Practice Exam 1 (scorebuilders)

A physical therapist reviews a physician report on a patient referred to physical therapy. In the report it indicates the patient presents with a Dowager's hump. Which patient description would be MOST likely based on the stated spinal deformity? 1.A 16-year-old female with idiopathic scoliosis 2.A 62-year-old male with ankylosing spondylitis 3.A 66-year-old female with osteoporosis 4.A 57-year-old male with thoracic kyphosis

A Dowager's hump is often seen in older patients and results from degeneration of the thoracic vertebral bodies. The anterior portions of the vertebrae degenerate and compress, leading to a kyphotic structural deformity in the thoracic spine. A Dowager's hump is characterized by a kyphotic curvature of the thoracic spine secondary to the osteoporotic process that occurs in postmenopausal women.

.A physical therapist teaches a patient with a recent transtibial amputation to wrap his residual limb to promote shrinking and shaping. What should the therapist instruct the patient to do? 1.Keep the limb wrapped only during the day time; leave it exposed to air at night 2.Use two six-inch ace wraps when wrapping the limb 3.Use a figure-eight pattern when wrapping, avoiding circumferential wraps 4.Apply more pressure proximally and less distally

A figure-eight pattern should be used when wrapping the residual limb. Use of a circumferential pattern can result in an undesired tourniquet effect.

A physical therapist prepares to complete a selected manual muscle test on a patient with rotator cuff tendonitis by placing the upper extremity in the recommended test position. The therapist determines that the patient is unable to maintain the test position and slowly allows the arm to sag. Which of the following muscle grades is MOST consistent with this scenario? 1.Good minus 2.Fair 3.Fair minus 4.Poor

A grade of fair minus is characterized by the patient being unable to complete the full available range of motion against gravity, however, can complete more than half of the range. If placed in the test position, the patient will have insufficient strength to maintain the position. 1.A grade of good minus is characterized by the patient completing range of motion against gravity with minimal-moderate resistance. 2.A grade of fair is characterized by the patient completing range of motion against gravity without manual resistance. 4.A grade of poor is characterized by the patient completing range of motion with gravity-eliminated.

A 13-year-old patient diagnosed with mild left c-curve thoracic scoliosis is referred to physical therapy. During the initial examination the patient is asked to bend forward allowing the arms to hang freely. Which of the following observations would be anticipated? 1.Right convexity with left posterior rib hump 2.Left convexity with left posterior rib hump 3.Right convexity with right posterior rib hump 4.Left convexity with right posterior rib hump

A left thoracic c-curve is named based on the left sided convexity of the curve. The associated posterior rib hump would appear on the same side as the convexity.

A physical therapist concludes that a patient exhibits exaggerated reflex responses during reflex testing. Which pathology would be LEAST likely to be associated with the identified finding? 1.Cerebrovascular accident 2.Duchenne muscular dystrophy 3.Cerebral palsy 4.Multiple sclerosis

A lower motor neuron disease is characterized by a lesion that affects nerves or their axons at or below the level of the brainstem, usually within the "final common pathway." An upper motor neuron disease is characterized by a lesion found in descending motor tracts within the cerebral motor cortex, internal capsule, brainstem or spinal cord. Lower motor neuron diseases tend to exhibit diminished or absent reflexes, while upper motor neuron diseases tend to exhibit exaggerated reflexes. Duchenne muscular dystrophy is a progressive neuromuscular degenerative disorder that manifests symptoms once fat and connective tissue begin to replace muscle that has been destroyed by the disease process. The mutation of the dystrophin gene causes the symptoms associated with the condition. Duchenne muscular dystrophy is a lower motor neuron disease. 1.Cerebrovascular accident is a specific event that results in a lack of oxygen supply to a specific area of the brain secondary to either ischemia or hemorrhage. Cerebrovascular accident is an upper motor neuron disease. 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. Cerebral palsy is an upper motor neuron disease. 4.Multiple sclerosis produces patches of demyelination of the myelin sheaths that surround nerves within the brain and spinal cord. Multiple sclerosis is an upper motor neuron disease.

A patient with a spinal cord injury controls a power wheelchair using a hand-controlled joystick. Which level of spinal cord injury would be MOST likely to utilize this type of wheelchair adaptation? 1.C4 tetraplegia 2.C5 tetraplegia 3.C6 tetraplegia 4.T1 paraplegia

A patient with C5 tetraplegia would have functional use of elbow flexion and with the help of a specialized assistive device (e.g., wrist or hand orthotic), would be able to use a hand-controlled joystick. 1.A patient with C4 tetraplegia would exhibit movement of the head and neck, as well as shoulder elevation. The patient would not have the necessary upper extremity innervation to use a hand-controlled joystick. 3.A patient with C6 tetraplegia would have functional use of wrist extension. This would permit tenodesis during active wrist extension, which assists with grasp and release. The patient would likely have the ability to use a manual wheelchair with rim projections or another similar modification to enhance gripping of the wheel rims. 4.A patient with T1 paraplegia would have functional use of all upper extremity musculature. The patient would be independent with a manual wheelchair and would likely require advanced wheelchair training to safely propel on uneven surfaces, rough terrain, and ramps and curbs.

A physical therapist completes a series of manual muscle tests on a patient diagnosed with C6 quadriplegia. Based on the patient's level of injury, which muscle would NOT typically be innervated? 1.Pectoralis major 2.Flexor digitorum superficialis 3.Serratus anterior 4.Extensor carpi radialis

A patient with a C6 spinal cord injury would have use of all muscles innervated by the C6 spinal nerve, including the extensor carpi radialis, infraspinatus, latissimus dorsi, pectoralis major, pronator teres, serratus anterior, and teres minor. Innervation to the flexor digitorum superficialis would be present with a C7 spinal cord injury. The patient in the scenario would not have use of this muscle.

physical therapist assistant uses neuromuscular electrical stimulation to treat a patient rehabilitating from a lower extremity injury. The physical therapist assistant utilizes the exact parameters used by the supervising physical therapist on the patient's previous visit. However, after increasing the intensity of the current the patient complains of sharp pain under one of the electrodes. What is the MOST appropriate physical therapist assistant action? 1.Modify the parameters of the stimulation to make it more comfortable 2.Discontinue electrical stimulation as an intervention 3.Consult with the supervising physical therapist 4.Contact the referring physician

A physical therapist assistant can modify the parameters of an existing intervention within the established plan of care. Modifying electrical stimulation parameters to improve patient comfort does not change the patient's plan of care. The physical therapist assistant can make such adjustments without consulting the supervising physical therapist.

A patient returns to physical therapy after meeting with a physician for a surgical consultation. The patient indicates that the surgeon discussed two different surgical options. During the physical therapy session the patient asks the therapist which surgical option would be the most ideal. What is the MOST appropriate physical therapist action? 1.Offer to conduct a literature search that explores various surgical and non-surgical options to managing the patient's injury 2.Answer the patient's question based on personal experience treating patients with similar medical conditions 3.Encourage the patient to reflect on the information gathered during the surgical consultation and schedule a follow up meeting with the surgeon 4.Suggest the patient consider seeking a second surgical opinion

A physical therapist should use a tremendous amount of caution when providing advice to a patient on topics outside the scope of physical therapy practice. Clarification related to the advantages and disadvantages associated with different surgical options should come from the surgeon.

