TherapyED review questions

A patient with active tuberculosis is referred for physical therapy. Which of the following is an appropriate precaution? Choices: 1. The patient must wear a tight-fitting mask while being treated in his or her room. 2. The assistant must wash hands only upon leaving the patient's room. 3. The assistant must wear a tight-fitting mask, gown, and gloves while treating the patient. 4. The patient must be in a private, negative-pressurized room.

Correct Answer : 4 The assistant should wash hands upon entering and leaving every patient's room. This is not unique to TB. When the patient is suspected of having tuberculosis, the patient should be in a private, negative-pressurized room. The room is considered a potentially infective environment, and the assistant should don a tight fitting mask prior to entering the room. Incorrect Choices: Gown and gloves are not always necessary because TB is airborne and not contact. The patient only needs to wear a mask if there is a need to leave the room (for a medical test, etc.).

A patient with T10 paraplegia has recently been fi tted with bilateral knee-ankle-foot orthoses and is receiving initial ambulation training with axillary crutches. The patient is unable to ambulate with a reciprocal gait pattern. Which of the following gait patterns is the BEST INITIAL choice to teach the patient? Choices: 1. 4-point. 2. Swing-to. 3. 2-point. 4. Swing-through.

Correct Answer: 2 A swing-to gait pattern is indicated for individuals with limited use of both lower extremities and trunk instability. It is slower and more stable than a swing-through gait pattern (a gait pattern this patient can be progressed to after initial training).

A patient recovering from stroke is having diffi culty bearing weight on the left lower extremity. The patient is unable to advance the tibia forward and abbreviates the end of the stance phase on the left going directly into swing phase. Which factor following stroke is MOST likely to result in failure to advance the lower extremity when walking? Choices: 1. Weakness or contracture of hip extensors. 2. Spasticity or contracture of the plantar flexors. 3. Spasticity of the anterior tibialis muscle. 4. Weakness or contracture of the dorsiflexors.

Correct Answer: 2 Forward advancement of the tibia from midstance to heel-off is controlled by eccentric contraction of the plantar flexors; from heel-off to toe-off the plantar flexors contract concentrically. Either spasticity or contracture of the plantar fl exors would limit this forward progression by limiting the amount of dorsifl exion the ankle can move in to. Patients compensate by moving right into swing, typically with a circumducted gait or with increased hip and knee fl exion because there is no push-off. This is commonly seen in the patient with stroke. Incorrect Choices: Excessive spasticity of the anterior tibialis would limit the plantarflexion and would prevent the patient from achieving foot flat. Weakness or contracture of the hip extensors would affect the swing phase of gait.

A patient had a myocardial infarction 4 weeks ago. Which BEST represents restrictions that should be followed for resistive training using weights to improve muscular strength and endurance? Choices: 1. Ensure exercise intensities are kept below 85% maximal voluntary contraction. 2. Exercise tolerance is greater than 5 METs with no anginal symptoms or ST segment depression. 3. Initiate program at 4-6 weeks as long as judicious monitoring of heart rate is used. 4. Wait until post-acute phase III cardiac rehabilitation.

Correct Answer: 2 Resistance training is typically initiated after patients have completed 4-6 weeks of supervised cardiorespiratory endurance exercise. Lower intensities are prescribed. Careful monitoring of blood pressure is necessary as blood pressure will be higher and heart rate lower than for aerobic exercise. Contraindications to resistance training include unstable angina, uncontrolled arrhythmias, recent history of congestive heart failure, left ventricular outflow obstruction, severe valvular disease, and uncontrolled hypertension. Patients should demonstrate an exercise capacity greater than 5 METs without anginal symptoms or ST segment depression (Source: American College of Sports Medicine: Guidelines for Exercise Testing and Prescription, Ed 6). Incorrect Choices: Up to 85% max would be too intense for 4 weeks s/p MI. Phase III cardiac rehab is postacute and is more than 4 weeks post-MI. Exercises can be more intense with higher METs at that point.

In a research study resulting in a skewed distribution that includes extreme scores on a balance measure that deviate from the total group performance, which of the following measures MOST accurately represents the central tendency? Choices: 1. Mean. 2. Mode. 3. Median. 4. Standard deviation.

Correct Answer: 3 The median is the middle score of all the scores. The most accurate measure of performance in skewed distribution with extreme scores is the median.

During the first 8 weeks following a central zone repair of the lateral meniscus, what activity is contraindicated? Choices: 1. Full active knee extension. 2. Muscle setting exercises. 3 . Partial weight bearing at 25%. 4. Knee flexion greater than 60°-70°.

Correct Answer: 4 Central zone repairs of the meniscus are progressed more conservatively than peripheral zone repairs. Flexion beyond 60°-70° places posterior translation forces on the repaired meniscus, thus increasing the risk of displacement. Muscle setting and A-AAROM exercises begin the day after surgery. Incorrect Choices: Restriction of full active knee extension exercises are part of the protocol following anterior cruciate ligament repair, not following meniscus repair. Muscle setting exercises and weight bearing limited to 25% do not present a contraindication following meniscus injury.

A physical therapist assistant is working with an individual with a diagnosis of low back pain, degenerative disc disease, and gastroesophageal reflux disease. The patient reports that at night upon going to bed the exercises have resulted in upset stomach and inability to sleep very well. The assistant should instruct the patient to: Choices: 1. Avoid doing the exercises. 2. Drink plenty of water throughout the day. 3. Sleep in the supine position. 4. Avoid eating large meals later in the day.

Correct Answer: 4 Patients who suffer from gastroesophageal refl ux disease (GERD) should eat smaller meals; avoiding meals close to bed or exercise time can help as well. Sleeping with the head of their bed elevated can help decrease the symptoms. Incorrect Choices: The supine position should be avoided. Exercising with the upper trunk supported in the elevated position is also recommended. Avoiding exercise will not necessarily help the low back pain. Drinking plenty of water can help decrease the chances of constipation but does not affect reflux.

An infant was referred to physical therapy for right torticollis. In order to MOST effectively stretch the muscle, the head and neck should be positioned into which position? Choices: 1. Flexion, left side-bending, and left rotation. 2. Extension, right side-bending, and left rotation. 3. Flexion, right side-bending, and left rotation. 4. Extension, left side-bending, and right rotation.

Correct Answer: 4 Right torticollis involves tightness and spasm of the sternocleidomastoid muscle. The right sternocleidomastoid produces left lateral (external) rotation and right lateral flexion of the cervical spine as well as flexion of the spine. The right sternocleidomastoid is in lengthened position with the head turned to the right, laterally flexed to the left and the cervical spine extended.

A patient with a complete spinal cord injury at the T6 level is being discharged home after 2 months of rehabilitation. In preparation for discharge, the rehabilitation team visits the home and finds three standard-height steps going into the home. What length ramp will need to be constructed for wheelchair access into this home? Choices: 1. 60 inches (5 feet). 2. 192 inches (16 feet). 3. 120 inches (10 feet). 4. 252 inches (21 feet).

Correct Answer: 4 The architectural standard for rise of a step is 7 inches (steps may vary from 7-9 inches). The recommended ratio of slope to rise is 1:12 (an 8% grade). For every inch of vertical rise, 12 inches of ramp will be required. A straight ramp will have to be 252 inches or 21 feet long. Incorrect Choices: A ramp less than 252 inches (21 feet) long will not meet identified standard ratio for slope to rise—for every inch of vertical rise, 12 inches of ramp is required.

A patient is recovering from a left transtibial amputation and reports numbness and tingling of the left great toe and on the dorsum of the left foot. The patient knows the extremity is gone and cannot understand why this is happening. The physical therapist assistant informs the physical therapist of the patient's newly reported symptom. The therapist suspects the source of discomfort is MOST likely pressure from residual limb wrapping and asks the assistant to check to make sure there is NO pressure on the peripheral nerve. The physical therapist assistant should check for pressure on which peripheral nerve? Choices: 1. Sural nerve. 2. Medial calcaneal nerve. 3. Tibial nerve. 4. Common peroneal (fibular) nerve.

