Exam 2-N

A male patient had an uncomplicated MI two weeks ago and has just completed phase one of cardiac rehab. He is now set to begin phase two of cardiac rehab and begin a walking program. Which of the following MET values is NOT appropriate for this patient's walking program during phase two of cardiac rehab? Select one: 1. 4-5 METs 2. 6-7 METs 3. 8-9 METs 4. 10-11 METs

The correct answer is: 10-11 METs Answer:During phase two of cardiac rehab, a patient will tolerate activities between 4-9 METs. The frequency is 3-4 sessions per week and the duration is 30-60 minutes with 5-10 minutes of warm-up and cool-down. The patient is ready to be discharged when he reaches 9 METs functional capacity. Reference: ACSM's Guidelines for Exercise Testing and Prescription ninth edition pages 2-3.

Which of the following patients will have an absolute contraindication for aquatic therapy? Select one: 1. A 40 year female with lymphedema post mastectomy but with a fear of water 2. A 55 year patient status post stroke with a G-tube 3. A 22 year male athlete with an open wound covered with an occlusive dressing 4. A 50 year patient with respiratory disorder and vital capacity <1 litre

The correct answer is: A 50 year patient with respiratory disorder and vital capacity <1 litre Answer: Special precautions may be required for patients with open wounds with occlusive dressing, fear of water and for patients with a G-tube. These patients need to be closely monitored and have relative contraindications for aquatic therapy. Water immersion may adversely affect the breathing of a patient with a respiratory disorder. Lung expansion tends to be inhibited secondary to hydrostatic pressure against the chest wall. Additionally, increased circulation in the chest cavity may further inhibit lung expansion due to increased circulation to the center of the body. Hence, a patient with vital capacity <1L is an absolute contraindication for aquatic therapy. Reference: Therapeutic exercises. Kisner . 6thed. Page 291-292.

A patient with a history of Parkinson's disease demonstrates a festinating gait. Which strategies given by the Physical Therapist is least effective in improving his gait? Select one: 1. A rolling walker to improve speed 2. Leather shoes with hard flat heels to prevent falls 3. Addition of a toe wedge to his shoes to slow propulsion 4. Vertical poles for upright posture

The correct answer is: A rolling walker to improve speed Answer: A walker with wheels can be a hazard for these patients as it can increase festination. So, it is the least effective. Generally, a toe wedge or flat heel is preferred in a shoe as it decreases the forward propulsion. A hard composition shoe or leather shoes are preferred over rubber soles which might not slide easily and catch and cause a fall. Vertical poles promote upright posture and can decrease festination due to forward propulsion. Reference: Physical Rehabilitation by Susan O Sullivan. ED.6 Pg. 811-813,824-825.

Which of the following are the three tracts that make up the spinothalamic pathway and what are the specific sensations for each tract? Select one: 1. Anterior (ventral) spinothalamic tract: crude localized touch and pressure; Lateral spinothalamic tract: fine touch, pressure, and vibration; Spinoreticular tract: pain and temperature 2. Anterior (ventral) spinothalamic tract: fine touch, pressure, and pressure; Lateral spinothalamic tract: diffused pain sensations; Spinoreticular tract: pain and temperature 3. Lateral spinothalamic tract: crude localized touch and pressure; Anterior (ventral) spinothalamic tract: pain and temperature; Spinoreticular tract: diffused pain sensations 4. Anterior (ventral) spinothalamic tract: crude localized touch and pressure; Lateral spinothalamic tract: pain and temperature; Spinoreticular tract: diffused pain sensations

The correct answer is: Anterior (ventral) spinothalamic tract: crude localized touch and pressure; Lateral spinothalamic tract: pain and temperature; Spinoreticular tract: diffused pain sensations Answer: Compared with the dorsal column-medial lemniscal system, the anterolateral spinothalamic pathways make up a cruder, more primitive system. The spinothalamic tracts are capable of transmitting a wide variety of sensory modalities. However, their diffuse pattern of termination results in only crude abilities to localize the source of a stimulus on the body surface, and poor intensity discrimination. The three major tracts of the spinothalamic system are the (1) anterior (ventral) spinothalamic tract, which carries the sensations of crudely localized touch and pressure; (2) the lateral spinothalamic tract, which carries pain and temperature; and (3) the spinoreticular tract, which is involved with diffuse pain sensations. Reference: O'Sullivan Physical Rehabilitation 6th edition, page 99-100.

A 50-year-old patient with colon cancer is 10 weeks status post a debulking surgery and is undergoing chemotherapy for the next 6 months. The patient has asked his Physical Therapist for an appropriate exercise program to improve his endurance. What would be the best approach to improve his endurance and attain optimal fitness? Select one: 1. Tell him to come back after 6 months, as it is harmful to exercise during chemotherapy 2. Prescribe exercise of 60-70% VO2max, 5 days/ week 3. Ask him to exercise at an intensity of 40-60% VO2max, as higher intensities can be harmful 4. Give him an exercise prescription of 60-70% VO2max, 75 minutes/week

The correct answer is: Ask him to exercise at an intensity of 40-60% VO2max, as higher intensities can be harmful Answer: According to the ACSM guidelines patients recovering from cancer or undergoing chemotherapy/cancer treatments are encouraged to exercise 5 or more days a week at an intensity of 40-60% VO2max for optimum health benefits. Unless the patient has anemia or undue fatigue, exercise at this intensity is not harmful. It is actually beneficial to improve endurance and attain optimal fitness. Reference: ACSM's Guidelines for Exercise Testing and Prescription ninth edition page 267

When deciding to perform postural drainage, which of the following is NOT a RELATIVE consideration for the Trendelenburg position? Select one: 1. Congestive heart failure 2. Pulmonary edema 3. Hiatal hernia 4. Axillofemoral bypass graft

The correct answer is: Axillofemoral bypass graft Answer: Positioning a patient so that the bronchus of the involved lung segment is perpendicular to the ground is the basis for postural drainage. Using gravity, these positions assist the mucociliary transport system in removing excessive secretions from the tracheobronchial tree. Although these postural drainage positions are optimal for gravity drainage of specific lung segments, such positioning may not be realistic for some patients. Modification of these standard positions may prevent any untoward effects yet will still enhance secretion removal. Reference: O'Sullivan Physical Rehabilitation 6th edition, page 515-517.

