Practice Questions 2019 P3@7

Which of the following lung sounds heard during auscultation would BEST be described as continuous musical sounds during exhalation for a patient who has difficulty breathing and who has an increased respiratory rate? 1. Stridor 2. High-pitched wheezes 3. Pleural rub 4. Crackles (rales)

2. High-pitched wheezes are continuous musical sounds of variable pitch and duration that are heard on inspiration, expiration (most common), or both and are usually caused by narrow airways or stenosis (Main; O'Sullivan, p. 449).

Which of the following T-scores for bone density indicates that the patient has osteopenia? 1. -3.0 2. -2.0 3. +2.0 4. +3.0

2. T-scores falling in the range -1.0 to -2.5 indicate low bone mass, which is osteopenia.

Which of the following signs is MOST characteristic of an upper motor neuron lesion? 1. Clonus 2. Paresis 3. Areflexia 4. Hypotonia

Correct Answer: 1 1. The presence of clonus is indicative of an upper motor neuron lesion (p. 377).

A patient had a biceps femoris tendon repair 3 days ago. After the initial postsurgical assessment, the physical therapist should FIRST initiate which of the following interventions? 1. Gentle isometric strengthening 2. Closed kinetic chain exercises 3. Passive end-range stretching 4. Concentric exercises with gentle resistance

1. Muscle setting isometric exercises are begun immediately to prevent adhesions of the tendon to the sheath or surrounding tissues and to promote alignment of healing tissue.

The patient whose radiograph [L5 anterior slippage] is shown MOST likely has which of the following conditions? 1. Stenosis 2. Spondylolysis 3. Intervertebral disc herniation 4. Spondylolisthesis

Correct Answer: 4 4. Spondylolisthesis is the forward displacement of one vertebra upon the stationary vertebra beneath it, as shown in the radiograph (pp. 336-339).

The device shown in the photograph [chest tube collection device] has been removed from a patient. Which of the following tests is required prior to mobilizing the patient? 1. Radiograph 2. Electrocardiogram 3. Pulmonary function test 4. Computed tomography scan

1. The device shown in the photograph is a chest tube collection device. Removal of a chest tube may result in pneumothorax. A radiograph of the chest is needed to rule out pneumothorax prior to mobilization of the patient. (p. 439)

A patient has a lesion in the right middle cerebral artery. During examination, a physical therapist should expect to find: 1. impaired spatial perception. 2. ataxia of limbs and gait. 3. visual agnosia. 4. short-term memory loss.

1. A lesion of the right middle cerebral artery, which affects the right parietal lobe, typically produces impairment of spatial perception (p. 600).

Based on the data in the table, what is the BEST characterization of the relationship between the score on the Functional Reach assessment (FR) and the score on the Fear-Avoidance Beliefs Questionnaire (FABQ)? 1. Fair in strength, inverse in direction 2. Excellent in strength, direct in direction 3. Good in strength, inverse in direction 4. No relationship, direct in direction

1. A negative correlation shows an inverse direction, and a correlation of 0.32 is fair in strength.

Which of the following postural characteristics are MOST likely to be seen in a patient who has lower crossed syndrome? 1. Anterior pelvic tilt and slight hip flexion 2. Anterior pelvic tilt and slight hip extension 3. Posterior pelvic tilt and slight hip flexion 4. Posterior pelvic tilt and slight hip extension

1. A patient who has lower crossed syndrome will have tight erector spinae and iliopsoas muscles and weak abdominal and gluteus maximus muscles. This results in an anterior pelvic tilt, an increased lumbar lordosis, and a slight flexion of the hip.

A physical therapist is using exercise as an intervention for a patient with advanced ankylosing spondylitis. Which of the following types of exercise would be MOST important for the patient? 1. Aerobic exercise 2. Balance exercises 3. Light-weight resistance exercises 4. Short-duration, high-intensity exercise

1. Advanced ankylosing spondylitis would cause loss of chest wall excursion, which compromises breathing. Aerobic exercise done consistently would be most important in order to optimize efficiency of oxygen transport and maintain cardiopulmonary function. (pp. 1333, 1337)

A patient has decreased eccentric control of the elbow flexors. Which of the following proprioceptive neuromuscular facilitation (PNF) techniques is MOST appropriate to perform? 1. Agonist reversals (combination of isotonics) 2. Dynamic reversals (isotonic reversals) 3. Rhythmic stabilization 4. Rhythmic initiation

1. Agonist reversals include resisted concentric, isometric, and eccentric contraction tasks. Therefore, a patient who has decreased eccentric control would benefit from this technique. (Martin, pp. 275, 277)

A patient had a central line peripherally inserted via the cephalic vein. Proper placement has been confirmed. Which of the following activities of the ipsilateral arm should be AVOIDED? 1. Blood pressure measurement 2. Weight-bearing through the hand 3. Active upper extremity range of motion 4. Positioning the hand below the level of the chest

1. Blood pressure should not be taken on the ipsilateral side. This is a precaution for patients who have a peripherally inserted central line, as well as for patients who have some other lines. (pp. 450, 458)

Which of the following methods is MOST appropriate for evaluation of chest excursion in a patient with an incomplete spinal cord injury at the C7 level who is in supine position? 1. Use a tape measure circumferentially at the levels of the axillae and the xiphoid process. 2. Use a tape measure circumferentially at the level of the umbilicus. 3. Measure distance between the xiphoid and umbilicus during inhalation. 4. Measure distance between the xiphoid and umbilicus during an air shift maneuver.

1. Chest wall motion can be assessed using a tape measure with the patient in supine position. The therapist should measure the chest's circumference at the levels of the axillae and the xiphoid process to assess motions of the upper and middle chest, respectively. (O'Sullivan; DeTurk)

A 77-year-old female patient who has a long history of taking antiparkinsonian medications exhibits random, rapid, and jerky movements. Which of the following terms BEST describes these movements? 1. Chorea 2. Dysmetria 3. Segmental dystonia 4. Abnormal synergies

1. Chorea is a type of dyskinesia that is often observed as a side effect of antiparkinsonian medication and that typically emerges with prolonged use of such medications. Chorea is characterized by involuntary, rapid, irregular, and jerky movements.

A patient with low back pain has L4 nerve root impingement. The patient will MOST likely demonstrate which of the following gait deviations? 1. Trendelenburg gait 2. Foot slap 3. Posterior thrust of the trunk at heel strike (initial contact) 4. Toe walking

2. The L4 nerve root is the main segmental innervation to the tibialis anterior. The L4 nerve root is also the myotome for ankle dorsiflexion. Impingement of the L4 nerve root would result in foot slap. (Magee, p. 585; O'Sullivan, p. 239)

A physical therapist is treating a patient with bicipital tendonitis. The therapist has determined that iontophoresis with medication for a total treatment dosage of 80 milliampere-minutes is most appropriate. Which of the following current parameters should a physical therapist use when applying the iontophoresis to achieve the BEST results? 1. 3-4 milliamperes, direct current 2. 8-10 milliamperes, direct current 3. 3-4 milliamperes, pulsed current 4. 8-10 milliamperes, pulsed current

1. Direct current is indicated with a maximum safe amplitude of 4 milliamperes. (Belanger - Therapeutic Electrophysical Agents)

A patient reports numbness and tingling in the medial aspect of the hand. The patient reports having used a stapler on 100 packets of paper last week for a presentation. Which of the following syndromes is MOST likely present? 1. Ulnar tunnel 2. Carpal tunnel 3. Thoracic outlet 4. Complex regional pain

1. Entrapment of the ulnar nerve as it courses through the hook of the hamate and the pisiform can lead to paresthesia along the ulnar side of the hand into the volar (palmar) aspect in the little finger (5th digit) and medial half of the ring finger (4th digit). It will also lead to weakness of the hypothenar muscles, making it difficult to perform gripping activities, such as opening jars or turning doorknobs. Common etiologies include repetitive gripping as occurs with knitting, tying knots, or using pliers and staplers. (Kisner p. 409)

Which of the following findings is MOST commonly associated with patients who have chronic obstructive pulmonary disease? 1. Below normal diaphragmatic excursion of 0.4 to 0.8 inch (1 to 2 cm) 2. Above normal diaphragmatic excursion of 0.4 to 0.8 inch (1 to 2 cm) 3. Below normal diaphragmatic excursion of 1.2 to 2 inches (3 to 5 cm) 4. Above normal diaphragmatic excursion of 1.2 to 2 inches (3 to 5 cm)

1. Excursion is decreased in patients who have chronic obstructive pulmonary disease due to hyperinflation of the chest and a resultant flattened diaphragm. Normal excursion of the diaphragm is 1.2 to 2 inches (3 to 5 cm); therefore, 0.4 to 0.8 inch (1 to 2 cm) would be below the normal excursion value.

A physical therapist reads about a clinically based study in which electrical stimulation was used for subjects with acute disc herniation. The author gives details about the parameters used and reports that the intervention had a statistically significant effect. External validity is LEAST threatened if the study findings are applied to which of the following groups? 1. Patients from the same population, when the same parameters are used, even if the stimulation device is not the same model 2. Patients from a similar population, when the same stimulation device model and the same parameters are used 3. Patients with a variety of diagnoses as long as they have low back pain 4. Patients with a similar physical therapy problem list as long as the same stimulation device model is used

1. External validity is the degree to which the results of a study can be generalized to another situation. In this option, the only change in the procedure is the model of the electrical stimulation machine. External validity should be maximized in this situation.

Where on the forearm should a physical therapist place electrodes for biofeedback therapy in order to facilitate hook grasp? 1. Proximal anteromedial 2. Proximal posterolateral 3. Distal anteromedial 4. Distal posterolateral

1. For best biofeedback results, electrode placement should be as close to the muscle as possible (Prentice). Hook grasp requires finger flexion (Lippert, p. 215). The finger flexors are located proximal to the anterior forearm (Lippert, pp. 201-202).

A patient who has a spinal cord injury reports having spastic (reflex) bowel function. Which of the following descriptions BEST characterizes the patient's neurologic injury? 1. Injury above spinal segments S2-S4, leaving spinal defecation reflexes intact 2. Injury at or below spinal segments S2-S4, leaving spinal defecation reflexes intact 3. Injury above spinal segments S2-S4, abolishing spinal defecation reflexes 4. Injury at or below spinal segments S2-S4, abolishing spinal defecation reflexes

1. In spastic bowel dysfunction, the level of cord injury occurs above S2-S4, leaving the spinal defecation reflexes intact.

The degree of hemiparesis initially noted after a cerebrovascular accident is MOST predictive of which of the following? 1. Motor recovery 2. Proprioception 3. Executive functions 4. Risk for seizures

1. Initial paresis grade is an important predictor of motor recovery. Of patients admitted with complete paralysis, less than 15% experience complete motor recovery.

A patient has jaundice, dark urine, and ascites. Which of the following findings is MOST likely to be present during the physical therapy examination? 1. Asterixis 2. Pronator drift 3. Hoffman 4. Rebound tenderness

1. Jaundice, darkened urine, and ascites are all clinical signs of liver disease. Asterixis, or liver flap, is also likely to be present as a result of ammonia imbalance, which causes this neurologic symptom. (Goodman, p. 341)

Lesions of the skin are the FIRST clinical sign of underlying disease for which of the following diagnoses? 1. Scleroderma 2. Thromboangiitis obliterans 3. Anemia 4. Hypothyroidism

1. Lesions in the skin are often the first sign of an underlying rheumatic disease. Scleroderma is accompanied by many skin changes. (p. 445)

A patient who had a medial meniscus repair 1 week ago has limited knee flexion. Which of the following interventions is MOST appropriate for the patient at this time? 1. Limit knee flexion to 90°. 2. Perform full knee flexion as tolerated. 3. Perform sit-to-stand transfers from a low chair. 4. Perform gluteus bridges with knee flexion at 100°.

1. Limiting the knee flexion to 90° for the first 4 to 6 weeks is recommended to limit the shear stress to the healing meniscus. Flexion beyond 90° introduces shear to the meniscus and joint, damaging the repaired and healing meniscus.

A patient is referred to a physical therapist for treatment of chronic neck pain. During the examination, the therapist notices that the patient has a marked ulnar drift in both hands at the MCP joints. Which of the following treatments should the therapist perform? 1. Cervical stabilization exercises with the patient in good postural alignment 2. Gentle cervical mobilization for 8 minutes 3. Intermittent cervical traction at 8% of the patient's body weight for 10 minutes 4. Moist hot pack on the patient's cervical spine with the patient in sitting position for 15 minutes

1. Marked ulnar drift is a hallmark sign of rheumatoid arthritis (O'Sullivan, p. 1000). Because cervical spine ligaments can be affected in this population, cervical stabilization exercises in neutral are appropriate for managing neck pain in patients who have rheumatoid arthritis (Brody).

A patient whose car was hit from behind developed superficial cervical paraspinal muscle guarding. Three months post injury, the patient continues to demonstrate muscle guarding, although the pain has diminished considerably. As a result of 3 months of muscle guarding, which of the following consequences is MOST likely to occur? 1. Adaptive shortening of the involved myofascia 2. Osteophytic spurring of the facet joints 3. Weakening of the muscles involved with the muscle guarding 4. Increased proprioceptive awareness in the cervical region

1. Myofascial tightness in the posterior structures is a common occurrence with chronic whiplash injuries (Dutton, p. 1320).

Palsy of which of the following cranial nerves would MOST likely lead to the presentation of torticollis in a child? 1. Trochlear nerve (CN IV) 2. Facial nerve (CN VII) 3. Vestibulocochlear nerve (CN VIII) 4. Hypoglossal nerve (CN XII)

1. Ocular torticollis may result from a lesion to the trochlear nerve. Damage to the trochlear nerve results in diplopia. Patients will frequently compensate for the diplopia by tilting the head anteriorly and laterally toward the side of the normal eye. (pp. 1080-1081)

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

1. Pain from urinary calculi results from the ureter contracting in the attempt to dislodge the calculi. (Paz. - Acute Care Handbook for PT's)

Which of the following descriptions BEST represents the highest potential of function for a patient who sustained a C4 spinal cord injury (ASIA Impairment Scale A)? 1. Level transfers with total assistance, bed mobility with total assistance, power wheelchair mobility 2. Level transfers with moderate assistance, bed mobility with maximum assistance, power wheelchair mobility with modified independence 3. Unlevel transfers with assistance, bed mobility with minimal assistance, manual wheelchair mobility over level surfaces 4. Unlevel transfers without assistance, bed mobility without assistance, manual wheelchair mobility over unlevel surfaces with modified independence

1. Patients who have sustained a C1-C4 spinal cord injury are dependent in bed mobility and transfers and use a power wheelchair independently as the primary means of mobility (Umphred p. 470).

Which of the following interventions would be MOST appropriate for a child who has Sever disease? 1. Stretch the gastrocnemius and soleus, and use a heel wedge. 2. Stretch the plantar fascia, and use an arch support. 3. Stretch the quadriceps, and use a patellar tendon band. 4. Stretch the tibialis posterior, and use a medial heel wedge.

1. Sever disease is a calcaneal apophysitis and will benefit from stretching to improve flexibility of the gastrocnemius and soleus and use of a heel wedge to decrease the stress and traction of the Achilles insertion.

