NPTE

*A patient receives neuromuscular electrical stimulation to the quadriceps femoris in supine position with 30° of knee flexion. No contraction is elicited, even though the patient reports a strong tingling sensation under the electrodes. Which of the following alterations is MOST appropriate in order to elicit a contraction? 1. Increase in current amplitude 2. Increase in pulse duration 3. Decrease in electrode size 4. Decrease in distance between electrodes

1. Amplitude is the magnitude of current or voltage (p. 227). The patient already reports a strong tingling sensation, and increasing amplitude would increase the sensation. 2. Pulse duration is the time from the beginning of the first phase of a pulse to the end of the last phase of a pulse (p. 226). Most patients find longer pulse durations more comfortable when larger muscles are being stimulated (p. 248). Longer pulses are needed to depolarize motor nerves (p. 229). 3. Current density is the amount of current delivered per unit area (p. 236). Current density is inversely proportional to the size of the electrode; larger electrodes are more comfortable than smaller ones (p. 234). Decreasing electrode size would increase current density. Increasing current density would increase the strong tingling sensation the patient is currently feeling. 4. The distance or spacing between electrodes affects the depth and course of the current. The closer together electrodes are configured, the more superficially the current travels, and conversely, the greater the distance between them, the deeper the current travels (p. 234). The quadriceps femoris is a long muscle; therefore, increasing electrode spacing would be more appropriate.

A patient with undiagnosed type 2 diabetes is MOST likely to have which of the following signs or symptoms? 1. Overall decrease in urinary output 2. Reported shakiness after exercise 3. Increased heart rate variability with exercise 4. Stocking-glove numbness of the lower extremities

1. Increased, not decreased urinary output is a symptom of undiagnosed or poorly controlled type 2 diabetes (p. 426). 2. Shakiness after exercise is a common complaint of hypoglycemia. Undiagnosed individuals would tend to be hyperglycemic. Exercise is likely to further raise blood glucose levels in patients with undiagnosed type 2 diabetes. (p. 430) 3. Individuals with type 2 diabetes often show reduced heart rate variability due to dysfunction of the parasympathetic and sympathetic nervous system (p. 427). 4. Since multiple nerves are affected with diabetic neuropathy, a stocking-and-glove pattern of loss of sensation is present rather than an alteration in sensation that corresponds to a nerve root or peripheral nerve distribution (pp. 428-429).

A patient who is an avid runner had insidious onset of anterior leg pain that is localized, sharp, shooting in nature, and especially aggravated with heel strike (initial contact) during walking and running. The pain first occurred after an increase in running speed and hardness of the training surface 2 weeks ago. Which of the following tests and measures is MOST appropriate to determine the cause of the pain? 1. Compartmental pressure testing 2. Joint range of motion and strength 3. Biomechanical gait assessment 4. Vibration and percussion testing

1. Exertional compartment syndrome presents with subjective symptoms, including exertional leg pain (not the pin-point tenderness as presented in this case), decreased sensation after exertion, and paresthesias (Magee, p. 856). 2. Although these measures should be included in the examination, joint range of motion is usually maintained in persons with a stress fracture and would not be of utmost importance to include in the examination (Magee, p. 856). 3. Although gait assessment may be included as an examination measure, testing for conditions affecting the bones would be inherent at this point, because the patient is having pain with walking. The patient's gait may be altered due to pain at heel strike (initial contact), and an assessment at this point would not reflect the patient's normal gait. (Magee, p. 856) 4. Most individuals with stress fractures report an insidious onset of pain that correlates with a change in equipment or training and is exacerbated by the offending activity. They will have localized bony tenderness and palpable periosteal thickening, especially if they have long-standing symptoms. Some persons have pain at the fracture site with percussion or vibration at a distance from the fracture. Joint range of motion is usually maintained. Persons with a tibial stress fracture will have pin-point tenderness on the tibia and have pain with three-point stress. (Magee, p. 856) If a stress fracture is suspected, a tuning fork may be used at the suspected fracture site to provoke symptoms (Goodman, p. 1031).

*A patient with myasthenia gravis has been transferred from intensive care to an acute care neurology unit after a myasthenic crisis. Which of the following physical therapy interventions is MOST appropriate for the patient? 1. Deep breathing exercises 2. Instruction in skin inspection 3. Neuromuscular electrical stimulation 4. Treadmill training with progressive incline

1. In the acute care setting, deep breathing and coughing should be encouraged (p. 1698). 2. Patients with myasthenia gravis have intact sensation and do not typically have problems with skin breakdown. The cardinal features are muscle weakness with fatigue. (p. 1697) 3. Because the fundamental defect in myasthenia gravis is failure of neural transmission at the neuromuscular junction, electrical stimulation would not be appropriate (p. 1696). 4. A patient who has myasthenia gravis should avoid strenuous exercise. Frequent rest periods help conserve energy and give muscles a chance to regain strength. (p. 1698) Myasthenia Gravis Etiology: autoimmune disorder resulting in neuromuscular junction disorder - defect in transmission of nerve impulses; antibodies block/destroy receptors that are needed for acetylcholine uptake & this prevents muscle contraction; enlarged thymus S&S: extreme fatiguability & skeletal muscle weakness that can fluctuate (periods of remissions and exacerbations); ocular muscles typically affected first, half of pts experience ptosis & diplopia; dysphagia, dysarthria, and CN weakness are also common, like affecting facial expression; other neurological findings are normal (reflexes, sensation, etc) Triggers: activity, heat, stress, illness, certain meds, menstruation, pregnancy Tx: MG "crisis" is a medical emergency (involves exacerbation of respiratory muscles & requires a ventilator; Meds to inhibit acetylcholinesterase (the enzyme that breaks down Ach) to allow Ach to buildup at neuromuscular junction (will diminish symptoms of weakness and fatiguability; corticosteroids to suppress immune system; PT focus on obtaining respiratory baseline & pulmonary intervention (breathing techniques), energy conservation techniques, strengthening using isometric contractions, endurance; caution to avoid overexertion

In the acute setting, which of the following characteristics is shared by individuals with complete spinal cord injury at C5 and individuals with complete spinal cord injury at T4? 1. Decreased respiratory ability 2. Decreased risk of deep vein thrombosis 3. Inability to mobilize a wheelchair 4. Ability to extend wrists

1. Individuals who have a cervical spinal cord injury or a high thoracic spinal cord injury are subject to respiratory impairments and demonstrate some compromise in respiratory function. There is a progressively greater loss of respiratory function with increasingly higher level lesions, but individuals who have thoracic level lesions still lack intercostal innervation responsible for chest expansion as well as expiration. In addition, muscles of the abdomen affect maintenance of intercostal pressure and the passive expiration of air. (pp. 897-898) 2. Deep vein thrombosis is a potential occurrence with individuals in acute care who have a complete injury at either C5 or T4 (p. 901). 3. Individuals who have a complete spinal cord injury at T4 should be able to independently mobilize a manual wheelchair, whereas individuals who have a C5 lesion are likely to have some difficulty on uneven terrain (pp. 922, 924). 4. Patients who have a complete spinal cord injury at the level of T4 have the ability to extend the wrist, whereas individuals who have a complete C5 injury do not. Wrist extension is innervated at C6. (pp. 892, 922)

The device shown in the photograph would be MOST beneficial for a patient who has which of the following conditions? 1. Osteoarthritis 2. Ankylosing spondylitis 3. Reiter syndrome 4. Psoriatic arthritis

1. Osteoarthritis is a degenerative disease that mainly affects the hands, hips, and knees, causing disability. Manifestations of the disease do not compromise ventilation, and, therefore, use of an incentive spirometer would not be beneficial. (Goodman, p. 1304) 2. Ankylosing spondylitis is a chronic inflammatory disease that leads to spinal and chest wall rigidity (Hillegass, p. 246; Frownfelter, p. 538). Due to the chest wall restriction, there is a decrease in total lung capacity, vital capacity, and inspiratory muscle function (Frownfelter, p. 538). The device in the photograph is an incentive spirometer, which encourages deep breathing and extended inspiration, leading to an increase in vital capacity and chest wall mobility (Frownfelter, pp. 695-696). This device would be beneficial for a patient who has ankylosing spondylitis. 3. Reiter syndrome is a form of reactive arthritis that can follow an infection by a microbial pathogen. Symptoms include urethritis, conjunctivitis, and arthritis. There is no compromise to ventilation indicated, and, therefore, use of an incentive spirometer would not be beneficial. (Goodman, pp. 1343-1344) 4. Psoriatic arthritis occurs in 20% of patients who have psoriasis and leads to joint disorders due to the development of inflammatory synovitis. The disease is most likely to affect the distal interphalangeal joints of the hands. Symptoms do not compromise ventilation; therefore, use of an incentive spirometer would not be beneficial. (Goodman, pp. 1341-1342)

The joint mobilization shown in the photograph will have the GREATEST effect on improving which of the following phases of gait? 1. Heel off (terminal stance) 2. Foot flat (loading response) 3. Toe off (preswing) 4. Midswing

1. The therapist is performing an anterior glide of the tibia on the femur, which would increase knee extension (Kisner, p. 149). During heel off (terminal stance), a knee extension of 0° is necessary for normal function (Magee, p. 992). 2. The knee angle in the foot flat (loading response) phase required for normal gait is 15°. The photograph shows an angle greater than 15°. The joint mobilization shown in the photograph helps to restore knee extension. This would not improve the foot flat (loading response) phase of gait. (Magee, p. 992) 3. The knee angle in toe off (preswing) is 40° of flexion. The joint mobilization shown in the photograph helps to improve knee extension, which would not improve toe off (preswing). (Magee, p. 992) 4. No gait deviation is caused by lack of extension during the swing phase. The knee achieves 25° of flexion in this phase. (Magee, p. 992)

During initial examination of a patient who has rotator cuff tendinitis, a physical therapist notices that, during arm elevation, the involved scapula upwardly rotates early, compared to the uninvolved scapula. Passive range of motion of the involved shoulder is normal. Based on the findings, which of the following pairs of muscles BEST stabilizes the scapula to promote a balanced force couple on the involved side? 1. Rhomboids and upper trapezius 2. Upper trapezius and serratus anterior 3. Latissimus dorsi and lower trapezius 4. Latissimus dorsi and serratus anterior

1. The upper trapezius is a prime mover in scapular elevation and upward rotation. The rhomboids are prime movers in shoulder retraction and elevation as well as scapular downward rotation. These two muscles are not the best pair to promote a balanced force couple because they are pulling in different directions to accomplish different motions. (p. 136) 2. The upper trapezius muscle pulls up and the lower fibers of the serratus anterior pull outward in a horizontal direction. The net effect is that together the two muscles pull in different directions to accomplish the same motion, which is the scapula rotating upward. (pp. 135, 137-139) 3. The latissimus dorsi does not affect the movement of the scapula significantly. It works to extend, adduct, medially (internally) rotate, and hyperextend the shoulder. The lower trapezius depresses and upwardly rotates the scapula. This answer is incorrect because the two muscles together do not produce a balanced force couple. (pp. 135, 152) 4. Although the serratus anterior is involved in stabilization of upward rotation, the latissimus dorsi does not affect the movement of the scapula significantly (pp. 137, 152).

A patient has a diagnosis of L3 lumbar nerve root impingement. Which of the following tests is MOST appropriate for a physical therapist to include during an examination of this patient? 1. Knee flexion strength and sensation over the posterior aspect of the thigh 2. Hip flexion strength and sensation over the lateral aspect of the knee 3. Knee extension strength and sensation over the medial aspect of the knee 4. Knee extension strength and sensation over the proximal anterior aspect of the thigh

4. Knee extension strength and sensation over the proximal anterior aspect of the thigh Rationale 1. The S1 nerve root is assessed by testing the strength of the hamstrings and the integrity of the S1 dermatomal pattern (p. 25). 2. Testing of the lateral aspect of the knee is used to evaluate the L4/L5 dermatome, not the L3 dermatome, which includes the back, upper buttock, anterior thigh and knee, and medial lower leg (pp. 25, 853). 3. To examine for possible L3 neurological impairment, the examiner should assess knee extension strength (L3 myotome) and sensation over the inner knee and anterior lower leg (pp. 25, 853). 4. Testing of the proximal anterior thigh region is used to evaluate the L2 dermatome, not the L3 dermatome (p. 25, 853). 1. L2-L3 sensation is on the lateral thigh (Magee, p. 585). 2. L3-L4 sensation is on the anteromedial thigh and leg (Magee, p. 585). 3. L5-S1 sensation is on the lateral foot; muscles controlling hip abduction are innervated at L4-S1 (Magee, p. 585; Drake, p. 575). 4. S2-S3 sensation is on the plantar foot (Magee, p. 585).

A patient has a distal radius fracture as a result of falling on an outstretched hand. Which of the carpal bones labeled on the illustrated normal radiograph is MOST likely to be fractured with this type of injury? 1. A 2. B 3. C 4. D

Rationale "A" is the anatomical location of the trapezium carpal bone. "B" is the anatomical location of the capitate carpal bone. "D" is the anatomical location of the triquetrum. The scaphoid carpal bone is more likely to be fractured with this type of injury. A scaphoid fracture occurs during a fall on an outstretched hand with the wrist dorsiflexed and radially deviated. In the image, "C" is the anatomical location of the scaphoid carpal bone. The scaphoid carpal bone is most likely to be fractured with this type of injury.

A quantitative research design would be MOST appropriate for addressing which of the following research questions? 1. What are the perceptions of students from minority populations regarding possible bias in a standardized graduate school admission test? 2. What are undergraduate students' opinions on the efficacy of a standardized graduate school admission test as a predictor of success in graduate school? 3. What are the opinions of teachers regarding the validity of a standardized graduate school admission test as a predictor of success in graduate school? 4. What is the relationship between scores on a standardized graduate school admission test and completion of a doctoral program?

Rationale 1, 2, 3. This research question would require a qualitative research design involving interviewing students/faculty to obtain their opinions. 4. This research question would require statistical analysis to answer, which requires a quantitative research design.

A patient with a brainstem infarction resulting in left lateral medullary syndrome is MOST likely to demonstrate which of the following symptoms? 1. Hemiparesis in the left side of the body 2. Hemiparesis in the right side of the body 3. Loss of discriminative touch and proprioception in the left side of the body 4. Loss of pain and temperature sensation in the right side of the

Rationale 1, 2. Corticospinal fibers that supply motor activity are located in the anteromedial aspect of the entire brainstem. Since the infarction is located laterally, it would not include any corticospinal fibers supplying the lower motor neurons. 3. Discriminative touch and proprioceptive information travel through the brainstem in the medial lemniscus, which lies medially. Because it lies medially, it would not be involved in lateral medullary syndrome. 4. The spinothalamic tract in the brainstem, which carries sensory information regarding pain and temperature, lies laterally and thus would be impaired in a lateral medullary stroke. The spinothalamic fibers cross at the spinal cord level, and if they are impaired in the medulla, a deficit would manifest on the opposite side of the body. This would also be combined with cranial nerve signs on the same side of the lesion. A combination of cranial nerve signs on one side with other deficits (sensory or motor) in the body is a clear sign of brainstem dysfunction.

When taking a patient's pulse, which of the following numerical pulse amplitude classifications represents a normal finding? 1. 1+ 2. 2+ 3. 3+ 4. 4+

Rationale 1. 1+ is diminished pulse and is the result of reduced stroke volume and ejection fraction and/or increased vascular resistance. 2. 2+ is considered normal under resting conditions. 3. 3+ is a moderately increased pulse amplitude and is associated with increased stroke volume and ejection fraction. 4. 4+ is a markedly increased pulse amplitude and is associated with increased stroke volume and ejection fraction.

Two days after sustaining a contusion and resultant hematoma of the right anterior tibia, a patient notices numbness, tingling, and coolness in the lower leg. The MOST likely cause of these symptoms is: 1. Volkmann ischemic contracture. 2. thrombophlebitis of the saphenous vein. 3. anterior compartment syndrome. 4. ischemia of the tibial nerve.

Rationale 1. A Volkmann ischemic contracture is a nerve injury resulting from the compressions of fluid, producing a deformed limb (p. 261). 2. Thrombophlebitis of the saphenous vein presents with generalized leg pain, swelling, increased temperature, and bluish discoloration (pp. 268-269). 3. Anterior compartment syndrome can be caused by a blunt trauma and presents with sensory deficits, such as numbness, tingling, and coolness of the extremity (p. 267). 4. Ischemia of the superficial fibular (peroneal) nerve, not the tibial nerve, is more likely to occur as a result of the patient's injury (p. 1061).

A physical therapist is examining a patient who reports anterior knee pain during activity. The patient's resisted knee extension is strong but painful. Palpation elicits tenderness over the patient's patellar tendon, but no structural faults are noted. Which of the following protective devices is MOST appropriate to facilitate a return to sports for the patient? 1. Hinged knee brace 2. Knee sleeve with lateral buttress 3. Thrust unloader brace 4. Infrapatellar strap

Rationale 1. A hinged knee brace does not protect the patellar tendon. It is commonly used with medial collateral ligament or lateral collateral ligament injuries. (Magee, p. 758) 2. Because the result of the biomechanical examination is negative, a lateral buttress is unnecessary (Lusardi, p. 328; Magee, pp. 823-824). à Stabilizes The Kneecap To Help Prevent Dislocations And Help Alleviate Pain. ... The brace is equipped with a tubular, lateral "J" buttress that runs alongside the knee and provides support against lateral patellar subluxation, dislocations, or improper patellar tracking. 3. A thrust unloader brace is used for osteoarthritis in order to unload the medial femoral and tibial condyles (Lusardi, p. 325). 4. An infrapatellar strap is most appropriate for treating patellar tendinitis in the absence of a patellar tracking problem (Magee, p. 762).

*During shoulder evaluation, the following is noted: tenderness with palpation of the subacromial area, a painful arc with passive ROM, and protective muscle spasms around the joint. The end-feel is empty and painful. The physical therapist should suspect: 1. severe sprain. 2. inflamed bursae. 3. tendinitis. 4. fibrosis.

Rationale 1. A patient who has a rotator cuff sprain would demonstrate tenderness with palpation and a painful arc but would have full end-range range of motion, not an empty end-feel. 2. The stem describes the classic signs of acute bursitis. 3. A patient who has rotator cuff tendinitis would demonstrate tenderness with palpation and a painful arc but would have full end-range range of motion, not an empty end-feel. 4. Fibrosis/adhesive capsulitis would result in a capsular end-feel, not an empty end-feel. Normal End-Feel · Soft - soft tissue approximation; ex: elbow flx, knee flx · Firm - stretch; ex: DF, finger ext, hip IR, arm sup · Hard - bone to bone; ex: elbow ext Abnormal End-Feel: end feel felt at an abnormal/inconsistent point in the ROM or in a joint that normally presents with a different end-feel · Soft - ex: edema, synovitis, ligament instability/tear · Firm - ex: increased tone, capsule tightness, ligament shortening · Hard - ex: fracture, OA, osteophyte formation · Empty - cannot reach end-feel, usually due to pain; ex: joint inflammation, fracture, bursitis

For a patient who has diabetic neuropathy, which of the following home modifications would be MOST important to reinforce during patient education? 1. Anti-scald valves on hot water faucets 2. Hand-held shower head 3. Rocker-style light switches 4. Lever-style door handles

Rationale 1. A patient who has diabetic neuropathy usually has sensory impairment of the extremities, and the anti-scald valves will prevent the water temperature from rising above a preset limit, protecting the patient from potential injury from hot water (Goodman, p. 427; O'Sullivan, pp. 355-356). 2. A hand-held shower head does not reduce a risk of injury. The purpose of the hand-held shower head is to allow the direction of the water flow from the bathtub or shower faucet to specific areas to assist with bathing and hair washing. (O'Sullivan, pp. 355-357) 3. A rocker switch does not reduce a risk of injury. The purpose of the rocker switch is to allow the lights to be turned on and off without requiring fine motor skills and use of fingers (e.g., fisted hand, lateral aspect of hand, distal forearm). (O'Sullivan, p. 350) 4. A lever-style door handle does not reduce a risk of injury. The purpose of the lever-style door handle is to promote ease of access for individuals with limited grip strength by using other body parts (e.g., fisted hand, forearm, elbow). (O'Sullivan, p. 348)

A patient's electrocardiogram report describes the presence of significant Q waves. This finding is suggestive of which of the following conditions? 1. Premature atrial complex 2. Myocardial infarction 3. Supraventricular tachycardia 4. Atrial fibrillation

Rationale 1. A premature atrial complex is indicated by an R wave that is close to the preceding R wave (p. 165). 2. A prominent, pathological Q wave is indicative of a transmural myocardial infarction (p. 170). 3. Supraventricular tachycardia is indicated by a diminished P wave, but the duration of the QRS complexes occur within an appropriate interval (p. 166). 4. Atrial fibrillation is characterized by inconsistent, irregular R-R intervals (p. 166).

A patient reports pain at the anterior and lateral aspects of the knee after prolonged sitting and when ascending or descending stairs. After applying tape to the knee, the patient is able to ascend and descend stairs without pain. Which of the following interventions is MOST appropriate to use in addition to the taping? 1. Closed chain quadriceps strengthening exercises 2. Plyometric exercises 3. Pulsed ultrasound to the lateral retinaculum 4. Patellar mobilization focusing on stretching medial structures

Rationale 1. A review of the literature showed strong evidence that both open and closed kinetic chain exercises are at least equally effective in reducing pain and improving function. In one study there appeared to be only a slight advantage to using only closed kinetic chain exercises over using open kinetic chain exercises. Both methods resulted in improved function and decreased pain up to 3 months after concluding the exercise program. 2. Plyometric exercises would apply too much stress on the anterior and lateral aspects of the knee, making symptoms worse. 3. Continuous ultrasound may be of benefit to improve elasticity of structures secondary to the deep heating effect; however, pulsed ultrasound does not produce a heating effect. 4. Patellar mobilization should be used to stretch lateral structures, not medial structures.

A patient has a burn with marked edema, broken blisters, and waxy discoloration. Which of the following classifications BEST describes this wound? 1. Superficial 2. Full-thickness 3. Superficial partial-thickness 4. Deep partial-thickness

Rationale 1. A superficial (epidural) burn appears red or erythematous. Slight edema may be present, but blisters will be absent. (p. 1092) 2. A full-thickness burn is characterized by a hard, parchment-like eschar covering the area. The color can be white, charred, tan, mahogany, black, or red. (p. 1095) 3. The most common sign of a superficial partial-thickness burn is the presence of intact blisters. The wound will be bright pink, red, or mottled red. (p. 1093) 4. A deep partial-thickness burn appears as a mixed red or waxy white color. The surface is wet from broken blisters, and marked edema is the hallmark sign of this burn depth. (p. 1094)

Which of the following characteristics is MOST likely to be found in a superficial partial-thickness burn? 1. Shiny appearance 2. Exposed fat 3. Mild erythema without blisters 4. White color without blisters

Rationale 1. A superficial partial-thickness burn would be wet, with a shiny and weeping surface, and mottled red in color. 2. Full-thickness burn would have fat exposed. A partial-thickness burn would have a broken epidermis. 3. Mild to severe erythema without blisters would characterize a superficial burn. 4. White color would characterize a full-thickness burn. Partial-thickness burns are mottled red in color.

A patient who has tetraplegia experiences an insidious onset of pain inferior to the glenohumeral joint. Soft tissue swelling, local warmth, and erythema are present, as well as limited range of motion. The patient's serum alkaline phosphatase levels are elevated. Which of the following conditions are MOST likely present? 1. Actinomycosis and osteomalacia 2. Pyogenic infection and cellulitis 3. Septic arthritis and ectopic bone formation 4. Granulomatous infection and thrombophlebitis

Rationale 1. Actinomycosis has associated signs and symptoms of chest pain, dyspnea, fatigue, and fever (Ferri, p. 14). Osteomalacia is characterized by painful muscle weakness, bone pain, and tenderness (Goodman, pp. 1227-1228). Alkaline phosphatase levels are elevated. Since the patient is not experiencing chest pain, this is not the correct answer. 2. Alkaline phosphatase is an enzyme produced by bone cells. Increased levels would increase bone formation due to active osteoclasts (Goodman, p. 1232). This does not occur with a pyogenic infection or cellulitis. Cellulitis is associated with redness, tenderness, and edema (Goodman, pp. 700-701). 3. Septic arthritis is characterized by rapid onset, over hours or days, of monoarthritis with a joint that is swollen, red, tender, and warm with limited range of motion due to pain (Goodman, p. 1245). Increases in alkaline phosphatase levels with local edema, heat, and erythema are indicative of heterotopic ossification (ectopic bone formation) (Umphred, pp. 476-478; Goodman, pp. 1288-1289). 4. Neither granulomatous infection nor thrombophlebitis are associated with decreased glenohumeral range of motion (Goodman, pp. 230, 646).

During a bedside evaluation, a patient shows a sudden increase in the rate and depth of respirations, followed by a gradual decrease in respirations and periods of apnea. Which of the following respiratory patterns is the patient exhibiting? 1. Hyperventilation 2. Paradoxical breathing 3. Tachypnea 4. Cheyne-Stokes

Rationale 1. Hyperventilation is characterized by rapid deep breathing (p. 517). 2. Paradoxical breathing is characterized by inward abdominal or chest wall movements with inspiration and outward movement with expiration (p. 518). 3. Tachypnea is characterized by rapid shallow breathing (p. 517). 4. Cheyne-Stokes respiration is breathing that waxes and wanes cyclically so that periods of deep breathing alternate with periods of apnea (no breathing)

A patient has shoulder pain and decreased shoulder active range of motion. The patient's past medical history is unremarkable. Which of the following information would be MOST helpful in determining the source of the patient's symptoms? 1. Date of onset of the problems 2. Passive shoulder range of motion measures 3. Upper extremity deep tendon reflex measures 4. Manual muscle testing scores for the rotator cuff

Rationale 1. Although date of onset is important information, it alone does not give much insight. For example, date of onset will not differentiate between adhesive capsulitis and cuff tear. 2. With just the information listed in the stem, it is impossible to determine whether the problem is adhesive capsulitis or rotator cuff tendinitis/tear, etc. Passive range of motion measures are needed to make this determination, i.e., full passive range of motion points to tendinitis, whereas limited passive range of motion points to adhesive capsulitis. 3. Deep tendon reflexes or neurological status would not be most useful in determining the source of the symptoms. 4. Although manual muscle testing scores for the rotator cuff are also important information, simple manual muscle testing of the cuff might not differentiate tendinitis from other problems such as adhesive capsulitis.

A patient has left-sided hemiparesis that began 3 weeks ago. The left upper extremity is flaccid, and 1 inch (2.5 cm) of shoulder subluxation is evident. The patient is independent in bed mobility and requires minimal assistance for unsupported sitting. A short-term goal for the patient is to maintain correct alignment in sitting position for 2 minutes when challenged. Which of the following activities should the patient perform as a FIRST step toward achieving the goal?

Rationale 1. Although symmetrical weight-bearing provides the necessary base of support for achieving the described goal, reaching forward with the hands clasped is more advanced than symmetrical weight-bearing with an anterior pelvic tilt. 2. Sitting with symmetrical weight-bearing with an anterior pelvic tilt will improve postural alignment and would be the most appropriate first step in meeting the goal. As the patient progresses, this activity will help prepare for transitioning to more advanced activities and transfers. 3. Although symmetrical weight-bearing provides the necessary base of support for achieving the described goal, hitting a balloon away is too advanced to further facilitate the intervention. 4. Crossing legs leads to asymmetrical weight-bearing and is too advanced to further facilitate the intervention.

*A patient has an ulcer on the right lateral malleolus. The ulcer has minimal drainage and measures 1.5 cm × 2.0 cm and 0.5 cm in depth. The patient has an ankle-brachial index of 0.68. Which of the following interventions should be undertaken FIRST? 1. Elevation 2. Compression 3. Hyperbaric oxygen 4. Pressure off-loading

Rationale 1. An ankle-brachial index of 0.68 indicates probable arterial insufficiency (p. 199). Elevation will decrease arterial flow and should not be used. 2. An ankle-brachial index of 0.68 indicates probable arterial insufficiency (p. 199). The wound description does not indicate any edema. Maintained compression would further compromise perfusion in the presence of arterial insufficiency (p. 199). 3. Hyperbaric oxygen can increase oxygen delivery to the wound; however, pressure unloading should occur first to remove the cause of the wound and prevent further breakdown (pp. 199, 362). 4. This wound is over a pressure area. In patients who have vascular disease, the skin and its supporting structures have a decreased ability to endure pressures. Therefore, patients who have vascular disease are at high risk for developing pressure injuries. Off-loading is a first response. (p. 129)

After a 30-day backpacking trip, a patient has pain over the lateral aspect of the shoulder. Upon examination of the patient, the physical therapist notes weakness of elbow flexion and shoulder abduction on the same side as the pain. A lesion at which of the following sites is MOST likely the source of these symptoms? 1. Axillary nerve 2. Upper trunk of the brachial plexus 3. Long thoracic nerve 4. Musculocutaneous nerve

Rationale 1. An axillary nerve lesion will not cause weakness in elbow flexion. 2. The symptoms are consistent with damage to the C5 and C6 nerve roots. à supraspinatus (suprascapular n (C4-6)) and bicep (musculocutaneous n (C5-6)) 3. Symptoms of a long thoracic nerve lesion would be more widely distributed and distal. (serratus) 4. A lesion of the musculocutaneous nerve would not cause lateral shoulder pain.

