P2

A patient has a resting blood pressure of 120/80 mm Hg. During an activity with a metabolic equivalent level of 4, which of the following blood pressure responses is MOST likely associated with poor left ventricular function? 1. 108/78 mm Hg 2. 129/76 mm Hg 3. 138/83 mm Hg 4. 164/84 mm Hg

***1. 108/78 mm Hg Rationale: 1. A drop in systolic blood pressure greater than or equal to 10 mm Hg with an increase in workload is considered an abnormal response and correlates with left ventricular dysfunction

A patient has a comminuted femoral fracture with an external fixator. There is no sign of quadriceps contraction with electrical stimulation. Which of the following is the MOST likely cause? 1. A lesion in the femoral nerve 2. A contusion of the quadriceps muscle 3. An unstable fracture site 4. A lesion in the L4-L5 nerve roots

***1. A lesion in the femoral nerve Rationale: 1. If a muscle becomes denervated, a contraction cannot be produced by neuromuscular electrical stimulation 2. A contusion is a bruise, which is characterized by swelling, discoloration, and pain. Innervation of the muscle is typically intact, and, therefore, electrical stimulation would produce a contraction in the quadriceps. 3. If the nerve is intact at the fracture site, a muscle contraction may be produced by neuromuscular electrical stimulation 4. The quadriceps are innervated by the femoral nerve, which is derived from spinal nerves L2-L4. A lesion in the L4-L5 nerve roots would still leave innervation in the quadriceps, and, therefore, electrical stimulation would produce a contraction in the quadriceps.

If the test shown in the photograph (ULTT- ulnar nerve) has positive findings, which of the following muscles is MOST likely affected? 1. Adductor pollicis 2. Pronator quadratus 3. Flexor pollicis longus 4. Abductor pollicis longus

***1. Adductor pollicis Rationale: 1. The nerve being stretched in the photograph is the ulnar nerve. The adductor pollicis is innervated by the ulnar nerve (nerve roots C7-C8, T1) 2. The pronator quadratus is innervated by the median nerve. The nerve being stretched in the photograph is the ulnar nerve 3. The flexor pollicis longus is innervated by the anterior interosseous nerve, which is a branch of the median nerve (Magee, p. 450). The nerve being stretched in the photograph is the ulnar nerve 4. The abductor pollicis longus is innervated by the posterior interosseus nerve, which is a branch of the radial nerve (Magee, p. 399). The nerve being stretched in the photograph is the ulnar nerve

A patient had an open cholecystectomy 2 days ago and is currently having difficulty moving from supine to sitting position due to pain. Before the patient's next attempt to move, which of the following interventions would be MOST appropriate? 1. Bracing an abdominal pillow to splint 2. Using an incentive spirometer 3. Instruction in huffing 4. Tilt table regimen

***1. Bracing an abdominal pillow to splint

A patient reports insidious onset of pain and paresthesias on the lateral aspect of the right forearm and hand. The symptoms are reproduced with neck extension. Which of the following is the MOST likely diagnosis? 1. C6 radiculopathy 2. Ulnar nerve entrapment 3. Radial nerve entrapment 4. C8 radiculopathy

***1. C6 radiculopathy Rationale: 1. The dermatome for the C6 nerve root is the lateral aspect of the forearm and hand. Cervical extension with compression is a part of the foraminal compression test for nerve root involvement. 2. Injury to the ulnar nerve would result in sensory disturbance of the little and ring fingers (4th and 5th digits). 3. Injury to the radial nerve would result in sensory disturbance of the dorsum of the hand, thumb (1st digit), and fingers. 4. The dermatome for the C8 nerve root is in the medial hand and lower forearm.

Which of the following examination findings MOST likely indicates a favorable prognosis for a patient who has a posterior lumbar disc herniation? 1. Centralization and ability to restore extension mobility 2. Proximal symptoms and ability to restore flexion mobility 3. Peripheralization with flexion and a positive straight leg raise result 4. Leg pain with extension and a negative crossed straight leg raise result

***1. Centralization and ability to restore extension mobility Rationale: 1. Individuals who have centralization of symptoms and have the ability to restore extension of the spine demonstrate a good prognosis. 2. Proximal symptoms are suggestive of a good prognosis; however, flexion mobility is not a predictor of a good prognosis for patients who have a disc herniation. 3. Neither of these options have been found to have a predictive value in the prognosis of patients who have a disc herniation. 4. Although a negative result on the crossed straight leg raise is favorable, leg pain reproduced with extension is predictive of a poor prognosis.

A patient has impaired sensory and motor function of the left limbs and the left side of the face. The patient is unable to sit independently. In which of the following regions of the nervous system is the lesion MOST likely located? 1. Cerebrum 2. Brainstem 3. Spinal cord 4. Peripheral nerve

***1. Cerebrum Rationale: 1. Motor and sensory deficits are entirely on the left side of the body. The lower half of the face, the trunk, and both limbs are involved, indicating damage to vertical tract neurons. Facial signs indicate a lesion above the lower midbrain, because a spinal cord lesion would not affect the face and a lesion in most areas of the brainstem would have facial signs contralateral to the limb signs. The most likely location is the cerebrum. 2. A lesion in most areas of the brainstem would have facial signs contralateral to the limb signs. 3. A spinal cord lesion would not affect the face. 4. Motor and sensory deficits are entirely on the left side of the body. The lower half of the face, the trunk, and both limbs are involved, indicating damage to vertical tract neurons. Peripheral nerve lesion signs and symptoms are specific to the nerve injured and would not encompass entire limbs and the face.

A patient is referred to physical therapy with a diagnosis of adhesive capsulitis. During the initial evaluation, the patient is found to have limited shoulder range of motion, decreased tolerance to weight-bearing, recurrent night pain, and increased deep tendon reflexes. Which of the following courses of action is BEST for the physical therapist? 1. Contact the patient's referring physician. 2. Initiate small-amplitude oscillations performed at the beginning of the range of motion. 3. Perform pulsed ultrasound to the anterior aspect of the shoulder. 4. Delay therapy for 1-2 weeks until the pain decreases.

***1. Contact the patient's referring physician. Rationale: 1. These measures do not fit with the diagnosis of adhesive capsulitis and might indicate a more serious pathological condition. Signs and symptoms of metastases include decreased tolerance to weight-bearing, change in deep tendon reflexes, and change in sleep habits.

Which of the following integumentary system observations is consistent with skin cancer? 1. Dark, raised spot that bleeds with minimal contact 2. Redness, scaling, and edema of the skin 3. Red fluid-filled vesicles that vary in size 4. Ring-shaped pigmented patches covered with scales

***1. Dark, raised spot that bleeds with minimal contact Rationale: 1. These observations are classic signs of malignant melanoma 2. These observations are signs of contact dermatitis 3. These observations are signs of herpes zoster 4. These observations are signs of tinea corporis, also known as ringworm

A patient reports constant bilateral posterior calf pain with itching. The examination reveals a body temperature of 98.8°F (37.1°C), normal temperature of the lower extremities, and tenderness to palpation and crusting of the skin in the affected areas. Which of the following conditions is MOST likely present? 1. Dermatitis 2. Cellulitis 3. Atrophie blanche 4. Superficial venous thrombosis

***1. Dermatitis Rationale: 1. Symptoms of dermatitis include lack of fever, itching, normal temperature of the lower extremities, inflammation, tenderness to touch, presence of vesicles and crusting, and either unilateral or bilateral distribution (Bryant, pp. 178, 211). 2. Although the patient's limb is painful, the other reported findings are not consistent with cellulitis. Signs of cellulitis include fever, elevated temperature of the lower extremities, erythema, inflammation, tenderness, one or a few bullae, no lesions, and unilateral distribution. (Bryant, p. 237; Sussman, p. 376) 3. Atrophie blanche is characterized by white, scar-like areas associated with pain at rest and when standing (Sussman, p. 376). Affected areas present as smooth white plaques (Bryant, p. 210). 4. Superficial venous thrombosis is characterized by pain and tenderness along the affected vein, usually the saphenous vein. Crusting of the skin is not a feature of this condition.

A patient experiences peripheralization of low back pain with repeated trunk flexion. Repeated trunk extension in prone centralizes the pain. Which of the following activities would MOST likely aggravate the patient's symptoms? 1. Driving a car for several hours 2. Lifting light objects with the spine maintained in neutral 3. Work that involves frequent standing 4. Sleeping all night in a supine position

***1. Driving a car for several hours

After evaluating a patient who is a baseball player, a physical therapist concludes that there is insufficient deceleration of the shoulder during throwing. Which of the following strengthening techniques will be MOST effective in improving control of deceleration of the shoulder? 1. Eccentric exercises of the lateral (external) rotators 2. Eccentric exercises of the medial (internal) rotators 3. Concentric exercises of the lateral (external) rotators 4. Concentric exercises of the medial (internal) rotators

***1. Eccentric exercises of the lateral (external) rotators

A patient with C5 and C6 nerve root compression is MOST likely to have a decrease in motor function of which of the following muscles? 1. Elbow flexors 2. Scapular elevators 3. Elbow extensors 4. Finger flexors

***1. Elbow flexors Rationale: 1. The biceps muscle is a critical muscle for the C5 level, so it, and the motion of elbow flexion, are probably impaired if there is damage to C5-C6. 2. The trapezius is innervated by C4 and the spinal accessory nerve (CN XI), so this motion should be intact in this person. 3. The triceps are innervated at the C7 level, so this motion should not be affected by this patient's injury. 4. The finger flexors are innervated at the C8 to T1 level and should be intact.

A patient with an incomplete C8 spinal cord injury reports of burning in the buttocks when sitting in a wheelchair. Which of the following problems with the patient's wheelchair would be MOST likely to contribute to the burning? 1. Footplates are too high. 2. Footplates are too low. 3. Seat is too narrow. 4. Seat is too deep.

***1. Footplates are too high. Rationale: 1. Footrests that are too high shift the patient's weight posteriorly onto the buttocks, leading to pressure and pain (p. 1419). 2. Footrests that are too low shift weight forward onto the thighs. Although this would cause problems due to pressure on the thighs, it would not lead to pain in the buttocks. (p. 1419) 3. A narrow seat will lead to pressure and pain on the lateral pelvis and thighs, not in the buttocks (pp. 1413, 1429). 4. A long seat will lead to pressure and pain behind the knees, not in the buttocks

A patient who had an uncomplicated vaginal delivery 3 months ago has a 3-cm diastasis recti and Fair minus (3-/5) strength of the abdominal muscles. Which of the following therapeutic exercises, performed with arms bracing the abdomen, is MOST appropriate for the patient INITIALLY? 1. Head lift 2. Partial sit-ups 3. Lower trunk rotation 4. Bilateral straight leg raises

***1. Head lift Rationale: 1. With a 3-cm diastasis, the head lift is the most appropriate exercise initially. The patient braces the abdomen toward the midline to approximate the diastasis while performing the head lift. This will help to keep the separation of the abdominal muscles to a minimum, minimize the action of the obliques, and control intraabdominal pressure. 2. Given the strength of this patient's abdominal muscles in addition to the extent of the diastasis, this activity would be too strenuous and may further compromise the diastasis. The head lift should be performed exclusive of all other abdominal exercises until the diastasis is 2 cm or less. 3. Lower trunk rotation should be avoided until the diastasis is 2 cm or less. Due to the angle of attachment of the obliques into the linea alba, there is a possibility that trunk rotation exercises will perpetuate the diastasis. 4. With an abdominal strength of Fair minus (3-/5) and a diastasis of 3 cm, bilateral straight leg raises could cause a further separation of the diastasis by increasing intraabdominal pressure as the patient tries to stabilize while lifting the legs. The head lift corrective exercise should be performed exclusive of all other abdominal exercises until the diastasis is reduced to 2 cm or less.

Which of the following chronic hormonal responses to exercise may contribute to menstrual dysfunction? 1. High levels of cortisol, low levels of follicle-stimulating hormone (FSH) 2. High levels of cortisol, high levels of follicle-stimulating hormone (FSH) 3. Low levels of cortisol, low levels of follicle-stimulating hormone (FSH) 4. Low levels of cortisol, high levels of follicle-stimulating hormone (FSH)

***1. High levels of cortisol, low levels of follicle-stimulating hormone (FSH) Rationale: 1. It has been proposed that exercise stress chronically elevates cortisol levels in athletes. This in turn suppresses the secretion of gonadotropin-releasing hormone (GnRH), which in turn results in the suppression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Low levels of FSH will result in menstrual dysfunction.

A physical therapist working in an acute care facility is developing an aerobic exercise program for a patient who has had a sickle cell anemia crisis. The patient's current hematocrit is 27%. The therapist should be MOST concerned about the patient developing which of the following conditions while exercising? 1. Hypoxia 2. Excessive bruising 3. Dependent edema 4. Hypertension

***1. Hypoxia Rationale: 1. The hematocrit level is well below normal values (36% to 46%), which indicates anemia. Anemia leads to possible hypoxia and decreased exercise tolerance. Hypoxia is common in sickle cell anemia. 2. Excessive bruising occurs in response to a decrease in platelets (p. 1712), not a low hematocrit level. 3. Neither sickle cell anemia nor a hematocrit value of 27% will cause dependent edema, which is caused by position and often occurs in patients who have right-sided heart failure 4. Hematocrit changes do not influence blood pressure

Which of the following changes in cardiopulmonary function is MOST likely to occur in a pregnant woman in her third trimester of pregnancy? 1. Increase in oxygen consumption 2. Decrease in respiratory rate 3. Decrease in cardiac output 4. Decrease in heart rate

***1. Increase in oxygen consumption Rationale: 1. Cardiac output increases 30% to 60%, and oxygen consumption increases 15% to 20% during pregnancy. 2. Respiratory rate does not change during pregnancy. 3. Cardiac output increases 30% to 60%, and oxygen consumption increases 15% to 20% during pregnancy. 4. Heart rate increases during pregnancy.

Which of the following functions is MOST likely to be impaired in a patient who has a pontine infarct? 1. Jaw movement 2. Eyelid elevation 3. Tongue movement 4. Pharyngeal swallowing

***1. Jaw movement Rationale: 1. Observed jaw deviation during mastication results from an insult to the trigeminal nerve (CN V), which originates in the pons (p. 134). 2. Impaired eyelid elevation (ptosis) results from an insult to the oculomotor nerve (CN III), which originates in the midbrain, not the pons (p. 134). 3. Impaired tongue movement results from an insult to the hypoglossal nerve (CN XII), which originates in the medulla, not the pons (p. 135). 4. Difficulty swallowing (dysphagia) results from an insult to the vagus nerve (CN X), which originates in the medulla, not the pons (p. 135).

While playing recreational baseball, an individual is hit with a baseball just anterior to the ear. Later that evening, the person is drooling from the left side of the mouth and has noticeable drooping of the face on the left side. Which of the following cranial nerves is MOST likely involved? 1. Left facial (CN VII) 2. Right facial (CN VII) 3. Left trigeminal (CN V) 4. Right trigeminal (CN V)

***1. Left facial (CN VII) Rationale: 1. The facial nerve (CN VII) exits the skull at the stylomastoid foramen (auditory canal), which is the anterior aspect of the ear. It is responsible for innervating all muscles of facial expression on the ipsilateral side of the face. Damage to this nerve results in flaccid paralysis, or hypotonia of the facial muscles. 2. The right facial nerve controls the muscles on the right side of the face. The patient has flaccidity on the left side. 3. The trigeminal nerve (CN V) exits the skull at the superior orbital fissure, the foramen rotundum, and the foramen ovale. The trigeminal nerve (CN V) is responsible for sensation to the ipsilateral face and motor function of the ipsilateral muscles of mastication. 4. The trigeminal nerve (CN V) exits the skull at the superior orbital fissure, the foramen rotundum, and the foramen ovale. The trigeminal nerve (CN V) is responsible for sensation to the ipsilateral face and motor function of the ipsilateral muscles of mastication.

A physical therapist is considering using neuromuscular electrical stimulation as an alternative to static bracing for control of ankle position during gait in a client 3 months post cerebrovascular accident. Which of the following criteria improves chances of success with this treatment approach? 1. Limited spasticity in the ankle plantar flexors 2. Altered selective control of the hip/knee with volitional ankle activity 3. Hyperactive deep tendon reflexes at the ankle and knee 4. Limited sensation of the lower extremity

***1. Limited spasticity in the ankle plantar flexors Rationale: 1. Spasticity in the ankle plantar flexors may reduce the effectiveness of electrical stimulation to act on ankle; therefore, limited spasticity would improve the chances of success with this treatment. 2. The hip and knee control may be important, but if the patient has volitional ankle activity, electronic stimulation is not needed. 3. Hyperactive deep tendon reflexes indicate spasticity is present, which will reduce the effectiveness of electrical stimulation. 4. Limited sensation may also reduce the effectiveness of electrical stimulation.

A patient who is participating in a weight-loss program has been walking 3 days/week for 15 minutes for the past 3 weeks. When progressing the exercise program, which of the following modifications will MOST likely accomplish the weight-loss goal? 1. Maintain the current walking speed and increase the duration to 30 minutes. 2. Increase the walking speed and keep the duration at 15 minutes. 3. Walk 4 days/week and decrease the duration to 10 minutes. 4. Change from walking 3 days/week to jogging 1 day/week for 20 minutes.

