Dunaway B

89. A clinical instructor is explaining to his student how a muscle contracts. The instructor describes the cycle of cross bridging. He begins stating the first step is that the cross-bridges attach to the thin filament. Which of the following occurs next (in the correct order)? A. The attachment with the actin filament is lost. The cross-bridge moves into position to attach to the thick filament. Cross-bridge moves, causing the thin filament to move. B. The cross-bridge moves into position to attach to the thick filament. The attachment with the myosin filament is lost. Cross-bridge moves, causing the thin filament to move. C. The attachment with the myosin filament is lost. Cross-bridge moves, causing the myosin filament to move. The cross-bridge moves into position to attach to a myosin filament. D. Cross-bridge moves, causing the actin filament to move. The attachment with the thin filament is lost. The cross-bridge moves into position to attach to an actin filament.

D. After the cross-bridge attaches to the thin filament (or actin), it moves, causing the thin filament to move. After the cross-bridge is broken, it moves into position to reattach to an thin filament (or actin) to repeat the cycle.

38. A physical therapist is setting up a portable whirlpool unit in the room of a severely immobile patient. What is the most important task of the physical therapist before the patient is placed in the whirlpool? A. Check for a ground fault circuit interruption outlet. B. Check to make sure the water temperature is below 110o C. Make sure the whirlpool agitator is immersed in the water. D. Obtain the appropriate assistance to perform a transfer.

A. A ground fault interruption circuit protects the patient from pa potentially life-threatening situation. The other choices are valid concerns, but A is the most important.

40. A physical therapist is ordered to provide gait training for an 18-year-old girl who received a partial medial meniscectomy of the right knee one day earlier. The patient was independent in ambulation without an assistive device before surgery and has no cognitive deficits. The patient's weight bearing status is currently partial weight bearing on the involved lower extremity. Which of the following is the most appropriate assistive device and gait pattern? A. Crutches, three-point gait pattern B. Standard walker, three-point gait pattern C. Standard walker, four-point gait pattern D. Crutches, swing-to gait pattern

A. A patient of this age usually can begin with crutches instead of a standard walker. If the patient has no cognitive deficits and was independent in ambulation without an assistive device before surgery, she most likely will have the balance and coordination necessary to ambulate with crutches. A three-point gait pattern is necessary because of the current partial weight-bearing status. A swing-to pattern also can be used, but a three-point pattern assists more quickly in returning a more normal gait pattern.

53. An outpatient physical therapist notices that a large number of patients with impingement of the rotator cuff have been treated in the past 6 months. The clinic finds that most patients are employed at a new auto manufacturing plant. The therapist is invited to the plant to perform an ergonomic assessment and finds that a certain number of the employees must work with their shoulders at 120o of elevation and internal rotation. Which of the following recommendation would decrease the occurrence of impingement? A. Provide the employees a step stool to perform their tasks. B. Raise the employees' work surface. C. Adjust their tasks so that overhead activities are performed with palm of the hand downward D. A and B are correct

A. A step stool decreases the overall shoulder elevation required. Answer B increases shoulder elevation and answer C maintains internal rotation with increased elevation. External rotation with elevation decreases the impingement to the rotator cuff muscles.

52. A physical therapist is beginning the evaluation of a patient with AIDS. The patient was admitted to the acute floor of the hospital on the previous night after receiving a right total hip replacement. The physician has ordered gait training and dressing change of the surgical site. Of the following precautions, which is the least necessary? A. Mask B. Gloves C. Handwashing D. Gown

A. AIDS is transmitted by blood or bodily fluids. Masks are usually used with airborne precautions. Handwashing should be done between all wound care patients. Gloves are also indicated with all open wounds. Gowns may not be a necessity but should be used if there is a chance of soiling the clothing with infected fluids.

17. A 60-year-old woman who has suffered a recent stroke has right-side homonymous hemianopsia. Which of the following statements is true about placement of eating utensils in early rehabilitation? A. The utensils should be placed on the left side of the plate. B. The utensils should be placed on the right side of the plate. C. The utensils should be placed on both sides of the plate. D. The plate and utensils should be placed slightly to the right.

A. As perception improves, objects should be moved into the area of the deficit (the right side in this case), but initially should be placed in plain view of the patient (the left side in this case).

12. A physical therapist in an outpatient clinic is called into a room to assist an infant who is unconscious and not breathing. The therapist opens the airway of the infant and attempts ventilation. The breaths do not make the chest rise. After the infant's head is repositioned, the breaths still do not cause the chest to move. What should the therapist do next? A. Give five back blows B. Look into the throat for a foreign body C. Have someone call 911 D. Perform a blind finger sweep of the throat

A. Back blows should be followed by chest thrusts with complete airway obstruction when CPR is performed on an infant. The therapist then should check for a foreign body in the airway. A blind finger sweep of the throat should not be performed on an infant.

43. A physical therapist is asked by a co-worker to finish evaluating a patient because an emergency requires the therapist to leave. The co-worker agrees and resumes the examination. The first therapist left notes titled, "sensory assessment". Two wooden blocks identical in appearance but 1 pound different in weight are on the table in front of the patient. What test was the prior therapist most likely performing? A. Barognosis test B. Stereognosis test C. Graphesthesia test D. Texture recognition

A. Barognosis is the ability to differentiate between different weights. Stereognosis is the ability to differentiate between different sizes and shapes. Graphesthesia is the ability to identify letters, numbers, or designs traced on the skin. Texture recognition is the ability to differentiate between textures such as cotton, wool, and silk.

59. A physical therapist is ordered to evaluate and treat in the acute setting a patient who received a left total knee replacement 1 day ago. Before surgery, the patient was independent in all activities of daily living, transfers, and ambulation with an assistive device. The family reports that ambulation was slow and guarded because of knee pain. The physician's orders are to ambulate with partial weight bearing on the left lower extremity and to increase strength/range of motion. At this point, bed-to-wheelchair transfers, sit-to-stand transfers, and wheelchair-to-toilet transfers require the minimal assistance of one person. The left knee has 63o of active flexion and 77o of passive flexion. The left knee also lacks 7o of full extension actively and 3o passively. Right hip strength is recorded as follows: hip flexion and abduction = 4+/5, hip adduction and extension = 5/5, knee flexion = 4+/5, knee extension = 5/5, ankle plantarflexion = 4+/5, and dorsiflexion = 5/5. Left lower extremity strength is recorded as follows: hip flexion = 3/5, hip abduction and adduction = 3+/5, hip extension = 3/5, knee flexion and extension = 3-/5, ankle dorsiflexion = 3+/5, and plantarflexion = 3+/5.

A. Because the patient lives alone, independent transfer is the most important goal listed. Functional ambulation is an important goal, but choice B is an unrealistic goal for the patient to accomplish in a 2- or 3-day period.

33. Which of the following should a therapist evaluate first when performing a job-site analysis? A. Job description and duties B. Bathroom accessibility C. Lighting conditions D. Parking conditions

A. Before a job-site analysis can begin, the therapist should be familiar with the injuries or problems that occurred at the job-site and employee's job description.

99. A physician ordered a splint for a patient who should keep the thumb of the involved hand in abduction. A new graduate is treating the patient and is confused about the difference between thumb flexion, extension, abduction and adduction. Which of the following lists is correct? A. Extension is performed in a plane parallel to the palm of the hand, and abduction is performed in a plane perpendicular to the palm of the hand. B. Flexion is performed in a plane perpendicular to the palm of the hand, and adduction is performed in a plane parallel to the palm of the hand. C. Extension is performed in a plane perpendicular to the palm of the hand, and adduction is performed in a plane parallel to the palm of the hand. D. In referring to positions of the thumb, flexion and adduction are used synonymously, and extension and abduction are used synonymously.

A. Flexion and extension of the thumb are performed in a plane parallel to the palm of the hand. Abduction and adduction are performed in a plane perpendicular to the palm of the hand.

95. A 65-year-old man presents to physical therapy with complaints of pain due to compression fractures of the C2 and C3 vertebrae. The patient has an unusually large cranium. He describes his condition by stating, "Much of my bone tissue is continually decreasing, then reforming". The patient also indicates that the condition has caused limb deformity. Which of the following diseases does he have? A. Paget's disease B. Achondroplastic dwarfism C. Osteogenesis imperfecta D. Osteopetrosis

A. In Paget's disease (also known as osteitis deformans), bone is resorbed and deposited at different rates during different stages of the disease. One of the deformities sometimes present as an enlarged cranium. This increased weight can result in compression fractures of the more superior cervical vertebrae. The origin of this condition is not exactly known. It usually involves people over 60 years of age.

61. A physical therapist is reviewing the chart of a 49-year-old woman who recently suffered a myocardial infarction. The lab reports reveal that this particular patient has a hematocrit of 41%. How should the therapist proceed? A. Continue with the evaluation and treatment. B. Do not perform this evaluation due to the hematocrit level C. Inform nursing of this lab report D. Check nursing notes to determine the last time the patient received a beta-blocker.

