Miscellaneous

A 76 year old frail older adult is confined to bed in a nursing facility. He has developed a small superficial wound over the sacral area. Since only small amounts of necrotic tissue are present, the physician has decided to use an autolytic wound debridement. This is BEST achieved with: a) Occlusive dressing b) hydrotherapy c) wet-to-dry dressings d) forceful irrigations

A

A patient who is undergoing chemotherapy is referred to physical therapy for wound care; you would do the following: A. You would treat them based on the severity of the wound B. You would put them on hold until they have finished their chemotherapy C. You would not treat them due to them being radioactive and possibility a hazard to you D. You would treat them using only modalities where you did not have to come in contact with them

A

A patient with a transfemoral amputation is unable to wear his total contact prothesis for the past 4 days. Examination of the residual limb reveals erythema and edema extending over most the lower anterior limb. He tells you his limb is very itchy and painful after he scratches it. The most likely cause of his problem is: a) dermatitis b) cellulitis c) impetigo d) herpes zoster

A

Hyperperfusion of the foot secondary to neuropathy would cause the temperature of the foot to: a) increase b) decrease c) cease d) Be rerouted via andiogenesis

A

While only superficial or partial thickness, skin tears may bleed significantly in patient who are on blood thinners? A. True B. False

A- true

Your 85-year-old patient with Alzheimer's disease has an ulcer over her greater trochanter. The ulcer measures 3.6 x 3.2 cm can is 100% covered in eschar. The patient is confused, restless and easily agitated during your exam. You would perform which of the following? A. sharp debridement B. Enzymatic debridement to remove dead tissue C. Discharge the patient noting they are inappropriate for treatment D. Bandage the wound with gauze and send them home

B

The following are commonly misdiagnosed as spider bites except? A) Impetigo B) Pyoderma Gangrenosum C) Toxic Epidermal Necrolysis D) Community acquired MRSA E) All of the above are commonly misdiagnosed as due to a spider bite.

B)

An individual is left lying on his side for an extended position of time. Which of the following areas is least likely to develop a decubitus ulcer? a) The area of the greater trochanter b) The area area over the greater tubercle c) The area over the mastoid process d) The area over the lateral malleolus

C

During a treatment session for low back pain, a 67-year old patient tells you that she has had urinary incontinence for the last year. It is particularily problematic when she has a cold and coughs a lot. She has not told her doctor about this problem because she is too embarrassed. Your BEST course of action is to: a) refer the patient back to her doctor b) evaluate the patient and proceed with her back treatment c) evaluate, document, and discuss your findings with the doctor d) evaluate, document the problems, then send her back to her doctor.

C

One of the ways to differentiate venous insufficiency from arterial insufficiency is, venous insufficiency... A) Have a uniform shape B) Present with very little drainage C) Typically with swelling of the legs D) Typically has no swelling of the legs

C

You have been working with a patient with a pressure ulcer daily for the last 3 weeks. Initially, the wound appeared as a crater and was 1.0 cm deep. Today when you remove the bandage, you notice the granulation tissue has risen above the skin surrounding wound. How would you describe this tissue? A. Surgical dehiscence B. Superficial Infection C. Hypergranular D. Secondary intention

C

Your patient, Anne had a TKR, Five days after surgery her knee becomes infected and is surgically debrided. One week after debridement the surgeon decided to surgically close the wound. This is an example of what type of healing? A. Dehiscence B. Primary intention C. Tertiary intention D. Secondary intention

C

According to the PT, which of the following test should be used to assess sufficiency of blood flow in the area of a neuropathic ulcer? A) Massage B) E-stim C) Doppler Ultrasound D) Intermittent Claudication

C) Doppler Ultrasound

According to the PT, it is possible for an electrical burn patient to suffer _____ as a result of the trauma of the burn. A) MRSA B)EBSP C) PTSD D) HVES

C) PTSD

Desquamation can be one of the results of radiation burn/exposure. This ?? is... A) The loss of hair B) Internal Vomiting C) Peeling or flaking skin D) Blisters and wet peeling skin

C) Peeling or flaking skin

During the use of the trendelenburg test, a tourniquet is applied around the distal thigh to block venous flow after facilitating draining of the veins in the leg (Patient supine with leg elevated to 45 degrees). The patient is then asked to stand and variation in venous distension over time is noted. During this test the tourniquet is being used to block flow primarily in which of the following? A) Deep Veins B) Perforating Veins C) Superficial Veins D) Incompetent Veins

