FB Ch.2 🌟

In the geriatric population, ________________ usually occurs after _______________ is present. a. Spondylolisthesis, spondylolysis b. Spondylolysis, spondylolisthesis c. Spondyloschisis, spondylolysis d. Spondylolisthesis, spondyloschisis

RATIONALE: A. A defect in the lamina of a vertebrae usually occurs first. This defect is called spondylolysis. The vertebrae may then slip because of shear forces; this slippage is called spondylolisthesis.

What is the difference in testing motor function when examining for a nerve root deficit versus a peripheral nerve deficit? a. In peripheral nerve deficit, the motor weakness is evident more rapidly when applying resistance compared with nerve root deficit. b. In nerve root deficit, the motor weakness is evident more rapidly when applying resistance compared with peripheral nerve deficit. c. In peripheral nerve deficit, the motor weakness is only evident when applying resistance without gravity. d. In nerve root deficit, the motor weakness is only evident when applying resistance without gravity.

RATIONALE: A. A lesion of a peripheral nerve produces a complete paralysis of the muscles innervated by this nerve. Weakness is immediately apparent when testing the motor function. A lesion of a unique nerve root produces paresis of the myotome (group of muscles innervated by a single nerve root) innervated by this nerve root. Some time is necessary for the weakness to become apparent when testing for motor function. The isometric contraction must be held for a minimum of 5 seconds.

A 5-year-old male had an undiagnosed arteriovenous malformation and is recently hospitalized because of an acute brain bleed. The patient is not acknowledging individuals who stand on the left side of his bed, he does not respond to sensory stimuli that is applied to the left side of his body, and he displays visual spatial deficits. What lobe of the brain has been affected by the stroke? a. Right parietal b. Left temporal c. Frontal d. Occipital

RATIONALE: A. A lesion to the parietal lobe results in loss of contralateral stimulus location and intensity, impairment of two-point discrimination, tactile and visual agnosia, visual disorientation, and neglect of contralateral self and surroundings.

A patient's lawyer calls the therapist requesting his or her client's clinical records. The lawyer states that he or she needs the records to pay the patient's bill. What is the best course of action? a. Tell the lawyer either to have the patient request a copy of the records or to have the patient sign a medical release. b. Fax the needed chart to the lawyer. c. Mail a copy of the chart to the patient. d. Call the patient and tell him or her of the recent development.

RATIONALE: A. A patient can obtain his or her medical records simply by signing a release form. Charts and records should never be given or faxed to an attorney unless the patient has signed a release.

The therapist observes a patient with the latter stages of Parkinson's disease during ambulation. Which of the following characteristics is the therapist most likely observing? a. Shuffling gait b. Increased step width c. Wide base of support d. Increased cadence especially at the onset of gait

RATIONALE: A. A shuffling gait and difficulty with initiating gait are typical signs of Parkinson's disease. This population would also present with a small base of support.

What is the most likely cause of anterior pelvic tilt during initial contact (heel strike)? a. Weak abdominals b. Tight hamstrings c. Weak abductors d. Back pain

RATIONALE: A. Abdominal muscles attach to the lower border of the ribs and the superior surface of the pelvis. Strong abdominals prevent excessive anterior rotation of the pelvis during gait.

Which of the following statements best describes lower extremity positioning in standing during the first 2 years of life of a child with no dysfunction? a. Femoral anteversion, femoral external rotation, foot pronation b. Femoral anteversion, femoral internal rotation, foot supination c. Femoral retroversion, femoral external rotation, foot pronation d. Femoral retroversion, femoral internal rotation, foot supination

RATIONALE: A. After the first 2 years of life, the femurs rotate to a more neutral position, and the amount of anteversion decreases.

A physical therapist is asked by a coworker to finish examining a patient because an emergency requires the therapist to leave. The coworker 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

RATIONALE: 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.