A Physical Therapist is treating a 70 year-old patient with Parkinson's disease and wants to teach the patient how to perform a wheelchair transfer to the commode. The patient has low endurance but is able to transfer to the wheelchair from the bed without any assistance after a week of practice. What motor learning strategy would work best for this patient to learn this task? Select one: 1. Blocked and massed practice. 2. Random and massed practice. 3. Random order and distributed practice. 4. Blocked and distributed practice

The correct answer is: Blocked and distributed practice Answer: The patient is wheelchair bound and has low endurance, this suggests he is an advanced PD patient. These patients do not have cognitive abilities to do random practice. The focus here should be to help them learn the activity through repetition, which is best with blocked practice. The patient has low endurance, so distributed practice (less practice, more rest) is preferred. Reference: Physical Rehabilitation by Susan O Sullivan. ED.6 Pg. 829-830

A patient complains of right foot pain during long distance walking. During gait assessment, the Physical Therapist notices the calcaneus is going into eversion and there is an internal rotation of the tibia. Which foot orthotic device is most suitable to limit flexible calcaneal eversion? Select one: 1. Posterior leaf spring 2. Valgus post 3. Lateral wedge 4. Calcaneovalgus correction post

The correct answer is: Calcaneovalgus correction post Answer:Calcaneovalgus correction post is given to correct a flexible calcaneovalgus deformity. Lateral wedge is the same as valgus post. It is given for a fixed calcaneovalgus deformity for support or to correct excessive supination. Posterior leaf spring helps in providing dorsiflexion when the dorsiflexors are weak. Reference: Physical Rehabilitation by Susan O Sullivan. ED.6 Pg. 1330-1332

A 36 year-old-male patient arrived at an outpatient physical therapy clinic with chief complaints of pain in the right foot that has lasted more than six months with pain spreading at times to the right lower leg. The patient describes the pain as burning, pins and needles, abnormal sweating, changing from hot to cold, shiny thin skin, and changes in nail and hair growth. According to the medical report, the physician did confirm a potential nerve injury. The Physical Therapist should suspect the patient MOST likely as which of the following conditions? Select one: 1. Complex Regional Pain Syndrome 2 2. Diabetic neuropathy 3. Complex Regional Pain Syndrome 1 4. Guillain Barre Syndrome

The correct answer is: Complex Regional Pain Syndrome 2 Answer: The physician confirmed a potential nerve injury which coincides with CRPS 2. If the physician did not confirm nerve injury then it would classified as CRPS 1 as the signs and symptoms are similar. Guillain Barre Syndrome occurs from an infection that attacks the immune system (symptoms: ascending muscle weakness distal to proximal, eye muscles weakness, difficulty with swallowing, prickling of pins and needles of hands and feet, unsteadiness on feet. With diabetic neuropathy, high levels of blood glucose/triglycerides causes nerve damage. The patient would experience loss of sensation in bilateral feet with shooting/burning pain in lower legs. In this case it was only observed in the right lower extremity rather than bilateral.Reference: O'Sullivan, Physical Rehabilitation, Sixth Edition, Page 174

A 45 year old male arrived to an outpatient clinic with complaints of pain that has been present for several weeks in his right shoulder specifically at the supraspinatus area. The Physical Therapist considers using ultrasound in an effort to decrease his pain. Which of the following parameters SHOULD be utilized? Select one: 1. Pulsed/50% duty cycle/1 MHz/0.8 W/cm2 2. Continuous/100% duty cycle/3 MHz/ 1.2 W/cm2 3. Continuous/100% duty cycle/1 MHz/ 1.2 W/cm2 4. Pulsed/ 50% duty cycle/3 MHz/0.6 W/cm2

The correct answer is: Continuous/100% duty cycle/1 MHz/ 1.2 W/cm2 Answer: Ultrasound parameters should be set at continuous/100% duty cycle/1 MHz/ 1.2 w/cm2. The supraspinatus is deep below the upper trapezius which is why the Physical Therapist would need to perform at 1 MHz (depth 2-5 cm). A frequency of 3 MHz is used to heat superficial tissues. Pulsed US (non-thermal) is used primarily for acute conditions.Reference:Michlovitz SL, Bellew JW, Nolan TP Modalities for Therapeutic Intervention, fifth edition, page 104

A 15 year-old gymnast walks into the Physical Therapy clinic complaining of constant low back pain. Patient presents with a hyperlordotic curve, retracted bilateral shoulder blades and displaced plumb line. Post examination, the Physical Therapist documents several observations regarding pelvic dysfunction, and pathological standing posture. The patient's pelvis is MOST likely positioned in which of the following? Select one: 1. Nutation with a posterior pelvic tilt 2. Counternutation with an anterior pelvic tilt 3. Nutation with and anterior pelvic tilt 4. Counternutation with posterior pelvic tilt

The correct answer is: Counternutation with an anterior pelvic tilt Answer: Counternutation relative to the anterior rotation of the ilium ON the sacrum or backward motion of the base of the sacrum out of the pelvis. Reference: Magee Orthopedic Physical Assessment Sixth Edition page 655.