A. Normal hematocrit values for women are 36-48%; for men, 40-52%.

45. A therapist is sent to the intensive care unit to evaluate a patient who has suffered a severe recent head injury. While reviewing the patient's chart, he discovers that the patient exhibits decerebrate rigidity. The therapist is likely to find this patient in which of the following positions? A. The patient will be positioned with all extremities extended and the wrist and fingers flexed B. The patient will be positioned with the upper extremities flexed, the lower extremities hyperextended, and the fingers tightly flexed C. The patient will be positioned with all extremities flexed and wrist and fingers extended D. The patient will be positioned with the upper extremities extended, the lower extremities flexed and the fingers hyperextended.

A. Patients with decerebrate rigidity are positioned with all extremities extended, and wrist and fingers flexed. Patients with decorticate posturing are positioned with the upper extremities flexed, the lower extremities hyperextended, and fingers tightly flexed.

16. A physical therapist is ordered to evaluate a 65-year-old woman who has suffered a recent stroke. The occupational therapist informs the physical therapist that the patient has apraxia. She cannot brush her teeth on command. However, she can point out the toothbrush and verbalize the purpose of the brush. From this information, what sort of apraxia does this patient have? How should the physical therapist approach treatment? A. Ideomotor apraxia. The physical therapist should speak in short, concise sentences. B. Ideomotor apraxia. The physical therapist should always give the patient 3-step commands. C. Ideomotor apraxia. The physical therapist should always give the patient 5-step commands. D. Ideational apraxia. The physical therapist should speak in short, concise sentences.

A. Patients with ideomotor apraxia often can identify objects but cannot use them correctly on command. Such patients often can perform the activity spontaneously. Patients with ideational apraxia often cannot identify objects or use them. Both situations call for short one-step commands.

42. A patient is receiving crutch training 1 day after a right knee arthroscopic surgery. The patient's weight bearing status is toe-touch weight bearing on the right lower extremity. The therapist first chooses to instruct the patient how to perform a correct sit to stand transfer. Which of the following is the most correct set of instructions? A. (1) Slide forward to the edge of the chair; (2) put both the crutches in front of you and hold both grips together with the right hand; (3) press on the left arm rest with the left hand and the grips with the right hand; (4) lean forward; (5) stand up, placing your weight on the left lower extremity; (6) place one crutch slowly under the left arm, then under the right arm. B. (1) Slide forward, (2) put one crutch in each hand, holding the grips; (3) place crutches in a vertical position; (4) press down on the grips; (5) stand up, placing more weight on the left lower extremity C. (1) Slide forward to the edge of the chair; (2) put both the crutches in front of you and hold both grips with the left hand; (4) lean forward; (5) stand up placing your weight on the left lower extremity; (6) place one crutch slowly under the right arm, then under th

A. The method used in answer A is the safest. The method used in answer C is too unstable.

44. A therapist places a pen in front of a patient and asks him to pick it up and hold it as he normally would to write. The patient picks the pen up and holds it between the pad of the thumb and the middle and index fingers. Why type of grasp or prehension is the patient using? A. Palmar prehension B. Fingertip prehension C. Lateral prehension D. Hook grasp

A. The patient is using palmar prehension in this scenario. Palmar prehension is holding an object between the thumb pad and middle and index finger. Fingertip prehension is used when a person picks up an object between the thumb pad and either the index or middle finger (not both at the same time, as with palmar prehension). In lateral prehension, the thumb pad is in contact with the lateral side of the index finger proximal to the distal interphalangeal joint. In hook grasp, the fingers are flexed as if carrying a bucket by the handle. The thumb does not provide much active movement when the hook grasp is used.

14. A patient presents to an outpatient clinic with a diagnosis of reflex sympathetic dystrophy (RSD) of the left upper extremity. The physician's order is to evaluate and treat. While obtaining a subjective history, the therapist is informed that the patient has along-standing diagnosis of carpal tunnel syndrome. Left upper extremity signs and symptoms include constant burning pain, abnormal fast hair and nail growth, decrease range of motion, and increased sensitivity to pain and/or light touch. The patient is most likely in what stage of RSD? A. Acute B. Dystrophic C. Atrophic D. Chronic

A. The signs and symptoms are consistent with a patient in the acute stage of RSD. Dystrophic signs and symptoms are decreased temperature, cessation of hair and nail growth, pale skin, and muscle atrophy. Atrophic signs and symptoms are decreased hypersensitivity, normal temperature, marked muscle atrophy, and smooth skin.

74. A physical therapist is ordered to evaluate a patient in the intensive care unit who recently suffered a stroke. The evaluation reveals the following signs and symptoms: contralateral hemiplegia (upper extremity involvement greater than lower extremities), homonymous hemianopsia, aphasia (due to the dominant hemisphere being involved), and contralateral loss of sensation in the upper extremities. Which of the following arteries is the most likely location of the lesion? A. Middle cerebral artery B. Anterior cerebral artery C. Internal carotid artery D. Posterior cerebral artery

A. These signs and symptoms are consistent with a lesion in the middle cerebral artery.

67. A 25-year-old man suffered C4 quadriplegia in a motor vehicle accident. The injury is acute, and the patient is beginning to work on increasing upright tolerance in the sitting position with an abdominal binder. He is looking to the therapist for encouragement. The therapist is attempting to convey realistic long-term goals for self-care ability and overall mobility. Of the below listed goals, what can this patient reasonably expect at his highest level of function in the future? A. Transfer from wheelchair to bed independently with a sliding board B. Use of a power wheelchair C. Independent feeding with an assistive device. D. Donning a shirt independently and pants with minimal assistance.

B. A person with C4 quadriplegia can be reasonably expected to use a power wheelchair for locomotion with mouth, chin, breath, or sip-and-puff controls. A person with C5 quadriplegia may be reasonably expected to be able to transfer independently from wheelchair to bed with a sliding board. A person with C4 quadriplegia may be able to feed independently but will need some type of assistive device. A person with C5 quadriplegia may be able to don a shirt with assistance. Sources vary significantly on this subject.

68. A 17-year-old boy presents to therapy after being involved in a motor vehicle accident resulting in C7 quadriplegia. The therapist is setting long-term goals for the patient. Which of the following goals represents the most reasonable and highest level of function that the patient should achieve? A. Use of a wheelchair with power hand controls on even terrain. B. Negotiation of uneven terrain with a manual wheelchair. C. Ambulation for short distances on level surfaces with knee-ankle-foot orthoses D. Use of a power wheelchair with head or chin controls on even surfaces

B. A person with C7 quadriplegia should be able to use a wheelchair without power controls. The goals set in answers A and D do not represent the maximal functional potential for this patient. The goal in answer C is set too high for this patient.

11. An acute care physical therapist is ordered to evaluate and treat a patient who has suffered a right hip fracture in a recent fall. During the evaluation, the family informs the therapist that the patient suffered a stroke approximately 1 week before the fall. The patient's chart has no record of the recent stroke. What should the physical therapist do first? A. Immediately call the referring physician and request a magnetic resonance scan B. Evaluate and treat the patient as ordered. C. Immediately call the referring physician and request a computed tomography scan. D. Immediately call the referring physician for an occupational therapy referral.

B. Although a stroke may have occurred, the physical therapist can first evaluate and treat the patient. After the evaluation has been performed, the therapist will be more informed about the patient's condition and can then contact the physician if necessary.

6. A 50-year-old woman has been receiving treatment in the hospital for increased edema in the right upper extremity. The therapist has treated the patient for the past 3 weeks with an intermittent compression pump equipped with a multicompartment compression sleeve. The patient's average blood pressure is 135/80 mmHg. The daily sessions are 3 hours in duration. The pump is set at 50 mmHg, 40 mmHg, and 30 mmHg (distal to proximal) for 30 seconds, on and off for 15 seconds. The therapist decides to change the parameters. Of the following changes, which is the most likely to increase the efficiency of treatment? A. Patient in a seated position with the right upper extremity in a dependent position versus supine and elevated. B. Increase the maximal pressure from 50 mmHg to 60 mmHg C. Change the on/off time to 15 seconds on and 45 seconds off D. Equalize the sleeve compartments versus having greater pressure distally

B. Although the change may be minimal, increasing the maximal pressure to 60 mmHg is the most likely choice to have a positive effect on edema reduction. The pressure, however, should not exceed the diastolic pressure of the patient. Answer A is not the right choice because placing the extremity in a dependent position causes the pump to work against gravity. Answer C is an incorrect choice because decreasing the on time means that the extremity receives compression for a shorter period. Answer D is an incorrect choice because greater pressure distally is more likely to move fluid than equal pressure throughout the sleeve.