Which of the following findings are associated with the LOWEST risk for a subsequent cardiac event? 1. Left ventricular ejection fraction of 55% and functional capacity of 3 metabolic equivalents (METs) 2. Occasional premature ventricular contractions and functional capacity of 6 metabolic equivalents (METs) 3. Exercise-induced ST segment depression of less than 2 mm and sustained supraventricular tachycardia 4. Exercise-induced ST segment depression of greater than 2 mm and left ventricular ejection fraction of 45%

Rationale 1. An ejection fraction of 55% to 75% is considered normal (O'Sullivan, p. 525). A patient is at moderate risk for increased morbidity and mortality if functional capacity is less than 5-6 metabolic equivalents 3 or more weeks after a clinical event (O'Sullivan, p. 560). 2. It is common to have a few premature ventricular contractions in a normal heart (O'Sullivan, p. 547). A patient is at low risk for increased morbidity and mortality if functional capacity is greater than or equal to 6 metabolic equivalents 3 or more weeks after a clinical event (O'Sullivan, p. 560). 3. ST segment depression and supraventricular tachycardia (SVT) are not normal cardiac events. ST segment depression during activity is considered diagnostic of myocardial ischemia (Frownfelter, p. 170). Supraventricular tachycardia (SVT) is an electrical conduction abnormality (O'Sullivan, p. 547). Complex ventricular arrhythmias (e.g., SVT) at rest indicate a high risk for increased morbidity and mortality (O'Sullivan, p. 560). 4. An ejection fraction of 45% is below normal. Normal ejection fraction is between 55% and 75% (O'Sullivan, p. 525). ST segment depression during activity is often considered diagnostic of myocardial ischemia (Frownfelter, p. 170). Exercise-induced ST segment depression greater than 2 mm indicates a high risk for increased morbidity and mortality (O'Sullivan, p. 560).

A patient has the gait deviation shown in the photograph. Which of the following pathological conditions of the involved limb is MOST likely the cause? 1. Excessively supinated foot 2. Decreased ankle dorsiflexion strength 3. Increased limb length 4. Weak knee extensors

Rationale 1. An excessively supinated foot occurs during the stance phase and would be accompanied by a general medial (internal) rotation of the lower extremity during stance, which is not evident in the photograph (p. 1005). 2. Decreased dorsiflexion strength will produce an ankle that remains plantar flexed during the swing phase of gait associated with dragging of the toes. The patient would have to hike the hip or circumduct the affected leg to decrease the toe drag. These gait deviations are not shown in the photograph. (p. 1005) 3. Increased limb length would result in the patient having to vault over the longer leg, circumduct the longer leg during swing phase, or hike the hip of the longer leg during swing phase. These gait deviations are not shown in the photograph. (pp. 1006-1007) 4. A patient who has weak knee extensors will likely exhibit genu recurvatum during the stance phase, as shown in the photograph (p. 1003).

A patient is taking anticoagulants. Which of the following side effects should the therapist be concerned about during the patient's exercise? 1. Ecchymosis 2. Deep vein thrombosis 3. Dehydration 4. Hypotension

Rationale 1. Anticoagulants prevent clots. A potential side effect is ecchymosis due to the increased risk of bleeding. 2. Anticoagulants are used to prevent deep vein thromboses. 3. Anticoagulants affect clotting factors and do not directly affect body fluid volume levels; therefore, dehydration would not be the highest concern for this patient. 4. Hypotension is not a side effect of anticoagulants. Bleeding or bruising would be the highest concern for this patient.

A patient in physical therapy is bleeding from a small hand laceration. Which of the following actions should the physical therapist take FIRST? 1. Don protective gloves. 2. Cover the wound with a clean or sterile towel. 3. Elevate the patient's hand above the level of the heart. 4. Apply pressure to the wound.

Rationale 1. Applying protective gloves is the action taken first. 2. Covering the wound is the second action taken. 3. If the blood flow is excessive, the third action would be to elevate the wound above the level of the heart to reduce blood flow to the area. 4. Applying pressure to the wound is the fourth course of action. If arterial bleeding is present, it may be necessary to apply intermittent direct pressure to the artery above the level of wound or direct pressure on wound.

A physical therapist decides that a patient would benefit from strengthening with variable resistance using elastic bands. Which of the following statements BEST describes how the resistance varies? 1. Resistance decreases as the antagonist elongates. 2. Resistance decreases as the agonist shortens. 3. Resistance increases as the agonist elongates. 4. Resistance increases as the agonist shortens.

Rationale 1. As resistance decreases on the band, the antagonist shortens. 2. As resistance decreases, the agonist elongates. 3. As resistance increases, the agonist shortens. 4. Elastic resistance is a function of elongation beyond its resting length. As an agonist shortens to move a joint through a range of motion, the elastic resistance increases because it elongates from its resting position.

Which of the following groups of integumentary signs is MOST typically associated with underlying vascular disease? 1. Shiny skin, blisters, and asymmetric moles 2. Dry scaly skin, hair loss, and color changes 3. Blisters, hair loss, and rash 4. Asymmetric moles, rash, and color changes

Rationale 1. Asymmetrical moles are associated with cancer (Goodman, p. 178). Shiny skin is characteristic of arterial disease (Bryant, p. 193). Blistering is more associated with pressure injuries (Bryant, p. 135). 2. Dry scaly skin, hair loss, and color changes are tropic and circulatory changes associated with venous or arterial disease (Bryant, p. 193; Sussman, p. 174). 3. Rash is associated with an allergic reaction, virus, or parasites (Goodman, p. 180). Blistering is more associated with pressure injuries (Bryant, p. 135). Hair loss is characteristic of arterial disease (Bryant, p. 193). 4. Asymmetrical moles are associated with cancer (Goodman, p. 178). Rash may be associated with an allergic reaction, virus, parasites, or a reaction to chemicals and may not be associated with chronic venous insufficiency (Goodman, p. 180).

A child with trisomy 21 is MOST likely to have which of the following conditions? 1. Athetosis 2. Seizures 3. Hypotonia 4. Hydrocephalus

Rationale 1. Athetosis is not associated with trisomy 21 (Down syndrome) but is characteristic of a type of cerebral palsy 2. Seizures are uncommon in children with trisomy 21 (Down syndrome) but are associated with cerebral palsy 3. Children with trisomy 21 (Down syndrome) have hypotonia (p. 392). 4. Hydrocephalus is uncommon in trisomy 21 (Down syndrome) but is commonly associated with spina bifida

A physical therapist is teaching a patient and her husband about positioning for prevention of contractures. The husband becomes agitated and states that he is unable to help his wife. The therapist is MOST likely to facilitate effective communication with the husband by: 1. offering to leave and come back later when the patient and her husband are calmer. 2. apologizing and asking the husband to repeat what he said. 3. asking the husband to put his concerns in writing so that the problems can be better understood. 4. verbalizing the husband's feelings and asking him if his intended meaning was reflected correctly.

Rationale 1. Avoidance is not recommended. Active listening at the time of intense emotion is an effective means of diffusing emotion. 2. Apologies do not help to diffuse emotion-laden exchanges. 3. Listening skills are needed to diffuse emotion. Writing the problem down will not help diffuse the agitation. 4. Active listening/reflection, rather than reacting to the person's words, helps to clarify what the person is saying.

A patient has resulting lymphedema after a radical mastectomy on the left side and has an arteriovenous dialysis shunt in the right upper extremity. Which of the following locations would be MOST appropriate to auscultate the patient's blood pressure? 1. Left cubital fossa 2. Right cubital fossa 3. Left popliteal fossa 4. Right femoral triangle

Rationale 1. Blood pressure should not be monitored in the arm with an arteriovenous shunt. 2. Blood pressure should not be measured in the arm with lymphedema. 3. If both arms are inappropriate for measuring blood pressure, the thigh is an appropriate location with auscultation at the popliteal artery. Alternative sites for measurement in the lower extremity are proximal to the popliteal artery or proximal to the ankle with auscultation of the posterior tibial artery. 4. If both arms are inappropriate for measuring blood pressure, the thigh is an appropriate location with auscultation at the popliteal artery. The femoral triangle is too high for placement of a blood pressure cuff.

A patient has right shoulder pain that extends from the right upper trapezius to the thorax between the scapulae. The patient reports a recent tendency to bruise easily and has dark-colored urine and clay-colored stools. Which of the following organs is MOST likely the etiology of these findings? 1. Heart 2. Kidney 3. Liver 4. Pancreas

Rationale 1. Cardiac dysfunction can cause right shoulder pain but not the associated symptoms described in the stem (p. 281). 2. Renal pathology can cause pain that is felt in the shoulder on the same side as the involved kidney but will not cause the associated symptoms described in the stem (pp. 385-386, 401). 3. Liver dysfunction will cause all of the symptoms described in the stem: jaundice, dark urine, clay-colored stool, easy bruising, and right shoulder pain (pp. 359-363, 375). 4. Pancreatic pain is referred to the left shoulder; pancreatic dysfunction will not produce the associated symptoms described in the stem (p. 351).

A patient who has stage IV metastatic cancer has been admitted to the hospital for a course of chemotherapy, placed in protective isolation, and referred to a physical therapist for general mobility. What is the BEST way to protect the patient's health while treating the patient at bedside? 1. The patient should be seen for 10 minutes 1 time/day until the isolation restriction has been lifted. 2. The patient should wear a mask and gloves during the treatment. 3. The therapist should wear a mask and gloves during the treatment. 4. The therapist should frequently wash hands at the bedside sink during the treatment.

Rationale 1. Changing the duration of physical therapy intervention would not minimize the chance for infection. 2. The patient should wear a mask, if out of the room. The patient is not required to wear a mask or gloves while in the room. 3. Wearing a mask and gloves during treatment is the universal precaution recommendation when treating a patient in protective isolation. 4. In the immunosuppressed patient, isolation should be maintained. Hand washing alone is not a sufficient precaution for a patient in protective isolation.

A patient reports low back pain. The physical therapist should suspect that the pain is of a non-mechanical origin if the pain: 1. increases in intensity with active forward bending of the trunk. 2. is worse in the morning. 3. is not reproduced during range of motion of the spine and hips. 4. resolves completely when the patient lies prone.

Rationale 1. Constant pain that is not dependent on position or activity and is increased with weight-bearing is a warning symptom (Goodman, p. 1255). Pain that subsides with movement or varies with intensity of movement can generally be considered to be of musculoskeletal origin. 2. Pain that awakens a patient from sleep, rather than pain that makes it difficult to fall asleep or pain upon waking, is considered a warning symptom (Goodman, p. 1255). Pain in the morning may be due to prolonged lying in a static posture. Morning stiffness or pain is common in patients who have low back pain (Magee, p. 558). 3. Pain arising from the spine is almost always influenced by posture and movement (Magee, p. 559). Therefore, pain not reproduced with range of motion testing of the back and hips would be cause for concern. 4. Prone positioning can extend the lumbar spine (Magee, p. 572). Therefore, pain abolished in this position would be considered mechanical or musculoskeletal in nature.

Which of the following strategies for intervention would be MOST appropriate for a patient with moderate Alzheimer disease and urinary incontinence? 1. Continuous catheterization 2. Functional exercises 3. Biofeedback 4. Prompted voiding

Rationale 1. Continuous catheterization is usually used for patients who have a neurological deficit that directly affects urinary function (p. 917). 2. Functional exercises and breathing exercises help to retrain and strengthen the pelvic floor muscles, assisting with the weakness associated with stress incontinence. However, this intervention works best for patients who have stress incontinence, are able to know when they have to void, and do not have neurological deficits or cognitive deficits affecting their ability to control voiding. (p. 915) 3. Biofeedback can be used as an adjunct to functional exercises, but the patient must be cognitively aware to use biofeedback (p. 915). 4. Prompted voiding is used for patients who may have cognitive deficits and require reminders of regular intervals for voiding (p. 917).

A physical therapist is completing an examination of an inpatient with multiple comorbidities who had a total knee arthroplasty 2 days ago. The therapist observes a bluish discoloration of the nail beds of the toes on the operative extremity. This finding is MOST often associated with which of the following conditions? 1. Decreased peripheral blood flow 2. Deep vein thrombosis 3. Lymphedema 4. Aneurysm

Rationale 1. Cyanosis is described in the stem. Peripheral cyanosis is associated with decreased peripheral blood flow 2. Deep vein thrombosis is associated with edema and localized tenderness (p. 205). 3. Lymphedema is associated with swelling of the feet (p. 274). 4. Aneurysms are associated with a palpable, pulsing mass (p. 259).

A patient has a Stage 3 pressure injury on the left heel. The physical therapist notes that the wound contains 80% tan-yellow necrotic tissue. The wound is round, measures 3.8 cm in diameter, has a depth of 2 mm, and produces moderate amounts of drainage. The BEST initial emphasis for intervention for the first week of treatment would be to decrease which of the following measurement parameters? 1. Depth 2. Diameter 3. Exudate 4. Necrotic tissue

Rationale 1. Depth might actually increase as the necrotic tissue is removed. 2. Diameter might actually increase as the necrotic tissue is removed. 3. Amount of exudate will probably increase as the necrotic tissue is debrided. 4. Necrotic tissue must be decreased in order to make room for granulation tissues and enable wound healing.

*A patient with a recent onset of steroid-induced myopathy would have the MOST difficulty performing which of the following activities? 1. Writing with a pen 2. Dressing 3. Climbing stairs 4. Rising from a supine position

Rationale 1. Distal musculature is typically spared in steroid-induced myopathy until late stages of the myopathy. 2. Although upper extremity proximal musculature is also a component of steroid-induced myopathy, patients usually compensate and continue to perform dressing activities without difficulty. 3. Prolonged use of corticosteroids can lead to corticosteroid-induced catabolism, resulting in inhibition of muscle protein synthesis and muscle weakness. The proximal muscles of the lower and upper extremities are affected first. Patients first report difficulty in climbing stairs. 4. Involvement of the trunk musculature is a late finding in the progression of steroid-induced myopathy.

A patient reports right lower quadrant pain. When the patient is in the supine position with hips and knees flexed 90°, deep palpation in the right lower quadrant reproduces the pain. What is the MOST appropriate action for the physical therapist to do NEXT? 1. Inform the patient about possible diverticulitis. 2. Test rectus abdominis strength. 3. Stretch the right hip flexor muscles. 4. Contact the physician about possible iliac vein thrombosis.

Rationale 1. Diverticulitis (inflammation of a diverticulum, especially in the colon, causing pain and disturbance of bowel function) would create left-sided, not right-sided, abdominal pain upon palpation (Goodman & Snyder, pp. 339-340). 2. The test position described in the question is for the iliopsoas muscle. Rectus abdominis symptoms with palpation would be more centered in the abdomen; therefore, there is no indication that the rectus abdominis muscle should be evaluated. (Goodman & Snyder, p. 333) 3. This is the test position to identify dysfunction of the iliopsoas muscles; therefore, stretching the right hip flexor, which is the muscle action of the iliopsoas, is the appropriate action (Goodman & Snyder, p. 333). 4. Thrombosis that occludes the iliac vein produces posterior lower leg swelling, pain or tenderness, dilation of superficial veins, and pitting edema. The patient does not have these signs or symptoms. (Goodman & Fuller, p. 649) Liver and gallbladder (usually interrelated): RUQ à + murphy sign (gallbladder pathology); rebound tenderness à peritoneal inflammation; liver usually <12cm (hepatomegaly > 12cm); pain referral = R shoulder/R flank Spleen: LUQ; normally <13cm (splenomegaly >13cm); pain referral = L shoulder

An inpatient who is being seen in the physical therapy department vomits material with the appearance of coffee grounds. While reviewing the patient's medical record, the physical therapist notes that the patient recently started taking heparin. Which of the following conditions is the MOST likely cause of the coffee-ground emesis? 1. Diverticulitis 2. Gastroesophageal reflux 3. Ulcerative colitis 4. Peptic ulcer

Rationale 1. Diverticulitis refers to the presence of outpouchings in the wall of the colon or small intestine. Symptoms include passing of blood in the stool but do not include coffee-ground emesis. (p. 892) 2. Gastroesophageal reflux disease is defined as an inflammation of the esophagus due to a backward flow of gastric juices. The clinical symptoms include painful swallowing, heartburn, and dysphagia. Vomiting is not a classic symptom. (p. 869) 3. Ulcerative colitis is a chronic inflammatory disorder of the mucosa and submucosa of the colon. It is characterized by diarrhea and rectal bleeding. Symptoms do not include coffee-ground emesis. (pp. 883-885) 4. Signs of peptic ulcer disease include weakness, diaphoresis, epigastric pain, and coffee-ground emesis. Coffee-ground emesis results from bleeding that has slowed or stopped, with conversion of red hemoglobin to brown hematin by gastric acid. Heparin is an anticoagulant and is associated with a higher risk of gastrointestinal bleeding. (p. 878)

A patient is able to put on a pair of pants independently in sitting position but is unable to perform the activity in a standing position. Which of the following parts of the physical therapy examination is MOST important to identify the source of the patient's problem? 1. Dynamic standing balance 2. Vestibular function 3. Dynamic sitting balance 4. Lower extremity range of motion

Rationale 1. Dynamic standing balance is a critical skill for independence with standing activities of daily living. The patient may not have adequate balance for standing hands free for dressing, etc. (Umphred, pp. 664-665) 2. The role of the vestibular system is to maintain clear vision during head motion (Umphred, p. 689). Vestibular function would affect activities of daily living in both positions. 3. The patient is able to perform movements involved in putting on pants in sitting position without difficulty. Therefore, sitting balance is not an issue with this patient, and an assessment of dynamic standing balance would be more important. (Umphred, pp. 664-665) 4. Range of motion in lower extremities would affect activities of daily living in both positions (Dutton, p. 521-522).

*A physical therapist is providing supervised exercise to a patient who has been restricted to extended bed rest. After 2 weeks of intervention, which of the following measures would BEST reflect cardiopulmonary system improvement? 1. Delayed cardiovascular response upon rising from supine position 2. Decreased heart rate response to exercise 3. Decreased respiratory rate in response to exercise 4. Increased cardiovascular peripheral resistance

Rationale 1. Early mobilization with cardiopulmonary conditioning will improve vascular reflexes and the responsiveness of blood vessels in the lower extremity to constrict, reducing postural hypotension and dizziness. This would be demonstrated with an increased cardiovascular response upon rising from the supine position. (Reid, p. 290) 2. Exercise will increase the patient's stroke volume secondary to increased myocardial contractility. The increased stroke volume will result in a reduced heart rate response with exercise. The intensity of the exercises is directly correlated to the heart rate response. (Kisner, p. 252) 3. Early mobilization increases minute ventilation (tidal volume and respiratory rate) and does not decrease heart rate response (Reid, p. 290). 4. There is a decrease in cardiovascular resistance with training. Vascular reflexes and the responsiveness of blood vessels improve. (Reid, p. 290; Kisner, p. 245)

*A patient with Parkinson disease exhibits typical end-of-dose akinesia (loss of voluntary movt) during exercise. Which of the following courses of action is MOST appropriate for a physical therapist? 1. Review with patient and family the importance of adherence to medication doses. 2. Modify the exercise program to be less aggressive. 3. Schedule physical therapy for 1 hour after antiparkinsonian medications are given. 4. Discontinue physical therapy sessions until medications are modified.

Rationale 1. End-of-dose akinesia occurs when a drug's effectiveness wears off prior to the next dose (p. 139). It does not result from medication nonadherence. 2. End-of-dose akinesia is not a complication of an aggressive exercise program (p. 139). 3. Effectiveness of antiparkinsonian medicine wanes before the next dose, causing end-of-dose akinesia. Scheduling physical therapy 1 hour after medicine is taken assists in avoiding effects of end-of-dose akinesia. (p. 144) 4. Physical therapy does not have to be discontinued for a patient who exhibits end-of-dose akinesia, but scheduling of sessions should be adjusted (p. 144).

Which of the following procedures should be used to assess a patient's equilibrium? 1. Marching in place 2. Rebound test 3. Heel on shin 4. Finger to therapist's finger

Rationale 1. Equilibrium is a dynamic reaction essential for upright posture and smooth transitional movements. Equilibrium is assessed by testing the body's ability to respond to a change in body position or surface support to maintain body alignment. Of the options, only marching in place requires a displacement of the center of gravity and a places a demand on the body to maintain upright posture. (Umphred, p. 393) 2. The rebound test is a nonequilibrium coordination test, involving contraction of the biceps, sudden release of resistance, and sudden contraction of the triceps to retrain limb movement (O'Sullivan, p. 219). 3. Heel on shin is a nonequilibrium coordination test (O'Sullivan, p. 219). 4. Finger to therapist's finger is a nonequilibrium coordination test (O'Sullivan, p. 218).

A physical therapist uses a foam-based dressing in the treatment of a healing pressure injury that is producing a large amount of exudate. The therapist's rationale for using this dressing is to prevent: 1. eschar formation. 2. desiccation. 3. maceration. 4. infection.

Rationale 1. Eschar is associated with desiccation. Using a foam dressing will not likely prevent eschar formation and may promote further desiccation. (Baranoski, p. 193) 2. Foam dressings will not provide protection from mechanical damage. Foam dressings are likely to cause desiccation. (Baranoski, p. 193) 3. Exudate is produced when a wound releases fluid. Foam dressings are moisture retaining and will absorb excess fluid (Myers, pp. 124-126). Accumulation of excess fluid will cause maceration or skin breakdown around the wound (Myers, pp. 27-28). 4. Although a foam dressing may be used to absorb excess exudate produced during infection, it will not prevent the onset of infection. Only antimicrobial dressings will do this. (Myers, pp. 131-132)

A physical therapist is examining a child who habitually sits in the position shown in the photograph. The child will MOST likely have: 1. lateral (external) tibial torsion. 2. femoral retroversion. 3. medial (internal) tibial torsion. 4. femoral anteversion.

Rationale 1. External tibial torsion is rotation of the long axis of the tibia. Knee motion might be limited, but this torsion would not lead to the sitting position of the child in the photograph. (p. 304) 2. Femoral retroversion results in an increase in hip lateral (external) rotation, and the child would have difficulty sitting in the "W" position (p. 295). 3. Medial (internal) tibial torsion would rotate the long axis of the tibia and turn the foot inward. The child would not be able to have the feet everted easily as required in the position shown in the photograph. (p. 301) 4. Femoral antetorsion (anteversion) is commonly seen in children and results in excessive hip medial (internal) rotation and a loss of passive lateral (external) rotation. The child in the photograph is sitting with excessive medial (internal) rotation. (pp. 295, 300) Torsion Angle: Normal anteversion (Head is forward relative to shaft): 10-15 deg, Excessive anteversion (toe in AKA hip IR): >15 deg, Retroversion (head is behind relative to shaft à toe out AKA hip ER): <15 deg

A physical therapist is administering a graded exercise test. Which of the following patient responses is an ABSOLUTE indication for terminating the exercise test? 1. Fatigue, shortness of breath, or wheezing 2. A drop in systolic blood pressure of 10 mm Hg in the absence of ischemic changes 3. A request to stop the test 4. A rise in diastolic blood pressure to 90 mm Hg

Rationale 1. Fatigue and shortness of breath are relative indications for stopping a test. 2. Falls in systolic blood pressure in the absence of ischemia are a relative indication to stop the test. 3. The test is over when the subject requests that the test be stopped. 4. Hypertensive responses are relative but not absolute indications for stopping an exercise test.

A patient is frequently awakened at night by symptoms of gastroesophageal reflux disease. Which of the following recommendations should a physical therapist make FIRST? 1. Change sleeping positions every 2 hours. 2. Sleep in right sidelying and use pillows to elevate the head. 3. Sleep in left sidelying and use pillows to elevate the head. 4. Sleep sitting up in a comfortable chair.

Rationale 1. Frequent position changes and using sleeping positions that increase reflux (right sidelying and supine) will not improve the patient's ability to sleep through the night. 2. The lower esophagus bends to the left; lying on the right side straightens out the esophagus, increasing reflux. 3. For nocturnal reflux, the patient should be encouraged to sleep on the left side with a pillow in place to maintain this position. The lower esophagus bends to the left, so reflux is minimized in this position. 4. Although sleeping while sitting up might be an ultimate solution if the patient is unable to avoid nocturnal reflux, it should not be the first recommendation.

The test shown in the photograph is being performed on a 1-month-old infant who was carried to full term. The test result shown is MOST consistent with which of the following findings? 1. Normal tone 2. Spasticity 3. Hypotonicity 4. Rigidity

Rationale 1. From birth to 3 months, the infant's head will lag behind the body until a sitting position is attained. 2. Head lag is normal until 3 months in the pull-to-sit test. No spasticity is evident. 3. Head lag is normal until 3 months in the pull-to-sit test. No hypotonicity is evident. 4. Head lag is normal until 3 months in the pull-to-sit test. No rigidity is evident.

*Glossopharyngeal breathing is an appropriate technique to teach a patient who has: 1. a high cervical spinal cord injury. 2. emphysema. 3. cystic fibrosis. 4. asthma.

Rationale 1. Glossopharyngeal breathing is a means of increasing pulmonary function, especially tidal volume and vital capacity, when there is severe weakness of the muscles of inspiration (Frownfelter, p. 372), as found in a patient with a higher cervical spinal cord injury à weak respiratory muscles 2. While weakness of some muscles is associated with emphysema, emphysema is primarily an obstructive lung disease (Goodman, p. 796). Glossopharyngeal breathing will not assist patients with emphysema. 3. Cystic fibrosis is a secondary obstructive disorder due to copious, thick secretions (Goodman, p. 821), not due to muscle weakness. Glossopharyngeal breathing will not assist patients with cystic fibrosis. 4. Asthma is a chronic inflammatory condition of the airways (Goodman, p. 799) and is not due to muscle weakness. Glossopharyngeal breathing will not assist patients with asthma. Glossopharyngeal breathing is a form of positive pressure breathing technique that can be used to assist failing respiratory muscles. As an analogy to positive pressure breathing used by amphibians, it is called frog breathing: The mouth is open, allowing the air to enter the oral and pharyngeal cavities (Step 1). While the mouth is sealed by the lips or the tongue, muscles of the tongue and pharynx are used to propel small volumes of air into the lower airways through the open glottis, which is raised during the maneuver (Step 2). Closure of the glottis ensures that the air is trapped into the lungs while preparing for the next gulp of air (Step 3).

An infant's family has just been referred to physical therapy for discharge instructions following surgical repair of an L5 myelomeningocele. Which of the following is MOST critical for the family to learn before leaving the hospital? 1. Signs of increased intracranial pressure 2. Passive range of motion exercises for the lower extremities 3. Signs of hip dislocation 4. Strengthening exercises for the lower extremities

Rationale 1. Hydrocephalus occurs in 25% or more of children with myelomeningocele, and an additional 60% develop it after surgical closure of their back lesion. Between 80% and 90% of children with hydrocephalus will require a cerebrospinal fluid (CSF) shunt. Even if the child has a shunt, recognizing signs of increased intracranial pressure and shunt dysfunction is critical because these conditions can lead to additional functional and cognitive decline of the child. (pp. 553-554) Enlarged head, bulging fontanelle, HA, changes in vision, large veins on scalp, behavioral changes, seizures, alteration in appetite, vomiting, "sun setting of eyes/downward deviation of eyes, incontinence 2. Passive range of motion is important, but deficits in this area would not be life-threatening. 3. Hip dislocation is unlikely to occur in infancy and is not an immediate emergency as is increased intracranial pressure. 4. Strengthening within the child's ability level is important, but deficits in this area would not be life-threatening.

A patient has a fracture of the third metacarpal that occurred 2 months ago. The patient currently has heat, swelling, erythema, and tenderness at the fracture site. Which of the following courses of action would be MOST appropriate at this time? 1. Apply a compression glove. 2. Administer continuous ultrasound. 3. Instruct in active range of motion exercises. 4. Contact the physician.

Rationale 1. Heat, swelling, erythema, and tenderness at the fracture site are signs of a nonunion fracture; a compression glove would not be an appropriate treatment. 2. Heat, swelling, erythema, and tenderness at the fracture site are signs of a nonunion fracture; continuous ultrasound may increase inflammation. 3. Hat, swelling, erythema, and tenderness at the fracture site are signs of a nonunion fracture; active range of motion may make the fracture worse. 4. Heat, swelling, erythema, and tenderness at the fracture site indicate a potential nonunion fracture. A referral to a physician is indicated.

Which of the following signs and symptoms are MOST characteristic of herpes zoster? 1. Unilateral scales along the affected dermatome followed by numbness and burning 2. Bilateral scales along the affected dermatomes followed by numbness and burning 3. Pain and paresthesia followed by a unilateral rash along the affected dermatome 4. Pain and paresthesia followed by a bilateral rash along the affected dermatomes

Rationale 1. Herpes zoster (shingles) has initial symptoms of pain and paresthesia localized to the affected dermatome, followed by vesicular eruptions along a facial, cervical, or thoracic lumbar dermatome. Shingles is often present as a rash, not scales, unilaterally. This answer is incorrect as the rash develops later, not initially. 2. Herpes zoster (shingles) is initially manifested as paresthesia and pain along the affected dermatome with a rash that forms days later. Shingles is a rash, not scales, that characteristically presents unilaterally. 3. Herpes zoster (shingles) is initially manifested as pain and paresthesia along the affected dermatome with a rash that forms days later. Shingles is characteristically present unilaterally. 4. Herpes zoster (shingles) is characteristically present unilaterally, not bilaterally.

A patient had a total hip arthroplasty with a constrained (cemented) prosthesis using a posterolateral approach. Which of the following recreational activities has the LEAST risk of causing prosthetic loosening or dislocation for this patient? 1. Distance freestyle swimming 2. Water skiing 3. Stationary rowing 4. Playing racquetball

Rationale 1. High-impact sports are contraindicated for this patient. Hip positioning into end-range flexion, adduction, and medial (internal) rotation is also contraindicated. Freestyle swimming does not involve either of these two concerns. 2. Water skiing involves both high-impact activity and the possibility of positioning in end-range flexion, both of which are contraindicated for this patient. 3. Stationary rowing involves positioning in end-range flexion, which is contraindicated for this patient. 4. Playing racquetball involves high-impact activity, which is contraindicated for this patient.

A patient reports not feeling the output from a continuous transcutaneous electrical nerve stimulation unit, although the unit appears to be functioning properly and the amplitude is adjusted appropriately. What is the physical therapist's MOST appropriate immediate course of action? 1. Adjust the pulse width (pulse duration). 2. Turn the unit off and check the connections. 3. Continue to turn up the amplitude. 4. Turn the unit off and replace the electrodes.