A patient who has decreased tactile sensation due to diabetes mellitus is being treated for a mild Achilles tendon strain. Which of the following interventions is MOST appropriate to restore normal alignment of the healing collagen? 1. Gastrocnemius stretching 2. Ultrasound to the gastrocnemius 3. Cross-friction massage at the muscle belly 4. Hot pack to the gastrocnemius

1. Stretching is a stimulus in the early healing stages for the proper alignment of healing collagen. Gentle stretching is performed to provide a stimulus for fiber orientation without disruption of the immature collagen. (p. 522) Author: Dutton MTitle: Dutton's Orthopaedic Examination, Evaluation, and InterventionEdition: 4Publisher: McGraw-HillYear: 2017Pages: 381, 422, 522

Which of the following findings is MOST associated with Stage 2 lymphedema? 1. Swelling that feels hard with palpation 2. Edema that forms a dimple when fingertip pressure is removed 3. Signs and symptoms that are improved with elevation of the limb 4. Skin on the dorsum of the foot that can be pinched in a fold

1. Swelling that feels hard with palpation describes brawny edema. Brawny edema is associated with Stage 2 (spontaneously irreversible) lymphedema. (Kisner)

While exercising on a stationary bicycle, a patient experiences sudden pain behind the sternum. The pain radiates down the left upper extremity into the ring and little fingers (4th and 5th digits). The pain subsides with rest but returns several times throughout the session. Which of the following conditions is the MOST likely source of these symptoms? 1. Angina 2. Left-sided heart failure 3. Right-sided heart failure 4. Myocardial infarction

1. Symptoms consistent with angina are transient/temporary pain that radiates down the left arm into the ulnar border of the hand with the ring and little fingers (4th and 5th digits) affected. It is generally increased with exertion and decreased with rest. (Goodman pp. 572-573)

A patient is admitted to a local hospital after experiencing falls and severe oscillopsia for the past 2 days. To examine the patient's postural control during gait, which of the following measures is BEST to perform? 1. Dynamic Gait Index 2. Observational Gait Analysis 3. Wolf Motor Function Test 4. Segmental Assessment of Trunk Control

1. The Dynamic Gait Index was designed to examine postural control during gait. It can help identify patients who have vestibular dysfunction and examines fall risk by means of a cutoff score. (Umphred)

A patient who has hemiparesis is learning to propel a manual wheelchair. Which of the following interventions is MOST appropriate for the cognitive stage of learning this task? 1. The physical therapist guides the patient with hand-over-hand cues and demonstrates the propulsion technique. 2. The patient propels the wheelchair with variable speed through an obstacle course with supervision from the physical therapist. 3. The physical therapist allows the patient to problem-solve when steering errors occur and does not provide feedback. 4. The physical therapist allows the patient to independently explore strategies for propulsion and steering during a specific propulsion task.

1. The cognitive stage is the beginning of the learning process. Cues, instructions, and guidance are provided by the therapist, and demonstration is used. (Umphred)

After beginning an initial interview with a patient, a physical therapist discerns that the patient is becoming angry. The patient declares that numerous other clinicians have asked the same questions and demands that the therapist contact the physician. What is the MOST appropriate FIRST response by the therapist? 1. Validate the patient's feelings of anger. 2. Attempt to change the direction of the examination questions. 3. Step out of the area and allow the patient to calm down. 4. Explain to the patient the importance of collecting the same information.

1. The first step in dealing with an angry patient who is not disruptive or a security risk is to validate the patient's feelings by listening and by acknowledging the patient's anger over the situation. This may diffuse the anger, allowing the therapist to carry on with the examination. (Goodman)

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

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

A patient who has amyotrophic lateral sclerosis exhibits severe lower extremity weakness and moderate upper extremity weakness. The patient has been increasingly dependent for activities of daily living. Which of the following interventions is MOST appropriate for the patient? 1. Education in positioning principles 2. Fitting with ankle-foot orthoses 3. Education in manual wheelchair propulsion 4. Strength training of the upper extremities

1. The patient descriptors align with Stage 5 amyotrophic lateral sclerosis. A physical therapist should educate the family and patient on proper positioning and turning principles to avoid skin breakdown. Author: Umphred DA, Lazaro RT, Roller ML, Burton GUTitle: Umphred's Neurological RehabilitationEdition: 6Publisher: Elsevier MosbyYear: 2013Pages: 535

Which of the following provocative maneuvers is MOST likely to elicit symptoms in the area highlighted in the photograph [median nerve distribution of hand and fingers]. 1. Tapping the anterior wrist moving from proximal to distal 2. Applying direct pressure to the base of the thumb (1st digit) 3. Palpating along the pronator teres 4. Compressing the cervical spine with ipsilateral rotation and extension

1. The photograph depicts the median nerve distribution, which is commonly disrupted in carpal tunnel syndrome. Tapping the anterior wrist describes the Tinel sign at the carpal tunnel. Author: Giangarra CE, Manske RCTitle: Clinical Orthopaedic Rehabilitation: A Team ApproachEdition: 4Publisher: ElsevierYear: 2018Pages: 35

At the completion of the test in the photographs, the patient's right lower extremity has the position shown in photograph B. Which of the following tests would be MOST appropriate for follow-up? 1. Modified Ober test 2. Prone hip extension 3. Prone knee flexion 4. Supine straight leg raise

1. The photographs show the modified Thomas test. This test is used to assess iliopsoas complex flexibility. The extreme position of abduction should raise suspicion of possible tensor fasciae latae shortness. To confirm possible shortness of the tensor fasciae latae, the modified Ober test would be appropriate as a follow-up examination. (Dutton pp. 916-918)

A patient who has buttock pain exhibits tenderness to palpation in the mid gluteal area. Pain is reproduced with resisted hip lateral (external) rotation when the hip is in the anatomical position and with resisted hip medial (internal) rotation when the hip is flexed greater than 90°. Which of the following muscles is MOST likely involved? 1. Piriformis 2. Gluteus minimus 3. Obturator externus 4. Obturator internus

1. The piriformis arises from the anterior aspect of S2-S3 and S4 segments of the sacrum and attaches to the upper border of the greater trochanter of the femur. The piriformis primarily functions to produce lateral (external) rotation and abduction of the femur but is also thought to function as a medial (internal) rotator and abductor of the hip if the hip joint is flexed beyond 90°. The piriformis has been implicated as the source for a number of conditions in this area, including entrapment neuropathies of the sciatic nerve, trigger points, and tender points. (Dutton pp. 879, 1533)

Which of the following joint mobilization techniques would MOST effectively increase elbow joint flexion? 1. Humeroulnar distraction 2. Humeroradial posterior glide 3. Radioulnar anterior glide 4. Radioulnar posterior glide

1. The purpose of humeroulnar distraction is to increase flexion (or extension) of the elbow joint. (Brody - Therapeutic Exercise: Moving Toward Function)

A patient has a finding of extreme laxity during the test shown in the photograph [knee valgus stress test]. Which of the following ligaments is MOST likely injured? 1. Medial collateral 2. Lateral collateral 3. Posterior cruciate 4. Anterior cruciate

1. The valgus stress test with 20° of knee flexion isolates the medial collateral ligament. Laxity during the test shown would indicate a tear of this ligament. (Magee p. 814 - Orthopedic Physical Assessment)

Which of the following ankle-foot orthoses is MOST appropriate for a patient who exhibits Trace (1/5) strength of the tibialis anterior muscle? 1. Posterior leaf spring 2. Floor reaction 3. Patellar tendon-bearing 4. Solid ankle

1. Trace (1/5) strength in the anterior tibialis indicates the ankle is unable to move into dorsiflexion, resulting in foot drop (Avers, pp. 284-285). The posterior leaf spring is designed to help lift the foot for adequate clearance during the swing phase of gait (O'Sullivan, p. 1293).

A patient has diplopia, dysphagia, and bilateral weakness of the lower extremities. The patient also has loss of vibratory sense, two-point discrimination, and position sense. There are no signs of personality changes or aphasia. Which of the following arteries is MOST likely affected? 1. Basilar 2. Anterior cerebral 3. Middle cerebral 4. Posterior cerebral

1. Vertebral (basilar) arteries supply the brainstem and cerebellum. Lesions of these arteries usually manifest as unilateral or bilateral weakness of extremities and loss of vibratory sense, two-point discrimination, and position sense. Diplopia, homonymous hemianopsia, dysphagia, dysarthria, nausea, and confusion may also occur. Author: Paz JC, West MPTitle: Acute Care Handbook for Physical TherapistsEdition: 4Publisher: Elsevier SaundersYear: 2014Pages: 146

Which of the following tests is MOST accurate for assessing volume reduction in a patient who has lymphedema? 1. Water displacement 2. Limb circumference 3. Bioelectrical impedance 4. Optoelectronic volumetry

1. Water displacement has been regarded as the most sensitive and accurate standard for volume measurement.

Which of the following communication strategies is MOST appropriate for a physical therapist to use with a patient who has dysarthria following a recent cerebrovascular accident? 1. Provide feedback indicating understanding of the patient's speech. 2. Utilize an increased level of tactile or visual cueing. 3. Use open-ended questions to elicit responses. 4. Speak and interact with the patient's family rather than the patient.

1. When communicating with a person who has difficulty speaking, physical therapists should intensify their listening skills and provide feedback to the individual to indicate understanding. (Fairchild)

On the basis of the magnetic resonance imaging data shown in the photograph [luminosity of the R posteriolateral cortex and L ventricle], which of the following findings is MOST likely to be found during examination of a patient who is left-handed? 1. Receptive aphasia 2. Executive function changes 3. Bilateral ataxia observed with intentional movement 4. Lower extremity involvement greater than upper extremity involvement

1. When the dominant temporal lobe is involved, receptive aphasia may be present. The magnetic resonance imaging (MRI) shows a lesion in the parietal and temporal areas. (Goodman p. 1514)

Which of the following muscles is MOST likely being tested in the photograph [prone position with the arm extended diagonally overhead and the shoulder is medially (externally) rotated] ? 1. Lower trapezius 2. Rhomboid major 3. Latissimus dorsi 4. Middle trapezius

1. lower trapezius manual muscle test

A patient who has right hemiparesis following a cerebrovascular accident is habitually positioned in right sidelying position. Which of the following problems may result from this positioning and should be of GREATEST concern to the physical therapist? 1. Left gaze preference 2. Chronic right shoulder pain 3. Trunk shortening on the right 4. Skin breakdown on the medial aspect of left knee

2. Hemiplegic shoulder pain is a common complication after stroke. Poor positioning of the more affected upper extremity has been implicated in producing joint microtrauma and pain. Prolonged soft tissue injury can result in complex regional pain syndrome. (pp. 646-647)

A patient has a pink, shiny, shallow wound without slough on the heel after 3 weeks of bed rest following a motor vehicle accident. Which of the following classifications BEST represents the wound? 1. Stage 1 2. Stage 2 3. Stage 3 4. Stage 4

2. A pink, shiny, shallow wound without slough on the heel associated with bed rest is consistent with a Stage 2 pressure injury. (O'Sullivan)

Which of the following characteristics of a skin lesion is MOST likely to require referral to a physician? 1. Smooth and even borders 2. Black and brown coloration 3. Round and symmetrical shape 4. 0.20 inches (5 mm) in diameter

2. A single lesion with more than one shade of black, brown, or blue may be a sign of malignant melanoma.

A physical therapist is designing an independent home program for a patient who has a 10-year history of recurrent low back pain. The goal of the program is to reduce the recurrence rate and improve the patient's function. Which of the following recommendations is MOST appropriate? 1. Rest whenever pain is increased. 2. Start an aerobic conditioning program. 3. Place an order for a home traction unit. 4. Use a lumbar brace regularly.

2. Aerobic exercise combined with specific strengthening may decrease the frequency of low back pain recurrence (p. 1480).

Testing of reactive balance as shown in the photograph is MOST likely to provide useful findings for a patient who reports which of the following problems? 1. Tendency to fall forward 2. Tendency to fall backward 3. Tendency to fall on uneven surfaces 4. Tendency to fall when standing with a narrow base of support

2. An ankle strategy in response to a posterior perturbation is demonstrated in the photograph. The correct muscle recruitment for a posterior displacement of center of gravity for an ankle strategy is tibialis anterior, quadriceps femoris, and abdominals. This is the body motion used to reestablish stability in response to backward instability.

Which of the following functional tests would be MOST appropriate to verify that a patient lacks figure-ground discrimination? 1. Have the patient find an object, such as a toothbrush, among similarly shaped objects. 2. Have the patient locate a white button on a white shirt. 3. Ask patient to identify an object, such as a key, with eyes closed. 4. Ask the patient to reach for a bright blue paper located on a white desk.

2. An impairment in figure-ground discrimination is the inability to visually distinguish a figure from the background in which it is embedded. A functional test that can be given to the patient to assess figure-ground discrimination is to ask a patient to point out a white button on a white shirt. Compensatory techniques to be used with patients who lack figure-ground perception are placing red tape over the Velcro strap of the shoe to aid the patient in locating it or using bright red tape to mark the edges on stairs. (O'Sullivan pp. 1207-1208)

A physical therapist is assisting with bed mobility for a patient who is receiving antibiotics for vancomycin-resistant Enterococcus (VRE). Which of the following precautions and personal protective equipment are indicated for physical therapy intervention? 1. Contact precautions; the therapist should wear a mask. 2. Contact precautions; the therapist should wear a gown. 3. Droplet precautions; the therapist should wear a mask. 4. Droplet precautions; the therapist should wear a gown.

2. Contact precautions are followed for vancomycin-resistant Enterococcus (VRE). A gown is needed for contact precautions. (Fairchild)

A non-English-speaking patient is accompanied to physical therapy by her young English-speaking grandson. The patient does not understand or speak enough English to fully participate in an initial examination. To provide the MOST appropriate services, the therapist should take which of the following actions? 1. Ask the grandson to translate and proceed with the examination. 2. Use a professional translator and proceed with the examination. 3. Ask a same-language-speaking member of the hospital's staff to translate and proceed with the examination. 4. Use gestures, pictures, and simple terms in order to proceed with the examination.

2. Culturally and linguistically appropriate services require professional translators with knowledge of the patient's language and knowledge of medical terms.

A patient who has chronic obstructive pulmonary disease is participating in a mild graded exercise program at a level of 2 metabolic equivalents (METs). The patient's heart rate at rest is 80 bpm. During an incremental increase in exercise up to 4 metabolic equivalents (METs), the patient experiences an elevation in heart rate to 120 bpm. Which of the following actions is MOST appropriate? 1. Discontinue exercise while monitoring vital signs. 2. Continue the exercise session while monitoring vital signs. 3. Continue the exercise session and refer the patient to a physician to evaluate exercise response. 4. Discontinue the exercise session and refer the patient to an emergency department to evaluate exercise response.

2. During acute exercise, patients who have chronic obstructive pulmonary disease experience elevated heart rates and blood pressures with incremental exercise. The patient's response is an expected compensatory response, and exercise can continue as prescribed with continued monitoring of vital signs.

If treatment time and surface area are kept constant, which of the following ultrasound parameters would MOST likely deliver the GREATEST amount of energy through tissues? 1. 0.5 W/cm2 in continuous mode at 1 MHz 2. 0.8 W/cm2 in continuous mode at 3 MHz 3. 1.0 W/cm2 in 50% pulsed mode at 1 MHz 4. 1.2 W/cm2 in 25% pulsed mode at 3 MHz

2. Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Continuous mode (or 100% duty cycle) produces thermal effects, compared to pulsed mode (p. 185). Research indicates that a frequency of 3 MHz results in a higher maximal temperature than 1 MHz despite delivering a lesser depth of penetration (p. 175). Furthermore, higher intensities produce higher temperature increases in tissues (p. 175). (Cameron)

A patient has excessive ankle eversion when walking. Which of the following examination measures is MOST likely to determine the cause of the patient's gait deviation? 1. Manual muscle test of the gastrocnemius and soleus 2. Manual muscle test of the tibialis anterior and tibialis posterior 3. Modified Ashworth test of the tibialis posterior and flexor digitorum 4. Modified Ashworth test of the tibialis anterior and extensor digitorum

2. Excessive ankle eversion during stance is most frequently associated with marked weakness of inverters such as the tibialis anterior and tibialis posterior (Dutton, p. 309), which may result from a malalignment such as a forefoot or rearfoot varus/valgus (Magee). Other causes of excessive eversion include plantar flexion contracture, fibular (peroneal) hypertonicity, and valgus deformity (Dutton, p. 314). A manual muscle test of the tibialis anterior and tibialis posterior muscles would best determine if these muscles are weak and in need of strengthening (Dutton, pp. 1136-1137).