9. Which of the following statements is false about treatment with infrared lamps? A. Near infrared heats deeper than far infrared. B. Infrared lamps heat both sides of an extremity at one time. C. The therapist can change the intensity of the heat by changing the angle between the beam and the body part being treated. D. The therapist can change the intensity by placing the lamp closer to the part being treated.

B. Answer A is true because near infrared can penetrate up to 10 mm compared with 2 mm with far infrared. Answer B is a false statement because infrared lamps can heat only one side of an extremity at a time. Answers C and D are true statements because the intensity of the infrared can be changed by altering the angle of the beam with the treated part or the distance between the body part and the lamp.

91. A physical therapist is beginning an evaluation of a 5-year-old boy. The mother indicates that she pulled the child from a seated position by grasping the wrists. The child then experienced immediate pain at the right elbow. The physician's orders are for right elbow range of motion and strengthening. Which of the following is the most likely diagnosis? A. Radial head fracture B. Nursemaid's elbow C. Erb's palsy D. Ulnar coronoid process fracture

B. Nursemaid's elbow is defined as dislocation of the radial head from the annular ligament. Choices A and D are usually due to a fall on an extended elbow. Erb's palsy is due to cervical trauma.

25. A 60-year-old woman is referred to outpatient physical therapy services for rehabilitation after receiving a left total knee replacement 4 weeks ago. The patient is currently ambulating with a standard walker with a severely antalgic gait pattern. Before the recent surgery the patient was ambulating independently without an assistive device. Left knee flexion was measured in the initial evaluation and found to be 85o actively and 94o passively. The patient also lacked 10o of full passive extension and 17o of full active extension. Which of the following does the therapist need to first address? A. Lack of passive left knee flexion B. Lack of passive left knee extension C. Lack of active left knee extension D. Ability to ambulate with a lesser assistive device.

B. Answer B is correct because the patient has to achieve passive knee extension before she can gain full active knee extension. Full active knee extension and full flexion are important and should be a major focus of the patient's session, but the question asks for the most serious deficit. Ambulating with a lesser assistive device should be the focus at a later time because the patient's gait is still severely antalgic and obvious instability is still present. Usually a patient is advanced to a lesser assistive device when he or she can ambulate without large gait deviations with the current assistive device.

54. A physical therapist is treating a 17-year-old boy with an incomplete T11 spinal cord injury. The patient was treated for 2 months in the rehabilitation unit of the hospital before beginning outpatient physical therapy. He is currently ambulating with standard walker with maximal assist of two. The therapist sets an initial long-term goal of "ambulation with a standard walker with minimum assist of 1 for a distance of 50 feet, with no loss of balance, on a level surface - in 8 weeks." If the patient achieves the long-term goal in 4 weeks, which of the following courses of action should be taken by the therapist? A. Discharge the patient secondary to completion of goals. B. Set another long-term goal regarding ambulation and continue treatment. C. Return the patient to the rehabilitation unit of the hospital for more intensive treatment. D. Call the patient's physician and ask for further instructions.

B. Because the goals were not completed in a short amount of time, a new long-term goal should be set. Because of the significant progress made in outpatient therapy, there is no need to return to the rehabilitation unit.

51. A patient is being treated with iontophoresis, driving dexamethasone, for inflammation around the lateral epicondyle of the left elbow. The therapist is careful when setting the parameters and with cleaning the site of electrode application to prevent a possible blister. This possibility is not as strong with some other forms of electrical stimulation, but with iontophoresis using a form of _________ , precautions must be taken to ensure that the patient does not receive a mild burn or blister during the treatment session. Fill in the blank A. Alternating current B. Direct current C. Pulsed current D. Transcutaneous electrical nerve stimulation

B. Iontophoresis uses direct current to drive medication through the skin by repelling ions. For example, if a medication is positively charged, it can be driven by the anode (the positive electrode); if a medication is negatively charged, it can be driven by the cathode (the negative electrode).

58. A 20-year old man with anterior cruciate ligament reconstruction with allograft presents to an outpatient physical therapy clinic. The patient's surgery was 5 days ago. The patient is independent in ambulation with crutches. He also currently has 53o of active knee flexion and 67o of passive knee flexion and lacks 10o of full knee extension actively and 5o passively. What is the most significant deficit on which the physical therapist should focus treatment? A. Lack of active knee extension B. Lack of passive knee extension C. Lack of active knee flexion D. Lack of passive knee flexion

B. Passive extension is the most important motion to gain after an anterior cruciate ligament reconstruction, regardless of the graft type. Active extension can be achieved once passive extension is full (or equal bilaterally).

3. A patient with dysarthria and dysphagia is being treated by physical and speech therapy services. The physical therapist can assist the patient in which of the following ways? A. Provide posture control exercise; teach the patient swallowing techniques of thin liquids; provide facial musculature exercises; provide good verbal interaction B. Teach the patient to have good eye contact; provide facial muscular exercises; teach increased head and trunk control C. Provide posture control exercises; provide multiple sources of stimuli during exercise sessions; teach the patient swallowing techniques of thin liquids; teach the patient swallowing techniques for prescribed medications in capsular form D. None of the above lists is completely correct

B. Physical therapists can assist a patient with dysarthria and dysphagia by (1) providing posture control exercises for the head and trunk, which assist the effectiveness of the respiration muscles in providing air volume for vocalization; (2) providing exercises for the facial musculature, including the lips and tongue, to assist in vocalization; (3) providing effective verbal interaction with patient; and (4) minimizing any unnecessary stimuli or distractions during physical therapy sessions. The speech therapist is most qualified to work with the patient on swallowing techniques for liquids and solids.

39. A 37-year-old man fell and struck his left temple area on the corner of a mat table. He begins to bleed profusely but remains conscious and alert. Attempts to stop blood flow with direct pressure to the area of injury are unsuccessful. Of the following, which is an additional area to which pressure should be applied to stop bleeding? A. Left parietal bone one inch posterior to the ear. B. Left temporal bone just anterior to the ear. C. Zygomatic arch of the frontal bone D. Zygomatic arch superior to the mastoid process.

B. Pressure on the left temporal bone just anterior to the ear helps to occlude blood flow from the temporal artery.

79. A physical therapist is speaking to a group of pregnant women about maintaining fitness level during pregnancy. Which of the following statements contain incorrect information? A. Perform regular exercise routines at least three times per week. B. Perform at least fifteen minutes per day of abdominal exercises in supine position, during the second and third trimesters. C. Increase caloric intake by 300 per day D. Exercise decreases constipation during pregnancy

B. Supine positioning after the first trimester is associated with decreased cardiac output.

29. A therapist is assessing a patient's ability to perform basic activities of daily living. The assessment tool chose by the therapist measures bathing, toileting, dressing, transfers, continence and feeding. The tool does not assess the patient's ability to maneuver in a wheelchair. The therapist is using which of the following tests? A. Barthel Index B. Katz Index of Activities of Daily Living C. Kenny Self-Care Evaluation D. Functional Status Index

B. The Barthel Index assesses 10 self-care and mobility areas (including locomotion). The score is based on the amount of time and assistance required to perform a task. The Kenny Self-Care Evaluation measures 17 basic activities of daily living and grades from 1 to 4 (totally dependent to independent). The Katz Index measures 6 basic activities of daily living but does not measure wheelchair mobility or ambulation skills. The Functional Status Index measures the patient's opinion about how much pain is involved with an activity, how much assistance he or shoe requires to perform a task, and his or her dependence level.

46. A therapist is preparing a poster that will clarify some of the data in an inservice presentation. The poster reflects the mode, median, and mean of a set of data. The data consist of the numbers 2, 2, 4, 9, and 13. If presented in the above order (mode, median mean), which of the following is the correct list of answers calculated from the data? A. 4, 2, 6 B. 2, 4, 6 C. 6, 2, 4 D. 6, 4, 2

B. The mean is the average of the set of numbers. The mode is the number that appears most often in the set of data. The median is the middlemost value.

96. A patient informs his therapist that his problem began 3 months after a bout of the flu. The patient originally experienced tingling of the hands and feet. He also reports progressive weakness to the point that he required a ventilator to breathe. He is now recovering rapidly and is expected to return to a normal functional level in 3 more months. From which of the following conditions is the patient most likely suffering? A. Parkinson's disease B. Guillain-Barrè syndrome C. Multiple sclerosis D. Amyotrophic lateral sclerosis

B. The patient is suffering from Guillain-Barrè syndrome. Some permanent damage can result, with loss of sensory or motor function, but most patients make a full recovery in approximately 6 months. The syndrome often starts after a person has had a bout of the flu or a respiratory infection.