Rationale 1. If the amplitude is adjusted appropriately, it would be expected that the patient should be feeling the output. Adjusting the pulse width (pulse duration) would not be indicated at this time, but problem solving to determine why the patient is not feeling the output would be a priority. 2. Turn off and checking the lead wires for continuity or signs of excessive wear would be an appropriate response. (Cameron, p. 235) 3. If the amplitude is adjusted appropriately, it would be expected that the patient should be feeling the output. Continuing to turn up the amplitude would not be indicated at this time, but problem solving to determine why the patient is not feeling the output would be a priority. Checking the lead wires for continuity or signs of excessive wear would be an appropriate response. (Cameron, p. 235) 4. If the amplitude is adjusted appropriately, it would be expected that the patient should be feeling the output. Checking the electrode for signs of wear should be done before treatment begins, but if the gel coating on the electrodes was wearing out or drying out, the current density would be high in some areas and could potentially cause a burn (Cameron, p. 233). The patient in this scenario does not feel anything, so checking the connections may be the most appropriate immediate course of action.

A patient exhibits heel rise in the midstance phase of gait. Which of the following impairments is MOST likely associated with this finding? 1. Shortening of the hamstrings 2. Shortening of the gastrocnemius 3. Weakness of the tibialis anterior 4. Weakness of the flexor digitorum longus

Rationale 1. In order to achieve midstance, 3° of ankle dorsiflexion is necessary. Lack of dorsiflexion causes premature heel off. Tight hamstrings would not cause early heel off (terminal stance). Hamstrings are shortened during heel off (terminal stance). 2. A common cause of decreased dorsiflexion is a tight Achilles tendon or shortening of the gastrocnemius. 3. Lack of dorsiflexion causes premature heel off (terminal stance). Weakness of the tibialis anterior would not cause a lack of dorsiflexion and early heel off (terminal stance). 4. Lack of dorsiflexion causes premature heel off (terminal stance). Weakness of the flexor digitorum would not cause a lack of dorsiflexion and early heel off (terminal stance).

*A patient who is restricted to partial weight-bearing on the right lower extremity is participating in stair training. A physical therapist is standing below the patient on the stairs. The patient loses balance while descending the stairs. Which of the following actions is MOST appropriate for the therapist to take? 1. Weight-shift the patient over the affected lower extremity and wait for assistance. 2. Provide bracing by moving toward the patient. 3. Keep communication to a minimum to avoid frightening the patient. 4. Pull the patient toward the therapist's body for support.

Rationale 1. In the event of loss of balance, a physical therapist could consider leaning the patient to one side against a stairwell wall, but shifting the patient's weight to the affected side (right) would not be prudent in order to regain balance. 2. In descending the stairs, the physical therapist would be guarding from in front of the patient (anterior and lateral). The therapist would make contact with the hand guarding the shoulder and then move toward the patient to help brace the patient. 3. Keeping communication channels open with the patient to gain the patient's assistance in regaining balance is essential. 4. The position of the therapist when descending stairs is in front of the patient (down the stairs from the patient). When a patient loses balance in this position, the patient should not be pulled toward the therapist, as this would jeopardize the safety of both the patient and the therapist.

The manager of a work-hardening clinic has data showing that 42% of the clinic's patients did not return to work at their previous level of function. To improve this percentage, which of the following areas would be the MOST appropriate focus for a quality improvement study? 1. Sources of patient referrals 2. Speciality certification of the clinic's therapists 3. Types of diagnoses 4. Treatment plans of care

Rationale 1. In this case, referral sources are not likely to affect outcomes, but the practice must be aware of how access to physical therapy (direct access, practice without referral or self-referral) may influence reimbursement for services provided (pp. 194-195). 2. Care should be based in the science and evidence for the treatment approach. Specialist certification may provide improved plans of care, but how the plan is executed is more likely to affect outcomes. (p. 110) 3. If the problem for quality improvement was rate of return to work, then all diagnoses would be considered a factor, not specific types. 4. Quality is defined as the degree to which an organization increases the likelihood of desired outcomes. Quality depends on the integration of several factors: what happens to the patient, the care delivered by the clinician, the organization's management, and the external environment where policies are made. In this situation, outcomes are most likely to improve by focusing on the plans of care. (p. 111)

A male patient with low back pain reports a history of increased urinary frequency and difficulty initiating a urine stream. The patient sees a physician biannually for monitoring of the urinary condition. Which of the following actions is MOST appropriate for a physical therapist to take next? 1. Ask if the urinary symptoms have changed since the patient's last visit to the physician. 2. Recommend that the patient see the physician before the next physical therapy session. 3. Discontinue physical therapy. 4. Call the patient's physician and report the patient's urinary symptoms.

Rationale 1. Increase in urinary function could be related to a medical condition. The most important thing to note is change. 2. It is not known if there has been a change in urinary function compared to baseline. Thus, a physician consult may not be warranted. Discovering if the urinary condition is normal for the patient is required first. 3. A red flag (warning) symptom has not been identified. 4. A change in urinary function has not been established.

Which of the following actions would constitute the MOST important aspect of patient informed consent for physical therapy interventions? 1. Explaining the risks of the intervention and asking for patient agreement 2. Explaining the risks of the intervention and showing the patient the prescription from the physician 3. Directing the patient to read the informed consent form and bring it to every visit 4. Directing the patient to contact the physician regarding the risks and benefits of the intervention

Rationale 1. Informed consent requires three conditions: 1) the patient must be competent to understand the treatment, 2) proper information must be given (risk, benefits, procedure), and 3) the patient must agree (volunteer). This option most closely represents these aspects. The patient is assumed to be competent in this scenario. 2. The risks and benefits are explained, but patient consent is not granted prior to treatment in this scenario. 3. Informed consent requires three conditions. This option does not ensure all conditions are met. 4. The physical therapist is competent to clearly communicate the risks and benefits of the procedure to the patient and to obtain informed consent.

*The BEST exercise level for an aerobic program for weight loss is: 1. less than or equal to 60% of maximum heart rate for 45 to 60 minutes, 5 to 7 days/week. 2. 80% to 90% of maximum heart rate for 45 to 60 minutes, 3 days/week. 3. less than or equal to 60% of maximum heart rate for 15 to 20 minutes, 3 days/week. 4. 80% to 90% of maximum heart rate for 15 to 20 minutes, 5 to 7 days/week.

Rationale 1. Initial exercise training for obese individuals should be moderate (40% to 60% of maximum heart rate) and eventually progress to higher intensities (50% to 75%). Frequency should be 5-7 days/week; duration should be 45-60 minutes/session. 2. 80% to 90% of maximum heart rate is too high of an intensity; and 3 days a week is not a high enough frequency. 3. 15 to 20 minutes is not a long enough duration; and 3 days a week is not a high enough frequency. 4. 80% to 90% of maximum heart rate is too high of an intensity; 15-20 minutes is not a long enough duration. maxHR = 220-age

*A physical therapist is evaluating a patient who reports difficulty descending stairs and trouble reading when a book is held in the lap. The patient denies blindness in either eye. When a light is shone into the eyes, each pupil constricts as expected. When the patient looks straight ahead, each eyeball is centered. Which cranial nerve is MOST likely involved? 1. Optic (CN II) 2. Oculomotor (CN III) 3. Trochlear (CN IV) 4. Abducent (CN VI)

Rationale 1. Ipsilateral blindness is a symptom of optic nerve (CN II) injury (p. 1232). The patient denied blindness. 2. With oculomotor nerve (CN III) injury, deficits are found in eye movements up, down, and in. The oculomotor nerve (CN III) also controls the pupillary reflex, which is intact in the patient described in the stem. (p. 116) 3. Trochlear nerve (CN IV) involvement results in a deficit in looking inferomedially, which would contribute to impairment in reading and descending stairs as reported by the patient (p. 116). 4. With abducent nerve (CN VI) injury, deficits are found in eye movements inward, because this nerve turns the eye outward. This pattern is not found in the patient described in the stem. (p. 116)

Postural screening of a patient reveals that the greater trochanters are not level in the standing position. The pelvis is not rotated or tilted, and the knee and ankle landmarks are level in the standing position. The findings indicate which of the following impairments? 1. Tibial length disparity 2. Femoral length disparity 3. Nutation of the sacroiliac joint 4. Hemivertebrae in the lumbar spine

Rationale 1. Knee and ankle landmarks are level; the tibia is not involved. 2. Because of level knee and ankle landmarks and normal pelvic symmetry, the leg length discrepancy is due to femoral length disparity. 3. Sacral nutation is not present in this scenario. 4. Hemivertebrae in the lumbar spine would not affect hip landmark height.

A physical therapist is assisting a patient in rehabilitation following an ankle sprain. The therapist reviews the patient's first attempt in use of a balance board and asks the patient to visualize the movement of the ankle and the balance board anteriorly and posteriorly in preparation for the next attempt. Which form of motor learning is being used? 1. Knowledge of results 2. Knowledge of performance 3. Mental practice 4. Serial practice

Rationale 1. Knowledge of results is a form of feedback, not a process of visualization (Shumway-Cook, p. 33). 2. Knowledge of performance is a form of feedback, not a process of visualization (Shumway-Cook, p. 33). 3. The patient is being asked to visualize the appropriate movement. Mental practice is the act of performing a skill mentally before performing it physically (Shumway-Cook, p. 36). 4. Serial practice is a physical form of motor learning, not a mental form (Goodman, p. 1403).

A physical therapist is treating a patient with a traumatic brain injury who has severe cognitive impairments and bilateral hip & knee flexion contractures. The MOST appropriate intervention to treat the patient's contractures is: 1. manual resistance-through-range technique. 2. prolonged stretch technique. 3. contract-relax technique. 4. neurodevelopmental techniques.

Rationale 1. Manual resistance-through-range technique is appropriate for a patient with a primary problem of muscular weakness, which is not the case in this patient example (pp. 178-179). 2. Prolonged stretch technique has ample evidence to suggest that it is most efficient for reducing this patient's primary problem of muscle stiffness (pp. 86, 87). 3. Contract-relax technique requires that a patient exert voluntary control of muscle actions, which is not likely given this patient's severe cognitive impairments (p. 94). 4. Neurodevelopmental techniques, such as rhythmic stabilization and alternating isometrics, are designed to improve postural stability or dynamic stability of a joint. Although this may assist the patient's performance, it does not address the primary problem of muscle stiffness. (pp. 214-215)

*A patient with a mild hemiparesis is able to stand and walk independently with a quad cane, but reports difficulty transferring from sitting to standing. A physical therapist is MOST likely to find the cause of the difficulty by testing the patient's: 1. lower extremity strength. 2. static standing balance. 3. joint position sense. 4. dynamic standing balance.

Rationale 1. Muscle weakness affects the performance of functional movement. Weakness in the extremities interferes with functional use either in weight-bearing (in this case, sitting to standing) or during movement in space. (pp. 725, 731) 2. Impairment of static balance is assessed in quiet standing position with the therapist applying perturbation. The goal is for the patient to remain still. This is not likely to be an issue if the patient can stand and walk independently. (p. 660) 3. Although impairment of the somatosensory system can be a cause of balance impairment, the independence of transfers and gait indicate that this is not a significant impairment for this patient (p. 682). 4. Dynamic balance integrity is evidenced by a patient who can recover balance with voluntary weight-shifting. The ability to stand and walk indicates that the patient had adequate dynamic balance. (p. 660)

*A patient with which of the following injuries has the BEST prognosis for nonsurgical recovery? 1. Neurapraxia 2. Axonotmesis 3. Neurotmesis 4. Complete nerve severance

Rationale 1. Neurapraxia involves blockage that stops or slows conduction across that point in the nerve. Conduction above and below the blockage is usually normal. Recovery is possible. 2. With axonotmesis, the neural tube is intact, but axonal damage has occurred with Wallerian degeneration. Surgical intervention may be required. 3. Neurotmesis involves total loss of axonal function, with disruption of the neural tube. Surgical intervention is usually required. 4. The nerve is completely separated. Surgical intervention is required.

An 11-year-old patient who is recovering from a knee injury is beginning a resistance exercise program to strengthen the quadriceps. Which of the following exercise schedules is MOST appropriate for the patient? 1. 1 time/week 2. 3 times/week 3. 5 times/week 4. 7 times/week

Rationale 1. Once a week is not a sufficient exercise volume to promote tissue adaptation. 2. Evidence suggests that resistance training programs can be performed safely and appropriately both by children and adolescents. Yet to avoid injury, it is important to allow an adequate recovery (2 to 3 days) between training sessions. 3, 4. Five or seven times/week does not allow sufficient recovery time between sessions and could increase risk for overuse injury.

A patient who uses an insulin pump is beginning an outpatient aerobic conditioning session. The patient's current blood glucose level is 95 mg/dL (5.3 mmol/L). Which of the following responses is MOST appropriate for the patient? 1. Reduce the insulin infusion dose. 2. Increase the insulin infusion dose. 3. Continue insulin infusion at the current metered dose. 4. Rest for 1 hour, then remeasure blood glucose level.

Rationale 1. One benefit of using an insulin pump is being able to change the insulin delivery. Reducing or suspending the insulin will safely address the decreased blood glucose level (which is less than 100 mg/dL [5.5 mmol/L]) without the need for a carbohydrate snack (pp. 528, 618). 2. Increasing the insulin infusion dose would further decrease the blood glucose level. The patient's blood glucose is already less than normal. (p. 507) 3. Insulin pump delivery should be reduced, not maintained, in a patient whose current blood glucose level is 95 mg/dL (5.3 mmol/L) (p. 520). If the patient continued at the current rate, the insulin level would be too low (p. 507). 4. Rest would not address the problem, given the blood glucose level. Blood glucose less than 100 mg/dL (5.5 mmol/L) is abnormal and could be addressed by adjusting the insulin infusion dose. (p. 507)

A 17-year-old patient sustained a knee injury while playing soccer 2 weeks ago. The patient reports falling and landing with the right knee fully flexed. Since the injury, the patient reports the knee has had intermittent catching in motion and has been painful in full flexion. The patient MOST likely has which of the following diagnoses? 1. Osgood-Schlatter disease 2. Anterior cruciate ligament tear 3. Patellofemoral syndrome 4. Meniscal tear

Rationale 1. Osgood-Schlatter disease is an apophysitis of the tibial tubercle. It is not due to a traumatic incident and is commonly seen in pubescent individuals with a report of pain and tenderness over the tibial tubercle. (p. 820) 2. Hyperflexion is not a common mechanism of an anterior cruciate ligament tear. Locking sensation is not a symptom of an anterior cruciate ligament tear. (pp. 721-722) 3. Patellofemoral pain syndrome is used to describe many disorders around the knee that result in anterior knee pain. The patient would report pain in the anterior portion of the knee that worsens during impact-loading activities. (pp. 820-825) 4. The symptoms of catching and pain at end range flexion are considered indicative of a meniscal tear (pp. 787-794).

A physical therapist is evaluating a 25-year-old volleyball player who reports knee tenderness, which began after playing in a tournament 2 days ago. The patient has had no previous knee pain or recent trauma. The therapist has identified the patient's point of tenderness as indicated in the photograph. This is MOST indicative of: 1. Osgood-Schlatter disease. 2. bipartite patella. 3. infrapatellar tendinitis. 4. a stress fracture of the patella.

Rationale 1. Osgood-Schlatter disease occurs most often in skeletally immature individuals (p. 1059). Since the patient is 25 years old, this disease is unlikely. In addition, pain is over the tibial tubercle in Osgood-Schlatter disease. 2. Bipartite patella is a condition common in childhood. It is often bilateral, and can manifest as pain and tenderness at the distal pole of the patella. Since the patient is 25 years old, it is an unlikely diagnosis. Rarely, in response to overuse or acute injury, it will become painful. (p. 266) 3. Infrapatellar tendinitis is associated with eccentric overloading during deceleration activities and repeated jumping and landing (p. 1057). This would be most plausible, because increased jumping and landing occurred in the activity described in the stem. 4. Stress fractures of the patella would likely present as discomfort and point-tenderness at the patella versus at the tendon below, and the patient would not be able to extend the knee (pp. 1000-1001).

A patient with osteoarthritis in the left hip walks with a left lateral trunk shift during left stance phase. A physical therapist should advise the patient to walk with a cane in which hand and for what reason? 1. Right hand, to reduce the force in the left hip abductors 2. Left hand, to reduce the force in the left hip abductors 3. Right hand, to increase the force in the left hip abductors 4. Left hand, to increase the force in the left hip abductors

Rationale 1. Osteoarthritis may lead to severe hip pain with weight-bearing as a result of joint deterioration and loss of articular cartilage. Use of a cane in the contralateral hand has been shown to decrease electromyogram activity in the hip abductors, which would lead to a decrease in joint reaction forces (contact pressure equals contact force/contact area). 2. The cane should be used in the contralateral hand to decrease the left hip abductor force, thereby decreasing the joint reaction forces. 3. Use of a cane in the contralateral hand has been shown to decrease electromyogram activity in the hip abductors.

A physical therapist notes areas of reddened skin without open lesions on the sacrum of a nonambulatory patient. Which of the following instructions to the patient is MOST appropriate? 1. Pad the reddened area. 2. Cleanse the reddened area with antiseptic soap. 3. Call the physician. 4. Avoid lying in supine position.

Rationale 1. Padding an area will not alter the area that the patient has in contact with a surface. Therefore, it is not effective in reducing pressure. (Myers, p. 285) 2. Although it is important to maintain hygiene, cleansing reddened skin with antiseptic soap will not reduce interface pressure over the sacrum (Myers, pp. 102-106). 3. The physician should be notified of the change in patient status; however, this will not actively address the need to reduce interface pressure over the sacrum (Myers, p. 273). 4. The ideal intervention for treatment of a pressure injury is to position the patient off of the area of the injury (O'Sullivan, p. 591). Therefore, a patient who has a pressure injury on the sacrum should not be positioned in supine position (Myers, p. 273).

Pain and weakness were elicited with the test illustrated. Which of the following should be AVOIDED during the early treatment phase? 1. Rotator cuff strengthening 2. Joint mobilization 3. Overhead activities 4. Deep friction massage

Rationale 1. Pain and weakness with the pictured test (empty can test) indicate partial rotator cuff tear or impingement. Rotator cuff strengthening is indicated. 2. Joint mobilization is not contraindicated for a patient who has a partial rotator cuff tear or impingement. 3. Overhead activities are painful and should be avoided in the early stages of treatment for a patient who has a partial rotator cuff tear or impingement. Work should occur only in the pain-free range. 4. Deep friction massage can be used for pain relief and to decrease scar tissue for a patient who has a partial rotator cuff tear or impingement.

*A patient who has a grade III ligamentous sprain of the radial collateral ligament of the metacarpophalangeal joint of the thumb (1st digit) is MOST likely to exhibit pain during which of the following tests? 1. Passive range of motion into thumb (1st digit) metacarpophalangeal joint flexion 2. Valgus stress testing of the metacarpophalangeal joint 3. Resisted isometric testing of the abductor pollicis longus 4. Palpation of the radial portion of the thumb (1st digit) metacarpophalangeal joint

Rationale 1. Passive range of motion into thumb (1st digit) metacarpophalangeal joint flexion should not stretch the involved ligament (p. 431). 2. Valgus stress testing of the metacarpophalangeal joint does not stress the injured side (p. 431). 3. Resisted isometric testing of the abductor pollicis longus should not stretch the affected ligament (p. 431). 4. The radial portion of the thumb (1st digit) metacarpophalangeal joint is the affected structure and would be tender to palpation (p. 32).

A patient has right lower lobe atelectasis following abdominal surgery. Upon auscultation, a physical therapist notes no adventitious breath sounds. Which of the following is MOST appropriate for this patient? 1. Percussion and vibration in left Trendelenburg position 2. Vigorous percussion and vibration with nebulizer 3. Spirometry with segmental breathing exercises 4. Practice of incisional splinting for coughing techniques

Rationale 1. Percussion and vibration are appropriate for airway clearance (pp. 315-316). However, the absence of adventitious breath sounds suggests the airway is clear. 2. Percussion and vibration with a nebulizer that delivers medication are appropriate for airway clearance (pp. 315-316). However, the absence of adventitious breath sounds suggests the airway is clear. 3. Adventitious breath sounds are abnormal sounds such as crackles, wheezes, and stridor. Atelectasis is a collapse of lung tissue. Spirometry (maximizes alveolar expansion; used specifically for atelectasis) and segmental breathing exercises are appropriate interventions for atelectasis without the presence of adventitious breath sounds (pp. 363-364, 496). à augments localized lung expansion, expands collapsed alveoli, increases chest wall mobility 4. Incisional splinting is appropriate for pain control when coughing after abdominal surgery but would not address the atelectasis (p. 498).

A physical therapist places a patient in a seated position with the patient's back leaning against a pillow at a 45° to 60° angle. This position BEST facilitates postural drainage of which of the following parts of the lungs? 1. Bilateral apical 2. Right anterior 3. Left lingula 4. Bilateral posterior

Rationale 1. Postural drainage of the apical segments of the upper lobes occurs when the patient leans back on a pillow at a 30° angle (O'Sullivan, p. 516; Frownfelter, p. 314). 2. The position for postural drainage of the anterior segment of the upper lobes is supine with a pillow under the knees (O'Sullivan, p. 516; Frownfelter, p. 314). 3. The patient lies head down on the right side to drain the left upper lobe lingular segment. This segment is not found on the right side. (Frownfelter, p. 314) 4. The patient would lie in prone position over pillows with the feet elevated 20 inches (51 cm) to facilitate drainage of the bilateral posterior parts of the lungs (Frownfelter, p. 315; O'Sullivan, p. 516).

A patient who has global aphasia is being discharged to home. Which of the following strategies is MOST appropriate for educating the caregivers about the patient's care? 1. Have the caregivers practice appropriate care techniques with the physical therapist role-playing the patient. 2. Give the patient written instructions regarding care and ask the patient to discuss the instructions with caregivers. 3. Have the patient and caregivers view an educational video about the patient's condition. 4. Provide organized treatment sessions during which the caregivers practice caring for the patient.

Rationale 1. Practicing care techniques with the therapist role-playing the patient does not provide the caregiver variable features consistent with real-world, open environments. 2. The patient has global aphasia and will not be able to read, comprehend, or follow the instructions listed in the written handouts. 3. Since caregiving is a psychomotor skill, practice is essential in its mastery. An educational video does not allow the caregiver to practice caring for the patient. 4. Practice is important for the caregiver. In general, the more the practice, the greater the learning. As learning progresses, the environment should be varied and should incorporate more variable features consistent with real-world, open environments. Allowing the caregiver to practice caring for the patient allows the caregiver to learn to manage the nuances of real life.

A patient sustains severe chemical burns on both legs, requiring split-thickness skin grafts. To prevent hypertrophic scar formation, the BEST intervention is: 1. pressure garments. 2. functional positioning for the legs. 3. a walking exercise program. 4. prolonged muscle stretching.

Rationale 1. Pressure garments worn 23 hours/day have been found to reduce the formation or thickness of hypertrophic scar (Bryant, p. 77). 2. Positioning may be used to maintain the soft tissue in a stretched position to counter scar contraction, but this would not affect the thickness of the scar tissue. 3. A walking exercise program can be helpful for regaining strength and endurance and would apply some stretch to scar tissue but would not provide the compression necessary to prevent an increase in the thickness of the tissue (hypertrophic scar formation). Directed functional exercise is the more appropriate approach (Sussman, p. 426) 4. It is important to maintain the soft tissue in a stretched position to counter scar contraction, but this would not affect the thickness of the scar tissue (Sussman, pp. 419, 426)

A patient with complete C6 tetraplegia reports a 3-day history of increased lower extremity spasticity, left shoulder pain, and fever. Which of the following conditions is MOST likely responsible for these findings? 1. Decreased respiratory function 2. Autonomic dysreflexia 3. Urinary tract infection 4. Deep vein thrombosis

Rationale 1. Pulmonary dysfunction is a long-standing issue in patients who have C6 quadriplegia and would not cause the recent change in status (O'Sullivan, p. 898). 2. Autonomic dysreflexia results in hypertension, not left shoulder pain or fever, and has a rapid onset (O'Sullivan, p. 896). 3. Urinary tract infection is correct because spasticity can be influenced by internal factors such as a urinary tract infection. Also, a urinary tract infection can be associated with fever and can refer pain to the ipsilateral shoulder. (Goodman, p. 388) 4. Symptoms of deep vein thrombosis include swelling, erythema, and heat in a localized area (O'Sullivan, p. 901). These symptoms are not described in the stem.

A patient is referred to physical therapy with thoracic spine pain. Which of the following data obtained from the patient's history is MOST likely indicative of the presence of an underlying cardiac condition? 1. Sharp mid back pain that increases with lifting of heavy objects 2. Increased pain with deep breathing 3. Feeling of heaviness in the chest 4. Persistent night pain

Rationale 1. Sharp pain in the body part being used is a typical characteristic of nerve or nerve root pain (Magee, p. 9). Also, muscle pain will increase when the muscle contracts or is stretched (Magee, p. 8). 2. Pain related to breathing may signal pulmonary problems or may be related to movement of the ribs 3. A feeling of heaviness in the chest may be a sign of a cardiovascular condition and indicates the need for referral to a physician (Magee, p. 2). 4. Persistent night pain is a classic symptom of cancer, but it may also be present in a patient who has an occult bone fracture. If a musculoskeletal condition can be ruled out, night pain indicates the need for medical consultation. (Goodman, p. 126)

A physical therapist is prescribing therapeutic exercises for a patient who had a left cerebrovascular accident 2 weeks ago with resultant right lower extremity paresis. The patient also has a history of gastroesophageal reflux disease. The therapist should AVOID placing the patient in which of the following positions during the exercises? 1. Sitting upright at 90° 2. Standing 3. Supine 4. Sitting semireclined at 45°

Rationale 1. Sitting upright is appropriate for the patient and would not promote reflux. 2. Standing is appropriate for the patient and would not promote reflux. 3. Supine position could facilitate relaxation of the lower esophageal sphincter and promote reflux from the stomach into the esophagus. 4. A semireclined position is appropriate for the patient and would not promote reflux.

*Effective physical therapy intervention for an infant with torticollis should include teaching the caregiver to: 1. supervise prone positioning with the infant's head turned to the same side as the affected muscle. 2. perform cervical range of motion while the infant is sleeping. 3. provide brief, passive stretch to the affected muscles. 4. apply electrical stimulation on the uninvolved side.

Rationale 1. Sleeping in prone with tight muscles (sternocleidomastoid) being stretched provides long duration stretch that is optimal for treatment of torticollis (Palisano, p. 197). 2. Range of motion alone will not achieve muscle stretching necessary for treatment of torticollis (Palisano, p. 197). 3. Passive stretch of long duration is needed to effectively stretch muscles involved in torticollis (Palisano, pp. 197, 199-200). 4. Electrical stimulation is contraindicated in the carotid sinus region (Cameron, p. 231) and is a precaution for the very young

A 60-year-old patient reports the insidious development of low back pain with no radicular symptoms. There is no history of trauma or significant medical history. The patient plays golf once a week and reports sitting at a desk for approximately 6 hours each weekday. The patient has poor posture and significant loss of lumbar extension range of motion. Which of the following factors is the MOST likely cause of the patient's decreased range of motion? 1. Spondylolisthesis 2. Disc herniation 3. Golfing 4. Prolonged sitting

Rationale 1. Spondylolisthesis is incorrect because it is usually found in gymnasts, weight lifters, and football linemen as a result of repetitive flexion and hyperextension forces. It may also present as radiating pain into the buttocks or posterior thigh. (Shultz, pp. 379-380) 2. Disc herniation is incorrect because it occurs with movements into flexion, rotation, side flexion, or extension and does not have an insidious onset. The patient would exhibit radicular pain into the leg and foot that increases with extension. (Magee, p. 641) 3. Golfing is incorrect because golf is a sport, and sports injuries are usually not insidious. The patient reports an insidious onset of symptoms. The mechanism of injury for a herniated nucleus pulposus is repetitive movements into flexion, rotation, side flexion, or extension. (Magee, p. 641) 4. Prolonged sitting is correct because the patient's lower back pain developed over time. The patient has impaired sitting alignment as a result of postural alignment impairments and possible environmental factors. Prolonged sitting may contribute to increased back pain through a gradual creep of tissues (Magee, p. 557)

A patient has significant shortening of tissues around a joint after immobilization. Patient instruction in which of the following interventions would BEST produce rapid, lasting changes in tissue length? 1. Stretching exercises of short duration performed multiple times throughout the day 2. Use of a dynamic splint worn multiple hours throughout the day 3. Stretching exercises of ballistic quality performed multiple times throughout the day 4. Multiple repetitions of range of motion exercises performed to end range

Rationale 1. Stretching exercises of short duration would produce changes over time through remodeling, but these changes would take much longer to occur. Creep, on the other hand, would produce lasting changes over a shorter period of time. (pp. 83-84) 2. This option uses the concept of creep. Creep is permanent deformation of tissue through the application of a low magnitude load over a long period of time (p. 84). The use of a dynamic splint will allow the application of such a load and induce rapid changes over an extended period with minimal tissue damage and inflammation (p. 89). 3. Ballistic stretches are not recommended for individuals after immobilization because they are thought to create significant trauma to atrophied tissues (pp. 89, 92). 4. Range of motion exercises are not thought to increase tissue length because they are not sustained long enough to induce lasting changes. They may be used to maintain tissue length but generally do not provide enough stress by themselves to increase tissue length. (p. 52)

Which of the following nerves are MOST active during the emptying phase of micturition? 1. Sympathetic nerves from the hypogastric plexus 2. Parasympathetic nerves from the hypogastric plexus 3. Sympathetic nerves from the pelvic plexus 4. Parasympathetic nerves from the pelvic plexus

Rationale 1. Sympathetic nerves from the pelvic plexus are most active during the filling phase of micturition (Umphred, pp. 902, 904). 2. Parasympathetic nerves from the pelvic plexus at S2-S4 fire, not from the hypogastric plexus (Drake, p. 494). 3. Sympathetic nerves from the pelvic plexus are most active during the filling phase of micturition (Umphred, pp. 902, 904). 4. Parasympathetic nerves from the pelvic plexus fire in order to contract the bladder and begin emptying (Umphred, pp. 902, 904; Drake, p. 494).