***1. Maintain the current walking speed and increase the duration to 30 minutes.

A patient with spinal stenosis is referred to physical therapy. The patient reports pain in the right knee, ankle, and foot. While walking, the patient exhibits a mild foot-drop with no evidence of hypertonicity. When weight bearing, the foot and ankle are pronated. Which of the following orthoses is MOST appropriate? 1. Molded ankle-foot orthosis (AFO) 2. AFO with a split stirrup 3. Custom insole with lateral arch supports 4. Metal AFO with the ankle set in 5° of dorsiflexion

***1. Molded ankle-foot orthosis (AFO) Rationale: 1. A custom-molded thermoplastic ankle-foot orthosis provides an intimate fit for control of the extremity, and will permit correction of the patient's foot and ankle position as well as the foot drop (pp. 224-225). This type of ankle-foot orthosis also is lighter weight and more cosmetic and comfortable to wear than a metal double-upright ankle-foot orthosis with dorsiflexion assist. 2. The conventional metal double-upright ankle-foot orthosis can have a split stirrup to allow use of the ankle-foot orthosis with more than one shoe (p. 234). This type of ankle-foot orthosis is not the best choice for this patient, however, because it is heavy and less cosmetic than thermoplastic ankle-foot orthoses (p. 232). This patient does not have significant hypertonicity or limb volume changes that would necessitate use of a metal ankle-foot orthosis 3. A custom insole would not address the patient's foot drop. An ankle-foot orthosis is needed to position the foot and ankle to enhance toe clearance during gait. 4. This type of ankle-foot orthosis is not the best choice for this patient because it is heavy and less cosmetic than thermoplastic ankle-foot orthoses (p. 223). This patient does not have significant hypertonicity or limb volume changes that would necessitate use of a metal ankle-foot orthosis

A physical therapist is treating a patient who has Parkinson disease. The patient expresses concern about declining health and a poor prognosis. Which of the following is the MOST appropriate response for the therapist to make? 1. Offer resources on support groups. 2. Refer the patient to a psychiatrist. 3. Have the patient speak with another patient who has Parkinson disease. 4. Tell the patient that physical therapy will prevent disease progression.

***1. Offer resources on support groups.

During assessment of pressure and vibration sense, which of the following structures are responsible for transmission of the tested sensation? 1. Pacinian corpuscles 2. Krause end bulbs 3. Golgi tendon organs 4. Free nerve endings

***1. Pacinian corpuscles Rationale: 1. Pacinian corpuscles are responsible for pressure and vibration sense. 2. Krause end bulbs are responsible for cold sensation. 3. Golgi tendon organs are sensitive to muscle contraction force. 4. Free nerve endings are sensitive to pain and itch.

Which of the following is consistent with pain of musculoskeletal origin? 1. Pain decreases with rest. 2. Pain is reduced by constant pressure. 3. Pain follows a migratory pattern. 4. Pain awakens the patient at night.

***1. Pain decreases with rest. Rationale: 1. Musculoskeletal pain is often relieved by a change in position or by rest. 2. Pressure may increase musculoskeletal pain but may decrease pleural friction/irritation and decrease visceral pain. 3. Migratory pain is pain of a systemic nature. 4. Pain that awakens a patient at night is a symptom of systemic origin.

A patient is referred to physical therapy for right shoulder pain. Which of the following findings suggests that physical therapy intervention may not be appropriate? 1. Pain that subsides with right sidelying 2. Tenderness to palpation at the origin of the biceps tendon 3. Trigger points at the right rib 2-3 intercostal space 4. Pain with resisted shoulder lateral (external) rotation

***1. Pain that subsides with right sidelying Rationale: 1. Right sidelying often increases musculoskeletal pain but may decrease pleural friction/irritation and thus may decrease visceral pain (Goodman, p. 694). 2. Musculoskeletal pain is often tender to palpation or pressure (Magee, pp. 8-9, 61). 3. Trigger points are the most common musculoskeletal cause of chest pain (Goodman, p. 694). 4. Resisted testing or contraction of the involved muscle may increase pain of a musculoskeletal origin

When evaluating wheelchair positioning of a child with cerebral palsy, the position of which of the following body parts should be examined FIRST? 1. Pelvis 2. Lower extremities 3. Head 4. Spine

***1. Pelvis Rationale: - The assessment of posture in a wheelchair begins with the pelvis and its relationship to its adjacent segments.

Iontophoresis should be used with precaution for a patient who has which of the following conditions? 1. Peripheral neuropathy 2. Raynaud disease 3. Degenerative joint disease 4. Chronic edema

***1. Peripheral neuropathy Rationale: 1. Iontophoresis should be used with precaution in patients who have conditions involving decreased sensation (Cameron, p. 268; Bellew, p. 323). 2. Raynaud disease is not a precaution or contraindication for iontophoresis (Cameron, p. 268). 3. Degenerative joint disease may be associated with joint pain and inflammation, both of which could be indications for iontophoresis (Bellew, p. 319). 4. Chronic edema may be an indication for iontophoresis

A physical therapist should withhold resistive exercise for a patient who has which of the following laboratory test results? 1. Platelet count of 18,000/mm3 2. White blood cell count of 8000/mm3 3. Hemoglobin of 12 g/dL 4. International normalized ratio (INR) of 1

***1. Platelet count of 18,000/mm3 Rationale: 1. This is a very low platelet count. With a low platelet count, the patient's blood is not clotting properly and severe bleeding can occur. A patient will usually need a transfusion at this level, and exercise should be limited to just activities of daily living. A normal platelet count is 150,000-400,000/mm3. 2. A normal white blood cell count is an indicator of immune system function. Normal count is 4500-11,000/mm3, so this is at an acceptable level for resistance exercise. 3. The normal range for hemoglobin is 12-18 g/dL, and resistance training is typically acceptable even at a level of 10 g/dL 4. The international normalized ratio (INR) indicates blood's ability to clot. The normal range for people who are not taking anticoagulant medications is 0.9-1.1. When patients are at a higher risk of blood clots or have mechanical heart valves, they take anticoagulants to thin their blood, thus increasing their INR to a necessary range of 2-3.5. When the INR is over 3-3.5, the patient is at a higher risk of bleeding and it may be necessary to limit exercise

A patient who had a cerebrovascular accident 4 days ago is being taught to roll to the uninvolved side. Which of the following motions should the physical therapist advise the patient to AVOID? 1. Pushing against a supporting surface with the uninvolved foot. 2. Lifting the head from the surface to assist with movement initiation. 3. Using the uninvolved arm to assist bringing the involved arm forward. 4. Positioning the involved lower extremity over the uninvolved extremity.

***1. Pushing against a supporting surface with the uninvolved foot. Rationale: 1. Pushing against a supporting surface with the uninvolved foot will encourage extension of the trunk when rolling. The patient should be taught motions that encourage flexion of the trunk. 2. Lifting the head from the surface to assist with movement initiation will help with the induction of flexion of the trunk. 3. Using the uninvolved arm to assist bringing the involved arm forward should occur to protect the uninvolved arm. 4. Positioning the involved lower extremity over the uninvolved extremity is an appropriate motion to begin the training process to encourage flexion of the trunk.

A patient sustained a T10 complete spinal cord injury. Which of the following wheelchair-to-bed transfer techniques is MOST appropriate for the patient? 1. Sit pivot 2. Sliding board 3. Standing pivot 4. Mechanical lift

***1. Sit pivot Rationale: 1. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They may initially use a sliding board to assist transfers, but in the long term they should be able to independently perform a sit pivot transfer.

A patient who has chronic obstructive pulmonary disease reports severe shortness of breath after walking 80 ft (24.4 m). Which of the following positions will BEST relieve the patient's dyspnea? 1. Sitting with forward arm support 2. Supine with the feet elevated 3. Sitting with the feet elevated 4. Standing with good posture

***1. Sitting with forward arm support Rationale: 1. Forward supported sitting is a common position for dyspnea relief. This position increases the intraabdominal pressure, improving the length-tension relationship of the diaphragm, and allows accessory muscle use.

A patient presents with moderate pain in the elbow after a fall. The radiograph is negative for a fracture. Which of the following mobilizations is MOST appropriate for decreasing the pain? 1. Small-amplitude oscillations before the onset of tissue resistance 2. Small-amplitude oscillations into tissue resistance 3. Large-amplitude oscillations into tissue resistance 4. Large-amplitude oscillations at the end of tissue resistance

***1. Small-amplitude oscillations before the onset of tissue resistance Rationale: - Small-amplitude oscillations before the onset of tissue resistance are appropriate for pain modulation.

During the test in the photograph (patellar reflex), the patient demonstrates hyperreflexia. What is the MOST likely cause of this finding? 1. A spinal cord tumor at L1 2. A herniated nucleus pulposus at L4 3. Femoral nerve impingement 4. A cauda equina lesion

***1. Spinal cord syndrome at L1 Rationale: 1. Pressure on the spinal cord at L1 would cause signs of upper motor neuron lesions below this level. A sign of upper motor neuron lesion is hyperreflexia. (p. 1494) 2. A weak or absent patellar reflex is expected with nerve root L4 compression (p. 1494). 3. Peripheral nerve injuries, such as a femoral nerve impingement, would result in a diminished patellar reflex (pp. 96-97). 4. Peripheral nerve injuries, such as a cauda equina lesion, would result in a diminished patellar reflex

A physical therapist is working with a patient who had a total knee arthroplasty 2 days ago. The patient's resting electrocardiogram is shown in strip A. While gait training, the patient's electrocardiogram changes, as shown in strip B (ST Segment depression). Based on this finding, what is the BEST action for the therapist to take at this time? 1. Stop gait training and notify the nurse. 2. Continue gait training, because the heart rate is less than 100 bpm. 3. Stop gait training and allow the patient to sit down and rest. 4. Continue gait training, but allow the patient standing rest breaks.

***1. Stop gait training and notify the nurse. Rationale: - The electrocardiogram change shows 3-mm ST depression, which is indicative of cardiac ischemia and is an indication to stop exercise and notify medical staff.

Which of the following interventions is MOST appropriate for an individual who has multiple sclerosis? 1. Submaximal exercise performed in the morning 2. Swimming exercises performed in a heated indoor pool 3. Resistance exercise alternating each day between upper and lower body workouts 4. Maximal exercise to the point of fatigue with several days of rest between training sessions

***1. Submaximal exercise performed in the morning Rationale: 1. Persons with multiple sclerosis are susceptible to fatigue and heat intolerance. Submaximal exercises at moderate intensity (50% to 70%) are tolerated well. In addition, exercising in the morning is recommended because the body's core temperature is lowest at this time. 2. Persons with multiple sclerosis should take precautions to manage core body temperature and prevent overheating. Swimming in a heated pool could result in overheating and an increase in fatigue. 3. Because persons with multiple sclerosis are susceptible to fatigue, circuit training alternating work between upper and lower extremities is recommended during one training session. Performing upper extremity resistance exercise one day followed by lower extremity resistance exercise is more likely to result in increased fatigue. 4. Persons with multiple sclerosis are susceptible to fatigue. Submaximal exercises at moderate intensity (50% to 70%) are more appropriate.

A physical therapist examines a right-handed patient who demonstrates a rounded upper back and protracted shoulders. The patient may be at INCREASED risk for developing which of the following conditions in the left upper extremity? 1. Thoracic outlet syndrome 2. Carpal tunnel syndrome 3. Paresthesia in an ulnar nerve distribution 4. Lateral epicondylalgia

***1. Thoracic outlet syndrome Rationale: - Anterior scalene or pectoralis minor tightness from this posture can impinge the neurovascular bundle, causing thoracic outlet syndrome (p. 331).

Which of the following splints is appropriate to use for treatment of de Quervain disease? 1. Thumb spica 2. Posterior long arm 3. Ulnar gutter 4. Wrist cock-up

***1. Thumb spica Rationale: 1. A thumb spica is frequently used for immobilization of the thumb (1st digit) for 3 weeks when treating de Quervain disease 2. A posterior long arm splint does not immobilize the thumb (1st digit). Long arm casting is often used to immobilize the forearm in patients who have a Smith fracture (p. 856). Immobilization of the thumb (1st digit) is used when treating de Quervain disease 3. An ulnar gutter splint is used on the ulnar side of the wrist, whereas de Quervain disease affects the radial side 4. A wrist cock-up splint is typically used for carpal tunnel syndrome and would not immobilize the thumb (1st digit)

A patient is initiating a pelvic floor strengthening program. Which of the following positions would be considered gravity assisted? 1. Trendelenburg 2. Sitting 3. Quadruped 4. Standing

***1. Trendelenburg Rationale: 1. The Trendelenburg position, with the hips positioned higher than the heart, is considered a gravity-assisted position for this exercise, given the location of the pelvic floor muscles and the action of these muscles when tightened, which pull upward toward the abdomen. 2. The sitting position is a progression to improve strength and proprioception of the pelvic floor muscles. Gravity will be working against the pelvic floor. 3. The quadruped position is a progression to improve strength and proprioception of the pelvic floor muscles. 4. The standing position is a progression to improve strength and proprioception of the pelvic floor muscles. Also, this would be considered the gravity position.

A patient who is a waiter has hand pain when carrying trays overhead. Which of the following nerve tension tests is MOST likely to have a positive result? 1. Ulnar 2. Median 3. Radial 4. Musculocutaneous

***1. Ulnar Rationale: - The overhead positioning of carrying food trays is similar to the end position of the ulnar nerve tension test. The tension test for the ulnar nerve includes shoulder depression, abduction, and lateral (external) rotation; elbow flexion; forearm pronation or supination; and wrist and finger extension.

During a gait training session, a patient who has Parkinson disease exhibits freezing episodes when attempting to negotiate turns. Which of the following training methods would be MOST beneficial for the patient? 1. Visual cue on the floor 2. Video of correct turning 3. Feedback at the end of the session 4. Blocked practice of turns

***1. Visual cue on the floor Rationale: - Visual stimuli have been shown to be effective in overcoming freezing episodes in patients who have Parkinson disease. Parkinson disease causes a deficit in proprioception for which visual cues may compensate.

A physical therapist is examining a patient who reports decreased walking endurance. The therapist notes that the muscles of the L4 myotome weaken after the patient holds the muscle contraction for 4 seconds. These findings are MOST likely due to: 1. a single nerve root lesion. 2. a central nervous system lesion. 3. femoral nerve compression. 4. central spinal stenosis.

***1. a single nerve root lesion. Rationale: 1. Findings for a single nerve root lesion may not be apparent on testing immediately but may emerge after a few seconds. 2. Central nervous system lesions typically are not manifested in this way. 3. Peripheral nerve injury will cause weakness that is discernible more quickly than weakness resulting from a single nerve root injury. 4. Peripheral nerve injury will cause weakness that is discernible more quickly than weakness resulting from a single nerve root injury.

A patient with no history of trauma has nonradiating low back pain. Lumbar flexion does not reverse the lordosis and is pain-free; lumbar extension increases the symptom. Palpation reveals a step-off in the lower lumbar region. The MOST appropriate treatment for this patient would be: 1. abdominal strengthening. 2. sustained prone positioning on elbows. 3. exaggerated lumbar lordosis in sitting. 4. grade III posteroanterior glide to L5.

***1. abdominal strengthening. Rationale: 1. This patient's signs and symptoms are consistent with spondylolisthesis. Abdominal muscle strengthening and stabilization are key to conservative management. 2. Extension activities are not indicated for a patient with spondylolisthesis. 3. Extension activities are not indicated for a patient with spondylolisthesis. 4. Extension activities are not indicated for a patient with spondylolisthesis.

A patient with diabetes had a right transtibial amputation 5 days ago. An advantage of a rigid removable dressing versus bandaging is that the rigid dressing: 1. allows for early weight bearing. 2. requires less monitoring. 3. allows applied pressure to be varied. 4. is less costly.

***1. allows for early weight bearing. Rationale: 1. A rigid dressing allows for early fitting of a prosthesis and weight-bearing and helps alleviate edema and pain, which is an advantage. 2. A rigid dressing requires more (not less) supervision because there is no access available to the incisions and the dressing is fabricated by the surgeon or prosthetist. As the residual limb heals, sutures are removed, and the limb changes shape, a new cast must be made. 3. Pressure cannot be varied when using a rigid dressing, unlike bandaging with an elastic wrap or shrinker. 4. A rigid dressing requires careful application by a skilled individual and, therefore, may be more costly. An elastic shrinker is a less expensive option.

The INITIAL rehabilitation program for a patient post coronary artery bypass surgery would consist of: 1. low-intensity walking. 2. lifting light weights. 3. low-level upper extremity ergometry. 4. stationary bike riding.

***1. low-intensity walking. Rationale: 1. Walking in hall is included as an initial activity in a Phase I treatment program 2. Resistance training should not begin until a minimum of 8 weeks after coronary artery bypass surgery 3. Arm activity, such as use of ergometer, is not appropriate for patients immediately after coronary artery bypass surgery. The activity is contraindicated due to incisional precautions. 4. Stationary bike riding is a higher-level aerobic activity that should not be the initial choice after coronary artery bypass surgery. Limitation or restriction of upper body activities, including unloading the upper extremities, is an important element in the initial rehabilitation program for a patient post coronary artery bypass graft. A patient who may lean on the handlebars would potentially place too much pressure on their sternal incision.

The BEST cleanser to use on a beefy, red wound is: 1. normal saline. 2. hydrogen peroxide. 3. Dakin's solution. 4. povidone-iodine.

***1. normal saline. Rationale: 1. Normal saline is an effective cleansing agent. 2. When a wound is suspected of being infected or having a bacterial colonization, irrigation with an antiseptic or antimicrobial is indicated. Saline is appropriate for a wound with no signs of infection. 3. When a wound is suspected of being infected or having a bacterial colonization, irrigation with an antiseptic or antimicrobial is indicated. Saline is appropriate for a wound with no signs of infection. 4. When a wound is suspected of being infected or having a bacterial colonization, irrigation with an antiseptic or antimicrobial is indicated. Saline is appropriate for a wound with no signs of infection.

A 90-year-old hospitalized patient was referred for physical therapy evaluation and intervention following a C5 fracture secondary to a fall. The patient describes neck pain and left knee pain but reports no other postinjury changes in the extremities. The rehabilitation prognosis for the patient should PRIMARILY be based on: 1. prior level of function. 2. left knee range of motion. 3. use of a cervical collar. 4. upper extremity sensory integrity.

***1. prior level of function. Rationale: 1. Understanding a patient's prior level of function is a critical factor to determine a reasonable prognosis, because this information establishes the baseline for recovery. 2. Although knee range of motion should be monitored, it is not more critical than prior level of function as a determinant of prognosis. 3. Although a cervical collar is a potential intervention, its use is not more critical than prior level of function as a determinant of prognosis. 4. Although upper extremity sensory integrity should be monitored, it is not more critical than prior level of function as a determinant of prognosis.