72. A therapist is asked to evaluate a patient in the intensive care unit. The patient is comatose but breathing independently. During the assessment of range of motion in the right upper extremity the therapist notices that the patient is breathing unusually. The pattern is an increase in breathing rate and depth followed by brief pauses in breathing. The therapist should notify the appropriate personnel that the patient is exhibiting which of the following patterns? A. Biot's B. Cheyne-Stokes C. Kussmaul's D. Paroxysmal nocturnal dyspnea

B. The pattern described in the question - a gradual increase in the rate and depth of respirations followed by periods of absent breathing - is known as Cheyne-Stokes breathing. Small breaths followed by inconsistent periods of absent breathing are known as Biot's breathing pattern. Deep gasping breaths are known as Kussmaul's breathing pattern. Awakening during the night due to periods of absent breathing is known as paroxysmal nocturnal dyspnea.

84. A physical therapist in the rehabilitation unit is ordered to evaluate and treat a 3-year-old girl with cerebral palsy. The patient's supportive family is present during the evaluation. When should the physical therapist explain the treatment plan and possible functional outcomes to the family? A. During the evaluation B. After the evaluation C. After the first full treatment session D. After the first rehabilitation team conference meeting

B. The physical therapist can give his or her ideas about the treatment plan and possible functional outcomes after the evaluation. These ideas may change after treatment sessions and team meetings. The family should be continually informed of the patient's progress and expected level of function after discharge.

20. Which of the following statements is false about cardiovascular response to exercise in trained and/or sedentary patients? A. If exercise intensities are equal, the sedentary patient's heart rate will increase faster than the trained patient's heart rate. B. Cardiovascular response to increased workload will increase at the same rate for sedentary as it will for trained patients. C. Trained patients will have a larger stroke volume during exercise. D. The sedentary patient will reach anaerobic threshold faster than the trained patient, if workloads are equal

B. The sedentary patient's cardiovascular response increases faster than the trained patient's if the workloads are equal.

90. A therapist is evaluating a wound in a patient with the following signs: the right foot has a toe that is gangrenous, the skin on the dorsum of the foot is shiny in appearance, and no calluses are present. The patient has what type of ulcer? A. Venous insufficiency ulcer B. Arterial insufficiency ulcer C. Decubitus ulcer D. Trophic ulcer

B. These signs are characteristic of an arterial insufficiency ulcer. A venous ulcer often presents with the following symptoms: no pain around the wound, no gangrene, location typically on the medial ankle, pigmented skin around the ulcer, and significant edema. A trophic ulcer (also known as a pressure or decubitus ulcer) present with decreased sensation, callused skin, and no pain and is located over body prominences.

69. A therapist is treating a patient with spinal cord injury. The therapist is discharging the patient after completion of all physical therapy goals. One of the completed long-term goals involved the ability to dress and bathe independently with assistive devices. This would be a most challenging but obtainable goal for which of the following? A. C5 quadriplegia B. C7 quadriplegia C. T1 paraplegia D. C4 quadriplegia

B. This goal should be most challenging and obtainable for a patient with C7 quadriplegia. A person with C4 or C5 quadriplegia probably needs assistance from another person to dress and bathe. A person with C7 quadriplegia would find this goal more challenging than a person with T1 paraplegia.

77. A physical therapist is evaluating a patient with muscular dystrophy. The patient seems to "waddle" when she walks. She rolls the right hip forward when advancing the right lower extremity and the left hip forward when advancing the left lower extremity. Which of the following gait patterns is the patient demonstrating? A. Gluteus maximus gait B. Dystrophic gait C. Arthrogenic gait D. Antalgic gait

B. This is a description of a dystrophic gait pattern, also called penguin gait. Patients with muscular dystrophy commonly demonstrate this gait pattern. A gluteus maximus gait presents with a patient leaning the trunk back while striking the heel on the involved side (or lurching). An Arthrogenic gait pattern presents with the patient circumducting and elevating the hip on the involved side. This pattern is present with severe stiffness or a fused joint in the involved lower extremity. An antalgic gait pattern is exhibited when a person has pain with weight bearing on the involved lower extremity.

24. A patient is receiving electrical stimulation for muscle strengthening of the left quadriceps. One electrode from one lead wire, 4 x 4 inches in size, is place on the anterior proximal portion of the left quadriceps. Each of two other electrodes from one lead wire is 2 x 2 inches in size. One of the electrodes is placed on the inferior medial side of the left quadriceps and one on the inferior lateral side of the left quadriceps. This is an example of what type of electrode configuration? A. Monopolar B. Bipolar C. Tripolar D. Quadripolar

B. This is an example of a bipolar configuration. Another form of bipolar configuration is to have two electrodes of equal size, each from a different lead wire. In a monopolar configuration, one smaller electrode is placed over the intended site and a larger electrode is placed some distance away. The stimulation is perceived by the patient, in this case, only under the smaller electrode. In a quadripolar configuration, two electrodes coming from two different lead wires are placed over the intended area.

83. A physical therapist is performing an isokinetic test on a 16-year-old boy's shoulder. This particular test compares the right shoulder with the left shoulder. The patient's father asks the physical therapist, "What is the purpose of this test?" How should the therapist respond? A. "This isokinetic test will show changes in concentric and eccentric strength." B. "This test will show strength differences between the injured arm and the non-injured arm." C. "This test shows differences in external rotation strength at specific ranges in the arc of motion." D. "This test will provide muscular torque data which will help us to determine when to discontinue therapy"

B. This is the most appropriate response in a person who has not indicated that he or she has a medical background. If the patient's father inquires further, the therapist can be more detailed.

75. A physical therapist is treating a patient with significant burns over the limbs and upper trunk. Which of the following statements is false about some of the changes initially experienced after the burn? A. This patient initially experienced an increase in the number of white blood cells. B. This patient initially experienced an increase in the number of red blood cells C. This patient initially experienced an increase in the number of free fatty acids D. This patient initially experienced a decrease in fibrinogen

B. This patient is likely to experience a decrease in the number of red blood cells. All of the other statements are correct. Fibrinogen drops initially but then rises throughout recovery.

4. A 30-year-old man is referred to physical therapy after a recent motor vehicle accident that resulted in total loss of motor control of both legs. Trunk and bilateral upper extremity control allows independent sitting at bedside. The patient is to be discharged from the hospital and will return home a few hours after the physical therapy session. The therapist notices, from the history in the chart, that the patient lives alone and has little or no outside support from family members. The patient also suffers from severe obesity. The therapist decides to practice transfer from the bed to the wheelchair. Which assistive device should the therapist use for this transfer attempt? A. Hoyer lift (pneumatic lift) B. Sliding board C. Geriatric chair (using a slide sheet transfer) D. Trapeze bar

B. Use of a sliding board is the most functional transfer for this patient. The pneumatic lift requires assistance from another person, on which this patient can rely because he lives alone and has poor outside family support. A fully reclined geriatric chair is often used to transfer obese patients with a slide sheet transfer, which requires two or more people. A trapeze bar may be useful, but transferring wheelchair to be with a sliding board teaches the patient the skill needed to transfer from the wheelchair to many other surfaces (that may not have a trapeze bar to assist).

8. The terms below refer to properties of water that make hydrotherapy valuable to a variety of patient populations. Match the following terms with the statement that best relates to each term. 1. Viscosity 2. Buoyancy 3. Relative density 4. Hydrostatic pressure a. This property can assist in prevention of blood pooling in the lower extremities of a patient in the pool above waist level b. This property makes it harder to walk faster through water. c. A person with a higher amount of body fat can float more easily than a lean person because of this property. d. This property makes it easier to move a body part to the surface of the water and harder to move a part away from the surface A. 1-b, 2-c, 3-d, 4-a B. 1-b, 2-d, 3-c, 4-a C. 1-c, 2-b, 3-a, 4-d D. 1-a, 2-c, 3-b, 4-d

B. Viscosity is the friction of fluids. Buoyancy is the property that pushes up on the part immersed with a pressure that is equal to the weight of the amount of water displaced by that part. Relative density states that if the specific gravity of an object is less than one it will float and if it is greater than one it will sink. Hydrostatic pressure is the property of water that places pressure equally on the immersed part.

76. Each of the following choices consists of a list of two summaries of some of the principles in the code of ethics of the American Physical Therapy Association. Which of the answers below is a false summary? A. (1) Obey regulations governing physical therapists, and (2) maintain high standards when providing therapy. B. (1) Respect the rights of patients, and (2) inform people appropriately of the services provided. C. (1) Maintain high standards when providing therapy, and (2) provide services for the length of time ordered. D. (1) Assist the public when there are public health needs, and (2) accept fair monetary compensation for services.

C. "Provide services for the length of time ordered" is not a summary of one of the principles of the code of ethics. If a physician orders an inappropriate frequency and/or duration, it is the responsibility of the therapist to resolve the dilemma to ensure that the patient is treated with an appropriate frequency and duration.