Correct Answer: 4 The common peroneal nerve supplies sensation to the dorsal foot and big toe. Phantom limb sensation (sensation of an extremity that is no longer there) usually occurs in the immediate postoperative phase and can be stimulated by external pressure (residual limb wrapping or rigid dressing). It typically dissipates over time though some patients may experience the sensation for the rest of their lives. This is a common finding and should not interfere with prosthetic rehabilitation. Incorrect Choices: Sensation to the dorsum of the foot and big toe is supplied by the superficial peroneal (fibular) nerve, a branch off the common peroneal (fibular) nerve. The sural nerve is a distal branch of the tibial nerve that supplies the back of the lower extremity and the lateral side of the foot and little toe. The medial calcaneal nerve is also a branch of the tibial nerve that supplies the heel and medial sole of the foot

A patient is being treated for secondary lymphedema of the right upper extremity as a result of a radical mastectomy and radiation therapy. What is the BEST physical therapy method to help reverse pitting edema? Choices: 1. Isokinetics, extremity positioning in elevation, and massage. 2. Active range of motion and extremity positioning in a functional upper extremity/hand position. 3. Isometric exercises, extremity positioning in elevation, and compression bandaging. 4. Intermittent pneumatic compression, extremity elevation, and massage.

Correct Answer: 4 Lymphedema following surgery and radiation is classified as secondary lymphedema. Stage 1 means that there is pitting edema that is reversible with elevation. The arm may be normal size first thing in the morning with edema developing as the day goes on. It can be effectively managed by external compression and extremity elevation. Manual lymph drainage (massage and passive range of motion) are also appropriate interventions. Incorrect Choices: Exercise and positioning alone would not provide the needed lymph drainage; isometric exercise is contraindicated.

An individual with a body mass index (BMI) of 33 kg/m2 is referred to an outpatient exercise program. Which of the following risk factors should the physical therapist assistant recognize this patient is susceptible to? Choices: 1. Hyperthermia during exercise. 2. Hypothermia during exercise. 3. Rapid weight loss during the initial weeks. 4. Increased anxiety and depression.

Correct Answer: 1 A patient with a BMI of 33 kg/m2 is obese (BMI >30 kg/m2 ) and is at increased risk for heat intolerance or hyperthermia during exercise (as well as orthopedic injury)

The initial evaluation for a patient with a right cerebrovascular accident (CVA) identifi es that the patient has a profound defi cit of homonymous hemianopsia. Which of the following represents the BEST INITIAL strategy to assist the patient in compensating for this deficit? Choices: 1. Teach the patient to turn the head to the affected left side. 2. Provide constant reminders, printed notes on the left side, telling the patient to look to the left. 3. Place items, eating utensils on the patient's left side. 4. Rearrange the room so while the patient is in bed the left side is facing the doorway

Correct Answer: 1 A patient with homonymous hemianopsia needs to be made aware of his or her defi cit and instructed to turn the head to the affected left side (a compensatory training strategy)

A patient with chronic obstructive pulmonary disease has developed respiratory acidosis. What should the patient be monitored closely for? Choices: 1. Disorientation. 2. Tingling or numbness of the extremities. 3. Dizziness or lightheadedness. 4. Hyperreflexia.

Correct Answer: 1 A patient with respiratory acidosis may present with many symptoms of increased carbon dioxide levels in the arterial blood. Significant acidosis may lead to disorientation, stupor or coma. Incorrect Choices: The other choices are signs and symptoms of respiratory alkalosis or a decrease of carbon dioxide in the arterial blood.

An obese individual who has diabetes is coming to physical therapy to participate in a conditioning program. What should the physical therapist assistant instruct the participant to do? Choices: 1. Eat a carbohydrate-balanced snack at least 2 hours prior to participating in the conditioning program. 2. Avoid eating foods for several hours prior to participating in the conditioning program. 3. Inject insulin into the large muscle groups such as the quadriceps prior to participating in the conditioning program. 4. Participate in the conditioning program when blood glucose levels are greater than 300 mg/dL.

Correct Answer: 1 Eating a carbohydrate-balanced snack at least 2 hours prior to participating in the conditioning program will help to ensure regulation of blood sugars. Incorrect Choices: Insulin injections should be given in muscles that are not going to be used heavily during exercises; an abdominal injection is recommended, not the quadriceps as those will be used during exercise. Participation in exercise programs is contraindicated with fasting blood glucose levels greater than 300 mg/dL, or less than 70 mg/dL.

A patient with a transtibial amputation has recently been fitted with a patellar tendon-bearing (PTB) socket. Following gait training, the patient removes the prosthesis. If the prosthesis is fitted correctly, which area should the physical therapist assistant NOT expect to find skin redness? 1. Anterior tibia and tibial crest. 2. Patellar tendon and tibial tuberosity. 3. Medial tibial and fibular plateaus. 4. Medial and lateral distal ends of the residual limb

Correct Answer: 1 In a PTB socket, reliefs are provided for pressure-sensitive areas: the anterior tibia and tibial crest, fibular head and peroneal nerve. Incorrect Choices: All the other choices, with the exception of the tibial tuberosity, are considered pressure-tolerant areas and will likely have redness present even with a properly fitting prosthesis. Type of Reasoning: Inferential One must infer or draw a reasonable conclusion about gait training with a PTB socket and areas that are not likely to show redness after walking. This requires one to determine what may not occur with the patient, necessitating an inferential reasoning skill. For this situation, one should not expect to fi nd redness on the anterior tibia and tibial crest. If answered incorrectly, review properties of a PTB socket and pressure relief.

A patient presents with multiple fractures of both hands and wrists as a result of a mountain bike accident. Now, 5 weeks later, the patient has limited wrist and finger motion, and dry scaly skin over the previously casted areas. What physical agent is MOST appropriate to aid in increasing range of motion? Choices: 1. Paraffin. 2. Hot packs. 3. Functional electrical stimulation. 4. Contact ultrasound.

Correct Answer: 1 Paraffin bath will provide circumferential heating of the hands and fingers and will aid in softening the skin. Incorrect Choices: Active exercise, including functional electrical stimulation, would be more effective after the application of paraffin as tissue extensibility and pliability would be increased. Hot packs or ultrasound using direct contact would not completely cover the area to be treated.

A patient has extensive full-thickness burns to the dorsum of the right hand and forearm and is being fitted with a resting splint to support the wrists and hands in a functional position. What position should this splint place the wrist and hand in? Choices: 1. Neutral wrist position with slight finger flexion and thumb flexion. 2. Slight wrist extension with fingers supported and thumb in partial opposition and abduction. 3. Slight wrist flexion with interphalangeal joint extension and thumb opposition. 4. Neutral wrist position with interphalangeal joint extension and thumb flexion.

Correct Answer: 2 A resting splint that positions the wrist and hand in a functional position includes 10°-20° of wrist extension, fingers supported, and thumb in partial opposition and abduction. Incorrect Choices: The neutral and fl exed wrist positions are contraindicated for this condition.

A patient is recovering from a complete spinal cord injury, at the level of L2. What is the expected outcome in this case? Choices: 1. A spastic or reflex bladder. 2. Some recovery of function. 3. Loss of motor function, pain, and temperature sensation below the level of lesion. 4. Greater loss of upper-extremity function than of lower-extremity function.

Correct Answer: 2 A spinal cord lesion below L1 is a cauda equina lesion, thus a lower motor neuron injury to peripheral roots and nerves. Because some regeneration is possible, some recovery in function can be expected.

A frail older adult is confined to bed in a nursing facility and has developed a small superficial wound over the sacral area. Because only small amounts of necrotic tissue are present, the physical therapist has decided to use autolytic wound débridement. How will this intervention BEST be achieved? Choices: 1. Wound irrigation using a syringe. 2. Transparent film dressing. 3. Wet-to-dry gauze dressing with antimicrobial ointment. 4. Sharp débridement.

Correct Answer: 2 Autolytic wound débridement allows the body's natural enzymes to promote healing by trapping them under a synthetic, occlusive dressing. Moisture-retentive dressings are applied for short durations (less than 2 weeks). Choices include transparent film dressings, hydrocolloid, or hydrogel dressings. Incorrect Choices: The other choices are wound management techniques; however, they are not autolytic.