Which of the following tools is MOST appropriate for assessing progress in an 8-year-old child who has cerebral palsy with spastic quadriplegia and limited mobility? 1. Bayley III 2. Gross Motor Function Measure (GMFM) 3. Peabody Developmental Motor Scales 4. Bruininks-Oseretsky Test of Motor Proficiency

Rationale 1. The Bayley III is a revised version of the Bayley Scales of Infant Development, which is norm referenced for children from birth to 42 months old (Palisano, p. 532; Tecklin, pp. 82, 84-85). 2. The Gross Motor Function Measure was constructed to evaluate progress over time in children with cerebral palsy. The test was developed to evaluate change in motor status and proficiency due to therapeutic intervention. The test has been validated for sensitivity to change in children with cerebral palsy age 5 months to 16 years (Palisano, pp. 15-16, 90; Tecklin, pp. 77-79) 3. The Peabody Developmental Motor Scales is appropriate for children from birth to 72 months of age (Palisano, p. 219; Tecklin, pp. 79-81). 4. The Bruininks-Oseretsky Test of Motor Proficiency is a test of motor function for children 4 to 21 years of age. The test is primarily constructed to assess motor coordination and balance (Tecklin, pp. 81-83). This test will be too advanced for this patient.

A patient who has low back pain exhibits Poor (2/5) strength of the lower abdominal muscles. Which of the following exercises would be most appropriate for the patient INITIALLY? 1. Anterior pelvic tilts 2. Partial sit-ups 3. Posterior pelvic tilts 4. Oblique sit-ups

Rationale 1. The abdominals help to posteriorly tilt the pelvis, not anteriorly tilt the pelvis (p. 199). 2. This exercise is too advanced for someone with poor strength; the patient would not be able to move against gravity (pp. 200-201). Fair plus (3+/5) strength would be needed for this activity. 3. Posterior pelvic tilts incorporate an isometric contraction of the abdominals and would be helpful for strengthening initially (p. 199). 4. Oblique sit-ups require movement against gravity, which cannot be done with poor abdominal strength (pp. 200-201).

Which of the following activities tests a patient's limits of stability in standing position? 1. Time how long the patient can stand with feet together. 2. Gently push on the patient's sternum and observe the response. 3. Measure how far the patient can reach without losing balance. 4. Observe postural sway with the patient standing in front of a grid.

Rationale 1. The ability to stand with feet together gives information about static balance, not limits of stability. 2. Observing a patient's response to external perturbation does not test the limits of stability. 3. The limit of stability in any direction is how far outside the base of support a person can move without losing balance. Measuring how far the patient can reach is a test of limits of stability. 4. Postural sway in quiet standing position gives information about static balance, not limits of stability.

Which of the following statements BEST explains why a patient with reports of dyspnea would benefit from the position shown in the photograph? 1. The accessory respiratory muscles are relaxed in the position shown. 2. The position increases the thoracic cavity volume. 3. The position allows increased strength of contraction of the diaphragm. 4. The position encourages pursed-lip breathing and emphasizes expiration.

Rationale 1. The accessory muscles are generally activated in this position, because the arms are supported, and, therefore, the accessory muscles can work on the rib cage to assist the respiratory muscles. The accessory muscles are performing their role and not "resting." Therefore, this is an incorrect option. 2. This is incorrect, because the diaphragm is pushed upward and not downward when the intraabdominal pressure rises, as in this position. 3. When the person leans forward as in the photograph, the intraabdominal pressure rises and lengthens the diaphragm as it is raised upward. This allows the strength of the contraction to increase. Due to the improved length-tension relationship, the diaphragm has an improved strength of contraction. 4. This position does not have any impact on pursed-lip breathing and expiration. Both these actions can be performed in any position and not necessarily in the position shown.

A patient with chronic obstructive pulmonary disease would MOST likely have a DECREASED value in which of the following pulmonary function tests? 1. Residual volume 2. Total lung capacity 3. Vital capacity 4. Functional residual capacity

Rationale 1. The amount of air remaining within the lungs when the expiratory reserve volume has been exhaled is called the residual volume (Goodman, p. 1723). Chronic obstructive pulmonary disease causes increases in residual volume due to air trapping (O'Sullivan, pp. 486-491). 2. At full inspiration, the lungs contain their maximum amount of gas. This volume of air is called the total lung capacity (Goodman, p. 1723). Total lung capacity is increased with chronic obstructive pulmonary disease due to destruction of alveolar walls (O'Sullivan, pp. 486-491). 3. Chronic obstructive pulmonary disease is a combination of airway narrowing, parenchymal destruction, and pulmonary vascular thickening. Vital capacity is an indicator of the amount of air that is expelled after the patient takes a maximal inspiration and follows that with a maximal expiration (Goodman, p. 1723). Chronic obstructive pulmonary disease causes a decrease in vital capacity (O'Sullivan, pp. 486-490). 4. Functional residual capacity is the amount of air in the lungs at the end of quiet exhalation (Goodman, p. 1723). Chronic obstructive pulmonary disease causes an increase in functional residual capacity due to air trapping (O'Sullivan, p. 486).

A physical therapist is performing gait training with a patient who has right hemiparesis. The patient displays extensor tone in the stance and swing phases of gait. Which of the following is the MOST appropriate orthotic recommendation? 1. Solid ankle-foot orthosis set in 10° of plantar flexion 2. Floor reaction ankle-foot orthosis 3. Hinged plastic ankle-foot orthosis with plantar flexion stop 4. Posterior leaf spring orthosis

Rationale 1. The ankle-foot orthosis should be set in slight dorsiflexion to discourage the extension synergy, which includes ankle plantar flexion (pp. 671, 700) 2. A floor-reaction ankle-foot orthosis encourages knee extension, which is consistent with an extension synergy (p. 1334). 3. A hinged plastic ankle-foot orthosis with plantar flexion stop provides the greatest control for the patient and limits the amount of plantar flexion, thereby decreasing the extension synergy (p. 1332). 4. A posterior leaf spring orthosis does not provide adequate control for a patient with increased extensor tone and is not recommended in the presence of hypertonia (p. 1331).

An attorney calls the physical therapy department seeking information on the status of the attorney's client, a patient who is undergoing rehabilitation following total knee arthroplasty. The patient's physical therapist should: 1. refer the attorney to the patient's insurance carrier. 2. describe the patient's current status. 3. require written authorization from the patient to release information. 4. obtain verbal permission from the patient to release information.

Rationale 1. The health care provider does supply records to the patient's insurance carrier, but referring the attorney to the patient's insurance carrier is inappropriate. The patient's insurance information is part of the confidential record. 2. Written release is required from the patient prior to providing protected health information. Describing the patient's status without the patient's written permission would violate the patient's privacy. 3. Information relating to the physical therapist/patient relationship is confidential and may not be communicated to a third party not involved in that patient's care without the prior written consent of the patient. 4. Written permission, not verbal, is required to release protected health information.

*Which of the following activities is the HIGHEST level functional activity that a 15-month-old child with L1 myelomeningocele should be expected to achieve independently within 6 months? 1. Rolling 2. Sitting 3. Standing 4. Walking

Rationale 1. The child should be able to roll independently but also should be able to sit without assistance. Sitting is considered a higher functional task than rolling. 2. With a lesion below the L1 nerve root level, innervation is intact to all the abdominal muscles and to the iliopsoas, so the child should be able to sit up independently. 3. The child would have innervation to the hip flexors, but would lack innervation to the other lower extremity muscles needed for standing independently. 4. The child would have innervation to the hip flexors, but would lack innervation to the other lower extremity muscles needed for walking independently.

During flexibility testing, a patient is supine with knees flexed over the end of the table. With passive flexion of the right hip, the physical therapist observes that the patient's left knee extends. This is MOST likely due to tightness of the: 1. left rectus femoris. 2. right biceps femoris. 3. left iliopsoas. 4. right iliotibial band.

Rationale 1. The described position posteriorly tilts the pelvis and, in the presence of left rectus femoris tightness, results in decreased left knee flexion. 2. The right biceps femoris would not be affected, because right knee extension is not assessed in the position. 3. The left iliopsoas would not cause decreased left knee flexion, because it is a hip flexor muscle. 4. The right iliotibial band is not being stretched in this position, and it would not contribute to decreased knee flexion.

A patient who has a complete C6 spinal cord injury is MOST likely able to perform complete active range of motion during which of the following actions? 1. Elbow extension 2. Elbow flexion 3. Wrist ulnar deviation 4. Thumb (1st digit) interphalangeal extension

Rationale 1. The elbow extension myotome is at C7 and is, therefore, affected by the spinal cord injury (p. 154). 2. Elbow flexion is at the C5-C6 myotome and is, therefore, not affected. This is the correct option (p. 154). 3. Ulnar deviation of the wrist is at the C8 myotome and is, therefore, affected (p. 154). 4. Thumb (1st digit) interphalangeal extension is innervated by C6-C8 and would be affected (p. 153).

During scoliosis screening, the forward bend evaluation is conducted to determine the presence of which of the following clinical features? 1. Excessive thoracic kyphosis 2. Vertebral rotation 3. Lateral spinal deviation 4. Lumbar lordosis

Rationale 1. The forward bend test will show a rotary component of the spine if there is a scoliosis. Excessive thoracic kyphosis is not determined by the forward bend evaluation. Excessive kyphosis should be viewed from the side. (p. 205) 2. Scoliosis during forward bending is indicated by a spinal curve. This is called a rib hump and is caused by rotation of the vertebral bodies. (pp. 205, 240) 3. The purpose of the forward bend test is to assess for the rotary component of the scoliosis, not lateral spinal deviation (p. 240). 4. The purpose of the forward bend test is to assess for the rotary component of the scoliosis, not lumbar lordosis (p. 240).

A physical therapist examines a patient with a left transfemoral amputation and an acute episode of low back pain. Which muscle can the therapist test for S1 nerve root function on the patient's left side? 1. Gluteus medius 2. Adductor magnus 3. Iliopsoas 4. Pectineus

Rationale 1. The gluteus medius is innervated by the superior gluteal nerve (L5, S1). 2. The adductor magnus is innervated by L4. 3. The iliopsoas is innervated by the femoral nerve (L2-L3-L4). 4. The pectineus is innervated by the obturator nerve (L2-L3).

Which of the following cranial nerves is tested by resisting the patient's ability to keep the eyes tightly shut? 1. Oculomotor (CN III) 2. Trochlear (CN IV) 3. Trigeminal (CN V) 4. Facial (CN VII)

Rationale 1. The oculomotor nerve (CN III) innervates the muscles that move the eye itself rather than the muscle that closes the eye (pp. 330-331). 2. The trochlear nerve (CN IV) innervates the superior oblique muscle and not the muscle that closes the eye (p. 331). 3. The motor functions of the trigeminal nerve (CN V) are opening and closing of the mouth (jaw) rather than the eyes (pp. 336-338). 4. Closing the eye tightly is controlled by the facial nerve (CN VII). Therefore, applying resistance to eye closure tests the function of this nerve. (pp. 338-339)

A patient sustained a cervical hyperextension injury that caused bleeding into the central gray matter of the lower cervical spinal cord. Which of the following descriptions BEST reflects the highest level of function the patient is likely to achieve? 1. Inability to transfer without assistance and use of a motorized wheelchair required for mobility 2. Ability to propel a standard wheelchair independently with upper extremities but inability to walk 3. Independence in bed mobility and self-care activities but use of a sliding board required for transfers 4. Ability to walk but difficulty with distal upper extremity and hand function

Rationale 1. The lower extremities are often spared with a central cord injury; therefore, a motorized wheelchair is an inappropriate assistive device. 2. The patient is more likely to have distal arm weakness, which should affect wheelchair mobility with upper extremities, but the patient may recover the ability to walk. 3. Patients who have central cord syndrome should expect to have difficulty with activities of daily living that require upper extremity function. Since the lower extremities may be spared, the patient might be able to transfer without a sliding board. Because the question asks for the highest level hoped for, this would not be the best choice. 4. This is a description of central cord syndrome. Because the spinal tracts for the lower extremities are positioned more laterally in the spinal cord, upper extremities are more affected than lower extremities. Patients with central cord syndrome typically recover the ability to ambulate with some remaining distal arm weakness. 77% of patients with central cord syndrome will attain ambulatory function, and 42% will attain hand function.

On initial evaluation of a patient, a physical therapist finds a weakness in plantar flexion, forefoot inversion, and toe flexion. The therapist should suspect involvement of which of the following peripheral nerves? 1. Medial plantar 2. Tibial 3. Common peroneal 4. Femoral

Rationale 1. The medial plantar nerve is a cutaneous nerve of the lower limb (p. 538). 2. The tibial nerve innervates the muscles that flex the toes and plantar flex and invert the foot (p. 593). 3. The common fibular (peroneal) nerve supplies cutaneous innervation via a branch, as well as innervation to the knee joint via another branch (p. 593). 4. The femoral nerve supplies innervation in the upper portion of the lower limb (p. 546).

A physical therapist is treating an adolescent patient who has medial elbow pain. The patient has been advised by the physician to rest the elbow, but the patient's parents insist that the patient play in an upcoming baseball tournament. Which of the following actions is MOST appropriate for the therapist? 1. Instruct the family in pain relief strategies. 2. Discuss concerns about the patient's condition with the patient's baseball coach. 3. Report concerns about the patient's treatment adherence to the referring physician. 4. Tape the patient's elbow.

Rationale 1. The patient could be instructed in pain relief strategies, because the family does not have the child's best interest in mind, but the referring physician should be contacted first in this case. 2. Discussing the patient's case with the baseball coach would violate the privacy rules of the Health Insurance Portability and Accountability Act (HIPAA). 3. Concerns about the patient's recovery should be communicated to the referring practitioner prior to action. 4. Taping is used to prevent further injury during the activity. Taping is not indicated to allow participation when rest is recommended

A patient reports leg pain that begins after 3 minutes of walking and is relieved by lying down and hanging the leg off the side of the bed. Which of the following tests or measures should the physical therapist use to identify the degree of dysfunction? 1. Ankle-brachial index 2. Dynamic Gait Index 3. Visual analog scale 4. Angina scale

Rationale 1. The patient exhibits signs of vascular intermittent claudication, which is associated with arterial insufficiency. The ankle-brachial index (ABI) compares or indexes the ankle blood pressure to the arm blood pressure and is a noninvasive measure of arterial blood supply. (Bryant, p. 194) 2. Dynamic Gait Index is a test of ability to modify gait in response to task demands, not for arterial insufficiency (Shumway-Cook, p. 413). 3. Visual analog scales are used to estimate perceptions of pain and do not indicate degree of organic dysfunction (Bryant, p. 391). 4. An angina scale is used to quantify chest pain and is not relevant for the condition described in the patient scenario (Frownfelter, p. 116).

A physical therapist is developing an exercise program for an 18-year-old patient. The patient is presently covered for physical therapy services by the parents' insurance. Which of the following actions is MOST appropriate for the therapist to take prior to beginning the patient's therapy? 1. Obtain informed consent from the patient. 2. Obtain informed consent from the parents. 3. Encourage the patient's parents to leave the treatment area during therapy. 4. Require a release by a medical physician.

Rationale 1. The patient is not a minor and, therefore, can give informed consent. 2. Since the patient is not a minor, parental consent is not necessary prior to initiation of a formal exercise program. 3. Having parents present will often help therapy. Encouraging them to leave is not a good first step. 4. A release by a medical physician is recommended but is not a necessity. A thorough examination and/or physical screening should be performed, and a referral should be made if the patient's condition warrants.

The result of the pictured mobility test indicates marked limitation. Which range of motion will MOST likely be limited? 1. Ankle plantar flexion 2. Ankle dorsiflexion 3. Subtalar inversion 4. Subtalar eversion

Rationale 1. The photograph shows anterior glide of the talus on the distal tibia. Anterior glide is needed for the anterior movement of the talus on the mortis, which is required for plantar flexion to occur. (p. 152) 2. Dorsiflexion would be restricted with limited posterior glide of the talus on the distal tibia (p. 152). The photograph shows anterior glide of the talus on the distal tibia. 3. Mobilizing to increase subtalar inversion would require moving the calcaneus laterally while maintaining a grade I distraction force (p. 153). 4. Mobilizing to increase subtalar eversion would require a medial glide of the calcaneus while maintaining a grade I distraction force (p. 153).

An inability to perform the exercise shown in the photograph is MOST likely to be associated with difficulty performing which of the following shoulder movements? 1. Flexion 2. Extension 3. Horizontal abduction 4. Medial (internal) rotation

Rationale 1. The photograph shows strengthening for the serratus anterior (Kisner). It is impossible to raise the arm above the head without the action of the serratus anterior muscle (Lippert). 2, 3, 4. The photograph shows strengthening of the serratus anterior (Kisner). It is impossible to raise the arm above the head without the action of the serratus anterior muscle (Lippert), but extension, horizontal abduction, and medial (internal) rotation should not be impacted.

Which of the following impairments is MOST likely causing the limitation depicted in the patient's right upper extremity? 1. Infraspinatus tightness 2. Tight inferior glenohumeral joint capsule 3. Posterior deltoid tightness 4. Tight anterior glenohumeral joint capsule

Rationale 1. The photograph shows the patient performing medial (internal) rotation with the hand behind the back. Because the infraspinatus is a lateral (external) rotator, tightness will limit medial (internal) rotation (Norkin, pp. 86, 97). 2. Based on the convex-concave rule, a tight inferior joint capsule would limit abduction (Kisner, p. 134). Since the limitation is in medial (internal) rotation and not abduction, this option would be incorrect. 3. The posterior deltoid could contribute to the limited range since part of its function is lateral (external) rotation. However, it also functions during extension, so this position could shorten the muscles, making it less likely than the infraspinatus to contribute to the limitation (Norkin, p. 86; Lippert, p. 151). 4. Based on the convex-concave rule of the shoulder, anterior capsule tightness would limit extension and lateral (external) rotation (Kisner, pp. 132, 135).

A healthy, older, sedentary individual has normal vital signs at rest. During maximal aerobic exercise, which of the following values should demonstrate MINIMAL change? 1. Stroke volume 2. Diastolic blood pressure 3. Venous oxygen content 4. Systolic blood pressure

Rationale 1. The primary cardiovascular response to aerobic exercise that is attributed to aging is a decrease in heart rate. Therefore, stroke volume does not change as much as heart rate, and ventricular volumes in older people are similar to those in younger adults. (pp. 454-455) à CO = HR x SV 2. During endurance exercise systolic blood pressure increases, but diastolic blood pressure should not change significantly. Change in blood pressure response to exercise is not the primary difference in an elderly person's cardiovascular system. (p. 189) 3. Even in the elderly population, a great amount of oxygen is extracted from working muscles, and venous oxygen changes significantly with exercise (pp. 454-455). 4. Systolic blood pressure increases in direct proportion to the increase in exercise intensity. This response may change some with aging, but it is not the primary change in response to exercise for the elderly. Also, a rise in systolic pressure must occur as the result of increased cardiac output required to sustain exercise. (p. 189)

Which of the following peripheral joint mobilization techniques performed over the distal radius and ulna is MOST appropriate for a patient with limited ulnar deviation range of motion due to capsular tightness? 1. Radial glide of the proximal carpal row 2. Ulnar glide of the proximal carpal row 3. Dorsal glide of the proximal carpal row 4. Volar glide of the proximal carpal row

Rationale 1. The radiocarpal joint consists of the concave distal radius and the convex proximal row of carpals. Utilizing proper joint kinematics and the concave-convex rule, radial glide will be the best technique to perform to increase ulnar deviation. 2. Ulnar glide of the proximal carpal row would be a reverse of the concave-convex rule. This mobilization technique should improve radial deviation. 3. Moving the proximal (convex) carpal row dorsally over the distal radius and ulna (concave) is a technique to assist wrist flexion. 4. Moving the proximal (convex) carpal row volarly over the distal radius and ulna (concave) is a technique to assist wrist extension.

A patient reports recent onset of unilateral pain in the temporalis region and upper neck area and a sensation of fullness in the ear. The patient's range of mouth opening is 4 fingers' width. Pain increases when the patient bites down on a cotton roll with the back molars and during palpation over the area of the masseter muscle. There is no clicking joint noise during repeated mouth opening. Which of the following interventions is MOST appropriate? 1. Heat and masticatory muscle strengthening 2. Heat and masticatory muscle relaxation technique 3. Joint mobilization with anterior translation followed by ice 4. Joint mobilization with vertical distraction and long-axis distraction

Rationale 1. The recent onset indicates this may be in the acute phase of healing. There is no indication that weakness is present, so relaxation techniques may be more appropriate in this stage of healing. (pp. 1370, 1376-1377) 2. Absence of joint clicks, normal range of motion, and increased pain during the biting down test indicate muscular or ligament involvement (most likely excessive muscle tension). This intervention would address the soft tissues involved. (pp. 1370, 1376-1377) 3, 4. This patient has normal mouth opening. Joint mobilization to increase mouth opening is not indicated (pp. 1360-1361).

A 4-year-old child has maxillary hypoplasia, an elongated mid face, and a short, upturned nose. The child has a short attention span and poor growth. Which of the following interventions would be MOST appropriate for the child? 1. Gait training with a rolling walker 2. Sensory desensitization activities 3. Activities to inhibit spasticity 4. Dynamic balance activities

Rationale 1. The stem describes characteristics of a child with fetal alcohol syndrome. Severe delays in walking are not characteristic of a child with fetal alcohol syndrome, and it is likely that a child of this age would be walking independently. Since facial and physical features of fetal alcohol syndrome may be subtle, the diagnosis may not be made until the preschool or school-age years when inattention, hyperactivity, and learning problems are more apparent. (Tecklin, p. 158) 2. The stem describes characteristics of a child with fetal alcohol syndrome. Oversensitivity to sensory input is not a characteristic associated with fetal alcohol syndrome. This is more characteristic of children with autism spectrum disorders. (Tecklin, pp. 406, 415-416) 3. The stem describes characteristics of a child with fetal alcohol syndrome. Spasticity is not associated with fetal alcohol syndrome. Fine motor dysfunction, visuomotor deficits, and weak grasp are characteristics of children with fetal alcohol syndrome. (Palisano, p. 426) 4. The stem describes characteristics of a child with fetal alcohol syndrome. Fine motor dysfunction, visuomotor deficits, balance problems, and weak grasp are characteristics of children with fetal alcohol syndrome. Balance activities would benefit the child. (Palisano, p. 426)

A patient reports pain and weakness following a fall on an outstretched arm. The patient is unable to raise the arm past 90° without assistance and has lost the ability to actively laterally (externally) rotate the arm against gravity. Which structures are MOST likely injured? 1. Supraspinatus, subscapularis, deltoid 2. Supraspinatus, teres minor, infraspinatus 3. Subscapularis, subacromial bursa, acromioclavicular joint 4. Anterior deltoid, teres minor, teres major

Rationale 1. The subscapularis muscle is a medial (internal) rotator. The deltoid abducts, flexes, and extends the shoulder joint. (pp. 61, 69, 83) 2. All three muscles are lateral (external) shoulder joint rotators (pp. 61, 89). 3. The subscapularis muscle is a medial (internal) rotator (p. 83). 4. The teres major is a medial (internal) rotator; the anterior deltoid is a shoulder flexor (pp. 47, 83, 89).

A patient reports lateral elbow pain after playing tennis for 2 hours. Which of the following muscles is MOST likely involved? 1. Supinator 2. Extensor carpi radialis brevis 3. Brachioradialis 4. Triceps

Rationale 1. The supinator may be involved with radial tunnel syndrome and have a referral to the elbow. The radial nerve may refer pain to the lateral elbow. Evaluation should note possible sensory paresthesias in the superficial radial nerve distribution to rule out radial tunnel syndrome. However, the extensor carpi radialis brevis is the muscle most commonly affected. (Dutton, p. 764) 2. Lateral epicondylalgia (tennis elbow) is defined as a pathologic condition of the wrist extensor muscles at their origin on the lateral humeral epicondyle. The tendinous origin of the extensor carpi radialis brevis is the area of most pathologic change. Changes can also be found in the musculotendinous structure of the extensor digitorum communis. (Kisner, p. 636; Magee, p. 407) 3. The brachioradialis can refer symptoms to the elbow region but is not commonly linked to repetitive extension activities such as tennis (Hislop, p. 139). The brachioradialis acts as a shunt muscle, overcoming centrifugal forces acting on the elbow and also adds power to increase the speed of flexion (Dutton, p. 716). 4. Tendinitis of the triceps distal tendon at the olecranon may elicit some posterior elbow or olecranon pain (Dutton, p. 754), but the extensor carpi radialis brevis is the muscle most commonly associated with lateral elbow pain related to repetitive activity (Dutton, p. 764).

During a phone call with a physical therapist regarding a patient referral, the physician who has referred the patient expresses a belief that the patient is fabricating symptoms for secondary gain and asks the therapist to provide documentation to demonstrate this impression. Which of the following responses is BEST for the therapist to provide in this situation? 1. Deciding whether a patient is fabricating symptoms for secondary gain is beyond the scope of physical therapy practice. 2. The physical therapy evaluation will include tests that will specifically assess for nonorganic signs and behavioral symptoms. 3. The patient will be confronted on issues of fabricating symptoms for secondary gain in an attempt to alter the behavior. 4. It is recommended that the patient be referred to a psychologist prior to initiating physical therapy.

Rationale 1. The therapist can and should act as part of the medical team, which includes determining sincerity of patients to the extent possible and documenting a finding of malingering to assist in appropriate care as needed. To ignore this responsibility would be unfair to the insurance company, the malingering patient (e.g., in case a psychiatric referral is needed), and other patients who could have used the treatment resources used by the malingering patient. 2. All patients should be given the benefit of the doubt until the clinician, with a high degree of confidence, can rule out an organic cause for the pain. A number of tests can be performed to help determine if the symptoms are of a nonorganic nature, but it is very difficult to judge the intent (psychogenic versus intentional exaggeration for gain). 3. The therapist should not initiate patient care with preconceived ideas that are potentially harmful to the patient's success. Expressing such assumptions to the patient will bias the feedback the patient provides because the patient will be defensive, further skewing the results of the evaluative process. 4. As a member of a health care team, a physical therapist can play a role in documentation of malingering, once behavior that is characteristic of malingering is observed. The therapist should not recommend referral to a psychologist prior to performing the initial evaluation.

A patient describes a progression of weakness over a 4-day period that began with moderate weakness in the lower extremities and has progressed to difficulty with all movements. The patient reports symptoms of paresthesia, but no loss of sensation. The MOST likely diagnosis is: 1. amyotrophic lateral sclerosis. 2. Guillain-Barré syndrome. 3. multiple transient ischemic attacks. 4. subdural hematoma.

Rationale 1. The timeline is quite inappropriate for amyotrophic lateral sclerosis to develop. Normally this develops in a matter of months or years, not days. (Goodman and Fuller, p. 1459) 2. There is rapidly ascending bilateral muscle weakness with paresthesias, but no anesthesia is present in Guillain-Barré syndrome (Goodman and Snyder, p. 478). 3. The pattern of rapid and continuous decline is atypical for even a series of vascular accidents. The typical vascular event starts with a dramatic onset of symptoms, which then improve. The ischemic episode typically lasts 5-20 minutes. (Goodman and Snyder, p. 269) 4. Although the timeline is appropriate for the development of a subdural hematoma, symptoms that are symmetrical and paresthesias without anesthesia are not typical for a subdural hematoma (Goodman & Fuller, pp. 1529-1530).

A patient with a recent prostatectomy has urinary incontinence. Loss of support to which of the following structures is MOST likely contributing to the incontinence? 1. Ureter 2. Ductus deferens 3. Levator ani 4. Urethra

Rationale 1. The ureters connect the kidneys to the bladder and are not in proximity to the prostate gland. 2. During the pelvic part of its course, the ductus deferens maintains direct contact with the peritoneum; no other structure intervenes between them. A vasectomy is the procedure in which the ductus deferens is ligated. It is not affected by prostatectomy. 3. The levator ani muscle is a skeletal muscle that attaches to the pelvis and is not DIRECTLY impacted by removal of the prostate. When the prostate is removed, there will be an expected period of incontinence lasting up to 6 weeks. Strengthening of the pelvic floor muscles can be a compensatory strategy for the loss of the support previously supplied by the prostate. 4. Prostatectomy indicates removal of the prostate gland. The prostate gland provides mechanical support to the urethra between the bladder neck and the penis.

Which of the following changes occur when using intermittent pneumatic compression during the inflation (compression) phase? 1. Decrease in venous blood flow and lymphatic pressure 2. Increase in interstitial tissue pressure and venous blood flow 3. Decrease in interstitial pressure and arterial blood flow 4. Increase in arterial and venous blood flow

Rationale 1. The venous blood flow & lymphatic pressure would increase, not decrease, during the inflation/compression phase. 2. During the compression phase, the arterial blood flow is reduced. Venous blood flow is enhanced, as is lymphatic flow. The interstitial pressure is increased, which forces fluid out of the interstitium into the lymphatic system. The compression of the veins and lymphatics forces fluids proximally. Arterial flow would increase during the deflation period. 3. Interstitial pressure is increased, not decreased, during the inflation (compression) phase. 4. Arterial flow will not increase during the compression phase.

A 65-year-old patient arrives for outpatient physical therapy. The patient reports swimming earlier that morning. Since then the patient has felt pain down both arms, has had shortness of breath, and has continued to perspire. What should a physical therapist do NEXT? 1. Refer the patient to a physician for magnetic resonance imaging of the cervical spine. 2. Contact emergency medical services. 3. Evaluate the cervical spine and provide stretches to decrease bilateral arm pain. 4. Treat the patient and recommend that the patient follow up with a physician within 1 week.

Rationale 1. There is not enough information to support a suspicion of disc injury in the cervical spine that would warrant magnetic resonance imaging. 2. The patient shows signs of having had a myocardial infarction. A myocardial infarction is more apt to occur in the morning, during exertion, and when one is working with the arms overhead (e.g., swimming). The patient demonstrates all of these warning signs, and emergency medical services should be contacted immediately. 3. Radiating upper extremity pain, shortness of breath, and diaphoresis are signs of myocardial infarction. Evaluating the cervical spine and providing upper extremity stretches is inappropriate and would delay emergent medical testing. 4. Based on the reported symptoms and the warning signs for a myocardial infarction, action should be taken immediately.

