IER A

most common infection transmitted to health care workers is

-Health care workers are most likely to contract hepatitis B -Transmission is through exposure to blood and blood products and infected body fluids

baseball pitcher was seen by a PT following surgical repair of a SLAP (superior labral, anterior posterior) lesion of his pitching arm. the phase of the throwing motion that puts the greatest stress on the anterior labrum and capsule is

During the cocking phase, the arm is taken into the end-range of humeral external rotation. *At that point, the anterior aspects of the capsule and labrum are acting as constraints to prevent excessive anterior glide of the humerus*.

stasis dermatitis

(also known as "Congestion eczema," "Gravitational dermatitis," "Gravitational eczema," "Stasis eczema," and "Varicose eczema") refers to the skin changes that occur in the leg as a result of "stasis" or blood pooling from insufficient venous return( venous insufficiency) vs insufficient arterial return(arterial insufficiency)

SLAP lesion

-Lesion of detachment of the superior labral anterior/posterior to the long head biceps tendon. -O'Brien Test is used

grade II inversion ankle sprain 2 weeks ago. The BEST intervention in the early subacute phase of rehabilitation would most likely include

1. Plyometric-based exercise program. *2*. Closed-chain strengthening and proprioceptive exercises. 3. Functional soccer-related drills. 4. Mobilization at the talocrural and subtalar joints =>the rest is used for later stage.

Which is an abnormal finding during an examination of a newborn infant

1. Symmetry in ROM. 2. Response decrement to repetitive stimuli. *3*. Continuous tremulousness. 4. Dramatic skin color changes with change of state =>the rest is normal.

multiple sclerosis (MS) demonstrates 3+ extensor tone in both lower extremities. The therapist needs to order a wheelchair. It would be BEST to recommend

A patient with strong extensor tone needs controls over the hips (pelvic belt) to maintain the hips in flexion.The tilt-in-space design best assists in keeping the patient from coming out of the chair when extensor spasms are active. ->*Tilt-in-space wheelchair with a pelvic belt* - A reclining back would only increase extensor tone and extensor spasms. - Elevating legrests assist circulatory flow in the lower extremities but may increase, not decrease, extensor tone. -Toe loops function to keep the feet on the foot pedals. In the event of an extensor spasm, they would not control for proximal tone

hyperthermia

Abnormally high body temperature

agitated patient with dementia inx

An agitated patient with dementia does not process information easily. *A calm and supportive approach with low-level commands (one or two actions)* provides the best approach for this patient

patient from TBI demonstrates sacral sitting with a rounded, kyphotic upper back. The therapist suspects the cause of this posture is

Excessive leg length on a wheelchair can result in sliding forward in the wheelchair to reach the foot plate. This results in a posterior tilt of the pelvis and sacral sitting

young child with newly diagnosed cystic fibrosis is being seen by a PT in the home. Which intervention should be considered for this patient

For a child this age, proper home interventions include secretion removal techniques including manual techniques performed by an adult-parents- once or twice a day

She is using a single-case experimental design with an A-B-A-B format. Her research hypothesis states that pain-rating scores will decrease with the treatment intervention. Acceptance of this hypothesis would be indicated if

In an A-B-A-B single-subject design, A represents multiple baseline measurements, and B represents multiple posttreatment measurements. If the hypothesis is accepted, the pain-rating scores will be lower following treatment compared with the baseline measurements

spinal stenosis

PT should educate the patient to avoid swimming using a crawl stroke; cause spinal extension

meta analysis refers to

Pooling of data of RCTs to yield a larger sample for quantitative systemic review

The patient w/low back pain is employed as a loading dockworker. He performs repetitive lifting and carrying of boxes weighing between 15 and 30 lb. An appropriate engineering control to reduce the stresses of lifting and carrying would be to

Provide a two-wheel handcart for use in moving the boxes; Implementation of an engineering control technique can be accomplished by designing or modifying the workstation, work methods and tools to eliminate/reduce exposure to excessive exertion, awkward postures and repetitive motions.

In what position should the knee be placed when performing a valgus stress test for the medial collateral ligament?

The medial collateral ligament is the primary restraint of valgus movement with the knee in 20 -30 flexion. =In less than 20 of knee flexion, the bony congruency of the knee and the cruciate ligaments contribute significantly to resisting a valgus force. =In greater than 30 of flexion, the joint capsule contributes significantly to resisting a valgus force.

navicular drop test in weight bearing can be utilized clinically in the examination of Medial longitudinal arch collapse

The navicular drop test is a measurement of the difference in navicular height in millimeters from standing subtalar joint neutral to standing relaxed foot posture and is used clinically as a composite measure (indicator) of excessive foot pronation. *Collapse of the medial longitudinal arch is typically associated with excessive rearfoot and midfoot pronation*

substrate

The reactant on which an enzyme works.

complaining of loss of cervical AROM. X-rays showed degenerative joint disease (DJD) at the uncinate processes in the cervical spine. The motion that would be MOST restricted would be

The uncinate processes (joints of Luschka) are located at the inferolateral aspect of the lower cervical vertebrae. Side-bending is lost with degenerative changes at the joint that the uncinate process makes with the vertebra below.

claudication

a condition in which cramping pain in the leg is induced by exercise, typically *caused by obstruction of the arteries*.

Normal Sa02

When using pulse oximetry, the therapist should expect a minimum of more than *88*%(M:88올림픽은 한국의 경제를 살리다) saturation during exercise.

spondylolisthesis

correct choice The spinal defect is spondylolisthesis, and the radiographic view that demonstrates the Scotty dog neck fracture is the *oblique view*. Incorrect Choices: A lateral radiographic view will show the degree of anterior or posterior slippage of one vertebra on another, *allowing the radiologist to grade the spondylolisthesis*.

O'Brien Test

labrum tear of SLAP lesion

lumbar spondylosis

degenerative changes such as osteoarthritis of the vertebral joints and degenerating intervertebral discs (degenerative disc disease) in the low back

patient with COPD has developed respiratory acidosis. The PT instructs a PT student participating in the care to monitor the patient closely for

*1*. Disorientation; symptoms of increased carbon dioxide levels in the arterial blood. Significant acidosis may lead to disorientation, stupor or coma -Tingling or numbness of the extremities and Dizziness or lightheadedness/ Hyperreflexia are sx of respiratory alkalosis

patient with metabolic syndrome is participating in a circuit-training program involving both aerobics and strength training. The therapist notices that the patient is sweating and having difficulty concentrating on an activity and coordinating movements. When asked if there is a problem, the patient is confused and has difficulty speaking. The therapist should

*Metabolic syndrome (prediabetic state*) is characterized by central obesity, insulin resistance, and dyslipidemia. Individuals with metabolic syndrome may develop hypertension and reactive hypoglycemia (as in this case) in response to exercise. -Signs and symptoms of hypoglycemia include difficulty concentrating and speaking, confusion and developing incoordination. -*The therapist should sit the patient down and administer fruit juice immediately*

manual lymphatic drainage techniques

- Lymphedema is a swelling of the soft tissues that occurs with an accumulation of protein-rich fluid in the extracellular spaces. -Causes of primary lymphedema include developmental abnormalities, heredity, surgery or unknown etiology. -Stage II lymphedema is characterized by nonpitting edema with connective scar tissue and clinical fibrosis. -cardinal principles: =proximal limb segments before distal, =trunk segments before limb segments and directing the flow of the lymphatics => *Decongesting the proximal portions of the limb first and working distally*

patient diagnosed with lumbar spinal root impingement due to narrowing of the intervertebral foramen has been referred to physical therapy for mechanical traction. What is the lowest percentage of body weight that should be considered for the initial traction force when using a split table

-In order to overcome the coefficient of friction of the body moving horizontally over the surface of a table, the traction force should be at least 25% of the body weight when using a split table, or 50% when using a nonsplit table. -To achieve joint distraction, a force of 50% body weight is recommended. However, because it is the initial traction, a minimum of 25% for the first treatment is recommended to determine patient response. This would provide sufficient force to decrease muscle spasm and stretch the soft tissue, thereby decreasing the compressive force on the spine and allowing for greater ease of joint separation as the force is progressed

a fracture of the proximal humerus, which has healed well. Upon examination, the therapist notes limitation in active shoulder flexion. The scapula protracts, elevates and upwardly rotates early and elevates excessively when the patient attempts to lift the arm. The NEXT thing the therapist should do

-Limitation of active shoulder flexion can be due to weakness (less than 3/5 strength) of any of the following muscles;deltoid, supraspinatus, serratus anterior and upper trapezius. However, the loss of active shoulder flexion could also be due to capsular restrictions. A patient who sustained a proximal humerus fracture and resulting immobilization would likely have a capsular restriction as well as muscle atrophy. *Performing passive shoulder flexion and glenohumeral accessory mobility testing will help determine the tissue( s) at fault*. If there are restrictions in passive shoulder flexion and capsular restrictions, a program including joint mobilization is appropriate. Incorrect Choices: -Manual muscle test of serratus anterior and rhomboids. Certainly, restricted shoulder flexion could be due to weakness in the serratus anterior. However, a weak serratus anterior would result in retraction of the scapula and possible winging, not protraction and upward rotation of the scapula. In addition, the rhomboids are downward rotators, retractors and elevators of the scapula. -Manual resistance exercises for the supraspinatus and infraspinatus. This treatment would be appropriate for weakness of the rotator cuff. -Large amplitude oscillations performed at the end-range of joint play for the glenohumeral inferior and posterior capsule. This treatment would be appropriate for capsular restrictions.

carcinoma of the colon

-Most common cause of large bowel obstructions in adults -def;cancer in the colon or rectum -Signs and symptoms may include blood in the stool, a change in bowel movements, weight loss, and feeling tired all the time

patient has a 4-year history of taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin for joint pain, and recently began taking a calcium channel blocker (verapamil). The IT examines the patient for possible adverse reactions/side effects that could include

-Stomach pain, bruising, confusion Correct Answer -With advanced age, the capacity of the individual to break down and convert drugs diminishes (secondary to decreased liver and kidney function, reduced hepatic and renal blood flow, etc.). -Some drugs additionally slow metabolism (e.g., calcium channel blockers like verapamil and diltiazem or antigout drugs like allopurinol).

home exercise program after liver transplantation

-The in-hospital program should be continued until the home care therapist can make his/her own assessment and plan of care. -The postoperative goals of improved ventilation, assisted mobility and AROM are appropriate for the 3-week postoperative time period, considering the debilitation before the abdominal surgery

patient with multiple sclerosis (MS) has been on prednisolone for the past 4 weeks. side effects of corticosteroid is

-This patient is receiving systemic corticosteroids to suppress inflammation and the normal immune system response during an MS attack. -Chronic treatment leads to adrenal suppression->hyperglycermia -Numerous adverse reactions/ side effects can occur. Those affecting the patient's capacity to exercise include *muscle wasting and pain, weakness and osteoporosis*. Weight loss is common (anorexia) with nausea and vomiting

transplant rejection

-sx =The organ's function may start to decrease =General discomfort, uneasiness, or ill feeling =Pain or swelling in the area of the organ (rare) =Fever (rare) =Flu-like symptoms, including chills, body aches, nausea, cough, and shortness of breath -causes =When a person receives an organ from someone else during transplant surgery, that person's immune system may recognize that it is foreign. This is because the person's immune system detects that the antigens on the cells of the organ are different or not "matched." Mismatched organs, or organs that are not matched closely enough, can trigger a blood transfusion reaction or transplant rejection. =These harmful substances have proteins called antigens coating their surfaces. As soon as these antigens enter the body, the immune system recognizes that they are not from that person's body and that they are "foreign," and attacks them.

cranio-cervical flexion testing

-used to To determine the function of the deep cervical flexors -findings of a normal test would be *during active chin tuck, the pressure in the stabilizer cuff increases to 22 and the patient can hold this position for 10 seconds*

middle cerebral artery stroke. Based on this diagnosis, a PT can expect that the patient will present with

1. Contralateral hemiplegia with central poststroke pain and involuntary movements. posterior cerebral artery(central territory) *2*. Contralateral hemiparesis and sensory deficits, with the arm more involved than the leg. 3. Decreased pain and temperature to the face and ipsilateral ataxia, with contralateral pain and thermal loss of the body; *characteristic of a CVA affecting the vertebral artery, and posterior inferior cerebellar artery (lateral medullary syndrome)* 4. Contralateral hemiparesis and sensory deficits, with the leg more involved than the arm; anterior cerebral artery

post-CVA is being treated in physical therapy for adhesive capsulitis of the right shoulder. Today, the patient complains of new symptoms, including constant burning pain in the right upper extremity that is increased by the dependent position and touch. The right hand is mildly edematous and stiff. In this case, the intervention that is CONTRAINDICATED

1. Stress loading using active compression during upper-extremity weight-bearing activities. *2*. Passive manipulation and ROM of the shoulder; This patient is demonstrating early signs of complex regional pain syndrome (CRPS) type I (formerly known as reflex sympathetic dystrophy). These changes typically begin up to 10 days after injury. Passive manipulation and ROM of the shoulder can further aggravate the patient's sympathetically maintained pain 3. Positional elevation, compression and gentle massage to reduce edema. 4. AROM exercises of the limb within a pain-free range to regain motion

diabetic foot care

1. Wash the feet daily and hydrate with moisturizing lotion. 2. Inspect the skin daily for inflammation, swelling, redness, blisters or wounds. 3. Use daily hot soaks and moisturize the skin; Daily hot soaks are contraindicated because of the increased risk of thermal injury. The patient with diabetes typically has loss of protective sensations 4. Wear flexible shoes that allow adequate room and change shoes frequently

During which phases of the gait cycle would a physical therapist expect to observe an everted posture of the calcaneus?

Correct Answer: Calcaneal eversion is a component of the triplanar motion described as rearfoot pronation. During the gait cycle, rearfoot pronation, caused by normal ground reaction forces, occurs from initial contact (heel strike) through loading response (foot-flat).

wrestler has been taking anabolic-androgenic steroids for the past 6 months to build muscle and improve performance. The PT working with the team suspects illegal drug use and examines the athlete for

Correct Answer - Rapid weight gain, marked muscular hypertrophy and mood swings = Signs and symptoms of anabolic steroid use include rapid weight gain, elevated BP, acne on the face and upper back and changes in body composition with marked muscular hypertrophy, especially in the upper body. Additional signs include frequent bruising, needle marks, male breast enlargement, or in females, secondary male characteristics and menstrual irregularities. -With prolonged use, jaundice or changes in personality (mood swings, rages) may develop

patient with MS demonstrates strong bilateral lower extremity extensor spasticity in the typical distribution of antigravity muscles. This patient would be expected to demonstrate

Correct Answer -Spasticity is typically strong in antigravity muscles. In the lower extremities, this is *usually the hip and knee extensors, adductors and plantarflexors*. -Strong extensor tone results in sacral sitting with the pelvis tilted posteriorly. This results in a rounded upper spine (kyphotic) and forward head. Incorrect Choices: -A laterally tilted pelvis with both lower extremities in a windswept position is likely the result of asymmetrical spasticity. -Hips are typically adducted and internally rotated, with extended lower extremities (scissoring position). -Skin breakdown can occur on the ischial tuberosities with sacral sitting

14-year-old girl complains of subpatellar pain after participation in an aerobic exercise program for 2 weeks. The PT's examination shows a large Q angle, pain with palpation at the inferior pole of the patella and mild swelling at both knees. The BEST intervention for this situation is

Correct Answer: -Q angles of greater than 15 o could be indicative of abnormal lateral patellar tracking. -VM muscle strengthening can reduce the tendency for the patella to track laterally. Incorrect Choices: -*VL strengthening can promote greater lateral patellar tracking and further irritation of the patellofemoral joint. VL strengthening may promote an outward pull or dislocation of the patella*. -In the closed chain, problems at the hip or foot can also contribute to patellofemoral pain syndrome. -Taping to increase lateral patellar tracking will exacerbate the problem.

elderly patient with a transfemoral amputation is having difficulty wrapping the residual limb. The PT's BEST course of action is to

Correct Answer: A shrinker is a suitable alternative to elastic wraps. It is important to select the right size shrinker to limit edema and accelerate healing. Incorrect Choices: -An Unna's paste dressing is applied at the time of initial surgery. -Use of a temporary prosthesis should be a prosthetic team decision and is based on additional factors such as age, balance, strength, cognition, and so forth. -Continuing to teach elastic bandage wrapping may be inefficient and ultimately fruitless, since the patient is elderly

During clinical examination, the nonmodified Ober's test is BEST used to assess for loss of extensibility of the

Correct Answer: Ober's test is used to assess the extensibility of the tensor fascia lata and iliotibial band and is performed with the patient in a side-lying position with the lower leg flexed at the hip and the knee for stability. The upper leg is passively abducted and slightly extended at the hip with the knee flexed to 90° (or extended). The examiner stabilizes the pelvis and allows the upper limb to slowly lower. The test is considered positive when the examined leg fails to lower beyond horizontal. The leg will remain abducted if the tensor fascia lata and iliotibial band are tight.

