NPTE Scorebuilders OA Practice Exam 1

A physical therapist works with a patient on vertical positioning using a tilt table. During the session, the patient suddenly begins to demonstrate signs of intolerance to being upright. Which symptom would be LEAST anticipated? 1.Bradycardia 2.Dizziness 3.Nausea 4.Syncope

1. Bradycardia refers to a sinus rhythm with a heart rate of less than 60 beats per minute. Heart rate is typically significantly higher in a vertical position since the heart has to work against gravity. As a result, the patient would be more likely to exhibit tachycardia. (Fairchild p. 219)

A therapist performs a special test with a patient positioned on a treatment plinth with the involved knee in 90 degrees of flexion. Which of the following special tests would be LEAST likely based on the described position of the knee? 1.Anterior drawer test 2.Craig's test 3.Ely's test 4.Posterior sag sign

Ely's test is performed with the patient in prone. The therapist passively flexes the patient's knee through the available range of motion. A positive test is indicated by spontaneous hip flexion and may be indicative of a rectus femoris contracture. (Magee p. 723)

A patient is admitted to a tertiary care facility after sustaining full and partial-thickness burns over 50% of his body. Which physiologic characteristic associated with the burns would be the MOST acutely life-threatening? 1.Hyperthermia 2.Polyuria 3.Hypovolemia 4.Infection

Hypovolemia refers to a reduction in blood plasma volume resulting in decreased blood and oxygen perfusion to the body. The acute threat of hypovolemia is high for patients who have sustained severe burn injuries and is considered to be life-threatening without immediate medical attention. (Paz p. 272)

A physical therapist works with a 36-year-old male diagnosed with rotator cuff tendonitis. During the session the therapist asks the patient to medially rotate the arm behind the back with the dorsum of the hand resting in the mid-lumbar region. The therapist then instructs the patient to attempt to lift the hand off the back. Which of the following is this test MOST appropriate to assess? 1.Infraspinatus 2.Subscapularis 3.Supraspinatus 4.Teres minor

The scenario describes the procedure for the lift-off sign, a test which is designed to indicate a lesion of the subscapularis muscle. The subscapularis is a medial rotator of the shoulder and is innervated by the subscapular nerve (C5-C6). (Magee p. 336)

A patient referred to physical therapy with a diagnosis of carpal tunnel syndrome reports that she experiences intermittent pins and needle sensations in her upper extremity including her entire hand. During the examination, the therapist is unable to reproduce the reported paresthesias when performing special tests that compress the median nerve. Which pathology would be MOST likely to produce the described symptoms? 1.Cubital tunnel syndrome 2.Thoracic outlet syndrome 3.C4 nerve root impingement 4.Reflex sympathetic dystrophy

Thoracic outlet syndrome occurs due to compression, injury or irritation involving the neurovascular structures of the brachial plexus. Symptoms typically include diffuse arm pain especially at night, paresthesias, and upper extremity weakness. Symptoms are typically exacerbated by poor posture and activities such as overhead movement and lifting activities. (Hertling p. 317)

A patient sustains damage to the left medial collateral ligament during a soccer game. The patient's symptoms include tenderness with palpation, minimal bruising, mild effusion, and a negative valgus stress test. Which of the following BEST describes the damage to the involved ligament? 1.Grade I sprain 2.Grade II sprain 3.Grade III sprain 4.Complete rupture

.A grade I sprain of the MCL is characterized by tenderness to palpation, minimal bruising, and effusion. When compared to the unaffected limb, no significant difference will be noted during valgus stress testing with the knee slightly flexed. Magee p. 32)

A patient diagnosed with rheumatoid arthritis is referred to physical therapy. The physical therapist observes bilateral thumb deformities characterized by metacarpophalangeal joint flexion with interphalangeal hyperextension. Which deformity is MOST consistent with the described presentation? 1.Boutonniere 2.Swan neck 3.Mallet finger 4.Dupuytren

1. In the thumb, chronic synovitis eventually forces the metacarpophalangeal (MCP) joint into a flexed position. The associated palmar displacement causes tension on the extensor mechanism of the interphalangeal (IP) joint resulting in hyperextension. In the fingers, this deformity presents with flexion in the proximal interphalangeal (PIP) joint and extension of the distal interphalangeal (DIP) joint. (Goodman - Pathology p. 1267)

A physical therapist instructs a patient with complex regional pain syndrome in a home exercise program. Which of the following is the MOST appropriate intensity and duration guideline for the program? 1.Pain free activities, short periods of time 2.Pain free activities, extended periods of time 3.Exacerbating activities, short periods of time 4.Exacerbating activities, extended periods of time

1. Therapeutic activities that are part of a patient's home care routine (e.g., stress loading, desensitization techniques) should be performed frequently, for short periods of time, and to the patient's tolerance. The patient should be encouraged to perform only activities that are pain free in order to limit the risk of symptom exacerbation. (Brody p. 721)

A patient's radiology report states that the patient's wrist fracture was characterized as a "dinner fork" deformity with dorsal displacement of the radius. This type of deformity is typically associated with which fracture type? 1.Colles' fracture 2.Smith's fracture 3.Hutchinson's fracture 4.Bennett's fracture

1.A Colles' fracture is typically characterized as a "fall on an outstretched hand" (FOOSH) extension injury. The distal extremity may sustain a buckling or shearing wrist fracture during impact due to the combined forces of weight and momentum. A "dinner fork" or "bayonet" deformity is commonly identified on x-ray as well as some degree of dorsal displacement of the distal radius, wrist, and hand. (Hertling p. 408)

A physical therapist working in a wound clinic considers using a hyperbaric oxygen chamber to treat a recently referred patient. Which scenario would be the MOST appropriate for this type of intervention? 1.A chronic diabetic foot ulcer that is infected 2.A large abdominal wound from a recent hernia surgery 3.A superficial burn covering the majority of the body 4.A penetration wound that caused a pneumothorax

1.A chronic diabetic foot ulcer is one of the primary indications for the use of HBOT. Diabetic foot ulcers often become chronic wounds because of tissue hypoxia and infection. HBOT can be used to treat both of these underlying factors since it increases oxygenation to the tissue, which also helps to treat infection through increased leukocyte activity. (Sussman p. 786)

A patient is diagnosed with a grade II sprain of the anterior talofibular ligament. During the initial interview, the patient states that he jumped to rebound a basketball and immediately fell to the floor upon landing on the ankle. What motions of the foot and ankle were MOST likely associated with the ligamentous injury? 1.Plantar flexion and inversion 2.Dorsiflexion and inversion 3.Plantar flexion and eversion 4.Dorsiflexion and eversion

1.A lateral ankle sprain typically occurs as a result of excessive stress with the foot and ankle in an inverted and plantar flexed position. As the foot makes contact with the ground and rolls laterally, the anterior talofibular ligament is typically the first to sustain damage. (Hertling p. 601)

A patient with chronic liver failure is awaiting an organ transplant. What should be the PRIMARY focus of a patient while preparing for transplant surgery? 1.Functional mobility 2.Core strength 3.Energy conservation 4.Normalization of tone

1.A patient with organ failure will possess a decreased work capacity secondary to the disease process. A functional exercise program is indicated for transplant candidates to increase oxygen consumption and utilization. Exercise should be functional and meet the physical and psychological needs of the patient. (Goodman - Pathology p. 1056)

A physical therapist attempts to decrease a patient's extensor tone at the knees using positioning. Which position would be LEAST beneficial to accomplish the therapist's objective? 1.Sitting 2.Half kneeling 3.Kneeling 4.Quadruped

1.A sitting position would not permit weight bearing through the lower extremities and therefore would be less likely than the other options to decrease the patient's extensor tone at the knee. (O'Sullivan p. 415)

A physical therapist measures a patient's two-point discrimination at several different areas of the body using a caliper and a ruler. Which area would the therapist expect to produce the SMALLEST measured value? 1.Cheek 2.Lateral to the umbilicus 3.Medial forearm 4.Medial leg

1.An average two-point discrimination value for the cheek is 11.9 millimeters. (O'Sullivan p. 122)

A 55-year-old patient who sustained a femur fracture is referred to physical therapy. The fracture is now healed, but the quadriceps muscle remains very weak (grade of "3" or fair). Which activity would permit the patient to utilize the GREATEST amount of weight with the quadriceps muscle in a sitting position? 1.Eccentric exercise with a cuff weight on the ankle 2.Concentric exercise with a cuff weight on the ankle 3.The patient would only be able to perform isometric exercise with a cuff weight on the ankle 4.There would be no difference in the maximum amount of weight the patient could utilize

1.An eccentric contraction can produce more force than either a concentric or isometric contraction. With eccentric contractions, the lowering of the load is controlled by the active contractile components of the muscle as well as noncontractile connective tissue around the muscle. Since this patient's quadriceps strength is graded as a 3, an eccentric contraction using a small cuff weight would be possible. (Kisner p.180)

A physical therapist determines that a patient has no sensation below the L2 dermatome after completing a sensory examination. The patient was admitted through the emergency room 14 days ago secondary to a motor vehicle accident. What is the MOST likely rationale for the patient's current condition? 1.The patient has a complete transection of the spinal cord 2.The patient has a dorsal column lesion within the spinal cord 3.The patient has a hemisection of the spinal cord 4.The patient has a spinothalamic tract lesion within the spinal cord

1.Complete transection of the cord is the only injury which would inhibit sensory information from all ascending pathways. This would result in the patient having no sensation below the level of the lesion. A lesion of the dorsal columns is most closely related to posterior cord syndrome. A patient with this injury would lose the sensations of discriminative touch, pressure, vibration, kinesthesia, and proprioception. However, they would still maintain the sensations of pain, temperature, and crude touch. A hemisection of the spinal cord is also known as Brown-Sequard's syndrome. This injury affects all pathways in the spinal cord, however, only one side of the spinal cord is affected. A lesion of the spinothalamic tract is not associated with a specific injury, although this tract does become injured with anterior cord syndrome and Brown-Sequard's syndrome. A patient with a lesion to this tract would lose the sensations of pain, temperature, and crude touch. However, they would maintain the sensations of vibration, kinesthesia, and proprioception. (O'Sullivan p. 893)

A 16-year-old competitive male runner presents with patellofemoral syndrome and a moderate pes planus deformity. The physical therapist observes that the patient's patella tracks laterally only in weight bearing positions. What would be the MOST appropriate intervention to facilitate a long term mechanical correction? 1.Foot orthotics 2.Patellar taping 3.Lateral retinaculum release 4.Vastus medialis obliquus strengthening

1.Correction of the pes planus deformity with some form of orthotic arch support is the most appropriate long term intervention. This intervention serves to correct the cause of the lower extremity malalignment rather than the effects that have manifested at the knee. (Hertling p. 531)

A physical therapist reviews the medical record of a patient diagnosed with suspected trochanteric bursitis. Which method would be the MOST appropriate to confirm the suspected diagnosis? 1.Diagnostic injection 2.Ultrasonography 3.Bone scan 4.X-ray

1.Diagnostic injection is typically considered the most definitive means of confirming trochanteric bursitis. A corticosteroid and local anesthetic solution is injected into the bursa with the diagnosis confirmed if the patient experiences significant relief from symptoms. In many cases, the injection doubles as a therapeutic intervention, although in chronic or recurrent cases, surgical intervention may be necessary. (Magee - Pathology p. 499)

A physical therapist examines a patient two weeks status post right total knee arthroplasty. During the examination the therapist notes a significant restriction of passive and active inferior patellar mobility. Which of the following would be the MOST likely clinical finding? 1.Diminished active and passive knee flexion 2.Presence of an extension lag 3.Increased pain with active knee range of motion 4.Diminished knee flexion strength

1.During knee flexion, the patella glides inferiorly on the femoral condyles. A restriction in inferior patellar mobility would lead to decreased active and passive knee flexion. (Levangie p. 426)

A physical therapist instructs a patient recently diagnosed with ankylosing spondylitis in a home exercise program. After completing the exercises, the patient asks the therapist how his current symptoms are likely to be affected by engaging in regular exercise. What should the therapist advise the patient? 1.Exercise typically will reduce symptoms and reduce the risk of future pulmonary complications 2.Exercise typically does not affect symptoms, but is necessary to prevent postural deformities 3.Exercise typically exacerbates symptoms, but is necessary to reduce the risk of pulmonary complications 4.Exercise typically can be deferred as long as normal posture is maintained

1.Exercise typically reduces complaints of pain and stiffness in patients with ankylosing spondylitis. Exercise is especially beneficial before significant ossification begins to occur as it can greatly support maintenance of normal posture which in turn maintains space within the thoracic cavity allowing for optimal lung expansion. (Goodman - Pathology p. 1285)

A physical therapist has a patient perform active shoulder flexion in supine without using any weights. Which patient would LEAST benefit from this intervention? 1.A patient that is two weeks status post rotator cuff repair 2.A patient that has severe pain when performing standing shoulder flexion 3.A patient that has active cancer near the shoulder joint 4.A patient that is severely deconditioned

1.Following a rotator cuff repair, a patient will likely have restrictions placed on the movement and use of the affected arm. Protocols for a rotator cuff repair will vary, but commonly include limitations in active range of motion and strengthening exercises for several weeks following the surgery. Supine active shoulder flexion would not be an appropriate exercise for a patient that is two weeks status post rotator cuff repair. (Kisner p. 570)

A physical therapist initiates gait training with a patient one day status post lumbar laminectomy and spinal fusion surgery. During the session, the patient reports that the numbness and tingling they experienced in the leg prior to surgery is still present. What is the MOST immediate physical therapist action? 1.Inform the patient that this is common post-operatively 2.Instruct the patient in the use of a rolling walker 3.Discontinue ambulation 4.Contact the patient's surgeon

1.Following spinal surgery, symptoms such as radiating pain and sensory changes may persist secondary to edema at the surgical site. However, the patient should be informed to remain alert to any changes in bowel or bladder function or significant increases in pain. (Paz p. 121)

After three weeks of physical therapy for a shoulder contusion sustained during a fall, an elderly patient's pain complaints have subsided and passive range of motion is within normal limits. The therapist is concerned, however, that the patient is still unable to actively abduct the shoulder. Which potential diagnosis would BEST explain the patient's current limitations? 1.Rotator cuff tear 2.Adhesive capsulitis 3.Supraspinatus tendonitis 4.Biceps tendon rupture

1.In geriatric patients, a rotator cuff tear may present with or without trauma. Key characteristics vary in severity with the size of the tear, but typically include difficulty or an inability to abduct the affected limb or maintain an abducted position against gravity. (Hertling p. 306)

A physical therapist examines a patient diagnosed with "whiplash" following a motor vehicle accident approximately two months ago. Prior to initiating a trial of manual traction the therapist attempts to determine if the patient is an appropriate candidate. Which of the following findings would be considered a contraindication for the specified intervention? 1.Rheumatoid arthritis 2.Cervical hypomobility 3.Headaches 4.Neck pain

1.In patients with rheumatoid arthritis, the disease leads to weakened connective tissue. It would be contraindicated to use stretching techniques on these patients since tissue could become damaged and cause instabilities. Gentle manual traction may be used for pain relief as long as inflammation is not present. (Michlovitz p. 188)

