulation 3. right TMJ, superior glide manipulation 4. right TMJ, inferior glide manipulation

4. right TMJ, inferior glide manipulation -in the picture chin is deviated to the right at terminal opening. the active ROM would be limited with ipsilateral opening and a lateral deviation to the side of restriction for patients with TMJ capusular pattern resriction -left TMJ incorrectly states the capsular pattern -superior glide manipulation on the right would compress the joint, not affording stretch to capsule tightness

What would a therapist who is examining the breathing pattern of a patient with a complete (ASIA A) C5 spinal cord injury expect to observe? 1. asymmetrical lateral costal expansion due to ASIA A injury 2. increased subcostal angle due to air trapping from muscle weakness 3. no diaphragmatic motion since the diaphragm is below the level of lesion 4. rising of abdomen due to no abdominal muscle tone on the abdominal viscera

4. rising of abdomen due to no abdominal muscle tone on the abdominal viscera -abdominal musculature provides external stability to the abdominal viscera, without this, the viscera are displaced with respiration -with an ASIA A injury the muscle weakness would be symmetric -the diaphragm is innervated by C3-5 nerve roots so it would be functioning in this patient -muscle weakness would cause a restrictive disorder (inability to generate negative pressure), not a obstructive disorder (air trapping)

to prevent contractures in a newly admitted patient with anterior neck burns, it would be best to position the neck in which of the following? 1. hyperflexion 2. slight flexion 3. neutral 4. slight extension

4. slight extension positioning of the neck/head in slight extension will counteract the expected pull into flexion with contracture development -positioning in slight flexion or hyperflexion would enhance the expected development of anterior neck flexion contracture -neutral position doe not provide enough lengthening of tissues

a competitive gymnast is examined by a PT. the chief complaint is nagging, localized pain in the anterior left lower leg that is consistently present at night and increases during activity with swelling. what are these complaints most characteristic of? 1. bone tumor 2. anterior compartment syndrome 3. shin splints 4. stress fracture

4. stress fracture edema after an increase in activity is characteristic of stress fracture

following a period of spinal shock, a patient with a complete spinal cord injury (ASIA A) at T5 level is placed on a bladder training program coordinated by the nurse. a realistic ultimate outcome for this program would be independent voiding using which of the following? 1. the crede maneuver 2. the valsalva manuever 3. a time voiding program 4. suprapubic stroking or tapping

4. suprapubic stroking or tapping a spastic or reflex (UMN) bladder contracts and reflexively empties in response to a certain level of filling pressure. reflex emptying can be triggered by manual stimulation techniques (e.g. stroking, kneading, or tapping the suprapubic area) -all other options are for LMN (flaccid bladder)

a physical therapist observes a full term infant in the NICU just after birth. in the supine position, shoulders are abducted, externally rotated, elbows and fingers are flexed, hips are abducted and externally rotated, and knees are flexed. what would this posturing be an indication of? 1. UE tone is abnormal 2. LE tone is abnormal 3. tone is abnormal in both UE and LE 4. tone is normal in both UE and LE

4. tone is normal in both UE and LE initial tone and posturing involve some flexion of the limbs, at one month decreased flexion can be expected

a patient in the late stages of parkinson's disease exhibits episodes of akinesia while walking. what should the therapist examine? 1. primary involvement of head and trunk 2. associated dykinesias 3. primary involvement of the hips and knees 4. triggers that precipitate the freezing episodes

4. triggers that precipitate the freezing episodes freezing of gait (episodes of akinesia) is typically associated with a trigger (turning, changing direction, speed, doorways). identifying triggers is helpful in development of POC.

following a hard tackle, a football player exhibits signs of fracture ribs and a pneumothorax. when auscultating during inhalation over the injured area, what would the PT expect to hear? a. soft, rustling sounds on inhalation b. decreased or no breath sounds c. crackles d. wheezes

b. decreased or no breath sounds the fractured ribs would cause the patient to have pain and therefore not take deep breaths. more importantly, the pneumothorax will cause an increasingly positive pressure on the lung, not allowing it to inflate. the result would be minimal air movement and decreased absent breath sounds -soft rustling are normal vesicular sounds -crackles are expected with atelectasis or secretions -wheezes would not be possible to hear because there is minimal air movement