NPTE 5

C2. A newborn is examined at birth using the APGAR test. Which of the following APGAR results is a likely indicator of potential neurological complications? 1. 3 at 10 minutes. 2. 9 at 1 minute. 3. 8 at 1 minute. 4. 8 at 5 minutes.

1. 3 at 10 minutes.

C153. A young, otherwise healthy, adult is recovering from a complete spinal cord injury (ASIA A) at the level of L4. What are the functional expectations for this individual? 1. Ambulation using bilateral AFOs and canes. 2. Ambulation using bilateral KAFOs, crutches, and a swing-through gait. 3. Ambulation using reciprocating gait orthoses and a reciprocating walker. 4. Ambulation using bilateral KAFOs and a reciprocating walker.

1. Ambulation using bilateral AFOs and canes.

C184. A patient has diffuse distal bilateral lower extremity pain, edema, and numbness that occurs with level and uphill walking. Which of the following examination items would be most likely to assist in the proper diagnosis? 1. Ankle-brachial index (ABI). 2. Lumbar quadrant test. 3. Stemmer's sign. 4. Monofilament testing.

1. Ankle-brachial index (ABI).

C98. During an initial interview and history, a patient with a right CVA seems unconcerned about obvious paralysis of the left arm and leg. When the therapist asks the patient to describe what happened, the patient says "I must have slept wrong and my arm and leg fell asleep." The patient further tells the therapist, "My family put me in this place so they could go on vacation." Which type of perceptual disorder BEST characterizes the patient's responses? 1. Anosognosia. 2. Prosopagnosia. 3. Spatial relations disorder. 4. Somatoagnosia.

1. Anosognosia.

C188. A physical therapist is working on reconditioning a 31-year-old female admitted to the hospital for acute alcoholic hepatitis and is currently going through detoxification. As the therapist starts to work with the patient, she appears to be pregnant and is short of breath. Her abdomen is distended and tense. She denies any abdominal pain. The therapist checks her lab work and notes that her urine hCG (pregnancy test) is negative. Based on the patient's history, what is the most likely cause of her distended abdomen? 1. Ascites. 2. Cholecystitis. 3. Acute pancreatitis. 4. Opiate-induced constipation.

1. Ascites.

C110. A patient with lower back pain has marked elevation of BP and complains of mild to severe mid-abdominal pain that increases upon exertion. Palpation reveals a pulsing mass in the lower abdomen. What is the therapist's BEST course of action? 1. Discontinue treatment and notify the patient's physician immediately. 2. Provide hot packs to the abdomen to help relieve the muscle spasm. 3. Instruct the patient to contact his/her physician at the conclusion of therapy. 4. Instruct in relaxation exercises because a pulsating mass is not unusual with hypertension.

1. Discontinue treatment and notify the patient's physician immediately.

C48. A physical therapist is providing treatment to a patient in the hospital setting. The patient slips on a wetfloor but is guarded well by the therapist and incurs no injury. Which of the following statements reflects what the therapist should do? 1. Document the occurrence as a part of the risk management program. 2. Document this sentinel event to The Joint Commission. 3. Omit the incidence from the medical record as there was no negligence. 4. Report the occurrence to the Occupational Health and Safety Administration (OSHA) since it was a facility problem.

1. Document the occurrence as a part of the risk management program.

C177. A patient presents with pain and muscle spasm of the upper back (C7-T8) extending to the lateral border of the scapula. This encompasses a 10×10-cm area on both sides of the spine. If the US unit only has a 5-cm2 sound head, how should the therapist treat the upper back area? 1. Each side, allotting 5 minutes for each section. 2. The entire area in 5 minutes. 3. The entire area in 10 minutes. 4. Each side, allotting 2.5 minutes for each section.

1. Each side, allotting 5 minutes for each section.

C69. A single 22-year-old woman who is 3 months pregnant arrives at a therapist's private practice complaining of shoulder and leg pain. She has a black eye and some bruising at the wrists. The state in which the therapist practices has direct access. What is the BEST course of action for the therapist? 1. Examine the patient, and if abuse is suspected, report the findings to the appropriate authorities. 2. Administer massage for bruising, TENS, and ice modalities for pain, as indicated by the examination findings. 3. Direct the patient to the nearest ambulatory care center for physician evaluation. 4. Refuse to examine the patient and send her to the nearest emergency room.

1. Examine the patient, and if abuse is suspected, report the findings to the appropriate authorities.

C7. A patient has fixed forefoot varus malalignment. What possible compensatory motion or posture might occur? 1. Excessive subtalar pronation. 2. Ipsilateral pelvic external rotation. 3. Hallux varus. 4. Genu recurvatum.

1. Excessive subtalar pronation.

C82. Following an initial functional examination using the Functional Independence Measure (FIM), a patient is found to require minimal contact assistance in transferring from sit-to-stand and bed-to-wheelchair. Which of the following accurately documents these results? 1. FIM level 4; completes activity with 75% or more of the effort. 2. FIM level 6; completes activity with extra time. 3. FIM level 5; completes activity with cueing. 4. FIM level 3; completes activity with 50% or more but less than 75% of the effort.

1. FIM level 4; completes activity with 75% or more of the effort.

C200. A group of researchers investigated the effect of tai chi on perceived health status in older, frail adults. The subjects were 269 women who were older than 70 years of age and recruited from five independent senior living facilities. Participants took part in a 48-week single-blind RCT. Perceived health status was measured by five pretrained testers using the Sickness Impact Profile (SIP). The researchers found significant perceived health benefits. Which of the following is an accurate conclusion regarding the design of this study? 1. Generalizability to a larger population of elderly women. 2. Errors in reliability due to the number of testers. 3. Errors in validity due to the selection of the outcome measure. 4. Limited findings on the effects of tai chi exercise in the frail elderly.

1. Generalizability to a larger population of elderly women.

C79. A patient with a history of coronary artery disease and recent myocardial infarction (MI) is exercising in an inpatient cardiac rehabilitation program. Because the patient is new, continuous ECG telemetry monitoring is being done. The therapist observes the following (PVC's). What is the therapist's BEST course of action? . 1. Have the patient sit down, continue monitoring, and notify the physician immediately. 2. Activate the emergency medical response team. 3. Have the patient sit down, rest, and then resume the exercise at a lower intensity. 4. Have the patient sit down and send him/her back to the room after a brief rest period.

1. Have the patient sit down, continue monitoring, and notify the physician immediately.

C117. An apparently healthy individual has several risk factors for coronary artery disease. The client is interested in improving overall fitness and cardiac health. After a graded exercise test, which was asymptomatic, the client is referred for an exercise class. Which is the BEST measure of exercise intensity in a newly tested and exercising individual? 1. Heart rate (HR). 2. Rating of perceived exertion (RPE). 3. MET level. 4. Respiratory rate.

1. Heart rate (HR).

C62. A patient recovering from stroke is taking warfarin (Coumadin). What potential adverse reactions are associated with this medication? 1. Hematuria and ecchymosis. 2. Palpitations and edema. 3. Edema and dermatitis. 4. Cellulitis and xeroderma.

1. Hematuria and ecchymosis.

C86. A patient has been referred to physical therapy with a diagnosis of cervicogenic headaches. During the initial examination, the therapist notes clinical findings of a droopy eyelid, constricted pupil (a pinpoint pupil), and lack of sweating on the same side of the face. What is the MOST likely diagnosis based on this group of symptoms? 1. Horner's syndrome. 2. Bell's palsy. 3. Trigeminal neuralgia. 4. Myasthenia gravis.

1. Horner's syndrome.

C22. A patient recovering from a burn on the back of the hand is referred to physical therapy for mobilization exercises. The therapist observes a 14-cm irregular area that is thick and pink. How should the therapist document this finding? 1. Hypertrophic scarring. 2. An excoriation. 3. Atrophic scarring. 4. A scale.

1. Hypertrophic scarring.

C156. A therapist suspects lower brain stem involvement in a patient with amyotrophic lateral sclerosis (ALS). Examination findings reveal motor impairments of the tongue with ipsilateral wasting and deviation on protrusion. These findings confirm involvement of which cranial nerve? 1. Hypoglossal. 2. Glossopharyngeal. 3. Vagus. 4. Spinal accessory.

1. Hypoglossal.

C178. An adult patient is referred to physical therapy with knee pain after falling from a ladder. The patient is seen the day after the injury and is unable to articulate the exact mechanism of injury. The knee is swollen and the patient's gait is antalgic. The therapist is concerned about an undiagnosed fracture. What physical examination finding would indicate a need for knee radiographs? 1. Inability to flex the knee to 90°. 2. Joint line tenderness. 3. Inability to fully extend the knee. 4. Positive anterior drawer test.

1. Inability to flex the knee to 90°.

C61. A patient with a significant history of coronary artery disease is currently taking atropine. Based on knowledge of this medication, what are the expected effects? 1. Increased HR and contractility at rest. 2. Increased myocardial ischemia. 3. Palpitations at rest and with exercise. 4. Orthostatic hypotension.

1. Increased HR and contractility at rest.

C45. A patient with left hemiplegia due to a stroke uses a solid ankle AFO to ambulate. When ambulating, the patient is noted to hyperextend his knee during midstance. Which of the following interventions woulddecrease this gait deviation? 1. Inserting of a heel lift in the left shoe. 2. Tightening the calf strap on the AFO. 3. Increasing the length of the footplate on the AFO. 4. Adding an external lateral post to the AFO.

1. Inserting of a heel lift in the left shoe.

C105. Which of the following conditions associated with pelvic floor muscle dysfunction may actually worsen when treated with Kegel exercises? 1. Interstitial cystitis. 2. Stress incontinence. 3. Pelvic organ prolapse. 4. Chronic constipation.

1. Interstitial cystitis.

C116. A patient presents with decreased motion at the occipitoatlantal joint (OA). The PT wants to use the principles of coupled motions that occur in that area of the spine during manual therapy techniques. In order to improve OA mobility, when the occiput is side bent to the right, how should the therapist mobilize C1? 1. Into rotation to the left. 2. Into rotation to the right. 3. Back into extension. 4. Forward into flexion.

1. Into rotation to the left.

C103. A patient with a confirmed left C6 nerve root compression due to foraminal encroachment complains of pain in the left thumb and index finger. What is the MOST effective cervical motion to alleviate this patient's pain? 1. Lower cervical flexion. 2. Right rotation. 3. Lower cervical extension. 4. Left side bending.

1. Lower cervical flexion.

C174. A male patient is referred to outpatient physical therapy for lower back pain. During the patient interview, he describes a recent increased difficulty with urinating that does not affect his lower back pain symptoms. Neurological screening examination is normal and Murphy's sign is negative. Based on this clinical scenario, what may this patient's low back pain be associated with? 1. Lower urinary tract. 2. First lumbar nerve root. 3. Kidney. 4. Sacro-iliac joint.

1. Lower urinary tract.

C137. The patient has a fifth rib that is "stuck" in the position of maximal inspiration. Which technique is BEST to improve the rib mobility and assist it in returning to its resting position? 1. Maitland grade IV mobilization of the head of the rib at the costovertebral joint in the superior direction. 2. Maitland grade II mobilization of the head of the rib at the costovertebral joint in the superior direction. 3. Maitland grade IV mobilization of the head of the rib at the costovertebral joint in the inferior direction. 4. Maitland grade II mobilization of the head of the rib at the costovertebral joint in the inferior direction.

1. Maitland grade IV mobilization of the head of the rib at the costovertebral joint in the superior direction.

C191. A patient is taking a disease-modifying anti-rheumatic drug (DMARD) for rheumatoid arthritis. Which chemotherapy agent is also a common DMARD? 1. Methotrexate. 2. Norvasc. 3. Demerol. 4. Relafen.