A physical therapist receives orders to perform ambulation activities with a female patient status post total knee arthroplasty. The therapist reads in the patient's medical chart that her hemoglobin value from a recent laboratory report is 7.8 gm/dL. What is the MOST appropriate level of activity for the patient? 1.No physical activity 2.Slow ambulation 3.Low-level resistive exercises 4.There is no restriction to physical activity

1.Individuals with a hemoglobin level less than 8 gm/dL should not participate in exercise. (Fairchild p. 279)

4. A physical therapist prepares to apply a pneumatic intermittent compression device to a patient diagnosed with venous insufficiency. When applying the device to an extremity, what should the therapist NOT set the pressure of the unit above? 1.Patient's diastolic blood pressure 2.Patient's systolic blood pressure 3.Difference between the patient's diastolic and systolic blood pressure 4.Patient's resting heart rate

1.It is recommended that inflation pressure not exceed a patient's diastolic blood pressure since higher pressures may impede arterial circulation. However, inflation pressures must be at least 30 mm Hg, as pressures below this level will not likely affect circulation. (Cameron p. 407)

A therapist examines a 58-year-old patient who is recovering from a humeral neck fracture. The therapist determines that all passive and active movements of the shoulder joint are moderately restricted. Which of the following mobilization techniques would be the MOST appropriate to improve the patient's lateral rotation? 1.Anterior gliding of the head of the humerus on the glenoid fossa 2.Posterior gliding of the head of the humerus on the glenoid fossa 3.Inferior gliding of the head of the humerus on the glenoid fossa 4.Superior gliding of the head of the humerus on the glenoid fossa

1.Lateral rotation of the shoulder facilitates the humerus to move in a posterior direction. Therefore, the mobilization should be directed anteriorly. Posterior gliding of the humerus may be used to increase flexion or medial rotation. Inferior gliding of the humerus may be used to increase abduction. Superior gliding of the humerus is not usually performed since adduction is a movement which is rarely limited. Additionally, there is bony obstruction (i.e., acromion and clavicle) which would prevent the humerus from being mobilized in a superior direction. (Kisner p. 134)

A physical therapist employed in an acute care hospital works with a patient three days status post abdominal surgery. While working bedside with the patient on lower extremity exercises in supine, the patient complains of mild dizziness, fatigue, and nausea. What is the MOST immediate physical therapist action? 1.Take the patient's vital signs 2.Assist the patient to a sitting position 3.Contact the supervising physical therapist 4.Call a code

1.Physical therapists should recognize common signs and symptoms associated with potentially emergent conditions. This patient's symptoms are not unexpected; by taking the patient's vital signs, further objective data can be obtained to clarify if assistance is needed. (Fairchild p. 50)

A physical therapist observes an infant positioned in prone with arms outstretched and a lateral trunk bend. Which component of the developmental sequence is the infant BEST exhibiting? 1.Pivot prone 2.Prone on elbows 3.Modified plantigrade 4.Hooklying rotation

1.Pivot prone is exhibited when the infant is in prone with extension of the neck, spine, and hips as well as retraction of the scapulae with lateral rotation of the shoulders. The infant in the picture is demonstrating the pivot prone position with the arms in a high guard position. Typically, the infant develops the ability to perform pivot prone at approximately five months of age. This activity develops scapular and pelvic mobility. (Tecklin p. 34)

A 23-year-old male sustains serious burns to over 30% of his body in a house fire. The burns range from superficial partial-thickness to full-thickness and encompass the majority of the patient's lower extremities. What is the MOST appropriate therapeutic position for the patient? 1.Supine with the knees extended and the toes pointing toward the ceiling 2.Prone with a pillow placed on the dorsum of the feet and ankles 3.Sidelying with the hips and knees slightly flexed using pillows between the legs 4.Hooklying with a pillow placed between the knee

1.Positioning the patient in supine with the knees extended and the toes pointing toward the ceiling maintains the hips, knees, and ankles in an optimal position and therefore reduces the likelihood of lower extremity contracture. (Goodman - Pathology p. 442)

During an examination, a physical therapist determines that an adult patient's respiratory rate is 30 breaths per minute. What is the FIRST intervention the therapist should perform to help the patient slow his respiratory rate? 1.Pursed-lip breathing 2.Inspiratory hold 3.Diaphragmatic breathing 4.Active cycle of breathing

1.Pursed lip breathing is often a desirable intervention whenever there is an increase in the respiratory rate and effort of breathing. This intervention can slow respiratory rate and help to relieve dyspnea in some patients. (Hillegass p. 544)

A physical therapist attempts to assess a patient's protective sensation in their right foot. The therapist believes the patient is at significant risk for developing a neuropathic ulcer due to poor circulation and a long standing history of diabetes. Which equipment would be the MOST desirable when assessing the patient's sensory integrity? 1.Semmes-Weinstein monofilaments 2.Cotton ball 3.Pin with a sharp and blunt end 4.Test tubes filled with warm and cool water

1.Semmes-Weinstein monofilaments are a valid and reliable method of assessing protective light touch sensation. Monofilaments are applied perpendicular to the area being assessed with enough pressure to cause a "C" shaped deformation in the filament. The testing protocol states that contact should be applied for one second. (Sussman p. 337)

A 19-year-old male rehabilitating from a tibia fracture sustained in a motor vehicle accident is referred to physical therapy. The patient demonstrates loss of active dorsiflexion and a high stepping gait in which he raises his foot higher than necessary and suddenly brings it down producing a "slapping" sound. What is the MOST likely rationale for the patient's current condition? 1.Severing of the common peroneal nerve 2.Anterior compartment syndrome 3.Hip flexor weakness 4.Calcaneal spurring

1.Severing the peroneal nerve would cause foot slap and dragging of the toe during gait, which would result in a compensatory high-stepping gait pattern. (Brody p. 555)

A physical therapist has been given an assignment by his supervisor to determine the effectiveness of ultrasound for musculoskeletal pathologies. When searching the available databases, which type of study would provide the highest level of evidence? 1.Systematic review of randomized controlled trials 2.Individual randomized controlled trial with a narrow confidence interval 3.Systematic review of case-control studies 4.Systematic review of cohort studies

1.Systematic reviews of randomized controlled trials are considered the highest level of evidence for information about interventions. (Portney p. 361)

A physical therapist completes an initial examination of a patient diagnosed with complete C7 tetraplegia. As part of the clinical documentation, the therapist classifies the patient using the American Spinal Injury Association Impairment Scale. Based on this scale, which degree of impairment would be MOST consistent with this patient's medical diagnosis? 1.A 2.B 3.C 4.D

1.The ASIA degree of impairment "A" is typical of a complete spinal cord injury. This degree is characterized by a full loss of sensory and motor function below the neurological level of injury. (O'Sullivan p. 893)

A physical therapist talks with a mother holding her three-month-old infant. During the conversation the mother loses control of the baby's head, suddenly dropping it into extension. What reflex would this action MOST likely elicit? 1.Moro 2.Grasp 3.Tonic labyrinthine 4.Extensor thrust

1.The Moro reflex is stimulated by a sudden change in the position of the head relative to the trunk. The response is extension and abduction of the arms, hand opening, and crying, followed by flexion and adduction of the arms across the chest. The response begins at 28 weeks of gestation and is typically integrated between five and six months of age. (O'Sullivan p. 177)

A patient with complete C6 tetraplegia is learning how to perform a wheelchair to mat transfer. Which of the following muscles can effectively lock the patient's elbows during the transfer? 1.Anterior deltoids 2.Biceps 3.Triceps 4.Latissimus dorsi

1.The anterior deltoids are innervated by the C5 nerve root and assist with shoulder flexion. With appropriate hand placement in a weight bearing position, shoulder flexion can functionally lock the elbow in extension. (O'Sullivan p. 921)

A 45-year-old female that has recovered from an extended illness is referred to physical therapy for home exercise program instruction. Which of the following accurately describes the benefits of aerobic exercise? 1.Increased stroke volume, decreased blood pressure, and decreased blood cholesterol 2.Decreased resting pulse rate, increased triglycerides, and increased cardiac output 3.Increased resting pulse rate and decreased exercise threshold for accumulation of lactate in the blood 4.Increased high density lipoprotein cholesterol, decreased body fat, and decreased stroke volume

1.The benefits of exercise include increased stroke volume, decreased blood pressure, and decreased blood cholesterol. (Kisner p. 251)

A physical therapy plan of care includes ultrasound to the insertion of the biceps femoris tendon. What is the MOST appropriate area for the therapist to sonate? 1.Slightly proximal to the fibula head 2.Slightly proximal to the pes anserine region 3.Slightly proximal to the tibial tuberosity 4.Slightly distal to the popliteal fossa

1.The biceps femoris inserts on the lateral side of the head of the fibula. It would be appropriate to sonate just proximal to this site if trying to target the biceps femoris tendon. (Kendall p. 419)

A physical therapist receives a referral for a 48-year-old male with shoulder pathology. The physical therapy examination indicates that the drop arm test was positive, however magnetic resonance imaging had earlier confirmed that the rotator cuff was not torn. Which condition would be MOST likely to produce the objective finding? 1.Axillary nerve palsy 2.Multidirectional instability 3.Thoracic outlet syndrome 4.Bell's palsy

1.The deltoid acts as a primary abductor of the shoulder and is innervated by the axillary nerve, originating from C5-C6 and the brachial plexus. Paralysis resulting from axillary nerve palsy can result in a positive drop arm test. (Magee p. 283)

As part of a reassessment for a patient with a Colles' fracture, a physical therapist measures wrist range of motion. The therapist positions the patient in sitting with the involved extremity supported on a treatment plinth. To measure wrist ulnar deviation, what should the movable arm of the goniometer be aligned with? 1.Third metacarpal 2.Capitate 3.Triquetrum 4.Radial styloid process

1.The dorsal midline of the third metacarpal should be used to align the movable arm of the goniometer when measuring ulnar deviation. (Norkin p. 124)

A collegiate lacrosse player sustains a knee injury during a game. The team's physical therapist suspects that the patient may have sustained a grade III sprain of the anterior cruciate ligament. Which special test would be the MOST appropriate to assess the anterolateral instability of the injured knee? 1.Lateral pivot shift test 2.Bounce home test 3.Varus stress test 4.Lachman test

1.The lateral pivot shift test combines a medially rotated tibia position with an applied valgus force to the knee in order to specifically assess anterolateral rotational instability of the knee. This test is often used as part of the examination of a patient with a suspected ACL injury. (Magee p. 823)

. A physical therapist administers a survey at a community health fair to identify individuals at risk for osteoporosis. Which of the following items would be MOST closely associated with osteoporosis? 1.Early menopause 2.Obesity 3.African American race 4.High bone mineral density

1.The onset of menopause prior to the age of 40 is characterized as early menopause. Women experiencing early menopause are at a significantly greater risk for developing osteoporosis. (Goodman - Pathology p. 1159)

A physical therapist and a physical therapist assistant employed in a rehabilitation hospital begin to focus on discharge planning for a patient with a spinal cord injury. Which statement BEST describes the appropriate role of the two health care providers? 1.Have the physical therapist assistant participate in discharge activities, however, have the physical therapist complete the discharge summary 2.Have the physical therapist assistant participate in discharge activities and complete the discharge summary 3.Have the physical therapist complete discharge activities, however, have the physical therapist assistant complete the discharge summary 4.Have the physical therapist complete all activities associated with discharge including the discharge summary

1.The physical therapist assistant can be involved in discharge activities, however, the discharge summary should be completed by the physical therapist. (Guide to Physical Therapist Practice)

A physical therapist works with a female patient who is in her third trimester of pregnancy. The patient complains of persistent low back pain, radiating from the sacrum to the hip joint along the sciatic nerve distribution. The therapist determines that tightness in the right piriformis muscle is contributing to the patient's discomfort. In order to stretch the muscle, the patient should be positioned on the patient's left side with the affected hip in what position? 1.Medial rotation and adduction 2.Lateral rotation and adduction 3.Medial rotation and abduction 4.Lateral rotation and abduction

1.The piriformis assists in laterally rotating and abducting the thigh, therefore stretching would be performed in the directions of medial rotation and adduction. Tightness or spasm in the piriformis can compress the sciatic nerve causing pain in the described distribution along the low back and buttocks. (Kendall p. 453)

A note in the medical record indicates that a patient acquired a staphylococcus aureus infection in the hospital following spinal surgery. The patient is instructed to remain on a low dose oral antibiotic despite already completing 35 days of intravenous antibiotic therapy. Which surgical scenario is MOST consistent with this scenario? 1.The surgical procedure utilized internal fixation 2.The surgical procedure utilized healing by primary intention 3.The surgical procedure included postoperative immobilization 4.The surgical procedure required overnight hospitalization

1.The presence of internal fixation significantly increases the complexity of staphylococcus aureus infection. This occurs since the bacteria binds with the metals and alloys used in internal fixation devices (e.g., wires, pins, plates, screws). In some cases, the internal fixation is removed, while in other cases it remains and the patient is prescribed a long term, low dose antibiotic. (Goodman - Pathology p. 336)

A physical therapist treats a patient recently admitted to an acute care hospital after being diagnosed with Guillain-Barre syndrome. Which of the following MOST accurately represents the condition's typical prognosis? 1.The majority of patients will experience a full recovery 2.The majority of patients will experience significant residual deficits 3.The majority of patients will not experience any functional return 4.The majority of patients will experience lethal complications

1.The reported percentage of patients diagnosed with Guillain-Barre syndrome who fully recover varies somewhat among studies. However, studies consistently report that between 60% and 75% of patients will experience a full recovery. (Goodman - Pathology p. 1623)

A physical therapist administers an ultrasound treatment to the low back of a patient recently referred to physical therapy. During the treatment the patient suddenly complains of "hot spots" directly under the ultrasound transducer. Which ultrasound parameters are MOST likely to produce this type of subjective complaint? 1.Stationary technique, high beam nonuniformity ratio 2.Dynamic technique, low beam nonuniformity ratio 3.Stationary technique, low beam nonuniformity ratio 4.Dynamic technique, high beam nonuniformity ratio

1.The stationary technique encourages the occurrence of painful hot spots due to the lack of movement of the soundhead. A high BNR results in a greater intensity of the highest peaks and increases the probability that patients will experience painful hot spots. (Prentice p. 372)

A 35-year-old female is referred to physical therapy for rehabilitation after sustaining an injury to her left knee and lower leg in an automobile accident six weeks ago. Sensory evaluation revealed some loss of superficial tactile sensation over the posterolateral aspect of the lower leg and lateral portion of the foot. What peripheral nerve would MOST likely be involved? 1.Sural nerve 2.Lateral plantar nerve 3.Common fibular (peroneal) nerve 4.Saphenous nerve

1.The sural nerve is a branch of the tibial nerve which supplies sensation to the posterolateral aspect of the lower leg and lateral portion of the foot (Magee p. 946)

