NPTE Review Questions 11

A home health patient who recently had a three-vessel coronary artery bypass graft describes experiencing bilateral lower extremity swelling, leg pain, and shortness of breath, especially when lying down. The patient MOST likely has which of the following diagnoses? 1. Deep vein thrombosis 2. Myocardial infarction 3. Pulmonary embolism 4. Heart failure

1. A deep vein thrombosis corresponds to the leg pain and possibly swelling, but symptoms would typically be unilateral. 2. A myocardial infarction corresponds to shortness of breath but typically does not result in swelling acutely. A myocardial infarction could result in the development of heart failure, which would result in these symptoms, but this is a secondary result, not a primary result. 3. A pulmonary embolism would result in shortness of breath, usually not changed by position, and typically cardiac arrest. 4. Typical signs of heart failure include dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and peripheral edema.

A patient reports low back pain that radiates down one leg below the knee. The patient also reports numbness and tingling in the middle dorsum of the foot. Which of the following examination findings is MOST likely? 1. Diminished knee reflex 2. Diminished ankle reflex 3. Weakness of the gastrocnemius 4. Weakness of the extensor hallucis longus

1. A diminished knee reflex is indicative of a herniated disc at the L4 level, which would not be consistent with the symptoms reported by the patient (Agur, p. 367). 2. A diminished ankle reflex is indicative of a herniated disc at the S1 level, which would not be consistent with the symptoms reported by the patient (Agur, p. 367). 3. A weak gastrocnemius is indicative of a herniated disc at the S1 level, which would not be consistent with the symptoms reported by the patient (Agur, p. 367). 4. The patient's symptoms are indicative of a herniated disc at the L5 level, which causes compression of the 5th lumbar nerve root. Sensory deficits extend on the dorsolateral foot as indicated in the photograph. Subsequent motor weakness involves the extensor hallucis longus. (Dutton, pp. 141, 1463; Agur, p. 367)

When evaluating wheelchair positioning of a child with cerebral palsy, the position of which of the following body parts should be examined FIRST? 1. Pelvis 2. Lower extremities 3. Head 4. Spine

1. The assessment of posture in a wheelchair begins with the pelvis and its relationship to its adjacent segments. 2. The pelvis, not the lower extremities, should be considered first when evaluating wheelchair seating. 3. The pelvis, not the head, should be considered first when evaluating wheelchair seating. 4. The pelvis, not the spine, should be considered first when evaluating wheelchair seating.

ACE Inhibitor

blocks the action of the enzyme that causes the blood vessels to contract resulting in hypertension

Which of the following patient factors would MOST increase the risk for an adverse drug reaction? 1. Male gender 2. Age 55 years 3. Use of herbal compounds 4. Presence of irritable bowel syndrome

1. Female gender is considered to be a risk factor for experiencing a serious adverse drug reaction. 2. Being over age 75 years is considered to be a risk factor for experiencing a serious adverse drug reaction. 3. Concomitant use of herbal compounds is considered to be a risk factor for experiencing a serious adverse drug reaction. 4. Hepatic or renal insufficiency, not irritable bowel syndrome, is considered to be a risk factor for experiencing a serious adverse drug reaction.

To conduct an experimental study on pain in postsurgical orthopedic patients, a physical therapist randomly assigns patients to two groups. One group is treated with transcutaneous electrical nerve stimulation, heat, and exercise; the second receives heat and exercise only. In this experimental design, transcutaneous electrical nerve stimulation is the: 1. continuous variable. 2. dependent variable. 3. discrete variable. 4. independent variable.

1. "Continuous" is a classification of variables based on the method of quantifying the variable, not based on the role of the variable in the experimental design. Continuous variables may theoretically be measured to a finer and finer degree. (p. 234) 2. The dependent variable can be thought of as the effect or response, which in this case is pain (p. 69). 3. "Discrete" is a classification of variables based on the method of quantifying the variable, not based on the role of the variable in the experimental design. A discrete variable is one that can assume only distinct values. (p. 234) 4. The independent variable can be thought of as the cause or treatment. In this case, the transcutaneous electrical nerve stimulation is the treatment or independent variable. (p. 68)

Which of the following test findings is MOST consistent with a diagnosis of idiopathic pulmonary arterial hypertension? 1. VO2 max of 25 mL/kg/minute 2. Cardiac index of 0.8 L/minute/m2 3. Right atrial pressure of 15 mm Hg 4. Six-minute walk test result of 1640 ft (500 m)

1. A VO2 max of 25 mL/kg/minute is associated with no to only mild impairments. This is unlikely to be observed in patients who have idiopathic pulmonary arterial hypertension. (p. 101) 2. A cardiac index of 0.8 L/min/m2 is inconsistent with this diagnosis. A lower cardiac index is expected. (p. 389) 3. A right atrial pressure of 15 mm Hg is indicative of idiopathic pulmonary arterial hypertension and is an indication for lung transplantation. Normal atrial pressures are 0-8 mm Hg. (pp. 389, 424) 4. The ability to walk 500 meters during a six-minute walk test is inconsistent with this diagnosis. This is a normal distance for this test. (pp. 101-102)

During an intervention session with a patient who had a recent onset of hemiplegia, a physical therapist plans to focus on transfers to and from a wheelchair, a bathtub, and an automobile. Which of the following methods is MOST effective for long-term retention of these skills? 1. Practice the activities in random order. 2. Sequence the activities from easiest to most difficult. 3. Allow the patient to determine the sequence of activities. 4. Establish a predictable but variable practice sequence.

1. A critical factor in improving learning is that the subject must do something different on consecutive trials. Therefore the traditional approach for retraining by practicing one skill repeatedly is not the most effective. Having a patient practice a number of tasks in random order would probably be more successful for long-term retention. 2. Sequencing the tasks based on level of difficulty would not provide for randomization of the activities and is less likely to provide for long-term retention. 3. Allowing the patient to choose the order of tasks does not provide for randomization of the activities and is less likely to provide for long-term retention. 4. A predictable schedule will not provide randomization of the activities and is less likely to provide for long-term retention.

A patient with spinal stenosis is referred to physical therapy. The patient reports pain in the right knee, ankle, and foot. While walking, the patient exhibits a mild foot-drop with no evidence of hypertonicity. When weight bearing, the foot and ankle are pronated. Which of the following orthoses is MOST appropriate? 1. Molded ankle-foot orthosis (AFO) 2. AFO with a split stirrup 3. Custom insole with lateral arch supports 4. Metal AFO with the ankle set in 5° of dorsiflexion

1. A custom-molded thermoplastic ankle-foot orthosis provides an intimate fit for control of the extremity, and will permit correction of the patient's foot and ankle position as well as the foot drop (pp. 224-225). This type of ankle-foot orthosis also is lighter weight and more cosmetic and comfortable to wear than a metal double-upright ankle-foot orthosis with dorsiflexion assist. 2. The conventional metal double-upright ankle-foot orthosis can have a split stirrup to allow use of the ankle-foot orthosis with more than one shoe (p. 234). This type of ankle-foot orthosis is not the best choice for this patient, however, because it is heavy and less cosmetic than thermoplastic ankle-foot orthoses (p. 232). This patient does not have significant hypertonicity or limb volume changes that would necessitate use of a metal ankle-foot orthosis (p. 224). 3. A custom insole would not address the patient's foot drop. An ankle-foot orthosis is needed to position the foot and ankle to enhance toe clearance during gait. (p. 223) 4. This type of ankle-foot orthosis is not the best choice for this patient because it is heavy and less cosmetic than thermoplastic ankle-foot orthoses (p. 223). This patient does not have significant hypertonicity or limb volume changes that would necessitate use of a metal ankle-foot orthosis (p. 231).

A patient with evidence of nerve root involvement at the L4-L5 level would MOST likely have which of the following signs and symptoms? 1. Weak knee flexors, diminished Achilles tendon reflex, and paresthesia at the lateral aspect of the lower extremity 2. Weak foot intrinsics, diminished patellar tendon reflex, and paresthesia at the medial aspect of the knee 3. Weak ankle dorsiflexors, diminished patellar tendon reflex, and paresthesia at the medial calf and ankle 4. Weak ankle plantar flexors, diminished Achilles tendon reflex, and paresthesia at the lateral border of the foot

1. A decreased Achilles tendon reflex implicates S1. Paresthesias at the lateral aspect of the lower extremity involve L5-S1. 2. Foot intrinsics are innervated at the S1-S2 level. 3. The L4 nerve root exits at the L4-L5 level. Weak ankle dorsiflexors, diminished knee jerk, and paresthesias along the medial calf and ankle are the only combination of signs and symptoms listed that could all be a result of L4 nerve root compromise. 4. This combination of signs and symptoms would occur with nerve root involvement at the S1-S2 level.

A patient has a resting blood pressure of 120/80 mm Hg. During an activity with a metabolic equivalent level of 4, which of the following blood pressure responses is MOST likely associated with poor left ventricular function? 1. 108/78 mm Hg 2. 129/76 mm Hg 3. 138/83 mm Hg 4. 164/84 mm Hg

1. A drop in systolic blood pressure greater than or equal to 10 mm Hg with an increase in workload is considered an abnormal response and correlates with left ventricular dysfunction (ACSM, p. 127) 2. An increase in systolic blood pressure is a normal response. Diastolic blood pressure may remain the same or increase or drop by 10 mm Hg (O'Sullivan, p. 531). This drop in diastolic blood pressure is within normal limits. 3. An increase in systolic blood pressure is a normal response. Diastolic blood pressure may increase or drop by 10 mm Hg (O'Sullivan, p. 531). These increases in systolic and diastolic blood pressure are normal. 4. An increase in systolic blood pressure is a normal response. A drop in systolic blood pressure is associated with left ventricular failure. (ACSM, p. 127)

A patient is seen in physical therapy after an arthroscopic debridement of the knee. Which of the following describes the optimal parameters for electrical stimulation to address an extensor lag noted during the examination? 1. Duty cycle of 50%; current intensity high enough to produce 40% of maximal voluntary isometric contraction; 20 minute total treatment time 2. Duty cycle of 20%; current intensity high enough to produce 40% of maximal voluntary isometric contraction; 20 minute total treatment time 3. Duty cycle of 20%; current intensity high enough to produce 60% of maximal voluntary isometric contraction; 10 minute total treatment time 4. Duty cycle of 50%; current intensity high enough to produce 60% of maximal voluntary isometric contraction; 10 minute total treatment time

1. A duty cycle of 50% is too high, the current intensity is too low, and the treatment time is too long (Bellew, pp. 382-383; Cameron, pp. 247-249). 2. The duty cycle is correct (20%), but the current intensity is too low and the treatment time is too long (Bellew, pp. 382-383; Cameron, pp. 247-249). 3. For strengthening with electrical stimulation the current intensity should be maximal, so 60% is the better answer when compared with 40% of maximal voluntary contraction. Also, the duty cycle should allow for the rest period to be 5 times as long as the hold cycle, so a 20% duty cycle is best. One treatment session should include at least eight contractions, so a 10-minute treatment time is best. (Bellew, pp. 382-383; Cameron, pp. 247-249) 4. The duty cycle is too high in this example; more rest time is needed for muscle recovery (Bellew, pp. 382-383; Cameron, pp. 247-249).

Which of the following home programs is MOST appropriate for a patient who has chronic lateral epicondylalgia? 1. Using a forearm cuff to increase loading on the extensor tendons 2. Performing exercises for wrist strength and stretching 3. Administering iontophoresis with dexamethasone (Decadron) and lidocaine (Xylocaine) 4. Doing friction massage of the brachioradialis tendon

1. A forearm cuff is thought to decrease the muscle loading (p. 756). 2. Lateral epicondylalgia is caused by overuse of the wrist extensors that originate on the lateral epicondyle of the humerus, especially the extensor carpi radialis brevis. If the lateral epicondylalgia is at a chronic stage, conditioning of the extensor muscles and sustained grip activities will be most effective in long-term management. (p. 756) 3. Iontophoresis would not be appropriate for a home program and is more appropriate for acute lateral epicondylalgia (p. 755). 4. Friction massage of the brachioradialis would not be appropriate since the extensor carpi radialis brevis muscle is usually the muscle that is affected.

Which of the following exercise combinations is MOST appropriate for a patient who has a forward head posture? 1. Strengthen the deep cervical flexors and stretch the sternocleidomastoids and upper cervical extensors. 2. Strengthen the deep cervical flexors and sternocleidomastoids and stretch the upper cervical extensors. 3. Strengthen the cervical extensors and stretch the sternocleidomastoids and deep cervical flexors. 4. Strengthen the cervical extensors and sternocleidomastoids and stretch the deep cervical flexors.

1. A forward head position is due to decreased cervical retraction (Kisner). Treatment should include deep cervical flexor and shoulder retractor strengthening and cervical extensor and pectoral muscle stretching (Dutton). 2. Treatment for forward head posture should include deep cervical flexor and shoulder retractor strengthening and cervical extensor and pectoral muscle stretching (Dutton). 3. The deep cervical flexors should be strengthened, not stretched (Dutton). 4. The deep cervical flexors should be strengthened, not stretched (Dutton).

Which of the following factors is MOST linked to the development of osteoporosis and a greater risk of fracture? 1. Abnormally high body mass index 2. Abnormally low body mass index 3. Low cholesterol levels 4. Vegetarian diet or low intake of animal protein

1. A high body mass index is not associated with osteoporosis. 2. Body build is related to bone fragility, with thin patients having less cortical bone and a higher risk for fracture. 3. High cholesterol levels and atherosclerosis are associated with loss of calcification of bone. 4. Meat protein and fat provide acid precursors, with higher animal protein proportions leading to more rapid femoral neck bone loss.

A patient who had a myocardial infarction is in a cardiac rehabilitation program. Which of the following changes should cause the physical therapist to stop the exercise session? 1. An increase in systolic blood pressure of 10 mm Hg 2. A decrease in diastolic blood pressure of 5 mm Hg 3. An increase in the respiratory rate of 5 breaths/minute 4. A decrease in the heart rate of 15 bpm

1. A linear increase in systolic blood pressure is expected with increased activity. 2. A diastolic blood pressure increase or decrease greater than 10 mm Hg would be an abnormal finding. 3. An increase in respiration is an expected response to an increase in activity level. 4. A drop in heart rate greater than 10 bpm is an abnormal response to exercise and should cause the physical therapist to halt the activity.

Which of the following conditions would BEST explain the characteristics of the patient's knees are both internally rotated? 1. Long patellar tendon 2. Short patellar tendon 3. Femoral retroversion, lateral (external) tibial rotation 4. Femoral anteversion, medial (internal) tibial rotation

1. A long patellar tendon could result in a height change of the patella, but the patella would not appear to be facing inward ("squinting patella") as shown in the photograph. An inward patella("squinting patella") could indicate femoral anteversion. (Dutton) 2. A long patellar tendon could result in a height change of the patella, but the patella would not appear to be facing inward ("squinting patella") as shown in the photograph. An inward patella ("squinting patella") could indicate femoral anteversion. (Dutton) 3. The position of the patella appears inward ("squinting patella"), which could indicate femoral anteversion (Dutton). In the photograph, the right patella appears to be facing inward, which suggests femoral anteversion, not retroversion (Magee). 4. The position of the patella appears inward ("squinting patella"), which could indicate femoral anteversion (Dutton). In the photograph, the right patella appears to be facing inward, which suggests femoral anteversion and medial (internal) tibial rotation (Magee).

A patient who reports back pain has increased lumbar lordosis. The MOST appropriate exercises for this patient are: 1. abdominal strengthening and iliopsoas stretching. 2. hip flexor strengthening and hamstring stretching. 3. hip flexor strengthening and erector spinae stretching. 4. erector spinae strengthening and iliopsoas stretching.

1. A lordotic posture contributes to weak or inhibited abdominals and gluteus maximus. It also contributes to tight iliopsoas and erector spinae. Therefore, the abdominals should be strengthened, and the iliopsoas should be stretched. 2. The hip flexors should be stretched, not strengthened. 3. The hip flexors should be stretched, not strengthened. 4. The erector spinae should be stretched, not strengthened.

A patient who has severe bilateral hip and knee flexion contractures requires the assistance of two people for bed-to-chair transfers. The patient demonstrates normal dynamic sitting balance and Normal (5/5) upper body strength. The patient lives at home with one caregiver. The physical therapist's FIRST intervention should be to teach which of the following transfers? 1. Use of a mechanical lift operated by the caregiver 2. Sliding-board transfer performed by the patient with assistance from the caregiver 3. One-person lift transfer performed by the caregiver 4. One-person stand pivot transfer performed by the patient with assistance from the caregiver

1. A mechanical lift will promote total dependence for the patient, which should not be necessary in this case. 2. With normal sitting balance and normal upper body strength, this patient should be able to participate significantly with transfers, thereby easing much of the strain on the caregiver and allowing transfers to be done with assistance of only one person. 3. A one-person lift transfer performed by the caregiver does not allow the patient to participate by using existing abilities. 4. The description of the patient's lower extremities indicates that the patient is not likely to be a good candidate for a stand pivot transfer.

An appropriate long-term goal for a young adult with a C6 spinal cord injury and no additional complicating factors is: 1. propelling a standard wheelchair on level surfaces with moderate assistance. 2. completing sliding board transfers to a level surface independently. 3. completing a respiratory muscle exercise program with minimal assistance. 4. sitting on the edge of the bed without arm support independently.

1. A patient who has a C6 spinal cord injury can independently (without requiring moderate assistance) propel a manual wheelchair and negotiate mild obstacles, such as 1:12 grade ramps and 2-4 inch (5-10 cm) curbs. 2. A patient who has a C6 spinal cord injury can independently perform sliding board transfers. 3. A patient who has a C6 spinal cord injury can complete a respiratory breathing muscle exercise program without assistance. 4. A patient who has a C6 spinal cord injury will need upper extremity support to sit.

A patient has completed a 2-week course of comprehensive physical therapy for treatment of constant right shoulder and scapular pain and has not had any improvement. The patient states that change in position does not alter the pain intensity. The physical therapist should NEXT ask the patient about: 1. persistent sore throat. 2. difficulty swallowing food. 3. burning with urination. 4. intolerance to fatty foods.

1. A persistent sore throat is not a symptom manifested in acute cholecystitis (Paz, pp. 216-217). 2. Dysphagia is generally indicative of esophageal dysfunction. Furthermore, esophageal dysfunction/pain will typically refer to the middle of the back. (Goodman, p. 324) 3. Dysuria is associated with renal/urologic dysfunction. Such dysfunction may refer to the costovertebral areas, low back, and/or groin. (Goodman, p. 388) 4. The signs and symptoms of acute cholecystitis may include pain that radiates to the right shoulder, right scapula, or interscapular area. In patients with renal calculi, there may be a history of past episodes of biliary colic and fatty food intolerance. The patient may also report nausea, vomiting, fever, and right upper quadrant pain. (Paz, pp. 216-217)

A physical therapist is performing a supine hamstring stretch on a patient who has a T5 level spinal cord injury. The patient describes a pounding sensation in the ear. What should the therapist do FIRST? 1. Roll the patient to the left side. 2. Take the patient's blood pressure. 3. Bring the patient to an upright position. 4. Notify the patient's physician for immediate medical attention.

1. A pounding sensation in the ear in a patient with a spinal cord injury above the level of T6 is indicative of autonomic dysreflexia. With autonomic dysreflexia, the patient's blood pressure will be elevated and the patient should be brought to an upright position to lower the blood pressure. Rolling the patient to the left side would not lower the blood pressure. 2. A pounding sensation in the ear in a patient with a spinal cord injury above the level of T6 is indicative of autonomic dysreflexia. With autonomic dysreflexia, the patient's blood pressure will be elevated and the patient should be brought to an upright position to lower the blood pressure. 3. A pounding sensation in the ear in a patient with a spinal cord injury above the level of T6 is indicative of autonomic dysreflexia. With autonomic dysreflexia, the patient's blood pressure will be elevated and the patient should be brought to an upright position to lower the blood pressure. 4. A pounding sensation in the ear in a patient with a spinal cord injury above the level of T6 is indicative of autonomic dysreflexia. Although autonomic dysreflexia can be a life-threatening condition, notifying the physician would not be the most immediate action to take and would be the appropriate action only if the blood pressure cannot be reduced by other means.

A research team is using information from medical records to compare outcomes between a group of patients who received a 2-month intervention and a group who did not. Which of the following study designs is being used by the researchers? 1. Prospective cohort 2. Retrospective cohort 3. Cross-sectional 4. Case control

1. A prospective cohort would require the investigators to follow the patients until the outcome. Because the information was collected from medical records, and the outcome has already occurred, the stem does not describe a prospective cohort study. (p. 287) 2. The patients in this study have already received the exposure (intervention) and have already experienced the outcome. Therefore, this is a retrospective study. (p. 288) 3. A cross-sectional study is used to assess exposure and outcomes at a single point in time. This study abstracted data over a period of time and, therefore, cannot be a cross-sectional study. (p. 280) 4. A case control study classifies people based on whether they had an outcome of interest and then looks retrospectively at different exposures. Because the sample in this study is compared on the basis of exposure (intervention), this study cannot be a case control study. (pp. 282-283)

A patient with diabetes had a right transtibial amputation 5 days ago. An advantage of a rigid removable dressing versus bandaging is that the rigid dressing: 1. allows for early weight bearing. 2. requires less monitoring. 3. allows applied pressure to be varied. 4. is less costly.

1. A rigid dressing allows for early fitting of a prosthesis and weight-bearing and helps alleviate edema and pain, which is an advantage. 2. A rigid dressing requires more (not less) supervision because there is no access available to the incisions and the dressing is fabricated by the surgeon or prosthetist. As the residual limb heals, sutures are removed, and the limb changes shape, a new cast must be made. 3. Pressure cannot be varied when using a rigid dressing, unlike bandaging with an elastic wrap or shrinker. 4. A rigid dressing requires careful application by a skilled individual and, therefore, may be more costly. An elastic shrinker is a less expensive option.

Which of the following splints is appropriate to use for treatment of de Quervain disease? 1. Thumb spica 2. Posterior long arm 3. Ulnar gutter 4. Wrist cock-up

1. A thumb spica is frequently used for immobilization of the thumb (1st digit) for 3 weeks when treating de Quervain disease (p. 848). 2. A posterior long arm splint does not immobilize the thumb (1st digit). Long arm casting is often used to immobilize the forearm in patients who have a Smith fracture (p. 856). Immobilization of the thumb (1st digit) is used when treating de Quervain disease (p. 848). 3. An ulnar gutter splint is used on the ulnar side of the wrist, whereas de Quervain disease affects the radial side (p. 846). 4. A wrist cock-up splint is typically used for carpal tunnel syndrome and would not immobilize the thumb (1st digit) (p. 853).

During auscultation of the chest wall, a physical therapist notes an area of decreased breath sounds. Which of the following additional findings would support the suspicion of consolidation? 1. Tympanic sound with percussion 2. Increased fremitus 3. Hypertrophy of accessory muscles 4. High-pitched wheezes

1. A tympanic sound with percussion may be heard over a hyperinflated chest (Frownfelter, p. 212). 2. Increased fremitus is palpated in the presence of an increase in secretions (Frownfelter, p. 212). 3. A person with chronic obstructive pulmonary disease might exhibit increased muscle activity in the respiratory accessory muscles (Frownfelter, p. 212). This would not typically be observed in a person with an increase in secretions. 4. The adventitious sound associated with consolidation would be crackles, not wheezing (McCance, p. 1273).

Which of the following describes the use of a physical restraint for an older adult living in a long term care facility that can be used by a physical therapist without a physician's order? 1. A wheelchair tray used for proper positioning of the upper trunk that can be removed by the patient 2. A vest restraint while in bed for a patient who may wander away from the residence 3. For a patient who self propels with the lower extremities, elevating the wheelchair seat so the patient's feet do not reach the ground 4. Removing a patient's ambulatory device to control disruptive behavior

1. A wheelchair tray is a physical support that the patient is able to remove when it is not in use. It does not require a physician order because it is being used for positioning. 2. Use of a vest restraint is not consistent with patients' rights under Omnibus Reconciliation Act (OBRA) because it restricts a patient's mobility and requires a physician order. 3. Elevating the wheelchair seat is not consistent with patients' rights under Omnibus Reconciliation Act (OBRA) because it restricts a patient's mobility and requires a physician order. 4. Removing an ambulatory device is not consistent with patients' rights under Omnibus Reconciliation Act (OBRA) because it restricts a patient's mobility.

Which of the following monofilament grades indicates that only protective sensation is intact? 1. 3.61 2. 4.37 3. 5.07 4. 6.65

1. Ability to sense the 3.61 monofilament indicates fully normal sensation. 2. Ability to sense the 4.37 monofilament indicates fully normal sensation. 3. The 5.07 monofilament supplies the least amount of force that can be sensed by patients with only protective sensation intact. 4. Ability to sense only the 6.65 monofilament indicates a loss of protective sensation.

A physical therapist is at a community pool leading a class for patients who have arthritis. The therapist observes an adult patient suddenly fall to the ground. Which of the following sequences of actions is MOST appropriate? 1. Assess the airway, breathing, and circulation of the patient. 2. Begin cardiopulmonary resuscitation and activate the emergency response system. 3. Give two quick breaths, activate the emergency response system, and get an automated external defibrillator. 4. Check responsiveness, activate the emergency response system, check pulse, and begin chest compressions.

1. According to the 2016 American Heart Association (AHA) guidelines, the basic life support sequence is currently chest compressions, followed by opening the airway, then giving breaths (C-A-B). 2. According to the 2016 AHA guidelines, resuscitation is initiated after assessing responsiveness and then activating the emergency medical system, which includes obtaining an automated external defibrillator (AED). 3. Per 2016 AHA guidelines, the recommendation is to assess responsiveness prior to activating the emergency medical system. 4. This is the recommended sequence per the 2016 AHA guidelines.

Appropriate knee positioning when strength testing the hamstrings in the prone position will minimize: 1. active insufficiency of the hamstrings and rectus femoris. 2. active insufficiency of the rectus femoris and passive insufficiency of the hamstrings. 3. active insufficiency of the hamstrings and passive insufficiency of the rectus femoris. 4. passive insufficiency of the hamstrings and rectus femoris.

1. Active insufficiency occurs when the agonist is shortened actively to a point that the actin and myosin do not have optimal contact for maximal contraction. When testing the hamstrings with the patient in prone position, the hamstrings would have the tendency to become overly shortened (active insufficiency) because the hip is blocked from flexing. The quadriceps would be stretched over both the hip and knee joints (passive insufficiency). 2. Active insufficiency occurs when the agonist is shortened actively to a point that the actin and myosin do not have optimal contact for maximal contraction. Passive insufficiency occurs when the actin and myosin are overstretched, preventing optimal contraction. When testing the hamstrings with the patient in prone position, the hamstrings would have the tendency to become overly shortened (active insufficiency) because the hip is blocked from flexing. The quadriceps would be stretched over both the hip and knee joints (passive insufficiency). 3. Active insufficiency occurs when the agonist is shortened actively to a point that the actin and myosin do not have optimal contact for maximal contraction. Passive insufficiency occurs when the actin and myosin are overstretched, preventing optimal contraction. When testing the hamstrings with the patient in prone position, the hamstrings would have the tendency to become overly shortened (active insufficiency) because the hip is blocked from flexing. The quadriceps would be stretched over both the hip and knee joints (passive insufficiency). 4. Passive insufficiency occurs when the actin and myosin are overstretched, preventing optimal contraction. When testing the hamstrings with the patient in prone position, the hamstrings would have the tendency to become overly shortened (active insufficiency) because the hip is blocked from flexing. The quadriceps would be stretched over both the hip and knee joints (passive insufficiency).