AROM is 35° of flexion and abduction with scapular elevation noted. *Passive ROM is nearly full* with mild pain and muscle guarding at the end of range. Resisted abduction is weak with pain noted in the anterior and lateral deltoid region. There is no atrophy. Based on the above findings, the physical therapist should MOST LIKELY suspect

Correct Answer: - A *rotator cuff tear would be provoked by resisted testing because it is a contractile lesion*. -The patient would not be able to raise the arm over the head because of lack of force transmission secondary to the tear. Also, the mechanism of injury (trauma) could cause a tear. *Incorrect Choices*: -A patient with supraspinatus tendinitis would likely be able to raise the arm overhead with a painful arc of motion or pain at end range. It is also more typically caused by overuse. -An adhesive capsulitis would exhibit only a small amount of more passive range than active because the tight capsule is restricting ROM. -An axillary nerve palsy is typically caused by a dislocation and would cause marked atrophy of the deltoid

During an exercise tolerance test (ETI), a patient demonstrates a poor reaction to increasing exercise intensity. An absolute indication for terminating this test is

Correct Answer: -an absolute indication for terminating an exercise is the onset of moderate to severe angina. - Other absolute indications include acute Ml, *a drop in systolic BP with increasing workload*, serious arrhythmias (second- or third-degree heart blocks, sustained ventricular tachycardia or premature ventricular contractions, atrial fibrillation with fast ventricular response) unusual or severe shortness of breath, CNS symptoms (ataxia, vertigo, confusion), or patient's request. Incorrect Choices: fatigue, 1.5 mm downsloping ST segment(>2) and supraventricular tachycardia are considered relative indications and would require close monitoring.

patient with complete C6 tetraplegia (ASIA A) should be instructed to initially transfer with a sliding board using

Correct Answer: The patient with complete C6 tetraplegia will lack triceps (elbow extensors), and should be taught to lock the elbow for push-up transfers by using shoulder external rotators and extensors to position the arm; the *anterior deltoid-shoulder flexor- locks the elbow by reverse actions* (all of these muscles are functional). =>cervical innervation levels and transfer skills for SCI Incorrect Choices: -Triceps are not functional in this patient. - Pectoral muscles cannot be used to stabilize the elbows in extension.

patient with stasis dermatitis secondary to venous insufficiency is being examined by the physical therapist. Visual inspection of the skin can be expected to reveal

Correct Answer: *Hemosiderin staining* is indicative of venous insufficiency. It is characterized by dark pigmentation (bluishred color) and results from leakage of hemosiderin (the by-product of red cell hemolysis) in the presence of blood stasis and incompetent valves. Incorrect Choices: Red, oozing crusting rash, erosions, exudate and pruritic vesicles are characteristic of eczema

severe traumatic brain injury and multiple fractures after a motor vehicle accident. On day 1, the patient is semialert, and drifts in and out during physical therapy. On day 2, the patient is less alert with changing status. Signs and symptoms that would require emergency consultation with a physician include

Correct Answer: *Signs of increased intracranial pressure secondary to cerebral edema and brain herniation include decreasing consciousness with slowing of pulse and Cheyne-Stokes respirations*. Cranial nerve dysfunction is typically noted in CN II (papilledema) and CN III (dilation of pupils). Incorrect Choices: 1. Developing irritability, with increasing symptoms of photophobia, disorientation and restlessness. 2. Decreasing function of cranial nerves IV, VI and VII. 3. Positive Kernig's sign with developing nuchal rigidity -> *signs of meningeal irritation and CNS infection*. All of the problems listed are serious, and can be life-threatening.

CONTRAINDICATION to initiating extremity joint mobilization on a patient with chronic pulmonary disease may include

Correct Answer: *Very often, patients with chronic pulmonary disease have been managed using corticosteroid therapy*. Longterm steroid use has the catabolic effects of osteoporosis, weakened supporting joint structures and muscle wasting, making joint mobilization contraindicated. Incorrect Choices: -Inhalation therapy, even with a corticosteroid, has minimal systemic uptake of the drug and, therefore, would not be a contraindication to performing joint mobility. -A functionally limited thorax may be considered when deciding on the starting body position for joint mobility, but will not change the ability to perform the task.

The optimal position for ventilation of a patient with a C5 SCI (ASIA A) is

Correct Answer: -A patient with a C5 SCI will not have the abdominal musculature necessary to return the diaphragm to a high-domed position during exhalation. -Inspiration will be affected by the change in the diaphragm's resting position. *In the supine position, gravity will take the place of abdominals, holding the abdominal contents under the diaphragm, improving the zone of apposition, the height of the diaphragm dome and therefore, the ability to ventilate*. Incorrect Choices: The other positions listed negate the positive effects of gravity acting on the abdomen to hold the abdominal contents under the diaphragm

2-year history of ALS and exhibits moderate functional deficits. The patient is still ambulatory with bilateral canes, but is limited in endurance. An important goal for the physical therapy POC should be to prevent

Correct Answer: -ALS is a progressive degenerative disease that affects both upper and lower motor neurons. - An important early goal of physical therapy is to maintain the patient's level of conditioning, while *preventing overwork damage in denervated muscle*(lower motor neuron injury). Incorrect Choices: - Myalgia is common in lower motor neuron lesions. It can be ameliorated but not prevented. - Ataxia and radicular pain are not associated with ALS.

patient with brittle (uncontrolled) diabetes mellitus is being seen in physical therapy for a prosthetic checkout. The patient begins to experience lethargy, vomiting and abdominal pain. The therapist notes weakness with some confusion, and suspects

Correct Answer: -An insulin deficiency in a patient with diabetes leads to the release of fatty acids from adipose cells with a production of excess ketones by the liver (*diabetic ketoacidosis*). -The *therapist should report these changes immediately; the patient is in need of immediate intravenous insulin, fluid and electrolyte replacement solutions*. Incorrect Choices: - Respiratory acidosis is caused by inadequate ventilation and the retention of carbon dioxide. -Renal acidosis is the result of kidney failure, with accumulation of phosphoric and sulfuric acids. - Lactic acidosis is an accumulation of lactic acid in the blood due to tissue hypoxia, exercise, hyperventilation or some drugs

6-year-old boy has a diagnosis of Duchenne's muscular dystrophy, with more than a third of lower extremity muscles graded less than 3/5. The child is still ambulatory with assistive devices for short distances. The MOST appropriate activity to include in his POC would be

Correct Answer: -Exercise at low to moderate intensities is the general rule for patients with muscular dystrophy. -Because of the young age of this child, exercise should be fun. Recreational exercise (swimming) satisfies this requirement and should be helpful in maintaining functional level as long as possible. -At 6 years of age, wheelchair confinement is not usual. Incorrect Choices: -Muscles with grades of 3 or less will not benefit from active or resistive exercise. -Progressive resistance strength training and circuit training can be harmful at high intensities, producing overwork injury. -Wheelchair sports is not applicable for a 6-year-old child

During a sensory examination, a patient complains of a dull, aching pain and is not able to discriminate a stimulus as sharp or dull. Two-point discrimination is absent. Based on these findings, the pathway that is intact is the

Correct Answer: -Sensations interpreted as dull, aching pain travel in the anterior (paleo)spinothalamic tract. Incorrect Choices: -Discriminative, fast pain is carried in the lateral (neo)spinothalamic tract. -Discriminative touch is carried in the proprioceptive pathways (fasciculus gracilis/cuneatus, medial lemniscus).

The use of ultrasound in the area of a joint arthroplasty is permissible, even if the surrounding area contains

Correct Answer: -Several studies have shown the safe use of US over metal implants; The acoustical energy is dispersed throughout the metal and is absorbed into the surrounding tissue. There is no significant heating within the implant. Incorrect Choices: 1. Plastic implants. 2. Infected tissue. 3. Neoplastic lesions are contraindications for the use of US.

A patient presents with limited ankle dorsiflexion range of motion both actively and passively when tested with the knee flexed. Which of the following tests would be MOST beneficial to confirm the suspected reason for the decreased range of motion?

Correct Answer: -Testing the joint mobility of the talocrual and distal tibiofibular joints would be indicated if a restriction in the arthrokinematic glide of the talocrual joint was present and therefore limiting the dorsiflexion range of motion. -The other possibility would be decreased flexibility in the soleus. If this was the case, then a finding of normal joint mobility would indicate that decreased soleus flexibility was the culprit. Incorrect Choices: -Testing active and passive range of motion with the knee straight would add a potential influence from the gastrocnemius as this is a two-joint muscle crossing the ankle and the posterior aspect of the knee. Since the initial testing position with the knee flexed indicated restricted range of motion, adding the effect of the gastrocnemius would provide no additional useful information. -*The restricted range of motion was present both actively and passively, ruling out decreased muscle performance as a potential reason for the limitation in range of motion*

obtaining laboratory cultures

Correct Answer: -The specimens must be collected from the wound site with a minimum of contamination by material from adjacent tissues. -The exudate provides the best culture. Incorrect Choices: -The margins of cutaneous lesions or pressure ulcers are usually contaminated with environmental bacteria. -Using the dressing for a specimen sample would also contain contaminated tissues

patient is recovering from a right cerebrovascular accident (CVA), resulting in severe left hemiplegia and visuospatial deficits. In addition, there is a large diabetic ulcer on the left foot with pitting edema. The BEST choice for wheelchair prescription for this patient

Correct Answer: A hemiplegic chair has a low seat height (17 1/2 inches as compared with the standard seat height of 19 inches) and is the best choice for this patient. The patient propels it with the sound right hand and leg. An elevating leg rest on the left is indicated for edema. Incorrect Choices: - A one-arm drive wheelchair has both drive mechanisms located on one wheel. The patient can propel the wheelchair by using one hand. It is *contraindicated in patients with cognitive or perceptual deficits* (as in this case). -The electric wheelchair with joystick might also work but is significantly more expensive and less transportable and would also require increased maintenance. - The seat height of a standard height wheelchair (lightweight active duty wheelchair) would be too high to allow propulsion using the sound foot and hand.

Which of the following is a correct reason to terminate a maximum exercise tolerance test for a patient with pulmonary dysfunction

Correct Answer: A maximum exercise tolerance test is a sign- or symptom-limited test. Dyspnea with a drop of 20 mm Hg in Pa02 is an indication for stopping the test. Incorrect Choices: -Achieving age-adjusted predicted maximum HR is not a sign or symptom, and therefore does not stop the test. -HR is expected to increase with normal rhythm. - ST segment depression, not a flat ST segment, reveals ischemia and would be a reason to stop the test

pain (7/10) and limited range of motion (ROM) of the right shoulder as a result of chronic overuse. The PT elects to use procaine hydrochloride iontophoresis as part of the intervention for this patient's problems with Continuous monophasic current, with the medication under the anode

Correct Answer: Because like charges are repelled, the positively charged medication would be forced into the skin under the positive electrode (anode). A continuous, unidirectional current flow is very effective in repelling ions into the skin. Procaine is a positive medicinal ion, and will be repelled from the anode (positive pole). Incorrect Choices: A pulsed, interrupted or bidirectional current generates less propulsive force owing to the discontinuous nature of the current. N;나는 아프다. 나(negative) 아프다(anode) Negative는 애니와 데니와 데이트하다

diagnosis of Bell's palsy. Which cluster of examination findings below would the physical therapist expect to find?

Correct Answer: Decreased function of the facial nerve (cranial nerve VII) is associated with motor weakness of the muscles of facial expression, which could result in a *decreased ability to close the eye tightly, raise the eyebrow and raise the corner of the mouth as in a smile*. Other functions of the facial nerve include *taste to the anterior tongue, tearing, salivation* and dampening sound. Incorrect Choices: -Ptosis is related to decreased function in the oculomotor nerve (CN III). -Motor function to the muscle of mastication and sensation to the face are functions of the trigeminal nerve ( CN V). -Motor function of the tongue is a function of the hypoglossal nerve ( CN XII). -The gag reflex is a function of the glossopharyngeal ( CN IX) (efferent) and vagus ( CN X) (afferent) nerves. -Abduction of the eye is a function of the abducens nerve ( CN VI).

10-year history of Parkinson's disease (PD) has been taking levodopa (Sinemet) for the last 5 years. The patient presents with deteriorating function and is no longer able to walk independently due to constant and uncontrolled involuntary movements. During the examination, the PT observes that the *patient is restless, with constant dancing, hyperkinetic movements of his legs*. The therapist's BEST course of action is to

Correct Answer: Dyskinesias (involuntary movements) are caused by an adverse effect of prolonged use of dopamine. Document the observations and refer the patient back to the physician for possible medication adjustment. Incorrect Choices: -Selegiline is used in early PD; its main adverse effects include nausea, dry mouth, dizziness, anxiety and hallucinations. Failure to notify the physician of these documented adverse effects can jeopardize the patient's functional outcomes and safety.

patient demonstrates hesitancy in getting started and is then unable to control the movement. The moving finger slams into the side of the face and misses the nose completely

Correct Answer: Dysmetria refers to impaired ability to judge the distance or range of movement. Incorrect Choices: -Response orientation refers to the ability to select the correct movement in response to a stimulus. -Dysdiadochokinesia refers to impaired ability to perform rapid alternating movements. - Dyssynergia refers to impaired ability to associate muscles together for complex movement (decomposition of movement)

patient felt an immediate sharp pain in the right lower back. The following morning, the patient reported stiffness, with easing of pain after taking a shower. Based on this information, the source of the pain is MOST LIKELY

Correct Answer: Facet joint dysfunction is *exacerbated with sustained positions, and eases with movement*. Progressive increase in activity intensifies the pain. Incorrect Choices: -Stress fracture pain is worse when weight-bearing, and is not necessarily worse in the morning. - Nerve root involvement would cause radiating pain to the extremity. - The spinal cord has no innervation and is not a source of pain

complains of right buttock pain after slipping. The right hip had been forced into internal rotation. Lumbar active motion testing is full and pain free. Neurological findings are unremarkable. Sl provocation testing is unremarkable. Passive hip internal rotation is limited with pain and pulling noted in the right buttock region. Resisted external rotation produces pain in the same region

Correct Answer: Forceful hip internal rotation would overstretch and potentially strain the piriformis muscle. Limited passive hip internal rotation would reproduce symptoms from a tight or tense piriformis. Pain with resisted external rotation would suggest a contractile problem with the piriformis. Incorrect Choices: - Unremarkable sacroiliac provocation testing would rule out the sacroiliac joint as a cause of symptoms. - Full pain-free lumbar AROM would rule out a quadratus lumborum strain. -Negative neurological findings and neural tension would assist in ruling out an LS/Sl disc herniation

from stroke is having difficulty bearing weight on the left leg. The patient is unable to advance the tibia forward and abbreviates the end of the stance phase on the left going directly into swing phase. The MOST LIKELY cause of the patient's problem is:

Correct Answer: Forward advancement of the tibia from midstance to heel-off is controlled by eccentric contraction of the plantarflexors; from heel-off to toe-off, the plantarflexors contract concentrically. Either spasticity or contracture of the plantarflexors would limit this forward progression. Patients compensate by going right into swing, typically with a circumducted gait or with increased hip and knee flexion because there is no pushoff. Incorrect Choices: -Spasticity or contracture of the dorsiflexors is typically not seen, and could not cause this deficit. -Weakness of the hip extensors would be evident at heel strike, with a backward lean of the trunk

presents with an enlargement in the neck in the area of the Adam's apple. The growth is resulting in difficulty while eating and episodes of dyspnea. The patient also has abnormal protrusion of the eyes

Correct Answer: Graves' disease is caused by excess secretion of thyroid hormone (hyperthyroidism) and produces a number of clinical manifestations. Difficulty eating, mild facial edema, and abnormal protrusion of the eyes ( exophthalmos) are classic signs. Other symptoms can include heat intolerance, nervousness, weight loss, muscle weakness and fatigue, tremor and palpitations. Incorrect Choices: -Chronic autoimmune thyroiditis (Hashimoto's disease) causes hypothyroidism. A number of clinical manifestations can occur,including muscle weakness and fatigue. -Patients with fibromyalgia can also develop hypothyroidism. -Hyperparathyroidism is caused by overactivity of the parathyroid glands, leading to elevated serum calcium levels (*hypercalcemia, increased bone absorption*, hypercalciuria) and decreased serum phosphate levels.