A physical therapist treats a 29-year-old male who sustained a superficial partial-thickness burn to the anterior portion of his left forearm and wrist. Based on the classification of the burn, what is the MOST likely outcome? 1.Hypertrophic scarring of the burned areas unless compression garments are used for six to twelve months 2.Painful burns that present with thickened blisters that heal in less than three weeks 3.Impaired sensation of pain and temperature, potential scar hypertrophy, and healing within six weeks 4.Excision and grafting of the wounds to expedite healing and avoid contractures

A superficial partial-thickness burn involves the epidermis and the majority of the dermis. The burn is characterized by blister formation and the presence of pain. Healing typically occurs in 5 to 14 days, however, can take up to 21 days to heal. 1.Hypertrophic scarring is more likely to occur with deep partial-thickness or full-thickness burns. Compression garments are used to limit the extent of hypertrophic scarring. 3.A superficial partial-thickness burn would not exhibit impaired sensation of pain or temperature since nerve endings are not damaged. This would be more characteristic of a deep partial-thickness burn. A deep partial-thickness burn would also potentially exhibit scar formation, while a superficial partial-thickness burn would not. 4.Healing with the use of grafting is more characteristic of a full-thickness burn.

A physical therapist determines that a patient diagnosed with degenerative lateral lumbar spinal stenosis is ready to progress from isometrics to more challenging trunk stability exercises. Which exercise is MOST appropriate to advance the exercise progression without symptom exacerbation? 1.Resisted trunk extension in sitting 2.Abdominal curls in hooklying 3.Alternating arm and leg raises in prone 4.Alternating arm and leg raises in quadruped

Abdominal curls in a hooklying position best ensures that the patient will maintain a neutral or flexed position with respect to the lumbar spine while still addressing the goal of improved trunk stability. 1.Although resisted trunk extension may generally be an appropriate exercise for increasing trunk stability, extension causes the foramen space between facet joints to be further reduced which typically exacerbates symptoms associated with lateral spinal stenosis. 3.Alternating arm and leg raises in prone are commonly utilized for trunk stability goals. However, this position would encourage extension and likely exacerbate symptoms. It is possible to make this exercise more appropriate for the patient by placing pillows under the abdomen. 4.Alternating arm and leg raises in quadruped would typically be considered too aggressive when progressing from isometric trunk stability exercises. It is unlikely that the patient would be able to maintain a neutral spine during the activity and would more likely assume a position of increased lumbar lordosis.

A physical therapist reviews a new referral for a patient diagnosed with congenital torticollis. Which of the following is the MOST accurate regarding the diagnosis in a newborn? 1.Symptoms are typically observable immediately after delivery 2.Associated edema typically presents over the mastoid process 3.The etiology is often associated with some degree of birth trauma 4.The condition typically presents with bilateral symptoms

Although often considered idiopathic, research suggests that in utero restrictions and perinatal trauma are the most likely causes of congenital torticollis. There is a significant prevalence of congenital torticollis among infants who were delivered breech or with the assistance of forceps. 1.Congenital torticollis is not typically observed immediately after delivery. Although trauma sustained during delivery is often linked to development of the condition, infants typically appear healthy on delivery with symptoms presenting gradually over days or weeks. 2.Edema in the form of a pseudo-tumor is typically associated with the presentation of congenital torticollis. A firm, non-tender mass will typically form over the sternocleidomastoid (SCM) muscle belly or near the muscle's clavicular attachment. 4.Torticollis (i.e., Latin for "twisted neck") presents unilaterally involving the SCM muscle. As a result, the patient will demonstrate ipsilateral side bending and contralateral rotation with respect to the affected muscle. Bilateral SCM shortening would cause cervical flexion with the mastoid and temporal bones moving closer to the sternum.

A physical therapist conducts an examination on a patient diagnosed with cervical radiculopathy. The therapist identifies weakness in the patient's wrist flexors and sensory abnormalities in the dorsal forearm as well as in the long and ring fingers. Which additional finding would be MOST likely? 1.Impaired triceps reflex 2.Weakness of the wrist extensor muscles 3.Impaired brachioradialis reflex 4.Weakness of the biceps muscle

An impaired triceps reflex (C6-C7) is most commonly associated with C7 nerve root involvement. Other signs of C7 involvement include weakness in the triceps, wrist flexors and sensory abnormalities in the dorsal forearm, long and ring fingers. The described clinical scenario and an impaired triceps reflex are both characteristic of C7 involvement. 2.Weakness of the wrist extensors is most commonly associated with C6 nerve root involvement. Other signs of C6 involvement include weakness of the biceps (also commonly seen with C5 involvement), supinator and an impaired brachioradialis reflex. 3.An impaired brachioradialis reflex (C5-C6) is most commonly associated with C6 nerve root involvement. Other signs of C6 involvement include weakness of the biceps (also commonly seen with C5 involvement), supinator, wrist extensors and sensory abnormalities in the lateral forearm and thumb. 4.Weakness of the biceps muscle (C5-C6) is most commonly associated with C5 or C6 nerve root involvement. Other signs of C5 involvement include weakness of the deltoid and an impaired biceps reflex.

A physical therapist works with a patient who is rehabilitating from a T2 spinal cord injury. During the session the patient begins to demonstrate signs and symptoms consistent with autonomic dysreflexia. What would be the MOST immediate course of action? 1.Discontinue the treatment session and call emergency medical services 2.Instruct the patient to perform deep breathing exercises 3.Assess for obstruction of the urinary catheter line or any irritating stimuli 4.Assist the patient to the supine position and closely monitor vital signs

Autonomic dysreflexia is an autonomic reflex which typically occurs in spinal cord lesions above the T6 level. It is seen with both complete and incomplete lesions. This clinical syndrome produces an acute onset of autonomic activity from noxious stimuli below the level of the lesion. Common signs and symptoms include hypertension, bradycardia, headache, sweating, flushing above the level of the lesion, piloerection, blurred vision, and restlessness. 3.Attempting to eliminate the noxious stimulus causing autonomic dysreflexia would be the most immediate course of action. Failure to identify and address the irritating stimuli would result in the therapist calling emergency medical services.

A patient reports significant discomfort in the lower leg during ultrasound treatment. The therapist believes the discomfort is caused by periosteal pain from the ultrasound. Which scenario is MOST likely associated with the patient's subjective report of discomfort? 1.An ultrasound unit with a high beam nonuniformity ratio 2.An ultrasound unit with a low beam nonuniformity ratio 3.A transducer with a large effective radiating area 4.A transducer with a small effective radiating area

Beam nonuniformity ratio (BNR) is the ratio between the spatial peak intensity and spatial average intensity. The higher the quality of the crystal, the lower the BNR. The BNR is derived from the intrinsic factors and quality of the piezoelectric crystal. A high beam nonuniformity ratio produces a less uniform beam and therefore places the patient at greater risk for undesirable side effects such as periosteal pain or hot spots. 2.A low beam nonuniformity ratio produces a more uniform beam and therefore allows for greater patient comfort and safety. 3.Large ultrasound transducers have relatively large effective radiating areas. Effective radiating area (ERA) refers to the area of the transducer that transmits ultrasound energy. The ERA is more relevant when considering the size of the transducer to utilize and the duration of treatment. 4.Small ultrasound transducers have small effective radiating areas. The ERA is always slightly smaller than the total size of the transducer head. A transducer with a small effective radiating area would be unlikely to produce the described discomfort without additional contributing variables.