A patient reports pain (7/10) and limited range of motion of the right shoulder as a result of chronic overuse. The therapist has identified procaine hydrochloride iontophoresis as part of a physical therapy intervention. Which of the following treatments would be correct? Choices: 1. Continuous biphasic current with the medication under the anode. 2. Continuous monophasic current with the medication under the anode. 3. Continuous monophasic current with the medication under the cathode. 4. Interrupted biphasic current with the medication under the cathode.

Correct Answer: 2 Because like charges are repelled, the positively charged medication would be forced into the skin under the positive electrode (anode). A continuous, unidirectional current fl ow is very effective in repelling ions into the skin. Incorrect Choices: A pulsed or bidirectional current generates less propulsive force owing to the discontinuous nature of the current. Procaine is a positive medicinal ion and will be repelled from the anode (positive pole).

Following major surgery of the right hip, a patient walks with a Trendelenburg gait. The initial evaluation reveals right hip abductor weakness and range-of-motion limitations in fl exion and lateral (external) rotation. Which application describes the BEST placement for functional electrical stimulation? Choices: 1. Stimulation applied to the right abductors during swing on the right. 2. Stimulation applied to the right abductors during stance on the right. 3. Stimulation applied to the left abductors during stance on the right. 4. Stimulation applied to the left abductors during swing on the right

Correct Answer: 2 During the stance phase of gait, the hip abductors of the weight-bearing limb are activated to maintain the pelvis in a relative horizontal position. This allows the opposite foot to clear the floor during swing. If there is weakness of the weight-bearing limb the pelvis will drop, which is called a Trendelenburg. The right hip abductors need to be stimulated during stance in order to prevent the pelvis from dropping. Incorrect Choices: Stimulation of the right abductors throughout swing or the left hip abductors during swing or stance would not compensate for the weakness of the right hip abductors during the support period.

A child with full-thickness burns to both upper extremities is developing hypertrophic scars. What is the BEST intervention to manage these scars? Choices: 1. Primary excision followed by autografts. 2. Application of custom-made pressure garments. 3. Application of compression wraps. 4. Application of occlusive dressings.

Correct Answer: 2 Following burns, edema and hypertrophic scarring can be effectively controlled with pressure garments. Custom garments are the best choice. Pressure should be maintained 23 hours per day, often for 6-12 months. Incorrect Choices: Surgery is the option of last choice

A patient who is 70 pounds overweight is recovering from a myocardial infarction, which occurred 6 weeks ago. The plan of care includes exercise class in conjunction with dietary program to promote weight reduction. Which exercise protocol is MOST appropriate for this patient? Choices: 1. Jogging, for 10 minutes at 4 miles per hour. 2. Walking, intensity set at 50% target heart rate. 3. Walking, intensity set at 75% of heart rate reserve. 4. Swimming, intensity set at 75% age-adjusted heart rate

Correct Answer: 2 Obese individuals are typically more sedentary with lower initial levels of physical conditioning. The initial exercise prescription should focus on a lower intensity exercise progressing to longer durations. Incorrect Choices: Higher intensity exercise (75% or 85% of heart rate maximum) should be avoided initially. Jogging is also too intense and may yield additional orthopedic problems. Swimming at 75% age-adjusted heart rate is too intense for this individual.

A patient has f xed forefoot varus malalignment. What compensatory motion(s) or posture(s) might a clinician expect to see in this patient? Choices: 1. Genu recurvatum. 2. Excessive subtalar pronation. 3. Ipsilateral pelvic lateral (external) rotation. 4. Hallux varus.

Correct Answer: 2 Possible compensatory motions or postures for forefoot varus malalignment include plantar flexed first ray; hallux valgus; excessive midtarsal or subtalar pronation or prolonged pronation; excessive tibial, tibial and femoral, or femoral and pelvic medial (internal) rotation; and/or all with contralateral lumbar spine rotation. Incorrect Choices: Genu recurvatum is seen to compensate for limited dorsiflexion. Hallux valgus is not expected with a forefoot varus deformity. Contralateral and medial rotation deviations are more likely

The physical therapist evaluation identifi es that a patient has scored low on the Berg Balance Scale. What functional activities should the physical therapist assistant recognize have been assessed? Choices: 1. Hold a single-limb standing position without losing balance. 2. Perform multiple daily activities including turning, stepping up or down, and reaching. 3. Reach forward without losing balance. 4. Rise from a chair, walk and return to a chair and sit back down.

Correct Answer: 2 The Berg Balance Scale assessment identifies the patient's ability to maintain posture and control during a variety of daily activities, such as stepping onto and off a step, turning and looking over a shoulder, and stooping to pick something off the floor. Incorrect Choices: The Timed Up and Go test (#4) assesses the patient's ability to rise from a chair, walk 3 m and return to and sit back down in a chair. Single limb stance (#1) and the Forward Reach test (#3) specific measures of balance control that assess the patient's ability to perform those specific tasks.

Which of the following physical therapy interventions is MOST appropriate to use at school during class for a child with decreased sitting balance and normal tone? Choices: 1. Sitting on a therapy ball while performing desktop activities. 2. Sitting in an adaptive wheelchair with lateral supports and lap tray. 3. Standing on a static prone-stander with lap tray. 4. Sitting in an appropriate height chair with lateral postural supports.

Correct Answer: 2 The goal of school physical therapy is to directly facilitate the educational process—for example, interacting in class, viewing the blackboard, etc. The adaptive wheelchair is the best choice for this child because it allows the child to move around in the classroom while maintaining a stable position. Incorrect Choices: Sitting on a therapy ball is too advanced for a child with decreased sitting balance. The prone-stander is restrictive and does not promote sitting, and a chair with lateral supports would assist with sitting but would not assist with overall mobility of the student.

What is a preferred treatment position when one is providing strengthening exercises for a patient who is diagnosed with pulmonary edema? Choices: 1. Supine with the lower extremities elevated. 2. Sitting with the lower extremities dangling. 3. Side-lying. 4. Prone with the head down.

Correct Answer: 2 The sitting position helps decrease the work of breathing and reduces venous return. Incorrect Choices: Supine lying is a more difficult position for breathing. The side-lying or prone positions do not alleviate the difficulty with breathing.

A college soccer player sustained a hyperextension knee injury when kicking the ball with the opposite lower extremity. The physician in the emergency room discharged the patient with a diagnosis of "knee sprain." The patient was sent to physical therapy the NEXT day for rehabilitation. The therapist's initial evaluation identifi es a positive Lachman's test for anterior cruciate ligament (ACL) integrity. What type of exercise is indicated in the acute phase of treatment? Choices: 1. Agility exercises. 2. Closed-chain terminal knee extension exercises. 3. Open-chain terminal knee extension exercises. 4. Plyometric functional exercises.

Correct Answer: 2 The test that was conducted was a Lachman's test to determine integrity of the ACL. A positive test suggests laxity of the anterior cruciate ligament. Incorrect Choices: Quick cutting or lateral movements that occur in agility training and heavy joint loading that occurs with plyometric exercise should be avoided until the muscular restraints that reduce excessive anterior translation of the affected tibiofemoral joint are strengthened. Open-chain knee extension may place excessive load on the ACL. Closed-chain terminal knee extension exercises are safe and effective secondary to the dynamic stability inherent with this type of exercise.

An older, frail adult is receiving physical therapy in the home environment to improve general strength and mobility. The patient has a 4-year history of taking NSAIDs (aspirin) for joint pain and recently began taking a calcium-channel blocker. What adverse side effects should the physical therapist assistant be aware of? Choices: 1. Increased sweating, fatigue, chest pain. 2. Stomach pain, hypertension, confusion. 3. Weight increase, hyperglycemia, hypotension. 4. Paresthesias, incoordination, bradycardia.

Correct Answer: 2 With advanced age, the capacity of the individual to break down and convert drugs diminishes secondary to decreased liver and kidney function, reduced hepatic and renal blood fl ow, etc. Some drugs additionally slow metabolism (e.g., calcium-channel blockers). NSAIDs are associated with potential gastrointestinal (GI) effects (stomach pain, peptic ulcers, GI hemorrhage), peripheral edema, and easy bruising and bleeding. NSAIDs can also lessen the effects of antihypertensive drugs. Central nervous system effects can include headache, dizziness, lightheadedness, insomnia, tinnitus, confusion, and depression. Incorrect Choices: The other choices are not expected adverse effects of NSAID or calcium-channel blocker usage.