C) Superficial Veins

According to the PT, pyoderma gangrenosum may appear as a small very painful papule, vesicle, or pustle with ______ borders. However, when the previous has an insidious onset and has an irregular brder, the PT should refer for discernment. A) Debased B) Macerated C) Violaceous D) Epithelialized

C) Violaceous

Another name for a pressure ulcer is... A) Bed Sore B) Stasis Ulcer C) Decubitus Ulcer D) The use of any of the above may refer to a pressure ulcer

D

If Mr. I. B. Score has a stasis ulcer, what stage is it? a) stage II b) stage III c) stage IV d) not wise to stage it at this time

D

Intermittent claudication, ischemic rest pain, and aggravation of symptoms due to elevation are all signs of... a) Arterial insufficiency b) Venous insufficiency c) Varicose veins d) Both a and b

D

Melissa the physical therapist would not use the following intervention when treating a burn patient a) infection control b) postioning, ROM and mobility training c) Education of the patient and primary caregivers d) surgical debridement e) All the above

D

Mr. I B. Score, one week post left CVA with right sided paralysis, has a closed, non blanchable area over his right greater tubercle, the temperature of the area is elevated, and you note present.. You would suspect what? a) bed sore b) stasis ulcer c) decubitus ulcer d) All the above

D

The occurence of Kaposi Sarcoma is associated with... A) Patients with cancer treated with cytotoxic chemotherapy recipients of renal transplant B) Patients who are HIV Positive C) Patients who are immunosuppresed D)All of the above are associated with occurrence of Kaposi's Sarcoma

D

You should use which of the following to classify a thermal burn. A)Rule of 9's B) Lund Browder C) Palmer Method D) Any of the above may be used to classify a thermal burn

D

Your wound patient, on a visual analog scale expresses a pain level of 9, this would indicate that they have which of the following types of wounds. A. Superficial B. Full thickness C. Superficial partial thickness D. Cant determine based on the given information

D

Miss Smith presents with the following presentation for PT: "PT evaluate and treat, acute second-degree burn dorsal right foot, apply silver sulfdiazine bid." The amount of inflammation is proportional to the size and extent of the wound, there is minimal serous drainage, and the wound is 50% eschar covered. When you follow up with the patient 3 days later, you notice an increase in inflammation an ascending erythema from the wound site but no other objective or subjective changes. What is the most likely cause of these new findings? A) Patemonia B)Normal Response C) Arterial Occlusion D) Allergic Reaction to one of the materials used

D) Allergic reaction to one of the materials used

The PT correctly believes that debridement of a severe burn: a. Would decrease the risk of infection b. May require premedication c. Often requires serial instrumental debridement d. All of the above

D. All of the above

Incompetent valves and calf muscle pump failure can cause vein hypertension and thus vein distension, chronic venous hypertension can cause insufficiency ulcerations. This in turn, based on theory, may lead to which of the following? A. An increase in vascular premeability B. Excessive fluid and protein flowing across vessel walls C. Peripheral Edema D. Fibrin adhering to vessel walls and subsequently blocking oxygen and nutrients E. All of the above

E

Which of the following may not increase the chance of wound dehiscence ? A) Too much tension across the wound edges B) Malnutrition, especially deficiencies of vitamins A,C, and B C)Having diabetes D) Long term use of steroids E) All of the above may increase the chance of wound dehiscence

E

Puncture wounds, such as being stuck by a sewing needle, cactus or rose briar do not bleed much and as such pose no risk for infection. T/F

F

Two SPT's stated that liquefaction as a result of a chemical wound can be abated via flushing the wound with large amounts of water. T/F

T

Most bites are polymicrobial with human bites being more so than animal bites. T/F