A physical therapist initiates gait training with a patient who is two days status post total knee arthroplasty. During the activity, the therapist observes that the patient is experiencing foot drop on her surgical limb. Damage to which of the following nerves is MOST likely associated with with this finding? 1.Sural 2.Tibial 3.Peroneal 4.Saphenous

Because of their proximity to the surgical field and the positioning required for surgery, several neurovascular structures are at risk for sustaining damage during a total knee arthroplasty (TKA). Peroneal nerve palsy is the most common neurological complication, while injuries to the superficial femoral and popliteal vessels are among the vascular structures at greatest risk. The peroneal nerve is derived from the sciatic nerve providing sensory and motor innervation to the lower leg. Injury to the peroneal nerve typically manifests as weakness in the ankle dorsiflexors (e.g., foot drop) and sensory deficits radiating from the fibular head to the dorsum of the foot. (Dutton 95)

A patient referred to physical therapy presents with obvious disuse atrophy after having a lower extremity cast removed. The primary goals of physical therapy include increasing muscle strength and returning to functional ambulation on level and unlevel surfaces. The patient has cancer in several sites including the involved extremity. What are the MOST appropriate interventions for the patient? 1.Electromyographic biofeedback and progressive ambulation 2.High voltage pulsed current and walking on a treadmill 3.Neuromuscular electrical stimulation and progressive resistive exercises 4.Warm whirlpool and multiple angle isometrics

Biofeedback has no contraindications other than possible skin irritation from the coupling gel or adhesives. Progressive ambulation would be an appropriate intervention for a patient trying to improve their functional ambulation. 2.Although treadmill training may be an appropriate intervention for a patient trying to improve their functional ambulation, high voltage pulsed current would be contraindicated for this patient due to their history of cancer. 3.Although progressive resistive exercise may be an appropriate intervention for a patient trying to improve their strength, neuromuscular electrical stimulation would be contraindicated for this patient due to their history of cancer. 4.Although multiple angle isometrics may be an appropriate intervention for a patient trying to improve their strength, a warm whirlpool (i.e., thermotherapy) would be contraindicated for this patient due to their history of cancer.

A physical therapist provides education regarding skin care and the signs and symptoms of cellulitis for a patient with lymphedema. Why would the patient be at increased risk for developing cellulitis? 1.Increased skin fragility on the affected extremity 2.Reduced blood flow to the affected extremity 3.Depressed systemic immunity 4.Increased proportion of cellular waste in the affected extremity

Cellulitis is a fast spreading inflammation that occurs as a result of a bacterial infection of the skin and connective tissues. It can develop anywhere under the skin, but will typically affect the extremities. Cellulitis is caused by particular bacterial infections including streptococci or staphylococci. The lymphatic system is responsible for the removal of excess cellular waste and foreign materials from the interstitium. When this process is impaired, the interstitium becomes an environment where infectious microbes are able to thrive increasing the risk of local infection.

An infant with cerebral palsy is referred to physical therapy for an adaptive equipment evaluation. What is the PRIMARY purpose for the use of adaptive equipment with this child? 1.Normalization of tone 2.Remediation of strength 3.Remediation of postural control 4.Participation in activities

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. Adaptive equipment is prescribed based on individual deficits in order to increase a patient's general independence. Adaptive equipment should be used to assist children with cerebral palsy to participate in activities. Although adaptive equipment does not normalize tone, strengthen or improve postural control, it is an effective compensatory strategy to assist children to participate in activities. 1.Normalization of tone can enhance a patient's independence by increasing or decreasing existing tonal influences. Physical therapists may utilize facilitation and inhibition techniques during treatment, therapeutic positioning or orthotic prescription when attempting to normalize abnormal tone. Adaptive equipment is not primarily intended for the normalization of tone. 2.Remediation of strength would result from interventions that may include functional activities and therapeutic play. Adaptive equipment is designed for improving independence, but is not primarily intended for remediation of strength. 3.Remediation of postural control would result from interventions that may include wheelchair seating, facilitation or inhibition techniques, and proximal control activities. Adaptive equipment is designed for improving independence, but does not provide remediation of postural control.

A physical therapist observes a patient completing a closed chain activity emphasizing knee flexion. Which description is MOST consistent with the described therapeutic activity? 1.The femoral condyles roll backward and glide forward on the tibia 2.The femoral condyles roll forward and glide backward on the tibia 3.The tibia rolls and glides posteriorly on the femoral condyles 4.The tibia rolls and glides anteriorly on the femoral condyles

Closed chain activities involve the body moving over a fixed distal segment. Open chain activities involve the distal segment, usually the hand or foot, moving freely in space. The proximal joint surface of the tibiofemoral joint is formed by the convex medial and lateral condyles of the distal femur. The distal joint surface is formed by the concave medial and lateral condyles of the proximal tibia. During closed chain knee flexion the femoral condyles roll backward and glide forward on the tibia. (Dutton 855)

A patient is evaluated in physical therapy after sustaining brain damage secondary to closed head trauma. When performing a sensory examination, the therapist notes that the patient has impaired stereognosis, two-point discrimination, and barognosis. Which type of sensations are MOST representative of the patient's impairments? 1.Superficial sensations 2.Deep sensations 3.Combined cortical sensations 4.Cutaneous sensations

Combined cortical sensations include stereognosis, tactile localization, two-point discrimination, double simultaneous stimulation, graphesthesia, texture recognition, and barognosis. 1.Superficial sensations include pain, temperature, touch, and pressure. 2.Deep sensations include kinesthesia, proprioception, and vibration. 4.Cutaneous sensation is synonymous with superficial sensation.

A physical therapist employed in an acute care setting performs auscultation on a patient diagnosed with atelectasis. Based on the patient's current medical status, which classification of breath sounds would the therapist expect to identify during inhalation? 1.Vesicular 2.Wheezes 3.Bronchial 4.Crackles

Crackles, also known as rales, are discrete, high-pitched, discontinuous sounds (like the sound of hairs being rubbed together between the thumb and forefinger) that result from the opening and closing of alveoli and small airways. Patients with atelectasis, which is the collapse of alveoli, have crackles over the collapsed area. 1.Vesicular breath sounds are soft rustling sounds heard during inhalation and the beginning of exhalation. These are normal breath sounds. 2.Wheezes are continuous, "musical" or whistling sounds heard during both inspiration and expiration. They arise from turbulent airflow and the vibrations of the walls of small airways due to narrowing by bronchospasm, edema, collapse, or by secretions, neoplasm, or foreign body. 3.Bronchial breath sounds are coarse, hollow, loud sounds with the inspiratory phase shorter than the expiratory phase and a slight pause between them. They are normal sounds when heard over the trachea, but are considered abnormal sounds when heard over peripheral lung tissue, as they may indicate consolidation or compression of the tissue.

A physical therapist administers a high intensity neuromuscular electrical stimulation treatment to enhance quadriceps recovery in a patient that is three weeks status post medial meniscectomy. The patient complains of severe pain directly under the 2" x 2" electrodes that the therapist affixed to the quadriceps. Which of the following actions would be the MOST appropriate? 1.Attempt the intervention with a new set of 2 inch x 2 inch electrodes 2.Attempt the intervention with a new set of larger electrodes 3.Discontinue the intervention with neuromuscular electrical stimulation and use interferential current 4.Discontinue the intervention

Current density is inversely proportional to the size of the electrodes. Therefore, larger electrodes will have decreased current density and be more comfortable for the patient.

A physical therapist receives a referral for a patient diagnosed with Cushing's disease. Which of the following BEST characterizes this condition? 1.Hypofunction of the adrenal gland 2.Hyperfunction of the adrenal gland 3.Hypofunction of the thyroid gland 4.Hyperfunction of the thyroid gland

Cushing's disease is a form of adrenal dysfunction that presents with hyperfunction of the adrenal gland, allowing for excessive amounts of cortisol (glucocorticoid) production. Hyperfunction of the adrenal gland is characteristic of Cushing's disease. Symptoms evolve over years and can include persistent hyperglycemia, growth failure, truncal obesity, "moon-shaped face," and "buffalo hump" posteriorly at the base of the neck. 1.Hypofunction of the adrenal gland is characteristic of Addison's disease. Symptoms include a widespread metabolic dysfunction secondary to cortisol deficiency as well as fluid and electrolyte imbalances secondary to aldosterone deficiency. 3.Hypofunction of the thyroid gland occurs when there are decreased levels of thyroid hormones in the bloodstream. This deficiency slows the processes within the body and symptoms may include fatigue, weakness, decreased heart rate, and weight gain. 4.Hyperfunction of the thyroid gland occurs when there are excessive levels of thyroid hormones in the bloodstream. Symptoms may include an increase in nervousness, excessive sweating, weight loss, increase in blood pressure, exophthalmos, myopathy, chronic periarthritis, and an enlarged thyroid gland.