Which of the following exercises promotes context-dependent responses in a patient who has Parkinson disease? 1. Lap swimming 2. Walking outdoors 3. Unsupervised treadmill walking 4. Riding a stationary bicycle

2. Exercises such as karate and other martial arts, dancing, and walking outdoors promote context-dependent responses and are important to incorporate in treatment of patients who have movement disorders because these exercises require patients to adjust the response to a specific task. (Umphred)

A 47-year-old female patient who has diabetes reports a 7-month history of right shoulder and upper arm pain of gradual onset. The patient reports waking up at night due to the pain and has decreased active range of motion in all ranges but especially in lateral (external) rotation and abduction. Which of the following conditions is MOST likely present? 1. Bicipital tendinitis 2. Adhesive capsulitis 3. Glenohumeral instability 4. Acromioclavicular joint sprain

2. Factors associated with development of adhesive capsulitis include age older than 40 years, history of diabetes, and female gender. Stage II adhesive capsulitis, which is present for 3-9 months, is associated with decreased lateral (external) rotation and abduction and with pain that disrupts sleep. (pp. 650, 665, 667) Author: Dutton MTitle: Dutton's Orthopaedic Examination, Evaluation, and InterventionEdition: 4Publisher: McGraw-HillYear: 2017Pages: 650, 665, 667, 670

Which of the following interventions would be BEST for a patient who has cervical stenosis and right upper extremity radicular symptoms? 1. Supine cervical traction in 10° of flexion 2. Supine cervical traction in 30° of flexion 3. Sitting cervical traction facing toward the door 4. Sitting cervical traction facing away from the door

2. Flexion at 30° results in greater separation of the posterior structures, which include the facet joints and the intervertebral foramina. Cervical flexion in supine position allows for more patient comfort and muscle relaxation than cervical flexion in sitting position.

A patient who had a cerebrovascular accident exhibits a flexion synergy of the left upper extremity. To promote good upper extremity movement, a physical therapist should mobilize the patient's scapula toward which of the following directions? 1. Upward rotation and retraction 2. Upward rotation and protraction 3. Downward rotation and retraction 4. Downward rotation and protraction

2. Flexion synergy of the upper extremity includes scapular retraction/elevation or hyperextension. In the upper extremity, correct passive range of motion techniques require careful attention to lateral (external) rotation and distraction of the humerus, especially as ranges approach 90° of flexion or more. The scapula should be mobilized on the thoracic wall with an emphasis on upward rotation and protraction to prevent soft tissue impingement in the subacromial space during overhead movements of the arm.

A patient who was in a motor vehicle accident 10 weeks ago sustained a whiplash injury. To facilitate long-term return to function, which of the following interventions would be MOST appropriate for the patient? 1. Levator scapulae stretching 2. Cervical proprioception exercises 3. Continuous ultrasound to the suboccipitals 4. Exercises for selective recruitment of type II muscle fibers

2. For patients in the subacute phase of healing after a whiplash injury, cervical proprioception exercises along with deep neck flexor strengthening are recommended. (Clinical Orthopaedic Rehabilitation: A Team Approach)

Which of the following options BEST describes a normal response to the cremasteric reflex test? 1. Skin tenses in the gluteal area. 2. Ipsilateral scrotum elevation 3. Contraction of the anal sphincter muscles 4. Umbilicus moves down and toward area being stroked.

2. For the cremasteric reflex text, the patient lies in supine position while the examiner strokes the inner side of the upper thigh with a pointed object. The test result is negative if the scrotal sac on the tested side pulls up. Unilateral absence of this response indicates a lower motor neuron lesion between L1 and L2.

A patient has a severed musculocutaneous nerve. Which of the following muscles can the patient use to substitute for the resultant loss in upper extremity function? 1. Biceps brachii and supinator 2. Brachioradialis and pronator teres 3. Extensor digitorum and anconeus 4. Brachialis and extensor carpi radialis longus

2. If the biceps brachii and the brachialis are paralyzed, weak elbow flexion is achieved through function of the brachioradialis, which is innervated by the radial nerve (p. 170), with assistance from the pronator teres, which is innervated by the median nerve (p. 173).

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

2. It is normal to urinate 6 to 8 times in a 24-hour period. A frequency beyond 8 times/day is considered abnormal. (Brody)

Which of the following positions is BEST for postural drainage of the posterior segments of the upper lobes? 1. Lying in a supine position with the bed flat 2. Sitting in a chair, leaning forward over a pillow 3. Long-sitting position, leaning back 4. Lying in a prone position with the bed flat

2. Leaning forward over a pillow is the best position to allow for drainage of the upper lobes, posterior segments. (Hillegass - Essentials of Cardiopulmonary Physical Therapy)

A 6-year-old boy has decreased stance time on the left lower extremity. There is no history of trauma and no pain in the extremity. Passive and active ranges of motion of both hip medial (internal) rotation and hip abduction are limited by 50%. Which of the following conditions is MOST likely present? 1. Femoral retroversion 2. Legg-Calvé-Perthes disease 3. Slipped capital femoral epiphysis 4. Gluteus medius muscle weakness

2. Legg-Calvé-Perthes disease is associated with limited hip abduction and medial (internal) rotation and higher prevalence in boys than in girls. An age of 6 years is the most common age for the presentation of this condition. (Palisano)

A patient has a history of breast cancer, lymph node dissection surgery, and lymphedema. Which of the following interventions is MOST appropriate? 1. Cryotherapy 2. Compression 3. Percussive massage 4. Negative pressure therapy

2. Manual lymphatic drainage and compression with short-stretch dressings are the cornerstones of lymphedema therapy (Zuther, p. 247).

A patient who is a secretary has a well-healed fracture of the right scaphoid. The findings upon the initial physical therapy examination include 55° of wrist flexion and 45° of wrist extension with pain at end-range. Which of the following additional findings would result in the GREATEST delay in return to work? 1. Passive pronation and supination limited to 65° on the right 2. Pain with light touch and increased sweating of the right hand 3. Subjective pain of 3/10 with right wrist movement and 1/10 at rest 4. Grip dynamometer strength of 72 lb (32.7 kg) on the right and 80 lb (36.3 kg) on the left

2. One of the complications after an upper extremity trauma is the advent of complex regional pain syndrome. This complication often presents with burning pain with any movement of the body part, excessive sensitivity to light touch or minor stimulation, temperature changes, localized sweating, localized changes of the skin, or trophic changes of the skin, hair, and nails. Of the four options, this complication would result in longest delay in recovery and return to work. (Dutton)

A patient is performing three sets of 15 repetitions at 30% of the one-repetition maximum. To improve power, which of the following modifications would be BEST? 1. Increase the resistance and the number of repetitions per set. 2. Increase the resistance and the speed at which the exercise is performed. 3. Decrease the number of sets and increase the number of repetitions per set. 4. Increase the resistance and decrease the speed at which the exercise is performed.

2. Power requires a combination of strength and speed. Strength is improved by training at a greater percentage of the one-repetition maximum, at least 60% for untrained individuals and 80% to 100% for an advanced training program. Speed is an essential component of power. Strength training in the absence of increasing speed may actually reduce power. In the example described in the stem, the individual is training below 60%, so increasing the weight at which the exercise is performed, in combination with increasing the speed at which the exercise is performed, would be most likely to increase power.

A 74-year-old patient who is obese underwent a total hip arthroplasty 5 days ago. Currently, the patient exhibits dyspnea, tachycardia, and light-headedness. When a physical therapist squeezes the patient's calf muscle while positioning the ankle in dorsiflexion, no pain is reported and no swelling or warmth is seen. These findings are MOST indicative of which of the following conditions? 1. Deep vein thrombosis 2. Pulmonary embolism 3. Poor conditioning 4. Infection

2. Pulmonary embolism is a common postsurgical condition with symptoms that include dyspnea, chest pain, cough, apprehension, and tachycardia. Individuals undergoing a total hip arthroplasty are at high risk of developing a pulmonary embolus. (Dutton, p. 56; Goodman, p. 850)

Postural drainage for the posterior segments of the lower lobes would be CONTRAINDICATED for which of the following patients? 1. A patient who has a pleural effusion. 2. A patient who had a recent head trauma. 3. A patient who had a recent total knee arthroplasty. 4. A patient who has a history of pulmonary embolism.

2. Recent head trauma is a contraindication for postural drainage. (Hillegass)

A 12-year-old patient who has spastic diplegic cerebral palsy has full passive range of motion of the lower extremities, but demonstrates crouching with hip and knee flexion angles of 20° each in standing position. Which of the following interventions is BEST to achieve sustained improvements in lower extremity alignment during walking? 1. Stretching of the iliopsoas 2. Strengthening of the quadriceps and gluteals 3. Stretching of the hamstrings and gastrocnemius 4. Strengthening of the hamstrings and gastrocnemius

2. Strength training has been shown to improve gait and muscle performance in patients who have cerebral palsy. The physical therapist should seek to create a balance of muscle activity across a joint. In this case, addressing quadriceps and gluteal muscles will be beneficial for improving knee and hip extension by counteracting the forces potentiating flexion.

A patient has an irregularly shaped, open wound on the medial leg that is 5 mm deep and 25 mm wide. Moderately severe edema is observed. The patient reports aching pain that worsens when the leg is in a dependent position and decreases when the leg is elevated. The patient MOST likely has which of the following conditions? 1. Arterial wound 2. Venous wound 3. Neuropathic ulcer 4. Pressure injury

2. The aching pain, especially worsened with the limb in the dependent position, is a classic sign for venous wounds. The dependent position causes increased pressure in the venous system. (p. 343)

A patient falls with an outstretched hand for protection. Tenderness is present on palpation of the scaphoid bone. The patient MOST likely has which of the following conditions? 1. Hamate fracture 2. Scaphoid fracture 3. De Quervain tenosynovitis 4. Median nerve injury

2. The anatomic snuffbox is the landmark for the scaphoid; a fall with an outstretched hand is a common mechanism of injury for a scaphoid fracture.

A physical therapist lightly touches a patient's skin with a cotton ball and asks the patient to point to the area that was touched. The patient's vision was occluded during the examination. Which of the following sensory modalities was being tested? 1. Bilateral touch 2. Touch localization 3. Touch awareness 4. Touch pressure threshold

2. The assessment described in the stem tests the sensory modality of touch localization, which is the ability to localize the area tested after a stimulus was provided with vision occluded (p. 95)

When donning personal protective equipment prior to working with a patient who has tuberculosis, which of the following items should be applied LAST? 1. Gown 2. Gloves 3. Goggles 4. N-95 respirator

2. The general order for donning personal protective equipment is gown, then face mask or respirator, then goggles or face shield, then gloves. Gloves are the last piece of equipment applied.

The clinical presentation of the patient in the photograph [scapular winging] is MOST likely to result from compression of which of the following nerves? 1. Axillary 2. Long thoracic 3. Suprascapular 4. Musculocutaneous

2. The long thoracic nerve innervates the serratus anterior. Injury to this nerve could result in winging of the scapula. (pp. 76-77)

A physical therapist is examining a patient who has a whiplash injury and a mid-cervical spine sprain. To determine the function of the patient's longus colli and longus capitis, which of the following assessments should be included in the examination? 1. Axial extension 2. Craniocervical flexion 3. Cervical compression test 4. Neck flexion range of motion

2. The longus colli and longus capitis are deep neck flexors. The craniocervical flexion test or the deep neck flexor endurance test is included in the examination of these muscles.

Examination of a patient's right lower extremity reveals weakness in great toe extension and decreased sensation along the lateral leg and dorsum of the foot. Which of the following nerve roots is MOST likely contributing to these findings? 1. L4 2. L5 3. S1 4. S2

2. The myotome associated with L5 is toe extension/dorsiflexion. The dermatome associated with L5 is the lateral leg and dorsum of the foot.

A patient fell 1 day ago, sustaining the injury shown in the photograph. What is the MOST appropriate intervention and expected number of weeks for the patient to return to activity? 1. Immobilization at night for 3 weeks; 3 weeks to return to activity 2. Immobilization for 3 weeks; 6 weeks to return to activity 3. Active assistive range of motion exercises; 6 weeks to return to activity 4. Active abduction and lateral (external) rotation exercises; 12 weeks to return to activity

2. The patient depicted presents with a step-off deformity, which would be considered a type III disruption. Initially, the arm should be put in a sling. The patient will return to activity in about 6 weeks. The second degree of subluxation requires at least 6 weeks to return to activity, although the patient will have good structural strength at about 3 weeks.

A physical therapist is MOST likely to perform shoulder anterior mobilization for a patient who has difficulty with which of the following functional activities? 1. Hanging clothes in a closet 2. Pulling the cord to start a lawn mower 3. Reaching across the body to scrub the back of the opposite shoulder 4. Bringing the arm out to the side and over the head

2. The photograph depicts an anterior glide of the humerus, which helps improve glenohumeral extension, according to the concave-convex rule. Pulling a lawn mower cord is a movement into glenohumeral extension. (Kisner)

A patient has pain and sensory changes in the distribution shown in the photograph [L5]. The patient is MOST likely to exhibit impaired strength in which of the following pairs of motions? 1. Knee extension and knee flexion 2. Great toe extension and foot eversion 3. Knee extension and ankle plantar flexion 4. Foot inversion and ankle plantar flexion

2. The photograph depicts the L5 dermatome (Moore; Magee, p. 942). Muscles innervated by L5 include the extensor hallucis longus (great toe extension) and fibularis (peroneal) muscles (foot eversion) (Moore).

For a patient who has undergone a transtibial amputation, which of the following seated positions is MOST appropriate? 1. High Fowler position with the residual limb supported by pillows and the knee resting in 45° of flexion 2. Residual limb supported by pillows and the knee resting in full extension 3. Residual limb supported by pillows and the knee resting in 30° of flexion 4. Upright with bilateral hips and knees in 90° of flexion

2. The residual limb supported by pillows and the knee resting in full extension is the preferred position, because it decreases the risk for knee flexion contracture (p. 190).

Which of the following combinations of activities would be MOST beneficial for maintaining bone density in a patient with osteoporosis? 1. Treadmill walking and balance training 2. Treadmill walking and resistance training 3. Swimming and balance training 4. Swimming and resistance training

2. This question presents two comparisons and asks which is better: 1) treadmill walking or swimming and 2) resistance or balance training. The correct answer is treadmill walking and resistance training. Walking is a beneficial weight-bearing aerobic activity. Resistance training is important to maintain bone mineral density or prevent loss of bone mineral density. (Moore)

A patient exhibits a steppage gait pattern. Which of the following muscles is MOST likely weak? 1. Quadriceps 2. Gluteus medius 3. Tibialis anterior 4. Gluteus maximus

3. A patient who has weakness of the tibialis anterior muscle would have a steppage gait due to the decrease in ankle dorsiflexion. The patient would exhibit high steppage to allow clearing of the ankle and foot during gait and to avoid tripping over the foot.

A patient makes heel strike (initial contact) with the midfoot while walking. Which of the following gait interventions would MOST effectively normalize the patient's gait pattern? 1. Strengthening of the plantaris muscle 2. Strengthening of the tibialis anterior muscle 3. Posterior-anterior mobilization of the talocrural joint 4. Posterior-anterior mobilization of the tibiofemoral joint

2. Weak dorsiflexors are typically associated with the gait deviation described in the stem. Tibialis anterior strengthening will improve ankle dorsiflexion and, therefore, improve this gait pattern. (O'Sullivan)

During lung auscultation, a physical therapist asks a patient to continuously say "E." Transmission of an "A" sound is heard over the right lower lobe when the patient says "E." Which of the following conditions is MOST likely present in the right lower lobe? 1. Atelectasis 2. Consolidation 3. Pleural effusion 4. Pneumothorax

2. When a patient has consolidated lung tissue or increased secretions, egophony will be present. Egophony is a voice sounds test and is the transmission of an "A" sound when the patient says "E." Voice sounds will increase in patients who have consolidation .

A patient in intensive care is recovering from cardiovascular surgery. Which of the following medical devices would require the MOST restrictions for implementing an upright mobility program beginning with sitting and transferring from the bed to a chair? 1. Temporary pacemaker with an external pacing box 2. Intraaortic balloon pump via femoral sheath access 3. Chest tubes inserted bilaterally at the sixth intercostal space 4. Assist control mode of mechanical ventilation

2. When mobilizing patients who have an intra-aortic balloon pump, no hip flexion is allowed in the leg where the catheter is inserted, therefore, sitting at the edge of the bed or moving from sitting to standing position would be restricted. Patients are restricted to strict bed rest but can participate in therapeutic activities. Out-of-bed activities are contraindicated until the intra-aortic balloon pump is removed. (Hillegass, p. 440)

Which of the following signs would be MOST indicative of a patient who is experiencing chronic lower limb ischemia? 1. There is an increase in the hair growth in the lower extremities. 2. The skin of the lower extremities has become transparent and appears dehydrated. 3. The nail beds of the toes have become thin and supple in texture and strength. 4. There is an increase in skin temperature in the lower extremity.