During manual muscle testing of the hip flexors in the sitting position, a patient exhibits lateral (external) rotation with abduction of the thigh as resistance is applied. The physical therapist should suspect muscle substitution by the: 1. sartorius. 2. tensor fasciae latae. 3. adductor longus. 4. semimembranosus.

***1. sartorius. Rationale: 1. The sartorius flexes, laterally (externally) rotates, and abducts the hip joint. With resisted hip flexion, the sartorius will be recruited to perform all three actions, giving the observed substitution pattern. 2. The tensor fasciae latae is a medial (internal) rotator and flexor of the hip, so substitution by it would involve medial (internal) rotation and abduction. 3. The adductor longus would adduct the hip. 4. Substitution by the semimembranosus would cause hip extension.

A physical therapist is designing a rehabilitation program for a patient who has a recent diagnosis of ankylosing spondylitis. The therapist should anticipate that as the disease progresses, the patient is MOST likely to require: 1. special precautions for osteoporosis. 2. a wheelchair for community mobility. 3. spinal surgery. 4. bilateral ankle-foot orthoses.

***1. special precautions for osteoporosis. Rationale: 1. Osteoporosis is a skeletal complication associated with long-standing ankylosing spondylitis. 2. Requiring a wheelchair is incorrect because the patient should still be able to walk, even with advanced stages of ankylosing spondylitis. 3. Spinal surgery has a very limited role in the treatment of ankylosing spondylitis. 4. Peripheral nerve dysfunction is not characteristic of ankylosing spondylitis. Orthoses to manage foot drop would not be expected in the plan of care for a patient who has ankylosing spondylitis

A physical therapist performs heart auscultation as part of a patient's cardiac systems review. The therapist hears a sound represented by "A" in the illustration (sound between S1 and S2). This sound is BEST described as a: 1. systolic murmur not considered to be normal. 2. normal heart sound occurring during systole. 3. diastolic murmur not considered to be normal. 4. normal heart sound occurring during diastole.

***1. systolic murmur not considered to be normal. Rationale: 1. S1 represents closure of the mitral and tricuspid valves, while S2 represents closure of the aortic and pulmonary valves. These are the only two heart sounds that should occur normally. Sounds occurring between S1 and S2 are considered systolic murmurs.

Following a partial-thickness burn over the entire anterior hip and anterior knee regions, the patient should be positioned with the hip in: 1. 0° of extension and the knee in 0° of extension. 2. 0° of extension and the knee in 20° of flexion. 3. 20° of flexion and the knee in 0° of extension. 4. 20° of flexion and the knee in 20° of flexion.

***2. 0° of extension and the knee in 20° of flexion. Rationale: 1. The knee should be flexed to prevent an extension contracture. 2. The hip should be neutral to prevent a flexion contracture. The knee should be flexed to prevent an extension contracture. 3. The hip should be neutral to prevent a flexion contracture. The knee should be flexed to prevent an extension contracture. 4. The hip should be neutral to prevent a flexion contracture.

Which of the following ultrasound parameters are MOST appropriate to treat a patient with a painful superficial Morton neuroma between the 2nd and 3rd metatarsals? 1. 1 MHz frequency with 0.79 in (2 cm) sound head 2. 3 MHz frequency with a 0.79 in (2 cm) sound head 3. 1 MHz frequency with a 1.97 in (5 cm) sound head 4. 3 MHz frequency with a 1.97 in (5 cm) sound head

***2. 3 MHz frequency with a 0.79 in (2 cm) sound head Rationale: 2. Higher frequency waves do not penetrate as easily as lower frequency waves and, therefore, are better for treatment of superficial conditions. A smaller 2-cm sound head is better for small areas, such as between the metatarsals in a patient who has a Morton neuroma.

Which of the following factors is MOST linked to the development of osteoporosis and a greater risk of fracture? 1. Abnormally high body mass index 2. Abnormally low body mass index 3. Low cholesterol levels 4. Vegetarian diet or low intake of animal protein

***2. Abnormally low body mass index Rationale: 1. A high body mass index is not associated with osteoporosis. 2. Body build is related to bone fragility, with thin patients having less cortical bone and a higher risk for fracture. 3. High cholesterol levels and atherosclerosis are associated with loss of calcification of bone. 4. Meat protein and fat provide acid precursors, with higher animal protein proportions leading to more rapid femoral neck bone loss.

A physical therapist is examining the posterior aspect of the heels of a patient who has darkly pigmented skin. Which of the following findings would indicate the presence of a Stage 1 pressure injury? 1. An intact area of the skin that is black and leathery 2. An intact area of the skin that is warm and purple 3. A shallow crater with a moist wound bed 4. An intact blister with a boggy feel

***2. An intact area of the skin that is warm and purple Rationale: 1. This presentation would indicate the presence of eschar. A pressure injury with eschar cannot be staged (p. 135). 2. This presentation fits the National Pressure Ulcer Advisory Panel's definition of a Stage 1 pressure injury. Warmth and color change indicate pressure damage. Damaged skin may look purple rather than red in people with darkly pigmented skin. Intact skin indicates that the pressure injury is not deeper than Stage 1. (p. 112) 3. A shallow crater with a moist wound bed is characteristic of a Stage 2 pressure injury (p. 135). 4. An intact blister with a boggy feel is characteristic of a Stage 2 pressure injury

Which of the following conditions would MOST likely be experienced by a 7-year-old patient who has a tethered spinal cord? 1. Upper extremity hypertonicity 2. Bladder dysfunction 3. Blurred vision 4. Headache

***2. Bladder dysfunction Rationale: 1. Upper extremity hypertonicity is consistent with shunt dysfunction, not tethered cord 2. A tethered spinal cord occurs when adhesions anchor the spinal cord at the site of the lesion as individuals with spina bifida grow. The tethering of the spinal cord can result in rapidly progressive scoliosis, hypertonicity in the lower extremities, changes in gait, and changes in urologic function. 3. Blurred vision is consistent with shunt dysfunction, not tethered cord 4. Headache is consistent with shunt dysfunction, not tethered cord

A patient reports dizziness and frequent falls. Upon examination, the patient demonstrates constant vertical pendular nystagmus, abnormal smooth pursuit, and abnormal saccadic eye movements. The patient's symptoms are MOST likely caused by which of the following conditions? 1. Vertebrobasilar insufficiency 2. Central vestibular system lesion 3. Peripheral vestibular system lesion 4. Posterior semicircular canalithiasis

***2. Central vestibular system lesion Rationale: - 2. A patient who has a central vestibular system lesion, in particular a cerebellar lesion, may have pure vertical nystagmus that oscillates at equal speeds (pendular nystagmus). In addition, abnormal smooth pursuits and abnormal saccadic eye movements are symptoms associated with a central vestibular lesion.

Which of the following associated conditions places children with Down syndrome at GREATER risk for frequent respiratory infections? 1. Cervical instability 2. Chest muscle hypotonicity 3. Immune system dysfunction 4. Arrested alveolar development

***2. Chest muscle hypotonicity Rationale: 2. Respiratory tract infections are very common secondary to hypotonicity of the chest and abdominal muscles and contribute significantly to morbidity and mortality. Decreased muscle tone compromises respiratory expansion. (Goodman, p. 1163) Cardiopulmonary manifestations include poor ability to clear secretions from both upper and lower airways, resulting in greater susceptibility to pulmonary infections, and postural abnormalities that may lead to restrictive lung dysfunction in older children.

A patient sustained a C6 spinal cord injury (ASIA Impairment Scale B) 2 weeks ago. Which of the following techniques would be MOST effective to reduce the risk of deep venous thrombosis in the lower extremities? 1. Ankle pumps 2. Compressive stockings 3. Standing in a standing frame 4. Gastrocnemius-soleus stretch

***2. Compressive stockings Rationale: 1. Ankle pumps are an effective technique for reducing venous stasis and blood clots, but a patient with an ASIA Impairment Scale B injury would have sensory, but not motor function preserved below the neurological level and would be unable to actively perform active ankle pumps due to paraplegia 2. Compressive stockings are the most effective device to use for a patient with a cervical spinal cord injury who is unable to move the lower extremities and will have venous stasis due to the lack of "muscle pumping" action. The compressive stockings decrease the venous stasis and blood pooling and reduce the risk of blood clotting. 3. A standing frame would be useful for the prevention of osteoporosis and bone density loss. It is also useful for improving respiratory function but would not be the best method for preventing the development of deep venous thrombosis. 4. Gastrocnemius-soleus stretch may aide in some movement of blood in the lower extremities but is not the most effective means of reducing deep venous thrombosis formation

When performing manual lymphatic drainage, which of the following techniques is MOST appropriate to use? 1. Decongest the distal segments before progressing to the proximal segments. 2. Decongest the involved trunk quadrant before decongesting the involved limb. 3. Decongest proximal segments before decongesting the involved trunk quadrant. 4. Decongest distal portions of the involved limb before decongesting the involved trunk quadrant.

***2. Decongest the involved trunk quadrant before decongesting the involved limb. Rationale: 1. The goal of manual lymphatic drainage is to direct the lymphatics centrally. The progression is trunk quadrant first, followed by proximal to distal segments. 2. When performing manual lymphatic drainage, the therapist must decongest the involved trunk quadrant before decongesting the involved limb from proximal to distal locations. This is done to direct the flow of the lymphatics centrally toward the lymphatic ducts. 3. Lymphatic drainage is performed with the goal of directing the lymphatics centrally. If the therapist does not first decongest the trunk quadrants, the lymphatics will remain blocked. 4. Lymphatic drainage is performed with the goal of directing the lymphatics centrally. If the therapist does not first decongest the trunk quadrants, the lymphatics will remain blocked.

A patient who had a cerebrovascular accident 1 year ago walks independently using a standard cane. During heel strike (initial contact), the forefoot makes contact with the floor first. Which of the following reasons BEST explains this gait pattern? 1. Increased reciprocal movements 2. Excessive activity of the plantar flexors 3. Overactivity of the muscles in the lateral compartment 4. Noncontractile tissue tightness in the anterior aspect of the lower leg

***2. Excessive activity of the plantar flexors Rationale: 1. Excessive activity of the plantar flexors would position the foot into plantar flexion, which would result in a forefoot contact (O'Sullivan, p. 264). Increased reciprocal movements would not be a likely cause for this pattern. The velocity of the hemiparetic leg is usually decreased 2. Excessive activity of the plantar flexors would position the foot into plantar flexion, which may result in a forefoot contact (O'Sullivan, p. 264). Other causes for this gait include weak dorsiflexors, a decreased ability to perform fast reciprocal movements, and noncontractile soft tissue limitations of the plantar flexors 3. Overactivity of the muscles in the lateral compartment (the fibularis [peroneal] muscles) would result in increased eversion, not forefoot contact 4. Tightness would be in the posterior (not anterior) aspect of the lower leg (i.e., plantar flexors)

Which of the following cardiovascular exercise prescription guidelines would be MOST beneficial for a patient who has dyslipidemia? 1. Exercising at 40% to 80% of heart rate reserve, 3-4 times/week 2. Exercising at 40% to 80% of heart rate reserve, 5 or more times/week 3. Exercising at a rating of perceived exertion on the Borg scale of 11-14/20, 3-4 times/week 4. Exercising at a rating of perceived exertion on the Borg scale of 9-11/20, 5 or more times/week

***2. Exercising at 40% to 80% of heart rate reserve, 5 or more times/week Rationale: 2. The best evidence for reduction of lipid levels is to exercise at a moderate intensity of the 40% to 80% of the heart rate reserve 5 or more times/week (ACSM, p. 278).

Which of the following BEST describes the huffing technique of airway clearance? 1. Cough while holding a pillow against the chest. 2. Forcefully exhale while keeping the mouth open. 3. Forcefully exhale through pursed lips. 4. Take two normal breaths, then cough firmly on the third exhalation.

***2. Forcefully exhale while keeping the mouth open. Rationale: 1. Coughing while holding a pillow against the chest refers to splinting the incision and is most commonly used by surgical patients to reduce pain while coughing 2. Huffing consists of taking a deep inspiration followed by forceful exhalation with an open mouth 3. Huffing consists of taking a deep inspiration followed by forceful exhalation with an open mouth, not through pursed lips 4. Taking two normal breaths, then coughing firmly on the third exhalation is a controlled cough, not a huff

Which of the following skeletal conditions is NORMAL in a newborn infant? 1. Pes cavus 2. Genu varum 3. Genu valgum 4. Talipes equinovarus

***2. Genu varum Rationale: - At birth, an infant's knees are bowlegged (genu varum) to accommodate for the flexed position in utero. The legs and hips gradually straighten until they reach a neutral alignment between the first and second years.

A patient positioned in prone has difficulty initiating hip extension with the knee bent. Which of the following muscles will MOST likely need strengthening? 1. Hamstrings 2. Gluteus maximus 3. Lumbar erector spinae 4. Gluteus medius

***2. Gluteus maximus -2. The gluteus maximus is the primary hip extensor muscle tested in this manner

A physical therapist is teaching a patient who has hemiplegia to perform overhead reaching activities. Which of the following teaching methods is MOST likely to encourage retention of the skill? 1. Provide instructions while demonstrating the activity. 2. Have the patient perform multiple repetitions of the activity. 3. Demonstrate movements that should be avoided during the activity. 4. Passively move the patient's limb through multiple repetitions of the activity.

***2. Have the patient perform multiple repetitions of the activity. Rationale: 1. Instructions and demonstration assist the patient in learning what to do (p. 20). 2. When active movement is the desired outcome, active limb movement should be practiced repeatedly. This is the preferred strategy for better learning and retention in the associative stage of learning. (p. 21) 3. Practicing incorrect movement patterns can lead to negative learning (p. 25). 4. Continued guidance may result in the patient becoming dependent on the physical therapist

During auscultation of the chest wall, a physical therapist notes an area of decreased breath sounds. Which of the following additional findings would support the suspicion of consolidation? 1. Tympanic sound with percussion 2. Increased fremitus 3. Hypertrophy of accessory muscles 4. High-pitched wheezes

***2. Increased fremitus Rationale: 1. A tympanic sound with percussion may be heard over a hyperinflated chest (Frownfelter, p. 212). 2. Increased fremitus is palpated in the presence of an increase in secretions (Frownfelter, p. 212). 3. A person with chronic obstructive pulmonary disease might exhibit increased muscle activity in the respiratory accessory muscles (Frownfelter, p. 212). This would not typically be observed in a person with an increase in secretions. 4. The adventitious sound associated with consolidation would be crackles, not wheezing

A patient sustained a distal radius fracture involving the Lister tubercle 6 weeks ago. During a physical therapist's assessment, no limitation in passive range of motion in the thumb (1st digit) interphalangeal and metacarpophalangeal joints is found. What active thumb (1st digit) motion is MOST likely to be affected? 1. Interphalangeal flexion 2. Interphalangeal extension 3. Metacarpophalangeal flexion 4. Metacarpophalangeal adduction

***2. Interphalangeal extension Rationale: 1. The flexor pollicis longus acts on interphalangeal flexion. Although its proximal attachment is on the radius (Reese, p. 159), it does not wrap around the Lister tubercle. 2. The extensor pollicis longus wraps around the Lister tubercle (Biel, p. 118) and attaches distally on the dorsal side of the distal phalange of the thumb (1st digit) (Reese, p. 167). If a patient has a fracture to the distal radius and no other soft tissue restrictions are noted, then interphalangeal extension would be affected. 3. The flexor pollicis brevis acts to achieve thumb (1st digit) metacarpophalangeal flexion. The flexor pollicis brevis is part of the thenar eminence and does not wrap around the Lister tubercle. 4. The adductor pollicis acts to achieve thumb (1st digit) metacarpophalangeal adduction. The adductor pollicis is part of the thenar eminence and does not wrap around the Lister tubercle.

To address the illustrated impairment (Left PSIS Higher than Right PSIS), which of the following is an appropriate intervention for this patient? 1. Right unilateral manual traction 2. Isometric contractions of the left gluteus maximus 3. Lateral trunk-shift correction procedures 4. A mobilization procedure to anteriorly rotate the left innominate

***2. Isometric contractions of the left gluteus maximus Rationale: 1. This patient has an uneven posterior superior iliac spine, suggesting iliosacral dysfunction. Traction performed unilaterally is more often used for treating hip impairments. 2. Isometric contraction of the left gluteus maximus is a muscle energy technique that is indicated with iliosacral dysfunction involving an anteriorly rotated innominate 3. Lateral trunk-shift is associated with disc-related back pain or sciatica (pp. 1451, 1484). The photograph indicates iliosacral dysfunction. 4. A mobilization procedure to anteriorly rotate the left innominate is inappropriate. The photograph suggests an anterior position of the innominate.

A patient reports back pain with radiating pain to the anterior right thigh. The pain increases with passive flexion of the knee in prone position. Which of the following nerve roots is MOST likely involved? 1. L1-L2 2. L2-L3 3. L4-L5 4. L5-S1

***2. L2-L3 Rationale: 2. The symptoms of pain radiating to the posterior thigh could implicate the L2-L3 nerve roots in association with a herniated lumbar disc. The action of knee flexion with the patient in a prone position is specific for placing tension or stretch on the L2 or L3 nerve root. If pain in the back or posterior thigh intensified with this maneuver, the L2-L3 nerve roots are most implicated. (p. 597)

A patient recovering from Guillain-Barré syndrome exhibits Poor (2/5) quadriceps strength. The BEST therapeutic exercise would be active knee extensions with which of the following parameters? 1. Multiple repetitions in sidelying, maximally stressing the quadriceps 2. Limited number of repetitions in sidelying, avoiding fatigue of the quadriceps 3. Limited number of repetitions in sitting, avoiding fatigue of the quadriceps 4. Multiple repetitions in sitting, maximally stressing the quadriceps

***2. Limited number of repetitions in sidelying, avoiding fatigue of the quadriceps Rationale: 1. In patients recovering from Guillain-Barré syndrome, overwork will delay recovery. 2. In patients recovering from Guillain-Barré syndrome, overwork and fatigue should be avoided. 3. In patients recovering from Guillain-Barré syndrome, poor strength would prohibit knee extension against gravity. 4. In patients recovering from Guillain-Barré syndrome, overwork will delay recovery, and poor strength would prohibit knee extension against gravity.