A patient reports relief of pain when actively assisted by the physical therapist in the scapular assistance test. The patient MOST likely has which of the following conditions? 1. Adhesive capsulitis 2. Sternoclavicular sprain 3. Subacromial impingement 4. Acromioclavicular degeneration

1. Adhesive capsulitis is characterized by a loss of mobility at the glenohumeral joint. Assisting the scapula would not be expected to decrease pain. Moreover, an individual who has adhesive capsulitis is likely to have compensatory scapular mobility. (pp. 665-666) 2. The test in the photograph is used to assess for the presence of subacromial impingement. Sternoclavicular joint problems occur later in the range of motion. (p. 675) 3. The test in the photograph is designed to assist scapular motion. Scapular abnormalities can be a cause of impingement, and the test is designed to identify the scapular role in impingement. (p. 679) 4. The test in the photograph is used to assess for the presence of subacromial impingement. Acromioclavicular joint problems occur later in the range of motion. (p. 673)

While examining a patient with left-sided low back pain, a physical therapist notes that the left sacral sulcus is deeper and the left anterior superior iliac spine is more superior than the right. Which of the following is the MOST likely explanation for this finding? 1. The patient has a left innominate upslip. 2. The patient's left innominate has rotated posteriorly. 3. The patient has a left innominate downslip. 4. The patient's left innominate has rotated anteriorly.

1. Although an upslip would likely cause the anterior superior iliac spine to be superior on the left, it would also create a shallowness of the left sacral sulcus (p. 79). 2. With a left innominate posterior rotation, the left sulcus becomes deeper and the left anterior superior iliac spine is more superior (p. 85). 3. A left innominate downslip would likely produce a low left anterior superior iliac spine along with the left sulcus being deeper (p. 79). 4. Anterior rotation of the innominate would cause an ipsilateral shallow sulcus and a low and posterior position of the anterior superior iliac spine (p. 86).

Which of the following associated conditions places children with Down syndrome at GREATER risk for frequent respiratory infections? 1. Cervical instability 2. Chest muscle hypotonicity 3. Immune system dysfunction 4. Arrested alveolar development

1. Although cervical instability is associated with Down syndrome, it is more likely to contribute to neurological problems than to respiratory infections (Magee, p. 1017). Structural abnormalities of the airways and lungs and cough deficits related to hypotonia are more likely to be related to increased risk for respiratory infections. 2. Respiratory tract infections are very common secondary to hypotonicity of the chest and abdominal muscles and contribute significantly to morbidity and mortality. Decreased muscle tone compromises respiratory expansion. (Goodman, p. 1163) Cardiopulmonary manifestations include poor ability to clear secretions from both upper and lower airways, resulting in greater susceptibility to pulmonary infections, and postural abnormalities that may lead to restrictive lung dysfunction in older children. 3. Immune system dysfunction in children with Down syndrome is associated with a higher incidence of acute myeloid leukemia than in the general pediatric population (Goodman, p. 1163). This option is incorrect since it is not the most common or likely cause of increased respiratory infections. 4. Arrested alveolar development occurs when the lungs are injured during development and is characteristic of children with bronchopulmonary dysplasia. It is the most common chronic lung disease associated with prematurity (Tecklin, p. 146) but is not associated with Down syndrome.

Prior to initiating an intervention, a physical therapist MUST perform which of the following actions? 1. Discuss prognosis for improvement with the patient. 2. Obtain the patient's consent for the treatment. 3. Review the clinic's reimbursement policy with the patient. 4. Provide the patient with the clinic's policy for privacy of patient information.

1. Although the physical therapist should document any communication with the patient, a discussion of the patient's prognosis is not as essential as receiving consent to perform treatment. 2. Consent must be obtained from all patients prior to the initiation of any treatment. Informed consent is a communication between the physical therapist and the patient (p. 42). 3. Although knowledge of the clinic's policy on reimbursement is important to review, there is no obligation to provide the information prior to treatment. 4. The clinic's policies governing disclosure of patients' medical information should be discussed prior to the examination (p. 34).

A 41-year-old patient sustained a grade II injury to the right medial collateral ligament of the elbow 3 weeks ago. A systems review reveals normal cardiopulmonary, integumentary, and neuromuscular status. Which of the following is MOST likely the status of the healing tissue? 1. Well organized and gaining in tensile strength 2. Well organized and capable of withstanding high tensile forces 3. Disorganized but able to withstand high tensile forces 4. Disorganized and unable to withstand high tensile forces

1. Although the repair is gaining in tensile strength, 3 weeks is not enough time for a grade II injury to fully organize. 2. A longer period of time is needed for a well-organized repair in a grade II injury. 3. A disorganized repair is not able to withstand high tensile forces. 4. A grade II ligament injury requires significant repair, and, although the tissue is beginning to organize at 3 weeks, it is not fully organized and is deficient in tensile strength.

A physical therapist should anticipate that an abnormal lymph node will feel: 1. soft and nonmobile and have an increased skin temperature. 2. firm and nontender and have an increased skin temperature. 3. firm, mobile, and tender or nontender. 4. soft, mobile, and tender or nontender.

1. An abnormal lymph node would not feel soft, and an elevated skin temperature is not expected. 2. An abnormal lymph node may feel firm and nontender, but an elevated skin temperature is not an expected accompanying feature of an abnormal lymph node. 3. An abnormal lymph node can range in feeling from firm to hard, be mobile or nonmobile, and be tender or nontender. 4. An abnormal lymph node would not feel soft.

Which of the following ankle-brachial index values suggests arterial calcification? 1. 0.6 2. 0.9 3. 1.0 4. 1.4

1. An ankle-brachial index of 0.6 is suggestive of moderate peripheral artery disease and is a common finding. This result would warrant referral but does not suggest arterial calcification. 2. An ankle-brachial index of 0.9 is a normal finding. 3. An ankle-brachial index of 1.0 is a normal finding. 4. Ankle-brachial index measures above 1.1 indicate arterial calcification. The calcification limits the compressibility of the artery.

When instructing a patient with rheumatoid arthritis in a home exercise program, the physical therapist should advise the patient to rest: 1. after the onset of joint pain. 2. after one hour of exercise. 3. when fatigued. 4. before becoming fatigued.

1. Any exercise that increases joint pain should be modified or avoided. 2. Pain and/or fatigue should be the limiting factor in an exercise program, not duration. 3. Undue fatigue after exercise indicates a need to further modify the exercise program. 4. An exercise program for a patient who has rheumatoid arthritis should be able to be performed without pain and fatigue.

A patient who is taking an angiotensin-converting enzyme (ACE) inhibitor is performing a therapeutic exercise program in a heated pool. Which of the following physiologic effects is MOST likely to occur in this scenario? 1. Cardiac arrhythmias 2. Increase in fluid retention 3. Decrease in blood pressure 4. Difficulty breathing

1. An arrhythmia is a disorder of the heart rate (pulse) or heart rhythm, such as beating too fast (tachycardia), too slow (bradycardia), or irregularly. Angiotensin-converting enzyme (ACE) inhibitors are occasionally associated with bothersome side effects such as skin rashes, gastrointestinal discomfort, and dizziness; these effects are often transient or can be resolved with an adjustment in dosage. Cardiac arrhythmias are not listed as a side effect of ACE inhibitors (Vallerand, p. 161). Exercise in a heated pool should also not trigger arrhythmias. Exercise may be beneficial for persons with arrhythmias because of improvement in ischemic threshold and/or reduction in sympathetic tone (Cameron, p. 333). 2. With immersion, the physiologic changes include increased need to urinate to eliminate fluid; the need to hydrate orally to replace fluid excreted from the system by renal, endocrine, and cardiovascular responses to immersion; and a potential decrease in systemic and local edema from this peripheral-to-central fluid shift response (Cameron, p. 329). 3. A heated therapeutic pool can aggravate the vasodilatory effects of peripheral vascular dilators such as lisinopril, an ACE inhibitor, and lead to a marked decrease in blood pressure (Cameron, p. 327). 4. Reduction in expiratory reserve volume occurs with immersion, but a compensatory increase in inspiratory reserve volume occurs to produce only a modest reduction in overall vital capacity. (Cameron, pp. 328-329)

Which of the following glenohumeral joint mobilization techniques is MOST appropriate for increasing the motion required to scratch the back at the T9 level? 1. Distraction with inferior glide 2. Anterior glide with abduction 3. Superior glide with approximation 4. Distraction with posterior glide

1. An inferior glide will increase abduction. 2. An anterior glide will increase lateral (external) rotation. 3. A superior glide with approximation would not increase joint range of motion. 4. To scratch the back at the T9 level requires a person to reach behind the back, with the shoulder moving into medial (internal) rotation. Posterior glide of the humerus will increase medial (internal) rotation.

Elevating a patient's lower extremity for less than 1 minute produces a noticeable pallor of the foot, followed by delayed reactive hyperemia in a dependent position. These signs are indicative of: 1. an intact circulatory system. 2. arterial insufficiency. 3. venous insufficiency. 4. thrombophlebitis.

1. An intact circulatory system can sustain adequate blood flow to an elevated limb. 2. A limb with arterial insufficiency may not be able to sustain adequate blood flow with the leg elevated. The vasodilation, caused by local mechanisms, occurs in response to ischemia. 3. Pallor upon limb elevation and reactive hyperemia when the limb is placed in dependent position are signs of arterial, not venous, insufficiency. 4. Thrombophlebitis (or deep vein thrombosis) would result in unilateral lower extremity pain and dependent edema.

A patient sustained a C6 spinal cord injury (ASIA Impairment Scale B) 2 weeks ago. Which of the following techniques would be MOST effective to reduce the risk of deep venous thrombosis in the lower extremities? 1. Ankle pumps 2. Compressive stockings 3. Standing in a standing frame 4. Gastrocnemius-soleus stretch

1. Ankle pumps are an effective technique for reducing venous stasis and blood clots, but a patient with an ASIA Impairment Scale B injury would have sensory, but not motor function preserved below the neurological level and would be unable to actively perform active ankle pumps due to paraplegia (p. 922). 2. Compressive stockings are the most effective device to use for a patient with a cervical spinal cord injury who is unable to move the lower extremities and will have venous stasis due to the lack of "muscle pumping" action. The compressive stockings decrease the venous stasis and blood pooling and reduce the risk of blood clotting. (p. 901) 3. A standing frame would be useful for the prevention of osteoporosis and bone density loss. It is also useful for improving respiratory function but would not be the best method for preventing the development of deep venous thrombosis. (p. 902) 4. Gastrocnemius-soleus stretch may aide in some movement of blood in the lower extremities but is not the most effective means of reducing deep venous thrombosis formation (p. 901).

A physical therapist examines a right-handed patient who demonstrates a rounded upper back and protracted shoulders. The patient may be at INCREASED risk for developing which of the following conditions in the left upper extremity? 1. Thoracic outlet syndrome 2. Carpal tunnel syndrome 3. Paresthesia in an ulnar nerve distribution 4. Lateral epicondylalgia

1. Anterior scalene or pectoralis minor tightness from this posture can impinge the neurovascular bundle, causing thoracic outlet syndrome (p. 331). 2. Overuse injury of the wrist is unrelated to this postural presentation (p. 835). 3. The ulnar nerve is well protected above the elbow. Injury most often occurs at the elbow or wrist. (pp. 761-762, 853) 4. Overuse injury of the elbow is unrelated to this postural presentation (p. 755).

The patient who has a neuropathic wound of the plantar surface of the 2nd metatarsal head has received conservative care for 2 months without improvement. To promote wound healing, which of the following treatments is MOST appropriate to add at this time? 1. Antibiotic treatment 2. Total contact casting 3. Daily dressing changes 4. Sharp debridement of the callus

1. Antibiotic treatment is generally not indicated for uninfected wounds. While the foot wound in the photograph is not progressing, there are not signs of infection present. Off-loading pressure areas is important to facilitate wound healing. 2. Total contact casting is the accepted standard for off-loading pressure areas on the plantar surface of the foot. 3. Daily dressing changes may make the total contact casting impractical. Daily dressing changes may prevent a patient from taking advantage of the increased healing rates associated with total contact casting. 4. While periodic callus removal is important, the foot in the photograph does not demonstrate significant callus formation. Long-term pressure relief from total contact casting may help prevent callus formation.

A physical therapist is examining a patient following open reduction internal fixation of the distal tibia and fibula. The physical therapy examination reveals active range of motion of the involved ankle from 10° of dorsiflexion to 0° of plantar flexion. What phase of gait is MOST likely affected? 1. Heel strike (initial contact) 2. Midstance 3. Toe off (preswing) 4. Acceleration (initial swing)

1. At heel strike (initial contact), the ankle is in a neutral position, so only having 10° of movement at the ankle would not affect this phase of gait. 2. The ankle will move from plantar flexion to dorsiflexion during midstance, but the greatest plantar flexion occurs at toe off (preswing). 3. The greatest amount of plantar flexion is needed in the ankle during the toe off (preswing) phase of gait. The patient has 0° of plantar flexion, so this phase of gait would be most affected. 4. The ankle remains in a neutral position during acceleration (initial swing). Since the patient has 10° of dorsiflexion, this phase of gait would not be affected.

Which of the following changes is a result of stimulation of the sympathetic nervous system? 1. Increased blood flow to skin 2. Decreased blood glucose 3. Constriction of bronchioles 4. Rise in heart rate

1. Blood vessels are generally constricted by sympathetic stimulation. 2. Blood glucose levels would increase, not decrease, by sympathetic stimulation. 3. Bronchioles would dilate in preparation for increased work. 4. The sympathetic nervous system is responsible for adjustments in preparation for emergency situations (fight or flight). With stimulation of the sympathetic nervous system, the heart rate would rise.

Which of the following findings is MOST likely a negative prognostic indicator for surgical wound healing? 1. Bloody discharge on postoperative day 1 2. Clear and watery discharge on postoperative day 3 3. Purulent discharge on postoperative day 5 4. No discharge and a raised suture line on postoperative day 10

1. Bloody discharge on postoperative day 1 is a normal response for a healing surgical wound. 2. Clear and watery discharge on postoperative day 3 is a normal response for a healing surgical wound. 3. A purulent exudate from a surgical wound site is an indication of infection and is a negative prognostic indicator for healing. 4. No discharge and a raised suture line on postoperative day 10 are consistent with a normal response for a healing surgical wound.

A patient has a cerebellar dysfunction that affects both the trunk and the limbs. During examination, which of the following findings will MOST likely be observed? 1. Bradykinesia 2. Festinating gait 3. Impairments in muscle force generation 4. Impairments in the timing of muscle activation

1. Bradykinesia is associated with Parkinson disease and is not seen with cerebellar disorders (pp. 637-642). Parkinson disease affects the basal ganglia and not the cerebellum (p. 607). 2. Festination of gait is typically seen with persons living with Parkinson disease (p. 610), not persons with cerebellar ataxia. Parkinson disease affects the basal ganglia and not the cerebellum (p. 607). 3. Cerebellar impairments may cause some hypotonia initially, but patients recover normal passive muscle tone and normal reflexes quickly (p. 639). 4. Cerebellar dysfunction is characterized by delays in initiating and timing of movements. Ataxia is a general term used to describe abnormal coordination of movements. It is demonstrated by deficits in speed, amplitude of displacement, directional accuracy, and force of movement (pp. 637-638). Ataxic movements are thought to occur due to impairments in the timing and duration of muscle activation.

A physical therapist is working with a patient who has pneumonia and who exhibits symptoms of respiratory distress while walking. Which of the following signs is the patient MOST likely to exhibit? 1. Bradypnea 2. Tachypnea 3. Sternal protraction 4. Symmetrical chest expansion

1. Bradypnea is not a symptom of respiratory distress. A high respiratory rate is associated with respiratory distress. (p. 422) 2. Of the options listed, tachypnea is the most likely symptom of respiratory distress (pp. 422, 541). 3. Sternal retraction is a symptom of respiratory distress; however, it is not the most likely symptom of respiratory distress (p. 422). 4. Paradoxic (often asymmetrical) chest expansion is a symptom of respiratory distress; however, it is not the most likely symptom of respiratory distress (p. 422).

Which of the following changes in cardiopulmonary function is MOST likely to occur in a pregnant woman in her third trimester of pregnancy? 1. Increase in oxygen consumption 2. Decrease in respiratory rate 3. Decrease in cardiac output 4. Decrease in heart rate

1. Cardiac output increases 30% to 60%, and oxygen consumption increases 15% to 20% during pregnancy. 2. Respiratory rate does not change during pregnancy. 3. Cardiac output increases 30% to 60%, and oxygen consumption increases 15% to 20% during pregnancy. 4. Heart rate increases during pregnancy.

A patient displays a hand tremor at rest. The tremor has a regular rhythm of 4 to 7 beats/second. The patient MOST likely has which of the following conditions? 1. Cerebellar lesion 2. Multiple sclerosis 3. Parkinson disease 4. Tardive dyskinesia

1. Cerebellar lesions are associated with action tremors, which are absent at rest and elicited during muscle activation (p. 638). 2. Tremors are associated with multiple sclerosis but do not have a regular rhythm of 4 to 7 beats/second (p. 591). 3. Patients who have Parkinson disease display tremors at rest. The tremors have a rhythm of 4 to 7 beats/second. (p. 609) 4. Tremors are not associated with tardive dyskinesia (p. 624).

A female patient had a radical mastectomy with axillary node removal. Which of the following signs would indicate initial development of lymphedema in the patient? 1. Increased blood pressure 2. Numbness in the antecubital fossa 3. Atrophy of the brachioradialis muscle 4. Decreased flexibility of the digits of the hand

1. Changes in blood pressure are not an initial sign of lymphedema (Goodman, pp. 682-683). 2. Numbness of the affected body part is a possible symptom of lymphedema, but the antecubital fossa is not the most likely location (Goodman, p. 680; Drake, pp. 140-141) 3. Muscular atrophy, conceivably due to nerve compression from lymphedema, is an unlikely initial sign of lymphedema (Goodman, p. 680). 4. Decreased finger flexibility may be an initial sign of peripheral lymphedema (Goodman, p. 680)

A patient being treated for weakness is suspected of having acute appendicitis. Which of the following interventions is MOST appropriate after notifying the patient's physician? 1. Continue with gentle exercises but avoid gait training. 2. Apply a moist hot pack to the right back and flank. 3. Offer the patient some soda crackers and water. 4. Have the patient lie down and remain as quiet as possible.

1. Continuing exercise may aggravate the condition further. The patient should lie down and remain as still as possible. 2. There is danger of aggravating the condition with the use of the hot pack. 3. Giving the patient food or water may aggravate the condition and cause difficulties if surgery is needed. 4. When appendicitis is suspected because of a patient's symptoms, a physician should be notified and the patient should lie down and be as still as possible.

Which of the following BEST describes the huffing technique of airway clearance? 1. Cough while holding a pillow against the chest. 2. Forcefully exhale while keeping the mouth open. 3. Forcefully exhale through pursed lips. 4. Take two normal breaths, then cough firmly on the third exhalation.

1. Coughing while holding a pillow against the chest refers to splinting the incision and is most commonly used by surgical patients to reduce pain while coughing (O'Sullivan, p. 540). 2. Huffing consists of taking a deep inspiration followed by forceful exhalation with an open mouth (Frownfelter, p. 321). 3. Huffing consists of taking a deep inspiration followed by forceful exhalation with an open mouth, not through pursed lips (Frownfelter, p. 321). 4. Taking two normal breaths, then coughing firmly on the third exhalation is a controlled cough, not a huff (Frownfelter, pp. 339-340).

A physical therapist is examining a patient who has emphysema and no acute symptoms. During auscultation of the lungs, the therapist will MOST likely observe which of the following findings? 1. Wet crackles (rales) 2. Friction rub 3. Low-pitched wheezes (rhonchi) 4. Diminished breath sounds

1. Crackles are present with secretions in peripheral airways (Goodman, p. 774). 2. A friction rub is associated with a large pleural effusion rather than with emphysema (Hillegass, p. 8). 3. Low-pitched wheezes are associated with obstruction, such as bronchospasm (Goodman, p. 774). 4. Diminished breath or absent breath sounds are present with emphysema (Hillegass, p. 194).

A patient being examined by a physical therapist for bilateral shoulder pain and weakness is noted to have undiagnosed exophthalmos. Further screening for which of the following diseases would be MOST appropriate? 1. Cushing syndrome 2. Wilson disease 3. Graves disease 4. Addison disease

1. Cushing syndrome does not produce protruding eyes. Cushing syndrome is secondary to increased intake of glucocorticoids. (pp. 500-501) 2. Wilson disease does not produce protruding eyes. Wilson disease is characterized by Kayser-Fleischer rings around the iris of the eye (from copper deposits). (p. 537) 3. Graves disease, a form of hyperthyroidism, can cause fluid accumulation behind the eyeball, resulting in protruding eyes (p. 484). 4. Addison disease does not produce protruding eyes. Addison disease is associated with decreased adrenocortical secretions. (p. 498)

A patient in the 3rd trimester of pregnancy has a 2-week history of progressive pain in the right wrist. The right lateral wrist appears swollen, and pain is exacerbated over the styloid process when the patient closes the fingers around the thumb (1st digit) and the wrist is passively moved into ulnar deviation. Which of the following diagnoses is MOST likely? 1. De Quervain tenosynovitis 2. Carpal tunnel syndrome 3. Scapholunate instability 4. Scaphoid fracture

1. De Quervain tenosynovitis is a progressive condition that affects the tendon sheath of the abductor pollicis longus and extensor pollicis brevis tendons. Arthritis and overuse, consisting of repetitive tasks that involve overexertion of the thumb (1st digit) or radial and ulnar deviation of the wrist, are the most common predisposing factors. (p. 848) 2. Compression of the median nerve in the carpal tunnel can occur in pregnancy due to fluid retention or can occur due to repetitive trauma usually associated with repeated wrist flexion and extension. The clinical features include intermittent pain and paresthesia in the median nerve distribution in the hand. (p. 852) 3. The lunate is the most commonly dislocated carpal bone, and the scapholunate articulation is the most common area for carpal instability. Scapholunate synovitis or posterior wrist syndrome presents with tenderness or swelling over the posterior wrist. (p. 837) 4. A scaphoid fracture most commonly occurs with a fall on an outstretched hand. Most individuals with a scaphoid fracture have severe discomfort over the scaphoid. (p. 856)

A physical therapist has been treating a female patient with low back pain for 6 weeks. The patient reports that the pain seemed to lessen earlier in the course of treatment but has intensified again in the past week. To help identify a systemic cause for the pain, the therapist should ask the patient whether the pain: 1. decreases when she lies down. 2. corresponds with her menstrual cycle. 3. increases when she is driving to work. 4. increases when she has a bowel movement.

1. Decreased pain with rest is more likely to indicate a mechanical cause of pain. 2. Pain from endometriosis often is cyclic in nature and corresponds with the menstrual cycle. 3. Pain with driving is more likely to indicate a mechanical cause of pain. 4. Pain with bowel movement is more likely to indicate a mechanical cause of pain.

A physical therapist is treating a patient with urge incontinence. Which of the following outcomes of the intervention program are MOST desirable? 1. Decrease in bladder capacity and decrease in urinary frequency 2. Increase in bladder capacity and decrease in urinary frequency 3. Decrease in bladder capacity and increase in urinary frequency 4. Increase in bladder capacity and increase in urinary frequency

1. Decreases in both of these features are characteristic of urge incontinence and a decrease in bladder capacity is undesirable. 2. With an urge incontinence, the desire is to improve the ability to inhibit automatic detrusor contractions. The body is trained to respond to a specific voiding schedule. An increase in bladder capacity and a decrease in the frequency of urination are features of improved bladder control. 3. A decrease in bladder capacity and an increase in urinary frequency are the opposite of what is desired with training for urge incontinence. 4. Although an increase in bladder capacity is desirable, the goal is to decrease the frequency of urination, not increase it.

During examination of a patient, a physical therapist notes bradycardia. The patient reports constipation and cold intolerance. Which of the following conditions is the MOST likely cause of the sign and symptoms? 1. Hypothyroidism 2. Hyperthyroidism 3. Hyperparathyroidism 4. Hypoparathyroidism

1. Hypothyroidism is consistent with signs and symptoms of bradycardia, constipation, and cold intolerance. 2. Hyperthyroidism causes diarrhea, rather than constipation. 3. Hyperparathyroidism is not associated with bradycardia. 4. Hypoparathyroidism is associated with arrhythmias and either constipation or diarrhea.

A patient reports a recent significant weight loss as a result of diarrhea and vomiting. The patient is MOST at risk for which of the following conditions? 1. Bradycardia 2. Euvolemia 3. Shortness of breath 4. Orthostatic hypotension

1. Dehydration is likely owing to fluid losses associated with emesis and diarrhea. Tachycardia is more likely with dehydration. 2. Euvolemia is an indication of normal fluid balance, which is not likely to be present in a patient who has weight loss associated with diarrhea and vomiting. 3. Shortness of breath is not associated with body fluid volume loses. Significant postural hypotension results from extracellular fluid volume depletion. 4. Body fluid loses associated with weight loss, excessive diarrhea, and vomiting may cause electrolyte imbalances, which can result in orthostatic changes in blood pressure.

A patient reports worsening medial foot and ankle pain. Examination reveals a loss of arch height, excessive pronation during walking, and pain with palpation of the posterior aspect of the medial malleolus. Which of the following combinations of movements is MOST likely to be weak? 1. Dorsiflexion and eversion 2. Dorsiflexion and inversion 3. Plantar flexion and eversion 4. Plantar flexion and inversion

1. Dorsiflexion and eversion are performed by fibularis (peroneus) tertius, which is not implicated by the impairments identified in the stem (p. 265). 2. Dorsiflexion and inversion are performed by the tibialis anterior, which is not implicated by the impairments identified in the stem (p. 259). 3. Plantar flexion and eversion are performed by the fibularis (peroneus) longus, which is not implicated by the impairments identified in the stem (p. 266). 4. Plantar flexion and inversion are performed by the tibialis posterior. The tibialis posterior tendon is implicated by the impairments identified in the stem. (p. 262)

Which of the following tests would MOST likely produce symptoms if the pain was due to restricted mobility of the tibial nerve? 1. Contractile test of the hamstrings with the knee at 90° 2. Straight leg raises with 10° of ankle dorsiflexion 3. Prone knee flexion with 35° of ankle plantar flexion 4. Repeated lumbar extension in standing

1. Dorsiflexion, foot eversion, and toe extension stress the tibial branch. A resisted hamstrings test will not tension the tibial nerve. 2. Straight leg raises with ankle dorsiflexion, foot eversion, and toe extension will tension the tibial nerve. 3. Prone knee flexion will tension the femoral nerve. 4. Dorsiflexion, foot eversion, and toe extension stress the tibial branch. Repeated lumbar extension in standing position is not a test that will tension the tibial nerve.

A patient with a C7 spinal cord injury wants to perform sit pivot transfers. Which of the following resisted exercises would be MOST appropriate to accomplish this goal? 1. Scapular protraction 2. Elbow flexion 3. Shoulder internal rotation 4. Scapular elevation

1. During the transfer, protraction and depression of the scapulae increase the height of the lift to clear the buttocks (p. 933). 2. The elbows should be locked into extension either through activity of the triceps or positioning the shoulders in lateral (external) rotation (p. 933). 3. Medial (internal) rotation of the shoulders is not needed to maintain elbow extension (p. 924). 4. The scapulae should be depressed to increase the height of the lift (p. 933).