Which of the following activities is LEAST effective for improving the gait of patients who have Stage 1 Parkinson disease? 1. Repetitive wall squats 2. Performance of t'ai chi 3. Walking outdoors on uneven ground 4. Dancing with rhythmic auditory cues

Rationale 1. This activity is unlikely to affect the patient's gait pattern, although these exercises often are indicated for other impairments in Parkinson disease. These activities are static and not placed in context. Strength training is not the most important intervention in Stage 1 Parkinson disease. Postural and balance activities within functional activities are shown to have greater effect, especially in early stages. 2, 3, 4. Activities using visual and auditory stimuli in a context-specific setting have been shown to be effective for gait characteristics in individuals with Parkinson disease.

Which of the following findings are MOST consistent with the presence of a grade I sprain of the medial (ulnar) collateral ligament of the elbow? 1. Pain with valgus stress testing and minimal instability with the elbow in 60° of flexion 2. Pain with varus stress testing and moderate instability with the elbow in 60° of flexion 3. No pain with valgus stress testing and moderate instability with the elbow in 5° of flexion 4. No pain with varus stress testing and minimal instability with the elbow in 5° of flexion

Rationale 1. This is an example of a false negative. The test failed to identify correctly those who have the condition or in this case are at risk for falling. (p. 622) 2. This is an example of a true positive. The test correctly identified those at risk for falls. (p. 620) 3. This is an example of a true negative. The test correctly identified those patients not at risk for falls. (pp. 619-620) 4. This is an example of a false positive. The test failed to identify those not at risk for falling. (p. 620)

*A patient demonstrates active, pain-free shoulder range of motion that is moderately limited in horizontal adduction. Which of the following joint mobilization techniques is MOST appropriate? 1. Large amplitude oscillations performed at the beginning of the range of motion in an anteroinferior direction 2. Small amplitude oscillations into tissue resistance up to the limit of available motion in an anterosuperior direction 3. Large amplitude oscillations within the available range of motion in a posterior direction 4. Small amplitude oscillations into tissue resistance at the limit of available joint motion in a posteroinferior direction

Rationale 1. This mobilization includes an incorrect direction and is primarily used to treat joints that are limited by pain or muscle guarding (p. 120). 2. Although the mobilization can increase tissue flexibility, the direction of the glide is incorrect. It would increase horizontal abduction. (p. 122) 3. The joint mobilization described is used to increase flexibility; however, it is performed up to the limit of available motion, and the posterior direction is not as beneficial as a posteroinferior direction (p. 127). The direction of the glide is not as effective in maximizing arthrokinematic motion. 4. This mobilization technique is the most effective in increasing tissue flexibility in the absence of pain. The glide is in the direction that will maximize arthrokinematic motion. (p. 134)

A patient in supine position with lower extremities extended exhibits an anterior pelvic tilt. To test the patient's upper abdominal strength effectively, which of the following procedures should be implemented FIRST? 1. Manually stabilize the pelvis. 2. Place a hand at the posterior lumbar spine. 3. Place a pillow roll under the patient's knees. 4. Manually stabilize the lower extremities.

Rationale 1. This option is not correct because manual stabilization of the pelvis is not indicated during upper abdominal muscle testing. Correct pelvic positioning should be achieved first before conducting the test. (pp. 199-201) 2. Placing a hand at the posterior lumbar spine would be done if trunk flexion was being tested by using the leg lowering method (p. 202). 3. The patient's short hip flexors are preventing posterior pelvic tilt in the supine position; placing a pillow roll under the knees will passively flex the hips and allow the lumbar spine to flatten in preparation for the upper abdominal muscle test. The first step in this muscle test is correct positioning of the patient. (p. 199) 4. Stabilization of the lower extremities should not be done because it increases activity in the hip flexors, allowing them to substitute for weak abdominals (p. 201).

Which of the following conditions are malignant tumors of the connective tissue? 1. Fibroma and chondroma 2. Fibrosarcoma and chondrosarcoma 3. Papilloma and adenoma 4. Adenocarcinoma and basal cell carcinoma

Rationale 1. This option lists two types of benign tumors of the connective tissue. 2. This option lists two types of malignant tumors of the connective tissue. 3. This option lists two types of benign tumors of the epithelium/skin. 4. This option lists two types of malignant tumors of the epithelium/skin.

* A patient who had a myocardial infarction 5 days ago is referred for a low-level treadmill test. The patient reports having had several episodes of mild angina at rest, after meals, and during the night since being hospitalized. Which of the following actions is MOST appropriate for the physical therapist? 1. Proceed with the usual low-level protocol, because mild angina is common this soon after a myocardial infarction. 2. Defer testing the patient, because the symptoms suggest unstable angina after a myocardial infarction. 3. Perform the test at a lower-than-usual workload, because the symptoms suggest unstable angina after a myocardial infarction. 4. Defer testing the patient, because 5 days after a myocardial infarction is too soon to begin physical exertion.

Rationale 1. This patient has signs of unstable angina, and this warrants immediate medical attention (O'Sullivan, p. 534). 2. Unstable angina warrants immediate medical attention (O'Sullivan, p. 534). 3. Unstable angina warrants immediate medical attention (O'Sullivan, p. 534). 4. Five days after a myocardial infarction is not too soon for exercise testing. Testing should be performed before discharge, but the patient has signs of unstable angina, which warrant immediate medical attention. (ACSM, p. 113; O'Sullivan, p. 534)

In a study investigating the change in pinch strength after hand splinting in patients with rheumatoid arthritis, the strength was greater in the group receiving the splint than in the group not using the splint (p = .001). Given this evidence, the physical therapist should: 1. not splint the wrists of patients with rheumatoid arthritis, because the study does not show significant differences between the control and treatment groups. 2. splint the wrists of patients with rheumatoid arthritis, because the study indicates significant differences between the control and treatment groups. 3. wait for further studies before splinting the wrists of patients with rheumatoid arthritis, because the sample size of the current study was not given. 4. wait for a pilot study comparing the current treatment group to a control group receiving anti-inflammatory medication, because the current study ignored other treatment options.

Rationale 1. This response demands that the candidate knows that p = 0.001 is a highly significant value and that the research it represents should be considered seriously in the treatment of patients with rheumatoid arthritis. 2. This research article supports the use of splinting for patients with rheumatoid arthritis, because the p value is highly significant and supports rejection of the null hypothesis (H0). Also, this study supports evidence-based practice; therefore, the physical therapist should consider splinting for patients with rheumatoid arthritis. 3. The student should recognize that a p value of 0.001 is always significant regardless of sample size. The problem with small sample sizes is the possibility of not having a great enough power of the test to pick up differences if they truly exist. Because differences were found at a highly significant level (p = 0.001), consideration of splinting is supported by the research study. 4. This response presupposes all possible treatments for rheumatoid arthritis should be considered. The candidate should recognize that a study and its parameters are identified at the beginning of the investigation and that the investigators have the latitude to determine which interventions they wish to study.

Which of the following conditions would cause a patient to have the GREATEST risk for contracting an infection? 1. Thrombocytopenia 2. Leukopenia 3. Thrombocytosis 4. Leukocytosis

Rationale 1. Thrombocytopenia occurs when platelets are less than 150,000/mm3. This would not put the patient at risk for infection but it would for spontaneous bleeding (Goodman, Pathology, p. 758). 2. In leukopenia, the total number of leukocytes is less than normal, and the individual is at greater risk for infection (Goodman, Pathology, p. 719). 3. Thrombocytosis occurs when there is an increase in platelets. Symptoms include increased tendency to clot, splenomegaly, and easy bruising. (Goodman, Differential Diagnosis, p. 234) 4. Leukocytosis is an abnormally high number of leukocytes that generally develops in response to acute infection (Goodman, Pathology, pp. 718-719).

A patient with a hypertonic piriformis will also MOST likely have: 1. sacroiliac joint dysfunction. 2. limited hip extension. 3. anterior thigh paresthesia. 4. gluteus maximus weakness.

Rationale 1. Tightness or spasm of the piriformis may have a significant influence on the sacroiliac joint, causing dysfunction (Dutton, p. 1487). 2. The piriformis can function as a hip lateral (external) rotator, abductor, or extensor (Houglum, pp. 398-399). It is unlikely, therefore, to restrict hip extension. 3. The piriformis muscle derives its innervation from the L5-S2 nerve roots, which innervate the posterior thigh (Houglum, pp. 398-399). The anterior thigh is innervated by the femoral nerve (L2-L4), which arises from a different spinal segment. Therefore, hypertonicity and shortness of the piriformis would produce pain or paresthesias in the posterior thigh, not the anterior thigh. 4. One of the six classic findings in piriformis syndrome is gluteal atrophy. This can occur depending on the duration of the condition (Dutton, p. 250); however, it is not the most likely event, compared to sacroiliac dysfunction.

After moving a patient from long-sitting into the position shown in the photograph, the physical therapist notes upbeating torsional nystagmus, starting 5 seconds after the patient assumes the position and lasting for 10 seconds. The patient reports vertigo. The desired outcome after successful intervention would be: 1. dislodging of debris from the cupula. 2. removing of debris from the canal. 3. diminished sensitivity to motion. 4. improved stability of gaze with head movement.

Rationale 1. To dislodge the debris from the cupula would be the desired outcome for cupulolithiasis, which occurs when otoconia or debris adheres to the cupula, resulting in vertigo and nystagmus that persist as long as the patient is in the provoking position (p. 978). 2. The brief duration of the nystagmus indicates canalithiasis or debris free-floating in one of the semicircular canals on the right. The desired outcome is to remove the debris from the canal. (p. 981) 3. To diminish sensitivity to movement is a desired outcome in unilateral vestibular hypofunction (p. 982). The patient shows signs of canalithiasis (p. 981). 4. To improve gaze stability is a desired outcome in unilateral vestibular hypofunction (p. 982). The patient shows signs of canalithiasis (p. 981).

For the healthcare professional, the MOST effective means of preventing the spread of infection among patients with burns is: 1. topical chemotherapy. 2. sterile dressings. 3. prophylactic antibiotics. 4. hand washing.

Rationale 1. Topical chemotherapy is also means of reducing the occurrence of infection in burns patients, but the effectiveness would be significantly diminished if strict hand washing is not in place (pp. 42, 108-109). 2. Sterile dressings are also means of reducing the occurrence of infection in burns patients, but their effectiveness would be significantly diminished if strict hand washing is not in place (p. 339). 3. Prophylactic antibiotics are not typically prescribed in this population secondary to adverse side effects (p. 339). 4. The most common mode of spreading infection within burn patients is through contact from hospital personnel. This option is correct because hand washing is the most effective means of minimizing cross-contamination in the hospital setting. (pp. 108-109)

For patients who have lymphedema, the presence of which of the following conditions would be a CONTRAINDICATION for manual lymphatic drainage? 1. Type 2 diabetes 2. Third-trimester pregnancy 3. Acute deep vein thrombosis 4. Chronic venous insufficiency

Rationale 1. Type 2 diabetes is not listed as a contraindication to manual lymph drainage. Conditions in which increased blood flow or circulation may cause worsening of symptoms are typical contraindications. (O'Sullivan; Zuther) 2. Manual lymph drainage is contraindicated during the first months of pregnancy but may be beneficial in later months to manage edema in the breast and lower extremities (O'Sullivan; Zuther). 3. Manual lymph drainage is contraindicated in the presence of acute deep vein thrombosis due to risk of clot dislodgement resulting in pulmonary embolism (O'Sullivan; Zuther). 4. Chronic venous insufficiency is not a contraindication to manual lymph drainage. Conditions in which increased blood flow or circulation may cause worsening of symptoms are typical contraindications. (O'Sullivan; Zuther)

Following a left cerebrovascular accident, a patient displays mild balance deficits along with weakness in the gluteus medius. Which of the following activities is MOST appropriate for this problem? 1. Walking backward on an inclined surface 2. Sidelying right hip abduction 3. Partial squats against a wall 4. Lateral weight-shifts in stance

Rationale 1. Walking backward on an inclined surface does not address gluteus medius weakness and may be too difficult for this patient (p. 757). 2. Sidelying right hip abduction does not provide balance practice/training (p. 752). 3. Partial squats against a wall would not provide balance practice/training and will strengthen hip and knee extensors more than hip abductors (p. 756). 4. Lateral weight-shifting in stance can help to improve balance abilities and also involves gluteus medius activation. Any shift in body mass in a lateral direction involves hip abductors/adductors. (p. 264)

The patient shown in the photograph has a history of a herniated nucleus pulposus in the lumbar spine. Which of the following exercises is BEST for improving the patient's muscle length? 1. Reaching for toes in long sitting 2. Reaching for toes in standing, keeping the knees straight 3. Pulling one knee to the opposite shoulder in supine 4. Flexing one hip with the same knee extended in supine

Rationale 1. With a herniated disc, symptoms can increase with forward bending. The patient in the photograph is displaying a flexed lumbar spine. Reaching for the toes in long sitting position promotes trunk flexion and would increase the patient's symptoms. 2. With a herniated disc, symptoms can increase with forward bending. The patient in the photograph is displaying a flexed lumbar spine. Reaching for the toes in standing position promotes trunk flexion and would increase the patient's symptoms. 3. With a herniated disc, symptoms can increase with forward bending. The patient in the photograph is displaying a flexed lumbar spine. Pulling one knee to the opposite shoulder promotes trunk flexion and would increase the patient's symptoms. 4. In supine position, the lumbar spine would be in neutral, avoiding a flexed posture.

A physical therapist is treating a patient for a nonhealing lower extremity wound. The therapist performs an ankle-brachial index test. The MOST likely rationale for choosing this test is to screen for evidence of which of the following conditions? 1. Venous insufficiency 2. Arterial insufficiency 3. Mixed vascular disease 4. Valvular incompetence

Rationale The ankle-brachial test is used to screen for arterial insufficiency

After a long-term history of bilateral lower extremity vascular insufficiency, an otherwise healthy patient had a right transfemoral amputation. Which of the following factors would MOST impact achievement of the long-term goal of functional ambulation? 1. Status of the wound at the amputation site 2. Range of motion of the right hip 3. Condition of the left lower extremity 4. Ability to maintain upright posture

Rationale 1. Wound healing is relevant, but the integrity of the remaining limb is the greatest concern for this patient in establishing long-term, functional goals. 2. Impaired range of motion of the right hip may cause gait deviations but would not prevent gait. Integrity of the remaining limb is the greatest concern for this patient in establishing long-term, functional goals. 3. The left limb must function as the main support limb. Any treatment strategy for ambulation must ensure that the remaining limb is optimally functioning and that the limb is healthy. 4. Although the ability to maintain upright posture is relevant, the integrity of the remaining limb is the greatest concern for this patient in establishing long-term, functional goals.

Excessive anterior tilting of the scapula is MOST likely to result from tightness of which of the following muscles? 1. Anterior deltoid 2. Pectoralis major 3. Pectoralis minor 4. Rhomboids

Rationale 1. anterior deltoid attaches to the clavicle (Hislop, p. 110) and, therefore, would not affect the scapular tipping. 2. The pectoralis major does not attach to the scapula (Hislop, p. 124) and, therefore, would not cause the scapula to tip forward. 3. Anterior tilting of the scapula is caused by a tight pectoralis minor, because stretching the muscle requires tipping of the scapula posteriorly (Kisner, p. 594). 4. The rhomboids attach to the thoracic spine and vertebral border of the scapula. The rhomboids perform scapular adduction and downward rotation and, if tight, would tighten in those directions (Hislop, p. 100).

A patient has sensory deficits to pin-prick and muscle weakness in the median nerve distribution. Based on these findings, which of the following should be expected with testing of median nerve conduction velocity and latency? 1. Increased latency and decreased nerve conductive velocity 2. Increased latency and increased nerve conductive velocity 3. Decreased latency and decreased nerve conductive velocity 4. Decreased latency and increased nerve conductive velocity

Rationale 1. increased latency and decreased nerve conductive velocity. Velocity equals distance/time. The time is latency. Therefore, velocity and time always vary inversely. The clinical examination suggests compromise of the median nerve. Latency would be increased and would be inversely proportional to conduction velocity. When a nerve is damaged, the electrical signals take more time to get around the blocked area, so velocity decreases.

A patient with a focal lesion in the region of the left basal ganglia will MOST likely demonstrate: 1. clasp knife resistance to active range of motion and hypotonia in the left extremities. 2. cogwheel resistance to passive range of motion and tremor in the right extremities. 3. clasp knife resistance to passive range of motion and tremor in the right extremities. 4. cogwheel resistance to active range of motion and hypotonia in the left extremities.

Rationale 2. cogwheel resistance The clasp-knife phenomenon occurs as a result of injury to descending motor pathways from the cortex or brainstem, not the basal ganglia Cogwheel resistance to passive manipulation results from lesions of the basal ganglia. Tremor is also seen with injury to the basal ganglia. Rigidity rather than hypotonia is seen with lesions of the basal ganglia.

*Which of the following phases of running is MOST likely to aggravate a hamstring injury? 1. Heel strike (initial contact) 2. Midswing 3. Foot flat (loading response) 4. Deceleration (terminal swing)

Rationale 4.Deceleration [not heel strike (initial contact), midswing, or foot flat (loading response)] is the phase of the gait cycle where the hamstrings are most active in eccentrically controlling hip flexion and knee extension. With running or sprinting, the amount of strain put on the hamstrings is much greater, and the eccentric force needed to control hip flexion and knee extension can cause the hamstrings to be injured.

*For a patient with a lesion proximal to the dorsal root ganglion, a sensory nerve conduction velocity test will reveal that conduction times are: 1. decreased in amplitude. 2. markedly decreased. 3. markedly increased. 4. within normal limits.

Rationale A sensory nerve conduction test only measures the distal component of a peripheral nerve. The technique would not be able to detect abnormalities in a lesion proximal to the dorsal root ganglion. If only sensory roots are injured, no electromyogram changes occur.

The patient in the photograph has actively, laterally (externally) rotated her shoulders. Which of the following interventions is MOST appropriate to address the patient's right upper extremity impairment seen in the photograph? 1. Strengthen the anterior portion of the rotator cuff and mobilize the glenohumeral joint with the shoulder abducted to 90°. 2. Strengthen the anterior portion of the rotator cuff and mobilize the glenohumeral joint with the upper extremity at the side of body. 3. Strengthen the posterior portion of the rotator cuff and mobilize the glenohumeral joint with the shoulder abducted to 90°. 4. Strengthen the posterior portion of the rotator cuff and mobilize the glenohumeral joint with the upper extremity at the side of body

Rationale The patient is lacking lateral (external) rotation, which can be caused by weakness of the lateral (external) rotators (infraspinatus and teres minor), which are part of the posterior aspect of the rotator cuff (Magee, p. 287; Dutton, p. 580). It can also be caused by tightness in the anterior band of the inferior glenohumeral ligament, which restrains lateral (external) rotation at 90° of abduction (Dutton, p. 597). This option is incorrect because the anterior portion of the rotator cuff is the subscapularis, which functions during medial (internal) rotation (Dutton, p. 580; Magee, p. 287). It can also be caused by tightness in the anterior band of the inferior glenohumeral ligament, which restrains lateral (external) rotation at 90° of abduction (Dutton, p. 597). The arm at the side of the body would not address targeting this ligament, making it incorrect. 3. The patient is lacking lateral (external) rotation, which can be caused by weakness of the lateral (external) rotators (infraspinatus, teres minor), which are part of the posterior aspect of the rotator cuff (Magee, p. 287; Dutton, p. 580). 4. It can also be caused by tightness in the anterior band of the inferior glenohumeral ligament. Since the ligament restrains lateral (external) rotation at 90° of abduction, this option would be best (Dutton, p. 597).

*When selecting exercises for a patient who has diabetes mellitus, the patient's insulin injection site is important to consider because insulin has which of the following characteristics? 1. Longer duration of action if large muscle masses are involved in the exercise 2. Slower mobilization if the injection site is in the exercised extremity 3. Faster delivery into the bloodstream if the injection site is in the exercised extremity 4. Faster degradation due to metabolic by-products in the exercised extremity

Rationale 3. Faster delivery into the bloodstream if the injection site is in the exercised extremity Insulin is absorbed much more quickly in an active extremity and could result in hypoglycemia during the short term. Insulin is absorbed much more quickly in an active extremity, not degraded faster by metabolic by-products.

A patient with hip pain demonstrates the gait deviation shown in the photograph. Which of the following exercises would be MOST beneficial to reduce this deviation? 1. Left sidelying with right hip abduction, extension, and lateral (external) rotation 2. Right sidelying with left hip abduction, extension, and lateral (external) rotation 3. Supine hip flexion with the knee in extension 4. Right sidelying with right hip adduction and flexion

Rationale 1. L SL with R hip ABD EXT and ER The photograph shows a positive Trendelenburg sign, which occurs when the patient stands on one foot and the pelvis drops on the opposite side, indicating weakness of the stance leg's hip abductors (Magee, pp. 675, 1009). To strengthen the right hip abductors, the patient should lie on the left side to work the right lower extremity against gravity (Kisner, pp. 751-752).

An 18-month-old child with developmental delay collapses into a rounded "C"-shaped posture of forward flexion when placed in a sitting position. Which of the following techniques is most appropriate INITIALLY to improve the child's posture? 1. Seat the child in a chair with an abduction wedge. 2. Apply approximation through the spinal joints. 3. Present toys from above so that the child must look up. 4. Provide postural correction at the pelvis.

Rationale 4: 1. An abduction wedge addresses hip alignment, not forward flexed posture. 2. Without the pelvis in proper positioning, this strategy is ineffective. 3. Without the pelvis in proper positioning, this strategy is ineffective. 4. This technique will address the posterior pelvic tilt associated with "C"-shaped posture.

Which of the following interventions are components of complete decongestive therapy (CDT) for patients who have lymphedema? 1. Manual lymphatic drainage, iontophoresis, and aquatic exercises 2. Manual lymphatic drainage, ultrasound, and decongestive exercises 3. Manual lymphatic drainage, electrical stimulation, and aquatic exercises 4. Manual lymphatic drainage, compression therapy, and decongestive exercises

Rationale 4: Complete decongestive therapy (CDT) consists of restoration of the skin with follow-up skin care, manual lymph drainage, compression therapy, and decongestive exercise therapy, not iontophoresis, ultrasound, or e-stim.

The rationale for using superficial heat prior to exercise includes all of the following EXCEPT: 1. increasing core temperature. 2. increasing tissue temperature. 3. promoting relaxation. 4. reducing pain.

1. Rationale Superficial heat cannot increase core (body) temperature. Superficial heat can increase tissue temperature, decreases the nerve firing rate and muscle spasm, thereby relaxing the muscle, and can increase the pain threshold (reduce pain).

Which of the following locations of pain is MOST consistent with bladder infection? 1. Groin 2. Sacral area 3. Lower buttocks 4. Suprapubic area

1. Groin pain is associated with upper urinary tract problems, such as kidney or ureter infection. (ureter referral) 2. Sacral pain is associated with colon cancer and colitis. 3. Lower back, not lower buttocks, is associated with bladder infection. (kidney referral) 4. Pain generated by the bladder typically manifests in the suprapubic area and the lower back.

Which of the following laboratory values should a physical therapist monitor when treating a patient who is taking warfarin (Coumadin)? 1. Hemoglobin 2. Red blood cell count 3. International normalized ratio 4. Erythrocyte sedimentation rate

1. Hemoglobin would not be changed by anticoagulant medication. Hemoglobin values measure the oxygen-carrying capacity of the red blood cells. (p. 1713) 2. Red blood cell counts are not changed by anticoagulants. The red blood cell count is a method used to assess the oxygen-carrying capacity of the blood. (p. 1712) 3. Warfarin (Coumadin) is an anticoagulant. The physical therapist must be aware when a patient is taking an anticoagulant so that treatment can be modified if there is an increased risk of hemorrhage. The international normalized ratio (INR) was developed to provide results that would not vary between laboratories. Therapeutic anticoagulation requires an INR of 2 to 3. As the INR increases above these values, the risk of bleeding during activity is increased. (pp. 1712-1713) 4. The erythrocyte sedimentation rate is not expected to be affected by anticoagulant medication. The erythrocyte sedimentation rate is used to identify inflammatory or necrotic processes. (p. 1715)

A patient is 12 weeks post talus fracture and has a chief complaint of catching her toe during gait since the removal of the boot cast. Evaluation demonstrates limited ankle dorsiflexion, leg atrophy, and ankle weakness. The physical therapy plan should FIRST emphasize: Top of Form 1. mobilization of the talocrural joint. 2. stretching the tibialis anterior. 3. strengthening the gastrocnemius. 4. fitting for an ankle-foot orthosis (AFO).

1. MOBILIZATION OF THE TALOCRURAL JOINT. At 12 weeks post fracture the goals of the functional phase should be to restore joint kinematics and attain full range of pain-free motion. Joint mobilization should improve accessory motion, decrease guarding, and lengthen the tissue around a joint. (pp. 1139, 1172-1174) 2. Stretching the tibialis anterior will not help the limited ankle dorsiflexion but may improve plantar flexion. This should not be performed first. (pp. 1172-1174) 3. Before progressing to strengthening the gastrocnemius, emphasis should be on strengthening the dorsiflexors to address the chief complaint (pp. 1172-1174). 4. Catching of the toe, not foot drop, was the chief complaint. Use of an ankle-foot orthosis may be premature, because the patient may improve range of motion with mobilization and strengthening. (p. 1142)

An exercise session that includes 25 minutes of continuous practice and 5 minutes of rest BEST represents which of the following types of practice? 1. Massed 2. Distributed 3. Blocked 4. Random

1. Massed practice refers to a sequence of practice and rest times in which rest time is much less than the practice time (p. 34). 2. Distributed practice refers to practice intervals in which the practice time is equal to or less than the rest time (p. 34). 3. Blocked practice refers to a practice sequence organized around one task performed repeatedly, uninterrupted by practice of any other tasks. Therefore, this type of practice is not related to the amount of time spent on performing a task. (p. 35) 4. Random practice refers to a practice sequence in which several various tasks are ordered randomly across trials (p. 35). · Massed: Practice time > rest time · Distributed: Practice time = rest time · Blocked: Practice of one task repeatedly (111) (222) (333) · Serial: Predictable, repeated order of multiple tasks (123123123) · Random: Tasks practiced in random order (123321312) · Parts-to-Whole: Tasks broken into component parts for separate then integrated practice · Mental: Motor task is envisioned without overt physical practice

During gait evaluation, a physical therapist notes that a patient demonstrates a shorter step length with the right lower extremity. Which of the following problems is MOST likely the cause of the gait dysfunction? 1. Right iliopsoas contracture 2. Painful left knee 3. Decreased ankle pronation on the right 4. Left gluteus medius weakness

1. Right iliopsoas contracture may cause a shorter step length with the left lower extremity but not with the right lower extremity (Mansfield, p. 356). 2. Left knee pain will cause the patient to spend less time in left-sided stance, because the patient will try to minimize the time spent in stance (weight-bearing on the knee) to minimize the pain. Therefore, the patient will take a shorter step with the right lower extremity. (Magee, p. 1007). 3. Decreased ankle pronation would not have an effect on right-sided step length (Magee, p. 1005). 4. Gluteus medius weakness would be seen as an increase in lateral pelvic tilt, not step length (Mansfield, p. 357).

A patient in a persistent vegetative state in a nursing home has developed a Stage 2 ischial pressure injury. The pressure injury has not improved after 4 weeks of standard wound care treatment. The physical therapist should recommend a consultation with: 1. an orthotist to investigate lower extremity bracing. 2. a nutritionist to investigate level of protein. 3. a respiratory therapist to administer oxygen therapy. 4. a surgeon to perform a skin flap.

1. Since the pressure injury is not a result of contractures that would warrant braces, this would not be the most effective consultation. 2. A NUTRITIONIST TO INVESTIGATE LEVEL OF PROTEIN. Increased protein levels are linked to improved wound healing in patients with pressure injuries. The international guidelines for prevention and treatment of pressure injuries includes referral of all individuals with a pressure injury to a dietician (nutritionist) for early assessment and intervention for nutritional problems. 3. Oxygen is imperative for wound healing in both preventing infection and meeting the metabolic demands of the tissues. In this patient, who is in a persistive vegetative state, inadequate nutrition should be a primary concern and referral to a dietician (nutritionist) is a standard of care. 4. A skin flap would not be indicated for a wound that is not improving. The underlying issues preventing the wound from healing would most likely compromise the integrity of the skin flap.

To assess an anterior tibiofibular ligament injury, which of the following tests is MOST appropriate? 1. Talar tilt with the ankle in neutral dorsiflexion 2. Anterior drawer at the ankle with the ankle in neutral dorsiflexion 3. Compression of the shafts of the tibia and fibula at mid calf 4. Squeezing the calf with the ankle in neutral dorsiflexion (Thompson Test)

1. The talar tilt test with the ankle in neutral dorsiflexion is used for evaluating the integrity of the calcaneofibular ligament. 2. The anterior drawer test with the ankle in neutral dorsiflexion is used for evaluating the integrity of the anterior talofibular ligament. 3. Compression of the shafts of the tibia and fibula at mid calf is used to test for syndesmosis ligament injury, including injury to the anterior tibiofibular ligament. 4. Squeezing the calf with the ankle in neutral dorsiflexion is used to test the integrity of the Achilles tendon.

A physical therapist is examining a 50-year-old patient who sustained a right Colles fracture following a fall 6 weeks ago. The patient has a sedentary lifestyle and has rheumatoid arthritis that has been treated with steroids. Which of the following factors will have the GREATEST impact on the patient's fracture healing? 1. Patient's age 2. Rheumatoid arthritis 3. Steroid usage 4. Sedentary lifestyle

3. STEROID USAGE. steroid use - Although age, diagnosis, and sedentary lifestyle may have some impact, the long-term steroid usage will impact healing time to the greatest degree.

When compared to maximal oxygen uptake values obtained in a lower extremity exercise test, values obtained in an upper extremity exercise test are typically: 1. 30% to 40% lower. 2. the same. 3. 10% to 20% higher. 4. 30% to 40% higher.

Arm exercise typically results in 30% to 40% lower maximal oxygen uptake than leg exercise.