When working with a patient who has tuberculosis, which of the following options BEST describes the appropriate location for treatment and type of personal protective equipment that a physical therapist should wear? 1. Therapy gym, N-95 respirator 2. Patient's room, N-95 respirator 3. Therapy gym, standard mask 4. Patient's room, standard mask

***2. Patient's room, N-95 respirator Rationale: 2. Because of the nature if its transmission, tuberculosis necessitates airborne precautions. Airborne precautions require the health professional to wear an N-95 respirator (Fairchild, p. 35). Airborne precautions also specify that the patient should stay in an airborne-infection-isolation room to prevent the spread of tuberculosis through the facility's ventilation system (Minor, pp. 94-95). If a patient who has tuberculosis is treated in the physical therapy gym, others in the environment will be exposed to tuberculosis.

When providing patient education in cardiac rehabilitation, which of the following signs and symptoms of exertional intolerance should the physical therapist emphasize? 1. Anginal pain, insomnia, sudden weight gain, leg stiffness 2. Persistent dyspnea, dizziness, anginal pain, sudden weight gain 3. Persistent dyspnea, anginal pain, insomnia, weight loss 4. Anginal pain, confusion, leg numbness, weight loss

***2. Persistent dyspnea, dizziness, anginal pain, sudden weight gain Rationale: 1. Leg stiffness is not a sign/symptom associated with exercise intolerance among patients undergoing cardiac rehabilitation. 2. The signs and symptoms listed in this option are associated with exercise intolerance among patients undergoing cardiac rehabilitation. 3. Weight loss is not a sign associated with exercise intolerance among patients undergoing cardiac rehabilitation. However, angina and dyspnea are important signs of exercise intolerance. 4. Leg numbness, confusion, and weight loss are not associated with exercise intolerance. However, angina is important to note in the patient who has cardiac dysfunction.

A patient has an acute grade I sprain of the acromioclavicular joint. Which of the following activities would be MOST painful for the patient to perform? 1. Reaching behind the back to tuck in a shirt 2. Reaching across the chest and scratching the opposite shoulder with the hand 3. Opening a car door 4. Using both hands to lift a 10-lb (4.5-kg) bag of groceries from the floor to a waist-high table

***2. Reaching across the chest and scratching the opposite shoulder with the hand Rationale: 2. Reaching across the chest and scratching the opposite shoulder with the hand is the correct response since active and passive movements in the extreme ranges of motion, especially elevation of the shoulder above 90° and horizontal adduction, reproduce acromioclavicular joint pain in patients who have sprains or degenerative joint disease.

An outpatient physical therapist is working with a patient who suddenly demonstrates repetitive and rhythmic head and neck movements and has an unfocused stare. Which of the following actions should the therapist perform FIRST? 1. Call emergency medical services. 2. Remove objects from the immediate area. 3. Place a tongue depressor in the patient's mouth. 4. Hold the patient's head and neck still.

***2. Remove objects from the immediate area.

A patient who has severe bilateral hip and knee flexion contractures requires the assistance of two people for bed-to-chair transfers. The patient demonstrates normal dynamic sitting balance and Normal (5/5) upper body strength. The patient lives at home with one caregiver. The physical therapist's FIRST intervention should be to teach which of the following transfers? 1. Use of a mechanical lift operated by the caregiver 2. Sliding-board transfer performed by the patient with assistance from the caregiver 3. One-person lift transfer performed by the caregiver 4. One-person stand pivot transfer performed by the patient with assistance from the caregiver

***2. Sliding-board transfer performed by the patient with assistance from the caregiver Rationale: - With normal sitting balance and normal upper body strength, this patient should be able to participate significantly with transfers, thereby easing much of the strain on the caregiver and allowing transfers to be done with assistance of only one person.

Which of the following gait parameters are MOST important for independence in community mobility for an individual who had a cerebrovascular accident? 1. Stride length and knee flexion strength 2. Speed and knee extension strength 3. Endurance and knee flexion strength 4. Stride length and ankle dorsiflexion strength

***2. Speed and knee extension strength Rationale: 2. Gait velocity and knee extension control were found to be highly predictive parameters of gait performance.

Which of the following conditions is MOST likely to be associated with the presence of spastic bowel dysfunction in a patient? 1. Myelomeningocele at S2-S3 2. Spinal cord injury at T10 3. Spinal muscular atrophy 4. Cauda equina tumor

***2. Spinal cord injury at T10 Rationale: 1. Spina bifida (myelomeningocele) is a disorder of the spinal cord (Umphred, pp. 419-420). Patients who have an injury below S2-S4 would have a flaccid bowel, not a spastic bowel 2. Spastic bowel occurs in patients who have a spinal cord lesion above S2 (O'Sullivan, p. 894). The T10 level is above S2. 3. Spastic bowel occurs in patients who have a spinal cord lesion above S2 (O'Sullivan, p. 899). Spinal muscular atrophy affects motor neurons and is characterized by limb and trunk weakness, hypotonia, and areflexia 4. Spastic bowel occurs in patients who have a spinal cord lesion above S2 (O'Sullivan, p. 899). Individuals who have cauda equina injuries exhibit areflexic bowel dysfunction

A home health physical therapist conducts an initial evaluation of a patient who sustained a tibial plateau fracture. The patient's status is non-weight-bearing, and the patient uses a walker. The patient lives alone, but has a neighbor who helps with meals. With which of the following aspects of the home environment should the therapist be MOST concerned? 1. Depth of the bathtub 2. Steps without a handrail 3. Width of the doorways 4. Height of the countertops

***2. Steps without a handrail Rationale: 1. The patient will require a shower seat, so depth of bathtub is not the primary aspect of concern. 2. Ascending and descending stairs with a walker should be performed only when a handrail is available and all of the feet of the walker fit on the stair treads. Instruction without a handrail should be reserved for emergency situations only. 3. The walker can be used sideways through a narrow doorway. 4. Because the neighbor is helping with meals, the height of the countertop is not relevant.

After a kidney transplant, a patient develops a Stage 3 pressure injury over the sacrum and is referred to physical therapy for wound care. Which of the following is the MOST appropriate agent to use initially on this wound? 1. Povidone-iodine solution 2. Sterile normal saline 3. Silver sulfadiazine (Silvadene) cream 4. Zinc oxide cream

***2. Sterile normal saline Rationale: 1. Povidone-iodine is usually used as a skin preparation to prevent surgical site infection. It can be used in acute traumatic wounds. A Stage 3 pressure injury is an example of a chronic wound. (Sussman, p. 518) 2. Sterile normal saline is the appropriate initial agent used to clean a wound (Sussman, p. 518). 3. Use of silver sulfadiazine may be indicated if infection is present. However, it is not indicated in the initial treatment. (Sussman, p. 513) 4. Zinc oxide is used in dental fillings and in local surface treatment for various skin disorders but not for chronic pressure injuries

Which of the following tests would MOST likely produce symptoms if the pain was due to restricted mobility of the tibial nerve? 1. Contractile test of the hamstrings with the knee at 90° 2. Straight leg raises with 10° of ankle dorsiflexion 3. Prone knee flexion with 35° of ankle plantar flexion 4. Repeated lumbar extension in standing

***2. Straight leg raises with 10° of ankle dorsiflexion Rationale: 1. Dorsiflexion, foot eversion, and toe extension stress the tibial branch. A resisted hamstrings test will not tension the tibial nerve. 2. Straight leg raises with ankle dorsiflexion, foot eversion, and toe extension will tension the tibial nerve. 3. Prone knee flexion will tension the femoral nerve. 4. Dorsiflexion, foot eversion, and toe extension stress the tibial branch. Repeated lumbar extension in standing position is not a test that will tension the tibial nerve.

Which dermatome is associated with the area that includes the umbilicus? 1. T3 2. T10 3. L1 4. L3

***2. T10 Rationale: 1. The T3 dermatome is closer to the nipple line (p. 135). 2. The T10 dermatome includes the umbilicus (p. 268).

A physical therapist is working with a patient who has pneumonia and who exhibits symptoms of respiratory distress while walking. Which of the following signs is the patient MOST likely to exhibit? 1. Bradypnea 2. Tachypnea 3. Sternal protraction 4. Symmetrical chest expansion

***2. Tachypnea

While examining a patient with left-sided low back pain, a physical therapist notes that the left sacral sulcus is deeper and the left anterior superior iliac spine is more superior than the right. Which of the following is the MOST likely explanation for this finding? 1. The patient has a left innominate upslip. 2. The patient's left innominate has rotated posteriorly. 3. The patient has a left innominate downslip. 4. The patient's left innominate has rotated anteriorly.

***2. The patient's left innominate has rotated posteriorly. Rationale: 1. Although an upslip would likely cause the anterior superior iliac spine to be superior on the left, it would also create a shallowness of the left sacral sulcus 2. With a left innominate posterior rotation, the left sulcus becomes deeper and the left anterior superior iliac spine is more superior 3. A left innominate downslip would likely produce a low left anterior superior iliac spine along with the left sulcus being deeper 4. Anterior rotation of the innominate would cause an ipsilateral shallow sulcus and a low and posterior position of the anterior superior iliac spine

A physical therapist plans to use autolytic debridement to treat a patient's shallow, dry, partly necrotic leg wound. Which of the following dressings is MOST appropriate for this wound? 1. Hydrofiber dressing 2. Transparent film 3. Enzymatic agent 4. Foam dressing

***2. Transparent film Rationale: 1. Hydrofibers are alginate-like in appearance and are activated by moisture in the wound. They are used for wounds with heavy exudate. The wound described is dry. 2. A dry wound will be best autolytically debrided by using a transparent film dressing 3. Enzymes are not used in autolytic debridement 4. A foam dressing is best used for a moist, draining wound

Which of the following movement patterns is MOST likely to be present in a patient who exhibits abdominal paradoxical breathing? 1. Synchronous upward and outward motion of the abdomen and upper chest 2. Upward and outward motion of the upper chest and inward motion of the abdomen 3. Upward and outward motion of the abdomen and inward motion of the upper chest 4. Excessive upper chest motion with decreased use of the sternocleidomastoid and scalene muscles

***2. Upward and outward motion of the upper chest and inward motion of the abdomen Rationale: 2. Upward and outward motion of the upper chest and inward motion of the abdomen indicates an abdominal paradoxical breathing pattern (Chaitow, p. 105). Patients who have paralyzed or weak intercostal/abdominal muscles can develop a specific type of compensatory breathing pattern. These patients counterbalance the strength of the diaphragmatic inferior pull by using their sternocleidomastoid muscles and possibly their scalene, trapezius, and pectoralis muscles. Allowing for superior and possibly some anterior and lateral expansion of the chest wall, this compensatory pattern minimizes the collapse of the upper chest that is observed in paradoxical breathing

A patient is referred to physical therapy with a diagnosis of myositis ossificans in the quadriceps muscle after sustaining a contusion. The MOST appropriate treatment for the patient is: 1. progressive resistance exercises through full range. 2. active range of motion in the pain-free range. 3. passive range of motion into resistance. 4. transverse friction massage.

***2. active range of motion in the pain-free range. Rationale: 2. Once rehabilitation can begin, initial treatment is geared toward range of motion

Elevating a patient's lower extremity for less than 1 minute produces a noticeable pallor of the foot, followed by delayed reactive hyperemia in a dependent position. These signs are indicative of: 1. an intact circulatory system. 2. arterial insufficiency. 3. venous insufficiency. 4. thrombophlebitis.

***2. arterial insufficiency.

An appropriate long-term goal for a young adult with a C6 spinal cord injury and no additional complicating factors is: 1. propelling a standard wheelchair on level surfaces with moderate assistance. 2. completing sliding board transfers to a level surface independently. 3. completing a respiratory muscle exercise program with minimal assistance. 4. sitting on the edge of the bed without arm support independently.

***2. completing sliding board transfers to a level surface independently. Rationale: 1. A patient who has a C6 spinal cord injury can independently (without requiring moderate assistance) propel a manual wheelchair and negotiate mild obstacles, such as 1:12 grade ramps and 2-4 inch (5-10 cm) curbs. 2. A patient who has a C6 spinal cord injury can independently perform sliding board transfers. 3. A patient who has a C6 spinal cord injury can complete a respiratory breathing muscle exercise program without assistance. 4. A patient who has a C6 spinal cord injury will need upper extremity support to sit.

A physical therapist has been treating a female patient with low back pain for 6 weeks. The patient reports that the pain seemed to lessen earlier in the course of treatment but has intensified again in the past week. To help identify a systemic cause for the pain, the therapist should ask the patient whether the pain: 1. decreases when she lies down. 2. corresponds with her menstrual cycle. 3. increases when she is driving to work. 4. increases when she has a bowel movement.

***2. corresponds with her menstrual cycle.

A physical therapist can perform a quick, nonspecific functional assessment of shoulder abduction and lateral (external) rotation by instructing the patient to use the arm being tested to reach: 1. across the chest and touch the contralateral shoulder. 2. overhead and touch the superior medial border of the contralateral scapula. 3. up and touch the ipsilateral shoulder. 4. behind the back and touch the inferior angle of the contralateral scapula.

***2. overhead and touch the superior medial border of the contralateral scapula. Rationale: 2. Reaching overhead and touching the superior medial border of the contralateral scapula requires normal shoulder abduction and external (lateral) rotation.

While walking with a prosthesis, a patient with a right transtibial amputation fails to flex the right knee in early stance. This gait pattern is MOST likely due to excessive: 1. dorsiflexion of the prosthetic foot. 2. posterior displacement of the socket relative to the foot. 3. medial displacement of the socket relative to the foot. 4. lateral rotation of the prosthetic foot

***2. posterior displacement of the socket relative to the foot. Rationale: 1. Excessive dorsiflexion will result in knee instability. 2. Excessive knee hyperextension (or failure to flex the knee) can be due to a socket that is too posterior to the foot. 3. Medial displacement of the socket relative to the foot can result in the prosthetic foot leaning medially (internally). 4. Lateral placement of the prosthetic foot can lead to increased step width.

Which of the following monofilament grades indicates that only protective sensation is intact? 1. 3.61 2. 4.37 3. 5.07 4. 6.65

***3. 5.07 Rationale: 1. Ability to sense the 3.61 monofilament indicates fully normal sensation. 2. Ability to sense the 4.37 monofilament indicates fully normal sensation. 3. The 5.07 monofilament supplies the least amount of force that can be sensed by patients with only protective sensation intact. 4. Ability to sense only the 6.65 monofilament indicates a loss of protective sensation.

A physical therapist is performing a supine hamstring stretch on a patient who has a T5 level spinal cord injury. The patient describes a pounding sensation in the ear. What should the therapist do FIRST? 1. Roll the patient to the left side. 2. Take the patient's blood pressure. 3. Bring the patient to an upright position. 4. Notify the patient's physician for immediate medical attention.

***3. Bring the patient to an upright position. Rationale: 3. A pounding sensation in the ear in a patient with a spinal cord injury above the level of T6 is indicative of autonomic dysreflexia. With autonomic dysreflexia, the patient's blood pressure will be elevated and the patient should be brought to an upright position to lower the blood pressure.

For a patient who takes a thiazide medication (hydrochlorothiazide), which of the following combinations of signs may indicate an adverse effect of the medication? 1. Agitation, dizziness, dyspnea, and hyperventilation 2. Abdominal cramps, agitation, dyspnea, and numbness 3. Clammy skin, dizziness, hyperventilation, and hypotension 4. Abdominal cramps, clammy skin, hypotension, and numbness

***3. Clammy skin, dizziness, hyperventilation, and hypotension Rationale: 3. Thiazide diuretics enhance secretion of sodium and potassium in the urine, leading to hyponatremia and hypokalemia (Ciccone, p. 319). Clammy skin and hypotension are signs of hyponatremia, and dizziness and hyperventilation are signs of hypokalemia (Goodman, p. 207).

An elderly patient is being evaluated for discharge from an acute care setting. Prior to admission, the patient lived alone on the second floor of a building without an elevator and walked with the use of a cane. Currently, the patient performs bed mobility and stand pivot transfers with moderate assistance. The patient does not want to go to a transitional care facility for rehabilitation, and prefers to go home instead. Which of the following approaches is MOST appropriate for the physical therapist to take? 1. Recommend discharge to home with a home health aide during the day, and order all necessary equipment. 2. Clearly explain to the patient that the physician is the one who determines the type of facility to which the patient will be discharged. 3. Clearly explain to the patient that the goal of discharge to a transitional care facility is for short-term rehabilitation. 4. Recommend discharge to home with home physical therapy and community services, and order all necessary equipment.

***3. Clearly explain to the patient that the goal of discharge to a transitional care facility is for short-term rehabilitation.

Which of the following is the normal equilibrium response of a patient tilting side to side while seated on a rocker board? 1. Convexity of the trunk on the upward side with downward side protective extension 2. Concavity of the trunk and shoulder adduction on the upward side 3. Concavity of the trunk and shoulder abduction on the upward side 4. Convexity of the trunk and protective extension on the upward side

***3. Concavity of the trunk and shoulder abduction on the upward side Rationale:

Which of the following muscular responses would be expected during normal micturition? 1. Relaxation of the detrusor and relaxation of the pelvic floor 2. Relaxation of the detrusor and contraction of the pelvic floor 3. Contraction of the detrusor and relaxation of the pelvic floor 4. Contraction of the detrusor and contraction of the pelvic floor

***3. Contraction of the detrusor and relaxation of the pelvic floor Rationale: 1. If the detrusor does not contract, the result is incomplete bladder emptying. 2. Neither relaxation of the detrusor nor the contraction of the pelvic floor would allow for complete bladder emptying as expected in normal micturition. 3. The contraction of the detrusor acts to empty the bladder, while the relaxation of pelvic floor allows the urine to pass. 4. Contraction of the pelvic floor would limit the flow of urine.