1. Methotrexate.

C34. What muscle length test for the tensor fascia lata is recommended in a patient with decreased muscle length of the rectus femoris? 1. Modified Ober test (knee extended). 2. FAIR (flexion, adduction, internal rotation) test. 3. Ober test (knee flexed). 4. Ely's test.

1. Modified Ober test (knee extended).

C196. After a recent cesarean, a patient tells the therapist that she is anxious to return to her prepregnancy level of physical activity (working out at the gym three days/wk and running 5 miles every other day). What is the BEST choice of activities for this patient at this time? 1. Pelvic floor and gentle abdominal exercises for the first 4-6 weeks. 2. A walking program progressing to running after 4 weeks. 3. Pelvic floor exercises and refrain from all other exercise and running for at least 12 weeks. 4. Abdominal crunches with return to running after 5 weeks.

1. Pelvic floor and gentle abdominal exercises for the first 4-6 weeks.

C197. A patient diagnosed with schizophrenia, disorganized type, is referred for gait training after a compound fracture of the tibia. The therapist suspects the patient has recently experienced an exacerbation of schizophrenia. Which behaviors support this conclusion? 1. Poor ability to perform multistep tasks requiring abstract problem-solving. 2. Sleep disturbances and flashbacks. 3. Increased fear of going out in public. 4. Frequent verbalizations of pervasive feelings of low self-esteem.

1. Poor ability to perform multistep tasks requiring abstract problem-solving.

C157. A baseball pitcher reports insidious onset of symptoms characteristic of impingement, including catching and popping in the throwing arm. Examination reveals that glenohumeral passive internal rotation is painful and limited to 30°. External rotation is less symptomatic and has 130° of passive range. What is the BEST initial course of action for the therapist? 1. Recommend an MRI. 2. Mobilize the glenohumeral joint to increase internal rotation ROM. 3. Begin elastic resistance exercises for impingement. 4. Recommend an anteroposterior radiograph.

1. Recommend an MRI.

C136. A therapist is treating a patient with a diagnosis of right shoulder rotator cuff tendinitis. The findings of a work site ergonomic assessment indicate that the worker is required to perform repetitive reaching activities above shoulder height. Which of the following is the MOST beneficial work site modification? 1. Reposition the height of the shelf and items to below shoulder height. 2. Provide the worker with a taller, sit-stand chair. 3. Allow the worker to take more frequent rests to avoid overuse. 4. Provide the worker with a standing desk for daily activities.

1. Reposition the height of the shelf and items to below shoulder height.

C66. A physical therapist evaluates a patient who sustained a whiplash injury in a recent motor vehicle accident. The therapist is concerned that the patient may have an unstable upper cervical spine. During examination of the seated patient, the therapist performs a ligament integrity test by slightly flexing the cervical spine, fixating the C2 spinous process with one hand, and gliding the head in a posterior direction with the other hand. What is the name of this special test 1. Sharp-Purser test. 2. Alar ligament stress test. 3. Quadrant test. 4. Vertebral artery test.

1. Sharp-Purser test.

C99. The therapist is treating a child with mild developmental delay secondary to 7 weeks prematurity at birth. The child is now 8 months old and is just learning to sit. Which is the BEST choice for a training activity? 1. Sideward protective extension in sitting. 2. Supine tilting reactions. 3. Standing tilting reactions. 4. Prone tilting reactions.

1. Sideward protective extension in sitting.

C40. A patient recovering from surgery for triple coronary artery bypass grafts is scheduled to begin a phase III cardiac rehabilitation program. During the resistance training portion of the circuit training program, the therapist instructs the patient to avoid the Valsalva maneuver. What are the expected adverse effects of the Valsalva maneuver? 1. Slowing of pulse and increased venous pressure are possible. 2. The decreased return of blood to the heart can lead to pitting edema. 3. Heart rate (HR) and blood pressure are likely to be elevated. 4. A cholinergic or vagal response can occur.

1. Slowing of pulse and increased venous pressure are possible.

C20. During surgery to remove an apical lung tumor, the long thoracic nerve was injured. Muscle testing of the serratus anterior demonstrates its strength to be 3+/5. What is the BEST initial exercise for this patient? 1. Standing wall push-ups. 2. Standing arm overhead lifts using hand weights. 3. Supine arm overhead lifts using weights. 4. Sitting arm overhead lifts using a pulley.

1. Standing wall push-ups.

C10. A PT is reviewing a medical record prior to examining a patient for the first time. The suspected diagnosis is multiple sclerosis. On the neurologist's note, the therapist finds the following: deep tendon reflex (DTR); right quadriceps is 2+, left quadriceps is 4+. What is the correct interpretation of these findings? 1. The right DTR is normal, the left is abnormal. 2. Both DTRs are abnormal and indicative of hyporeflexia. 3. The right DTR is exaggerated, the left is clearly abnormal. 4. Both DTRs are abnormal and indicative of upper motor neuron (UMN) syndrome.

1. The right DTR is normal, the left is abnormal.

C123. A young patient presents with primary lymphedema of the right lower extremity. What is the BEST choice for initial exercise? 1. Treadmill walking. 2. Treadmill jogging. 3. Exercising on a stair climbing machine. 4. Step aerobics.

1. Treadmill walking.

C152. A patient is referred for physical therapy with a diagnosis of degenerative joint disease (DJD) affecting C2 and C3. The patient complains of pain and stiffness in the cervical region and transient dizziness with some cervical motions. What is the BEST initial examination procedure? 1. Vertebral artery test. 2. Adson's maneuver. 3. Lhermitte's test. 4. Oppenheim's test.

1. Vertebral artery test.

C179. A therapist is examining a patient's balance using posturography testing with the Clinical Test for Sensory Integration in Balance (CTSIB). The patient's sway increases with loss of balance under conditions with the eyes closed and platform moving (condition 5). During condition 6, with both the visual surround and platform moving, loss of balance is more immediate. Which of the following BEST identifies the source of the patient's problems? 1. Vestibular deficiency. 2. Visual dependency. 3. Problems with sensory selection. 4. Somatosensory dependency.

1. Vestibular deficiency.

C198. The rehabilitation team is completing a home visit to recommend environmental modifications for a patient who is scheduled to be discharged next week. The patient is wheelchair dependent. The home has not been adapted. Which of the following recommendations is correct? 1. Widening the door entrance to 28 inches. 2. Adding horizontal grab bars in the bathroom positioned at 34 inches. 3. Raising the toilet seat to 25 inches. 4. Installing an entry-way ramp with a running slope of 1:10.

2. Adding horizontal grab bars in the bathroom positioned at 34 inches.

C119. A patient complains of pain with mouth opening that makes it difficult to eat foods that require chewing. Which of the following provides the normal limits of mouth opening that should guide the therapist's examination? 1. 15-24 mm. 2. 35-50 mm. 3. 51-65 mm. 4. 66-74 mm.

2. 35-50 mm.

C102. When performing scoliosis screening in a school setting, what is the optimal age (in years) for girls to be screened? 1. 6-8. 2. 9-11. 3. 12-14. 4. 15-17.

2. 9-11.

C165. An examination of a patient reveals drooping of the shoulder, rotary winging of the scapula, an inability to shrug the shoulder, and complaints of aching in the shoulder. Based on these findings, what is the MOST likely cause of these symptoms? 1. Strain of the serratus anterior. 2. A lesion of the spinal accessory nerve. 3. A lesion of the long thoracic nerve. 4. Muscle imbalance.

2. A lesion of the spinal accessory nerve.

C28. A patient with a 10-year history of scleroderma is referred for physical therapy to improve functional status and endurance. The patient was recently treated with corticosteroids for a bout of myositis. Examination findings reveal limited ROM and fibrotic soft tissue along with hyperesthesia. What is the BEST choice for initial ntervention? 1. Treadmill walking using body weight support at an intensity of 40% HRmax. 2. Active range of motion (AROM) exercises and walking in a therapeutic pool. 3. Closed-chain and modified aerobic step exercises. 4. Soft tissue mobilization and stretching.

2. Active range of motion (AROM) exercises and walking in a therapeutic pool.

C43. During an examination, a patient complains of right upper quadrant pain and tenderness. The PT percusses over the costal margin at the point where the lateral border of the rectus muscle intersects with the costal margin. The patient complains of acute pain and stops inspiratory effort. What does this patient's response indicate? 1. Hernia. 2. Acute cholecystitis. 3. Irritation of the psoas muscle by an inflamed appendix. 4. Peritoneal inflammation.

2. Acute cholecystitis.

C194. A patient recovering from stroke presents with predominant involvement of the contralateral lower extremity and lesser involvement of the contralateral upper extremity. These clinical manifestations are characteristic of which cerebral syndrome? 1. Basilar artery syndrome. 2. Anterior cerebral artery syndrome. 3. Posterior cerebral artery syndrome. 4. Middle cerebral artery syndrome.

2. Anterior cerebral artery syndrome.

C114. An elderly, frail resident of an extended care facility has intractable constipation. During a scheduled visit from the PT, the patient complains of abdominal pain and tenderness. Where may this patient experience referred pain? 1. Buttock, thigh, and posterior leg. 2. Anterior hip, groin, or thigh region. 3. Low back and front of the thigh to the knee. 4. Medial thigh and leg.

2. Anterior hip, groin, or thigh region.

C176. A therapist is reviewing x-rays from a patient with a trimalleolar fracture. What are the BEST radiographic views to visualize this bony fracture? 1. Oblique and lateral. 2. Anteroposterior and lateral. 3. Posteroanterior and lateral. 4. Lateral and coronal.

2. Anteroposterior and lateral.

C67. During an examination of an adolescent female who complains of anterior knee pain, the PT observes that the lower extremity shows medial femoral torsion and toeing-in position of the feet. What pathology of the hip is commonly associated with medial femoral torsion and toeing-in? 1. Retroversion. 2. Anteversion. 3. Medial/internal rotation. 4. Lateral/external rotation.

2. Anteversion.

C29. An 89-year-old individual who is living independently in the home has a history of three falls in the last 3 months. A referral was initiated to a home health agency for physical therapy evaluation and intervention. The visiting therapist begins the initial visit obtaining an accurate history including medications. Which of the following types of drugs are strongly linked to falls in the elderly? 1. Medications that raise blood sugar. 2. Antidepressants. 3. Multivitamins and calcium. 4. Thyroid medications.

2. Antidepressants.

C144. A middle-aged patient complains of "throbbing pain" in the lumbar region with activities upon exertion, such as walking up a flight of steps or playing tennis. The patient expresses no complaints of pain with bending, twisting, sitting, standing, or walking any distance. Active movements of the lumbar spine are full and pain free. Provocation testing is negative. Neurological signs are unremarkable. There is no significant tenderness to palpation. What is the MOST likely diagnosis for this patient? 1. Lumbar disc herniation. 2. Aortic aneurysm. 3. Quadratus lumborum muscle strain. 4. Sacroiliac joint sprain.

2. Aortic aneurysm.

C41. A patient experiences color changes in the skin during position changes of the foot. During elevation, pallor develops. When the limb is then positioned in the seated hanging position, hyperemia develops. What do these changes indicate? 1. Lymphedema. 2. Arterial insufficiency. 3. Deep vein thrombophlebitis. 4. Chronic venous insufficiency.