The multifidi are in spasm because of pain. During the examination, the patient is asked to perform a concentric activity involving the multifidi. The expected US image of the cross-sectional area (thickness) of the muscle when compared to the resting state of the muscle would

Correct Answer: If a muscle were in a hypertonic state (muscle spasm), one would expect little change in cross-sectional area (CSA) since the exercise engages a muscle that is already contracting to some extent. Incorrect Choices: - Normally, as a muscle concentrically contracts from its resting state, the CSA increases and the length decreases. -A variety of factors can influence the CSA if the muscle is in a lengthened position, CSA won't increase much if another muscle invades the space of that muscle (e.g., longissimus invading the multifidus space), it may decrease or limit the CSA of the muscle being monitored the angle of the transducer head can alter the dimensions of the muscle

The patient is now scheduled for a lateral release and is worried about any complications of the surgical procedure. The patient asks the therapist to describe any potential complications. The therapist's BEST response is to

Correct Answer: It is within the surgeon's scope of practice to discuss the indications and problems that could arise from this surgical procedure. Incorrect Choices: It is not within the PTs scope of practice to be the expert that discusses problems associated with surgery. Referral should be made to the physician, not another therapist

patient is able to walk independently with an assistive device in the hall outside the PT gym. When asked to walk across the hospital lobby and through a revolving door, the patient slows down considerably and stops by the revolving door, unable to proceed. The therapist determines

Correct Answer: Open motor skills are movement skills that can be performed in a variable, changing environment. Externally paced skills must comply with timing demands from the environment (e.g., walking through a revolving door). Incorrect Choices: -Closed motor skills are movement skills that are performed in a stable, nonchanging environment. -Serial skills are movements that combine a series of discrete elements, with a specific order of elements. -Continuous skills are movement skills that appear to have no recognizable beginning or inherent beginning and end.

complains of back pain, the PT notes pain with end-range active range of motion (AROM) into left hip flexion, abduction and external rotation. The origin of the pain is MOST LIKELY the:

Correct Answer: Pain at *end-range* of flexion, abduction, external rotation and extension *(FABERE test) is diagnostic for SI joint dysfunction because it both gaps and compresses the joint*. =M:*S*I is south asia far away-end range-from ny. Incorrect Choices: -*Pain at the midrange into hip flexion, abduction and external/lateral rotation suggests hip joint pathology*. -Patient reported low back pain, and if the sartorius or the hip were involved, the complaint of pain would have been reported in the anterior and medial thigh. -Renal pain is often referred to the costovertebral region, flank, or lower abdominal quadrant.

factory worker injured the right arm in a factory press with damage to the ulnar nerve at the elbow. A diagnostic electromyogram (EMG) was performed 3 weeks after the injury, with evidence of spontaneous fibrillation potentials. In this case, the PT recognizes that

Correct Answer: Spontaneous fibrillation potentials and positive sharp waves present on EMG 2-3 weeks after injury are evidence of denervation. This occurs with axonotmesis, a class 2 peripheral nerve injury (PNI) with axonal damage and Wallerian degeneration distal to the lesion. Incorrect Choices: -Polyphasic motor units of low amplitude and short duration are evidence of reinnervation. -Neurapraxia is a class 1 PNI with local compression or blockage. EMG typically reveals no spontaneous activity

child with a history of primary lymphedema of the right lower extremity that was diagnosed at birth. Thickening of skin folds of the toes is evident. The therapist documents these findings as

Correct Answer: Stemmer's sign is positive for lymphedema in the presence of a thickened cutaneous fold of skin over the dorsal proximal toes or fingers. There is an inability or difficulty lifting up or pinching the skin in this area. It appears in the late stages of lymphedema. Incorrect Choices: -Pitting edema is present in early stage I (reversible) lymphedema, while during stage II pitting is difficult to induce due to the presence of fibrotic tissue. - Dermal backflow refers to the movement of a tracer substance back down the limb during a lymphoscintigram. -The scenario clearly rules out secondary edema since the history is indicative of primary lymphedema.

presents to the emergency room with complaints of fever, shaking chills, and a worsening productive cough. Complaints of chest pain over the posterior base of the left thorax are made worse on inspiration. An anteroposterior x-ray shows an infiltrate on the lower left thorax at the posterior base. This patient's chest pain is MOST LIKELY caused by

Correct Answer: The case is supportive of a pulmonary process as evidenced by radiography and history. Because the radiographic findings and the pain are in the same vicinity and worsen with inspiration, the likelihood is that this pain is pleuritic in origin. *Infected pleura*(pleuritis)

C5 tetraplegia. The PT is performing PROM exercises on the mat when the patient complains of a sudden, pounding headache and double vision. The therapist notices that the patient is sweating excessively, and determines BP at 240/95. The therapist's BEST course of action is

Correct Answer: The patient is exhibiting autonomic dysreflexia (an emergency situation). The therapist should first sit the patient up and check for irritating or precipitating stimuli (e.g., a blocked catheter). The next step is to call for emergency medical assistance. Incorrect Choices: Placing the patient supine can aggravate the situation.

patient is unable to perform overhead activities because of a painless inability to reach past 80 of right shoulder abduction. The "empty can" test was positive. Early subacute physical therapy intervention should focus on

Correct Answer: The patient is most likely suffering from a supraspinatus tear or impingement Acute physical therapy intervention should focus on reduction of pain and inflammation. During the early subacute phase, active assistive pulley exercises would be indicated to promote healing of the supraspinatus muscle and maintain AROM of the glenohumeral joint. Incorrect Choices: -Performing a superior glide-extension- of the glenohumeral joint would not be beneficial to improve elevation of the arm. -Use of modalities-for acute sx- is not the focus at this point of intervention. -Resistance exercise would be too difficult and not beneficial to promote healing of the injured tissues.

hospitalized for 3 weeks after a surgical resection of carcinoma of the colon. During the initial sessions, the patient complains of pain in the left shoulder that is aggravated by weight bearing when using the walker. The therapist decides to

Correct Answer: The risk of metastatic disease is present; the therapist should notify the physician immediately. Incorrect Choices: -Monitoring or modifying the plan of care to reduce pain should be considered only after consultation with the physician. -If metastatic disease is present, the US would be contraindicated. -Ambulating in the parallel bars exerts the same weight-bearing forces through the upper extremities as does a walker.

patient is receiving immunosuppressants( cyclosporine) following renal transplantation. Initial examination reveals paresthesias in both lower extremities, with peripheral weakness in both hands and feet. The therapist determines that the patient is MOST LIKELY experiencing

Correct Answer: This patient is experiencing peripheral neuropathy, as evidenced by the paresthesias and distal weakness in both hands and feet. Incorrect Choices: -Whereas myopathy may be a potential adverse effect of immunosuppression, it would not present as symmetrical distal weakness with paresthesias. -Quadriparesis can also occur with immunosuppression, but would present with spasticity and more widespread paresis. -Leukopenia is an abnormal decrease in the number of white blood cells, and can also occur with immunosuppression.

traction injury to the anterior division of the brachial plexus, the PT would expect to see weakness of the elbow flexors, wrist flexors, and forearm pronators. The therapist would also expect to find additional weakness in

Correct Answer: Thumb abductors are innervated by the median nerve, primarily by the C6 nerve root. The anterior divisions contribute to nerves that primarily serve flexors and, in this case, the thumb. Incorrect Choices: All other choices are innervated by nerves off the posterior division. -Wrist extensors include the extensor carpi radialis longus (ECRL), extensor carpi radialis brevi (ECRB), innervated by the radial nerve C6-7 and the extensor carpi ulnaris (ECU), innervated by the radial nerve C6-8. -Supination results from action of the biceps brachii (musculocutaneous nerve C5-6) and the supinator (radial nerve C6).

patient is diagnosed with a deep vein thrombosis (DVT). The patient was immediately started on an anticoagulant and the therapist is preparing for treatment. The BEST treatment program should include

Correct Answer: To assist with venous return and decrease edema, pain and clot extension, intermittent pneumatic compression stockings are used. Incorrect Choices: - The patient should not be kept on strict bed rest nor should treatment be deferred (both choices contribute to venous stasis). - Vigorous walking is contraindicated.

appropriate fine motor behavior that should be established by 9 months of age is the ability

Correct Answer: Transferring objects from one hand to another is a task developmentally appropriate for an 8-or 9-monthold. Incorrect Choices: -A fine pincer grasp is an 11-month skill -stacking 2 blocks is a 12-15 month skill, while stacking 6 blocks is a 16-24 month skill. -Holding a cup by the handle while drinking usually occurs by 12 months of age

sensory changes secondary to left CVA. Upon testing, the patient is unable to detect pinprick or temperature in the right hand, leading to disuse and increased safety risk

Correct Answer: *Anal*gesia refers to a complete loss of pain sensibility (in this case); N;paining in anal Incorrect Choices: -Anesthesia is a more global term referring to loss of sensation.(마취제) - Abarognosis refers to an inability to recognize weight. -Allodynia refers to pain produced by a non-noxious stimulus (e.g., light touch).

adolescent female is referred to physical therapy with a diagnosis of anterior knee pain. Positive findings include pes planus, lateral tibial torsion and genu valgum. The position that the femur will be in is excessive

Correct Answer: *Common abnormal postural findings consistent with anterior knee pain in an adolescent female include pes planus, lateral tibial torsion and genu valgum. These are compensatory changes that occur when the femur is in excessive medial rotation*. Incorrect Choices: -Abduction is associated with coxa valga (an increase in the angle of the femoral head to the neck), which is not commonly associated with knee pain. -Lateral femoral rotation is commonly observed with genu varum. -Retroversion of the hip is an abnormally small angle between the femoral neck and the condyles, and is not affected by posture

When conducting a bicycle ergometer test on a patient with a history of a myocardial infarction and diabetes, it is MOST important to monitor

Correct Answer: - *Patients with diabetes are prone to silent ischemia and therefore may not feel traditional anginal symptoms*. A 12-lead ECG will provide real-time information as to whether the patient is experiencing ischemia. Incorrect Choices: -Angina is not a reliable indicator of ischemia in this case. -Perceived exertion and age predicted heart rate do not provide enough specific information when monitoring a patient during an ergometer test with a combination of history of Ml and diabetes.

When conducting the anterior drawer stress test at the ankle one week following acute inversion injury, the physical therapist is attempting to test mechanical stability provided primarily by the

Correct Answer: - *The anterior talofibular ligament (ATFL) provides the main restraint to anterior lateral translation of the talus within the mortise*. -Passive anterior translation of the talus is performed in 20 o of plantarflexion. Excessive anterior translation of the talus during an anterior drawer test is considered indicative of significant laxity or rupture of the ATFL, and the test appears to be the most useful when performed within 4-7 days of the initial injury. Incorrect Choices: -The calcaneofibular ligament acts as the primary restraint to inversion when the ankle is in neutral or dorsiflexion and limits talar tilt. Testing of lateral talar tilt would be performed when attempting to examine integrity of the calcaneofibular ligament. -The lateral talocalcaneal ligament is associated with stability of the talocalcaneal ( subtalar joint) and would not offer significant restraint to motions of the talus within the mortise joint. - The anterior tibiofibular ligament stabilizes the distal tibiofibular joint and would not offer restraint to anterior translation of the talus.

For arm exercise as compared with leg exercise, at a given workload, the PT can expec

Correct Answer: - Arm ergometry uses a smaller muscle mass than leg ergometry, with resulting lower maximal oxygen uptake->In upper extremity exercise, both HR and BP will be higher than for the same level of work in the lower extremities

most efficient intervention to regain biceps brachii strength if the muscle is chronically inflamed and has a painful arc of motion is

Correct Answer: - For a muscle that is chronically inflamed, focus should be placed on eccentric contractions, because there is less effort and stress placed on the contractile units than with concentric contractions at the same level of work. -The exercise should be performed in the pain-free portion of the range. Incorrect Choices: Isokinetic, isometric and isotonic exercises do not allow for pain-free muscle contractions and can cause further inflammation of the muscle.

As the result of blunt trauma to the quadriceps femoris muscle, a patient experiences loss of knee function. The BEST choice for early physical therapy intervention is

Correct Answer: - Gentle weight-bearing AROM exercises to patient's tolerance will minimize the chance of myositis ossificans and promote improved function. -KC(key concept);*myositis ossificans*-bone in muscle- and exercise after blunt muscle trauma of the lower extremity Incorrect Choices: -Aggressive soft tissue stretching and strengthening can promote myositis ossificans. -Gentle PROM exercises in a non-weight-bearing position is not likely to maintain knee function

patient with breast cancer had a surgical removal of the mass, followed by 12 weeks of chemotherapy (six treatments) and 8 weeks of radiation therapy (daily). She is referred to physical therapy for mobilization of her upper extremity. The therapist recognizes that in providing postradiation therapy, it is important to

Correct Answer: - Immediate effects of radiation include skin effects (erythema, edema, dryness, itching, hair and fingernail loss and loose skin). -The therapist should *observe skin care precautions* (avoid topical use of alcohol and drying agents and avoid positioning the patient directly on the radiated area). -Exposure to heat modalities is also contraindicated. Incorrect Choices: -Stretching exercises are important during and after radiation. -Low-to moderate-intensity aerobic exercise is appropriate.

complaints of weakness and unsteady gait. The patient had a kidney transplant 2 years ago. Medications included oral steroids and immunosuppression agents. Examination reveals decreased proprioception and strength 4/5 both lower extremities. Berg Balance Test score was 40/56. The MOST important action for the PT to take in this case is to

Correct Answer: - Myopathy and neuropathy can develop, indicating rejection in a patient with a solid organ transplant in either the acute or the chronic stage. - Given the onset of the new symptoms, reporting the changes and securing medical follow-up are the most important actions for the therapist. -KC; the patient's symptoms are *indicative of transplant rejection* and require referral to the primary care physician for follow-up Incorrect Choices: -Although initiating an exercise program would be indicated, the stated balance exercises are at too low a level considering the Berg Balance score. -Progressive resistance exercises would not be the exercise of choice due to possible rejection problems.

patient diagnosed with lumbar spondylosis without discal herniation or bulging has a left LS neural compression. The most likely structure compressing the nerve root is the

Correct Answer: - The ligamentum flavum becomes hypertrophied with lumbar spondylosis and may invade the intervertebral foramen, compressing the left LS spinal nerve root. -KC; lumbar anatomy and lumbar spondylosis Incorrect Choices: -The supraspinous ligament and anterior longitudinal ligaments are unlikely to compress any neurological structures based on their anatomical locations. -The posterior longitudinal ligament is so small and centrally located in the lower lumbar region that it is not able to compress a spinal nerve (actually more likely to compress the spinal cord [i.e., cauda equina]).

After completing an examination of a patient with shoulder pain, the PT concludes that the cause is subscapularis tendinitis. The clinical finding supportive of this conclusion is

Correct Answer: - The subscapularis is an internal rotator of the humerus. -It will be *painful if passively stretched into external rotation* and irritated when contracting or being resisted when the shoulder internally rotates. -The muscle inserts onto the lesser tubercle of the humerus and plays no role in shoulder adduction. Incorrect Choices: -**Active glenohumeral external rotation does not require activation of the subscapularis muscle**. -The subscapularis attaches to the lesser tuberosity. The subscapularis is not the primary mover for shoulder adduction, so is not likely to be painful with resisted shoulder adduction

local tenderness with swelling and pain on movement in the hip area. While palpating the tissues, the therapist detects a mass. The therapist's BEST course of action is

Correct Answer: - These signs and symptoms are characteristic of heterotopic ossification (HO), an abnormal bone growth typically around a joint. -While the etiology is unknown, its presence can lead to serious ROM limitations. These findings should be *reported promptly to the physician*. incorrect Choices: -Petrissage and aggressive ROM exercises could exacerbate the condition. -Ice does decrease metabolic activity; however, more in-depth medical management is required

arterial blood gas analysis with the following values: Fraction of inspired oxygen (Fi02) = 0.21 Arterial oxygen pressure (Pa02) =53 mm Hg Arterial carbon dioxide pressure (PaC02) = 30 mm hg-normal range is, pH= 7.48 Bicarbonate ion = 24 mEqjL This would indicate the patient is in

Correct Answer: - This arterial blood gas shows an increased pH, which is an alkalosis. -When looking at arterial blood gas values, carbon dioxide-nornal range is 35~45m- can be viewed essentially as an acid. If the carbon dioxide level is low, then you have less acid, or a resulting alkalosis. This is, therefore, a *respiratory alkalosis*. -Values at sea level: = Partial pressure of oxygen (PaO2): 75 - 100 mmHg. =Partial pressure of carbon dioxide (PaCO2): 38 - 42 mmHg. =Arterial blood pH: 7.38 - 7.42. Incorrect Choices: -Because the blood pH is higher than normal (7.35-7.45), the condition is an alkalosis, not an acidosis. -If the increased pH was due to a metabolic disorder, a high bicarbonate value would be anticipated. As the HC03 is normal (24 mEqjdL), the alkalosis is not from a metabolic cause

PT communication with other health professional

Correct Answer: - When a referral relationship exists with another health care professional, it is the PTs responsibility to communicate with the referring practitioner regarding the physical therapy examination, treatment plan and management of the referred patient. -This is particularly crucial when the findings are inconsistent with the referrer's diagnosis. Incorrect Choices: The therapist cannot diagnose metastatic cancer but can be held responsible for not communicating with the primary physician

type 1 insulin-dependent diabetes mellitus (IDDM), controlled with twice daily insulin injections. In order to minimize the risk of a hypoglycemic event during exercise

Correct Answer: -The patient should monitor blood glucose levels frequently when initiating an exercise program and *avoid exercise during periods of peak insulin* activity (2-4 hours after injection). -The therapist should use RPE in addition to HR to monitor exercise intensity. Incorrect Choices: -A carbohydrate snack should be eaten before and during prolonged exercise bouts. -Blood glucose levels should be monitored frequently throughout the day, not weekly. -Exercise should begin with daily sessions, 20 minutes twice a day, not 40-to 50-minute sessions.

postoperative rehabilitation following a Type II SLAP repair performed 1 week ago. The physical therapist should

Correct Answer: -*Internal rotation ROM does not create the peel back mechanism that increases stress to the repair*. -Given the nature of this repair, an understanding of the postoperative precautions is paramount to a successful surgical outcome. Incorrect Choices: -Type II SLAP lesions are characterized by a detachment of the superior labrum and the origin of the tendon of the long head of the biceps brachii that results in instability of the biceps-labral anchor. The surgery requires reattachment of the labrum and biceps anchor. -*Given the repair of the biceps, contraction and stretching of the biceps should be avoided during the maximum protection phase. In addition, external rotation ROM/stretching should be avoided given the peel back mechanism and increased stress to the repair*.

functional goal for a 5-year-old child with a high lumbar lesion (myelomeningocele, L2 level) and minimal cognitive involvement would be

Correct Answer: -A child with a high-level myelomeningocele will be able to ambulate for limited (household) distances with an RGO and Lofstrand crutches. -Physiological benefits include improved cardiovascular and musculoskeletal functions. Incorrect Choices: - The child will not be able to be a community ambulator because of the high-energy expenditure necessary with this level of lesion. - An RGO is the best choice. The hips are joined by metal cables that prevent inadvertent hip flexion (possible using KAFOs) during a reciprocal two-or four-point gait

A PT observes genu recurvatum during ambulation in a patient with hemiplegia. the lower extremity score to be 22 (of a possible 34 ), *with strong synergies in the lower extremity and no out-of-synergy movement*. The most likely cause of this deviation is

Correct Answer: -A hyperextended knee can be caused by extensor spasticity, quadriceps weakness (a compensatory locking of the knee), or plantarflexion contractures or deformity. -The most likely cause in this case is extensor spasticity, which is *consistent with strong obligatory synergies*;(stage 3 recovery). Incorrect Choices: -Spasticity in dorsiflexors is atypical and would not cause knee hyperextension. -Hip flexor and hamstring weakness would result in decreased lower extremity clearance during swing

A PT examines a patient with a right CVA and determines that the patient has a profound deficit of homonymous hemianopsia. The BEST INITIAL strategy to assist the patient in compensating for this deficit is to

Correct Answer: -A patient with homonymous hemianopsia needs to be made aware of the deficit and instructed to turn the head to the affected left side (a compensatory training strategy). Incorrect Choices: -Initial strategies include placing items on the right (unaffected side), not the left side, so that the patient can successfully interact with the environment. Later, as there is ability to compensate, items can be moved to midline, and finally to the affected left side.

