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A therapist is massaging the upper trapezius of a patient. One of the techniques involves lifting and kneading of the tissues. What is the correct name of this technique? A. Tapotement massage B. Effleurage massage C. Petrissage massage D. Friction massage

C. This is a description of the petrissage technique. Effleurage is stroking of the skin. Friction massages are used to mobilize scar tissue. Tapotement is tapping of the skin.

In taping an athlete's ankle prophylactically before a football game, in what position should the ankle be slightly positioned before taping to provide the most protection against an ankle sprain? A. Inversion, dorsiflexion, abduction B. Eversion, plantarflexion, adduction C. Eversion, dorsiflexion, abduction D. Inversion, plantarflexion, adduction

C. This position, which limits inversion, plantarflexion, and adduction, is the most common position for ankle sprains.

When the knee is at its maximal amount of flexion during the gait cycle, which of the following muscles are active concentrically? A. Hamstrings B. Gluteus maximus C. Gastrocnemius D. All of the above

A. The hamstrings bring the knee to approximately 60o of flexion during acceleration. The hip flexors, ankle dorsiflexors, and toe extensors are also active.

Which of the following is the best treatment plan for the above patient? A. Patellofemoral taping, open chain quadriceps strengthening at 90-45o of flexion, closed chain quadriceps strengthening at 45-0o of flexion B. Patellofemoral taping, open chain quadriceps strengthening at 45-0o, closed chain quadriceps strengthening at 90-45o of flexion C. Hamstring strengthening terminal knee extension exercises, and ice. D. B and C

A. The patellofemoral joint is stressed less if exercised in the ranges noted in answer A, with open and closed chain exercises. Patellofemoral taping helps to decrease pain and therefore increases exercise participation. Answers B and C involve open-chain exercises that are performed within the range of 45-0 degrees of knee flexion.

A patient presents to therapy with an ankle injury. The therapist has determined that the injury is at the junction of the distal tibia and fibula. Which of the following functions most in preventing excessive external rotation and posterior displacement of the fibula? A. Anterior inferior tibiofibular ligament B. Posterior inferior tibiofibular ligament C. Interosseous membrane D. None of the above

A. This is the primary function of the anterior inferior tibiofibular ligament.

Each of the following choices consists of a list of two summaries of some of the principles in the code of ethics of the American Physical Therapy Association. Which of the answers below is a false summary? A. (1) Obey regulations governing physical therapists, and (2) maintain high standards when providing therapy. B. (1) Respect the rights of patients, and (2) inform people appropriately of the services provided. C. (1) Maintain high standards when providing therapy, and (2) provide services for the length of time ordered. D. (1) Assist the public when there are public health needs, and (2) accept fair monetary compensation for services.

C. "Provide services for the length of time ordered" is not a summary of one of the principles of the code of ethics. If a physician orders an inappropriate frequency and/or duration, it is the responsibility of the therapist to resolve the dilemma to ensure that the patient is treated with an appropriate frequency and duration.

A therapist is assisting a patient with pre-gait activities who has been fitted with a hip disarticulation prosthesis. To ambulate with the most correct gait pattern, what must be mastered first? A. Forward weight shift on to the prosthesis B. Swing-through of the prosthesis C. Maintain stability while in single limb support of the prosthesis D. Posterior pelvic tilt to advance the prosthesis

D. All of the above are important skills for a patient with a hip disarticulation prosthesis to master, but posterior pelvic tilt should be mastered first to advance the prosthesis.

Which of the following sources of stimulation is least effective in obtaining functional goals when treating an infant with decreased muscular tone? A. Vestibular B. Weight-bearing C. Cutaneous D. Vibratory

D. Although vibration often elicits a muscle contraction, a therapist should first choose stimuli that are more likely to occur naturally.

At a team meeting. the respiratory therapist informs the rest of the team that the patient, just admitted to the subacute floor, experienced breathing difficulty in the acute care department. The respiratory therapist describes the breathing problem as a pause before exhaling after a full inspiration. Which of the following is the therapist describing? A. Apnea B. Orthopnea C. Eupnea D. Apneusis

D. Apneusis can be described as an inspiratory cramp. Orthopnea is difficulty with breathing in a lying position. Eupnea is normal breathing. Apnea is the absence of breathing.

A 47-year-old man with end-stage renal disease arrives at an outpatient facility. He has a physician's order to evaluate and treat 3 times/week for 4 weeks secondary to lower extremity weakness. The patient also attends dialysis 3 times/week. If the clinic is open Monday through Friday, which of the following schedule is appropriate? A. On the days that the patient has dialysis, schedule the therapy session before the dialysis appointment. B. On the days that the patient has dialysis, schedule the therapy session after the dialysis appointment. C. Contact the physician and obtain a new order to decrease the frequency to 2 times/week, D. A and C are correct

D. Dialysis leads to a change in blood chemistry and volume, often causing extreme fatigue.

A 25-year-old man suffered C4 quadriplegia in a motor vehicle accident. The injury is acute, and the patient is beginning to work on increasing upright tolerance in the sitting position with an abdominal binder. He is looking to the therapist for encouragement. The therapist is attempting to convey realistic long-term goals for self-care ability and overall mobility. Of the below listed goals, what can this patient reasonably expect at his highest level of function in the future? A. Transfer from wheelchair to bed independently with a sliding board B. Use of a power wheelchair C. Independent feeding with an assistive device. D. Donning a shirt independently and pants with minimal assistance.

B. A person with C4 quadriplegia can be reasonably expected to use a power wheelchair for locomotion with mouth, chin, breath, or sip-and-puff controls. A person with C5 quadriplegia may be reasonably expected to be able to transfer independently from wheelchair to bed with a sliding board. A person with C4 quadriplegia may be able to feed independently but will need some type of assistive device. A person with C5 quadriplegia may be able to don a shirt with assistance. Sources vary significantly on this subject.

A 17-year-old boy presents to therapy after being involved in a motor vehicle accident resulting in C7 quadriplegia. The therapist is setting long-term goals for the patient. Which of the following goals represents the most reasonable and highest level of function that the patient should achieve? A. Use of a wheelchair with power hand controls on even terrain. B. Negotiation of uneven terrain with a manual wheelchair. C. Ambulation for short distances on level surfaces with knee-ankle-foot orthoses D. Use of a power wheelchair with head or chin controls on even surfaces

B. A person with C7 quadriplegia should be able to use a wheelchair without power controls. The goals set in answers A and D do not represent the maximal functional potential for this patient. The goal in answer C is set too high for this patient.

A physical therapist is setting up a portable whirlpool unit in the room of a severely immobile patient. What is the most important task of the physical therapist before the patient is placed in the whirlpool? A. Check for a ground fault circuit interruption outlet. B. Check to make sure the water temperature is below 110o C. Make sure the whirlpool agitator is immersed in the water. D. Obtain the appropriate assistance to perform a transfer.

A. A ground fault interruption circuit protects the patient from pa potentially life-threatening situation. The other choices are valid concerns, but A is the most important.

A 68-year-old man is being treated by a physical therapist after a right below-knee amputation. The patient is beginning ambulation with a preparatory prosthesis. In the early stance phase of the involved lower extremity, the therapist notes an increase in knee flexion. Which of the following are possible causes of this gait deviation? A. The heel is too stiff. B. The foot is set too far anterior in relation to the knee C. The foot is set in too much plantarflexion D. All of the above

A. A heel that is too stiff causes excessive knee flexion. Choices B and C cause excessive knee extension during this stage of the gait cycle.

A physical therapist is ordered to provide gait training for an 18-year-old girl who received a partial medial meniscectomy of the right knee one day earlier. The patient was independent in ambulation without an assistive device before surgery and has no cognitive deficits. The patient's weight bearing status is currently partial weight bearing on the involved lower extremity. Which of the following is the most appropriate assistive device and gait pattern? A. Crutches, three-point gait pattern B. Standard walker, three-point gait pattern C. Standard walker, four-point gait pattern D. Crutches, swing-to gait pattern

A. A patient of this age usually can begin with crutches instead of a standard walker. If the patient has no cognitive deficits and was independent in ambulation without an assistive device before surgery, she most likely will have the balance and coordination necessary to ambulate with crutches. A three-point gait pattern is necessary because of the current partial weight-bearing status. A swing-to pattern also can be used, but a three-point pattern assists more quickly in returning a more normal gait pattern.

An outpatient physical therapist notices that a large number of patients with impingement of the rotator cuff have been treated in the past 6 months. The clinic finds that most patients are employed at a new auto manufacturing plant. The therapist is invited to the plant to perform an ergonomic assessment and finds that a certain number of the employees must work with their shoulders at 120o of elevation and internal rotation. Which of the following recommendation would decrease the occurrence of impingement? A. Provide the employees a step stool to perform their tasks. B. Raise the employees' work surface. C. Adjust their tasks so that overhead activities are performed with palm of the hand downward D. A and B are correct

A. A step stool decreases the overall shoulder elevation required. Answer B increases shoulder elevation and answer C maintains internal rotation with increased elevation. External rotation with elevation decreases the impingement to the rotator cuff muscles.

A 14-year old girl place excessive valgus stress to the right elbow during a fall from a bicycle. Her forearm was in supination at the moment the valgus stress was applied. Which of the following is most likely involved in this type of injury? A. Ulnar nerve B. Extensor carpi radialis C. Brachioradialis D. Annular ligament

A. A valgus stress is most likely to injure any medial elbow structures, such as the ulnar nerve. The structures on the lateral side are likely to be injured with a varus stress. Choice C originates on the lateral supracondylar ridge.

A physical therapist is beginning the evaluation of a patient with AIDS. The patient was admitted to the acute floor of the hospital on the previous night after receiving a right total hip replacement. The physician has ordered gait training and dressing change of the surgical site. Of the following precautions, which is the least necessary? A. Mask B. Gloves C. Handwashing D. Gown

A. AIDS is transmitted by blood or bodily fluids. Masks are usually used with airborne precautions. Handwashing should be done between all wound care patients. Gloves are also indicated with all open wounds. Gowns may not be a necessity but should be used if there is a chance of soiling the clothing with infected fluids.

While obtaining the subjective history, the therapist learns that the patient was recently hospitalized for malfunction of the anterior pituitary gland. Based on this information alone, the therapist knows that there may be problems with the patient's ability to produce which of the following hormones? A. Adrenocorticotropic hormone, thyroid stimulating hormone, growth hormone, follicle stimulating hormone, luteinizing hormone B. Insulin and glucagons C. Epinephrine and norepinephrine D. Cortisol, androgens, and aldosterone

A. Adrenocorticotropic hormone, thyroid-stimulating hormone, growth hormone, follicle-stimulating hormone, and luteinizing hormone are all produced by the anterior pituitary gland. Insulin and glucagons are produced in the pancreas. Epinephrine and norepinephrine are produced in the adrenal medulla. Cortisol, androgens, and aldosterone are produced by the adrenal cortex.

Which of the following statements best describes lower extremity positioning in standing during the first 2 years of life of a child with no dysfunction? A. Femoral anteversion, femoral external rotation, foot pronation B. Femoral anteversion, femoral internal rotation, foot supination C. Femoral retroversion, femoral external rotation, foot pronation D. Femoral retroversion, femoral internal rotation, foot supination

A. After the first 2 years of life, the femurs rotate to a more neutral position, and the amount of anteversion decreases.

A physical therapist is reviewing the chart of a 49-year-old woman who recently suffered a myocardial infarction. The lab reports reveal that this particular patient has a hematocrit of 41%. How should the therapist proceed? A. Continue with the evaluation and treatment. B. Do not perform this evaluation due to the hematocrit level C. Inform nursing of this lab report D. Check nursing notes to determine the last time the patient received a beta-blocker.

A. Normal hematocrit values for women are 36-48%; for men, 40-52%.

A 60-year-old woman who has suffered a recent stroke has right-side homonymous hemianopsia. Which of the following statements is true about placement of eating utensils in early rehabilitation? A. The utensils should be placed on the left side of the plate. B. The utensils should be placed on the right side of the plate. C. The utensils should be placed on both sides of the plate. D. The plate and utensils should be placed slightly to the right.

A. As perception improves, objects should be moved into the area of the deficit (the right side in this case), but initially should be placed in plain view of the patient (the left side in this case).

A therapist is attempting to open the spastic and flexed had of a patient who has suffered a recent stroke. Which of the following does not inhibit hand opening? A. Avoid touching the interossei B. Apply direct pressure to the thenar eminence C. Hyperextend the metacarpophalangeal joint D. A and B

A. Avoiding the interossei helps to inhibit tone. Direct pressure to any hand musculature may increase tone. Hyperextension of the MCP joints also may cause an increase in tone.

A physical therapist in an outpatient clinic is called into a room to assist an infant who is unconscious and not breathing. The therapist opens the airway of the infant and attempts ventilation. The breaths do not make the chest rise. After the infant's head is repositioned, the breaths still do not cause the chest to move. What should the therapist do next? A. Give five back blows B. Look into the throat for a foreign body C. Have someone call 911 D. Perform a blind finger sweep of the throat

A. Back blows should be followed by chest thrusts with complete airway obstruction when CPR is performed on an infant. The therapist then should check for a foreign body in the airway. A blind finger sweep of the throat should not be performed on an infant.

A physical therapist is asked by a co-worker to finish evaluating a patient because an emergency requires the therapist to leave. The co-worker agrees and resumes the examination. The first therapist left notes titled, "sensory assessment". Two wooden blocks identical in appearance but 1 pound different in weight are on the table in front of the patient. What test was the prior therapist most likely performing? A. Barognosis test B. Stereognosis test C. Graphesthesia test D. Texture recognition

A. Barognosis is the ability to differentiate between different weights. Stereognosis is the ability to differentiate between different sizes and shapes. Graphesthesia is the ability to identify letters, numbers, or designs traced on the skin. Texture recognition is the ability to differentiate between textures such as cotton, wool, and silk.

A physical therapist is teaching a class in geriatric fitness/strengthening at a local gym. Which of the following is not a general guideline for exercise prescription in this patient population? A. To increase exercise intensity, increase treadmill speed rather than the grade B. Start at a low intensity (2-3 METs) C. Use machines for strength training rather than free weights D. Set weight resistance so that the patient can perform more than 8 repetitions before fatigue.

A. Because of poor balance, geriatric patients should increase the treadmill grade rather than the speed. Use of machines allows better posture and low intensities and limits the exercise within the patient's safe range of motion.

Which of the following is the correct method to test for interossei muscular tightness of the hand? A. Passively flex the proximal interphalangeal (PIP) joints with the metacarpophalangeal (MCP) joints in extension, then passively flex the PIP joints with the MCP joints in flexion. Record the difference in PIP joint passive flexion. B. Passively extend the PIP joints with the MCP joints in extension, then passively extend the PIP joints with the MCP joints in flexion. Record the difference in PIP joint passive flexion. C. Passively flex the PIP joints with the MCP joints in extension, then passively extend the PIP joints with the MCP joints in flexion. Record the difference in PIP joint passive flexion. D. Passively extend the PIP joints with the MCP joints in extension, then passively flex the PIP joints with the MCP joints in flexion. Record the difference in PIP joint passive flexion.

A. Because the interossei cross the MCP joints and the PIP joints, the PIP joints should be flexed with the MCP joints in flexion and extension.