2. Arterial insufficiency.

C56. A patient who is participating in a cardiac rehabilitation program suddenly collapses and falls to the floor. The PT is the lone rescuer on site. The therapist checks for a response and finds the patient unresponsive. After activating the emergency response system (phone 911), what is the BEST action for the therapist to take? 1. Use the automated external defibrillator (AED) to shock the patient after 3 minutes of cardiopulmonary resuscitation (CPR). 2. Begin CPR and attach and use the AED as soon as possible. 3. Give 100 chest compressions per minute. 4. Give two rescue breaths followed by 15 chest compressions, repeating the cycle for at least 2 minutes.

2. Begin CPR and attach and use the AED as soon as possible.

C60. A patient presents with an acute onset of vertigo overnight. Symptoms worsen with rapid change in head position. If the head is held still, symptoms subside usually within 30-60 seconds. What is the MOST likely cause of these symptoms? 1. Ménière's disease. 2. Benign paroxysmal positional vertigo (BPPV). 3. Bilateral vestibular neuritis. 4. Acoustic neuroma.

2. Benign paroxysmal positional vertigo (BPPV).

C143. An older adult at risk for falls has undergone a structured home-based exercise program that consisted of standing balance training and strengthening exercises. Which measure is the BEST choice to document improvements? 1. Timed Up & Go Test. 2. Berg Balance Test. 3. 6-Minute Walk Test. 4. Performance-Oriented Mobility Assessment (Tinetti).

2. Berg Balance Test.

C23. A patient presents with an acute left L5 radiculopathy. Pain is rated as 9/10. The therapist decides to apply transcutaneous electrical nerve stimulation (TENS) to modulate pain prior to manual therapy. Which TENSmode should provide the BEST relief? 1. Low rate TENS. 2. Brief intense TENS. 3. Modulated TENS. 4. Conventional (high-rate) TENS.

2. Brief intense TENS.

C25. A patient demonstrates some out-of-synergy movements in the right upper extremity indicative of stage 4 recovery after a left cerebrovascular accident (CVA). Which proprioceptive neuromuscular facilitation (PNF) pattern represents the BEST choice to promote continued recovery of the right upper extremity? 1. Bilateral symmetrical D2F and D2E, elbows straight. 2. Chop, reverse chop with right arm leading. 3. Lift, reverse lift with right arm leading. 4. Bilateral symmetrical D1 thrust and reverse thrust.

2. Chop, reverse chop with right arm leading.

C8. A patient presents with fingertips that are rounded and bulbous. The nail plate is more convex than normal. These changes are the likely result of which condition? 1. Psoriasis. 2. Chronic hypoxia from heart disease. 3. Inflammation of the proximal and lateral nail folds. 4. Trauma to the nail bed.

2. Chronic hypoxia from heart disease.

C75. A college soccer player sustained a hyperextension knee injury of the plant leg while kicking the ball with the other lower extremity. The patient was taken to the emergency room of a local hospital and was diagnosed with "knee sprain." The patient was sent to physical therapy the next day for rehabilitation. As part of the examination, the therapist conducts the test shown in the figure (Lachman's test). Based on a positive test, what type of exercise intervention is indicated during the acute phase of treatment? 1. Open-chain terminal knee extension exercises. 2. Closed-chain terminal knee extension exercises. 3. Plyometric functional exercises. 4. Agility exercises.

2. Closed-chain terminal knee extension exercises.

C173. An adolescent with a 4-year history of type 2 diabetes is insulin dependent and wants to participate in cross-country running. The PT working with the school team advises the athlete to measure plasma glucose concentrations before and after running. What additional advice should the therapist give this student athlete? 1. Increase insulin dosage immediately before running. 2. Consume a carbohydrate before or during practice to avoid hypoglycemia. 3. Avoid carbohydrate-rich snacks within 12 hours of a race. 4. Consume a carbohydrate after practice to avoid hyperglycemia.

2. Consume a carbohydrate before or during practice to avoid hypoglycemia.

C106. A therapist is applying a symmetrical biphasic pulsed current at 25 pps (tetany) to the vastus medialis to improve patellar tracking during knee extension. The patient complains that the current is too strong and uncomfortable. To make the current more tolerable to the patient, yet maintain a good therapeutic effect, what adjustment should the therapist make? 1. Change the current polarity. 2. Decrease the pulse duration. 3. Increase the amplitude. 4. Decrease the pulse rate.

2. Decrease the pulse duration.

C57. A patient who was casted for 3 weeks after a grade III right ankle sprain has been referred to physical therapy for mobility exercises. Examination shows a loss of 10° of dorsiflexion. Which activity will be the MOST difficult for the patient? 1. Ambulating over rough surfaces. 2. Descending stairs. 3. Ambulating barefoot. 4. Descending a ramp.

2. Descending stairs.

C101. A patient with complete spinal cord injury at the level of T11 is on a bowel program. Which of the following is the MOST effective bowel training program for this patient? 1. Diet and medications to manage a flaccid bowel. 2. Digital stimulation of intact defecation reflexes. 3. Manual removal of stool from the rectum. 4. Medications such as laxatives for passive elimination.

2. Digital stimulation of intact defecation reflexes.

C168. A patient is taking the drug baclofen to control spasticity after a complete spinal cord injury at T10. This medication can be expected to decrease muscle tone and pain. What are the possible adverse effects of taking baclofen? 1. Urinary retention and discomfort. 2. Drowsiness and muscle weakness. 3. Hypertension and palpitations. 4. Headache with visual auras.

2. Drowsiness and muscle weakness.

C195. A patient presents with significant intermittent claudication with onset after 2 minutes of walking. Which of the following are likely findings for this patient, given the patient's symptoms in response to walking? 1. Persistent local redness of the extremity in both gravity-dependent and -independent positions. 2. Elevation-induced pallor and dependent redness with the extremity in the gravity-dependent position. 3. Little or no changes in color with changes in extremity position. 4. A brownish color just above the ankle in both gravity-dependent and -independent positions.

2. Elevation-induced pallor and dependent redness with the extremity in the gravity-dependent position.

C37. Based on the spinal defect shown in the diagram(Pars fracture), what lumbar spinal motion should be avoided? 1. Rotation. 2. Extension. 3. Lateral flexion. 4. Flexion.

2. Extension.

C76.A patient with a grade III diabetic ulcer is being treated with a calcium alginate wound dressing. What are the primary indications for this type of wound dressing? 1. Provide semirigid support for the limb while maintaining a sterile field. 2. Facilitate autolytic debridement and absorb exudate. 3. Absorb exudate and allow rapid moisture evaporation. 4. Restrict bacteria from the wound while supporting the tissues.

2. Facilitate autolytic debridement and absorb exudate.

C42. An elderly and frail adult is referred to physical therapy for an examination of balance. The patient has a recent history of falls (two in the last 6 months). Based on knowledge of balance changes in the elderly and scoring of standardized balance measures, which of the following test results BEST indicates increased fall risk? 1. Tinetti Performance Oriented Mobility Assessment (POMA) score of 27. 2. Functional Reach of 7 inches. 3. Timed Get Up & Go (GUG) test result of 13 seconds. Berg Balance score of 50.4.

2. Functional Reach of 7 inches.

C39. A patient presents with rapidly progressive symmetrical weakness that started in the distal lower extremity muscles but now has ascended to include proximal trunk and upper extremity muscles. The motor segments of the lower cranial nerves are also showing impairment. The patient complains of abnormal sensations of tingling and burning of the affected extremities. Consciousness, cognition, and communication are all normal. These signs and symptoms are characteristic of what diagnosis? 1. Multiple sclerosis. 2. Guillain-Barré syndrome. 3. Amyotrophic lateral sclerosis. 4. Postpolio syndrome.

2. Guillain-Barré syndrome.

C70. An elderly patient presents with a stage III decubitus ulcer on the plantar surface of the right foot. After a series of conservative interventions with limited success, the therapist chooses to apply electrical stimulation for tissue repair. What is the BEST electrical current to administer in this case? 1. Medium-frequency burst current. 2. High-volt monophasic pulsed current. 3. Medium-frequency beat current. 4. Low-volt biphasic pulsed current.

2. High-volt monophasic pulsed current.

C63. The PT reviews the laboratory results of a patient admitted to the acute care hospital yesterday: Hematocrit 45%, fasting blood glucose 180 mg/dL, and cholesterol 180 mg/dL. Based on these laboratory results, what condition is MOST likely? 1. Polycythemia vera. 2. Hyperglycemia of diabetes. 3. Anemia. 4. Hyperlipidemia.

2. Hyperglycemia of diabetes.

C138. A patient with a fibular fracture complains of weakness in the RLE following cast removal. Examination reveals measurable loss of muscle bulk (2-inch girth difference between the right and left legs). The therapist suspects neurogenic atrophy and next examines tone. Which finding is consistent with this diagnosis? 1. Normal tone. 2. Hypotonia. 3. Dystonia. 4. Hypertonia.

2. Hypotonia.

C33. A therapist is examining a patient with chronic obstructive pulmonary disease (COPD) GOLD stage III. What would be a clinical finding that the therapist would expect for this patient? 1. Decreased subcostal angle. 2. Increased anteroposterior-to-lateral chest ratio. 3. Use of supplemental oxygen. 4. Weight gain.

2. Increased anteroposterior-to-lateral chest ratio.

C84. A patient is referred to physical therapy with a diagnosis of "frozen shoulder." Which of the following is the BEST choice of technique to increase shoulder abduction? 1. Lateral glide. 2. Inferior glide. 3. Posterior glide. 4. Anterior glide.

2. Inferior glide.

C175. A PTA is ambulating a patient with a stroke using a walker. The patient is unsteady and fearful of falling. The patient does not appear to understand the correct gait sequence. What is the supervising PT's BEST course of action? 1. Intervene and teach the correct sequence because the PTA is apparently unable to deal with this special situation. 2. Instruct the PTA to have the patient sit down and utilize mental practice of the task. 3. Tell the PTA and patient to stop the ambulation and work on dynamic balance activities instead. 4. Instruct the PTA to use a distributed practice schedule to ensure patient success.

2. Instruct the PTA to have the patient sit down and utilize mental practice of the task.

C1. After an uncomplicated acute myocardial infarction (MI), which graded exercise test (GXT) should be administered to the patient before hospital discharge? 1. Symptom-limited GXT at 10 days post MI. 2. Low level GXT at 4 to 6 days post MI. 3. GXT to 85% age predicted maximum HR 3 to 5 days post MI. 4. GXT to 75% age predicted maximum HR 4 to 6 days post MI.

2. Low level GXT at 4 to 6 days post MI.

C111. A patient presents for the initial examination with an acute and painful shoulder impingement. During the examination, the PT finds significantly increased muscle guarding around the shoulder girdle with difficulty in accurately assessing joint mobility. Which manual therapy technique is the BEST option to use to assist in performing a proper assessment? 1. Maitland grade III posterior glide to the glenohumeral joint. 2. Maitland grade II oscillation to the glenohumeral joint. 3. Maitland grade III inferior glide to the glenohumeral joint. 4. Maitland grade IV inferior glide to the glenohumeral joint.

2. Maitland grade II oscillation to the glenohumeral joint.

C30. A patient recovering from stroke with minimal lower extremity weakness and spasticity is able to walk without an assistive device. The therapist observes that as the patient walks there is noticeable hip hiking on the more affected side during swing phase. What is the BEST initial intervention? 1. Bridging exercises progressing to sit-to-stand training. 2. Marching while sitting on a therapy ball. 3. Standing and marching with manual pressure applied downward on the pelvis. 4. Partial wall squats using a small ball held between the knees.

2. Marching while sitting on a therapy ball.

C169. A teen-aged female distance runner presents a history of stress fractures and general leg pain. Her parents think it may be due to overtraining. Based on this subjective information, what should the physical therapist question the patient about next? 1. Recent growth spurts. 2. Menses and eating habits. 3. Type of running shoe. 4. Participation in other sports.

