PTH 226 Final exam

A PTA educates a patient s/p transfemoral amputation on the importance of frequent skin checks. What is the MOST appropriate resource for the patient to utilize when inspecting the posterior aspect of the residual limb?

Hand mirror

Which of the following activities should be used initially to correct a diastasis recti postpartum?

Have the patient lie supine, arms across the abdomen, and perform head lifts.

You are treating a patient with weak hip abductors (muscle grade is 2/5). Which of the following ROM exercises is most appropriate to prevent tightness of the hip adductors and maintain the current level of strength of the hip abductors?

Have the patient perform active hip abduction through the available ROM while positioned in the supine position as you support the weight of the leg

Your goal is to improve lower extremity proprioception, balance, and strength. Which of the following closed-chain exercises is the most challenging?

Have the patient stand on one foot on a piece of foam and maintain his balance

Which of the following statements about stretching is true?

To stretch the posterior tibialis, you dorsiflex and evert the foot and ankle.

Which of the following orthopedic questionnaires would be most appropriate for a patient with a diagnosis of frozen shoulder/ adhesive capsulitis?

quick dash

`A PTA observes a patient complete a standing squat as shown in the image. During the squat the assistant notes that the patient is unable to maintain their heels in contact with the ground. Based on this finding, which muscle is MOST likely shortened?

soleus

An orthosis that includes a pelvic band that wraps around the hips, a thigh strap, hinge component at the knee, and goes to the shoe is called a:

HKAFO

Your instructions to a patient who has been fit with an elastic shrinker for the residual limb is to wear it

23 hours a day, except when bathing

When a person is standing in chest-deep water (at the level of the xiphoid process), the percentage of weight bearing is approximately what percentage of body weight?

33%

Which of the following is true regarding appropriate HEP's?

A HEP is an important component for success of a PT program and should be provided early in the treatment, updating as appropriate

Each of the following is an indication that muscle fatigue is occurring when a patient is exercising against resistance except:

A gradual increase in temperature (sensation of warmth) in the exercising muscles

Which of the following is a true statement about the use of autografts and allografts for repair of tissue lesions?

A risk associated with an autograft is potential weakening of a patient's otherwise healthy tissue at the donor site.

Which of the following is a correct statement about surgical repair of a torn or ruptured muscle or tendon?

A surgically repaired muscle or tendon is immobilized in a shortened position for a period of time after surgery.

Ms. L is a 78-year-old who underwent surgery for internal fixation of an intertrochanteric fracture of the (L) hip 3 days ago. For the next few weeks she must remain nonweight-bearing on the operated side and has begun to use a walker for ambulation. She is able to walk for short distances around her hospital bed but is not yet able to rise from a chair to standing. According to the ICF model, the inability to stand from a sitting position is classified as a(n):

Activity limitation

A PTA observes a patient in standing use predominantly lower extremity distal muscle activation to subtly shift their center of mass toward the center of their base of support. Which balance strategy would have MOST likely been utilized to accomplish this action?

Ankle strategy

What balance strategy is activated with small external pertubations?

Ankle strategy

The center of gravity in most adult humans is located slightly:

Anterior to the S2 vertebra

To strengthen the posterior tibialis using manual resistance, have the patient assume a long sitting position on a table or mat. Support and hold the lower leg with one hand and:

Apply resistance to the plantar and medial surfaces of the foot at the first metatarsal as the patient plantar flexes and inverts the ankle and foot

John is a 25-year-old active athlete and outdoorsman who suffered a severe lateral ankle injury 5 years ago, resulting in progressive subtalar arthritis, pain, and instability of the ankle and hindfoot. His quality of life and ability to work are now restricted owing to the pain and instability despite repeated sessions in therapy. The surgical procedure of choice for John is most likely:

Arthrodesis (fusion)

Which of the following is a true statement about a muscle's response to immobilization?

As the immobilized muscle atrophies, an increase in fibrous and fatty tissue in the muscle occurs.

To prevent falls and maximize safety while lifting heavy objects from the floor, an elderly patient is instructed to:

Bend at the knees partially while keeping the back straight and pick up the load slowly.

Decreasing the amount of weight bearing by immersing more of a person's body in water is a result of what property of water?