True

A PT applies silver sulfadiazine to a wound after hydrotherapy treatment. What type of aseptic equipment is necessary when apply the topical agent? a) gloves b) sterile gloves c) gloves, gown d) sterile gloves, gown

a

Bruises and skin cancer may be different to discern the difference in looks both may appear _____ and flat on the skin. However, when the previous has and insidious onset and has an irregular border, the PT should refer for discernment. a) violaceous b) as a pustule c) as an ulceration d) as none of above

a

By managing their risk factors and controlling underlying conditions, such as malnutrition, anemia, and diabetes patients can increase their healing potential? a) true b) false

a

Does the parent's explanation of the wound etiology warrant further investigation? a) yes b) no

a

Lil D, a 60 year old widow had NIDDM. She has had it for 5 years and it is well controlled. her medical history is otherwise unremarkable. She bowls twice a week as a part of a bowling club and walks 3 miles at least 3 times a week at the local high school track. The reports to your clinical for treatment of an ulcer that is located over the 1st MTP joint of the plantar surface of the right foot. She has bad it for 2 months. The cause of this ulcer is most likely which of the following. a) trauma b) ischemia c) spider bite d) surgical dehiscence

a

Pyoderma gangrenosum is associated w/ having the following conditions a) Crohn's disease, lupus, and ulcerative colitis b) Liupus, RA, and fibromyalgia c) Crohn's disease, OA, and RA d) Ulcerative colitis, OA, IRB

a

When assessing your patients sacral pressure ulcer, you are able to probe to bone but cannot visualize the bone. This patient is at risk for osteomyelitis a) true b) false

a

When examining your acute care patient, you notice an open wound on his extensor forearm that looks to be an epidermal flap with the exposed dermis. The wound is bleeding minimally. This would likely: a) a skin tear b) a degloving c) an abrasion d) a pressure ulcer

a

When using compression therapy for venous insufficiency ulcer management, the patient should be instructed to: a) walk regularly b) avoid performing heel or toe raises c) dangle his/her legs frequently to proximate blood flow d) all of above

a

Which of the following is the most common complication of diabetes mellitus? a) neuropathy b) vascular disease c) delayed wound healing d) intermittent claudication

a

You are treating a post surgical patient, three times a day, with a regimen of postural drainage. You could reduce the frequency of treatment if the: a) amount of productive secretions decreases b) consistency of the sputum changes c) patient becomes febrile d) patient experiences decreased postoperative pain

a

Your patient complains of left calf pain after walking for 10 minutes. You believe the patient may have partial obstruction of the: a) iliofemoral artery b) dorsalis pedis artery c) infrapopliteal artery d) posterior tibial artery

a

Your patient reports that she hurt her hand when she punched her bf in the mouth for cheating on her. You would classify thus as.. a) a bite wound b) pressure ulcer c) surgical wound d) abrasion

a

________ ABI values correlate with increased severity of atherosclerosis and CAD? a) lower b) higher c) normal d) ABI's dont correlate with the severity of atherosclerosis or CDA

a

Your patient receives a burn on the anterior neck. Which of the following types of contracture are likely to develop? a. Cervical flexion b. Cervical rotation c. Cervical extension d. Cervical lateral flexion

a. Cervical flexion

A student you are supervising is on final affirmation following completion of academic training. He is overheard discussing a pt. history in the elevator. When you later point this out to the student, he tells you he was unaware of any hospital policy regarding confidentiality. Your BEST analysis of this situation is that: a. He should be expected to value patient confidentiality b. Compliance was not realistic expectation since he just arrived at this facility. c. Now that he is aware of confidentiality restrictions, he should do better next time. d. Since this is not strictly part of the professional code of ethics, you should not reasonably expect him to demonstrate adherence to this concept.

a. He should be expected to value patient confidentiality

A 72yo patient with diabetes is recovering from recent surgery to graft a large ulcer over the heel of her left foot. You are concerned that the loss of range at the ankle (-5˚ to neutral) will limit her ambulation and independent status. One afternoon you are very busy and request that one of the PT aides do her ROM exercises. The aide is new but tells you she is willing to take this challenge on if you show her how to do it. your BEST course of action is: a. Perform ROM exercises yourself b. Reschedule the pt. for tomorrow when you have more time. c. Take 5 minutes to instruct the aide in ROM then have her do them. d. Modify the treatment session to eliminate ROM exercise and have the aide walk the patient in this parallel bars.

a. Perform ROM exercises yourself

A PT (cardiopulmonary specialist) was asked to treat a patient who had a surgical repair of lacerated index finger flexor tendon. This was the first hand injury that the therapist had ever treated. During the treatment the patient felt a pop which was the result of a rupture of the new repaired tendon. The PT in this case should have: a. Refused to treat this patient. b. Treated the patient per request c. Used heat prior to treatment. d. Requested more time to read literature about this repair

a. Refused to treat this patient.