A physical therapist is ordered to evaluate and treat in the acute setting a patient who received a left total knee replacement 1 day ago. Before surgery, the patient was independent in all activities of daily living, transfers, and ambulation with an assistive device. The family reports that ambulation was slow and guarded because of knee pain. The physician's orders are to ambulate with partial weight bearing on the left lower extremity and to increase strength/range of motion. At this point, bed-to-wheelchair transfers, sit-to-stand transfers, and wheelchair-to-toilet transfers require the minimal assistance of one person. The left knee has 63o of active flexion and 77o of passive flexion. The left knee also lacks 7o of full extension actively and 3o passively. Right hip strength is recorded as follows: hip flexion and abduction = 4+/5, hip adduction and extension = 5/5, knee flexion = 4+/5, knee extension = 5/5, ankle plantarflexion = 4+/5, and dorsiflexion = 5/5. Left lower extremity strength is recorded as follows: hip flexion = 3/5, hip abduction and adduction = 3+/5, hip extension = 3/5, knee flexion and extension = 3-/5, ankle dorsiflexion = 3+/5, and plantarflexion = 3+/5. The patient is currently able to ambulate 30 feet x 2 with a standard walker and minimal assist of one person on level surfaces. She also ambulates with a flexed knee throughout the gait cycle. According to the physician, she most likely will be discharged to home (with home health services), where she lives alone, within the next 2 - 3 days. Of the choices below, which is the most important long-term goal in the acute setting? A. In three days the patient will be independent in all transfers. B. In three days the patient will ambulate with a quad cane independently, with no gait deviation on level surfaces 50 feet x 3 C. In three days the patient will increase all left lower extremity manual muscle testing grades by one half grade D. In three days the patient will have active left knee range of motion from 0 to 90o and passive range of motion from 0 to 95o

A. Because the patient lives alone, independent transfer is the most important goal listed. Functional ambulation is an important goal, but choice B is an unrealistic goal for the patient to accomplish in a 2- or 3-day period.

Which of the following should a therapist evaluate first when performing a job-site analysis? A. Job description and duties B. Bathroom accessibility C. Lighting conditions D. Parking conditions

A. Before a job-site analysis can begin, the therapist should be familiar with the injuries or problems that occurred at the job-site and employee's job description.

Which of the following is inappropriate for a physical therapist to include in the treatment plan of an infant with a gestational age of 27 weeks and Down's syndrome? A. Bottle feeding B. Encourage sidelying position C. Tactile stimulation with the entire hand rather than the fingertips of the examiner D. Prone positioning

A. Bottle or breast-feeding is rarely performed successfully before 34 weeks of gestational age. Sidelying position allows the infant to move the hands toward the mouth. The prone position encourages flexion. Full contact with the hand is more comforting to the infant.

A physician ordered a splint for a patient who should keep the thumb of the involved hand in abduction. A new graduate is treating the patient and is confused about the difference between thumb flexion, extension, abduction and adduction. Which of the following lists is correct? A. Extension is performed in a plane parallel to the palm of the hand, and abduction is performed in a plane perpendicular to the palm of the hand. B. Flexion is performed in a plane perpendicular to the palm of the hand, and adduction is performed in a plane parallel to the palm of the hand. C. Extension is performed in a plane perpendicular to the palm of the hand, and adduction is performed in a plane parallel to the palm of the hand. D. In referring to positions of the thumb, flexion and adduction are used synonymously, and extension and abduction are used synonymously.

A. Flexion and extension of the thumb are performed in a plane parallel to the palm of the hand. Abduction and adduction are performed in a plane perpendicular to the palm of the hand.

Which of the following is widely considered the most accurate body composition assessment? A. Hydrostatic weighing B. Electrical impedance C. Anthropometric measurement D. None of the above

A. Hydrostatic (underwater) weighing involves comparing body weight in and out of water. Electrical impedance involves the principle that lean tissues have greater electrolyte content than fat. Impedance measurements have a high margin of error. Anthropometric (skin fold) measurements also have a high margin of error, especially when made by unskilled individuals.

A 65-year-old man presents to physical therapy with complaints of pain due to compression fractures of the C2 and C3 vertebrae. The patient has an unusually large cranium. He describes his condition by stating, "Much of my bone tissue is continually decreasing, then reforming". The patient also indicates that the condition has caused limb deformity. Which of the following diseases does he have? A. Paget's disease B. Achondroplastic dwarfism C. Osteogenesis imperfecta D. Osteopetrosis

A. In Paget's disease (also known as osteitis deformans), bone is resorbed and deposited at different rates during different stages of the disease. One of the deformities sometimes present as an enlarged cranium. This increased weight can result in compression fractures of the more superior cervical vertebrae. The origin of this condition is not exactly known. It usually involves people over 60 years of age.

A patient presents to physical therapy with a long-standing diagnosis of bilateral pes planus. The therapist has given the patient custom-fit orthotics. After using the orthotics for 1 week, the patient complains of pain along the first metatarsal. The therapist decides to use joint mobilization techniques to decrease the patient's pain. In which direction should the therapist mobilize the first metatarsal? A. Inferiorly B. Superiorly C. Laterally D. A and C

A. In response to a pronated subtalar joint, the forefoot undergoes a supination twist and the first ray dorsiflexes. Because the distal first cuneiform is convex and the proximal first metatarsal is concave, inferior mobilization of the first metatarsal is required.

Which of the following statements about developmental motor control is incorrect? A. Isotonic control develops before isometric control B. Gross motor control develops prior to fine motor control C. Eccentric movement develops prior to concentric movement D. Trunk control develops prior to distal extremity control

A. Isometric control develops before isotonic control.

Which of the following is inappropriate exercise for a patient who received an anterior cruciate ligament reconstruction with a patella tendon autograft 2 weeks ago? A. Lateral step-ups B. Heel slides C. Stationary bike D. Pool walking

A. Lateral step-ups are probably too difficult for a patient who received an anterior ligament reconstruction with a patella tendon autograft 2 weeks ago.

A physical therapist is discharging a 32-year-old man from outpatient physical therapy. The patient received therapy for a traumatic ankle injury that occurred several months prior. The surgery performed on the patient's ankle required placement of plates and screws, which resulted in a permanent range of motion deficit of 10o of active and passive dorsiflexion. Strength in the ankle is 5/5 with manual muscle testing. Of the following, which is the highest functional outcome that the patient can expect? A. Independent ambulation with no gait deviations B. Ambulation with a cane with minimal gait deviations C. Running with no gait deviations D. Ascend or descend stairs with no gait deviations

A. Normally, the ankle requires 20o or more of dorsiflexion for a patient to run or ascend/descend stairs properly. Independent ambulation with a normal gait pattern requires 10o of dorsiflexion.

A physical therapist is treating an 81-year-old man with Parkinson's disease. The patient has been ambulation on a cane. He was referred to physical therapy because of a fall at home. The family reports a decrease in gait ability during the past several months. The therapist decides to begin gait training with a rolling walker. Which of the following is incorrect for the treatment of this patient? A. Strengthening of the hip flexors, and stretching of the gluteals B. Slow, rhythmical rocking techniques C. Biofeedback during ambulation D. Prolonged passive stretching of the gastrocnemius muscle group bilaterally.

A. Patients with Parkinson's disease usually ambulate with the trunk in flexion. Increased trunk flexion causes a festinating gait to be more pronounced. Therapy should strengthen extensor muscles while stretching the flexors. Slow rocking has been shown to decrease tone, and biofeedback can improve a gait with shorter step and stride length by placement of markers on the floor for the feet.

A therapist is sent to the intensive care unit to evaluate a patient who has suffered a severe recent head injury. While reviewing the patient's chart, he discovers that the patient exhibits decerebrate rigidity. The therapist is likely to find this patient in which of the following positions? A. The patient will be positioned with all extremities extended and the wrist and fingers flexed B. The patient will be positioned with the upper extremities flexed, the lower extremities hyperextended, and the fingers tightly flexed C. The patient will be positioned with all extremities flexed and wrist and fingers extended D. The patient will be positioned with the upper extremities extended, the lower extremities flexed and the fingers hyperextended.

A. Patients with decerebrate rigidity are positioned with all extremities extended, and wrist and fingers flexed. Patients with decorticate posturing are positioned with the upper extremities flexed, the lower extremities hyperextended, and fingers tightly flexed.

A physical therapist is ordered to evaluate a 65-year-old woman who has suffered a recent stroke. The occupational therapist informs the physical therapist that the patient has apraxia. She cannot brush her teeth on command. However, she can point out the toothbrush and verbalize the purpose of the brush. From this information, what sort of apraxia does this patient have? How should the physical therapist approach treatment? A. Ideomotor apraxia. The physical therapist should speak in short, concise sentences. B. Ideomotor apraxia. The physical therapist should always give the patient 3-step commands. C. Ideomotor apraxia. The physical therapist should always give the patient 5-step commands. D. Ideational apraxia. The physical therapist should speak in short, concise sentences.

A. Patients with ideomotor apraxia often can identify objects but cannot use them correctly on command. Such patients often can perform the activity spontaneously. Patients with ideational apraxia often cannot identify objects or use them. Both situations call for short one-step commands.

A physical therapist is speaking to a group of avid tennis players. The groups asks how to prevent tennis elbow (lateral epicondylitis). Which of the following is incorrect information? A. Primarily use the wrist and elbow extensors during a backhand stroke B. Begin the backhand stroke in shoulder adduction and internal rotation C. Use a racket that has a large grip D. Use a light racket.

A. Tennis elbow results from overuse of the wrist extensors. The shoulder external rotators should be used to power a backhand.

A high school athlete is considering whether to have an anterior cruciate ligament reconstruction. The therapist explains the importance of this ligament, especially in a person that is young and athletic. Which of the statements below is correct in describing part of the function of the anterior cruciate ligament? A. The anterior cruciate ligament prevents excessive posterior roll of the femoral condyles during flexion of the femur at the knee joint B. The anterior cruciate ligament prevents excessive anterior roll of the femoral condyles during flexion of the femur at the knee joint C. The anterior cruciate ligament prevents excessive posterior roll of the femoral condyles during extension of the femur at the knee joint D. The anterior cruciate ligament prevents excessive anterior roll of the femoral condyles during extension of the femur at the knee joint

A. The anterior cruciate ligament prevents excessive posterior roll of the femoral condyles during flexion of the femur at the knee joint.

A supervisor is asked by a hired architect to provide some of the measurements needed to make a new clinic accessible for people who require wheelchairs. Some of the concerns of the architect are the minimal width of the doorways, the steepest slope allowed for the wheelchair ramp at the front entrance, and the minimal height of the bathroom toilet seat. If the supervisor provided measurements based on normal adult size, which of the following lists of measurements would be correct? A. The minimal doorway width should be 32 inches. The steepest slope allowed is 1:12 (for every 12 feet of horizontal length, the ramp can rise vertically by 1 foot). The minimal toilet seat height is 17 inches. B. The minimal doorway width should be 12 inches. The steepest slope allowed is 1:14 (for every 14 feet of horizontal length, the ramp can rise vertically by 1 foot). The minimal toilet seat height is 23 inches. C. The minimal doorway width should be 30 inches. The steepest slope allowed is 1:12 (for every 12 feet of horizontal length, the ramp can rise vertically by 1 foot). The minimal toilet seat height is 24 inches. D. The minimal doorway width should be 28 inches. The steepest slope allowed is 1:12 (for every 12 feet of horizontal length, the ramp can rise vertically by 1 foot). The minimal toilet seat height is 15 inches.

A. The average adult wheelchair width is 26 inches, but the opening should be at least 32 inches to allow for hand clearance. A wheelchair ramp should be built with a 1:12 slope. The toilet seat needs to be between 17 and 19 inches in height.

A patient is receiving crutch training 1 day after a right knee arthroscopic surgery. The patient's weight bearing status is toe-touch weight bearing on the right lower extremity. The therapist first chooses to instruct the patient how to perform a correct sit to stand transfer. Which of the following is the most correct set of instructions? A. (1) Slide forward to the edge of the chair; (2) put both the crutches in front of you and hold both grips together with the right hand; (3) press on the left arm rest with the left hand and the grips with the right hand; (4) lean forward; (5) stand up, placing your weight on the left lower extremity; (6) place one crutch slowly under the left arm, then under the right arm. B. (1) Slide forward, (2) put one crutch in each hand, holding the grips; (3) place crutches in a vertical position; (4) press down on the grips; (5) stand up, placing more weight on the left lower extremity C. (1) Slide forward to the edge of the chair; (2) put both the crutches in front of you and hold both grips with the left hand; (4) lean forward; (5) stand up placing your weight on the left lower extremity; (6) place one crutch slowly under the right arm, then under the left arm. D. (1) Place crutches in close proximity; (2) slide forward; (3) place hands on the arm rests; (4) press down and stand up; (5) place weight on the left lower extremity; (6) reach slowly for the crutches and place under the axilla

A. The method used in answer A is the safest. The method used in answer C is too unstable.

A physical therapist is evaluating a 17-year-old distance runner with complaints of lateral knee pain. During evaluation, the therapist performs the following test: The patient is placed in supine position with the hip flexed to 45o and the knee to 90o. The therapist then places firm pressure over the lateral femoral epicondyle and extends the patient's knee. Pain is felt by the patient at the point of palpation when her knee is 30o from full knee extension. The positive result of this test suggests which of the following structures as the source of pain? A. Iliotibial band B. Biceps femoris C. Quadriceps D. Lateral collateral ligament

A. The patient has an irritation of the iliotibial band as it passes over the lateral femoral epicondyle. This occurs at approximately 30o from full knee extension.

A therapist places a pen in front of a patient and asks him to pick it up and hold it as he normally would to write. The patient picks the pen up and holds it between the pad of the thumb and the middle and index fingers. Why type of grasp or prehension is the patient using? A. Palmar prehension B. Fingertip prehension C. Lateral prehension D. Hook grasp

A. The patient is using palmar prehension in this scenario. Palmar prehension is holding an object between the thumb pad and middle and index finger. Fingertip prehension is used when a person picks up an object between the thumb pad and either the index or middle finger (not both at the same time, as with palmar prehension). In lateral prehension, the thumb pad is in contact with the lateral side of the index finger proximal to the distal interphalangeal joint. In hook grasp, the fingers are flexed as if carrying a bucket by the handle. The thumb does not provide much active movement when the hook grasp is used.

A therapist is assisting a patient in gaining lateral stability of the knee joint. The therapist is using strengthening exercises to strengthen muscle groups that will increase active restraint on the lateral side of the joint. Which of the following offers the least amount of active lateral restraint? A. Gastrocnemius B. Popliteus C. Biceps femoris D. Iliotibial band

A. The popliteus, biceps femoris, and iliotibial band offer active restraint for the lateral side of the knee joint. The gastrocnemius assists in active restraint of the posterior side of the knee joint.

A patient presents to an outpatient clinic with a diagnosis of reflex sympathetic dystrophy (RSD) of the left upper extremity. The physician's order is to evaluate and treat. While obtaining a subjective history, the therapist is informed that the patient has along-standing diagnosis of carpal tunnel syndrome. Left upper extremity signs and symptoms include constant burning pain, abnormal fast hair and nail growth, decrease range of motion, and increased sensitivity to pain and/or light touch. The patient is most likely in what stage of RSD? A. Acute B. Dystrophic C. Atrophic D. Chronic

A. The signs and symptoms are consistent with a patient in the acute stage of RSD. Dystrophic signs and symptoms are decreased temperature, cessation of hair and nail growth, pale skin, and muscle atrophy. Atrophic signs and symptoms are decreased hypersensitivity, normal temperature, marked muscle atrophy, and smooth skin.

A physical therapist is evaluating a female distance runner who complains of intermittent medial ankle pain. In static standing, the therapist palpates excessive lateral deviation of the head of the talus. From this information, in what position is the subtalar joint during palpation? A. Supination B. Pronation C. Neutral D. Unable to determine from the information given

A. The talus is palpated just anterior and lateral to the medial malleolus. Supination is excessive lateral deviation of the talus, and pronation is excessive medial deviation.

In the terminal swing phase of gait, what muscles of the foot and ankle are active? A. Extensor digitorum longus B. Gastrocnemius C. Tibialis posterior D. B and C

A. The tibialis anterior, extensor digitorum longus, and extensor hallucis longus contract concentrically to achieve a neutral ankle position before initial contact.