The initial evaluation indicates that a patient has a weak gluteus maximus. What gait deviation should the physical therapist assistant expect to see with this patient during stance phase? Choices: 1. Lateral bending of the trunk to the same side. 2. Lateral bending of the trunk to the opposite side. 3. Backward trunk lean. 4. Forward trunk lean.

Correct Answer: 3 A backward trunk lean is the substitution pattern most commonly used by a person with a weak gluteus maximus. This position helps to maintain hip extension by relying on the tension of the hip joint capsule and ligaments. Incorrect Choices: A lateral trunk lean to the same side is a common gait deviation demonstrated by a patient with a weak gluteus medius. A lateral trunk lean to the opposite side may be demonstrated by the presence of a weak hip flexor. A forward trunk lean may be a function of a weak quadriceps or a hip or knee flexion contracture.

An inpatient with a grade 3 diabetic foot ulcer is referred for physical therapy. Panafil is being applied to the necrotic tissue twice a day. The wound has no foul smell; however, the physical therapist assistant notes a green tinge on the dressing. What should the physical therapist assistant do in this case? Choices: 1. Document the finding and contact the therapist immediately. 2. Begin a trial of acetic acid to the wound. 3. Document the finding and continue with treatment. 4. Fit the patient with a total contact cast.

Correct Answer: 3 A greenish tinge to the dressing is expected with the use of Panafil. Panafil is a keratolytic enzyme used for selective débridement. A greenish or yellowish exudate can be expected. Incorrect Choices: If the exudate were green and had a foul smell, Pseudomonas aeruginosa should be suspected and acetic acid would be the topical agent of choice. Beginning acetic acid treatment does not relate to the identification of a green-tinged discharge. A total contact cast can be used only after the wound is free of necrotic tissue.

A patient has a 5 year history of acquired immunodeficiency syndrome (AIDS). The case worker reports that the patient has had a gradual increase in difficulty with walking. The patient rarely goes out anymore. A referral to physical therapy is initiated. The physical therapist assistant has been directed to provide functional training including bed mobility and transfer training. The physical therapist assistant would expect which of the following neuromuscular symptoms with this patient? Choices: 1. Paraplegia or tetraplegia. 2. Widespread sensory loss resulting in sensory ataxia. 3. Motor ataxia and paresis with pronounced gait disturbances. 4. Progressive rigidity and akinesia with severe balance disturbances.

Correct Answer: 3 Alterations in memory, confusion and disorientation are characteristic of AIDS dementia complex, a common central nervous system manifestation of HIV infection. Motor deficits may include ataxia, paresis with gait disturbances, and loss of fine motor coordination. Patients may also develop peripheral neuropathy with distal pain and sensory loss. Incorrect Choices: Paraparesis (not paraplegia) might be a finding. The sensory loss is not widespread but is in similar distribution of peripheral neuropathies. Rigidity and akinesia are not associated with AIDS.

A male child who plays catcher on his baseball team complains of bilateral knee pain that is exacerbated with forceful quadriceps contraction. The physical therapist examination noted pain and swelling at the distal attachment of the patellar tendon. The therapist has instructed the physical therapist assistant to begin treatment that addresses the pain and swelling. What should EARLY management focus on? Choices: 1. Isometric exercises to decrease inflammation. 2. Active range of motion exercises to prevent contracture. 3. Decreased loading of the knee by the quadriceps femoris muscle. 4. Casting followed by decreased loading of the knee.

Correct Answer: 3 Baseball catchers must make forceful contractions of the quadriceps muscles each time they stand up to throw the ball to the pitcher. This may precipitate Osgood-Schlatter disease in the adolescent boy. Early intervention of this condition focuses on reduction of the loading by the quadriceps but still retaining normal lower-extremity function. Incorrect Choices: Isometric exercises and active range will still "stress" the patella tendon/tibial tubercle causing continued irritation and pain. Casting is not indicated as you do not want to immobilize the limb.

The plan of care for a patient following acute whiplash of the cervical spine calls for initiating cervical stabilization exercises. The patient is tolerating cervical nodding exercises and has a pain rating of 5 out of 10 (10 being the worst pain). As the patient maintains the cervical nod, how should the physical therapist assistant progress the cervical nodding exercise? Choices: 1. Perform active shoulder flexion to 90° while sitting on a ball. 2. Perform active shoulder flexion to 180° while supine. 3. Perform active shoulder flexion to 90° while supine. 4. Perform active shoulder flexion to 180° while standing

Correct Answer: 3 Because the patient is only tolerating a cervical nod and has a pain rate of 5, the exercises should be progressed slowly. The correct progression from maintaining a cervical nod is to initiate partial shoulder range of motion with the head and trunk in a supported position. Incorrect Choices Once the patient can do this successfully without significant increase in pain, then further progressions will include full range motion of the shoulders in a supported position (#2). Once able to do full range with body supported, body support will be taken away (#4) and then challenged (#1) with decreasing trunk support as the patient tolerates.

Which of the following processes will MOST accurately measure the circumference of a patient's lower leg following a knee arthroplasty? Choices: 1. Begin at the area of the greatest edema, then every 2 inches proximal and 2 inches distal. 2. Begin at the inferior angle of the greater trochanter of that extremity and continue distally until the inferior angle of the lateral malleolus. 3. Begin at the inferior angle of the lateral malleolus, and in 2-4-inch increments proximally, stopping proximal to the edematous area. 4. Begin at the bend of the knee and proceeding distally every 2 cm, stopping distal to the edematous area.

Correct Answer: 3 Circumferential measurement must be based from a bony landmark that is reproducible for future measurements. The measurements should include areas immediately proximal and distal to the edematous area. Circumferential measurements are best taken with an anthropometric measuring tape that has a pressure gauge on one end to ensure consistent pressure on the tape during measurement.

A physical therapist assistant is applying high-volt pulsed current to the vastus medialis to improve patellar tracking during knee extension. The patient reports that the current is uncomfortable. To make the current more tolerable to the patient, yet maintain a good therapeutic effect, what parameter should the assistant consider adjusting? Choices: 1. Pulse rate. 2. Current intensity. 3. Pulse duration. 4. Current polarity.

Correct Answer: 3 Decreasing the pulse duration reduces the electrical charge of each pulse, making the current more comfortable by decreasing the total current applied while maintaining the full therapeutic effect. Incorrect Choices: Pulse rate will not affect the comfort of the current. Lowering the intensity of the intensity can result in the inability to achieve a muscle contraction and thus diminish effectiveness. Current polarity does not affect current tolerance.

A patient is exercising in a phase III outpatient cardiac rehabilitation program that utilizes circuit training. One of the stations utilizes weights. The patient lifts a 5-lb weight, holds it for 20 seconds and then lowers it slowly. The physical therapist assistant corrects the activity and tells the patient to reduce the length of the static hold. What can this static exercise expect to produce? Choices: 1. Abnormal oxygen uptake. 2. Lower heart rate and arterial blood pressure. 3. Higher heart rate and arterial blood pressure. 4. Reduced normal venous return to the heart and elevated blood pressure.

Correct Answer: 3 Dynamic exercise facilitates circulation whereas isometric (static) exercise hinders blood flow, producing higher heart rates and arterial blood pressures. Incorrect Choices: Abnormal oxygen uptake is more likely indicative of a pulmonary issue and lower HR and arterial blood pressure is an abnormal response to exercise that may have a variety of causes.

A weight lifter exhibits marked hypertrophy after embarking on a strength training regime. At what point in training can hypertrophy of major muscle groups be expected to occur? Choices: 1. 2-4 weeks of training. 2. 4-6 weeks of training. 3. 6-8 weeks of training. 4. 8-10 weeks of training

Correct Answer: 3 Hypertrophy is the increase in muscle size as a result of resistance training and can be observed following at least 6-8 weeks of training. Individual muscle fi bers are enlarged, contain more actin and myosin, and have more, larger myofibrils. Incorrect Choices: Prior to 6-8 weeks of training muscle fi bers will gain in endurance and strength before signifi cant hypertrophy develops.