After evaluating a patient who is a baseball player, a physical therapist concludes that there is insufficient deceleration of the shoulder during throwing. Which of the following strengthening techniques will be MOST effective in improving control of deceleration of the shoulder? 1. Eccentric exercises of the lateral (external) rotators 2. Eccentric exercises of the medial (internal) rotators 3. Concentric exercises of the lateral (external) rotators 4. Concentric exercises of the medial (internal) rotators

1. Eccentric training is consistent with the eccentric demand of deceleration, and exercise of the posterior shoulder muscles is needed to improve this function. The eccentric contraction of the rotator cuff lateral (external) rotators decelerates the rapid medial (internal) rotation of the shoulder. 2. Although eccentric training is necessary, the medial (internal) rotators do not function in this manner. 3. Concentric exercise is not consistent with functional demand. 4. Concentric exercise is not consistent with functional demand, and the medial (internal) rotators do not require attention in this scenario.

A patient who had a cerebrovascular accident 1 year ago walks independently using a standard cane. During heel strike (initial contact), the forefoot makes contact with the floor first. Which of the following reasons BEST explains this gait pattern? 1. Increased reciprocal movements 2. Excessive activity of the plantar flexors 3. Overactivity of the muscles in the lateral compartment 4. Noncontractile tissue tightness in the anterior aspect of the lower leg

1. Excessive activity of the plantar flexors would position the foot into plantar flexion, which would result in a forefoot contact (O'Sullivan, p. 264). Increased reciprocal movements would not be a likely cause for this pattern. The velocity of the hemiparetic leg is usually decreased (Gillen, p. 200). 2. Excessive activity of the plantar flexors would position the foot into plantar flexion, which may result in a forefoot contact (O'Sullivan, p. 264). Other causes for this gait include weak dorsiflexors, a decreased ability to perform fast reciprocal movements, and noncontractile soft tissue limitations of the plantar flexors (Gillen, p. 200). 3. Overactivity of the muscles in the lateral compartment (the fibularis [peroneal] muscles) would result in increased eversion, not forefoot contact (Hislop, p. 265). 4. Tightness would be in the posterior (not anterior) aspect of the lower leg (i.e., plantar flexors) (O'Sullivan, p. 264; Gillen, p. 201).

While walking with a prosthesis, a patient with a right transtibial amputation fails to flex the right knee in early stance. This gait pattern is MOST likely due to excessive: 1. dorsiflexion of the prosthetic foot. 2. posterior displacement of the socket relative to the foot. 3. medial displacement of the socket relative to the foot. 4. lateral rotation of the prosthetic foot.

1. Excessive dorsiflexion will result in knee instability. 2. Excessive knee hyperextension (or failure to flex the knee) can be due to a socket that is too posterior to the foot. 3. Medial displacement of the socket relative to the foot can result in the prosthetic foot leaning medially (internally). 4. Lateral placement of the prosthetic foot can lead to increased step width.

A physical therapist is examining a patient who reports decreased walking endurance. The therapist notes that the muscles of the L4 myotome weaken after the patient holds the muscle contraction for 4 seconds. These findings are MOST likely due to: 1. a single nerve root lesion. 2. a central nervous system lesion. 3. femoral nerve compression. 4. central spinal stenosis.

1. Findings for a single nerve root lesion may not be apparent on testing immediately but may emerge after a few seconds. 2. Central nervous system lesions typically are not manifested in this way. 3. Peripheral nerve injury will cause weakness that is discernible more quickly than weakness resulting from a single nerve root injury. 4. Peripheral nerve injury will cause weakness that is discernible more quickly than weakness resulting from a single nerve root injury.

A patient with an incomplete C8 spinal cord injury reports of burning in the buttocks when sitting in a wheelchair. Which of the following problems with the patient's wheelchair would be MOST likely to contribute to the burning? 1. Footplates are too high. 2. Footplates are too low. 3. Seat is too narrow. 4. Seat is too deep.

1. Footrests that are too high shift the patient's weight posteriorly onto the buttocks, leading to pressure and pain (p. 1419). 2. Footrests that are too low shift weight forward onto the thighs. Although this would cause problems due to pressure on the thighs, it would not lead to pain in the buttocks. (p. 1419) 3. A narrow seat will lead to pressure and pain on the lateral pelvis and thighs, not in the buttocks (pp. 1413, 1429). 4. A long seat will lead to pressure and pain behind the knees, not in the buttocks (pp. 1413, 1429).

A patient who has chronic obstructive pulmonary disease reports severe shortness of breath after walking 80 ft (24.4 m). Which of the following positions will BEST relieve the patient's dyspnea? 1. Sitting with forward arm support 2. Supine with the feet elevated 3. Sitting with the feet elevated 4. Standing with good posture

1. Forward supported sitting is a common position for dyspnea relief. This position increases the intraabdominal pressure, improving the length-tension relationship of the diaphragm, and allows accessory muscle use. 2. Supine with feet elevated does not improve diaphragm or accessory muscle function. 3. Sitting with feet elevated does not improve diaphragm or accessory muscle function. 4. Leaning against a wall while standing can be beneficial, but standing with good posture does not facilitate accessory muscle function as much as forward sitting.

A patient with normal urine control reports not being able to reach the toilet in time due to muscle weakness and joint pain. Which type of incontinence BEST describes the patient's condition? 1. Functional 2. Stress 3. Urge 4. Overflow

1. Functional incontinence occurs in people who have normal urine control but who have difficulty reaching a toilet in time because of muscle or joint dysfunction (p. 987). 2. Stress incontinence is the loss of urine during activities that increase intraabdominal pressure such as coughing, lifting, or laughing (p. 988). 3. Urge incontinence is the sudden unexpected urge to urinate and the uncontrolled loss of urine. Urge incontinence is often related to reduced bladder capacity or detrusor instability. (p. 988) 4. Overflow incontinence is the constant leaking of urine from a bladder that is full but unable to empty (p. 991).

Which of the following conditions is a CONTRAINDICATION for mechanical traction of the cervical spine? 1. Muscle spasm 2. Rheumatoid arthritis 3. Hypomobility of the spine 4. Decreased upper extremity sensation

1. Gentle intermittent traction may assist in decreasing muscle spasm and the resultant spinal compressive forces. 2. Joint capsules, ligaments, and bones are fragile in patients with rheumatoid arthritis (RA). A patient with RA is subject to atlantoaxial subluxation or to developing instability next to areas of hypomobility. 3. Longitudinal traction force provides a gliding separation of the facets, general capsular stretch, and opening of the intervertebral foramen. Traction can improve range of motion. 4. Reduction of neurological deficits may result from improved conduction in large-diameter myelinated afferent and efferent nerve fibers. Mechanical traction can release pressure on nerve fibers, thereby increasing nerve conduction.

An elderly patient is being evaluated for discharge from an acute care setting. Prior to admission, the patient lived alone on the second floor of a building without an elevator and walked with the use of a cane. Currently, the patient performs bed mobility and stand pivot transfers with moderate assistance. The patient does not want to go to a transitional care facility for rehabilitation, and prefers to go home instead. Which of the following approaches is MOST appropriate for the physical therapist to take? 1. Recommend discharge to home with a home health aide during the day, and order all necessary equipment. 2. Clearly explain to the patient that the physician is the one who determines the type of facility to which the patient will be discharged. 3. Clearly explain to the patient that the goal of discharge to a transitional care facility is for short-term rehabilitation. 4. Recommend discharge to home with home physical therapy and community services, and order all necessary equipment.

1. Given that the patient lives on the 2nd floor and still needs assistance for transfers, the best option is discharge to a short-term rehabilitation facility. 2. The physical therapist can educate the patient about discharge planning as part of the treatment team; referral to a physician is not required. 3. If the physical therapist educates the patient about the need for a short-term placement, the patient may better understand the need to become more independent before going home. 4. Given that the patient lives on the 2nd floor and still needs assistance for transfers, short-term rehabilitation would be the best option.

A patient is lacking forearm supination due to associated joint restriction. Which of the following glides at the distal radioulnar joint will MOST likely be limited with testing? 1. Volar glide of the radial head on the ulna 2. Dorsal glide of the radial head on the ulna 3. Volar glide of the radius on the head of the ulna 4. Dorsal glide of the radius on the head of the ulna

1. Glide of the radial head on the ulna is for the proximal radioulnar joint, not the distal radioulnar joint. 2. Glide of the radial head on the ulna is for the proximal radioulnar joint, not the distal radioulnar joint. 3. At the distal radioulnar joint, the concave ulnar notch of the radius articulates with the convex head of the ulna. A volar glide of the radius on the head of the ulna would test for pronation, which is incorrect. 4. At the distal radioulnar joint the concave ulnar notch of the radius articulates with the convex head of the ulna. A dorsal glide of the radius on the head of the ulna would test for supination. If there were associated joint restrictions here, testing of this glide would be restricted.

A patient positioned in prone has difficulty initiating hip extension with the knee bent. Which of the following muscles will MOST likely need strengthening? 1. Hamstrings 2. Gluteus maximus 3. Lumbar erector spinae 4. Gluteus medius

1. Hamstrings are primarily knee flexors. They can be secondary hip extensors but would be tested with the knee extended, not flexed. (p. 242) 2. The gluteus maximus is the primary hip extensor muscle tested in this manner (p. 216). 3. Lumbar erector spinae extend the trunk on the legs. They do not attach on the femur and have no impact on hip extension. (pp. 43-44) 4. Gluteus medius weakness would be assessed by testing hip abduction in sidelying position (p. 223).

Which of the following patient activities will BEST facilitate the goal of a posterior glide mobilization of the talus? 1. Performing heel raises while seated 2. Walking on tiptoes on level surfaces 3. Performing single limb stance activities 4. Ascending and descending stairs with a reciprocal pattern

1. Heel raises would augment plantar flexion, bringing the ankle only to neutral dorsiflexion (Loudon, pp. 324, 326). 2. Walking on tiptoes would emphasize plantar flexion motion rather than dorsiflexion (Loudon, pp. 324-325). 3. Single limb stance activities would not require dorsiflexion (Loudon, p. 325). 4. The photograph illustrates a posterior glide mobilization of the talus. This mobilization is intended to improve dorsiflexion at the ankle (Brody, p. 168). Therefore, the mobilization would be best augmented by exercises emphasizing active/passive dorsiflexion. Stair climbing requires dorsiflexion and plantar flexion movement. Normal dorsiflexion is 0° to 20°, and normal plantar flexion is 0° to 50°. Therefore, ascending and descending stairs is the best option. (Loudon, pp. 324-326)

A physical therapist plans to use autolytic debridement to treat a patient's shallow, dry, partly necrotic leg wound. Which of the following dressings is MOST appropriate for this wound? 1. Hydrofiber dressing 2. Transparent film 3. Enzymatic agent 4. Foam dressing

1. Hydrofibers are alginate-like in appearance and are activated by moisture in the wound. They are used for wounds with heavy exudate. The wound described is dry. (Sussman, p. 511) 2. A dry wound will be best autolytically debrided by using a transparent film dressing (Sussman, p. 446). 3. Enzymes are not used in autolytic debridement (Sussman, p. 442). 4. A foam dressing is best used for a moist, draining wound (Myers, p. 141).

A patient has a comminuted femoral fracture with an external fixator. There is no sign of quadriceps contraction with electrical stimulation. Which of the following is the MOST likely cause? 1. A lesion in the femoral nerve 2. A contusion of the quadriceps muscle 3. An unstable fracture site 4. A lesion in the L4-L5 nerve roots

1. If a muscle becomes denervated, a contraction cannot be produced by neuromuscular electrical stimulation (Cameron, p. 246). 2. A contusion is a bruise, which is characterized by swelling, discoloration, and pain. Innervation of the muscle is typically intact, and, therefore, electrical stimulation would produce a contraction in the quadriceps. (Mosby, pp. 436-437) 3. If the nerve is intact at the fracture site, a muscle contraction may be produced by neuromuscular electrical stimulation (Cameron, p. 240). 4. The quadriceps are innervated by the femoral nerve, which is derived from spinal nerves L2-L4. A lesion in the L4-L5 nerve roots would still leave innervation in the quadriceps, and, therefore, electrical stimulation would produce a contraction in the quadriceps. (Moore, p. 547)

A patient experiences peripheralization of low back pain with repeated trunk flexion. Repeated trunk extension in prone centralizes the pain. Which of the following activities would MOST likely aggravate the patient's symptoms? 1. Driving a car for several hours 2. Lifting light objects with the spine maintained in neutral 3. Work that involves frequent standing 4. Sleeping all night in a supine position

1. If repeated trunk flexion peripheralizes symptoms, then it is likely that prolonged sitting will also, as both are flexed postures for the lumbar spine, causing mechanical deformation/pain. 2. Lifting an object with spine in neutral should not cause pain, as the spine is in optimal alignment with neither flexion or extension deformations. 3. Standing typically implies lumbar extension. Therefore, if symptoms subside or peripheralize in prone position, it is likely they will also in standing position, since both are extension activities. 4. Sleeping all night in supine position may not cause significant pain, because there is no compressive load through the spine.

Which of the following muscular responses would be expected during normal micturition? 1. Relaxation of the detrusor and relaxation of the pelvic floor 2. Relaxation of the detrusor and contraction of the pelvic floor 3. Contraction of the detrusor and relaxation of the pelvic floor 4. Contraction of the detrusor and contraction of the pelvic floor

1. If the detrusor does not contract, the result is incomplete bladder emptying. 2. Neither relaxation of the detrusor nor the contraction of the pelvic floor would allow for complete bladder emptying as expected in normal micturition. 3. The contraction of the detrusor acts to empty the bladder, while the relaxation of pelvic floor allows the urine to pass. 4. Contraction of the pelvic floor would limit the flow of urine.

Instructing a patient in specific movement strategies would be MOST effective in which stage of motor learning? 1. Implicit 2. Associative 3. Autonomous 4. Cognitive

1. Implicit memory is memory formed through repetition. Implicit learning is reflexive, automatic, and habitual in character. This type of learning does not require the awareness, attention, and reflection that one would need when learning a specific movement strategy. (p. 25) 2. In the associative phase of learning, the goal is to refine a skill learned in the cognitive stage. Verbal/cognitive aspects of learning may not be as important at this stage because the person focuses more on refining a particular pattern rather than on selecting among alternative strategies. (p. 29) 3. The autonomous stage should be automatic and require very little attention and information processing (p. 29). 4. Cognitive learning requires attention and is characterized by rapidly improving and variable performance. Improvements in performance are also quite large in the first stage, perhaps as a result of selecting the most effective strategy for a specific task. (p. 29)

An 8-year-old child who has Duchenne muscular dystrophy would MOST likely have which of the following examination findings? 1. Swayback posture and protraction of the scapulae 2. Hamstrings contractures and excessive hip extension 3. Standing lordotic posture and winging of the scapulae 4. Quadriceps contractures and excessive hip abduction

1. In a swayback posture, the pelvis is posteriorly tilted and the thoracic spine is in relative flexion. In children who have Duchenne muscular dystrophy, the hip flexors become shortened from overuse and the pelvis tilts anteriorly. The thoracic spine begins to move into relative extension to compensate for the pelvic tilt, and the scapulae wing in an attempt to keep the center of mass behind the hip joint. (p. 246) 2. Tensor fasciae latae contractures become increasingly frequent from age 8-10 years in patients who have Duchenne muscular dystrophy. In addition, hip extension range of motion is often limited due to shortness of the hip flexor muscles. (pp. 248-249) 3. No limitations in range of motion are typically noted before 5 years of age in children who have Duchenne muscular dystrophy. By age 8, the deficits listed would be clearly present. The normal lordotic standing posture is increased, and winging of the scapulae is seen as compensation to keep the center of mass behind the hip joint to promote standing ability. (p. 246) 4. In children who have Duchenne muscular dystrophy, the hamstrings become contracted, not the quadriceps (p. 248).

A patient recovering from Guillain-Barré syndrome exhibits Poor (2/5) quadriceps strength. The BEST therapeutic exercise would be active knee extensions with which of the following parameters? 1. Multiple repetitions in sidelying, maximally stressing the quadriceps 2. Limited number of repetitions in sidelying, avoiding fatigue of the quadriceps 3. Limited number of repetitions in sitting, avoiding fatigue of the quadriceps 4. Multiple repetitions in sitting, maximally stressing the quadriceps

1. In patients recovering from Guillain-Barré syndrome, overwork will delay recovery. 2. In patients recovering from Guillain-Barré syndrome, overwork and fatigue should be avoided. 3. In patients recovering from Guillain-Barré syndrome, poor strength would prohibit knee extension against gravity. 4. In patients recovering from Guillain-Barré syndrome, overwork will delay recovery, and poor strength would prohibit knee extension against gravity.

The parent of a 2-year-old child reports that while holding the child's hand when walking down a street, the child fell down. The parent tried to hold the child up while the child regained balance. The child now holds the arm at the side with the palm facing down. Which of the following conditions is MOST likely present? 1. Radial tunnel syndrome 2. Necrosis of the capitellum 3. Valgus extension overload syndrome 4. Partial slippage of the annular ligament

1. In radial tunnel syndrome, there is pain over the extensor muscle mass of the forearm distal to the lateral epicondyle. In addition, long finger extension testing would produce pain, and there could be weakness of finger and thumb (1st digit) extensors and the extensor carpi ulnaris. Typically, this syndrome results from overuse and not from a traumatic event. 2. Necrosis of the capitellum typically affects the dominant elbow of children, mainly boys, between the ages of 5 and 10 years. It is a diagnosis that is often associated with throwing in a young child (i.e., little-league elbow). 3. It is highly unlikely that a 2-year-old child would have valgus extension overload syndrome, because it typically is seen in throwing athletes in whom the repetitive stresses of throwing lead to progressive changes within the elbow joint, which cause pain and athletic impairment. Findings include pain and tenderness around the tip of the olecranon, pain with forced passive elbow extension, and increased valgus laxity. 4. A diagnosis of partial slippage of the annular ligament is made from the history with a report of longitudinal traction on an extended elbow, as with a child whose arm is pulled by a parent when walking. This injury typically occurs in children age 2-3 years.

A patient has fibular (peroneal) nerve palsy. Which of the following gait deviations is the patient LEAST likely to demonstrate during the swing phase of walking? 1. Increased knee flexion 2. Hip circumduction 3. Increased hip flexion 4. Increased ankle dorsiflexion

1. Increased knee flexion would be a possible compensation for the lack of dorsiflexion resulting from the fibular (peroneal) palsy in order to clear the foot during the swing phase of gait. 2. Circumduction is a possible lower extremity compensation to clear the foot during the swing phase of gait due to a lack of ankle dorsiflexion resulting from the fibular (peroneal) nerve palsy. 3. Increasing hip flexion during the swing phase of gait would help clear the foot to compensate for a lack of dorsiflexion resulting from the fibular (peroneal) nerve palsy. 4. Increasing dorsiflexion of the ankle would be the least likely deviation, because a fibular (peroneal) nerve palsy would reduce the ability of the patient to actively dorsiflex the ankle during the swing phase of gait.

Which of the following interventions is MOST appropriate for a child who had a resection of a cerebellar glioma? 1. Auditory cues to improve motor initiation 2. Balance training to promote a stable base of support 3. Somatosensory stimulation to increase limb awareness 4. Functional electrical stimulation to antagonists to reduce spasticity

1. Individuals who have basal ganglia dysfunction have difficulty initiating movements, and this can be addressed through the augmentation of sensory cues (Umphred, p. 608). However, individuals who have cerebellar dysfunction have difficulty scaling movements according the correct amplitude (overshooting or undershooting) (Umphred, pp. 631, 639). 2. Gliomas in children are primarily found in the cerebellum (Umphred, p. 792). Tumors in the cerebellum can result in ataxia, dysmetria, dysdiadochokinesia, and intention tremor (Umphred, p. 795). A cardinal sign of cerebellar damage is postural instability in both static and dynamic conditions (Umphred, pp. 631). Further, the gait pattern may be wide-based (Umphred, p. 639). Common interventions for ataxia include balance training and gait activities (Umphred, p. 646). 3. Individuals with cerebellar deficits have primarily motor deficits, including deficits in coordinating and adaptive movements (Umphred, p. 631). Somatosensory stimulation would be useful for individuals who have impairments related to unilateral neglect, somatosensation, and spatial relations (Shumway-Cook, pp. 116-117). Somatosensory stimulation is a multisensory approach to retraining individuals with sensory impairments (Umphred, p. 239). Impairments such as neglect, somatosensory loss, and impaired spatial relationship are common with resections in the parietal lobe (Umphred, p. 796). 4. Although functional electrical stimulation can be used to promote walking in individuals with neurological disorders (Umphred, pp. 1021-1024) and potentially reduce spasticity through improved reciprocal activation of muscles, individuals who have cerebellar lesions have hypotonia due to the decreased excitatory drive from the cerebellum to the extensor muscles (Umphred, p. 639). Activities to attempt to decrease tone would not be appropriate.

Which of the following examination findings MOST likely indicates a favorable prognosis for a patient who has a posterior lumbar disc herniation? 1. Centralization and ability to restore extension mobility 2. Proximal symptoms and ability to restore flexion mobility 3. Peripheralization with flexion and a positive straight leg raise result 4. Leg pain with extension and a negative crossed straight leg raise result

1. Individuals who have centralization of symptoms and have the ability to restore extension of the spine demonstrate a good prognosis. 2. Proximal symptoms are suggestive of a good prognosis; however, flexion mobility is not a predictor of a good prognosis for patients who have a disc herniation. 3. Neither of these options have been found to have a predictive value in the prognosis of patients who have a disc herniation. 4. Although a negative result on the crossed straight leg raise is favorable, leg pain reproduced with extension is predictive of a poor prognosis.

A patient with an excessive anterior pelvic tilt will usually have which of the following associated conditions? 1. Weak lumbar extensors 2. Weak hip flexors 3. Piriformis flexibility deficits 4. Iliacus flexibility deficits

1. Low back extensors are typically short and strong in a patient who has an excessive anterior pelvic tilt. 2. Hip flexor muscles are typically short and strong in a patient who has an excessive anterior pelvic tilt. 3. The piriformis attaches from the pelvis to the greater trochanter. Therefore, an excessive anterior pelvic tilt would not be associated with a tight piriformis; the sacral-femoral position is more likely to be related to piriformis flexibility deficits. 4. Hip flexor muscles (iliacus/iliopsoas) are short and strong in a patient who has an excessive anterior pelvic tilt.

A patient is referred to physical therapy with a diagnosis of myositis ossificans in the quadriceps muscle after sustaining a contusion. The MOST appropriate treatment for the patient is: 1. progressive resistance exercises through full range. 2. active range of motion in the pain-free range. 3. passive range of motion into resistance. 4. transverse friction massage.

1. Initially strengthening should be avoided; the focus should be on range of motion (Dutton, p. 1059; Kisner, p. 636). 2. Once rehabilitation can begin, initial treatment is geared toward range of motion (Dutton, p. 1059; Goodman, p. 1289). 3. Passive range of motion into resistance should not be done initially in the treatment of myositis ossificans (Dutton, p. 1059; Goodman, p. 1289). 4. Initial treatment is geared toward range of motion (Dutton, p. 1059). Transverse friction massage is contraindicated in the presence of acute inflammation, hematomas, debilitated or open skin, and decreased sensation (Dutton, p. 422). Massage should be avoided early in the treatment of myositis ossificans (Kisner, p. 636).

A physical therapist is teaching a patient who has hemiplegia to perform overhead reaching activities. Which of the following teaching methods is MOST likely to encourage retention of the skill? 1. Provide instructions while demonstrating the activity. 2. Have the patient perform multiple repetitions of the activity. 3. Demonstrate movements that should be avoided during the activity. 4. Passively move the patient's limb through multiple repetitions of the activity.

1. Instructions and demonstration assist the patient in learning what to do (p. 20). 2. When active movement is the desired outcome, active limb movement should be practiced repeatedly. This is the preferred strategy for better learning and retention in the associative stage of learning. (p. 21) 3. Practicing incorrect movement patterns can lead to negative learning (p. 25). 4. Continued guidance may result in the patient becoming dependent on the physical therapist (pp. 20-21).

Iontophoresis should be used with precaution for a patient who has which of the following conditions? 1. Peripheral neuropathy 2. Raynaud disease 3. Degenerative joint disease 4. Chronic edema

1. Iontophoresis should be used with precaution in patients who have conditions involving decreased sensation (Cameron, p. 268; Bellew, p. 323). 2. Raynaud disease is not a precaution or contraindication for iontophoresis (Cameron, p. 268). 3. Degenerative joint disease may be associated with joint pain and inflammation, both of which could be indications for iontophoresis (Bellew, p. 319). 4. Chronic edema may be an indication for iontophoresis (Bellew, p. 319).

Which of the following chronic hormonal responses to exercise may contribute to menstrual dysfunction? 1. High levels of cortisol, low levels of follicle-stimulating hormone (FSH) 2. High levels of cortisol, high levels of follicle-stimulating hormone (FSH) 3. Low levels of cortisol, low levels of follicle-stimulating hormone (FSH) 4. Low levels of cortisol, high levels of follicle-stimulating hormone (FSH)

1. It has been proposed that exercise stress chronically elevates cortisol levels in athletes. This in turn suppresses the secretion of gonadotropin-releasing hormone (GnRH), which in turn results in the suppression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Low levels of FSH will result in menstrual dysfunction. 2. Although it has been proposed that exercise stress chronically elevates cortisol levels in athletes, this rise in levels of cortisol suppresses, not stimulates, the secretion of gonadotropin-releasing hormone (GnRH), which in turn results in the suppression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) rather than stimulation of the secretion of these hormones. 3. It has been proposed that exercise stress chronically elevates cortisol levels in athletes, although lower levels of follicle-stimulating hormone (FSH) will result in menstrual dysfunction. 4. It has been proposed that exercise stress chronically elevates cortisol levels in athletes.

During gait evaluation, a physical therapist notes that a patient demonstrates a shorter left step length and excessive left knee flexion during the left midstance phase. Which of the following problems is the MOST likely the cause of the gait dysfunction? 1. Left hamstrings contracture 2. Right iliopsoas weakness 3. Left hip flexion contracture 4. Right quadriceps weakness

1. Left hamstrings contracture is a fixed, mechanical limitation. It is the most likely cause of the gait impairment, because it directly affects both the knee joint during the midstance phase and the step length. It is the only option that can contribute to both of the gait impairments. (p. 1013) 2. Hip flexor weakness is more likely to result in a posterior lurch to facilitate right limb swing (p. 1013). 3. A left hip flexor contracture would result in decreased step length on the right limb due to limited left hip extension (pp. 1007-1008). 4. Quadriceps weakness would be more likely to result in an anterior lurch at midstance to create a knee extension moment (p. 1014).

When providing patient education in cardiac rehabilitation, which of the following signs and symptoms of exertional intolerance should the physical therapist emphasize? 1. Anginal pain, insomnia, sudden weight gain, leg stiffness 2. Persistent dyspnea, dizziness, anginal pain, sudden weight gain 3. Persistent dyspnea, anginal pain, insomnia, weight loss 4. Anginal pain, confusion, leg numbness, weight loss

1. Leg stiffness is not a sign/symptom associated with exercise intolerance among patients undergoing cardiac rehabilitation. 2. The signs and symptoms listed in this option are associated with exercise intolerance among patients undergoing cardiac rehabilitation. 3. Weight loss is not a sign associated with exercise intolerance among patients undergoing cardiac rehabilitation. However, angina and dyspnea are important signs of exercise intolerance. 4. Leg numbness, confusion, and weight loss are not associated with exercise intolerance. However, angina is important to note in the patient who has cardiac dysfunction.