70. A therapist is treating a new patient in an outpatient facility. The patient has recently been diagnosed with type I insulin-dependent diabetes mellitus. The patient asks the therapist the differences between type I insulin-dependent diabetes mellitus and type II non-insulin-dependent diabetes mellitus. Which of the following statements is true? A. There is usually some insulin present in the blood in type I and none in type II B. Ketoacidosis is a symptom of type II C. The age of diagnosis with type I is usually younger than the age of diagnosis with type II D. Both conditions can be managed with a strict diet only without taking insulin.

C. A person is usually diagnosed with type I at 25 years or age or younger. A person is usually 40 years of age or older when diagnosed with type II. Ketoacidosis is a symptom of type I. Metabolism of free fatty acids in the liver causes this condition, which is an excess of ketones. A type II diabetic may be able to control his or her condition with diet only (depending on the severity of the condition), but a type I diabetic needs insulin.

80. A physical therapist is ordered to provide gait training to a 78-year-old man who received a right cemented total knee replacement 24 hours earlier. The patient also had a traumatic amputation of the left upper extremity 3 inches above the elbow 40 years ago. If the patient lives at home alone, which of the following is an appropriate assistive device? A. Rolling walker B. Standard walker C. Hemi-walker D. Wheelchair for 2 weeks.

C. Although the patient will have to use the hemi-walker with the right upper extremity, answer C is still the best choice for this patient. Answers A and B are unsafe with one upper extremity. Answer D does not encourage weight bearing and is not the most functional choice. A person with a cemented prosthesis can bear weight as tolerated on the involved lower extremity in early rehabilitation.

26. In comparing the use of cold pack and hot pack treatments, which of the following statements is false? A. Cold packs penetrate more deeply than hot packs. B. Cold increases the viscosity of fluid and heat decreases the viscosity of blood. C. Cold decreases spasm by decreasing sensitivity to muscle spindles and heat decreases spasm by decreasing nerve conduction velocity. D. Cold decreases the rate of oxygen uptake, and heat increases the rate of oxygen uptake.

C. Answer C is incorrect. Heat decreases spasm by causing the vessels to dilate, which brings more blood (containing oxygen) to the area. Cold decreases spasm by decreasing sensitivity of the muscle spindles.

10. A patient is referred to physical therapy because of hypertension. The physician has ordered relaxation training. The therapist first chooses to instruct the patient in the technique of diaphragmatic breathing. Which of the below is the correct set of instructions? A. Slow breathing rate to 8-12 breaths per minute, increase movement of the upper chest, and decrease movement in the abdominal region. B. Slow breathing rate to 12-16 breaths per minute, increase movement of the abdominal region and decrease movement in the upper chest. C. Slow breathing rate to 8-12 breaths per minute, increase movement of the abdominal region and decrease movement in the upper chest. D. Slow breathing rate to 12-16 breaths per minute, increase movement of the upper chest and decrease movement in the abdominal region.

C. Answer C provides correct instructions. The patient is often instructed to begin this technique in the supine position and progress to the sitting position. This technique should be practiced for approximately 5 minutes several times per day.

27. A home health physical therapist is sent to evaluate a 56-year-old man who has suffered a recent stroke. The patient is sitting in a lift chair, accompanied by his 14-year-old nephew. He seems confused several times throughout the evaluation. The nephew is unable to assist in clarifying much of the subjective history. The patient reports to the therapist that he is independent in ambulation with a standard walker as an assistive device and in all transfers without an assistive device. Based on the above information, which of the following sequence of events, chosen by the therapist, is in the correct order? A. Ambulate with the standard walker with the wheelchair in close proximity; transfer sit to stand in front of the wheelchair; transfer wheelchair to bed, assess range of motion and strength of all extremities in supine position. B. Ambulate with the standard walker with the wheelchair in close proximity, transfer wheelchair to bed; assess range of motion and strength of all extremities in supine position; transfer sit to stand at bedside. C. Assess range of motion and strength of all extremities in the lift chair; transfer sit to stand in front of the lift chair; ambulate with th

C. Because of the unreliable history obtained in the evaluation, the therapist at least should make a quick assessment of range of motion and strength before the patient attempts to stand. Sit-to-stand transfer should then be assessed in front of the lift chair before the patient attempts to ambulate.

32. A 27-year-old man with a diagnosis of incomplete spinal cord injury at the L4 level is being evaluated by a physical therapist. The patient is nearing discharge from the rehabilitation unit. Manual muscle testing reveals the following: right hip flexion = 3+/5, right hip adduction = 5/5, right knee flexion = 2/5, right knee extension = 3+/5, right ankle plantarflexion = 1/5, and right ankle dorsiflexion = 2-/5; left hip flexion = 4+/5, left hip adduction = 4+/5, left knee flexion = 2+/5, left knee extension = 3+/5, left ankle plantarflexion = 2-/5, and left ankle dorsiflexion = 2-/5. What is the appropriate orthotic for this patient? What is his most likely functional outcome? A. Hip-knee-ankle-foot orthosis (HKAFO) with forearm crutches - household ambulator. B. Knee-ankle-foot orthosis (KAFO) with forearm crutches - household ambulator. C. KAFO with forearm crutches - functional ambulator D. HKAFO with forearm crutches - functional ambulator.

C. Because the hip flexors are strong, there is no need for the hip component of an orthotic.

18. The physical therapist has just given the patient a custom wheelchair. The patient has a long-standing history of hamstring contractures resulting in fixation of the knees into 60o of flexion. The patient is also prone to develop decubitus ulcers. Which of the following is incorrect advice to give the family and patient? A. Keep the patient's buttocks clean and dry. B. Make sure that the wheelchair cushion is always in the wheelchair seat. C. Keep the leg rests of the wheelchair fully elevated. D. Never transfer using a sliding board from one surface to another.

C. Fully elevating the leg rests of the patient's chair increases hip flexion. The already tight hamstrings (secondary to contracture) would tilt the pelvis posterior. This maneuver would increase weight on the ischial tuberosity, risking a decubitus ulcer. Choice D is correct advice because sliding board transfers can lead to abrasions. Choices A and B are also correct measures to decrease the chance of developing ulcers.

63. The physical therapist is reading the physician's interpretation of an x-ray that was taken of the left humerus of a 7-year-old patient. The physician notes in the report the presence of an incomplete fracture on the convex side of the humerus. Which type of fracture is the physician describing? A. Comminuted B. Avulsion C. Greenstick D. Segmental

C. This scenario describes a greenstick fracture, which is common in young people. In a comminuted fracture, the bone is broken into pieces. An example of an avulsion fracture is when the tibial tuberosity is pulled off the tibia. A bone that has a segmental fracture is fractured in two places.

31. A physical therapist is ordered to evaluate a patient in the late stages of amyotrophic lateral sclerosis. In the patient's chart is an electromyography report and nerve conduction velocity test. What should the physical therapist not expect to find in these test results? A. Fibrillation potentials B. Polyphasic motor unit potentials C. Decreased sensory evoked potentials D. A and B only

C. In performing these tests on patients who have a motor neuron disease, sensory potentials are generally unchanged.

48. A therapist is treating a patient with cystic fibrosis who has just walked 75 feet before experiencing significant breathing difficulties. In an effort to assist the patient in regaining her normal breathing rate, the therapist gives a set of instructions. Which of the following set of instructions is appropriate? A. "Take a slow deep breath through pursed lips and exhale slowly through your nose only" B. "Take small breaths through your nose only and exhale quickly through pursed lips" C. "Breath in through your nose and exhale slowly through pursed lips" D. "Breath in through pursed lips and breath out slowly through pursed lips"

C. Patients with chronic obstructive airway disease are often given this set of instructions, which is known as the method of pursed lips breathing. This method helps a patient regain control of his or her breathing rate and increase tidal volume and amount of oxygen absorbed.

23. When using electrical stimulation with a unit that plugs into the wall, the therapist must take many different safety precautions. Which of the following precautions probably would not increase safety to the patient and therapist? A. Never placing the unit in close proximity to water pipes while treating the patient. B. Never using an extension cord when using a plug-in unit. C. Always adjusting the intensity of stimulation during the off portion of the cycle. D. Both A and C are measures that are not likely to increase safety.

C. Placing a plug-in unit close to water pipes is a potential hazard because it offers another possible ground pathway to the patient. Never us an extension cord or an adaptor with plug-in unit. If the adaptor or cord does not have a ground prong, it may cause shock to the patient through a leaking current. If the machine intensity is adjusted during the off portion of the cycle, the stimulation may be too high for the patient when the on cycle returns.