Which of the following is the correct method to test for interossei muscular tightness of the hand? a. Passively flex the proximal interphalangeal (PIP) joints with the metaphalangeal (MP) joints in extension, then passively flex the PIP joints with the MP joints in flexion. Record the difference in PIP joint passive flexion. b. Passively extend the PIP joints with the MP joints in extension, then passively extend the PIP joints with the MP joints in flexion. Record the difference in PIP joint passive flexion. c. Passively flex the PIP joints with the MP joints in extension, then passively extend the PIP joints with the MP joints in flexion. Record the difference in PIP joint passive flexion. d. Passively extend the PIP joints with the MP joints in extension, then passively flex the PIP joints with the MP joints in flexion. Record the difference in PIP joint passive flexion.

RATIONALE: A. Because the interossei cross the MP joints and the PIP joints, the PIP joints should be flexed with the MP joints in flexion and extension.

CT studies of the knee typically include three planes of study. Which choice is not one of the conventional planes? a. Condylar oblique b. Sagittal c. Coronal d. Axial

RATIONALE: A. CT employs views on the three anatomic planes; there is no condylar oblique view.

After performing an examination, a therapist notes the following information: severe spasticity of plantar flexors in the involved lower extremity; complete loss of active dorsiflexion in the involved lower extremity; minimal spasticity between 0 degrees and 5 degrees of dorsiflexion, with increased spasticity when the ankle is taken into more than 5 degrees of dorsiflexion. Which ankle-foot orthosis (AFO) is most likely contraindicated for the patient, an 87-year-old man who had a stroke 4 weeks ago? a. Dorsiflexion spring assist AFO b. Posterior leaf spring AFO c. Hinged AFO d. Spiral AFO

RATIONALE: A. Choice A probably would activate increased tone because of the resistance to plantar flexion offered by the spring.

What is the BEST order of these tests during neurologic patient examination? a. Cognition, sensation, range of motion (ROM), reflexes, spasticity testing, manual muscle testing (MMT) b. Reflexes, MMT, cognition, sensation, ROM, spasticity testing c. Cognition, sensation, spasticity testing, ROM, MMT, reflexes d. ROM, reflexes, sensation, MMT, spasticity testing, cognition

RATIONALE: A. Cognition, sensation, ROM, reflexes, spasticity testing, MMT is the best order. Sensory testing results can only be considered accurate if a patient's cognitive status is known. Spasticity and manual muscle testing results are based on range of motion, so ROM must come first.

What shoulder view BEST demonstrates the greater tubercle? a. External rotation b. Internal rotation c. Baby arm d. Transthoracic

RATIONALE: A. Due to the anatomic location of the greater tubercle, external rotation positions it in profile for best visualization.

The "FS" in and FS PD FSE sequence refers to: a. Fat presaturation technique b. Fast spin echo c. Use of contrast media d. Functional MRI sequence

RATIONALE: A. Fat saturation or presaturation is abbreviated "FS" and referred to verbally as "fatsat."

Increased bone density viewed on plain film x-rays would appear as ____ bone on T1 weighted MRI images. a. Low SI b. High SI c. Radiopacity d. None of these

RATIONALE: A. Increased mineral content in bone will show decreased SI on MRI because of decreased or absent fluid and fat hydrogen nuclei.

A therapist has been treating a patient who received a rotator cuff surgical repair with sessions consisting only of passive range of motion (for an extended period). The patient has just returned from a follow-up doctor's visit with an additional order to continue with passive range of motion only. Which of the following is the best course of action for the therapist? a. Continue with passive range of motion as instructed, and call the physician to consult with him or her about the initiation of active range of motion. b. Begin active range of motion within the pain-free range, and continue passive range of motion. c. Continue passive range of motion, and do not question the physician's decision. d. Perform passive range of motion and any other exercise that is within the normal protocol for this diagnosis.

RATIONALE: A. It is best to consult with the physician because of an extended amount of passive range of motion. A therapist should not deviate from a physician's order, but a telephone call to clarify the order is necessary when the therapist feels that another treatment plan is more appropriate.

Your patient complains of neck pain and peripheral symptoms. Radiographs revealed narrowing of the C4-C5 intervertebral foramen. The nerve root most likely involved would be the: a. C5 nerve root b. C4 nerve root c. C6 nerve root d. Sensory branch of C4

RATIONALE: A. It is well known that the C5 nerve root exits the C4-C5 intervertebral space. The other choices exit above and below this level.