A 26 year-old male has a history of unrepaired neurotmesis of superficial Peroneal nerve. Which foot deformity and cutaneous sensation loss should be expected in this patient? Select one: 1. Calcaneovalgus deformity, loss of sensation over the dorsum of foot 2. Calcaneovarus deformity, loss of sensation in the webspace between big toe and second toe 3. Equinovarus deformity, loss of sensation over the dorsum of the foot 4. Equinovarus deformity, loss of sensation over the lateral plantar aspect of the foot

The correct answer is: Equinovarus deformity, loss of sensation over the dorsum of the foot Answer: Superficial peroneal nerve innervates evertors of foot. If evertors are weak, the foot is pulled into inversion and plantar flexion and an equinovarus deformity occurs. The superficial peroneal nerve has a cutaneous nerve supply over the dorsum of foot and anterolateral aspect of the leg except the web space between the big toe and second toe which is innervated by the deep peroneal nerve that innervates the dorsiflexors.The lateral plantar aspect of the foot has a cutaneous nerve supply from the lateral plantar nerve which is a branch of the tibial nerve. Reference: O'Sullivan Physical Rehabilitation, sixth edition pages 90,1328

A 32 year-old female presents to the clinic with symptoms of neck, scapular and low back pain and reports her right elbow is constantly feeling tired. She states that the symptoms started 9 months ago after a motor vehicle accident. The symptoms fluctuate with the pain ranging from 2/10 at best and 9/10 at worst. The patient is an accountant and has noticed a sudden increase in her symptoms lately which she thinks is attributed to stress. On assessment the patient has multiple tender spots at various locations with no specific tight bands of muscles and no radiation to the extremities. What is the most probable diagnosis based on this observation? Select one: 1. Myofascial syndrome 2. Acute Fatigue Syndrome 3. Trigger point syndrome 4. Fibromyalgia

The correct answer is: Fibromyalgia Answer:Fibromyalgia is a chronic condition characterized by widespread pain that covers half the body (right or left half, upper or lower half) plus the axial skeleton, and generally has been present for more than 3 months. Additional symptoms include 11 of the 18 tender points at specific sites throughout the body. It usually develops after a trauma such as MVA and has fluctuating symptoms which are aggravated by physical, emotion and environmental stress. There is no referred pain pattern, no tight muscle bands and the patient usually complains of fatigue and waking unrefreshed. There is no fatigue related complaint observed with myofascial pain syndrome. Trigger point with referred pattern and tight bands of muscles are common with myofascial pain syndrome.Reference:Therapeutic exercises. Kisner . 6thed. Page. 338-339.

Avascular necrosis of the hip is caused by multiple etiologies resulting in an impaired blood supply to the femoral head. Which of the following ROMs are decreased in the hip with avascular necrosis? Select one: 1. Flexion, internal rotation, abduction 2. Flexion, external rotation, adduction 3. Flexion, external rotation, abduction 4. Flexion, internal rotation, adduction

The correct answer is: Flexion, internal rotation, abduction Answer:"FABIR" (F flexion, AB abduction, IR internal rotation) all have a decreased ROM at the hip with avascular necrosis. Avascular necrosis has symptoms including pain in the groin and/or thigh, and tenderness with palpation at the hip joint. Reference: Dutton's Orthopedic Examination Evaluation and Intervention, Third Edition Page 228

A patient is 8 weeks status post an Achilles tendon repair. The patient has recently started discontinuing the CAM boot and is unable to bear weight with complains of pain with weight bearing. The Physical Therapist should FIRST do which of the following? Select one: 1. Notify the doctor 2. Heel lift 3. Stretching of posterior compartment muscles in standing 4. Continue with CAM boot

The correct answer is: Heel lift Answer: With the conventional approach, after discontinuing the functional brace or splint, many surgeons prescribe a 1.0- or 1.5-cmheel lift for both shoes. The lifts are worn for several weeks to decrease ground reaction forces during functional activities. It is normal for a patient to have pain after weaning from CAM boot. When a patient that is 8 weeks status post an Achilles tendon repair, it is not advisable to do any standing stretches of utilize the tibialis anterior as it could affect healing. The response in the scenario is a normal response, the Physical Therapist would not need to inform the doctor unless there is severe pain/swelling in the ankle. Reference:Kisner, Carolyn. Colby, Lynn Allen. Therapeutic Exercises. Sixth Edition. 2012. 879-881

A 13 year old female presents with anterior groin pain which started two weeks ago after turning over in bed. The patient is able to walk, but with difficulty. The Physical Therapist noticed limited ROM at the hip and weakness of the hip musculature. Which hip ROM would the Physical Therapist expect to be limited? Select one: 1. Hip flexion, internal rotation, and abduction 2. Hip flexion, external rotation, and adduction 3. Hip Extension, internal rotation, abduction 4. Hip flexion, internal rotation, adduction

The correct answer is: Hip flexion, internal rotation, and abduction Answer: The condition described in the stem is SCFE. The hip will often show decreased ROM, particularly of internal rotation, abduction, and flexion. With passive flexion of the hip, the patient will frequently externally rotate the leg.Reference:Dutton's Orthopedic Examination, Evaluation, and Intervention Third Edition Pages 1141.

Which of the following medical conditions or medications does NOT cause secondary osteoporosis? Select one: 1. Glucocorticoids 2. GI diseases 3. Hypothyroidism 4. Chronic renal failure

The correct answer is: Hypothyroidism Answer:Hypothyroidism actually causes an increase in bone density. Secondary osteoporosis (develops owing to other medical conditions) including: GI diseases; hyperthyroidism; chronic renal failure; excessive alcohol consumption; use of certain medications such as glucocorticoids. Osteoporosis is detected radiographically by cortical thinning, osteopenia (increased bone radiolucency), trabecular changes, and fractures. Reference: Pathology Implications for physical therapist by Catherine c. Goodman. Ed.3 Pg. 1299

A 50 year-old female patient comes to the clinic with complaints of crepitus of her knee joint and knee pain especially when sitting for prolonged periods. The Physical Therapist is assessing the accessory movement of her knee joint. During open chain knee flexion which of the following movements should be present for normal knee biomechanics? Select one: 1. IR of tibia with inferior glide of patella 2. ER of tibia with inferior glide of patella 3. IR of tibia with superior glide of patella 4. ER tibia with superior glide of patella