2. With chronic ischemia due to arterial insufficiency, a cardinal sign is that the skin in the lower extremities becomes thin, scaly or shiny, and transparent due to inadequate blood flow. (Goodman)

A physical therapist plans to perform a job analysis for a worker who had a T10 complete spinal cord transection 6 months ago. Which of the following elements would be MOST appropriate to include in the job analysis? 1. Identify specific job tasks that increase the patient's satisfaction. 2. Determine the previous level of function related to the job tasks. 3. Identify specific components of the job tasks and environment. 4. Determine the appropriate level of salary and benefits related to the job tasks.

3. A job analysis as a component of a workplace assessment is the identification of the specific components of job tasks and the work environment.

In which of the following wrist positions would maximal grip strength MOST likely be generated? 1. 0° (neutral) 2. 15° of flexion 3. 30° of extension 4. 60° of extension

3. A muscle has maximal ability to generate force (or tension) when the muscle is contracted at its optimal length. Finger flexors involved in grip cross the wrist, so wrist position affects the length of the finger flexors and consequently also affects the ability of the flexors to generate force. The optimal length of the finger flexors is maintained when the wrist is held at approximately 30° of extension.

A patient who has a C6 spinal cord injury (ASIA Impairment Scale A) is MOST likely to exhibit which of the following movement patterns during inhalation? 1. Inward motion of the abdomen and inward motion of the upper chest 2. Inward motion of the abdomen and outward motion of the upper chest 3. Outward motion of the abdomen and inward motion of the upper chest 4. Outward motion of the abdomen and outward motion of the upper chest

3. A patient who has a C6 spinal cord injury retains full use of the diaphragm but lacks innervation to abdominal and intercostal musculature. The patient will display outward motion of the abdomen and inward motion of the upper chest. The outward motion of the abdominal area is caused by the diaphragm contracting and pushing abdominal contents forward and outward, and the inward motion of the upper chest is due to the lack of structural support from paralyzed thoracic musculature. (DeTurk- Cardiovascular & Pulmonary Physical Therapy)

A patient is referred for partial weight bearing (25%) on the right and arrives in the clinic walking as shown in the photograph. The physical therapist should instruct the patient in: 1. proper use of a quad cane in the right hand. 2. proper use of a quad cane in the left hand. 3. use of crutches instead of a quad cane. 4. use of a standard walker instead of a quad cane.

3. A quad cane may not offer enough support to relieve weight-bearing to partial weight-bearing. Given the patient's age, crutches appear to be a better choice. (pp. 294, 308-309)

A patient who had a cerebrovascular accident has not progressed with mobility during the past 2 weeks of treatment in a skilled nursing facility. The physical therapist's prognosis is that the patient has residual deficits that will prevent the patient from becoming more independent. The family wants to take the patient home. Which of the following treatment plans is MOST appropriate for the patient? 1. Continue treatment for 2 weeks and then reassess to determine if the additional intervention has resulted in further improvement. 2. Recommend transferring the patient back to the hospital for reassessment for possible extension of the cerebrovascular accident. 3. Change the focus of the treatment to family or caregiver training in assisting the patient to ensure a safe discharge. 4. Discharge the patient to home at the current level of function and have the patient's family monitor the patient for further improvement.

3. A revision in the plan of care is indicated if the patient progresses more slowly than expected. Each modification must be evaluated in terms of overall effect on the plan of care. Family and caregiver education/training is a component of effective discharge planning. The caregiver should understand the proper use of any relevant assistive equipment and appropriate transfer and guarding techniques and should use correct body mechanics.

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

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

A patient who had an atrial septal defect repair continues to have mild pulmonary hypertension. Which of the following activity-level recommendations is MOST appropriate? 1. Participation in all sports is restricted. 2. Participation in sports is not restricted. 3. Participation is limited to low-intensity sports. 4. Participation is limited to basic activities of daily living.

3. Although exercise tolerance for this patient is likely to be normal or only mildly impaired, intense exertion accompanied by pulmonary hypertension may result in cyanosis, heart failure, or pulmonary hemorrhage. The patient may participate in low-intensity sports.

A physical therapist notes that a patient has a fatty mass and an unusual patch of hair on the low back. Which of the following conditions is MOST likely present? 1. Arthrogryposis 2. Spondylolisthesis 3. Spina bifida occulta 4. Paget disease

3. An unusual patch of hair on the back may be evidence of a bony defect of the spine. Fatty masses appearing as lumps in the area of the low back may be a sign of spina bifida. (p. 1171)

A patient who has Stage 0 lymphedema should be educated to AVOID which of the following activities? 1. Prolonged air travel 2. Running barefoot 3. Aquatic activities 4. Stationary cycling

3. Aquatic activities, which include swimming, are recommended. Swimming would not cause skin breakdown and is not contraindicated for patients who have Stage 0 lymphedema. (Zuther - Lymphedema Management)

A patient has a recent onset of intermittent signs of cervical radiculopathy. Which of the following conditions is MOST likely to be detected by plain radiographs as the structural cause of the symptoms? 1. Tumor 2. Disc herniation 3. Osteophytes 4. Acute stress fractures

3. Bone spurs are a common cause of lateral stenosis, which can cause radicular pain. Osteophytes is the correct answer because radiographs provide an excellent view of cortical bone and are more sensitive than magnetic resonance imaging in detecting calcification. (Dutton, pp. 345, 1317)

A partial-thickness wound that has been treated for 10 days is currently debrided of all devitalized tissue, but granulation tissue is still not apparent. The wound is draining a minimal amount of serous fluid. Which of the following interventions would be MOST appropriate? 1. Enzymatic agent 2. Calcium alginate dressing 3. Hydrocolloid dressing 4. Nonwoven gauze dressing

3. Hydrocolloids are indicated for wounds that have low to moderate amounts of drainage and that need protection from bacteria or other contaminants (pp. 312, 314).

Chorea-type movements are noted during an initial gait assessment of a patient referred to physical therapy following a stroke. This clinical finding is indicative of a lesion in the: 1. cerebellum. 2. thalamus. 3. basal ganglia. 4. limbic system.

3. Hyperkinetic disorders such as chorea arise from a pathological condition of the basal ganglia.

A patient who has a hiatal hernia is receiving physical therapy. Which of the following exercises would MOST likely worsen the symptoms related to the hernia? 1. Wall sits 2. Overhead press 3. Bilateral leg lifts 4. Hamstring stretch

3. Individuals who have a hiatal hernia should avoid supine position and avoid the Valsalva maneuver. Bilateral leg lifts must be performed in supine position and require strong contractions of the stomach muscles, encouraging the Valsalva maneuver, which would worsen the hiatal hernia.

A patient has a superficial partial-thickness burn. Which of the following signs would MOST likely be observed in the burned area? 1. Mixed red-white coloring 2. Marked edema 3. Intact blisters 4. Eschar

3. Intact blisters are the most common sign of superficial partial-thickness burns. Damage is through the epidermis and into the papillary layer of the dermis.

A patient has begun practicing 50 repetitions of hitting a ball tossed by the physical therapist. Which of the following options BEST reflects the feedback that should be given regarding the number of times the patient used the correct technique for hitting the ball? 1. No feedback is required. 2. Feedback should be given after every repetition. 3. Feedback should be given after every five repetitions. 4. Feedback should be given after the 50 repetitions.

3. Knowledge of results (terminal feedback about the outcome of the movement in terms of the movement's goal) has been shown to be important for learning motor tasks. Feedback for very simple movements has been shown to be more beneficial if given every 15 repetitions as a summary. For more complex tasks, such as hitting a ball with a bat, the most effective summary length for learning is every five repetitions.

Which of the following activities is CONTRAINDICATED for a patient who is 2 weeks post coronary artery bypass surgery? 1. Walking for 15 minutes 2 times/day 2. Performing bilateral arm lifts using 2-lb (0.9-kg) weights 3. Pushing up from the armrest of a chair during sit-to-stand transfers 4. Holding a pillow against the sternal incision when coughing or sneezing

3. Patients who are at risk for sternal instability (e.g. following open-heart surgery) demonstrate the greatest separation when pushing up from a chair (O'Sullivan p. 487).

A patient displays an irregular heart rhythm, increased respiratory rate, and acetone-like breath odor after performing 15 minutes of intense exercise. Which of the following conditions is MOST likely present? 1. Thyroid hypersecretion 2. Pituitary hypersecretion 3. Pancreatic hyposecretion 4. Adrenal hyposecretion

3. Patients who have diabetes potentially have a lack of insulin secretion or effectiveness, leading to disruption of glucose metabolism. Results of acute metabolic changes related to glucose metabolism include hyperglycemia (high blood glucose), electrolyte disturbances that are manifested by acidosis that triggers an increased respiration rate, irregular heart rate, and increased fatty acid metabolism resulting in acetone breath. (Goodman p. 522)

A patient who has primary progressive multiple sclerosis requests guidelines for an exercise plan. Which of the following recommendations would be MOST appropriate for the patient? 1. Resistance training should be avoided. 2. Exercise should be performed to the point of fatigue. 3. Exercise sessions should be scheduled for the morning. 4. Measuring heart rate is the best way to monitor exercise intensity.

3. Patients who have primary progressive multiple sclerosis should exercise when the core body temperatures is the lowest and before fatigue sets in. Most commonly, this is in the morning hours. (O'Sullivan p. 690)

Which of the following patients whose laboratory test values are shown in the table is MOST likely to benefit from rebreathing in a paper bag? 1. Patient A pH = 7.2 PaCO2 = 68 mmHg HCO3- = 22 mEq/L 2. Patient B pH = 7.5 PaCO2 = 35 mm Hg HCO3- = 29 mEq/L 3. Patient C pH = 7.53 PaCO2 = 26 mmHg HCO3- = 24 mEq/L 4. Patient D pH = 7.33 PaCO2 = 37 mmHg HCO3- = 17 mEq/L

3. Patients who have respiratory alkalosis will have the following laboratory test values: pH greater than 7.45, PaCO2 less than 35 mm Hg, and HCO3- of 22-26 mEq/L (p. 1709). A patient who has respiratory alkalosis would benefit from rebreathing carbon dioxide (Goodman p. 215).

Which of the following statements is the MOST appropriate example of patient care documentation? 1. Patient ambulated up and down stairs with a reciprocal stepping pattern without difficulty. 2. Patient ambulated up and down 6 steps using a right handrail and recip. stepping pattern with min assist. 3. Patient ambulated up and down 6 steps using a right handrail and a reciprocal stepping pattern with minimal assistance. 4. Patient ambulated up and down stairs using a right handrail and reciprocal stepping pattern with minimal assist.

3. Principles of documentation require the use of objective statements that are clearly measurable. This statement also avoids non-standardized abbreviations and fully spells out terms.

Superficial cooling is CONTRAINDICATED in which of the following situations? 1. For a patient with an injury near the location of the fibular nerve 2. For a patient who has a blood pressure of 176/90 mm Hg 3. For a patient who has periodic vasoconstriction in the fingers 4. For a patient who has a Mini-Mental State Examination score of 20/30

3. Raynaud syndrome is listed as a contraindication for use of superficial cooling (p. 133).

A patient has thin, bloody drainage from an abdominal surgical wound. This finding should be classified as which of the following types of drainage? 1. Serous 2. Chylous 3. Sanguinous 4. Purulent

3. Sanguineous drainage is described as thin, bloody drainage from a surgical wound or acute traumatic wound. Author: Hamm RLTitle: Text and Atlas of Wound Diagnosis and TreatmentEdition: 1Publisher: McGraw-HillYear: 2015Pages: 80-83

Which of the following options BEST describes the role of the center coordinator for clinical education? 1. Practices as a physical therapist 2. Reviews daily student documentation 3. Serves as a liaison to the academic institution 4. Acts as a clinical instructor for physical therapy students

3. Serving as a liaison between clinical education sites and the academic institution is the primary role of the center coordinator for clinical education (Stern p. 91).

Which of the following conditions is MOST likely to be associated with systemic lupus erythematosus? 1. Uveitis 2. Urethritis 3. Photosensitivity 4. Psoriasis

3. Skin rashes, fever, fatigue, malaise, photosensitivity, dyspnea, cough, and peripheral neuropathies are all common findings in patients who have systemic lupus erythematosus (pp. 307-308).

When examining a patient's pressure injury, a physical therapist notes that in the area of the wound, the patient has complete loss of skin and intact underlying fascia. The therapist should recognize this as a: 1. Stage 1 wound. 2. Stage 2 wound. 3. Stage 3 wound. 4. Stage 4 wound.

3. Stage 3 pressure injuries are characterized by full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia (deep crater with or without undermining).

Which of the following interventions is MOST appropriate to improve stability in long sitting for an individual with a complete T4 spinal cord injury? 1. Stretch the gluteus maximus to 90° of hip flexion. 2. Strengthen the abdominal muscles to grade Fair (3/5). 3. Stretch the hamstrings to 110° of straight leg raising. 4. Strengthen the erector spinae muscles to grade Good (4/5).

3. Stretching of the hamstring muscles prevents overstretching of the back during long sitting. Passive low back muscle tightness is important to develop for passive trunk stability. Straight leg raises less than 100° to 110° in long sitting put a passive pull on the pelvis, resulting in posterior pelvic tilt and stretching of the low back. (O'Sullivan, p. 894)

A patient reports decreased levels of low back pain after receiving physical therapy interventions over a 3-week period. The patient then cancels the last three scheduled appointments. Which of the following actions is MOST appropriate for the physical therapist to take? 1. Leave a message on the patient's answering machine discussing the patient's noncompliance. 2. Document that the patient has discharged self from physical therapy. 3. Talk with the patient to find out the reason for the cancellations. 4. Speak to the referring physician concerning the patient's nonadherence to the plan of care.

3. Termination of the provider-patient relationship is justified when the patient makes a knowing voluntary election to end the relationship. This is the only option that seeks to determine the patient's wishes. (p. 467)

To determine if paratenonitis is present in the thumb (1st digit), which of the following tests is MOST appropriate to perform? 1. Tinel 2. Allen 3. Finkelstein 4. Phalen Your Answer:1Correct Answer:3You haveincorrectlyanswered the question.

3. The Finkelstein test is used to determine the presence of de Quervain or Hoffmann disease, a paratenonitis of the thumb (1st digit). Author: Magee DJTitle: Orthopedic Physical AssessmentEdition: 6Publisher: Elsevier SaundersYear: 2014Pages: 471-472

Sensation in the area highlighted in the photograph [middle ventral wrist distally to the palmar aspect of 3rd finger] is absent due to a nerve root lesion. Which of the following muscles is MOST likely to be affected? 1. Deltoid 2. Brachialis 3. Triceps 4. Supinator

3. The area highlighted in the photograph is the C7 nerve root distribution. Absent sensation due to a nerve root lesion would cause muscles innervated by the C7 nerve root to be affected as well (p. 24). The triceps, which is innervated by the radial nerve (C7-C8), would most likely be affected as well (p. 24).

When treating a patient who has transient upbeating nystagmus and left ocular torsion, canalith repositioning maneuvers should be targeted to which of the following structures? 1. Right posterior semicircular canal 2. Right superior semicircular canal 3. Left posterior semicircular canal 4. Left superior semicircular canal

3. The canalith repositioning maneuver for the left posterior semicircular canal is performed to move free-floating debris in the posterior semicircular canal back into the vestibule, thus resolving the signs and symptoms of nystagmus and dizziness. Debris in the left posterior semicircular canal produces symptoms of transient upbeating nystagmus and/or left ocular torsion.

A collegiate athlete reports right anterior groin pain first encountered after a rotational injury. The patient is also experiencing painful clicking. Hip range of motion is normal, but pain is provoked with combined end-range hip flexion, adduction, and medial (internal) rotation. Radiographs of the hip and pelvis are normal. Which of the following diagnoses is MOST likely? 1. Transient synovitis 2. Trochanteric bursitis 3. Anterior acetabular labral tear 4. Femoral head stress fracture

3. The clinical presentation of anterior acetabular labral tears most often includes pain on passive adduction, flexion, and medial (internal) rotation. The description of mechanism of injury and clinical presentation in the stem are most typical of this injury. (pp. 936-938)

A patient had a right total hip arthroplasty yesterday and sustained a surgical injury to the right femoral nerve. To maximize safety of a bed-to-chair transfer, the physical therapist should: 1. have the patient transfer towards the right. 2. use a hydraulic lift. 3. stabilize the right knee. 4. pre-position with an abduction pillow.