12 weeks' pregnant asks a PT if it is safe to continue with her aerobic exercise. Currently, she jogs 3 miles, three times a week, and has done so for the past 10 years. The therapist's BEST answer is

Correct Answer: -According to the American College of Sports Medicine, women can continue to exercise regularly (three times a week) at mild to moderate intensities throughout pregnancy if no additional risk factors are present. -After the first trimester, women should avoid exercise in the supine position because this position is associated with decreased cardiac output. -Prolonged standing with no motion should also be avoided. Incorrect Choices: -Non-weight-bearing exercise (swimming) is an acceptable alternative to walking or jogging. However, this patient's interests and skills are with jogging, making it the most appropriate choice. -Exercise prescription should be specific to the individual. Using a target HR of 140 or a target date of the fifth month of pregnancy does not allow for this

patient developed right throbbing shoulder pain after painting the kitchen. *Passive and active glenohumeral motions increase pain*. The BEST INITIAL intervention for this *acute* shoulder condition is

Correct Answer: -Because pain occurs with both AROM and PROM, bursitis is the most likely cause of dysfunction. -Initial interventions should focus on reducing pain and inflammation. Modalities and manual therapy are the best choices. Incorrect Choices: - Supraspinatus and/or bicipital tendonopathy would be most painful with AROM, not both AROM and PROM. -An inflammatory condition of the acromioclavicular joint would not be improved by stretching the pectoralis minor muscle.

therapist examines the patient for function of the glossopharyngeal/vagus nerves ( CN IX/X). The BEST test for motor function of these nerves is to

Correct Answer: -Because the glossopharyngeal and vagus nerves mediate similar functions, they are tested simultaneously. -The gag reflex is correct and is tested by swiping a tongue depressor at the back of the throat. Incorrect Choices: -Swallowing is a complex function involving the combined actions of several cranial nerves (CN V, VII, IX, X, XI, and XII). -Tongue protrusion is a function of the hypoglossal nerve ( CN XII). -Rise and fall of the larynx during swallowing is a function of the cranial nerve root of the spinal accessory nerve ( CN XI).

beta-blockers on cardiovascular function

Correct Answer: -Beta-adrenergic blocking agents (e.g., propranolol [Inderal]) are *used to treat hypertension, prevent angina pectoris and prevent certain arrhythmias*. - *In individuals taking these drugs, HR is low at rest and rises very little with exercise (blunted response)*. *These changes, therefore, invalidate the use of HR to monitor exercise responses. A more sensitive measure would be RPE*. Incorrect Choices: -HR does not rise linearly with exercise in patients on propranolol. -The medication is used for treatment of hypertension. Both resting and exercise BP are suppressed

child with full-thickness burns to both arms is developing hypertrophic scars. The BEST initial intervention to manage these scars

Correct Answer: -Following burns, edema and hypertrophic scarring can be effectively controlled with *custom pressure garments*. -Pressure should be maintained 23 hours per day, often for 6-12 months. Incorrect Choices: -Surgery (surgical release) is an option of last resort. -Compression wraps (elastic bandages) and occlusive dressings have no impact on hypertrophic scarring

To test for maximal passive tibiofemoral internal or external rotation the knee should be placed in

Correct Answer: -Rotation of the tibia on the femur is influenced by sagittal knee position. -Rotation of the knee increases with increasing flexion up to 90 degree. After 90 degree, the soft tissues behind the knee restrict further increases in rotation at the knee.

therapist finds unusual swelling and enlargement in the anterior neck with mild tenderness. The patient does not have any hoarseness or difficulty swallowing. The therapist's BEST course of action is to

Correct Answer: -This patient is likely exhibiting hyperthyroidism (Graves' disease) and should be referred to the physician of record. -Additional manifestations of hyperthyroidism include *cardiopulmonary changes* (increased HR and respiratory rate, palpitations, dysrhythmias, breathlessness), CNS changes (tremors, hyperkinesias, nervousness, *increased DTRs*), musculoskeletal changes (weakness, fatigue, atrophy) and integumentary effects (heat intolerance). Incorrect Choices: -Documenting the findings in the medical record without notifying the physician delays medical intervention. - This disorder should be treated before beginning an exercise program. The patient will exhibit exercise intolerance and reduced exercise capacity.

A patient has been referred to physical therapy for acute shoulder pain after shoveling snow in a driveway for 2 hours. Positive findings include pain and weakness with flexion of an extended upper extremity as well as scapular winging with greater than 90 o of abduction

Correct Answer: -Vigorous upper limb activities can cause inflammation of soft tissues surrounding the shoulder, resulting in compression of the long thoracic nerve and weakness of the serratus anterior. -The *serratus anterior stabilizes the scapula with greater than 90 of abduction*. Incorrect Choices: - The *supraspinatus muscle in concert with the deltoids initiates abduction in the upper extremity*. -*Subdeltoid bursitis causes pain with all AROM* and does not result in scapular winging.

While evaluating the gait of a patient with right hemiplegia, the PT notes foot drop during midswing on the right. The MOST LIKELY cause of this deviation is

Correct Answer: -Weakness or delayed contraction of the ankle dorsiflexors or spasticity in the ankle plantarflexors may cause foot drop during midswing. Incorrect Choices: -Excessive extensor synergy would cause plantarflexion during stance. -Decreased proprioception of the foot-ankle muscles would cause difficulties with foot placement and balance during stance. -A strong flexor synergy can cause dorsiflexion with hip and knee flexion during swing.

patient with vague hip pain that radiates to the lateral knee, the PT finds a negative FABER test, a negative grind test and a positive Noble's compression test. The dysfunction is MOST LIKELY due to

Correct Answer: A positive Noble's compression test is an indication of an iliotibial band friction disorder. Incorrect Choices: -A negative FABER test can rule out SI joint dysfunction. -A negative grind(scouring) test eliminates DJD at the hip.

patient now exhibits an elbow flexion contracture. In this case, an absolute CONTRAINDICATION for joint mobilization would be

Correct Answer: An empty end-feel (no real end-feel) may be indicative of severe pain and muscle guarding associated with pathological conditions. empty end-feel is atypical after immobilization. Incorrect Choices: - Springy and firm end-feels may be expected after elbow surgery. -*Soft end-feel is an indication of range limitation because of tissue compression* (e.g., in knee flexion, there is contact between the posterior leg and the posterior thigh).

conventional (high-rate) transcutaneous electrical nerve stimulation (TENS) to the low back to modulate a chronic pain condition. The patient now states that the TENS unit is no longer effective in reducing the pain in spite of increasing the intensity to maximum. The PT should now advise the patient to

Correct Answer: Because of the.long-term, continuous use of TENS, the sensory receptors accommodated to the continuous current, and no longer responded to the stimuli. Changing to modulation mode (i.e., burst modulation), which periodically interrupts the current flow, does not allow accommodation to occur. Incorrect Choices: -Low-rate TENS is a motor level stimulation, not sensory. -Increasing treatment frequency would result in accommodation occurring more quickly. -Decreasing the pulse duration would require increasing the intensity to get a response, and the patient has already maximized the intensity

elderly and frail resident of an extended care facility presents with hot, red and edematous skin over the shins of both lower extremities. The patient also has a mild fever. The MOST LIKELY cause of the symptoms

Correct Answer: Cellulitis is an inflammation of the cellular or connective tissue in or close to the skin. It is characterized by skin that is hot, red, and edematous. Fever is a common finding. Incorrect Choices: -Dermatitis produces red, weeping, crusted skin lesions, but is not commonly accompanied by fever. -Location on shins makes herpes an unlikely choice, and there are no skin eruptions or vesicles. -Scleroderma is a collagen disease producing tight, drawn skin

multiple sclerosis (MS) exhibits moderate fatigue during a 30-minute exercise session

Correct Answer: Common problems in MS include fatigue and heat intolerance. Exercise intensity should be reduced, and a distributed practice schedule should be used, in which rest times equal or exceed exercise times. Incorrect Choices: A massed practice schedule in which the exercise time exceeds the rest time is contraindicated as is a warm environment or warm pool, which can increase fatigue.

presents with pronounced muscle weakness and wasting in the lower extremities, hypertension and a moon-shaped face with truncal obesity. The therapist recognizes these symptoms as characteristic of

Correct Answer: Cushing's syndrome causes a variety of signs and symptoms including hypoglycemia, *hypokalemia*, hypertension, muscle weakness and wasting. Abnormal fat distribution (moon-shaped face, truncal or central obesity) is a visible clinical feature. Incorrect Choices: -Addison's disease, primary adrenal insufficiency, causes insufficient release of cortisol and aldosterone from the adrenal glands with widespread clinical manifestations, including hypotension, weakness, anorexia and nausea and vomiting. -Type II diabetes also causes weakness and fatigue along with polyuria, and other symptoms. It is associated with abdominal obesity but not moon-shaped face. - Mild hypoparathyroidism is asymptomatic while chronic hypoparathyroidism produces *hypocalcemia* and neuromuscular irritability (tetany)

Examination of the right hip reveals abductor weakness (gluteus medius 3/5) and ROM limitations in flexion and external rotation. As part of the intervention, the PT opts to include functional electrical stimulation to help improve the gait pattern. Stimulation should be initiated for the

Correct Answer: During the stance phase of gait, the hip abductors of the support limb are activated to maintain the pelvis in a relatively horizontal position. This allows the opposite foot to clear the floor during swing.

the most appropriate imaging view to identify abnormal anatomy of the pars interarticularis in the lumbar region is

Correct Answer: For the lumbar region, the oblique view will clearly demonstrate the pars interarticularis. *Incorrect Choices*: The lateral view may show anterior displacement of the segment above a pars defect if the condition has progressed to a bilateral displaced fracture of the pars interarticularis (i.e., spondylolisthesis); however, *the lateral view will not show the anatomy of the pars interarticularis*.

patient with right hemiparesis has difficulty clearing the more affected foot during the swing phase of gait. An appropriate physical therapy intervention for the right lower extremity

Correct Answer: Forward step-ups in standing, using graduated height steps to functionally strengthen the hip and knee flexors using task-specific training. 3 Decreased foot clearance during swing may result from weak hip and knee flexors or from a drop foot (weak dorsiflexors or spastic plantarflexors). Incorrect Choices: - Bridging promotes knee flexion with hip extension. -Sitting on a therapy ball, alternating lateral side steps and back to neutral(hip abduction) -Pushing backward while sitting on a rolling stool(knee extension)

recent compression fracture at T8. The medical history includes osteoporosis and gastroesophageal reflux disease (GERD). The patient is currently taking antacids. Which of the following is MOST important for the therapist to consider in the POC

Correct Answer: Gastric contents reflux into the esophagus in GERD. *Scheduling therapy at least 90 minutes after eating* reduces the possibility of food remaining in the stomach and aggravating the esophagus during therapy. Incorrect Choices: -Concentric abdominal exercises (sit-ups) are contraindicated in recent thoracic compression fractures. -Eating right before a therapy session may aggravate GERD. -Recommending a medication change is outside the scope of a PT.

computer programmer in her second trimester of pregnancy was referred to physical therapy with complaints of tingling and loss of strength in both of her hands. Her symptoms are exacerbated if she is required to use her keyboard at work for longer than 20 minutes. The MOST beneficial physical therapy intervention

Correct Answer: Gestational carpal tunnel syndrome (CTS) is not an unusual phenomenon, and results from extra fluid retention. The most effective intervention would be to place the *wrists in a neutral position in resting splints*. The carpal tunnel is, therefore, not compromised by poor hand positioning while at work. Incorrect Choices: -Modalities that use steroids are contraindicated for pregnant women. -Although ice packs may relieve discomfort, they do little to correct the source of the problem

patient is 4 weeks' post-myocardial infarction (MI). Resistive training using weights to improve muscular strength and endurance is appropriate

Correct Answer: If exercise capacity is greater than 5 metabolic equivalents (MErs) with no anginal symptoms/ST segment depression - Resistance training is typically initiated after patients have completed 4-6 weeks of supervised cardiorespiratory endurance exercise. Lower intensities are prescribed. -*Careful monitoring of BP is necessary, because BP will be higher and HR lower than for aerobic exercise*. Incorrect Choices: -The common use of a percentage of 1 RM (repetition maximum) estimates intensity, and should be used only as a general guideline. - Intensity should be assessed using perceived intensity. -Exercise should be terminated at a rate of perceived exertion (RPE; Borg Scale 6-20) of 15-16. - *During resistance training, HR response is disproportionate to oxygen consumption and should not be used as a measure of intensity*. =HR is lower

fracture of the femur 6 months ago. The cast has been removed, but the patient is unable to volitionally contract the quadriceps. The PT decides to apply electrical stimulation to the quadriceps muscle. The BEST choice of electrode size and placement is:

Correct Answer: Large electrodes are used on large muscles in order to disperse the current (minimize current density under the electrode), enabling a more comfortable delivery of current. Widely spaced electrodes permit the current to travel deeper into the muscle to stimulate a greater number of deeper muscle fibers.

She is currently taking a tricyclic antidepressant medication (amitriptyline) and has a recent history of a fall. The PT suspects the precipitating cause of the fall is the medication, because it can cause

Correct Answer: Most tricyclic antidepressants have significant anticholinergic and sedative properties and may cause lethargy, sedation, arrhythmias, *hypotension* and blurred vision, thus increasing fall risk-> *Postural hypotension* The elderly are particularly susceptible to adverse drug effects because of a multitude of factors.

which measure of aerobic capacity is supported as a reliable and valid functional capacity measure with reported minimal detectable change scores in patients with heart failure

Correct Answer: Only the 6-minute walk test (6MWT) has minimal detectable change-can report minimal detectable change-(MDC) scores associated with it. Incorrect Choices: All of these tests have literature to support that they are reliable (test-retest, intra-tester and inter-tester reliability) and valid (concurrent, construct and predictive validity), but cannot report minimal detectable changes.

surgical repair of an inguinal hernia and is experiencing persistent discomfort in the groin area. Patient education should focus on

Correct Answer: Patients should be educated about proper lifting techniques and precautions against heavy lifting. Incorrect Choices: -Closed-mouth breathing during lifting is contraindicated, due to increased risk of intra-abdominal pressure with Valsalva's maneuver. -Avoiding excessive straining is important.

There is strong evidence linking certain drugs to increased fall risk in older adults. Patients should be cautioned about fall risk when taking

Correct Answer: Psychotherapeutic drugs (e.g., tricyclic antidepressants such as *Elavil*) reduce alertness and slow central processing, thereby increasing fall risk. Other medications linked to increased risk of falls include antihypertensives (especially vasodilators), antiarrhythmics, diuretics and analgesics (especially opioids ). Incorrect Choices: - Baclofen is used to diminish spasticity. -Raloxifene is used in the prevention/treatment of osteoporosis. -Levodopa is used to control the symptoms of Parkinson's disease

(HIV) is hospitalized with a viral infection, and has a history of four infectious episodes within the past year. The PT recognizes that ongoing systemic effects are likely to include

Correct Answer: Repeat infections produce a chronic inflammatory state. Systemic effects include *low-grade fever, weight loss, malaise, anemia, fatigue*, leukocytosis and lymphocytosis. Incorrect Choices: -Inflammatory activity can be detected by an elevated ESR. -Redness, warmth, swelling and pain are signs of acute inflammation. -Fever, tachycardia and a hypermetabolic state are signs of the systemic effects of an acute inflammation.

In differentiating between stress urinary incontinence and urge incontinence, the therapist should first investigate

Correct Answer: Stress incontinence occurs when exercising, coughing, sneezing or laughing as intra-abdominal pressures increase. *Incorrect Choices*: -The pubourethral ligament maintains the relative position of the urethra to the urinary bladder; loosening of this ligament can result in bladder prolapse or herniation. -A cystocele typically causes difficulty initiating voiding. -Impaired sensation of the lower extremities reveals central or peripheral nerve dysfunction. -Urge incontinence is the result of motor-detrusor instability or detrusor hyperreflexia with impaired contractility

Parkinson's disease (PD) demonstrates a highly stereotyped gait pattern characterized by impoverished movement and a festinating gait. The intervention that would be the MOST beneficial to use with this patient is

Correct Answer: Task-specific training using body weight support and treadmill training (BWSTI) is the best choice The patient with PD typically presents with postural deficits of forward head and trunk, with hip and knee flexion contractures. Gait is narrow-based and shuffling. *A festinating gait typically results from persistent forward posturing of the body near the forward limits of stability*. Incorrect Choices: -A rolling walker is contraindicated because it would increase forward postural deformities and festinating gait. -Braiding is a complex gait activity that most likely exceeds this patient's abilities. -Standing and reaching with body weight support is an important lead-up activity

current patient is anterior cruciate ligament (ACL) deficient in the right knee. Which of the following tests would be UNNECESSARY for determining whether the ACL was ruptured?