2. Menses and eating habits.

C14. A physical therapist is reviewing the medication list with a patient with osteoarthritis during their initial visit. All of the medicines/supplements they are taking were prescribed by one of their physicians. The therapist is concerned and has decided to call the patient's primary care physician. Which combination of medications/supplements is a red flag? 1. Naproxen 500 mg 2x/day and Tylenol 500 mg 4x/day. 2. Naproxen 500 mg 2x/day and Aleve 500 mg 2x/day. 3. Naproxen 500 mg 2x/day and Glucosamine sulfate/chondroitin 400 mg 3x/day. 4. Tylenol 500 mg 4x/day and Fish Oil 1,000 mg 1x/day.

2. Naproxen 500 mg 2x/day and Aleve 500 mg 2x/day.

C128. A patient with trigeminal nerve neuralgia (CN V) is referred to the physical therapist. What are the expected examination findings? 1. Sudden severe pains in the ophthalmic division of CN V. 2. Paroxysmal and severe pain originating from the mandibular or maxillary divisions of CN V. 3. Unilateral sensory loss of the ophthalmic division of CN V. 4. Bilateral sensory loss of CN V in all three divisions.

2. Paroxysmal and severe pain originating from the mandibular or maxillary divisions of CN V.

C24. A patient recovering from traumatic brain injury (TBI) demonstrates difficulties in feeding resulting from an unstable posture while sitting. The therapist determines that modification is necessary to ensure optimal function. What is the first body segment or segments that the therapist should align? 1. Trunk. 2. Pelvis. 3. Head. 4. Lower extremities.

2. Pelvis.

C87. A patient with a recent history of rib fractures suddenly becomes short of breath during a bout of coughing. The patient looks panicked and complains of sharp pain in the left chest. A quick screen shows a deviated trachea to the right, among other signs and symptoms. What is the MOST likely diagnosis based on these symptoms? 1. Pulmonary emboli. 2. Pneumothorax. 3. Angina. 4. Mucous plugging of an airway.

2. Pneumothorax.

C65. An elderly patient has been hospitalized and on complete bed rest for 10 days. A physical therapy referral requests mobilization out of bed and ambulation. The patient complains of aching in the right calf. The therapist's examination reveals calf tenderness with slight swelling and warmth. What is the BEST course of action for the therapist? 1. Begin with ankle pump exercises in bed and then ambulate. 2. Postpone ambulation and report the findings immediately. 3. Ambulate the patient with support stockings on. 4. Use only AROM exercises with the patient sitting at the edge of the bed.

2. Postpone ambulation and report the findings immediately.

C121. A patient presents with complaints of tingling and paresthesias in the median nerve distribution of the right forearm and hand. The following tests were found negative bilaterally: Adson's, hyperabduction, costoclavicular, Phalen's, and the ulnar nerve Tinel's sign. Based on this information, what is the likely diagnosis? 1. Ulnar nerve entrapment. 2. Pronator teres syndrome. 3. Thoracic outlet syndrome (TOS). 4. Carpal tunnel syndrome.

2. Pronator teres syndrome.

C142. A patient with a transfemoral amputation and an above-knee prosthesis demonstrates knee instability while standing. The patient's knee buckles easily when performing weight shifts. What is the MOST likely cause of the problem? 1. Weak gluteus medius. 2. Prosthetic knee set too far anterior to the TKA line. 3. Tight extension aid. 4. Prosthetic knee set too far posterior to the trochanter-knee-ankle (TKA) line.

2. Prosthetic knee set too far anterior to the TKA line.

C9. The PT is examining a patient for right neck pain and spasms. Several inflamed submandibular nodes are noted. The nodes are approximately 1.0 cm in size, tender, and erythematous. The patient has no known history of cancer or metabolic diseases. What is the FIRST action the therapist should take? 1. Question the patient regarding impact of neck pain and emotional distress. 2. Question the patient regarding any recent dental or throat infections. 3. Refer the patient for x-ray imaging. 4. Begin manual lymphatic drainage.

2. Question the patient regarding any recent dental or throat infections.

C59. An adult recreational runner is referred to physical therapy with a diagnosis of Achilles' tendinopathy. Thepatient reports initial pain when running that resolves after a half-mile, but then returns a few hours after therun is complete. The insertion of the tendon is tender to palpation and the patient's pain is reproduced whenperforming a single leg heel raise. What is the BEST intervention to decrease pain and improve function in apatient with Achilles' tendinopathy? 1. Resisted eccentric ankle dorsiflexion. 2. Resisted eccentric ankle plantarflexion. 3. Stretching of the gastrocnemius and soleus. 4. Soft tissue mobilization of the gastrocnemius and soleus.

2. Resisted eccentric ankle plantarflexion.

C135. A middle-aged patient has been undergoing long-term corticosteroid treatment for pulmonary sarcoidosis. Due to the side effects of treatment, which intervention is the MOST important component to the patient's physical therapy plan of care? 1. Supplemental oxygen use. 2. Resisted exercise for proximal muscle strengthening. 3. Acapella for airway clearance. 4. Education on pursed-lip breathing.

2. Resisted exercise for proximal muscle strengthening.

C38. A patient with a history of interstitial lung disease is being evaluated for treatment of chronic back pain. The patient has been administered opioids for the pain. What potential side effect of opioids should be a concern? 1. Pulmonary hypertension, which would be a contraindication to exercise. 2. Respiratory depression, which could reduce the patient's tolerance to exercise. 3. Raynaud's syndrome, which could reduce the patient's tolerance to therapeutic modalities. 4. Deep vein thrombosis, which would be a contraindication to exercise.

2. Respiratory depression, which could reduce the patient's tolerance to exercise.

C91. A patient recovering from traumatic brain injury (TBI) is functioning at level IV on the Rancho Los Amigos Levels of Cognitive Functioning Scale (LOCF). During the therapist's initial examination, the patient becomes agitated and tries to bite the therapist. What is the therapist's BEST course of action? 1. Postpone the examination for 1 week and then try again. 2. Restructure the formal examination so the therapist can complete it in three very short sessions. 3. Document the behaviors and engage in a calming activity. 4. Postpone the examination until later in the day when the patient calms down.

2. Restructure the formal examination so the therapist can complete it in three very short sessions.

C50. An elderly individual was found unconscious at home and was hospitalized with a diagnosis of cerebrovascular accident (CVA). Examination by the PT reveals normal sensation and movement on the right side of the body with impaired sensation (touch, pressure, proprioception) and paralysis on the left side of the body. The left side of the lower face and trunk are similarly impaired. What is the MOST likely location of the CVA? 1. Left parietal lobe. 2. Right parietal lobe. 3. Left side of brain stem. 4. Spinal cord.

2. Right parietal lobe.

C148. Which cluster of examination findings would indicate that a patient is in decompensated heart failure? 1. S4 heart sound, wheezes on lung auscultation, decreased jugular vein distension. 2. S4 heart sound, crackles on lung auscultation, increased jugular vein distension. 3. S2 heart sound, crackles on lung auscultation, decreased jugular vein distension. 4. S2 heart sound, wheezes on lung auscultation, increased jugular vein distension.

2. S4 heart sound, crackles on lung auscultation, increased jugular vein distension.

C189. A female patient complains of right lumbosacral pain after giving natural childbirth to her first child 2 months ago. Pain has subsided somewhat, but remains high enough that she has to sit after walking more than 2 blocks. Pain is noted in the right lumbosacral region, buttock, and groin and is aggravated with weight bearing on the right. Active flexion, extension, and side bending reproduce the patient's symptoms. Hamstrings are slightly tight on the right, but no neural tension is noted. Neurological findings (reflexes, sensation, and motor) are unremarkable. SI provocation tests are positive. What is the MOST likely diagnosis for this patient? 1. Lumbar disc protrusion at L5/S1. 2. Sacroiliac sprain. 3. Quadratus lumborum strain. 4. Piriformis syndrome.

2. Sacroiliac sprain.

C72. A patient recovering from stroke demonstrates hemiparesis of the right upper extremity with moderate flexion and extension synergies (flexion stronger than extension). The therapist's goal is to strengthen the shoulder muscles first to promote elevation of the arm. What is the BEST exercise intervention to achieve this goal? 1. Shoulder abduction with elbow flexion. 2. Shoulder flexion with elbow extension. 3. Shoulder horizontal adduction with elbow extension. 4. Shoulder horizontal adduction with elbow flexion.

2. Shoulder flexion with elbow extension.

C27. A patient is admitted to a coronary care unit with a mild myocardial infarction (MI). After 2 days, the patient is referred to physical therapy for inpatient cardiac rehabilitation. During an initial exercise session on the unit, the patient reports chest pain, appears anxious and wants to go back to bed to rest. What is the therapist's BEST initial course of action? 1. Assist the patient back to bed and contact the charge nurse on the floor. 2. Sit the patient down and monitor vital signs carefully during the rest period. 3. Assign the PTA to assist the patient back to bed and monitor vital signs carefully. 4. Terminate the exercise and contact the attending physician immediately.

2. Sit the patient down and monitor vital signs carefully during the rest period.

C88. A patient presents with supraspinatus tendinitis. After the initial cryotherapy, the therapist decides to apply ultrasound (US). In what position should the therapist place the shoulder joint in order to effectively treat the supraspinatus tendon? 1. Adduction and external rotation. 2. Slight abduction and internal rotation. 3. Adduction and internal rotation. 4. Slight abduction and external rotation.

2. Slight abduction and internal rotation.

C11. A patient has an episode of syncope in the physical therapy clinic. The therapist attempts to rule out orthostatic hypotension as the cause of the fainting. What is the BEST test protocol to use? 1. Palpate the carotid arteries and take resting HR and BP in the supine position. 2. Take resting HR and BP in supine, then in sitting, then in standing after 1 minute. 3. Take resting HR and BP in supine after 5 minutes, then in semi-Fowler position. 4. Take resting HR and BP in sitting and after 3 and 5 minutes of cycle ergometry exercise.

2. Take resting HR and BP in supine, then in sitting, then in standing after 1 minute.

C150. Where should a therapist's hand/fingers be located for posteroanterior mobilization to improve down- gliding/closure of the T7-8 facet joints? 1. Spinous process of T6. 2. Transverse processes of T8. 3. Spinous process of T8. 4. Transverse processes of T7.

2. Transverse processes of T8.

C77. The PT receives a referral to treat a hospitalized patient with adhesive capsulitis. The patient is recovering from a recent hepatitis B infection. What precautions should the therapist observe? 1. Use droplet transmission precautions. 2. Use contact precautions. 3. Ask the patient to wear gloves and avoid contact. 4. Wear personal protection equipment (PPE) when transporting the patient to therapy.

2. Use contact precautions.

C53. A patient presents with maximal claudication (grade 4) that is evident when walking distances greater than 200 feet. The patient also exhibits muscle fatigue and cramping of both calf muscles. Upon examination, the PT finds the skin is pale and shiny with some trophic nail changes. What is the BEST choice for this patient's initial exercise program? 1. Avoid any exercise stress until the patient has been on calcium channel blockers for at least 2 weeks. 2. Utilize an interval walking program, exercising to the level of intense pain, then resting before resumingexercise. 3. Utilize non-weight-bearing exercises such as cycle ergometry. 4. Utilize a continuous walking program of moderate intensity for 10-minute bouts.