3. The femoral nerve is vulnerable to injury, which would result in quadriceps weakness. Quadriceps injury leads to knee buckling and possible injury during the transfer. Stabilizing the right knee will allow the transfer to take place with the physical therapist in control of the weak extremity. (Fairchild)

A patient who performs repetitive manual labor reports difficulty working with a screwdriver. A physical therapist identifies weakness of the flexor carpi radialis, flexor digitorum superficialis, and flexor pollicis longus and brevis. The patient has a negative result on the Phalen test. Which of the following locations is the MOST likely site of nerve entrapment? 1. Carpal tunnel 2. Cubital tunnel 3. Pronator teres 4. Thoracic outlet

3. The flexor carpi radialis, flexor digitorum superficialis, and flexor pollicis longus and brevis are innervated by the median nerve (p. 413). The pronator teres can compress the median nerve as it passes through this muscle. Repetitive movements may be one cause of enlargement and entrapment. Symptoms would include weakness in the distribution of the median nerve distal to the pronator teres, affecting the wrist and hand (p. 413). However, because the entrapment is superior to the wrist rather than at the wrist, the result of the Phalen test would not likely be positive.

Low-intensity conventional transcutaneous electrical nerve stimulation is being used to control pain. Which of the following physiological responses is MOST likely to occur? 1. Activation of the A (large-diameter) fibers only 2. Activation of the C (small-diameter) fibers only 3. Activation of the A (large-diameter) fibers and substantia gelatinosa 4. Activation of the C (small-diameter) fibers and substantia gelatinosa

3. The gate control theory of pain states that large-diameter fibers are activated with nonnoxious stimulation, such as transcutaneous electrical nerve stimulation. This will cause activation of the substantia gelatinosa, which will close the gate and block pain signals being sent by T-cells. (Umphred)

A physical therapist is teaching a patient pursed-lip breathing. This intervention will MOST likely result in which of the following changes? 1. Decreased ventilation-perfusion ratio 2. Increased partial pressure of arterial oxygen (PaO2) 3. Decreased respiratory rate 4. Increased strength of the ventilatory muscles

3. The increase in exhalation time creates a decrease in respiratory rate.

While performing an assessment of a patient's active shoulder flexion in supine, a physical therapist notices that the patient cannot complete the motion unless the lumbar spine is allowed to extend. Shortness in which of the following muscles is MOST likely the problem? 1. Pectoralis major 2. Pectoralis minor 3. Latissimus dorsi 4. Serratus anterior

3. The latissimus dorsi is the only muscle listed that has an attachment to the lumbar spine (through the thoracolumbar fascia). Therefore, this is the only muscle listed that could be affected by the position of the lumbar spine. If the latissimus dorsi is short, the lumbar spine is not allowed to extend and shoulder flexion/elevation will be limited.

A patient who has a forward head posture reports right-sided headaches and neck pain. Assessment reveals stiffness of the right occipitoatlantal joint segment. The patient's goal is to decrease headache intensity and to improve cervical function. Which of the following muscles would be MOST appropriate to strengthen? 1. Neck extensors 2. Upper trapezius 3. Deep neck flexors 4. Sternocleidomastoid

3. The presence of cervicogenic headaches is suggested by the patient's posture, pain distribution, and cervical joint hypomobility. Decreased strength in the deep cervical cranioflexors is associated with this condition; therefore, strengthening of the deep neck flexors would be appropriate. (Olson, p. 325; Dutton, pp. 1232-1233)

The patient in the photograph was asked to slowly lower and relax the left leg [Thomas Test]. The photograph indicates the final position in a relaxed state. How will the findings indicated in the photograph MOST likely influence the patient's posture? 1. Sitting with the knees flexed will cause hyperlordosis. 2. Sitting with the knees straight will cause a flat lumbar spine. 3. The patient will have a tendency to stand with hyperlordosis. 4. The patient will have a tendency to stand with a flat back.

3. The result shown in the photograph indicates hip flexor tightness (Reese, p. 423). Tight hip flexors contribute to an increase in lumbar lordosis (Fruth).

A 14-year-old high school wrestler is participating in a conditioning program. Proximal muscle weakness, swelling of the hands and feet, and clubbing of the fingers are evident. The physical therapist should be MOST concerned with which of the following conditions? 1. Ulcerative colitis 2. Celiac disease 3. Anorexia nervosa 4. Irritable bowel syndrome

3. The signs exhibited by the patient described in the stem are indicative of anorexia nervosa, which can occur frequently in this population (Goodman, p. 93).

A 43-year-old male patient reports the recent appearance of silver and scaly-appearing plaques on the scalp, elbows, and knees. If left unaddressed, which of the following complications is MOST likely to develop? 1. Bluish digits with cold exposure 2. Dermal reaction to sun exposure 3. Erosive arthritis in the DIP joints of the hands 4. Erosive arthritis in the hip joints

3. The stem describes a patient who recently developed psoriasis, a systemic disease hallmarked by silver scaled papules and plaques in the scalp, elbows, knees, back, and buttocks. It is a systemic disease that can result in erosive arthritis, particularly in the DIP joints of the hands. (pp. 449-450)

A 16-year-old patient reports the insidious onset of middle to lower thoracic pain. The pain is worse with prolonged standing or sitting. The patient's posture is characterized by excessive thoracic kyphosis and lumbar lordosis. Active rotation in sitting position is painful. Which of the following conditions is the MOST likely cause of the patient's pain? 1. Annular disc tear 2. Compression fracture 3. Scheuermann disease 4. Spondylolisthesis

3. The stem describes the presentation of Scheuermann disease, which typically affects the T7-T10 region.

The test shown in the photograph [jaw reflex test] should be used for assessment of which of the following structures? 1. Cartilage 2. Ligament 3. Cranial nerve 4. Peripheral nerve

3. The test in the photograph is the jaw reflex test, which tests the integrity of the trigeminal nerve (CN V), which is a cranial nerve.

Which of the following examination activities is used in testing of the vestibuloocular reflex? 1. Tandem stance with eyes closed 2. Lateral movement of the eyes 3. Rapid movement of the head 4. Cervical extension with rotation

3. The vestibuloocular reflex keeps the visual environment in focus during rapid head movements. The vestibuloocular reflex is essential for gaze stabilization during high-frequency, high-velocity, and high-acceleration head movements. (p. 921)

A physical therapist is monitoring a patient's blood pressure while the patient exercises on a stationary bike. Prior to exercise, the patient's blood pressure was 140/80 mm Hg. After the patient exercises for 10 minutes at a moderate intensity, which of the following blood pressure values represents a normal response? 1. 120/60 mm Hg 2. 140/80 mm Hg 3. 170/80 mm Hg 4. 180/100 mm Hg

3. This is a normal response to exercise because systolic blood pressure increased and diastolic blood pressure stayed the same. A change to 170/80 mm Hg is a normal response to exercise since the systolic pressure increased and the diastolic pressure remained the same.

Which of the following household measurements requires modification to allow proper wheelchair accessibility? 1. A ramp of 5 ft (1.5 m) with a 5 in (13 cm) rise 2. A threshold of 0.5 in (1.3 cm) 3. A doorway with a width of 28 in (71 cm) 4. A door opening space of 5 ft x 5 ft (1.5 m x 1.5 m)

3. Wheelchairs require a minimum of 32 to 34 inches (81 to 86 cm) in doorway width and would be unable to go through a door 28 inches (71 cm) in width (p. 326). Author: O'Sullivan SB, Schmitz TJ, Fulk GDTitle: Physical RehabilitationEdition: 7Publisher: F.A. DavisYear: 2019Pages: 324-326

A patient has a Foley catheter, diabetes mellitus, a decline in appetite and fluid intake, confusion, and an oral temperature of 101°F (38.3°C). The signs and symptoms are MOST consistent with which of the following diagnoses? 1. Insulin shock 2. Renal failure 3. Heart failure 4. Sepsis

4. A patient who has the risk factors described in the stem, including diabetes and placement of a Foley catheter, is at risk for a urinary tract infection. Urinary tract infections can result in sepsis. The signs and symptoms of sepsis include fever and confusion. (pp. 364-365)

A patient has a thoracic right rib hump that is present when the patient is standing but disappears upon forward bending. Which of the following conditions is MOST likely present? 1. Structural scoliosis involving left thoracic rotation and right side bending 2. Structural scoliosis involving right thoracic rotation and left side bending 3. Functional scoliosis involving left thoracic rotation and right side bending 4. Functional scoliosis involving right thoracic rotation and left side bending

4. A right thoracic rib hump is associated with a right thoracic rotoscoliosis. Scoliosis is an abnormal lateral curve that can be structural or functional. Structural scoliosis is a fixed deformity that persists during forward bending. Functional scoliosis is a changeable adaptation that is not present when fully forward flexed. The abnormal lateral curve is associated with rotation to the convex side of the curve. The rotation causes the transverse processes of the vertebrae to move posteriorly on the ipsilateral side, and the attached ribs follow to create a rib hump. In this example, the rib hump is on the right, so the rotation is to the right. The rotational component of scoliosis most frequently occurs to the convex side of the curve, so this example most likely involves left side bending.

A pregnant patient reports discomfort and dizziness while lying in supine. Which of the following factors is the MOST likely explanation? 1. Hormonal changes 2. Decreased blood volume 3. Positional effect on oxygen consumption 4. Fetal pressure on the inferior vena cava

4. After the 20th week of gestation, the weight of the fetus can impair blood flow through the inferior vena cava when the woman is in supine position.

A patient has nontraumatic neck and shoulder pain, decreased hand dexterity, paresthesia in the right upper extremity, hyperreflexia, and urinary retention with overflow incontinence. The patient MOST likely has which of the following conditions? 1. Central cord syndrome 2. Cervical transverse ligament tear 3. Cervical disc herniation 4. Cervical myelopathy

4. All of the signs and symptoms in the stem fit the clinical presentation of cervical myelopathy (Goodman).

An aquatic-based rehabilitation program is MOST likely to be contraindicated for a patient who has which of the following conditions or characteristics? 1. History of seizures 2 years previously 2. Human immunodeficiency virus (HIV) 3. Leg ulcer covered in an occlusive dressing 4. Pulmonary fibrosis with a vital capacity of 0.8 liters

4. Aquatic therapy is contraindicated for patients who have a vital capacity of 1 liter or less. (Kisner)

A patient is referred to physical therapy 1 day after having a colon resection with a colostomy. Breath sounds are decreased at lung bases, and arterial oxygen saturation is 91% on room air. Which of the following interventions is BEST for the patient? 1. Postural drainage 2. Supplemental oxygen 3. Deep coughing 4. Deep-breathing exercises

4. Atelectasis is present in up to 95% of patient who undergo abdominal surgery (p. 180). Deep breathing (diaphragmatic breathing) is used to resolve atelectasis and increase oxygenation (pp. 550-551, 553).

When performing active cervical rotation range of motion, a patient moves as shown in the photographs [decreased ROM R]. Translation testing of the mid-cervical spine reveals no restrictions to the right and moderate restrictions to the left. Which of the following cervical motions will MOST likely be restricted in the patient? 1. Forward bending 2. Backward bending 3. Side bending to the left 4. Side bending to the right

4. Cervical rotation follows the same arthrokinematic motions as side bending; therefore, side bending to the right would be limited. Side bending mechanics include a superoanterior glide of the left superior facet and a posteroinferior glide of the right facet, which would be restricted with decreased cervical motion and translation of the mid cervical spine to the left. (p. 1268)

During an initial examination, a physical therapist observes that a patient has clubbing of the digits on bilateral upper extremities. The patient MOST likely has which of the following conditions? 1. Pleuritis 2. Atelectasis 3. Pleural effusion 4. Pulmonary fibrosis

4. Clubbing of the digits is associated with conditions that have interfered with tissue oxygenation and perfusion for a long period of time. A chronic disorder that causes hypoxemia, such as pulmonary fibrosis, can cause digital clubbing. (Goodman pp. 775-776, 812)

What form of validity is measured by comparing results obtained with a test to results obtained using an already well-established and validated tool? 1. Face 2. Construct 3. Content 4. Criterion-related

4. Criterion-related validity of a new tool is tested by using practical and objective comparisons to a reliable/valid (gold) standard measure already in use.

A patient with type 1 diabetes is planning to begin an exercise program. Which of the following actions is MOST appropriate for the patient to perform? 1. Inject insulin just prior to starting an exercise session. 2. Avoid food consumption just prior to an exercise session. 3. Complete an exercise session within 1 hour of receiving an insulin injection. 4. Increase food intake prior to an exercise session.

4. Exercise typically increases insulin sensitivity and enhances the effect of insulin. Therefore, glucose intake should be increased to counter the effects of exercise. Insulin intake could be decreased to counter the effects of exercise. During prolonged activity, a snack is recommended for every 30 minutes of activity.

A patient who is 6 weeks post surgery for a patellar fracture has a well-healed scar with poor mobility. Which of the following massage techniques is BEST for addressing this problem? 1. Tapotement 2. Effleurage 3. Pétrissage 4. Friction

4. Friction involves direct circular or cross-fiber massage applied to increase mobility of scar tissue (Dutton, p. 422; Benjamin, p. 279).

A patient has a granular ulcer that is non-draining. Which of the following types of dressing would be MOST appropriate for the patient? 1. Foam 2. Collagen 3. Calcium alginate 4. Hydrogel

4. Hydrogel dressings provide hydration to dry wound beds and are appropriate for a granular wound that is not draining (p. 190).

A patient reports pain in the lateral lower leg with application of an calcaneal inversion stretch as shown in the photograph. Which of the following muscles should be tested for pain with contraction? 1. Gastrocnemius and soleus 2. Tibialis anterior and extensor hallucis longus 3. Extensor digitorum longus and extensor digitorum brevis 4. Fibularis (peroneus) longus and fibularis (peroneus) brevis

4. Lateral lower leg pain is in the area of the fibularis (peroneal) musculature. These muscles are stretched when moved into dorsiflexion and inversion, which would provoke pain. The fibularis (peroneal) muscles perform plantar flexion and eversion; which, with contraction, would be painful.

A patient has anterior shoulder pain and a positive result on the shoulder clunk test after performing repetitive overhead throwing. Results of which of the following imaging studies would BEST confirm a diagnosis? 1. Contrast arthrography radiograph 2. Anterior-posterior bilateral radiograph with weights 3. Computed tomography arthrogram 4. Magnetic resonance arthrogram

4. Magnetic resonance arthrogram is correct because the mechanism of injury described is one of anterior dislocation causing a labral tear with a superior labrum anterior to posterior (SLAP) lesion, which is indicated by the positive result on the clunk test (Magee, pp. 321-322). Magnetic resonance arthrogram is the best choice for imaging labral tears (McKinnis, p. 529).

To determine exercise intensity for a patient who is taking metoprolol (Lopressor), which of the following methods is MOST appropriate to use? 1. Pulse oximetry 2. Karvonen formula 3. Percentage of maximum heart rate 4. Rating of perceived exertion

4. Metoprolol is a beta-blocker that lowers the maximum heart rate and, therefore, lowers the target heart rate zone. The rating of perceived exertion is the most appropriate method to determine exercise intensity since it is not affected by metoprolol. Rating of perceived exertion is a subjective rating of intensity of exertion used to quantify effort during exercise. (O'Sullivan p. 48)

A patient who is experiencing knee pain originating from the musculoskeletal system is MOST likely to make which of the following subjective reports? 1. Throbbing pain is present. 2. Pain at night interrupts sleep. 3. Pain is the same with rest and activity. 4. Active motion provokes pain.