A 14-year-old girl presents to an outpatient physical therapy clinic with complaints of anterior knee pain for 2 weeks. The patient notes no particular incident of onset. She indicates that pain increases when she attempts to ascend and descend stairs and with squatting to 130o of knee flexion. The evaluation show limited quadriceps strength on the involved side at 4/5 with manual muscle testing and normal hamstring strength. All meniscus and ligament tests are negative. Given the above information, what is the most likely cause of the signs and symptoms? A. Lateral glide of the patella B. Medial tilt of the patella C. Baker's cyst D. Anterior cruciate ligament tear

A. These complaints are consistent with patellofemoral symptoms. The primary symptoms are pain in performing squats or ascending/descending stairs. Most patellofemoral pain is due to a lateral glide or tilt. This diagnosis is common in adolescent girls. Baker's cysts involve the posterior knee, and anterior cruciate ligament tears most often have a definite mechanism of injury.

A physical therapist is ordered to evaluate a patient in the intensive care unit who recently suffered a stroke. The evaluation reveals the following signs and symptoms: contralateral hemiplegia (upper extremity involvement greater than lower extremities), homonymous hemianopsia, aphasia (due to the dominant hemisphere being involved), and contralateral loss of sensation in the upper extremities. Which of the following arteries is the most likely location of the lesion? A. Middle cerebral artery B. Anterior cerebral artery C. Internal carotid artery D. Posterior cerebral artery

A. These signs and symptoms are consistent with a lesion in the middle cerebral artery.

The therapist is evaluating a 38-year-old man who complains of right sacroiliac joint pain. The therapist decides to assess leg length discrepancy to supine versus sitting position. When the patient is in supine position, leg lengths are equal; however, when the patient rises to the sitting position, the right lower extremity appears 2 cm. shorter. Which of the following should be a part of the treatment plan? A. Right posterior S1 mobilization B. Right anterior S1 mobilization C. Left posterior S1 mobilization D. Left anterior S1 mobilization

A. This patient most likely has a right anterior rotation of the right innominate and thus needs right posterior mobilization of the right innominate.

When ambulating on uneven terrain, how should the subtalar joint be positioned to allow forefoot rotational compensation? A. Pronation B. Supination C. Neutral position D. The position of the subtalar joint does not influence forefoot compensation

A. When the hindfoot is pronated, the forefoot (transverse tarsal joints) can compensate for uneven terrain. If the hindfoot is supinated, the forefoot also is likely to supinate and possible cause damage to the lateral ankle ligaments.

An acute care physical therapist is ordered to evaluate and treat a patient who has suffered a right hip fracture in a recent fall. During the evaluation, the family informs the therapist that the patient suffered a stroke approximately 1 week before the fall. The patient's chart has no record of the recent stroke. What should the physical therapist do first? A. Immediately call the referring physician and request a magnetic resonance scan B. Evaluate and treat the patient as ordered. C. Immediately call the referring physician and request a computed tomography scan. D. Immediately call the referring physician for an occupational therapy referral.

B. Although a stroke may have occurred, the physical therapist can first evaluate and treat the patient. After the evaluation has been performed, the therapist will be more informed about the patient's condition and can then contact the physician if necessary.

A 50-year-old woman has been receiving treatment in the hospital for increased edema in the right upper extremity. The therapist has treated the patient for the past 3 weeks with an intermittent compression pump equipped with a multicompartment compression sleeve. The patient's average blood pressure is 135/80 mmHg. The daily sessions are 3 hours in duration. The pump is set at 50 mmHg, 40 mmHg, and 30 mmHg (distal to proximal) for 30 seconds, on and off for 15 seconds. The therapist decides to change the parameters. Of the following changes, which is the most likely to increase the efficiency of treatment? A. Patient in a seated position with the right upper extremity in a dependent position versus supine and elevated. B. Increase the maximal pressure from 50 mmHg to 60 mmHg C. Change the on/off time to 15 seconds on and 45 seconds off D. Equalize the sleeve compartments versus having greater pressure distally

B. Although the change may be minimal, increasing the maximal pressure to 60 mmHg is the most likely choice to have a positive effect on edema reduction. The pressure, however, should not exceed the diastolic pressure of the patient. Answer A is not the right choice because placing the extremity in a dependent position causes the pump to work against gravity. Answer C is an incorrect choice because decreasing the on time means that the extremity receives compression for a shorter period. Answer D is an incorrect choice because greater pressure distally is more likely to move fluid than equal pressure throughout the sleeve.

Which of the following statements is false about treatment with infrared lamps? A. Near infrared heats deeper than far infrared. B. Infrared lamps heat both sides of an extremity at one time. C. The therapist can change the intensity of the heat by changing the angle between the beam and the body part being treated. D. The therapist can change the intensity by placing the lamp closer to the part being treated.

B. Answer A is true because near infrared can penetrate up to 10 mm compared with 2 mm with far infrared. Answer B is a false statement because infrared lamps can heat only one side of an extremity at a time. Answers C and D are true statements because the intensity of the infrared can be changed by altering the angle of the beam with the treated part or the distance between the body part and the lamp.

A 60-year-old woman is referred to outpatient physical therapy services for rehabilitation after receiving a left total knee replacement 4 weeks ago. The patient is currently ambulating with a standard walker with a severely antalgic gait pattern. Before the recent surgery the patient was ambulating independently without an assistive device. Left knee flexion was measured in the initial evaluation and found to be 85o actively and 94o passively. The patient also lacked 10o of full passive extension and 17o of full active extension. Which of the following does the therapist need to first address? A. Lack of passive left knee flexion B. Lack of passive left knee extension C. Lack of active left knee extension D. Ability to ambulate with a lesser assistive device.

B. Answer B is correct because the patient has to achieve passive knee extension before she can gain full active knee extension. Full active knee extension and full flexion are important and should be a major focus of the patient's session, but the question asks for the most serious deficit. Ambulating with a lesser assistive device should be the focus at a later time because the patient's gait is still severely antalgic and obvious instability is still present. Usually a patient is advanced to a lesser assistive device when he or she can ambulate without large gait deviations with the current assistive device.

A physical therapist is treating a 17-year-old boy with an incomplete T11 spinal cord injury. The patient was treated for 2 months in the rehabilitation unit of the hospital before beginning outpatient physical therapy. He is currently ambulating with standard walker with maximal assist of two. The therapist sets an initial long-term goal of "ambulation with a standard walker with minimum assist of 1 for a distance of 50 feet, with no loss of balance, on a level surface - in 8 weeks." If the patient achieves the long-term goal in 4 weeks, which of the following courses of action should be taken by the therapist? A. Discharge the patient secondary to completion of goals. B. Set another long-term goal regarding ambulation and continue treatment. C. Return the patient to the rehabilitation unit of the hospital for more intensive treatment. D. Call the patient's physician and ask for further instructions.

B. Because the goals were not completed in a short amount of time, a new long-term goal should be set. Because of the significant progress made in outpatient therapy, there is no need to return to the rehabilitation unit.

Which of the following is a false statement about below-knee amputations? A. Gel socket inserts should be left in the prosthesis overnight B. The therapist should puncture any blisters that appear on the stump C. Areas of skin irritation on the stump can be covered with a dressing, then a nylon sock before donning the prosthesis. D. When not in use the prosthesis should be lain on the floor

B. Blisters should be allowed to subside naturally. Gel inserts lose their shape if not left in the prosthesis overnight. The prosthesis should be propped up in a corner or lain on the floor to prevent it from falling and cracking.

A physical therapist is asked to evaluate a 37-year-old man with right side sciatica. The therapist performs a passive straight leg raise test of the right lower extremity with the knee and ankle in neutral position. In performing this test on a patient with an L5 disc protrusion, what is the lowest degree at which the therapist would expect to reproduce the patient's symptoms? A. At 0o of hip flexion B. At 35o of hip flexion C. At 70o of hip flexion D. At 90o of hip flexion

B. During a unilateral straight leg raise of the involved lower extremity, tension is placed on the sciatic nerve at approximately 35o of hip flexion. At 0o of hip flexion, tension is minimal to none, and tension is maximal above 70o of hip flexion.

A therapist is sent to provide passive range of motion to a patient in the intensive care unit. The chart reveals that the patient is suffering from pulmonary edema. The charge nurse informs the therapist that the patient is coughing up a thin white sputum with a pink tint. Which of the following terms best describes this sputum? A. Purulent B. Frothy C. Mucopurulent D. Rusty

B. Frothy sputum is thin and white or has a slight pink color. This type of sputum is commonly present with pulmonary edema. Purulent sputum resembles pus, with a yellow or green color. Mucopurulent sputum is yellow to light green in color. Rusty sputum is a rust-colored sputum often associated with pneumonia.

A clinical instructor is explaining to a physical therapy student the function of the screw home mechanism in the knee joint. Part of the therapist's explanation involves teaching the student the movement of the tibia and femur during closed chain activities. When the knee joint is extended in a closed-chain activity, which of the following statements is true? A. The femur laterally rotates on the tibia. B. The femur medially rotates on the tibia C. The tibia laterally rotates on the femur D. The tibia medially rotates on the femur

B. In closed-chain activity, the femur medially rotates on the tibia. In open-chain activity, the tibia laterally rotates on the femur.

A patient is being treated with iontophoresis, driving dexamethasone, for inflammation around the lateral epicondyle of the left elbow. The therapist is careful when setting the parameters and with cleaning the site of electrode application to prevent a possible blister. This possibility is not as strong with some other forms of electrical stimulation, but with iontophoresis using a form of _________ , precautions must be taken to ensure that the patient does not receive a mild burn or blister during the treatment session. Fill in the blank A. Alternating current B. Direct current C. Pulsed current D. Transcutaneous electrical nerve stimulation

B. Iontophoresis uses direct current to drive medication through the skin by repelling ions. For example, if a medication is positively charged, it can be driven by the anode (the positive electrode); if a medication is negatively charged, it can be driven by the cathode (the negative electrode).

A physical therapist is treating a 17-year-old boy who suffered a traumatic brain injury. The patient has been in stage IV of Rancho Los Amigos Cognitive Functioning Scale for 1 week. Which of the following is an inappropriate treatment approach? A. Start treatment at the same time each day B. Teach wheelchair safety techniques C. Change treatment if the patient show a decrease in interest D. Give the patient many different exercises options

B. Learning wheelchair safety techniques would be difficult for this patient in this stage of recovery, who have a difficult time learning new skills (because they are confused and easily agitated). Treatment should include activities that are familiar to the patient.

A physical therapist is beginning an evaluation of a 5-year-old boy. The mother indicates that she pulled the child from a seated position by grasping the wrists. The child then experienced immediate pain at the right elbow. The physician's orders are for right elbow range of motion and strengthening. Which of the following is the most likely diagnosis? A. Radial head fracture B. Nursemaid's elbow C. Erb's palsy D. Ulnar coronoid process fracture

B. Nursemaid's elbow is defined as dislocation of the radial head from the annular ligament. Choices A and D are usually due to a fall on an extended elbow. Erb's palsy is due to cervical trauma.

A 20-year old man with anterior cruciate ligament reconstruction with allograft presents to an outpatient physical therapy clinic. The patient's surgery was 5 days ago. The patient is independent in ambulation with crutches. He also currently has 53o of active knee flexion and 67o of passive knee flexion and lacks 10o of full knee extension actively and 5o passively. What is the most significant deficit on which the physical therapist should focus treatment? A. Lack of active knee extension B. Lack of passive knee extension C. Lack of active knee flexion D. Lack of passive knee flexion

B. Passive extension is the most important motion to gain after an anterior cruciate ligament reconstruction, regardless of the graft type. Active extension can be achieved once passive extension is full (or equal bilaterally).

A patient with dysarthria and dysphagia is being treated by physical and speech therapy services. The physical therapist can assist the patient in which of the following ways? A. Provide posture control exercise; teach the patient swallowing techniques of thin liquids; provide facial musculature exercises; provide good verbal interaction B. Teach the patient to have good eye contact; provide facial muscular exercises; teach increased head and trunk control C. Provide posture control exercises; provide multiple sources of stimuli during exercise sessions; teach the patient swallowing techniques of thin liquids; teach the patient swallowing techniques for prescribed medications in capsular form D. None of the above lists is completely correct

B. Physical therapists can assist a patient with dysarthria and dysphagia by (1) providing posture control exercises for the head and trunk, which assist the effectiveness of the respiration muscles in providing air volume for vocalization; (2) providing exercises for the facial musculature, including the lips and tongue, to assist in vocalization; (3) providing effective verbal interaction with patient; and (4) minimizing any unnecessary stimuli or distractions during physical therapy sessions. The speech therapist is most qualified to work with the patient on swallowing techniques for liquids and solids.

A patient is being evaluated by a physical therapist because of bilateral knee pain. The therapist is attempting to rule out ankle or foot dysfunction as the source of the pain. Which of the following observations is not true in evaluating a patient without foot or ankle problems in the standing position? A. The talus is situated somewhat medially to the midline of the foot B. In quiet standing the muscles surrounding the ankle joint remain silent C. The first and second metatarsal heads bear more weight than the fourth and fifth metatarsal heads D. The talus transmits weight to the rest of the bones of the foot

B. Plantarflexors have to contract in quiet standing. Other muscles are recruited with movement of the center of gravity.

Which of the following is the most important goal in treating pediatric patients with postural reaction deficits? A. Age-appropriate responses B. Automatic responses C. Conscious responses D. Lower extremity control before upper extremity control

B. Postural reactions are automatic unconscious reactions to changes in center of mass. Choice A is an appropriate goal but not always the most important.

A 37-year-old man fell and struck his left temple area on the corner of a mat table. He begins to bleed profusely but remains conscious and alert. Attempts to stop blood flow with direct pressure to the area of injury are unsuccessful. Of the following, which is an additional area to which pressure should be applied to stop bleeding? A. Left parietal bone one inch posterior to the ear. B. Left temporal bone just anterior to the ear. C. Zygomatic arch of the frontal bone D. Zygomatic arch superior to the mastoid process.

B. Pressure on the left temporal bone just anterior to the ear helps to occlude blood flow from the temporal artery.

A physical therapist is speaking to a group of pregnant women about maintaining fitness level during pregnancy. Which of the following statements contain incorrect information? A. Perform regular exercise routines at least three times per week. B. Perform at least fifteen minutes per day of abdominal exercises in supine position, during the second and third trimesters. C. Increase caloric intake by 300 per day D. Exercise decreases constipation during pregnancy

B. Supine positioning after the first trimester is associated with decreased cardiac output.

A patient presents to outpatient physical therapy with tarsal tunnel syndrome. What nerve is involved? Where should the therapist concentrate treatment? A. Superficial peroneal nerve - inferior to the medial malleolus B. Posterior tibial nerve - inferior to the medial malleolus C. Superficial peroneal nerve - inferior to the lateral malleolus D. Posterior tibial nerve - inferior to the lateral malleolus.

B. Tarsal tunnel syndrome is caused by compression of the posterior tibial nerve as it travels through the tarsal tunnel. The tarsal tunnel is formed by the medial malleolus, medial collateral ligament, talus, and calcaneus.

A therapist is assessing a patient's ability to perform basic activities of daily living. The assessment tool chose by the therapist measures bathing, toileting, dressing, transfers, continence and feeding. The tool does not assess the patient's ability to maneuver in a wheelchair. The therapist is using which of the following tests? A. Barthel Index B. Katz Index of Activities of Daily Living C. Kenny Self-Care Evaluation D. Functional Status Index

B. The Barthel Index assesses 10 self-care and mobility areas (including locomotion). The score is based on the amount of time and assistance required to perform a task. The Kenny Self-Care Evaluation measures 17 basic activities of daily living and grades from 1 to 4 (totally dependent to independent). The Katz Index measures 6 basic activities of daily living but does not measure wheelchair mobility or ambulation skills. The Functional Status Index measures the patient's opinion about how much pain is involved with an activity, how much assistance he or shoe requires to perform a task, and his or her dependence level.