2. Utilize an interval walking program, exercising to the level of intense pain, then resting before resuming exercise.

C108. A patient presents with symptoms of uncoordinated eye movements, profound gait and trunk ataxia, and difficulty with postural orientation to vertical. Balance deficits are pronounced in standing with eyes open and eyes closed. Examination of the extremities reveals little change in tone or coordination. What is the likely CNS location of the patient's dysfunction? 1. Premotor cortex. 2. Vestibulocerebellum. 3. Spinocerebellum. 4. Basal ganglia.

2. Vestibulocerebellum.

C26. An elderly individual has limited endurance as a result of a sedentary lifestyle. There is no history of cardiorespiratory problems. An exercise tolerance test was negative for coronary heart disease. What is the BEST initial exercise prescription for this individual? 1. 40%-50% HRmax. 2. 35%-50% of VO2max. 3. 60%-90% HRmax. 4. 30%-50% HRmax.

3. 60%-90% HRmax.

C55. A PT is prescribing a wheelchair for a patient with left hemiplegia who is of average height (5 feet 7 inches). Which of the following is the BEST choice to improve the patient's function? 1. Desk armrests. 2. A 20-inch seat height. 3. A 17.5-inch seat height. 4. Elevating leg rests.

3. A 17.5-inch seat height.

C161. Following a hip fracture that is now healed, a patient presents with weak hip flexors (2/5). All other muscles are within functional limits. Based on these findings, what should the therapist expect the patient may display during gait? 1. Backward trunk lean. 2. Forward trunk lean. 3. A circumducted gait. 4. Excessive hip flexion.

3. A circumducted gait.

C52. The PT is supervising a phase II cardiac rehabilitation class of 10 patients. One of the patients, who is being monitored with radiotelemetry, is having difficulty. Which change would be a criterion for terminating this exercise session? 1. An increase in systolic BP to 150 and diastolic BP to 90. 2. 1-mm ST segment depression, upsloping. 3. A second-degree atrioventricular (AV) heart block. 4. An increase in HR 20 beats/minute above resting.

3. A second-degree atrioventricular (AV) heart block.

C154. To examine a patient with a suspected deficit in graphesthesia, what should the therapist ask the patient to identify with eyes closed? 1. Different objects placed in the hand and manipulated. 2. The vibrations of a tuning fork when placed on a bony prominence. 3. A series of letters traced on the hand. 4. Differently weighted, identically shaped cylinders placed in the hand.

3. A series of letters traced on the hand.

C122. A young adult patient is referred to outpatient physical therapy for an insidious onset of thoracic spine stiffness and mild pain. The patient reports a great deal of difficulty moving the mid-back region in the morning and states that this has become progressively worse over the past 6 months. The neurological exam is negative. Based on these symptoms, what is the likely diagnosis? 1. Pneumothorax. 2. Thoracic compression fracture. 3. Ankylosing spondylitis. 4. Lyme disease.

3. Ankylosing spondylitis.

C100. The picture depicts a patient who is learning to take her own pulse. What is the patient doing incorrectly? 1. Taking the pulse with the forearm supinated. 2. Palpating the ulnar artery. 3. Assessing the pulse with the thumb. 4. Palpating the right arm as opposed to the more accurate left arm.

3. Assessing the pulse with the thumb.

C94. A patient has been taking corticosteroids (hydrocortisone) for management of adrenocortical insufficiency and is referred to physical therapy for mobility training after a prolonged hospitalization. What are the potential adverse effects from prolonged use of this medication? 1. Hypotension and myopathy. 2. Decreased appetite and weight loss. 3. Atrophy and osteoporosis. 4. Confusion and depression.

3. Atrophy and osteoporosis.

C89. A patient is referred for postmastectomy rehabilitation. During the initial examination, the therapist observes an irregular area of skin on the patient's shoulder about 7 mm in diameter. The patient reports that there has always been a mole there but is more prominent lately and that the color has changed, now ranging from black to red to blue. How should the therapist document this finding? 1. Papule. 2. Wheal. 3. Atypical dysplastic nevus. 4. Benign nevus.

3. Atypical dysplastic nevus.

C85. A patient presents with insidious onset of pain in the jaw that is referred to the head and neck regions. As best as the patient can recall, it may be related to biting into something hard. Cervical ROM is limited in flexion by 20°, cervical lateral flexion limited to the left by 10°. Mandibular depression is 10 mm with deviation to the left, protrusion is 4 mm, and lateral deviation is 15 mm to the right and 6 mm to the left. What is the MOST likely diagnosis given this patient's symptoms? 1. Weak lateral pterygoids on the right. 2. Weak lateral pterygoids on the left. 3. Capsule-ligamentous pattern of temporomandibular joint (TMJ) on the left. 4. Cervical spine and TMJ capsular restrictions on the left.

3. Capsule-ligamentous pattern of temporomandibular joint (TMJ) on the left.

C44. An elderly woman is experiencing incontinence and is referred for physical therapy. Her history is an important part of the physical therapist's examination. What question should the therapist ask to differentiate/diagnose stress urinary incontinence from urge urinary incontinence, using a time frame of the last 3 months? 1. Did you experience a sudden urge and leak urine while hurrying to the toilet? 2. Did you leak urine during sleep? 3. Did you leak urine when sneezing or coughing? 4. Did you leak urine while sitting in a chair?

3. Did you leak urine when sneezing or coughing?

C17. Which is a typical early clinical manifestation of cystic fibrosis (CF)? 1. Increase in secretions of the endocrine system. 2. Frequent recurrent urinary tract infections. 3. Excessive appetite and weight loss. 4. Increased FEV1 (forced expiratory volume in 1 sec) during pulmonary function testing.

3. Excessive appetite and weight loss.

C139. A patient has a 10-year history of peripheral vascular disease (PVD) affecting the right lower extremity. During auscultation in a peripheral vascular examination, the therapist should examine for: 1. Cool temperature of the LE. 2. Pitting edema of the dorsum of foot. 3. Femoral and popliteal artery bruits. 4. Capillary refill greater then 5 seconds.

3. Femoral and popliteal artery bruits.

C96. Recently, a 10-year-old patient has begun walking with supination and calcaneal inversion of the right foot. With the shoe off, the therapist finds a new callus on the lateral side of the metatarsal head of the fifth toe. Which of the following is the BEST choice for orthotic prescription for this patient? 1. Scaphoid pad. 2. Flexible foot orthosis with a medial rearfoot post. 3. Flexible foot orthosis with lateral rearfoot post. 4. Ankle foot orthosis with full length foot plate.

3. Flexible foot orthosis with lateral rearfoot post.

C183. A patient in an exercise class develops muscle weakness and fatigue. Examination reveals leg cramps and hyporeflexia. The patient also experiences frequent episodes of postural hypotension and dizziness. Abnormalities on the ECG include a flat T wave, prolonged QT interval, and depressed ST segment. Which electrolyte imbalance is consistent with this patient's signs and symptoms? 1. Hypocalcemia. 2. Hyperkalemia. 3. Hypokalemia. 4. Hyponatremia.

3. Hypokalemia.

C187. A patient has a 10-year history of Parkinson's disease and has been on levodopa (Carbidopa) for the past 6 years. The patient has fallen three times in the past month, resulting in a Colles' fracture. The therapist decides to try postural biofeedback training using a platform balance training device. Which of the following is the BEST choice for a training protocol? 1. Increase the limits of stability and improve anterior weight displacement. 2. Decrease the limits of stability and anterior weight displacement. 3. Increase the limits of stability and improve center of pressure alignment. 4. Decrease the limits of stability and improve posterior weight displacement.

3. Increase the limits of stability and improve center of pressure alignment.

C145. A patient who is undergoing spinal cord rehabilitation is viewed as uncooperative by staff. The patient refuses to complete the training activities outlined to promote independent functional mobility. A review of history reveals that previously the patient was the director of a company with a staff of 20. What is the MOST appropriate action the therapist can take? 1. Have the patient work with a supervisor who is a person in authority. 2. Refer the patient to a support group before resuming rehabilitation. 3. Involve the patient in goal setting and structuring the training session. 4. Carefully structure the activities and slow down the pace of training.

3. Involve the patient in goal setting and structuring the training session.

C78. A patient with a transtibial amputation is learning to walk using a patellar tendon-bearing (PTB) prosthesis and is having difficulty maintaining knee stability from heelstrike to foot-flat. Which muscles are MOST likely weak? 1. Hip flexors. 2. Back extensors. 3. Knee extensors. 4. Knee flexors.

3. Knee extensors.

C120. While providing sports coverage at a local high school, a physical therapist is asked to examine an athlete with a knee injury. Based on the mechanism of injury, the therapist suspects rupture of the ACL. What test should be performed immediately to identify a torn ACL? 1. McMurray's test. 2. Reverse Lachman's stress test. 3. Lachman's stress test. 4. Posterior sag test.

3. Lachman's stress test.

C21. A PT examination reveals posterior superior iliac spine (PSIS) is low on the left; anterior superior iliac spine (ASIS) is high on the left; standing flexion test shows that the left PSIS moves first and farthest superiorly; Gillet's test demonstrates that the left PSIS moves inferiorly and laterally less than right; long sitting test shows that the left malleolus moves short to long; and the sitting flexion test is negative. Based on these findings, what is the therapist's diagnosis? 1. Left upslip. 2. Iliac inflare on the left. 3. Left posterior rotated innominate. 4. Left anterior rotated innominate.

3. Left posterior rotated innominate.

C124. An elderly patient is recovering from a right CVA and demonstrates strong spasticity in the left upper extremity. The therapist wants to reduce the expected negative effects of spasticity in the left upper extremity while the patient is working on sitting control. What is the BEST position for the upper extremity? 1. Left elbow flexed with arm resting on supporting pillow, positioned on the patient's lap. 2. Affected upper extremity extended and internally rotated with the hand at the side. 3. Left shoulder abducted and externally rotated with elbow extended and weight supported on the palm of the hand. 4. Left shoulder adducted and internal rotation with arm extended and hand resting on the thigh.

3. Left shoulder abducted and externally rotated with elbow extended and weight supported on the palm of the hand.

C164. A patient has a very large right-sided bacterial pneumonia. Oxygen level is dangerously low. Which of the following body positions is the MOST likely to improve this patient's arterial oxygen pressure (PaO2)? 1. Prone-lying with the head of the bed in the Trendelenburg position. 2. Right side-lying with the head of the bed in the flat position. 3. Left side-lying with the head of the bed in the flat position. 4. Supine-lying with the head of the bed in the Trendelenburg position.

3. Left side-lying with the head of the bed in the flat position.

C18. Which of the following activities demonstrates an infant's integration of the asymmetrical tonic neck reflex? 1. Turns head to one side and brings opposite hand to mouth. 2. Can turn head to either side with extended arms. 3. Turns head to one side and brings hand to mouth on the same side. 4. Turns head to one side and looks at the extended arm on that side.

3. Turns head to one side and brings hand to mouth on the same side.

C131. A patient with a complete spinal cord injury at the level of T1 (ASIA A) is in the community phase of mobility training. In order for the patient to navigate a 4-inch-height curb with the wheelchair, what should the therapist tell the patient to do? 1. Ascend backward with the large wheels first. 2. Descend backward with the trunk upright and arms hooked around the push handles. 3. Lift the front casters and ascend in a wheelie position. 4. Place the front casters down first during descent.

3. Lift the front casters and ascend in a wheelie position.

C180. A patient presents with severe, frequent seizures originating in the medial temporal lobes. After bilateral surgical removal of these areas, the patient is unable to remember any new information from just prior to the surgery to the present. The patient cannot recall text read minutes ago or remember people previously met. How should this surgical outcome be characterized? 1. Loss of integration of the temporal lobe with the basal ganglia and frontal cortex. 2. Loss of procedural memory and integration with frontal cortex. 3. Loss of the hippocampus and declarative memory function. 4. A primary deficit from the loss of the amygdala.