The correct answer is: IR of tibia with inferior glide of patella Answer: Knee flexion is accompanied by inferior glide of the patella and internal rotation of the tibia. Knee extension is accompanied by tibial external rotation and superior glide of patella. Reference: Therapeutic exercise by Colby and Kisner, Sixth Edition, Page: 766

A 55 year-old male patient suffered a left CVA 5 weeks ago. During the examination, the Physical Therapist instructed the patient to pick up an object. The Physical Therapist stepped out of view from the patient and noticed him not picking up the object. Which of the following disorders MOST LIKELY describes this scenario? Select one: 1. Ideational apraxia 2. Ataxia 3. Aphasia 4. Ideomotor apraxia

The correct answer is: Ideational apraxia Answer: Motor apraxia is the execution of coordinated movement. Apraxia and aphasia are more common in left hemisphere lesions. Ideational Apraxia is the inability to produce movement on command as the patient is unable to formulate the required motor task. With Ideomotor apraxia the patient is unable to produce any movement on command yet the patient will be able to perform habitual tasks when not provided on command.O'Sullivan Susan B. Schmitz J.Thomas, Fulk D. George. Physical Rehabilitation. Sixth edition. 2014. Page 672

A 7 year-old complains of a vague ache in their groin that radiates to the medial thigh and inner aspect of the knee. On examination, the Physical Therapist notices decreased abduction and internal rotation. What is the MOST appropriate intervention for this child? Select one: 1. Improving the containment of the femoral head in acetabulum using the brace 2. Improving the flexibility of the adductors and internal rotators 3. Improving the flexibility of abductor and external rotators 4. Improving the strength of abductor muscle using closed chain exercises

The correct answer is: Improving the containment of the femoral head in acetabulum using the brace Answer: An important aspect in the intervention is the containment of the femoral head in the acetabulum. This is ensured by maintaining the hip in abduction and mild internal rotation for an extended period, using the Atlanta Scottish-Rite Hospital Orthosis. Although this brace does not use internal rotation-like casts as some other orthotics do, it does maintain the hip in abduction and permits approximately 90 degrees of hip flexion. Treatment methods include observation only; ROM exercises in all planes of hip motion (especially internal rotation and abduction);bracing; casting; gait training with brace and aquatic therapy. Reference: Dutton's Orthopedic Examination Evaluation and Intervention, Third Edition Page 1410-1411.

A 62 year-old male arrived to the emergency department complaining of abdominal pain, nausea, vomiting and feeling fatigued. Upon further examination, the physician conducted a blood analysis and concluded that the value of INR would MOST LIKELY: Select one: 1. Decrease 2. Remain normal for this patient 3. Be of no concern for this patient 4. Increase

The correct answer is: Increase Answer: An increase in INR indicates the blood is thinner than normal. A patient who is dehydrated would be lacking vitamin k and/or have malabsorption of multiple vitamins. A lack of vitamin k would cause the blood to become thinner. A decrease in INR would cause the blood to become thicker and would increase the risk of patient's developing a clot. Reference: Goodman CC, Fuller KS Pathology: Implications for the Physical Therapist Third Edition Pages 1712-1713, 1715

A 55 year-old female arrived at an outpatient clinic with complaints of nausea and dizziness during positional changes including getting in and out of bed. When performing the dix hall pike test, the Physical Therapist notices a persistent up beating torsional nystagmus on the left side which lasted for a duration of 1 min 20 seconds. The Physical Therapist findings are MOST consistent with which of the following diagnosis? Select one: 1. Left posterior SCC canalisthesis 2. Right posterior SCC canalisthesis 3. Right posterior SCC cupulolithiasis 4. Left posterior SCC cupulolithiasis

The correct answer is: Left posterior SCC cupulolithiasis Answer:The patient most likely presents with left posterior SCC cupulolithiasis as there is an up beating nystagmus and the duration of the nystagmus is >1 min(persistent).Canalithiasis is usually transient (transient nystagmus: duration <1 min) and superior/anterior SCC will present with down beating. Reference: Physical Rehabilitation by Susan O Sullivan. ED.6 Pg. .981.

A patient presents to an outpatient clinic with an abnormal blood pressure. The patient has a history of hyperthyroidism. What is MOST LIKELY seen in this patient? Select one: 1. Low blood pressure and cold intolerance 2. High blood pressure and cold intolerance 3. High blood pressure and heat intolerance 4. Low blood pressure and heat intolerance

The correct answer is: Low blood pressure and heat intolerance Signs and symptoms for patients with hyperthyroidism include heat intolerance, low blood pressure, tachycardia, weight loss, fatigue, hyperactive reflexes, increased sweating, tremor, nervousness, polydipsia, weakness, increased appetite and dyspnea.Reference: Goodman Differential Diagnosis For Physical Therapists 5th edition, page: 417-419

A patient complains of back pain that radiates to his buttock and leg when bending his trunk forward however the pain centralizes when he moves to an erect posture. What's the best initial intervention? Select one: 1. Lumbar traction with 25 percent body weight in prone 2. Lumbar traction with 50 percent BW in prone 3. Lumbar traction with 25 percent BW in supine 4. Lumbar traction with 50 percent body weight in supine

The correct answer is: Lumbar traction with 25 percent body weight in prone Answer: The symptoms suggest a disc pathology. Treatment force of lumbar traction for disc protrusion is 25 percent BWT in prone position. For joint distraction it is 50 percent BWT in prone. Reference: Cameron Physical agents in rehabilitation, Physical Agents in Rehabilitation: From research to Practice, fourth edition page 375

A Physical Therapist and Occupational Therapist working in a skilled Nursing facility are discussing wheelchair prescription for a patient who incurred a C6 (ASIA B) Spinal cord lesion. What is the best wheelchair prescription for this patient? Select one: 1. Manual wheelchair with propulsion aids 2. Manual wheelchair with standard hand rims for increased propulsion 3. Manual wheelchair with standard hand rims 4. Manual wheelchair with friction surface hand rims Feedback The correct answer is: Manual wheelchair with friction surface hand rims