*A patient with a transtibial amputation is being treated by a physical therapist for gait training with a prosthesis. The patient reports tingling and shooting pain at the end of the residual limb. The pain occurs whether or not the patient is wearing the prosthesis. The pain is MOST likely caused by which of the following? 1. A neuroma 2. Inadequate prosthetic tibial relief 3. Distal soft-tissue adhesions 4. Osteomyelitis

Rationale 1. A neuroma is a collection of axons and fibrous tissue that can cause sharp, shooting, and localized pain (Lusardi, p. 707). Localized hypersensitivity may be an indicator that a neuroma has developed. 2. Inadequate prosthetic tibial relief may result in skin breakdown, which would be seen and is not indicated in the stem (Lusardi, p. 714). 3. Adherent scar tissue near the end of the bone is a particular problem that may lead to skin breakdown, which is not indicated in the stem (Lusardi, p. 819). 4. Clinical manifestation of pain with osteomyelitis may be described as deep, constant, and increasing with weight-bearing when present in the lower extremity. Patients may report local pain and swelling, which is not indicated in the stem. (Goodman, p. 1236)

A person with spina bifida uses a knee-ankle-foot orthosis to: 1. provide support for muscle incoordination. 2. facilitate muscular activity. 3. prevent development of muscle contractures. 4. substitute for the lack of muscle activity.

Rationale 1. A person who has spina bifida uses a knee-ankle-foot orthosis when motor function is weak or absent or to address knee instability. It is not commonly used for incoordination of muscles. 2. A knee-ankle-foot orthosis is not able to facilitate muscle activity. 3. A knee-ankle-foot orthosis is not commonly used to prevent muscle contractures. It may be used when contractures are already present, if these contractures prevent upright positioning. 4. A knee-ankle-foot orthosis is commonly used when muscles of the knee are weak and muscles of the ankle are absent. It substitutes for lack of muscle activity. Spina Bifida: a congenital defect of the spine in which part of the spinal cord and its meninges are exposed through a gap in the backbone. It is a developmental abnormality due ti insufficient closure of the neural tube by the 28th day of gestation. It often causes paralysis of the lower limbs, and sometimes mental handicap.

A patient with severe arthritis of the hips and knees is able to partially stand but cannot clear the armrest of the wheelchair adequately during stand-pivot transfers. Which of the following strategies is BEST to facilitate the transfer? 1. Design a therapy program for increasing strength of the lower extremities. 2. Design a therapy program for improving active range of motion of the lower extremities. 3. Recommend that the family acquire a wheelchair with removable armrests. 4. Recommend that the family acquire a mechanical lift for transfers.

Rationale 1. A strengthening program should be encouraged, but a wheelchair with removable armrests would allow the patient to transfer even during periods of exacerbation of the severe arthritis. 2. A range of motion program should be encouraged, but a wheelchair with removable armrests would allow the patient to transfer even during periods of exacerbation of the severe arthritis. 3. The patient is able to partially stand. Removable armrests are recommended for patients who will perform a lateral swinging or squat-pivot transfer. 4. The patient is able to partially stand. The least restrictive device should be used to encourage independence.

A physical therapist is using lumbar mechanical traction with the patient in supine position for a patient who weighs 180 lb (81.6 kg). The traction weight is initially set to 60 lb (27.2 kg). The patient reports not being able to feel any pull. Which of the following actions is MOST appropriate for the therapist to take? 1. Increase the pull to approximately 50% of the patient's body weight. 2. Switch to manual traction. 3. Substitute 40 lb (18.1 kg) of pull in prone position. 4. Discontinue the treatment.

Rationale 1. A traction force of 30% to 50% of the patient's weight is necessary to cause effective segmental vertebral separation. This patient could have a force up to 90 lb (40.8 kg). 2. Manual traction would be less likely to produce the needed force. 3. More weight, not less weight, is needed. Prone position could be considered, depending on the examination findings. 4. Increasing the traction force should be considered prior to discontinuing the treatment.

A patient with a left tibial fracture is restricted to 25% weight-bearing. The patient is currently walking with a single axillary crutch on the left side. Which of the following is the MOST appropriate action for the physical therapist? 1. Have the patient use a walker instead of a crutch. 2. Have the patient use 2 axillary crutches. 3. Switch the crutch to the patient's right side. 4. Prescribe a quad cane to use on the left side.

Rationale 1. A walker would accommodate the weight-bearing restrictions but would be more restrictive than bilateral axillary crutches (pp. 475, 479). 2. HAVE THE PATIENT USE 2 AXILLARY CRUTCHES. Physical therapists should chose the least restrictive device that the patient can safely use. Given the patient is familiar with use of crutches, having the patient use crutches bilaterally would be most appropriate. (pp. 429, 696) Crutches are used to improve balance and to relieve weight-bearing fully or partially on a lower extremity. They are typically used bilaterally. (p. 472) 3. Bilateral axillary crutches are needed to unload the left lower extremity sufficiently. Single devices are not intended for use with restricted weight-bearing gait. (p. 472) 4. Canes are not intended for use with restricted weight-bearing gaits (p. 464).

A physical therapist uses underwater ultrasound as part of the intervention to treat a patient with an ankle injury. The MOST appropriate mode of application is to immerse the patient's ankle in a: 1. whirlpool filled with degassed water and hold the transducer underwater directly on the skin. 2. metal basin filled with mineral oil and hold the transducer underwater approximately 1 in (2.54 cm) away from the body surface. 3. ceramic basin filled with glycerin and move transducer underwater directly on the skin. 4. plastic basin filled with tap water and move the transducer approximately 0.25 in (0.17 cm) away from the body surface.

Rationale 1. A whirlpool will increase the intensity of ultrasound by reflecting waves. Optimally ultrasound wave reflection should be reduced, not increased. 2. A metal basin will increase the intensity of ultrasound by reflecting waves, which is incorrect. 3. The immersion technique requires holding the ultrasound head away from skin. Holding the transducer directly on the skin is incorrect. 4. Plastic basin filled with tap water and move the transducer approximately 0.25 in (0.17 cm) away from the body surface. This option has the correct basin (with reduced reflection) and application (parallel to and the correct distance from the body surface).

A physical therapist is developing an exercise program for a patient who has upper extremity lymphedema. Which of the following exercises should the patient perform LAST? 1. Elbow flexion 2. Cervical rotation 3. Wrist circumduction 4. Shoulder circumduction

Rationale 1. Active elbow exercise is indicated but would be performed before exercises for the wrist because the elbow is a proximal segment relative to the wrist (pp. 975-976). 2. The exercise program for lymphedema should begin with total body relaxation. Cervical rotation is an example of this initial exercise. Exercises are prescribed from proximal to distal areas. (p. 976) 3. Exercises are performed from proximal to distal areas (p. 976). Wrist circumduction is performed last because the wrist is the most distal segment (pp. 975-976). 4. Shoulder circumduction represents proximal clearance (p. 977).

After 1 week of a progressive resistance exercise training program, an individual demonstrates significant strength gains. The MOST likely explanation for the observed strength gains is: 1. an increased ratio of fast- to slow-twitch fibers. 2. improved neuromuscular recruitment. 3. muscle-fiber hyperplasia. 4. muscle hypertrophy.

Rationale 1. Although transformation of type IIB to type IIA fibers occurs in the early weeks of resistance training, transformation from slow-twitch to fast-twitch fibers is unlikely (p. 169). 2. The initial rapid gain in the tension-generating capacity of skeletal muscle is largely attributable to neural responses, including increased recruitment in number of motor units firing and increased rate of synchronization of firing (p. 168). 3. Muscle-fiber hyperplasia is an increase in the number of muscle fibers, and if it occurs, it is in response to heavy resistance training and only accounts for a small percentage of the increase in strength (p. 168). 4. Muscle hypertrophy, or increase in the size of individual muscle fibers, requires an extended period (4-8 weeks) of moderate-intensity to high-intensity resistance training (p. 168). One week is too short of a duration for such change.

*In determining the prognosis of an individual with a traumatic brain injury, which of the following variables is MOST associated with higher level of life satisfaction? 1. Independence in bowel care 2. Being unmarried 3. Age less than 20 years 4. Rapid initial recovery from injury

Rationale 1. Among the variables that significantly increase life satisfaction in individuals with traumatic brain injury is bowel independence (p. 760). 2. Among the variables that significantly increase life satisfaction in individuals with traumatic brain injury is being married (p. 760). 3. Younger age (less than 20 years) is associated with better outcome but not with a higher level of life satisfaction 4. Rate of recovery is not associated with life satisfaction (pp. 759-760).

*A patient admitted to the hospital with a diagnosis of exacerbation of heart failure is preparing for discharge to home. Which of the following clinical characteristics would be MOST important to monitor as part of the home program? 1. Blood pressure and fatigue level 2. Heart rate and cough productivity 3. Presence of cyanosis and diaphoresis 4. Presence of shortness of breath and dependent edema

Rationale 1. An increase in fatigue is a symptom of heart failure exacerbation; blood pressure changes are not. 2. A productive cough is a symptom of heart failure; heart rate changes are not. 3. Cyanosis is a symptom of heart failure; diaphoresis (sweating) is not. 4. Shortness of breath and dependent edema are symptoms of heart failure exacerbation. HF Exacerbation: fatigue, productive cough, cyanosis, SOB, dependent edema, wheezing NOT HF: BP changes, HR changes, diaphoresis

A patient who has a C5 spinal cord injury (ASIA Impairment Scale A) suddenly reports light-headedness and ringing in the ears while sitting upright in a wheelchair. Which of the following conditions is MOST likely present? 1. Angina pectoris 2. Deep vein thrombosis 3. Orthostatic hypotension 4. Autonomic dysreflexia

Rationale 1. Angina is cardiac-related chest pain due to ischemia; it is unrelated to ringing in the ears (p. 534). 2. The hallmark sign of deep vein thrombosis is rapid onset of unilateral leg swelling, erythema, and heat (p. 901). 3. Orthostatic hypotension is a common complication in patients who have an acute cervical injury. It manifests with dizziness or light-headedness and ringing in the ears when in a vertical position, such as sitting or standing. (pp. 72, 896) 4. Autonomic dysreflexia is common in patients who have a spinal cord injury at T6 or above and results in significantly increased blood pressure and a pounding headache (p. 895).

Paraffin would be MOST beneficial for a patient with which of the following conditions? 1. Edematous wrist 1 week following carpal tunnel surgery 2. Swollen elbow resulting from rheumatoid arthritis exacerbation 3. Aching fingers resulting from chronic osteoarthritis 4. Painful hand resulting from early-stage complex regional pain syndrome

Rationale 1. Applying heat may increase the edema due to vasodilation and increased metabolic rate, leading to an increase in inflammation (p. 152). Paraffin as a thermotherapy agent would also be difficult to remove from the healing site of the incision (p. 153). 2. Paraffin wax is used for thermotherapy (p. 157). Cryotherapy is usually recommended for chronic inflammatory conditions such as rheumatoid arthritis (p. 133). 3. As long as no active swelling is noted, paraffin will help increase motion and decrease pain associated with chronic osteoarthritis in the fingers (p. 150). 4. Thermotherapy, aside from the application of neutral warmth, may aggravate the pain associated with complex regional pain syndrome (p. 7).

Which of the following activities should be the PRIMARY emphasis of a physical therapy treatment program for a child who has athetoid cerebral palsy? 1. Facilitating cocontraction patterns and encouraging control in voluntary movement gradation 2. Increasing muscle strength using progressive resistive exercises 3. Facilitating use of primitive reflexes to perform gross motor tasks 4. Preventing development of contractures and ensuring full voluntary range of motion

Rationale 1. Athetoid cerebral palsy is characterized by involuntary movements that are slow and writhing. In therapy, the emphasis should be on facilitating cocontraction and encouraging control in voluntary movement. 2. Although strength training is indicated in children with cerebral palsy, a child with athetoid cerebral palsy lacks the control to consistently produce a maximal effort in a controlled movement. Therefore, the focus must first be on gaining control, then on traditional strength training. 3. A goal of therapy would not be to reinforce primitive reflexes. The primary need for this child is to gain controlled movement.

A patient is referred to physical therapy after a quadriceps contusion. After good initial progress with rehabilitation, the patient reports sharp pain of the anterior thigh and progressive loss of knee flexion. Which of the following conditions is MOST likely present? 1. Avascular necrosis of the femur 2. Osteochondritis dissecans 3. Slipped capital femoral epiphysis 4. Myositis ossificans

Rationale 1. Avascular necrosis of the femur causes hip pain due the lack of blood to the femoral head. There is usually an insidious onset without trauma to the quadriceps. (p. 256) 2. Osteochondritis dissecans is a necrotic bone lesion with no known cause. The knee, talus, and elbow can be involved. (p. 1148) 3. Slipped capital femoral epiphysis occurs when the capital femoral epiphysis becomes displaced. The patient is usually an adolescent male with limited hip range of motion and hip and thigh pain. This condition is not associated with quadriceps contusion. It is characterized by a sudden or gradual displacement of the femoral neck from the capital femoral epiphysis, while the head remains in the acetabulum. (p. 1580) 4. Myositis ossificans is a complication of quadriceps contusion and is caused by heterotropic bone formation on the femur. During quadriceps contraction, the muscle belly rubs across the bone, causing the sharp pain. (p. 767) Myositits ossificans a condition where bone tissue forms inside muscle or other soft tissue after an injury. It tends to develop in young adults and athletes who are more likely to experience traumatic injuries. Most of the time, myositis ossificans occurs in the large muscles of the arms or the legs.

*A patient reports fatigue, proximal upper extremity weakness, and double vision that increases in intensity as the day progresses. The patient demonstrates bilateral ptosis of the eyelids, difficulty chewing, dysphagia, and inability to raise the eyebrows. Which of the following conditions is MOST likely present? 1. Bell palsy 2. Myasthenia gravis 3. Trigeminal neuralgia 4. Amyotrophic lateral sclerosis

Rationale 1. Bell palsy would not result in dysphagia or difficulty chewing, although there may be residual food between the teeth and the cheek due to weakness of the buccinator (Lundy-Ekman, p. 349). 2. The loss of function described in the scenario involves multiple cranial nerves. The fact that it increases as the day progresses implies fatigue that is typical of myasthenia gravis. (Goodman, pp. 1696-1698) Myasthenia Gravis Etiology: autoimmune disorder resulting in neuromuscular junction disorder - defect in transmission of nerve impulses; antibodies block/destroy receptors that are needed for acetylcholine uptake & this prevents muscle contraction; enlarged thymus S&S: extreme fatiguability & skeletal muscle weakness that can fluctuate (periods of remissions and exacerbations); ocular muscles typically affected first, half of pts experience ptosis & diplopia; dysphagia, dysarthria, and CN weakness are also common, like affecting facial expression; other neurological findings are normal (reflexes, sensation, etc) Triggers: activity, heat, stress, illness, certain meds, menstruation, pregnancy Tx: MG "crisis" is a medical emergency (involves exacerbation of respiratory muscles & requires a ventilator; Meds to inhibit acetylcholinesterase (the enzyme that breaks down Ach) to allow Ach to buildup at neuromuscular junction (will diminish symptoms of weakness and fatiguability; corticosteroids to suppress immune system; PT focus on obtaining respiratory baseline & pulmonary intervention (breathing techniques), energy conservation techniques, strengthening using isometric contractions, endurance; caution to avoid overexertion 3. Trigeminal neuralgia is a dysfunction of the trigeminal nerve (CN V) that produces sharp, severe, stabbing pain in the distribution of one or more branches of the trigeminal nerve (CN V). It does not cause ptosis, dysphagia, and fatigue, which are described in the stem. (Lundy-Ekman, p. 347). 4. Amyotrophic lateral sclerosis symptoms more typically include tripping, stumbling, and falling; loss of muscle control and strength in hands and arms; difficulty speaking, swallowing, and/or breathing; chronic fatigue; and muscle twitching and/or cramping. Amyotrophic lateral sclerosis is characterized by both upper and lower motor neuron damage. Symptoms of upper motor neuron damage include stiffness (spasticity), muscle twitching (fasciculations), and muscle shaking (clonus). Symptoms of lower motor neuron damage include muscle weakness and muscle shrinking (atrophy). (Lundy-Ekman, pp. 224-225)

A patient has been prescribed warfarin (Coumadin) following total hip arthroplasty. Which of the following over-the-counter medications listed in the patient's medical history at the first postoperative visit would be of GREATEST concern to a physical therapist? 1. Diphenhydramine (Benadryl) 2. Cetirizine (Zyrtec) 3. Omeprazole (Prilosec) 4. Acetylsalicylic acid (Aspirin) - beta blocker

Rationale 1. Benadryl is a histamine antagonist and is not listed as a drug that has anticoagulant effects (p. 278). 2. Cetirizine is a histamine antagonist and is not listed as a drug that has anticoagulant effects (p. 278). 3. Omeprazole is a proton pump inhibitor. It is not described to interact with warfarin or have anticoagulant effects. (pp. 1085-1089) 4. Acetylsalicylic acid (Aspirin) and warfarin are both anticoagulants. The most serious interactions with warfarin are those that increase anticoagulant effects and the risk of bleeding (p. 610). Patients who are taking warfarin should be instructed not to take acetylsalicylic acid (Aspirin) simultaneously without discussing the combination with a physician. Taking both could cause excessive anticoagulation, which could be harmful.

*Initial examination of a patient reveals paresthesia over the hypothenar eminence. The MOST probable cause of this condition is: 1. carpal tunnel syndrome. 2. C8 nerve root involvement. 3. de Quervain tenosynovitis. 4. pronator teres syndrome.

Rationale 1. Carpal tunnel syndrome is a result of entrapment of the median nerve, which innervates the thenar eminence. 2. The C8 nerve root innervates the hypothenar eminence. Injury to the C8 nerve root will cause paresthesia in the hypothenar eminence 3. De Quervain tenosynovitis affects the first dorsal compartment. It would not cause paresthesia in the hypothenar eminence. (Dutton, pp. 847-848) 4. Pronator teres syndrome affects the median nerve. It would cause paresthesia in the thenar eminence.

A 6-year-old patient with juvenile rheumatoid arthritis involving the cervical spine, bilateral hips, knees, and ankles is referred to the physical therapy department. The patient has developed contractures of all involved joints and continues to complain of morning stiffness. A gait deviation that the physical therapist is likely to observe is: 1. increased cadence. 2. increased plantar flexion range at toe-off (preswing). 3. decreased hip extension at terminal stance. 4. decreased anterior pelvic tilt throughout the gait cycle.

Rationale 1. Children with juvenile rheumatoid arthritis ambulate with a decreased cadence. 2. Children with juvenile rheumatoid arthritis ambulate with decreased plantar flexion at toe off (preswing) and terminal stance. 3. DECREASED HIP EXTENSION AT TERMINAL STANCE. Children with juvenile rheumatoid arthritis ambulate with decreased hip extension at terminal stance and toe off (preswing). 4. Children with juvenile rheumatoid arthritis ambulate with increased anterior pelvic tilt throughout the gait cycle.

A patient who sustained a traumatic brain injury and is unable to follow commands has been referred for physical therapy evaluation. When the physical therapist arrives at bedside, the patient is agitated. Which of the following actions should the therapist take INITIALLY? 1. Carefully observe the patient's spontaneous behavior. 2. Postpone the assessment until the patient has become calm. 3. Apply soft restraints to calm the patient before assessment. 4. Proceed with the assessment regardless of the patient's agitated state.

Rationale 1. Confused-agitated is a state common in patients following traumatic brain injury. Observing the patient without touching the patient will reveal information that is important for the evaluation. 2. The agitated state may exist for some time, and the assessment should not be postponed. 3. The patient needs to feel safe. The therapist should model calm behavior. Restraining the patient would produce more fear and agitation. 4. Formal measurements of range of motion and strength are difficult, and the patient is unable to cooperate. The therapist should use only observation and estimate functional abilities.

*A physical therapist is evaluating a 55-year-old male patient with low back pain. The therapist asks the patient if he has noticed any changes in bowel or bladder function. The patient reports he is having difficulty initiating urination. This symptom is MOST often a result of which of the following conditions? 1. Bladder cancer 2. Stress incontinence 3. Prostate enlargement 4. Renal failure

Rationale 1. Difficulty initiating a urine stream is not consistent with bladder cancer (p. 982). 2. Stress incontinence is characterized by loss of urine with coughing or sneezing (activities that increase intraabdominal pressure) (pp. 985-986). 3. The most common presentation for enlargement of the prostate is difficulty initiating the urine stream (pp. 998-999). 4. Difficulty initiating a urine stream is not consistent with renal failure (pp. 969-970).

A patient being evaluated for a C4-C5 herniated disc also reports having periodic dizziness. Which of the following actions should the physical therapist perform INITIALLY? 1. Ask questions about the precipitating factors for the dizziness. 2. Ask questions about sensory changes. 3. Assess deep tendon reflexes of the upper extremities. 4. Assess the integrity of the vertebral artery system.

Rationale 1. Dizziness is associated with disorders in many different systems as well as drug reactions. A more specific definition will lead the physical therapist to which system should be investigated in more detail. 2. The problem of dizziness should be further clarified before going on to another area, such as screening for changes in sensation. 3. After taking a complete history, the therapist should then perform an upper quarter screening, which would include assessing deep tendon reflexes of the upper extremities. 4. For the patient with dizziness, the integrity of the vertebral artery should be tested during the specific tests and measures section of the examination, which follows the history and systems screening process.

A physical therapist is testing the strength of a patient's latissimus dorsi with the patient in prone position and arms at the side with palms facing the ceiling. Following instruction in the desired motion, the patient lifts the arm off the table after first turning the palm downward. The therapist should ask the patient to do which of the following actions NEXT? 1. Repeat the motion with the palm upward. 2. Extend the arm while seated without back support. 3. Repeat the motion while the therapist adds resistance. 4. Extend the arm while in sidelying position with the upper arm supported.

Rationale 1. Extending the shoulder with lateral (external) rotation allows the long head of the triceps to substitute for the latissimus dorsi. The therapist must ensure that the patient understands the desired motion before determining whether to add resistance or change the patient's position. (pp. 58-60) 2. Sitting is not a position used to test latissimus dorsi strength. Sitting would decrease the effect of gravity. (pp. 57-58) 3. The patient must be able to perform the proper motion against gravity before resistance can be added (p. 59). 4. The therapist may have chosen to start testing in the gravity-eliminated position (sidelying) if less than Fair (3/5) strength was suspected, but, having chosen to start in the against-gravity position, the therapist should first determine whether the patient truly cannot perform the motion against gravity before changing position (p. 60). Lat Action: The latissimus dorsi is responsible for extension, adduction, horizontal abduction, flexion from an extended position, and (medial) internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine.

The patient whose feet are shown in the photograph is a waitress who reports 5/10 pain at the anterior calcaneus on the plantar aspect of the left foot. Pain is worse early in the morning and during weight-bearing activities throughout the day. Which of the following associated findings would result in the GREATEST delay in recovery? 1. Fibularis (peroneus) brevis strength of Fair plus (3+/5) and 0° to 10° ankle dorsiflexion range of motion 2. Tibialis posterior strength of Good (4/5) and 0° to 10° ankle dorsiflexion range of motion 3. Body mass index of 36 kg/m2 and 0° to 35° ankle plantar flexion range of motion 4. Body mass index of 36 kg/m2 and 0° to 25° hallux extension range of motion

Rationale 1. Factors that may prolong recovery are a history of an additional lower extremity pathological condition, presence of other medical conditions, or severe obesity. The fibularis (peroneus) brevis is not a medial longitudinal arch support, and the level of dorsiflexion is functional. Therefore, this option should not result in prolonged recovery of the fasciitis. (Magee, pp. 903-904, 915) 2. The tibialis posterior can act as a support for the medial longitudinal arch of the foot and thereby reduce the strain on the plantar fascia in the pronated position. However, the level of tibialis posterior weakness is small, and the degree of talocrural dorsiflexion is functional. Therefore, these factors would not alter the rate of recovery to a substantial degree. (Magee, pp. 903-904, 915) 3. This option includes a body mass index (BMI) in the morbid obesity classification. However, the limitation of plantar flexion is minimal, compared to the discharge criteria of 40°. In addition, limited plantar flexion should not strain or elongate the plantar fascia. Therefore, this option only has one factor that would prolong recovery. (Kisner, p. 868) 4. BODY MASS INDEX 36 KG/M^2 AND 0˚ TO 25˚ HALLUX EXTENSION ROM. The description of the patient is consistent with a diagnosis of plantar fasciitis (Magee, p. 947). Interventions for the diagnosis of plantar fasciitis should focus on the goals of midfoot stability, functional foot and ankle range of motion, Normal (5/5) foot and ankle strength, minimal pain, and return to functional status for activities of daily living and vocational activities. Extra body weight places increased loads on the plantar fascia. Obesity and even a body mass index greater than 25 kg/m2 would be a contributing factor. In addition, the range of motion for hallux extension is more than 50% limited from the normal range of 70°. Therefore, the factors in this option should result in the greatest delay in recovery. (Magee, p. 915) Underweight = <18.5 Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity = BMI of 30 or greater

*Which of the following factors is MOST important when considering footwear for a patient with diabetes? 1. Leather soles and heels 2. Selection of a shoe without laces 3. Snug fit around the heel 4. Non-leather material uppers

Rationale 1. For all patients who have diabetes, footwear should have a soft lining for protection from and prevention of excessive friction and pressure (Nather, p. 528). Shoes with leather soles are made of firmer material and are typically not soft and cushioned. 2. Shoes should be fastened with adjustable laces, straps, or Velcro high on the foot to keep the foot secure and reduce frictional force (Nather, p. 528). 3. For all patients who have diabetes, footwear should offer a supportive structure for stability and offer protection from and prevention of excessive friction (Nather, p. 528). A snug fit around the heel can provide this stability. 4. Shoes for the insensitive foot should be soft leather that will conform to abnormalities on the dorsal surface (Lusardi, p. 175).

A patient who has diabetes mellitus reports a progressive loss of shoulder mobility. A physical therapist performs the test shown in photographs A and B. Which of the following conditions is MOST likely being assessed? 1. Functional horizontal adduction 2. Posterior capsule tightness 3. Acromioclavicular joint tightness 4. Scapular dyskinesia

Rationale 1. Functional horizontal adduction is performed in sitting or standing position, and strength testing for horizontal adduction is performed with the patient in supine position (Hislop, p. 128). Functional activities require accompanying movements at the scapula. The procedure shown in the photographs prevents scapular movement. 2. The photograph shows the technique to test for posterior capsular tightness. Retracting the scapula as illustrated removes the confounding compensatory effect of scapular protraction and allows isolation of the glenohumeral joint. The posterior capsule has been implicated as the source of restriction in this test (Magee, p. 285). In addition, patients who have diabetes are likely to experience shoulder disorders/mobility limitations (Goodman, p. 429). 3. Horizontal adduction does indeed test for pathological conditions of the acromioclavicular joint. However, the test is performed in sitting or standing position, and the scapula is not retracted, because one would need to be able to adduct the humerus to end range to elicit acromioclavicular joint symptoms. Retracting the scapula will limit horizontal adduction. (Magee, pp. 285, 330) 4. Assessment of scapular dyskinesia would require assessment of scapular mobility. The procedure shown in the photographs prohibits movement of the scapula. (Magee, p. 260).

A physical therapist is instructing a patient's care provider on how to perform a bed-to-wheelchair transfer. Which of the following teaching strategies would be MOST appropriate? 1. Have the care provider practice transferring the therapist. 2. Have the care provider observe the therapist perform the transfer with the patient. 3. Explain the transfer while demonstrating and have the care provider practice transferring the therapist. 4. Explain the transfer while demonstrating and have the care provider practice transferring the patient.

Rationale 1. Having the care provider perform without an explanation of the transfer would be trial-and-error and not the best way to learn (p. 36). 2. Demonstrating a transfer without an explanation would skip the cognitive stage of learning a psychomotor skill (p. 29). 3. The closer the learning experience is to the actual transfer, the more likely that the skill will be learned. Given that transfer skills are very specific to the individual being transferred, it is important that practice with the patient take place. (pp. 36) 4. Motor learning occurs first in the cognitive domain. Explaining the task allows for processing of the skill on a cognitive level. In order to progress to the associative phase of learning, where the goal is to fine-tune the skill, one must perform and practice that skill. Given that transfer skills are very specific to the individual being transferred, it is important that practice with the patient take place. (pp. 29, 36)

A patient who has diabetes is exercising and has onset of a headache, blurred vision, and slurred speech. Which of the following conditions is the patient MOST likely experiencing? 1. Hypoglycemia 2. Lipogenic effect of insulin 3. Diabetic ketoacidosis 4. Vitamin B12 deficiency

Rationale 1. Headache, blurred vision, and slurred speech represent central nervous system activity specifically due to decreased blood glucose to the brain (p. 534). 2. Lipogenic effects include thickening of the subcutaneous tissues and a loss of subcutaneous fat. resulting in dimpling of the skin (p. 522) 3. Although diabetic ketoacidosis would result in headaches, other signs of ketoacidosis include acetone breath, dehydration, weak and rapid pulse, and Kussmaul respirations progressing to hyperosmolar coma (polyuria, thirst, neurological abnormalities, and stupor) (p. 534). 4. Vitamin B12 deficiency would result in headaches and cognitive changes but would not be the most likely cause in this scenario. Neuropsychiatric conditions such as dementia, ataxia, psychosis, and peripheral neuropathy can develop in the case of B12 deficiency. (p. 715)

A chart review of an adult female patient indicates a hematocrit value of 42% following minor elective surgery. This value is indicative of: 1. anemia. - academic review error 2. inflammation. 3. infection. 4. normal findings.

Rationale 1. Hematocrit is the proportion of the blood that is composed of red blood cells. A low hematocrit is indicative of anemia, but a hematocrit value of 42% is considered normal for an adult female. (p. 268) 2. Inflammation would increase neutrophils and would not influence hematocrit (p. 360). 3. Infection would most influence white blood cell count (p. 360). 4. NORMAL FINDINGS. A hematocrit value of 42% is within normal range for adult females (normal range: 36% to 47%) (p. 268).