Correct Answer: The *anterior drawer test places the knee in 90 of flexion. In this position, the knee joint capsule is the primary constraint to movement*, so performing this test may result in a false-negative determination. Incorrect Choices: 1. Lachman's test. 3. Slocum's test. 4. Lateral pivot shift test are appropriate to assess the integrity of the ACL

SACH (solid ankle cushion heel) prosthetic foot

Correct Answer: The SACH foot is the most commonly prescribed type of prosthetic foot. It provides for sagittal plane motion (primarily plantarflexion) and very limited frontal plane motion (mediolateral motion). Incorrect Choices: -Articulated feet (joined by a metal bolt or cable to the lower shank section) have rubber bumpers that absorb shock and control plantarflexion excursion. - An anterior stop resists dorsiflexion. -Full sagittal and frontal plane motions are not allowed.

Based on the pictured CT scan, this patient is LIKELY to manifest

Correct Answer: The arrow is pointing to a hemorrhage in the cerebellum. *Damage to this area results in difficulty with movement, postural control, eye-movement disorders and muscle tone*. *Ataxia* is a common finding. Incorrect Choices: - Aphasia is more typical of a left cerebral infarct -left-sided unilateral neglect is typically due to a right cerebral injury. CT scans and MRis can help the therapist predict clinical manifestations based on the area of injury

weakness when rotating the head to one side as well as weakness flexing the head laterally and forward to the same side. The therapist recognizes these are symptoms of a lesion of the

Correct Answer: The spinal nerve root of the accessory nerve ( CN XI) innervates the sternocleidomastoid muscle. This allows for head rotation and flexion of the head laterally and forward, both to the contralateral side. Incorrect Choices: -The motor portion of the facial nerve ( CN VII) innervates the muscles of facial expression and is also responsible for eyelid closing and control of the stapes of the middle ear. -The hypoglossal nerve ( CN XII) is a motor nerve that innervates the muscles of the tongue

patient with superficial partial-thickness burns over 20% of the trunk. The correct identification of this burn type by surface appearance characteristics includes

Correct Answer: The surface appearance of a superficial partial-thickness burn is characterized by intact blisters and moist, weeping or glistening surface when blisters are removed. Incorrect Choices: - A dry surface with no blisters is characteristic of a superficial burn. -A wet surface with broken blisters is characteristic of a deep partial-thickness burn. -Parchment-like, leathery and dry surface is characteristic of a full-thickness burn

neck pain presents with subjective complaints of frank upper cervical spine instability. One test that would safely assist in identifying the integrity of the C1-C2 articulation would be

Correct Answer: The transverse ligament stress test is specifically designed to assess the integrity of the transverse ligament, which maintains the position of the dens of C2 with the anterior arch of Cl. Incorrect Choices: -The vertebral artery test is utilized to assess the status of the vertebrobasilar arterial system - the maximum cervical compression test is utilized to identify dysfunction in the *cervical facet joints*. The motions associated with these two tests would be *contraindicated for a patient who was suspected of having bony/joint instability*. -Hautant's test is utilized to *differentiate between a vascular dysfunction in the vertebrobasilar system and a dysfunction of the vestibular system*

patient presents with problems with swallowing. When the PT tests for phonation by having the patient say "Ah" with the mouth open, there is *deviation of the uvula to one side*. The therapist then tests for function of the gag reflex and notices decreased response to stimulation. These findings suggest involvement of the

Correct Answer: These are the tests to examine vagus nerve ( CN X) function. *Incorrect Choices*: -The trigeminal nerve (CN V) has both sensory and motor components. Sensory tests include pain and light touch to forehead, cheeks and jaw along with light touch (cotton wisp) to cornea. Motor function involves testing the temporal and masseter muscle (patient clenches teeth and holds against resistance). -The facial nerve ( CN 7) is tested using motor tests: raise eyebrows, frown, show teeth, smile, close eyes tightly and puff out both cheeks. -The hypoglossal nerve (CN 12) is testing using motor tests: tongue movements

adult is running a marathon race and collapses well short of the finish line. *Ambient temperature is 92 degree and body temperature is measured at 101F*. This individual has a rapid pulse and rapid respirations. Skin feels warm and dry. When questioned by the PT who is helping monitor the runners, the individual is confused.

Correct Answer: This individual is demonstrating signs and symptoms of *dehydration (inadequate fluid intake) and hypovolemic shock*. Pulse and respirations are increased; blood pressure (BP) may decline. Restlessness, anxiety and confusion may all be present. Incorrect Choices: -Hypervolemia is an abnormal increase in the volume of circulating blood. -Anaphylactic shock is a severe hypersensitivity (allergic reaction) to a substance with symptoms of local allergen-antibody interaction (hives, edema, warmth, erythema) as well as systematic symptoms of flushing, wheezing, dyspnea and anxiety. -Septic shock (sepsis) is a systematic inflammatory response to infection characterized by fever, tachycardia, tachypnea and organ failure.

full thickness burn wound

Correct Answer: This is a full-thickness burn wound. It is characterized by white (ischemic) and black (charred) areas. Skin is parchment-like, leathery, and dry. Full-thickness burns heal with skin grafting and scarring. Incorrect Choices: -Partial-thickness burns are bright pink or red with a wet surface and blisters. -Superficial burns heal with minimal to no scarring.

11-year-old was referred to physical therapy with complaints of vague pain at the right hip and thigh that radiated to the knee. AROM is restricted in abduction, flexion and internal rotation. A gluteus medius gait was observed with ambulation for 100 feet. The BEST choice for PT intervention is

Correct Answer: This patient is exhibiting signs and symptoms of slipped capital femoral epiphysis, characterized by a gluteus medius gait. *Closed-chain exercises with weight bearing to tolerance* will help regain or maintain functional muscular strength and normal motion. Incorrect Choices: - Avascular necrosis of the femoral head (osteochondritis dissecans) involves the necrosis and separation of a small segment of the subchondral bone from the femoral head (epiphysis). The hip is painful upon weight bearing. - Legg-Calve-Perthes disease (osteochondrosis of the femoral head) produces a painful hip with limited motion in abduction and internal rotation. Deformity (flattening) of the femoral head is a complication. -Femoral anteversion occurs when the femoral neck is directed anteriorly when the knee is directed anteriorly.

forefoot varus

Correct Answer: When observing the position of plantar aspect of the forefoot relative to the neutral posture of the rearfoot (subtalar neutral), an inverted forefoot is described as a forefoot varus. Incorrect Choices: - Forefoot varus can be the result of developmental failure of the talar neck to derotate, osseous abnormality of the midtarsal joints, or as a result of increased muscle activity of muscles that invert the foot. -*Metatarsus adductus is a deformity in the transverse plane, whereas forefoot varus is a deformity in the frontal plane*.

typical neuromuscular changes associated with AIDS

Correct Answer: *Motor ataxia and paresis with pronounced gait disturbances* -Alterations in memory, confusion and disorientation are characteristic of AIDS dementia complex, a common central nervous system (CNS) manifestation of human immunodeficiency virus (HIV) infection. -Motor deficits may include ataxia, paresis with gait disturbances and loss of fine motor coordination. Patients may also develop peripheral neuropathy with distal pain and sensory loss.

with active hepatitis B infection. Transmission of the disease is best minimized if the PT Wears gloves during any direct contact with blood or body fluids

Correct Answer: *glove, gown, mask*. Standard precautions specify that health care workers wear personal protective equipment (moisture resistant gowns, masks) for protection from the splashing of blood, other body fluids or respiratory droplets resulting from direct body contact with the patient. Incorrect Choices: The patient with risk of transmission of known or suspected infectious agents is typically isolated in a single-patient room and wears protective equipment (masks) only when being transported out of the room.

body mass index (BMI) of 33 kgjm-2 is referred to an outpatient exercise program. The PT in charge of the program recognizes this patient is at increased risk for

Correct Answer: 1 A patient with a BMI of 33 kgjm-2 is obese (BMI > 30 kgjm-2) and is at increased risk for hyperthermia- during exercise (as well as orthopedic injury).

patient with chronic stroke is pushing strongly backward, displacing the center of mass at or near the posterior limits of stability. The MOST LIKELY cause of this is

Correct Answer: => *backward displacement of the body during standing is indicative of gastrocnemius-soleus spasticity* -The muscles of the foot and ankle move the long lever of the body forward and backward (ankle strategy). -The gastrocnemius-soleus moves the body backward as compensatory and the anterior tibialis moves the body forward. -*Poststroke, spasticity of the gastrocnemius-soleus and weakness of the anterior tibialis are common*. Incorrect Choices: -Action of the hip extensors would result in a backward lean, with the center of motion occurring at the hip (hip strategy). -*Contracture of the hamstrings increases knee flexion and forward trunk lean*. -*Spasticity occurs in lower extremity antigravity extensor muscles, not the anterior tibialis*.

client who fractured the left fibula 3 months ago. The client is still having pain with exercise. Based on the recent radiograph pictured and the given information, the prognosis for this client

Correct Answer: A bone stimulator or surgery will be required -Normally, radiographic evidence of healing is present within 2-6 weeks (soft callus phase). -This radiograph represents a nonunion fracture. A nonunion is a fracture that will not heal, and there are no signs of bone repair over a period of 3 consecutive months (bridging and callus formation are absent) -Typical causes of nonunion fractures include infection, inadequate mobilization, poor blood supply and muscle or some type of tissue interpositioned between the fractured segments. -The distal tibia is more frequently the site of nonunion fractures in the long bones of the lower extremity, due to a sometimes inadequate blood supply. Incorrect Choices: -*If there were bridging or a callus formation, then it would be classified as a delayed union fracture*. - A delayed union is characteristic of a fracture that has not healed within the expected time frame, and there is evidence that it will heal given time and the right environment. -In the case of delayed union, a bone stimulator, change in weight-bearing status and/or the use of an immobilizer boot for the leg may be needed. -A fibular fracture typically does not restrict weight-bearing status because this is a non-weight-bearing bone.

During an ultrasound (US) treatment, the patient flinches and states that a strong ache was felt in the treatment area. To address this patient's concern, it would be BEST to

Correct Answer: A reduction in intensity is indicated if a strong ache is felt. Incorrect Choices: -The question assumes that the treatment size of the area is correct. -Increasing the size of the treatment area would minimize the ability to elevate the tissue temperature. Thus, the patient would not experience a strong ache from rapid tissue temperature elevation. -Adding more transmission medium would encourage transmission of acoustical energy, and thus potentiate the rapid tissue temperature elevation, contributing to the patient's symptom. -The frequency has to do with the depth of penetration of the US energy, not the rate/speed at which the tissue temperature is being elevated.

presents with significant shortness of breath. Notable on physical examination is a deviated trachea to the left. Which of the following processes would account for such a finding

Correct Answer: A right hemothorax (blood was in the pleural space) takes up space in the right hemithorax, shifting the trachea to the left. Incorrect Choices: -A left pneumothorax and a left pleural effusion take up space in the left thorax. -The air (pneumothorax) or the sterile fluid (effusion) in the pleural space would push contents of the left hemithorax, including the trachea, to the right. -A lung collapse, or a volume loss phenomenon, on the right would pull the trachea over toward the right. =>right hemothorax/pneumothorax/pleural effusion can cause opposite left tracheal shift.

T 10 SCI (ASIA C) 4 years ago and is now referred for an episode of outpatient physical therapy. During initial examination, the physical therapist observes redness over the ischial seat that persists for 10 minutes when not sitting. The BEST intervention in this case would be to

Correct Answer: Arm push-ups, at least every 15 minutes, are indicated if redness is present. Incorrect Choices: -High-density (not low-density) foam or gel cushions are used to relieve ischial pressure. -Increasing the armrest height increases the height of the push-up but does not address the frequency of push-ups needed. -A tilt-in-space can relieve ischial pressure but is not typically ordered for SCI patients at the level of TIO unless mitigating factors prevent use of the upper extremities for pressure relief

During the examination of the cervical spine of a client for CS radiculopathy, small groupings of nevi are noted near the superior angle of the left scapula. The NEXT action the therapist should take is

Correct Answer: Ask the patient about any history of moles and examine them closely - Nevi (moles) should be examined 'for asymmetry, border irregularities, color and diameter(> 6 mm). -It is not uncommon to have a group of moles and they are usually benign, but if there is a transformation of a nevus (plural, nevi), then the primary care physician should be contacted. -In this situation, the therapist needs to establish a baseline (history and physical examination) of the moles, and then determine whether there is an indication to contact the physician. Incorrect Choices: -A photograph can be part of the examination, but this does not replace a thorough history and visual inspection. -There are no indications for a vertebral artery examination. A vertebral artery examination is performed before manual or mechanical techniques of the cervical spine or if the client exhibits signs or symptoms of vertebral artery compromise.

PT is providing postural drainage in the Trendelenburg position to an adolescent with cystic fibrosis. The patient suddenly complains of right-sided chest pain and shortness of breath. On auscultation, there are no breath sounds on the right. The therapist should

Correct Answer: Call Emergency Medical Services, because it may be a pneumothorax -The combined signs and symptoms of absent breath sounds, sudden onset of chest pain and shortness of breath indicate a pneumothorax, especially in an adolescent (growth spurt) with pathological changes of lung tissue. This is an emergency situation.

the mother of an 18-month-old child with developmental delay and an atrioventricular shunt for hydrocephalus tells the PT that her daughter vomited several times, was irritable and is now lethargic. The therapist's BEST course of action is to

Correct Answer: Call for emergency transportation and notify the pediatrician immediately These signs and symptoms could be the result of increased cerebral edema due to a clogged or infected shunt. Medical attention should be obtained immediately to avoid damage to the brain.

stage II decubitus ulcer over the left lateral malleolus is referred for physical therapy. The therapist notes a greenish, pungent exudate at the wound site. The therapist decides to use electrical stimulation. The BEST choice of polarity and electrode placement

Correct Answer: Cathode placed in the wound - It is purported that the *bactericidal effect* produced by negative current is a result of substrate depletion or alteration of the internal processes of the microorganisms. =M:음기운의 귀신이 박테리아를 죽이다 Incorrect Choices: -The *anode is used to promote healing in clean-N;+ for healing cleaning- uninfected wounds*, and placement of an electrode in the wound ensures current will be delivered throughout the wound.

patient with a T4 spinal cord injury (SCI) is being measured for a wheelchair. In determining the correct seat height the IT can use as a measure

Correct Answer: Clearance between the floor and the foot plate of at least 2 inches. -The correct measure for seat height in a wheelchair is 2 inches clearance between the floor and the foot plate, measured from the lowest point on the bottom of the footplate. Incorrect Choices: Leg measurement from the popliteal fossa to heel with customary footwear in place is used to determine footrest length on the wheelchair, not correct seat height.

It is most important for the physical therapist to educate a client who recently had a radical lymph node dissection secondary to prostate cancer to

Correct Answer: Closely monitor any changes in the fitting of their socks or shoes - Seventy percent of men after a radical lymph node resection for prostate cancer will develop lymphedema in one or both lower extremities and potentially the genitals. -Early changes include a perception of heaviness of the limb and an inability to wear old socks or shoes due to tightness. These are often precursors to clinically significant swelling. *Incorrect Choices*: -Although circumferential measurements are important, they are not sensitive to small accumulations of lymphedema. -Significant accumulation of lymphedema is recognized by greater than a 2.0 em difference at one measurement point between upper extremity (UE) limbs and 1.0-1.5 em difference between lower extremity (LE) limbs. -Use of alkaline soaps will result in loss of normal pH of skin (slightly acidic), drying of the skin, and increased risk of bacterial infection due to breaks in skin. - Use of compression pumps at pressures higher than 60 mm Hg can cause damage to the lymphatic vessels.

patient sprained the left ankle 4 days ago. The patient complains of pain ( 4/10), and there is moderate swelling that is getting worse. At this time, which intervention would be BEST to use

Correct Answer: Cold/intermittent compression combination with the limb elevated -The combination of RICE-for acute- (rest, ice, compression, elevation) is best. Cold to decrease pain along with intermittent compression and elevation to facilitate fluid drainage provides the best intervention. Rest is required. Incorrect Choices: -Contrast baths and whirlpool place the ankle in a dependent position, which might tend to increase edema. -The interventions of intermittent compression and elevation should be combined, not sequential

patient's left knee is being tested using McMurray's test to assess meniscus integrity. During one of the portions of the test, the knee is taken from a position of flexion and internal rotation, into a position of extension and internal rotation. In the test's final position described above, the MOST ACCURATE description of the stresses placed on each meniscus is

Correct Answer: Compressive stress at the lateral meniscus and tensile stress at the medial meniscus. In a combination of knee extension and internal rotation the menisci will move anteriorly during extension as they follow the tibia. In addition, the medial meniscus will move further anterior and the lateral meniscus will move posteriorly as they follow the femoral condyles during rotation. This specific combination will result in a tensile stress at the medial meniscus and a compressive stress at the lateral meniscus of a left knee

patient with a grade 2 quadriceps strain returns to physical therapy after the first exercise session, complaining of muscle soreness that developed later in the evening and continued into the next day. The patient is unsure whether to continue with the exercise. The therapist can minimize the possibility of this happening again by using:

Correct Answer: Concentric exercises, 3 sets of 10, with gradually increasing intensity This patient is experiencing delayed-onset muscle soreness (DOMS) as a result of vigorous exercise or muscular overexertion. It typically begins 12-24 hours after exercise, peaks in 24-48 hours, and can last up to 5-7 days. Incorrect Choices: DOMS is usually greater after muscle lengthening or eccentric exercise. It can be lessened by gradually increasing intensity and duration of exercise, and not starting at 80% of maximal intensity.