A physical therapist reviewing a patient's past medical history reads that the patient was diagnosed with a grade 3 cystocele due to childbirth complications. This diagnosis specifically relates to the displacement of what organ? 1.Bladder 2.Uterus 3.Rectum 4.Small bowel

Cystocele refers to a forward and downward displacement of the bladder within the pelvic cavity. Cystocele can result from delivery-related muscle weakness or injury to the bladder's supporting structures. Cystocele is typically associated with a weakening of the bladder's support structures. Depending on the degree of weakness and how far the bladder has descended, there may be protrusion of the bladder through the anterior vaginal wall. 2.Uterine prolapse is associated with a weakening of the uterine supporting structures. Depending on the degree of prolapse, the uterus may even protrude externally through the vaginal canal. 3.Rectocele is associated with a weakening of the rectal supporting structures. A small tissue bulge may be noticeable depending on the degree of rectocele present. 4.Enterocele is most commonly diagnosed in women who have had a hysterectomy. Without the structure of the uterus for support, the small bowel may descend into the pelvic cavity and rest on the upper portion of the vagina creating a small bulge.

A physical therapist is teaching diaphragmatic breathing to a patient. What should the therapist have the patient do in order to facilitate the patient's awareness of using the diaphragm? 1.Flex at the waist while standing 2.Perform a sit-up 3.Huff 4.Sniff

Diaphragmatic breathing involves breathing predominantly with the diaphragm while minimizing the action of accessory muscles and motion of the upper rib cage during inspiration. Physical therapists commonly teach diaphragmatic breathing to their patients in an effort to correct abnormal chest wall motion; to decrease the work of breathing, accessory muscle activity, and dyspnea; to increase the efficiency of breathing; and to improve the distribution of ventilation. Sniffing enlists the diaphragm and is useful as a training technique to promote diaphragmatic breathing.

While auscultating over the posterior basal lung segments, a physical therapist asks the patient to verbalize the long "E" sound. The sound the physical therapist hears in the stethoscope, however, is a nasal long "A" sound. Which medical diagnosis would MOST likely benefit from the described intervention? 1.Bronchial breath sounds 2.Bronchophony 3.Pectoriloquy 4.Egophony

Egophony is demonstrated when the patient says the long "E" sound, but the long "A" sound is heard during auscultation. The stronger the sound, the greater the indication for consolidation of the underlying lung tissue. 1.Bronchial breath sounds are normal when present over the large airways in the anterior chest near the second and third intercostal spaces. They are abnormal sounds when heard over areas of the lung where vesicular sounds are expected. 2.Bronchophony refers to increased vocal resonance with greater clarity and loudness of spoken words (e.g., "99"). It is always an abnormal sign and is associated with increased consolidation of the underlying lung tissue. 3.Pectoriloquy is noted when the whispered sounds, "99" or "1, 2, 3" are easily heard during auscultation. This is always an abnormal sign and is associated with increased consolidation of the underlying lung tissue.

A physical therapist reviews a summary report for a patient that recently completed a graded exercise test. The report indicates that the patient had greater than 2.0 mm of horizontal ST segment depression. Which scenario is MOST consistent with the reported findings? 1.Experienced ventricular arrhythmia during exercise 2.Experienced myocardial ischemia during exercise 3.Had adequate myocardial perfusion during exercise 4.Had a normal electrocardiographic response to exercise

Exercise induced changes in the electrocardiogram may be indicative of underlying cardiac pathology. The ST segment of the ECG represents the repolarization of the ventricles and begins when ventricular contraction ends. Normally, the ST segment is isoelectric and is between the end of the QRS complex and the beginning of the T wave. ST segment depression is the most common manifestation of exercise-induced myocardial ischemia. 1.Arrhythmias are a loss of rhythm or irregularities of the heart beat and manifest as changes in the P waves and QRS complexes on the electrocardiograph. 3.If the heart were normally perfused, the ST segment would be isoelectric. 4.If the patient had a normal electrocardiographic response to exercise, the ST segments would be isoelectric, not 2.0 mm depressed.

A physical therapist works with a patient on abdominal strengthening. The therapist attempts to have the patient complete a modified sit-up with their head and shoulders positioned on a wedge while in supine. What is the MOST likely rationale associated with the use of the wedge? 1.Weak rectus abdominis 2.Shortened hip flexors 3.Increased lordosis 4.Disk pathology

Failure to complete a sit-up due to weakness of the rectus abdominis often requires a wedge placed behind the head and shoulders. As the patient gradually becomes stronger, the size of the wedge can be diminished and ultimately eliminated. A patient with shortened hip flexors often performs a sit-up with pillows under the knees to decrease the pull of the hip flexors on the spine and allow the patient to lie with the pelvis and spine in neutral. Utilizing a wedge placed behind the head and shoulders would unnecessarily minimize the difficulty of the sit-up. 3.Patients with increased lordosis typically perform sit-ups with the knees bent. The presence of increased lordosis would not justify the use of a wedge placed behind the head and shoulders. 4.Patients with disk pathology often have a highly variable clinical presentation. The presented information does not provide adequate justification for the use of a wedge placed behind the head and shoulders. Therapists often have patients with disk pathology avoid straight leg sit-ups in order to avoid a significant increase in intradiskal pressure.

A physical therapist treating a patient rehabilitating from spinal surgery observes a patient's incision. What type of healing is BEST depicted in the image? 1.Delayed primary intention 2.Primary intention 3.Secondary intention 4.Tertiary intention

Healing by primary intention is most commonly associated with acute wounds which have minimal associated tissue loss (e.g., surgical wound, laceration, puncture wound). In these wounds, clean edges are reapproximated and closed with sutures, staples or adhesives to facilitate re-epithelialization. 1.Healing by delayed primary intention is most commonly associated with acute wounds which have minimal associated tissue loss, but are at high risk for developing complications (e.g., infection, dehiscence). These wounds are temporarily left open until risk factors have been alleviated and then are closed by usual primary intention methods. 3.Healing by secondary intention is most commonly associated with wounds which have significant tissue loss, necrosis or borders which cannot be reapproximated (e.g., full-thickness wound, pressure ulcer). These wounds are left open and typically require specialized dressings and ongoing wound care to facilitate healing. 4.Healing by tertiary intention is synonymous with healing by delayed primary intention. Risk factors such as wound bed contamination, infection, and significant local edema increase the risk of healing complications and must be addressed before the wound can be appropriately closed by usual primary intention methods.

A physical therapist working in a neonatal intensive care unit examines a one-week-old infant born with L4 myelomeningocele which was surgically repaired at birth. What would be the PRIMARY goal of immediate surgical intervention? 1.Restore motor function 2.Restore sensory function 3.Prevent infection 4.Prevent hydrocephalus

Infection prevention is a primary goal of early surgical intervention. The lesion provides direct access to the spinal column and brain, significantly increasing the risk of a serious infection. Complications can be significant including death, brain damage, and greater sensory-motor impairments.