A patient has been referred for physical therapy following a fracture of the femur 6 months ago. The cast was removed, but the patient was unable to volitionally contract the quadriceps. To address this problem the physical therapist indicates utilization of electrical stimulation to the quadriceps muscle in the plan of care. Which of the following BEST describes the appropriate electrode size and placement for this patient? Choices: 1. Large electrodes, closely spaced. 2. Small electrodes, closely spaced. 3. Large electrodes, widely spaced. 4. Small electrodes, widely spaced.

Correct Answer: 3 Large electrodes are used on large muscles to disperse the current (minimize current density under the electrode) enabling a more comfortable delivery of current. Incorrect Choices: Widely spaced electrodes permit the current to travel deeper into the muscle to stimulate a greater number of deeper muscle fibers. Small electrodes will increase density of stimulus and will likely not be tolerated by the client.

A patient has been confined to bed for a period of 2 months and now demonstrates limited range of motion in both lower extremities. Range in hip fl exion is 5°-115° and knee fl exion is 10°-120°. The physical therapist has indicated that flexibility activities should be implemented to improve the range of motion in preparation of standing activities. Which represents the MOST appropriate intervention to improve flexibility and ready this patient for standing? Choices: 1. Manual passive stretching, 10 repetitions each joint, two times a day. 2. Tilt table standing, 20 minutes daily. 3. Mechanical stretching using traction and 5-lb weights, 2 hours, twice daily. 4. Hold-relax techniques followed by passive range of motion, 10 repetitions, two times a day

Correct Answer: 3 Prolonged mechanical stretching involves a low-intensity force (generally 5-15 lb) applied over a prolonged period (30 minutes to several hours). It is generally the most effective way to manage long-standing flexion contractures. Incorrect Choices: Manual passive stretching and tilt table standing are shorter duration stretches that are not likely to be effective in this case. Hold-relax techniques can be used to improve flexibility in the presence of shortening of muscular elements but are not likely to be effective in this case because of the short duration and longstanding contracture affecting connective tissue elements.

A clinician has moved a patient's joint through its available range of motion and stops to hold the joint near end range, then asks the patient to identify the position of the joint. What sense is the clinician testing? Choices: 1. Tactile localization. 2. Kinesthesia. 3. Proprioception. 4. Pressure perception.

Correct Answer: 3 Proprioception tests are performed by positioning a patient's affected joint into a position, following an instructional trial, and asking the patient to verbally (or visually using the uninvolved extremity) report which position the joint is in. Incorrect Choices: Kinesthesia awareness is tested by moving the patient's affected joint through a portion of its range of motion and asking the patient to identify or replicate the range of movement performed. Tactile localization is assessing the patient's ability to identify the location of a touch stimulus provided by the clinician, e.g., radial condyle, web space of hand. Pressure perception is tested by applying pressure to a specific location using a fingertip or cotton swab and asking the patient to respond "yes" or "no" when they feel pressure.

Which of the following conditions would allow the clinician to continue with orders to implement ultrasound? Choices: 1. Plastic implants 2. Infected tissue. 3. Metal implants. 4. Neoplastic lesions.

Correct Answer: 3 Several studies have shown the safe use of ultrasound over metal implants. The acoustical energy is dispersed throughout the metal and is absorbed into the surrounding tissue. There is no signifi cant heating within the implant. Incorrect Choices: The other choices identified are contraindications for the use of ultrasound.

A patient with Parkinson's disease demonstrates a gait pattern typical of this diagnosis. Which activity could present a danger if used by the physical therapist assistant? Choices: 1. Standing, using body weight support from a harness. 2. Sidestepping and cross-stepping using light touch-down support of hands. 3. Gait training using a rolling walker. 4. Rhythmic stepping using a motorized treadmill.

Correct Answer: 3 The patient with Parkinson's disease typically presents with postural deficits of forward head and trunk with hip and knee flexion contractures. Gait is narrow-based and shuffling. A festinating gait typically results from persistent forward posturing of the body near the forward limits of stability. A rolling walker is contraindicated because it has the potential to increase forward postural deformities and festinating gait. Incorrect Choices: All other choices are appropriate training activities to improve upright standing balance and gait for an individual who has Parkinson's disease.

A physical therapist assistant is working with a postal worker who reports numbness and tingling in the right hand. Symptoms are reported on the palm, the palmar surface of the first two fingers, and the pad of the thumb. Which nerve should the physical therapist assistant report that the patient was demonstrating diminished sensation in? Choices: 1. Radial nerve. 2. Ulnar nerve. 3. Median nerve. 4. Accessory nerve.

Correct Answer: 3 The symptoms best typify median nerve distribution. Incorrect Choices: Sensory distribution of the radial nerve covers the dorsum of the thumb and dorsal surface of the thumb and first two fingers. The ulnar nerve covers the thenar eminence, little finger, and medial border of the ring finger.

What is the BEST intervention to improve functional mobility in an individual with a stable humeral neck fracture? Choices: 1. Active resistive range of motion. 2. Isometrics for all shoulder musculature. 3. Pendulum exercises. 4. Modalities to decrease pain.

Correct Answer: 3 This individual will typically be immobilized with a sling for a period of 6 weeks. After 1 week the sling should be removed to have the patient perform pendulum exercises to prevent shoulder stiffness and to begin mobilization of the joint. Incorrect Choices: Resistive exercises are not indicated during this early period and address muscle performance not mobility. Isometrics may be used early in treatment but address muscle performance/strength not mobility. Modalities may be effective in reducing pain but do not improve mobility.

A physical therapist assistant is working with a patient in the patient's home. The patient is being seen for right hemiparesis. The physical therapy evaluation indicates that the patient demonstrates good recovery; both involved extremities are categorized as out-of-synergy. The patient is ambulatory with a small-based quad cane. Which activity is MOST appropriate for a patient at this stage of recovery? Choices: 1. Supine, bending the hip and knee up to the chest with some hip abduction. 2. Sitting, marching in place (alternate hip flexion movements). 3. Standing, picking the foot up behind and slowly lowering it. 4. Standing, small-range knee extension movements to gain quadriceps control.

Correct Answer: 3 This stage of recovery is characterized by some movement combinations that do not follow paths of either flexion or extension obligatory synergies. Knee flexion in standing is an out-of-synergy movement. Incorrect Choices: All other choices represent synergistic movements: the supine and sitting options are flexion synergy movements whereas the other standing option focuses on knee extensor movement within an extended position.

When working with a patient in a pool who is submerged to chest level, which clinical effect will be produced? Choices: 1. The patient will be able to better regulate body temperature in the water. 2. Exercises will be more easily performed with the body part submerged more deeply in the water. 3. The patient's center of gravity (buoyancy in the water) moves higher, closer to the area of the sternum. 4. The more quickly the patient moves the easier the exercises will be.

Correct Answer: 3 When the patient is submerged in the pool, the patient's center of gravity moves to the area of the sternum. Buoyancy devices will alter this center of gravity, e.g., a buoyancy device placed posteriorly will cause the patient to lean forward. Incorrect Choices: Temperature regulation is more challenging while submerged as less skin is exposed to allow heat dissipation through evaporation. Once the body part has overcome the surface tension and has been submerged in the water it will need to overcome the effects of buoyancy and viscosity; being submerged more deeply does not necessarily mean the exercise is harder to perform. Performing an exercise more quickly increases the water turbulence and drag thus making the exercise more difficult.