You have been treating a patient for chronic subluxation of the patella in the outpatient clinic. He is now scheduled for a lateral release and is worried about complications of the surgical procedure. He asks you to describe any potential complications. your BEST response is: a. Suggest that the patient speak with his surgeon. b. Explain how patients you have treated responded to the surgery. c. Refer the patient to a PT colleague who specialized in knee problems. d. Do a search on the internet and get back to the patient with the desired info.

a. Suggest that the patient speak with his surgeon.

A 44-year-old patient has marked elevation of blood pressure. he complains of mild to sever midabdominal pain that increases upon exertion. Palpitation reveals a pulsing mass in the lower abdomen. You should: a) instruct in relaxation exercises; postpone all other treatment b) discontinue treatment and notify his physician immediately c) do not treat; instruct the patient to see his physician as soon as possible d) provide warm hot packs to the abdomen to relieve the pain; do not exercise

b

A PT inspects the skin of a child recently admitted to the hospital after sustain a scald burn from hot water on his torso. The burn is moist and red with several areas of blister formation. The burn covers approximately 8cm^2 and is very painful. This wound would be classified as? a) superficial b) superficial partial-thickness c) dep partial thickness d) full thickness

b

A PT treats a patient status post femur fracture with external fixation. While monitoring the patient during an exercise session, the therapist observes clear drainage from a distal pin site. The most appropriate therapist action is: a) discontinue exercise session and contact the referring MD b) use a gauze pad to absorb the drainage and notify nurses c) use a gauze pad to absorb the drainage and continue with exercise session d) document the finding and discontinue the exercise session

b

A patient sustains a deep-partial thickness burn to the anterior surface of the right upper extremity and a superficial partial thickness burn to the anterior surface of the trunk. According to the Rule of Nines, the patient has burns over: a) 18.5% b) 22.5% c) 27% d) 36%

b

An open reduction internal fixation (ORIF) in relation to a fracture means what a) The fracture has been stabilized using metal pieces outside of the body b) the fracture has been stabilized using metal pieces inside the body c) the fracture has been stabilized using a cast d) the fracture has been left open to heal

b

Debridement of burn wounds take priority over intravenous fluid administration a) true b) false

b

High triglyercide levels are thought to promote.. a) CAD b) atherosclerotic plaque growth c) peripheral arterial insufficiency d) all of above

b

In addition to the physician, should you report your findings to any other team members? a) yes, a dietician b) yes, social worker b) no, this is between the MD and the mother and child d) no, this should be kept between you and the parent

b

Most electrical burns are the result of: a) lightning strikes b) low voltage c) high voltage d) accidents resulting from a combination of water and electricity

b

Nosocomial means a) not amusing or comic b) originating in a hospital c) not of sufficient amount d) a bacteria count that is below infection levels

b

What prognosis of the healing time would you make Kyrie's injury to heal in? a) 3-5 days b) 10 to 14 days c) 3 to 5 weeks d) it wont heal b/c it is a chemical burn

b

You are a PT who is taking a your board exam. You note that to answer a question on wounds you need to know what nosocomial infection is. You know that you did not do all of your reading assignments. Can you truthfully say this was not a part of your PT training? a) yes b) no

b

You are treating a patient with active hepatitis B infection. Transmission of the disease is best minimized if you: a) avoid direct contact with any part of the patient b) wear gloves if there is direct contact with blood or body fluids c) have the patient wear gloves to prevent him from touching you d) have the patient wear a gown and mask every time you are in the room

b

Your patient's ABI is .72. How would you interpret this? a) ABI is normal b) should have a vascular consult c) diabetes mellitus that is artificially elevating his ABI d) trial of PT and if no improvements are found, should be referred for a surgical consult

b

Your patient's wound presents with copious amounts of thick, blue-green drainage. This wound is most likely a) inflamed b) infected c) acute d) exfoliating

b

a patient has been taking corticosteroids (hydrocortisone) for management of adrenocortical insufficiency. she is referred to PT for mobility training following a prolonged hospitalization. Potential adverse effects that one can expect from prolonged used of this medication include: a) confusion and depression b) muscle wasting and increased risk of fracture c) decreased appetite and weight loss d) hypotension and myopathy