3. Loss of the hippocampus and declarative memory function.

C166. A therapist decides to use biofeedback to decrease the muscle tension associated with a suboccipital tension headache. What is the proper initial biofeedback protocol? 1. Low-detection sensitivity with recording electrodes placed far apart. 2. High-detection sensitivity with recording electrodes placed closely together. 3. Low-detection sensitivity with recording electrodes placed closely together. 4. High-detection sensitivity with recording electrodes placed far apart.

3. Low-detection sensitivity with recording electrodes placed closely together.

C6. A patient seeks physical therapy with a chief complaint of low back pain with radiation into the buttock, posterior thigh, and calf. Physical examination findings include peripheralization of symptoms on extension of the lumbar spine and a positive crossed straight leg raise test. Based on these examination findings, the therapist determines that the patient will respond favorably to which treatment approach? 1. Stabilization exercises. 2. Spinal manipulation. 3. Lumbar traction. 4. Extension exercises.

3. Lumbar traction.

C47. In the photo below (Valgus stress test), the physical therapist is examining a recent ligament injury to the patient's right knee. The examiner is applying a medially directed force at the knee. The results reveal hypermobility with a ligamentous laxity end-feel and pain. Based on this information, what ligament is injured and what is the grade of injury? 1. Lateral collateral ligament (LCL) Grade II. 2. LCL III. 3. Medial collateral ligament (MCL) Grade II. 4. MCL III.

3. Medial collateral ligament (MCL) Grade II.

C147. Patient presents with burning and tingling on the left lateral thigh that has manifested recently in her third trimester of pregnancy. The patient states that symptoms occur more in standing than sitting, and that light touch is more aggravating than applied pressure. Patient was negative for the neurological findings involving reflexes, dermatomes, and myotomes. Based upon this information, what is the MOST LIKELY cause of these symptoms? 1. Disc derangement L 2/3 segment. 2. Nerve root L3 compression. 3. Meralgia paresthetica. 4. Referred pain from the sacroiliac joint due to instability post-relaxin release.

3. Meralgia paresthetica.

C182. A patient is admitted to a hospital after a fall. A review of the patient's medical chart reveals a blood pressure (BP) of 160/85, a triglyceride level of 160 mg/dL, and a fasting blood glucose level of 115 mg/dL. Weight is 310 lb. Examination of the patient reveals a rotund man with a 54-inch waistline. Which diagnosis is consistent with this patient's signs and symptoms? 1. Type 1 diabetes. 2. Cushing's syndrome. 3. Metabolic syndrome. 4. Chronic heart disease.

3. Metabolic syndrome.

C90. A patient is 2 days, post-left CVA and has just been moved from the intensive care unit to a stroke unit. When beginning the examination, the therapist finds the patient's speech slow and hesitant. The patient is limited to one- and two-word productions, and expressions are awkward and arduous. However, the patient demonstrates good comprehension. What type of speech disorder is this patient exhibiting? 1. Fluent aphasia. 2. Global aphasia. 3. Nonfluent aphasia. 4. Dysarthria.

3. Nonfluent aphasia.

C186. A client walks into a private physical therapy practice with a chief complaint of a possible ankle sprain. The physical therapist observes a foot and ankle which is swollen, erythematous, and warm. As part of the systems review, the therapist assesses the lymphatic system and detects a positive Stemmer's sign. What other lymphatic system test or measure should also be performed? 1. Calf palpation and use of Wells Criteria Score. 2. Ankle brachial index (ABI) testing for the involved lower extremity. 3. Observation of proximal red streaks and palpation of inguinal nodes. 4. Application of Ottawa Ankle rules including assessment of pain above the malleoli and ability to weight-bear.

3. Observation of proximal red streaks and palpation of inguinal nodes.

C193. After a traumatic brain injury, a patient presents with significant difficulties in learning how to use a wheelchair. Memory for new learning is present but limited (Rancho Los Amigos Levels of Cognitive Functioning, level VII). The patient is wheelchair dependent and needs to learn how to transfer from the wheelchair to the mat (a skill never done before). Which of the following is the BEST strategy to enhance this patient's motor learning? 1. Use only guided movement to ensure correct performance. 2. Provide bandwidth feedback using a random practice schedule. 3. Provide consistent feedback using a blocked practice schedule. 4. Provide summed feedback after every few trials using a serial practice schedule.

3. Provide consistent feedback using a blocked practice schedule.

C113. A patient with a right transfemoral amputation is undergoing prosthetic gait training. What is the BEST technique to use to improve the patient's shortened step length on the right? 1. Provide anterior-directed resistance to the right PSIS during swing. 2. Provide posterior-directed resistance to the left ASIS during swing. 3. Provide posterior-directed resistance to the right ASIS during stance. 4. Facilitate the gluteals with tapping over the muscle belly.

3. Provide posterior-directed resistance to the right ASIS during stance.

C13. A PT receives a referral to examine the fall risk of an elderly patient with Parkinson's disease who lives alone and has had two recent falls. Which activity is the MOST common reason for falls in the elderly? 1. Walking with a roller walker with hand brakes. 2. Climbing on a step stool to reach overhead objects. 3. Turning around and sitting down in a chair. 4. Dressing while sitting on the edge of the bed.

3. Turning around and sitting down in a chair.

C172. An elderly male patient recovering from a fractured hip repaired with ORIF has recently been discharged home. During a home visit, his wife tells the therapist that he woke up yesterday morning and told her he couldn't remember much. Upon examination, the therapist finds some mild motor loss in his right hand and anomia. The therapist affirms the presence of short-term memory loss. What is the therapist's BEST course of action? 1. Advise the family to document and record any new problems that they notice over the next week and then report back to the therapist. 2. Ignore the findings because they are expected after surgical anesthesia. 3. Refer him to his physician immediately because the therapist suspects a stroke. 4. Refer him to his physician because the therapist suspects Alzheimer's type dementia.

3. Refer him to his physician immediately because the therapist suspects a stroke.

C74. A patient is referred for physical therapy after a graded exercise test (GXT). The physician reports the test was positive and had to be terminated at 7 minutes. Which of the following criteria is an absolute indication for terminating exercise testing? 1. Mild angina and dyspnea with progressive increases in the treadmill speed and grade. 2. A hypertensive response with blood pressure of at least 170/95. 3. ST segment depression from baseline of 3-mm horizontal or downsloping depression. 4. ECG changes from baseline of 1-mm ST segment elevation.

3. ST segment depression from baseline of 3-mm horizontal or downsloping depression.

C141. A teenager presents to the clinic with vague left hip and groin pain that worsens with weight bearing. The PT's examination reveals limited and painful hip internal rotation, antalgic gait, and a weak gluteus medius. Based upon this clinical presentation, what is the MOST likely diagnosis? 1. Gluteus medius muscle strain. 2. Oligoarticular juvenile rheumatoid arthritis (JRA). 3. Slipped capital femoral epiphysis (SCFE). 4. Legg-Calvé-Perthes disease.

3. Slipped capital femoral epiphysis (SCFE).

C107. Which of the following gastrointestinal sources of pain can refer to the left shoulder? 1. Esophageal pain. 2. Colon or appendix pain. 3. Spleen or diaphragmatic pain.. 4. Gallbladder pain.

3. Spleen or diaphragmatic pain..

C97. A patient is recovering from a right total hip replacement (posterolateral incision, cementless fixation). During initial healing, what is the MOST appropriate type of bed-to-wheelchair transfer to teach this patient? 1. Squat-pivot transfer to the surgical side. 2. Lateral slide transfer to the surgical side using a transfer board. 3. Stand-pivot transfer to the sound side. 4. Stand-pivot transfer to the surgical side.

3. Stand-pivot transfer to the sound side.

C64. A patient recovering from a stroke is having difficulty with stair climbing. During ascent, the patient is able to position the more involved foot on the step above but is unable to transfer the weight up to the next stair level. What is the BEST exercise intervention to remediate this problem? 1. Bridging, holding. 2. Standing, side steps. 3. Standing, partial wall squats. 4. Plantigrade, knee flexion with hip extension.

3. Standing, partial wall squats.

C71. Intermittent traction is being used for the management of a patient with a lateral stenosis at L3-4. After the third visit with intermittent traction at 40% of the patient's body weight, the patient states their leg pain is now 50% less on a numeric pain rating scale prior to treatment. Additionally, the therapist's re-examination reveals quadriceps deep tendon reflexes are now asymmetrical (absent on involved side and 2+ uninvolved side). What is the next action the therapist should take? 1. Continue with traction at the same percentage of body weight. 2. Continue with traction, but increase the traction to 50% of body weight. 3. Stop the traction and consult with the patient's physician. 4. Stop the traction and begin the patient on a repeated flexion exercise regime.

3. Stop the traction and consult with the patient's physician.

C171. A patient complains of pain in the right lower aspect of the lateral rib cage. The chief complaint is intense pain, which also occurs at night. The pain lasts for approximately 15 minutes and then subsides. There was no mechanism of injury and no pain with activity during the day. Active and passive motion of the thoracic spine and costal cage is normal and pain free. Mild tenderness is present inferior to the right lateral ribcage. What is the MOST likely diagnosis for this patient? 1. Intercostal muscle strain. 2. Costochondritis. 3. Systemic disease. 4. Abdominal muscle strain.

3. Systemic disease.

C146. A group of 10 patients is recruited into a study investigating the effects of relaxation training on blood pressure (BP). One group of patients is scheduled to participate in a supervised cardiac rehabilitation program that includes relaxation training three times a week for 12 weeks. The other group of patients is instructed to perform activities as usual. At the conclusion of the study, there was no significant difference between the groups; BP decreased significantly in both groups. What is the MOST accurate interpretation of this study? 1. The activities of the rehabilitation group were not properly monitored. 2. Both groups had BPs initially so high that reductions should have been expected. 3. The activities of the nonrehabilitation group were not properly monitored. 4. Cardiac rehabilitation is not effective in promoting relaxation.

3. The activities of the nonrehabilitation group were not properly monitored.

C163. A researcher uses a group of volunteers (healthy college students) to study the effects of therapy ball exercises on ankle ROM and balance scores. Twenty volunteers participated in the 20-minute ball exercise class three times a week for 6 weeks. Measurements were taken at the beginning and end of the sessions. Significant differences were found in both sets of scores and reported at the local physical therapy meeting. What is the MOST accurate interpretation of this study and its results? 1. The reliability of the study was threatened with the introduction of systematic error of measurement. 2. The Hawthorne effect may have influenced the outcomes of the study. 3. The validity of the study was threatened with the introduction of sampling bias. 4. Therapy ball exercises are an effective intervention to improve ankle stability after chronic ankle sprain.

3. The validity of the study was threatened with the introduction of sampling bias.

C68. A patient with osteoporosis and no fractures complains of increased middle and lower back pain during breathing and other functional activities. What is the MOST beneficial exercise intervention for this patient? 1. Trunk flexion and rotation exercises. 2. Trunk flexion and extension exercises. 3. Trunk extension and abdominal stabilization exercises. 4. Trunk rotation and abdominal stabilization exercises.

3. Trunk extension and abdominal stabilization exercises.

C36. Examination of a patient with a dermal ulcer over the coccyx reveals a wound exposing the deep fascia. There is no necrotic tissue, exudate is minimal, and the borders of the ulcer are diffusely covered with granulation tissue. Previous treatment has included wet-to-dry dressings with normal saline. What is the BEST choice for intervention? 1. Hydrogel dressings and whirlpool immersion. 2. Continuation of the same treatment. 3. Wound irrigation with pressures below 15 psi. 4. Calcium alginate dressings.