right total hip replacement (THR) 4 months ago. The patient is now referred to physical therapy for gait evaluation. The patient demonstrates shortened stride length on the right. This patient MOST LIKELY has

Correct Answer: Contracted hip flexors - Patients are less active after surgery and spend less time in standing and more time in sitting. The iliopsoas muscles become shortened with increased time in sitting. The contracted iliopsoas limits the patient's ability to extend the hip, which effectively shortens the stride length on the affected side. Incorrect Choices: - Contracted hamstrings or weak quadriceps result in decreased knee extension during stance and an unstable knee. -Weak hip flexors produce decreased limb shortening during swing, typically compensated by circumduction

2-year-old child to a neurologist after the initial evaluation. The therapist has concluded that the child may be autistic. The MOST PERTINENT factor to include in the referral is that the child is

Correct Answer: Defensive when touched Not tolerating being touched would signal a possible sensory integration issue that is common in children with autism. Incorrect Choices: -Responsive to most commands would be a positive outcome when dealing with a 2-year-old child. -A child with autism may not respond to commands due to issues with cognition, lack of focus or verbal deficits.

patient with CHF is on digitalis to improve myocardial contraction. effects of it are

Correct Answer: Depressed ST segment on ECG with QT and T wave changes -Digitalis produces characteristic changes on the ECG: gradual downward sloping of ST segment with a flat T wave and shortened QT interval. (increase myocardial contraction and decrease HR) Incorrect Choices: - HR is decreased (not increased). -BP is unchanged (not decreased). -Exercise capacity is increased (not reduced).

depression

Correct Answer: Depression is associated with symptoms of social withdrawal, fatigue, and weight loss. Incorrect Choices: -Sleep apnea is a potentially lethal disorder in which breathing stops for 10 seconds or more, many times a night. It is associated with obesity and anatomical obstruction. -Increasing dizziness and palpitations are suggestive of cardiovascular problems. - The Geriatric Depression Scale is a valid measure of depression in the elderly. High, not low, scores(> 8 of a possible 30) are indicative of depression.

reviewing precautions and contraindications regarding various pediatric pathologies. The precaution with the MOST credibility that merits discussion is

Correct Answer: Do not do PROM with children with osteogenesis imperfecta (OI). Those with OI (fragile bones) are very susceptible to fractures. PROM as well as traction to any long bones is contraindicated. Incorrect Choices: -One can actively exercise those with MD; however, do not overexercise these children because damage to muscle fibers can result in permanent damage and decline in function. -*PROM with children with arthrogryposis is indicated because contractures are one of their main issues*. -Limiting sensory input for some children with autism is appropriate; however, for others the treatment strategy that is best is to increase sensory inputs

after stroke. When tested for two-point discrimination on the right hand, the patient is unable to tell whether the therapist is touching with one or two points. The therapist determines that there is impaired function in the

Correct Answer: Dorsal column/lemniscal pathways and somatosensory cortex - Discriminative touch, proprioceptive sensibility and vibration sense are carried in the posterior white columns (fasciculus cuneatus for the upper extremity and fasciculus gracilis for the lower extremity). -The long ascending tracts cross the medulla (sensory decussation) and form the medial lemniscus, which then travels to the thalamus (ventral posterolateral nucleus) and finally to the *cortex (postcentral gyrus*). -Loss of two point discrimination could result from an insult affecting any of these component parts. *Parietal lobe* or internal capsule lesions are the most common sites. *Incorrect Choices*: -The anterolateral system pathways (spinothalamic tracts) convey pain and temperature. -The spinotectal tract conveys information for spinovisual reflexes

posterior thoracic pain, the therapist finds no musculoskeletal causes for the patient's symptoms. Pain may be referred to this thoracic region from the

Correct Answer: Dysfunction of the gallbladder often refers pain to the thorax. Incorrect Choices: -The commonly observed referral pattern of the heart is to the chest and upper extremity, - the ovaries to the low back -the appendix to the right lower quadrant

diagnosis of left-sided CHF, class II, is referred for physical therapy. During exercise, this patient can be expected to demonstrate

Correct Answer: Dyspnea with fatigue and muscular weakness 4 Left-sided heart failure is the result of the left ventricle failing to pump enough blood through the arterial system to meet the body's demands. It produces pulmonary edema and disturbed respiratory control mechanisms. Patients can be expected to demonstrate progressive dyspnea ( exertional at first, then paroxysmal nocturnal dyspnea), fatigue and muscular weakness, pulmonary edema, cerebral hypoxia and renal changes. Incorrect Choices: -Severe chest pain and shortness of breath are symptoms of impending myocardial infarction (MI). - *Weight gain with dependent edema and anorexia, nausea with abdominal pain and distension are associated with right sided*

elderly patient has been hospitalized for the past 3 days with pneumonia. The physician and patient are hoping for a home discharge tomorrow. The patient lives with her sister in a first-floor apartment. The PT has determined that ambulation status is independent with rolling walker and endurance is only up to 15 feet, not enough to allow the patient to get from the bed to the bathroom (a distance of 20 feet). The therapist should recommend

Correct Answer: Environmental modifications (the addition of a commode) and assistance of a home care aide should allow the patient to safely return home. Home physical therapy should focus on improving endurance to regain independence in the home. Treatment in the home is the most cost-effective in this case.

elderly woman with low back pain tells the PI that she has had urinary incontinence for the last year. It is particularly problematic when she has a cold and coughs a lot

Correct Answer: Examine the patient, document impairments and discuss findings with the physician -The PT should complete the examination of the patient, adequately document the findings, and determine the physical therapy diagnosis. -Although many states have direct access laws that permit physical therapy intervention without referral, most insurance companies, including Medicare (affecting the patient in this example), require a physician referral in order for services to be reimbursed. Thus, the therapist needs to consult with the physician to get a referral before initiating any intervention for this problem. -This patient demonstrates stress incontinence, a problem that could be successfully treated with physical therapy (e.g., Kegel's exercises and other interventions). Incorrect Choices: *The therapist is not being an active advocate for the patient in dealing with the incontinence*

2-year-old child with Down syndrome who frequently uses a W sitting position. The main reason to discourage W sitting in this child is that it may cause

Correct Answer: Femoral antetorsion and medial knee stress - W sitting is a stable and functional position, but may cause later orthopedic problems of femoral antetorsion and knee stress. - Low muscle tone and difficulty with achieving sitting are reasons why these children choose to sit in a stable W sit position. -Children with Down syndrome typically exhibit low tone and hyperextensibility

rheumatoid arthritis presents at the physical therapy clinic with severe whiplash from a motor vehicle accident 1 week ago. Initial cervical radiograph results revealed osseous structures appeared intact. The client's chief complaints are of cervical pain and sudden falls with loss of consciousness. Examination reveals a positive Romberg sign and hyperreflexia. The PTs INITIAL action is to

Correct Answer: Fit this client with a hard cervical collar and contact the referring physician recommending a computed tomography (CT) scan;Upper cord signs require immediate stabilization and contact with the physician -This patient is exhibiting *signs and symptoms of spinal cord compression with upper motor neuron signs (hyperreflexia), a positive Romberg sign, and sudden falls with loss of consciousness*. This requires immediate immobilization and contact with the physician for further imaging. Some cervical lesions (nondisplaced dens fracture, rupture of the transverse ligament) require greater imaging detail than radiographs provide. This individual also has rheumatoid arthritis, which is often accompanied by erosion of the dens and facets and ligamentallaxity (transverse). Incorrect Choices: -Another series of radiographs is inadequate. More detailed imaging is required. -An MRI is important, but would likely miss a fracture. Sometimes, MRis can detect fractures indirectly via imaging bone marrow edema, peripheral edema or impingement of soft tissue structures. -Because there are signs and symptoms of cord compression, it would be unwise to perform ligamentous laxity testing designed to exacerbate the symptoms. -Provocation tests are performed only to clear the cervical spine of ligamental laxity, NOT when it is suspected.

difficulty learning how to transfer from mat to wheelchair. The patient just cannot seem to get the idea of how to coordinate this movement. In this case, the MOST effective use of feedback during early motor learning

Correct Answer: Focus on knowledge of results and visual inputs - During the early stage of motor learning (cognitive stage), learners benefit from seeing the whole task correctly performed. Dependence on visual inputs is high. -Developing a reference of correctness (knowledge of results) is critical to ensure early skill acquisition (cognitive mapping). Incorrect Choices: -Focus on proprioceptive inputs is important during the middle (associative) stage of motor learning. -Delayed feedback may be used during later learning

patient was referred for physical therapy after a right breast lumpectomy with axillary lymph node dissection. Scapular control is poor when upper extremity flexion or abduction is attempted. Early PT intervention should focus on

Correct Answer: Gravity-assisted right upper extremity exercises to promote scapular control following damage to the long thoracic nerve. - With axillary dissection, the long thoracic nerve may be damaged. This leads to serratus anterior weakness and loss of scapular control. -Gravity-assisted exercises to promote scapular control should be emphasized early in rehabilitation to help restore proper scapular humeral rhythm. Incorrect Choices: -Because the dysfunction is associated with scapular control, the rotator cuff and deltoid muscles would not be involved. -The rhomboids are important for scapular control, but they are innervated by the dorsal scapular nerve, which is not typically injured during the surgical procedure stated.

PT suspects postpolio syndrome. The BEST INITIAL intervention for this patient based on current findings is to

Correct Answer: Instruct in activity pacing and energy conservation techniques -The therapist should initially teach this patient activity pacing and energy conservation techniques. It is important to balance rest with activity in order to not further weaken muscles affected by progressive postpolio muscular atrophy. Incorrect Choices: -Resistance training, conditioning and aquatic therapy may be helpful in improving activity tolerance if kept at low to moderate intensities. They should not be the therapist's initial priority

patient is 5 days' postmyocardial infarction and is referred for inpatient cardiac rehabilitation. Appropriate criteria for determining the initial intensity of exercise include

Correct Answer: HR < 120 bpm and rate of perceived exertion (RPE) < 13(120~130HR) -Intensity of exercise is prescribed using HR and RPE and monitored using HR, RPE and signs of exertional intolerance. Incorrect Choices: -HR plus 30 beats/min is recommended for postsurgery patients. -Signs and symptoms for an upper limit of exercise intensity include = Systolic BP < 240 mm Hg or diastolic BP < 110 mm Hg. =HR resting plus 30 bpm and RPE < 14 along with onset of angina, and ECG disturbances (ventricular arrhythmias, second-or third-degree atrioventricular block, atrial fibrillation, etc).

new patient being seen for balance deficits and general deconditioning. Prior to admission, the chief finding by the physician, 3 days ago, was a positive fecal blood test. Which laboratory value would confirm that the patient is safe for balance retraining activities

Correct Answer: Hematocrit 42% -The stated hematocrit value is within the normal range for both males and females, and indicates the fecal blood loss and is indictive of Gi bleeding -In this situation, the hematocrit level is the indicator of a patient's safety to engage in the activity.

after a tendon transfer of the extensor carpi radialis longus. The muscle strength tests poor (2/5) in spite of previous intensive therapy. biofeedback inx

Correct Answer: High-detection sensitivity with recording electrodes placed close together - High-detection sensitivity is needed to detect low-amplitude signals generated by a small number of motor units such as in a weak extensor carpi radialis longus. Incorrect Choices: -Wide electrode placement would pick up signals from more than one muscle and might invalidate the procedure. -Low-detection sensitivity may not pick up the necessary motor unit signals

18-month-old child with Down syndrome and moderate developmental delay is being treated at an Early Intervention Program. Daily training activities that should be considered include

Correct Answer: Holding and weight shifting in sitting and standing using tactile and verbal cueing -Children with Down syndrome typically present with generalized hypotonicity. The low tone is best managed by weight-bearing activities in antigravity postures. -Typical responses include widened base of support and cocontraction to gain stability. -Verbal cueing for redirection is generally the best form of feedback to use, along with visually guided postural control. Incorrect Choices: -Proprioceptors are not in a high state of readiness, and the child may be slow to respond to proprioceptive facilitation techniques (i.e., stretch, resistance, rhythmic stabilization). -With developmental delay, this child is not ready for intensive locomotor training. -Rolling is probably not age appropriate for this child. The child should already possess this skill since most children with Down syndrome walk at 24 months of age

player is tackled violently and incurs a blow to the head. The therapist determines that the player is unresponsive with normal respirations. The IMMEDIATE course of action should be to:

Correct Answer: If the victim is unresponsive, Emergency Medical Services must be activated immediately by calling 911 Incorrect Choices: As long as the patient is breathing, initial stabilization techniques are best left to emergency personnel or experienced first responders.

The family reports that the elderly patient is demonstrating increasing forgetfulness and some memory deficits. From the examination, the therapist would expect to find

Correct Answer: Impairments in short-term memory -Elderly patients with memory impairments typically demonstrate intact immediate recall (e.g., can repeat words) - impairments are often noted in memory for recent events (e.g., Why did I come into this room? Who came to see me yesterday?). -Long-term memory is usually intact. Incorrect Choices: -Periods of fluctuating confusion are typically found in delirium, an acute state of disorientation and confusion. Hallucinations or delusions are common (not present in this case). -Periods of agitation and wandering (sundowning) are seen in patients with Alzheimer's disease. Whereas the disease begins with mild memory loss (stage I), agitation and wandering typically do not occur until stage II.

patient with COPD is sitting in a bedside chair. The apices of the lungs in this position compared with other areas of the lungs in this position would demonstrate

Correct Answer: Increased volume of air at REEP -The gravity-independent area of the lung in the upright sitting position refers to the apices of the lungs, which house the most air at resting end expiratory pressure (REEP). -The gravity-dependent area of the lungs in the upright sitting position refers to the bases of the lungs, which will house the most pulmonary perfusion. -The relative increase in blood in the pulmonary capillaries around the alveoli in the bases results in less room for air in those alveoli. Because there is a relative decrease in blood in the pulmonary capillaries around the alveoli in the apices, there is more room for air. Incorrect Choices: -The apices of the lungs in that position have the least perfusion because of the effects of gravity on blood flow. -The apices also have the smallest change in ventilation during the respiratory cycle because they are the most full at rest, and that area has the least ROM of the thorax. -The apices of the lung have the highest oxygenation and lowest carbon dioxide content as a result of the small blood volume that passes by these alveoli. Therefore, a relatively small amount of oxygen is extracted from the alveolar air, and a relatively small amount of carbon dioxide is given off into the alveolar air.

T 10 paraplegia. An extensive neurological workup has failed to reveal a specific cause for the paraplegia. The physician has determined a diagnosis of conversion disorder. During physical therapy, it would be BEST to

Correct Answer: Initiate functional training consistent with the level of injury -A conversion disorder (hysterical paralysis) represents a real loss of function for the patient. The therapist should treat this patient the same as any patient with spinal cord injury with similar functional deficits. Early intervention is crucial. Incorrect Choices: -A psychologist or psychiatrist is best able to help the patient understand the cause of the patient's paralysis. -The therapist should be empathetic; however, counseling should not be the main focus of intervention -Confrontation (using E-Stim to prove the patient has functioning muscles) is contraindicated

In treating a patient with a diagnosis of right shoulder impingement syndrome, the FIRST intervention the PT should consider is to

Correct Answer: Instruct the patient in proper postural alignment -*Without regaining normal postural alignment and scapular-humeral rhythm, the patient will continue to impinge the supraspinatus and/or for biceps tendon at the acromion and never regain normal function of the shoulder*. Incorrect Choices: Appropriate AROM exercises and/or stretching could be the focus after posture has been corrected

patient is being treated for secondary lymphedema of the right arm as a result of a radical mastectomy and diation therapy. The resulting edema (stage 1) can BEST be managed in physical therapy by

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

12-year-old has been referred to a physical therapy clinic for treatment of patellar tendinitis. The examination reveals that the patient is unable to hop on the affected lower extremity because of pain. The PT decides to refer the patient back to the pediatrician for an x-ray of the knee. The patient returns for therapy with the x-ray shown in the figure. The therapist's initial intervention should focus on

Correct Answer: Iontophoresis using dexamethasone and patient education regarding avoidance of squatting and jumping activities -The dysfunction observed on the x-ray is Osgood-Schlatter disease. -The radiograph depicts epiphysitis of the tibia at the attachment of the patellar tendon seen in adolescents. - It occurs as the result of activities that require continued explosive contractions of the quadriceps muscle complex during pubescent growth spurts. - Patient education should focus on controlling knee-loading activities such as squatting and jumping. Iontophoresis using dexamethasone (a corticosteroid) provides a safe mechanism to deliver local anti-inflammatory medication. Incorrect Choices: -Explosive contractions of the quadriceps complex should be avoided. -Ambulation and AROM activities maintain mobility while the structure heals. -*Phonophoresis would be contraindicated because it may be painful to move the sound head over the affected area. In addition, US should be used with precaution over open epiphyses*. -Open-chain knee extension exercise may aggravate symptoms due to the increased load at the attachment of the patellar tendon to the tibial tuberosity.

significant proprioceptive losses in both lower extremities, distal greater than proximal. The BEST strategy to assist in compensatory gait training is to have the patient

Correct Answer: Look at the feet for placement while walking -Selection of compensatory strategies for sensory losses is dependent upon careful assessment of the sensory systems contributing to balance (somatosensory, visual and vestibular). -Control should be refocused to use available intact sensory systems. In this case, proprioception is impaired while vision is intact. Incorrect Choices: -Use of counting can aid gait rhythm, but not foot placement. - Light touch-down support can aid balance, but training using available furniture is a bad idea. - Walking on smooth tile floors does not address the need for compensatory training.