Standard nomenclature used to describe radiodensity employed when reading plain film x-rays include all of the following except: a. Ligamentous density b. Air c. Bone density d. Fat density

RATIONALE: A. Ligaments fall into the generic description of "soft tissue" or "mid-density" on plain film x-ray.

MRI studies of the knee typically include three planes of study. Which choice is not one of the conventional planes? a. Medial oblique b. Sagittal c. Coronal d. Axial

RATIONALE: A. Medial oblique is a term used for specific plain film x-ray views. It is not appropriate nomenclature for any MRI study.

Superimposition of soft tissue structures on plain film images creates the illusion of: a. Increased density b. Decreased density c. Abnormal lucency d. Gas bubbles

RATIONALE: A. Multiple layers of any soft tissue structure increases apparent, not true, radiodensity.

During physical therapy examination, the patient has full ROM bilaterally. Muscle tone at rest appears normal bilaterally. Reflexes on the right side are 2+ On the left they are 1+ What is the next thing you should test for? a. Repeat reflex testing with Jendrassik maneuver to enhance deep tendon reflex on the left b. Spasticity testing on the left due to increased reflexes c. Assess for associated reactions as patient has upper motor neuron syndrome findings on the left. d. Cognition, as the patient may have been confused with reflex testing so results could be unreliable

RATIONALE: A. Repeat reflex testing with Jendrassik maneuver to enhance DTR on the left. This answer is correct because you have no reason to suspect abnormal reflexes (normal muscle tone), so tester error is the most likely first hypothesis. Reflexes of 2+ are normal, and 1+ is hyporeflexia, not increased or a sign of upper motor neuron syndrome. Cognition will not change findings with reflex testing, as it is a test of an unconscious spinal reflex arc.

Lumbar spondylolisthesis is best evaluated on what x-ray projection? a. Lateral b. AP c. PA d. Anterior oblique

RATIONALE: A. Spondylolisthesis is best viewed and measured on lateral views only.

A therapist is asked to estimate the percentage of a patient's body that has been burned. The patient is a 32-year-old man of normal size. Burns are located along the entire anterior surface of the face. The patient also burned the entire anterior portion of the right upper extremity in an attempt to guard himself from flames. Using the rule of nines, what percentage of the patient's body is burned? a. 9% b. 18% c. 4.5% d. 27%

RATIONALE: A. The anterior surface of the face and the upper extremity are each considered 4.5% of the body, according to the rule of nines. The anterior trunk is 18%. Each anterior surface of the lower extremities is 9%. The posterior side is the same, respectively. The total groin area is 1%.

The therapist is treating a 52-year-old woman after right total hip replacement. The patient complains of being self-conscious about a limp. She carries a heavy briefcase to and from work every day. The therapist notes a Trendelenburg gait during ambulation on level surfaces. What advice can the therapist give the patient to minimize gait deviation? a. Carry the briefcase in the right hand. b. Carry the briefcase in the left hand. c. The patient should not carry a briefcase at all. d. It does not matter in which hand the briefcase is carried.

RATIONALE: A. The briefcase should be carried in the right hand. Carrying the briefcase in the left hand would increase the amount of force that the right gluteus medius would have to exert to maintain a stable pelvis during gait.

When the knee is at its maximal amount of flexion during the gait cycle, which of the following muscles are active concentrically? a. Hamstrings b. Gluteus maximus c. Gastrocnemius d. Flexor hallucis longus

RATIONALE: A. The hamstrings bring the knee to approximately 60 degrees of flexion during acceleration. The hip flexors, ankle dorsiflexors, and toe extensors are also active.

The front leg of the celebrated "Scotty Dog" is what anatomic structure? a. Inferior articular process b. Superior articular process c. Pars interarticularis d. Transverse process

RATIONALE: A. The ipsilateral inferior articular process is seen as the front leg.

At what point in the gait cycle is the center of gravity the lowest? a. Double support b. Terminal swing c. Deceleration d. Midstance

RATIONALE: A. The lowest point in the gait cycle occurs when both lower extremities are in contact with the ground (double support).