A patient who is taking an angiotensin-converting enzyme (ACE) inhibitor is performing a therapeutic exercise program in a heated pool. Which of the following physiologic effects is MOST likely to occur in this scenario? 1. Cardiac arrhythmias 2. Increase in fluid retention 3. Decrease in blood pressure 4. Difficulty breathing

***3. Decrease in blood pressure

Which of the following blood pressure changes is an ABNORMAL response to increased exercise intensity and a reason to terminate exercise? 1. Decrease in diastolic blood pressure of 5 mm Hg 2. Increase in diastolic blood pressure of 5 mm Hg 3. Decrease in systolic blood pressure of 20 mm Hg 4. Increase in systolic blood pressure of 20 mm Hg

***3. Decrease in systolic blood pressure of 20 mm Hg

A patient had a positive result on the test shown in the photograph (posterior drawer of knee at 90 degrees flexion). What is the MOST likely mechanism of injury? 1. Hyperextension of the knee 2. Vertical compression through the tibia 3. Direct impact to the anterior proximal tibia 4. Direct impact to the lateral aspect of the fibula

***3. Direct impact to the anterior proximal tibia Rationale: 1. The posterior drawer test at 90° of knee flexion has been shown to be the most sensitive test for clinical assessment of the posterior cruciate ligament (Dutton, p. 1005). Extreme hyperextension of the knee can cause anterior cruciate ligament injury (Kisner, p. 803), not posterior cruciate ligament injury. 2. The posterior drawer test at 90° of knee flexion has been shown to be the most sensitive test for clinical assessment of the posterior cruciate ligament (Dutton, p. 1005). An activity that results in a very strong quadriceps contraction that coincides with sudden knee flexion, such as landing from a jump, can cause patellar tendon rupture (Kisner, p. 876), not posterior cruciate ligament injury. 3. The posterior drawer test at 90° of knee flexion has been shown to be the most sensitive test for clinical assessment of the posterior cruciate ligament (Dutton, p. 1005). Rupture of the posterior cruciate ligament is usually caused by a direct blow to the proximal tibia, a fall on the knee with the foot in a plantar flexed position, or hyperflexion of the knee 4. The posterior drawer test at 90° of knee flexion has been shown to be the most sensitive test for clinical assessment of the posterior cruciate ligament (Dutton, p. 1005). A direct impact to the outside of the knee can cause an anterior cruciate ligament injury (Kisner, p. 803), not posterior cruciate ligament injury.

A patient is seen in physical therapy after an arthroscopic debridement of the knee. Which of the following describes the optimal parameters for electrical stimulation to address an extensor lag noted during the examination? 1. Duty cycle of 50%; current intensity high enough to produce 40% of maximal voluntary isometric contraction; 20 minute total treatment time 2. Duty cycle of 20%; current intensity high enough to produce 40% of maximal voluntary isometric contraction; 20 minute total treatment time 3. Duty cycle of 20%; current intensity high enough to produce 60% of maximal voluntary isometric contraction; 10 minute total treatment time 4. Duty cycle of 50%; current intensity high enough to produce 60% of maximal voluntary isometric contraction; 10 minute total treatment time

***3. Duty cycle of 20%; current intensity high enough to produce 60% of maximal voluntary isometric contraction; 10 minute total treatment time Rationale: 1. A duty cycle of 50% is too high, the current intensity is too low, and the treatment time is too long 2. The duty cycle is correct (20%), but the current intensity is too low and the treatment time is too long 3. For strengthening with electrical stimulation the current intensity should be maximal, so 60% is the better answer when compared with 40% of maximal voluntary contraction. Also, the duty cycle should allow for the rest period to be 5 times as long as the hold cycle, so a 20% duty cycle is best. One treatment session should include at least eight contractions, so a 10-minute treatment time is best. 4. The duty cycle is too high in this example; more rest time is needed for muscle recovery

The person in the photograph is asked to perform a bilateral squat. Based on the rearfoot position (rearfoot pronation), which of the following will MOST likely be observed? 1. Genu varum with tibial medial (internal) rotation 2. Genu varum with tibial lateral (external) rotation 3. Genu valgus with tibial medial (internal) rotation 4. Genu valgus with tibial lateral (external) rotation

***3. Genu valgus with tibial medial (internal) rotation Rationale: - Pronation is associated with medial (internal) rotation of the tibia and resulting genu valgus.

A physical therapist is examining a patient who has multiple sclerosis. The patient sits for 12 hours/day with good spinal and pelvic alignment in a standard wheelchair with a foam cushion. The patient sleeps in a sidelying position. The patient's family reports that the patient has recently gained a considerable amount of weight. Which of the following areas is/are at GREATEST risk for skin breakdown? 1. Lateral malleoli 2. Sacrum 3. Greater trochanters 4. Scapulae

***3. Greater trochanters Rationale: 1. The skin over the malleoli is unlikely to be under pressure when the patient is sitting in the wheelchair. 2. Because the patient sits with good alignment, skin breakdown over the sacrum is not likely to occur. 3. With the patient's recent weight gain, the wheelchair armrests and/or frame may be putting pressure on the skin over the greater trochanters. The greater trochanters are also at risk when the patient is in sidelying position. 4. Because the patient sits with good alignment, skin breakdown over the scapulae is not likely to occur.

A patient who has emphysema reports a weight gain of 20 lb (9 kg) over the past month. There is 3+ pitting edema in both distal lower extremities. Which of the following tests is MOST important to identify the likely underlying condition? 1. Heart rate 2. Capillary refill 3. Heart auscultation 4. Ankle-brachial index

***3. Heart auscultation Rationale: 1. The patient has concerning symptoms suggestive of heart failure. Heart rate would not be most important measure because right ventricular heart failure is not associated with acute changes to heart rate. Right ventricular failure is due to the sustained elevation in pulmonary arterial hypertension. 2. Capillary refill is used to assess for surface arterial blood flow (Myers, p. 208). Edema is associated with venous insufficiency 3. The patient has concerning symptoms suggestive of heart failure. The classic signs include peripheral pitting edema, weight gain, jugular vein distention, diminished appetite, right upper quadrant discomfort, and a ventricular gallop (S3) heart sound (Hillegass, pp. 87, 98). Assessing the heart sounds would be of value for the medical diagnosis or for determining whether consultation with another health care professional is needed. 4. The ankle-brachial index is performed to assess for arterial disease and is designed to test the potential loss of profusion in the lower extremities. Clinical manifestations of arterial disease include pain, pallor, paralysis, diminished pulses, hair loss, and thin shiny skin. Venous insufficiency is represented by edema, hemosiderin staining of the skin, and normal arterial pulses. The patient could have secondary venous issues, but the ankle-brachial index would not be indicated as an additional testing measure.

Which of the following lower extremity proprioceptive neuromuscular facilitation patterns is MOST appropriate to strengthen a patient's weak tibialis posterior? 1. Hip extension, abduction, and medial (internal) rotation, with ankle plantar flexion and eversion 2. Hip flexion, adduction, and lateral (external) rotation, with ankle dorsiflexion and inversion 3. Hip extension, adduction, and lateral (external) rotation, with ankle plantar flexion and inversion 4. Hip flexion, abduction, and medial (internal) rotation, with ankle dorsiflexion and eversion

***3. Hip extension, adduction, and lateral (external) rotation, with ankle plantar flexion and inversion Rationale: 3. The tibialis posterior plantar flexes and inverts the foot. Hip extension, adduction, and lateral (external) rotation, with ankle plantar flexion and inversion requires the specific action of that muscle. (pp. 212-214, 854)

Which of the following clinical findings is MOST likely to be associated with a C7 nerve root lesion? 1. Pain in the medial aspect of the upper arm 2. Diminished light touch on the volar forearm 3. Inability to extend the elbow against gravity 4. Inability to supinate the forearm

***3. Inability to extend the elbow against gravity Rationale: 1. The medial side of the arm is innervated by C8 and T1 2. The volar surface of the entire arm is innervated by C5- C6 and T1 3. A C7 nerve root lesion will affect the triceps, which is an elbow extensor 4. The biceps and supinator (both responsible for supination of the forearm) are innervated by C5-C6

Which of the following conditions would MOST likely occur in a patient who has decreased production of insulin? 1. Accelerated fat metabolism 2. Accelerated protein synthesis 3. Increased thirst 4. Decreased urination

***3. Increased thirst Rationale: 1. Reduction of insulin production results in the opposite effect. Fat production is altered, and fat breakdown occurs to liberate more glucose. 2. Reduction of insulin production impairs protein synthesis because amino acid transport into cells requires insulin. 3. Reduction of insulin production results in large quantities of urine being excreted, resulting in excessive thirst. 4. Reduction of insulin production results in large quantities of urine being excreted.

What reaction is MOST likely being assessed in the photograph (infant being held prone/in airplane position)? 1. Moro reflex 2. Startle reflex 3. Landau reflex 4. Positive support reflex

***3. Landau reflex Rationale: 1. The Moro reflex is elicited by supporting the infant in a supine position, allowing the head to gently drop posteriorly in relation to the trunk, and assessing the response at the arms ( 2. The startle reflex is elicited by making a sudden loud or harsh noise and results in sudden extension or abduction of the upper extremities and crying 3. The Landau reflex/reaction is elicited by supporting the infant horizontally in prone position. The expected response is that the infant will extend the neck and trunk. 4. The positive support reflex/reaction is elicited by supporting the infant vertically with contact of the feet to a surface and assessing the lower extremity response

Which of the following clinical features is a CONTRAINDICATION to intermittent compression? 1. Past history of deep vein thrombosis 2. Impaired sensation 3. Local infection 4. Peripheral neuropathy

***3. Local infection Rationale: 1. Recent or acute deep vein thrombosis is a contraindication, but a past history or having a predisposition to deep vein thrombosis is not. 2. Impaired sensation is a precaution. 3. Infection may spread as a result of compression, and, therefore, infection is a clear contraindication. 4. Peripheral neuropathy is not a contraindication; it is a precaution.

In a patient with breast cancer, which of the following sites are the MOST common sites of metastasis? 1. Central and peripheral nervous systems 2. Liver and gastrointestinal tract 3. Lungs and bony skeleton 4. Spleen and pituitary gland

***3. Lungs and bony skeleton Rationale: 1. The central nervous system is a common metastatic site, but not the peripheral nervous system. 2. The liver is a common metastatic site, but not the gastrointestinal tract. 3. Lungs and bones are common metastatic sites for breast cancer. 4. Neither the spleen nor the pituitary gland is a common metastatic site for breast cancer.

During the examination of a patient who went on a hiking trip 1 week ago, a physical therapist notes neck stiffness and notices a red rash with partial central clearing on the patient's upper extremity. The therapist should suspect that the patient has which of the following conditions? 1. Meningitis 2. Herpes zoster 3. Lyme disease 4. Retropharyngeal abscess

***3. Lyme disease Rationale: 1. The history of the patient is inconsistent with the classic history of meningitis (pre-existing respiratory infection)(p. 235). 2. Herpes zoster (shingles) occurs in a dermatologic distribution and is characterized by burning pain (p. 260). 3. The history of this patient (hiking trip), symptoms (neck stiffness), and findings (rash) are consistent with Lyme disease (p. 236). 4. Retropharyngeal abscess usually occurs in children younger than 4 years old or is the result of trauma or dental infection (p. 240).

A patient has severe chronic obstructive pulmonary disease and bilateral knee osteoarthritis. During aquatic therapy involving slow walking, which of the following water levels is MOST appropriate for this patient? 1. Knees 2. Hips 3. Navel 4. Shoulders

***3. Navel Rationale: 1. Water level up to the navel would minimize knee compressive force to a greater extent than water level up to the knees, because more loading forces would be removed 2. Water level up to the navel would minimize knee compressive force to a greater extent than water level up to the hips 3. Patients who have knee arthritis often have difficulty and pain when walking on land. Due to buoyancy, ground reaction forces and knee joint forces are less during walking in the water, compared to these same forces while walking on land. The greater the amount of water displaced by the body, the less the ground reaction forces experienced, and the less force transmitted up the body through the ankles, knees, hips, and trunk. Therefore, as water depth increases and more of the body is immersed in water, knee compressive force decreases. This allows a patient who has knee arthritis to be able to walk in water with minimal difficulty and pain, even though the patient may be unable to walk without pain and difficulty on land. Water level up to the navel would minimize knee compressive force to a greater extent than water level up to the knees or hips 4. A water level to the shoulders could affect the ability of the lungs to expand

A patient displays a hand tremor at rest. The tremor has a regular rhythm of 4 to 7 beats/second. The patient MOST likely has which of the following conditions? 1. Cerebellar lesion 2. Multiple sclerosis 3. Parkinson disease 4. Tardive dyskinesia

***3. Parkinson disease Rationale: 1. Cerebellar lesions are associated with action tremors, which are absent at rest and elicited during muscle activation 2. Tremors are associated with multiple sclerosis but do not have a regular rhythm of 4 to 7 beats/second 3. Patients who have Parkinson disease display tremors at rest. The tremors have a rhythm of 4 to 7 beats/second. 4. Tremors are not associated with tardive dyskinesia

Which of the following strategies would be MOST appropriate when measuring the size and shape of a partial-thickness wound? 1. Hold a tape measure above the wound surface and measure the diameter. 2. Insert a cotton-tipped applicator into the wound at its deepest point and measure the distance from the wound bed to the level of the skin surface. 3. Place a sheet of plastic wrap on the wound and use a marking pen to draw a tracing of the wound's perimeter on the plastic. 4. Place normal saline in the wound, using a measured syringe to fill the wound to the level of the skin surface.

***3. Place a sheet of plastic wrap on the wound and use a marking pen to draw a tracing of the wound's perimeter on the plastic. Rationale: 1. This technique can be used to measure size, but it is not useful for measuring the shape of the wound 2. This technique can be used to measure depth but not to measure size and shape. It is not accurate and is difficult to reproduce measurements. A partial-thickness wound has no measurable depth. 3. This is the only option in the list that measures size and shape 4. This technique is used to measure wound volume, rather than size and shape. Volume measurement is of questionable value to clinicians. A partial-thickness wound has no measurable depth.

A patient is unable to reach behind the low back during activities of daily living. Muscle performance testing is pain-free, normal, and symmetrical. What is the MOST likely problem contributing to this functional impairment? 1. Subscapularis disorder 2. Pectoralis minor stiffness 3. Posterior capsular stiffness 4. Acromioclavicular joint arthrosis

***3. Posterior capsular stiffness Rationale: - Posterior capsular stiffness would decrease medial (internal) rotation, which is required for reaching the hand behind the back

A patient has a Mobitz type I (Wenckebach) second-degree heart block. Which of the following electrocardiogram findings would MOST likely be present? 1. Inverted P waves in leads I, II, and III 2. A uniform PR interval that exceeds 0.20 second 3. Progressive prolongation of the PR interval until one impulse is not conducted 4. Variable P waves that are not related to QRS complexes

***3. Progressive prolongation of the PR interval until one impulse is not conducted Rationale: 1. P wave inversion is indicative of a premature junctional complex, not a Mobitz type I heart block 2. A uniform but prolonged PR interval (greater than 0.20 second) describes first-degree heart block 3. Mobitz type I (Wenckebach) heart block is a progressive prolongation of the PR interval until one impulse is dropped and is not followed by a QRS complex 4. Variable P waves that are not related to QRS complexes describe third-degree heart block

Which of the following findings is MOST likely a negative prognostic indicator for surgical wound healing? 1. Bloody discharge on postoperative day 1 2. Clear and watery discharge on postoperative day 3 3. Purulent discharge on postoperative day 5 4. No discharge and a raised suture line on postoperative day 10

***3. Purulent discharge on postoperative day 5 Rationale: 1. Bloody discharge on postoperative day 1 is a normal response for a healing surgical wound. 2. Clear and watery discharge on postoperative day 3 is a normal response for a healing surgical wound. 3. A purulent exudate from a surgical wound site is an indication of infection and is a negative prognostic indicator for healing. 4. No discharge and a raised suture line on postoperative day 10 are consistent with a normal response for a healing surgical wound.

A patient demonstrates wrist drop and sensory loss in the region of the anatomical snuffbox. These signs are MOST likely due to an injury to what nerve? 1. Musculocutaneous 2. Median 3. Radial 4. Ulnar

***3. Radial Rationale: 1. The musculocutaneous nerve innervates the skin on the lateral side of forearm and the elbow flexors 2. The median nerve innervates the skin on the anterior surface of the hand and posterior tips of the lateral three fingers and the wrist flexor muscles, not the extensors 3. The radial nerve innervates the skin on the posterior surface of the arm, forearm, and hand, including the snuffbox, and the elbow and wrist extensors. When the latter are weak, the patient has wrist drop. 4. The ulnar nerve innervates the skin of the medial two fingers and the wrist flexors and hand muscles

Which of the following options BEST describes the mode of action of angiotensin-converting enzyme (ACE) inhibitors? 1. Reduction of heart rate and increase in cardiac contractility 2. Reduction of heart rate and decrease in cardiac contractility 3. Reduction of peripheral vascular resistance and increase in venous capacitance 4. Reduction of peripheral vascular resistance and decrease in venous capacitance

***3. Reduction of peripheral vascular resistance and increase in venous capacitance Rationale: 3. Angiotensin-converting enzyme inhibitors produce vasodilation, reduce peripheral vascular resistance, and increase venous capacitance (p. 472).

Which of the following test findings is MOST consistent with a diagnosis of idiopathic pulmonary arterial hypertension? 1. VO2 max of 25 mL/kg/minute 2. Cardiac index of 0.8 L/minute/m2 3. Right atrial pressure of 15 mm Hg 4. Six-minute walk test result of 1640 ft (500 m)

***3. Right atrial pressure of 15 mm Hg Rationale: 1. A VO2 max of 25 mL/kg/minute is associated with no to only mild impairments. This is unlikely to be observed in patients who have idiopathic pulmonary arterial hypertension. 2. A cardiac index of 0.8 L/min/m2 is inconsistent with this diagnosis. A lower cardiac index is expected. 3. A right atrial pressure of 15 mm Hg is indicative of idiopathic pulmonary arterial hypertension and is an indication for lung transplantation. Normal atrial pressures are 0-8 mm Hg. 4. The ability to walk 500 meters during a six-minute walk test is inconsistent with this diagnosis. This is a normal distance for this test.