A physical therapist works with a patient who sustained a closed tibia fracture. The patient was non-weight bearing and casted for six weeks prior to being referred to physical therapy. As part of a treatment session the therapist explains how resistance training will increase the patient's knee extensor strength. From a physiological perspective, which description BEST explains the anticipated change in strength? 1.Hypertrophy of muscle fibers causing an increase in the cross sectional area of the muscle 2.An increase in the number of active muscle fibers 3.Splitting of current muscle fibers 4.An increase in the bone density of the femur and tibia

1.The tension-producing capacity of a muscle is directly related to its cross-sectional area. An increase in the size of individual muscle fibers (i.e., hypertrophy) leads to an increase in the cross-sectional area of the muscle. (Kisner p.168)

A patient who received iontophoresis during his last physical therapy session indicates that his skin under one of the electrodes stayed red for approximately two hours after the treatment. Documentation from the session indicates that the therapist used a current amplitude of 3.0 milliamperes for 10 minutes. Based on the patient's subjective report, what should the therapist do? 1.Continue with the present treatment 2.Decrease the current amplitude 3.Decrease the treatment duration 4.Select a different therapeutic ion

1.The therapist should continue with the previously used parameters since the patient's response to treatment was considered to be normal. (Cameron p. 272)

A physical therapist designs a research study that examines the influence of a selected training program on cardiovascular endurance. The therapist determines it will be necessary to utilize a control group. What is the PRIMARY purpose of the control group? 1.Serve as a baseline for controlling the effects of the manipulated variable 2.Function to minimize the probability of a Type I error 3.Eliminate the need for a systematic random sample 4.Ensure reliability and validity of collected data

1.The use of a control group is the most effective experimental design for establishing a cause and effect relationship between a treatment (independent variable) and response (dependent variable). (Portney p. 164)

A physical therapist instructs a new mother in stretching and positioning techniques to assist in correcting her infant's congenital torticollis. What MOST likely caused the infant's condition? 1.Breech delivery 2.Premature birth 3.Genetic predisposition 4.Maternal birthing position

1.The use of forceps or manual traction is often required to assist a breech delivery, further increasing the risk of traction to the cervical spine and trauma to the sternocleidomastoid muscle. There is a notable prevalence of congenital torticollis associated with breech deliveries. (Tecklin p. 430)

A physical therapist prepares to write a S.O.A.P. note after performing gait training activities with a patient status post total hip arthroplasty. In which section should the statement "I'm getting a little dizzy, I better sit down" be included? 1.Subjective 2.Objective 3.Assessment 4.Plan

1.This statement should be included in the subjective section of the S.O.A.P. note. The subjective section contains any statements or reports made by the patient or the patient's caregivers. (Disagree: 3- Assessment includes patient response to interventions.) (Quinn p. 134)

A physical therapist treats a patient diagnosed with central cord syndrome following a motor vehicle accident. Which mechanism of injury is MOST often associated with the diagnosis? 1.Hyperextension of the cervical spine 2.Hyperflexion of the cervical spine 3.Axial loading of the cervical spine 4.Compression of the cervical spine

1.Traumatic cervical hyperextension is most commonly associated with central cord syndrome. The resultant injury typically involves the spinothalamic tract, corticospinal tract, and dorsal columns. (O'Sullivan p. 894)

A physical therapist examines a two-month-old infant with suspected hip dysplasia. The therapist positions the patient in supine with the hips and knees flexed and moves the lower extremity into abduction using gentle pressure which creates an audible clunking sound. What is the interpretation of this maneuver? 1.A positive Ortolani test 2.A positive Clarke's sign 3.A negative Barlow test 4.A negative tripod sign

1.When performing the Ortolani test, the patient is positioned in supine with the hips flexed to 90 degrees and the knees flexed. The therapist abducts the patient's hips and applies gentle pressure to the greater trochanters until resistance is felt at approximately 30 degrees. A positive test is indicated by a click or a clunk and may be indicative of a dislocation being reduced. (Campbell p. 426)

A physical therapist uses electromyographic biofeedback to improve a patient's ability to recruit the vastus medialis obliquus muscle. After initiating the intervention the therapist observes that the patient is unable to generate the anticipated level of audio and visual activity on the biofeedback unit. What is the MOST appropriate therapist action? 1.Modify the location of the surface electrodes 2.Increase the size of the surface electrodes 3.Remove oil and dead skin from the target area using an alcohol prep pad 4.Select a more conservative strengthening intervention

1.When using electromyographic biofeedback the electrodes must be placed as close as possible to the muscle being monitored. Failure to achieve appropriate electrode placement can result in inadequate audio and/or visual activity as well as an increase in extraneous electrical activity. Prentice p. 208

A female patient who is status post stroke is working on ambulation in physical therapy. The patient has good sensation and her strength is within functional limits. When walking in the community, the patient is able to walk up stairs with supervision. Yet, when the patient practices this same task in the therapy gym, the patient is unable to complete the activity. Which of the following BEST describes this difficulty? 1.Ideomotor apraxia 2.Impaired body schema 3.Impaired problem solving 4.Ideational apraxia

1.With ideomotor apraxia, the patient is able to perform a task automatically, but cannot do so on command. This option is consistent with the described scenario since the patient can climb stairs in the community, but is unable to do so when practicing the task in the therapy gym. (Shumway-Cook p. 134)

A physical therapist examines a patient diagnosed with suspected arterial occlusive disease. The therapist identifies a number of findings consistent with the diagnosis including absent femoral pulse, dependent rubor, and intermittent claudication in the buttocks, hamstrings, and calf muscles. What is the MOST likely site of occlusion? 1.Iliac artery 2.Femoral artery 3.Popliteal artery 4.Tibial artery

1.With occlusion of the iliac artery, the femoral pulse and all distal pulses are absent. Claudication is felt in the buttock, hip, thigh, calf, and foot. (Goodman - Pathology p. 618)

A physical therapist receives orders to treat a patient in an acute care hospital. The medical record indicates that health care providers need to utilize contact precautions when treating the patient. What is the MOST relevant laboratory finding associated with the need to use contact precautions? 1.Decrease in white blood cell count 2.Increase in white blood cell count 3.Decrease in hematocrit 4.Increase in hematocrit

2. An increased white blood cell count often indicates the presence of infection. The therapist may be required to use contact precautions during treatment to protect both the therapist and the patient. (Goodman - Pathology p. 1649)

A physical therapist reviews the results of a patient's recent pulmonary function test prior to initiating an aerobic conditioning program. Which of the following is MOST consistent with the anticipated findings associated with restrictive lung disease? 1.Increased residual volume, increased total lung capacity 2.Decreased residual volume, decreased total lung capacity 3.Increased residual volume, decreased total lung capacity 4.Decreased residual volume, increased total lung capacity

2. Decreased RV and TLC are characteristic of restrictive lung disease. Patients are unable to fully inflate the lungs mechanically, reducing TLC and the volumes of the individual components that combine to form TLC (e.g., RV). (Hillegass p. 138)

A physical therapist reviews the results of blood glucose testing for a patient with diabetes mellitus. Which value would be MOST representative of the anticipated normal blood glucose value prior to eating a meal? 1. 60 mg/dL 2. 90 mg/dL 3. 160 mg/dL 4. 250 mg/dL

2. The anticipated blood glucose level for a patient before a meal (preprandial) is 70-130 mg/dL. A value of 90 mg/dL would fall within the specified range (Goodman - Pathology p. 498)

A patient experiences left lower extremity sciatica secondary to posterior derangement of the L5 disk. The patient tolerated a prone on elbows position without an increase in symptoms, however, after performing 10 prone press-ups the patient reports increased radicular pain in the left lower extremity. What would be the physical therapist's MOST appropriate response? 1.Instruct the patient to assume a prone position 2.Instruct the patient to assume a prone on elbows position 3.Instruct the patient to assume a standing extension position 4.Discontinue the extension progression

2. The prone press-up position may have been initiated prematurely. Returning to the non-exacerbating prone on elbows position should assist the therapist to determine how to best proceed with the patient's care (e.g., more time accommodating to prone on elbows position or discontinuing the extension progression). (Brody p. 402)

A special test confirms the presence of a sensory disturbance affecting the fourth and fifth digits of the hand. What form of testing would MOST likely have been used to generate the positive test? 1.Resisted testing 2.Tapping 3.Joint mobility testing 4.Reflex testing

2. Tinel's sign requires the therapist to tap with the index finger between the olecranon process and the medial epicondyle. A positive test is indicated by a sensory disturbance in the ulnar nerve distribution. (Magee p. 474)

A physical therapist examines a patient diagnosed with an avulsion fracture of the left anterior superior iliac spine. What is the MOST likely scenario associated with this diagnosis? 1.A 14-year-old soccer player who experienced a forceful contraction of the rectus femoris 2.A 13-year-old basketball player who experienced a forceful contraction of the sartorius 3.A 22-year-old sprinter who experienced a forceful contraction of the hamstrings 4.A 40-year-old hockey player who experienced a direct blow to the ilium

2.A 13-year-old athlete is in a high-risk population for an avulsion fracture and the sartorius originates on the anterior superior iliac spine. An avulsion fracture commonly occurs with vigorous athletic activities, such as basketball, which requires rapid acceleration and deceleration. (Kendall p. 424)

A patient diagnosed with temporomandibular joint pain is referred to physical therapy. During the examination, the patient demonstrates a kyphotic, forward head posture. What is this position MOST likely to result in? 1.Anterior displacement of the mandible 2.Posterior displacement of the mandible 3.Lateral displacement of the mandible 4.Posterior displacement of the maxilla

2.A forward head posture creates passive tension in selected suprahyoid and infrahyoid muscles which affects the resting posture of the mandible. The result is a posterior displacement of the mandible. (Dutton p. 1122)

A physical therapist examines a patient with a venous ulcer on the medial side of her lower leg. The therapist observes that the ulcer penetrates through the subcutaneous tissue partially exposing several tendons. Using Wagner's Ulcer Grade Classification Scale, what is the MOST appropriate grade for this ulcer? 1.Grade 1 2.Grade 2 3.Grade 3 4.Grade 4

2.A grade of 2 is indicative of a deep ulcer with penetration through the subcutaneous tissue; potentially exposing bone, tendon, ligament or joint capsule. A grade of 1 is indicative of a superficial ulcer not involving the subcutaneous tissue. A grade of 3 is indicative of a deep ulcer with osteitis, abscess or osteomyelitis. A grade of 4 is indicative of the presence of gangrene in a digit. (Goodman - Pathology p. 443)

A physical therapist works with a patient recovering from surgery on gait activities on a level surface. Which value represents the MAXIMUM amount of knee flexion required to complete the described activity? 1.0-90 degrees 2.0-60 degrees 3.0-30 degrees 4.0-20 degrees

2.A patient requires 0-60 degrees of knee flexion with gait on a level surface. The greatest amount of knee flexion is required from the initial swing to midswing. (O'Sullivan p. 257)

A physical therapist assesses a patient who recently sustained a spinal cord injury. The patient exhibits a normal patellar tendon reflex, but the Achilles tendon reflex is completely absent. Which spinal cord injury classification is MOST likely? 1.L1 paraplegia 2.L4 paraplegia 3.L2 paraplegia 4.S2 paraplegia

2.A patient with L4 paraplegia would have an intact patellar tendon reflex since the last level of intact innervation would be L4 and the reflex is innervated at the L3-L4 level. The Achilles reflex would be absent. (O'Sullivan p. 175)

A 21-year-old male has a complete spinal cord injury at the L2 level. The patient is independent with wheelchair use and has returned to independent living in the home and community. The patient is otherwise healthy and expresses a desire to begin gait training. What is the PRIMARY goal of gait training for this patient? 1.Stand daily in a standing frame for weight bearing 2.Ambulate within his home environment with knee-ankle-foot orthoses 3.Ambulate within the home and community with knee-ankle-foot orthoses 4.Ambulate within the home and community with ankle-foot orthoses

2.A patient with an L2 spinal cord injury could realistically ambulate short distances (i.e., household distances) with bilateral knee-ankle-foot orthoses (KAFOs) and an assistive device (e.g., walker, crutches). (O'Sullivan p. 925)

A physical therapist uses a handheld dynamometer to measure the grip strength of a patient rehabilitating from a work related accident. The patient has been in physical therapy for four weeks and should be able to return to work in approximately two weeks. After the treatment session the therapist records in the patient's chart that grip strength varied by approximately 25% in a test-retest situation. What is the MOST plausible hypothesis? 1.The patient is susceptible to fatigue 2.The patient is not exerting maximal effort 3.The patient experienced an increase in pain with repeated muscle contraction 4.The patient sustained an exacerbation of the original injury

2.A relatively large discrepancy in force production (over 20%) in a test-retest situation is often an indication that the patient is not exerting maximal effort. On occasion, patients may attempt to manipulate this form of objective measure in order to secure or reinforce secondary gains. (Magee p. 453)

A physical therapist completes a positional assessment of a patient's pelvis and sacrum. Which objective finding BEST supports the presence of a right anteriorly rotated innominate? 1.Left posterior superior iliac spine superior to the right posterior superior iliac spine 2.Right posterior superior iliac spine superior to the left posterior superior iliac spine 3.Right anterior superior iliac spine superior to the left anterior superior iliac spine 4.Left anterior superior iliac spine inferior to the right anterior superior iliac spine

2.A right PSIS which is superior to the left PSIS is characteristic of a right anteriorly rotated innominate. It could also be characteristic of a left posteriorly rotated innominate. (Hertling p. 950)

A physical therapist prepares to apply a triangular bandage to a patient. Which medical diagnosis would be the MOST likely based on the type of bandage utilized? 1.Lymphedema 2.Shoulder subluxation 3.Transtibial amputation 4.Lateral ankle sprain

2.A shoulder subluxation involves a temporary, partial dislocation of the shoulder. The injury may result in significant pain and difficulty actively moving the arm. As a result, immobilization using a triangular bandage may be desirable. (Fairchild p. 334)

A physical therapist examines the skin of a 42-year-old patient diagnosed with multiple sclerosis. The therapist identifies a pressure ulcer approximately two centimeters in diameter near the patent's left ischial tuberosity. The ulcer looks like an abrasion and appears to involve the entire epidermis. Which ulcer stage is MOST consistent with the described clinical presentation? 1.I 2.II 3.III 4.IV

2.A stage II pressure ulcer is described as partial-thickness skin loss involving the epidermis or dermis. The superficial ulcer often presents clinically as a blister, abrasion or shallow crater. The scenario described refers to a stage II pressure ulcer. A stage I pressure ulcer is described as a relative alteration of intact skin. This may appear as a change in skin color, temperature, stiffness or sensation as compared to adjacent tissues. A stage III pressure ulcer is described as full-thickness skin loss extending to, but not through the fascia that underlies the subcutaneous tissue. The ulcer will typically present as a deep crater and may include necrosis or undermining. A stage IV pressure ulcer is described as full-thickness skin loss with extensive tissue destruction that extends to muscle, bone or other supporting structures and includes significant necrosis. (Goodman - Pathology p. 444)

A physical therapist completes crutch training with a patient who has recently sustained an Achilles tendon rupture. The patient comments that he is trying to decide between undergoing surgical repair of the tendon or pursuing conservative treatment. Which statement is MOST accurate with regard to anticipated outcomes? 1.Surgically managed ruptures typically result in the achievement of higher functional levels and an increased incidence of reinjury. 2.Surgically managed ruptures typically result in the achievement of higher functional levels and a decreased incidence of reinjury. 3.Conservatively managed ruptures typically result in the achievement of higher functional levels and an increased incidence of reinjury. 4.Conservatively managed ruptures typically result in the achievement of higher functional levels and a decreased incidence of reinjury.