3. Wound irrigation with pressures below 15 psi.

C4. A patient with coronary artery disease received inpatient cardiac rehabilitation after a mild myocardial infarction (MI). The patient is now enrolled in an outpatient exercise class that utilizes intermittent training. What is the BEST initial spacing of exercise/rest intervals to safely stress the aerobic system? 1. 5:1. 2. 1:1. 3. 10:1. 4. 2:1.

4. 2:1.

C192. A patient with a traumatic brain injury presents with hemiparesis. The examination reveals slight cutaneous and proprioceptive impairment, fair (3/5) strength of the shoulder muscles and triceps, and slight spasticity of the biceps. Voluntary control of the patient's left arm has not progressed since admission. The therapist decides to use functional electrical stimulation (FES), placing the active electrode on the triceps to facilitate active extension of the elbow. Which of the following is the BEST choice of timing sequence for FES in this case? 1. No ramp up, 8-second stimulation, 2-second ramp down. 2. 1-second ramp up, 9-second stimulation, no ramp down. 3. 0-second ramp up, 8-second stimulation, 2-second ramp down. 4. 4-second ramp up, 5-second stimulation, 1-second ramp down.

4. 4-second ramp up, 5-second stimulation, 1-second ramp down.

C158. A woman is hospitalized in the intensive care unit with multiple closed and open fractures after a motor vehicle accident. A review of her medical record reveals the following laboratory values: hematocrit 28%, hemoglobin 10 g/100 mL and serum white blood cell (WBC) count 12,000/mm3. What is the MOST accurate interpretation of these findings? 1. Only serum WBC is abnormal. 2. Only hematocrit values are abnormal. 3. Hematocrit and hemoglobin values are abnormal; WBC is normal. 4. All values are abnormal.

4. All values are abnormal.

C133. The physical therapist is examining the patient's left ankle. The test pictured (Anterior drawer for the ankle) below is testing the integrity of which structure? ​ 1. Anterior tibiofibular ligament. 2. Tibiotalar ligament. 3. Calcaneofibular ligament. 4. Anterior talofibular ligament.

4. Anterior talofibular ligament.

C81. The PT is completing general activity recommendations for a group home of young adults with emotional and behavioral issues. All patients are chemically controlled with either antipsychotic or antidepressant medications. Full-time supervision is available for any activity recommended. Which exercise considerations would be important in this situation? 1. Avoid games with throwing activities to prevent injuries. 2. Promote rhythmic movement to soothing music to avoid agitation. 3. Promote activities with sequential movements to improve memory. 4. Avoid aerobic exercises outdoors when temperature is over 90°F.

4. Avoid aerobic exercises outdoors when temperature is over 90°F.

C151. A patient complains of waking up several times at night from severe "pins and needles" in the right hand. On awakening, the hand feels numb for half an hour and fine hand movements are impaired. The therapist's examination reveals sensory loss and paresthesias in the thumb, index, middle, and lateral half of the ring finger, and reduced grip and pinch strength. Some thenar atrophy is present. Based on these examination findings, what is the MOST appropriate diagnosis? 1. Pronator teres syndrome. 2. Ulnar nerve entrapment. 3. Thoracic outlet syndrome. 4. Carpal tunnel syndrome.

4. Carpal tunnel syndrome.

C54. A patient is hospitalized with diabetes and a large stage II plantar ulcer located over the right heel. The patient has been non-weight-bearing for the past 2 weeks as a result of the ulcer. What is the BEST choice for this patient's initial intervention? 1. Wash the foot and apply skin lubricants followed by a transparent film dressing. 2. Clean and bandage with a sterile gauze dressing. 3. Refer the patient for a surgical consult. 4. Clean and debride the wound and apply a hydrogel dressing.

4. Clean and debride the wound and apply a hydrogel dressing.

C58. An elderly patient presents to therapy after a fall onto an outstretched arm, now complaining of (L) wrist pain. The patient states medications are Aricept, Lasix, and warfarin. The patient has difficulty describing the exact incident and is withdrawn and distant. Upon examination of the wrist the therapist notes multiple contusions along the left wrist and forearm, as well as limited AROM with pain into extension. What is the therapist's next step in the process? 1. Halt the examination and call protective services to discuss possible elder abuse/neglect. 2. Initiate treatment to modulate. 3. Refer the patient to an orthopedic physician. 4. Continue with the examination.

4. Continue with the examination.

C127. A physical therapist is examining a patient who reports bilateral groin pain during weight-bearing activities. Which item noted during the review of systems will have the MOST impact on the therapist's prognosis for this patient? 1. Fifteen pounds overweight. 2. Hypertension and hyperlipidemia. 3. Diabetes. 4. Crohn's disease.

4. Crohn's disease.

C132. A patient with a long history of systemic steroid use for asthma control is hospitalized with pneumonia. Which of the following is a contraindication to percussion? 1. Barrel chest. 2. BP > 140/90. 3. Intercostal muscle wasting. 4. Decreased bone density.

4. Decreased bone density.

C159. A patient with a transfemoral amputation is unable to wear a total contact prosthesis for the past 4 days. Examination of the residual limb reveals erythema and edema extending over most of the lower anterior limb. The patient tells the therapist that the limb is very itchy and painful. What is the MOST likely cause of these symptoms? 1. Impetigo. 2. Herpes zoster. 3. Cellulitis. 4. Dermatitis.

4. Dermatitis.

C12. An inpatient with a grade III diabetic foot ulcer is referred for physical therapy. Panafil has been applied to the necrotic tissue BID. The wound has no foul smell; however, the therapist notes a green tinge on the dressing. What is the BEST action for the therapist to take? 1. Fit the patient with a total contact cast. 2. Document the finding and contact the physician immediately. 3. Begin a trial of acetic acid to the wound. 4. Document the finding and continue with treatment.

4. Document the finding and continue with treatment.

C118. A mother brings her 8-week-old infant to be examined at early intervention clinic because she noticed that the infant was taking steps in supported standing at 2 weeks but is not able to do it now. What should the therapist do given the infant's symptoms and behaviors? 1. Recommend that the mother bring the infant to a pediatric neurologist. 2. Explain that this was abnormal and it is a good sign that it has disappeared. 3. Recommend that a full developmental examination be performed by the early intervention team. 4. Explain that this is normal and that this early automatic walking is a newborn response.

4. Explain that this is normal and that this early automatic walking is a newborn response.

C149. A physical therapist is observing a child who is typically developing and has just begun to walk within the last month. Which of the following is expected in a child just learning to walk? 1. Neutral hip position. 2. Bilateral hip adduction. 3. Genu valgum. 4. External rotation of the hips.

4. External rotation of the hips.

C190. A patient presents with a complaint of severe neck and shoulder pain of 2 days' duration. The patient reports falling asleep on the couch watching TV and has been stiff and sore since. There is tenderness of the cervical muscles on the right, with increased pain upon palpation. Passive ROM is most limited in flexion, then side-bending left, and then rotation left and active extension. Side-bending right and rotation right are also painful. What is the MOST likely diagnosis for this patient? 1. Cervical strain. 2. Herniated disc. 3. Cervical radiculopathy. 4. Facet syndrome.

4. Facet syndrome.

C19. A physical therapy aide is cleaning a mat table with a new product supplied by the housekeeping department. The spray from the cleaning agent contacted the skin resulting in irritation, redness, and some swelling. The symptoms were minor and abated within 20 minutes. Later, the aide informed the physical therapy supervisor of this situation. What action should the supervisor take? 1. Initiate first aid by rinsing the affected area with a skin cleanser and applying cortisone cream for the inflammation. 2. Inform housekeeping to immediately cease using the cleaning agent. 3. Fill out an incident/occurrence report and have the aide examined by employee health or their own primary care physician. 4. Fill out an incident/occurrence report and review the Material Safety Data Sheet (MSDS) from Occupational Safety and Health Administration (OSHA) with the aide on how to properly handle the cleaning agent.

4. Fill out an incident/occurrence report and review the Material Safety Data Sheet (MSDS) from Occupational Safety and Health Administration (OSHA) with the aide on how to properly handle the cleaning agent.

C31. The therapist is instructing a patient with traumatic brain injury (TBI) how to lock the brakes on a wheelchair. The patient is right-handed, and the right upper extremity is more affected than the left. What is the BEST motor learning strategy to use with this patient? 1. Have the patient practice brake locking using the left hand to assist the right. 2. Guide the patient's right hand through the locking motions, then the left. 3. Verbally talk the patient through the locking motions, practicing with both hands simultaneously. 4. Have the patient practice locking the brakes first with the left hand and then with the right.

4. Have the patient practice locking the brakes first with the left hand and then with the right.

C170. A patient is exercising in a phase 3 outpatient cardiac rehabilitation program that utilizes circuit training. One of the stations utilizes weights. The patient lifts a 5-lb weight, holds it for 20 seconds, and then lowers it slowly. The therapist corrects the activity and tells the patient to reduce the length of the static hold. Which of the following BEST describes the expected effects of isometric exercise? 1. Reduced normal venous return to the heart and elevated BP. 2. Abnormal oxygen uptake. 3. Lower heart rate (HR) and arterial blood pressure (BP). 4. Higher HR and arterial BP.

4. Higher HR and arterial BP.

C93. A patient with anterior knee pain has increased adduction and internal rotation at the hip when performing a squat. Which muscles are MOST likely weak, causing this compensatory movement? 1. Knee flexors and extensors. 2. Hip adductors and internal rotators. 3. Hip and knee flexors. 4. Hip abductors and external rotators.

4. Hip abductors and external rotators.

C126. A physical therapist utilizes ultrasound imaging as a real time feedback tool while having a patient performabdominal muscle activation exercises. The therapist identifies the transversus abdominus muscle as a darkband that runs between two white streaks or lines. What is the term used to describe structures that appear dark on an ultrasound image? 1. Radiolucent. 2. Radiopaque. 3. Hyperechoic. 4. Hypoechoic.

4. Hypoechoic.

C162. An elderly patient with a left transfemoral amputation complains that when sitting, the left foot feels cramped and twisted. What is the therapist's BEST choice of intervention? 1. Appropriate bed positioning with the residual limb in extension. 2. Iontophoresis to the distal residual limb using hyaluronidase. 3. Hot packs and continuous US to the residual limb. 4. Icing and massage to the residual limb.

4. Icing and massage to the residual limb.

C140. When performing the Thomas test, the patient's thigh does not touch the table, indicating limited hip extension. The amount of limited hip extension does not change when the ipsilateral knee is extended. What is the range-limiting muscle? 1. Rectus femoris. 2. Tensor fascia lata. 3. Biceps femoris. 4. Iliopsoas.

4. Iliopsoas.

C15. A high school student sustains a wrist injury after slipping on ice and falling with an out-stretched hand.The patient reports that the wrist swelled immediately. The physical therapist's examination revealedtenderness with palpation in the anatomical snuff box and at the palmar aspect of the base of the thumb. What is the BEST initial treatment for this injury? 1. Range of motion exercises. 2. Wrist strengthening exercises. 3. Cryotherapy several times a day. 4. Immobilization.

4. Immobilization.

C160. A PT is treating a patient who lacks wrist extension. The cause of the impairment is a problem at the radiocarpal joint with a lack of arthrokinematic motion necessary for proper wrist extension. What direction should the proximal aspect of the scaphoid/lunate glide? 1. In a dorsal direction relative to the radius. 2. Radially. 3. Ulnarly. 4. In a palmar direction relative to the radius.