The correct answer is: Manual wheelchair with friction surface hand rims Answer: Manual wheelchair with propulsion aids would be best for a patient with C5 SCI as the patient would not have a tenodesis grip or any grip strength. Manual wheelchair with standard hand rims would be best for a patient with C8-T1 SCI. A patient with a C8-T1 SCI will have improved grip strength secondary to preserved finger flexors and small muscles of the hand that will be innervated. Manual wheelchair with friction surface hand rims would be best for a patient with C6 SCI as tenodesis grip can be used to propel the wheelchair, however their grip is not strong and friction surface is required. Manual wheelchair with friction surface hand rims for increased propulsion would be best for a patient with C7 SCI as they will have improved grip strength but may still benefit with friction surface for increased propulsion. Reference: Physical Rehabilitation by Susan O Sullivan. ED.6 Pg. 921-923

A 45 year-old patient presented with pes planus and complains of pain on the plantar aspect during the late stance phase of gait. Which of the following interventions would be LEAST effective for this patient? Select one: 1. Stretching of gastrocnemius muscle 2. Marble pick ups 3. Improvement of 1stTMT joint ROM 4. Medial glide at the subtalar joint

The correct answer is: Medial glide at the subtalar joint Answer: Patient's with pes planus present with a limited windlass effect and with an abnormally dropped medial longitudinal arch. The patient will have an overstretched and weakened plantar fascia and cannot adequately accept or dissipate body weight. A foot with pes planus(flat foot) typically has a poorly supported medial longitudinal arch. During an attempt to stand up on their tiptoes, the forefoot sags under the load of the body weight. The reduced extension of the metatarsophalangeal joints limits the usefulness of the windlass effect. Even with strong activation of the intrinsic muscles, the arch remains flattened and the midfoot and forefoot unstable. Reference: Neumann, Kinesiology of the Musculoskeletal System, second edition, page 604.

A Physical Therapist is performing PROM on a patient with foot pain, status post immobilization from a deltoid ligament. The patient has eversion of 10 degrees and inversion of 30 degrees at their right foot. No muscle tightness is observed. MMT of the peroneus longus and brevis is 4+ and tibialis anterior is 4. What is the MOST appropriate intervention to perform on this patient? Select one: 1. Medial glide at the subtalar joint 2. Lateral glide at the subtalar joint 3. Strengthening of peroneus longus and brevis 4. Strengthening of tibialis anterior

The correct answer is: Medial glide at the subtalar joint Answer: The patient has a limited eversion, but good muscle strength. Additionally the PROM is limited. The mobilization performed should be a medial glide at the subtalar joint, as the convex surface of calcaneus glides medially in the concave surface of talus during eversion. Inversion and eversion occur at the subtalar joint. Reference: Neumann, Kinesiology of the Musculoskeletal System, Second edition, page 604

A Physical Therapist working in an acute care setting is evaluating a patient, who was admitted the previous night after suffering a stroke. The Physical Therapist notes that the patient has left hemiparesis of their face, upper and lower extremities. They also note medial strabismus of their right eye and nystagmus. Which of the following syndromes is most Likely to be associated with this presentation_____ Select one: 1. Medial inferior pontine syndrome 2. Complete basilar artery syndrome 3. Medial medullary syndrome 4. Wallenberg syndrome

The correct answer is: Medial inferior pontine syndrome Answer: Medial inferior pontine syndrome is associated with contralateral hemiparesis of face and extremities and ipsilateral nystagmus. CN 6 or Abducens nerve controls the lateral rectus muscle if there is a lesion to CN 6 medial strabismus of ipsilateral eye is observed. Reference: O'Sullivan Physical Rehabilitation 6th edition, pages 654-655

A 42 year old patient presents to the clinic with chief complaints of paresthesia in their hand after working on the computer for a couple of hours. On evaluation, the patient has a forward head posture and thoracic kyphosis. Sensory changes were noted in the palmar aspect of thumb, index, middle and half of ring finger as well as the distal dorsal aspect of index, middle and half of ring finger. The patient's deep tendon reflexes were normal. The Physical Therapist noted that the patient had weakness in their Opponens pollicis, abductor pollicis brevis, flexor pollicis longus and brevis, as well as the two lateral lumbricals. Which of the following is the MOST LIKELY diagnosis for this patient? Select one: 1. C6 nerve root injury 2. Radial nerve injury 3. Median nerve injury 4. C7 nerve root injury

The correct answer is: Median nerve injury Answer: Area of sensory and motor loss is associated with the distribution of the median nerve (injury distal to wrist). Paresthesia in the thumb, index finger, and middle finger may be caused by a C6 nerve root palsy. Paresthesia of the thumb, index finger, middle finger, and half of the ring finger on the palmar aspect may be caused by an injury to the median nerve, possibly through the carpal tunnel; on the dorsal aspect, it could be caused by injury to the radial nerve (distal aspect of dorsal hand is supplied by medial nerve). Triceps tendon reflexes as well as loss of sensation over the lateral forearm to index, middle and ring finger on palmer and dorsal aspect would be present with a C7 nerve root injury. Reference: Orthopedic Physical Assessment. David Magee. 6thed. Page 30, 263, 482

Which of the following conditions will NOT lead to symptoms of fasciculation, decreased cutaneous reflexes and segmental patterns of weakness? Select one: 1. Polio 2. Peripheral nerve injury 3. Mild traumatic brain injury 4. Guillain Barre syndrome

The correct answer is: Mild traumatic brain injury Answer: Fasciculations, decreased cutaneous reflexes and segmental pattern of weakness are signs of LMN lesion. Mild TBI will have UMN signs and symptoms. Reference: O'Sullivan Physical Rehabilitation, sixth edition, page 870

A 34 year old male arrived to an outpatient clinic with right shoulder pain. Upon examination, the Physical Therapist assesses the arthrokinematics of horizontal abduction. The patient presents with limited ROM and increased pain. The Physical Therapist would like to perform a mobilization technique to help relieve the pain as well as increase ROM. Which of the following mobilization techniques would be MOST appropriate to include in the plan of care? Select one: 1. Mobilize humerus in a posterior direction 2. Mobilize humerus in a lateral direction 3. Mobilize humerus in a medial direction 4. Mobilize humerus in an anterior direction.