A patient is an outpatient facility because of an injury sustained to the right knee joint. Only the structures within the synovial cavity were compromised during the injury. Knowing this information only, the therapist is not concerned with injury to which of the following structure? A. Patellofemoral joint B. Anterior cruciate ligament C. Medial meniscus D. Femoral condyles

B. The anterior cruciate ligament is located within the articular cavity but outside the synovial lining. The anterior and posterior cruciate ligaments have their own synovial lining.

Which tendon is most commonly involved with lateral epicondylitis? A. Extensor carpi radialis longus B. Extensor carpi radialis brevis C. Brachioradialis D. Extensor digitorum

B. The extensor carpi radialis brevis absorbs most of the stress placed on the involved upper extremity in the position of wrist flexion, ulnar deviation, forearm pronation, and elbow extension (as with a backhand swing in tennis).

Which of the following muscle tendons most commonly sublux in patients who suffer from rheumatoid arthritis? A. Flexor digitorum profundus B. Extensor carpi ulnaris C. Extensor carpi radialis longus D. Flexor pollicis longus

B. The extensor carpi ulnaris is frequently subluxed after rupture of the triangular fibrocartilage complex. Subluxation leads to many mechanical changes in the wrist common in patients with rheumatoid arthritis.

A therapist is evaluating a patient with traumatic injury to the left hand. The therapist asks the patient to place the left hand on the examination table with the palm facing upward. The therapist then holds the second, third, and fifth digits in full extension. The patient is then asked to flex the fourth digit. What movement would be expected by a patient with an uninjured hand, and what muscle or muscles is the therapist restricting? A. The fourth finger would flex at the distal interphalangeal (DIP) joint only, and the muscle being restricted would be the flexor digitorum superficialis B. The fourth finger would flex at the proximal interphalangeal (PIP) joint only, and the muscle being restricted would be the flexor digitorum profundus. C. The fourth finger would flex at the DIP joint only, and the muscles being restricted would be the lumbricals D. The fourth finger would flex at the PIP joint only, and the muscles being restricted would be the palmar interosseous

B. The flexor digitorum profundus has four tendons, each attaching to the distal phalanx. If the three mentioned in the question are restricted, flexion at the distal interphalangeal joint in the normal hand would not be possible.

A therapist is beginning an evaluation of a 34-year-old woman with a diagnosis of carpal tunnel syndrome. Part of the evaluation consists of grip strength testing. To accurately test strength of the flexor digitorum profundus, where should the grip dynamometer's adjustable handle be placed? A. 1 inch from the dynamometer's nonadjustable handle B. 3 inches from the dynamometer's nonadjustable handle C. 1.5 inches from the dynamometer's nonadjustable handle D. All of the above are equally effective

B. The last position (3 inches) of a grip strength dynamometer tests the extrinsic muscles of the hand (muscles located in the forearm). The closer positions test the intrinsic muscles.

A therapist is preparing a poster that will clarify some of the data in an inservice presentation. The poster reflects the mode, median, and mean of a set of data. The data consist of the numbers 2, 2, 4, 9, and 13. If presented in the above order (mode, median mean), which of the following is the correct list of answers calculated from the data? A. 4, 2, 6 B. 2, 4, 6 C. 6, 2, 4 D. 6, 4, 2

B. The mean is the average of the set of numbers. The mode is the number that appears most often in the set of data. The median is the middlemost value.

A patient is being treated in an outpatient facility after receiving a meniscus repair to the right knee 1 week ago. The patient has full passive extension of the involved knee but lacks 4o of full extension when performing a straight leg raise. The patient's active flexion is 110o and passive flexion is 119o. What is a common term used to describe the patient's most significant range of motion deficit? What is a possible source of this problem? A. Flexion contracture - quadriceps atrophy B. Extension lag - joint effusion C. Flexion lag - weak quadriceps D. Extension contracture - tight hamstrings

B. The patient has an extension lag, which may be due to any source that has inhibited the quadriceps and results in an inability to fully extend the knee actively.

A patient with decreased function of the gluteus minimus is referred to physical therapy for gait training. During the evaluation, the therapist places the patient in prone position and instructs the patient to extend the hip. Knowing that the gluteus minimus is extremely weak, which of the following is most likely to happen? A. The patient will abduct the hip more than usual when attempting to perform hip extension B. The patient will externally rotate the hip excessively when attempting to perform hip extension C. The patient will excessively flex the knee when attempting to perform hip extension D. The patient will not have difficulty performing straight hip extension

B. The patient is prone to excessive external rotation when attempting to extend the involved hip, because the gluteus minimus counteracts the lateral rotational force created by the gluteus maximus.

A patient informs his therapist that his problem began 3 months after a bout of the flu. The patient originally experienced tingling of the hands and feet. He also reports progressive weakness to the point that he required a ventilator to breathe. He is now recovering rapidly and is expected to return to a normal functional level in 3 more months. From which of the following conditions is the patient most likely suffering? A. Parkinson's disease B. Guillain-Barrè syndrome C. Multiple sclerosis D. Amyotrophic lateral sclerosis

B. The patient is suffering from Guillain-Barrè syndrome. Some permanent damage can result, with loss of sensory or motor function, but most patients make a full recovery in approximately 6 months. The syndrome often starts after a person has had a bout of the flu or a respiratory infection.

A therapist is asked to evaluate a patient in the intensive care unit. The patient is comatose but breathing independently. During the assessment of range of motion in the right upper extremity the therapist notices that the patient is breathing unusually. The pattern is an increase in breathing rate and depth followed by brief pauses in breathing. The therapist should notify the appropriate personnel that the patient is exhibiting which of the following patterns? A. Biot's B. Cheyne-Stokes C. Kussmaul's D. Paroxysmal nocturnal dyspnea

B. The pattern described in the question - a gradual increase in the rate and depth of respirations followed by periods of absent breathing - is known as Cheyne-Stokes breathing. Small breaths followed by inconsistent periods of absent breathing are known as Biot's breathing pattern. Deep gasping breaths are known as Kussmaul's breathing pattern. Awakening during the night due to periods of absent breathing is known as paroxysmal nocturnal dyspnea.

A physical therapist in the rehabilitation unit is ordered to evaluate and treat a 3-year-old girl with cerebral palsy. The patient's supportive family is present during the evaluation. When should the physical therapist explain the treatment plan and possible functional outcomes to the family? A. During the evaluation B. After the evaluation C. After the first full treatment session D. After the first rehabilitation team conference meeting

B. The physical therapist can give his or her ideas about the treatment plan and possible functional outcomes after the evaluation. These ideas may change after treatment sessions and team meetings. The family should be continually informed of the patient's progress and expected level of function after discharge.

A patient arrives at an outpatient clinic with an order from the physician for whirlpool and wound care to a lower extremity wound. The therapist decides to set the temperature in the whirlpool at warm. Which of the following setting in degrees Celsius is appropriate? A. 27.5o Celsius B. 35.5o Celsius C. 49o Celsius D. 60o Celsius

B. The range considered "warm" for water settings in a whirlpool is between 35.5 and 36.5o Celsius, which is approximately 96-98o Fahrenheit. The formula for converting Celsius to Fahrenheit: oF = (oC x 9/5) + 32.

Which of the following statements is false about cardiovascular response to exercise in trained and/or sedentary patients? A. If exercise intensities are equal, the sedentary patient's heart rate will increase faster than the trained patient's heart rate. B. Cardiovascular response to increased workload will increase at the same rate for sedentary as it will for trained patients. C. Trained patients will have a larger stroke volume during exercise. D. The sedentary patient will reach anaerobic threshold faster than the trained patient, if workloads are equal

B. The sedentary patient's cardiovascular response increases faster than the trained patient's if the workloads are equal.

A 67-year-old man with a below-knee amputation presents to an outpatient clinic. His surgical amputation was 3 weeks ago, and his scars are well healed. Which of the following is incorrect information about stump care? A. Use a light lotion on the stump after bathing each night B. Continue with use of a shrinker 12 hours per day C. Wash the stump with mild soap and water D. Scar massage techniques

B. The shrinker should be removed only for bathing. Because the surgical scars are healed, the stump can be immersed in water.

A therapist is evaluating a wound in a patient with the following signs: the right foot has a toe that is gangrenous, the skin on the dorsum of the foot is shiny in appearance, and no calluses are present. The patient has what type of ulcer? A. Venous insufficiency ulcer B. Arterial insufficiency ulcer C. Decubitus ulcer D. Trophic ulcer

B. These signs are characteristic of an arterial insufficiency ulcer. A venous ulcer often presents with the following symptoms: no pain around the wound, no gangrene, location typically on the medial ankle, pigmented skin around the ulcer, and significant edema. A trophic ulcer (also known as a pressure or decubitus ulcer) present with decreased sensation, callused skin, and no pain and is located over body prominences.

A therapist is treating a patient with spinal cord injury. The therapist is discharging the patient after completion of all physical therapy goals. One of the completed long-term goals involved the ability to dress and bathe independently with assistive devices. This would be a most challenging but obtainable goal for which of the following? A. C5 quadriplegia B. C7 quadriplegia C. T1 paraplegia D. C4 quadriplegia

B. This goal should be most challenging and obtainable for a patient with C7 quadriplegia. A person with C4 or C5 quadriplegia probably needs assistance from another person to dress and bathe. A person with C7 quadriplegia would find this goal more challenging than a person with T1 paraplegia.

A physical therapist is evaluating a patient with muscular dystrophy. The patient seems to "waddle" when she walks. She rolls the right hip forward when advancing the right lower extremity and the left hip forward when advancing the left lower extremity. Which of the following gait patterns is the patient demonstrating? A. Gluteus maximus gait B. Dystrophic gait C. Arthrogenic gait D. Antalgic gait

B. This is a description of a dystrophic gait pattern, also called penguin gait. Patients with muscular dystrophy commonly demonstrate this gait pattern. A gluteus maximus gait presents with a patient leaning the trunk back while striking the heel on the involved side (or lurching). An Arthrogenic gait pattern presents with the patient circumducting and elevating the hip on the involved side. This pattern is present with severe stiffness or a fused joint in the involved lower extremity. An antalgic gait pattern is exhibited when a person has pain with weight bearing on the involved lower extremity.

A patient is receiving electrical stimulation for muscle strengthening of the left quadriceps. One electrode from one lead wire, 4 x 4 inches in size, is place on the anterior proximal portion of the left quadriceps. Each of two other electrodes from one lead wire is 2 x 2 inches in size. One of the electrodes is placed on the inferior medial side of the left quadriceps and one on the inferior lateral side of the left quadriceps. This is an example of what type of electrode configuration? A. Monopolar B. Bipolar C. Tripolar D. Quadripolar

B. This is an example of a bipolar configuration. Another form of bipolar configuration is to have two electrodes of equal size, each from a different lead wire. In a monopolar configuration, one smaller electrode is placed over the intended site and a larger electrode is placed some distance away. The stimulation is perceived by the patient, in this case, only under the smaller electrode. In a quadripolar configuration, two electrodes coming from two different lead wires are placed over the intended area.

A physical therapist is performing an isokinetic test on a 16-year-old boy's shoulder. This particular test compares the right shoulder with the left shoulder. The patient's father asks the physical therapist, "What is the purpose of this test?" How should the therapist respond? A. "This isokinetic test will show changes in concentric and eccentric strength." B. "This test will show strength differences between the injured arm and the non-injured arm." C. "This test shows differences in external rotation strength at specific ranges in the arc of motion." D. "This test will provide muscular torque data which will help us to determine when to discontinue therapy"

B. This is the most appropriate response in a person who has not indicated that he or she has a medical background. If the patient's father inquires further, the therapist can be more detailed.

A physical therapist is treating a patient with significant burns over the limbs and upper trunk. Which of the following statements is false about some of the changes initially experienced after the burn? A. This patient initially experienced an increase in the number of white blood cells. B. This patient initially experienced an increase in the number of red blood cells C. This patient initially experienced an increase in the number of free fatty acids D. This patient initially experienced a decrease in fibrinogen

B. This patient is likely to experience a decrease in the number of red blood cells. All of the other statements are correct. Fibrinogen drops initially but then rises throughout recovery.

What motion takes place in the lumbar spine with right lower extremity single limb support during the gait cycle? A. Left lateral flexion B. Right lateral flexion C. Extension D. Flexion

B. To maintain balance, the lumbar spine must laterally flex toward the supporting lower extremity during single-limb support.

A 30-year-old man is referred to physical therapy after a recent motor vehicle accident that resulted in total loss of motor control of both legs. Trunk and bilateral upper extremity control allows independent sitting at bedside. The patient is to be discharged from the hospital and will return home a few hours after the physical therapy session. The therapist notices, from the history in the chart, that the patient lives alone and has little or no outside support from family members. The patient also suffers from severe obesity. The therapist decides to practice transfer from the bed to the wheelchair. Which assistive device should the therapist use for this transfer attempt? A. Hoyer lift (pneumatic lift) B. Sliding board C. Geriatric chair (using a slide sheet transfer) D. Trapeze bar

B. Use of a sliding board is the most functional transfer for this patient. The pneumatic lift requires assistance from another person, on which this patient can rely because he lives alone and has poor outside family support. A fully reclined geriatric chair is often used to transfer obese patients with a slide sheet transfer, which requires two or more people. A trapeze bar may be useful, but transferring wheelchair to be with a sliding board teaches the patient the skill needed to transfer from the wheelchair to many other surfaces (that may not have a trapeze bar to assist).

The terms below refer to properties of water that make hydrotherapy valuable to a variety of patient populations. Match the following terms with the statement that best relates to each term. 1. Viscosity 2. Buoyancy 3. Relative density 4. Hydrostatic pressure a. This property can assist in prevention of blood pooling in the lower extremities of a patient in the pool above waist level b. This property makes it harder to walk faster through water. c. A person with a higher amount of body fat can float more easily than a lean person because of this property. d. This property makes it easier to move a body part to the surface of the water and harder to move a part away from the surface A. 1-b, 2-c, 3-d, 4-a B. 1-b, 2-d, 3-c, 4-a C. 1-c, 2-b, 3-a, 4-d D. 1-a, 2-c, 3-b, 4-d

B. Viscosity is the friction of fluids. Buoyancy is the property that pushes up on the part immersed with a pressure that is equal to the weight of the amount of water displaced by that part. Relative density states that if the specific gravity of an object is less than one it will float and if it is greater than one it will sink. Hydrostatic pressure is the property of water that places pressure equally on the immersed part.

A physical therapist performs the following test during an evaluation. With the patient lying in supine position, the therapist traces a diamond shape around the patient's umbilicus with a sharp object. What reflex is being assessed, and what is the significance if the patient's umbilicus does not move in response to the stimulus provided by the therapist? A. Cremaster reflex; suggest upper motor neuron involvement B. Superficial abdominal reflex; suggests upper motor neuron involvement C. Cremaster reflex; suggests lower motor neuron involvement D. Superficial abdominal reflex; suggests lower motor neuron involvement

B. When the test is performed on a patient with no motor neuron lesion, the umbilicus should move toward the stimulus. Unilateral movement suggests lower motor neuron involvement. A cremaster reflex is performed by stroking the medial thigh of a male with a sharp object. A normal response consists of superior movement of the scrotum on the ipsilateral side. An abnormal response is absence of scrotal movement on one side, which indicates possible lower motor neuron involvement. Bilateral absence of movement indicates upper motor neuron involvement.

A therapist is screening a patient complaining of pain at the anterior left shoulder region. The pain is increased when the examiner instructs the patient to position the left arm by his side with the elbow flexed at 90o and to actively supinate the forearm against resistance (provided by the examiner). What test is being performed? A. Froment's sign B. Yergason's test C. Waldron test D. Wilson test

B. Yergason's test detects tendinitis of the long head of the biceps. Froment's sign is a test to determine adductor pollicis weakness due to ulnar nerve dysfunction. In the Waldron test, the patient performs squats while the therapist assesses the patella region for Crepitus or pain. A positive test indicates possible chondromalacia. A positive Wilson test indicates possible osteochondritis dissecans. The test is performed by asking the patient to extend the knee in the seated position with internal rotation and again with external rotation of the tibia. The test is positive if there is pain with internal rotation and no pain with external rotation of the tibia.