5. A therapist should consider using a form of treatment other than moist heat application on the posterior lumbar region of all of the following patients except A. Patient with a history of hemophilia B. Patient with a history of malignant cancer under the site of heat application C. Patient with a history of Raynaud's phenomenon D. Patient with a history including many years of steroid therapy

C. Raynaud's phenomenon is a vasospastic disorder of the vessels of the distal parts of the extremities. Patients with Raynaud's phenomenon do not respond well to cold treatment. Choice B is incorrect because it is believed that moist heat may encourage more rapid growth of cancer. Choice D is incorrect because prolonged use of steroids may cause capillaries to lose their integrity, which compromises the body's ability to dissipate heat. Choice A is incorrect because moist heat may encourage hemorrhaging, in patients with hemophilia by causing vasodilation.

78. Which of the following statements is not a common physiologic change of aging? A. Blood pressure taken at rest and during exercise increases B. Maximal oxygen uptake decreases C. Residual volume decreases D. Bone mass decreases

C. Residual volume, the amount of air left in the lungs after a forceful expiration, increases with age.

62. A physical therapist is treating a 24-year-old woman with lumbar muscle spasm. Part of the patient's treatment involves receiving instruction on correct sleeping positions. Which of the following would be most comfortable? A. Supine with no pillows under the head or extremities B. Prone with a pillow under the head only. C. Sidelying with a pillow between flexed knees. D. A and C are equally correct

C. Supine positioning without a pillow under the knees places too much stress on the lumbar spine. Sidelying position with a pillow between the knees places less stress on the lumbar area than prone positioning.

98. A therapist is sent to evaluate a patient with tumor in the mid-thoracic region. In the chart, the therapist notes that the tumor has been staged using the TNM system. With this system, the letters TNM represent which of the following in the correct order? A. Tumor type, number of tumors, tumor metastasis B. Tumor location, lymph node involved, mass size of the tumor C. Tumor size, lymph node involvement, tumor metastasis D. Tumor mass, number of lymph nodes, major organs involved

C. T-N-M is the most commonly recognized system of tumor staging. An Arabic number (0,1,2, or 3) follows each letter. The number behind the T represents the size of the tumor. Zero means no tumor. The higher the number, the larger the tumor. The number behind the N represents the degree of local lymph node involvement. Zero means no lymph node involvement. The higher the number, the greater the lymph node involvement. The number behind the M represents the degree of metastasis. Zero means no metastasis. The higher the number, the greater the degree of metastasis.

22. A therapist is treating a 35-year-old man who has suffered loss of motor control in the right lower extremity due to peripheral neuropathy. The therapist applies biofeedback electrodes to the right quadriceps in an effort to increase control and strength of this muscle group. The biofeedback can help achieve this goal in all of the following ways except: A. Providing visual input for the patient to know how hard he is contracting the right quadriceps. B. Assisting the patient in recruitment of more motor units in the right quadriceps. C. Providing the measure of torque in the right quadriceps. D. Providing the therapist input on the patient's ability and effort in contracting the right quadriceps.

C. The EMG does not record torque. It assists by showing a linear relationship between the EMG and the force produced by the muscle during an isometric contraction.

37. How often does the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) require that all electrical equipment in hospitals be inspected? A. Every 3 months B. Every 6 months C. Every 12 months D. Every 3 years

C. The Joint Commission on Accreditation of Healthcare Organizations requires at least one-year inspection of electrical equipment.

36. A 15-year-old girl with no reports of trauma or radiculopathy presents to an outpatient physical therapy clinic with complaints of low back pain. The physical therapist decides to measure leg length of each side from the anterior superior iliac spine (ASIS) to the medial malleolus. The measurements are equal. However, when measurements are taken from the umbilicus to the medial malleolus, the right lower extremity is 2.5 cm longer than the left lower extremity. Based on the above information, which of the following would most directly address the source of this patient's problem? A. Ask the patient if she has ever had a femur fracture. B. Ask the patient is she has ever been diagnosed with cerebral palsy or avascular necrosis. C. Ask the patient if she has ever been diagnosed with scoliosis. D. Ask the patient to perform active motion to assess lumbar range of motion.

C. The difference in measurements suggests a pelvic imbalance, which often is seen in patient who have scoliosis. Answers A and B would have exhibited differences in real leg length (anterior superior iliac spine to the medial malleolus).

81. A 48-year-old woman is being evaluated by a physical therapist. Her diagnosis is right rotator cuff tendinitis. She reports right shoulder weakness and pain for the past 2 months. The patient describes "pins and needles", over the lateral right shoulder and upper extremity, extending into the thumb. She also reports no causative trauma. Manual muscle testing reveals in the right upper extremity: flexion = 4/5, extension = 3+/5, abduction = 3+/5, adduction = 4/5, internal rotation = 3+/5, and external rotation = 3+/5. Manual muscle testing reveals in the left upper extremity: flexion = 4+/5, extension = 5/5, abduction = 5/5, adduction = 4+/5, internal rotation = 4+/5, and external rotation = 4+/5. Active and passive shoulder range of motion is within normal limits and equal bilaterally. All thoracic outlet tests are negative. All shoulder special tests are negative. Which of the following steps would most likely assess the source of the patient's problems? A. Elbow strength and range of motion testing B. Grip strength testing C. Cervical spine testing D. Scapular muscle strength testing

C. The subjective complaints of "pins and needles" suggest that the source of the problem is either vascular or neurologic. Because thoracic outlet syndrome has been cleared, focus should be placed on the cervical spine.

41. A physical therapist is treating a 72-year-old woman with a diagnosis of Parkinson's disease 3 times/week at an outpatient facility. The patient is taking 500 mg/day of a medication designed to decrease spasticity. The therapist notices that the patient is performing well on certain days and poorly on others. Which of the following ways can the therapist possibly improve the patient's performance on the days when she performs poorly? A. The therapist can encourage the patient to increase her daily dosage of medication to 600 mg/day on the days she usually performs poorly. B. The therapist can encourage the patient to decrease her daily dosage of medication to 100 mg/day on the days she usually performs poorly. C. The therapist can schedule sessions so that there are fewer sessions on the days the patient performs poorly. D. The therapist should call the physician to suggest another medication.

C. The therapist should never instruct a patient to change the dosage of the medication. In addition, calling the physician and expressing concerns about the possible effects of the medication observed at therapy would be much more appropriate than calling to suggest another medication.

49. A therapist is massaging the upper trapezius of a patient. One of the techniques involves lifting and kneading of the tissues. What is the correct name of this technique? A. Tapotement massage B. Effleurage massage C. Petrissage massage D. Friction massage

C. This is a description of the petrissage technique. Effleurage is stroking of the skin. Friction massages are used to mobilize scar tissue. Tapotement is tapping of the skin.

15. A physician has ordered a physical therapist to treat a patient with chronic low back pain. The order is to "increase gluteal muscle function by decreasing trigger points in the quadratus lumborum". What is the first technique that should be used by the physical therapist? A. Isometric gluteal strengthening B. Posture program C. Soft tissue massage D. Muscle reeducation

C. Trigger points are often treated with soft tissue massage. Other techniques include strain/counterstrain, myofascial release, and muscle energy techniques.

55. A physical therapist is ordered to evaluate a 74-year-old man who has suffered a recent stroke. The therapist performs a chart review before performing the evaluation. Which of the following is of the least importance to the physical therapist in assessing the patient's chart? A. Nursing assessment B. Physician's orders/notes C. Respiratory assessment D. Dietary assessment

D. All of the choices are important, but the dietary assessment contains the least amount of critical information at this stage of the physical therapy evaluation.

64. A patient is referred to physical therapy with a history of temporomandibular joint pain. The therapist notices that the patient is having difficulty closing his mouth against minimal resistance. With this information, which of the following muscles would not be a target for strengthening exercise to correct this deficit? A. Medial pterygoid muscle B. Temporalis C. Masseter D. Lateral pterygoid muscle

D. All of the listed muscles participate in mandibular elevation with the exception of the lateral pterygoid muscle. The lateral pterygoid muscle and suprahyoid muscles participate in mandibular depression.

88. Which of the following exercises does not increase strength of the muscles of forceful inspiration? A. Active cervical flexion exercises B. Active glenohumeral extension exercises C. Shoulder shrugs D. Crunches

D. Answer A increases strength of the scalenes and sternocleidomastoid. Answer B strengthens the latissimus dorsi. Answer C increases the strength of the upper trapezius. All of these are accessory inspiratory muscles. Answer D strengthens the abdominals, which are muscles of forceful expiration.

21. Use of shortwave diathermy and microwave diathermy is not contraindicated in which of the following conditions? A. On a patient who has a pacemaker. B. Over the site of a metal implant. C. On a patient who has hemophilia. D. Using pulse shortwave over an acute injury.

D. Answer A is contraindicated because the electromagnetic field produced by use of shortwave diathermy or microwave diathermy may alter the settings of a pacemaker. Answer B is contraindicated because the metal heats quickly and may cause the surrounding tissue to heat excessively, potentially causing a burn. Answer C is contraindicated because heating causes vasodilation, making a hemorrhage more likely. Answer D is the correct choice because pulsed shortwave diathermy can be used on acute or chronic conditions. With most pulsed shortwave treatments there is no measurable temperature increase in the tissues.

