Genitourinary System - All Practice Questions

A new staff PT on the oncology unit of a large medical center receives a referral for strengthening and ambulation for a woman with ovarian cancer. She is undergoing radiation therapy after a surgical hysterectomy. Her current platelet count is 17,000. What intervention nis indicated for the patient at this time? 1. AROM and ADL exercises 2. Aerobic exercises at 3-5X per week at 40-60% oxygen uptake 3. Resistance training at 60% one rep max 4. Progressive stair climbing with a weighted waist belt

1. AROM and ADL Rationale: Exercise testing and training is contraindicated with platelets <50,000, WBC <3000 or hemoglobin <10.

What is pain and tenderness with palpation over McBurney's point associated with? 1. Acute appendicitis 2. Distal hernia 3. Acute cholecysitis 4. GERD

1. Acute appendicitis Rationale: McBurney's point is located half the distance between the ASIS and umbilicus in the R lower abdominal quadrant.

Which of the following structures provide active compression of the urethra? 1. Pubococcygeus, iliococcygeus, and puborectalis 2. Pubococcygeus, obturator internus, and puborectalis 3. Iliococcygeus, puborectalis, and pubovesical ligament 4. Pubococcygeus, iliococcygeus, and anococcygeus ligament

1. Pubococcygeus, iliococcygeus, and puborectalis Rationale: The levator ani muscles consist of the pubococcygeus, iliococcygeus, and puborectalis, which actively compress the urethra, vagina, and rectum, thus maintaining continence.

A woman is referred to PT with a diagnosis of pelvic floor weakness after delivering a baby. Proper instructions for pelvic floor would NOT include which of the following? 1. Stop and start flow of urine every time you go to the toilet 2. Squeeze muscles around vagina, imagining that you are stopping flow of urine, hold for 5-10 seconds, and then relax 3. Repeat exercises 10 times, 3X a day 4. Start in supine, progress to sitting and standing practice

1. Stop and start flow of urine every time you go to the toilet Rationale: Kegel exercises should not include the above. This can be used once as a test to find if the correct muscles are contracting. Continued use can result in bladder complications

Pain associated with urinary calculi MOST often occurs because of blockage of which of the following structures? 1. Ureter 2. Urethra 3. Bladder 4. Kidney

1. Ureter Rationale: Pain from urinary calculi results from the ureter contracting in the attempt to dislodge the calculi.

On the third day following a cesarean delivery, what should a PT's interventions include? 1. Gentle partial sit ups and head lifts 2. Breathing, coughing and pelvic floor exercises 3. Low intensity aerobic conditioning 4. Pelvic tilts on all fours

2. Breathing, coughing, pelvic floor Rationale: Initial postpartum interventions (days 1-3) should include breathing, coughing and pelvic floor exercises. All other choices are later recovery

A physical therapist is examining a patient who had a urinary tract infection that was successfully treated with antibiotics. The patient reveals a need to urinate 6 times/day. The patient reports normal fluid intake. Which of the following actions should the therapist take? 1. Request that the physician determine if urinary tract infection has reoccurred. 2. Document that the patient's report indicates normal function of the urinary system. 3. Recommend reducing fluid intake to determine if urinary frequency diminishes. 4. Advise the patient to avoid caffeine, alcohol, and nicotine.

2. Document that the patient's report indicates normal urinary function Rationale: It is normal to urinate 6 to 8 times in a 24-hour period. A frequency beyond 8 times/day is considered abnormal.

A teenager is receiving outpatient physical therapy for a shoulder injury sustained during football practice. He is complaining of nausea, malaise, abdominal pain that started in his mid abdomen but is now predominantly in the RLQ. The PT suspects acute appendicitis and wants to elicit the obturator sign. What is the correct method for performing this special test? 1. Extension of the R hip, patient on left side 2. IR of the R hip, hip and knee flexed to 90 3. Application of pressure in the LLQ which elicits pain in RLQ 4. Have patient stand on toes and drop to heels suddenly

2. IR of the R hip with hip and knee flexed to 90 Rationale: This positioning accurately depicts the obturator sign because the obturator interns muscle may come in contact with an inflamed appendix eliciting pain. Other choices are also tests for acute appendicitis: but they represent the Psoas Sign, Roving's Sign and Markle's Sign

A patient in chronic renal failure is being seen in PT for reconditioning and decreased gait endurance. The PT needs to schedule sessions around dialysis, which is received three mornings a week. What guidelines should the PT follow when taking BP? 1. Every minute during walking on non shunt arm 2. Pre and post activities on non shunt arm 3. In sitting when activity has ceased using shunt arm 4. In supine position using shunt arm

2. Pre and post activities on non shunt arm

A patient is referred to a women's health clinic with moderate to severe uterine prolapse. What should the PT examine for? 1. Absent perineal sensation 2. Bowel leakage 3. LBP, perineal discomfort aggravated by prolonged standing 4. LBP, perineal discomfort aggravated by lying down

3. LBP, perineal discomfort aggravated by standing Rationale: These symptoms are common with uterine prolapsed. Pain is often relieved by lying down.