Buoyancy

All of the following are signs and symptoms your patient may exhibit that would alert you to a possible pulmonary embolism except:

Chest pain alleviated with deep breathing and rib compression

Which of the following stages of soft tissue healing is characterized by remodeling and maturation of collagen in the scar?

Chronic stage

Rhythmic stabilization exercises are important in a spinal rehabilitation program because they:

Develop postural muscle response to external disturbances

Which of the following PROM exercises provides the most flexion of the lumbar spine?

Double knees to chest

A patient rehabilitating from a burn to their right wrist and hand is fit for a splint that will attempt to regain lost range of motion by offering a sustained force using rubber bands. Which splint classification is MOST consistent with the described scenario?

Dynamic splint

Individuals with symptoms from an intervertebral disk lesion and individuals with osteoporosis should not do:

Dynamic trunk flexion exercises

A PTA observes a patient complete a test that requires the patient to perform quick alternating pronation and supination of the forearm. What can this test be used to identify?

Dysdiadochokinesia

Mr. J underwent a repair of a torn biceps brachii 2 days ago. During PROM exercises, which combination of motions should you avoid at end range to protect (not disrupt) the healing tissue?

Elbow extension, shoulder extension, forearm pronation

When designing an exercise program to return a patient to his/her prior functional level, each of the following guidelines is true except:

Exercises for strength and power should precede balance and stability exercises

A PTA observes the gait of a patient referred to physical therapy for gait training following a transtibial amputation. The assistant concludes that the patient exhibits decreased step length bilaterally. What is the MOST likely rationale associated with this finding?

Fear and insecurity

Which of the following tests can be performed with only a stopwatch and four canes?

Four Square Step Test

A PTA works with a patient referred to physical therapy with incontinence. Interventions include upper and lower extremity strengthening and gait training. What would the described interventions be MOST effective treating?

Functional incontinence

Which of the following is NOT an indication for an AFO?

Good anterior tibialis strength

A properly applied and progressed therapeutic exercise program should:

Grade the exercise to the stage of recovery to stress the tissues safely

According to the International Classification of Functioning, Disability and Health (ICF) endorsed by the American Physical Therapy Association (APTA), a rotator cuff tear is considered a(n): Correct Answer

Health condition

What balance strategy is activated with larger rapid external pertubations or from movements that occur near the limits of stability?

Hip strategy

If a patient has lower extremity edema, which of the following principles associated with hydrotherapy (an aquatic environment) will assist with decreasing the edema?

Hydrostatic pressure

Which of the following is a true statement about surgical repair of the rotator cuff and postoperative management?

If the size and severity of the tears are similar, rehabilitation after repair of an acute, traumatic cuff tear typically progresses more rapidly than after repair of an atraumatic tear associated with chronic impingement

Contraindications to the use of plyometrics include all of the following except:

Individuals under 10 years or over 70 years

Following recovery of a posterolateral disk protrusion, your patient will be returning to a job that requires prolonged forward bending and stooping. Your instructions to the patient must include:

Interruption of the flexed postures at frequent intervals by standing upright and bending backward

The anterior pillar of the spine:

Is the weight-bearing portion of the spinal column

All of the following are generally true of the nucleus pulposus except:

It is centrally aligned within the annulus fibrosis at all levels of the spine to provide uniform shock absorption

Your patient, a 19-year-old college student, sustained a nondisplaced fracture of the distal humerus, which was managed by closed reduction and 6 weeks of immobilization in a cast. Yesterday the cast was removed and the patient is to begin exercises to improve range of motion (ROM) and strength of the elbow. Your examination reveals significant limitation of elbow flexion/extension and forearm pronation/supination as well as reduced joint play at the elbow. The patient describes her elbow as feeling "very stiff," but pain occurs only when overpressure is applied at the end of the available ranges. One of the goals in this patient's treatment plan is to increase elbow ROM. With which of the following techniques should you begin to increase ROM?

Joint-mobilization techniques to stretch the restricted joints (grade III sustained glide or grade IV oscillation techniques) after evaluating the reactivity of the elbow joints with grade II sustained glides

Fundamental techniques that every patient with spinal impairments should learn before progressing to basic and advanced training exercises include:

Kinesthetic awareness of safe spinal positions and movement, activation of deep segmental muscles, and global muscle control of spinal posture when moving the extremities or moving from one position to another.