The correct answer is: Mobilize humerus in an anterior direction. Answer: Mobilize into an anterior glide direction to help increase horizontal abduction ROM and decrease pain in the patient's right shoulder. An anterior glide could also help increase external rotation and extension. Mobilizing in a posterior glide direction would help increase internal rotation and horizontal adduction. Mobilizing in a medial glide direction would be ineffective with increase horizontal abduction. Mobilizing in a lateral glide would be effective with increasing horizontal abduction however an anterior glide would be most effective in this particular case. Reference: Kinser, Carolyn. Colby, Lynn Allen. Therapeutic Exercise. Foundations and Techniques. Sixth edition. 2007. 540-541

A newborn presents with flexed arms and legs, HR of 99 bpm, prompt response to stimulation, vigorous crying, blue extremities, and pink trunk. According to APGAR scale, the Physical Therapist would interpret the scoring as which of the following? Select one: 1. Severe 2. Moderate 3. Normal 4. Mild

The correct answer is: Normal Answer The APGAR score is 7. A moderate range would be classified as: 4-6. A severe range would be classified as 0-3. Reference: Apgar, Innovative Female Physician and Inventor, First Edition, Page 52

The patient presents to the clinic with complete loss of vision from one eye (mono-ocular vision). Which is the MOST appropriate location for the lesion? Select one: 1. Optic tract 2. Optic chiasm 3. Optic nerve 4. Occipital cortex

The correct answer is: Optic nerve Answer: Optic nerve lesion leads to complete loss of vision in ipsilateral eye. Optic chiasm would lead to loss of heteronymous hemianopsia. Optic tract lesion would cause Homonymous Hemianopia. Occipital cortex lesion would lead to macular sparing. Reference: Physical rehabilitation by Sullivan. Fifth edition. Page 1158

A 53 year-old diabetic male patient with lower extremity weakness is having difficulty with ambulation and is referred for Physical Therapy. What would be the most appropriate treatment to address this problem? Select one: 1. PNF D1 flexion 2. PNF D2 flexion 3. PNF D2 extension 4. PNF D1 extension

The correct answer is: PNF D1 flexion Answer: PNF D1 flexion is most relevant to Gait progression. It includes flexion adduction external rotation and dorsiflexion with inversion. Reference: O'Sullivan Physical Rehabilitation, sixth edition page 690-693

A 45-year-old male, who is being treated for low back pain, mentions that he had a colonoscopy in the past week. He reports that his physician observed that he had pouches in the walls of his large intestine with abscesses in it. What are the features most commonly seen in this condition? Select one: 1. Pain at the left lower abdomen with fever, nausea, and red bloody stools 2. Pain generalized in the lower abdomen, relieved on passing gas 3. Pain in the epigastric region that is relieved with food intake 4. Pain in the right lower abdomen with severe diarrhea, loss of appetite, and weight loss

The correct answer is: Pain at the left lower abdomen with fever, nausea, and red bloody stools Answer: Diverticulitis is characterized by the presence of formation of pouches and abscesses in the wall of the large intestine, especially the colon. The pain is referred to left lower abdomen and lower back. Other symptoms that can be seen are nausea, fever and red bloody stools due to the bleeding abscess. Additionally the patient may report having either diarrhea or constipation. Reference: Goodman, Pathophysiology Implication for the Physical Therapist, Fourth Edition, Page 333, 339-340

A 56 year old male arrived to an outpatient clinic with chief complaints of low back pain. Upon further examination, the Physical Therapist noted that the patient has left sided thoracic curvature during postural assessment. Which of the following is NOT correct for this patient presentation? Select one: 1. Right lower extremity shortening during leg length discrepancy 2. Vertebral body rotated to left 3. Pelvis elevated on left side 4. Vertebral spinous process rotated to right

The correct answer is: Pelvis elevated on left side Answer: The vertebral body is rotated to left side towards convexity side. The spinous process is rotated to right side towards concavity side. Pelvis elevated on left side is incorrect as the pelvis is elevated on right side. The right lower extremity is shortened during leg length discrepancy. Reference: Kisner, Carolyn. Colby, Lynn Allen. Therapeutic Exercises. Sixth Edition. 2012. 427-429

A 42 year old male patient arrived to an outpatient clinic with complaints of having neck discomfort when turning to the right. Upon examination the Physical Therapist palpated C5-C6 facets and noticed there was a closing restriction. Which of the following techniques would MOST likely correct this restriction pattern? Select one: 1. Perform a PA glide on right transverse process of C6 while stabilizing C5 2. Perform a PA glide on left transverse process of C5 while stabilizing C6 3. Perform a PA glide on right transverse process on C5 while stabilizing C6 4. Perform a PA glide on right transverse process on C5 while stabilizing C4

The correct answer is: Perform a PA glide on right transverse process of C6 while stabilizing C5 Answer: Perform a PA glide on the right transverse process of C6 while stabilizing C5 to address the closing restriction. A PA glide on the right transverse process on C5 while stabilizing C6 would open the intervertebral space. A PA glide on the left transverse process of C5 while stabilizing C6 would help open the intervertebral space. Reference: Magee, J David. Orthopedic Physical Assessment. Fifth Edition. 2008. P. 183, 184

A 21 year old male has been receiving Physical Therapy for 3 weeks status post a left knee ACL reconstruction. At this point in time, a goal of the Physical Therapist would MOST likely include which of the following? Select one: 1. Improving kinesthetic awareness 2. Achieving dynamic control of left knee 3. Achieving full-pain free ROM 4. Preventing reflex inhibition of muscle