2.A surgically managed Achilles tendon rupture will typically allow patients to maximize function while diminishing the risk of reinjury. (Kisner p. 876)

. A physical therapist participates in a sports medicine screening clinic at a local recreational facility. During the clinic, the therapist identifies and makes recommendations for individuals at risk for injuries. Which individual would be at the GREATEST risk for sustaining an Achilles tendon rupture? 1.A 38-year-old female who runs with a track club three nights a week 2.A 45-year-old male who plays competitive tennis once a week 3.A 32-year-old female who plays in a softball game every other weekend 4.A 23-year-old male who plays in a pick-up basketball game once a month

2.Achilles tendon ruptures are most prevalent among males between the ages of 30 and 50 who exercise inconsistently (e.g., "weekend warriors"). Racquet sports are frequently associated with Achilles tendon injuries since the activity requires frequent and sudden changes in direction as well as rapid acceleration. (Dutton p. 1012)

A 70-year-old male status post right hip fracture is referred to physical therapy for gait training. The physician has ordered the patient to remain non-weight bearing on the right lower extremity for four weeks. What is the MOST appropriate gait training method? 1.Ambulation with bilateral crutches and a four-point gait pattern 2.Ambulation with a walker and a three-point gait pattern 3.Ambulation with a single point cane and a three-point gait pattern 4.Ambulation with a quad cane and a three-point gait pattern

2.Ambulation with a walker and a three-point gait pattern is the most appropriate choice for this patient. A walker provides maximal stability and allows the patient to ambulate while maintaining the prescribed non-weight bearing status. A walker also requires minimal coordination to use. A three-point gait pattern is most appropriate since it allows the patient to bear full weight on one lower extremity while maintaining non-weight bearing on the opposite lower extremity. (Fairchild p. 228)

A physician discusses the impact of increased afterload on a patient's current cardiac status. Which statement is MOST accurate when describing afterload? 1.Afterload is directly proportional to stroke volume. 2.Afterload is inversely proportional to stroke volume. 3.Afterload is directly proportional to heart rate. 4.Afterload is inversely proportional to heart rate.

2.An increase in the volume of blood ejected per beat (i.e., stroke volume) would result in a decreased afterload. As a result, the measures are inversely proportional. (Hillegass p. 44)

A physical therapist assists a member of the nursing staff to measure the ankle-brachial index (ABI) of a patient recently admitted to the hospital due to complications from diabetes. After conducting the measurement the ABI is determined to be 1.44. What is the MOST likely interpretation of the test? 1.The patient has moderate arterial insufficiency 2.The patient has arterial calcification 3.The patient has superior peripheral tissue perfusion 4.The patient's ABI is within normal limits

2.Arterial calcification is commonly seen in patients with diabetes. When measuring the ABI, the calcification makes it more difficult to compress the arteries resulting in falsely high ABI measurements. ABI values over 1.4 generally indicate that arterial calcification is present. (Goodman - Pathology p. 622)

A 30-year-old female is seen in physical therapy secondary to benign paroxysmal positional vertigo. Which of the following physical therapy treatments would MOST benefit this patient? 1.Dix-Hallpike maneuver 2.Canalith repositioning maneuvers 3.Singular neurectomy 4.Gaze stability exercises

2.Canalith repositioning maneuvers are a highly effective treatment for BPPV and are designed to dislodge the provoking canaliths. This treatment technique attempts to move the canalith debris out of the affected semicircular canal and back to the otolith. Canalith repositioning maneuvers begin in the Dix-Hallpike position to provoke vertigo. Repeated head rolling utilizes gravity to assist with movement of the debris. Treatment continues until no further nystagmus is noted. (Goodman-Pathology p. 1577)

A physical therapist treats a patient status post open reduction internal fixation secondary to a hip fracture. While preparing to transfer the patient, the therapist notes that the calf on the surgical side is swollen and extremely warm to touch. The patient complains of pain in the calf with passive dorsiflexion and reports mild discomfort to light touch. What is the MOST likely explanation? 1.Compartment syndrome 2.Deep vein thrombosis 3.Infection 4.Peroneal nerve palsy

2.Deep vein thrombosis is a common post-operative complication associated with limited functional mobility and diminished gastrocnemius muscle pumping activity. The described symptoms are considered hallmark signs of a deep vein thrombosis and should be reported immediately to a physician for further assessment and intervention. (Paz p. 241)

A patient is shown an x-ray that identifies the area of the spine impacted by a recently diagnosed herniated disk [arrow pointing to vertebral body of C6]. Assuming the arrow identifies the spinal segment involved, which of the following would be the MOST typical finding during the examination? 1.Impaired triceps reflex 2.Diminished strength of the wrist extensors 3.Diminished sensation along the medial arm and forearm 4.Paresthesias in the index, long, and ring fingers

2.Diminished strength of the wrist extensors is characteristic of involvement of the C6 (and rarely the C7) nerve root. (Magee p. 24)

A physical therapist designs an exercise program for a patient diagnosed with a lower motor neuron lesion. The patient often exhibits a short attention span and when fatigued the therapist has noted a sharp drop off in performance. What type of practice would be the MOST appropriate based on the patient's current status? 1.Massed 2.Distributed 3.Random 4.Blocked

2.Distributed practice is defined as a session in which the amount of rest between trials is equal to or greater than the amount of practice time in a trial. Since the patient has a short attention span and a drop in performance with fatigue, this type of practice would be the most appropriate. Massed practice is defined as a session in which the amount of practice time in a trial is greater than the rest between trials. This type of practice can lead to fatigue and would not be appropriate for this patient. Blocked practice refers to the order in which different tasks are performed. With blocked practice, one task is practiced several times before moving on to the next task. The order in which the tasks are practiced will have no effect on a patient's attention span or fatigue level. Random practice refers to the order in which different tasks are performed. With random practice, the order in which different tasks are performed is variable. The order in which the tasks are practiced will have no effect on a patient's attention span or fatigue level. (Shumway-Cook p. 36)

A physical therapist administers the rubor of dependency test to a patient with known peripheral arterial disease. With the patient in supine, the physical therapist passively elevates the patient's leg 45 degrees and maintains the position for one minute. What is the MOST likely observation? 1.Mild blanching on the plantar aspect of the foot 2.Dramatic blanching on the plantar aspect of the foot 3.Dark redness on the plantar aspect of the foot 4.Normal coloration on the plantar aspect of the foot

2.Dramatic blanching on the plantar aspect of the foot would be the anticipated response with the leg elevated based on the history of peripheral arterial disease. Elevation of the leg increases pressure on an already compromised arterial system. (Hillegass p. 322)

A physical therapist examines the lower extremity of a patient with a transtibial amputation. During the examination the therapist determines the patient has weak (2/5) adductors and normal (5/5) abductors. Based on the patient's clinical presentation, what position might the lower extremity tend to favor in standing? 1.Adduction 2.Abduction 3.Adduction and lateral rotation 4.Abduction and medial rotation

2.Due to the relative strength of the abductors in relation to the adductors, the lower extremity would tend to assume an abducted position. (Kendall p. 433)

A 16-year-old female athlete is referred to physical therapy with a diagnosis of Osgood-Schlatter syndrome. Which anatomical variation in females contributes to an increased incidence of the condition when compared to males? 1.Decreased Q angle 2.Increased femoral anteversion 3.Genu varus 4.Decreased pronation

2.Femoral anteversion refers to the angle of medial femoral torsion. In adults, the normal range of femoral anteversion is 8 to 15 degrees. Normal anteversion approximates 8 degrees in males and 15 degrees in females. This difference can significantly impact the angle of quadriceps force and influence the amount of stress on the tibial tubercle. (Dutton p. 1414)

A physical therapist administers grade I and II oscillatory mobilizations to the left shoulder of a patient after completing a series of upper extremity resistive exercises. What is the PRIMARY purpose of the intervention? 1.Increase periarticular extensibility 2.Decrease pain 3.Reduce hypomobility 4.Facilitate muscle recruitment

2.Grade I and II mobilizations are used primarily to treat joints limited by pain. By stimulating the mechanoreceptors in the joint, the oscillations help to inhibit the perception of painful stimuli. (Kisner p. 126)

A physical therapist administers air to a patient's lungs using a bag-valve-mask resuscitation device. What is the MOST immediate method to determine if the air is reaching its target area? 1.Identify the extent of pupil dilation 2.Determine if the patient's chest is rising 3.Examine the color of the patient's skin 4.Determine if air is escaping from the patient's nostrils

2.If sufficient ventilation is being provided using the bag-valve-mask, the patient's chest will visibly rise. (Le Baudour p. 160)

A physical therapist determines that a patient rehabilitating from knee surgery has a 10 degree extension lag. What is the MOST plausible rationale for the presence of the extension lag? 1.Tightness of the hamstrings 2.Inhibition of the quadriceps 3.Capsular restriction 4.Bony obstruction

2.Inhibition of the quadriceps is a common rationale for an extension lag. This can occur for a variety of reasons including pain and effusion. Inhibition of the quadriceps limits active knee extension range of motion, however, it would not typically influence passive range of motion. As a result, passive range of motion is typically greater than active range of motion (i.e., extension lag). (Kisner p. 985)

A physical therapist is concerned about the potential for a patient to develop skin breakdown over the sacral and ischial regions. As a result, the therapist closely inspects the patient's skin twice daily during physical therapy treatment. Which of the following is the earliest sign of a pressure ulcer that can be obtained through inspection? 1.Macerated tissue 2.Localized redness 3.Pale or blanched skin 4.Decubitus ulceration

2.Localized redness is often the first sign of a pressure injury which may develop into a pressure ulcer. Based on the Pressure Ulcer Staging System, an area of intact, red skin that does not blanch with pressure would be classified as stage I. (Fairchild p. 295)

A physical therapist works with a patient diagnosed with postural dysfunction who presents with cervical pain and tightness of the upper trapezii. The patient's job requires her to complete a minimum of six hours of data entry on a computer each day. Which modification to the patient's work environment would potentially be the MOST beneficial? 1.Raise the keyboard 2.Lower the keyboard 3.Rest the feet flat on the floor 4.Rest the feet on a foot stool

2.Lowering the keyboard would likely prevent shoulder elevation and place the upper trapezii in a relaxed, lengthened position. (Dutton p. 1156)

A physical therapist works with a 40-year-old male who is status post stroke. The patient reports having difficulty clearing his leg when taking a step. When observing his gait, it is clear that the patient advances his leg by hip hiking. Which of the following activities would be the MOST beneficial to improve the patient's motor control during swing? 1.Stretching of the gastrocnemius 2.Marching in place when standing 3.Slow rotation of the leg to reduce extensor spasticity 4.Prone knee bends

2.Marching in place while standing would be the most appropriate intervention for this patient. The scenario does not state why the patient has difficulty clearing his leg during gait. Marching addresses all muscles involved in the swing phase of gait. (Shumway-Cook p. 439)

A physical therapist employed in an acute care hospital reviews the function of the autonomic nervous system. Which stimulus causes an increase in heart rate and force of contraction? 1.Neural stimulation by the vagus nerve 2.Neural stimulation by the sympathetic center in the medulla oblongata 3.Increased levels of carbon dioxide in the blood 4.Decrease in blood pH

2.Neural stimulation by the sympathetic division of the ANS increases the heart rate and increases its force of contraction primarily through the beta 1 receptors in the atria, sinoatrial node, atrioventricular node, and ventricles. (Hillegass p. 333)

A patient diagnosed with uterine cancer is referred to physical therapy for general deconditioning associated with a recent hysterectomy and the effects of radiation. During a treatment session, the patient reports that her right ankle has been noticeably more swollen than her left ankle since completing radiation. What is the MOST likely cause of the patient's observation? 1.Right-sided heart failure 2.Secondary lymphedema 3.Left-sided heart failure 4.Cyclic idiopathic edema

2.Oncology interventions including surgery, chemotherapy, and radiation are all known to be potentially disruptive to the lymphatic system. (Goodman - Pathology p. 1034)

A physical therapist advises a patient that she can safely begin performing pelvic floor contractions immediately after an uncomplicated, full-term, vaginal delivery. Which method would be MOST effective to decrease edema and stiffness of the perineal tissues? 1.Muscle strengthening 2.Increased circulation 3.Muscle relaxation 4.Increased sensation

2.Pelvic floor contractions act as a pumping mechanism which increases circulation to the perineal tissues, helping to reduce edema and stiffness while promoting healing. (Brody p. 304)

A patient referred to physical therapy complains of medial knee pain particularly during functional activities. Which condition would MOST likely be associated with pain in this region? 1.Tibial apophysitis 2.Pes anserine bursitis 3.Iliotibial band syndrome 4.Baker's cyst

2.Pes anserine bursitis refers to inflammation of the bursa located at the common insertion of the tendons of the sartorius, gracilis, and semitendinosus muscles on the anteromedial portion of the superior tibia. The bursa separates the conjoined tendons from the surface of the tibia. Patients with pes anserine bursitis typically report pain in the immediate area of the bursa. (Magee p. 858)

A physical therapist participating in a research study gathers subjects that are deliberately selected based on a specific set of predefined criteria established by the parameters of the research study. What is this type of sampling BEST termed? 1.Convenience sampling 2.Purposive sampling 3.Quota sampling 4.Snowball sampling

2.Purposive sampling occurs when subjects are deliberately selected based on predefined criteria chosen by the researcher. Convenience sampling occurs when the sample is selected from subjects who are convenient or readily available to the researcher. Quota sampling occurs when subgroups or strata of interest are identified from the population. The researcher then uses convenience sampling to select the required number of subjects from each stratum. Snowball sampling occurs when existing subjects are asked to identify the names of other potential participants. (Portney p. 155)

A physical therapist treats a female that is 24 weeks pregnant with complaints of pain in the area of the pubic bone. The therapist suspects the pain may be related to the pubic symphysis due to hypermobility associated with pregnancy. What are the hormones MOST likely responsible for the ligamentous laxity? 1.Relaxin and estrogen 2.Relaxin and progesterone 3.Progesterone and estrogen 4.Estrogen and prolactin

2.Relaxin is described in Option 1. Progesterone is a hormone formed by the corpus luteum, placental syncytial cells, and both maternal and fetal adrenal glands. The hormone facilitates relaxation of pelvic ligaments and connective tissue, development and maintenance of the endometrial bed, softening of the cervix, and inhibition of uterine motility. (Cameron - Physical Rehabilitation p. 235)

A physical therapist instructs a physical therapist assistant to perform neuromuscular electrical stimulation to the wrist extensors of a patient rehabilitating from a wrist injury. After setting up the patient according to the specified parameters provided by the physical therapist, the physical therapist assistant believes the muscle contraction produces too much radial deviation and insufficient wrist extension. What is the MOST appropriate physical therapist assistant action? 1.Increase the current intensity 2.Reposition the electrodes 3.Alter the wave form of the current 4.Discuss the situation with the supervising physical therapist