A patient had a ruptured right middle cerebral artery aneurysm that was repaired. Which of the following functional limitations would the patient MOST likely exhibit? 1. Horizontal nystagmus 2. Ataxic gait 3. Apraxia 4. Rigidity

Rationale 1. Horizontal nystagmus is a symptom of a cerebellar problem, such as a lesion of the anterior inferior cerebellar artery. 2. An ataxic gait is a symptom of a cerebellar problem, such as a lesion of the basilar artery. 3. Apraxia is a clinical symptom of a middle cerebral artery lesion. 4. Rigidity is not caused by a lesion of middle cerebral artery.

Which of the following features are MOST characteristic of a room designed for airborne infection isolation? 1. Negative air pressure, with the direction of the airflow into the room from the adjacent space outside the room 2. Negative air pressure, with the direction of the airflow from the room into the adjacent space outside the room 3. Positive air pressure, with the direction of the airflow into the room from the adjacent space outside the room 4. Positive air pressure, with the direction of the airflow from the room into the adjacent space outside the room

Rationale 1. In airborne infection isolation, the isolation area is under negative pressure, such that the direction of the airflow is from the outside adjacent space (e.g., the corridor) into the room. 2. In airborne infection isolation, the isolation area is under negative pressure, such that the direction of the airflow is from the outside adjacent space (e.g., the corridor) into the room, not from the room into the outside adjacent space (e.g., the corridor). 3. In airborne infection isolation, the isolation area is under negative pressure, not positive pressure, such that the direction of the airflow is from the outside adjacent space (e.g., the corridor) into the room. 4. In airborne infection isolation, the isolation area is under negative pressure, not positive pressure, such that the direction of the airflow is from the outside adjacent space (e.g., the corridor) into the room, not from the room into the outside adjacent space (e.g., the corridor).

A physical therapist can BEST assess for dysdiadochokinesia by asking the patient to: 1. identify a spoon, a toothbrush, and a comb by touch. 2. bring a toothbrush or a spoon to the mouth repeatedly, using rapid brisk motions. 3. demonstrate how to use a toothbrush, a spoon, or a comb. 4. name familiar objects, such as a toothbrush, a spoon, and a comb.

Rationale 1. Inability to identify objects by touch is astereognosis (p. 1256). 2. Dysdiadochokinesia is the impaired ability to perform rapid alternating movements, which could be demonstrated by the repeated elbow flexion and extension in repetitively bringing a utensil to the mouth (p. 211). 3. Apraxia is characterized by the inability to perform purposeful movements, such as using some type of utensil (p. 1257). 4. Aphasia (expressive) is a communication disorder characterized by impaired language formation and use (pp. 652, 1450), which would impair the ability to name objects.

A patient who has chronic obstructive pulmonary disease becomes short of breath when walking 5 feet (1.5 m) with a rolling walker. Which of the following techniques would be MOST appropriate in order to increase the distance the patient is able to walk without becoming short of breath? 1. Incentive spirometry 2. Pacing 3. Diaphragmatic breathing 4. Segmental breathing

Rationale 1. Incentive spirometry is used to improve inspiratory volumes and chest expansion. It should be used with caution in patients who have chronic obstructive pulmonary disease. It does not improve exercise tolerance. (Reid, p. 261) 2. Using pacing, the patient would learn to work within his or her exercise tolerance. This may mean walking slower or walking with breaks and would allow greater total walking distance without shortness of breath. (O'Sullivan, p. 513) 3. Diaphragmatic breathing is used to decrease the work of breathing and improve diaphragmatic movement, not to improve exercise tolerance (Frownfelter, pp. 357-358; Hillegass, pp. 550-551). 4. Segmental breathing is used for patients with chest hypomobility to augment localized lung expansion (Frownfelter, pp. 362-364). Chest hypomobility is not usually an issue in patients who have chronic obstructive pulmonary disease.

*A patient with advanced liver disease has developed severe ascites. This condition will MOST likely have which of the following effects on the patient's respiratory system? 1. Increased residual volume 2. Increased functional residual capacity 3. Decreased inspiratory reserve volume 4. Decreased forced expiratory volume in 1 second (FEV1)

Rationale 1. Increased residual volume is seen in obstructive lung disease and not in restrictive lung disease (Frownfelter, pp. 139-141). This would not be seen with ascites and would not be present in the patient described. 2. Increased functional residual capacity is seen in obstructive lung disease and not in restrictive lung disease (Frownfelter, pp. 139-141). This would not be seen with ascites and would not be present in the patient described. 3. Ascites is a condition where there is increased fluid in the peritoneal cavity, causing distention - abdominal swelling (Moore, p. 233). This distention puts increased pressure upon the diaphragm and thoracic cavity, which may lead to a restrictive lung pattern. Decreased inspiratory reserve volume is a component of restrictive lung disease (Frownfelter, pp. 139-141). 4. Decreased forced expiratory volume in 1 second (FEV1) is commonly seen in obstructive lung disease, caused by either secretions or bronchospasm (Frownfelter, pp. 139-141). These do not result from ascites and would not be present in the patient described. Obstructive Lung Diseases: increased RV, FRC, TLC; decreased FEV1 Restrictive Lung Diseases: decreased IRV

A mother reports that her 6-month-old infant has had vomiting and diarrhea over the last 2 days. Which of the following signs would be the MOST accurate indication of severe dehydration? 1. Decreased respiratory rate 2. Sunken fontanelle - academic review error 3. Warm hands and feet 4. Loud crying when touched

Rationale 1. Increased respiratory rate is a sign of severe dehydration (not decreased rate). 2. The fontanelle will be sunken in infants who are dehydrated. 3. Cold hands and feet are present in severe dehydration. 4. In severe dehydration, the infant would be unable to cry. Fontanelle: a space between the bones of the skull in an infant or fetus, where ossification is not complete and the sutures not fully formed. The main one is between the frontal and parietal bones. Signs of severe dehydration: increased RR, cold hands/feet, inability to cry, and sunken fontanelle

The resting heart rate of a 32-year-old runner is measured at 46 bpm. Which of the following explanations for this heart rate is MOST likely? 1. The individual has a hypotensive disorder. 2. The rate is secondary to an increased stroke volume. 3. The individual has an atrioventricular block. 4. Endurance training has stimulated the sympathetic nervous system.

Rationale 1. It is more likely that the bradycardia is a training effect associated with a greater stroke volume (pp. 144-146). 2. Cardiac output is the product of stroke volume multiplied by heart rate. A training effect is an increase in stroke volume. There is a resultant decrease in heart rate to maintain the same cardiac output at rest. (pp. 144-146) CO = SV x HR 3. It is more likely that the bradycardia is a training effect associated with a greater stroke volume (pp. 144-146). 4. Exercise training increases parasympathetic activity and causes a small decrease in sympathetic discharge. Training also decreases the intrinsic firing rate of the sinoatrial node. These training adaptations explain the resting bradycardia in individuals who train aerobically. (p. 140)

A patient's electrocardiogram shows a junctional rhythm. The patient's heart rate is 60 bpm and regular. Which of the following waves will MOST likely be absent from the rhythm strip? 1. P 2. R 3. S 4. T

Rationale 1. Junctional rhythm originates from the atrioventricular junction instead of the sinoatrial node, which normally causes the P wave. Therefore, the P wave will be missing. R, S, T waves come from the ventricles after stimulation from the atrioventricular junction and will be unaffected. 2. R waves come from the ventricles after stimulation from the atrioventricular junction and will be unaffected. 3. S waves come from the ventricles after stimulation from the atrioventricular junction and will be unaffected. 4. T waves come from the ventricles after stimulation from the atrioventricular junction and will be unaffected.

*A physical therapist is examining a 4-year-old child with a history of prematurity and developmental delay. To determine if the child has age-appropriate gross motor skills, the therapist's assessment should include: 1. kicking a rolling ball, catching a small ball, and hopping on one foot. 2. kicking a stationary ball, fast walking, and walking with assistance on stairs. 3. dribbling a basketball, riding a bicycle, and skipping. 4. catching a large ball, riding a tricycle, and running short distances.

Rationale 1. Kicking a rolling ball, catching a small ball, and hopping on one foot are gross motor tasks that are most age-appropriate for a 4-year-old. Gross motor developmental assessment at age 4 years should include functional tasks. (Palisano, p. 62; Tecklin, p. 64) 2. Kicking a stationary ball, fast walking, and walking with assistance on stairs are skills that are appropriate for children age 18 months to 3 years (Palisano, p. 62; Tecklin, p. 64). 3. Dribbling a basketball, riding a bicycle, and skipping are skills that are appropriate for children age 5-6 years (Palisano, p. 63; Tecklin, p. 64). 4. Catching a large ball, riding a tricycle, and running short distances are skills that are appropriate for children age 2-3 years (Palisano, p. 62; Tecklin, p. 64).

A patient experiences abnormal sensation on the lateral edge of the left foot. Muscle testing reveals weakness of the left hip abductors. Which combination of nerve root levels is MOST likely affected? 1. L2-L3 2. L3-L4 3. L5-S1 4. S2-S3

Rationale 1. L2-L3 sensation is on the lateral thigh (Magee, p. 585). 2. L3-L4 sensation is on the anteromedial thigh and leg (Magee, p. 585). 3. L5-S1 sensation is on the lateral foot; muscles controlling hip abduction are innervated at L4-S1 (Magee, p. 585; Drake, p. 575). 4. S2-S3 sensation is on the plantar foot (Magee, p. 585).

A patient reports pain in the posterior lower leg during the test performed in the photograph. Which of the following conditions is MOST likely present? 1. Herniated disc in the lumbar spine 2. Idiopathic lumbar scoliosis 3. Right-sided lumbar paraspinal muscle strain 4. Osteoarthritis of the lumbar facet joints

Rationale 1. Leg pain elicited with straight leg raise may indicate lateral disc herniations. 2. Idiopathic lumbar scoliosis would not be affected by a straight leg raise test. 3. A straight leg raise test would not produce posterior lower leg pain in the presence of right-sided lumbar paraspinal muscle strain but would cause pain over the right lumbar paraspinals. 4. A straight leg raise test would not produce posterior lower leg pain in the presence of osteoarthritis of the lumbar facet joints. Flexion of the hip would cause lumbar flexion, which decreases pressure on the facet joints and would decrease pain in the lumbar spine.

A patient has an irregularly shaped wound at the left medial malleolus. The skin around the wound is darkened. The underlying cause of this wound is MOST likely: 1. lymphedema. 2. venous insufficiency. 3. cellulitis. 4. osteomyelitis.

Rationale 1. Lymphedema presents as swelling over the limb. The most common integumentary complication is cellulitis, which does not present as a single defined ulcer. (pp. 679, 700-701) 2. VENOUS INSUFFICIENCY. The classic presentation of a venous ulcer involves the medial leg and is irregular in shape, with hyperpigmented periwound skin (p. 642). 3. Cellulitis is a painful infection of the soft tissue that is characterized by expanding local erythema, palpable lymph nodes, fever, and chills. Most cases are caused by cuts, abrasions, insect bites, and local burns. (pp. 339-340) 4. Osteomyelitis is an infection of the bone. Clinical characteristics include pain, fever, edema, erythema, and tenderness but not a wound as described in the stem (p. 1236).

A patient's leg has the skin changes shown in the photograph. Further examination reveals the presence of similar lesions on the opposite extremity, elbows, knees, and scalp. The patient MOST likely has which of the following conditions? 1. Melanoma 2. Lyme disease 3. Scleroderma 4. Psoriasis

Rationale 1. Melanoma typically is characterized by a colored, irregularly shaped lesion that can be mottled with light brown to black colors (p. 435). 2. The rashes associated with Lyme disease typically start as a red spot that expands with clearing of redness in the central area (p. 359). 3. Skin changes associated with scleroderma mainly include Raynaud phenomenon and tightening of the skin. Appearance of a rash is not typical of this disease. (pp. 445-447) 4. The image shows well-defined, dry, erythematous keratinous plaques, which are typical of psoriasis. These plaques are most commonly found in the scalp, extensor surfaces of extremities, and, in severe cases, the trunk. Identifying these plaques is important for the physical therapist in making decisions regarding referral for further medical attention. (pp. 440-441)

An 80-year-old patient who has left hemiparesis relies heavily on the right extremities for support. The patient has shoulder pain when the left upper extremity is elevated above 60°. Which of the following positions is BEST to facilitate simultaneous upper and lower extremity weight-bearing for the patient? 1. Modified plantigrade 2. Standing with both hands on a wall 3. Bridging 4. Quadruped

Rationale 1. Modified plantigrade is an ideal early standing posture in which to develop upper extremity and lower extremity control. Affected extremities are weight-bearing out of synergy patterns. This position is easily tolerated by elderly patients. (pic shown) 2. The patient will get limited weight-bearing through the upper extremity and is likely to have pain in the left shoulder in this position. 3. The bridging position may be difficult for an older patient to tolerate and does not involve weight-bearing through the upper extremities. 4. The quadruped position may be difficult for an elderly patient to tolerate and does not involve weight-bearing through the entire lower extremity.

A physical therapist is conducting a graded exercise stress test of an apparently healthy adult using a treadmill. The test should be discontinued if which of the following events occurs? 1. Heart rate continues to increase throughout the test. 2. Borg rating of perceived exertion is reported as 13/20. 3. Diastolic blood pressure reaches 120 mm Hg. 4. Significant redness of the skin and perspiration are observed.

Rationale 1. Monitoring heart rate response to exercise is the purpose of conducting the test, and, therefore, an increasing heart rate is not a reason to stop. Failure of the heart rate to rise with increasing exercise intensity would be a reason to stop. (ASCM, p. 84) 2. A Borg rating of perceived exertion of 13/20 converts to 70% of maximum heart rate and should not be a reason to stop the test (ASCM, p. 83; Kenney, p. 515). 3. A diastolic blood pressure of 120 mm Hg is an indicator for ending the test. A diastolic blood pressure greater than 115 mm Hg is too high to continue testing. (ASCM, p. 84) 4. Significant redness of the skin and perspiration are normal responses to exercise testing. Cyanosis or pallor would be a reason to stop. (ASCM, p. 84)

A patient reports upper extremity numbness and tingling that extends from the neck to the thumb and index finger (1st and 2nd digits). Which of the following shoulder positions would MOST likely exacerbate the patient's symptoms? 1. Lateral (external) rotation with abduction 2. Medial (internal) rotation with abduction 3. Lateral (external) rotation with adduction 4. Medial (internal) rotation with adduction

Rationale 1. Numbness and tingling over the thumb and index finger (1st and 2nd digits) involves the median nerve. Shoulder lateral (external) rotation with abduction is used to test the median nerve (upper limb tension test [ULTT 2a]). Shoulder lateral (external) rotation is added to 90° of shoulder abduction combined with shoulder girdle depression to place tension on the median nerve. 2. Shoulder medial (internal) rotation is used when testing for radial nerve involvement (upper limb tension test [ULTT 2b]). 3. Adduction of the shoulder would reduce tension on the median nerve; abduction increases tension on the nerve. 4.. Medial (internal) rotation with adduction is not used to test upper extremity neural tension because it does not create adequate neural tension.

A nonathletic male patient reports occasional brief palpitations that occur in the absence of pain, dizziness, or light-headedness. The patient has no personal or familial history of heart disease and is otherwise healthy. Which of the following factors is the MOST likely source of the palpitations? 1. Gender 2. Sedentary activity level 3. Excess caffeine intake 4. Cardiac abnormality

Rationale 1. Palpitations can occur as a result of hormonal changes (i.e., during menopause or with ovulation). Since this is a healthy male patient, hormonal changes associated with gender can be ruled out. 2. Generally, a low-activity-level/nonathletic lifestyle does not cause or increase the likelihood of palpitations. Exercise can both induce and reduce the frequency and onset of palpitations. 3. Palpitations can occur due to diet, particularly with excessive intake of caffeine. Typically, caffeine intake precipitates the palpitations and causes brief palpitations of gradual onset and without any associated pain, dizziness, or light-headedness. 4. Typically, palpitations of cardiac origin are associated with dyspnea, fainting, or severe light-headedness or dizziness. This patient does not have any of these additional symptoms.

Examination of a patient with balance dysfunction reveals the following: Romberg test: positive Gait: wide-based, slow, with decreased trunk rotation Loss of balance when asked to turn head while walking No sign of ataxia Based on these findings, which of the following diagnoses is MOST likely correct? 1. Benign paroxysmal positional vertigo 2. Cerebellar lesion 3. Unilateral vestibular lesion 4. Mononeuropathy of the sural nerve

Rationale 1. Patients with BPPV most likely will not have a positive finding on the Romberg test. 2. Patients with cerebellar lesions are more likely to exhibit ataxic gait. 3. Patients with a unilateral vestibular lesion will experience vertigo, postural instability, oscillopsia, and disequilibrium. The wide-based gait is an attempt to minimize trunk rotation and movement of the head, which can increase sensory conflict and vertigo in the patient with a unilateral vestibular lesion. 4. Mononeuropathy of the sural nerve is unlikely to cause a balance deficit.

A physical therapist is obtaining the medical history of a patient with amyotrophic lateral sclerosis. Which of the following is MOST important to ask about in order to determine the prognosis for this patient? 1. Swallowing difficulties 2. Cognitive deficits 3. Bowel and bladder function 4. Neck pain

Rationale 1. Patients with an initial onset of bulbar and respiratory weakness tend to have a more rapid progression to death than patients whose weakness begins in the distal extremities. 2. Cognitive deficits are not associated with amyotrophic lateral sclerosis. 3. Sphincter control problems are not a component of amyotrophic lateral sclerosis. 4. Musculoskeletal pain is not predictive for prognosis in amyotrophic lateral sclerosis. ALS: a disease affecting UPPER AND LOWER motor neurons of the spinal cord, which causes progressive weakness and atrophy of muscles.

Patients with advanced emphysema experience difficulty in breathing during exercise because of: 1. hypocapnia. 2. atrophy of secondary breathing muscles. 3. alveolar dilation. 4. damage to the phrenic nerve.

Rationale 1. Patients with emphysema have normal or slightly elevated partial pressure of arterial carbon dioxide (PaCO2) (p. 88), not hypocapnia (or decreased CO2). 2. Patients who have emphysema tend to breathe with accessory muscles of respiration (p. 87), which may lead to hypertrophy, not atrophy of those muscles. 3. Emphysema is characterized by abnormal and permanent enlargement of the air spaces distal to the terminal nonrespiratory bronchioles accompanied by destructive changes of the alveolar walls (p. 86). 4. There is no involvement of the phrenic nerve in this condition. Emphysema results from a long history of chronic bronchitis, recurrent alveolar inflammation or from genetic predisposition of a congenital alpha 1-antitrypsin deficiency; results from a non-reversible injury and destruction of elastic protein within the alveolar walls à permanent enlargement of airspaces distal to terminal bronchioles; chronic progressive disease; blebs and bullae risk factors: chronic bronchitis, cig smoking, lower respiratory infections, genetics S&S: wheezing, persistent cough, difficulty breathing - especially with expiration, increased RR, barrel chest, rounded shoulders d/t tight pecs, pursed-lip breathing strategy (Pg 431)Pulmonary fxn tests: impaired FEV1, VC, and FVA; increased TLC, RV, and FRC

A 4-year-old child who has a plantar flexion contracture is referred for serial casting. The child is tearful and combative, and the parents are frustrated. Which of the following actions is MOST appropriate for the physical 1. Ask the physician to sedate the child prior to the physical therapy session. 2. Allow the child to cast a doll's leg while the therapist applies a cast to the child. 3. Ask an aide to hold the child down so the therapist can apply the cast. 4. Ask the parents to leave the room while the therapist applies the cast.

Rationale 1. Preventative interventions are directed toward minimizing potential problems that would limit a patient's participation in therapy. Therapists should choose interventions most likely to achieve successful outcomes (O'Sullivan, p. 12). Since the child will be coming for multiple appointments, and the child's independent participation in therapy is desired, this option is not the most appropriate choice. 2. Appropriate play can be important in easing tension related to the health care setting. Giving the child power in a role can be helpful. (Purtilo, p. 284) 3. Restraining the child would not demonstrate respect for the child and would not foster the child's independent participation in therapy (Purtilo, p. 284). 4. The physical therapist should not exclude the family from the health care interaction and should foster a supportive family context for the child (Purtilo, p. 288).

A patient who has hypothyroidism is MOST likely to exhibit which of the following signs or symptoms? 1. Ptosis 2. Muscle ache 3. Dysphagia 4. Tachycardia

Rationale 1. Ptosis is not a common symptom of hypothyroidism. 2. Muscle ache (myalgia) is a common musculoskeletal symptom of hypothyroidism. 3. Dysphagia is not a common symptom of hypothyroidism. 4. Bradycardia, not tachycardia, is a common symptom of hypothyroidism. Common signs of hypothyroidism: fatigue, muscle ache, weakness, bradycardia, weight gain, constipation, delayed puberty, retarded growth/development

A 24-month-old child who has a genetic disorder and developmental delay is able to sit independently but can easily be displaced and demonstrates emerging protective reactions and slow trunk-righting reactions in sitting position. Which of the following functional activities is BEST for short-term physical therapy for the child? 1. Pulling up to standing position 2. Obtaining a toy when placed out of reach 3. Holding a toy at midline with both hands 4. Transitioning from sitting to quadruped position

Rationale 1. Pulling to stand is too difficult for a short-term physical therapy goal for this child, who is functioning at a 5-month to 6-month level. This activity would require intact protective extension and trunk righting. (p. 61) 2. This child is at the second stage of sitting (around 5 months) and would benefit from activities that challenge trunk righting, sitting balance, and protective reactions. These are within the child's ability to achieve, because they are items in the third stage of sitting, which usually occurs around age 6-7 months. (pp. 56-57) 3. No position is noted. This task could be achieved in a supine position. Holding a toy within the center of mass in sitting position is also a skill that is likely already achieved in the second stage of sitting, at age 5-6 months. (p. 57) 4. Transitioning from sitting to quadruped position is a task that is generally achieved in the third quarter of the first year, so it is not an appropriate goal of short-term physical therapy for a child who is in the 5-month to 6-month range of development, which is consistent with second stage of sitting. (p. 61)

*A patient in an intensive care unit is intubated and is being treated with a mechanical ventilator. The patient would be UNABLE to participate in which of the following interventions? 1. Pursed-lip breathing training 2. Diaphragmatic breathing training 3. Deep breathing exercises 4. Lateral costal expansion exercises

Rationale 1. Pursed-lip breathing is not possible when the patient is intubated. Diaphragmatic breathing, Deep breathing, and Lateral costal breathing ARE possible and helpful for a patient who has synchronized intermittent mandatory ventilation in ventilator mode, in which the patient is allowed to breathe spontaneously between machine-delivered breaths.

*Which of the following types of practice is MOST appropriate for long-term motor learning for a patient with a cerebrovascular accident? 1. Varied task practice with variable time intervals 2. Task practice of one activity for 15 minutes with 10-minute rest 3. Practice of a variety of related skills in blocks of 5 minutes 4. Partial task practice with patient-preferred time intervals

Rationale 1. Random practice provides a higher level of contextual interference that requires the individual to retrieve practice from memory stores. Research has shown superior long-term effects for random practice due to the higher cognitive processes required. (Umphred, p. 82; O'Sullivan p. 413) 2. Massed practice is preferred for individuals with fatigue issues. Although learning occurs with this type of practice schedule, the depth of cognitive processes required is typically not as high as is expected with changes in tasks and environments. (O'Sullivan, p. 411) 3. Blocked practice is practice of one task performed repeatedly without interruption from other tasks. Although this practice allows for motor learning, it is not best for long-term retention due to the lack of variability, which is a hallmark of typical, daily movement. (Umphred, p. 82; O'Sullivan, p. 413) 4. Although complex motor skills can be broken into component parts for practice, delaying practice of the integrated tasks can interfere with the transfer effects and learning. Integrated practice is best for learning, particularly with continuous movement. The daily practice of the same task may improve performance, yet may not be best for long-term retention, as it does not allow the individual to retrieve from cognitive stores. (O'Sullivan, p. 413) Patient-preferred intervals will not be the best choice, considering that optimal learning occurs with random practice schedules. · Massed: Practice time > rest time · Distributed: Practice time = rest time · Blocked: Practice of one task repeatedly (111) (222) (333) · Serial: Predictable, repeated order of multiple tasks (123123123) · Random: Tasks practiced in random order (123321312) · Parts-to-Whole: Tasks broken into component parts for separate then integrated practice · Mental: Motor task is envisioned without overt physical practice

*Which of the following findings is MOST consistent with the presence of rebound tenderness noted during palpation of the abdomen of a patient who has low back pain? 1. Muscle guarding 2. Superficial reflex 3. Muscle soreness 4. Peritoneal irritation

Rationale 1. Rebound tenderness at the abdomen is not consistent with muscle guarding (pp. 340, 342). 2. Rebound tenderness is not consistent with a superficial reflex of the umbilicus when assessing for a neurologic impairment (pp. 201-203). 3. Rebound tenderness is not consistent with muscle soreness but rather is a classic sign of peritonitis (p. 341). 4. Pain on release of pressure confirms rebound tenderness, a reliable sign of peritoneal inflammation (p. 342).

* A physical therapist is examining a patient with low back pain which began 2 months ago while mopping the floor at work. The patient has pain radiating to the buttocks and posterior thigh, has limited lumbar spine range of motion, is unable to perform repeated movements into lumbar flexion, and can only tolerate standing for 5 minutes. Based on this information, which of the following is the MOST appropriate goal for this patient to be met in 2 weeks? 1. Demonstrate normal lumbar spine flexion range of motion. 2. Be able to bend forward 20 times without an increase in leg pain. 3. Return to work with no job modifications. 4. Stand for 10 to 15 minutes without an increase in leg pain.

Rationale 1. Restoring flexion range of motion is not necessarily a functional goal, and the patient would be unlikely to achieve this goal within 2 weeks. 2. Bending forward 20 times without an increase in leg pain is not necessarily a functional goal, and the patient would be unlikely to achieve this goal within 2 weeks. 3. This is a long-term goal, but not one likely to be attained in 2 weeks with a patient who has been symptomatic for 2 months. 4. Improved standing for 10 to 15 minutes within 2 weeks without leg pain is a functional level goal and may reasonably be achieved in 2 weeks.

*A patient who has pleural effusion is performing segmental breathing exercises. Where should manual counterpressure be applied to encourage expansion of the posterior basal segments of the patient's lower lobes? 1. Lower lateral costal area 2. Posterior lower ribs 3. Anterior midchest 4. Anterior lower ribs

Rationale 1. Segmental breathing combines breathing control with manual cues to specific areas of the chest wall. The lateral costal area would be a position to treat the lateral basal segments of the lower lobes, not the posterior basal segments. 2. Proper hand placement to encourage posterior basal expansion is over the posterior aspect of the lower ribs. 3. Midchest would be used to treat the superior segments of the lower lobe, not the posterior basal segments. 4. The anterior lower ribs would be a position to treat the anterior basal segments of the lower lobes, not the posterior basal segments. Segmental breathing AKA localized breathing or thoracic expansion exercise; intended to improve regional ventilation and prevent/treat pulmonary complications after surgery; based on the presumption that asymmetrical chest wall motion may coincide with underlying pathology (pneumonia, pleuritic chest wall pain, retained secretions, etc) and that inspired air can be directed to a particular area by facilitation or inhibition of chest wall movt through proper hand placements, verbal cues, or coordination of breathing à augments localized lung expansion for chest hypomobility (dec lung compliance, dec intrathoracic lung volume)

A patient has acute rheumatoid arthritis involving the wrist joints. Which of the following interventions is MOST appropriate? 1. Resistive exercises to end range 2. Functional fine motor tasks 3. Splints with wrists in neutral position 4. Passive stretching exercises

Rationale 1. Strengthening can be difficult especially with pain of the acute phase. 2. Active exercise (needed for functional fine motor tasks) has questionable benefit in the acute phase. 3. Splints can be applied to rest the involved joints, prevent excessive movement, and reduce mechanical stresses, all of which are desired outcomes in the acute phase of rheumatoid arthritis. 4. Passive stretching exercises are important as a part of a rehabilitation effort; however, given the acute nature of the problem, rest and protection are paramount, making this option inappropriate.

A patient is asked to perform a previously demonstrated hamstring stretch for a physical therapist. The patient, referring to pictures of the stretch in the home exercise program, comfortably performs the stretch at end range for 60 seconds, while maintaining a posterior pelvic tilt. To ensure the most effective stretch during future performance, the therapist should make which of the following changes? 1. Decrease the intensity of the stretch. 2. Instruct the patient in proper stretch duration. 3. Provide re-direction on proper body alignment. 4. Provide visual aids to cue the patient to perform the exercise regularly.

Rationale 1. Stretch intensity should be enough to load tissues (Kisner, pp. 86-87). Since this stretch is at end range and is comfortable, it would not be beneficial to decrease the intensity. 2. The stretch duration (60 seconds) is well within cited recommendations for this parameter (Kisner, pp. 86-88). 3. Instructing the patient in proper body alignment is cited as an essential component of teaching stretching exercises. To properly perform a hamstring stretch, a posterior tilt should be avoided, because this assists with stretching the rectus femoris (Kisner, p. 749). Therefore, this aspect of teaching the stretching exercise must be addressed. 4. Although visual aids are an important part of teaching stretching exercises, the patient has already been provided with these as described in the stem. The main problem is incorrect alignment when performing the exercise. (Fairchild, p. 16)

Which of the following exercise programs is MOST appropriate for a patient who is at Stage IV on the Hoehn and Yahr Classification of Disability scale? 1. Treadmill 2. Elliptical machine 3. Stationary bicycle 4. Stair-climbing machine

Rationale 1. The Hoehn and Yahr Classification of Disability Stage IV describes a patient who has Parkinson disease with disability in the moderate to severe range (pp. 815-817). Postural instability and an increased risk of falling rule out a treadmill as a safe means of exercise for a patient who has moderate Parkinson disease (p. 842). 2. Postural instability and an increased risk of falling rules out an elliptical machine as a safe means of exercise for a patient who has moderate Parkinson disease (p. 842). 3. Exercise on a stationary bicycle allows for cardiovascular conditioning in a safe environment, because the patient is seated on a stationary surface (p. 842). 4. Postural instability and an increased risk of falling rule out a stair-stepping machine as a safe means of exercise for a patient who has moderate Parkinson disease (p. 842). The Hoehn and Yahr scale is used to describe the symptom progression of Parkinson disease. The scale was originally described in 1967 and included stages 1 through 5.