A patient sustained a T10 spinal cord injury 4 years ago and is now referred for an episode of outpatient physical therapy. In the initial examination the physical therapist documented redness over the ischial seat that persisted for 10 minutes when the patient was not sitting. The plan of care includes strengthening and instruction in functional activities. Which of the following activities should the physical therapist assistant include in the therapy session to meet the plan of care? Choices: 1. Supine chest press with 20-pound barbell. 2. Half-standing transfers between surfaces. 3. Bilateral upper-extremity dips in the parallel bars. 4. Seated, gravity-resisted triceps curls with 10 pounds

Correct Answer: 3. Bilateral upper-extremity dips in the parallel bars will best strengthen the musculature needed to assist the patient to improve the ability to perform wheelchair push-ups to relieve pressure on the ischial tuberosities. Excessive ischial pressure and redness from prolonged sitting require an aggressive approach. Incorrect Choices: Supine chest presses and gravity-resisted triceps curls only incorporate the triceps muscles and do not incorporate the latissimus; therefore, they are not as comprehensive in muscle recruitment as the parallel bar dips are. Performing the half-standing transfers for the patient is not functional training

A home health physical therapist assistant is working with an older adult patient who has a history of hypertension and hyperlipidemia. On this day the patient is confused with shortness of breath and generalized weakness. What information should the physical therapist assistant immediately report to the supervising physical therapist? Choices: 1. Mental changes are indicative of early Alzheimer's disease. 2. The patient may be experiencing unstable angina. 3. The patient forgot to take his or her hypertension medication. 4. The patient may be presenting with early signs of myocardial infarction.

Correct Answer: 4 An elderly patient with a cardiac history may present with initial symptoms of mental confusion, the result of oxygen deprivation to the brain during developing myocardial infarction. The shortness of breath and generalized weakness may also be attributable to generalized circulatory insufficiencies coexisting with the developing myocardial infarction. Incorrect Choices: Alzheimer's disease would not present with shortness of breath. An individual with unstable angina would complain of pain. Forgetting hypertension medications would most likely present itself as increased blood pressure.

A 12-year-old child presents with pain (4/10) and limited knee range of motion (5°-95°) following surgical repair of the medial collateral and anterior cruciate ligaments. Which modality should be used with caution in this case? Choices: 1. Premodulated interferential current. 2. Continuous short-wave diathermy. 3. High-rate transcutaneous electrical stimulation. 4. Low-dose ultrasound.

Correct Answer: 4 Because the epiphyseal plates do not close until the end of puberty, ultrasound energy should be applied with caution around the epiphyseal area because of the potential for causing bone growth disturbances. However, there is no documented evidence that ultrasound creates any direct untoward effects on the growth plates, especially if applied at low dosage. Incorrect Choices: Electrical stimulation or deep thermotherapy would have no deleterious effects on the epiphyseal plates because no mechanical effects on hard tissue are associated with their use.

A patient has lumbar spinal stenosis encroaching on the spinal cord. What activity should the physical therapist assistant instruct the patient to AVOID? Choices: 1. Bicycling on hills. 2. Use of a rowing machine. 3. Tai Chi activities. 4. Swimming using a crawl stroke.

Correct Answer: 4 Continuous positioning in spinal extension increases symptoms in patients with spinal stenosis. Activities such as swimming using a crawl stroke place the spine in extension which needs to be avoided. Incorrect Choices: All other activities (numbers 1, 2, and 3) described do not require the patient to maintain a continuous extended spinal position and do not need to be avoided.

A woman recently delivered twins. After delivery she developed a 4-cm diastasis recti abdominis. What is the BEST initial intervention for this condition? Choices: 1. Pelvic tilts and bilateral straight leg raising. 2. Pelvic floor exercises and sit-ups. 3. Gentle stretching of hamstrings and hip flexors. 4. Protection and splinting of the abdominal musculature.

Correct Answer: 4 Diastasis recti abdominis is a condition in which there is a lateral separation or split of the rectus abdominis. It is important to FIRST teach protection (splinting) of the abdominal musculature. The key is INITIAL; once the patient is able to splint and protect the musculature, then it is appropriate to address muscle performance. Incorrect Choices: Patients should be instructed to avoid full sit-ups or bilateral straight leg raising. Pelvic floor exercises are done but are not remediation for diastasis recti. Gentle stretching of the hamstring and hip flexors does not apply

A patient has a 3-year history of multiple sclerosis. One of the disabling symptoms is persistent and severe diplopia, which leaves the patient frequently nauseated and immobile. Which represents an appropriate intervention strategy to assist the patient to successfully participate in rehabilitation? Choices: 1. Provide the patient with special glasses that magnify images. 2. Instruct the patient to close both eyes and practice movements without visual guidance. 3. Provide the patient with a soft neck collar to limit head and neck movements. 4. Patch one eye.

Correct Answer: 4 Double vision (diplopia) can be managed by patching one eye. Patients are typically on an eye-patching schedule that alternates the eye that is patched. Loss of depth perception can be expected with eye-patching but is not as disabling as diplopia. Incorrect Choices: It is not beneficial for this patient to wear magnification glasses. Closing eyes to perform movements without visual guidance will not help diminish or eliminate diplopia. A soft collar to limit neck movements will not diminish or eliminate diplopia.

A patient in a cardiac exercise class develops muscle weakness and fatigue. The physical therapist's examination reveals lower-extremity cramps and hyporeflexia. The patient also experiences frequent episodes of postural hypotension and dizziness. There are some abnormalities on the electrocardiogram. What do these findings suggest? Choices: 1. Hyperkalemia. 2. Hypocalcemia. 3. Hyponatremia. 4. Hypokalemia.

Correct Answer: 4 Hypokalemia, decreased potassium in the blood, is characterized by the above signs and symptoms. Other possible symptoms include respiratory distress, irritability, confusion or depression, and gastrointestinal disturbances. Electrocardiogram abnormalities would include flat T wave, prolonged QT interval, and depressed ST segment. Incorrect Choices: Hyperkalemia is excess potassium in the blood and may present with widened PR interval and QRS and tachycardia. Hyponatremia is decreased sodium in the blood which presents with hypotension and tachycardia, and hypocalcemia is decreased calcium in the blood which presents with arrhythmias and hypotension.

Which of the following represents the MOST appropriate feedback strategy for a physical therapist assistant to utilize when providing gait training for a patient who has been receiving gait training for 3 weeks? Choices: 1. Immediate feedback given after each practice trial. 2. Intermittent feedback given at scheduled intervals, every other practice trial. 3. Continuous feedback with ongoing verbal cuing during gait. 4. Occasional feedback given when consistent errors appear.

Correct Answer: 4 In learning a psychomotor skill, the patient needs to be able to actively process information and self-correct responses. Occasional feedback provides the best means of allowing for introspection and is appropriate for later practice (associated and autonomous phases of motor learning). Incorrect Choices: Continuous feedback and immediate feedback are used when fi rst training and when in the cognitive phase of motor learning. Intermittent feedback is best used during the associated stage of motor learning.

A patient who sustained a complete spinal cord injury at the level of T10 is ready to begin community wheelchair training. The plan of care includes instructions in wheelchair skills to manage curbs. What is the BEST strategy to provide the patient? Choices: 1. Throw their head and trunk backward to rise up on the large wheels. 2. Place hand on the top of the handrims to steady the chair while throwing the head and trunk forward. 3. Lean backward while moving the hands slowly backward on the rims. 4. Grasp the handrims posteriorly and pull them forward abruptly and forcefully.

Correct Answer: 4 In order for a wheelchair user to manage curbs the patient needs to learn to "pop a wheelie." A wheelie can be assumed by having the patient place the hands posterior on the handrims and pulling them abruptly and sharply forward. If the patient is unable to lift the casters in this manner, he or she can throw the head back forcefully when pulling the handrims. An alternate technique is to grasp the handrims anteriorly, pull backward, then abruptly and forcefully reverse the direction of pull. The therapist can assist by steadying the chair at the patient's balance point until he or she learns to adjust the position through the use of handrim movements forward and backward. Incorrect Choices: In order to perform a wheelie more than just leaning or throwing the body back is needed. The rims need to be forcefully and abruptly moved.

The plan of care indicates ultrasound treatment for a muscle spasm of the piriformis. The piriformis is compressing the sciatic nerve and producing pain in the posterior hip region. The pain has been worsening over the past 3 months. What is the MOST benefi cial ultrasound setting for this case? Choices: 1. 3 MHz continuous at 1.0 w/cm.2 2. 3 MHz pulsed at 1.0 w/cm.2 3. 1 MHz pulsed at 1.0 w/cm.2 4. 1 MHz continuous at 1.0 w/cm.2

Correct Answer: 4 One MHz of continuous ultrasound provides deep heating to a depth of 3-5 cm. At this frequency, attenuation (absorption) is less in superficial tissues. This allows more energy to be absorbed; thus, more heat is produced in deeper tissue layers. Continuous ultrasound is applied to achieve thermal effects (e.g., for chronic pain), and pulsed ultrasound is used when nonthermal effects are desired (e.g., for acute soft-tissue injuries).