A 6-year-old patient who has Legg-Calvé-Perthes disease is MOST likely to have which of the following gait deviations? 1. Vaulting 2. In-toeing 3. Toe-walking 4. Trendelenburg

1. Legg-Calvé-Perthes disease affects the hip and is not typically associated with vaulting. Vaulting is typically seen with hemiparetic limbs. 2. Legg-Calvé-Perthes disease affects the hip and is not typically associated with in-toeing. Further, limited range of motion into hip medial (internal) rotation is common in patients who have Legg-Calvé-Perthes disease, making in-toeing even less likely. 3. Legg-Calvé-Perthes disease affects the hip and is not typically associated with toe-walking. Toe-walking can be caused by short ankle plantar flexors or excessive tone. This is not seen in Legg-Calvé-Perthes disease, which typically only affects the muscles of the hip. 4. A positive Trendelenburg sign secondary to hip pain and/or hip abductor weakness is very common in children who have Legg-Calvé-Perthes disease. Although Legg-Calvé-Perthes disease can affect children of nearly any age, it is most common among boys ages 4 to 8 years.

Following anterior cruciate ligament reconstruction using a graft from the patellar ligament, which of the following early interventions will BEST facilitate healing of the patellar ligament? 1. High-load short-arc quads 2. Prolonged immobilization with the knee fully extended 3. Deep squats 4. Active knee range of motion

1. Low loads are indicated at this phase of tissue healing, not high loads. High loads may overload the tissue and cause damage. 2. Prolonged immobilization will lead to adhesions and decreased range of motion, along with weak/unorganized tissue that is less able to tolerate the normal stresses eventually placed upon it. 3. Although weight-bearing may provide a low-load stimulus, deep squats are too aggressive at this stage and may cause tissue damage/harm. 4. Active range of motion provides a light load similar to normal stress to facilitate tissue healing during the repair and regeneration phase of tissue healing.

Which of the following ultrasound parameters are MOST appropriate to treat a patient with a painful superficial Morton neuroma between the 2nd and 3rd metatarsals? 1. 1 MHz frequency with 0.79 in (2 cm) sound head 2. 3 MHz frequency with a 0.79 in (2 cm) sound head 3. 1 MHz frequency with a 1.97 in (5 cm) sound head 4. 3 MHz frequency with a 1.97 in (5 cm) sound head

1. Lower frequency waves penetrate deeply and are not appropriate for superficial tissue. 2. Higher frequency waves do not penetrate as easily as lower frequency waves and, therefore, are better for treatment of superficial conditions. A smaller 2-cm sound head is better for small areas, such as between the metatarsals in a patient who has a Morton neuroma. 3. Lower frequency waves penetrate deeply and are not appropriate for superficial tissue. The 5-cm sound head is only appropriate for large treatment areas (e.g., the lumbar spine). 4. The 5-cm sound head is only appropriate for large treatment areas (e.g., the lumbar spine).

A physical therapist performs the Dix-Hallpike test and finds a positive result. Which of the following interventions is MOST appropriate? 1. Manual cervical traction 2. Canalith repositioning maneuver 3. Referral to physician 4. Cervical stretching exercises

1. Manual cervical traction would not be the best treatment option for benign paroxysmal positional vertigo. 2. A positive test result indicates benign paroxysmal positional vertigo, which is treated by the canalith repositioning maneuver. 3. A positive test result indicates benign paroxysmal positional vertigo, which can be treated by the physical therapist and does not require physician referral. 4. Cervical stretching would not affect this condition.

A patient reports a burning sensation along the medial aspect of the knee and lower leg. The sensation is increased during resisted hip adduction and knee flexion. The patient MOST likely has which of the following conditions? 1. Meralgia paresthetica 2. Neuropathy of the obturator nerve 3. Complex regional pain syndrome 4. Neuropathy of the saphenous nerve

1. Meralgia paresthetica is described as burning pain along the anterolateral aspect of the thigh that increases with hip extension (not hip adduction as described in the stem) (Dutton, p. 951). 2. The obturator nerve has no cutaneous innervation to the lower leg (Moore, pp. 537-538). Pain would reside in the adductor thigh compartment (Dutton, p. 951). 3. Complex regional pain syndrome of the lower extremity typically involves the foot and ankle. There are multiple characteristics present, such as pain, allodynia, hyperalgesia, abnormal vasomotor response, and abnormal sudomotor (sympathetic nervous system) activity. (Dutton, p. 273) 4. The saphenous nerve is cutaneous and supplies skin on medial aspect of leg and foot (Moore, pp. 537-538). Entrapment can cause pain at the medial side of knee. The pain is described as burning pain that increases with knee flexion and hip adduction. (Dutton, p. 979)

The anterior drawer test of the ankle will MOST likely be positive following which type of injury mechanism? 1. Midtarsal stress 2. Dorsiflexion 3. Eversion 4. Inversion

1. Midtarsal stress is not the traditional method of injury for any single ligament, including anterior talofibular ligament. 2. Dorsiflexion would be the most likely mechanism of injury for the anterior tibiofibular ligament (high ankle sprain), not the anterior talofibular ligament. The integrity of the anterior tibiofibular ligament would be tested with a dorsiflexion/rotation maneuver, not a straight anterior glide. 3. Eversion would be the most likely mechanism of injury for the deltoid ligament, not the anterior talofibular ligament. The integrity of the deltoid ligament would be tested with a straight eversion stress, not a straight anterior glide. 4. The photograph shows an anterior drawer test, which is used to evaluate the anterior talofibular ligament. This is the ligament that is injured most often with an inversion mechanism.

A patient has impaired sensory and motor function of the left limbs and the left side of the face. The patient is unable to sit independently. In which of the following regions of the nervous system is the lesion MOST likely located? 1. Cerebrum 2. Brainstem 3. Spinal cord 4. Peripheral nerve

1. Motor and sensory deficits are entirely on the left side of the body. The lower half of the face, the trunk, and both limbs are involved, indicating damage to vertical tract neurons. Facial signs indicate a lesion above the lower midbrain, because a spinal cord lesion would not affect the face and a lesion in most areas of the brainstem would have facial signs contralateral to the limb signs. The most likely location is the cerebrum. 2. A lesion in most areas of the brainstem would have facial signs contralateral to the limb signs. 3. A spinal cord lesion would not affect the face. 4. Motor and sensory deficits are entirely on the left side of the body. The lower half of the face, the trunk, and both limbs are involved, indicating damage to vertical tract neurons. Peripheral nerve lesion signs and symptoms are specific to the nerve injured and would not encompass entire limbs and the face.

A patient is unable to reach behind the low back during activities of daily living. Muscle performance testing is pain-free, normal, and symmetrical. What is the MOST likely problem contributing to this functional impairment? 1. Subscapularis disorder 2. Pectoralis minor stiffness 3. Posterior capsular stiffness 4. Acromioclavicular joint arthrosis

1. Muscle performance testing is normal, thus subscapularis disorder is not likely (p. 476). 2. Stiffness of the pectoralis minor would lead to impairments in activities requiring upward rotation and posterior tilting of scapula (p. 474). 3. Posterior capsular stiffness would decrease medial (internal) rotation, which is required for reaching the hand behind the back (p. 612). 4. Acromioclavicular joint arthrosis is most likely to limit horizontal adduction and overhead motions (p. 675).

A physical therapist examines a patient recovering from a gunshot wound affecting the left deep fibular (peroneal) nerve. To which surface of the lower leg should the therapist apply electrodes for biofeedback therapy? 1. Posteromedial 2. Posterolateral 3. Anteromedial 4. Anterolateral

1. Muscles in the posteromedial aspect of the lower leg are supplied by the tibial nerve (Moore, pp. 596-602). 2. Muscles in the posterolateral aspect of the lower leg are supplied by the superficial fibular (peroneal) nerve (Moore, pp. 595). 3. Muscles in the anteromedial aspect of the lower leg are part of the posterior compartment and are supplied by the tibial nerve (Moore, pp. 596-602). 4. Electrode placement during biofeedback should be as near to the muscle being treated as possible. The deep fibular (peroneal) nerve supplies muscles in the anterior compartment of the leg, most prominently the ankle dorsiflexors and toe extensors. The specific location of these muscles can best be described as anterolateral. (Moore, pp. 589-593; Lippert, p. 357)

Which of the following is consistent with pain of musculoskeletal origin? 1. Pain decreases with rest. 2. Pain is reduced by constant pressure. 3. Pain follows a migratory pattern. 4. Pain awakens the patient at night.

1. Musculoskeletal pain is often relieved by a change in position or by rest. 2. Pressure may increase musculoskeletal pain but may decrease pleural friction/irritation and decrease visceral pain. 3. Migratory pain is pain of a systemic nature. 4. Pain that awakens a patient at night is a symptom of systemic origin.

On the basis of the history and objective assessment of a patient with knee pain, a physical therapist suspects a ligamentous lesion. Which of the following diagnostic tests should the therapist request to confirm these findings? 1. Myelography 2. Radiography 3. Magnetic resonance imaging (MRI) 4. Computed tomography (CT) scan

1. Myelograms are used to help diagnose pathological conditions of the spine (p. 358). 2. Radiography is best for noting of fractures, arthritis, or degeneration. Non-weight-bearing, stress x-rays may be used to indicate ligamentous instability (p. 346), but radiographs do not provide the most accurate image of soft tissue structures, such as muscles, tendons, ligaments, and intervertebral discs. (p. 345) 3. Magnetic resonance imaging (MRI) has the ability to show soft tissue as well as bone tissue without the need to expose the patient to the ionizing radiation needed for computed tomography scans (p. 360). 4. Computed tomography (CT) scans are used to view soft tissue as well as bone, although a contrasting agent must be used. Magnetic resonance imaging has largely replaced CT scans for knee evaluations. (p. 359)

Which of the following arterial blood gas readings indicates acidemia? 1. 7.3 2. 7.4 3. 7.45 4. 7.5

1. Normal range of arterial blood gas is a pH between 7.35 and 7.45. A pH of 7.35 or lower indicates acidemia, also called an acidotic state. 2. A pH of 7.4 falls within the normal range of arterial blood gas, which is a pH between 7.35 and 7.45. 3. A pH of 7.45 falls within the normal range of arterial blood gas, which is a pH between 7.35 and 7.45. 4. A pH of 7.5 is above normal range and represents an alkalotic state.

The BEST cleanser to use on a beefy, red wound is: 1. normal saline. 2. hydrogen peroxide. 3. Dakin's solution. 4. povidone-iodine.

1. Normal saline is an effective cleansing agent. 2. When a wound is suspected of being infected or having a bacterial colonization, irrigation with an antiseptic or antimicrobial is indicated. Saline is appropriate for a wound with no signs of infection. 3. When a wound is suspected of being infected or having a bacterial colonization, irrigation with an antiseptic or antimicrobial is indicated. Saline is appropriate for a wound with no signs of infection. 4. When a wound is suspected of being infected or having a bacterial colonization, irrigation with an antiseptic or antimicrobial is indicated. Saline is appropriate for a wound with no signs of infection.

Which of the following findings BEST describes a positive result of the median nerve tension test? 1. Elicitation of numbness in the cubital fossa 2. Elicitation of numbness in the hypothenar eminence 3. Reproduction of symptoms in the dorsal and ulnar side of the hand 4. Reproduction of symptoms in the volar (palmar) and radial side of the hand

1. Numbness in the cubital fossa is incorrect. Although the median nerve courses through the cubital fossa, its sensory branches supply only the palmar and radial side of the hand. 2. The median nerve does not innervate the hypothenar region, which is innervated by the ulnar nerve. 3. The location of symptoms and the wrist position are descriptive of radial nerve tension, not median nerve tension. 4. This option correctly states the location of symptoms (palmar and radial side of hand) when there is tension on the median nerve.

Which of the following functions is MOST likely to be impaired in a patient who has a pontine infarct? 1. Jaw movement 2. Eyelid elevation 3. Tongue movement 4. Pharyngeal swallowing

1. Observed jaw deviation during mastication results from an insult to the trigeminal nerve (CN V), which originates in the pons (p. 134). 2. Impaired eyelid elevation (ptosis) results from an insult to the oculomotor nerve (CN III), which originates in the midbrain, not the pons (p. 134). 3. Impaired tongue movement results from an insult to the hypoglossal nerve (CN XII), which originates in the medulla, not the pons (p. 135). 4. Difficulty swallowing (dysphagia) results from an insult to the vagus nerve (CN X), which originates in the medulla, not the pons (p. 135).

A physical therapist is designing a rehabilitation program for a patient who has a recent diagnosis of ankylosing spondylitis. The therapist should anticipate that as the disease progresses, the patient is MOST likely to require: 1. special precautions for osteoporosis. 2. a wheelchair for community mobility. 3. spinal surgery. 4. bilateral ankle-foot orthoses.

1. Osteoporosis is a skeletal complication associated with long-standing ankylosing spondylitis. 2. Requiring a wheelchair is incorrect because the patient should still be able to walk, even with advanced stages of ankylosing spondylitis. 3. Spinal surgery has a very limited role in the treatment of ankylosing spondylitis. 4. Peripheral nerve dysfunction is not characteristic of ankylosing spondylitis. Orthoses to manage foot drop would not be expected in the plan of care for a patient who has ankylosing spondylitis

A physical therapist is treating a patient who has Parkinson disease. The patient expresses concern about declining health and a poor prognosis. Which of the following is the MOST appropriate response for the therapist to make? 1. Offer resources on support groups. 2. Refer the patient to a psychiatrist. 3. Have the patient speak with another patient who has Parkinson disease. 4. Tell the patient that physical therapy will prevent disease progression.

1. Offering resources, including talking with many other patients, will allow choice and keep the locus of control within the patient (p. 164). 2. A psychiatrist could be among the resources that may be used by the patient, but there is no indication in the scenario of a need for psychiatric services. (pp. 90-91) 3. Each patient will face the experience of having Parkinson disease differently. Participation in a support group with several other patients would be more beneficial. (p. 164) 4. The physical therapist should not give misleading statements (pp. 194-196).

Which of the following activities would be appropriate to direct a physical therapist assistant to do? 1. Responding to inquiries from a patient's family regarding the patient's prognosis 2. Determining a patient's need for continued therapy at home after discharge from a skilled nursing facility 3. Modifying a patient's home program to include exercises listed in the clinic's protocol for the patient's diagnosis 4. Performing reevaluation of patients who will be treated free of charge as a public service

1. Only the physical therapist should respond to inquiries regarding a patient's prognosis (p. 56). 2. Determining a patient's need for continued therapy at home is a level of evaluation that is the responsibility of the physical therapist. The physical therapist assistant is not qualified to evaluate and make determinations about a patient's need for therapy at home. (p. 56) 3. Physical therapist assistants are allowed to modify specific treatments in accordance with changes in patient status. This modification does not require a new evaluation. It is simply a modification that is typically performed at a certain point of rehabilitation. (p. 51) 4. Physical therapists give services free of charge as a public service, as their practice permits. These services should be given at the same level of care, regardless of patient payment. Reevaluation of patients must be done by a physical therapist. (p. 56)

A physical therapist is initiating intervention with a postoperative patient who has just taken a 20-mg dose of oral oxycodone (OxyContin) for pain relief. In planning an intervention for this patient, the physical therapist should anticipate that: 1. the patient may be hypertensive. 2. the medication may trigger cardiac arrhythmias in the patient. 3. the patient will have an increased likelihood for developing diarrhea. 4. the patient may demonstrate respiratory depression.

1. Orthostatic hypotension is a potential side effect of oxycodone, so the patient is unlikely to be hypertensive. 2. Arrhythmias are not listed as a recognized side effect of opioids. 3. Regarding developing diarrhea, gastrointestinal motility is decreased, so the opposite effect of constipation is a frequent problem. Constipation is a listed side effect. 4. Opioids tend to make the medullary chemoreceptors less responsive to carbon dioxide, thus slowing down the respiratory rate and inducing a relative hypoxia and hypercapnia. The respiratory response to exercise may be blunted.

A 4-year-old child who has an L1 myelomeningocele has developed scoliosis over the past 2 years. The curve currently measures 25°. Which of the following recommendations is MOST appropriate for scoliosis management? 1. Continue to monitor the scoliosis, with no intervention at this time. 2. Begin a home program of stretching exercises for trunk rotators. 3. Refer to an orthopedic surgeon for evaluation for spinal fusion. 4. Fit the child with a thoracolumbosacral orthosis.

1. Orthotic intervention, usually with a thoracolumbosacral orthosis, is helpful in maintaining improved trunk position for functional activities. For children with progressive spinal deformities, orthotic intervention is continued until the child reaches a sufficient age (10+ years) to allow surgical fusion of the spine. (Palisano, pp. 547-548) 2. Stretching programs have not been found to halt or improve scoliosis. If stretching exercises are performed, they should focus on the iliopsoas and low back extensors and lateral trunk flexors on the concave side of the curvature. (Goodman, pp. 1167-1168) 3. This child is too young for surgery for scoliosis. The ideal minimum age for spinal fusion is 10 to 11 years old in girls and 12 to 13 years old in boys. Long spinal fusions before the skeletal age of 10 result in greater loss of trunk height and an increased frequency of instrumentation failure. (Palisano, pp. 547-548) 4. Orthotic intervention, usually with a thoracolumbosacral orthosis, is helpful in maintaining improved trunk position for functional activities. For children with progressive spinal deformities, orthotic intervention is continued until the child reaches a sufficient age (10+ years) to allow surgical fusion of the spine (Palisano, pp. 547-548) and is indicated for a curvature 25° to 45° (Goodman, p. 1167).

A patient reports a 2-day history of a hot, swollen, first metatarsophalangeal joint. This complaint is MOST common in: 1. osteoarthritis. 2. polymyositis. 3. gout. 4. rheumatoid arthritis.

1. Osteoarthritis is typically characterized by dull, achy pain in weight-bearing joints (e.g., hips, knees, etc.) (pp. 1304-1306). 2. Polymyositis presents as symmetric proximal muscle weakness with malaise and weight loss. There is no joint involvement. (p. 1247) 3. Gout's typical presentation is severe joint pain, occurring at night, typically in the first metatarsophalangeal joint. Signs and symptoms also include erythema, warmth, and extreme tenderness and hypersensitivity of the affected joint. (p. 1345) 4. Rheumatoid arthritis presents with symmetrical joint inflammation and pain with subluxations (pp. 1319-1322).

A patient has a Mobitz type I (Wenckebach) second-degree heart block. Which of the following electrocardiogram findings would MOST likely be present? 1. Inverted P waves in leads I, II, and III 2. A uniform PR interval that exceeds 0.20 second 3. Progressive prolongation of the PR interval until one impulse is not conducted 4. Variable P waves that are not related to QRS complexes

1. P wave inversion is indicative of a premature junctional complex, not a Mobitz type I heart block (p. 321). 2. A uniform but prolonged PR interval (greater than 0.20 second) describes first-degree heart block (p. 322). 3. Mobitz type I (Wenckebach) heart block is a progressive prolongation of the PR interval until one impulse is dropped and is not followed by a QRS complex (p. 323). 4. Variable P waves that are not related to QRS complexes describe third-degree heart block (p. 324).

During assessment of pressure and vibration sense, which of the following structures are responsible for transmission of the tested sensation? 1. Pacinian corpuscles 2. Krause end bulbs 3. Golgi tendon organs 4. Free nerve endings

1. Pacinian corpuscles are responsible for pressure and vibration sense. 2. Krause end bulbs are responsible for cold sensation. 3. Golgi tendon organs are sensitive to muscle contraction force. 4. Free nerve endings are sensitive to pain and itch.

A patient sustained a T10 complete spinal cord injury. Which of the following wheelchair-to-bed transfer techniques is MOST appropriate for the patient? 1. Sit pivot 2. Sliding board 3. Standing pivot 4. Mechanical lift

1. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They may initially use a sliding board to assist transfers, but in the long term they should be able to independently perform a sit pivot transfer. 2. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They should be able to independently transfer and not need a sliding board in the long term. 3. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They would not have adequate lower extremity strength to perform a standing pivot transfer. 4. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They should be able to independently transfer and not need a mechanical lift.

Which of the following strategies for transfer training is MOST likely to be successful for a patient who has apraxia? 1. Give frequent and detailed verbal commands. 2. Provide the patient with written instructions. 3. Teach one component of the transfer at a time. 4. Have the patient practice transfers in a variety of settings and contexts.

1. Patients with apraxia will not be able to use verbal cues or commands to make corrections. The physical therapist should use the shortest possible sentences, not detailed or complex commands. 2. Patients with apraxia have a great deal of difficulty following written or verbal instructions for movement. 3. When teaching a new task to a patient with apraxia, the task should be broken down into its component parts. One component is taught at a time, and the patient is physically guided through the task if necessary. 4. Patients with apraxia benefit from repetition of the task using the same approach in the same environment. It is helpful to use as normal an environment as possible.

A patient has radicular pain due to C4-C5 intervertebral foramen stenosis on the right side. In addition to cervical flexion, which of the following combinations of cervical motions is likely to provide the MOST pain relief for the patient? 1. Right side bending and left rotation 2. Right side bending and right rotation 3. Left side bending and right rotation 4. Left side bending and left rotation

1. Performing right side bending would decrease the size of the intervertebral foramen (Mansfield, p. 193). 2. Performing right side bending, although limited by coupled left side bending (induced by performing left rotation), still reduces the size of the intervertebral foramen, compared to performing left side bending and left rotation (Mansfield, p. 193). 3. In the mid cervical region the coupling motions of side bending and rotation occur in an ipsilateral fashion (Loudon, p. 103). Therefore, performing right rotation would cause a decrease in the area of the intervertebral foramen by inducing coupled right side bending. The induced right side bending will limit the amount of the intervertebral foramen opening on the right side at the affected segment. (Loudon, pp. 102-103) 4. The area of the intervertebral foramen on the right increases with left side bending and left rotation (Mansfield, p. 194; Loudon, p. 103).

Which of the following interventions is MOST appropriate for an individual who has multiple sclerosis? 1. Submaximal exercise performed in the morning 2. Swimming exercises performed in a heated indoor pool 3. Resistance exercise alternating each day between upper and lower body workouts 4. Maximal exercise to the point of fatigue with several days of rest between training sessions

1. Persons with multiple sclerosis are susceptible to fatigue and heat intolerance. Submaximal exercises at moderate intensity (50% to 70%) are tolerated well. In addition, exercising in the morning is recommended because the body's core temperature is lowest at this time. 2. Persons with multiple sclerosis should take precautions to manage core body temperature and prevent overheating. Swimming in a heated pool could result in overheating and an increase in fatigue. 3. Because persons with multiple sclerosis are susceptible to fatigue, circuit training alternating work between upper and lower extremities is recommended during one training session. Performing upper extremity resistance exercise one day followed by lower extremity resistance exercise is more likely to result in increased fatigue. 4. Persons with multiple sclerosis are susceptible to fatigue. Submaximal exercises at moderate intensity (50% to 70%) are more appropriate.

Which of the following skeletal conditions is NORMAL in a newborn infant? 1. Pes cavus 2. Genu varum 3. Genu valgum 4. Talipes equinovarus

1. Pes cavus is an atypically high arched foot type, common in neuromuscular conditions such as Charcot-Marie-Tooth disease. It is not typical in the newborn infant. (Magee, pp. 910-911) 2. At birth, an infant's knees are bowlegged (genu varum) to accommodate for the flexed position in utero. The legs and hips gradually straighten until they reach a neutral alignment between the first and second years. (Palisano, p. 105) 3. At birth, an infant's legs are bowlegged to accommodate for the flexed position in utero. If infants were in genu valgum, it would not allow sufficient hip and knee flexion to attain the flexed posture. With genu valgum, the femur lies in relative medial (internal) rotation and adduction. (Palisano, p. 105) 4. Talipes equinovarus, also referred to as "clubfoot", is a congenital deformity of the foot seen in newborns. It is not a normal condition. The foot appears smaller due to the hypoplastic skeletal features of the bones. Surgical intervention or serial casting is required to correct this condition. (Palisano, pp. 307-308)

A patient has a cavernous wound on the sacrum. Which of the following data collection methods is MOST appropriate to identify the wound volume? 1. Take a photograph of the wound. 2. Measure the length and width using a disposable ruler. 3. Trace the wound onto an acetate measuring guide. 4. Measure the amount of hydrogel that fills the wound without spillage.

1. Photographing the wound will give an accurate assessment of the wound size (length and width) but not its depth (p. 119). 2. Measuring the area of the wound will not give volumetric information (p. 109). 3. Tracing the wound gives an indication of the size but not the depth of the wound (p. 110). 4. Filling the wound with hydrogel or water is used to determine the volume of the wound (p. 111).

A patient who had a posterolateral total hip arthroplasty should AVOID which of the following movements? 1. Hip adduction and hip medial (internal) rotation 2. Hip adduction and hip lateral (external) rotation 3. Hip abduction and hip medial (internal) rotation 4. Hip abduction and hip lateral (external) rotation

1. Posterior dislocation of the hip can occur in the presence of excessive flexion, adduction, and medial (internal) rotation. This can occur in a patient who has had a posterolateral surgical approach that has weakened the posterior hip capsule. 2. Posterior dislocation of the hip can occur in the presence of excessive flexion, adduction, and medial (internal) rotation, not lateral (external) rotation. 3. Posterior dislocation of the hip can occur in the presence of excessive flexion, adduction, and medial (internal) rotation, not abduction. 4. Posterior dislocation of the hip can occur in the presence of excessive flexion, adduction, and medial (internal) rotation, not abduction and lateral (external) rotation.

A patient's glenohumeral joint range of motion is limited in shoulder abudction. Which of the following mobilization techniques would BEST address this deficit? 1. Posterior glide 2. Anterior glide 3. Inferior glide 4. Superior glide

1. Posterior glides would not improve glenohumeral abduction. Shoulder flexion and medial (internal) rotation would be improved by posterior gliding. 2. An anterior glide is not used to improve glenohumeral abduction. Shoulder extension and lateral (external) rotation would be improved by anterior gliding. 3. The radiograph shows limitation of glenohumeral motion causing a reduction in shoulder abduction. Inferior glide assists with improving abduction. 4. A superior glide would not improve limited glenohumeral abduction. Superior gliding is rarely used but, when used, is helpful in improving glenohumeral adduction.

In an older adult patient, impaired proprioception may be a result of malabsorption of which of the following nutrients? 1. Potassium 2. Iron 3. Vitamin B12 4. Vitamin E

1. Potassium helps regulate normal muscle contraction and would affect the heart, intestines, and respiratory tract, but would not primarily affect proprioception (p. 185). 2. Iron deficiency can occur secondary to blood loss, malabsorption, and pregnancy. Iron deficiency may produce symptoms of irritability, lack of exercise tolerance, and headaches, but not impaired proprioception (pp. 714-715). 3. Intrinsic factor often declines with age. Intrinsic factor is a protein that helps the body absorb vitamin B12. When stomach secretions do not have enough intrinsic factor, vitamin B12 is not absorbed well. This results in pernicious anemia and other problems related to low levels of vitamin B12. Inadequate vitamin B12 gradually affects sensory and motor nerves, causing impaired proprioception to develop over time. These neurological symptoms are due to myelin degeneration and loss of nerve fibers in the dorsal and lateral columns of the spinal cord and cerebral cortex. (pp. 714-715) 4. Vitamin E is a fat-soluble vitamin that is an important antioxidant. Lack of vitamin E would not be expected to result in impaired proprioception. (p. 219)

After a kidney transplant, a patient develops a Stage 3 pressure injury over the sacrum and is referred to physical therapy for wound care. Which of the following is the MOSTappropriate agent to use initially on this wound? 1. Povidone-iodine solution 2. Sterile normal saline 3. Silver sulfadiazine (Silvadene) cream 4. Zinc oxide cream

1. Povidone-iodine is usually used as a skin preparation to prevent surgical site infection. It can be used in acute traumatic wounds. A Stage 3 pressure injury is an example of a chronic wound. (Sussman, p. 518) 2. Sterile normal saline is the appropriate initial agent used to clean a wound (Sussman, p. 518). 3. Use of silver sulfadiazine may be indicated if infection is present. However, it is not indicated in the initial treatment. (Sussman, p. 513) 4. Zinc oxide is used in dental fillings and in local surface treatment for various skin disorders but not for chronic pressure injuries (Mosby's, p. 1913).