A physical therapist reads in a patient's medical record that the patient's lymphedema is classified as Stage 1. Which sign or symptom should the therapist expect to observe when reviewing the patient's examination? 1.Reversible edema 2.Positive Stemmer's sign 3.Skin fibrosis 4.Non-pitting edema

Lymphedema is a chronic, incurable condition and is characterized by the accumulation of protein-rich fluid (i.e., lymph) in the body. The result is edema that typically presents in the extremities, but can occur anywhere in the body including the face, neck, abdomen, genitalia, and trunk. The severity of edema can be classified on a scale of four different "stages." Pitting edema is defined as fluid accumulation that can be compressed and demonstrates an indentation with applied pressure. This edema occurs in Stage 1 lymphedema and is reversible. It may increase with activity or heat and diminish with elevation or rest. 2.Stemmer's sign is a special test used to aid in the diagnosis of lymphedema. Stemmer's sign is positive if the skin at the dorsal base of the second toe/finger cannot be easily lifted away from the bone, which indicates thickening of the skin due to fibrotic changes. A positive Stemmer's sign is more characteristic of Stage 2 or Stage 3 lymphedema. 3.Fibrotic changes to the skin occur in patients with lymphedema because of the chronic state of inflammation that results from the condition. Skin fibrosis begins in Stage 2 lymphedema and progresses in Stage 3 lymphedema. 4.Non-pitting edema is defined by fluid accumulation that is not compressible with applied pressure. Non-pitting edema is more characteristic of Stage 2 or Stage 3 lymphedema.

Although both medical and nonmedical factors contribute to the decision to return to work after a cardiac event, the patient's performance on a graded exercise test can help assess their prognosis. Which of the following average job demands would be the largest allowable to safely return to work? 1.25% of the peak METs achieved on the exercise test 2.50% of the peak METs achieved on the exercise test 3.75% of the peak METs achieved on the exercise test 4.100% of the peak METs achieved on the exercise test

Most patients are considered to have the physical capacity to return to work if the average demand of their job is less than or equal to 50% of the peak METs achieved on an exercise test. 3.It is not necessary to be able to perform at 75% of the peak METs achieved on the exercise test to be able to return to most jobs. This would be too strict a requirement and would prevent some workers from returning to a job which they have the physical capacity to perform.

A 13-year-old female diagnosed with adolescent idiopathic scoliosis is referred to physical therapy for training in the use of a low profile thoracolumbosacral orthosis (TLSO). What is the MOST common rationale as to why the TLSO is often unsuccessful in improving a patient's condition? 1.Failure of the patient to exercise on a regular basis 2.Inadequate application of forces by the TLSO 3.Failure of the patient to wear the orthosis as indicated 4.Skin breakdown under the orthosis

Non-compliance is the most common reason that bracing is often an ineffective treatment option for scoliosis. TLSOs are effective if they are worn as prescribed, which is typically between 16 and 23 hours per day. Research indicates that there is typically a higher compliance with younger patients compared to older adolescents.

A physical therapist works with a seven-year-old child diagnosed with spina bifida. The therapist has noticed that over the last two months the child has become less participatory with physical therapy and has experienced more frequent behavioral issues. What is the MOST appropriate strategy to promote long-term improvement in the patient's level of participation? 1.Continue to encourage the child to participate during each session 2.Allow the child to select treatment activities from a list of available options 3.Develop a reward system for the child based on their level of participation 4.Inform the child about the consequences associated with not participating in physical therapy

Operant conditioning is learning that takes place when the learner recognizes the connection between the behavior (participating in therapy) and its consequences (receiving identified rewards). This is a form of associative learning that can be very effective with this age group Developing a reward system to improve the child's level of participation can be an effective long-term strategy. This approach is an example of positive reinforcement (operant conditioning). This type of approach attempts to promote desirable behaviors while attempting to extinguish less desirable behaviors.

A physical therapist interviews a patient diagnosed with osteoarthritis. Which statement would be MOST consistent with the typical clinical presentation of this disease? 1.Joint pain seemed to start symmetrically 2.Morning stiffness lasts for less than one hour 3.Onset of symptoms was quite sudden 4.Frequent fatigue and general malaise

Osteoarthritis is a chronic disease that causes degeneration of articular cartilage, primarily in weight bearing joints. Subsequent deformity and thickening of subchondral bone occurs resulting in impaired functional status. Any joint may be involved, however, the most commonly affected sites include the hands and weight bearing joints such as the hips and knees. Osteoarthritis tends to produce morning stiffness that subsides relatively quickly (e.g., less than 30 minutes) with movement or activity. Rheumatoid arthritis is more likely to produce prolonged stiffness lasting for hours. 1.Osteoarthritis tends to begin on one side of the body and often begins in a single joint. Rheumatoid arthritis is more likely to start on both sides of the body (i.e., symmetrically). 3.Osteoarthritis is characterized by a slow onset of symptoms that gradually intensifies over years. Rheumatoid arthritis is more likely to be associated with a relatively rapid onset of symptoms over weeks or perhaps months. 4.Osteoarthritis tends to impact affected joints only and although this may contribute to fatigue, malaise would more commonly be associated with a systemic condition such as rheumatoid arthritis.

A patient with Parkinson's disease is experiencing increased episodes of freezing when walking, occasionally resulting in a fall. Once the freezing occurs the patient is unable to resume walking without manual assistance. Which of the following will increase the patient's ability to independently resume walking following a freezing episode? 1.Trunk rotation in sitting prior to walking 2.Walking on a treadmill 3.Counting ("one, two, three,...") while attempting to resume walking 4.Practicing walking in a crowded environment

Patients diagnosed with Parkinson's disease often experience difficulty with gait including small, shuffling steps and freezing episodes. Both auditory and visual stimuli are used to address these difficulties. Although it may not decrease the frequency of freezing episodes, auditory cues (e.g., counting "one, two, three") are useful in assisting a patient to resume walking after a freezing episode. If a patient gets "stuck" in a freezing episode, they can independently use this strategy to continue walking.

A physical therapist elects to use cushion contact instead of traditional direct contact when administering ultrasound. Which medical condition would provide the MOST support for this method of ultrasound administration? 1.Peroneal tenosynovitis 2.Hamstrings strain 3.Carpal tunnel syndrome 4.Rotator cuff tendonitis

Peroneal tenosynovitis refers to inflammation of the tendon and its sheath. This condition is often precipitated by stress due an acute ankle sprain or repetitive ankle motion combined with weightbearing (e.g., running, jumping). This condition prevents the tendon from gliding smoothly within the sheath and may cause pain. The location of the peroneal tendons, along the lateral lower leg and posterior to the lateral mallelolus, make it difficult to maintain consistent surface contact with the ultrasound transducer. As a result, it is often beneficial to administer ultrasound using cushion contact when treating this condition.

A physical therapist treats a recently referred patient with Graves' disease. In reviewing the patient's laboratory results, which change in normative values are MOST representative of the patient's diagnosis? 1.Thyroxine and parathyroid hormone levels are above the normal reference values 2.Thyroxine and thyroid-stimulating hormone levels are above the normal reference values 3.Thyroxine and parathyroid hormone levels are below the normal reference values 4.Thyroxine and thyroid-stimulating hormone levels are below the normal reference values

Physical therapists should have knowledge of significant findings associated with conditions that are diagnosed primarily on the basis of laboratory values. Thyroxine (T4), triiodothyronine (T3), thyroid-stimulating hormone (TSH), and the thyroid-stimulating hormone receptor antibody (TRAb) values are used to diagnose Graves' disease and distinguish it from other forms of hyperthyroidism. Elevated thyroxine and thyroid-stimulating hormone levels are key laboratory findings in the diagnosis of Graves' disease. The increase in TSH acts to increase thyroid activity and therefore the secretion of T4. The metabolic influence of T4 has been linked to cardiopulmonary symptoms such as arrhythmia, tachycardia, palpitations, and dyspnea with exertion. 1.Elevated thyroxine levels are a key component in the diagnosis of Graves' disease. However, parathyroid hormone is secreted by the parathyroid gland and not the thyroid. Elevated parathyroid hormone levels (hyperparathyroidism) are associated with bone softening conditions such as osteomalacia. 3.Decreased thyroxine levels are inconsistent with a diagnosis of hyperthyroidism. Decreased parathyroid hormone levels are associated with hypoparathyroidism which significantly impacts systemic calcium and phosphorus levels in the body. Though rare, hypoparathyroidism can be life-threatening. 4.Decreased thyroxine and thyroid-stimulating hormone levels are consistent with a diagnosis of hypothyroidism. Hypothyroidism may occur as a result of normal aging, a specific pathology or overcorrection of a hyperthyroidism either surgically or pharmaceutically.