82. A 23-year-old woman arrives at an outpatient physical therapy clinic with a prescription to evaluate and treat the right hand. One week earlier the patient underwent surgical repair of the flexor tendons of the right hand at zone 2. She also had her cast removed at the physician's office a few minutes before coming to physical therapy. What is the best course of treatment for this patient? A. Ultrasound to decrease scarring. B. Gentle grip strengthening with putty. C. Splinting the distal interphalangeal joint and proximal interphalangeal joints at neutral D. Splinting with the use of rubber bands to passively flex the fingers.

D. Answer D is the correct treatment. Strengthening is not indicated at this time, and splinting as described in answer C places too much stretch on the tendons. In addition, static splinting does not allow tendon gliding. Ultrasound is contraindicated over a healing tendon repair.

71. At a team meeting. the respiratory therapist informs the rest of the team that the patient, just admitted to the subacute floor, experienced breathing difficulty in the acute care department. The respiratory therapist describes the breathing problem as a pause before exhaling after a full inspiration. Which of the following is the therapist describing? A. Apnea B. Orthopnea C. Eupnea D. Apneusis

D. Apneusis can be described as an inspiratory cramp. Orthopnea is difficulty with breathing in a lying position. Eupnea is normal breathing. Apnea is the absence of breathing.

1. A therapist is treating a patient with an injury at the T8 level and compromised function of the diaphragm. If no abdominal binder is available, what is the most likely position of comfort to allow him to breathe most efficiently? A. Sitting position B. Semi-fowler position C. Standing D. Supine

D. Choice D is the correct answer because in the supine position the abdominal contents are located more superiorly than in the other positions. This places the diaphragm in a more elevated resting position, which allows greater excursion of the diaphragm. Semi-Fowler's position resembles a reclining position, with the knees bent and the upper trunk slightly elevated. Semi-Fowler's position without an abdominal binder, allows gravity to pull the abdominal contents downward, which does not put the diaphragm in an optimal resting position. Semi-Fowler's position is, however, the position of choice for patients with uncompromised innervation of the diaphragm who have chronic respiratory difficulty. The standing and sitting positions present the same problem, but a greater extent, as semi-Fowler's position.

50. A therapist is assessing a patient in an attempt to discover the source of her pain. She positions the patient's cervical spine in different directions in an attempt to elicit the patient's symptoms. In one such direction, the patient reports return of symptoms, including pain located at the right posterior scapular region, which extends down the posterior side of the right upper extremity to the ends of the fingers, and tingling in the second, third, and fourth digits. The patient also indicates that she often has decrease in sensation on the dorsal side of the second and third digits. She also has noticeable weakness in the right triceps. Which nerve root is most likely involved? A. Fourth cervical root B. Fifth cervical root C. Sixth cervical root D. Seventh cervical root

D. Dermatome charts in distribution vary from source to source, but one common aspect of C7 innervation is the middle finger. The triceps muscles are also innervated by C7.

56. A 47-year-old man with end-stage renal disease arrives at an outpatient facility. He has a physician's order to evaluate and treat 3 times/week for 4 weeks secondary to lower extremity weakness. The patient also attends dialysis 3 times/week. If the clinic is open Monday through Friday, which of the following schedule is appropriate? A. On the days that the patient has dialysis, schedule the therapy session before the dialysis appointment. B. On the days that the patient has dialysis, schedule the therapy session after the dialysis appointment. C. Contact the physician and obtain a new order to decrease the frequency to 2 times/week, D. A and C are correct

D. Dialysis leads to a change in blood chemistry and volume, often causing extreme fatigue.

57. A physical therapist is performing a functional capacity evaluation on a patient with a L4-L5 herniated disc. Part of the evaluation consists of performing floor to waist lifts using 30 pounds as resistance. During the first trial, the physical therapist notices that patient exhibits decreased anterior pelvic tilt. What should the physical therapist do during the second trial? A. Correct the deviation verbally before the lift B. Correct the deviation with manual contact during the lift C. Correct the deviation both verbally and manually during the lift D. None of the above

D. During a functional capacity evaluation the physical therapist should not correct postural abnormalities. The therapist should only observe and record.

47. A patient with a spinal cord injury is being treated by physical therapy in an acute rehabilitation setting. The patient has been involved in a motor vehicle accident that resulted in a complete C8 spinal cord lesion. The patient is a 20-year-old man who has expressed concern to the therapist about his future sexual function. Which of the following is the most correct information to convey to the patient? A. Psychogenic erection is possible, reflexogenic erection is not possible, and ejaculation is possible. B. Psychogenic erection is not possible, reflexogenic erection is not possible, and ejaculation is not possible. C. Psychogenic erection is possible, reflexogenic erection is possible, and ejaculation is possible. D. Psychogenic erection is not possible, reflexogenic erection is possible, and ejaculation is not possible.

D. Men with high complete lesions are likely to be able to have reflexogenic erections, and men with lower complete lesion are likely to have the capability to have a reflexogenic or psychogenic erection. Men with incomplete lesions are likely to retain erectile capability much more than men with complete lesions. In addition, a man with a complete lesion is less likely to have the ability to ejaculate than a man with an incomplete lesion.

30. A physical therapist is performing electromyograhic testing. During a maximal output test of the patient's quadriceps muscle, 35% of the motor unit potential is polyphasic. What is the significance of this finding? A. It is normal in the quadriceps. B. It is normal in the triceps brachii, not in the quadriceps C. It is normal in the biceps brachii, not in the quadriceps D. It is abnormal in any muscle.

D. More than 10% of the polyphasic potentials in the total output of muscle is considered abnormal.

87. Which of the following are indications for pulmonary suctioning? A. Unproductive coughs B. Breath sounds or wet rales C. Respiratory distress D. All of the above

D. Suctioning also can be performed in patients with significant hypoxemia.

66. A therapist is evaluating an infant with the mother present. The therapist suddenly seems to temporarily lose grip of the infant, causing him to be startled and begin to cry. The infant's mother is noticeable upset but is reassured that startling the infant was part of the assessment. Which of the following may the therapist have been assessing? A. Landau response B. Symmetric tonic neck reflex C. Labyrinthine head righting D. Moro reflex

D. The Moro reflex and the Landau reaction are discussed in the answer to question 65. Labyrinthine head-righting is tested by holding a child upright and tilting the body slightly forward, back and side to side. The infant should be able to hold the head vertical despite the body movement. The symmetric tonic neck response (onset at 4-6 months, integrated at 8-12 months) is exhibited when the infant displays upper extremity extension and lower extremity flexion with passive cervical extension. Sources vary significantly in regard to the age at which these responses should be present and when they are integrated.

13. A physical therapist is assessing a 40-year-old man's balance and coordination. The following instructions are given to the patient: "Stand normally, with your eyes open. After fifteen seconds, close your eyes and maintain a normal standing posture". Several seconds after closing his eyes, the patient nearly falls. What type of test did the patient fail? A. Nonequilibrium test B. Equilibrium test C. Romberg test D. B and C

D. The Romberg test is a type of equilibrium test. Equilibrium tests are usually conducted with the patient in a standing position, whereas Nonequilibrium tests are performed with the patient in the supine position.

7. A therapist chose to work with her patient using fluidotherapy rather than paraffin wax. The patient has lack of range of motion and also needs to decrease hypersensitivity. There are no open wounds on the had to be treated. Which of the following would not be an advantage of using fluidotherapy versus paraffin wax in the above scenario? A. The therapist can assist range of motion manually while the patient has his hand in the fluidotherapy and not while in the paraffin wax. B. The fluidotherapy can be used to assist in desensitization by adjusting air intensity. C. The fluidotherapy can be provided at the same time as dynamic splinting, and this cannot be done while in paraffin wax. D. The fingers can be bound, to assist gaining finger flexion, with tape while in fluidotherapy and not in paraffin wax.

D. The fingers can be bound in paraffin wax as well as in fluidotherapy. When using this technique, the hand remains stationary throughout the heating process, which is necessary for paraffin to be most effective (when using the standard method of dipping the hand and wrapping with plastic wrap and a towel).

35. A physical therapist is treating a patient who is participating in cardiac rehabilitation. Because the patient complains of chest pain, the therapist attempts to assess heart sounds with a stethoscope. Which of the following is true about the first sound during auscultation of the heart? A. The first sound is of the closure of the aortic and pulmonic valves. B. The first sound is of the closure of the mitral and tricuspid valves. C. The first sound is of the beginning of ventricular systole. D. B and C

D. The first sound heard corresponds with closing of the mitral and tricuspid valves. The second sound corresponds to closing the aortic and pulmonic valves. Therefore, the first sound is indicative of the onset of ventricular systole, and the second is indicative of the onset of ventricular diastole.