b

antibiotics should be initiated for patients who: a) have sacral pressure ulcers due to the risk of stool contamination b) have advancing cellulitis c) have periwound erythema d) have stage II or IV pressure ulcers

b

what surface area of Tabitha's body is burnt? a) 3.5 b) 7 c) 9 d) 18

b

A burn that presents with a high level of pain, is blanchable, has mottled areas of red with white eschar, and some blisters would be classified as: a. First degree b. Second degree c. Third degree d. Fourth degree e. Fifth degree

b. Second degree

A patient presents with a large plantar ulcer that will be debrided in the whirlpool. The foot is cold, pale, and painless. The condition that would most likely result in this clinical presentation is: a) deep venous thrombosis b) acute arterial insufficiency c) chronic arterial insufficiency d) chronic venous insufficiency

c

Child abuse is thought to be responsible for _____ of all pediatric burns. a) 0-2% b) 2-5% c) 10-30% d)50-60%

c

Strong acids & bases that are allowed prolonged contact with the skin may cause which of the following types of wound? a) Thermal burns b) Electrical burns c) Chemical burns d) prolonged contact of bases and/or acids with the skin may cause any of the above

c

The following is a nonmodifiable risk factor for arterial ulceration and insufficiency. a) smoking b) diabetes c) advanced age d) hyperlipidemia e) all of the above are nonmodifiable

c

Which of the following "wenous" filling times would be indicative of "arterial" insufficiency? a) <5 b) 5-15 sec c) >20 d) none of above

c

You are covering for a PT who is on vacation. The assessment states that Ashley the patient has a grade 2 neuropathic foot ulcer. The Wagner scale designation indicates that.. a) superficial ulcer b) ulcer has localized gangrene c) ulcer is deep down to the tendon, capsule or bone d) patient has no open lesions but may have deformity or cellulitis

c

Your patient presents with an ulcer near his lateral malleolus that is covered with adherent yellow slough. Pedal pulses are absent on the affect side. You are unable to perform an ABI because the patient complains of severe pain when the cuff is inflated more than 30 mm Hg. Why is performing the ABI painful? a) cuff is pressing on the sciatic nerve causing pain b) misreading and needs to be recalibrated c) occluding circulation and thus precipitating ischemia d) ABI's normally hurts and the patient is over reacting

c

a 72 yo patient has been hospitalized, on complete bedrest for 10 days. Your referral requests mobilization out- of- bed and ambulation. The patient tells you that today his right calf is aching. If he gets up and moves around he is sure he will feel better. Your examination reveals calf tenderness. You decide to: a) begin w/ ankle pump exercise in bed b) ambulate the patient with elastic stocking c) postpone ambulation and report your findings immediately d) begin with sitting the patient up over the edge of the bed for 5 minutes

c

A patient who is to undergo surgery for a chronic shoulder dislocation asks you to explain rehabilitation following a surgical reconstructive procedure he is scheduled to undergo. your BEST response is to: a. Explain in detail about the surgical procedure b. Tell the patient to ask his surgeon for this information c. Explain how patients typically respond to the surgery and outline the progression of exercises. d. Refer the patient to a physical therapy specialist who is an expert of shoulder reconstructive rehab.

c. Explain how patients typically respond to the surgery and outline the progression of exercises.

You are treating a 16 year old with leukemia. Her parents decide not to tell her about her diagnosis. She is quite perceptive and asks you directly if she has cancer and about her future. your BEST course of action is to: a. Change the subject b. Discuss her condition gently indicating her parent's fear about not telling her the diagnosis c. Schedule a conference with the doctor and family about her condition and your discussions with the patient. d. Tell the patient that you don't know the specifics of her condition or prognosis.

c. Schedule a conference with the doctor and family about her condition and your discussions with the patient.