A physical therapist reads in the medical record that a patient is experiencing side effects including significant dizziness from a recently prescribed antihypertensive agent. Which pharmacological agent is LEAST likely to be associated with this scenario? 1.Alpha adrenergic antagonist agents 2.Angiotensin II receptor antagonist agents 3.Calcium channel blocker agents 4.Positive inotropic agents

Positive inotropic agents increase the force and velocity of myocardial contraction, slow the heart rate, decrease conduction velocity through the AV node, and decrease the degree of activation of the sympathetic nervous system. This type of pharmacological agent is most often used to treat heart failure and atrial fibrillation. 1.Alpha adrenergic antagonist agents reduce peripheral vascular tone by blocking alpha-1 adrenergic receptors. This action causes dilation of arterioles and veins and decreases blood pressure. 2.Angiotensin II receptor antagonist agents block angiotensin II receptors, which limits vasoconstriction and stimulation of vascular tissue. 3.Calcium channel blocker agents decrease the entry of calcium into vascular smooth muscle cells resulting in diminished myocardial contraction, vasodilation, and decreased oxygen demand of the heart.

A physical therapist attends an inservice that discusses the influence of preload, afterload, and contractility on stroke volume. Which description is MOST reflective of the term preload? 1.The tension in the ventricular wall at the end of diastole 2.The force that impedes the flow of blood out of the heart 3.The contraction of the right and left atria pushing blood into the ventricles 4.The period between atrial contractions when the atria are repolarizing

Preload reflects the venous filling pressure that fills the left ventricle during diastole. It is often described in terms of the end-diastolic volume and end-diastolic pressure. Preload refers to the tension in the ventricular wall at the end of diastole. 2.Afterload refers to the force that impedes the flow of blood out of the heart. 3.Atrial systole refers to the contraction of the right and left atria pushing blood into the ventricles. 4.Atrial diastole refers to the period between atrial contractions when the atria are repolarizing.

A physical therapist employed in an acute care hospital reviews a patient's medical record prior to initiating treatment. The physician's note states that recent laboratory values indicate the onset of type 2 diabetes mellitus. Which repeated laboratory finding BEST supports this diagnosis? 1.Random blood glucose greater than 130 mg/dL 2.Random blood glucose greater than 180 mg/dL 3.Fasting blood glucose greater than 90 mg/dL 4.Fasting blood glucose greater than 130 mg/dL

Repeated abnormal random, fasting or postprandial blood glucose values are considered indicators of diabetes mellitus. Each, however, provides a value for a single point in time and requires consecutive abnormal values to be considered diagnostic. Blood glucose values are typically augmented with additional testing such as the glycated hemoglobin A1c test (HbA1c) or an oral glucose tolerance test to provide a more complete representation of the patient's ability to metabolize glucose. American Diabetes Association guidelines suggest that repeated fasting blood glucose levels greater than 125 mg/dL are considered indicative of diabetes mellitus. 1.Repeated random blood glucose levels less than 200 mg/dL are typically considered normal. 2.American Diabetes Association guidelines suggest that repeated random blood glucose levels greater than 200 mg/dL are indicative of diabetes. 3.Repeated fasting blood glucose levels less than 125 mg/dL are typically considered normal.

A physical therapist searches the literature for a reliable and valid questionnaire to measure quality of life in patients with heart disease. The therapist plans to use the questionnaire to assess changes in quality of life before and after participating in a cardiac rehabilitation program. Which questionnaire property is MOST critical to achieve the therapist's objective? 1.Sensitivity 2.Specificity 3.Responsiveness 4.Linearity

Responsiveness is the ability of the instrument to detect change over time. This is an essential attribute when the goal is to assess changes in quality of life before and after participating in cardiac rehabilitation. If the questionnaire is being used to assess the effectiveness of an intervention, the score should change as the patient's status changes and stay the same if the patient is unchanged. 1.Sensitivity is a measure of validity of a diagnostic or screening test based on the probability that someone with a disease will test positive on the test. 2.Specificity is a measure of validity of a diagnostic or screening test based on the probability that someone who does not have a disease will test negative on the test. 4.Linearity of change refers to the magnitude of the change with respect to the starting score. The extent to which a score changes is a function of the starting score. For example, patients may experience substantial changes in joint ROM if their initial ROM is limited because there is more to be gained.

A physical therapist treating a patient diagnosed with spastic cerebral palsy performs an intervention designed to facilitate active movement. Which of the following proprioceptive neuromuscular facilitation interventions would be BEST utilized for this purpose? 1.Rhythmic stabilization 2.Slow reversal 3.Rhythmic initiation 4.Hold-relax active movement

Rhythmic initiation is a PNF exercise utilized to address the mobility level of motor control with focus on initiating movement in the presence of hypertonia. Movements progress from passive to active assistive to slightly resistive in nature. 1.Rhythmic stabilization is a PNF exercise utilized to address both the mobility and stability levels of motor control. It is a technique used to coordinate isometric contractions and make gains in a range of motion. 2.Slow reversal is a PNF exercise utilized to address stability, controlled mobility, and skill levels of motor control. It is a technique used to improve control of movement through slow and resisted concentric contractions of agonists and antagonists. 4.Hold-relax active movement is a PNF exercise utilized to address the mobility level of motor control. It is a technique to improve movement to muscle groups tested as 1/5 or less (significant hypotonia). Isometric contractions are used in a shortened range within the pattern.

A physical therapist works with a patient in an acute care hospital who has sustained significant facial burns following a workplace explosion. Which finding would MOST likely be associated with burn-related alterations in cell permeability and microcirculation? 1.Hypertrophic scarring 2.Eschar 3.Edema 4.Keloid scarring

Severe edema that occurs secondary to significant burns is a common occurrence and may involve damaged and adjacent undamaged tissues. The area and depth of the burn primarily influence the development of edema with larger burns typically causing edema in non-damaged tissues. Although the amount of edema in these adjacent tissues may be significant, the degree of edema formation and resolution time are typically much less than that of burn damaged areas. Severe burns cause protein loss from burned tissues and increased cell membrane permeability. Both factors contribute to alterations in tissue microcirculation resulting in significant edema formation in the interstitial spaces. 1.Hypertrophic scarring in patients with burns is most commonly associated with an imbalance of collagen lysis and synthesis during the healing process. This formation occurs during the remodeling phase of healing and is unlikely to present while the patient is in the acute care environment. 2.Eschar refers to necrotic tissue which is typically brown or black in color and thickly textured. Eschar may be observed while a patient with significant burns is in an acute care environment. However, eschar tissue is less likely than edema to be directly attributed to changes in cell permeability and microcirculation. 4.Keloid scarring is a form of hypertrophic scarring which extends beyond the borders of the original area of damage. It is the result of an imbalance of collagen lysis and synthesis during the remodeling phase of the healing process and is unlikely to present while the patient is in the acute care environment.