An 8-year-old child who has Duchenne muscular dystrophy would MOST likely have which of the following examination findings? 1. Swayback posture and protraction of the scapulae 2. Hamstrings contractures and excessive hip extension 3. Standing lordotic posture and winging of the scapulae 4. Quadriceps contractures and excessive hip abduction

***3. Standing lordotic posture and winging of the scapulae Rationale: 3. No limitations in range of motion are typically noted before 5 years of age in children who have Duchenne muscular dystrophy. By age 8, the deficits listed would be clearly present. The normal lordotic standing posture is increased, and winging of the scapulae is seen as compensation to keep the center of mass behind the hip joint to promote standing ability. (p. 246)

Which of the following strategies for transfer training is MOST likely to be successful for a patient who has apraxia? 1. Give frequent and detailed verbal commands. 2. Provide the patient with written instructions. 3. Teach one component of the transfer at a time. 4. Have the patient practice transfers in a variety of settings and contexts.

***3. Teach one component of the transfer at a time. Rationale: 1. Patients with apraxia will not be able to use verbal cues or commands to make corrections. The physical therapist should use the shortest possible sentences, not detailed or complex commands. 2. Patients with apraxia have a great deal of difficulty following written or verbal instructions for movement. 3. When teaching a new task to a patient with apraxia, the task should be broken down into its component parts. One component is taught at a time, and the patient is physically guided through the task if necessary. 4. Patients with apraxia benefit from repetition of the task using the same approach in the same environment. It is helpful to use as normal an environment as possible.

A physical therapist is examining a patient following open reduction internal fixation of the distal tibia and fibula. The physical therapy examination reveals active range of motion of the involved ankle from 10° of dorsiflexion to 0° of plantar flexion. What phase of gait is MOST likely affected? 1. Heel strike (initial contact) 2. Midstance 3. Toe off (preswing) 4. Acceleration (initial swing)

***3. Toe off (preswing) Rationale: 1. At heel strike (initial contact), the ankle is in a neutral position, so only having 10° of movement at the ankle would not affect this phase of gait. 2. The ankle will move from plantar flexion to dorsiflexion during midstance, but the greatest plantar flexion occurs at toe off (preswing). 3. The greatest amount of plantar flexion is needed in the ankle during the toe off (preswing) phase of gait. The patient has 0° of plantar flexion, so this phase of gait would be most affected. 4. The ankle remains in a neutral position during acceleration (initial swing). Since the patient has 10° of dorsiflexion, this phase of gait would not be affected.

Which of the following patient factors would MOST increase the risk for an adverse drug reaction? 1. Male gender 2. Age 55 years 3. Use of herbal compounds 4. Presence of irritable bowel syndrome

***3. Use of herbal compounds Rationale: 1. Female gender is considered to be a risk factor for experiencing a serious adverse drug reaction. 2. Being over age 75 years is considered to be a risk factor for experiencing a serious adverse drug reaction. 3. Concomitant use of herbal compounds is considered to be a risk factor for experiencing a serious adverse drug reaction. 4. Hepatic or renal insufficiency, not irritable bowel syndrome, is considered to be a risk factor for experiencing a serious adverse drug reaction.

In an older adult patient, impaired proprioception may be a result of malabsorption of which of the following nutrients? 1. Potassium 2. Iron 3. Vitamin B12 4. Vitamin E

***3. Vitamin B12 Rationale: 1. Potassium helps regulate normal muscle contraction and would affect the heart, intestines, and respiratory tract, but would not primarily affect proprioception 2. Iron deficiency can occur secondary to blood loss, malabsorption, and pregnancy. Iron deficiency may produce symptoms of irritability, lack of exercise tolerance, and headaches, but not impaired proprioception 3. Intrinsic factor often declines with age. Intrinsic factor is a protein that helps the body absorb vitamin B12. When stomach secretions do not have enough intrinsic factor, vitamin B12 is not absorbed well. This results in pernicious anemia and other problems related to low levels of vitamin B12. Inadequate vitamin B12 gradually affects sensory and motor nerves, causing impaired proprioception to develop over time. These neurological symptoms are due to myelin degeneration and loss of nerve fibers in the dorsal and lateral columns of the spinal cord and cerebral cortex. 4. Vitamin E is a fat-soluble vitamin that is an important antioxidant. Lack of vitamin E would not be expected to result in impaired proprioception.

A patient had a brainstem stroke 2 months ago and is currently able to independently walk 65 ft (20 m) over level surfaces with a straight cane and ascend stairs with minimum assistance. Which of the following activities would MOST appropriately challenge this patient's balance during a physical therapy session? 1. Ascending stairs using a single handrail 2. Standing on one leg with eyes closed 3. Walking over uneven terrain 4. Walking 130 ft (40 m) with a straight cane

***3. Walking over uneven terrain Rationale: 3. Walking over uneven terrain is a good example of an impairment-based, task-specific, functional activity that will improve the patient's dynamic balance

A patient with evidence of nerve root involvement at the L4-L5 level would MOST likely have which of the following signs and symptoms? 1. Weak knee flexors, diminished Achilles tendon reflex, and paresthesia at the lateral aspect of the lower extremity 2. Weak foot intrinsics, diminished patellar tendon reflex, and paresthesia at the medial aspect of the knee 3. Weak ankle dorsiflexors, diminished patellar tendon reflex, and paresthesia at the medial calf and ankle 4. Weak ankle plantar flexors, diminished Achilles tendon reflex, and paresthesia at the lateral border of the foot

***3. Weak ankle dorsiflexors, diminished patellar tendon reflex, and paresthesia at the medial calf and ankle Rationale: 3. The L4 nerve root exits at the L4-L5 level. Weak ankle dorsiflexors, diminished knee jerk, and paresthesias along the medial calf and ankle are the only combination of signs and symptoms listed that could all be a result of L4 nerve root compromise.

A patient with evidence of lateral stenosis at the C7-T1 level would MOST likely have which of the following signs and symptoms? 1. Weak biceps, normal biceps reflex, and paresthesia in the thumb (1st digit) and index finger (2nd digit) 2. Weak deltoid, diminished biceps reflex, and paresthesia along the lateral aspect of the upper extremity 3. Weak thumb extensors and adductors, normal triceps reflex, and paresthesia in the little finger (5th digit) 4. Weak triceps, diminished triceps reflex, and paresthesia in the index, middle, and ring fingers (2nd to 4th digits)

***3. Weak thumb extensors and adductors, normal triceps reflex, and paresthesia in the little finger (5th digit) Rationale: 1. These signs and symptoms are associated with involvement of the C5-C6 nerve roots. 2. These signs and symptoms are associated with involvement of the C4-C5 nerve roots. 3. The C8 nerve root exits at the C7-T1 level, and the signs and symptoms listed in this option constitute the only combination that could only be attributed to involvement of the C8 nerve. 4. These signs and symptoms are associated with involvement of the C6-C7 nerve roots.

Appropriate knee positioning when strength testing the hamstrings in the prone position will minimize: 1. active insufficiency of the hamstrings and rectus femoris. 2. active insufficiency of the rectus femoris and passive insufficiency of the hamstrings. 3. active insufficiency of the hamstrings and passive insufficiency of the rectus femoris. 4. passive insufficiency of the hamstrings and rectus femoris

***3. active insufficiency of the hamstrings and passive insufficiency of the rectus femoris. Rationale: 3. Active insufficiency occurs when the agonist is shortened actively to a point that the actin and myosin do not have optimal contact for maximal contraction. Passive insufficiency occurs when the actin and myosin are overstretched, preventing optimal contraction. When testing the hamstrings with the patient in prone position, the hamstrings would have the tendency to become overly shortened (active insufficiency) because the hip is blocked from flexing. The quadriceps would be stretched over both the hip and knee joints (passive insufficiency).

While walking on a treadmill during Phase II cardiac rehabilitation following coronary artery bypass surgery, a patient reports the new onset of chest pain and dyspnea. The physical therapist should instruct the patient to: 1. continue walking while the therapist monitors the patient's vital signs. 2. continue walking at 50% slower speed while the therapist calls the physician. 3. cease walking while the therapist reassesses the patient's vital signs. 4. cease walking while the therapist activates the emergency medical system.

***3. cease walking while the therapist reassesses the patient's vital signs. Rationale: 1. The symptoms should be regarded as indicators of a worsening or new condition. 2. These symptoms do not constitute a medical emergency but do indicate onset of a new condition. These are indications to terminate exercise and reassess vital signs. 3. The patient's symptoms indicate the onset of a new condition. These are indications to terminate exercise testing and reassess vital signs. 4. These symptoms do NOT constitute a medical emergency.

The medical record indicates that a patient is taking a beta-blocker for a cardiac condition. The physical therapist should expect that this medication will: 1. decrease angina pectoris and increase blood pressure. 2. increase heart rate and lower blood pressure. 3. decrease heart rate and lower blood pressure. 4. decrease heart rate and increase oxygen demand.

***3. decrease heart rate and lower blood pressure.

A physical therapist should anticipate that an abnormal lymph node will feel: 1. soft and nonmobile and have an increased skin temperature. 2. firm and nontender and have an increased skin temperature. 3. firm, mobile, and tender or nontender. 4. soft, mobile, and tender or nontender.

***3. firm, mobile, and tender or nontender.

A patient reports a 2-day history of a hot, swollen, first metatarsophalangeal joint. This complaint is MOST common in: 1. osteoarthritis. 2. polymyositis. 3. gout. 4. rheumatoid arthritis.

***3. gout. Rationale: 1. Osteoarthritis is typically characterized by dull, achy pain in weight-bearing joints (e.g., hips, knees, etc.) (pp. 1304-1306). 2. Polymyositis presents as symmetric proximal muscle weakness with malaise and weight loss. There is no joint involvement. (p. 1247) 3. Gout's typical presentation is severe joint pain, occurring at night, typically in the first metatarsophalangeal joint. Signs and symptoms also include erythema, warmth, and extreme tenderness and hypersensitivity of the affected joint. (p. 1345) 4. Rheumatoid arthritis presents with symmetrical joint inflammation and pain with subluxations

An adult patient requests feedback on his health and wellness exercise program. The patient reports a weekly weight loss of 4.4 lb (2 kg)/week for the last 2 months and is utilizing a dietary intake of 900 kcal/day over the same time period. The BEST advice for the physical therapist to provide to this patient is to: 1. decrease dietary intake further to improve ability for greater weight loss. 2. keep intake and weight loss targets the same. 3. increase dietary intake and target a weight loss of no more than 2.2 lb (1 kg)/week. 4. increase dietary intake and exercise to preserve weight loss at 4.4 lb (2 kg)/week.

***3. increase dietary intake and target a weight loss of no more than 2.2 lb (1 kg)/week. Rationale: 3. Dietary intake should be adequate to allow weight loss of no more than 1 kg (2.2 lb)/week.

Which of the following ankle-brachial index values suggests arterial calcification? 1. 0.6 2. 0.9 3. 1.0 4. 1.4

***4. 1.4 Rationale: 4. Ankle-brachial index measures above 1.1 indicate arterial calcification. The calcification limits the compressibility of the artery.

Which of the following scenarios BEST illustrates a violation of the Health Insurance Portability and Accountability Act of 1996? 1. A physical therapist contacts a patient's physician to discuss the patient's progress without asking the patient for written consent to do so. 2. A physical therapist discusses a complicated case with a colleague while driving home together after work without first seeking the patient's consent. 3. A patient asks a physical therapist to release a copy of the evaluation and plan of care to an insurance carrier without providing written consent to do so. 4. A patient asks a physical therapist what surgery another patient underwent and is told that the second patient had a total knee arthroplasty 1 month ago.

***4. A patient asks a physical therapist what surgery another patient underwent and is told that the second patient had a total knee arthroplasty 1 month ago.

After completing stroke rehabilitation, a patient wants to resume volunteering in a local program serving meals. Which of the following examination tools will provide the MOST relevant information for the physical therapist to determine if this activity is possible? 1. A self-report checklist of performance of motor skills that are pre-requisite to meal serving 2. A performance assessment of simulated meal serving in the clinical environment 3. A self-report checklist based on a task analysis of actual steps required for participation 4. A performance assessment of meal serving in the natural environment

***4. A performance assessment of meal serving in the natural environment Rationale: 1. The self-report approach would be acceptable only if the performance approach was not feasible. 2. The clinical environment is not as desirable as the natural environment. 3. The self-report approach would be acceptable only if the performance approach was not feasible. 4. Whenever possible, it is most desirable for the examination to be performed under conditions as close to the actual ones as possible. This option is the closest to the actual conditions that the patient will experience.

If the test shown in the photograph (ULTT- radial nerve) has positive findings, which of the following muscles is MOST likely affected? 1. Pronator teres 2. Adductor pollicis 3. Pronator quadratus 4. Abductor pollicis longus

***4. Abductor pollicis longus Rationale: 1. The pronator teres is innervated by the median nerve (Magee p. 399). The nerve being stretched in the photograph is the radial nerve 2. The adductor pollicis is innervated by the ulnar nerve (Magee p. 399). The nerve being stretched in the photograph is the radial nerve 3. The pronator quadratus is innervated by the median nerve (Magee p. 399). The nerve being stretched in the photograph is the radial nerve 4. The nerve being stretched in the photograph is the radial nerve (Kisner p. 393). The abductor pollicis longus is innervated by the radial nerve (nerve roots C5-C8, T1). When the abductor pollicis longus is affected, loss of thumb (1st digit) abduction could result (Magee, p. 399).

A physical therapist examines a patient recovering from a gunshot wound affecting the left deep fibular (peroneal) nerve. To which surface of the lower leg should the therapist apply electrodes for biofeedback therapy? 1. Posteromedial 2. Posterolateral 3. Anteromedial 4. Anterolateral

***4. Anterolateral Rationale: 1. Muscles in the posteromedial aspect of the lower leg are supplied by the tibial nerve 2. Muscles in the posterolateral aspect of the lower leg are supplied by the superficial fibular (peroneal) nerve 3. Muscles in the anteromedial aspect of the lower leg are part of the posterior compartment and are supplied by the tibial nerve 4. Electrode placement during biofeedback should be as near to the muscle being treated as possible. The deep fibular (peroneal) nerve supplies muscles in the anterior compartment of the leg, most prominently the ankle dorsiflexors and toe extensors. The specific location of these muscles can best be described as anterolateral.

Which of the following factors has the GREATEST effect on closure and healing of an open wound? 1. Amount of wound drainage 2. Type of wound dressing 3. Overall size of the wound bed 4. Arterial perfusion to the wound area

***4. Arterial perfusion to the wound area Rationale: 1. The amount of wound drainage does not have as strong an effect on wound closure and healing as does the level of arterial perfusion to the wound area. 2. The type of wound dressing does not have as strong an effect on wound closure and healing as does the level of arterial perfusion to the wound area. 3. Although wound size can affect the time required to close a wound, it does not have as much effect as vascular patency in the body's ability to close a wound. Many factors affect the rate of wound healing (i.e., nutrition, wound environment, etc.), but the overall prognosis for ability to heal is worst when vascular flow is absent or severely diminished (e.g., with an ankle-brachial index of 0.5). 4. Adequate delivery of blood to the wound tissue is vital for healing and will determine the wound diagnosis and plan of care. Wounds in patients with an ankle-brachial index of 0.8 or greater (vascular arterial flow established) are likely to heal; those in patients with an ankle-brachial index of 0.5-0.8 are at high risk for nonhealing (vascular arterial flow diminished). Gangrenous changes are likely in patients with an ankle-brachial index of 0.5, and referral of these patients to a vascular surgeon is necessary to spare the limb.

Which of the following patient activities will BEST facilitate the goal of the mobilization being performed in the photograph (talocrural posterior mob)? 1. Performing heel raises while seated 2. Walking on tiptoes on level surfaces 3. Performing single limb stance activities 4. Ascending and descending stairs with a reciprocal pattern

***4. Ascending and descending stairs with a reciprocal pattern Rationale: 4. The photograph illustrates a posterior glide mobilization of the talus. This mobilization is intended to improve dorsiflexion at the ankle (Brody, p. 168). Therefore, the mobilization would be best augmented by exercises emphasizing active/passive dorsiflexion. Stair climbing requires dorsiflexion and plantar flexion movement. Normal dorsiflexion is 0° to 20°, and normal plantar flexion is 0° to 50°. Therefore, ascending and descending stairs is the best option

A patient who sits with a severely slumped forward posture may experience respiratory compromise due to which of the following factors? 1. Entrapment of the intercostal nerves with respiratory muscle weakness 2. Inability of the respiratory muscles to resist gravity 3. Hypermobility of the costovertebral joints 4. Compression of the diaphragm by abdominal contents

***4. Compression of the diaphragm by abdominal contents

A female patient had a radical mastectomy with axillary node removal. Which of the following signs would indicate initial development of lymphedema in the patient? 1. Increased blood pressure 2. Numbness in the antecubital fossa 3. Atrophy of the brachioradialis muscle 4. Decreased flexibility of the digits of the hand

***4. Decreased flexibility of the digits of the hand Rationale: 4. Decreased finger flexibility may be an initial sign of peripheral lymphedema

A patient reports audible clicking in the temporomandibular joint while chewing food. When a physical therapist is palpating the joint, which of the following pairs of active mandible motions would be MOST informative to confirm temporomandibular dysfunction? 1. Elevation and protrusion 2. Elevation and retrusion 3. Protrusion and retrusion 4. Depression and elevation

***4. Depression and elevation Rationale: 3. Reciprocal clicking with mouth opening and closing has good diagnostic utility in diagnosing temporomandibular conditions and in particular anterior disc displacement (p. 1353). Protrusion of the mandible is used to assess tongue thrust conditions and for deviations during protrusion, which can be caused by muscle or disc problems; therefore it is not a very discriminatory test. Retrusion of the mandible may be painful in patients with an intracapsular injury, but it not as useful as depression of the mandible in diagnosis of temporomandibular dysfunction (pp. 1361-1362). Opening of the mouth, which is depression of the mandible, is the most revealing and diagnostic movement for temporomandibular dysfunction (pp. 1360-1361). 4. Reciprocal clicking with mouth opening and closing has good diagnostic utility in diagnosing temporomandibular conditions and in particular anterior disc displacement (p. 1353). Opening of the mouth, which is depression of the mandible, is the most revealing and diagnostic movement for temporomandibular dysfunction. Elevation of the mandible is mouth closing and primarily assesses the primary muscles that perform mouth closure

A physical therapist is examining a patient who has emphysema and no acute symptoms. During auscultation of the lungs, the therapist will MOST likely observe which of the following findings? 1. Wet crackles (rales) 2. Friction rub 3. Low-pitched wheezes (rhonchi) 4. Diminished breath sounds

***4. Diminished breath sounds Rationale: 1. Crackles are present with secretions in peripheral airways (Goodman, p. 774). 2. A friction rub is associated with a large pleural effusion rather than with emphysema (Hillegass, p. 8). 3. Low-pitched wheezes are associated with obstruction, such as bronchospasm (Goodman, p. 774). 4. Diminished breath or absent breath sounds are present with emphysema

A 41-year-old patient sustained a grade II injury to the right medial collateral ligament of the elbow 3 weeks ago. A systems review reveals normal cardiopulmonary, integumentary, and neuromuscular status. Which of the following is MOST likely the status of the healing tissue? 1. Well organized and gaining in tensile strength 2. Well organized and capable of withstanding high tensile forces 3. Disorganized but able to withstand high tensile forces 4. Disorganized and unable to withstand high tensile forces

***4. Disorganized and unable to withstand high tensile forces Rationale: 1. Although the repair is gaining in tensile strength, 3 weeks is not enough time for a grade II injury to fully organize. 2. A longer period of time is needed for a well-organized repair in a grade II injury. 3. A disorganized repair is not able to withstand high tensile forces. 4. A grade II ligament injury requires significant repair, and, although the tissue is beginning to organize at 3 weeks, it is not fully organized and is deficient in tensile strength.