A physical therapist is examining a 17-year-old distance runner with complaints of lateral knee pain. During the evaluation, the therapist performs the following test: The patient is placed in supine position with the hip flexed to 45 degrees and the knee to 90 degrees. The therapist then places firm pressure over the lateral femoral epicondyle and extends the patient's knee. Pain is felt by the patient at the point of palpation when her knee is 30 degrees from full knee extension. The positive result of this test suggests which of the following structures as the source of pain? a. Iliotibial band b. Biceps femoris c. Quadriceps d. Lateral collateral ligament

RATIONALE: A. The patient has an irritation of the iliotibial band as it passes over the lateral femoral epicondyle. This occurs at approximately 30 degrees from full knee extension.

The spinolaminar line employed in evaluation of a lateral view of the cervical spine is drawn immediately anterior to the: a. Posterior aspect of central canal b. Anterior aspect of vertebral bodies c. Posterior aspect of vertebral bodies d. Superior to C3 uncus if present

RATIONALE: A. The spinolaminar line represents the posterior aspect of the central canal.

In the terminal swing phase of gait, what muscles of the foot and ankle are active? a. Extensor digitorum longus b. Gastrocnemius c. Tibialis posterior d. Flexor hallucis longus

RATIONALE: A. The tibialis anterior, extensor digitorum longus, and extensor hallucis longus contract concentrically to achieve a neutral ankle position before initial contact.

A 10-year-old female has been diagnosed with a stage IV pressure sore on the sacrum. She was transferred to the hospital from a subacute facility and is being followed by the wound care team. After 2 weeks of wound care treatment, the physical therapist is reassessing the wound and determines that the bone is no longer visible. How would the physical therapist document the stage of the wound at this time? a. Stage IV b. Stage III c. Stage II d. Stage I

RATIONALE: A. The wound would be documented as a healing stage IV pressure sore. You cannot reverse staging of pressure sores. Healing of pressure ulcers should be documented by objective parameters such as size, depth, amount of necrotic tissue, amount of exudate, presence of granulation tissue, and so on.

Your patient is a framer on a construction project. He has been wearing a heavy carpenter's belt for the last month. He now complains of painful hyperthesias on the proximal anterior lateral thigh. He gets relief with sitting, and walking seems to aggravate his symptoms. The structure most likely producing these symptoms is the: a. Lateral femoral cutaneous nerve b. Motor branch of the femoral nerve c. Medial femoral cutaneous nerve d. Inguinal nerve

RATIONALE: A. This case represents a classic presentation of meralgia parasthetica, which involves the lateral femoral cutaneous nerve. The other choices are not in the area.

A patient presents to therapy with an ankle injury. The therapist has determined that the injury is at the junction of the distal tibia and fibula. Which of the following functions the most in preventing excessive external rotation and posterior displacement of the fibula? a. Anterior inferior tibiofibular ligament b. Posterior inferior tibiofibular ligament c. Interosseous membrane d. Long plantar ligament

RATIONALE: A. This is the primary function of the anterior inferior tibiofibular ligament.

The Waddell tests are used to identify: a. Pain of a nonorganic origin b. Space-occupying lesions c. Balance and coordination functions d. History of alcohol or substance abuse

RATIONALE: A. Waddell testing is used to identify patients suffering from pain of a nonorganic origin.

When ambulating on uneven terrain, how should the subtalar joint be positioned to allow forefoot rotational compensation? a. The subtalar joint should be placed in pronation. b. The subtalar joint should be placed in supination. c. subtalar joint should be placed in a neutral position. d. The position of the subtalar joint does not influence forefoot compensation.

RATIONALE: A. When the hindfoot is pronated, the forefoot (transverse tarsal joints) can compensate for uneven terrain. If the hindfoot is supinated, the forefoot also is likely to supinate and possibly cause damage to the lateral ankle ligaments.

A lateral x-ray projection of a dorsal phalangeal avulsion fracture reveals sagittal plane dislocation. What standard view should be ordered to assess possible coronal plane dislocation? a. AP b. PA c. Oblique d. Opposite side lateral

RATIONALE: B. A PA view demonstrates coronal plane relationships.