A patient had a brainstem stroke 2 months ago and is currently able to independently walk 65 ft (20 m) over level surfaces with a straight cane and ascend stairs with minimum assistance. Which of the following activities would MOST appropriately challenge this patient's balance during a physical therapy session? 1. Ascending stairs using a single handrail 2. Standing on one leg with eyes closed 3. Walking over uneven terrain 4. Walking 130 ft (40 m) with a straight cane

1. Practice ascending stairs addresses impaired ability to transfer weight onto a stance limb and lift the opposite dynamic limb (p. 242). Although dynamic balance is involved in this activity, ascending stairs using a single handrail is not more difficult than an activity the patient is currently able to perform and would not be challenging to the patient. 2. Static balance challenges will benefit static postural control (p. 195). 3. Walking over uneven terrain is a good example of an impairment-based, task-specific, functional activity that will improve the patient's dynamic balance (p. 233). 4. Increasing the duration of walking by progressing to longer distances primarily progresses endurance, not balance (p. 244).

During patellar reflex testing, the patient demonstrates hyperreflexia. What is the MOST likely cause of this finding? 1. A spinal cord tumor at L1 2. A herniated nucleus pulposus at L4 3. Femoral nerve impingement 4. A cauda equina lesion

1. Pressure on the spinal cord at L1 would cause signs of upper motor neuron lesions below this level. A sign of upper motor neuron lesion is hyperreflexia. (p. 1494) 2. A weak or absent patellar reflex is expected with nerve root L4 compression (p. 1494). 3. Peripheral nerve injuries, such as a femoral nerve impingement, would result in a diminished patellar reflex (pp. 96-97). 4. Peripheral nerve injuries, such as a cauda equina lesion, would result in a diminished patellar reflex (p. 134).

Which of the following patient positions would be the MOST appropriate treatment for atelectasis of the lower lobes, lateral basal segment? 1. Prone position with the bed flat 2. Long-sitting position, leaning back 30° 3. Supine position with the head down 15° 4. One-quarter turn from prone position with the head down 30°

1. Prone with bed flat is best used to drain the superior segments of the lower lobes (p. 314). 2. Long sitting, leaning back 30° is best used for involvement in the upper lobes, apical segments (p. 314). 3. Supine with head down and the patient rotated one-quarter backward is best used to drain the lingula (p. 314). 4. Treatment of atelectasis is directed at reversing the underlying contributing mechanism whenever possible. Atelectasis resulting from prolonged static positioning and monotonous tidal ventilation is managed with mobilization and manipulating body positions (i.e. postural drainage) to optimize alveolar ventilation and alveolar volume (p. 475). Lower lobe atelectasis may be cleared with the patient positioned on the uninvolved side, one-quarter turn from prone with the head down 30°. (p. 315)

A patient who had a cerebrovascular accident 4 days ago is being taught to roll to the uninvolved side. Which of the following motions should the physical therapist advise the patient to AVOID? 1. Pushing against a supporting surface with the uninvolved foot. 2. Lifting the head from the surface to assist with movement initiation. 3. Using the uninvolved arm to assist bringing the involved arm forward. 4. Positioning the involved lower extremity over the uninvolved extremity.

1. Pushing against a supporting surface with the uninvolved foot will encourage extension of the trunk when rolling. The patient should be taught motions that encourage flexion of the trunk. 2. Lifting the head from the surface to assist with movement initiation will help with the induction of flexion of the trunk. 3. Using the uninvolved arm to assist bringing the involved arm forward should occur to protect the uninvolved arm. 4. Positioning the involved lower extremity over the uninvolved extremity is an appropriate motion to begin the training process to encourage flexion of the trunk.

A patient who had a lumbar fusion 5 years ago now has acute lumbar disc dysfunction. The patient usually has pain rated at 6/10, but pain ratings are occasionally increased to 9/10 with prolonged sitting and standing. The patient also reports pain during sit-to-stand and sit-to-supine transfers. Which of the following factors would have the MOST impact on the thoroughness of the tests and measures section of the examination? 1. Presence of pain with transitional movements 2. Past medical history of lumbar fusion 3. Moderate pain with static positioning 4. High irritability of the patient's acute back pain

1. Range of motion measurements can provide accurate information even though the patient is having problems with transitional activities. Pain with testing of range of motion provides information about the dysfunction that is present. 2. Past history of lumbar fusion is not directly related to the current intensity of symptoms and would not limit accuracy of measurements. 3. If a position causes pain so intense the patient cannot maintain the position, a thorough evaluation can be performed by avoiding problematic positions. 4. Acute, highly irritable pain will cause limitations in the performance of evaluation tests and the accuracy of the findings.

A physical therapist can perform a quick, nonspecific functional assessment of shoulder abduction and lateral (external) rotation by instructing the patient to use the arm being tested to reach: 1. across the chest and touch the contralateral shoulder. 2. overhead and touch the superior medial border of the contralateral scapula. 3. up and touch the ipsilateral shoulder. 4. behind the back and touch the inferior angle of the contralateral scapula.

1. Reaching across the chest and touching the contralateral shoulder may be used to indicate horizontal adduction and flexion. 2. Reaching overhead and touching the superior medial border of the contralateral scapula requires normal shoulder abduction and external (lateral) rotation. 3. Reaching up and touching the ipsilateral shoulder primarily measures elbow flexion. 4. Reaching behind the back and touching the inferior angle of the contralateral scapula measures extension and internal (medial) rotation of the shoulder.

A patient has an acute grade I sprain of the acromioclavicular joint. Which of the following activities would be MOST painful for the patient to perform? 1. Reaching behind the back to tuck in a shirt 2. Reaching across the chest and scratching the opposite shoulder with the hand 3. Opening a car door 4. Using both hands to lift a 10-lb (4.5-kg) bag of groceries from the floor to a waist-high table

1. Reaching behind the back to tuck in a shirt would stress the rotator cuff muscle/tendons and not the acromioclavicular joint. 2. Reaching across the chest and scratching the opposite shoulder with the hand is the correct response since active and passive movements in the extreme ranges of motion, especially elevation of the shoulder above 90° and horizontal adduction, reproduce acromioclavicular joint pain in patients who have sprains or degenerative joint disease. 3. Opening a car door requires strength of the elbow flexors and shoulder extensors/scapular retractors and does not stress the acromioclavicular joint. 4. Using both hands to lift a 10-lb (4.5-kg) bag of groceries from the floor to a waist-high table requires strength in the elbow flexors and does not stress the acromioclavicular joint.

Which of the following clinical features is a CONTRAINDICATION to intermittent compression? 1. Past history of deep vein thrombosis 2. Impaired sensation 3. Local infection 4. Peripheral neuropathy

1. Recent or acute deep vein thrombosis is a contraindication, but a past history or having a predisposition to deep vein thrombosis is not. 2. Impaired sensation is a precaution. 3. Infection may spread as a result of compression, and, therefore, infection is a clear contraindication. 4. Peripheral neuropathy is not a contraindication; it is a precaution.

A patient is initiating a pelvic floor strengthening program. Which of the following positions would be considered gravity assisted? 1. Trendelenburg 2. Sitting 3. Quadruped 4. Standing

1. The Trendelenburg position, with the hips positioned higher than the heart, is considered a gravity-assisted position for this exercise, given the location of the pelvic floor muscles and the action of these muscles when tightened, which pull upward toward the abdomen. 2. The sitting position is a progression to improve strength and proprioception of the pelvic floor muscles. Gravity will be working against the pelvic floor. 3. The quadruped position is a progression to improve strength and proprioception of the pelvic floor muscles. 4. The standing position is a progression to improve strength and proprioception of the pelvic floor muscles. Also, this would be considered the gravity position.

An adult patient requests feedback on his health and wellness exercise program. The patient reports a weekly weight loss of 4.4 lb (2 kg)/week for the last 2 months and is utilizing a dietary intake of 900 kcal/day over the same time period. The BEST advice for the physical therapist to provide to this patient is to: 1. decrease dietary intake further to improve ability for greater weight loss. 2. keep intake and weight loss targets the same. 3. increase dietary intake and target a weight loss of no more than 2.2 lb (1 kg)/week. 4. increase dietary intake and exercise to preserve weight loss at 4.4 lb (2 kg)/week.

1. Reducing the patient's intake further would result in daily caloric intake below the minimal required daily caloric intake and would, therefore, be detrimental to overall health. 2. The patient's current rate of weight loss is than recommended, and the current caloric intake is lower than recommended. 3. Dietary intake should be adequate to allow weight loss of no more than 1 kg/week. 4. Weight loss of 2 kg/week is greater than recommended.

Which of the following conditions would MOST likely occur in a patient who has decreased production of insulin? 1. Accelerated fat metabolism 2. Accelerated protein synthesis 3. Increased thirst 4. Decreased urination

1. Reduction of insulin production results in the opposite effect. Fat production is altered, and fat breakdown occurs to liberate more glucose. 2. Reduction of insulin production impairs protein synthesis because amino acid transport into cells requires insulin. 3. Reduction of insulin production results in large quantities of urine being excreted, resulting in excessive thirst. 4. Reduction of insulin production results in large quantities of urine being excreted.

Which of the following activities would be LEAST appropriate in a treatment program for a patient with an ankle sprain and a history of prolonged corticosteroid use? 1. Elastic-band resistance training 2. Plyometric exercises 3. Calf raises 4. Single-leg balance activities

1. Resistance exercise with an elastic band would be safe and effective for this patient. There is no high force or excessive impact that may be damaging. 2. Plyometric exercise involves high speed, impact, and high force. Patients who have taken corticosteroids likely have decreased connective tissue strength. Plyometrics may cause additional harm/damage. 3. Calf raises are a resistance exercise that does not involve excessive force or impact. This should be a safe and appropriate exercise for this patient. 4. Single leg stance may safely build proprioception for this patient and is important to incorporate in a program after an ankle sprain.

A patient is referred to physical therapy for right shoulder pain. Which of the following findings suggests that physical therapy intervention may not be appropriate? 1. Pain that subsides with right sidelying 2. Tenderness to palpation at the origin of the biceps tendon 3. Trigger points at the right rib 2-3 intercostal space 4. Pain with resisted shoulder lateral (external) rotation

1. Right sidelying often increases musculoskeletal pain but may decrease pleural friction/irritation and thus may decrease visceral pain (Goodman, p. 694). 2. Musculoskeletal pain is often tender to palpation or pressure (Magee, pp. 8-9, 61). 3. Trigger points are the most common musculoskeletal cause of chest pain (Goodman, p. 694). 4. Resisted testing or contraction of the involved muscle may increase pain of a musculoskeletal origin (Goodman, p. 694).

A physical therapist performs heart auscultation as part of a patient's cardiac systems review. The therapist hears a longer sound in-between S1 and S2. This sound is BEST described as a: 1. systolic murmur not considered to be normal. 2. normal heart sound occurring during systole. 3. diastolic murmur not considered to be normal. 4. normal heart sound occurring during diastole.

1. S1 represents closure of the mitral and tricuspid valves, while S2 represents closure of the aortic and pulmonary valves. These are the only two heart sounds that should occur normally. Sounds occurring between S1 and S2 are considered systolic murmurs. 2. S1 represents closure of the mitral and tricuspid valves, while S2 represents closure of the aortic and pulmonary valves. These are the only two heart sounds that should occur normally. 3. Sounds occurring between S2 and S1 are known as diastolic murmurs. The illustration does not show the sound occurring between S2 and S1. 4. S1 represents closure of the mitral and tricuspid valves, while S2 represents closure of the aortic and pulmonary valves. These are the only two heart sounds that should occur normally.

Gastroesophageal reflux disease occurs when contents from what area of the gastrointestinal tract enter the esophagus? 1. Ileum 2. Jejunum 3. Pancreas 4. Duodenum

4. Gastroesophageal reflux disease (GERD) is the term applied to symptoms associated with the reflux of gastroduodenal contents into the esophagus; the disease involves the following parts of the upper gastrointestinal tract: mouth, esophagus, stomach, and duodenum (Goodman, pp. 862, 868, 870).

An outpatient physical therapist is working with a patient who suddenly demonstrates repetitive and rhythmic head and neck movements and has an unfocused stare. Which of the following actions should the therapist perform FIRST? 1. Call emergency medical services. 2. Remove objects from the immediate area. 3. Place a tongue depressor in the patient's mouth. 4. Hold the patient's head and neck still.

1. Seizures are usually finite in duration. Unless the individual develops status epilepticus (which is not described in the stem), calling emergency medical services is not the first action to perform. 2. A patient who is having a seizure normally only needs protection from injury in the environment. 3. It is not appropriate to insert a tongue protector to protect the tongue from injury. This is more likely to harm the patient. 4. The physical therapist could harm the patient by trying to restrict movement.

A school-based physical therapist receives a referral to evaluate a 6-year-old child who falls frequently. Based on the teacher's description, the therapist suspects that the child has developmental coordination disorder. Which of the following observations would BEST support this diagnosis? 1. Pattern of sensory loss in the lower extremities 2. Inaccuracy when throwing a ball short distances 3. Pseudohypertrophy of the posterior lower leg muscles bilaterally 4. Right hip adduction and medial (internal) rotation during gait

1. Sensory loss in the lower extremities is not consistent with a diagnosis of developmental coordination disorder (p. 398). 2. Children with developmental coordination disorder have difficulty with throwing, catching, and kicking a ball accurately. When throwing a ball, the child with developmental coordination disorder may have trouble judging the amount of force required (p. 398). 3. Pseudohypertrophy of posterior lower leg muscles bilaterally would suggest muscular dystrophy, not developmental coordination disorder (pp. 245-246). 4. Right hip adduction and medial (internal) rotation during gait would suggest cerebral palsy (spastic hemiplegia), not developmental coordination disorder (p. 467).

A patient had a total knee arthroplasty 2 days ago. The patient now has a cough, chest pain, and a dull ache in the leg. Physical examination reveals diaphoresis and unilateral lower extremity pitting edema. The patient MOST likely has which of the following conditions? 1. Pleuritis 2. Pneumonia 3. Myocardial infarction 4. Pulmonary embolism

1. Signs of pleuritis include pain with coughing but not pitting edema or dull ache in the leg (pp. 859-860). 2. Pneumonia is an infectious disease, resulting in inflammation of the lung parenchyma, which could result in the pulmonary symptoms but is not associated with pitting edema (pp. 779-780). Pitting edema suggests a vascular or fluid balance issue, not a pulmonary condition. 3. Myocardial infarction is characterized by prolonged crushing chest pain that may radiate to the arms, throat, neck, and sometimes back but is not typically associated with leg pain (pp. 585-587). 4. Signs of pulmonary embolism include chest pain, hemoptysis, cough, diaphoresis, dyspnea, and apprehension (pp. 585-587). The unilateral lower extremity edema may have been from a deep venous thrombosis that may have embolized.

A patient presents with moderate pain in the elbow after a fall. The radiograph is negative for a fracture. Which of the following mobilizations is MOST appropriate for decreasing the pain? 1. Small-amplitude oscillations before the onset of tissue resistance 2. Small-amplitude oscillations into tissue resistance 3. Large-amplitude oscillations into tissue resistance 4. Large-amplitude oscillations at the end of tissue resistance

1. Small-amplitude oscillations before the onset of tissue resistance are appropriate for pain modulation. 2. Small-amplitude oscillations into tissue resistance are more appropriate for joint stiffness, not pain. 3. Large-amplitude oscillations into tissue resistance are more appropriate for joint stiffness. 4. Large-amplitude oscillations at the end of tissue resistance are for end range joint restrictions and are too aggressive for patients who have pain.

A physical therapist is considering using neuromuscular electrical stimulation as an alternative to static bracing for control of ankle position during gait in a client 3 months post cerebrovascular accident. Which of the following criteria improves chances of success with this treatment approach? 1. Limited spasticity in the ankle plantar flexors 2. Altered selective control of the hip/knee with volitional ankle activity 3. Hyperactive deep tendon reflexes at the ankle and knee 4. Limited sensation of the lower extremity

1. Spasticity in the ankle plantar flexors may reduce the effectiveness of electrical stimulation to act on ankle; therefore, limited spasticity would improve the chances of success with this treatment. 2. The hip and knee control may be important, but if the patient has volitional ankle activity, electronic stimulation is not needed. 3. Hyperactive deep tendon reflexes indicate spasticity is present, which will reduce the effectiveness of electrical stimulation. 4. Limited sensation may also reduce the effectiveness of electrical stimulation.

Which of the following conditions is MOST likely to be associated with the presence of spastic bowel dysfunction in a patient? 1. Myelomeningocele at S2-S3 2. Spinal cord injury at T10 3. Spinal muscular atrophy 4. Cauda equina tumor

1. Spina bifida (myelomeningocele) is a disorder of the spinal cord (Umphred, pp. 419-420). Patients who have an injury below S2-S4 would have a flaccid bowel, not a spastic bowel (O'Sullivan, p. 899). 2. Spastic bowel occurs in patients who have a spinal cord lesion above S2 (O'Sullivan, p. 894). The T10 level is above S2. 3. Spastic bowel occurs in patients who have a spinal cord lesion above S2 (O'Sullivan, p. 899). Spinal muscular atrophy affects motor neurons and is characterized by limb and trunk weakness, hypotonia, and areflexia (Effgen, p. 252). 4. Spastic bowel occurs in patients who have a spinal cord lesion above S2 (O'Sullivan, p. 899). Individuals who have cauda equina injuries exhibit areflexic bowel dysfunction (O'Sullivan, p. 894).

A patient had an open cholecystectomy 2 days ago and is currently having difficulty moving from supine to sitting position due to pain. Before the patient's next attempt to move, which of the following interventions would be MOST appropriate? 1. Bracing an abdominal pillow to splint 2. Using an incentive spirometer 3. Instruction in huffing 4. Tilt table regimen

1. Splinting is an appropriate method for pain control with mobility (Paz, p. 81). 2. An incentive spirometer is used for pulmonary interventions and would not help with pain (Paz, p. 80). 3. Huffing is a method for pulmonary clearance when coughing is too painful. It would not help with the pain while moving. (Paz, p. 80) 4. Typically a tilt table regimen is used for patients who are restricted to prolonged bed rest and who have persistent orthostatic hypotension. It would not help with pain. (Fairchild, pp. 216-218)

Rate pressure product is MOST indicative of which of the following cardiac factors? 1. Stroke volume 2. Cardiac output 3. Pulse amplitude 4. Myocardial oxygen demand

1. Stroke volume is the amount of blood ejected from the left ventricle during each heartbeat. Stroke volume (SV) and heart rate (HR) are components of cardiac output (CO) (CO=SV x HR). (Frownfelter, p. 38) 2. Cardiac output is calculated by multiplying heart rate by stroke volume and is representative of the amount of blood pumped by the heart in 1 minute (Paz, p. 17). 3. Pulse amplitude is an assessment of the quality of the pulse determined by the pulse taker. The quality of the pulse being taken is classified as absent, diminished, normal, moderately increased, or markedly increased. (Paz, p. 22) 4. Rate pressure product is calculated by multiplying heart rate by systolic blood pressure. It is an indication of myocardial oxygen demand. (Paz, p. 43)

A physical therapist notes an increase in an athlete's heart rate when the athlete runs on a treadmill. This increase will directly cause: 1. a decrease in stroke volume. 2. a decrease in cardiac output. 3. an increase in stroke volume. 4. an increase in cardiac output.

1. Stroke volume typically plateaus around 35% to 40% of maximal exercise intensity. After that point, cardiac output is augmented by increases in heart rate. A decrease in stroke volume is not expected with an increase in heart rate. 2. Cardiac output increases, not decreases, commensurate with metabolic demand. 3. Stroke volume typically plateaus around 35% to 40% of maximal exercise intensity. After that point, cardiac output is augmented by increases in heart rate. Although increases in heart rate correspond directly to increases in cardiac output, increases in stroke volume do not always correspond directly to increases in cardiac output. 4. Cardiac output increases commensurate with metabolic demand.

A patient reports constant bilateral posterior calf pain with itching. The examination reveals a body temperature of 98.8°F (37.1°C), normal temperature of the lower extremities, and tenderness to palpation and crusting of the skin in the affected areas. Which of the following conditions is MOST likely present? 1. Dermatitis 2. Cellulitis 3. Atrophie blanche 4. Superficial venous thrombosis

1. Symptoms of dermatitis include lack of fever, itching, normal temperature of the lower extremities, inflammation, tenderness to touch, presence of vesicles and crusting, and either unilateral or bilateral distribution (Bryant, pp. 178, 211). 2. Although the patient's limb is painful, the other reported findings are not consistent with cellulitis. Signs of cellulitis include fever, elevated temperature of the lower extremities, erythema, inflammation, tenderness, one or a few bullae, no lesions, and unilateral distribution. (Bryant, p. 237; Sussman, p. 376) 3. Atrophie blanche is characterized by white, scar-like areas associated with pain at rest and when standing (Sussman, p. 376). Affected areas present as smooth white plaques (Bryant, p. 210). 4. Superficial venous thrombosis is characterized by pain and tenderness along the affected vein, usually the saphenous vein. Crusting of the skin is not a feature of this condition. (Goodman, pp. 647, 649)

Which of the following movement patterns is MOST likely to be present in a patient who exhibits abdominal paradoxical breathing? 1. Synchronous upward and outward motion of the abdomen and upper chest 2. Upward and outward motion of the upper chest and inward motion of the abdomen 3. Upward and outward motion of the abdomen and inward motion of the upper chest 4. Excessive upper chest motion with decreased use of the sternocleidomastoid and scalene muscles

1. Synchronous upward and outward motion of the abdomen and upper chest indicates a normal breathing pattern (Chaitow, p. 101). 2. Upward and outward motion of the upper chest and inward motion of the abdomen indicates an abdominal paradoxical breathing pattern (Chaitow, p. 105). Patients who have paralyzed or weak intercostal/abdominal muscles can develop a specific type of compensatory breathing pattern. These patients counterbalance the strength of the diaphragmatic inferior pull by using their sternocleidomastoid muscles and possibly their scalene, trapezius, and pectoralis muscles. Allowing for superior and possibly some anterior and lateral expansion of the chest wall, this compensatory pattern minimizes the collapse of the upper chest that is observed in paradoxical breathing (Frownfelter, p. 643). 3. Although this option describes another form of compensatory/paradoxical breathing, it is typically associated with inadequate stabilization from the intercostal muscles, not weakness of the abdominal muscles (Frownfelter, p. 642). 4. Excessive upper chest motion with increased use of the sternocleidomastoid, scalene, and other accessory muscles of inspiration indicates an excessive accessory muscle use pattern, not decreased use of those muscles (Chaitow, pp. 27, 101).

A patient who sustained an avulsion of the right C5 and C6spinal nerve roots will show functional loss of right: 1. distal thumb flexion. 2. ulnar wrist deviation. 3. elbow extension. 4. shoulder abduction.

1. The C8-T1 nerve roots form the median nerve (anterior interosseus), supplying the flexor pollicis longus muscle. A patient who has an avulsion of the C5 and C6 spinal nerve roots will be able to perform distal thumb (1st digit) flexion. (Dutton, p. 83; O'Sullivan, p. 154) 2. The C7-C8 nerve roots form the ulnar nerve and radial nerve (posterior interosseus), supplying the flexor and extensor carpi ulnaris. Therefore, a patient who has an avulsion of the C5 and C6 spinal nerve roots will be able to perform wrist ulnar deviation. (Dutton, pp. 83, 86; O'Sullivan, p. 154) 3. The C5-C8 and T1 nerve roots form the radial nerve, supplying the triceps brachii. Avulsion of the C5 and C6 nerve roots will result in weakness but not functional loss of elbow extension. (Dutton, pp. 81-82; O'Sullivan, p. 154) 4. The C5-C6 nerve roots form the axillary nerve, supplying the deltoid and teres minor. Avulsion of these nerve roots will result in decreased right shoulder abduction. (Dutton, p. 80; O'Sullivan, p. 154)

Which of the following scenarios BEST illustrates a violation of the Health Insurance Portability and Accountability Act of 1996? 1. A physical therapist contacts a patient's physician to discuss the patient's progress without asking the patient for written consent to do so. 2. A physical therapist discusses a complicated case with a colleague while driving home together after work without first seeking the patient's consent. 3. A patient asks a physical therapist to release a copy of the evaluation and plan of care to an insurance carrier without providing written consent to do so. 4. A patient asks a physical therapist what surgery another patient underwent and is told that the second patient had a total knee arthroplasty 1 month ago.

1. The Health Insurance Portability and Accountability Act (HIPAA) specifies that providing information to another health care provider who is involved in the patient's care is acceptable. 2. HIPAA does not prohibit health care providers from sharing information with another provider without written consent when the purpose relates to the provision of the patient's care. Consulting another physical therapist in order to improve care is not prohibited. 3. HIPAA specifies that providing copies of medical records to insurance companies for reimbursement purposes is acceptable. 4. The type of surgery or condition that a patient has is protected health information and should not be divulged without the patient's consent.

Which of the following instruments is MOST appropriate for measuring patients' quality of life? 1. Lysholm knee rating scale 2. Oswestry low back pain disability index 3. Goal Attainment Scale (GAS) 4. Medical Outcomes Study 36-item short form (SF-36)

1. The Lysholm knee rating scale is a condition-specific instrument, not a quality-of-life assessment tool (p. 209). 2. The Oswestry low back pain disability index is a condition-specific instrument, not a quality-of-life assessment tool (p. 203). 3. The Goal Attainment Scale (GAS) measures achievement of self-identified goals but does not indicate the impact of goal attainment on quality of life (p. 202). 4. The Medical Outcomes Study (MOS) resulted in development of the 36-item short form for measuring patient's quality of life. It is a self-report that covers eight domains of physical functioning, role limitation due to physical problems, role limitations due to emotional problems, fatigue, and general health perceptions. (p. 200)

What reaction is MOST likely being elicited by supporting the infant horizontally in prone position? 1. Moro reflex 2. Startle reflex 3. Landau reflex 4. Positive support reflex

1. The Moro reflex is elicited by supporting the infant in a supine position, allowing the head to gently drop posteriorly in relation to the trunk, and assessing the response at the arms (O'Sullivan, p. 177). 2. The startle reflex is elicited by making a sudden loud or harsh noise and results in sudden extension or abduction of the upper extremities and crying (O'Sullivan, p. 177). 3. The Landau reflex/reaction is elicited by supporting the infant horizontally in prone position. The expected response is that the infant will extend the neck and trunk. (Ropper, p. 592) 4. The positive support reflex/reaction is elicited by supporting the infant vertically with contact of the feet to a surface and assessing the lower extremity response (O'Sullivan, p. 177).