2.Repositioning the electrodes to improve motor recruitment would be the most appropriate option to produce the desired action. Small changes in the location of a surface electrode can significantly influence the quality and direction of movement. (Guide to Physical Therapist Practice)

A physical therapist is treating a patient with a head injury using a proprioceptive neuromuscular facilitation technique to enhance coordination and strength during gait. The therapist has the patient ambulate within the parallel bars while applying resistance to the pelvis during the gait cycle. What does this technique BEST describe? 1.Rhythmic initiation 2.Resisted progression 3.Repeated contractions 4.Hold-relax active movement

2.Resisted progression is a technique used to emphasize coordination of proximal components specifically during gait. Resistance is applied to an area such as the pelvis or hips during the gait cycle in order to enhance coordination, strength or endurance. Resisted progression is a PNF exercise utilized at the skill level of motor control. (O'Sullivan p. 432)

A patient is administered 8,000 units of a nonsteroidal anti-inflammatory drug, which has a half-life of two hours. After six hours, how much of the drug will remain in the patient's system? 1.125 units 2.500 units 3.1,000 units 4.2,000 units

3.If a drug has a half-life of two hours, it would take six hours (or three half-life cycles) to reach 1,000 units. If 8,000 units were administered, there would be 4,000 units left after two hours, 2,000 units left after four hours, and 1,000 units left after six hours. (Ciccone p. 35)

On radiographic imaging a patient has a pelvic angle that is angled 50 degrees anteriorly from the horizontal with the patient in standing. What effect would this MOST likely have on the patient's standing posture? 1.The patient would exhibit normal posture 2.The patient would have an increased lumbar lordotic curve 3.The patient would have a decreased lumbar lordotic curve 4.The patient would have a posteriorly rotated pelvis

2.Since the patient's pelvic angle is greater than 30 degrees, they would tend to assume an abnormal posture characterized by increased lumbar lordosis. (Magee p. 1023)

A physical therapist administers Craig's test to a 14-year-old female in order to quantify the amount of anteversion or retroversion in the patient's right hip. After completing the test the therapist asks the patient to maintain the position while he retrieves a goniometer. What measurement would be MOST consistent with the presented image? 1.5 degrees of anteversion 2.20 degrees of anteversion 3.5 degrees of retroversion 4.20 degrees of retroversion

2.The angle in the image is more consistent with a 20 degree angle (i.e., 20 degrees of anteversion). This also makes sense given the patient's age since she is still an adolescent and her femoral anteversion has not yet decreased to adult values. (Magee p. 711)

A physical therapist examines an x-ray of a patient's left foot using a lateral view. When examining the x-ray, what should the therapist identify as the bone indicated by the arrow? 1.Cuboid 2.Navicular 3.First cuneiform 4.Talus

2.The bone indicated by the arrow is the navicular. The navicular is located on the medial side of the foot and articulates with the three cuneiforms distally, the talus proximally, and the cuboid laterally. (Hoppenfeld p. 203)

A physical therapist designs a research project to examine the efficacy of biofeedback as a treatment for urinary stress incontinence. In preparation for the study, the physical therapist drafts an informed consent document as part of the process for approval to initiate the project at his clinical facility. Which of the following statements would violate the validity of the informed consent document? 1.There is no compensation available from the facility should an injury occur. 2.Participants must complete all the sessions outlined in the study in order to receive physical therapy services for their condition. 3.Participants must contact their own primary care physician in case of injury. 4.Participants may not begin any other new treatment program for the duration of the study.

2.The informed consent must make a statement emphasizing that participation is voluntary. A participant can withdraw from the study at any time. Furthermore, it would be unethical to withhold physical therapy services from a patient based on their decision to withdraw from a study. (Portney p. 57)

A physical therapist examines a patient diagnosed with piriformis syndrome due to spasm. The therapist notes that the patient demonstrates postural and gait abnormalities in an attempt to relieve symptoms while weight bearing. Which abnormality is MOST likely to be observed? 1.Increased stride length during gait 2.Functional leg length discrepancy 3.Internal rotation of the lower extremity 4.Increased lumbar lordosis

2.The muscle tightness associated with piriformis syndrome can cause abnormal alignment and mechanics of the hip and pelvis resulting in a functional shortening of the affected limb. (Hertling p. 246)

A physical therapist treats a patient using pulsed ultrasound at 3 MHz. Which patient scenario would MOST warrant the use of this intervention as part of the plan of care? 1.A 32-year-old male with decreased knee range of motion secondary to tight quadriceps muscles following cast removal 2.A 24-year-old female with patellar tendonitis 3.A 22-year-old male with a chronic hamstrings muscle strain 4.A 42-year-old female with decreased ankle range of motion secondary to a tight gastrocnemius/soleus complex

2.The patellar tendon, also called the patellar ligament, originates on the patella and inserts on the tibial tuberosity. The structure is a flat ligament approximately 10 centimeters in length. The patellar tendon's fibers are relatively superficial along the anterior surface of the knee and therefore would require ultrasound with a frequency of 3 MHz. (Prentice p. 370)

A physical therapist takes a series of measurements in order to secure an appropriate wheelchair for a patient recently admitted to a rehabilitation hospital. What is the MOST appropriate formula to utilize when determining seat depth? 1.Heel to popliteal crease plus two inches 2.Posterior buttocks to popliteal crease minus two inches 3.Seat to axilla minus four inches 4.Widest part of buttocks plus two inches

2.The seat depth is determined by measuring from the posterior buttocks to the popliteal crease and subtracting two inches to avoid pressure from the front edge of the seat against the popliteal space. (Fairchild p. 136)

A patient diagnosed with complete L3 paraplegia begins gait training with custom orthotics in an acute rehabilitation hospital. Which muscle would not contribute to the fluidity of the patient's gait? 1.Rectus femoris 2.Semitendinosus 3.Iliopsoas 4.Adductor magnus

2.The semitendinosus, in conjunction with the other hamstrings muscles, is primarily responsible for hip extension and knee flexion. This muscle is essential to the performance of functional activities such as rising from a chair and stair climbing and derives its primary innervation from the L5-S1 nerve roots and the tibial nerve. (Kendall p. 418)

A physical therapist is working with a patient who recently had a left middle cerebral artery stroke. Currently, the patient demonstrates minimal active movement on the right side and is having extreme difficulty moving in bed. Which of the following strategies would be MOST useful when initially teaching the patient to roll from supine to left sidelying? 1.Provide detailed verbal cues 2.Use part-practice 3.Avoid knowledge of performance feedback 4.Provide feedback on 100% of the practice trials

2.The use of part practice would be an effective strategy to use, especially since rolling in bed is a task that can easily be broken up into a number of steps. Part practice is useful because it allows the patient to master each step before learning the entire task. (Shumway-Cook p. 36)

A physical therapist demonstrates a D2 flexion proprioceptive neuromuscular facilitation pattern to a patient rehabilitating from an upper extremity injury. As the patient begins the activity, the therapist quickly concludes the patient is growing increasingly confused. Which verbal instruction would be the MOST appropriate to assist the patient to complete the activity correctly? 1.Open your hand and push down and away from your body 2.Open your hand and pull up and away from your body 3.Close your hand and pull up and across your body 4.Close your hand and pull down and across your body

2.This is the correct command used for D2 flexion, which consists of shoulder flexion, abduction, and external rotation; forearm supination; and wrist and finger extension. (Kisner p. 209)

A physical therapist working in a rehabilitation hospital treats a patient with T10 paraplegia. The patient was injured approximately six weeks ago in a snowmobile accident and was admitted to the rehabilitation hospital after a 28 day stay in an acute care hospital. Assuming an unremarkable recovery, what would be the MOST likely scenario for the patient at the conclusion of rehabilitation? 1.Require daily assistance from a home health aide for activities of daily living 2.Utilize a wheelchair for functional mobility 3.Utilize orthotics and a walker for household and community ambulation 4.Be unable to safely return to his home

2.This patient does not possess innervation to the lower extremity muscles and therefore will need a wheelchair for functional mobility. (O'Sullivan p. 924)

A physical therapist performs postural drainage activities including vibration on a patient with cystic fibrosis. When should the therapist perform vibration? 1.During the patient's inhalation 2.During the patient's exhalation 3.Before percussion 4.After percussion

2.Vibration is performed during the patient's exhalation using the palmar surface of the hand to oscillate the patient's chest wall. (Hillegass p. 573)

A patient is observed using a toothbrush as an eating utensil. When asked, the patient is not able to name the toothbrush and is also unable to describe or demonstrate the toothbrush's use. Which condition is MOST commonly associated with this type of clinical presentation? 1.Anomia 2.Visual object agnosia 3.Impaired figure ground 4.Cortical blindness

2.Visual object agnosia is the inability of the patient to name, describe or demonstrate the use of an object and is the most common form of agnosia. If the patient had been able to describe and demonstrate the use of the toothbrush, anomia would have been the better option. (O'Sullivan p. 1255)

A physical therapist works with a 52-year-old female with a wound. The wound is clean, measures one half centimeter deep, and granulation tissue is just beginning to form. Over a three week period the therapist treats that wound with a wet-to-dry dressing with acetic acid that is changed twice daily. Which of the following is MOST likely to occur as a result of this treatment regimen? 1.Wound infection 2.Hypogranulation with little to no epithelialization 3.Hypertrophic scarring 4.Wound healing

2.Wet-to-dry dressings disrupt the formation of granular tissue in a wound bed. Acetic acid is known to be cytotoxic to granular and epithelial tissue. This combination dressing for the described wound will result in delayed healing due to hypogranulation and little to no epithelialization. (Fairchild p. 302)

A physical therapist uses heart rate to determine the intensity of aerobic exercise. Which characteristic of heart rate BEST supports this approach? 1.Negative linear relationship with age 2.Positive linear relationship with age 3.Positive linear relationship with oxygen consumption 4.Negative linear relationship with oxygen consumption

3. A positive linear relationship between heart rate and oxygen consumption means that both are increasing with progressive exercise.

A physical therapist prepares to administer an iontophoresis treatment to a patient with myositis ossificans in the right mid-quadriceps region. Which treatment description would be the MOST appropriate? 1.Driving dexamethasone with a high volt pulsed current unit using the negative pole 2.Driving dexamethasone with a high volt pulsed current unit using the positive pole 3.Driving acetic acid with a direct current unit using the negative pole 4.Driving acetic acid with a direct current unit using the positive pole

3. Acetic acid is a medication which is useful in treating calcific deposits. Since it has a negative polarity, the negative pole would be used to deliver the medication. (Cameron p. 274)

A physical therapist reviews a note from a cardiologist which indicates that a patient has a diminished ejection fraction. Which value is MOST representative of a normal ejection fraction? 1.25% 2.40% 3.65% 4.80%

3. An ejection fraction of 65% is considered within normal limits (i.e., 60-70%). The amount of blood remaining in the ventricles following contraction is referred to as the end systolic volume. (Hillegass p. 44)

A therapist measures a patient's arterial blood pressure by auscultating over the brachial artery. The therapist listens to Korotkoff sounds as he slowly deflates the blood pressure cuff. Which phase is characterized by the sound becoming crisper and louder? 1.Phase I 2.Phase II 3.Phase III 4.Phase IV

3. Phase III is characterized by the sounds becoming crisper and louder. Phase I is characterized by the first appearance of clear tapping sounds corresponding to the appearance of a palpable pulse which represents the systolic blood pressure. Phase II is characterized by the sounds becoming softer and longer. Phase IV is characterized by the sounds becoming muffled and softer.

A patient is diagnosed with sciatica secondary to a posterior derangement of the L5 disk. After assuming a prone press-up position in a sequence of trunk extension exercises, the patient reports increased centralization of symptoms in the lower back. The physical therapist's MOST appropriate response would be to instruct the patient to do which of the following? 1.Return to a prone position 2.Return to a prone on elbows position 3.Continue to provide feedback regarding symptom changes 4.Discontinue all activities that emphasize extension

3. Recession of radicular signs and centralization of pain complaints are considered a positive sign with regard to the described diagnosis. The physical therapist should reassure the patient that centralization of symptoms is desirable and continue to monitor the patient's response. (Brody p. 402)

A physical therapist reviews the medical record of a patient admitted to a hospital with a restrictive lung disorder. What is the patient's MOST likely diagnosis? 1.Asthma 2.Bronchiectasis 3.Sarcoidosis 4.Chronic bronchitis

3. Sarcoidosis is a restrictive lung disease in which inflammation occurs in lymph nodes, lungs, liver or other tissues. Over time inflammation produces fibrotic changes in the lung tissue restricting lung expansion and ventilation. (Hillegass p. 164)

A physical therapist reviews a graphical representation of selected pulmonary function tests and capacities. Which two items combine to form functional residual capacity? 1.Inspiratory reserve volume and tidal volume 2.Vital capacity and residual volume 3.Inspiratory reserve volume and expiratory reserve volume 4.Expiratory reserve volume and residual volume

4.The expiratory reserve volume and residual volume combine to form the functional residual capacity.

A 65-year-old female was referred to physical therapy for mobilization of her left wrist. The patient sustained a Colles' fracture eight weeks ago and although the fracture is well healed the patient continues to experience significant wrist stiffness. What technique would be the MOST appropriate to help improve extension at the radiocarpal joint? 1.Glide the lunate and capitate anteriorly in relation to the radius 2.Glide the triquetrum and lunate anteriorly in relation to the head of the ulna 3.Glide the lunate and scaphoid anteriorly in relation to the radius 4.Glide the scaphoid and capitate posteriorly in relation to the radius

3. The appropriate direction for the mobilization would be anterior. The lunate and scaphoid directly articulate with the radius and would be the most appropriate bones to use when mobilizing the joint. (Kisner p. 141)

A patient has ambulated with a prosthesis since undergoing a transtibial amputation six years ago. During an examination for an unrelated diagnosis, the physical therapist observes the patient's gait pattern. Which of the following is MOST likely to be observed in relation to the prosthetic limb? 1.Extended stance time 2.Shortened swing time 3.Longer step length 4.Increased single limb support time

3.A longer swing phase will typically correspond with a longer step length on the prosthetic limb. This further increases asymmetrical loading forces on the intact limb. (Cameron - Physical Rehabilitation p. 286)

A physical therapist reviews an examination for a patient with a complete C3 spinal cord injury. Which description would be MOST consistent with the patient's level of injury? 1.Minimal assistance for bathing activities 2.Minimal assistance to modified independent for sliding board transfers 3.Independent after setup for using an environmental control unit 4.Modified independence for feeding with adaptive equipment

3.A patient with a C3 spinal cord injury has innervation to their face and neck muscles. They would not have innervation to any upper extremity muscles. Patients with this level injury are dependent for the majority of their activities of daily living. Communication includes the use of a call system, environmental control unit, telephone and computer. Typically, patients at all levels can become independent with communication after set up. Devices may include mouth sticks or may be controlled by the head or eye switches. (Umphred p. 470)

A physical therapist observes the gait of a 59-year-old male. The patient has a functionally fused ankle due to arthritic changes precipitated by a severe fracture sustained in a motor vehicle accident ten years ago. Which of the following shoe modifications would be the MOST beneficial to assist the patient? 1.Cushioned heel 2.Metatarsal bar 3.Rocker bar 4.Heel lift

3.A rocker bar is a convex rigid strip placed across the sole just posterior to the metatarsal heads. It assists rollover during gait by shifting the rollover point posterior to the metatarsal heads. It is indicated for patients with limitations in ankle range of motion.