A therapist is treating a new patient in an outpatient facility. The patient has recently been diagnosed with type I insulin-dependent diabetes mellitus. The patient asks the therapist the differences between type I insulin-dependent diabetes mellitus and type II non-insulin-dependent diabetes mellitus. Which of the following statements is true? A. There is usually some insulin present in the blood in type I and none in type II B. Ketoacidosis is a symptom of type II C. The age of diagnosis with type I is usually younger than the age of diagnosis with type II D. Both conditions can be managed with a strict diet only without taking insulin.

C. A person is usually diagnosed with type I at 25 years or age or younger. A person is usually 40 years of age or older when diagnosed with type II. Ketoacidosis is a symptom of type I. Metabolism of free fatty acids in the liver causes this condition, which is an excess of ketones. A type II diabetic may be able to control his or her condition with diet only (depending on the severity of the condition), but a type I diabetic needs insulin.

A physical therapist is treating a 76-year-old woman with left lower extremity hypotonia secondary to a recent stroke. Which of the following is an incorrect method to normalize tone? A. Rapid irregular movements B. Approximation C. Prolonged stretch D. Tactile cues

C. A prolonged stretch assists in decreasing tone.

Which of the following is the normal end-feel perceived by an examiner assessing wrist flexion? A. Bone to bone B. Soft tissue approximation C. Tissue stretch D. Empty

C. A tissue stretch end-feel is also felt with ankle dorsiflexion. An example of a bone-to-bone end-feel is with knee or elbow extension. Knee flexion is an example of soft tissue approximation. In an empty end-feel, a patient stops the movement due to pain.

A physical therapist is ordered to provide gait training to a 78-year-old man who received a right cemented total knee replacement 24 hours earlier. The patient also had a traumatic amputation of the left upper extremity 3 inches above the elbow 40 years ago. If the patient lives at home alone, which of the following is an appropriate assistive device? A. Rolling walker B. Standard walker C. Hemi-walker D. Wheelchair for 2 weeks.

C. Although the patient will have to use the hemi-walker with the right upper extremity, answer C is still the best choice for this patient. Answers A and B are unsafe with one upper extremity. Answer D does not encourage weight bearing and is not the most functional choice. A person with a cemented prosthesis can bear weight as tolerated on the involved lower extremity in early rehabilitation.

In comparing the use of cold pack and hot pack treatments, which of the following statements is false? A. Cold packs penetrate more deeply than hot packs. B. Cold increases the viscosity of fluid and heat decreases the viscosity of blood. C. Cold decreases spasm by decreasing sensitivity to muscle spindles and heat decreases spasm by decreasing nerve conduction velocity. D. Cold decreases the rate of oxygen uptake, and heat increases the rate of oxygen uptake.

C. Answer C is incorrect. Heat decreases spasm by causing the vessels to dilate, which brings more blood (containing oxygen) to the area. Cold decreases spasm by decreasing sensitivity of the muscle spindles.

A patient is referred to physical therapy because of hypertension. The physician has ordered relaxation training. The therapist first chooses to instruct the patient in the technique of diaphragmatic breathing. Which of the below is the correct set of instructions? A. Slow breathing rate to 8-12 breaths per minute, increase movement of the upper chest, and decrease movement in the abdominal region. B. Slow breathing rate to 12-16 breaths per minute, increase movement of the abdominal region and decrease movement in the upper chest. C. Slow breathing rate to 8-12 breaths per minute, increase movement of the abdominal region and decrease movement in the upper chest. D. Slow breathing rate to 12-16 breaths per minute, increase movement of the upper chest and decrease movement in the abdominal region.

C. Answer C provides correct instructions. The patient is often instructed to begin this technique in the supine position and progress to the sitting position. This technique should be practiced for approximately 5 minutes several times per day.

Of the following, which is the earliest period after surgery that an 18-year-old boy who received an uncomplicated partial meniscectomy of the right knee can perform functional testing, such as a one-leg hop test, for distance? A. 1 week after surgery B. 2 weeks after surgery C. 6 weeks after surgery D. 12 weeks after surgery

C. At 1-2 weeks after surgery, the patient has an inflamed knee and no functional testing can take place. Six weeks is an appropriate amount of time to allow inflammation to decrease enough for functional testing. Patients who have received a partial meniscectomy do not require as much healing time as patients who have received a meniscus repair.

A home health physical therapist is sent to evaluate a 56-year-old man who has suffered a recent stroke. The patient is sitting in a lift chair, accompanied by his 14-year-old nephew. He seems confused several times throughout the evaluation. The nephew is unable to assist in clarifying much of the subjective history. The patient reports to the therapist that he is independent in ambulation with a standard walker as an assistive device and in all transfers without an assistive device. Based on the above information, which of the following sequence of events, chosen by the therapist, is in the correct order? A. Ambulate with the standard walker with the wheelchair in close proximity; transfer sit to stand in front of the wheelchair; transfer wheelchair to bed, assess range of motion and strength of all extremities in supine position. B. Ambulate with the standard walker with the wheelchair in close proximity, transfer wheelchair to bed; assess range of motion and strength of all extremities in supine position; transfer sit to stand at bedside. C. Assess range of motion and strength of all extremities in the lift chair; transfer sit to stand in front of the lift chair; ambulate with the standard walker with the wheelchair in close proximity; transfer wheelchair to bed. D. Assess range of motion and strength of all extremities in the lift chair; ambulate with the standard walker with the wheelchair in close proximity; transfer sit to stand in front of the wheelchair; transfer wheelchair to bed.

C. Because of the unreliable history obtained in the evaluation, the therapist at least should make a quick assessment of range of motion and strength before the patient attempts to stand. Sit-to-stand transfer should then be assessed in front of the lift chair before the patient attempts to ambulate.

A 27-year-old man with a diagnosis of incomplete spinal cord injury at the L4 level is being evaluated by a physical therapist. The patient is nearing discharge from the rehabilitation unit. Manual muscle testing reveals the following: right hip flexion = 3+/5, right hip adduction = 5/5, right knee flexion = 2/5, right knee extension = 3+/5, right ankle plantarflexion = 1/5, and right ankle dorsiflexion = 2-/5; left hip flexion = 4+/5, left hip adduction = 4+/5, left knee flexion = 2+/5, left knee extension = 3+/5, left ankle plantarflexion = 2-/5, and left ankle dorsiflexion = 2-/5. What is the appropriate orthotic for this patient? What is his most likely functional outcome? A. Hip-knee-ankle-foot orthosis (HKAFO) with forearm crutches - household ambulator. B. Knee-ankle-foot orthosis (KAFO) with forearm crutches - household ambulator. C. KAFO with forearm crutches - functional ambulator D. HKAFO with forearm crutches - functional ambulator.

C. Because the hip flexors are strong, there is no need for the hip component of an orthotic.

In which of the following situations should the therapist be most concerned about the complications resulting from grade IV joint mobilization techniques? A. A 37-year-old man with a Colles' fracture suffered 10 weeks ago B. A 23-year-old woman with a boxer's fracture suffered 10 weeks ago C. A 34-year-old man with a scaphoid fracture suffered 12 weeks ago D. A 53-year-old man with a Bennett's fracture suffered 12 weeks ago

C. Because the scaphoid has a poor vascular supply, aggressive therapy should be avoided until the bone is fully healed (12-24 weeks). A Colles' fracture (fracture of the distal radius with dorsal movement of the fixed segment) should heal in 6-8 weeks. A boxer's fracture (fracture of the fifth metacarpal) requires 4-6 weeks. A Bennett's fracture (fracture of the proximal first metacarpal) usually requires 6-8 weeks. The length of healing time given in the above examples obviously depends on the individual patient and the type of surgical fixation (if any).

A 65-year-old man is scheduled to begin a wellness program. He has no cardiovascular disease, major systemic illness, or musculoskeletal abnormality. However, he is deconditioned because of an extremely sedentary lifestyle. Resting heart rate is 90 beats/minute, and resting blood pressure is 145/92 mmHg. Which of the choices below describes the most correct intensity, frequency and duration at which the patient should begin exercise? A. 75% VO2 max; 30 minutes/day; 3 days/week B. 40% VO2 max, 30 minutes/day; 5 days/week C. 40% VO2 max; 10 minutes twice daily; 5 days/week D. 75% VO2 max; 10 minutes twice daily; 5 days/week

C. Deconditioned people benefit initially from low-intensity exercise with multiple sessions per day and per week.

Which of the following is not part of the triangular fibrocartilage complex of the wrist? A. Dorsal radioulnar ligament B. Ulnar collateral ligament C. Radial collateral ligament D. Ulnar articular cartilage

C. The triangular fibrocartilage complex is made up of the dorsal radioulnar ligament, ulnar collateral ligament, ulnar articular cartilage, volar radioulnar ligament, ulnocarpal meniscus, and sheath of the extensor carpi ulnaris.

A therapist is evaluating a patient who complains of frequent foot, ankle and knee pain. The therapist asks the patient to assume a standing position with the knees slightly flexed. The therapist then demonstrates active bilateral foot pronation to the patient. When asked to perform this task, the patient has difficulty. Which of the following limitations is a possible cause of the patient's difficulty in performing this task? A. Restriction limiting plantar flexion and lateral rotation of the talus B. Restriction limiting dorsiflexion and medial rotation of the talus C. Restriction limiting eversion of the calcaneus and medial rotation of the talus D. B and C are correct

C. During pronation of the feet, the calcaneus everts, and the talus medially rotates and plantar flexes.

The physical therapist has just given the patient a custom wheelchair. The patient has a long-standing history of hamstring contractures resulting in fixation of the knees into 60o of flexion. The patient is also prone to develop decubitus ulcers. Which of the following is incorrect advice to give the family and patient? A. Keep the patient's buttocks clean and dry. B. Make sure that the wheelchair cushion is always in the wheelchair seat. C. Keep the leg rests of the wheelchair fully elevated. D. Never transfer using a sliding board from one surface to another.

C. Fully elevating the leg rests of the patient's chair increases hip flexion. The already tight hamstrings (secondary to contracture) would tilt the pelvis posterior. This maneuver would increase weight on the ischial tuberosity, risking a decubitus ulcer. Choice D is correct advice because sliding board transfers can lead to abrasions. Choices A and B are also correct measures to decrease the chance of developing ulcers.

A physical therapist is ordered to evaluate a patient in the late stages of amyotrophic lateral sclerosis. In the patient's chart is an electromyography report and nerve conduction velocity test. What should the physical therapist not expect to find in these test results? A. Fibrillation potentials B. Polyphasic motor unit potentials C. Decreased sensory evoked potentials D. A and B only

C. In performing these tests on patients who have a motor neuron disease, sensory potentials are generally unchanged.

A physical therapist must have a clear understanding of the normal development of the human body to treat effectively and efficiently. Which of the following principles of treatment is INCORRECT? A. Early motor activity is influenced primarily by reflexes B. Motor control develops from proximal to distal and from head to toe C. Increasing motor ability is independent of motor learning D. Early motor activity is influenced by spontaneous activity.

C. Increasing motor ability is not independent of motor learning. A therapist must facilitate motor learning with proper sensory cues and by promoting appropriate motor activity. Answer D is true because infants begin spontaneous movement, which later develops into more deliberate movement. Answer A is true because reflex movement can be used to develop more deliberate movement.

A therapist is performing chest physiotherapy on a patient who is coughing up a significant amount of sputum. The therapist later describes the quality of the sputum in his notes as mucoid. This description tells other personnel which of the following? A. The sputum is thick B. The sputum has a foul odor C. The sputum is clear or white in color D. The patient has a possible bronchopulmonary infection

C. Mucoid sputum is clear or white and is not usually associated with infection. Thick sputum is referred to as tenacious. Foul-smelling sputum is called fetid and is often associated with infection.

A physical therapist is reviewing the chart of 24-year-old woman with a diagnosis of L2 incomplete paraplegia. The physician noted that the left quadriceps tendon reflex is 2+. What does this information relay to the therapist? A. No active quadriceps tendon reflex B. Slight quadriceps contraction with reflex testing C. Normal quadriceps tendon reflex D. Exaggerated quadriceps tendon reflex

C. No activity = 0. Slight contraction = 1+. Normal response = 2+. Exaggerated response = 3+. Severely exaggerated = 4+

A therapist is treating a patient with cystic fibrosis who has just walked 75 feet before experiencing significant breathing difficulties. In an effort to assist the patient in regaining her normal breathing rate, the therapist gives a set of instructions. Which of the following set of instructions is appropriate? A. "Take a slow deep breath through pursed lips and exhale slowly through your nose only" B. "Take small breaths through your nose only and exhale quickly through pursed lips" C. "Breath in through your nose and exhale slowly through pursed lips" D. "Breath in through pursed lips and breath out slowly through pursed lips"

C. Patients with chronic obstructive airway disease are often given this set of instructions, which is known as the method of pursed lips breathing. This method helps a patient regain control of his or her breathing rate and increase tidal volume and amount of oxygen absorbed.

When using electrical stimulation with a unit that plugs into the wall, the therapist must take many different safety precautions. Which of the following precautions probably would not increase safety to the patient and therapist? A. Never placing the unit in close proximity to water pipes while treating the patient. B. Never using an extension cord when using a plug-in unit. C. Always adjusting the intensity of stimulation during the off portion of the cycle. D. Both A and C are measures that are not likely to increase safety.

C. Placing a plug-in unit close to water pipes is a potential hazard because it offers another possible ground pathway to the patient. Never us an extension cord or an adaptor with plug-in unit. If the adaptor or cord does not have a ground prong, it may cause shock to the patient through a leaking current. If the machine intensity is adjusted during the off portion of the cycle, the stimulation may be too high for the patient when the on cycle returns.

A physical therapist is speaking to a group of receptionists about correct posture. Which of the following is incorrect information? A. Position computer monitors at eye level B. Position seats so that the feet are flat on the floor while sitting C. Position keyboards so that wrists are approximately in 20o extension D. Take frequent stretching breaks

C. The wrists should be in neutral position when the fingers are on the middle row of the keyboard.

Which of the following statements is true in comparing infants with Down's syndrome to infants with no known abnormalities? A. Motor milestones are reached at the same time with both groups. B. Postural reactions are developed in the same time frame with both groups. C. Postural reactions and motor milestones are developed slower in patients who have Down's syndrome, but with the same association as with normal infants D. Postural reactions and motor milestones are not developed with the same association with patients who have Down's syndrome as with normal infants

C. Postural reactions and motor milestone development occur in the same sequence as with normal infants, but the progression of an infant with Down's syndrome is slower.

A therapist should consider using a form of treatment other than moist heat application on the posterior lumbar region of all of the following patients except A. Patient with a history of hemophilia B. Patient with a history of malignant cancer under the site of heat application C. Patient with a history of Raynaud's phenomenon D. Patient with a history including many years of steroid therapy

C. Raynaud's phenomenon is a vasospastic disorder of the vessels of the distal parts of the extremities. Patients with Raynaud's phenomenon do not respond well to cold treatment. Choice B is incorrect because it is believed that moist heat may encourage more rapid growth of cancer. Choice D is incorrect because prolonged use of steroids may cause capillaries to lose their integrity, which compromises the body's ability to dissipate heat. Choice A is incorrect because moist heat may encourage hemorrhaging, in patients with hemophilia by causing vasodilation.