4. In a palmar direction relative to the radius.

C16. A PT receives a referral for a young child that had been swung around while being held from the wrists. The referral reads, "functional disuse following nursemaid's elbow." Which of the following commonly results from a forceful longitudinal pull of the forearm of a child? 1. Superior subluxation of the radial head from the annular ligament. 2. Inferior subluxation of the ulna from the annular ligament. 3. Superior subluxation of the ulna from the annular ligament. 4. Inferior subluxation of the radial head from the annular ligament.

4. Inferior subluxation of the radial head from the annular ligament.

C185. A patient is referred to a woman's health specialist PT with a diagnosis of pelvic pain and uterine prolapse. Which of the following interventions is the BEST choice for this patient? 1. External stabilization with a support belt. 2. Gentle abdominal exercises with incisional support. 3. Protective splinting of abdominal musculature. 4. Kegel exercises.

4. Kegel exercises.

C167. Examination of a patient recovering from stroke reveals a loss of pain and temperature sensation on the left side of the face along with loss of pain and temperature sensation on the right side of the body. All other sensations are normal. What is the likely location of the lesion? 1. Right cerebral cortex or internal capsule. 2. Midbrain. 3. Left cerebral cortex or internal capsule. 4. Left posterolateral medulla.

4. Left posterolateral medulla.

C92. A therapist is working on a cardiac care unit in an acute care facility. After exercising a patient recovering from a ventricular infarct, the therapist notices fatigue and dyspnea after mild activity. Later that day, on a return visit, the therapist notices the patient has a persistent spasmodic cough while lying in bed, heart rate is rapid (140), and slight edema is evident in both ankles. The patient appears anxious and agitated. What are these signs and symptoms characteristic of? 1. Developing pericarditis. 2. Right ventricular failure. 3. Impending MI. 4. Left ventricular failure.

4. Left ventricular failure.

C115. An adult patient is diagnosed with thoracic outlet syndrome. The patient presents with guarding in the upper trapezius and scalene muscles. Given this situation, which technique would be the MOST effective way to decrease the muscle guarding and provide pain relief? 1. Maitland grade IV manipulation of the C6-C7 joint. 2. Maitland grade II mobilization of the atlanto-axial joint. 3. Maitland grade III mobilization of the C6-C7 joint. 4. Maitland grade IV manipulation of the first rib.

4. Maitland grade IV manipulation of the first rib.

C134. A patient with possible ligamentous injury of the knee presents with excessive tibial external rotation. Which ligament is MOST LIKELY to be injured? 1. Posterior cruciate. 2. Medial patello-femoral. 3. Anterior cruciate. 4. Medial collateral.

4. Medial collateral.

C129. A patient with hypothyroidism and poor drug compliance is referred to physical therapy following a fall. What symptoms might be evident during exercise based on this diagnosis? 1. Paresthesias of the lower limbs. 2. Elevated cardiac output. 3. Sinus tachycardia and arrhythmias. 4. Myalgia and weakness.

4. Myalgia and weakness.

C73. A physical therapist shines a light into a patient's eye and observes the pupil of the eye. Constriction of the pupil results. Which cranial nerve is being tested? 1. Abducens. 2. Trochlear. 3. Optic. 4. Oculomotor.

4. Oculomotor

C5. What is the BEST INITIAL intervention to improve functional mobility in an individual with a stable humeral neck fracture? 1. Isometrics for all shoulder musculature. 2. Heat modalities. 3. Active resistive range of motion (ROM). 4. Pendulum exercises.

4. Pendulum exercises.

C109. A patient with a 10-year history of diabetes complains of cramping, pain, and fatigue of the right buttock after walking 400 feet or climbing stairs. When the patient stops exercising, the pain goes away immediately. The skin of the involved leg is cool and pale. The therapist checks the record and finds no mention of this problem. Given this patient's symptoms, what is the likely diagnosis? 1. Peripheral nerve injury. 2. Spinal root impingement. 3. Raynaud's phenomenon. 4. Peripheral arterial disease (PAD).

4. Peripheral arterial disease (PAD).

C80. A patient recovering from traumatic brain injury (TBI) is unable to bring the right foot up on the step during stair climbing training. What is the BEST choice to promote independent stair climbing for this patient? 1. Practice marching in place. 2. Strengthen the hip flexors using an isokinetic training device before attempting stair climbing. 3. Passively bring the foot up and place it on the 7-inch step. 4. Practice stair climbing inside the parallel bars using a 3-inch step.

4. Practice stair climbing inside the parallel bars using a 3-inch step.

C199. During an examination of gait, the therapist observes lateral pelvic tilt on the side of the swing leg during frontal plane analysis. What is the purpose of the lateral pelvic tilt on the side of the swing leg during gait? 1. Reduce physiological valgum at the knee. 2. Reduce knee flexion at mid-stance. 3. Control forward and backward rotations of the pelvis. 4. Reduce peak rise of the pelvis.

4. Reduce peak rise of the pelvis.

C155. A patient recovering from stroke is ambulatory without an assistive device and demonstrates a consistent problem with an elevated and retracted pelvis on the affected side. Which manual therapeutic exercise procedure is the BEST choice to remediate this problem? 1. Provide downward compression during stance. 2. Utilize light resistance to posterior pelvic elevation during swing. 3. Provide anterior-directed pressure during swing. 4. Utilize light resistance to forward pelvic rotation during swing.

4. Utilize light resistance to forward pelvic rotation during swing.

C83. The therapist is on a home visit, scheduled at lunchtime, visiting an 18-month-old child with moderate developmental delay. The therapist notices that the child and mother are experiencing difficulties with feeding. The child is slumped down in the highchair and is unsuccessfully attempting to use a raking grasp to lift cereal pieces to the mouth. Both the child and the mother are frustrated. Which intervention should the therapist work on FIRST? 1. Recommend that the mother return to breastfeeding for a few more months. 2. Work on desensitizing the gag reflex. 3. Recommend that the mother feed the child baby food instead of cereal for a few more months. 4. Reposition the child in a proper sitting position using postural supports.

4. Reposition the child in a proper sitting position using postural supports.

C49. A therapist is beginning manual lymphatic drainage for a patient recently diagnosed with secondary lymphedema in the left upper extremity following a radical mastectomy. What is the BEST choice for initial bandaging of the limb? 1. Long-stretch compression wrap (Ace wrap). 2. Custom-made low-elastic garment. 3. Gauze wrap. 4. Short-stretch compression wrap (Comprilan®).

4. Short-stretch compression wrap (Comprilan®).

C125. During an initial examination, the therapist occludes vision by having the patient close the eyes. What can the therapist effectively examine? 1. Discriminative touch and fast pain but not proprioception. 2. Vestibular/visual/somatosensory integration. 3. Conscious proprioception but not discriminative touch. 4. Somatosensory integrity.

4. Somatosensory integrity.

C51. The loss of sensory function in peripheral neuropathy is often among the first noticeable symptoms. With large fiber damage, what is the typical pattern of the sensory loss? 1. Allodynia of the feet accompanied by pronounced dorsiflexor weakness. 2. Band-like dysesthesias and paresthesias in the hips and thighs. 3. Paresthesias affecting primarily the proximal limb segments and trunk. 4. Stocking and glove loss of light touch and position sense.

4. Stocking and glove loss of light touch and position sense.

C32. In neural tension testing, what position will BEST bias the tibial nerve? 1. Straight leg raise with plantarflexion and eversion. 2. Straight leg raise with dorsiflexion and inversion. 3. Straight leg raise with plantarflexion and inversion. 4. Straight leg raise with dorsiflexion and eversion.

4. Straight leg raise with dorsiflexion and eversion.

C35. During a postural screen for chronic shoulder pain, the therapist observes excessive internal rotation of the shoulders and winging of the scapula during overhead motion. What is the BEST choice for exercise intervention? 1. Strengthening of rhomboids and stretching of upper trapezius. 2. Strengthening of pectoral muscles and stretching of upper trapezius. 3. Strengthening of upper trapezius and stretching of pectoral muscles. 4. Strengthening of middle and lower trapezius and stretching of pectoral muscles.

4. Strengthening of middle and lower trapezius and stretching of pectoral muscles.

C112. A frail, elderly wheelchair-dependent resident of a community nursing home has a diagnosis of organic brain syndrome, moderate Alzheimer's type dementia, During the therapist's initial interview, the patient demonstrates limited interaction and mild agitation and keeps trying to wheel the chair down the hall. Because it is late in the day, the therapist decides to resume the examination the next morning. How should the therapist document this in the medical record? 1. Disorientation to time and date. 2. Inattention as a result of short-term memory loss. 3. Frustration because of an inability to communicate. 4. Sundowning behavior.

4. Sundowning behavior.

C46. A patient has limited right rotation caused by left thoracic facet joint capsular tightness at T6-7. What arthrokinematic glide would MOST effectively improve right rotation in sitting? 1. Superior and anterior glide on the right T7 transverse process. 2. Superior and anterior glide on the left T7 transverse process. 3. Superior and anterior glide on the right T6 transverse process. 4. Superior and anterior glide on the left T6 transverse process.

4. Superior and anterior glide on the left T6 transverse process.

C3. A PT requested that a physical therapy assistant (PTA) perform ultrasound (US) to the shoulder of a patient. During the treatment session, the patient experienced an electrical shock. In which situation would the PT be responsible for any injury the patient might receive? 1. Faulty circuitry. 2. The PTA failing to use a ground fault interrupter (GFI). 3. The patient touching the US device during treatment. 4. The PT having instructed the PTA to use a device that had malfunctioned on the previous day.

4. The PT having instructed the PTA to use a device that had malfunctioned on the previous day.

C95. A PT is treating a patient with deep partial-thickness burns over 35% of the body (chest and arms). Wound cultures reveal a bacterial count in excess of 105/g of tissue on the anterior left arm. What are the reasonable expectations for this type of burn wound? 1. With antibiotics, spontaneous healing can be expected. 2. The risk of hypertrophic and keloid scars is low because there is no viable tissue. 3. The burn area is pain free because all nerve endings in the dermal tissue were destroyed. 4. The infected wound can convert the area to a full-thickness burn.

4. The infected wound can convert the area to a full-thickness burn.

C104. A patient is standing with excessive subtalar pronation. Which of the following indicates the obligatory motions that accompany this condition? 1. Tibial, femoral, and pelvic external rotation. 2. Tibial and femoral internal rotation with pelvic external rotation. 3. Tibial and femoral external rotation with pelvic internal rotation. 4. Tibial, femoral, and pelvic internal rotation.

4. Tibial, femoral, and pelvic internal rotation.

C181. A 14-year-old with a body mass index of 33 kg/m2 and a history of limited participation in physical activities is referred for exercise training. The nutritionist has prescribed a diet limiting his caloric intake. What is the BEST initial exercise prescription for this patient? 1. Three weekly sessions of 60 minutes at 50% VO2max. 2. Three weekly sessions of 50 minutes at 75%-85% VO2max. 3. Three weekly sessions of 30 minutes at 65%-70% VO2max. 4. Two daily sessions of 30 minutes at 45%-70% VO2max.

4. Two daily sessions of 30 minutes at 45%-70% VO2max.

C130. A group of researchers utilized meta-analysis to identify the evidence for aerobic fitness exercises in the management of fibromyalgia. Thirteen randomized, controlled trials (RCTs) and three controlled clinical trials (cohort studies and case control studies) were selected. What is the main difference between the two types of trials? 1. Duration of the studies. 2. Use of multiple centers versus single center trials. 3. Length of the studies. 4. Use of randomization of subjects.

4. Use of randomization of subjects.