A patient has a positive result after 1 minute on the Roos test. Which of the following additional tests is MOST appropriate to perform to establish a firm diagnosis? 1. Adson test 2. Empty can test 3. Cervical compression test 4. Acromioclavicular joint palpation

1. The Roos test, shown in the photographs, is used to test for the presence of thoracic outlet syndrome (p. 283). The Adson test is also used to test for thoracic outlet syndrome (p. 285). 2. The empty can test is used to assess for rotator cuff tear (p. 166). The Roos test, shown in the photographs, is used to test for the presence of thoracic outlet syndrome (p. 283). 3. Even though cervical pain can mimic thoracic outlet pain with radicular symptoms (p. 120), the goal is to confirm thoracic outlet syndrome, not cervical involvement, so this is not the best answer. The Roos test, shown in the photographs, is used to test for the presence of thoracic outlet syndrome (p. 283). 4. The Roos test is used to test for the presence of thoracic outlet syndrome (p. 283). Acromioclavicular joint palpation tests for acromioclavicular joint involvement (p. 210).

During a symptom-limited graded exercise test, a patient exhibits wide QRS complex and absent P wave . This pattern is indicative of which of the following phenomena? 1. ST segment elevation 2. Premature ventricular contractions 3. Acute first-degree atrioventricular block 4. Normal response to exercise

1. The ST segment is not elevated in the photograph of the electrocardiogram (p. 331). 2. Premature ventricular contractions are present in the photograph of the electrocardiogram, as evidenced by the wide QRS complex and absent P wave(p. 325). 3. Acute first-degree atrioventricular block would be represented by a prolonged PR interval, which is not shown in this photograph (p. 323). 4. This electrocardiogram is not consistent with a normal response to exercise, because premature ventricular contractions are present (pp. 312-313).

Which dermatome is associated with the area that includes the umbilicus? 1. T3 2. T10 3. L1 4. L3

1. The T3 dermatome is closer to the nipple line (p. 135). 2. The T10 dermatome includes the umbilicus (p. 268). 3. The L1 dermatome includes the region over the inguinal ligament ( p. 290). 4. The L3 dermatome covers the anterior thigh (p. 547).

A patient reports back pain with radiating pain to the anterior right thigh. The pain increases with passive flexion of the knee in prone position. Which of the following nerve roots is MOST likely involved? 1. L1-L2 2. L2-L3 3. L4-L5 4. L5-S1

1. The action of knee flexion with the patient in a prone position is specific for placing tension or stretch on the L2 or L3 nerve root (p. 597). 2. The symptoms of pain radiating to the posterior thigh could implicate the L2-L3 nerve roots in association with a herniated lumbar disc. The action of knee flexion with the patient in a prone position is specific for placing tension or stretch on the L2 or L3 nerve root. If pain in the back or posterior thigh intensified with this maneuver, the L2-L3 nerve roots are most implicated. (p. 597) 3. The action of knee flexion with the patient in a prone position is specific for placing tension or stretch on the L2 or L3 nerve root (p. 597). 4. The L5-S1 nerve roots are more likely to be stressed by performing a unilateral straight leg raise (p. 603).

Which of the following factors has the GREATEST effect on closure and healing of an open wound? 1. Amount of wound drainage 2. Type of wound dressing 3. Overall size of the wound bed 4. Arterial perfusion to the wound area

1. The amount of wound drainage does not have as strong an effect on wound closure and healing as does the level of arterial perfusion to the wound area. 2. The type of wound dressing does not have as strong an effect on wound closure and healing as does the level of arterial perfusion to the wound area. 3. Although wound size can affect the time required to close a wound, it does not have as much effect as vascular patency in the body's ability to close a wound. Many factors affect the rate of wound healing (i.e., nutrition, wound environment, etc.), but the overall prognosis for ability to heal is worst when vascular flow is absent or severely diminished (e.g., with an ankle-brachial index of 0.5). 4. Adequate delivery of blood to the wound tissue is vital for healing and will determine the wound diagnosis and plan of care. Wounds in patients with an ankle-brachial index of 0.8 or greater (vascular arterial flow established) are likely to heal; those in patients with an ankle-brachial index of 0.5-0.8 are at high risk for nonhealing (vascular arterial flow diminished). Gangrenous changes are likely in patients with an ankle-brachial index of 0.5, and referral of these patients to a vascular surgeon is necessary to spare the limb.

Which of the following cardiovascular exercise prescription guidelines would be MOST beneficial for a patient who has dyslipidemia? 1. Exercising at 40% to 80% of heart rate reserve, 3-4 times/week 2. Exercising at 40% to 80% of heart rate reserve, 5 or more times/week 3. Exercising at a rating of perceived exertion on the Borg scale of 11-14/20, 3-4 times/week 4. Exercising at a rating of perceived exertion on the Borg scale of 9-11/20, 5 or more times/week

1. The best evidence for reduction of lipid levels is to exercise at a moderate intensity of 40% to 80% of the heart rate reserve 5 or more times per week (ACSM, p. 278). Therefore, this option is incorrect, since the frequency is set too low for lipid-lowering benefits. 2. The best evidence for reduction of lipid levels is to exercise at a moderate intensity of the 40% to 80% of the heart rate reserve 5 or more times/week (ACSM, p. 278). 3. The best evidence for reduction of lipid levels is to exercise at a moderate intensity 5 or more times/week (ACSM, p. 278). Therefore, this option is incorrect, since the frequency is set too low for lipid-lowering benefits. 4. The best evidence for reduction of lipid levels is to exercise at a moderate intensity (ACSM, p. 278). Exercising at a rating of perceived exertion on the Borg scale of 9-11/20 is considered very light to light effort; therefore, it would not be considered a moderate intensity (O'Sullivan, p. 561).

A patient reports dull pain over the right elbow radiating to the posterior forearm and dorsum of the hand. Activities involving wrist extension or gripping cause the patient's pain to become sharp. The pain is reproduced with full passive wrist flexion combined with ulnar deviation, forearm pronation, and elbow extension. Which of the following is MOST likely the correct diagnosis? 1. Biceps tendinosis 2. Triceps tendinosis 3. Lateral epicondylalgia 4. Medial epicondylalgia

1. The biceps attach at the tuberosity of the radius on the ventral side of the hand. It is a more central location and on the wrong side (ventral vs. dorsal) of the elbow. 2. The insertion of the triceps is on the posterior surface of the ulna, below the location of the pain described by the patient in the stem. 3. The extensor carpi radialis brevis is involved with lateral epicondylalgia. Pain is reproduced by placing the muscle on stretch (pronation, extension, and wrist flexion) while palpating the lateral epicondyle. 4. Medial epicondylitis involves inflammation and irritation of the flexor carpi radialis and flexor carpi ulnaris and is tested by supinating the forearm and extending the wrist and elbow (placing the muscles on stretch). A positive sign is pain over the medial epicondyle. In the description, the patient's pain is more lateral.

A patient with C5 and C6 nerve root compression is MOST likely to have a decrease in motor function of which of the following muscles? 1. Elbow flexors 2. Scapular elevators 3. Elbow extensors 4. Finger flexors

1. The biceps muscle is a critical muscle for the C5 level, so it, and the motion of elbow flexion, are probably impaired if there is damage to C5-C6. 2. The trapezius is innervated by C4 and the spinal accessory nerve (CN XI), so this motion should be intact in this person. 3. The triceps are innervated at the C7 level, so this motion should not be affected by this patient's injury. 4. The finger flexors are innervated at the C8 to T1 level and should be intact.

In a patient with breast cancer, which of the following sites are the MOST common sites of metastasis? 1. Central and peripheral nervous systems 2. Liver and gastrointestinal tract 3. Lungs and bony skeleton 4. Spleen and pituitary gland

1. The central nervous system is a common metastatic site, but not the peripheral nervous system. 2. The liver is a common metastatic site, but not the gastrointestinal tract. 3. Lungs and bones are common metastatic sites for breast cancer. 4. Neither the spleen nor the pituitary gland is a common metastatic site for breast cancer.

A patient demonstrates wrist drop and sensory loss in the region of the anatomical snuffbox. These signs are MOST likely due to an injury to what nerve? 1. Musculocutaneous 2. Median 3. Radial 4. Ulnar

1. The musculocutaneous nerve innervates the skin on the lateral side of forearm and the elbow flexors (pp. 378-380). 2. The median nerve innervates the skin on the anterior surface of the hand and posterior tips of the lateral three fingers and the wrist flexor muscles, not the extensors (p. 381). 3. The radial nerve innervates the skin on the posterior surface of the arm, forearm, and hand, including the snuffbox, and the elbow and wrist extensors. When the latter are weak, the patient has wrist drop. (pp. 378-379, 382) 4. The ulnar nerve innervates the skin of the medial two fingers and the wrist flexors and hand muscles (pp. 378-379, 381).

Which of the following activities would be MOST appropriate to practice to assist a 20-year-old patient who has Duchenne muscular dystrophy in maintaining independence? 1. Stair training using both handrails 2. Gait training using a rolling walker 3. Transfer training using a slide board 4. Power wheelchair training over various surfaces

1. The cessation of independent walking in boys with Duchenne muscular dystrophy typically occurs by age 10-12 (Palisano, pp. 250-251) or 13 years (Tecklin, p. 355). Therefore, stair climbing is not likely. 2. The cessation of independent walking in boys with Duchenne muscular dystrophy typically occurs by age 10-12 (Palisano, pp. 250-251) or 13 years (Tecklin, p. 355). Therefore, gait training is highly unlikely to be plausible. 3. The transition to adulthood marks a time of continued progressive disability. Assistance with transfers would be required at this stage. (Palisano, p. 254) 4. A 20-year-old patient with Duchenne muscular dystrophy is likely to require a power wheelchair for functional mobility due to the progressive nature of the disease (Tecklin, p. 362). Typically, by age 14 years, boys who have Duchenne muscular dystrophy are not ambulatory and require power-assisted mobility. The transition to adulthood marks a time of continued progressive disability with a greater reliance on assistive technologies such as a power wheelchair (Palisano, p. 254).

A patient reports insidious onset of pain and paresthesias on the lateral aspect of the right forearm and hand. The symptoms are reproduced with neck extension. Which of the following is the MOST likely diagnosis? 1. C6 radiculopathy 2. Ulnar nerve entrapment 3. Radial nerve entrapment 4. C8 radiculopathy

1. The dermatome for the C6 nerve root is the lateral aspect of the forearm and hand. Cervical extension with compression is a part of the foraminal compression test for nerve root involvement. 2. Injury to the ulnar nerve would result in sensory disturbance of the little and ring fingers (4th and 5th digits). 3. Injury to the radial nerve would result in sensory disturbance of the dorsum of the hand, thumb (1st digit), and fingers. 4. The dermatome for the C8 nerve root is in the medial hand and lower forearm.

A patient who had a recent carpal tunnel decompression surgery is referred to physical therapy. The patient also had a first rib resection and a pronator teres release on the same extremity within the past 2 years. The patient now reports burning pain in the wrist and dorsal forearm and that the wrist and hand often feel cold. These signs and symptoms MOST likely indicate: 1. T4 syndrome. 2. ulnar neuropathy. 3. cervical radiculopathy. 4. complex regional pain syndrome.

1. The distribution of the symptoms is not consistent with the level innervated by T4 (p. 1664). 2. The distribution of the ulnar nerve is not consistent with the description of symptoms (pp. 1664, 1669). 3. A radiculopathy is involvement of a nerve root as it emerges from the spinal cord (p. 1667). The distribution of symptoms is not consistent with a cervical nerve root distribution, and no weakness is reported. 4. The primary clinical features of complex regional pain syndrome are burning or aching pain, autonomic nervous system dysfunction, edema, and movement disorders. In the final stage, the affected limb is cooler. (p. 1699)

A physical therapist is working with a patient who had a total knee arthroplasty 2 days ago. The patient's resting electrocardiogram shows a normal ECG. While gait training, the patient's electrocardiogram shows a 3-mm ST depression. Based on this finding, what is the BEST action for the therapist to take at this time? 1. Stop gait training and notify the nurse. 2. Continue gait training, because the heart rate is less than 100 bpm. 3. Stop gait training and allow the patient to sit down and rest. 4. Continue gait training, but allow the patient standing rest breaks.

1. The electrocardiogram change shows 3-mm ST depression, which is indicative of cardiac ischemia and is an indication to stop exercise and notify medical staff. 2. Continuing gait training would endanger the patient. 3. Stopping and resting is appropriate; however, the medical staff should be alerted to this situation first. 4. Continuing gait training, despite some standing rests, could allow the ischemia to progress and endanger the patient.

While playing recreational baseball, an individual is hit with a baseball just anterior to the ear. Later that evening, the person is drooling from the left side of the mouth and has noticeable drooping of the face on the left side. Which of the following cranial nerves is MOST likely involved? 1. Left facial (CN VII) 2. Right facial (CN VII) 3. Left trigeminal (CN V) 4. Right trigeminal (CN V)

1. The facial nerve (CN VII) exits the skull at the stylomastoid foramen (auditory canal), which is the anterior aspect of the ear. It is responsible for innervating all muscles of facial expression on the ipsilateral side of the face. Damage to this nerve results in flaccid paralysis, or hypotonia of the facial muscles. 2. The right facial nerve controls the muscles on the right side of the face. The patient has flaccidity on the left side. 3. The trigeminal nerve (CN V) exits the skull at the superior orbital fissure, the foramen rotundum, and the foramen ovale. The trigeminal nerve (CN V) is responsible for sensation to the ipsilateral face and motor function of the ipsilateral muscles of mastication. 4. The trigeminal nerve (CN V) exits the skull at the superior orbital fissure, the foramen rotundum, and the foramen ovale. The trigeminal nerve (CN V) is responsible for sensation to the ipsilateral face and motor function of the ipsilateral muscles of mastication.

Following a fall onto an abducted and outstretched hand, a patient felt a sharp pain in the area between the abductor pollicis longus and the extensor pollicis longus. The physical therapist should suspect a fracture in which of the following? 1. First metacarpal 2. Lunate 3. Trapezoid 4. Scaphoid

1. The first metacarpal is not commonly fractured by a fall, and snuffbox tenderness would not be present. 2. The lunate is commonly subluxed, not fractured. 3. The trapezoid is not commonly fractured by this type of fall. 4. The stem describes a classic mechanism for a scaphoid fracture, with snuffbox tenderness.

If the ulnar nerve tension test has positive findings, which of the following muscles is MOST likely affected? 1. Adductor pollicis 2. Pronator quadratus 3. Flexor pollicis longus 4. Abductor pollicis longus

1. The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393). The adductor pollicis is innervated by the ulnar nerve (nerve roots C7-C8, T1) (Magee, p. 399). 2. The pronator quadratus is innervated by the median nerve (Magee, p. 399). The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393). 3. The flexor pollicis longus is innervated by the anterior interosseous nerve, which is a branch of the median nerve (Magee, p. 450). The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393). 4. The abductor pollicis longus is innervated by the posterior interosseus nerve, which is a branch of the radial nerve (Magee, p. 399). The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393).

A patient sustained a distal radius fracture involving the Lister tubercle 6 weeks ago. During a physical therapist's assessment, no limitation in passive range of motion in the thumb (1st digit) interphalangeal and metacarpophalangeal joints is found. What active thumb (1st digit) motion is MOST likely to be affected? 1. Interphalangeal flexion 2. Interphalangeal extension 3. Metacarpophalangeal flexion 4. Metacarpophalangeal adduction

1. The flexor pollicis longus acts on interphalangeal flexion. Although its proximal attachment is on the radius (Reese, p. 159), it does not wrap around the Lister tubercle. 2. The extensor pollicis longus wraps around the Lister tubercle (Biel, p. 118) and attaches distally on the dorsal side of the distal phalange of the thumb (1st digit) (Reese, p. 167). If a patient has a fracture to the distal radius and no other soft tissue restrictions are noted, then interphalangeal extension would be affected. 3. The flexor pollicis brevis acts to achieve thumb (1st digit) metacarpophalangeal flexion. The flexor pollicis brevis is part of the thenar eminence and does not wrap around the Lister tubercle. 4. The adductor pollicis acts to achieve thumb (1st digit) metacarpophalangeal adduction. The adductor pollicis is part of the thenar eminence and does not wrap around the Lister tubercle.

A patient who has an L1 spinal cord injury (ASIA Impairment Scale A) is working toward independent walking with knee-ankle orthoses and forearm crutches. When walking with crutches, the patient is unable to achieve neutral hip extension. Which of the following interventions would BEST address this problem? 1. Strengthening the hip extensors 2. Strengthening the back extensors 3. Stretching the hamstrings 4. Stretching the hip flexors

1. The gluteus maximus is innervated below L1 and could not be strengthened. 2. Strengthening the back extensors would not contribute to increased hip extension. 3. Stretching the hamstrings could contribute to increased hip flexion with knee extension, not increased hip extension. 4. Stretching the hip flexors will promote hip extension range of motion, which is necessary in order to ambulate over even surfaces.

When performing manual lymphatic drainage, which of the following techniques is MOST appropriate to use? 1. Decongest the distal segments before progressing to the proximal segments. 2. Decongest the involved trunk quadrant before decongesting the involved limb. 3. Decongest proximal segments before decongesting the involved trunk quadrant. 4. Decongest distal portions of the involved limb before decongesting the involved trunk quadrant.

1. The goal of manual lymphatic drainage is to direct the lymphatics centrally. The progression is trunk quadrant first, followed by proximal to distal segments. 2. When performing manual lymphatic drainage, the therapist must decongest the involved trunk quadrant before decongesting the involved limb from proximal to distal locations. This is done to direct the flow of the lymphatics centrally toward the lymphatic ducts. 3. Lymphatic drainage is performed with the goal of directing the lymphatics centrally. If the therapist does not first decongest the trunk quadrants, the lymphatics will remain blocked. 4. Lymphatic drainage is performed with the goal of directing the lymphatics centrally. If the therapist does not first decongest the trunk quadrants, the lymphatics will remain blocked.

A physical therapist working in an acute care facility is developing an aerobic exercise program for a patient who has had a sickle cell anemia crisis. The patient's current hematocrit is 27%. The therapist should be MOST concerned about the patient developing which of the following conditions while exercising? 1. Hypoxia 2. Excessive bruising 3. Dependent edema 4. Hypertension

1. The hematocrit level is well below normal values (36% to 46%), which indicates anemia. Anemia leads to possible hypoxia and decreased exercise tolerance. Hypoxia is common in sickle cell anemia. (pp. 765, 1712-1714) 2. Excessive bruising occurs in response to a decrease in platelets (p. 1712), not a low hematocrit level. 3. Neither sickle cell anemia nor a hematocrit value of 27% will cause dependent edema, which is caused by position and often occurs in patients who have right-sided heart failure (p. 593). 4. Hematocrit changes do not influence blood pressure (p. 1713).

While a patient is walking in the parallel bars, the patient's pelvis drops down on the side opposite the stance extremity. This gait deviation is an indication of weakness of the hip: 1. abductors of the swing extremity. 2. adductors of the swing extremity. 3. abductors of the stance extremity. 4. adductors of the stance extremity.

1. The hip abductors show little activity during swing phase. 2. The hip adductors are active during heel off (terminal stance) and through midswing and would not play a role in controlling the lateral rotation of the pelvis. 3. The hip abductors are particularly active during the midstance phase (single limb support) of gait to prevent the contralateral pelvis from excessive lateral tilting. Weakness of the hip abductors, particularly the gluteus medius, causes the hip to drop down on the side opposite the weakness. For example, weakness of the right gluteus medius would manifest during stance phase on the right by excessive downward movement (lateral tilt) of the left pelvis. 4. The hip adductors are active during heel off (terminal stance) and through midswing and would not play a role in controlling the lateral rotation of the pelvis.

During the examination of a patient who went on a hiking trip 1 week ago, a physical therapist notes neck stiffness and notices a red rash with partial central clearing on the patient's upper extremity. The therapist should suspect that the patient has which of the following conditions? 1. Meningitis 2. Herpes zoster 3. Lyme disease 4. Retropharyngeal abscess

1. The history of the patient is inconsistent with the classic history of meningitis (pre-existing respiratory infection)(p. 235). 2. Herpes zoster (shingles) occurs in a dermatologic distribution and is characterized by burning pain (p. 260). 3. The history of this patient (hiking trip), symptoms (neck stiffness), and findings (rash) are consistent with Lyme disease (p. 236). 4. Retropharyngeal abscess usually occurs in children younger than 4 years old or is the result of trauma or dental infection (p. 240).

When the Hawkins- Kennedy test is performed, the patient reports reproduction of pain. Which of the following functional activities is LEAST likely to cause pain in this patient? 1. Turning a doorknob 2. Reaching away from the side 3. Lifting overhead 4. Putting on a jacket

1. The image depicts the Hawkins-Kennedy test, a test for shoulder impingement (subacromial). Symptoms can be elicited by the combined movements of elevation, abduction, and medial (internal) rotation. Among all activities described, turning a doorknob is the activity that least requires these motions. 2. Reaching away from the side requires shoulder abduction, which can trigger impingement symptoms. 3. Lifting overhead requires shoulder elevation, which can trigger impingement symptoms. 4. Putting on a jacket requires abduction and medial (internal) rotation, which can trigger impingement symptoms.

A patient's arm that was recently removed from an immobilizer after an upper extremity laceration, the patient demo's wrist drop. Based on the position of the wrist, which of the following nerves was damaged and where did the damage occur? 1. Median nerve in the carpal tunnel 2. Radial nerve in the anatomic snuffbox 3. Radial nerve in the radial groove of the humerus 4. Ulnar nerve posterior to the medial epicondyle of

1. The image indicates wrist drop, which results from injury to the radial nerve. The most common radial nerve injury is damage to the radial nerve in the radial groove of the humerus. The median nerve enters the hand by passing through the carpal tunnel. (p. 816) 2. The image indicates wrist drop, which results from injury to the radial nerve. The most common radial nerve injury is damage to the radial nerve in the radial groove of the humerus. The distal branches of the superficial branch of the radial nerve run over the tendon of the extensor pollicis longus in the anatomic snuffbox, but damage to these branches is of little consequence because they supply only a small area of the skin. (p. 818) 3. The image indicates wrist drop, which results from injury to the radial nerve. The most common radial nerve injury is damage to the radial nerve in the radial groove of the humerus, which produces a global paralysis of the muscles of the posterior compartment and results in wrist drop. (p. 818) 4. The image indicates wrist drop, which results from injury to the radial nerve. The most common radial nerve injury is damage to the radial nerve in the radial groove of the humerus. This answer is incorrect because the ulnar nerve lies posterior to the medial epicondyle at the elbow. (p. 816)

A PT assessing the lungs during inspiration at the posterior inferior ribs finds that the right side moves more that the left, the patient MOST likely has restriction involving which of the following lung segments? 1. Left lingula 2. Left lower lobe 3. Right lower lobe 4. Right upper lobe

1. The image shows the technique for palpating the lower lobes. To assess the right middle lobe and lingular segment, the therapist places his/her widely outstretched fingers of both hands over the posterior axillary folds and his/her palms over the anterior chest wall. 2. The image clearly shows the technique for palpating the lower lobes. The therapist's thumbs and hands do not move the same distance from each other, indicating restriction on the left side. With unilateral restriction, there is evidence of diminished movement on only one side. 3. The image clearly shows the technique for palpating the lower lobes. The therapist's thumbs and hands do not move the same distance from each other, indicating restriction on the left side and not the right side. With unilateral restriction, there is evidence of diminished movement on only one side. 4. The image clearly shows the technique for palpating the lower lobes. To assess the upper lobes, the therapist places his/her palms anteriorly over the first four ribs with the fingertips extended over the trapezius muscle.

A patient who sits with a severely slumped forward posture may experience respiratory compromise due to which of the following factors? 1. Entrapment of the intercostal nerves with respiratory muscle weakness 2. Inability of the respiratory muscles to resist gravity 3. Hypermobility of the costovertebral joints 4. Compression of the diaphragm by abdominal contents

1. The intercostal nerves originate from the thoracic spinal nerve roots (Dutton, p. 86). The intervertebral foramina are large in this section of the spine, and entrapment of the nerve roots is rare (Dutton, p. 1384). 2. The diaphragm descends (moves caudally) during inspiration (Frownfelter, p. 640). In sitting position, gravity would not resist the diaphragm during inspiration. 3. Normal ventilatory mechanics involve the movement of the thorax in all three planes during inspiration. Mobility in the costovertebral joints facilitates chest wall expansion. (Frownfelter, pp. 365, 639) 4. The diaphragm descends (moves caudally) during inspiration. The severely slumped forward sitting position would lower the diaphragm and cause it to be compressed by the abdominal contents, thereby resulting in respiratory compromise. (Frownfelter, pp. 639-640)

Following a partial-thickness burn over the entire anterior hip and anterior knee regions, the patient should be positioned with the hip in: 1. 0° of extension and the knee in 0° of extension. 2. 0° of extension and the knee in 20° of flexion. 3. 20° of flexion and the knee in 0° of extension. 4. 20° of flexion and the knee in 20° of flexion.

1. The knee should be flexed to prevent an extension contracture. 2. The hip should be neutral to prevent a flexion contracture. The knee should be flexed to prevent an extension contracture. 3. The hip should be neutral to prevent a flexion contracture. The knee should be flexed to prevent an extension contracture. 4. The hip should be neutral to prevent a flexion contracture.

Which of the following clinical findings is MOST likely to be associated with a C7 nerve root lesion? 1. Pain in the medial aspect of the upper arm 2. Diminished light touch on the volar forearm 3. Inability to extend the elbow against gravity 4. Inability to supinate the forearm

1. The medial side of the arm is innervated by C8 and T1 (Lippert, p. 73). 2. The volar surface of the entire arm is innervated by C5- C6 and T1 (Lippert, p. 73). 3. A C7 nerve root lesion will affect the triceps, which is an elbow extensor (Dutton, p. 82; Lippert, p. 171). 4. The biceps and supinator (both responsible for supination of the forearm) are innervated by C5-C6 (Lippert, pp. 170, 174).

Which of the following options BEST describes the mode of action of angiotensin-converting enzyme (ACE) inhibitors? 1. Reduction of heart rate and increase in cardiac contractility 2. Reduction of heart rate and decrease in cardiac contractility 3. Reduction of peripheral vascular resistance and increase in venous capacitance 4. Reduction of peripheral vascular resistance and decrease in venous capacitance

1. The mode of action described does not occur with angiotensin-converting enzyme inhibitors (p. 472). 2. The mode of action described is for beta-blockers, which are another medication used to treat hypertension (p. 470). 3. Angiotensin-converting enzyme inhibitors produce vasodilation, reduce peripheral vascular resistance, and increase venous capacitance (p. 472). 4. Angiotensin-converting enzyme inhibitors produce vasodilation, reduce peripheral vascular resistance, and increase venous capacitance (p. 472). Therefore this option is incorrect since it states an action is decreasing venous capacitance.