A patient has an episode of syncope in the physical therapy clinic. The physical therapist asks the physical therapist assistant to check to see whether the patient is experiencing orthostatic hypotension. How should the physical therapist assistant complete this assessment? Choices: 1. Check the heart rate (HR) and blood pressure (BP) in supine position after 5 minutes rest, then repeating in semi-Fowler position. 2. Palpate the carotid arteries and taking HR; using the supine position for BP measurements. 3. Check the HR and BP at rest, and after 3 and 5 minutes of cycle ergometry exercise. 4. Check the resting BP and HR in sitting, then repeating measurements after standing for 1 minute.

Correct Answer: 4 Orthostatic hypotension is a fall in BP with elevation of position, i.e., from supine to sitting or sitting to standing. A small increase or no increase in heart rate upon standing may suggest baroreflex impairment. An exaggerated increase in HR upon standing may indicate volume depletion. A drop in blood pressure with change in position may indicate orthostatic hypotension. Incorrect Choices: Orthostatic hypotension is identified by first measuring blood pressure in the seated or reclined position— then progressing to standing; not in consistent reclining positions. Supine measurements must be compared to standing measurements; there is no need to measure the carotid pulse. Checking after 3-5 minutes of activity will provide inaccurate information as the patient's heart rate and blood pressure will be elevated during this ability.

A dancer with unilateral spondylolysis at L4 is referred for physical therapy. The patient reports generalized low back pain when standing longer than 1 hour. What strengthening exercises should be included in the subacute phase of healing? Choices: 1. Abdominals working from neutral to full flexion. 2. Multifidi working from neutral to full extension. 3. Abdominals working from full extension to full flexion. 4. Multifidi working from full flexion back to neutral.

Correct Answer: 4 Performing strengthening exercises to the multifidi from flexion to neutral will not stress the pars defect which is imperative with spondylolysis. Incorrect Choices: Abdominal strengthening will not provide the segmental stability needed with this condition. Lumbar extension beyond neutral and rotation will tend to aggravate the condition in the early stages of rehabilitation.

A patient with bilateral short transfemoral amputations will require a wheelchair for functional mobility in the home and community. What is an important feature to include in a wheelchair prescription for this patient? Choices: 1. Placement of the drive wheels 2 inches anterior to the vertical back supports. 2. Lowering the seat height by 3 inches. 3. Increasing the seat depth by 2 inches to accommodate the length of the residual extremities. 4. Placement of the drive wheels 2 inches posterior to the vertical back supports.

Correct Answer: 4 Placement of the drive wheels 2 inches posterior to the vertical back supports is an appropriate modification for a patient with bilateral transfemoral amputations. This increases the length of the base of support and provides increased posterior stability. This is needed to offset the change in mass given the anterior mass is much less with the loss of the lower extremities Incorrect Choices: Lowering the seat height by 3 inches is an appropriate modification for a patient following a cerebrovascular accident, who will use his or her sound extremities for wheelchair propulsion. Increasing the seat depth is not appropriate as that is not the method of accommodating the residual limb.

A patient suffered carbon monoxide poisoning from a work-related factory accident and is left with permanent damage to the basal ganglia. What impairments should the clinician expect the patient to present with? Choices: 1. Motor paralysis with the use of free weights to increase strength. 2. Muscular spasms and hyperreflexia with the use of ice wraps. 3. Impaired sensory organization of balance with the use of standing balance platform training. 4. Motor planning with the use of guided and cued movement.

Correct Answer: 4 The basal ganglia functions to convert general motor activity into specific, goal-directed action plans. Dysfunction results in problems with motor planning and scaling of movements and postures (e.g., bradykinesia). Patients benefit from initial guided movement and task-specific training. Proprioceptive, tactile, and verbal cues can also be used prior to and during a task to enhance movement. Incorrect Choices: The other listed deficits (choices) are not typically seen with basal ganglia disorders.

A physical therapist assistant is providing home care for an older adult patient. Upon arrival, the assistant notices that the patient is confused. The patient's skin color is pale and the turgor is poor. The patient reports an intestinal upset for the past few days with frequent vomiting and diarrhea. What is the physical therapist assistant's BEST course of action? Choices: 1. Monitor vital signs; if heart rate is not elevated, get the patient up and walking. 2. Notify the family, and insist that the patient not be alone until the illness is over. 3. Cancel therapy for today, carefully document the findings and notify the physician. 4. Give the patient water and notify the physician and physical therapist immediately.

Correct Answer: 4 The patient is exhibiting signs of dehydration. Confusion is a red flag and requires immediate action: administer fluids and notify the physician and therapist immediately. Incorrect Choices: Getting the patient up and walking or warning the family to stay with the patient will not address the dehydration. This situation can develop into a medical emergency and needs immediate medical attention

An athlete presents with pain and muscle spasm of the upper back (C7-T8) extending to the lateral border of the scapula. This encompasses a 5 cm by 10 cm area on each side of the spine. The ultrasound unit has a 5 cm2 sound head. How should the physical therapist assistant administer the ultrasound? Choices: 1. Covering the entire area in 5 minutes. 2. Covering the entire area in 10 minutes. 3. Along each side allotting 2.5 minutes for each area. 4. Along each side allotting 10 minutes for each area.

Correct Answer: 4 The total treatment area is too large for the 5 cm2 sound head to produce adequate tissue heating. Moving the transducer too fast to cover both sides adequately in the allotted time does not allow sufficient time for the acoustic energy to produce heat because the head is not in a given area long enough. Sonating each side independently, for 10 minutes on each area, will allow enough time to produce sufficient heating within the tissues to help decrease muscle spasm and pain. Incorrect Choices: Just increasing the treatment time will not affect the rate of heat production. Two and a half minutes is too brief to produce sufficient therapeutic tissue heating.

When preparing a patient who has incomplete T12 paraplegia for ambulation, which muscle groups should strengthening be focused on? Choices: 1. Upper trapezius, rhomboids, and levator scapulae. 2. Deltoid, triceps, and wrist flexors. 3. Middle trapezius, latissimus dorsi, and triceps. 4. Lower trapezius, latissimus dorsi, and triceps.

Correct Answer: 4 The upper-quadrant muscles that are most important to strengthen for crutch gaits include the lower trapezius, latissimus dorsi, and triceps. Shoulder depression and elbow extension strength are crucial for successful crutch gait. Incorrect Choices: The other muscles listed do not help in actions needed to depress shoulder and extend elbow in order for the UEs to take on the body weight to allow for movement of the LEs.

A physical therapist assistant observes genu recurvatum while gait training a patient with hemiplegia. The patient has been using a posterior leaf spring orthosis since discharge from subacute rehabilitation 4 weeks ago. The patient has strong synergies in the lower extremity and NO out-of-synergy movement. What is the MOST likely cause of this deviation? Choices: 1. Extensor spasticity. 2. Hip flexor weakness. 3. Dorsiflexor spasticity. 4. Hamstring weakness.

Correct Answer: 1 A hyperextended knee can be caused by extensor spasticity, quadriceps weakness (a compensatory locking of the knee), or by plantar flexion contractures or deformity. The most likely cause in this case is extensor spasticity, which is consistent with strong obligatory synergies. Incorrect Choices: Hip flexor weakness would likely result in difficulty with initiation of swing or use of hip hike to progress the limb forward; hamstring weakness would likely result in lack of knee flexion during swing, and dorsiflexion spasticity would result in excessive dorsiflexion with potential buckling of the knee.

A physical therapist assistant is working with a patient recovering from a stroke. In which of these conditions would it be MOST important for the assistant to implement additional safety precautions during treatment? Choices: 1. Anosognosia. 2. Ideational apraxia. 3. Unilateral neglect. 4. Ideomotor apraxia.