Which of the following statements is not a common physiologic change of aging? A. Blood pressure taken at rest and during exercise increases B. Maximal oxygen uptake decreases C. Residual volume decreases D. Bone mass decreases

C. Residual volume, the amount of air left in the lungs after a forceful expiration, increases with age.

A physical therapist is treating a 24-year-old woman with lumbar muscle spasm. Part of the patient's treatment involves receiving instruction on correct sleeping positions. Which of the following would be most comfortable? A. Supine with no pillows under the head or extremities B. Prone with a pillow under the head only. C. Sidelying with a pillow between flexed knees. D. A and C are equally correct

C. Supine positioning without a pillow under the knees places too much stress on the lumbar spine. Sidelying position with a pillow between the knees places less stress on the lumbar area than prone positioning.

A patient who has suffered a zone 2 rupture of the extensor tendon of the third digit presents to physical therapy. This patient had a surgical fixation of the avulsed tendon. During the period of immobilization, which of the following deformities is most likely to develop? A. Boutonniére deformity B. Claw hand C. Swan neck deformity D. Dupuytren's contracture

C. Swan-neck deformity involves hyperextension of the proximal interphalangeal (PIP) joint and flexion of the distal interphalangeal (DIP) joint. Splinting to avoid this deformity is the treatment of choice. Boutonnière deformity involves flexion of the PIP joint and DIP joint hyperextension. Dupuytren's contracture is contracture of the palmar aponeurosis. Claw hand is the result of laceration of the ulnar nerve.

A therapist is sent to evaluate a patient with tumor in the mid-thoracic region. In the chart, the therapist notes that the tumor has been staged using the TNM system. With this system, the letters TNM represent which of the following in the correct order? A. Tumor type, number of tumors, tumor metastasis B. Tumor location, lymph node involved, mass size of the tumor C. Tumor size, lymph node involvement, tumor metastasis D. Tumor mass, number of lymph nodes, major organs involved

C. T-N-M is the most commonly recognized system of tumor staging. An Arabic number (0,1,2, or 3) follows each letter. The number behind the T represents the size of the tumor. Zero means no tumor. The higher the number, the larger the tumor. The number behind the N represents the degree of local lymph node involvement. Zero means no lymph node involvement. The higher the number, the greater the lymph node involvement. The number behind the M represents the degree of metastasis. Zero means no metastasis. The higher the number, the greater the degree of metastasis.

A therapist is treating a 35-year-old man who has suffered loss of motor control in the right lower extremity due to peripheral neuropathy. The therapist applies biofeedback electrodes to the right quadriceps in an effort to increase control and strength of this muscle group. The biofeedback can help achieve this goal in all of the following ways except: A. Providing visual input for the patient to know how hard he is contracting the right quadriceps. B. Assisting the patient in recruitment of more motor units in the right quadriceps. C. Providing the measure of torque in the right quadriceps. D. Providing the therapist input on the patient's ability and effort in contracting the right quadriceps.

C. The EMG does not record torque. It assists by showing a linear relationship between the EMG and the force produced by the muscle during an isometric contraction.

How often does the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) require that all electrical equipment in hospitals be inspected? A. Every 3 months B. Every 6 months C. Every 12 months D. Every 3 years

C. The Joint Commission on Accreditation of Healthcare Organizations requires at least one-year inspection of electrical equipment.

A 15-year-old girl with no reports of trauma or radiculopathy presents to an outpatient physical therapy clinic with complaints of low back pain. The physical therapist decides to measure leg length of each side from the anterior superior iliac spine (ASIS) to the medial malleolus. The measurements are equal. However, when measurements are taken from the umbilicus to the medial malleolus, the right lower extremity is 2.5 cm longer than the left lower extremity. Based on the above information, which of the following would most directly address the source of this patient's problem? A. Ask the patient if she has ever had a femur fracture. B. Ask the patient is she has ever been diagnosed with cerebral palsy or avascular necrosis. C. Ask the patient if she has ever been diagnosed with scoliosis. D. Ask the patient to perform active motion to assess lumbar range of motion.

C. The difference in measurements suggests a pelvic imbalance, which often is seen in patient who have scoliosis. Answers A and B would have exhibited differences in real leg length (anterior superior iliac spine to the medial malleolus).

When comparing the gait cycle of young adults to the gait cycle of older adults, what would a therapist expect to find? A. The younger population has a shorter step length B. The younger population has a shorter stride length C. The younger population has a shorter period of double support D. The younger population has a decrease in speed of ambulation

C. The geriatric population would have a longer period of double support in an attempt to maintain balance. They also would have a shorter step and stride length.

A patient with cardiac arrythmia is referred to physical therapy services for cardiac rehabilitation. The therapist is aware that the heart receives nerve impulses that begin in the sinoatrial node of the heart and then proceed to which of the following? A. Atrioventricular node, then to the Purkinje fibers, and then to the bundle branches B. Purkinje fibers, then to the bundle branches, and then to the atrioventricular node C. Atrioventricular node, then to the bundle branches, and then to the Purkinje fibers D. Bundle branches, then to the atrioventricular node, and then to the Purkinje fibers.

C. The heart receives nerve impulses that travel through the sinoatrial node to the ventricles by way of the atrioventricular node, bundle branches, and Purkinje fibers.

A physical therapist is fabricating a splint for a patient who received four metacarpophalangeal joint replacements. The surgical joint replacement was necessary because of severe rheumatoid arthritis. Which of the following is the correct placement of the metacarpophalangeal joints in the splint? A. Full flexion and slight radial pull B. Full flexion and slight ulnar pull C. Full extension and slight radial pull D. Full extension and slight ulnar pull

C. The radial pull component is designed to allow tightening of the radial side of the capsule.

A physical therapist is beginning a gait evaluation. During heel strike to foot flat on the right lower extremity, which of the following does not normally occur? A. The left side of the pelvis initiates movement in the direction of travel B. The right femur medially rotates C. The left side of the thorax initiates movement in the direction of travel D. The right tibia medially rotates

C. The right shoulder and thorax begin to move forward at heel strike (initial contact).

A 10-year-old boy presents to outpatient physical therapy with complaints of diffuse pain in the right hip, thigh, and knee joint. The patient was involved in a motor vehicle accident 3 weeks ago. He is also obese and has significant atrophy in the right quadriceps. The right lower extremity is held by the patient in the position of flexion, abduction and lateral rotation. Which of the following is most likely the source of the patient's signs and symptoms? A. Greater trochanteric bursitis B. Avascular necrosis C. Slipped femoral capital epiphysis D. Septic arthritis

C. The signs and symptoms are most consistent with a slipped capital epiphysis. Bursitis presents with pain located over the bursa and is associated with overuse or rheumatoid arthritis. Avascular necrosis most frequently involves men 30-50 years of age. Septic arthritis is usually present in children 2 years of age or younger and often is due to steroid use of fever.

A 48-year-old woman is being evaluated by a physical therapist. Her diagnosis is right rotator cuff tendinitis. She reports right shoulder weakness and pain for the past 2 months. The patient describes "pins and needles", over the lateral right shoulder and upper extremity, extending into the thumb. She also reports no causative trauma. Manual muscle testing reveals in the right upper extremity: flexion = 4/5, extension = 3+/5, abduction = 3+/5, adduction = 4/5, internal rotation = 3+/5, and external rotation = 3+/5. Manual muscle testing reveals in the left upper extremity: flexion = 4+/5, extension = 5/5, abduction = 5/5, adduction = 4+/5, internal rotation = 4+/5, and external rotation = 4+/5. Active and passive shoulder range of motion is within normal limits and equal bilaterally. All thoracic outlet tests are negative. All shoulder special tests are negative. Which of the following steps would most likely assess the source of the patient's problems? A. Elbow strength and range of motion testing B. Grip strength testing C. Cervical spine testing D. Scapular muscle strength testing

C. The subjective complaints of "pins and needles" suggest that the source of the problem is either vascular or neurologic. Because thoracic outlet syndrome has been cleared, focus should be placed on the cervical spine.

A patient is placed in supine position with the knee in 90o of flexion. The foot is stabilized by the therapist's body on the examination table. The therapist then wraps his fingers around the proximal tibia so that the thumbs are resting along the anteromedial and the anterolateral margins. The therapist then applies a force to pull the tibia forward. What special test is being performed? A. Pivot shift B. Lachman's test C. Anterior drawer D. Posterior drawer

C. The tests in choices A, B, and C assess the integrity of the anterior cruciate ligament. The pivot shift test is performed with the patient in supine position. The therapist applies a valgus stress with the lower leg internally rotated while passively flexing and extending the knee. A positive test is associated with instability with this motion. Lachman's test is similar to the anterior drawer test, but the knee is in slight flexion. In performing a posterior drawer test, the positioning is the same as for performing an anterior drawer test, but a posterior force is applied to tibia to assess posterior cruciate ligament integrity. When performing these tests, the therapist is assessing the end-feel and amount of joint play to determine the integrity of the ligament

A physical therapist is treating a 72-year-old woman with a diagnosis of Parkinson's disease 3 times/week at an outpatient facility. The patient is taking 500 mg/day of a medication designed to decrease spasticity. The therapist notices that the patient is performing well on certain days and poorly on others. Which of the following ways can the therapist possibly improve the patient's performance on the days when she performs poorly? A. The therapist can encourage the patient to increase her daily dosage of medication to 600 mg/day on the days she usually performs poorly. B. The therapist can encourage the patient to decrease her daily dosage of medication to 100 mg/day on the days she usually performs poorly. C. The therapist can schedule sessions so that there are fewer sessions on the days the patient performs poorly. D. The therapist should call the physician to suggest another medication.

C. The therapist should never instruct a patient to change the dosage of the medication. In addition, calling the physician and expressing concerns about the possible effects of the medication observed at therapy would be much more appropriate than calling to suggest another medication.

The physical therapist is reading the physician's interpretation of an x-ray that was taken of the left humerus of a 7-year-old patient. The physician notes in the report the presence of an incomplete fracture on the convex side of the humerus. Which type of fracture is the physician describing? A. Comminuted B. Avulsion C. Greenstick D. Segmental

C. This scenario describes a greenstick fracture, which is common in young people. In a comminuted fracture, the bone is broken into pieces. An example of an avulsion fracture is when the tibial tuberosity is pulled off the tibia. A bone that has a segmental fracture is fractured in two places.

A patient is in prone position with his head rotated to the left side. The left upper extremity is placed at his side and fully internally rotated. The left shoulder is then shrugged toward the chin. The therapist then grasps the midshaft of the patient's left forearm. The patient is then instructed to "try to reach your feet using just your left arm." This movement is resisted by the therapist. The test is assessing the strength of what muscle? A. Upper trapezius B. Posterior deltoid C. Latissimus dorsi D. Triceps brachii

C. This test assesses the strength of the latissimus dorsi. One of the functions of the latissimus is to push up from a sitting position. This test simulates that movement.

A physical therapist is evaluating a patient who complains of posterior ankle pain. The patient is positioned prone with the feet extended over the edge of the mat. The therapist squeezes the involved gastrocnemius over the middle third of the muscle belly. What test is the therapist performing? What indicates a positive test? A. Thompson's test - plantarflexion of the ankle B. Homan's test - plantarflexion of the ankle C. Thompson's test - no ankle movement D. Homan's test - no ankle movement

C. Thompson's test checks the integrity of the Achilles tendon. When this test is performed on an ankle with no dysfunction, squeezing the gastrocnemius causes passive plantar flexion of the ankle.

An 81-year-old woman with right-side hemiparesis due to stroke is being treated by a physical therapist through home health services. The therapist is attempting to increase the functional reach of the right upper extremity. The patient currently has 120o of active flexion. The therapist decides to use trunk mobility/stability facilitation techniques to help achieve the patient's functional goals. Which of the following skills need to be mastered by the patient to attain the ability to reach 2 feet in front of her wheelchair and 2 feet to the right of midline at 125o of shoulder flexion with the right upper extremity? A. Weight shifting to the left buttock and right side trunk elongation B. Weight shifting to the left buttock and left side trunk elongation C. Weight shifting to the right buttock and right side trunk elongation D. Weight shifting to the right buttock and left side trunk elongation

C. To reach as described in the question, the patient must shift weight to the right buttock and elongate the right side of the trunk. With the same circumstances given in the question, but to the left side, the patient would shift weight to the left buttock and elongate the left side of the trunk.

A physical therapist is treating an automobile mechanic. The patient asks for tips on preventing upper extremity repetitive motion injuries. Which of the following is incorrect advice? A. Use your entire hand rather than just the fingers when holding an object B. Position tasks so that they are performed below shoulder height C. Use tools with small straight handles when possible D. When performing a forceful task, keep the materials slightly lower than the elbow

C. Tools with small handles require more grip strength. Tasks below shoulder height reduce the risk of impingement, and more force can be applied to tasks if they are kept below elbow height.

A physical therapist is treating a 35-year-old man with traumatic injury to the right hand. The patient has several surgical scars from a tendon repair performed 6 weeks ago. What is the appropriate type of massage for the patient scars? A. Transverse and longitudinal B. Circular and longitudinal C. Transverse and circular D. Massage is contraindicated after a tendon repair

C. Transverse (perpendicular to the scar) or circular massage assists in mobilization of scar tissue.

A physician has ordered a physical therapist to treat a patient with chronic low back pain. The order is to "increase gluteal muscle function by decreasing trigger points in the quadratus lumborum". What is the first technique that should be used by the physical therapist? A. Isometric gluteal strengthening B. Posture program C. Soft tissue massage D. Muscle reeducation

C. Trigger points are often treated with soft tissue massage. Other techniques include strain/counterstrain, myofascial release, and muscle energy techniques.

A therapist is scheduled to evaluate a patient with a chronic condition of hammer toes. Where should the therapist expect to find callus formation? A. The distal tips of the toes B. The superior surface of the interphalangeal joints C. The metatarsal heads D. All of the above

D. A patient with hammer toes exhibits hyperextension of the distal interphalangeal joints and metatarsophalangeal joints and flexion of the proximal interphalangeal joints.

A physical therapist begins gait training for a patient with bilateral knee flexion contractures at 30o at a long-term care facility. The therapist knows that the patient will have a forward trunk lean during gait because: A. The patient's line of gravity is anterior to the hip B. The patient's line of gravity is anterior to the knee C. The patient's line of gravity is anterior to the ankle D. A and C

D. A patient with severe knee flexion contractures has a line of gravity that is anterior to the hip, posterior to the knee, and anterior to the ankle. This causes a flexion moment at the hip, knee, and ankle.

A therapist is treating a patient with a venous insufficiency ulcer over the medial malleolus. The wound is moist and not infected. The involved lower extremity is swollen, and the patient reports no pain around the wound. The physician has ordered wound care 3 times a week. Which of the following is the best treatment? A. Warm whirlpool B. Unna boot dressing between therapy sessions C. Intermittent compression pump D. B and C

D. A warm whirlpool with the lower extremity in a dependent position is likely to increase the edema. An Unna boot is cotton gauze covered with zinc oxide, gelatin, and calamine. It is put on much like an ACE wrap. The boot is left to harden overnight, and the dressing resists further edema because of its rigidity. A compression pump is often used for increased edema in the extremities.

A physical therapist receives an order from the physician to treat a patient using iontophoresis. The order indicates that the purpose of the treatment is to attempt to dissolve a calcium deposit in the area of the Achilles tendon. When preparing the patient for treatment, the therapist connects the medicated electrode to the negative pole. Which of the following medications is the therapist most like preparing to administer? A. Dexamethasone B. Magnesium sulfate C. Hydrocortisone D. Acetic acid

D. Acetic acid is sometimes used in attempts to dissolve a calcium deposit and is driven by negative pole. Dexamethasone is an anti-inflammatory driven by the negative pole. Magnesium sulfate is used to decrease muscle spasms and is driven by the positive pole. Hydrocortisone is also used to treat inflammation and is driven by the positive pole.