A patient who has meralgia paresthetica has been referred to physical therapy. Which of the following clinical features is MOST likely to be assessed by the physical therapist during the examination? 1. Strength of the adductor longus 2. Strength of the quadriceps femoris 3. Sensation of the superior medial aspect of the thigh 4. Sensation of the lateral aspect of the thigh

Rationale 1. The adductor longus is innervated by the obturator nerve, and strength testing would assess the motor integrity of this nerve. Meralgia paresthetica does not involve the obturator nerve. 2. The quadriceps femoris is innervated by the femoral nerve, and strength testing would assess the motor integrity of this nerve. Meralgia paresthetica does not involve the femoral nerve. 3. Meralgia paresthetica is an entrapment or injury to the lateral femoral cutaneous nerve, a purely sensory nerve. Injury affects sensation to the lateral thigh. Sensory testing of the superior medial aspect of the thigh would be an assessment of the ilioinguinal nerve. 4. Meralgia paresthetica is an entrapment or injury to the lateral femoral cutaneous nerve, a purely sensory nerve. Injury affects sensation to the lateral thigh. Sensory testing of this region is the most appropriate assessment.

A patient who has a history of heart disease is being treated for left glenohumeral dysfunction. The patient reports left upper quadrant pressure that continues after joint mobilization has ceased. Which of the following actions is MOST appropriate for the physical therapist? 1. Assess the patient's cervical spine nerve root integrity. 2. Have the patient perform relaxation exercises and inquire about cardiac symptoms. 3. Stop the treatment and monitor the patient's vital signs. 4. Resume joint mobilization at a lower intensity and reassess the patient's status.

Rationale 1. The cervical spine could be of concern, but neurologic symptoms typically include tingling, numbness, weakness, or burning pain, not "pressure" (p. 701). Left upper quadrant pain is a red flag (warning sign), especially with the patient's history of heart disease. 2. The patient is already having a potential cardiac symptom (p. 255). Relaxation may decrease sympathetic tone and decrease anginal symptoms, but first vital signs should be assessed. 3. Vague left upper quadrant pressure pain can be an anginal equivalent and indicate myocardial infarction. Given this possibility, one should stop and assess vital signs, especially in a patient with a past medical history of heart disease. (pp. 701-702) 4. The symptoms are present at rest after joint mobilization; thus, joint mobilization should not be resumed. Left quadrant pain is a red flag (warning sign), especially with the patient's history of heart disease; therefore, it is appropriate to stop treatment and seek medical attention. (p. 701)

*Which of the following structures provides thermoregulation for the body by means of insulation? 1. Epidermis 2. Subcutaneous tissue 3. Dermis 4. Deep fascia

Rationale 1. The epidermis is the most superficial layer of the skin and has no fat storage (p. 12). Fat is the main insulator for the body and provides significant thermoregulation (p. 13). 2. Subcutaneous tissue, or superficial fascia, contains loose connective tissue and provides for storage of most of the body's fat, which is the main insulator for the body and provides significant thermoregulation (p. 13). 3. Dermis is the layer of skin between the epidermis and subcutaneous tissue. Dermis is made of collagen and elastic fibers and does not contain fat, but it does contain sweat glands and arterioles. It contributes to thermoregulation through sweating and arteriole dilation and constriction (pp. 12-13) but does not provide for thermoregulation through insulation. 4. Deep fascia underlies the superficial fascia and is not technically a part of the skin. It does not contain fat, which is the main insulator for the body. (p. 16)

The condition shown for the patient's left hand in the photograph is MOST likely caused by entrapment of which of the following nerves? 1. Anterior interosseous nerve 2. Radial nerve 3. Posterior interosseous nerve 4. Ulnar nerve

Rationale 1. The image shows an anterior interosseous syndrome (Kiloh-Nevin syndrome) in the patient's left hand. The patient is unable to flex the distal phalanx of the thumb and index fingers (1st and 2nd digits) because the anterior interosseous nerve, which supplies the flexor pollicis longus and the radial half of the flexor digitorum profundus, is entrapped. (p. 411) 2. With entrapment of the radial nerve, all extensor muscles of the forearm would be affected (p. 416). The image shows a deficit in the pinch of the thumb and index finger (1st and 2nd digits). 3. Entrapment of the posterior interosseous nerve results in functional wrist drop (p. 416). The image shows a deficit in the pinch of the thumb and index finger (1st and 2nd digits). 4. When the ulnar nerve is affected, the patient cannot fully adduct the little finger (5th digit) and hold the finger abducted and extended (p. 415). The image shows a deficit in the pinch of the thumb and index finger (1st and 2nd digits).

A patient with pain on the right side of the face also has tenderness at the right temporomandibular joint. A physical therapist notes deviation of the mandible toward the left at the end of the available range of mouth opening. Which of the following additional findings would be MOST expected? 1. Abnormal jaw reflex 2. Indentation behind the left condyle of the mandible 3. Paresthesia in the facial nerve (CN VII) distribution on the right 4. Hypermobility of the right temporomandibular joint

Rationale 1. The jaw jerk reflex is used to test the trigeminal nerve (CN V), but the question does not indicate neurological deficits (p. 1366). 2. The left temporomandibular joint is not hypermobile, so an indentation would not be expected (p. 1361). 3. Facial nerve paresthesias are not expected with temporomandibular joint hypermobility. The temporomandibular joint is primarily supplied by three nerves that are part of the mandibular division of the trigeminal nerve (CN V). (p. 1347) 4. A deviation during opening is associated with hypomobility toward the temporomandibular joint deviation and hypermobility contralaterally (p. 1361).

The asymmetrical position in the photograph is MOST likely due to a lesion in which of the following nerves? 1. Long thoracic 2. Spinal accessory 3. Axillary 4. Dorsal scapular

Rationale 1. The long thoracic nerve innervates the serratus anterior. Weakness of the serratus anterior results in winging of the scapula, which is the pathological position shown in the photograph. (Magee, p. 281; Drake, pp. 726-727, 744) 2. The spinal accessory nerve innervates the sternocleidomastoid and trapezius. The trapezius adducts and upwardly rotates the scapula (Drake, pp. 895, 1024). The sternocleidomastoid flexes the head to the side and rotates the head to the contralateral side (Magee, p. 174). These muscles are not involved in the asymmetrical position shown in the photograph. 3. The axillary nerve innervates the deltoid and teres minor, which are not involved in the asymmetrical position shown in the photograph (Magee, pp. 177, 287). 4. The dorsal scapular nerve innervates the rhomboids, which elevate, retract, and downwardly rotate the scapula and are not involved in the asymmetrical position shown in the photograph (Drake, pp. 715-716, 744; Magee, p. 287).

A patient is referred to physical therapy with a history of ulnar nerve entrapment at the level of the hamate. Which of the following would be the MOST specific exercise to improve this patient's strength deficits? 1. Practice pinching between thumb (1st digit) and the tip of the index finger (2nd digit). 2. Squeeze hand grip with elastic-band resistance. 3. Oppose thumb (1st digit) to the metacarpal phalangeal joint of each finger (2nd through 5th digits). - academic review error 4. Squeeze therapy putty between the sides of the fingers.

Rationale 1. The muscles that are active during this movement are supplied by the median nerve, and impingement occurs in the carpal tunnel, not at the hamate (p. 378). 2. Doing this exercise would not isolate muscles supplied by the ulnar nerve, as only the 4th and 5th digits would be involved. This exercise would be appropriate if the ulnar nerve was entrapped at the level of the cubital tunnel and not in the tunnel of Guyon (at the level of the hamate). (p. 379) 3. This exercise would strengthen muscles supplied by the median nerve at the wrist. Deficits here would be loss of thumb (1st digit) abduction and opposition. (p. 378) 4. SQUEEZE THERAPY PUTTY BETWEEN THE SIDES OF THE FINGERS. This movement isolates the lumbricals and interossei, which are innervated by the ulnar nerve and are affected when entrapment occurs at the tunnel of Guyon (at the level of the hamate) (p. 379).

Which of the following medications is MOST likely to be used to treat the condition of the patient shown in the photograph? 1. Furosemide (Lasix) 2. Metformin (Glucophage) 3. Methotrexate (Trexall) 4. Atenolol (Tenormin)

Rationale 1. The patient in the photograph has rheumatoid arthritis (Goodman, p. 1323). Furosemide is a diuretic used for the treatment of hypertension, not the treatment of rheumatoid arthritis (Ciccone, p. 320). 2. The patient in the photograph has rheumatoid arthritis (Goodman, p. 1323). Metformin is indicated for diabetes, not rheumatoid arthritis (Ciccone, p. 519). 3. The patient in the photograph has rheumatoid arthritis. Methotrexate is a disease-modifying antirheumatic drug used in the treatment of rheumatoid arthritis. (Goodman, p. 1323; Ciccone, p. 240) 4. The patient in the photograph has rheumatoid arthritis (Goodman, p. 1323). Atenolol is a beta-adrenergic blocking agent used in the treatment of hypertension or angina, not rheumatoid arthritis (Ciccone, p. 311).

A 14-year-old baseball player reports shoulder pain of insidious onset. The patient displays apprehension when the shoulder is passively positioned in abduction and full external (lateral) rotation. Which of the following pathologies is MOST likely present in this individual? 1. Adhesive capsulitis 2. Atraumatic instability 3. Acromioclavicular separation 4. Superior labral tear

Rationale 1. The patient is too young for insidious onset of adhesive capsulitis, and full lateral (external) rotation can be achieved in this patient. With adhesive capsulitis, impaired range of motion would be expected. (Dutton, pp. 665-666) 2. ATRAUMATIC INSTABILITY. Symptoms occur with excessive abduction and lateral (external) rotation of the shoulder. Anterior instability should be considered. (Dutton, p. 670) 3. Although the closed packed position for the acromioclavicular joint is at 90° of abduction, apprehension with lateral (external) rotation of the shoulder is not cited in any test for the acromioclavicular joint (Dutton, p. 588). 4. Labral tears are commonly associated with traumatic injury with sudden onset (Magee, p. 318).

When is the BEST time to determine a patient's baseline respiratory pattern? 1. While the patient is unaware of the observation 2. While the patient is providing a medical history 3. After measuring the patient's heart rate 4. After measuring the patient's blood pressure

Rationale 1. The patient will not alter the respiratory pattern if the patient is unaware of the observation. 2. The patient will be speaking, which will affect the baseline respiratory pattern. 3. The order of measuring heart rate and respiratory pattern is not critical to obtaining an accurate measurement. 4. The order of measuring blood pressure and respiratory pattern is not critical to obtaining an accurate measurement.

A physical therapist is examining a patient by using the test shown in the photograph. Which of the following structures is MOST likely injured? 1. Anterior glenohumeral joint 2. Long head of the biceps brachii 3. Supraspinatus tendon 4. Glenohumeral labrum

Rationale 1. The photograph depicts the apprehension sign test for the presence of anterior glenohumeral instability 2. A test for biceps tendinopathy has the patient producing force into supination with the shoulder in neutral, the elbow bent to 90°, and the forearm starting in pronation (p. 520). 3. The empty can test and the drop arm test are used to check for supraspinatus injuries. In both cases the patient would be sitting upright with the arm raised against gravity. (pp. 522-523) 4. There are several tests used to assess glenohumeral labral tears. The biceps load test has a similar starting position and is used to check for glenoid labrum tear, but the patient's reaction to this position is positive for the apprehension sign, indicating possible anterior glenohumeral instability. (p. 524)

Shoulder pain during the test shown in the photograph MOST likely indicates which of the following pathologies? 1. Anterior glenohumeral instability 2. Cubital tunnel syndrome 3. Shoulder impingement syndrome 4. Thoracic outlet syndrome

Rationale 1. The photograph shows the Hawkins-Kennedy test. Anterior glenohumeral instability is not tested with the Hawkins-Kennedy test. The Hawkins-Kennedy test is used to test for impingement signs for the diagnosis of subacromial bursitis or rotator cuff pathology. (p. 630) 2. Cubital tunnel syndrome is not tested with the Hawkins-Kennedy test. The elbow flexion test or Tinel sign is used to test for cubital tunnel syndrome. (pp. 738-739) 3. The photograph shows the Hawkins-Kennedy test, which is used to test for impingement syndrome of the shoulder (p. 630). 4. Thoracic outlet syndrome is not tested with the Hawkins-Kennedy test. It is tested with the Roos test. (p. 1300)

A patient has a positive result on the test shown in the photograph. During the subacute phase of treatment, the MOST appropriate intervention for the patient is independent performance of which of the following exercises? 1. Lower extremity partial squats 2. Open kinetic chain knee extension 3. Straight leg raises 4. Plyometric exercises

Rationale 1. The photograph shows the anterior drawer test for the knee, which is used to assess the integrity of the anterior cruciate ligament. Closed kinetic chain extension exercises will put less stress on the anterior cruciate ligament and are appropriate for the subacute phase (week 4) of treatment. 2. Open kinetic chain knee extension, especially the last 25°, will put increased tension on the anterior cruciate ligament. 3. Although straight leg raises put no stress on the anterior cruciate ligament, this would be an exercise for the acute (not subacute) phase of treatment. 4. Plyometric exercises are an important part of the functional phase (week 10) of rehabilitation after an anterior cruciate ligament tear.

A patient has significant swelling around the lateral ankle. Radiographs of the ankle reveal no evidence of bone injury. The examination shown in the photograph has a positive result. Which of the following structures is MOST likely injured? 1. Achilles tendon 2. Fibularis (peroneus) brevis tendon 3. Calcaneofibular ligament 4. Anterior talofibular ligament

Rationale 1. The photograph shows the anterior drawer test of the ankle (Magee, pp. 932-933). The Thompson (Simmonds) test is used to assess for tears of the Achilles tendon (Magee, p. 940). 2. Palpation of the proximal (base) fifth metatarsal is used to rule out avulsion fracture from a fibularis (peroneus) brevis tendon pull (Giangarra, p. 257). 3. The talar tilt test is used to determine whether the calcaneofibular ligament is torn (Magee, pp. 936-937). 4. The photograph shows the anterior drawer test of the ankle (Magee, pp. 932-933). A positive result may be obtained on the anterior drawer test only if the anterior talofibular ligament is torn; however, anterior translation is greater if both the anterior talofibular ligament and calcaneofibular ligaments are torn (Magee, pp. 932-933).

A patient has a left thoracolumbar scoliosis. Pelvic landmarks are symmetrical. Which of the following muscles will MOST likely be tight? 1. Right hip abductors 2. Left latissimus dorsi 3. Right quadratus lumborum 4. Left iliocostalis lumborum

Rationale 1. The right hip abductors will be normal length since the pelvis is level. 2. The left latissimus dorsi will be normal or lengthened dependent on the severity of the curve. 3. With a left thoracolumbar scoliosis, the C curve is concave on the right, resulting in shortened trunk musculature on the right, i.e., quadratus lumborum. 4. The left iliocostalis lumborum will be of normal length or lengthened, depending on the severity of the curve.

*A home health physical therapist is working with a patient who had a myocardial infarction 2 weeks ago. The patient reports interrupted sleep, increased swelling of the feet, and shortness of breath. The patient's heart rate is 120 bpm and respiratory rate, 28 breaths/minute. Auscultation reveals crackles in both lung bases. The therapist should suspect: 1. acute congestive heart failure. 2. pneumonia in bilateral lower lobes. 3. atelectasis. 4. renal failure.

Rationale 1. These signs and symptoms are consistent with congestive heart failure (Hillegass, p. 97). 2. Pneumonia may result in orthopnea (shortness of breath (dyspnea) that occurs when lying flat) and disrupted sleep, but it would not cause lower extremity edema 3. Atelectasis may be associated with crackles (rales) and shortness of breath, but the other symptoms are not consistent with atelectasis (partial or complete collapse of the lung) 4. Renal failure may result in lower extremity edema, shortness of breath, and tachypnea (rapid breathing) but not crackles and tachycardia (Goodman, pp. 396-397).

Which of the following is the MOST appropriate technique to improve the flexibility of the hip flexors? 1. Active hip extension to end range, followed by isometric hip flexion 2. Resisted hip extension using cuff weights, followed by active hip flexion 3. Placing the patient in prone with pillows positioned under the abdomen 4. Gentle, sustained passive hip extension

Rationale 1. This exercise requires the addition of active relaxation of the hip flexors and active or passive movement into hip extension to be effective (pp. 94-95). 2. This exercise is a strengthening exercise for the hip extensors; active movement of tight muscles does not activate a relaxation response; an isometric contraction is required (p. 752). 3. Tight muscles need to be taken to their most lengthened position before maintaining the position; lying prone on pillows is not the most lengthened position of the hip flexors (p. 109). 4. GENTLE, SUSTAINED PASSIVE HIP FLEXION. Gentle, sustained passive hip extension is an appropriate method of stretching tight tissues (p. 88).

Which of the following muscles is MOST likely to demonstrate postural weakness in the patient shown in the photograph? 1. Long thoracic extensors 2. Pectoralis minor muscles 3. Sternocleidomastoid muscles 4. Suboccipital extensors

Rationale 1. This is correct because the long thoracic extensors demonstrate a stretch weakness in this posture 2. This is incorrect because this patient would use this muscle chronically in its shorter range. Manual muscle testing done in its longer range would have a weaker than normal result. Manual muscle testing in its shorter range would result in a normal or slightly stronger than normal result. Muscle imbalances can occur when a patient strengthens the anterior pectoral muscles and ignores the upper back. This results in tight pectoral muscles and weak rhomboids and trapezius. (Shultz, p. 201) 3. The sternocleidomastoid has increased use during cervical extension (forward head). This muscle would demonstrate a short-strong muscle imbalance. (Hueter-Becker, p. 114) 4. This is incorrect because the suboccipital extensors are chronically in a shorter range. This muscle would demonstrate a short-strong muscle imbalance. (Hueter-Becker, p. 114)

A qualitative research design would be MOST appropriate to address which of the following research questions? 1. What are the causes and number of spinal cord injuries in the United States each year? 2. What are the experiences of patients with spinal cord injuries in returning home and to school? 3. What is the average length of stay in an acute care or rehabilitation facility for patients who have spinal cord injuries? 4. What percentage of patients who have spinal cord injuries achieve their optimal functional outcome within 1 year after injury?

Rationale 1. This study would involve gathering and analysis of statistical measures, which is a quantitative research design. 2. This question would require the researcher to interview patients who have spinal cord injuries to get their perspective on their experience. This approach depends on the patient's story and constitutes a qualitative style study. 3. This study would involve gathering and analysis of statistical measures, which is a quantitative research design. 4. This study would involve gathering and analysis of statistical measures, which is a quantitative research design.

Which of the following findings is CONSISTENT with low risk for development of metabolic syndrome? 1. Triglyceride level of 135 mg/dL (1.5 mmol/L) 2. Blood pressure reading of 135/85 mm Hg 3. Fasting blood glucose level of 126 mg/dL (7.0 mmol/L) 4. Waist measurement of 41 in (104.1 cm)

Rationale 1. Triglyceride level below 150 mg/dL is normal. 2. Blood pressure reading equal to or greater than 130/85 mm Hg is a risk factor for the development of metabolic syndrome. 3. Fasting glucose of 100 mg/dL (5.5 mmol/L) or more is a risk factor for the development of metabolic syndrome. 4. Waist measurement greater than 35 inches (89 cm) for women or 40 inches (102 cm) for men is a risk factor for the development of metabolic syndrome. Metabolic Syndrome: a cluster of biochemical and physiological abnormalities associated with the development of cardiovascular disease and type 2 diabetes. Risk Factors for developing Metabolic Syndrome: · BP ≥ 135/85mmHg · blood sugar/fasting glucose ≥ 100mg/dL · waist measurement >35in F or >40in M · triglycerides > 150mg/dL · HDLs (good cholesterol) <50mg/dL F or <40 mg/dL M · If 3 risk factors are present, suspect metabolic syndrome

A physical therapist is evaluating a patient who reports shoulder pain during overhead activities. During active shoulder abduction on the affected side, the patient demonstrates diminished scapular upward rotation. Weakness of which of the following muscles is MOST likely to contribute to this dysfunction? 1. Upper trapezius 2. Posterior deltoid 3. Rhomboids 4. Teres major

Rationale 1. UPPER TRAP. The upper trapezius elevates the shoulder alone but, coupled with the lower trapezius and serratus anterior, produces upward rotation of the scapula via force coupling (p. 64). 2. The posterior deltoid extends, abducts, and laterally (externally) rotates the shoulder (p. 81). 3. The rhomboids retract, elevate, and downwardly rotate the scapula (p. 65). 4. The teres major extends, adducts, and medially (internally) rotates the shoulder (p. 77).

A 4-year-old child who received a diagnosis of spinal muscular atrophy at age 9 months is referred for home physical therapy. The child is unable to sit without upper extremity support but rolls independently. The child has bilateral hip and knee flexion contractures that make use of the child's standing frame uncomfortable. Which of the following interventions are MOST appropriate for physical therapy? 1. Teach parents airway clearance techniques, encourage upper extremity strengthening to prepare for wheelchair self-propulsion, and switch to using a modified prone stander. 2. Teach parents lower extremity stretching and strengthening exercises, adapt the standing frame to accommodate contractures, and encourage supported walking. 3. Teach parents proper transfers, facilitate upright positioning in kneeling and standing positions, and refer to an orthopedist for serial casting to address contractures. 4. Teach the parents range of motion exercises and positioning, encourage play in prone and sitting positions, and order customized seating insert for a power wheeled mobility device.

Rationale 1. Upper extremity strengthening is not realistic, considering the progressive weakness expected with this child. The skill level would be too high. Manual propulsion is not functional over the long term. 2. The literature supports that children who have spinal muscular atrophy and who do not develop sitting ability are unlikely to walk and will require power mobility. They may become independent in a power wheelchair by age 1-2 years. 3. These skills are too advanced. 4. These interventions are most appropriate to the patient's impairments and functional limitations. The literature supports that children who have spinal muscular atrophy and who do not develop sitting ability are unlikely to walk and will require power mobility. SMA is a progressive degenerative disease of anterior horn cells; autosomal recessive

*A physical therapist is treating a person who had a cerebrovascular accident and is unable to support full weight on the affected lower extremity. The patient's primary goal is to return to walking independently. Which of the following is the MOST effective intervention? 1. Upright supported standing in a frame, progressing to independent standing 2. Mobility training emphasizing independence in a wheelchair 3. Treadmill training with a harness and partial body-weight support 4. Walking with an ankle-foot orthosis and standard cane

Rationale 1. Upright supported standing in a frame is a stationary activity that does assist with weight-bearing but lacks the dynamics required for walking (p. 693). 2. The patient has the potential to regain mobility. A wheelchair would not enable the patient to realize that potential. (p. 696) 3. Early upright walking appears to be effective in fostering return of walking in persons following a cerebrovascular accident. Partial body-weight support allows for early upright walking without risk to the patient or therapist. (pp. 696-697) 4. Walking with an ankle-foot orthosis and standard cane is a goal, but since the patient cannot yet bear full weight on the affected limb, this goal would be beyond the patient's current capability. The treadmill with a harness would enable the patient to walk with a more normal gait pattern. (p. 696)

A physical therapist is treating a patient who had a traumatic brain injury 3 weeks ago. The patient is confused and agitated. Physical therapy evaluation found decreased lower extremity coordination and strength. Which of the following would be the MOST appropriate intervention? 1. Participating in biofeedback training for lower extremity muscles with supervision 2. Walking in parallel bars with supervision 3. Participating in an aerobics group exercise class for 30 minutes 4. Performing lower extremity exercises while following a written handout

Rationale 1. With impaired attention, the patient would have difficulty participating in biofeedback training (p. 868). 2. WALKING IN PARALLEL BARS WITH SUPERVISION. Walking in parallel bars permits the patient to use the bars if balance is lost (p. 448). The closed environment is appropriate secondary to the heightened state of activity of the patient (p. 868). 3. In the confused-agitated state, the patient's behavior is bizarre and not purposeful. Group exercise classes would not be appropriate. Gross attention to the environment is very brief. (p. 868) 4. With impaired attention, the patient would have difficulty focusing on the written instructions long enough to complete the task (p. 868).

*A therapist is treating a patient who recently had a myocardial infarction. At the beginning of treatment, blood pressure was 120/80 mm Hg and heart rate was 90 beats/min. Midway through treatment, blood pressure was 130/84 mm Hg and heart rate was 105 beats/min. The BEST action for the therapist to take is to: 1. continue with treatment. 2. increase the intensity of treatment. 3. stop the treatment, and notify the physician. 4. decrease the intensity of the next treatment.

Rationale 1.CONTINUE WITH TX Systolic blood pressure is expected to rise in direct proportion to the level of exertion performed. A hypertensive response to low-level exercise (over 160/90 mm Hg) in the patient who is at least 3 days post myocardial infarction may be indicative of cardiac ischemia. Heart rate should increase between 12-24 bpm above the resting heart rate. The patient is showing a normal response to exercise and should continue with treatment. There is NO indication to increase activity level or to stop treatment. After a recent myocardial infarction, the patient should avoid activities that cause a significant change in vital signs. Responses to exercise: HR increases linearly as a function of increasing workload and oxygen uptake (VO2) but plateaus just before maximal oxygen uptake (VO2max); systolic BP should rise with increasing workloads and VO2, but diastolic BP should remain about the same. See pg~160 of ACSM!!!! A peak DBP >90 mm Hg or an increase in DBP >10 mm Hg during exercise above the pretest resting value is considered an abnormal response (17) and may occur with exertional ischemia (53). A DBP >115 mm Hg is an exagerated response and a relative indication to stop a test

Which of the following procedures is MOST appropriate for measuring a wound that has well-defined margins? 1. Clean the skin around the wound, place a nonsterile ruler on the wound to obtain measurements, and then clean the ruler for future use. 2. Clean the skin around the wound, place a nonsterile ruler on the wound to obtain measurements, and then discard the ruler after use. 3. Place a nonsterile ruler close to the wound to obtain measurements and then clean the ruler for future use. 4. Place a nonsterile ruler close to the wound to obtain measurements and then discard the ruler after use.

Rationale 4. Despite cleaning the area, the ruler should not make contact with the wound, and the ruler should be discarded after a single use.

Which of the following interventions is MOST appropriate to assist with maintaining bone density for a patient with a history of osteoporosis and previous vertebral fractures? 1. Use of a rowing machine 2. Water aerobics 3. Walking on a treadmill 4. Performing sit-ups on a mat

Rationale For individuals who have vertebral osteoporosis or previous history of vertebral fractures, activities such as golfing, bowling, biking, rowing, sit-ups, or other exercise with a major component of spinal flexion, side bending, or spinal rotation should be avoided (p. 1224). 2. Swimming/water aerobics is an excellent physical activity, but it is not beneficial to offset the complications of osteoporosis or build bone density (p. 1224). 3. Walking is associated with changes in bone remodeling and results in greater bone mass (p. 1222).

A patient with chronic low back pain had a baseline Oswestry Disability Questionnaire score of 60 points. Three weeks later, the score was 8 points. With regard to the patient's current self-reported level of disability, which of the following courses of action should the physical therapist pursue NEXT? 1. Continue physical therapy until the patient returns to a score of 60. 2. Instruct the patient in a functional conditioning program to prepare for discharge. 3. Immediately refer the patient to the emergency department. 4. Have the patient return to the physician within the next few days.

Rationale Lower score = better 1. A change in the Oswestry score from 8 to 60 would be consistent with worsening of the patient's condition. 2. An Oswestry score of 8 is favorable, and a functional conditioning program is appropriate. 3. An Oswestry score of 8 does not indicate the need for an emergency department visit. 4. An Oswestry score change of 60 to 8 does not require a (medical) physician visit; it signifies improvement.

What is the MAXIMUM current density that should be used to initiate iontophoresis when the current amplitude is 10 milliamperes and the conductive surface area is 20 cm2? 1. 0.2 milliamperes/cm2 2. 0.5 milliamperes/cm2 3. 5 milliamperes/cm2 4. 20 milliamperes/cm2

Rationale To calculate current density, the current amplitude is divided by conductive surface area; therefore, 10/20 = 0.5.

*A patient has an irregular heartbeat of greater than 100 bpm. Which of the following methods is MOST accurate for measuring the patient's heart rate? 1. Auscultate the apical heart rate for at least 60 seconds. 2. Take the radial pulse for 15 seconds and multiply by 4. 3. Measure the carotid pulse for 30 seconds and multiply by 2. 4. Take the radial pulse for 30 seconds and multiply by 2.

Rationale With an irregular heart rate greater than 100 bpm, auscultation is the most accurate method of measuring the heart rate. Taking pulses for less than a minute would not be as accurate since irregular heartbeats could be missed, or could be present within only that 15 or 30 seconds of measurement. Rates faster than 100 bpm or slower than 60 bpm should be measured the full minute.

A patient with weakness of the muscle group being tested in the photograph would have the MOST difficulty with which of the following activities? 1. Stepping up on a curb 2. Walking on a level surface 3. Sitting up from a reclining position 4. Bringing the trunk forward in sitting position

The quadriceps group is being tested in the photograph (Hislop, p. 248). This option is correct because maximum torque of the knee extensors reaches a peak at about 60° of knee flexion and decreases with further extension of the knee. Stepping up on a curb requires a greater workload for the quadriceps muscle group, compared to the other activities listed. (Houglum, p. 460). Walking on a level surface requires less quadriceps work than stepping up on a curb because maximum torque of the knee extensors reaches a peak at about 60° of knee flexion and decreases with further extension of the knee (Houglum, p. 460). The quadriceps group is being tested in the photograph (Hislop, p. 248). With the femur fixed, the hip flexors will flex the trunk forward. Although the rectus femoris is a hip flexor and knee extensor, weakness of the rectus femoris can be compensated for in this action by other hip flexors such as the iliopsoas. (Loudon, p. 270)