A physical therapist attempts to assess the patency of a patient's airway who appears to be in distress. Which emergent condition would be MOST likely to make this type of assessment essential? 1.Fracture 2.Autonomic dysreflexia 3.Allergic reaction 4.Heat exhaustion

3.A severe allergic reaction may include swelling of the face or mouth, difficulty swallowing or speaking, wheezing and difficulty breathing, chest tightness, altered mental status, and dizziness or syncope. Common allergens include pollen, dust, eggs, shellfish, milk, wheat, soy, nuts, insect stings, chemicals, latex, and medications. Although the allergic reaction may be non life-threatening, checking the airway remains a critical action with any identified allergic reaction. If the airway is compromised, it is necessary to contact emergency medical services and begin cardiopulmonary resuscitation. (Fairchild p. 336)

After palpating several peripheral pulse sites a physical therapist concludes that a patient has a strong pulse at the popliteal artery, but a weak pulse at the dorsalis pedis artery. Which medical finding identified during exercise would be MOST likely based on the patient's current status? 1.Orthopnea 2.Deep vein thrombophlebitis 3.Intermittent claudication 4.Venous thrombosis

3.A strong popliteal artery pulse and weak dorsalis pedis artery pulse suggests that blood flow between these sites is diminished, perhaps from atherosclerosis. This patient could be expected to experience intermittent claudication, or pain in the calf muscles caused by ischemia during exercise. (Hillegass p. 71)

A physical therapist provides an inservice on pain modulation to their colleagues. Which nerve fiber is myelinated and transmits pain signals rapidly? 1.A-beta fibers 2.B fibers 3.A-delta fibers 4.C fibers

3.A-delta fibers are myelinated and transmit pain signals rapidly. Pain transmitted by these fibers tends to be described as sharp or stabbing. The pain lasts for a short duration and is localized to a specific area. (Cameron p. 47)

A patient successfully completes six weeks of aerobic exercise conditioning in a supervised outpatient cardiac rehabilitation program. On the last day of rehabilitation, while exercising on a bicycle ergometer, the patient classifies the workload as a 13 using a rate of perceived exertion scale. Which statement would BEST describe the patient's present workload? 1.The same workload that elicited a rating of 13 on the first day of cardiac rehabilitation 2.A lower workload than what elicited a rating of 13 on the first day of cardiac rehabilitation 3.A higher workload than what elicited a rating of 13 on the first day of cardiac rehabilitation 4.The same workload that elicited a rating of 6 on the first day of cardiac rehabilitation

3.After six weeks of successful aerobic conditioning, a patient with improved exercise tolerance would be able to exercise at a higher workload before reaching the equivalent rate of perceived exertion. (American College of Sports Medicine p. 475)

A physical therapist administers an ultrasound treatment using water immersion on a patient rehabilitating from ankle surgery. During the session the therapist notices that air bubbles tend to accumulate on the sonated area of the skin and face of the soundhead. What is the MOST appropriate therapist action? 1.Wipe off the air bubbles on the skin periodically 2.Wipe off the air bubbles on the face of the soundhead periodically 3.Wipe off the air bubbles on the skin and face of the soundhead periodically 4.Avoid wiping off any of the air bubbles

3.Air bubbles occurring on the transducer and the patient's skin should be wiped away by the therapist since they will interfere with ultrasound transmission. (Michlovitz p. 104)

A physical therapist prescribes an exercise program for a patient with Duchenne muscular dystrophy. The patient is ambulatory, but recently has experienced a general decrease in overall strength. Which type of exercise would be the LEAST desirable to incorporate into the program? 1.Isometric exercise 2.Concentric exercise 3.Eccentric exercise 4.Muscle setting exercise

3.An eccentric contraction occurs when the muscle lengthens while developing tension. Eccentric exercises are the least desirable since they tend to produce the most muscle damage, particularly in dystrophic muscles since they are more susceptible to stretch-induced damage. Eccentric contractions place high levels of stress on impaired membranes which disrupts homeostasis and potentially results in cell death. (Umphred p. 565)

A physical therapist treats a patient status post biceps tendon repair. The patient complains of continued difficulty lowering a five pound bag of flour from the top shelf of her kitchen cabinet to the countertop. In this activity, what would the biceps brachii be performing? 1.Cocontraction 2.Concentric contraction 3.Eccentric contraction 4.Isometric contraction

3.An eccentric contraction occurs when the muscle produces tension while lengthening. Since the arm is moving into an extended position, the biceps would be lengthening. (Kisner p. 180)

A physical therapist examines a four-year-old child with spina bifida at the S1 level. The patient's primary goal is to ambulate independently. Which of the following would be the MOST appropriate device to consider for this child? 1.Reciprocating gait orthosis 2.Knee-ankle-foot orthoses 3.Ankle-foot orthoses 4.Parapodium

3.Ankle-foot-orthoses are often used with a patient who has L4-S1 spina bifida. A patient with an injury at the S1 level may not require ankle-foot orthoses to ambulate, although they are often used to improve lower limb alignment and allow muscle groups to function at a more optimal length. (Campbell p. 734)

A physical therapist prepares to instruct a patient in diaphragmatic breathing. Which of the following conditions would MOST warrant the use of this intervention? 1.Hyperoxemia 2.Bradypnea 3.Atelectasis 4.Consolidation

3.Atelectasis is a condition in which one or more areas of the lungs collapse or do not inflate properly. Treatment varies based on the cause of the atelectasis, however, it often includes breathing exercises such as diaphragmatic breathing, changing positions, and airway clearance techniques to assist with lung expansion. (Hillegass p. 579)

A patient diagnosed with multiple sclerosis reports that she is experiencing side effects from a recent increase in a medication's daily dosage. While performing a series of exercises with the physical therapist, the patient complains of generalized muscle weakness. This is MOST likely a side effect of which medication? 1.Levodopa 2.Gabapentin 3.Baclofen 4.Diazepam

3.Baclofen is an antispasticity agent typically utilized to reduce hypertonicity and spasticity associated with neurological diagnoses such as multiple sclerosis and spinal cord injury. Side effects may include hypotonicity, generalized weakness, confusion, sedation, dizziness, and liver toxicity. (Ciccone p. 168)

A physical therapist treats a five-year-old child immediately before having a new lower leg cast applied. The child has had a new cast each week for the last four weeks. Which medical condition would MOST likely warrant this type of intervention? 1.Wilson's disease 2.Down syndrome 3.Cerebral palsy 4.Phenylketonuria

3.Cerebral palsy is an umbrella term used to describe movement disorders due to brain damage that are non-progressive and are acquired in utero, during birth or during infancy. The brain damage decreases the brain's ability to monitor and control nerve and voluntary muscle activity. Abnormal muscle tone, decreased range of motion, and contractures are extremely common with cerebral palsy, making serial casting a viable intervention. (Palisano p. 110)

A 28-year-old female with low back pain is referred to physical therapy. The patient indicates that her pain started the previous weekend after painting a ceiling and currently is localized on the left side of her low back. The patient states the pain is better when sitting in a "slouched" posture and is worse during periods of prolonged standing. An examination reveals a positive quadrant test and positive Kemp's test on the left. Based on the presented information, which structures are MOST likely involved? 1.Right thoracic facets 2.Left thoracic facets 3.Left lumbar facets 4.Right lumbar facets

3.During the quadrant test or Kemp's test, the patient extends and laterally flexes or rotates to the side of pain. This causes maximal narrowing of the intervertebral foramen and stress on the facet joint. Since the patient had a positive test when moving to the left, the left lumbar facet joints are likely the source of the pain. (Magee p. 610)

A patient diagnosed with a lower extremity muscle strain is referred to physical therapy. The plan of care incorporates ultrasound for deep heating of the involved muscle. For effective heating within a five minute period, the area to be treated should be approximately what size? 1.Half the size of the soundhead 2.The same size as the soundhead 3.Twice the size of the soundhead 4.Four times the size of the soundhead

3.Five minutes would be adequate to treat an area twice the size of the soundhead and still produce the desired thermal effects. (Cameron p. 188)

A physical therapist works with a patient rehabilitating from a stroke on strategies to compensate for form-constancy dysfunction. Which strategy would be the MOST appropriate based on the stated objective? 1.Reinforce body knowledge through tactile and proprioceptive stimulation applied in a variety of diverse positions 2.Mark common objects with colored tape so that similar objects can be differentiated from one another 3.Use tactile cues to feel objects in various positions to increase familiarity with the object 4.Ask the patient to recite right and left as they are interacting with their own body or the environment

3.Form-constancy dysfunction involves difficulty attending to subtle variations in form or changes in form such as a size variation of the same object. Using tactile cues to feel objects in various positions to increase familiarity with the object would be an effective therapeutic intervention for this condition. (O'Sullivan p. 1237)

A physical therapist classifies a patient's deep tendon reflexes as hyperreflexive. Which medical condition would MOST likely contribute to this clinical finding? 1.Addison's disease 2.Ankylosing spondylitis 3.Graves' disease 4.Cushing's syndrome

3.Graves' disease is caused by an autoimmune disease in which certain antibodies produced by the immune system stimulate the thyroid gland causing it to become overactive. Graves' disease is the most specific cause of hyperthyroidism and may contribute to hyperreflexia. Other conditions associated with hyperreflexia include upper motor neuron lesions (e.g., multiple sclerosis) and selected pharmacological agents (e.g., stimulants). (Goodman - Pathology p. 484)

A physical therapist uses the Braden Scale to quantify a patient's risk for developing a pressure ulcer. After administering the test the therapist determines that the patient scored an eleven. Based on the results, which of the following would BEST characterize the patient's risk for developing a pressure ulcer? 1.At risk 2.Moderate risk 3.High risk 4.Very high risk

3.Individuals scoring between 10-12 on the Braden Scale are considered at high risk for developing a pressure ulcer. Individuals scoring between 15-18 on the Braden Scale are considered at risk for developing a pressure ulcer. Individuals scoring between 13-14 on the Braden Scale are considered at moderate risk for developing a pressure ulcer. Individuals scoring less than 9 on the Braden Scale are considered at very high risk for developing pressure ulcers. (Goodman - Pathology p. 446)

A physical therapist employed in an acute care hospital treats a 67-year-old male with a venous ulcer immediately posterior to the medial malleolus. The patient has a lengthy medical history of venous insufficiency including admission to the hospital six months ago for a deep venous thrombosis. Which finding is MOST likely based on the patient's present condition? 1.Pale, white skin color 2.Absent peripheral pulses 3.Diminished pain with the legs elevated 4.Thin, shiny skin with hair loss

3.Individuals with venous insufficiency often complain of an aching pain in the lower extremities due to the tissue congestion and distention associated with significant edema. When the lower extremities are elevated, edema decreases thereby relieving the strain on the soft tissue and increasing overall comfort. (Paz p. 280)

A patient is referred to physical therapy with a diagnosis of C5 radiculopathy. While examining the patient, a physical therapist determines that the patient has limited active lateral flexion in the mid-cervical spine to the left. Which motion would be considered coupled with cervical lateral flexion to the left? 1.Cervical lateral flexion to the right 2.Cervical rotation to the right 3.Cervical rotation to the left 4.Thoracic extension

3.Lateral flexion to the left would be coupled with cervical rotation to the left. (Norkin p. 321)

A 17-year-old female soccer player diagnosed with right patellofemoral syndrome is referred to physical therapy. The physical therapist determines that mechanical factors are largely contributing to the patient's symptoms. Which clinical finding would be the MOST likely? 1.Excessive foot supination 2.Decreased Q angle 3.Lateral patella tracking 4.Vastus lateralis weakness

3.Lateral patella tracking is commonly observed in association with patellofemoral syndrome. Muscle tightness, muscle imbalance, excessive pronation, increased Q angle, knee hyperextension, and inherent patellofemoral joint characteristics are among the most commonly identified contributors to anterior knee pain and patellofemoral syndrome. (Magee p. 844)

A physical therapist reviews the medical record of a patient diagnosed with amyotrophic lateral sclerosis. Which objective finding is MOST likely based on the patient's diagnosis? 1.Normal deep tendon reflexes 2.Preserved respiratory function 3.Preserved sensory function 4.Bowel and bladder incontinence

3.Motor impairment without sensory impairment is a primary indicator of ALS. Cognition, bowel and bladder sphincter control, and extraocular muscle control are also typically spared as the disease progresses. (Goodman - Pathology p. 1404)

A physical therapist examines a patient referred to physical therapy with a prescription that reads "evaluate and treat - status post left knee sprain with resultant left lower extremity weakness." While taking a patient history, the therapist identifies complaints of lower extremity weakness, vertigo, visual disturbance, paresthesias in the lower extremities, fatigue, and urinary bladder disturbances. What are these findings MOST consistent with? 1.Lyme disease 2.Parkinson's disease 3.Multiple sclerosis 4.Rheumatoid arthritis

3.Multiple sclerosis is a chronic progressive demyelinating disease of the central nervous system characterized by exacerbation of symptoms followed by remissions. Symptoms include visual impairments, muscle weakness, paresthesias, vertigo, fatigue, ataxia, speech impairment, and bowel and bladder dysfunctions. (Goodman - Pathology p. 1425)

An individual with declining health due to unhealthy lifestyle choices plans to engage in an independent exercise program designed to improve their cardiovascular health. Which form of self-monitoring would be the MOST appropriate for the individual to utilize when exercising? 1.Metabolic equivalents 2.Systolic blood pressure 3.Rate of perceived exertion 4.Respiration rate

3.Patients can utilize a perceived exertion scale, such as Borg's Rating of Perceived Exertion (RPE) Scale, as a subjective means of self-monitoring during exercise. The RPE quantifies the subject's overall sense of effort by quantifying the amount of strain or level of exertion the patient is experiencing during activity. (American College of Sports Medicine p. 475)

A physical therapist administers an electrotherapy treatment for the purpose of muscle reeducation. According to the strength duration curve, which of the following BEST describes the order of nerve fiber recruitment as the amplitude is increased? 1.Motor nerve fibers, sensory nerve fibers, pain nerve fibers 2.Pain nerve fibers, motor nerve fibers, sensory nerve fibers 3.Sensory nerve fibers, motor nerve fibers, pain nerve fibers 4.Motor nerve fibers, pain nerve fibers, sensory nerve fibers

3.Sensory fibers require the lowest amplitude to depolarize and pain fibers require the greatest amplitude to depolarize. This sequence (i.e., sensory, motor, pain) is correct as amplitude is increased. (Cameron p. 229)

An eight-year-old child begins a trial of serial casting. Which clinical finding would BEST support the use of this type of intervention? 1.Delayed bone healing 2.Insufficient muscle strength 3.Limited range of motion 4.Inadequate bone density