Which of the following glenohumeral joint mobilization techniques is MOST appropriate for increasing the motion required to scratch the back at the T9 level? 1. Distraction with inferior glide 2. Anterior glide with abduction 3. Superior glide with approximation 4. Distraction with posterior glide

***4. Distraction with posterior glide Rationale: 4. To scratch the back at the T9 level requires a person to reach behind the back, with the shoulder moving into medial (internal) rotation. Posterior glide of the humerus will increase medial (internal) rotation.

A patient is lacking forearm supination due to associated joint restriction. Which of the following glides at the distal radioulnar joint will MOST likely be limited with testing? 1. Volar glide of the radial head on the ulna 2. Dorsal glide of the radial head on the ulna 3. Volar glide of the radius on the head of the ulna 4. Dorsal glide of the radius on the head of the ulna

***4. Dorsal glide of the radius on the head of the ulna Rationale: 4. At the distal radioulnar joint the concave ulnar notch of the radius articulates with the convex head of the ulna. A dorsal glide of the radius on the head of the ulna would test for supination. If there were associated joint restrictions here, testing of this glide would be restricted.

Gastroesophageal reflux disease occurs when contents from what area of the gastrointestinal tract enter the esophagus? 1. Ileum 2. Jejunum 3. Pancreas 4. Duodenum

***4. Duodenum Rationale: 4. Gastroesophageal reflux disease (GERD) is the term applied to symptoms associated with the reflux of gastroduodenal contents into the esophagus; the disease involves the following parts of the upper gastrointestinal tract: mouth, esophagus, stomach, and duodenum (small intestine order = duodenum > Jejunum > Ileum)

Which of the following findings BEST describes an injury in the acute stage? 1. Collagen fibers reorient in response to stresses placed on connective tissue. 2. Collagen formation and granulation tissue development occurs at an increased rate. 3. During range of motion testing, the patient experiences pain synchronous with tissue resistance. 4. During range of motion testing, the patient experiences pain with movement and before tissue resistance.

***4. During range of motion testing, the patient experiences pain with movement and before tissue resistance. Rationale: 1. This activity characterizes the chronic stage of healing, which involves tissue maturation and remodeling (p. 323). 2. This activity characterizes the subacute stage of healing (p. 320). 3. This response characterizes the subacute stage of healing (p. 317). 4. Pain on active movement is a hallmark of the acute stage of healing

A 4-year-old child who has an L1 myelomeningocele has developed scoliosis over the past 2 years. The curve currently measures 25°. Which of the following recommendations is MOST appropriate for scoliosis management? 1. Continue to monitor the scoliosis, with no intervention at this time. 2. Begin a home program of stretching exercises for trunk rotators. 3. Refer to an orthopedic surgeon for evaluation for spinal fusion. 4. Fit the child with a thoracolumbosacral orthosis.

***4. Fit the child with a thoracolumbosacral orthosis. Rationale: 1. Orthotic intervention, usually with a thoracolumbosacral orthosis, is helpful in maintaining improved trunk position for functional activities. For children with progressive spinal deformities, orthotic intervention is continued until the child reaches a sufficient age (10+ years) to allow surgical fusion of the spine. 2. Stretching programs have not been found to halt or improve scoliosis. If stretching exercises are performed, they should focus on the iliopsoas and low back extensors and lateral trunk flexors on the concave side of the curvature. 3. This child is too young for surgery for scoliosis. The ideal minimum age for spinal fusion is 10 to 11 years old in girls and 12 to 13 years old in boys. Long spinal fusions before the skeletal age of 10 result in greater loss of trunk height and an increased frequency of instrumentation failure. 4. Orthotic intervention, usually with a thoracolumbosacral orthosis, is helpful in maintaining improved trunk position for functional activities. For children with progressive spinal deformities, orthotic intervention is continued until the child reaches a sufficient age (10+ years) to allow surgical fusion of the spine (Palisano, pp. 547-548) and is indicated for a curvature 25° to 45°

A patient has right-sided upper abdominal and shoulder pain. The physical therapist suspects that the pain is not mechanical in origin. Which of the following structures is the MOST likely source of the referred pain? 1. Urinary tract 2. Appendix 3. Kidney 4. Gallbladder

***4. Gallbladder Rationale: 1. Urinary tract disease does not demonstrate this pain pattern 2. Symptoms from acute appendicitis are abdominal but do not refer to the shoulder 3. Kidney disease may manifest as back pain or upper abdominal pain, but the pain is not referred to the shoulder 4. Pain associated with the gallbladder is located in the right upper abdominal quadrant and radiates to the upper back. Pain may be referred to the scapula, right shoulder, or neck area.

A patient being treated for weakness is suspected of having acute appendicitis. Which of the following interventions is MOST appropriate after notifying the patient's physician? 1. Continue with gentle exercises but avoid gait training. 2. Apply a moist hot pack to the right back and flank. 3. Offer the patient some soda crackers and water. 4. Have the patient lie down and remain as quiet as possible.

***4. Have the patient lie down and remain as quiet as possible. Rationale: 1. Continuing exercise may aggravate the condition further. The patient should lie down and remain as still as possible. 2. There is danger of aggravating the condition with the use of the hot pack. 3. Giving the patient food or water may aggravate the condition and cause difficulties if surgery is needed. 4. When appendicitis is suspected because of a patient's symptoms, a physician should be notified and the patient should lie down and be as still as possible.

A home health patient who recently had a three-vessel coronary artery bypass graft describes experiencing bilateral lower extremity swelling, leg pain, and shortness of breath, especially when lying down. The patient MOST likely has which of the following diagnoses? 1. Deep vein thrombosis 2. Myocardial infarction 3. Pulmonary embolism 4. Heart failure

***4. Heart failure Rationale: - Typical signs of heart failure include dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and peripheral edema.

A patient who had a lumbar fusion 5 years ago now has acute lumbar disc dysfunction. The patient usually has pain rated at 6/10, but pain ratings are occasionally increased to 9/10 with prolonged sitting and standing. The patient also reports pain during sit-to-stand and sit-to-supine transfers. Which of the following factors would have the MOST impact on the thoroughness of the tests and measures section of the examination? 1. Presence of pain with transitional movements 2. Past medical history of lumbar fusion 3. Moderate pain with static positioning 4. High irritability of the patient's acute back pain

***4. High irritability of the patient's acute back pain

A patient with an excessive anterior pelvic tilt will usually have which of the following associated conditions? 1. Weak lumbar extensors 2. Weak hip flexors 3. Piriformis flexibility deficits 4. Iliacus flexibility deficits

***4. Iliacus flexibility deficits Rationale: 1. Low back extensors are typically short and strong in a patient who has an excessive anterior pelvic tilt. 2. Hip flexor muscles are typically short and strong in a patient who has an excessive anterior pelvic tilt. 3. The piriformis attaches from the pelvis to the greater trochanter. Therefore, an excessive anterior pelvic tilt would not be associated with a tight piriformis; the sacral-femoral position is more likely to be related to piriformis flexibility deficits. 4. Hip flexor muscles (iliacus/iliopsoas) are short and strong in a patient who has an excessive anterior pelvic tilt.

A patient who walks with an antalgic gait reports hip pain, loss of appetite, and night sweats. The patient has a low-grade fever. Which of the following tests is MOST important to perform to confirm the diagnosis? 1. Squat test 2. Patrick test 3. McBurney test 4. Iliopsoas muscle test

***4. Iliopsoas muscle test Rationale: 1. The squat test is a test to rule in or rule out a hip fracture. A patient who has a hip fracture will report increased pain with weight-bearing activities (p. 652). In addition to reporting hip pain, the patient has clinical signs and symptoms that indicate a psoas abscess (night sweats, low-grade fever). 2. The Patrick test is a test to rule in or rule out hip joint dysfunction (p. 642). In addition to reporting hip pain, the patient has clinical signs and symptoms that indicate a psoas abscess (night sweats, low-grade fever). 3. The McBurney test is a test for appendicitis. Pain resulting from appendicitis usually begins in the umbilical region and may be localized to the right lower quadrant. Pain is also generally accompanied by nausea, vomiting, and a low-grade fever. (pp. 340, 342) 4. The iliopsoas muscle test is a screening test for psoas abscess. A patient who has a psoas abscess will most likely have a low-grade fever, antalgic gait, and night sweats.

A patient has a cerebellar dysfunction that affects both the trunk and the limbs. During examination, which of the following findings will MOST likely be observed? 1. Bradykinesia 2. Festinating gait 3. Impairments in muscle force generation 4. Impairments in the timing of muscle activation

***4. Impairments in the timing of muscle activation Rationale: 1. Bradykinesia is associated with Parkinson disease and is not seen with cerebellar disorders (pp. 637-642). Parkinson disease affects the basal ganglia and not the cerebellum 2. Festination of gait is typically seen with persons living with Parkinson disease (p. 610), not persons with cerebellar ataxia. Parkinson disease affects the basal ganglia and not the cerebellum 3. Cerebellar impairments may cause some hypotonia initially, but patients recover normal passive muscle tone and normal reflexes quickly 4. Cerebellar dysfunction is characterized by delays in initiating and timing of movements. Ataxia is a general term used to describe abnormal coordination of movements. It is demonstrated by deficits in speed, amplitude of displacement, directional accuracy, and force of movement (pp. 637-638). Ataxic movements are thought to occur due to impairments in the timing and duration of muscle activation.

A patient has fibular (peroneal) nerve palsy. Which of the following gait deviations is the patient LEAST likely to demonstrate during the swing phase of walking? 1. Increased knee flexion 2. Hip circumduction 3. Increased hip flexion 4. Increased ankle dorsiflexion

***4. Increased ankle dorsiflexion Rationale: 1. Increased knee flexion would be a possible compensation for the lack of dorsiflexion resulting from the fibular (peroneal) palsy in order to clear the foot during the swing phase of gait. 2. Circumduction is a possible lower extremity compensation to clear the foot during the swing phase of gait due to a lack of ankle dorsiflexion resulting from the fibular (peroneal) nerve palsy. 3. Increasing hip flexion during the swing phase of gait would help clear the foot to compensate for a lack of dorsiflexion resulting from the fibular (peroneal) nerve palsy. 4. Increasing dorsiflexion of the ankle would be the least likely deviation, because a fibular (peroneal) nerve palsy would reduce the ability of the patient to actively dorsiflex the ankle during the swing phase of gait.

The photograph demonstrates the joint integrity test (Anterior Drawer) MOST likely to be positive following which type of injury mechanism? 1. Midtarsal stress 2. Dorsiflexion 3. Eversion 4. Inversion

***4. Inversion Rationale: 1. Midtarsal stress is not the traditional method of injury for any single ligament, including anterior talofibular ligament. 2. Dorsiflexion would be the most likely mechanism of injury for the anterior tibiofibular ligament (high ankle sprain), not the anterior talofibular ligament. The integrity of the anterior tibiofibular ligament would be tested with a dorsiflexion/rotation maneuver, not a straight anterior glide. 3. Eversion would be the most likely mechanism of injury for the deltoid ligament, not the anterior talofibular ligament. The integrity of the deltoid ligament would be tested with a straight eversion stress, not a straight anterior glide. 4. The photograph shows an anterior drawer test, which is used to evaluate the anterior talofibular ligament. This is the ligament that is injured most often with an inversion mechanism.

A physical therapist is examining a patient and finds that when the patient's feet are together in standing position, the left iliac crest appears lower than the right. However, when the feet are spread apart, the iliac crests are level. This discrepancy is MOST likely caused by tightness of which of the following muscle groups? 1. Right hip abductors 2. Left hip adductors 3. Right hip adductors 4. Left hip abductors

***4. Left hip abductors Rationale: 1. Tight right hip abductors would not pull the left hip downward; they would tend to raise the left iliac crest. 2. With feet together, there is slack on the hip adductors, so there should not be any effect on the iliac crest height. 3. With feet together, there is slack on the hip adductors, so there should not be any effect on the iliac crest height. 4. The iliac crests are level with the hips abducted (feet spread apart), but the right iliac crest is higher when the hips are adducted (feet together). Tightness in the left hip abductors would be the most likely cause, because the tight left hip abductors would be pulling the left hip downward.

A patient has radicular pain due to C4-C5 intervertebral foramen stenosis on the right side. In addition to cervical flexion, which of the following combinations of cervical motions is likely to provide the MOST pain relief for the patient? 1. Right side bending and left rotation 2. Right side bending and right rotation 3. Left side bending and right rotation 4. Left side bending and left rotation

***4. Left side bending and left rotation Rationale: 1. Performing right side bending would decrease the size of the intervertebral foramen 2. Performing right side bending, although limited by coupled left side bending (induced by performing left rotation), still reduces the size of the intervertebral foramen, compared to performing left side bending and left rotation 3. In the mid cervical region the coupling motions of side bending and rotation occur in an ipsilateral fashion (Loudon, p. 103). Therefore, performing right rotation would cause a decrease in the area of the intervertebral foramen by inducing coupled right side bending. The induced right side bending will limit the amount of the intervertebral foramen opening on the right side at the affected segment. 4. The area of the intervertebral foramen on the right increases with left side bending and left rotation

A patient reports cervical muscle tightness and headaches originating in the back of the head. Which of the following nerves is MOST likely involved? 1. Trigeminal 2. Spinal accessory 3. Hypoglossal 4. Lesser occipital

***4. Lesser occipital Rationale: 1. The trigeminal nerve (CN V) is a sensory and motor nerve of the face, not the area in which the patient reports pain or tightness 2. The spinal accessory nerve (CN XI) supplies motor innervation to the sternocleidomastoid and trapezius, not the muscles in which the patient reports tightness 3. The hypoglossal nerve (CN XII) supplies motor innervation to the muscles of the tongue and is unrelated to the tightness or pain 4. The lesser occipital nerve is a cutaneous nerve supplying the skin of the neck and scalp posterior superior to the auricle, the area in which the patient reports pain

A patient has a cavernous wound on the sacrum. Which of the following data collection methods is MOST appropriate to identify the wound volume? 1. Take a photograph of the wound. 2. Measure the length and width using a disposable ruler. 3. Trace the wound onto an acetate measuring guide. 4. Measure the amount of hydrogel that fills the wound without spillage.

***4. Measure the amount of hydrogel that fills the wound without spillage. Rationale: 1. Photographing the wound will give an accurate assessment of the wound size (length and width) but not its depth (p. 119). 2. Measuring the area of the wound will not give volumetric information (p. 109). 3. Tracing the wound gives an indication of the size but not the depth of the wound (p. 110). 4. Filling the wound with hydrogel or water is used to determine the volume of the wound

Which of the following instruments is MOST appropriate for measuring patients' quality of life? 1. Lysholm knee rating scale 2. Oswestry low back pain disability index 3. Goal Attainment Scale (GAS) 4. Medical Outcomes Study 36-item short form (SF-36)

***4. Medical Outcomes Study 36-item short form (SF-36) Rationale: 1. The Lysholm knee rating scale is a condition-specific instrument, not a quality-of-life assessment tool 2. The Oswestry low back pain disability index is a condition-specific instrument, not a quality-of-life assessment tool 3. The Goal Attainment Scale (GAS) measures achievement of self-identified goals but does not indicate the impact of goal attainment on quality of life 4. The Medical Outcomes Study (MOS) resulted in development of the 36-item short form for measuring patient's quality of life. It is a self-report that covers eight domains of physical functioning, role limitation due to physical problems, role limitations due to emotional problems, fatigue, and general health perceptions.