19. Which of the following circumstances would normally decrease body temperature in a healthy person? A. Exercising on a treadmill. B. Pregnancy C. Normal ovulation D. Reaching age of 65 years or older

D. The geriatric population usually has a decreased body temperature due to poor diet, decreased cardiovascular status, and decreased metabolic rates.

34. A physical therapist is treating a patient with balance deficits. During treatment the physical therapist notes that large-amplitude changes in center of mass cause the patient to lose balance. The patient, however, can accurately compensate for small changes nearly every time a change is introduced. What muscles most likely need to be strengthened to help alleviate this dysfunction? A. Tibialis anterior, gastrocnemius B. Peroneus longus/brevis, tibialis posterior C. Rectus abdominis, erector spinae D. Iliopsoas, gluteus maximus

D. The hip strategy is used to compensate for large movements in the center of mass, and the ankle strategy is used to compensate for small movements.

85. A physical therapist is treating a 65-year-old man with pneumonia. The patient questions the benefits of the flow incentive spirometer left in the room by the respiratory therapist a few minutes ago. Which of the following is an appropriate response to the patient's question? A. "It gives visual feedback on the lung performance" B. "It helps you maintain current lung volumes" C. "You need to ask the respiratory therapist this question" D. A and B are correct responses.

D. The incentive spirometer provides visual feedback of maximal inspiratory efforts. The physical therapist is qualified to answer the patient's question.

2. A therapist is assisting a patient with an injury at the C5 level in performing an effective cough. The patient has experienced significant neurologic damage and is unable to perform an independent, effective cough. If the patient is in supine position, which of the following methods is most likely to produce an effective cough? A. The therapist places the heel of one hand just above the xiphoid process, instructs the patient to take a deep breath while pressing down moderately on the sternum and instructs the patient to cough. B. The therapist places the heel of one hand, reinforced with the other hand, just above the xiphoid process; instructs the patient to take a deep breath; instructs the patient to hold the breath; and presses moderately as the patient coughs. C. The therapist places the heel of one had on the area just above the umbilicus, instructs the patient to take a deep breath, applies moderate pressure; and releases pressure just before the patient attempts to cough. D. The therapist places the heel of one hand just above the umbilicus, instructs the patient to take a deep breath, and applies moderate pressure as the patient is instructed to cough.

D. The pressure applied by the therapist should be applied as the patient coughs to assist in a forceful exhalation. Placing the heel of one hand approximately one inch above the umbilicus applies pressure immediately inferior to the diaphragm.

100. A patient is referred to physical therapy with complaints of sensation loss over the area of the radius of the right upper extremity, extending from the elbow joint distally to the wrist. Therapy sessions are focused on assisting the patient in regarding normal sensation. Which of the following nerves is responsible for sensation in this region? A. Medial antebrachial cutaneous B. Lateral antebrachial cutaneous C. Musculocutaneous D. Both B and C

D. The radial side is the lateral side of the forearm, which is innervated by the musculocutaneous nerve. The lateral antebrachial cutaneous nerve is a continuation of the musculocutaneous nerve.

73. A patient presents to therapy with poor motor control of the lower extremities. The therapist determines that to work efficiently toward the goal of returning the patient to his prior level of ambulation, he must work in the following order regarding stages of control: A. Mobility, Controlled mobility, stability, skill B. Stability, controlled stability, mobility, skill C. Skill, controlled stability, controlled mobility D. Mobility, stability, controlled mobility, skill

D. This answer lists the stages of control in the correct order.

92. A physician has ordered a specific type of electrical stimulation that utilizes a frequency of 2500 Hz with a base frequency at 50 Hz to achieve fused tetany. What type of electrical stimulation has the physician ordered? A. Iontophoresis B. Transcutaneous electrical nerve stimulation C. Intermittent flow configuration D. Russian stimulation

D. This is an example of Russian stimulation.

65. An infant is being examined by a physical therapist. The therapist is resisting movement of the right upper extremity and notices involuntary movement of the left upper extremity. Which of the following is displayed by the infant? A. Landau reaction B. Startle reflex C. Moro reflex D. Associated reaction

D. This is an example of an associated reaction, which presents from birth to 3 months and is integrated at 9 years of age. The Landau reaction (onset at 4 months, integrated at 24 months) is assessed by supporting the patient in prone position and passively or actively extending the neck. A positive response is extension of the spine and lower extremities. The startle reflex is positive if an infant is startled by a loud or sudden noise. This response should be present at birth and persists throughout life. The Moro reflex is tested by lowering an infant suddenly from a sitting position. A positive response is crying with sudden extension and abduction of the upper extremities, followed by adduction of the upper extremities across the chest (an infant should have this response up to 6 months of age). Sources vary significantly in regard to the age at which these responses should be present and when they are integrated.

93. A physical therapist who is pregnant has been studying the use of transcutaneous electrical nerve stimulation during labor and birth to decrease pain perception. Which of the following is the most effective technique in this situation? A. Place the electrodes over the upper abdominals during the first stages of labor and over the lower abdominals during the later stages. B. Place the electrodes over the paraspinals at the L5 level and S1 level throughout labor and delivery. C. Place the electrodes in a V pattern above the pubic region during labor and delivery D. Place the electrodes over the paraspinals at the L1 and S1 level initially during labor, and over the pubic region during the later stages.

D. This is the most common placement suggested by sources used in preparation of this book. Spinal level varies, but the overall consensus is that the electrodes are placed higher and on the back initially. Then they are moved lower and to the anterior pubic region as labor progresses.

86.A 53-year-old man with chronic obstructive pulmonary disease reports to an outpatient cardiopulmonary rehabilitation facility. Pulmonary testing reveals that forced expiratory volume in 1 second (FEV1) and vital capacity (VC) are within 60% of predicted values. What is the appropriate exercise prescription? A. Exercise at 75-80% of the target heart rate 3 times/week. B. Begin exercise with level of 1.5 METs and increase slowly 3 times/week C. Exercise at 75-80% of the target heart rate 7 times/week D. Begin exercise with levels of 1.5 METs and increase slowly 7 times/week.

D. This patient has moderate lung disease. Because the intensity of exercise is low, frequency should be increased to 5-6 times/week.

28. A therapist is evaluating a patient with poor motor coordination. The therapist observes that when the patient is standing erect and still, she does not respond appropriately when correcting a backward sway of the body. With the body in a fully erect position, a slight backward sway should be corrected by the body firing specific muscles in a specific order. Which list is the correct firing order? A. Bilateral abdominals, bilateral quadriceps, bilateral tibialis anterior. B. Bilateral abdominals, bilateral tibialis anterior, bilateral quadriceps C. Bilateral tibialis anterior, bilateral abdominals, bilateral quadriceps D. Bilateral tibialis anterior, bilateral quadriceps, bilateral abdominals.

D. This sequence assists in propelling the center of gravity forward to maintain balance after a backward sway.

97. A therapist is evaluating a patient in the intensive care unit. The therapist notices that the patient is moving his hands and fingers in slow, writhing motions. Which of the following terms best describes this type of movement? A. Lead-pipe rigidity B. Ballismus C. Chorea D. Athetosis

D. This type of movement, known as athetosis, also can involve the feet, proximal parts of the extremities and face. Chorea is rapid movements of the hands, wrist or face. Ballism refers to forceful and uncontrollable throwing of the extremities outward. Lead-pipe rigidity is increasing resistance of an extremity to passive ranging. All of the above can result from damage to the basal ganglia.

94. A patient with chronic back pain is referred to physical therapy for application of a transcutaneous electrical nerve stimulation unit. The parameters chosen by the therapist are set to provide a noxious stimulus described as an acupuncture type of stimulus. Which of the following lists of parameters produces this type of stimulation? A. Low intensity, duration of 60 sec, and a frequency of 50 Hz B. High intensity, duration of 150 sec, and a frequency of 100 Hz C. Low intensity, duration of 150 sec, and a frequency of 100 Hz D. High intensity, duration of 150 sec, and a frequency of 2 Hz

D. This type of stimulation is usually not well tolerated by patients with acute conditions. Acute conditions are usually treated by TENS with a high frequency, and chronic conditions can be treated with a low frequency (if tolerated by the patient). Treatments providing a noxious stimulus usually have a longer lasting effect.

60. A physical therapist is in a rehabilitation team meeting about a 58-year-old man with Parkinson's disease. The physician notes that the patient's recent decrease in level of function may be caused by long-term use of a certain drug. The physician plans to take the patient off the medication for 2 weeks. Which of the following medication is the patient probably taking? A. Cardizem B. Cortisone C. Epinephrine D. Levodopa

D. When a patient with Parkinson's disease has been using levodopa for an extended period, he or she may develop resistance to the medication. Sometimes a break from the drug for 7-10 days may enhance its effectiveness.