A patient who is well known to the PT clinic for treatment of chronic neck pain now presents with a new complaints of acute id-back pain. Current symptoms also include abdominal pain and dissension, which, along with the mid-back pain, intensifies after meals. Patient also reports having a recent episode of chronic neck pain that resolved after taking 4000 mg of acetaminophen daily for 2 weeks. What action should the therapist take? 1. Refer to PCP with possible nephrolithiasis 2. Treat with cryotherapy for pain relief and instruct the patient in a core strengthening program 3. Refer to PCP with possible pancreatitis 4. Instruct patient to rest and continue taking acetaminophen

3. Refer to PCP with possible pancreatitis Rationale: Excessive amounts of aceteamionphen can cause pancreatitis due to drug toxicity. Maximum daily dose of acetaminophen is 3000 mg. For Nephrolithiasis (kidney stones) pain typically occurs in the low back and groin.

A patient is recovering fro ma mild stroke with trunk weakness and postural instability. The patient complains of severe heartburn. What is the BEST choice to maximize stroke recovery and improve trunk stabilization while minimizing heartburn? 1. Trunk stabilization exercises with patient in semi-Fowler position 2. Begin with bridging exercises, progressing to sitting holding 3. resisted holding in sitting with rhythmic stabilization 4. Instruct the patient to take antacids right before PT

3. Resisted holding in sitting using rhythmic stabilization Rationale: Heartburn is a common symptom of GERD and can be aggravated by positioning in supine, prone or bridging. Modifying the patient's position to upright can alleviate symptoms.

A patient with a medical diagnosis of second-degree uterine prolapse is referred to a physical therapist for exercise. For the therapist to evaluate this case fully, questions about which of the following patient functional activities are MOST important to ask? 1. Sitting 2. Sleeping 3. Sexual activity 4. Personal hygiene

3. Sexual Activity Rationale: A second-degree prolapse is marked by the cervix as part of the uterus having descended through the introitus, or vaginal opening. Pelvic floor rehabilitation has become the recommended first course of treatment and should include a discussion of alternative positions for sexual intercourse. Symptoms may be exacerbated by prolonged standing, walking, coughing, or straining (i.e., for a bowel movement). Urinary incontinence is also a common problem as a result of uterine prolapse. Additional functional questions should include those related to bladder and bowel habits.

An elderly male patient is not able to participate in rehab. He is lethargic, complains of nausea and painful urination and is feverish. The PT should inform the PCP if which of the following is suspected? 1. Bladder cancer 2. Benign prostatic hyperplasia 3. UTI 4. Renal Calculi (kidney stones)

3. UTI Rationale: These are signs and symptoms of a UTI. Other choices present with similar signs and symptoms but fever is uncommon

A PT has been treating a 40 year old female patient who is 5'3 and 185 lbs. She is receiving PT for low back pain. The patient recently returned from a vacation where she was not really watching her diet. She now complains of new pain in the R upper quadrant, some mild nausea and pain near her R scapula. These pains become worse with meals. Based on her symptoms, which is the most likely source of these new complaints? 1. Cirrhosis 2. Acute Pancreatitis 3. Renal Stons 4. Gallstones

4. Gallstones Rationale: Classic symptoms include nausea and RUQ pain that can radiate to the R scapula. Gallstones are more common in patients who are obese, female and around the 4th decade of life. Gallstones occur more frequently in patients eating meals high in fat and cholesterol. Other choices: Cirrhosis typically does not cause pain as the primary complaint. Acute pancreatitis will present very ill and often not ambulatory, severe pain radiating to the mid back. Renal stones often presents with flank pain that can radiate to the groin

Which of the following bladder management techniques is MOST likely to be used for a patient with bladder dysfunction due to a cauda equina lesion? 1. Sacral nerve modulation 2. Pelvic floor biofeedback 3. Pelvic floor strengthening exercises 4. Intermittent catheterization

4. Intermittent Catheterization Rationale: Spinal cord lesions at the level of S2 and below lead to bladder areflexia and dysfunction of the external sphincter. Bladder tone is preserved, but bladder compliance decreases with time. Catheterization is a commonly employed intervention to avoid excessive bladder distention. (Goodman, p. 991)

A patient reports incontinence and a sensation of urgency to urinate with little output. Which of the following interventions is BEST to include in the therapeutic program? 1. Restriction of fluid intake 2. Scheduling an increased frequency of voiding 3. Detrusor contraction exercises 4. Relaxation training

4. Relaxation Training Rationale: The patient is describing signs of urge incontinence with possible detrusor contractions. Relaxation training is helpful to decrease bladder contractions.

During pregnancy, the presence of the hormone relaxin can lead to abnormal movement and pain. Which joints are typically affected? 1. GH joints 2. Hip joints 3. Lumbosacral joints 4. Sacroiliac Joints

4. SIJ Rationale: SIJ most often affected In pregnancy, resulting in pain