Rate pressure product is MOST indicative of which of the following cardiac factors? 1. Stroke volume 2. Cardiac output 3. Pulse amplitude 4. Myocardial oxygen demand

***4. Myocardial oxygen demand Rationale: 1. Stroke volume is the amount of blood ejected from the left ventricle during each heartbeat. Stroke volume (SV) and heart rate (HR) are components of cardiac output (CO) (CO=SV x HR). 2. Cardiac output is calculated by multiplying heart rate by stroke volume and is representative of the amount of blood pumped by the heart in 1 minute 3. Pulse amplitude is an assessment of the quality of the pulse determined by the pulse taker. The quality of the pulse being taken is classified as absent, diminished, normal, moderately increased, or markedly increased. 4. Rate pressure product is calculated by multiplying heart rate by systolic blood pressure. It is an indication of myocardial oxygen demand. (Paz, p. 43)

Which of the following intervention approaches for a child who has developmental coordination disorder will focus on the use of augmented feedback and practice to improve task performance? 1. Conductive education 2. Perceptual-motor training 3. Sensory Integration (SI) therapy 4. Neuromotor Task Training (NTT)

***4. Neuromotor Task Training (NTT) Rationale: 1. This is incorrect because conductive education is a therapy approach for children with cerebral palsy and is focused on improving motivation and self-esteem 2. This is incorrect because perceptual motor training is based upon the belief that an underlying deficit must be addressed before improving task performance 3. This is incorrect because sensory integration therapy focuses on addressing deficits in the sensory system to improve function (Palisano, p. 412) and motor and perceptual impairments 4. This is correct because this task-specific intervention is based on motor learning principles of feedback, memory cues, and practice

A patient reports a burning sensation along the medial aspect of the knee and lower leg. The sensation is increased during resisted hip adduction and knee flexion. The patient MOST likely has which of the following conditions? 1. Meralgia paresthetica 2. Neuropathy of the obturator nerve 3. Complex regional pain syndrome 4. Neuropathy of the saphenous nerve

***4. Neuropathy of the saphenous nerve Rationale: 1. Meralgia paresthetica is described as burning pain along the anterolateral aspect of the thigh that increases with hip extension (not hip adduction as described in the stem) 2. The obturator nerve has no cutaneous innervation to the lower leg (Moore, pp. 537-538). Pain would reside in the adductor thigh compartment 3. Complex regional pain syndrome of the lower extremity typically involves the foot and ankle. There are multiple characteristics present, such as pain, allodynia, hyperalgesia, abnormal vasomotor response, and abnormal sudomotor (sympathetic nervous system) activity. 4. The saphenous nerve is cutaneous and supplies skin on medial aspect of leg and foot (Moore, pp. 537-538). Entrapment can cause pain at the medial side of knee. The pain is described as burning pain that increases with knee flexion and hip adduction. (Dutton, p. 979)

Which of the following patient positions would be the MOST appropriate treatment for atelectasis of the lower lobes, lateral basal segment? 1. Prone position with the bed flat 2. Long-sitting position, leaning back 30° 3. Supine position with the head down 15° 4. One-quarter turn from prone position with the head down 30°

***4. One-quarter turn from prone position with the head down 30° Rationale: 1. Prone with bed flat is best used to drain the superior segments of the lower lobes 2. Long sitting, leaning back 30° is best used for involvement in the upper lobes, apical segments 3. Supine with head down and the patient rotated one-quarter backward is best used to drain the lingula 4. Treatment of atelectasis is directed at reversing the underlying contributing mechanism whenever possible. Atelectasis resulting from prolonged static positioning and monotonous tidal ventilation is managed with mobilization and manipulating body positions (i.e. postural drainage) to optimize alveolar ventilation and alveolar volume (p. 475). Lower lobe atelectasis may be cleared with the patient positioned on the uninvolved side, one-quarter turn from prone with the head down 30°

A patient reports a recent significant weight loss as a result of diarrhea and vomiting. The patient is MOST at risk for which of the following conditions? 1. Bradycardia 2. Euvolemia 3. Shortness of breath 4. Orthostatic hypotension

***4. Orthostatic hypotension Rationale: 1. Dehydration is likely owing to fluid losses associated with emesis and diarrhea. Tachycardia is more likely with dehydration. 2. Euvolemia is an indication of normal fluid balance, which is not likely to be present in a patient who has weight loss associated with diarrhea and vomiting. 3. Shortness of breath is not associated with body fluid volume loses. Significant postural hypotension results from extracellular fluid volume depletion. 4. Body fluid loses associated with weight loss, excessive diarrhea, and vomiting may cause electrolyte imbalances, which can result in orthostatic changes in blood pressure.

The parent of a 2-year-old child reports that while holding the child's hand when walking down a street, the child fell down. The parent tried to hold the child up while the child regained balance. The child now holds the arm at the side with the palm facing down. Which of the following conditions is MOST likely present? 1. Radial tunnel syndrome 2. Necrosis of the capitellum 3. Valgus extension overload syndrome 4. Partial slippage of the annular ligament

***4. Partial slippage of the annular ligament Rationale: - A diagnosis of partial slippage of the annular ligament is made from the history with a report of longitudinal traction on an extended elbow, as with a child whose arm is pulled by a parent when walking. This injury typically occurs in children age 2-3 years.

A patient reports worsening medial foot and ankle pain. Examination reveals a loss of arch height, excessive pronation during walking, and pain with palpation of the posterior aspect of the medial malleolus. Which of the following combinations of movements is MOST likely to be weak? 1. Dorsiflexion and eversion 2. Dorsiflexion and inversion 3. Plantar flexion and eversion 4. Plantar flexion and inversion

***4. Plantar flexion and inversion Rationale: 4. Plantar flexion and inversion are performed by the tibialis posterior. The tibialis posterior tendon is implicated by the impairments identified in the stem.

Which of the following activities would be MOST appropriate to practice to assist a 20-year-old patient who has Duchenne muscular dystrophy in maintaining independence? 1. Stair training using both handrails 2. Gait training using a rolling walker 3. Transfer training using a slide board 4. Power wheelchair training over various surfaces

***4. Power wheelchair training over various surfaces Rationale: 1. The cessation of independent walking in boys with Duchenne muscular dystrophy typically occurs by age 10-12 or 13 years. Therefore, stair climbing is not likely. 2. The cessation of independent walking in boys with Duchenne muscular dystrophy typically occurs by age 10-12 or 13 years. Therefore, gait training is highly unlikely to be plausible. 3. The transition to adulthood marks a time of continued progressive disability. Assistance with transfers would be required at this stage. 4. A 20-year-old patient with Duchenne muscular dystrophy is likely to require a power wheelchair for functional mobility due to the progressive nature of the disease. Typically, by age 14 years, boys who have Duchenne muscular dystrophy are not ambulatory and require power-assisted mobility. The transition to adulthood marks a time of continued progressive disability with a greater reliance on assistive technologies such as a power wheelchair.

An 18-year-old patient who has osteogenesis imperfecta has been receiving physical therapy services through the school system. The patient is independent in transfers, wheelchair mobility with a motorized wheelchair, and self-care and has been utilizing public transportation. Which of the following courses of action is MOST appropriate in planning for the patient? 1. Continue physical therapy services with a modified goal to maintain independence with mobility. 2. Continue physical therapy services under the care of a physical therapist assistant. 3. Recommend that the patient participate in a support group. 4. Refer the patient to vocational services.

***4. Refer the patient to vocational services. Rationale: 1. The patient has achieved the goals necessary for independent mobility, so there is no need to continue with a mobility goal. 2. Continuing physical therapy services, even by a physical therapist assistant, is inappropriate when the patient has achieved the goals and expected prognosis at this stage of life. 3. There is no indication in this question that the person requires any social support. 4. This 18-year-old patient is independent for activities of daily living and is developmentally appropriate for the workforce or further academic study. A vocational counselor will provide the best guidance and support for the next setting/stage.

Which of the following findings BEST describes a positive result of the median nerve tension test? 1. Elicitation of numbness in the cubital fossa 2. Elicitation of numbness in the hypothenar eminence 3. Reproduction of symptoms in the dorsal and ulnar side of the hand 4. Reproduction of symptoms in the volar (palmar) and radial side of the hand

***4. Reproduction of symptoms in the volar (palmar) and radial side of the hand Rationale: 1. Numbness in the cubital fossa is incorrect. Although the median nerve courses through the cubital fossa, its sensory branches supply only the palmar and radial side of the hand. 2. The median nerve does not innervate the hypothenar region, which is innervated by the ulnar nerve. 3. The location of symptoms and the wrist position are descriptive of radial nerve tension, not median nerve tension. 4. This option correctly states the location of symptoms (palmar and radial side of hand) when there is tension on the median nerve.

Following a fall onto an abducted and outstretched hand, a patient felt a sharp pain in the area between the abductor pollicis longus and the extensor pollicis longus. The physical therapist should suspect a fracture in which of the following? 1. First metacarpal 2. Lunate 3. Trapezoid 4. Scaphoid

***4. Scaphoid Rationale: 4. The stem describes a classic mechanism for a scaphoid fracture, with snuffbox tenderness.

To palpate the insertion of the supraspinatus tendon, a physical therapist should place a patient's arm in which of the following positions? 1. Shoulder flexion and lateral (external) rotation 2. Shoulder flexion and medial (internal) rotation 3. Shoulder extension and lateral (external) rotation 4. Shoulder extension and medial (internal) rotation

***4. Shoulder extension and medial (internal) rotation

A patient who has an L1 spinal cord injury (ASIA Impairment Scale A) is working toward independent walking with knee-ankle orthoses and forearm crutches. When walking with crutches, the patient is unable to achieve neutral hip extension. Which of the following interventions would BEST address this problem? 1. Strengthening the hip extensors 2. Strengthening the back extensors 3. Stretching the hamstrings 4. Stretching the hip flexors

***4. Stretching the hip flexors Rationale: 1. The gluteus maximus is innervated below L1 and could not be strengthened. 2. Strengthening the back extensors would not contribute to increased hip extension. 3. Stretching the hamstrings could contribute to increased hip flexion with knee extension, not increased hip extension. 4. Stretching the hip flexors will promote hip extension range of motion, which is necessary in order to ambulate over even surfaces.

A 6-year-old patient who has Legg-Calvé-Perthes disease is MOST likely to have which of the following gait deviations? 1. Vaulting 2. In-toeing 3. Toe-walking 4. Trendelenburg

***4. Trendelenburg Rationale: 1. Legg-Calvé-Perthes disease affects the hip and is not typically associated with vaulting. Vaulting is typically seen with hemiparetic limbs. 2. Legg-Calvé-Perthes disease affects the hip and is not typically associated with in-toeing. Further, limited range of motion into hip medial (internal) rotation is common in patients who have Legg-Calvé-Perthes disease, making in-toeing even less likely. 3. Legg-Calvé-Perthes disease affects the hip and is not typically associated with toe-walking. Toe-walking can be caused by short ankle plantar flexors or excessive tone. This is not seen in Legg-Calvé-Perthes disease, which typically only affects the muscles of the hip. 4. A positive Trendelenburg sign secondary to hip pain and/or hip abductor weakness is very common in children who have Legg-Calvé-Perthes disease. Although Legg-Calvé-Perthes disease can affect children of nearly any age, it is most common among boys ages 4 to 8 years.

A physical therapist notes an increase in an athlete's heart rate when the athlete runs on a treadmill. This increase will directly cause: 1. a decrease in stroke volume. 2. a decrease in cardiac output. 3. an increase in stroke volume. 4. an increase in cardiac output.

***4. an increase in cardiac output. Rationale: 1. Stroke volume typically plateaus around 35% to 40% of maximal exercise intensity. After that point, cardiac output is augmented by increases in heart rate. A decrease in stroke volume is not expected with an increase in heart rate. 2. Cardiac output increases, not decreases, commensurate with metabolic demand. 3. Stroke volume typically plateaus around 35% to 40% of maximal exercise intensity. After that point, cardiac output is augmented by increases in heart rate. Although increases in heart rate correspond directly to increases in cardiac output, increases in stroke volume do not always correspond directly to increases in cardiac output. 4. Cardiac output increases commensurate with metabolic demand.

When instructing a patient with rheumatoid arthritis in a home exercise program, the physical therapist should advise the patient to rest: 1. after the onset of joint pain. 2. after one hour of exercise. 3. when fatigued. 4. before becoming fatigued.

***4. before becoming fatigued. Rationale: 3. Undue fatigue after exercise indicates a need to further modify the exercise program. 4. An exercise program for a patient who has rheumatoid arthritis should be able to be performed without pain and fatigue.

A patient who had a recent carpal tunnel decompression surgery is referred to physical therapy. The patient also had a first rib resection and a pronator teres release on the same extremity within the past 2 years. The patient now reports burning pain in the wrist and dorsal forearm and that the wrist and hand often feel cold. These signs and symptoms MOST likely indicate: 1. T4 syndrome. 2. ulnar neuropathy. 3. cervical radiculopathy. 4. complex regional pain syndrome.

***4. complex regional pain syndrome. Rationale: 1. The distribution of the symptoms is not consistent with the level innervated by T4 2. The distribution of the ulnar nerve is not consistent with the description of symptoms 3. A radiculopathy is involvement of a nerve root as it emerges from the spinal cord (p. 1667). The distribution of symptoms is not consistent with a cervical nerve root distribution, and no weakness is reported. 4. The primary clinical features of complex regional pain syndrome are burning or aching pain, autonomic nervous system dysfunction, edema, and movement disorders. In the final stage, the affected limb is cooler

To conduct an experimental study on pain in postsurgical orthopedic patients, a physical therapist randomly assigns patients to two groups. One group is treated with transcutaneous electrical nerve stimulation, heat, and exercise; the second receives heat and exercise only. In this experimental design, transcutaneous electrical nerve stimulation is the: 1. continuous variable. 2. dependent variable. 3. discrete variable. 4. independent variable.

***4. independent variable. Rationale: 1. "Continuous" is a classification of variables based on the method of quantifying the variable, not based on the role of the variable in the experimental design. Continuous variables may theoretically be measured to a finer and finer degree. 2. The dependent variable can be thought of as the effect or response, which in this case is pain 3. "Discrete" is a classification of variables based on the method of quantifying the variable, not based on the role of the variable in the experimental design. A discrete variable is one that can assume only distinct values. 4. The independent variable can be thought of as the cause or treatment. In this case, the transcutaneous electrical nerve stimulation is the treatment or independent variable.

A patient has completed a 2-week course of comprehensive physical therapy for treatment of constant right shoulder and scapular pain and has not had any improvement. The patient states that change in position does not alter the pain intensity. The physical therapist should NEXT ask the patient about: 1. persistent sore throat. 2. difficulty swallowing food. 3. burning with urination. 4. intolerance to fatty foods.

***4. intolerance to fatty foods. Rationale: 1. A persistent sore throat is not a symptom manifested in acute cholecystitis 2. Dysphagia is generally indicative of esophageal dysfunction. Furthermore, esophageal dysfunction/pain will typically refer to the middle of the back. 3. Dysuria is associated with renal/urologic dysfunction. Such dysfunction may refer to the costovertebral areas, low back, and/or groin. 4. The signs and symptoms of acute cholecystitis may include pain that radiates to the right shoulder, right scapula, or interscapular area. In patients with renal calculi, there may be a history of past episodes of biliary colic and fatty food intolerance. The patient may also report nausea, vomiting, fever, and right upper quadrant pain.

A patient reports feeling a "pop" in the posterior leg accompanied by sudden onset of pain localized to the middle third of the posterior lower leg. There is no loss of functional strength. This injury is consistent with complete rupture of the: 1. tibialis posterior muscle. 2. popliteus muscle. 3. Achilles tendon. 4. plantaris tendon.

***4. plantaris tendon. Rationale: 1. The tibialis posterior muscle is a significant plantar flexor and invertor of the ankle. Complete rupture of this tendon will significantly affect functional strength evidenced by gait. 2. Rupture of the popliteus tendon will result in decreased knee function and difficulty unlocking the knee from an extended position. 3. Complete rupture at the Achilles tendon will result in the inability to flex the foot and an inability to walk, run, or jump. 4. Rupture of the plantaris is often felt as a "pop." However, the plantaris is a vestigal tendon that has no significant role in function at the knee or ankle.

Following insertion of a chest tube, a patient displays scapular winging. The physical therapist should expect the patient to have the MOST difficulty: 1. scratching the low back area. 2. turning a doorknob. 3. holding a briefcase. 4. reaching forward for an object.

***4. reaching forward for an object. Rationale: 4. Winging of the scapula is caused by weakness of the serratus anterior (Hislop, pp. 82-83; Dutton, p. 591). The serratus anterior abducts the scapula and rotates the interior angle laterally (Hislop, pp. 82-84). Weakness in this area would cause difficulty reaching forward for an object.

A patient who sustained an avulsion of the right C5 and C6 spinal nerve roots will show functional loss of right: 1. distal thumb flexion. 2. ulnar wrist deviation. 3. elbow extension. 4. shoulder abduction.

***4. shoulder abduction. Rationale: 1. The C8-T1 nerve roots form the median nerve (anterior interosseus), supplying the flexor pollicis longus muscle. A patient who has an avulsion of the C5 and C6 spinal nerve roots will be able to perform distal thumb (1st digit) flexion. 2. The C7-C8 nerve roots form the ulnar nerve and radial nerve (posterior interosseus), supplying the flexor and extensor carpi ulnaris. Therefore, a patient who has an avulsion of the C5 and C6 spinal nerve roots will be able to perform wrist ulnar deviation. 3. The C5-C8 and T1 nerve roots form the radial nerve, supplying the triceps brachii. Avulsion of the C5 and C6 nerve roots will result in weakness but not functional loss of elbow extension. 4. The C5-C6 nerve roots form the axillary nerve, supplying the deltoid and teres minor. Avulsion of these nerve roots will result in decreased right shoulder abduction

A physical therapist is initiating intervention with a postoperative patient who has just taken a 20-mg dose of oral oxycodone (OxyContin) for pain relief. In planning an intervention for this patient, the physical therapist should anticipate that: 1. the patient may be hypertensive. 2. the medication may trigger cardiac arrhythmias in the patient. 3. the patient will have an increased likelihood for developing diarrhea. 4. the patient may demonstrate respiratory depression.

***4. the patient may demonstrate respiratory depression. Rationale: 1. Orthostatic hypotension is a potential side effect of oxycodone, so the patient is unlikely to be hypertensive. 2. Arrhythmias are not listed as a recognized side effect of opioids. 3. Regarding developing diarrhea, gastrointestinal motility is decreased, so the opposite effect of constipation is a frequent problem. Constipation is a listed side effect. 4. Opioids tend to make the medullary chemoreceptors less responsive to carbon dioxide, thus slowing down the respiratory rate and inducing a relative hypoxia and hypercapnia. The respiratory response to exercise may be blunted