A clinical instructor is explaining to his student how a muscle contracts. The instructor describes the cycle of cross bridging. He begins stating the first step is that the cross-bridges attach to the thin filament. Which of the following occurs next (in the correct order)? A. The attachment with the actin filament is lost. The cross-bridge moves into position to attach to the thick filament. Cross-bridge moves, causing the thin filament to move. B. The cross-bridge moves into position to attach to the thick filament. The attachment with the myosin filament is lost. Cross-bridge moves, causing the thin filament to move. C. The attachment with the myosin filament is lost. Cross-bridge moves, causing the myosin filament to move. The cross-bridge moves into position to attach to a myosin filament. D. Cross-bridge moves, causing the actin filament to move. The attachment with the thin filament is lost. The cross-bridge moves into position to attach to an actin filament.

D. After the cross-bridge attaches to the thin filament (or actin), it moves, causing the thin filament to move. After the cross-bridge is broken, it moves into position to reattach to an thin filament (or actin) to repeat the cycle.

A physical therapist is ordered to evaluate a 74-year-old man who has suffered a recent stroke. The therapist performs a chart review before performing the evaluation. Which of the following is of the least importance to the physical therapist in assessing the patient's chart? A. Nursing assessment B. Physician's orders/notes C. Respiratory assessment D. Dietary assessment

D. All of the choices are important, but the dietary assessment contains the least amount of critical information at this stage of the physical therapy evaluation.

A physical therapist is beginning an evaluation of a patient with a diagnosis of "knee strain". Range of motion limitation does not follow the normal capsular pattern of the knee. Which of the following are possible causes of the restriction in range of motion? A. Ligamentous adhesions B. Internal derangement C. Extra-articular lesions D. All of the above

D. All of the following are capable of causing a noncapsular pattern.

A patient is referred to physical therapy with a history of temporomandibular joint pain. The therapist notices that the patient is having difficulty closing his mouth against minimal resistance. With this information, which of the following muscles would not be a target for strengthening exercise to correct this deficit? A. Medial pterygoid muscle B. Temporalis C. Masseter D. Lateral pterygoid muscle

D. All of the listed muscles participate in mandibular elevation with the exception of the lateral pterygoid muscle. The lateral pterygoid muscle and suprahyoid muscles participate in mandibular depression.

Which of the following exercises does not increase strength of the muscles of forceful inspiration? A. Active cervical flexion exercises B. Active glenohumeral extension exercises C. Shoulder shrugs D. Crunches

D. Answer A increases strength of the scalenes and sternocleidomastoid. Answer B strengthens the latissimus dorsi. Answer C increases the strength of the upper trapezius. All of these are accessory inspiratory muscles. Answer D strengthens the abdominals, which are muscles of forceful expiration.

Use of shortwave diathermy and microwave diathermy is not contraindicated in which of the following conditions? A. On a patient who has a pacemaker. B. Over the site of a metal implant. C. On a patient who has hemophilia. D. Using pulse shortwave over an acute injury.

D. Answer A is contraindicated because the electromagnetic field produced by use of shortwave diathermy or microwave diathermy may alter the settings of a pacemaker. Answer B is contraindicated because the metal heats quickly and may cause the surrounding tissue to heat excessively, potentially causing a burn. Answer C is contraindicated because heating causes vasodilation, making a hemorrhage more likely. Answer D is the correct choice because pulsed shortwave diathermy can be used on acute or chronic conditions. With most pulsed shortwave treatments there is no measurable temperature increase in the tissues.

A 23-year-old woman arrives at an outpatient physical therapy clinic with a prescription to evaluate and treat the right hand. One week earlier the patient underwent surgical repair of the flexor tendons of the right hand at zone 2. She also had her cast removed at the physician's office a few minutes before coming to physical therapy. What is the best course of treatment for this patient? A. Ultrasound to decrease scarring. B. Gentle grip strengthening with putty. C. Splinting the distal interphalangeal joint and proximal interphalangeal joints at neutral D. Splinting with the use of rubber bands to passively flex the fingers.

D. Answer D is the correct treatment. Strengthening is not indicated at this time, and splinting as described in answer C places too much stretch on the tendons. In addition, static splinting does not allow tendon gliding. Ultrasound is contraindicated over a healing tendon repair.

A physical therapist is performing passive range of motion on the shoulder of a 43-year-old woman who received rotator cuff repair 5 weeks ago. During passive range of motion, the therapist notes a capsular end feel at 95o of shoulder flexion. What should the therapist do? A. Continue with passive range of motion B. Begin joint mobilization C. Schedule the patient an appointment with the physician immediately D. A and B

D. Because of the length of the time since the surgical procedure, the patient may have adhesive capsulitis. The capsule should continue to be stretched to increase range of motion. The patient should visit the physician if the range-of-motion deficits continue.

A physical therapist is treating a 40-year-old business executive who lives a sedentary lifestyle. The patient tires quickly and complains of quadriceps fatigue and "burning" after 2 minutes on the stair stepper. The therapist explains to the patient that the "burning " is probably due to lactic acid build-up in muscles. Which of the following statements is incorrect? A. Lactic acid build-up is due to the aerobic system not keeping up with the energy demands of the muscles. B. Lactic acid builds up is more quickly in an unconditioned person than in a conditioned person exercising at the same intensity level C. A small amount of lactic acid is produced at low to moderate intensity levels of exercise D. Only the anaerobic system is active during rest

D. Both anaerobic and aerobic systems are active during rest. The anaerobic system is working at least at a cellular level during rest. The level of lactic acid produced at rest is not enough to cause any build-up. The aerobic system is also working at least at a cellular level during high-intensity activity.

A therapist is treating a patient with an injury at the T8 level and compromised function of the diaphragm. If no abdominal binder is available, what is the most likely position of comfort to allow him to breathe most efficiently? A. Sitting position B. Semi-fowler position C. Standing D. Supine

D. Choice D is the correct answer because in the supine position the abdominal contents are located more superiorly than in the other positions. This places the diaphragm in a more elevated resting position, which allows greater excursion of the diaphragm. Semi-Fowler's position resembles a reclining position, with the knees bent and the upper trunk slightly elevated. Semi-Fowler's position without an abdominal binder, allows gravity to pull the abdominal contents downward, which does not put the diaphragm in an optimal resting position. Semi-Fowler's position is, however, the position of choice for patients with uncompromised innervation of the diaphragm who have chronic respiratory difficulty. The standing and sitting positions present the same problem, but a greater extent, as semi-Fowler's position.

An outpatient physical therapist is gait training a patient recently discharged from the hospital. The inpatient therapist's notes describe a decrease in left stride length due to pain with weight bearing on the right lower extremity. The outpatient therapist knows that the patient's gait deviation is A. An abnormally short distance from the left heel strike and the successive right heel strike B. An abnormally short amount of time between the left heel strike and the successive right heel strike C. An abnormally short amount of time in stance phase on the left lower extremity D. An abnormally short distance between the left heel strike and the successive left heel strike

D. Choice D is the length of stride during one gait cycle. Choice A describes a decreased step length. Choice B describes a decrease in step duration, and choice C describes a decrease in single limb support time.

A therapist is assessing a patient in an attempt to discover the source of her pain. She positions the patient's cervical spine in different directions in an attempt to elicit the patient's symptoms. In one such direction, the patient reports return of symptoms, including pain located at the right posterior scapular region, which extends down the posterior side of the right upper extremity to the ends of the fingers, and tingling in the second, third, and fourth digits. The patient also indicates that she often has decrease in sensation on the dorsal side of the second and third digits. She also has noticeable weakness in the right triceps. Which nerve root is most likely involved? A. Fourth cervical root B. Fifth cervical root C. Sixth cervical root D. Seventh cervical root

D. Dermatome charts in distribution vary from source to source, but one common aspect of C7 innervation is the middle finger. The triceps muscles are also innervated by C7.

A physical therapist is performing a functional capacity evaluation on a patient with a L4-L5 herniated disc. Part of the evaluation consists of performing floor to waist lifts using 30 pounds as resistance. During the first trial, the physical therapist notices that patient exhibits decreased anterior pelvic tilt. What should the physical therapist do during the second trial? A. Correct the deviation verbally before the lift B. Correct the deviation with manual contact during the lift C. Correct the deviation both verbally and manually during the lift D. None of the above

D. During a functional capacity evaluation the physical therapist should not correct postural abnormalities. The therapist should only observe and record.

A 63-year-old woman presents to physical therapy with a diagnosis of herpes zoster. The physician informs the physical therapist that the L5 dorsal root is involved and that a transcutaneous electrical neuromuscular stimulation (TENS) unit should be used to help control the pain. Where should the TENS unit electrodes be placed? A. Posterior thigh B. Lateral hip/greater trochanter area C. Anterior thigh D. Anterior lateral tibia

D. Herpes zoster involves a particular dorsal root and its ganglia. TENS unit electrodes should be placed over the involved dermatome (L5 in this case).

A 63-year-old man presents to an outpatient physical therapy clinic with a diagnosis of sciatica. The MRI report is negative for lumbar disc involvement. During the evaluation the physical therapist cannot reproduce the symptoms of radiculopathy with any test. Lower extremity strength is equal bilaterally and is not weak in any particular pattern. The patient informs the therapist that the pain is bilateral, located in the gastrocnemius area, and increases with prolonged ambulation. The pain stops soon after resting in a seated position. What is the most likely source of this patient's pain? A. Impingement of the L5 dorsal root B. Multiple sclerosis C. Compartment syndrome D. Intermittent claudication

D. Intermittent claudication is a sign of chronic arterial disease. Answer A is incorrect because it produces unilateral signs and symptoms. Answer B is incorrect because, although the signs and symptoms may be present in a patient with multiple sclerosis, this scenario paints a more accurate picture of a patient who has intermittent claudication. A compartment syndrome usually involves the anterior tibialis. In addition, patient with compartment syndrome require a longer rest time than this question implies before pain subsides.

A patient with a spinal cord injury is being treated by physical therapy in an acute rehabilitation setting. The patient has been involved in a motor vehicle accident that resulted in a complete C8 spinal cord lesion. The patient is a 20-year-old man who has expressed concern to the therapist about his future sexual function. Which of the following is the most correct information to convey to the patient? A. Psychogenic erection is possible, reflexogenic erection is not possible, and ejaculation is possible. B. Psychogenic erection is not possible, reflexogenic erection is not possible, and ejaculation is not possible. C. Psychogenic erection is possible, reflexogenic erection is possible, and ejaculation is possible. D. Psychogenic erection is not possible, reflexogenic erection is possible, and ejaculation is not possible.

D. Men with high complete lesions are likely to be able to have reflexogenic erections, and men with lower complete lesion are likely to have the capability to have a reflexogenic or psychogenic erection. Men with incomplete lesions are likely to retain erectile capability much more than men with complete lesions. In addition, a man with a complete lesion is less likely to have the ability to ejaculate than a man with an incomplete lesion.

A 29-year-old woman who is 8 months pregnant presents to an outpatient clinic with complaints of "pain and tingling" over the lateral thigh. She also indicates no traumatic injury. The symptoms increase after she has been sitting for 30 minutes or longer, and the overall intensity of the symptoms has been increasing over the past 2 weeks. The therapist notes that repeated active lumbar flexion does not increase pain, and the patient's lumbar range of motion is normal for a pregnant woman. There is also no motor weakness in the hip or pelvis, and the sacroiliac joint is not abnormally rotated. What is the most probable diagnosis? A. L3 disc dysfunction B. Spondylolisthesis C. L4 disc dysfunction D. Meralgia paresthetica

D. Meralgia paresthetica is the compression of the lateral femoral cutaneous nerve of the thigh as it passes under the inguinal ligament near the anterior superior iliac spine. Examples of the source of this problem include periods of obesity, postural changes, and tight clothing. Lumbar disc involvement and spondylolisthesis are less likely choices because the question indicates normal range of motion, lack of motor weakness, and no change with repeated active lumbar flexion.

A physical therapist is performing electromyograhic testing. During a maximal output test of the patient's quadriceps muscle, 35% of the motor unit potential is polyphasic. What is the significance of this finding? A. It is normal in the quadriceps. B. It is normal in the triceps brachii, not in the quadriceps C. It is normal in the biceps brachii, not in the quadriceps D. It is abnormal in any muscle.

D. More than 10% of the polyphasic potentials in the total output of muscle is considered abnormal.

A 76-year-old woman received a cemented right hip arthroplasty (THA) 24 hours ago. The surgeon documented that he used a posterolateral incision. Which of the following suggestions in inappropriate for the next 24 hours? A. Avoid hip flexion above 30o B. Avoid hip adduction past midline C. Avoid any internal rotation D. Avoid abduction past 15o

D. Movements that stress the posterolateral hip joint capsule should be avoided. Sources vary on the exact amount of flexion that should be avoided. Passive hip abduction should be maintained after surgery with a wedge.

A physical therapist is evaluating a 5-day old infant with cerebral palsy. The infant has an abnormal amount of extensor tone. Which of the following is correct positioning advice for the family and nursing staff? A. Keep the infant in supine position B. Keep the infant in prone position C. Keep the infant in sidelying position D. B and C are correct

D. Prone and sidelying positions would encourage flexion of the extremities with this patient. In this population, prone positioning allows more efficient cardiovascular function.

A child presents to physical therapy with a diagnosis of right Sever's disease. What joint should be the focus of the therapist's evaluation? A. Right knee joint B. Right hip joint C. Right wrist joint D. Right ankle joint

D. Sever's disease is traction apophysitis of the gastrocnemius tendon in children. In other words, the gastrocnemius attempts to pull away from the calcaneus, causing an inflammatory condition.

Which of the following are indications for pulmonary suctioning? A. Unproductive coughs B. Breath sounds or wet rales C. Respiratory distress D. All of the above

D. Suctioning also can be performed in patients with significant hypoxemia.

A 43-year-old man with right biceps brachii rupture presents to physical therapy after a surgical repair. According to the surgeon, the rupture was at the musculotendinous junction. Which of the following has most likely been compromised? A. Meissner's corpuscles B. Merkel's disks C. Ruffini endings D. Golgi tendon organs

D. The Golgi tendon organs monitor tension at the musculotendinous junction. Ruffini endings are located in the joint capsule ligaments and deep layers of the dermis. Meissner's corpuscles are located in the dermis. Merkel's disks are located below the epidermis.

A therapist is evaluating an infant with the mother present. The therapist suddenly seems to temporarily lose grip of the infant, causing him to be startled and begin to cry. The infant's mother is noticeable upset but is reassured that startling the infant was part of the assessment. Which of the following may the therapist have been assessing? A. Landau response B. Symmetric tonic neck reflex C. Labyrinthine head righting D. Moro reflex

D. The Moro reflex and the Landau reaction are discussed in the answer to question 65. Labyrinthine head-righting is tested by holding a child upright and tilting the body slightly forward, back and side to side. The infant should be able to hold the head vertical despite the body movement. The symmetric tonic neck response (onset at 4-6 months, integrated at 8-12 months) is exhibited when the infant displays upper extremity extension and lower extremity flexion with passive cervical extension. Sources vary significantly in regard to the age at which these responses should be present and when they are integrated.

A physical therapist is assessing a 40-year-old man's balance and coordination. The following instructions are given to the patient: "Stand normally, with your eyes open. After fifteen seconds, close your eyes and maintain a normal standing posture". Several seconds after closing his eyes, the patient nearly falls. What type of test did the patient fail? A. Nonequilibrium test B. Equilibrium test C. Romberg test D. B and C

D. The Romberg test is a type of equilibrium test. Equilibrium tests are usually conducted with the patient in a standing position, whereas Nonequilibrium tests are performed with the patient in the supine position.

A therapist chose to work with her patient using fluidotherapy rather than paraffin wax. The patient has lack of range of motion and also needs to decrease hypersensitivity. There are no open wounds on the had to be treated. Which of the following would not be an advantage of using fluidotherapy versus paraffin wax in the above scenario? A. The therapist can assist range of motion manually while the patient has his hand in the fluidotherapy and not while in the paraffin wax. B. The fluidotherapy can be used to assist in desensitization by adjusting air intensity. C. The fluidotherapy can be provided at the same time as dynamic splinting, and this cannot be done while in paraffin wax. D. The fingers can be bound, to assist gaining finger flexion, with tape while in fluidotherapy and not in paraffin wax.