4. Musculoskeletal pain is most likely intermittent and dependent on activity or position. Certain movements will aggravate the symptoms. (Goodman p. 104)

Chest percussion may be an appropriate intervention for a patient who has which of the following findings? 1. Diastolic pulmonary arterial pressure of 3 mm Hg 2. Intracranial pressure of 30 mm Hg 3. Platelet count of 30,000/mm3 4. Partial pressure of arterial oxygen (PaO2) of 70 mm Hg

4. Normal partial pressure of arterial oxygen is greater than 80 mm Hg (Hillegass, p. 354). As this value drops, the patient may become tachypneic and tachycardic (Paz, p. 64). Airway clearance techniques, such as percussion, can help to optimize ventilation and perfusion matching, increase gas exchange, and increase alveolar ventilation by mobilizing secretions (Hillegass, p. 541).

A 45-year-old male patient who has a history of corticosteroid use reports a recent onset of constant hip pain unrelated to movement. The patient MOST likely has which of the following conditions? 1. Hip dysplasia 2. Femoroacetabular impingement 3. Slipped capital femoral epiphysis 4. Osteonecrosis of the femoral head

4. Osteonecrosis typically has a gradual onset of pain, occurs between the 3rd and 5th decades, and is more likely to occur in males than in females. History of corticosteroid use is a risk factor for osteonecrosis. (Goodman, pp. 1364-1365) Symptoms may be nonspecific and clinical findings vary. Pain is likely to be exacerbated with weight-bearing activities, however is often present even at rest. (Dutton, p. 252)

After undergoing a reverse total shoulder arthroplasty, a patient is MOST likely to dislocate the shoulder in which of the following positions? 1. Lateral (external) rotation and abduction with flexion 2. Medial (internal) rotation and abduction with flexion 3. Lateral (external) rotation and adduction with extension 4. Medial (internal) rotation and adduction with extension

4. Patients are most likely to dislocate a reverse total shoulder arthroplasty by performing medial (internal) rotation and adduction in conjunction with extension. This position allows the prosthesis to escape anteriorly and inferiorly.

Which of the following factors BEST predicts improvements in upper extremity functional outcomes for a patient following a cerebrovascular accident? 1. Family involvement in the patient's care 2. Use of blocked practice during intervention 3. Patient's cognitive understanding of the impairments and intervention program 4. Presence of active wrist and finger extension

4. Research evidence supports that patients who possess active wrist and finger extension have improved upper extremity functional outcomes after a cerebrovascular accident. Author: Umphred DA, Lazaro RT, Roller ML, Burton GUTitle: Umphred's Neurological RehabilitationEdition: 6Publisher: Elsevier MosbyYear: 2013Pages: 719

Which of the following orthoses would be MOST appropriate for a child who has a history of myelomeningocele at the S1 level and has Poor (2/5) gastrocnemius strength? 1. Supramalleolar 2. Knee-ankle-foot 3. Reciprocating gait 4. Solid ankle-foot

4. S1 myelomeningocele would cause weakness in the muscles of the posterior lower leg and tibia, without affecting muscle strength in the hips and knees. Solid ankle-foot orthoses would provide the appropriate support at the foot and ankle.

Which of the following statements is the BEST description of a physical therapist's role in secondary prevention of disease? 1. Stopping the process that leads to the development of disease. 2. Providing education to give people greater control over their own health. 3. Limiting the degree of disability and improving function in patients who have chronic disease. 4. Performing early detection of disease and health conditions through regular screening.

4. Secondary prevention involves early detection of disease and health conditions through regular screening.

Which of the following modalities is MOST appropriate to administer to a patient who has hip joint pain secondary to a labral tear that occurred 6 months ago? 1. Traction 2. 3-MHz thermal ultrasound 3. Ice pack 4. Sensory-level electrical stimulation

4. Sensory-level electrical stimulation can cover a large area and is effective for treating chronic pain (Cameron p. 7).

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

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

A patient who had knee arthroscopic surgery 2 weeks ago reports a new onset of calf pain 2 days after an intense exercise session. Which of the following findings should MOST raise suspicion of deep vein thrombosis? 1. Baker cyst, unilateral pitting edema, unilateral varicose veins 2. Bilateral varicose veins, bilaterally equal pitting edema, painful calf raise 3. Knee swelling of 1.2 inches (3 cm) compared to the previous session, painful calf raise, relief with recumbency 4. Calf swelling of 1.4 inches (3.5 cm) compared to the contralateral leg, pitting edema, recent history of cancer

4. The Wells Clinical Decision Rule for a deep vein thrombosis is a valid and reliable tool in predicting the risk of lower extremity deep vein thrombosis in the orthopedic population. Cancer within 6 months, unilateral swelling greater than 3 cm, and pitting edema are three of the factors in the Wells Clinical Decision Rule, which puts the probability of developing a deep vein thrombosis greater than 75%.

Which of the following automatic postural responses will a patient MOST likely use to maintain equilibrium following a small perturbation on a stable surface from a posterior to anterior direction? 1. Hip strategy to control sway and move the body anterior to midline 2. Hip strategy to control sway and move the body posterior to midline 3. Ankle strategy to control sway and move the body anterior to midline 4. Ankle strategy to control sway and move the body posterior to midline

4. The ankle strategy is appropriate for small perturbations on a stable surface (Umphred). Small perturbations forward (posterior to anterior) would create a backward weight-shift, then a return to midline in response (O'Sullivan).

A physical therapist is treating an infant who has a Pavlik harness for developmental dysplasia of the hip. The infant should wear the harness: 1. during rest only. 2. during activity only. 3. 2-4 hours/day. 4. 18-23 hours/day.

4. The harness must be worn 18-23 hours/day.

A patient who reports a history of liver damage exhibits signs of hyperbilirubinemia. Which of the following clinical manifestations is MOST likely present? 1. Pallor 2. Clear urine 3. Darkened stools 4. Light-colored stools

4. The liver removes bilirubin from the blood, conjugates it, and excretes this complex into the intestine. It is this conjugated bilirubin that darkens fecal material. Liver disease that limits bilirubin transport into the liver increases serum bilirubin (hyperbilirubinemia) and limits the amount of conjugated bilirubin entering the gut. Stools become light in color. This sign helps to distinguish jaundice caused by liver disease from jaundice caused by extrahepatic causes. (Goodman, Pathology; Goodman, Differential Diagnosis, pp. 340-341)

A patient exhibits swelling and pain in the medial aspect of the ankle. During examination, the patient demonstrates rearfoot pronation in standing position and inability to perform a heel raise on the affected side. The patient demonstrates forefoot abduction when observed from behind. Which of the following conditions is MOST likely present? 1. Eversion ankle sprain 2. Retrocalcaneal bursitis 3. Tarsal tunnel syndrome 4. Posterior tibial tendon dysfunction

4. The main function of the tibialis posterior is to plantar flex and invert the foot as well as support the medial arch. The tendon courses under the medial malleolus, causing pain and inflammation in this area when the tendon is dysfunctional. With a heel raise, the tendon becomes stressed due to its actions of plantar flexion and inversion. Finally, a finding of the "too many toes sign," which is the hallmark sign of this diagnosis, is due to forefoot abduction and hindfoot valgus. (Neumann)

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

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

The position demonstrated in the photograph [waiter sign] is BEST used to treat a patient who has which of the following conditions? 1. Cubital tunnel syndrome 2. Carpal tunnel syndrome 3. Medial epicondyle tendinopathy 4. Lateral epicondyle tendinopathy

4. The photograph shows a radial nerve glide (Kisner, p. 399). This maneuver is used to treat symptoms related to shoulder girdle depression, radial nerve distribution, and disorders such as tennis elbow (lateral epicondylalgia) and de Quervain syndrome (Kisner, pp. 399, 643).

A patient has a positive finding on the test shown in the photograph [passive shoulder IR]. The patient will MOST likely make which of the following subjective reports? 1. Anterior shoulder pain and a recent fall while bicycling 2. Shoulder instability and clicking with throwing activities 3. Diffuse upper extremity pain and numbness into the lateral upper extremity 4. Lateral shoulder pain and pain with overhead activities

4. The photograph shows the Hawkins-Kennedy test for subacromial impingement. Patients who have subacromial impingement often describe a painful arc and pain with overhead activities

If the test shown in the photograph [Phalen test] has a positive result, which of the following tests would MOST likely also have a positive result? 1. Allen test 2. Froment test 3. Piano keys test 4. Carpal compression test

4. The test shown in the photograph is the Phalen test, for which a positive result is indicative of carpal tunnel syndrome. A positive result of the carpal compression test is also indicative of carpal tunnel syndrome. (p. 474)

A 45-year-old male patient reports knee pain with a sudden onset 2 days ago. The patient denies trauma or injury to the knee. The patient's knee is warm, red, and swollen. The patient is afebrile and has knee range of motion of 20° to 60°. Which of the following pathologies is the MOST likely cause of the knee pain? 1. Graves disease 2. Diabetes mellitus 3. Sepsis 4. Gout

4. The typical symptom of gout is acute monoarticular arthritis with redness and swelling. The knee is one of the commonly affected joints. The peak incidence is in the 40-50-year age group, and it predominantly affects men. (Goodman, Differential Diagnosis, p. 413)

When educating a patient regarding the prognosis of lymphedema, which of the following concepts is MOST appropriate to communicate? 1. Pitting becomes more pronounced in the later stages of the condition. 2. Management strategies started in the later stages of the condition are ineffective. 3. The condition progresses in stages that develop at regular intervals. 4. Management strategies exist but are not a permanent cure.

4. There is no cure or permanent remedy for lymphedema (p. 71).

Which of the following descriptions BEST depicts the Cheyne-Stokes respiratory pattern? 1. Regular respiration pattern characterized by a rate of less than 10 breaths/minute 2. Regular respiration pattern characterized by a rate of more than 24 breaths/minute 3. Irregular respiration pattern characterized by highly variable respiratory depth and intermittent periods of apnea 4. Irregular respiration pattern characterized by a period of apnea followed by gradually increasing depth of respirations

4. This is a typical Cheyne-Strokes respiratory pattern, which is an irregular respiration pattern characterized by a period of apnea followed by gradually increasing depth and frequency of respirations (pp. 57-58). This breathing pattern is often observed with depression of the cerebral hemisphere (e.g., coma), in basal ganglia disease, and occasionally with congestive heart failure.

Which of the following substitution patterns should be prevented when measuring active forearm supination? 1. Shoulder medial (internal) rotation and shoulder abduction 2. Shoulder medial (internal) rotation and shoulder adduction past 0° 3. Shoulder lateral (external) rotation and shoulder abduction 4. Shoulder lateral (external) rotation and shoulder adduction past 0°

4. When measuring forearm supination, lateral (external) rotation of the shoulder or adduction past 0° should be avoided (p. 92). Author: Reese NB, Bandy WDTitle: Joint Range of Motion and Muscle Length TestingEdition: 3Publisher: ElsevierYear: 2017Pages: 92, 94

A physical therapist is testing the strength of a patient's middle deltoid. The patient is sitting with the arm at the side and the palm facing the trunk. When asked to move the arm out to the side, the patient turns the palm forward and brings the arm to 90° of abduction. What should the therapist do NEXT? 1. Apply resistance at the end of the movement. 2. Have the patient lie in supine position and repeat the movement. 3. Ask the patient to continue moving the arm into maximum abduction. 4. Have the patient repeat the movement, keeping the palm facing the trunk.

4. When the shoulder is laterally (externally) rotated (palm facing forward), the long head of the biceps can assist with the movement. To test middle deltoid strength, the shoulder must remain in neutral rotation (palm facing trunk).

Which of the following interventions would be MOST appropriate for a patient with a spinal cord lesion to the anterolateral sensory system? 1. Tactile stimulation using tuning forks and vibrators of varying frequencies 2. Active movement using visual feedback for facilitation of position sense 3. Sensory re-education utilizing objects of various sizes, shapes, and textures 4. Patient education concerning protection from hot/cold injuries

4. With lesions to the anterolateral system, a patient may exhibit sensory deficits in both light touch and hot/cold discrimination. Failure to distinguish extremes in temperature could result in the patient sustaining thermal injuries. Instruction in techniques to protect against these injuries would be of primary importance.

Which of the following clinical manifestations MOST indicates the onset of hypoglycemia? 1. Flushed appearance 2. Deep respirations 3. Slow pulse 4. Pallor

4. With the onset of hypoglycemia, an individual will experience a sudden change in appearance from normal coloration to pallor.

When a patient assumes the position shown in the photograph [L arm overhead with posterior wrist touching top of head], pain increases in the raised upper extremity. The patient MOST likely has which of the following conditions? 1. C5 disc lesion 2. Dural irritability 3. Radial nerve irritation 4. Thoracic outlet syndrome

4. With thoracic outlet syndrome, the position shown in the photograph would increase symptoms, since it would increase pressure on the interscalene triangle (Dutton, p. 1322). The patient would have pain when the arm is in abduction and lateral (external) rotation (Magee, p. 344), an arm position is similar to the arm position for the hyperabduction test, Roos test, and Wright test (Dutton, pp. 1299-1300).

A patient exhibits pusher syndrome (ipsilateral pushing) following a right cerebrovascular accident. Which of the following interventions is MOST appropriate? 1. Midline retraining in a sitting position 2. Weight-bearing on the right lower extremity 3. Providing fixed resistance on the left side 4. Raising the height of the assistive device

Correct Answer: 1 1. Midline retraining in both sitting and standing positions with the use of visual cues or a visual aide is an appropriate intervention for a patient who exhibits pusher syndrome (ipsilateral pushing).

Which of the following positions of the humerus is BEST for application of an ultrasound treatment to the supraspinatus tendon insertion? 1. Flexion and lateral (external) rotation 2. Extension and medial (internal) rotation 3. Abduction and lateral (external) rotation 4. Flexion and medial (internal) rotation

Correct Answer: 2

A patient who exhibits heat intolerance, tachycardia, fatigue, and weight loss is MOST likely to have an elevated level of which of the following hormones? 1. Adrenocorticotropic hormone 2. Thyroid-stimulating hormone 3. Insulin 4. Epinephrine

Correct Answer: 2 2. A hyperactive thyroid will elevate the body's metabolism, causing an elevated heart rate, fatigue, weight loss, heat intolerance, and muscle atrophy, among other symptoms (p. 484).

Changes in the level of which hormone are MOST likely to contribute to development of chondromalacia patella in a pregnant woman? 1. Calcitonin 2. Progesterone 3. Relaxin 4. Insulin

Correct Answer: 3

Which of the following exercises would be CONTRAINDICATED during pregnancy? 1. Standing push-ups 2. Modified squatting 3. Bilateral straight leg raises 4. Quadruped pelvic tilts

Correct Answer: 3

Which of the following actions should be done FIRST when teaching a new motor skill? 1. Provide frequent verbal feedback on performance. 2. Utilize massed practice. 3. Distribute written instructions with standardized formatting. 4. Identify and utilize learning preferences.

Correct Answer: 4 4. It is best to identify and use the patient's preferred learning style (p. 24).

A patient has the deformity shown in the photograph [hammer toes/bunion]. Which of the following shoe modifications is MOST likely to be beneficial for this patient? 1. High toe box 2. Metatarsal pad 3. Rocker bar 4. Metatarsal bar

Correct Answer: 1

A patient who has right shoulder pain exhibits bruising, palmar erythema, and signs of confusion. Which of the following organs is MOST likely involved? 1. Liver 2. Pancreas 3. Kidney 4. Spleen

Correct Answer: 1

Which of the following definitions BEST describes a systematic literature review? 1. Secondary analysis of individual studies with similar characteristics 2. Secondary analysis of individual studies with divergent characteristics 3. Aggregation of raw data from multiple studies to increase the sample size 4. Aggregation of raw data from multiple studies to generate new hypotheses

Correct Answer: 1 1. A systematic review of literature entails a secondary analysis of individual studies with similar characteristics in order to generate a combined conclusion (p. 338).

A physical therapist is preparing to treat a patient in an acute care setting following a total hip arthroplasty. The patient's past medical history includes chronic obstructive pulmonary disease. Which of the following concomitant conditions MOST indicates that the therapist should defer treatment? 1. White blood cell count of 16,000/mm3 2. Oxygen saturation level of 92% with activity 3. Postoperative hemoglobin level of 15 g/dL (compared with a preoperative level of 18 g/dL) 4. Partial pressure of arterial oxygen (PaO2) of 80 mm Hg and partial pressure of arterial carbon dioxide (PaCO2) of 40 mm Hg

Correct Answer: 1 1. A white blood cell count of 16,000/mm3 exceeds the normal range of 4,500 to 11,000/mm3 (Hillegass, p. 268). This elevated count suggests infection, which may compromise exercise tolerances (Goodman).