The correct answer is: Preventing reflex inhibition of muscle Answer: Preventing reflex inhibition of muscles would be expected during this time frame. The Physical Therapist would want to prevent atrophy from developing in the quadriceps and hamstrings in order to maintain stabilization. During weeks 4-10, the Physical Therapist will primarily focus on improving the kinesthetic awareness during closed chain activities, full pain free ROM, and dynamic control of left knee. Reference: Kisner, Carolyn. Colby, Lynn Allen. Therapeutic Exercise. Foundation and Techniques. Sixth Edition. 6. 812

A patient presents to outpatient clinic after recovering from a right CVA. The patient still has some residual effects of left hemiplegia, including spasticity. What is the BEST intervention for spasticity? Select one: 1. Quick stretch 2. Quick stroking 3. Prolonged icing 4. Rapid vestibular stimulation

The correct answer is: Prolonged icing Answer:Prolonged icing is an inhibitory technique which can help decrease spasticity. It decreases spasticity by decreasing muscle spindle discharge and decreasing gamma motor neuron activity. Other options like quick stroking, quick icing, rapid vestibular stimulation are neuro facilitatory treatment interventions for flaccid muscles to help stimulate them to contact. Reference: Physical Rehabilitation by Susan O Sullivan. ED.6 Pg. 432- 434

A 14-year-old patient arrived at an outpatient physical therapy clinic with chief complaints of mid back pain. Upon further examination, the patient has a right thoracic curve during the Adams forward bend test. Which of the following is NOT correct when describing this patient presentation? Select one: 1. Prominent left scapula 2. Spinous process deviated toward concave side 3. Shortening of muscle on left side 4. Vertebrae body distorted toward convex side

The correct answer is: Prominent left scapula Correct answer: Prominent left scapulaRationale: With a structural scoliosis, the vertebral bodies rotate to the convexity of the curve and become distorted. As the vertebral body rotates to the convex side of the curve, the spinous process deviates toward the concave side. The muscles on the concave side are shortened and are lengthened on the convex side. The scapula on the convex side (right) becomes prominent and the shoulder on the concave side may drop.Reference: Magee DJ; Orthopedic Physical Assessment, 6th edition Page: 516, 518

patient reports that they were lifting heavy weights in the gym a few days ago and have new lower abdominal pain. They have noticed that the pain is worse when lying on the left side. The pain subsides when awakening, yet will gradually increase throughout the day. What type of pain should the Physical Therapist determine is occurring? Select one: 1. Gallbladder pain 2. Pseudorenal pain 3. Common bile duct pain 4. Liver pain

The correct answer is: Pseudorenal pain Answer: With liver pain the patient will report right upper quadrant pain and pain in the liver during exercise. The pain will be constant and not change upon waking or throughout the day. Pseudorenal pain onset is usually acute and associated with a traumatic history such as lifting a heavy object. The patient will report having lower abdominal pain that is worse at night, especially when lying on the affected side. The pain is usually absent when arising but will get progressively worse throughout the day. With common bile duct pain, the patient will report pain in the mid-epigastric with vague discomfort. The pain is constant, mild at first and increases steadily. With gallbladder pain the patient will report right upper quadrant pain and possibly right shoulder pain. They will describe dull aching pain and a sense of fullness in their abdomen or epigastric. Reference: Goodman Differential Diagnosis For Physical Therapists 5th edition, pages 364-387

A 32 year old male patient arrived to an outpatient clinic with right heel pain during ambulation. Upon examination, the Physical Therapist observes the patient's calcaneus in eversion after heel strike. The Physical Therapist would like to utilize an orthotic that could help alleviate the patient's pain. Which of the following orthotics would MOST LIKELY benefit this patient? Select one: 1. Forefoot (lateral wedge) 2. Cushion heel 3. Rearfoot Varus post (medial wedge) 4. Rearfoot Valgus post (lateral wedge)

The correct answer is: Rearfoot Varus post (medial wedge) Answer: Medial wedge (rearfoot varus post) would be the most appropriate for a patient with an everted calcaneus after heel strike as the patient will have slight pes valgus. A rearfoot valgus post (lateral wedge) would prevent the calcaneus from going into an inverted position. A cushion heel is used to prevent plantar fasciitis with the use of additional cushion support. Reference: Magee, J David. Orthopedic Physical Assessment. Fifth Edition. 2008. P. 855-857

A 59 year-old female patient arrived to an outpatient clinic with complaints of wrist and hand discomfort. Upon examination the Physical Therapist observed a deformity of extension at the MCP and distal interphalangeal joint with flexion of the PIP joint. Which of the following conditions would MOST likely match this description? Select one: 1. Rupture of the extensor tendon at the distal phalanx 2. Contracture of the intrinsic muscles along with a dorsal subluxation of the lateral extensor tendons 3. Banding at the palm as well as digit flexion contractures 4. Rupture of the central tendon

The correct answer is: Rupture of the central tendon Answer: The Physical Therapist observed a deformity with extension of the MCP and the distal interphalangeal with flexion of PIP. A patient with a swan neck deformity would experience a contracture of the intrinsic muscles along with dorsal subluxation of the lateral extensor tendons. A patient with trigger finger would experience a rupture of the extensor finger at the distal phalanx. A patient with Dupuytren's contracture would have banding at the palm as well as digit flexion contractures. Reference: Magee, J David. Orthopedic Physical Assessment. Fifth Edition. 2008. P. 404-405

Which of the following changes are NOT associated with Postural Scoliosis? Select one: 1. Shortened foot pronator muscles on the short side 2. Shortened foot supinator muscles on the short side 3. Elongated hip abductor muscles on concave side 4. Short hip adductors muscles on the convex side

The correct answer is: Shortened foot pronator muscles on the short side Answer: The patient will have elongated foot pronator muscles on the elongated side. Short hip adductors muscles on the convex side, shortened foot supinator muscles on the short side and elongated hip abductor muscles on concave side are associated with postural scoliosis. Reference: Magee Orthopedic Physical Assessment Sixth Edition pages 1028-1030