Extreme caution should be used when manipulating the spine of patients with rheumatoid arthritis. There is high potential for subluxation of the vertebrae and damage to the spinal cord secondary to:

Ligamentous necrosis

Which of the following types of active exercises are the most appropriate to use first during the acute phase of healing after a muscle injury?

Low-intensity muscle setting

Which of the following is the primary function of the cerebellum?

Maintenance of upright posture

Your patient has osteoarthritis of the left hip and states he experiences hip and thigh pain after walking for more than 20 to 30 minutes. As a therapist, which of the following is the most appropriate intervention for you to recommend?

Measures to decrease the mechanical stresses on the hip joint, such as use of a cane when walking over an extended period of time

A PTA is performing an assessment of proprioception and has the patient close their eyes then lifts their finger by the side asking the patient to determine if it was moved up or down. This test is called:

Movement test

A patient has mild joint swelling and pain during active ROM, but resisted tests of the muscles that cross the swollen joints do not cause pain. Your goal is to maintain or possibly increase strength through the available ROM. The most appropriate choice of exercise is:

Multiple-angle isometric exercise against resistance

A lesion in the cerebellum will most likely cause which of the following impairments?

Nystagmus

Which of the following signs and symptoms in the hip region and/or lower extremity is most consistent with the finding associated with trochanteric bursitis?

Pain along the lateral aspect of the hip joint and possibly along the lateral thigh and knee to the insertion of the iliotibial band; pain typically worsens during long periods of asymmetrical standing with more weight shifted to the involved side

A PTA is treating a patient two weeks post rotator cuff repair. Which of the following interventions in the MOST appropriate?

Passive range of motion up to 10 degrees of external rotation

As you develop progressions of exercise programs for varied patients, which of the following describes the appropriate use of plyometric drills?

Patients in advanced phases of rehabilitation should be trained to return to high-demand functional activities and sports

Which of the following statements is true regarding the temperature range of water 26°C-35°C (78.8°F-95°F) recommended for aquatic exercise?

Patients should perform cardiovascular exercise at the low end of this range.

The Functional Independence Measure is an example of a multidimensional functional assessment instrument because it includes some measure of which of the following?

Physical function Social function Activities of daily living function Correct! All of the above

Of the following choices, which is the most appropriate application of the hold-relax (contract-relax) method of muscle inhibition and elongation of the gastrocnemius muscle? Extend the patient's knee, stabilize the lower leg, and:

Place the patient's ankle in as much dorsiflexion as is comfortable; have the patient isometrically contract the plantar flexors against resistance for 3 to 5 seconds. Then have the patient relax as you passively dorsiflex the ankle.

A 55-year old man with stable congestive heart failure is unable to tolerate land-based exercises for strengthening his back because of chronic low back pain. He has expressed concern with attempting pool therapy because of his inability to swim and his use of pain medications. Which of the following statements is true about his ability to participate in aquatic therapy?

Pool therapy can be used to decrease pain, improve mobility, and strengthen muscles.

During the subacute stage of soft tissue healing after injury and repair of the flexor tendons of the hand or forearm, each of the following is an important intervention except:

Progressive resistance exercise

A patient reports using a wheelchair for mobility for the past three months following a transfemoral amputation. Assuming the goal is to have the patient become a community ambulator, which intervention would be the MOST beneficial to improve terminal stance range of motion during gait?

Prone lying passive hip extension

A patient reports to PT one week s/p transtibial amputation. Which sleeping position would be the MOST appropriate to prevent a knee and hip contracture?

Prone lying without the use of a pillow

Which of the following braces for scoliosis would you instruct your client to wear only at night?

Providence brace

Ergonomics is defined as all of the following EXCEPT

Provides the design for the ramp to assist the worker to get into a job or establishment

Ambulation should begin in the early postoperative phase in order to:

Reduce the risk of a DVT after surgery

Synovectomy, when used, typically is indicated for:

Rheumatoid arthritis

You have a patient assume a prone-lying position and prop symmetrically on his forearms. You apply manual resistance in several directions at the shoulder girdles as you ask the patient to hold (maintain) the symmetrical position. This technique is known as:

Rhythmic stabilization

During the last trimester of pregnancy, pain in the groin area is often caused by overstretching of the:

Round ligament

Which of the following two upper extremity muscle groups are the MOST important to strengthen to assist with body lifting during ambulation?