Cortical bone as viewed on CT scans within a "bone window" will appear as: a. Low density b. High density c. Low SI d. Hyperintense signal

RATIONALE: B. A bone window enhances radiographic contrast of bone; therefore, cortical bone appears very radiodense or white.

Using tests of neurologic status and motor function, an experienced physical therapist or pediatrician should be able to accurately diagnose cerebral palsy in all but the mildest cases by a. 3 months of age b. 6 months of age c. 1 year of age d. 2 years of age

RATIONALE: B. A variety of tests can be used to determine the proper diagnosis by 6 months of age.

The patient has dysdiadochokinesia. What is the best measure of patient function? a. Drawing figure eight b. Alternating pronation/supination c. Rebound test d. Static balance

RATIONALE: B. Alternating pronation/supination is the correct answer. Dysdiadochokinesia is difficulty with rapid alternating motions such as pronation and supination. A drawing does not capture the rapid motion. The rebound test measures graded muscle response to stimulus. Static balance does not involve rapid alternating motion patterns.

Normal articular cartilage appears as ______ on plain film x-ray? a. Radiodense b. Water or mid-density c. Lucent or lung density d. Opaque or bone density

RATIONALE: B. Articular cartilage is histologically mostly water and appears as mid-density or water density.

Radiology reports using the terms, sequestra and involucrum are referring specifically to what diagnosis of concern to a treating physical therapist? a. Bone cancer b. Osteomyelitis c. Fracture d. Spondylolisthesis

RATIONALE: B. Both terms refer specifically to bacterial infections of bone. Sequestra refers to pieces of necrotic bone and involucrum refers to reactive bone formation in response to bacterial bone destruction.

Indicators of complex regional pain syndrome include all of the following except: a. Pain from superficial touch b. Profuse sweating c. Skin color changes d. Increased uptake on bone scan

RATIONALE: B. CRPS symptoms do not include sweating, but rather dryness compared to the normal side.

Following a suspected stress fracture of the third metatarsal bone, bone callus would normally first become radiographically visible at about: a. 3 to 4 days b. 10 to 14 days c. 2 to 4 months d. 6 to 18 months

RATIONALE: B. Calcification of the organized hematoma begins at about 10 to 14 days after injury. The hematoma, organized hematoma, and fibrous hematoma are soft tissue and not radiographically visible. Calcium deposition marks the onset of x-ray visibility of callus formation.

Which of the following does the therapist observe if a patient is correctly performing an anterior pelvic tilt in standing position? a. Hip extension and lumbar flexion b. Hip flexion and lumbar extension c. Hip flexion and lumbar flexion d. Hip extension and lumbar extension

RATIONALE: B. Choice B is the correct answer. Choice A is a posterior pelvic tilt.

Which of the following muscles would you not expect to be affected by a C6-C7 lesion? a. Biceps brachii b. Anterior deltoid c. Infraspinatus d. Triceps brachii

RATIONALE: B. Choices A, B, and C all receive innervation from that branch of the brachial plexus. The triceps brachii is innervated by C7-C8.

Which of the following is false regarding T2-weighted MRI images? a. Synovial fluid displays high signal intensity. b. Cortical bone displays high signal intensity unless fat-suppression techniques are used. c. Bone marrow edema-like lesions (when present) are commonly seen in these images. d. Cerebral spinal fluid displays high signal intensity.

RATIONALE: B. Cortical bone displays high signal intensity unless fat-suppression techniques are used. T2-weighted images show fluid as bright. In addition, fat will show up fairly bright in the bone marrow unless suppressed. Bone has extremely short T2 times and never displays high signal intensity in the absence of pathology (fracture, etc).

A 16-year-old male is diagnosed with a spinal tumor and has undergone surgery to resect the mass. After the procedure, the patient presents with variable motor paralysis and loss of pain and temperature sensation below the level of the injury. The patient would be diagnosed with what spinal cord syndrome? a. Brown-Sequard b. Anterior Cord c. Posterior Cord d. Cauda Equina

RATIONALE: B. Damage to the anterior cord results in loss of motor function and pain/temperature sensation. There will be preservation of light touch, proprioception, and vibratory sense.