A patient walks with excessive foot pronation during midstance through toe off (preswing). What is the MOST likely cause of the patient's gait deviation? 1. Compensated rearfoot varus deformity 2. Compensated forefoot valgus deformity 3. Uncompensated lateral (external) rotation of the tibia 4. Uncompensated pes cavus

Correct Answer: 1 1. Excessive foot pronation during midstance to toe off is the result of a compensated rearfoot (or forefoot) varus deformity.

One day after lumbar laminectomy surgery, a patient refuses to wear a thoracolumbosacral orthosis because of a painful and itching rash that extends in a narrow path from the central low back along the iliac crest to the right lateral trunk. Which of the following conditions is MOST likely present? 1. Herpes zoster 2. Infected surgical incision 3. Contact dermatitis 4. Allergic response to medication

Correct Answer: 1 1. Herpes zoster (shingles) is a painful, blistering skin rash caused by the varicella-zoster virus. The first symptom is usually one-sided pain, tingling, or burning followed by development of a rash that usually involves a narrow area from the spine around to the front of the chest or abdomen. A typical location for occurrence of shingles rash is the T11-T12 dermatome along the iliac crest. The location of the rash, postsurgical onset, and symptoms of pain all suggest herpes zoster. (Goodman, p. 177)

Following a total knee arthroplasty, a patient has been receiving moist heat to the knee prior to exercise and gait training. During the current visit, the physical therapist notes new redness, swelling, and increasing warmth surrounding the knee. Which of the following actions should the therapist take? 1. Notify the orthopedic surgeon of the changes. 2. Continue with the use of hot packs for 5 to 10 minutes prior to physical therapy. 3. Substitute ice instead of heat prior to physical therapy. 4. Discontinue physical therapy until the problems are resolved.

Correct Answer: 1 1. New symptoms of redness, swelling, and increasing warmth following a surgical procedure are indicators of a possible infection. The surgeon should be notified. (O'Sullivan)

A patient who has a long-term history of nonsteroidal antiinflammatory drug use reports back pain from the mid thoracic region to the right upper quadrant, including the posterior right shoulder. The patient also reports weight loss, loss of appetite, dark-colored stools, and episodes of epigastric pain within 3 hours of eating a meal. The patient reports an episode of vomiting material with a coffee-ground appearance prior to arriving for physical therapy. Which of the following gastrointestinal conditions is MOST likely responsible for these symptoms? 1. Peptic ulcer disease 2. Gastritis 3. Irritable bowel syndrome 4. Appendicitis

Correct Answer: 1 1. Patients who have a history of long-term nonsteroidal antiinflammatory drug use should be monitored for signs and symptoms of bleeding. Pain occurring within 1-3 hours of eating is typical in duodenal ulcers. The pain occasionally radiates to the mid thoracic back and right upper quadrant, including the right shoulder. Right shoulder pain alone may occur as a result of blood within the peritoneal cavity. Melena (dark, tarry stools) and coffee-ground vomitus are indicative of bleeding. Referral to a physician is warranted. (pp. 877-878)

While standing with eyes open on a compliant surface, which systems are PREDOMINANTLY being used by the patient to maintain balance? 1. Visual and vestibular 2. Visual and proprioceptive 3. Proprioceptive and vestibular 4. Vestibular, visual, and proprioceptive

Correct Answer: 1 1. Standing on foam allows the ankle joint to at least begin rotating and prevents the somatosensory systems from relaying accurate information from the ankle joints and the skin. The eyes are open, and the vestibular system is also not compromised. Visual input dominates under this condition.

The individual in the photograph is demonstrating how she lifts her laundry basket [holds in front]. What impact does the position of the basket have on the forces at the lumbar spine and disc? 1. The position increases the compressive forces and flexion moment of the disc. 2. The position decreases the compressive forces and flexion moment of the disc. 3. The position decreases the compressive forces and increases the flexion moment of the disc. 4. The position increases the compressive forces and extension moment of the disc.

Correct Answer: 1 1. The patient in the photograph demonstrates a lordotic posture of the lumbar spine, which increases compressive forces on the disc (Kisner). The position of the arms outstretched and away from the body increases the flexion moment around the body's center of mass (Samuels).

A patient reports pain in response to palpation of the anteromedial knee below the joint line. In addition, the patient reports pain with active knee flexion, passive knee extension, and valgus stress. Which of the following structures is the MOST likely source of the pain? 1. Pes anserine 2. Patellar tendon 3. Medial meniscus 4. Popliteus tendon

Correct Answer: 1 1. The pes anserine is medial and just distal to knee joint line. The semitendinosus and sartorius attach here, would be stretched with extension and valgus, and are involved in knee flexion. (p. 858)

The patient in the photograph [hooklying] sustained a twisting injury to the knee 1 week ago. The physical therapist notes laxity when performing an anterior drawer test. The patient wants to resume athletic activity as soon as possible. Which of the following criteria MUST be met before the patient returns to athletic activity? 1. The patient can demonstrate ability to jump and land with stability. 2. The patient's gait is nonantalgic. 3. Knee functional range of motion is restored, and pain is rated less than 5/10. 4. Knee effusion is abolished, quadriceps strength is Fair (4/5), and pain is rated 0/10.

Correct Answer: 1 1. The test shown in the photograph is used to assess the integrity of the anterior cruciate ligament. Jumping and landing with stability are required for the patient's functional goals associated with treatment of an anterior cruciate ligament injury.

Which of the following responses is a positive finding for a test of palpation to the center abdomen? 1. Palpation of a pulsating mass 2. Presence of back or flank pain 3. Distention on the costal margin 4. Costovertebral tenderness

Correct Answer: 1 1. The test shown in the photograph would be necessary if a patient reports a pulsing or pounding sensation in the abdomen during increased activity or when lying in supine position. A positive finding would be a palpable pulsating mass and would indicate an abdominal aneurysm. (p. 201)

A physical therapist provides soft tissue mobilization to a patient following a cesarean section. The mobilization is performed in a clockwise direction beginning at the bottom right quadrant. This intervention is MOST appropriate for which of the following conditions? 1. Diastasis recti 2. Intestinal gas pain 3. Rectus abdominis strain 4. Scar prevention

Correct Answer: 2

During the initial screening of a patient, the physical therapist notes contusions in various states of healing on the chest, back, and face, as well as multiple scars. The patient reports falling often. Which of the following courses of action should the therapist take FIRST? 1. Take the patient's dietary history to assess for mineral deficiency. 2. Ask the patient if bruising was caused by being hit, kicked, or abused. 3. Instruct the patient in safe movement patterns to avoid falls. 4. Report the patient's caregivers to the appropriate authorities.

Correct Answer: 2

A physical therapist is reviewing the medical record of a patient in the intensive care unit. The patient was admitted the previous night through the emergency department after a motorcycle accident resulting in a fractured right femur. The therapist notes a physician's order for a Doppler study of the left leg. The therapist should: 1. proceed with the evaluation and intervention without any restrictions. 2. withhold physical therapy until results of the study are obtained and interpreted by the physician. 3. proceed with the evaluation and limit intervention to transfer to a bedside chair. 4. obtain clearance from the nurse to provide intervention for the patient.

Correct Answer: 2 2. A physician's order for a Doppler study indicates possible deep vein thrombosis. Physical therapy should not be conducted until the Doppler study is completed and the results analyzed by the physician.

Which of the following dressings is MOST appropriate to use with an infected wound that also requires hemostasis? 1. Foam 2. Alginate 3. Transparent film 4. Hydrocolloid

Correct Answer: 2 2. An alginate dressing is best to use in this case because this type of dressing provides both hemostasis and is appropriate for use over an infected wound (pp. 565, 589).

A physical therapist is evaluating an infant who has bilateral ankle equinus, hindfoot varus, and forefoot adductus. The infant MOST likely has which of the following deformities? 1. Pes cavus 2. Talipes equinovarus 3. Calcaneovalgus 4. Metatarsus adductus

Correct Answer: 2 2. Clubfoot (talipes equinovarus) is a congenital deformity (environmental and genetic) that includes components of forefoot adductus, hindfoot varus, and ankle equinus. The primary distinguishing factor is the equinus component. (p. 307)

Which of the following positions of the humerus is BEST for application of an ultrasound treatment to the supraspinatus tendon insertion? 1. Flexion and lateral (external) rotation 2. Extension and medial (internal) rotation 3. Abduction and lateral (external) rotation 4. Flexion and medial (internal) rotation

Correct Answer: 2 2. Extension and medial (internal) rotation of the shoulder puts the supraspinatus tendon in the most accessible position.

A patient who is overweight reports pain and tenderness in the right lower quadrant of the abdomen that worsens upon coughing or sneezing. Which of the following actions should a physical therapist perform FIRST? 1. Defer examination and immediately contact the physician. 2. Measure the patient's body temperature and check for rebound tenderness. 3. Strength test the abdominal and right hip muscles. 4. Provide the patient with educational materials on dietary modification.

Correct Answer: 2 2. In view of the symptoms presented in the case, the therapist should screen for appendicitis by checking for the presence of a low fever as well as palpating the abdomen for tenderness (pp. 319-320).

Manual lymphatic drainage is CONTRAINDICATED for a patient who has which of the following conditions? 1. Chronic edema 2. Congestive heart failure 3. Chronic venous insufficiency 4. Complex regional pain syndrome

Correct Answer: 2 2. Manual lymph drainage facilitates the removal of fluid from the extremities back into the circulatory system. If the patient has heart failure, the heart will not be able to handle the additional fluid and the heart failure will worsen. (p. 253)

The intervention shown in the photograph [multilayered compression bandaging] is CONTRAINDICATED in the presence of which of the following clinical signs? 1. A positive Stemmer sign 2. A deep, dry, regularly shaped wound 3. A superficial, irregularly shaped, exudative wound 4. Presence of papillomas and hyperkeratosis

Correct Answer: 2 2. Multilayered compression bandaging or "lymphedema bandaging" is a technique used to provide compression therapy during the first phase of complete decongestive therapy (pp. 272-273). A wound that is deep, regularly shaped, and dry is most likely an arterial wound (p. 141). Compression therapy is contraindicated for management of edema in the presence of peripheral arterial disease (p. 267).

Which of the following exercise guidelines is MOST appropriate for a patient who has diabetes? 1. Exercise during peak insulin times. 2. Exercise at the same time each day. 3. Avoid exercise if the blood glucose level is less than 150 mg/dL (8.3 mmol/L). 4. Avoid exercise if the blood glucose level is greater than 200 mg/dL (11.1 mmol/L).

Correct Answer: 2 2. Patients who have diabetes should exercise regularly and consistently (Goodman; Porcari).

A patient underwent a C2-C4 fusion procedure and is ventilator dependent. In what position should the physical therapist position the patient to avoid skin breakdown of the sacrum, ischial tuberosity, scapula, posterior calcaneus, and occipital tuberosity? 1. Prone 2. Sidelying 3. Sitting 4. Supine

Correct Answer: 2 2. Sidelying is the best position to relieve pressure to the affected areas and will afford the patient a safe position that will not affect the cervical spine fusion or ventilator management.

A physical therapist tests the muscle strength of a patient who has had type 2 diabetes for 20 years and finds the following: Muscle Right Left Biceps Good (4/5) Good (4/5) Quadriceps Good (4/5) Good (4/5) Anterior tibialis Poor (2/5) Poor (2/5) Posterior tibialis Poor (2/5) Poor (2/5) Gastrocnemius Poor (2/5) Poor (2/5) Which of the following is the MOST likely outcome of sensory testing? 1. No loss of sensation in any distribution 2. Loss of sensation in a stocking glove distribution 3. Loss of sensation in a dermatomal distribution 4. Loss of sensation in a peripheral nerve distribution

Correct Answer: 2 2. Stocking glove distribution of sensory deficit is a hallmark of polyneuropathy, the presence of which is evidenced by the manual muscle testing results.

The patient being assessed in the photographs reports a deep pain in the shoulder when a physical therapist applies a downward force to the forearm during a Speed Test. The patient MOST likely has which of the following conditions? 1. Rotator cuff tear 2. Superior labrum tear 3. Subacromial bursitis 4. Supraspinatus tendinitis

Correct Answer: 2 2. The Speed test is shown in the photograph. Deep shoulder pain produced during this maneuver suggests a labral tear, (Dutton, p. 640) or a superior labrum anterior to posterior (SLAP) (Type II) lesion (Magee, p. 341).

A 62-year-old patient has ascites and bilateral pedal edema. The patient's pulse rhythm is regular. The patient's history is negative for any liver, kidney, or metabolic disease. Which of the following conditions is MOST likely present? 1. Hypotension 2. Hypertension 3. Left ventricular failure 4. Right ventricular failure

Correct Answer: 4 4. Right ventricular failure results in backup of blood into the systemic venous circulation, manifested by edema systemically, including jugular venous distention, ascites, and bilateral pedal edema (p. 143t).

A patient who fell while running 3 days ago reports diffuse lateral ankle pain with active movement. The patient exhibits localized swelling distal and anterior to the lateral malleolus. Minimal laxity is noted with an anterior drawer test. Which of the following interventions would be MOST appropriate for the patient at this time? 1. Gastrocnemius-soleus stretching 2. Posterior talocrural joint mobilizations 3. Stationary cycling for up to 30 minutes 4. Active range of motion to end-range

Correct Answer: 2 2. The patient has signs and symptoms consistent with a diagnosis of a lateral ankle (inversion) sprain. A grade 2 lateral ankle sprain is characterized by localized swelling and more diffuse lateral tenderness (Dutton, p. 1151). Gentle posterior talocrural joint mobilizations should be performed in the acute stage of healing to maintain mobility and inhibit pain.

The shoulder Lift-Off test is used to assess the integrity of which of the following muscles? 1. Infraspinatus 2. Subscapularis 3. Supraspinatus 4. Latissimus dorsi

Correct Answer: 2 2. The photograph demonstrates the lift-off sign or Gerber test which is considered a test for integrity of the subscapularis. Although several muscles contribute to medial (internal) rotation of the humerus at the shoulder, the subscapularis is thought to be best isolated with this special test. If a patient is able to lift the hand away from the lower back (through active shoulder medial [internal] rotation), subscapularis function is intact. A positive finding (subscapularis compromise) is indicated by at least one of the following: frank inability to lift the dorsum of the hand from the back or straightening of the elbow to move the hand from the lower back but inability to "lift-off." In the photograph, the patient is maintaining elbow flexion while lifting the dorsum of the hand away, which is a negative test result.

The photograph depicts the end range of a patient's hip motion [Hip internal rotation]. Which of the following arthrokinematic motions is MOST likely restricted? 1. Anterior glide 2. Posterior glide 3. Inferior glide 4. Superior glide

Correct Answer: 2 2. The photograph depicts passive assessment of hip medial (internal) rotation range of motion. A posterior glide facilitates this motion because of the convex-concave rule and would be most likely be restricted given the limitation.

In a patient who has weak oblique, rectus abdominis, and transversus abdominis muscles, which of the following interventions is MOST likely to improve the mechanical efficiency of the diaphragm? 1. Use of a rigid trunk support 2. Use of an abdominal binder 3. Assuming an erect sitting position 4. Assuming a forward leaning sitting position

Correct Answer: 2 2. Use of an abdominal corset in patients who have weak abdominal muscles can compensate for laxity and can improve respiratory function (Nichols-Larsen).

As a child ages from 1 to 7 years, which of the following factors indicate maturing gait? 1. Velocity decreases and cadence increases. 2. Velocity increases and cadence decreases. 3. Single-leg stance time decreases and step length increases. 4. Single-leg stance time increases and step length decreases

Correct Answer: 2 2. Velocity increases and cadence decreases as gait develops.

A patient has sustained a moderate ankle sprain with significant swelling greater than 1 inch (2.5 cm) throughout the ankle and into the foot. Which of the following wrapping techniques is MOST appropriate to control the edema? 1. Figure-8 compression wrap with consistent pressure on the limb distally and proximally 2. Spiral compression wrap with more pressure on the limb distally than proximally 3. Figure-8 compression wrap with more pressure on the limb proximally than distally 4. Spiral compression wrap with consistent pressure on the limb distally and proximally

Correct Answer: 2 2. When applying compression wraps to control edema, a spiral wrap is used with more pressure applied distally than proximally.