Scapular depressors and elbow extensors

You are observing your patient with a transfemoral prosthesis ambulate and note that she has increased lateral trunk bend in stance phase. Which of the following is the MOST likely explanation of the problem?

Short prosthesis

Each of the following is a relative or absolute contraindication for use of total joint replacement arthroplasty except:

Significant joint deformity

You are observing your patient with a transtibial prosthesis ambulate and note that she has insufficient knee flexion in early stance phase. Which of the following is a likely explanation of the problem

Soft heel cushion

A PTA is performing an assessment of proprioception and has the patient close their eyes while the PTA moves a body part to a position and asks the patient to match with the opposite side. This test is called

Space test

What balance strategy is activated when a large force displaces the center of mass beyond the limits of stability?

Stepping strategy

All of the following are recommendations of the National Osteoporosis Foundation for ways to prevent osteoporosis except:

Strengthen the core and protect the spine with flexion exercises (curls and sit-ups)

A 36 year old female who gave birth to three children over the span of nine years is referred to physical therapy during her fourth pregnancy. The patient presents with complaints of involuntary urine leakage when she coughs or sneezes and when she participates in aerobics class. Which type of incontinence is MOST consistent with the described presentation?

Stress

During pregnancy, in which direction does the center of gravity of the body move?

Superior and anterior

Your patient describes posterior cervical pain and headaches that get progressively worse throughout each workday. She is a computer programmer, plays tennis on the weekends, and is an aerobic walker in the evenings. Your evaluation reveals a person who is physically fit with well-balanced flexibility and strength. Your treatment emphasis will be:

Teaching tension-reducing postures and modification of chair, desk, and computer heights

An 82-year-old woman is referred to physical therapy with a history of two falls in the past month. She shows inadequate anticipatory control on the Functional Reach Test and is now expressing fear of falling. The patient lives alone and relies on her daughter for transportation. The best exercise program for this person is:

The Otego Home Exercise Program

Disc lesions are more common in the 30 year to 45 year age span because:

The annulus begins degenerating, loses tensile strength, and begins to tear with excessive forces

Which of the following is true about testing for a diastasis recti?

The fingertips are placed horizontally at the midline of the abdomen (perpendicular to the linea alba) at the level of the umbilicus to assess the size of the separation.

Your patient has only 50° of passive and active knee flexion (but full passive extension) 2 weeks after removal of a cast for a fracture of the tibia. The bone is now radiologically healed. Each of the following techniques will be of value to increase the range of knee flexion except:

The hold-relax technique, with isometric contraction of the hamstrings with the knee at 45°, followed by relaxation, then passive movement into more flexion

Which of the following is true about physical therapy intervention for pelvic floor dysfunction?

The primary contributing factor for pelvic floor dysfunction in men is prostate enlargement or prostate cancer treatment.

Each of the following is true about flexor tendon-gliding exercises except:

To perform these exercises, the therapist passively moves the patient's fingers into five different positions in a particular sequence

After a musculoskeletal injury of the lower extremity, you develop an aquatic exercise program for your patient. An aquatic exercise program is the least effective for:

Transfer of training to land-based functional activities

A PTA is performing balance exercises with a patient in the parallel bars on a firm surface with one hand hold assist on the bars. Which of the following would NOT be a progression?

Two hand hold on the bars on a firm surface

At what point with prosthetic socks do you request a reevaluation by the PT of socket fit?

Using more than 15-ply of socks

In order to maintain the web space of the hand, it is important to maintain which of the following motions of the carpometacarpal joint of the thumb?

abduction and extension

The special test that is performed to test for meniscal injury where the patient lies prone with 90 degrees of knee flexion and the therapist stabilizes the femur while pushing down on the heel medially and laterally rotating the tibia is called the

apleys compression test

Which of the following functional assessments does not include a gait component?

berg

Common postural changes/deviations that develop or become exaggerated during pregnancy include each of the following except:

decreased thoracic kyphosis

The special test that is performed to test for RTC tear where the arm is placed at 90 degrees abduction and then the patient slowly lowers to their side is called the Correct!

drop arm test

All of the following would be appropriate orthopedic questionnaires for a patient with a diagnosis of right knee OA except:

hoos

True or False? Older adults may report a fear of falling, with or without a history of a previous fall, that may result in them avoiding or restricting activities.

true