A 63-year-old female is referred to physical therapy with complaints of low back pain and lower extremity paresthesia due to degenerative L5 spondylolisthesis. Which of the following examination findings is MOST likely to be associated with the patient's diagnosis? 1.Decreased lumbar lordosis 2.Knee hyperextension 3.Hamstrings tightness 4.Decreased Achilles reflex

Some degree of hamstrings tightness is typically associated with all grades of spondylolisthesis. This tightness may contribute to nerve root irritation, limit straight leg raising and forward bending abilities, and functionally alter gait and posture. Hamstrings tightness often causes an individual to walk with short strides with the knees slightly bent. A waddling gait can also be observed since an individual rotates the pelvis more to compensate for decreased hamstrings length. (Dutton 1333)

Following a transtibial amputation, a patient with type 2 diabetes mellitus is admitted to a skilled nursing unit where the Braden Scale is utilized as a standard part of the admission process. What is the PRIMARY use of this scale? 1.Designate the stage of an existing pressure ulcer 2.Determine the risk of developing a pressure ulcer 3.Designate the stage of an existing neuropathic ulcer 4.Determine the risk of developing a neuropathic ulcer

The Braden Scale is utilized to assess a patient's current skin integrity and determine the relative risk of developing a pressure ulcer. A patient's risk is categorized as very high risk (≤ 9), high risk (10 to 12), moderate risk (13 to 14) or at risk (15 to 18) with specific preventative recommendations detailed for each category. 3.The Wagner Ulcer Grade Classification Scale may be appropriately utilized to stage a neuropathic ulcer. Ulcers are graded on a scale of 0 (e.g., no open lesion) to 5 (e.g., gangrene requiring amputation) based on the depth of tissue damage and presence of infection. 4.Semmes-Weinstein monofilament testing is a popular and reliable method of documenting areas of decreased sensation in areas at risk for neuropathic ulcer formation. The inability to detect pressure applied via a 10 gm monofilament is indicative of a loss of protective sensation and places the patient at an increased risk of developing a neuropathic ulcer.

A physical therapist provides a patient with a handout that includes several upper extremity strengthening exercises to be performed as part of a home exercise program. Which upper extremity proprioceptive neuromuscular facilitation exercise is MOST consistent with the presented illustration? 1.D1 extension 2.D1 flexion 3.D2 extension 4.D2 flexion

The D2 flexion pattern is characterized by shoulder flexion, abduction, and external rotation, forearm supination, and wrist and finger extension. 1.The D1 extension pattern is characterized by the patient ending in a position of shoulder extension, abduction, and internal rotation, forearm pronation, and wrist and finger extension. 2.The D1 flexion pattern is characterized by the patient ending in a position of shoulder flexion, adduction, and external rotation, forearm supination, and wrist and finger flexion. 3.The D2 extension pattern is characterized by the patient ending in a position of shoulder extension, adduction, and internal rotation, forearm pronation, and wrist and finger flexion.

A physical therapist plans to administer the Dynamic Gait Index to a patient with a traumatic brain injury to assess postural control during ambulation. Which of the following activities would the patient NOT have to perform? 1.Walking and pivoting 2.Stepping over obstacles 3.Climbing stairs

The DGI does not involve an assessment of ambulating backwards. However, this is an item included on the more challenging Functional Gait Assessment.

A physical therapist is teaching a female patient with cystic fibrosis how to use a Flutter device to promote airway clearance. What should the therapist instruct the patient to do? 1.Place the device in her mouth, inhale through the nose and exhale through the device 2.Place the device in her mouth and inhale through the device 3.Adjust the orifice of the device to increase the resistance to inhalation 4.Maintain 10 to 20 cm H2O pressure during exhalation

The Flutter Valve is a pipelike device with a steel ball-bearing inside that transmits high frequency oscillations through the airways during exhalation. The Flutter device is used to assist the patient to independently eliminate excessive mucus from the airways. Exhaling through the Flutter Valve causes the ball bearing in the pipe to be repeatedly raised and dropped creating an oscillation or vibration that is transmitted to the airway to aid in mucus clearance.

A physical therapist completes an examination on an infant with suspected developmental delay. Which primitive reflex would the therapist expect to be integrated at the youngest age? 1.Asymmetrical tonic neck 2.Galant 3.Plantar grasp 4.Startle

The Galant reflex is characterized by ipsilateral side bending of the trunk when the infant's skin is stroked on the side from the shoulder to the hip. The reflex begins at 30 weeks of gestation and is integrated at two months of age. 1.The asymmetrical tonic neck reflex is characterized by flexion of the contralateral arm and extension of the ipsilateral arm when the head is rotated. The reflex begins at birth and is integrated at four to six months of age. 3.The plantar grasp reflex is characterized by flexion of the toes with maintained pressure to the ball of the foot. The reflex begins at 28 weeks of gestation and is integrated at nine months of age. 4.The startle reflex is characterized by extension or abduction of the arms, along with crying, when there is a sudden loud or harsh noise. The reflex begins at birth and is integrated at five months of age.

A physician prescribes a hyperextension orthosis for a 16-year-old male with a T10 compression fracture. The patient was injured when he fell from a ladder while painting a house. The patient has no significant past medical history and currently lives with his father and two brothers. Which of the following orthoses was MOST likely prescribed? 1.Halo 2.Boston orthosis 3.Jewett orthosis 4.Flexible lumbosacral orthosis

The Jewett orthosis is a flexion control TLSO which consists of lateral uprights with a sternal plate, a dorsolumbar plate, and a suprapubic plate. The positioning of the plates restricts trunk flexion and encourages a posture of hyperextension. This orthosis would be used for a patient with compression fractures of the spine. 1.The halo is a cervicothoracic orthosis consisting of a rigid halo secured to the skull with four external fixation pins. The halo supports four posts which terminate in hardware attached to a vest. This orthosis provides the greatest control of cervical motion and is used in patients with high cervical fractures. 2.The Boston orthosis is a thoracolumbosacral orthosis (TLSO) which consists of a symmetrical rigid plastic jacket fitted with interior pads. This orthosis limits flexion, extension, rotation, and lateral flexion of the thoracolumbar spine. It is most commonly used for patients with moderate scoliosis. 4.A flexible lumbosacral orthosis (i.e., corset) is made of fabric with pouches for vertical stays. This type of orthosis does not restrict motion or realign the spine as much as rigid spinal orthoses do. They may be used for patients with low back pain or minor spondylolisthesis, but would be inappropriate for a patient with a spinal fracture.

A physical therapist employed in an acute care hospital contemplates using Wagner's Ulcer Grade Classification Scale as a standardized measure to grade ulcers. Which type of ulcer would be the LEAST appropriate when using the specified measurement scale? 1.Arterial 2.Neuropathic 3.Pressure 4.Venous

The Wagner Ulcer Grade Classification system is a 6-point scale (0-5) used to assess the depth and presence of infection in a wound. The system is most commonly used for dysvascular ulcers (i.e., any ulcer which results from the inadequacy of vascular structures). Pressure ulcers are not considered to be dysvascular ulcers. Although pressure ulcers are caused by a lack of blood flow, the main impairment is caused by pressure and not from inadequacy of the vascular structures. Pressure ulcers are more commonly assessed using the National Pressure Ulcer Advisory Panel's pressure ulcer staging system.

A physical therapist reports the results obtained using the WeeFIM on a four-year-old child at an interdisciplinary team meeting. What is this tool used to determine? 1.The optimal length of stay in an acute care facility 2.The amount of caregiver assistance required 3.The extent of gross motor delays present 4.The recommended programming to minimize disability

The WeeFIM provides assessment through observation and subsequent rating in established motor and cognitive categories. The higher the score, the greater the independence of the patient.