D. The fingers can be bound in paraffin wax as well as in fluidotherapy. When using this technique, the hand remains stationary throughout the heating process, which is necessary for paraffin to be most effective (when using the standard method of dipping the hand and wrapping with plastic wrap and a towel).

A physical therapist is treating a patient who is participating in cardiac rehabilitation. Because the patient complains of chest pain, the therapist attempts to assess heart sounds with a stethoscope. Which of the following is true about the first sound during auscultation of the heart? A. The first sound is of the closure of the aortic and pulmonic valves. B. The first sound is of the closure of the mitral and tricuspid valves. C. The first sound is of the beginning of ventricular systole. D. B and C

D. The first sound heard corresponds with closing of the mitral and tricuspid valves. The second sound corresponds to closing the aortic and pulmonic valves. Therefore, the first sound is indicative of the onset of ventricular systole, and the second is indicative of the onset of ventricular diastole.

Which of the following circumstances would normally decrease body temperature in a healthy person? A. Exercising on a treadmill. B. Pregnancy C. Normal ovulation D. Reaching age of 65 years or older

D. The geriatric population usually has a decreased body temperature due to poor diet, decreased cardiovascular status, and decreased metabolic rates.

A physical therapist is treating a patient with balance deficits. During treatment the physical therapist notes that large-amplitude changes in center of mass cause the patient to lose balance. The patient, however, can accurately compensate for small changes nearly every time a change is introduced. What muscles most likely need to be strengthened to help alleviate this dysfunction? A. Tibialis anterior, gastrocnemius B. Peroneus longus/brevis, tibialis posterior C. Rectus abdominis, erector spinae D. Iliopsoas, gluteus maximus

D. The hip strategy is used to compensate for large movements in the center of mass, and the ankle strategy is used to compensate for small movements.

A physical therapist is treating a 65-year-old man with pneumonia. The patient questions the benefits of the flow incentive spirometer left in the room by the respiratory therapist a few minutes ago. Which of the following is an appropriate response to the patient's question? A. "It gives visual feedback on the lung performance" B. "It helps you maintain current lung volumes" C. "You need to ask the respiratory therapist this question" D. A and B are correct responses.

D. The incentive spirometer provides visual feedback of maximal inspiratory efforts. The physical therapist is qualified to answer the patient's question.

A therapist is evaluating a patient in the intensive care unit. While performing a chart review, the therapist discovers that the patient was seriously injured to a fall from a 3-story building. The therapist determines from the physician's evaluation that of the many injuries the patient has sustained, a rupture of two ligaments extends from the side of the dens to the medial side of the occipital condyle. Which of the following was injured? A. Ligamentum nuchae B. Tectorial membrane C. Posterior atlanto-occipital ligament D. Alar ligament

D. The ligament to which this question refers is the alar ligament. The Tectorial membrane extends from the posterior part of C1 to the base of the occiput. The posterior atlanto-occipital ligament runs from the posterior arch of C1 to the posterior margin of the foramen magnum. The ligamentum nuchae is a triangular ligament that runs from the C7 spinous process to the external occipital protuberance.

A physical therapist is attempting to explain the importance of slow stretching to an athlete training to compete in a marathon. The therapist explains that quick stretching often causes the muscle to ______, which is a response initiated by the ______, which are located in the muscle fibers. Fill in the blanks. A. Relax - Golgi tendon organs B. Contract - Golgi tendon organs C. Relax - muscle spindles D. Contract - muscle spindles

D. The muscle spindles are responsible for the stretch reflex. When a muscle is stretched too quickly, the muscle spindles cause the muscle to contract and shorted (which is called the stretch reflex). The Golgi tendon organs are responsible for the inverse stretch reflex. They are located in the junction between the muscle and tendon and detect changes in tension. When a tendon is stretched too quickly, the Golgi tendon organs cause the muscle to relax.

A 17-year-old athlete has just received a posterior cruciate ligament reconstruction. The therapist is attempting to explain some of the characteristics of the posterior cruciate ligament. Which of the following is incorrect information? A. The posterior cruciate ligament prevents posterior translation of the tibia on the femur. B. Posterior bands of the posterior cruciate ligament are their tightest in full knee extension. C. The posterior cruciate ligament is attached to the lateral meniscus and not to the medial meniscus D. The posterior cruciate ligament helps with medial rotation of the tibia during full knee extension with open chain activities.

D. The posterior cruciate ligament becomes tight in full knee extension. This assists the tibia in external rotation, which is needed for the screw home mechanism with open-chain activities.

A therapist is assisting a patient with an injury at the C5 level in performing an effective cough. The patient has experienced significant neurologic damage and is unable to perform an independent, effective cough. If the patient is in supine position, which of the following methods is most likely to produce an effective cough? A. The therapist places the heel of one hand just above the xiphoid process, instructs the patient to take a deep breath while pressing down moderately on the sternum and instructs the patient to cough. B. The therapist places the heel of one hand, reinforced with the other hand, just above the xiphoid process; instructs the patient to take a deep breath; instructs the patient to hold the breath; and presses moderately as the patient coughs. C. The therapist places the heel of one had on the area just above the umbilicus, instructs the patient to take a deep breath, applies moderate pressure; and releases pressure just before the patient attempts to cough. D. The therapist places the heel of one hand just above the umbilicus, instructs the patient to take a deep breath, and applies moderate pressure as the patient is instructed to cough.

D. The pressure applied by the therapist should be applied as the patient coughs to assist in a forceful exhalation. Placing the heel of one hand approximately one inch above the umbilicus applies pressure immediately inferior to the diaphragm.

A patient is referred to physical therapy with complaints of sensation loss over the area of the radius of the right upper extremity, extending from the elbow joint distally to the wrist. Therapy sessions are focused on assisting the patient in regarding normal sensation. Which of the following nerves is responsible for sensation in this region? A. Medial antebrachial cutaneous B. Lateral antebrachial cutaneous C. Musculocutaneous D. Both B and C

D. The radial side is the lateral side of the forearm, which is innervated by the musculocutaneous nerve. The lateral antebrachial cutaneous nerve is a continuation of the musculocutaneous nerve.

A therapist is evaluating a patient who suffered brain injury in a motor vehicle accident. The somatosensory cortex is involved, resulting in deficits in sensation in the right upper and lower extremities. The therapist knows from visualizing the homunculus that at least part of the injury is in one of the following locations. A. Inferior right hemisphere of the somatosensory cortex B. Superior right hemisphere of the somatosensory cortex C. Inferior left hemisphere of the somatosensory cortex D. Superior left hemisphere of the somatosensory cortex

D. The right hemisphere is responsible for the left side of the body and vice versa.

A physical therapist is scheduled to evaluate the shoulder of a patient with hepatitis B. The therapist notices no open wounds or abrasions and also notices that the patient has good hygiene. The physician has ordered passive range of motion to the right shoulder because of adhesive capsulitis. Which of the following precautions is absolutely necessary to prevent the therapist from being infected? A. The therapist must wear a gown B. The therapist must wear a mask C. The therapist must wear gloves D. None of the above

D. The therapist does not need to wear a gown, gloves, or mask. These precautions are necessary only if there is a chance that the therapist or his clothing can become contaminated with blood, serum, or feces.

A physical therapist is attempting to increase a patient's functional mobility in a seated position. To treat the patient most effectively and efficiently, the following should be performed in what order? (1) Weight shifting of the pelvis, (2) Isometric contractions of the lower extremity, (3) Trunk range of motion exercises, (4) Isotonic resistance to the quadriceps A. 1,2,3,4 B. 2,3,1,4 C. 4,3,2,1 D. 3,2,1,4

D. The treatment techniques should be performed in the order of mobility, stability, controlled mobility, and skill.

A patient presents to an outpatient clinic with an order to evaluate and treat the right forearm and wrist secondary to nerve compression. The patient has the following signs and symptoms: pain with manual muscle testing of pronation, decreased strength of the flexor pollicis longus and pronator quadratus, and pain with palpation of the pronator teres. What nerve is most likely compromised? What is the most likely area of compression? A. Median nerve - carpal tunnel B. Ulnar nerve - Guyon's canal C. Ulnar nerve - pronator quadratus D. Median nerve - pronator teres

D. These signs and symptoms are common with median nerve compression as it travels through the two heads of the pronator teres. Carpal tunnel syndrome usually presents with a positive Tinel's sign, a positive Phalen's test, and decreased strength and sensation over the median nerve distribution. Ulnar nerve compression at Guyon's canal typically presents with numbness, pain, and tingling along the ulnar nerve distribution.

A patient presents to therapy with poor motor control of the lower extremities. The therapist determines that to work efficiently toward the goal of returning the patient to his prior level of ambulation, he must work in the following order regarding stages of control: A. Mobility, Controlled mobility, stability, skill B. Stability, controlled stability, mobility, skill C. Skill, controlled stability, controlled mobility D. Mobility, stability, controlled mobility, skill

D. This answer lists the stages of control in the correct order.

A physician has ordered a specific type of electrical stimulation that utilizes a frequency of 2500 Hz with a base frequency at 50 Hz to achieve fused tetany. What type of electrical stimulation has the physician ordered? A. Iontophoresis B. Transcutaneous electrical nerve stimulation C. Intermittent flow configuration D. Russian stimulation

D. This is an example of Russian stimulation.

An infant is being examined by a physical therapist. The therapist is resisting movement of the right upper extremity and notices involuntary movement of the left upper extremity. Which of the following is displayed by the infant? A. Landau reaction B. Startle reflex C. Moro reflex D. Associated reaction

D. This is an example of an associated reaction, which presents from birth to 3 months and is integrated at 9 years of age. The Landau reaction (onset at 4 months, integrated at 24 months) is assessed by supporting the patient in prone position and passively or actively extending the neck. A positive response is extension of the spine and lower extremities. The startle reflex is positive if an infant is startled by a loud or sudden noise. This response should be present at birth and persists throughout life. The Moro reflex is tested by lowering an infant suddenly from a sitting position. A positive response is crying with sudden extension and abduction of the upper extremities, followed by adduction of the upper extremities across the chest (an infant should have this response up to 6 months of age). Sources vary significantly in regard to the age at which these responses should be present and when they are integrated.

A physical therapist who is pregnant has been studying the use of transcutaneous electrical nerve stimulation during labor and birth to decrease pain perception. Which of the following is the most effective technique in this situation? A. Place the electrodes over the upper abdominals during the first stages of labor and over the lower abdominals during the later stages. B. Place the electrodes over the paraspinals at the L5 level and S1 level throughout labor and delivery. C. Place the electrodes in a V pattern above the pubic region during labor and delivery D. Place the electrodes over the paraspinals at the L1 and S1 level initially during labor, and over the pubic region during the later stages.

D. This is the most common placement suggested by sources used in preparation of this book. Spinal level varies, but the overall consensus is that the electrodes are placed higher and on the back initially. Then they are moved lower and to the anterior pubic region as labor progresses.

A therapist is ordered to fabricate a splint for a 2-month-old infant with a congenital hip dislocation. In what position should the hip be placed while in the splint? A. Flexion and adduction B. Extension and adduction C. Extension and abduction D. Flexion and abduction

D. This is the most stable position of the hip, which allows more normal growth.

While evaluating a patient who suffered a complete spinal cord lesion, the therapist notes the following strength grades with manual muscle testing: wrist extensors = 3+/5, elbow extensors = 2+/5, and intrinsic muscles of the hand = 0/5. What is the highest possible level of this lesion? A. C3 B. C4 C. C5 D. C7

D. This patient has a lesion at the level of C7.

A 53-year-old man with chronic obstructive pulmonary disease reports to an outpatient cardiopulmonary rehabilitation facility. Pulmonary testing reveals that forced expiratory volume in 1 second (FEV1) and vital capacity (VC) are within 60% of predicted values. What is the appropriate exercise prescription? A. Exercise at 75-80% of the target heart rate 3 times/week. B. Begin exercise with level of 1.5 METs and increase slowly 3 times/week C. Exercise at 75-80% of the target heart rate 7 times/week D. Begin exercise with levels of 1.5 METs and increase slowly 7 times/week.

D. This patient has moderate lung disease. Because the intensity of exercise is low, frequency should be increased to 5-6 times/week.

A therapist is evaluating a patient with poor motor coordination. The therapist observes that when the patient is standing erect and still, she does not respond appropriately when correcting a backward sway of the body. With the body in a fully erect position, a slight backward sway should be corrected by the body firing specific muscles in a specific order. Which list is the correct firing order? A. Bilateral abdominals, bilateral quadriceps, bilateral tibialis anterior. B. Bilateral abdominals, bilateral tibialis anterior, bilateral quadriceps C. Bilateral tibialis anterior, bilateral abdominals, bilateral quadriceps D. Bilateral tibialis anterior, bilateral quadriceps, bilateral abdominals.

D. This sequence assists in propelling the center of gravity forward to maintain balance after a backward sway.

A therapist is evaluating a patient in the intensive care unit. The therapist notices that the patient is moving his hands and fingers in slow, writhing motions. Which of the following terms best describes this type of movement? A. Lead-pipe rigidity B. Ballismus C. Chorea D. Athetosis

D. This type of movement, known as athetosis, also can involve the feet, proximal parts of the extremities and face. Chorea is rapid movements of the hands, wrist or face. Ballism refers to forceful and uncontrollable throwing of the extremities outward. Lead-pipe rigidity is increasing resistance of an extremity to passive ranging. All of the above can result from damage to the basal ganglia.

A patient with chronic back pain is referred to physical therapy for application of a transcutaneous electrical nerve stimulation unit. The parameters chosen by the therapist are set to provide a noxious stimulus described as an acupuncture type of stimulus. Which of the following lists of parameters produces this type of stimulation? A. Low intensity, duration of 60 sec, and a frequency of 50 Hz B. High intensity, duration of 150 sec, and a frequency of 100 Hz C. Low intensity, duration of 150 sec, and a frequency of 100 Hz D. High intensity, duration of 150 sec, and a frequency of 2 Hz

D. This type of stimulation is usually not well tolerated by patients with acute conditions. Acute conditions are usually treated by TENS with a high frequency, and chronic conditions can be treated with a low frequency (if tolerated by the patient). Treatments providing a noxious stimulus usually have a longer lasting effect.

A physical therapist is in a rehabilitation team meeting about a 58-year-old man with Parkinson's disease. The physician notes that the patient's recent decrease in level of function may be caused by long-term use of a certain drug. The physician plans to take the patient off the medication for 2 weeks. Which of the following medication is the patient probably taking? A. Cardizem B. Cortisone C. Epinephrine D. Levodopa

D. When a patient with Parkinson's disease has been using levodopa for an extended period, he or she may develop resistance to the medication. Sometimes a break from the drug for 7-10 days may enhance its effectiveness.

A patient who has suffered a recent stroke is being treated by a physical therapist. The patient exhibits increased extensor tone in the supine position along with an exaggerated symmetric tonic labyrinthine reflex (STLR). What is the best position to initiate flexion movements of the lower extremity? A. Prone position B. Sidelying position C. Supine position D. A and B

D. When an exaggerated symmetrical tonic labyrinthine reflex is present, supine position increases extensor tone and prone positioning increases flexor tone. Sidelying also provides an opportunity for the physical therapist to stimulate flexion.

A 30-year-old woman who had a full term infant 4 weeks ago presents to physical therapy with diastasis recti. The separation was measured by the physician and found to be 3 cm. Which of the following exercises is most appropriate to minimize the separation? A. Sit-ups while using the upper extremities to bring the rectus abdominis to midline B. Bridges while using the upper extremities to bring the rectus abdominis to midline C. Dynamic lumbar stabilization exercises in quadruped position D. Gentle head lifts in supine position while using the upper extremities to bring the rectus abdominis to midline.

D. With a separation of this size, the therapist should use gentle abdominal strengthening while binding the abdominal region.