patient with spastic hemiplegia is referred to physical therapy for ambulation training. The patient is having difficulty in rising to a standing position due to cocontraction of the hamstrings and quadriceps. The therapist elects to use biofeedback as an adjunct to help break up this pattern. For knee extension, the biofeedback protocol should consist of

Correct Answer: Low-detection sensitivity, with electrodes placed close together -When the electrodes are close together, the likelihood of detecting undesired motor unit activity from adjacent muscles (crosstalk) decreases. -By setting the sensitivity (gain) low, the amplitude of signals generated by the hypertonic muscles would decrease and keep the EMG output from exceeding a visual or auditory range. Incorrect Choices: -The wider the spacing of electrodes, the more volume of the muscle is monitored. Thus, when targeting a specific muscle, a narrow spacing should be used. -When the focus is not on a specific muscle but instead to encourage a generic motion such as shoulder elevation, then a wider spacing of electrodes can be used. In addition, when working with weakness of a muscle where there is a decreased ability to recruit motor units or a decrease in the size and number of motor units, then a wider spacing and a high sensitivity would be used in order to create an adequate visible signal

10-year-old presents with pain ( 4/10) and limited knee ROM following surgical repair of the medial collateral ligament and ACLs. In this case, the modality that can be used with PRECAUTION

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

ergonomic examination of a computer programmer and workstation, the most appropriate recommendation for achieving ideal wrist and elbow positioning would be to

Correct Answer: Maintain the keyboard in a position that allows a neutral wrist position -Work involving increased wrist deviation from a neutral posture in either flexion/extension or radial/ulnar deviation has been associated with increased reports of CTS and other wrist and hand problems. -KC;ergonomic workstation evaluation Incorrect Choices: - Increasing wrist flexion or extension can be harmful. -Adding armrests does not solve the wrist position problem

excessive forward head, and complains of pain and dizziness when looking upward. The MOST effective physical therapy intervention is

Correct Answer: Manual therapy techniques to provide pain relief and postural reeducation -Long-term postural changes with forward head posture include shortening of the posterior muscles, potential joint restrictions, with possible vertebral artery compromise at the occiput. Incorrect Choices: -The anterior cervical muscles are most likely already lengthened. -Strengthening the posterior muscles will not provide full restoration to the movement restrictions. In addition, the anterior muscle will also benefit from the reconditioning exercises.

patient is confused, with shortness of breath and generalized weakness. Given a history of hypertension and hyperlipidemia, the therapist suspects the patient

Correct Answer: May be presenting with early signs of myocardial infarction. -An elderly patient with a cardiac history may present with initial symptoms of mental confusion, the result of oxygen deprivation to the brain. -The shortness of breath and generalized weakness may be due to generalized circulatory insufficiencies coexisting with the developing myocardial infarction (MI). Incorrect Choices: -Chest pain would be evident with unstable angina. -Hypertension is usually silent (asymptomatic). Occasionally, patients report headache

patient has been confined to bed for 2 months, and now demonstrates limited ROM in both lower extremities. Range in hip flexion is 5o -115 o, and knee flexion is 10 o -120 o. The MOST beneficial intervention to improve flexibility and ready this patient for standing is

Correct Answer: Mechanical stretching using traction and 5-lb weights, 2 hours, two times per day Prolonged mechanical stretching involves a low-intensity force (generally 5 to 15 lb) applied over a prolonged period (30 minutes to several hours). It is generally the most beneficial way to manage long-standing flexion contractures. Incorrect Choices: -Manual passive stretching and tilt-table standing are shorter-duration stretches that are not likely to be as effective in this case. -Hold-relax techniques can be used to improve flexibility in the presence of shortening of muscular elements, but are not likely to be effective in this case, because of the short duration and long standing contracture affecting connective tissue elements.

patient with metabolic syndrome and multiple cardiovascular disease risk factors including hypertension, obesity and hyperglycemia is referred for physical therapy. Initial exercise prescription for this patient should include

Correct Answer: Moderate-intensity ( 40%-60% VO 2) exercise 30 minutes per day, most days of the week Initial exercise training should be performed at moderate intensity, defined as 40%-60% V02max. Duration and frequency should start at 30 minutes per day most days of the week (ACSM Guidelines). Incorrect Choices: - High-intensity exercise (not moderate-intensity), is defined as ( 60%-80% V02), and is too intense for this patient, as is a 45-minute duration. -A frequency of 2 days a week is too low to allow for adequate training effect

permanent damage to the basal ganglia. Intervention for this patient will need to address expected impairments of

Correct Answer: Motor planning with the use of guided and cued movement -The basal ganglia functions to convert general motor activity into specific, goal-directed action plans. -Dysfunction results in problems with motor planning and scaling of movements and postures. -Patients benefit from initial guided movement and task-specific training. Proprioceptive, tactile and verbal cues can also be used prior to and during a task to enhance movement. Incorrect Choices: -Paralysis, hypertonicity and hyperreflexia occur with upper motor neuron lesions (corticospinal tract involvement). -Problems with sensory organization and selection can occur with traumatic brain injury and stroke, and in children with cerebral palsy, Down syndrome and learning disabilities.

patient with neurapraxia involving the ulnar nerve secondary to an elbow fracture. Based on knowledge of this condition, the therapist expects that

Correct Answer: Nerve dysfunction will be rapidly reversed, generally in 2-3 weeks Neurapraxia is a mild peripheral nerve injury (conduction block ischemia) that causes transient loss of function. An example is a compression injury to the radial nerve from falling asleep with the arm over the back of a chair (Saturday night palsy). Incorrect Choices: -If the nerve is cut, the distal part degenerates (Wallerian degeneration). - Regeneration (nerve growth and repair) is dependent upon intact Schwann cell and continuity of the nerve pathway. -Regrowth is at the rate of 1-4 mm/d

methicillin-resistant Staphylococcus aureus (MRSA) infection has been discharged from an isolation setting with an open wound of the buttocks. The patient is now returning to physical therapy as an outpatient. The precaution that needs to be adhered to is

Correct Answer: Open wounds must be well contained with a dressing. - Staphylococcal organisms are spread by contact. -Standard germicidal cleaning measures (hand washing) should be followed. The therapist should be gloved for any direct contact with the patient's intact skin or surfaces or articles in close proximity to the patient. -All equipment should be cleaned with an approved germicidal agent before and after use. Incorrect Choices: -Isolation in a private room is not required; in ambulatory settings, the patient should be placed in an examination room or cubicle as soon as possible. -Treatment in an open gym is inappropriate for patients with MRSA.

pain and paresthesia over the first two metatarsal heads of her right foot. Pain is worse after prolonged periods of weight bearing. She typically wears shoes with 3-inch heels and pointed toes. The BEST intervention is a:

Correct Answer: Pad placed proximal to the metatarsal heads -Compression of the digital nerves in the forefoot results in sensory symptoms of pain and paresthesia (metatarsalgia). - It is typically the result of excessively tight shoes. The best intervention is *to wear larger shoes, with a metatarsal pad placed proximal to the metatarsal heads to elevate the transverse (anterior) arch and separate the metatarsals*. Custom orthotics can also be molded to decrease load. Wearing of high heels should be discouraged. Stretching of plantarflexors may also be helpful. Incorrect Choices: - A pad placed distal to the metatarsal heads will not provide effective relief of pressure. - A scaphoid pad and Thomas heel are used to support the longitudinal arch and prevent pes valgus, not metatarsalgia

PT is performing the *maximal cervical quadrant test* to the right with a patient with right C5-C6 facet syndrome. The patient would most likely complain of

Correct Answer: Pain in the right cervical region -The test position would consist of *right cervical side-bending with extension. This shortens the upper trapezius and stresses the right cervical facets*. - When a pathological cervical facet is provoked, the result will cause pain in the ipsilateral cervical region, with referred pain to the ipsilateral scapular region. The test might also compress the nerve root, creating radicular signs, but only on the right side. Incorrect Choices: -This test would shorten the upper trapezius so it will not cause tightness in the muscle. -Radicular pain would be consistent with dysfunction of a spinal nerve, not a facet joint syndrome. -Referred pain to the left midscapular region would be caused by a test that was applied to the structures on the left side

newborn with whole arm paralysis is referred for physical therapy. INITIALLY, the plan of care (POC) should include

Correct Answer: Partial immobilization of the limb across the abdomen, followed by gentle ROM after immobilization 1 Paralysis of the upper limb typically results from a traction injury at birth, causing a brachial plexus injury. Variations include Erb-Duchenne or Erb's paralysis (affecting C5-C6 roots), whole arm palsy (affecting C5-T1 roots), and Klumpke's paralysis (affecting the lower plexus nerve roots, C8 and T1 ). Incorrect Choices: -Mobilization in overhead motions is contraindicated. -Splinting the shoulder in abduction leads to formation of abduction contractures and later hypermobility of the shoulder. -Age-appropriate task training can follow after the initial treatment.

ulcer superior to the medial malleolus, the PT notes hemosiderosis and liposclerosis. There are no signs of infection, there is minimal drainage, granulation is present and the wound bed is clean except for a small amount of yellow fibrin deposits. The next action the therapist should take is

Correct Answer: Perform an ankle brachial index (ABI). The description of the wound is characteristic of a venous stasis ulceration, which is evident by the location (common site is superior to the medial malleolus), hemosiderosis (an accumulation of hemosiderin, a brown-colored pigment) and the liposclerosis (thickening of the tissue). -Although this is a venous insufficiency wound, there could be a concomitant arterial disease, and before any type of compression therapy is applied (primary management for venous ulcerations), arterial perfusion must be assessed. -The ABI is performed using a Doppler US and comparing the systolic pressure of the tibial or dorsalis pedis artery with that of the brachial artery. An ABI of 1 is normal. Incorrect Choices: -An ABI of 0.5-0.8 indicates signs of decreased arterial perfusion are present, and any compression therapies will be contraindicated. -Applying a four-layer bandage system (e.g., Pro fore) or an Unna boot is an appropriate compression therapy if arterial disease is absent. -Debriding the wound in this case is not necessary (small amounts of fibrin deposits are normal), and whirlpool irrigation is harmful to granulation. In addition, placing the limb in a dependent position may further aggravate the condition.

During the course of the physical therapy treatment in the ICU, a radial artery line gets pulled (comes out of the artery). The FIRST thing the PT should do is

Correct Answer: Place a BP cuff on the involved extremity and inflate the cuff until the bleeding stops -A radial arterial line is a catheter placed in the artery itself. If it becomes dislodged during treatment, the artery is now open to bleeding. This arterial bleeding needs to be stopped immediately, although it is not considered a cardiac emergency. Incorrect Choices: -Elevating the site of bleeding above heart level will not be as effective, because this is an arterial bleed. As long as the heart is pumping with adequate pressure, the site will continue to bleed. -Never replace any line that has become disconnected. The line is no longer sterile, and should not be reinserted into the patient. A new, sterile catheter will need to be used if the radial line is to be replaced.

patient with vestibular dysfunction. The patient is asked to assume a long sitting position with the head turned to the left side. The therapist then quickly moves the patient backward so that the head is extended over the end of the table approximately 30° below horizontal. This maneuver causes severe dizziness and vertigo. A repeat test with the head turned to the right produces no symptoms. The therapist reports these findings as a:

Correct Answer: Positive left Hallpike-Dix test The test described is the Hallpike-Dix. It is a left positive test because, with the head turned to the left, the change in position produces the patient's symptoms. Incorrect Choices: -The right Hallpike-Dix test with head turned to the right is negative. -The sharpened Romberg's test is used to assess standing balance (disequilibrium) with the eyes closed and feet in a tandem (heel-toe) position. -The Hallpike-Dix test is a positional test;

patient suffered a cerebral thrombosis 4 days ago and presents with the following symptoms: decreased pain and temperature sensation of the ipsilateral face, nystagmus, vertigo, nausea, dysphagia, ipsilateral Horner's syndrome and contralateral loss of pain and temperature sensation of the body. The MOST LIKELY site of the thrombosis is the

Correct Answer: Posterior inferior cerebellar artery - This patient presents with lateral medullary (Wallenberg's) syndrome, which can result from occlusion of the PICA, which is usually a branch of the vertebral artery. It involves the descending tract and nucleus of CN V, the vestibular nucleus and its connections, CN IX and CN X nuclei or nerve fibers, cuneate and gracile nuclei and spinothalamic tract. Incorrect Choices: -The symptoms in this case clearly indicate brain stem (cranial nerve) involvement, not cortical involvement (anterior or posterior cerebral artery). -An internal carotid artery stroke produces symptoms of combined middle cerebral and anterior cerebral artery strokes

patient who is insulin-dependent. In a review of the patient's medical record, the therapist notices that the blood glucose level for that day is 310 mg/dL. The therapist's BEST course of action is to

Correct Answer: Postpone therapy and consult with the medical staff as soon as possible -3 Normal fasting plasma glucose is less than 115 mg/dL, while a fasting plasma glucose level greater than 126 mg/dL on more than one occasion is indicative of diabetes. around 120mg/dl -*This patient is hyperglycemic with high glucose levels(250 mg/dL). Clinical signs that may accompany this condition include ketoacidosis (acetone breath) with dehydration, weak and rapid pulse, nausea/vomiting, deep and rapid respirations (Kussmaul's respirations), weakness, diminished reflexes and paresthesias*. -The patient may be lethargic and confused, and may progress to diabetic coma and death if not treated promptly with insulin. -Physical therapy intervention is contraindicated; exercise can lead to further impaired glucose uptake.= d/t ex uses up insulin that can be used to burn glucose. Incorrect Choices: Ambulation is contraindicated.

The problems associated with ankylosing spondylitis in its early stages can BEST be managed by the PT with

Correct Answer: Postural education -Postural reeducation will help to prevent further increases in thoracic kyphosis, and costal expansion exercise will improve breathing efficiency. Incorrect Choices: -Stretching of scapular stabilizers is not indicated because the postural changes may already have overstretched these muscles. - Pain management is usually not a factor in the early stages of the condition. - Joint mobilization is not a successful intervention in this progressive disorder

Patients diagnosed with Paget's disease typically have symptomatology similar to that of spinal stenosis. The MOST important aspect of physical therapy intervention is

Correct Answer: Postural reeducation to prevent positions that increase symptoms -Patients should be educated to minimize certain positions for long periods. -Symptoms resulting from Paget's disease are aggravated by positions in which the lumbar spine is in extension. Incorrect Choices: -Because this is a chronic condition, modalities are not the most effective management strategy. - Lumbar extension exercises decrease the space within the vertebral foramen, thereby increasing symptoms of pain associated with stenosis and Paget's disease. -Strengthening exercises for the abdominal and back muscles do not affect the disease processes of slowly progressive enlargement and deformity of multiple bones

elderly and frail older adult has low vision. The patient recently returned home from a 2-week hospitalization for stabilization of diabetes. The PTs goal is to mobilize the patient and increase ambulation level and safety. The BEST intervention strategy for this patient is to

Correct Answer: Practice walking in areas of high illumination and low clutter -Effective intervention strategies for the elderly patient with diabetes and low vision include ensuring adequate lighting. Vision and safety decrease dramatically in low lighting. -Reducing clutter-throw lug- in the home is also an important strategy to improve safety during ambulation. Incorrect Choices: -The patient should not continuously look down at the feet, because this poses a safety hazard. This restricts avoidance strategies for environmental objects. -Visual acuity decreases dramatically with bright glare from sunlit windows. -Color-coded stairs might help if they are well lit and if strong colors, not pastels, are used

Figure 1 depicts this patient's resting telemetric ECG recording, and Figure 2 depicts the patient's exercise (ambulating 2.5 mph on a flat surface in the hallway) telemetric ECG recording. The appropriate interpretation of the change between recordings is

Correct Answer: Preventricular contractions, indicating abnormal response to increasing work demands and high risk -*New onset of preventricular contractions (wide complex, lack of a P or T wave) indicates an abnormal response to increasing work demands, and indicates high risk for cardiac patients*

PT is instructing a student in proper positioning to prevent the typical contractures in a patient with a transfemoral amputation. The therapist stresses positioning the patient in

Correct Answer: Prone-lying with the residual limb in neutral rotation 1 The typical contractures with a transfemoral amputation are hip flexion (typically from too much sitting in a wheelchair). The residual limb also rolls out into abduction and external rotation. When in bed, hip extension should be emphasized (e.g., prone-lying). When sitting in the wheelchair, neutral hip rotation should be emphasized (e.g., using an abductor roll). Time in extension (prone, supine, or standing) should counterbalance time sitting in a wheelchair. Incorrect Choices: -Resting in supine with the residual limb resting on a small pillow in a position of hip flexion is contraindicated, as is an adductor roll in wheelchair sitting.

patient is recovering from stroke and demonstrates good recovery in the lower extremity (out-of-synergy movement control). Timing deficits are apparent during walking. Isokinetic training can be used to improve

Correct Answer: Rate control at varying movement speeds 2 Patients during recovery from stroke frequently exhibit problems with rate control during walking. *They are able to move at slow speeds, but as speed of movement increases, control decreases*. An isokinetic device can be an effective training modality to remediate this problem. Incorrect Choices: Both initiation of movement and reaction time may be impaired, but are not the likely cause of timing deficits during speed changes while walking.

complaint of neck pain on the right. full side-bending left, full rotation to the left, full forward flexion, limited and painful extension, limited and painful right side-bending and limited and painful right rotation. Based on this pattern, what is the arthrokinematic restriction

Correct Answer: Restriction with downglide of a facet on the right - If a facet on the right was restricted with downgliding (arthrokinematic restriction), then the osteokinematic motions that would be limited would be rotation and side-bending to the right with limited extension. -The fact that there is pain on the right supports that the restriction is on the right. Incorrect Choices: -The osteokinematic limitation could also be seen with a facet restricted with upglide on the left, but the differentiator is the fact that the pain is on the right, indicating that the restriction is on the right.

spasticity patterns after stroke

Correct Answer: Shoulder adductors; forearm pronators; and flexors of the elbow, wrist and hand - The typical pattern of spasticity in the UE of the patient recovering from stroke is shoulder adductors; forearm pronators; and flexors of the elbow, wrist and hand (*antigravity muscles*;extensor/postural muscles)). Incorrect Choices: -*Spasticity is strong in shoulder adductors, not abductors*. N:환자가 당랑권으로 치료사를 공격한다 -Spasticity is strong in elbow flexors, not extensors. -Spasticity is not typically strong in shoulder flexors (the elbow is typically held in flexion, with arm adducted to the side).