A patient has a positive Adson's test on the test. The patient's condition would be BEST addressed by stretching of which of the following muscles? 1. Levator scapulae 2. Upper trapezius 3. Pectoralis minor 4. Anterior scalene

1. The neurovascular bundle associated with thoracic outlet syndrome does not run through the levator scapulae. Stretching the anterior scalenes, not the levator scapulae, would be most appropriate. (p. 1322) 2. The neurovascular bundle does not run through the upper trapezius, and upper trapezius involvement is not expected to elicit thoracic outlet syndrome symptoms. Stretching the anterior scalenes, not the upper trapezius, would be most appropriate. (p. 1322) 3. The hyperabduction or Wright test would be more suggestive of the pectoralis minor contributing to thoracic outlet symptoms (p. 1300). 4. The photograph depicts a physical therapist administering the Adson test. A positive test result indicates scalene involvement in a patient's thoracic outlet symptoms. Recommended intervention includes stretching of the scapulothoracic muscles. In this case, stretching the anterior scalenes would be beneficial. (p. 1299)

Which of the following blood pressure changes is an ABNORMAL response to increased exercise intensity and a reason to terminate exercise? 1. Decrease in diastolic blood pressure of 5 mm Hg 2. Increase in diastolic blood pressure of 5 mm Hg 3. Decrease in systolic blood pressure of 20 mm Hg 4. Increase in systolic blood pressure of 20 mm Hg

1. The normal blood pressure response to increased exercise intensity consists of a progressive increase in systolic blood pressure and no change or a slight decrease in diastolic blood pressure (ACSM, pp. 125, 128). 2. The normal blood pressure response to increased exercise intensity consists of a progressive increase in systolic blood pressure and no change or a slight decrease in diastolic blood pressure (ACSM, pp. 125, 128). A slight increase in diastolic blood pressure would not be cause for termination of exercise. 3. A drop in systolic blood pressure is considered an abnormal test response (ACSM, pp. 125, 127). Criteria for terminating exercise include exercise hypotension (drop in systolic blood pressure of 20 mm Hg or more) (Frownfelter, p. 280). 4. This is a normal response. A drop in systolic blood pressure is considered an abnormal test response (ACSM, pp. 125, 127).

A patient who is participating in a weight-loss program has been walking 3 days/week for 15 minutes for the past 3 weeks. When progressing the exercise program, which of the following modifications will MOST likely accomplish the weight-loss goal? 1. Maintain the current walking speed and increase the duration to 30 minutes. 2. Increase the walking speed and keep the duration at 15 minutes. 3. Walk 4 days/week and decrease the duration to 10 minutes. 4. Change from walking 3 days/week to jogging 1 day/week for 20 minutes

1. The optimal exercise duration for achieving weight loss with a walking program is 30 to 60 minutes of continuous aerobic activity. Therefore once a patient is safely tolerating 15 minutes, the best progression is to increase the duration while maintaining the same intensity or walking speed. 2. Increasing walking speed should only be performed once the patient can consistently tolerate 30 minutes of exercise. 3. Decreasing the duration while increasing the frequency of exercise would not accomplish the goal of 30 to 60 minutes of continuous exercise. 4. A patient who has been walking for only 15 minutes 3 times/week would not be ready to begin jogging, and jogging 1 time/week would be too low of an exercise frequency in general to achieve any training benefit.

A patient who is a waiter has hand pain when carrying trays overhead. Which of the following nerve tension tests is MOST likely to have a positive result? 1. Ulnar 2. Median 3. Radial 4. Musculocutaneous

1. The overhead positioning of carrying food trays is similar to the end position of the ulnar nerve tension test. The tension test for the ulnar nerve includes shoulder depression, abduction, and lateral (external) rotation; elbow flexion; forearm pronation or supination; and wrist and finger extension. 2. The median nerve tension test employs elbow extension, but the position of the waiter is more consistent with elbow flexion. 3. The radial nerve tension test employs elbow extension, and the position of the forearm is low by the side, not reaching overhead. 4. The musculocutaneous nerve does not innervate the hand.

A patient had a stroke 2 years ago and has been unable to land on the heel during heel strike (initial contact) for the past year. What is the MOST appropriate way for the patient to lengthen the involved muscle? 1. Use of a night splint 2. Use of a hold-relax stretch 3. A 2-minute passive stretch 4. 5 bouts of 1-minute passive stretches

1. The patient has a fibrotic contracture, which may be effectively treated by using prolonged static stretch with a splint. 2. The duration of stretching is not sufficient to address a fibrotic contracture. 3. The duration of stretching is not sufficient to address a fibrotic contracture. 4. The duration of stretching is not sufficient to address a fibrotic contracture.

An 18-year-old patient who has osteogenesis imperfecta has been receiving physical therapy services through the school system. The patient is independent in transfers, wheelchair mobility with a motorized wheelchair, and self-care and has been utilizing public transportation. Which of the following courses of action is MOST appropriate in planning for the patient? 1. Continue physical therapy services with a modified goal to maintain independence with mobility. 2. Continue physical therapy services under the care of a physical therapist assistant. 3. Recommend that the patient participate in a support group. 4. Refer the patient to vocational services.

1. The patient has achieved the goals necessary for independent mobility, so there is no need to continue with a mobility goal. 2. Continuing physical therapy services, even by a physical therapist assistant, is inappropriate when the patient has achieved the goals and expected prognosis at this stage of life. 3. There is no indication in this question that the person requires any social support. 4. This 18-year-old patient is independent for activities of daily living and is developmentally appropriate for the workforce or further academic study. A vocational counselor will provide the best guidance and support for the next setting/stage.

A patient reports cervical muscle tightness and headaches originating in the back of the head. Which of the following nerves is MOST likely involved? 1. Trigeminal 2. Spinal accessory 3. Hypoglossal 4. Lesser occipital

1. The trigeminal nerve (CN V) is a sensory and motor nerve of the face, not the area in which the patient reports pain or tightness (p. 1058). 2. The spinal accessory nerve (CN XI) supplies motor innervation to the sternocleidomastoid and trapezius, not the muscles in which the patient reports tightness (p. 1059). 3. The hypoglossal nerve (CN XII) supplies motor innervation to the muscles of the tongue and is unrelated to the tightness or pain (p. 1059). 4. The lesser occipital nerve is a cutaneous nerve supplying the skin of the neck and scalp posterior superior to the auricle, the area in which the patient reports pain (p. 495).

A patient who has emphysema reports a weight gain of 20 lb (9 kg) over the past month. There is 3+ pitting edema in both distal lower extremities. Which of the following tests is MOST important to identify the likely underlying condition? 1. Heart rate 2. Capillary refill 3. Heart auscultation 4. Ankle-brachial index

1. The patient has concerning symptoms suggestive of heart failure. Heart rate would not be most important measure because right ventricular heart failure is not associated with acute changes to heart rate. Right ventricular failure is due to the sustained elevation in pulmonary arterial hypertension. (Goodman, pp. 593-595) 2. Capillary refill is used to assess for surface arterial blood flow (Myers, p. 208). Edema is associated with venous insufficiency (Myers, p. 236). 3. The patient has concerning symptoms suggestive of heart failure. The classic signs include peripheral pitting edema, weight gain, jugular vein distention, diminished appetite, right upper quadrant discomfort, and a ventricular gallop (S3) heart sound (Hillegass, pp. 87, 98). Assessing the heart sounds would be of value for the medical diagnosis or for determining whether consultation with another health care professional is needed. 4. The ankle-brachial index is performed to assess for arterial disease and is designed to test the potential loss of profusion in the lower extremities (O'Sullivan, p. 586). Clinical manifestations of arterial disease include pain, pallor, paralysis, diminished pulses, hair loss, and thin shiny skin (Goodman, pp. 639-640). Venous insufficiency is represented by edema, hemosiderin staining of the skin, and normal arterial pulses (Goodman, pp. 655-656). The patient could have secondary venous issues, but the ankle-brachial index would not be indicated as an additional testing measure.

A person with bilateral pronation of the feet is asked to perform a bilateral squat. Based on the rearfoot position, which of the following will MOST likely be observed? 1. Genu varum with tibial medial (internal) rotation 2. Genu varum with tibial lateral (external) rotation 3. Genu valgus with tibial medial (internal) rotation 4. Genu valgus with tibial lateral (external) rotation

1. The patient in the photograph exhibits pronation of the feet. Pronation is associated with valgus, not varus, stress at the knee, and pronation of the subtalar joint results in or is caused by medial (internal) rotation of the tibia. 2. The patient in the photograph exhibits pronation of the feet. Pronation is associated with valgus deformity of the knee and medial (internal) rotation of the tibia. 3. The patient in the photograph exhibits pronation of the feet. Pronation is associated with medial (internal) rotation of the tibia and resulting genu valgus. 4. The patient in the photograph exhibits pronation of the feet. Pronation is associated with medial (internal), not lateral (external), rotation of the knee along with valgus stress.

When working with a patient who has tuberculosis, which of the following options BEST describes the appropriate location for treatment and type of personal protective equipment that a physical therapist should wear? 1. Therapy gym, N-95 respirator 2. Patient's room, N-95 respirator 3. Therapy gym, standard mask 4. Patient's room, standard mask

1. The patient should not be treated in the physical therapy gym because patients and others in the environment will be exposed to tuberculosis. Airborne precautions specify that the patient should stay in an airborne-infection-isolation room to prevent the spread of tuberculosis. (Minor, pp. 94-95) 2. Because of the nature if its transmission, tuberculosis necessitates airborne precautions. Airborne precautions require the health professional to wear an N-95 respirator (Fairchild, p. 35). Airborne precautions also specify that the patient should stay in an airborne-infection-isolation room to prevent the spread of tuberculosis through the facility's ventilation system (Minor, pp. 94-95). If a patient who has tuberculosis is treated in the physical therapy gym, others in the environment will be exposed to tuberculosis.

A home health physical therapist conducts an initial evaluation of a patient who sustained a tibial plateau fracture. The patient's status is non-weight-bearing, and the patient uses a walker. The patient lives alone, but has a neighbor who helps with meals. With which of the following aspects of the home environment should the therapist be MOST concerned? 1. Depth of the bathtub 2. Steps without a handrail 3. Width of the doorways 4. Height of the countertops

1. The patient will require a shower seat, so depth of bathtub is not the primary aspect of concern. 2. Ascending and descending stairs with a walker should be performed only when a handrail is available and all of the feet of the walker fit on the stair treads. Instruction without a handrail should be reserved for emergency situations only. 3. The walker can be used sideways through a narrow doorway. 4. Because the neighbor is helping with meals, the height of the countertop is not relevant.

A physical therapist who is examining a patient's wrist joint play finds restriction with an ulnar glide. The therapist should suspect a decrease in which joint motion? 1. Radial deviation 2. Ulnar deviation 3. Flexion 4. Extension

1. The physical therapist is shown performing an ulnar glide, which is the same joint motion used for radial deviation. Limited motion in this direction indicates limited ability to perform radial deviation. 2. The physical therapist is shown performing an ulnar glide. A radial glide should be used to assess ulnar deviation. 3. The physical therapist is shown performing an ulnar glide. A dorsal glide should be used to assess wrist flexion. 4. The physical therapist is shown performing an ulnar glide. A volar glide should be used to assess wrist extension.

A physical therapist is guarding a patient who is using an assistive device to come down a flight of stairs. Which of the following is the SAFEST position for the therapist to take to avoid self-injury? 1. In front, with one foot on the step immediately below the patient 2. In front, with both feet on the step immediately below the patient 3. In back, with one foot on the same step as the patient 4. In back, with both feet on the same step as the patient

1. The physical therapist should stand in front and to the side of the patient with one foot on the step to which the patient will step and the other foot on the next step down. 2. Standing with both feet on the same step will make the physical therapist unstable if the patient begins to fall. This position does not provide a wide anteroposterior base of support. 3. In back, with one foot on the same step as the patient is not the safest position for the physical therapist, because the therapist may be pulled forward if the patient loses balance forward. 4. Standing with both feet on the same step will make the physical therapist unstable if the patient begins to fall. This position does not provide a wide anteroposterior base of support.

A patient had a positive posterior drawer test shown in the photograph. What is the MOST likely mechanism of injury? 1. Hyperextension of the knee 2. Vertical compression through the tibia 3. Direct impact to the anterior proximal tibia 4. Direct impact to the lateral aspect of the fibula

1. The posterior drawer test at 90° of knee flexion has been shown to be the most sensitive test for clinical assessment of the posterior cruciate ligament (Dutton, p. 1005). Extreme hyperextension of the knee can cause anterior cruciate ligament injury (Kisner, p. 803), not posterior cruciate ligament injury. 2. The posterior drawer test at 90° of knee flexion has been shown to be the most sensitive test for clinical assessment of the posterior cruciate ligament (Dutton, p. 1005). An activity that results in a very strong quadriceps contraction that coincides with sudden knee flexion, such as landing from a jump, can cause patellar tendon rupture (Kisner, p. 876), not posterior cruciate ligament injury. 3. The posterior drawer test at 90° of knee flexion has been shown to be the most sensitive test for clinical assessment of the posterior cruciate ligament (Dutton, p. 1005). Rupture of the posterior cruciate ligament is usually caused by a direct blow to the proximal tibia, a fall on the knee with the foot in a plantar flexed position, or hyperflexion of the knee (Dutton, p. 1052). 4. The posterior drawer test at 90° of knee flexion has been shown to be the most sensitive test for clinical assessment of the posterior cruciate ligament (Dutton, p. 1005). A direct impact to the outside of the knee can cause an anterior cruciate ligament injury (Kisner, p. 803), not posterior cruciate ligament injury.

Which of the following muscles is MOST active during a side-lying shoulder ER exercise? 1. Infraspinatus 2. Supraspinatus 3. Teres major 4. Rhomboid minor

1. The primary muscles that laterally (externally) rotate the glenohumeral joint are the infraspinatus, teres minor, and posterior deltoid (p. 74). 2. The action of the supraspinatus is primarily abduction of the arm (p. 73), which is not shown in the photograph. 3. The action of the teres major is adduction, medial (internal) rotation, and extension of the arm (p. 77), which is not shown in the photograph. 4. The rhomboid minor attaches to the medial border of the scapula, creating downward rotation and retraction of the scapula. It is not involved in movement of the humerus. (p. 65)

If the radial nerve tension test has positive findings, which of the following muscles is MOST likely affected? 1. Pronator teres 2. Adductor pollicis 3. Pronator quadratus 4. Abductor pollicis longus

1. The pronator teres is innervated by the median nerve (Magee p. 399). The nerve being stretched in the photograph is the radial nerve (Kisner, p. 393). 2. The adductor pollicis is innervated by the ulnar nerve (Magee p. 399). The nerve being stretched in the photograph is the radial nerve (Kisner, p. 393). 3. The pronator quadratus is innervated by the median nerve (Magee p. 399). The nerve being stretched in the photograph is the radial nerve (Kisner, p. 393). 4. The nerve being stretched in the photograph is the radial nerve (Kisner p. 393). The abductor pollicis longus is innervated by the radial nerve (nerve roots C5-C8, T1). When the abductor pollicis longus is affected, loss of thumb (1st digit) abduction could result (Magee, p. 399).

Incentive spirometry is used to assist a patient in achieving: 1. sustained maximal inspiration. 2. rapid ventilation. 3. a shallow breathing pattern. 4. a diaphragmatic breathing pattern.

1. The purpose of incentive spirometry is sustained maximum inspiration. Sustained maximum inspirations are a modification of deep breathing exercises in which the patient inspires through an open glottis. 2. Incentive spirometry encourages slow, deep breathing to improve lung volumes and reduce atelectasis. 3. Incentive spirometry encourages slow, deep breathing to improve lung volumes and reduce atelectasis. 4. Diaphragmatic breathing is not necessarily a component of incentive spirometry. Incentive spirometry uses a handheld device that provides patients with visual feedback regarding their performance during deep breathing exercises.

Which of the following gait parameters are MOST important for independence in community mobility for an individual who had a cerebrovascular accident? 1. Stride length and knee flexion strength 2. Speed and knee extension strength 3. Endurance and knee flexion strength 4. Stride length and ankle dorsiflexion strength

1. The relationship between impairments and gait parameters is very complex, however velocity was found to be the only single measure that predicted walking classification. A combination of gait velocity and knee extension control was found to be highly predictive of mobility function in patients who have had a cerebrovascular accident. Therefore stride length and knee flexion strength are incorrect. 2. Gait velocity and knee extension control were found to be highly predictive parameters of gait performance. 3. A combination of gait velocity and knee extension control was highly predictive of functional mobility in patients who have had a cerebrovascular accident. Endurance and knee flexion strength are not the most critical determinants of independence in community mobility in subjects with hemiplegia. 4. A combination of gait velocity and knee extension control was highly predictive of functional mobility in patients who have had a cerebrovascular accident. Stride length and ankle strength are not the most critical determinants of independence in community mobility in subjects with hemiplegia.

During manual muscle testing of the hip flexors in the sitting position, a patient exhibits lateral (external) rotation with abduction of the thigh as resistance is applied. The physical therapist should suspect muscle substitution by the: 1. sartorius. 2. tensor fasciae latae. 3. adductor longus. 4. semimembranosus.

1. The sartorius flexes, laterally (externally) rotates, and abducts the hip joint. With resisted hip flexion, the sartorius will be recruited to perform all three actions, giving the observed substitution pattern. 2. The tensor fasciae latae is a medial (internal) rotator and flexor of the hip, so substitution by it would involve medial (internal) rotation and abduction. 3. The adductor longus would adduct the hip. 4. Substitution by the semimembranosus would cause hip extension.

After completing stroke rehabilitation, a patient wants to resume volunteering in a local program serving meals. Which of the following examination tools will provide the MOST relevant information for the physical therapist to determine if this activity is possible? 1. A self-report checklist of performance of motor skills that are pre-requisite to meal serving 2. A performance assessment of simulated meal serving in the clinical environment 3. A self-report checklist based on a task analysis of actual steps required for participation 4. A performance assessment of meal serving in the natural environment

1. The self-report approach would be acceptable only if the performance approach was not feasible. 2. The clinical environment is not as desirable as the natural environment. 3. The self-report approach would be acceptable only if the performance approach was not feasible. 4. Whenever possible, it is most desirable for the examination to be performed under conditions as close to the actual ones as possible. This option is the closest to the actual conditions that the patient will experience.

A physical therapist is examining a patient who has multiple sclerosis. The patient sits for 12 hours/day with good spinal and pelvic alignment in a standard wheelchair with a foam cushion. The patient sleeps in a sidelying position. The patient's family reports that the patient has recently gained a considerable amount of weight. Which of the following areas is/are at GREATEST risk for skin breakdown? 1. Lateral malleoli 2. Sacrum 3. Greater trochanters 4. Scapulae

1. The skin over the malleoli is unlikely to be under pressure when the patient is sitting in the wheelchair. 2. Because the patient sits with good alignment, skin breakdown over the sacrum is not likely to occur. 3. With the patient's recent weight gain, the wheelchair armrests and/or frame may be putting pressure on the skin over the greater trochanters. The greater trochanters are also at risk when the patient is in sidelying position. 4. Because the patient sits with good alignment, skin breakdown over the scapulae is not likely to occur.

A patient who walks with an antalgic gait reports hip pain, loss of appetite, and night sweats. The patient has a low-grade fever. Which of the following tests is MOST important to perform to confirm the diagnosis? 1. Squat test 2. Patrick test 3. McBurney test 4. Iliopsoas muscle test

1. The squat test is a test to rule in or rule out a hip fracture. A patient who has a hip fracture will report increased pain with weight-bearing activities (p. 652). In addition to reporting hip pain, the patient has clinical signs and symptoms that indicate a psoas abscess (night sweats, low-grade fever). 2. The Patrick test is a test to rule in or rule out hip joint dysfunction (p. 642). In addition to reporting hip pain, the patient has clinical signs and symptoms that indicate a psoas abscess (night sweats, low-grade fever). 3. The McBurney test is a test for appendicitis. Pain resulting from appendicitis usually begins in the umbilical region and may be localized to the right lower quadrant. Pain is also generally accompanied by nausea, vomiting, and a low-grade fever. (pp. 340, 342) 4. The iliopsoas muscle test is a screening test for psoas abscess. A patient who has a psoas abscess will most likely have a low-grade fever, antalgic gait, and night sweats. (pp. 332-333)

To palpate the insertion of the supraspinatus tendon, a physical therapist should place a patient's arm in which of the following positions? 1. Shoulder flexion and lateral (external) rotation 2. Shoulder flexion and medial (internal) rotation 3. Shoulder extension and lateral (external) rotation 4. Shoulder extension and medial (internal) rotation

1. The supraspinatus tendon is most accessible for palpation when the shoulder is medially (internally) rotated. 2. The supraspinatus tendon is most accessible for palpation when the shoulder is extended. 3. The supraspinatus tendon is most accessible for palpation when the shoulder is medially (internally) rotated. 4. Extending and medially (internally) rotating the shoulder places the supraspinatus tendon in the optimal position for palpation.

While walking on a treadmill during Phase II cardiac rehabilitation following coronary artery bypass surgery, a patient reports the new onset of chest pain and dyspnea. The physical therapist should instruct the patient to: 1. continue walking while the therapist monitors the patient's vital signs. 2. continue walking at 50% slower speed while the therapist calls the physician. 3. cease walking while the therapist reassesses the patient's vital signs. 4. cease walking while the therapist activates the emergency medical system.

1. The symptoms should be regarded as indicators of a worsening or new condition. 2. These symptoms do not constitute a medical emergency but do indicate onset of a new condition. These are indications to terminate exercise and reassess vital signs. 3. The patient's symptoms indicate the onset of a new condition. These are indications to terminate exercise testing and reassess vital signs. 4. These symptoms do not constitute a medical emergency.

A patient reports feeling a "pop" in the posterior leg accompanied by sudden onset of pain localized to the middle third of the posterior lower leg. There is no loss of functional strength. This injury is consistent with complete rupture of the: 1. tibialis posterior muscle. 2. popliteus muscle. 3. Achilles tendon. 4. plantaris tendon.

1. The tibialis posterior muscle is a significant plantar flexor and invertor of the ankle. Complete rupture of this tendon will significantly affect functional strength evidenced by gait. (p. 355) 2. Rupture of the popliteus tendon will result in decreased knee function and difficulty unlocking the knee from an extended position. (p. 333) 3. Complete rupture at the Achilles tendon will result in the inability to flex the foot and an inability to walk, run, or jump. (pp. 334, 354) 4. Rupture of the plantaris is often felt as a "pop." However, the plantaris is a vestigal tendon that has no significant role in function at the knee or ankle. (p. 355)

Which of the following lower extremity proprioceptive neuromuscular facilitation patterns is MOST appropriate to strengthen a patient's weak tibialis posterior? 1. Hip extension, abduction, and medial (internal) rotation, with ankle plantar flexion and eversion 2. Hip flexion, adduction, and lateral (external) rotation, with ankle dorsiflexion and inversion 3. Hip extension, adduction, and lateral (external) rotation, with ankle plantar flexion and inversion 4. Hip flexion, abduction, and medial (internal) rotation, with ankle dorsiflexion and eversion

1. The tibialis posterior plantar flexes and inverts the foot. Ankle plantar flexion and eversion would strengthen the fibularis (peroneus) longus and brevis. (pp. 213, 854) 2. The tibialis posterior plantar flexes and inverts the foot. Ankle dorsiflexion and inversion would strengthen the tibialis anterior. (pp. 212-214, 854) 3. The tibialis posterior plantar flexes and inverts the foot. Hip extension, adduction, and lateral (external) rotation, with ankle plantar flexion and inversion requires the specific action of that muscle. (pp. 212-214, 854) 4. The tibialis posterior plantar flexes and inverts the foot. Ankle dorsiflexion and eversion would strengthen the fibularis (peroneus) tertius. (pp. 212-214, 854)

Which of the following is the normal equilibrium response of a patient tilting side to side while seated on a rocker board? 1. Convexity of the trunk on the upward side with downward side protective extension 2. Concavity of the trunk and shoulder adduction on the upward side 3. Concavity of the trunk and shoulder abduction on the upward side 4. Convexity of the trunk and protective extension on the upward side

1. The trunk being convex on the upward side is an abnormal response, and protective reactions are seen on upward side, not the downward side. 2. The trunk should curve toward the upside, creating a concavity, but shoulder adduction would not protect against falling. 3. The normal response is curvature of the trunk toward the upward side (creating concavity) with extension and abduction of the extremities on that side. Protective extension includes extension and abduction to support and protect body from falling. 4. The trunk convexity on the upward side is an abnormal response, although protective reactions on the upward side are normal.

A patient is referred to physical therapy with a diagnosis of adhesive capsulitis. During the initial evaluation, the patient is found to have limited shoulder range of motion, decreased tolerance to weight-bearing, recurrent night pain, and increased deep tendon reflexes. Which of the following courses of action is BEST for the physical therapist? 1. Contact the patient's referring physician. 2. Initiate small-amplitude oscillations performed at the beginning of the range of motion. 3. Perform pulsed ultrasound to the anterior aspect of the shoulder. 4. Delay therapy for 1-2 weeks until the pain decreases.

1. These measures do not fit with the diagnosis of adhesive capsulitis and might indicate a more serious pathological condition. Signs and symptoms of metastases include decreased tolerance to weight-bearing, change in deep tendon reflexes, and change in sleep habits. 2. Pain control mobilizations are not contraindicated, but it is more important to get the patient back to the physician for reevaluation. 3. Ultrasound should not be performed until a definitive diagnosis can be determined. 4. The physical therapist should take action to refer the patient the physician for reevaluation as soon as possible.

Which of the following integumentary system observations is consistent with skin cancer? 1. Dark, raised spot that bleeds with minimal contact 2. Redness, scaling, and edema of the skin 3. Red fluid-filled vesicles that vary in size 4. Ring-shaped pigmented patches covered with scales

1. These observations are classic signs of malignant melanoma (p. 435). 2. These observations are signs of contact dermatitis (p. 423). 3. These observations are signs of herpes zoster (p. 351). 4. These observations are signs of tinea corporis, also known as ringworm (p. 428).

A patient with evidence of lateral stenosis at the C7-T1 level would MOST likely have which of the following signs and symptoms? 1. Weak biceps, normal biceps reflex, and paresthesia in the thumb (1st digit) and index finger (2nd digit) 2. Weak deltoid, diminished biceps reflex, and paresthesia along the lateral aspect of the upper extremity 3. Weak thumb extensors and adductors, normal triceps reflex, and paresthesia in the little finger (5th digit) 4. Weak triceps, diminished triceps reflex, and paresthesia in the index, middle, and ring fingers (2nd to 4th digits)

1. These signs and symptoms are associated with involvement of the C5-C6 nerve roots. 2. These signs and symptoms are associated with involvement of the C4-C5 nerve roots. 3. The C8 nerve root exits at the C7-T1 level, and the signs and symptoms listed in this option constitute the only combination that could only be attributed to involvement of the C8 nerve. 4. These signs and symptoms are associated with involvement of the C6-C7 nerve roots.

For a patient who takes a thiazide medication (hydrochlorothiazide), which of the following combinations of signs may indicate an adverse effect of the medication? 1. Agitation, dizziness, dyspnea, and hyperventilation 2. Abdominal cramps, agitation, dyspnea, and numbness 3. Clammy skin, dizziness, hyperventilation, and hypotension 4. Abdominal cramps, clammy skin, hypotension, and numbness

1. Thiazide diuretics increase secretion of sodium, so an adverse drug effect is too much secretion, which leads to hyponatremia (Ciccone, p. 319). Agitation and dyspnea are signs of hypernatremia (Goodman, p. 207). 2. Thiazide diuretics enhance secretion of sodium and potassium in the urine, leading to hyponatremia and hypokalemia (Ciccone, p. 319). The signs given are for hypernatremia and hyperkalemia (Goodman, p. 207). 3. Thiazide diuretics enhance secretion of sodium and potassium in the urine, leading to hyponatremia and hypokalemia (Ciccone, p. 319). Clammy skin and hypotension are signs of hyponatremia, and dizziness and hyperventilation are signs of hypokalemia (Goodman, p. 207). 4. Abdominal cramps and numbness are signs of hyperkalemia (Goodman, p. 207). Potassium is excreted along with sodium in patients who are taking thiazide diuretics, so hypokalemia rather than hyperkalemia may result (Ciccone, p. 319).

Which of the following findings BEST describes an injury in the acute stage? 1. Collagen fibers reorient in response to stresses placed on connective tissue. 2. Collagen formation and granulation tissue development occurs at an increased rate. 3. During range of motion testing, the patient experiences pain synchronous with tissue resistance. 4. During range of motion testing, the patient experiences pain with movement and before tissue resistance.