3.Serial casting is primarily used when a muscle is too short (i.e., lacks the necessary flexibility) to allow functional or fluid movement. The joint is typically casted so that tension is applied to the muscle. Over time the muscle may become longer and allow for improved range of motion. (Palisano p. 110)

A physical therapist works with a patient who has a right transtibial and a left transfemoral amputation. The patient is learning to walk up and down stairs with bilateral prostheses. When teaching the patient, which lower extremity should lead when ascending and descending stairs? 1.Transtibial prosthesis when ascending and descending 2.Transfemoral prosthesis when ascending and descending 3.Transtibial prosthesis when ascending, and the transfemoral prosthesis when descending 4.Transfemoral prosthesis when ascending, and the transtibial prosthesis when descending

3.Since the transtibial limb is the only limb which has a functioning quadriceps muscle, the patient should ascend leading with the transtibial prosthesis and descend leading with the transfemoral prosthesis. (Seymour p. 243)

A physical therapist performs a goniometric measurement on a patient's ankle after classifying the end-feel as firm. Which finding would MOST likely have contributed to the identified end-feel associated with ankle plantar flexion? 1.Tension in the soleus muscle 2.Tension in the posterior talofibular ligament 3.Tension in the anterior joint capsule 4.Contact between the posterior tubercle of the talus and posterior tibia

3.Tension in the anterior joint capsule potentially contributes to a firm end-feel associated with plantar flexion, while tension in the posterior joint capsule contributes to a firm end-feel associated with dorsiflexion. (Norkin p. 274)

A patient diagnosed with cerebral palsy is scheduled to undergo a surgical psoas lengthening procedure to assist in improving the quality of his gait. This intervention will MOST significantly improve the quality of which phase of the gait cycle? 1.Initial swing 2.Midstance 3.Terminal stance 4.Pre-swing

3.Terminal stance phase requires the greatest amount of hip extension, approximately 10 degrees, and is most likely to be significantly impacted by a psoas lengthening procedure. (Tecklin p. 216)

While evaluating a patient diagnosed with cervical radiculopathy, a physical therapist discovers that a patient cannot differentiate between sharp and dull on the tip of his right thumb. Based on this information, which dermatome would the therapist anticipate being MOST affected? 1.C4 2.C5 3.C6 4.C7

3.The C6 dermatome covers the anterior arm and the radial side of the hand to the thumb and index finger. (Magee p. 24)

A physical therapist working with a college basketball team observes a player unexpectedly fall to the ground after making a jump shot. The therapist suspects the player has ruptured his Achilles tendon. When screening the patient, which special test would be the MOST appropriate? 1.O'Brien needle test 2.Anterior drawer test 3.Thompson test 4.Homans' sign

3.The Thompson test assists a physical therapist in making a clinical diagnosis when an Achilles tendon rupture is suspected. The patient is positioned in prone and asked to relax as the therapist squeezes the muscle bellies of the gastrocnemius and soleus. A positive test is indicated by the absence of plantar flexion. (Magee p. 940)

A physical therapist treats a patient referred to physical therapy following a left ankle sprain. The therapist determines that the anterior drawer test is positive on the affected side. Which ligament is assessed with this special test? 1.Deltoid 2.Calcaneofibular 3.Anterior talofibular 4.Posterior talofibular

3.The anterior talofibular ligament resists inversion of the talus and calcaneus and is taut during plantar flexion. The ligament also resists anterior translation of the talus on the tibia, therefore to specifically assess the integrity of this ligament, a therapist may perform an ankle anterior drawer test. (Magee p. 932)

A physical therapist reviews a meta-analysis of interventions and identifies a quantitative measure of the difference between two groups. Which of the following terms is MOST consistent with this measure? 1.P-value 2.Minimal detectable difference 3.Effect size 4.Sampling error

3.The effect size is a measure of the magnitude of the difference between two interventions or the magnitude of the relationship between two variables. The larger the effect size, the more likely it will be statistically significant. Effect size is one of the statistical elements used to estimate sample size and perform a power analysis. (Portney p. 373)

A morbidly obese patient is referred to physical therapy for treatment of multiple lower extremity venous stasis ulcers. Which etiology is MOST likely associated with the patient's current medical condition? 1.Impedance of normal arterial blood flow to the lower legs secondary to obesity 2.Callus buildup due to sustained pressure secondary to obesity 3.Excessive edema that accumulates in the lower legs secondary to obesity 4.Poor hygiene due to limited ability to perform self-care secondary to obesity

3.The excessive soft tissue that accompanies obesity creates mechanical impedance to normal blood flow and alters the pressure gradient between the capillaries and the interstitium. The resultant buildup of excess fluid produces edema which serves to increase tissue tension, diminish tissue perfusion, and increase the risk of developing venous stasis ulcers. (Sussman p. 316)

A physical therapist performs a series of lower extremity manual muscle tests on a patient with suspected unilateral weakness. The therapist begins one of the tests by placing the patient in a prone position with the knee flexed to 90 degrees while extending the hip. The position is MOST appropriate for testing which of the following? 1.Biceps femoris 2.Gluteus medius 3.Gluteus maximus 4.Hamstrings

3.The gluteus maximus is tested with the patient positioned in prone. The knee is flexed to 90 degrees or more with the hip extended. Knee flexion allows the therapist to better isolate the muscle by placing the hamstrings on slack. The therapist applies pressure against the lower portion of the posterior thigh in the direction of hip flexion. Kendall p. 436)

A physical therapist treats a patient rehabilitating from a serious hand and wrist injury sustained in a work related accident three months ago. The patient has made good progress in physical therapy, but still has severe difficulty with activities requiring opposition of the thumb. Which type of grip should be the easiest for the patient to perform? 1.Digital prehension 2.Three point chuck 3.Lateral prehension 4.Tip pinch

3.The lateral prehension grip is characterized by the pad of the thumb contacting the lateral side of the index finger. Opposition of the thumb is not required. Holding playing cards would be an example of a lateral prehension grip. (Magee p. 453)

A physical therapist completes a home assessment for a 39-year-old male who uses a wheelchair for household and community mobility. What should the MINIMUM doorway width be in order for the patient to enter his home? 1.24 inches 2.28 inches 3.32 inches 4.36 inches

3.The minimum width of a doorway necessary for wheelchair access is 32 inches. (Fairchild p. 357)

A physical therapist applies a custom fabricated hand splint to a patient that sustained a burn to his right wrist and hand. The splint maintains the wrist in extension, the metacarpophalangeal joints in 75 degrees of flexion, the proximal and distal interphalangeal joints in flexion, and the thumb in abduction. Based on the supplied description of the splint, which area would be MOST susceptible to contracture? 1.Wrist 2.Metacarpophalangeal joints 3.Proximal and distal interphalangeal joints 4.Thumb

3.The proximal and distal interphalangeal joints are prone to flexion contractures. As a result, the hand splint should place these joints in extension to avoid susceptibility to a flexion contracture. (Goodman - Pathology p. 442)

A physical therapist attempts to assess proprioception in a patient rehabilitating from a prolonged hospitalization. Which method would provide the therapist with the desired information? 1.The therapist moves the patient's upper extremity and asks the patient to indicate the direction of movement while the extremity is in motion 2.The patient moves the upper extremity and indicates the direction of movement while the extremity is in motion 3.The therapist moves the patient's upper extremity to a selected position and asks the patient to describe the position 4.The patient moves the upper extremity to a selected position and is asked to describe the position

3.This option describes the procedure for testing proprioception, which is an awareness of the positioning of a joint. The patient can respond by identifying the position of the joint or by duplicating the position of the joint with the opposite extremity. (O'Sullivan p. 108)

A physical therapist initiates ultrasound using water immersion to the distal calf of a patient rehabilitating from a motor vehicle accident. The therapist had previously administered ultrasound using direct contact; 1 MHz frequency at 1.2 W/cm2 for five minutes. In order to maintain the same amount of tissue heating as originally used with the direct contact technique, what should the therapist do? 1.Utilize the same treatment parameters 2.Increase the intensity and decrease the time 3.Increase the intensity and increase the time 4.Change the frequency to 3 MHz and increase the time

3.To compensate for the decreased tissue heating associated with the water immersion method, the therapist can increase the intensity and increase the duration. Increasing both parameters can allow for the same amount of tissue heating despite the use of water immersion. (Michlovitz p. 104)

A physical therapist performs an examination on a patient with a pressure ulcer on their left buttock. The patient's wound is relatively round, approximately one half centimeter in size, and is covered with black necrotic tissue. What must the physical therapist do in order to determine the stage of the pressure ulcer? 1.Estimate the depth of the ulcer based on the thickness of tissue typically present in this area 2.Make precise measurements of the surface area (i.e. perimeter) of the wound 3.Debride the wound of the necrotic tissue 4.Gather information pertaining to the cause of the wound

3.To correctly determine wound staging, necrotic tissue must first be debrided so that the wound base and depth can be visualized. (Sussman p. 80)

A patient diagnosed with right rotator cuff tendonitis is referred to physical therapy. As part of the examination, the physical therapist performs the Hawkins-Kennedy impingement test. Which shoulder position would be MOST appropriate when performing this special test? 1.90 degrees of abduction and 30 degrees of horizontal adduction 2.90 degrees of abduction, and 90 degrees of external rotation 3.90 degrees of flexion with 70 degrees of medial rotation 4.Neutral at the patient's side

3.To perform the Hawkins-Kennedy impingement test, the patient is positioned with the arm in 90 degrees of flexion before being medially rotated. A positive test may be indicative of shoulder impingement specifically involving the supraspinatus tendon. (Magee p. 315)

A physical therapist treats a patient referred to physical therapy after being diagnosed with arteriosclerosis obliterans. The therapist begins a walking program with the patient on a treadmill. After two minutes of walking at 1.0 mile per hour the patient reports significant cramping and pain in her lower legs. What is the MOST appropriate therapist action? 1.Encourage the patient to walk through the pain unless it becomes unbearable 2.Decrease the treadmill speed by one-half mile per hour and instruct the patient to continue walking 3.Allow the patient to rest and resume walking when the pain subsides 4.Discontinue walking and select an alternate exercise

3.Walking programs for patients with intermittent claudication are characterized by periods of walking to the point of symptom exacerbation, followed by periods of complete rest. (Goodman - Pathology p. 623)

A 66-year-old male status post right CVA is working on activities using the left upper extremity. The patient has minimal movement throughout the extremity and presents with mild left neglect. He can perform gross flexor movements, but does not exhibit active extension of the elbow, wrist, and hand. What should the therapist do when working with the patient? 1.Sit on the right side of the patient to assure that he is attending to the session 2.Avoid providing tactile cues to the patient's involved hand and arm 3.Encourage the patient to look at his left extremity while performing therapeutic activities 4.Compensate by using the right upper extremity instead of the left

3.When encouraging the patient to look at his left extremity during therapeutic activities, the therapist is addressing the left neglect. As the patient performs interventions to address neglect, it is better to perform particular functional tasks using the left side as opposed to solely reminding the patient to look to the involved side. (Umphred p. 884)

A physical therapist conducting a goniometric measurement aligns the stationary arm of the goniometer parallel to an imaginary line between the acromial processes. What is being measured when this alignment is used? 1.Flexion of the cervical spine 2.Lateral flexion of the cervical spine 3.Rotation of the cervical spine 4.Rotation of the thoracic and lumbar spines

3.When measuring rotation of the cervical spine, the stationary arm of the goniometer is aligned parallel to an imaginary line between the acromial processes. (Norkin p. 341)

A 37-year-old cross country runner is diagnosed with plantar fasciitis. Which of the following interventions is MOST likely to reduce the symptoms experienced when first waking each morning? 1.Heel cup 2.Rigid orthotics 3.Low dye taping 4.Dorsiflexion splint

4. A dorsiflexion splint is typically recommended for nighttime wear to assist in maintaining the plantar fascia in a lengthened position. A low level sustained stretch may also be achieved with this intervention, further reducing the likelihood of a painful loading response upon weight bearing in the morning. (Dutton p. 1013)

A physical therapist examines a three-year-old patient diagnosed with a genetic condition which affects collagen synthesis. The patient bruises easily and has a lifelong history of pathological fractures. What is the patient's MOST likely diagnosis? 1.Osteomalacia 2.Osteopetrosis 3.Pediatric osteoporosis 4.Osteogenesis imperfecta

4. Milder presentations of OI (types I and IV) are inherited as autosomal dominant traits while more severe forms (types II and III) are inherited as autosomal recessive traits. The condition is characterized by bone fragility that is linked to an abnormality in the synthesis of type I collagen. (Campbell p. 333)

A physical therapist performs a test to examine the motor component of a cranial nerve. Which cranial nerve would the therapist be unable to assess? 1.Trochlear 2.Trigeminal 3.Facial 4.Vestibulocochlear

4. The vestibulocochlear nerve does not possess a motor component and therefore the motor component cannot be assessed. (O'Sullivan p. 176)

A 60-year-old male presents with low back pain. The patient describes pain radiating down the outer thigh and leg, stiffness in the low back region, and increased pain with attempted movement of the spine. Which of the following would be the MOST likely cause of the patient's symptoms? 1.Microtears of the ligamentum flavum and posterior longitudinal ligament 2.L3-L4 lumbar facet joint arthropathy 3.Soft tissue strain of the lumbar extensors 4.Posterolateral protrusion of the lumbar intervertebral disk at L5-S1

4.A disk protrusion may push up against a spinal nerve root and cause radiating symptoms down the leg. Additionally, the patient will likely have stiffness in the back and increased pain with movement. (Dutton p. 1292)

A physical therapist prepares to order a wheelchair for a patient with complete C4 quadriplegia. Which type of wheelchair would be the MOST appropriate for the patient? 1.Hemi-chair with one arm drive 2.Manual wheelchair 3.Manual wheelchair with handrim projections 4.Power wheelchair

4.A patient with a C4 spinal cord injury would possess innervation to the diaphragm and trapezius. The patient would be independent with a power wheelchair, however, the patient would utilize head, mouth, chin or sip-and-puff controls. (O'Sullivan p. 921)

A physical therapist inserts a heel lift into a patient's shoe. Which condition would MOST warrant this type of modification? 1.Pes cavus deformity 2.Sesamoiditis 3.Metatarsalgia 4.Equinus contracture

4.An equinus contracture refers to the inability to bring the foot up to a neutral position due to either tightness of the muscles and/or tendons in the calf, scarring of the ankle joint capsule, or spurring that restricts normal ankle motion. The name originates from horses (equine) who essentially walk on their toes. A heel lift may be used with an equinus contracture in an attempt to improve the fluidity and efficiency of movement. (Brody p. 560)

A physical therapist administers cardiopulmonary resuscitation (CPR) to a patient who collapsed in the waiting area. The therapist is unable to establish a pulse after three cycles of CPR and therefore prepares to utilize an automated external defibrillation unit (AED). Which action would be the LEAST appropriate when using the device? 1.Wipe the patient's chest dry 2.Apply the pads to the patient's bare chest 3.Analyze the patient's heart rhythm 4.Ask another therapist to stabilize the patient's head when administering the electric shock