Parkinson's disease (PD) is referred for physical therapy. During the initial examination, the patient demonstrates significant rigidity, decreased PROM in both upper extremities in the typical distribution and frequent episodes of akinesia. The exercise intervention that BEST deals with these problems is

Correct Answer: Sitting, PNF bilateral symmetrical upper extremity D2 flexion patterns, rhythmic initiation =*The patient with PD typically develops elbow flexion, shoulder adduction contractures of the upper extremities, along with a flexed, stooped posture*. (UMN synergy pattern) -Bilateral symmetrical upper extremity PNF D2F patterns encourage shoulder flexion and abduction, with elbow extension and upper trunk extension (all needed motions) Incorrect Choices: -Both quadruped and modified plantigrade positions encourage postural flexion. -The patient needs exercises to improve postural flexibility and AROM, not strength of shoulder flexors.

child with spastic cerebral palsy is having difficulty releasing food from the hand to the mouth. Once the child has brought the food to the mouth, it would be helpful for the caregiver to

Correct Answer: Slowly stroke the finger extensors in a proximal-to-distal direction - Slowly stroking the finger extensors will help to facilitate opening of the hand and allow the child to release the food into the mouth. Incorrect Choices: -Stimulation of spastic finger flexors (slow stroking, quick stretch) is contraindicated. -Passive extension of the fingers will not enhance the activity of feeding

traumatic brain injury (TBI), a patient is unable to bring a foot up onto the next step during a training session on stair climbing. The BEST course of action to promote learning of this task is to have the patient practice

Correct Answer: Step-ups onto a low step while in the parallel bars. Active task-specific practice of stepping using a low step represents the best choice to ensure motor learning. Incorrect Choices: -Passively bringing the foot up does not promote active learning. - Marching in place and balance on stairs are appropriate lead-up skills to stair climbing, but are not task-specific practice.

common compensatory postures would a PT expect for a patient diagnosed with fixed severe forefoot varus?

Correct Answer: Subtalar pronation and medial rotation of the tibia. In order to maintain the center of gravity over the base of support the subtalar joint must pronate, and the entire lower quarter must medially rotate.

patient has been on bed rest for 4 days following complications after revascularization surgery involving a triple coronary artery bypass graft. During the first therapy session, the patient complains of tenderness and aching in the right calf. The therapist should immediately examine for

Correct Answer: Swelling in the calf or ankle -Deep vein thrombophlebitis (DVT) is characterized by classic signs of inflammation (tenderness, aching and swelling), typically in the calf. -Rapid screening is possible with Doppler ultrasonography. Color flow venous duplex scanning is the primary diagnostic test for detection of DVT. Incorrect Choices: -Tachycardia, not bradycardia, may be present. - Slight fever can be present, as part of the inflammatory reaction, not lowered temperature. -Homan's sign is pain in the calf perceived with squeezing the calf and dorsiflexion; this is not considered reliable and lacks specificity and sensitivity

ECG changes that may occur with exercise in an individual with coronary artery disease (CAD) and prior myocardial infarction (MI) include

Correct Answer: Tachycardia at a relatively low intensity of exercise with ST segment depression -The typical exercise ECG changes in the patient with CAD include tachycardia at low levels of exercise intensity. -The ST segment becomes depressed (> 1 mm is significant). In addition, complex ventricular arrhythmias (multifocal or runs of PVCs) may appear, and are associated with significant CAD and/or a poor prognosis. Incorrect Choices: -Chronotropic incompetence is indicated by an HR that fails to rise - bradycardia (slowing of HR) is not expected. -ST segment elevation with significant Q waves can occur and is indicative of aneurysm or wall motion abnormality

In a patient demonstrating early lift-off during the preswing phase of gait the mobility of which joints of the ankle and foot are important for assessing the ability to maintain forward progression of the foot

Correct Answer: Talocrual and first metatarsophalangeal joints -*The primary motions of the talocrual and first metatarsophalangeal joints are plantarflexion and dorsiflexion in the sagittal plane*. -Normal forward progression of the ankle and foot during late stance period (terminal stance and preswing) requires ankle and great toe dorsiflexion. Incorrect Choices: *The primary motions of the talonavicular and subtalar joints are pronation and supination in the frontal plane*.

pain (7 /10) in the shoulder region secondary to acute subdeltoid bursitis. As part of the plan of care during the acute phase, the therapist elects to use conventional TENS, which will modulate the pain primarily through

Correct Answer: The *gate control mechanism* is activated by the application of conventional (high-rate) TENS at the spinal cord level. Incorrect Choices: -Ascending inhibition occurs after the gate control mechanism has been activated. - Low-rate TENS, having a stronger stimulus and a longer pulse duration, activates the descending inhibition, stimulating endorphin production mechanisms

There is decreased motion at the third right MCP joint. To differentiate as to whether this is joint restriction or some other type of tightness (not joint), which examination procedure should be employed

Correct Answer: The Bunnel-Littler test is specifically utilized to determine if there is a joint restriction present at the MCP joints. Incorrect Choices: -The retinacular test is used to determine if there is a restriction at the PIP joint. -Finkelstein's test is used to assess for a tenosynovitis of the abductor pollicis longus and/or extensor pollicis brevis. -Froment's sign is utilized to identify an ulnar nerve dysfunction.

restricted left rotation of the C7-T1 spinal level. After stabilizing the thoracic spine, the therapist's hand placement for mobilization to improve left rotation should be at the

Correct Answer: The most effective hand placement for mobilization into greater left rotation is at the posterior aspect of the *right C7 articular pillar* because it rotates the C7 vertebra to the left. Incorrect Choices: -Hand placement on the left of C6 or C7 articular pillars will promote right rotation. -Hand placement on the Tl spinous process will create a posteroanterior glide, which will promote flexion at the Tl-2 segment and extension at the C7-Tl segment

small superficial wound over the sacral area. Because only small amounts of necrotic tissue are present, the physician has decided to use autolytic wound debridement. This is BEST achieved with

Correct Answer: Transparent film dressing -Autolytic wound debridement allows the body's natural enzymes to promote healing by trapping them under a synthetic, occlusive dressing. - Moisture-retentive dressings are applied for short durations(< 2 weeks). -Choices include transparent film dressings or hydrocolloid or hydrogel dressings

patient complains of difficulty walking. At rest, the skin in the lower leg appears discolored. After walking for about 2 minutes, the patient complains of pain in the leg. A marked pallor is also evident in the skin over the lower third of the extremity. The PT suspects

Correct Answer: Vascular claudication Intermittent claudication (leg pain) occurs with peripheral vascular disease (PVD). Exercising the extremity to the point of claudication results in the development of pain, along with increased pallor of the skin. Pulses may also be decreased or absent because of ischemia. The hallmark of claudication pain is that it is relieved with rest. Incorrect Choices: -Neurogenic claudication is associated with burning pain and dysesthesias. -Peripheral neuropathy produces aching pain with sensory loss and numbness of the feet. It can progress to involve the hands (stocking and glove distribution). Motor weakness and muscle atrophy can occur (chronic sensorimotor neuropathy) along with autonomic changes (autonomic neuropathy). -Restless leg syndrome is associated with "creeping" or "crawling" sensations in the legs that result in involuntary movements

congestive heart failure (CHF). Digitalis (digoxin) has been prescribed to improve heart function. The patient will demonstrate understanding of the adverse side effects of this medication by recognizing the importance of contacting the primary physician with the appearance of which of the following symptoms

Correct Answer: Weakness and palpitations =slowdown of heart causes papitayion n weakness dut to less blood flow *Digitalis (digoxin) is frequently used to treat CHF (it slows HR and increases force of myocardial contraction*).

diagnosed with Alzheimer's type dementia. In formulating a plan of care, it is important to understand that the patient

Correct Answer: Will likely be resistant to activity training if unfamiliar activities are used - Activity training is most likely to be successful if done with familiar activities. Incorrect Choices: -A patient with Alzheimer's disease cannot be trusted to safely perform ADLs or functional mobility skills. -Memory for past events may be retained initially, but eventually all memory becomes impaired

The postoperative course was complicated by atrial fibrillation, which has been controlled with medications prescribed by a cardiologist. The patient's resting vital signs are HR = 90 in atrial fibrillation, BP = 116/74, RR = 14, and Sp02 = 99% on room air. Should the physical therapist proceed with a symptom-limited exercise test as planned

Correct Answer: Yes, the heart rate is well controlled and the cardiologist is aware of the arrhythmia - It is appropriate to perform an exercise test on a patient who is on medication to control his/her rate with atrial fibrillation (AF). -A normal heart rate is between 60-100 beats per minute, which is where this patient's heart rate falls. Incorrect Choices: -*Patients can be asymptomatic with AF, so it is best to use objective measures to assess their response to activity*. It is safe to exercise a patient who is in AF. -It is a concern if the patient's heart rate is 115-120 beats per minute. This is the point at which diastolic filling time is decreased, which places a person in AF at risk of not maintaining his/her cardiac output with increased demand

slump test on a patient with a diagnosis of lumbar disc herniation whose complaint is pain in the posterior thigh. Which of the following findings would indicate a positive test result?

Correct Answer: a positive slump test would result from pain in the posterior thigh that is relieved with cervical extension

patient with peripheral vascular disease has been referred for conditioning exercise. The patient demonstrates moderate claudication pain in both legs following a 12-minute walking test. The MOST beneficial exercise frequency and duration for this patient

Correct Answer: times/week, BID 10 minutes/session - Patients with vascular insufficiency and claudication pain should be encouraged to walk daily, 2 to 3 times/ day. -Duration should be short. -The patient should walk to the point of maximum tolerable pain, and be allowed to rest.

physical therapy for vestibular rehabilitation. The patient presents with spontaneous nystagmus that can be suppressed with visual fixation, oscillopsia, and loss of gaze stabilization. Additional postural findings include intense disequilibrium, and an ataxic wide-based gait with consistent veering to the left. Based on these findings, the PT determines that the patient is MOST LIKELY exhibiting signs and symptoms of

Correct Answer: unilateral vestibular dysfunction -An abnormal vestibular ocular reflex (VOR) produces nystagmus (involuntary cyclical movements of the eye), loss of gaze stabilization during head movements and oscillopsia (an illusion that the environment is moving). -Abnormal vestibulospinal function produces impairments in balance and gait. -Veering to one side is indicative of unilateral vestibular dysfunction (in this case, the left side). Incorrect Choices: -BPPV is associated with episodic vertigo, nausea, blurred vision and autonomic changes that occur with head movement, and typically *stop within 30 seconds once the head is static*. -Acoustic neuroma is a benign tumor *affecting CN VIII*, and is associated with progressive hearing loss, tinnitus and disequilibrium. -Meniere's disease is associated with symptoms of nausea and vomiting, episodic vertigo and fullness in the ear with low-frequency hearing loss.

postpartum sacral pain. The patient complains that pain is increased with prolonged walking, ascending or descending stairs and rising from sit-to-stand. The intervention that is MOST beneficial for this problem is

Correct Answer:*Manual therapy techniques of the SI joint to provide relief of symptoms-pain-, and therapeutic exercise to restore normal function of the pelvic girdle*. - Ligamentous laxity and pain during pregnancy secondary to hormonal influences (relaxin) most commonly affects the SI joint. This ligamentous laxity continues to occur for up to 3 months after pregnancy and leaves the pelvic area vulnerable to injury;postpartum sacral pain from ligamentous laxity -SI pain is aggravated by prolonged weight bearing and stairs. Incorrect Choices: - Modalities may provide temporary relief of pain, but will not promote any significant impact on healing. - Promoting non-weight bearing does not allow the patient to return to normal function. - *Mobilization will further stretch joint structures that are already lax*

history of two myocardial infarctions ( Mls) and one episode of recent congestive heart failure (CHF). The patient also has claudication pain in the right calf during an exercise tolerance test. An INITIAL exercise prescription that BEST deals with these problems is walking

Correct Answer:Daily, using interval training for 10-to IS-minute periods -An appropriate initial exercise prescription for a patient with a history of CHF and claudication pain in the right calf should include low-intensity exercise (walking), low to moderate duration ( 10-15 min) and higher frequencies (daily). -The exercise session should carefully balance activity with rest (interval or discontinuous training).

patient with active tuberculosis (TB) is referred for physical therapy. The patient has been hospitalized and on appropriate antituberculin drugs for 3 weeks. During treatment, what precautions should the therapist observe

Correct Answer:The patient can be treated in the PT gym, without precautions Primary disease lasts approximately 10 days to 2 weeks. Two weeks on appropriate antituberculin drugs renders the host noninfectious. The patient can be safely treated in the PT gym without precautions. Medication is taken for prolonged periods (9-12 months). Incorrect Choices: -When the patient is diagnosed with active primary TB, the patient should be in a private, negative-pressured room. -The room is considered a potentially infective environment. -The therapist should observe all standard precautions (wearing personal protective equipment). -The patient need only wear a mask when leaving the room.

left lateral epicondylitis has no resolution of symptoms after 2 weeks of treatment. The PT reexamines the patient and finds the left biceps reflex is 1 +.The therapist should NEXT perform a complete examination of the

Correct Answer; Mid cervical region -The patient has symptoms (diminished reflex) of a possible left C5 nerve root compression in the mid cervical spine. -Any reflex change suggests nerve root irritation or compression. -Lateral epicondylitis frequently involves the extensor carpi radialis brevis, which is innervated by *spinal nerves emanating from the mid cervical region* =>1+ reflex in the left biceps is indicative of possible nerve root compression at the C5 level

important predictor for lymphedema after treatment for breast cancer

Correct Answer; Obesity is consistently reported as a predictor of lymphedema after modified radical mastectomy for breast cancer. Weight management should be an integral part of patient education.

weight lifter exhibits marked hypertrophy after embarking on a strength training regime. Hypertrophy can be expected to occur following at least

Hypertrophy is the increase in muscle size as a result of resistance training, and can be observed following at least 6-8 weeks of training. Individual muscle fibers are enlarged, contain more actin and myosin and have more larger myofibrils.

lab values

Increased total blood cholesterol levels (> 200 mg/dL) and levels of LDLs (> 130 mg/dL) increase the risk of coronary artery disease (CAD); conversely, low concentrations of HDLs ( < 40 mg/dL for men and< 50 mg/ dL for women) are also harmful

The cluster of special tests/ findings that has the highest diagnostic accuracy for sacroiliac dysfunction

SI gapping, sacroiliac compression, thigh thrust test (P4), sacral thrust and Gaenslen's test; if these 5 tests were clustered together as a group and at least 3/5 had a positive finding, they were found to have high diagnostic accuracy

Following a total knee replacement (TKR), continuous passive motion (CPM) is initiated. One of the main objectives in using CPM in this case is to facilitate

Studies have shown that following a TKR, CPM significantly increases active knee flexion ability as compared with active knee extension or passive motions

patient's timed up and go (TUG) score is 33 seconds. Based on these results the therapist determines that the patient's fall risk is:

The TUG test records the time it takes for an individual to stand up, walk 3 m, turn, return to the chair, turn and sit down. Most adults can complete the test in 10 seconds; scores between 11 and 20 are normal for frail elderly; *scores over 30 are indicative of impaired functional mobility and high risk for falls*.

with decreased ankle dorsiflexion range of motion following a repair of the Achilles tendon that is now well healed. Which joint, in addition to the talocrual joint, should be assessed as a likely contribution to the restricted range

The distal tibiofibular joint must separate slightly with ankle dorsiflexion in order to allow the talus to pass between the articulating surfaces of the malleoli

BEST shoulder position to expose the tendon of the long head of the biceps for application of phonophoresis would be

The long head of the biceps is best exposed in shoulder lateral rotation and extension, due to its attachment at the supraglenoid tubercle of the scapula, which is at the *medial aspect of the shoulder joint*

Tl2 paraplegia (ASIA A) for ambulation with crutches, the upper quadrant muscles that would be MOST important to strengthen include

The upper quadrant muscles that are most important to strengthen for crutch gaits include the lower trapezius, latissimus dorsi and triceps. Shoulder depression and elbow extension strength are crucial for successful crutch gait

the rehabilitation team visits the home and finds three standardheight steps going into his home. A ramp will have to be constructed for wheelchair access. The recommended length of this ramp should be

architectural standard for rise of a step is 7 inches (steps may vary from 7-9 inches). The recommended ratio of slope to rise is 1:12 (an 8% grade). For every inch of vertical rise, 12 inches of ramp will be required 3X7X12=252 inches

Dynamic Gait Index

assess patient's ability to *modify gait in response to changing task demands*

functional hand position splinting after burns

slight wrist extension, supported fingers in natural slightly flexed position, and thumb partially opposed; Slight wrist extension, with fingers supported and thumb in partial opposition and abduction

papilledema

stasis of blood flow out of the ocular fundus; sign of increased intracranial pressure