1. This activity characterizes the chronic stage of healing, which involves tissue maturation and remodeling (p. 323). 2. This activity characterizes the subacute stage of healing (p. 320). 3. This response characterizes the subacute stage of healing (p. 317). 4. Pain on active movement is a hallmark of the acute stage of healing (p. 317).

A physical therapist should withhold resistive exercise for a patient who has which of the following laboratory test results? 1. Platelet count of 18,000/mm3 2. White blood cell count of 8000/mm3 3. Hemoglobin of 12 g/dL 4. International normalized ratio (INR) of 1

1. This is a very low platelet count. With a low platelet count, the patient's blood is not clotting properly and severe bleeding can occur. A patient will usually need a transfusion at this level, and exercise should be limited to just activities of daily living. A normal platelet count is 150,000-400,000/mm3. (pp. 1714, 1717) 2. A normal white blood cell count is an indicator of immune system function. Normal count is 4500-11,000/mm3, so this is at an acceptable level for resistance exercise. (pp. 1711-1712) 3. The normal range for hemoglobin is 12-18 g/dL, and resistance training is typically acceptable even at a level of 10 g/dL (pp. 1712-1713). 4. The international normalized ratio (INR) indicates blood's ability to clot. The normal range for people who are not taking anticoagulant medications is 0.9-1.1. When patients are at a higher risk of blood clots or have mechanical heart valves, they take anticoagulants to thin their blood, thus increasing their INR to a necessary range of 2-3.5. When the INR is over 3-3.5, the patient is at a higher risk of bleeding and it may be necessary to limit exercise. (p. 1713)

Which of the following intervention approaches for a child who has developmental coordination disorder will focus on the use of augmented feedback and practice to improve task performance? 1. Conductive education 2. Perceptual-motor training 3. Sensory Integration (SI) therapy 4. Neuromotor Task Training (NTT)

1. This is incorrect because conductive education is a therapy approach for children with cerebral palsy and is focused on improving motivation and self-esteem (Effgen, pp. 378-379). 2. This is incorrect because perceptual motor training is based upon the belief that an underlying deficit must be addressed before improving task performance (Palisano, p. 412). 3. This is incorrect because sensory integration therapy focuses on addressing deficits in the sensory system to improve function (Palisano, p. 412) and motor and perceptual impairments (Effgen, p. 377). 4. This is correct because this task-specific intervention is based on motor learning principles of feedback, memory cues, and practice (Effgen, p. 310; Palisano, p. 412).

A patient who has bicipital tendinopathy is MOST likely to experience pain with which of the following maneuvers? 1. Resisted shoulder flexion with the forearm supinated and the elbow flexed to 15° 2. Passive shoulder medial (internal) rotation and abduction with 90° of elbow flexion 3. Passive shoulder flexion greater than 90° with application of light pressure on the acromion 4. Resisted shoulder extension with the elbow extended and the shoulder abducted to 90° and medially (internally) rotated

1. This movement describes the Speed test, which is diagnostic of bicipital tendinopathy. 2. This movement describes the Hawkins test, which is diagnostic of impingement syndrome. 3. This movement describes the Neer test, which is diagnostic of impingement syndrome. 4. This movement describes the empty can test, which is diagnostic of supraspinatus tendinopathy.

The medical record indicates that a patient is taking a beta-blocker for a cardiac condition. The physical therapist should expect that this medication will: 1. decrease angina pectoris and increase blood pressure. 2. increase heart rate and lower blood pressure. 3. decrease heart rate and lower blood pressure. 4. decrease heart rate and increase oxygen demand

1. This option is incorrect because beta-blockers decrease angina (p. 541) and also decrease blood pressure (pp. 533-534). 2. This option is incorrect because beta-blockers decrease heart rate (pp. 540-541). 3. This option is correct because beta-blockers decrease heart rate and blood pressure (pp. 533-534, 540-541). 4. This option is incorrect because beta-blockers decrease oxygen demand (p. 540-541).

To address a left PSIS that is higher than a right PSIS, which of the following is an appropriate intervention for this patient? 1. Right unilateral manual traction 2. Isometric contractions of the left gluteus maximus 3. Lateral trunk-shift correction procedures 4. A mobilization procedure to anteriorly rotate the left innominate

1. This patient has an uneven posterior superior iliac spine, suggesting iliosacral dysfunction. Traction performed unilaterally is more often used for treating hip impairments. (p. 954) 2. Isometric contraction of the left gluteus maximus is a muscle energy technique that is indicated with iliosacral dysfunction involving an anteriorly rotated innominate (p. 1561). 3. Lateral trunk-shift is associated with disc-related back pain or sciatica (pp. 1451, 1484). The photograph indicates iliosacral dysfunction. 4. A mobilization procedure to anteriorly rotate the left innominate is inappropriate. The photograph suggests an anterior position of the innominate. (p. 1561)

A patient with no history of trauma has nonradiating low back pain. Lumbar flexion does not reverse the lordosis and is pain-free; lumbar extension increases the symptom. Palpation reveals a step-off in the lower lumbar region. The MOST appropriate treatment for this patient would be: 1. abdominal strengthening. 2. sustained prone positioning on elbows. 3. exaggerated lumbar lordosis in sitting. 4. grade III posteroanterior glide to L5.

1. This patient's signs and symptoms are consistent with spondylolisthesis. Abdominal muscle strengthening and stabilization are key to conservative management. 2. Extension activities are not indicated for a patient with spondylolisthesis. 3. Extension activities are not indicated for a patient with spondylolisthesis. 4. Extension activities are not indicated for a patient with spondylolisthesis.

A physical therapist is examining the posterior aspect of the heels of a patient who has darkly pigmented skin. Which of the following findings would indicate the presence of a Stage 1 pressure injury? 1. An intact area of the skin that is black and leathery 2. An intact area of the skin that is warm and purple 3. A shallow crater with a moist wound bed 4. An intact blister with a boggy feel

1. This presentation would indicate the presence of eschar. A pressure injury with eschar cannot be staged (p. 135). 2. This presentation fits the National Pressure Ulcer Advisory Panel's definition of a Stage 1 pressure injury. Warmth and color change indicate pressure damage. Damaged skin may look purple rather than red in people with darkly pigmented skin. Intact skin indicates that the pressure injury is not deeper than Stage 1. (p. 112) 3. A shallow crater with a moist wound bed is characteristic of a Stage 2 pressure injury (p. 135). 4. An intact blister with a boggy feel is characteristic of a Stage 2 pressure injury (p. 135).

A graph shows a medium positive correlation. According to this graph, which of the following statements BEST describes the relationship between nerve conduction velocity and elbow extension range of motion? 1. There is a positive relationship between the two variables. 2. There is no relationship between the two variables. 3. There is a negative relationship between the two variables. 4. The direction and strength of the relationship cannot be determined.

1. This scatter plot is a useful method to examine the relationship between the variables. This plot shows a positive relationship. 2. If no relationship existed, then the points representing the variables would be more dispersed or would have a random pattern. 3. The line indicating the relationship of the variables would go in the opposite direction (left higher than right) if a negative relationship existed. 4. This type of scatter plot allows the direction and strength of the relationship to be determined.

Which of the following strategies would be MOST appropriate when measuring the size and shape of a partial-thickness wound? 1. Hold a tape measure above the wound surface and measure the diameter. 2. Insert a cotton-tipped applicator into the wound at its deepest point and measure the distance from the wound bed to the level of the skin surface. 3. Place a sheet of plastic wrap on the wound and use a marking pen to draw a tracing of the wound's perimeter on the plastic. 4. Place normal saline in the wound, using a measured syringe to fill the wound to the level of the skin surface.

1. This technique can be used to measure size, but it is not useful for measuring the shape of the wound (Bryant, p. 116). 2. This technique can be used to measure depth but not to measure size and shape. It is not accurate and is difficult to reproduce measurements. A partial-thickness wound has no measurable depth. (Bryant, p. 116) 3. This is the only option in the list that measures size and shape (Sussman, p. 124). 4. This technique is used to measure wound volume, rather than size and shape. Volume measurement is of questionable value to clinicians. A partial-thickness wound has no measurable depth. (Sussman, pp. 122-123)

A physical therapist is examining a patient and finds that when the patient's feet are together in standing position, the left iliac crest appears lower than the right. However, when the feet are spread apart, the iliac crests are level. This discrepancy is MOST likely caused by tightness of which of the following muscle groups? 1. Right hip abductors 2. Left hip adductors 3. Right hip adductors 4. Left hip abductors

1. Tight right hip abductors would not pull the left hip downward; they would tend to raise the left iliac crest. 2. With feet together, there is slack on the hip adductors, so there should not be any effect on the iliac crest height. 3. With feet together, there is slack on the hip adductors, so there should not be any effect on the iliac crest height. 4. The iliac crests are level with the hips abducted (feet spread apart), but the right iliac crest is higher when the hips are adducted (feet together). Tightness in the left hip abductors would be the most likely cause, because the tight left hip abductors would be pulling the left hip downward.

What is the BEST schedule of practice to ensure a patient's early success in the performance of a motor task? 1. Consistent practice using a blocked pattern 2. Consistent practice using a random pattern 3. Variable practice using a blocked pattern 4. Variable practice using a random pattern

1. To promote rapid performance gains, consistency in the practice (constant blocked practice) would be best. 2. This schedule describes practice that has some characteristics of variable random practice and some characteristics of constant blocked practice, which is suboptimal for early success in the performance of a motor task. To promote rapid performance gains, consistency in the practice (constant blocked practice) would be best. 3. Variable practice is suboptimal for early success in the performance of a motor task. 4. Variable and random practice would ensure learning of the task, but the patient would take longer to acquire the skill.

A patient who reports neck pain radiating to the elbow is treated with cervical traction. During the treatment, the patient reports increased neck pain with radiating pain into the ring finger (4th digit) and little finger (5th digit) of the right hand. Which of the following actions is MOST appropriate for the physical therapist to take? 1. Stop the intervention and reevaluate. 2. Refer the patient back to the physician. 3. Change the angle of pull of the traction. 4. Reduce the traction force.

1. Traction is contraindicated if peripheralization of signs and symptoms occurs during and following therapy. 2. The change described in the stem is consistent with the current presentation and does not warrant referral to physician. 3. Because progression of symptoms from central to a peripheral area indicates worsening nerve function and increased compression, changing the angle is insufficient. 4. Because progression of symptoms from central to a peripheral area indicates worsening nerve function and increased compression, reducing the poundage is insufficient.

A 90-year-old hospitalized patient was referred for physical therapy evaluation and intervention following a C5 fracture secondary to a fall. The patient describes neck pain and left knee pain but reports no other postinjury changes in the extremities. The rehabilitation prognosis for the patient should PRIMARILY be based on: 1. prior level of function. 2. left knee range of motion. 3. use of a cervical collar. 4. upper extremity sensory integrity.

1. Understanding a patient's prior level of function is a critical factor to determine a reasonable prognosis, because this information establishes the baseline for recovery. 2. Although knee range of motion should be monitored, it is not more critical than prior level of function as a determinant of prognosis. 3. Although a cervical collar is a potential intervention, its use is not more critical than prior level of function as a determinant of prognosis. 4. Although upper extremity sensory integrity should be monitored, it is not more critical than prior level of function as a determinant of prognosis.

Which of the following conditions would MOST likely be experienced by a 7-year-old patient who has a tethered spinal cord? 1. Upper extremity hypertonicity 2. Bladder dysfunction 3. Blurred vision 4. Headache

1. Upper extremity hypertonicity is consistent with shunt dysfunction, not tethered cord (Palisano, p. 554). 2. A tethered spinal cord occurs when adhesions anchor the spinal cord at the site of the lesion as individuals with spina bifida grow. The tethering of the spinal cord can result in rapidly progressive scoliosis, hypertonicity in the lower extremities, changes in gait, and changes in urologic function. (Tecklin, p. 285) 3. Blurred vision is consistent with shunt dysfunction, not tethered cord (Palisano, p. 554). 4. Headache is consistent with shunt dysfunction, not tethered cord (Palisano, p. 554).

A physical therapist is performing a manual muscle test of the shoulder abudctors in seated. If the patient is unable to achieve at least a grade of Fair (3/5), which of the following positions would be the BEST modification for the test? 1. Sitting against a wall for support 2. Lying sidelying 3. Lying supine 4. Lying prone

1. Upright sitting position does not eliminate the effects of gravity. If testing results in a grade below Fair (3/5), gravity should to be eliminated. 2. Sidelying is not a standard testing procedure for the deltoid/supraspinatus. Gravity will still be involved. If testing results in a grade below Fair (3/5), gravity should be eliminated. 3. Supine position allows the patient to slide the arm on the table. Gravity is eliminated in this position. This is the standard position to test the deltoid/supraspinatus for a grade of Poor (2/5). 4. Although prone position does minimize gravity, it is not the position of choice for the muscle group being tested.

A patient has right-sided upper abdominal and shoulder pain. The physical therapist suspects that the pain is not mechanical in origin. Which of the following structures is the MOST likely source of the referred pain? 1. Urinary tract 2. Appendix 3. Kidney 4. Gallbladder

1. Urinary tract disease does not demonstrate this pain pattern (p. 971). 2. Symptoms from acute appendicitis are abdominal but do not refer to the shoulder (p. 971). 3. Kidney disease may manifest as back pain or upper abdominal pain, but the pain is not referred to the shoulder (p. 971). 4. Pain associated with the gallbladder is located in the right upper abdominal quadrant and radiates to the upper back. Pain may be referred to the scapula, right shoulder, or neck area. (p. 951)

A patient reports dizziness and frequent falls. Upon examination, the patient demonstrates constant vertical pendular nystagmus, abnormal smooth pursuit, and abnormal saccadic eye movements. The patient's symptoms are MOST likely caused by which of the following conditions? 1. Vertebrobasilar insufficiency 2. Central vestibular system lesion 3. Peripheral vestibular system lesion 4. Posterior semicircular canalithiasis

1. Vertebrobasilar insufficiency is associated with drop attacks, transient blindness, and dysarthria. 2. A patient who has a central vestibular system lesion, in particular a cerebellar lesion, may have pure vertical nystagmus that oscillates at equal speeds (pendular nystagmus). In addition, abnormal smooth pursuits and abnormal saccadic eye movements are symptoms associated with a central vestibular lesion. 3. Peripheral vestibular lesions are associated with intermittent nystagmus that will incorporate slow and fast phases (jerk nystagmus) and with normal smooth pursuit and saccades. 4. Peripheral vestibular lesions, including posterior semicircular canalithiasis, are associated with intermittent nystagmus that will incorporate slow and fast phases (jerk nystagmus) and with normal smooth pursuit and saccades.

During a gait training session, a patient who has Parkinson disease exhibits freezing episodes when attempting to negotiate turns. Which of the following training methods would be MOST beneficial for the patient? 1. Visual cue on the floor 2. Video of correct turning 3. Feedback at the end of the session 4. Blocked practice of turns

1. Visual stimuli have been shown to be effective in overcoming freezing episodes in patients who have Parkinson disease. Parkinson disease causes a deficit in proprioception for which visual cues may compensate. (Umphred, p. 617; Pfeiffer, p. 204) 2. Use of a video is not appropriate because patients who have Parkinson disease have difficulty in shifting attention and have selective attention due to a deficit of the frontal lobe (Umphred, p. 610). 3. Feedback at the end of the session is not appropriate because patients who have Parkinson disease are unable to quickly access working memory due to a deficit of the frontal lobe (Umphred, p. 610). 4. Blocked practice enforces procedural learning, which is impaired due to dysfunction of the basal ganglia in patients who have Parkinson disease (Umphred, pp. 606, 610-611).

Which of the following variables TYPICALLY increases during the aging process in older adults? 1. Vital capacity 2. Skin elasticity 3. Glucose tolerance 4. Resting blood pressure

1. Vital capacity decreases with aging. 2. Elasticity decreases with aging. 3. Glucose tolerance decreases with aging. 4. Resting blood pressure increases with advancing age.

The INITIAL rehabilitation program for a patient post coronary artery bypass surgery would consist of: 1. low-intensity walking. 2. lifting light weights. 3. low-level upper extremity ergometry. 4. stationary bike riding.

1. Walking in hall is included as an initial activity in a Phase I treatment program (p. 228). 2. Resistance training should not begin until a minimum of 8 weeks after coronary artery bypass surgery (p. 241). 3. Arm activity, such as use of ergometer, is not appropriate for patients immediately after coronary artery bypass surgery. The activity is contraindicated due to incisional precautions. (p. 241) 4. Stationary bike riding is a higher-level aerobic activity that should not be the initial choice after coronary artery bypass surgery. Limitation or restriction of upper body activities, including unloading the upper extremities, is an important element in the initial rehabilitation program for a patient post coronary artery bypass graft. A patient who may lean on the handlebars would potentially place too much pressure on their sternal incision. (p. 241)

A patient who underwent a hernia repair should AVOID which of the following activities? 1. Walking at a metabolic equivalent of 3 or more during the 1st week after surgery 2. Performance of tasks using a Valsalva maneuver for 4-6 weeks after surgery 3. Stretching of the posterior spinal and hip musculature before the incision is fully healed 4. Active adduction or flexion of the lower extremities before the incision is fully healed

1. Walking is encouraged within the first week following repair. Walking at a metabolic equivalent of 3 is equivalent to a walking speed of 2.6 mph (p. 30), a relatively slow speed. A 1-week delay in walking would place the patient at risk for additional comorbidities (pp. 901-902). 2. Patients are advised to avoid straining for 4-6 weeks following repair, regardless of the procedure (pp. 901-902). 3. Hernias are repaired through an anterior incision, and thus stretching of the abdominal wall or groin region should be avoided (pp. 899, 901), but stretching the posterior structures should not be an issue. 4. Surgical repairs are anterior. Thus flexion or adduction does not affect the incision and would not be necessary to avoid. Moreover, some programs allow isometric adduction in the first week. (pp. 901-902)

A patient has difficulty with knee control while descending stairs. Which of the following exercises is MOST appropriate to improve function in this task? 1. Wall squats 2. Quadriceps setting exercises 3. Long arc knee extension with free weights 4. Concentric knee extension using an isokinetic dynamometer

1. Wall squats are a closed chain exercise that requires eccentric contraction of the quadriceps muscles in a pattern closely related to that used in descending stairs, making it the exercise most likely to lead to functional carry-over. 2. Quadriceps sets are isometric exercises that will strengthen the muscle but not in the same way needed to descend stairs. 3. Long arc knee extension exercises are an open chain exercise that will strengthen the muscle but not in the same way needed to descend stairs. 4. Exercises performed on an isokinetic dynamometer are open chain exercises that will strengthen the muscle but not in the same way needed to descend stairs.

A patient has severe chronic obstructive pulmonary disease and bilateral knee osteoarthritis. During aquatic therapy involving slow walking, which of the following water levels is MOST appropriate for this patient? 1. Knees 2. Hips 3. Navel 4. Shoulders

1. Water level up to the navel would minimize knee compressive force to a greater extent than water level up to the knees, because more loading forces would be removed (p. 292). 2. Water level up to the navel would minimize knee compressive force to a greater extent than water level up to the hips (pp. 292-293). 3. Patients who have knee arthritis often have difficulty and pain when walking on land. Due to buoyancy, ground reaction forces and knee joint forces are less during walking in the water, compared to these same forces while walking on land. The greater the amount of water displaced by the body, the less the ground reaction forces experienced, and the less force transmitted up the body through the ankles, knees, hips, and trunk. Therefore, as water depth increases and more of the body is immersed in water, knee compressive force decreases. This allows a patient who has knee arthritis to be able to walk in water with minimal difficulty and pain, even though the patient may be unable to walk without pain and difficulty on land. Water level up to the navel would minimize knee compressive force to a greater extent than water level up to the knees or hips. (pp. 292-293, 302) 4. A water level to the shoulders could affect the ability of the lungs to expand (p. 291).

On the basis of decreased hip extension on the Thomas test, tightness is MOST likely present in which of the following structures in the left lower extremity? 1. Iliopsoas 2. Hamstrings 3. Iliotibial band 4. Gluteus maximus

1. When the iliopsoas length is normal, the lumbar spine should flatten and the test leg should remain flat on the table (p. 729). 2. The hamstring muscles are tested with the patient in supine position using a combination of hip flexion and knee extension (p. 724). 3. The iliotibial band is most appropriately tested in sidelying with the test leg on top and with the examiner moving the hip into adduction (pp. 725-726). 4. The gluteus maximus only crosses the hip joint, and the length would not be tested with the hip in extension (p. 724).

A physical therapist is reviewing study findings summarized as follows: Patients with patellofemoral pain who received an experimental strengthening program plus a standard exercise program achieved improved outcomes, compared to patients who received only the standard exercise program (p = .001). The researchers had set the alpha level to .05 before the study began. Which of the following statements MOST accurately characterizes the results? 1. A statistically significant difference exists between the two interventions. 2. A small difference exists between the two interventions. 3. A large difference exists between the two interventions. 4. No difference exists between the two interventions.

1. When the p value is less than the alpha level, a statement can only be made that a significant difference exists. No statement can be made as to the magnitude of the difference. 2. When the p value is less than the alpha level, a statement can only be made that a significant difference exists. No statement can be made as to the magnitude of the difference. 3. When the p value is less than the alpha level, a statement can only be made that a significant difference exists. No statement can be made as to the magnitude of the difference. 4. The p value obtained is less than the alpha level, thus a statistical difference exists.

Following insertion of a chest tube, a patient displays scapular winging. The physical therapist should expect the patient to have the MOST difficulty: 1. scratching the low back area. 2. turning a doorknob. 3. holding a briefcase. 4. reaching forward for an object.

1. Winging of the scapula is caused by weakness of the serratus anterior (Hislop, pp. 82-83; Dutton, p. 591). Ability to scratch the low back area would not be affected by serratus anterior weakness. It would be affected by weakness of the medial rotators. (Hislop, pp. 133-137) 2. Winging of the scapula is caused by weakness of the serratus anterior (Hislop, pp. 82-83; Dutton, p. 591). Turning a doorknob would be most affected by weakness of the biceps and supinator (Hislop, pp. 147-150). 3. Winging of the scapula is caused by weakness of the serratus anterior (Hislop, pp. 82-83; Dutton, p. 591). Holding a briefcase would be affected by weakness of the flexor digitorum profundus, not by weakness of the serratus anterior (Dutton, p. 792). 4. Winging of the scapula is caused by weakness of the serratus anterior (Hislop, pp. 82-83; Dutton, p. 591). The serratus anterior abducts the scapula and rotates the interior angle laterally (Hislop, pp. 82-84). Weakness in this area would cause difficulty reaching forward for an object.

A patient who had an uncomplicated vaginal delivery 3 months ago has a 3-cm diastasis recti and Fair minus (3-/5) strength of the abdominal muscles. Which of the following therapeutic exercises, performed with arms bracing the abdomen, is MOST appropriate for the patient INITIALLY? 1. Head lift 2. Partial sit-ups 3. Lower trunk rotation 4. Bilateral straight leg raises

1. With a 3-cm diastasis, the head lift is the most appropriate exercise initially. The patient braces the abdomen toward the midline to approximate the diastasis while performing the head lift. This will help to keep the separation of the abdominal muscles to a minimum, minimize the action of the obliques, and control intraabdominal pressure. 2. Given the strength of this patient's abdominal muscles in addition to the extent of the diastasis, this activity would be too strenuous and may further compromise the diastasis. The head lift should be performed exclusive of all other abdominal exercises until the diastasis is 2 cm or less. 3. Lower trunk rotation should be avoided until the diastasis is 2 cm or less. Due to the angle of attachment of the obliques into the linea alba, there is a possibility that trunk rotation exercises will perpetuate the diastasis. 4. With an abdominal strength of Fair minus (3-/5) and a diastasis of 3 cm, bilateral straight leg raises could cause a further separation of the diastasis by increasing intraabdominal pressure as the patient tries to stabilize while lifting the legs. The head lift corrective exercise should be performed exclusive of all other abdominal exercises until the diastasis is reduced to 2 cm or less.

A patient's left eye is adducted at rest. During examination of extraocular eye movements, the patient is unable to move the left eye laterally. These findings MOST likely result from a lesion of which of the following nerves? 1. Oculomotor (CN III) 2. Trochlear (CN IV) 3. Trigeminal (CN V) 4. Abducent (CN VI)

1. With oculomotor nerve (CN III) injury, the affected eye would have ptosis and lateral deviation (pp. 330-331). 2. With a trochlear nerve (CN IV) injury, the person would have elevation of the involved eye during forward gaze (p. 331) and would not have difficulty with abducting the eye. 3. With trigeminal nerve (CN V) injury, the person would have impaired facial sensation, difficulty with jaw opening, and an impaired corneal reflex (pp. 336-338). 4. With a lesion of the abducent nerve (CN VI), the affected eye is adducted at rest and cannot be abducted (p. 331).

Which of the following individuals is authorized to have access to the medical records of a patient who is in the intensive care unit after a motor vehicle accident? 1. The patient's attorney, while preparing a civil suit related to the accident 2. The human resource representative at the patient's employer, inquiring about a return-to-work date 3. The patient's brother, who is providing financial support to the patient's family 4. The patient's friend, who is named in the durable power of attorney for health care

1. Written consent from the patient or the patient's power of attorney would be required before releasing the patient's medical record to an attorney. 2. Written consent from the patient or the patient's power of attorney would be required before releasing the patient's medical record to a human resource representative. 3. Written consent from the patient or the patient's power of attorney would be required before releasing the patient's medical record to a family member. 4. The patient executing a durable power of attorney may appoint a friend as his or her health care decision-maker. This person would have access to the patient's medical record.

A patient reports audible clicking in the temporomandibular joint while chewing food. When a physical therapist is palpating the joint, which of the following pairs of active mandible motions would be MOST informative to confirm temporomandibular dysfunction? 1. Elevation and protrusion 2. Elevation and retrusion 3. Protrusion and retrusion 4. Depression and elevation

4. Reciprocal clicking with mouth opening and closing has good diagnostic utility in diagnosing temporomandibular conditions and in particular anterior disc displacement (p. 1353). Opening of the mouth, which is depression of the mandible, is the most revealing and diagnostic movement for temporomandibular dysfunction. Elevation of the mandible is mouth closing and primarily assesses the primary muscles that perform mouth closure (pp. 1360-1361). Protrusion of the mandible is used to assess tongue thrust conditions and for deviations during protrusion, which can be caused by muscle or disc problems; therefore, it is not a strongly discriminatory test. Retrusion of the mandible may be painful in patients with an intracapsular injury, but it not as useful as depression of the mandible in diagnosis of temporomandibular dysfunction

The patient whose left hand lacks extension, capsular pattern and firm end-feel of the left wrist. While stabilizing the distal radius and ulna, a physical therapist performs small-amplitude oscillations to the proximal carpal bones at the limit of the available motion and into tissue resistance. In which directions should the therapist move the carpals to improve the patient's ability to lift a heavy suitcase? 1. Dorsal and ulnar 2. Dorsal and radial 3. Volar (palmar) and ulnar 4. Volar (palmar) and radial

4. The power grip produces the greatest amount of force for hand grip. The power grip of the hand requires range of motion of slight extension and ulnar deviation (Magee, p. 452). Although stabilizing the distal radius and ulna, mobilizing the proximal carpal rows in a volar (palmar) direction will increase extension, while a radial mobilization will increase ulnar deviation (Dutton, pp. 800-801). Therefore, a volar (palmar) glide followed by a radial glide would improve both extension and ulnar deviation, resulting in an improved power grip.