A patient receiving physical therapy due to a history of lumbar and thoracic pain reports a new onset of night pain, urinary incontinence, and severe abdominal pain after a recent fall from a roof. Which of the following courses of action is BEST for the physical therapist? 1. Document the patient's subjective report, and withhold therapy until the following week. 2. Withhold physical therapy, refer the patient to an emergency department, and contact the referring physician. 3. Document the patient's subjective report, palpate the painful area, and perform gentle lumbar oscillations. 4. Provide gentle lumbar mobilization and traction techniques, and send an email to the physician describing the patient's symptoms.

Correct Answer: 2 2. Withholding physical therapy, referring the patient to an emergency department, and contacting the referring physician is the best course of action. The patient's new symptoms of night pain, urinary incontinence, and abdominal pain may indicate the presence of cauda equina syndrome and require medical assessment.

A patient has diabetes with peripheral neuropathy. The patient's shoe on the involved side shows scuffing and wear on the outside of the shoe over the toe box. Which of the following gait deviations is MOST likely contributing to the wear on the shoe? 1. Increased stance phase 2. Excessive toe off (preswing) 3. Decreased dorsiflexion 4. Circumduction

Correct Answer: 3

A patient reports an insidious onset of swelling of 1 month's duration on the dorsum of the left foot. Which of the following conditions is the MOST likely cause? 1. Heart failure 2. Chronic venous insufficiency 3. Lymphedema 4. Lipedema

Correct Answer: 3

A patient with hypertension has been referred for aquatic physical therapy following a total hip arthroplasty. Which of the following statements is the BEST reason for altering this plan of care? 1. The increased buoyancy of the water may increase the patient's blood pressure. 2. The decreased buoyancy of the water may decrease the patient's blood pressure. 3. The increased hydrostatic pressure of the water may increase the patient's blood pressure. 4. The decreased hydrostatic pressure of the water may increase the patient's blood pressure.

Correct Answer: 3

A patient has a left brain injury resulting from a cerebrovascular accident. Which of the following impairments are MOST likely to be observed? 1. Spatial impairments, difficulty planning movements, and slow, cautious behavior 2. Spatial impairments, difficulty sustaining movements, and quick, impulsive behavior 3. Speech impairments, difficulty planning movements, and slow, cautious behavior 4. Speech impairments, difficulty sustaining movements, and quick, impulsive behavior

Correct Answer: 3 1. With left brain injuries, common impairments include speech and language problems, difficulty planning and sequencing movements, and a cautious behavioral style. Spatial impairments, difficulty sustaining movements, and impulsive behavior are more likely to be associated with right brain injuries.

A patient has an ankle-brachial index (ABI) of 1.5. Which of the following conditions affecting the lower extremity should a physical therapist suspect? 1. Arterial aneurysm 2. Arterial thrombosis 3. Arterial calcification 4. Arterial occlusive disease

Correct Answer: 3 3. Ankle-brachial index is a ratio of the systolic blood pressure at the ankle and the brachial systolic pressure. The normal value of the ankle-brachial index is 1.0, indicating similar blood flow in the ankle and brachial arteries. An ankle-brachial index greater than 1.1 relates to arterial calcification in the leg. With arterial calcification, the artery cannot be fully compressed for valid measurement of arterial pressure at the ankle. An ankle-brachial index greater than 1.1 is mostly found in patients who have diabetes. (p. 645)

A patient is being reevaluated after participating in 4 weeks of physical therapy. During the reevaluation, the physical therapist notices significant changes in the patient's skin and nail beds. The patient reports noticing the changes but does not consider them important enough to visit the physician. Which of the following actions would be MOST appropriate for the therapist? 1. Continue with the current treatment plan without taking any additional steps. 2. Put physical therapy on hold until the patient's skin and nail bed changes resolve. 3. Report the changes in the patient's skin and nail beds to the physician. 4. Refer the patient to an emergency department or urgent care center.

Correct Answer: 3 3. Any changes in the integumentary system maybe the precursor to infection, inflammation, and systemic disease. Since the patient declines any follow-up, changes should be reported to the physician. (pp. 163, 169)

Exercises to improve flexibility would be LEAST appropriate to include in a physical fitness program for children with which of the following diagnoses? 1. Spastic cerebral palsy 2. Juvenile rheumatoid arthritis 3. Down syndrome 4. Muscular dystrophy

Correct Answer: 3 3. Children who have Down syndrome are extremely flexible (p. 433).

A patient who is not able to walk has developed an ischial tuberosity pressure injury. The patient is able to perform independent intermittent catheterization and demonstrates independence in bed-to-chair transfers. Which of the following factors has MOST likely contributed to the formation of the pressure injury? 1. Friction 2. Infection 3. Tissue loading 4. Tissue maceration

Correct Answer: 3 3. In this patient, prolonged sitting due to the inability to walk leads to tissue loading and risk for skin breakdown on the ischial tuberosities (p. 145).

A physical therapist is conducting a research project that synthesizes the results of several studies in a quantitative process. This process represents which of the following research methods? 1. Cross-sectional 2. Correlational 3. Meta-analytical 4. Methodological

Correct Answer: 3 3. Meta-analytical research is a process by which the results of several studies are synthesized in a quantitative way (pp. 357-358). This is consistent with the stem.

A patient has medial ankle pain, a pronated foot with a calcaneal valgus deformity, pain with passive ankle eversion, and weakness of the great toe flexors. The patient MOST likely has which of the following conditions? 1. Common fibular (peroneal) nerve injury 2. Deltoid ligament strain 3. Tarsal tunnel syndrome 4. Tibialis posterior tendinitis

Correct Answer: 3 3. Pain only with passive ankle eversion, a pronated foot, valgus deformity, and weak toe flexion strength are associated with tarsal tunnel syndrome (p. 1137).

A patient who had a 1.96-inch (5-cm) rotator cuff tear underwent surgical repair 1 week ago. Which of the following interventions is MOST appropriate at this time? 1. Active range of motion 2. Active-assisted range of motion against gravity 3. Passive range of motion 4. Isotonic strengthening

Correct Answer: 3 3. Passive range of motion exercises are initiated immediately in rehabilitation. A 5-centimeter tear is considered a massive rotator cuff tear that requires a conservative approach to rehabilitation, but passive range of motion exercises should occur immediately.

A 45-year-old patient reports general weakness and fatigue that developed over the past few months, along with increased pain bilaterally in the wrists and hands. The MCP and carpal joints are tender to touch, and the MCP joints appear slightly swollen. The patient MOST likely has which of the following conditions? 1. Osteoarthritis 2. Reiter syndrome 3. Rheumatoid arthritis 4. Carpal tunnel syndrome

Correct Answer: 3 3. Rheumatoid arthritis often presents with general fatigue, weakness, and bilateral symptomatic joints, most often presenting first in the hands and wrists (Goodman, Differential Diagnosis, pp. 438-441; Goodman, Pathology, pp. 1318-1321).

A patient reports difficulty, but no pain, when pulling down from overhead to close the trunk of their van. Which of the following muscles MOST likely require strengthening in the patient? 1. Anterior and middle deltoid 2. Levator scapulae and serratus anterior 3. Rhomboids and latissimus dorsi 4. Upper and lower trapezius

Correct Answer: 3 3. The person is pulling the car rear hatch door shut. Forceful downward rotation of the upper limb is necessary to perform the pictured activity. The latissimus dorsi primarily performs this task, with medial (internal) rotation, adduction, and extension of the shoulder. The rhomboids adduct and elevate the scapula, rotating it so the glenoid faces downward.

Which of the following parameters of electrical stimulation control the recruitment of peripheral axons during therapeutic electrical stimulation? 1. Current density 2. Symmetry of waveform 3. Duration of stimulus 4. Duty cycle

Correct Answer: 3 3. The process by which increasing numbers of nerve fibers are activated by increasing the amplitude or the duration of the stimulus is called fiber recruitment.

A 13-year-old patient reports moderate knee pain persisting more than 3 weeks, with no trauma noted. The patient exhibits an out-toeing gait pattern, leg length discrepancy, and restriction in medial (internal) rotation of the involved leg. Which of the following test findings would MOST likely be present? 1. Pain with palpation of the trochanteric region 2. Pain and instability during the application of valgus stress to the knee in full extension 3. Pain in the groin region with hips flexed 80° to 90° and then medially (internally) rotated with adduction 4. Pain in the gluteal region with combined movements of hip flexion to 45° to 60°, abduction, and lateral (external) rotation

Correct Answer: 3 3. The stem describes a case of suspected slipped capital femoral epiphysis. Signs and symptoms are typically found in adolescent patients (10-16 years old) and include leg shortness, knee pain, and pain when the hip is medially (internally) rotated. Groin pain will be triggered with the anterior impingement test (hips flexed to 80° to 90° and medially [internally] rotated with adduction) if slipped capital femoral epiphysis exists. (pp. 1580-1581

The physical therapy plan of care for a patient with low back pain includes posterior pelvic tilts performed in the supine position. Modification of the plan of care would be MOST needed if the patient were found to have which of the following conditions? 1. Irritable bowel syndrome 2. Duodenal ulcer 3. Hiatal hernia 4. Diverticulosis

Correct Answer: 3 3. When a client has a known hiatal hernia, the supine position and any exercise (such as posterior pelvic tilts) for which the patient might use the Valsalva maneuver should be avoided (pp. 901-902).

A patient is practicing moving from seated to standing position. Which of the following transfers to standing position would BEST facilitate motor learning of the task? 1. From a single chair at a self-selected speed, with minimal feedback of results 2. From a single chair at a variety of speeds, with maximum feedback of results 3. From a variety of chairs at a single speed, with maximum feedback of results 4. From a variety of chairs at a variety of speeds, with minimal feedback of results

Correct Answer: 4

A patient reports significant hypersensitivity to light touch in the left foot and ankle region following minor trauma. A physical therapist notes warmth, swelling, and redness over the entire foot and ankle. Which of the following interventions is MOST appropriate? 1. Continuous ultrasound 2. Gait training, non-weight-bearing on the left 3. Deep friction massage 4. Progressive weight-bearing activities

Correct Answer: 4

A physical therapist is reviewing the laboratory report of a patient who received a diagnosis of pneumonia 2 weeks ago. The patient's white blood cell count is currently 9,000 cells/mm3. Which of the following conditions does this value indicate for the patient? 1. Anemia 2. Development of leukocytosis 3. Immunosuppression 4. Resolution of the pneumonia infection

Correct Answer: 4

Which of the following fall prevention strategies is MOST appropriate for a resident of a nursing home who has dementia, poor balance, and often wanders? 1. Place the patient in bed, with the side-rails up and secured. 2. Place the patient in a wheelchair with a seat belt that the patient is unable to remove independently. 3. Seat the patient in a geriatric recliner to reduce the likelihood of wandering. 4. Use an electronic monitor that will remotely alert staff when the patient gets out of bed.

Correct Answer: 4

Which of the following factors MOST contributes to adverse reactions to medications in aging adults? 1. Increase in hepatic blood flow 2. Increase in metabolic activity 3. Decrease in proportion of body fat 4. Decrease in total body water

Correct Answer: 4 4. A decrease in lean body mass and an increase in the proportion of body fat results in a decrease in body water. As a result, water-soluble drugs have a lower volume of distribution, which speeds up onset of action and raises peak concentration.

A child who has athetoid cerebral palsy is MOST likely to exhibit which of the following characteristics? 1. Sustained limb posturing 2. Low frequency tremor 3. Rapid, jerky motions 4. Mixed muscle tone

Correct Answer: 4 4. Athetoid cerebral palsy is characterized by slow, involuntary, writhing, twisting, "wormlike" movements. Some muscles demonstrate tone that is too high, and others demonstrate tone that is too low.

Which of the following tests or measurements is BEST to assess risk for skin ulceration in a patient who has diabetes? 1. Rate pressure product 2. Pulse pressure 3. Capillary refill 4. Light touch

Correct Answer: 4 4. Because peripheral neuropathy is a common secondary complication of diabetes, it is imperative for a physical therapist to assess a patient's ability to detect light touch and presence of protective sensation to determine risk of skin ulceration (Baranoski, pp. 381-382).

A patient has higher than normal residual volume, absent or mucoid sputum, and spirometry measures that are unimproved with bronchodilators. The patient MOST likely has which of the following conditions? 1. Asthma 2. Pneumococcal pneumonia 3. Chronic bronchitis 4. Emphysema

Correct Answer: 4 4. Emphysema has the features of higher than normal residual volume (because of destroyed alveolar walls and enlarged air spaces), absent or mucoid sputum (as opposed to sputum with a lot of neutrophils), and spirometry measures that are unimproved with bronchodilators (unlike asthma, which improves with bronchodilators) (Hillegass, pp. 192-193, 197).

A patient sustained a nondisplaced midshaft radial and ulnar fracture 12 weeks ago. The patient was casted in mid-range elbow flexion with the forearm in a neutral position. Which of the following muscle pairs would MOST likely demonstrate contractile tissue shortening following the cast removal? 1. Brachialis and flexor pollicis longus 2. Brachioradialis and triceps 3. Biceps brachii and triceps 4. Biceps brachii and brachioradialis

Correct Answer: 4 4. The biceps brachii and brachioradialis flex the elbow and supinate the forearm. The cast position would shorten both muscles.

For a patient who is undergoing postural drainage for secretions in the right lateral segment, which of the following positions would be MOST appropriate? 1. Prone with the lower extremities raised 18 inches (45.7 cm) 2. Supine with the lower extremities raised 12 inches (30.5 cm) 3. Supine with the lower extremities raised 18 inches (45.7 cm) 4. Left sidelying with the lower extremities raised 18 inches (45.7 cm)

Correct Answer: 4 4. The correct patient position for postural drainage of the right lateral segment is left sidelying with the legs raised 18 inches (45.7 cm).

When using electrical stimulation to treat a patient's nonhealing, infected wound, which of the following waveforms and parameters will be MOST helpful in facilitating wound closure? 1. Symmetrical biphasic waveform, 35 pps 2. Interferential current waveform, 100 beats/second 3. High-voltage pulsed current waveform, positive electrode in wound, 4 pps 4. High-voltage pulsed current waveform, negative electrode in wound, 100 pps

Correct Answer: 4 4. The principle behind wound healing with electrical stimulation is galvanotaxis. The current's polarity introduced into the wound attracts cells that promote healing. Thus, a generator that has polarity must be used. High-voltage pulsed currents are polar currents. The other stimulators are not polar because they have a counter-pulse in the opposite direction that cancels out any polar effects. The negative electrode will attract neutrophils and is used in infected wounds. The positive electrode attracts macrophages and epidermal cells and is used in treating noninfected wound states. The frequency of 100 pps provides a continuous, comfortable current and has been demonstrated to promote healing. (pp. 271-272, 278)

With a patient in a sitting position, a physical therapist stabilizes the patient's scapula while passively moving the shoulder into flexion and medial (internal) rotation. This movement reproduces the patient's shoulder pain. Which of the following assessments is MOST likely to confirm the suspected diagnosis? 1. Lift-off test 2. Hornblower sign 3. Apprehension sign 4. Hawkins-Kennedy test

Correct Answer: 4 4. The procedure described in the stem is the Neer test, which tests for the presence of subacromial impingement. The patient's response would be indicative of a subacromial impingement of the supraspinatus or long head of the biceps tendon. The Hawkins-Kennedy test is also a test for the presence of subacromial impingement. (p. 519)

An 18-year-old patient who has a traumatic brain injury exhibits mild cognitive deficits, poor head and trunk control, and slowly healing pressure injuries on the ischial tuberosities. The patient has good voluntary movement and motor control in the right arm but has significantly increased tone and poor functional use of the left arm. Which of the following methods of wheelchair pressure relief is BEST for the patient? 1. Manual recline 2. Power recline 3. Manual tilt-in-space 4. Power tilt-in-space

Correct Answer: 4 4. Tilt systems do not create shearing forces on the ischial tuberosities or sacrum, and power tilt-in-space will allow independence in pressure relief without causing shear forces on the buttocks.