It is illegal to release patient info without obtaining the patient's consent to: a. The referring physician when there is a referral relationship b. Another healthcare provider involved in the care of this patient. c. The patients employer when the condition is work related d. The insurance company that is paying for the patient's treatment.

c. The patients employer when the condition is work related

6&9 Your patient, Tabitha is a 3 month old infant who presents w/ superficial partial thickness burns of the bilateral lower extremities. The burns extend circumferentially, and equal from mid-tibia distally to the plantar aspect of her feet. The patient's parent reports the burns were sustained while drinking hot tea in her high chair. 6. what burn scale is most accurate and appropriate for the measurement of Tabitha's burn surface? a) grid b) rule of 9 c) palmer d) Lund-Browser

d

A PT was treating a patient and the patient in the next bed was uncomfortable and asked the therapist to move his leg. The therapist placed the leg on 2 pillows as requested by the pt. Unknown to the therapist, this patient had femoral artery graft 2 days previously. as a result the graft became occluded as the patient was rushed to surgery for replacement. The patient claimed the therapist placed his leg too high on pillows causing occlusion of the original graft and sued for malpractice. The hospital administrator decided: a. To counter-sue the patient b. It was the patients fault for requesting the position change. c. That the physical therapist was functioning according to common protocols of the institution and this supported the actions of the therapist d. That the therapist was functioning outside common protocol of the hospital and therefore did not support the actions of the PT.

d

Patients with clenched fist human bite wound injuries a) should be irrigated with an antimicrobial solution for 20 minutes and then sutured. b) are at an increased risk for infection because the human mouth has more varied microflora than an animal's c) are at increased risk for infection because the victim's teeth can penetrate into the patients joint or other deep tissue d) B and C

d

Poison ivy/oak would be classified as a... a) cellulitis b) dermatitis c) plant wound d) floral wound

d

The Lund-Browder classification for children is more appropriate for use on patients under the age of 16 when compared to the Rule of Nines because? a) It is more accurate b) Children's body portions are different than adults c) An adolescent head is relatively larger than its body when compared to an adult d) All of the above

d

The following is considered the gold standard for assessing light touch a) PROM b) cotton c) a pointy object d) Semmes- Weinstein Monofilaments

d

The zone of stasis a) is the central portion of the burn b) There is no such thing as a zone of stasis c) represents the outer edges of tissue affected by the burn injury d) surrounds the central necrotic region and represents an area of cellular injury and compromised tissue perfusion

d

Which of the following is not a function of the epidermis and dermis? a) provide for sensation b) assists w/ thermoregulation c) contributes to cosmesis d) none of the above is correct

d

Which of the following is not a risk factor for arterial ulceration a) diabetes b) smoking c) hyperlipidemia d) consumption of coffee

d

You are called to the ER to examine Kyrie, a high school student, who spilled hydrochloric acid on his left hand while conducting an experiment in chemistry class earlier that morning. The wound bed is blistered and draining. Kyrie is able to detect light touch and pressure with thte burned area. When digital pressure is applied to the wound bed, the area blanches and capillary refill is rapid. How would you classify the depth of Kyrie's burn injury? a) superficial b) full thickness c) deep- partial thickness d) superficial partial thickness

d

You should use which of the following to classify a thermal burn. a) rule of nines b) lund browder c) palmer method d) any of the above

d

Your patient sustains gross burns on their ankle. Which of following types of types of contracture are likely to develop? a) genuvalgus b) genuflexion c) dorsiflexion d) plantar flexion

d

When assessing peripheral pulses to determine blood flow you as the PT should: a. Asses both involved and uninvolved sides b. Assess the patient while they are resting in a supine position. c. Assess the femoral, popliteal, dorsalis pedis, and posterior tibial arteries. d. All of the above.

d. All of the above.

A patient's daughter wants to look at her father's medical record. he has recently been admitted for an insidious onset of LBP. You, the PT should: a. Give her the chart and let her read it. b. Tell her to ask the physician for permission c. Tell her she cannot see the chart because she would misinterpret the information d. Tell her that she must have the permission of her father before she can look at the chart.

d. Tell her that she must have the permission of her father before she can look at the chart.

Your patient presents with an open blister on the post. heel secondary to poor-fitting shoes. The following tissues are involved with this type of injury: a. The dermis and subcutaneous b. The dermis and hypodermis c. The epidermis and hypodermis d. The dermis and epidermis.

d. The dermis and epidermis.

Pyoderma gangrenosum may presents as which of the following? a) small, very painful papule b) vesicle or postule on the LE c) cluster of ulceration d) an ulceration w/ irregular, violaceous borders e) all of the above

e