A Physical therapist is performing a physical examination on a 35 year-old male with right side neck pain and flexibility deficits of the right anterior scalene muscle. Which of the following is the BEST way to stretch the right anterior scalene muscle? Select one: 1. Stabilize the patient's right clavicle and first rib, extend the lower cervical spine, then take the cervical spine into left sidebending and right rotation 2. Stabilize the patient's right clavicle and first rib, flex the lower cervical spine, then take the cervical spine into left sidebending and left rotation 3. Stabilize the patient's right clavicle and first rib, flex the lower cervical spine, then take the cervical spine into left sidebending and right rotation 4. Stabilize the patient's right clavicle and first rib, extend the lower cervical spine, then take the cervical spine into left sidebending and left rotation

The correct answer is: Stabilize the patient's right clavicle and first rib, extend the lower cervical spine, then take the cervical spine into left sidebending and right rotation Answer: When the rib is fixed the anterior scalene will perform flexion, side bending to the ipsilateral side and contralateral rotation. To stretch the right anterior scalene muscle, the patient should extend the neck, side-bend to the left and rotate to the right. Reference: Kisner, Carolyn Sixth edition page 492.

A 65-year-old female patient with chronic low back pain is being treated by the Physical Therapist. After reading the patient's chart, the Physical Therapist cautions the PTA to avoid any spinal flexion exercises and abdominal crunches. What of the following is NOT a reason for the Physical Therapist's concern? Select one: 1. The patient has hyperparathyroidism 2. The patients radiograph shows spondylolisthesis 3. The patient regularly takes corticosteroids 4. The patient has abdominal pain due to peptic ulcers

The correct answer is: The patients radiograph shows spondylolisthesis Answer: Spinal extension exercises should be avoided in spondylolisthesis, not spinal flexion exercises. Spinal Flexion exercises such as abdominal crunches should be avoided in patients with peptic ulcer, as increased abdominal pressure increases discomfort and pain and chances of perforation. Corticosteroids can lead to osteoporosis and flexion exercises could cause vertebral fracture in osteoporotic patients. Hyperparathyroidism can also lead to osteoporosis. Reference: Magee, Orthopedic Physical Assessment, Sixth Edition, Page 641

A Physical Therapist is including mobilizations in her plan of care to help increase knee extension. Which of the following techniques would be MOST appropriate in an effort to improve the patient's ROM? Select one: 1. Medial patellar glide 2. Tibiofemoral anterior glide 3. Tibiofemoral posterior glide 4. Inferior patellar glide

The correct answer is: Tibiofemoral anterior glide Answer: Tibial femoral anterior mobilization glide would be the most appropriate to increase knee extension. The concave moving on convex method applies when mobilizing in the same direction. Tibiofemoral posterior glide would increase knee flexion with concave moving on convex. An inferior patellar glide would help increase knee flexion. A medial patellar glide would help with patellar tracking and prevent any dislocation. Reference: Kinser, Carolyn. Colby, Lynn Allen. Therapeutic Exercise. Foundations and Techniques. Sixth edition. 2007. 773-774

A 25 year old female has been suffering from widespread pain with several tender points in the upper body which increases with stress. The Physical Therapist suspects the patient has Fibromyalgia. Which of the following intervention would be LEAST effective? Select one: 1. Trigger point massage 2. Deep breathing and relaxation exercises 3. Resistive exercises with therabands 4. Aerobic exercises at moderate intensity 5 days a week

The correct answer is: Trigger point massage Answer: Trigger points are tender knot like areas in the muscles. In Myofascial syndrome there is radiating pain on palpation with pressure. They can be released with a trigger point massage. But here the patient has Fibromyalgia and the tender points seen in this condition are not similar in pathophysiology to trigger points seen in myofascial syndrome. Trigger point massage is not helpful as they are absent in this condition. Light to moderate aerobic exercise, light resistance exercise, relaxation/breathing techniques are all helpful interventions for fibromyalgia. Reference: Therapeutic exercise by Carolyn Kisner Ed.6 Pg.338-339.

A Physical Therapist is examining a patient with balance problems. The patient walked with a slow, wide gait with reduced trunk rotation. The patient has no signs of ataxia but has a positive Romberg test. The patient had a loss of balance when asked to turn their head while ambulating. The MOST likely diagnosis for this patient is? Select one: 1. Benign paroxysmal positional vertigo 2. Unilateral vestibular Hypofunction 3. Peripheral neuropathy 4. Cerebellar pathology

The correct answer is: Unilateral vestibular Hypofunction Answer: Patients with unilateral vestibular hypofunction will experience vertigo, postural instability, oscillopsia, and disequilibrium. The wide-based gait is an attempt to minimize trunk rotation and movement of the head. Trunk rotation and movement of the head could increase sensory conflict and vertigo in the patient with unilateral vestibular hypofunction. Reference: O'Sullivan, Susan B. Schmitz, Thomas J. Fulk, George D. Physical Rehabilitation. 6th edition. 2014. Page 977.

A 52-year-old patient with a history of congestive heart failure and chronic renal disease is admitted to a cardiac rehabilitation unit. The Physical Therapist is evaluating the functional status, aerobic capacity, and endurance. What is the BEST indicator of their functional capacity correlating with long term and short term survival? Select one: 1. Stress echocardiogram 2. Negative exercise tolerance test 3. Walking 300 meters on the 6MWT 4. Ability to perform 5 to 7 METs without fatigue

The correct answer is: Walking 300 meters on the 6MWT Answer: A patient's ability to walk 300 meters on the 6MWT has shown to be the best indicator of long term and short term morbidity and mortality in patients with congestive heart failure. ETT is not performed in patients with CHF and is not indicative of functional capacity. Stress echocardiogram is performed to check the functioning of the heart valves and vessels. METs help in determining the energy requirements of activities and do not help in determining the functional status. Reference: O'Sullivan Physical Rehabilitation 6th edition, page 559