4.Asking another therapist to stabilize the patient's head when administering the electric shock could be harmful since the patient would act as an energy pathway, transmitting the shock to the therapist. (Le Baudour p. 207)

A physical therapist employed by a home health agency receives a new referral for a 27-year-old male with a traumatic brain injury. During the examination the patient becomes combative and appears to be extremely agitated. The therapist and the patient's spouse attempt to calm the patient for approximately ten minutes without any success. What is the MOST immediate therapist action? 1.Continue with the examination as planned 2.Attempt to condense the remaining portion of the examination 3.Document the patient's behavior in the medical record 4.Discontinue the treatment session

4.Because of the patient's combative behavior, it is important for the therapist to discontinue the treatment session. Acting in this manner minimizes the safety risk for all involved parties. (O'Sullivan p. 878)

During a physical therapy session, a patient reports that his physician suspects an underlying diagnosis of coronary artery disease and has referred him to a cardiologist for additional testing. What is the MOST accurate and conclusive method of confirming the physician's hypothesis? 1.Computed tomography with coronary angiography 2.Exercise electrocardiogram with 24-hour Holter monitor 3.Magnetic resonance arteriography with contrast dye 4.Cardiac catheterization with coronary angiography

4.Cardiac catheterization with coronary angiography is considered to be the most precise method of diagnosing CAD and its severity. This procedure utilizes a contrast dye and is typically utilized in circumstances where significant CAD has been confirmed or suspected and either bypass surgery or percutaneous transluminal angioplasty is being considered. (Hillegass p. 315)

During auscultation of a patient's chest, a physical therapist hears diminished breath sounds. To help confirm that the lung segment is not fully aerated, how does the therapist decide to test egophony? 1.Palpating the patient's trachea 2.Measuring the excursion of the patient's diaphragm 3.Auscultating over the lung segment while the patient whispers "1, 2, 3" 4.Auscultating over the lung segment while the patient speaks the sound "EEE"

4.Egophony is demonstrated when the patient says the long E sound, but the sound that is heard on auscultation is the long A sound. The change in the quality of the sound occurs due to the increase in density of lung tissue due to consolidation from atelectasis, secretions, or some other abnormality. (Hillegass p. 550)

A physical therapist works with a patient referred to physical therapy with incontinence. Interventions include upper and lower extremity strengthening and gait training. What would the described interventions be MOST effective treating? 1.Reflex incontinence 2.Urge incontinence 3.Stress incontinence 4.Functional incontinence

4.Functional incontinence is a form of overflow incontinence that occurs when impaired mobility, dexterity or cognition prevent a patient from being able to complete pre-toileting tasks (e.g., reaching a bathroom, removing clothing) prior to the loss of urine. Interventions include gait training, upper and lower extremity strengthening exercises, and environmental modifications. (Brody p. 440)

A physical therapist examines a patient in an outpatient setting that was recently diagnosed with testicular cancer. The male's appearance is tall with long legs and sparse body hair. The patient notes infertility due to a genetic disorder related to sex chromosomes. What condition is MOST likely responsible for these findings? 1.Turner syndrome 2.Trisomy 13 3.Down syndrome 4.Klinefelter syndrome

4.Klinefelter syndrome is characterized by abnormal body proportions including tall stature, abnormally large breasts, infertility, and sexual issues. This condition increases the risk for breast and testicular cancers, autoimmune disorders, and depression. Lifespan is typically not affected by the syndrome, but can be altered due to certain associated conditions. (Goodman - Pathology p. 980)

A physical therapist coordinating a cardiac rehabilitation program educates several patients about the potential for selected activities to significantly increase blood pressure. Which activity would typically produce the GREATEST increase in the patient's systolic blood pressure? 1.Walking 2.Cycling 3.Sitting unsupported 4.Shoveling

4.Persons in cardiac rehabilitation should be cautioned about performing arm exercises such as shoveling, digging, lifting, and carrying because of the potential for greater increases in systolic blood pressure. (Hillegass p. 616)

A physical therapist examines a 9-month-old female in her home. The patient's medical history includes osteogenesis imperfecta (type IV), plaque psoriasis, and a humeral fracture four months ago. Based on the patient's history, which physical therapy intervention should be the INITIAL priority? 1.Initiating treatment with a light therapy psoriasis lamp 2.Compensatory training secondary to the humeral fracture to avoid developmental delays 3.Weight bearing activities to decrease the rate of bone demineralization 4.Parent and caregiver education on handling techniques for fracture management

4.Proper handling techniques are critical to the integrity of these patients' bones since fractures are extremely common. Patients with type IV osteogenesis imperfecta will have bowing of long bones, a barrel shape of their rib cage, possible hearing loss, brittle teeth, and near normal sclera. (Campbell p. 342)

A physical therapist performs a series of exercises with a patient in a therapeutic pool to help improve their general strength. The therapist wants to challenge the patient and increase resistance during exercise. In order to increase resistance, what is the BEST way to move the extremity? 1.Rapidly upward toward the surface of the water 2.Slowly upward toward the surface of the water 3.Slowly downward away from the surface of the water 4.Rapidly downward away from the surface of the water

4.Rapidly moving the body segment away from the surface of the water would be the best way to increase resistance since the speed of movement is directly proportional to the resistance to movement. In addition, the body segment would be working against the buoyant force of the water. (Cameron p. 323)

A 62-year-old female with a transtibial amputation is examined in physical therapy. The patient has been using a roll-on silicone liner inside of her prosthesis. What is a potential disadvantage of this type of liner? 1.Increased shear force on the residual limb 2.Reduced padding over bony prominences 3.Potential trauma to the suture line 4.Heat buildup, especially in warmer climates

4.Silicone liners do not breathe as well as a fabric shrinker and as a result tend to produce a buildup of heat, especially in warmer climates. (Seymour p. 129)

A physical therapist works with a patient recently admitted to a rehabilitation hospital. During the initial session the therapist notes that the patient has significant difficulty with language to the extent that it is extremely difficult for the patient to convey even basic information. Which patient profile would MOST likely exhibit the described finding? 1.A 63-year-old female status post right CVA 2.A 41-year-old female diagnosed with Guillain-Barre syndrome 3.A 32-year-old male with a traumatic brain injury presently classified as confused-appropriate 4.A 52-year-old male status post left CVA

4.Since the language centers are typically located in the left hemisphere, patients status post left CVA will often have impairments in language. (O'Sullivan p. 656)

A 36-year-old female who gave birth to three children over the span of nine years is referred to physical therapy during her fourth pregnancy. The patient presents with complaints of involuntary urine leakage when she coughs or sneezes and when she participates in an aerobics class. Which type of incontinence is MOST consistent with the described presentation? 1.Urge 2.Overflow 3.Functional 4.Stress

4.Stress incontinence is characterized by the inability to hold urine during activities that increase intra-abdominal pressure, such as coughing, sneezing or exercising. Stress incontinence is typically the result of weak or poorly coordinated pelvic floor musculature. (Brody p. 440)

A physical therapist assesses the heart rate and SaO2 of a 42-year-old male diagnosed with chronic obstructive pulmonary disease during an exercise session. The therapist notes an increase in the patient's resting heart rate of 15 beats per minute and a decrease in SaO2 below the minimum acceptable saturation level of 90%. What action should the therapist take? 1.Activate the emergency medical system 2.Select an alternate exercise activity 3.Stop the activity and have the patient take his prescribed beta-blocker medication 4.Consult with the patient's physician about whether the patient could benefit from oxygen during activity

4.Supplemental oxygen may allow patients to increase exercise tolerance and improve their abilities to engage in a variety of every day functions. Additional benefits of supplemental oxygen in patients with chronic obstructive pulmonary disease include improving mental alertness, stamina, mood, and sleep. (Hillegass p. 443)

A physical therapist has been treating an adolescent with spina bifida for the last four months. Recently the therapist has noticed emerging hypertonicity of the bilateral lower extremities and possible progression of the patient's scoliotic curve. During a recent session the patient mentions that they have been experiencing low back pain and sporadic urinary incontinence. Which pathology is MOST likely based on the patient's clinical presentation? 1.Syringomyelia 2.Tetralogy of Fallot 3.Posterior cord syndrome 4.Tethered cord syndrome

4.Tethered cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. These attachments cause an abnormal stretching of the spinal cord causing metabolic changes and ischemia of the neural tissue. Rapid progression of scoliosis and increased tone are cardinal signs of tethering of the spinal cord. Once suspected, myelography is required to confirm the diagnosis. Surgical release is recommended in most cases as soon as the patient is diagnosed in order to avoid permanent neurological damage. This disorder is closely linked to spina bifida. (Tecklin p. 267)

A physical therapist designs a general strengthening program for a male patient rehabilitating from a flexor tendon repair. The therapist instructs the patient to place the rubber band around his fingers when they are together and then asks the patient to move the fingers as far apart as possible. What is the PRIMARY objective of this activity? 1.Stretch the lumbricales 2.Stretch the interossei 3.Strengthen the lumbricales 4.Strengthen the interossei

4.The interossei, specifically the dorsal interossei, act to abduct the index, middle, and ring fingers from midline through the third digit. Providing resistance to abduction would help strengthen the dorsal interossei. (Kendall p. 272)

A physical therapist treats a patient rehabilitating from a stroke in a rehabilitation facility. The medical record indicates that the patient was recently prescribed dantrolene sodium. Which activity would be MOST impacted by the use of this pharmacological agent? 1.Oral motor skills 2.Cognition 3.Fine motor skills 4.Ambulation

4.The most common side effect of dantrolene sodium is generalized muscle weakness which occurs throughout the body, not just in hyperexcitable tissues. As a result, activities requiring sustained muscular activity such as ambulation are potentially problematic. In addition, patients prescribed dantrolene sodium may initially experience mild dizziness when initiating the medication. (Ciccone p. 185)

A 21-year-old male with cerebral palsy uses a wheelchair for basic mobility. The patient has significant difficulty maintaining head and trunk control and has developed scoliosis and a resultant pelvic obliquity. What other deformity was likely accommodated for based on the pictured adaptive seating design? 1.Sacral sitting 2.Decorticate rigidity 3.Thoracic kyphosis 4.Windswept hips

4.The obliquity of the seat accommodates the described scoliosis related pelvic obliquity. The abductor pommel and large lateral thigh wedges are positioning aides that serve to maintain the hips and lower extremities in as much of a neutral position as tolerated. (Tan p. 318)

A patient who will be undergoing a total mastectomy considers her breast reconstruction options. She reports favoring the procedure that uses her own abdominal muscle and tissue to reconstruct the breast. Which of the following is the MOST likely complication associated with this method of reconstruction? 1.Restricted trunk mobility due to shortened abdominal tissue 2.Necrosis at the donor site due to inadequate blood supply 3.Reduced shoulder mobility due to the muscle flap attachment 4.Low back pain due to weakened abdominal support

4.The patient does lose a substantial portion of the structural support of the abdomen since a significant portion of the abdominal tissue is removed. As a result, low back pain due to trunk instability and abdominal hernia due to reduced anterior support are common complications of a TRAM flap procedure. (Goodman - Pathology p. 1026)

The muscles of the pelvic floor support and maintain the position of the bladder, uterus, and rectum within the pelvic cavity. Which ligament also assists in maintaining the position of the uterus? 1.Suspensory ligament 2.Ovarian ligament 3.Inguinal ligament 4.Round ligament

4.The round ligament attaches to the side of the uterus, below the uterine tube, extending to the labia majora. The ligament functions to maintain the fundus of the uterus in a forward position. (Goodman - Differential Diagnosis p. 618)

A physical therapist reviews the medical record of a patient recently admitted to physical therapy after being diagnosed with adhesive capsulitis. The patient describes an insidious onset of pain and stiffness approximately three months ago. Which patient profile would be MOST likely based on the medical diagnosis? 1.A 58-year-old female with multiple sclerosis 2.A 45-year-old male with peripheral neuropathy 3.A 52-year-old male with a history of recurrent rotator cuff tendonitis 4.A 48-year-old female with diabetes

4.Three risk factors, age, sex, and diabetes, are represented in this patient profile making it most likely to be associated with a diagnosis of adhesive capsulitis. (Dutton p. 556)

A physical therapist guards a patient that is descending a flight of stairs with handrails. The patient has left lower extremity weakness due to a tibial plateau fracture eight weeks ago. Assuming the patient descends the stairs according to the normal flow of traffic, what is the MOST appropriate therapist position when guarding the patient? 1.Beside the patient on the involved side 2.Beside the patient on the uninvolved side 3.In front of the patient on the uninvolved side 4.In front of the patient on the involved side

4.When descending the stairs, the therapist should stand in front of the patient. Since the patient is descending the stairs with the railing on the uninvolved side, it is most appropriate for the therapist to stand on the involved side. (Fairchild p. 241)

9. A patient in an acute care hospital complains to his physical therapist about point tenderness in his back following a diagnostic test earlier in the day. An entry in the medical record reveals that the patient had a lumbar puncture. Based on the given diagnostic test, at what spinal level would the therapist expect the patient to be the MOST tender? 1.T12-L1 2.L1-L2 3.L2-L3 4.L3-L4

A lumbar puncture is performed by inserting a needle in the midline of the spine most commonly at either the L3-L4 or L4-L5 level, depending on which offers the most available intervertebral space once the patient is appropriately positioned for the procedure. (Paz p. 175)

A patient presents to physical therapy with complaints of deconditioning following treatment for breast cancer. Though her cancer has been in remission for six months, the patient still presents with a lymphedematous left upper extremity that the patient describes as "weak and painful." Based on the patient's clinical presentation, which of the following would NOT be included as part of the patient's treatment session? 1.Frequent monitoring of limb circumference 2.Use of compression garments 3.Massage of the affected extremity 4.Moist heat on the affected extremity at the start of treatment

Patients with lymphedema should avoid heating the affected extremity. Localized heat will increase blood flow to the target area and will lead to worsening of the patient's lymphedema symptoms. (Goodman - Pathology p. 687)v

A physical therapist examines a 37-year-old female referred to physical therapy with an abdominal strain. The patient reports an insidious onset of pain that is worse after eating certain foods. The patient describes the pain as a dull ache located slightly to the right of the center of the back at the level of the inferior border of the scapula. The dysfunction of which of the following is MOST consistent with the patient's clinical presentation? 1.Pancreas 2.Liver 3.Gallbladder 4.Kidneys

Symptoms of gallbladder dysfunction typically includes pain in the right shoulder and between the scapulae, tenderness over the right 10th rib, and right upper quadrant epigastric pain. Patients with gallbladder dysfunction often have difficulty with foods high in refined carbohydrates and saturated fats. (Goodman - Pathology p. 923)

A patient three days status post myocardial infarction is medically ready to begin a formalized, inpatient exercise program. What is the MOST appropriate guideline to use when determining the patient's upper limit to exercise? 1.Resting respiratory exchange ratio 2.Rate of perceived exertion of 18 3.Maximum oxygen consumption 4.Resting heart rate plus 20 beats per minute

The arbitrary upper limit of intensity for inpatients who are post myocardial infarction is the patient's own resting heart rate plus 20 beats per minute. (Tan p. 760)