Correct Answer: 1 Anosognosia is a more severe form of neglect with lack of awareness and denial of the severity of one's paralysis. Incorrect Choices: With ideomotor apraxia, a patient cannot perform a task upon command but can do the task when on his or her own. With ideational apraxia, a patient cannot perform a requested task at all. Unilateral neglect might lead the patient to ignore something positioned on the involved side.

A patient with a transtibial amputation is learning to walk with a patellar tendon-bearing prosthesis and is having difficulty maintaining prosthetic stability from heel-strike (initial contact) to foot-flat (loading response). What muscles are MOST likely weak during stance phase? Choices: 1. Knee extensors. 2. Back extensors. 3. Hip flexors. 4. Knee flexors.

Correct Answer: 1 The quadriceps is maximally active at heel strike (initial contact) to stabilize the knee and counteract the flexion moment. Weakness may result in buckling of the knee. Incorrect Choices: Weak back extensors may present as excessive forward flexion of the trunk. Weak hip flexors may present as difficulty in initiation of swing or hip hike to initiate swing. Weak knee flexors may present as decreased knee flexion in swing.

A researcher states that he expects that there will be a significant difference between 20- and 30-year-olds after a 12-week exercise training program using exercise heart rates and myocardial oxygen consumption as measures of performance. What kind of hypothesis is being used in this study? Choices: 1. Quasi-experimental hypothesis. 2. Research hypothesis. 3. Null hypothesis. 4. Nondirectional hypothesis.

Correct Answer: 2 A research hypothesis is a generalization that predicts an expected relationship between variables. Incorrect Choices: The null hypothesis is a statistical hypothesis that states that there is no relationship (or difference) between variables. Any relationship found will be a chance relationship, not a true one. A research hypothesis predicts an expected relationship between variables (e.g., 20-year-olds will demonstrate improved measures of performance compared with 30-year-olds). Quasi-experimental means that the subjects cannot be randomly assigned to groups. Nondirectional means that a direction of change cannot be predicted.

A baseball pitcher is being seen following surgical repair of a glenoid labrum lesion of the pitching upper extremity. In follow-up care, the physical therapist assistant needs to pay attention to the pitching motion. What phase of throwing motion places the glenohumeral labrum and shoulder joint capsule at greatest stress? Choices: 1. Wind-up. 2. Cocking. 3. Acceleration. 4. Deceleration.

Correct Answer: 2 During the cocking phase, the upper extremity is taken into the end range of humeral lateral (external) rotation. At that point, the anterior aspects of the capsule and labrum are acting as constraints to prevent excessive anterior glide of the humerus. Incorrect Choices: Acceleration, deceleration, and wind-up are most affected by muscle performance and are not at the end range.

Two therapists are asked to perform a test on the same group of patients by using the Functional Independence Measure (FIM). The results of both sets of measurements reveal differences in therapists' scores but NOT in the repeat measurements. What type of measurement problem are these results indicative of? Choices: 1. Concurrent validity. 2. Intrarater reliability. 3. Interrater reliability. 4. Construct validity.

Correct Answer: 3 Interrater reliability is the degree to which two or more independent raters can obtain the same rating for a given variable. In this case, two therapists obtained different FIM scores for the same group of patients, indicating a problem in interrater reliability. Incorrect Choices: Intrarater reliability is the consistency of an examiner on repeat tests. Issues of validity (Does the test measure what it says it measures?) are not relevant.

Which of the following is an appropriate exercise modification for a woman who is 15 weeks into her pregnancy? Choices: 1. Encouraging unilateral exercise of the lower extremities. 2. Standing rather than supine lower-extremity resistive band exercises. 3. Avoiding quadruped exercise activities. 4. Placing a small wedge under right hip during supine exercise.

Correct Answer: 4 After the first trimester a pregnant women should avoid supine positioning for greater than 5 minutes at a time. When performing supine exercises, placement of a wedge under the right hip helps to decrease the effects of uterine compression on abdominal vessels and improves cardiac output. Incorrect Choices: Asymmetrical stretching or strengthening activities of the lower extremities can contribute to joint instability, especially of the lower back and sacroiliac joint area. Quadruped positioning is an appropriate modifi cation for prone activities; however, note that hip extension activities should be limited to midline, and hip extension beyond midline should be avoided as this position can place asymmetrical forces through the sacroiliac joint and lower back area.

A patient is transferred to a burn clinic with partial-thickness burns over 30% of the body. What type of healing will this type of wound be characterized by? Choices: 1. Blisters and minimal edema with spontaneous healing. 2. Depressed skin area that heals with grafting and scarring. 3. Moderate edema with spontaneous healing and minimal grafting. 4. Marked edema with slow healing and extensive hypertrophic scarring.

Correct Answer: 4 Deep partial-thickness burns involve destruction of the epidermis with damage of the dermis down into the reticular area. Appearance is mixed red/white color with sluggish capillary refill. Superficial sensation is decreased while sense of deep pressure is retained. The burn will heal spontaneously in 3-5 weeks if no infection develops (infection can convert the burn to full-thickness). There is most likely marked edema with excessive scarring (hypertrophic). Incorrect Choices: Superficial burns heal with minimal edema, whereas superficial partial-thickness burns heal spontaneously with moderate edema and minimal scarring; they do not require grafting. Full-thickness burns require skin grafting; appearance is depressed with significant scarring.

During surgery to remove an apical lung tumor, the long thoracic nerve was injured. Muscle weakness is 3+/5. The plan of care indicates strengthening exercises for the weak muscles. Which of the following BEST represents initial exercises for this patient? Choices: 1. Standing, upper-extremity overhead lifts using hand weights. 2. Supine, upper-extremity overhead lifts using weights. 3. Sitting, upper-extremity overhead lifts using a pulley. 4. Standing, wall push-ups.

Correct Answer: 4 The long thoracic nerve supplies the serratus anterior muscle. With a muscle grade of fair plus (3+/5), the patient can begin functional strengthening by using standing wall push-ups, with resistance provided by the patient's own body. Incorrect Choices: The other exercises identified are not optimal exercises for strengthening the serratus anterior with fair plus strength.

The cardiac rehabilitation team is conducting education classes for a group of patients. The focus is on risk factor reduction and successful lifestyle modifi cation. A participant asks the physical therapist assistant to explain these cholesterol fi ndings: Total cholesterol is 220 mg/dL, high-density liproprotein (HDL) cholesterol is 24 mg/dL, and low-density lipoprotein (LDL) cholesterol is 160 mg/dL. What should the physical therapist assistant explain that these readings indicate? Choices: 1. That the levels of HDL, LDL, and total cholesterol are all abnormally high. 2. That LDL and HDL cholesterol levels are within normal limits and total cholesterol should be below 200 mg/dL. 3. That the levels of HDL, LDL, and total cholesterol are all abnormally low. 4. The levels of LDL and total cholesterol are abnormally high and the level of HDL cholesterol is abnormally low.

Increased total blood cholesterol levels (>200 mg/dL) and levels of LDLs (>130 mg/dL) increase the risk of coronary artery disease (CAD); conversely, low concentrations of HDLs (<40 mg/dL for men and <50 mg/dL for women) are also harmful. The link between CAD and triglycerides is not as clear. Incorrect Choices: HDL levels are low and LDL levels represented are high.

A patient presents with a large plantar ulcer that will be debrided. The foot is cold, pale, and painless. Which of the following conditions BEST meets the described clinical presentation? Choices: 1. Chronic arterial insufficiency. 2. Chronic venous insufficiency. 3. Acute arterial insufficiency. 4. Deep venous thrombosis.

Teaching Points Correct Answer: 2 Venous ulcers are often painless, or present with minimal pain compared with arterial ulcers, which are painful (claudication and rest pain). Chronic venous insufficiency is also characterized by thickening, coarsening, and brownish pigmentation of the skin around the ankles. The skin is usually thin, shiny, and cyanotic. Incorrect Choices: Deep venous thrombosis may be asymptomatic initially. When symptoms occur, patients typically report a dull ache, tightness, or pain in the calf. Both acute or chronic arterial insufficiency are painful conditions.