A 45-year-old male who works as a carpenter is referred to physical therapy after being diagnosed with lateral epicondylitis. During the examination the therapist palpates the muscles attaching to the lateral epicondyle. Which of the following groups of muscles BEST meet this criteria? 1.Extensor carpi radialis brevis, extensor digitorum, extensor carpi ulnaris 2.Brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis 3.Extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris 4.Extensor carpi radialis brevis, supinator, extensor pollicis longus

The extensor carpi radialis brevis, extensor digitorum, and extensor carpi ulnaris muscles are part of the common extensor tendon that attaches to the lateral epicondyle. 2.The brachioradialis and extensor carpi radialis longus originate on the lateral supracondylar ridge of the humerus and lateral intermuscular septum. The extensor carpi radialis brevis originates on the common extensor tendon. 3.The extensor carpi radialis longus originates on the lateral supracondylar ridge of the humerus and lateral intermuscular septum. The extensor carpi radialis brevis and extensor carpi ulnaris originate on the common extensor tendon. 4.The extensor carpi radialis brevis originates on the common extensor tendon. The supinator originates on the lateral epicondyle of the humerus, radial collateral ligament, annular ligament, and supinator crest of the ulna. The extensor pollicis longus originates on the posterior surface of the ulna.

A physical therapist performs a developmental screening on an eight-month-old infant. Assuming normal development, which reflex would potentially hinder the child's ability to ambulate? 1.Walking (stepping) reflex 2.Positive support reflex 3.Galant reflex 4.Plantar grasp reflex

The plantar grasp reflex is stimulated by pressure to the base of the toes. The response is toe flexion. This reflex is typically integrated by nine months of age. The inability to stand with the feet flat on a surface causes impairments with balance reactions and weight shifting in standing which can interfere with ambulation. 1.The walking (stepping) reflex is stimulated through supported upright positioning with the soles of the feet on a firm surface. The response is reciprocal flexion and extension of the lower extremities. This reflex is typically integrated by two months of age which is considerably younger than the child's age. 2.The positive support reflex is stimulated by weight that is placed on the balls of the feet when upright. The response is stiffening of the lower extremities and trunk into extension. This reflex is typically integrated by two months of age which is considerably younger than the child's age. 3.The Galant reflex is stimulated by touching the skin along the spine from the shoulder to the hip. The response is lateral flexion of the trunk to the side of the stimulus. This reflex is typically integrated by two months of age which is considerably younger than the child's age.

A patient is referred to physical therapy after being diagnosed with entrapment of the posterior interosseous nerve. Which finding would be MOST anticipated based on the patient's diagnosis? 1.Weakness of the wrist extensors and finger extensors 2.Weakness of the wrist flexors and finger flexors 3.Weakness of the wrist flexors and ulnar deviators 4.Weakness of the finger abductors and thumb adductors

The radial nerve divides into the superficial radial nerve and the posterior interosseous nerve at the elbow. The posterior interosseous nerve is commonly entrapped in the proximal forearm in the area of the supinator muscle. Weakness of the wrist extensors and finger extensors would be anticipated with entrapment of the posterior interosseous nerve. Muscles innervated by the nerve contributing to the described weakness would include extensor carpi radialis brevis, extensor carpi ulnaris, and extensor digitorum communis.

A physical therapist reviews a recently published study that concludes the reliability coefficient of a newly marketed electronic device to measure percent body fat was 0.37. Which statement represents the BEST advice to a therapist who is contemplating using the device? 1.Utilize the device since the instrument is likely to produce reliable measurements that are free from error 2.Utilize the device since the instrument is likely to produce reliable and valid measurements that are free from error 3.Consider utilizing the device in combination with other tests and measures 4.Avoid using the device since it exhibits poor reliability

The reliability coefficient can range from 0.00 to 1.00, with 0.00 indicating no reliability and 1.00 indicating perfect reliability. Reliability coefficients below 0.50 indicate poor reliability, coefficients from 0.50 to 0.75 indicate moderate reliability, and coefficients above 0.75 indicate good reliability. The therapist should avoid using the device since it exhibits poor reliability and would not help in determining the patient's percent body fat.

A physical therapist reviews the results of a gait analysis summary for a patient with a lower extremity injury. The summary reveals that the patient's stance phase represents 45 percent of the patient's gait cycle. How does this compare to the values typically expected with normal gait? 1.The patient demonstrates slightly less than average time in stance phase 2.The patient demonstrates significantly less than average time in stance phase 3.The patient demonstrates an average amount of time in stance phase 4.The patient demonstrates slightly more than average time in stance phase

The stance phase of gait begins when the extremity contacts the ground (heel strike) and continues as long as a portion of the foot is in contact with the ground (toe off). The stance phase makes up approximately 60 percent of the gait cycle. Fifteen percent less than the normal amount of time spent in stance phase (i.e., 60 percent) is considered a significant deviation from normal gait biomechanics.

A physical therapist observes an intravenous line that is tangled around a patient's bed rail. What type of medical asepsis is indicated prior to coming in contact with the intravenous line? 1.None 2.Gloves, gown 3.Gloves, gown, mask 4.Gloves

The tubing is a non-sterile object that would not require the use of protective clothing. The physical therapist can reposition the I.V. line through direct hand contact.

A physical therapist prescribes an aquatic exercise program for a patient with multiple sclerosis. The exercise consists of walking in the pool and performing active exercises with the resistance of the water. The patient has minimal impairments at present, lives alone, and is employed as an elementary school teacher. What is the goal of this exercise program? 1.Reduce the severity and frequency of exacerbations 2.Improve the patient's fine motor coordination 3.Maintain or improve the patient's level of fitness 4.Improve the patient's balance when walking on uneven surfaces

Therapeutic exercise has the potential to improve fitness levels in patients with multiple sclerosis. Walking and performing active exercises in the pool is an appropriate way to improve this patient's level of fitness.

A physical therapist employed by a home health agency treats a 42-year-old female diagnosed with multiple sclerosis. During the session the patient suddenly reports feeling extremely tired and asks the therapist if she can avoid completing the remaining exercises. The therapist promptly takes the patient's vital signs and concludes they are within normal limits. What is the MOST appropriate therapist action? 1.Discontinue the treatment session 2.Modify the intensity of the remaining exercises 3.Complete a formal reassessment of the patient 4.Contact the referring physician to discuss the patient's condition

While exercise can be beneficial to increase general endurance and overall conditioning in this population, it is more important that the therapist not work the patient to the point of overexertion. If the patient is reporting extreme fatigue, the treatment session should be discontinued. 2. While decreasing the intensity of the remaining exercises would reduce the workload, the patient has already reached a point of extreme fatigue. At this point, it is more important that the patient avoid overexertion.

A 65-year-old man attends physical therapy complaining of progressive shortness of breath and lower leg swelling. During the examination the physical therapist identifies signs of increased jugular venous pressure, an S3 gallop, and moderate lower extremity edema. On auscultation of the patient's lungs, which of the following sounds would the therapist MOST expect to hear? 1.Bilateral crackles 2.Pleural rub 3.Orthopnea 4.Murmurs

physical therapist should recognize that progressive shortness of breath, leg edema, increased jugular venous pressure, and an S3 heart sound are signs consistent with congestive heart failure. Patients in left ventricular failure often have cardiogenic pulmonary edema due to an increase in hydrostatic pressure in the pulmonary capillaries. Fluid initially accumulates in the airways, progresses to the alveolar interstitium, and ultimately to the alveolar space. Crackles or wet rales along with decreased breath sounds are common auscultation findings. 2.Pleural rub is an indication of inflammation of the pleura. 3.Orthopnea or dyspnea in the recumbent position is a common symptom of congestive heart failure. However, it is not a lung sound and is not detected by auscultation. 4.Murmurs refer to abnormal heart sounds usually associated with abnormal blood flow through a heart valve.