A defining symptom of fibromyalgia is: a. Fatigue b. Diffuse pain c. Regional pain d. Unexplained weight loss

RATIONALE: B. Diffuse pain is a defining criterion of fibromyalgia. According to the American College of Rheumatologists' 1990 criteria for the classification of fibromyalgia, widespread pain must be present for at least 3 months. Pain is considered widespread when all of the following are present: pain in the left side of the body, pain in the right side of the body, pain above the waist, pain below the waist, and axial skeletal pain. Pain in 11 of 18 tender point sites on digital palpation must also be present in order to establish the diagnosis of fibromyalgia.

A physical therapist is asked to examine a 37-year-old man with right-side sciatica. The therapist performs a passive straight leg raise test of the right lower extremity with the knee and ankle in neutral position. In performing this test on a patient with an L5 disc protrusion, what is the lowest degree at which the therapist would expect to reproduce the patient's symptoms? a. At 0 degrees of hip flexion b. At 35 degrees of hip flexion c. At 70 degrees of hip flexion d. At 90 degrees of hip flexion

RATIONALE: B. During a unilateral straight leg raise of the involved lower extremity, tension is placed on the sciatic nerve at approximately 35 degrees of hip flexion. At 0 degrees of hip flexion, tension is minimal to none, and tension is maximal above 70 degrees of hip flexion.

Anteriorly located anatomic structures appear larger than posterior structures on anteroposterior (AP) x-ray projections because of what form of X-ray distortion? a. Superimposition b. Enlargement c. Foreshortening d. Compression

RATIONALE: B. Enlargement exaggerates the size of structures located closest to the x-ray beam source.

A patient who suffered a myocardial infarction is participating in an exercise test. The therapist notes ST-segment depression of 1.7 mm on the patient's current rhythm strip. What is the most appropriate course of action? a. Stop the exercise session immediately and send the patient to the emergency room. b. Continue with the exercise session c. Contact the patient's cardiologist about continuing exercise. d. Stop the exercise session to take the patient's heart rate and blood pressure.

RATIONALE: B. Exercise testing should be terminated at 2 mm of ST depression.

A 35-year-old woman with a diagnosis of lumbar strain has a physician's prescription with a frequency and duration of 3 sessions/week for 6 weeks. The physical therapy examination reveals radiculopathy into the L5 dermatome of the right lower extremity, increased radiculopathy with lumbar flexion, decreased radiculopathy with lumbar extension, poor posture, and hamstring tightness bilaterally at 60 degrees. What is the best course of treatment? a. Lumbar traction, hot packs, and ultrasound b. McKenzie style lumbar extensions, a posture program, hamstring stretching, and a home exercise program c. McKenzie style lumbar extensions, a posture program, hamstring stretching, home program, hot packs, and ultrasound d. Lumbar traction, hot packs, ultrasound, and hamstring stretching

RATIONALE: B. Hot packs are not indicated because there is no mention of abnormal muscle tone. The entire lumbar area is too much surface area for ultrasound. An argument could be made for lumbar traction, but it is paired with heating modalities in all of the answers.

The celebrated "Scotty Dog" appears on what x-ray projections? a. Lumbar AP b. Lumbar oblique c. Coned lateral d. Lumbar lateral

RATIONALE: B. Lumbar oblique, both anterior and posterior, visualize the "Scotty Dog."

Which of the following conditions is descriptive of osteoarthritis? a. It provokes giant cell pigmented villonodular synovitis. b. It is associated with decreased type II collagen, cytokines, and chondrolysis. c. Ankylosis and follicular inflammation are predominant. d. It is associated with increased cartilage matrix synthesis and deposition.

RATIONALE: B. Osteoarthritis is induced by aging, trauma, and genetic factors. Hence, fibrillation, osteophytes, and decreased collagen II synthesis are the main features. In contrast, synovitis and inflammation occur in other forms, such as rheumatoid and giant villonodular arthritis.

A 50-year-old, slightly obese man presents with a 1-month history of right hip pain without radiation, a protective limp, and activity-induced symptoms. He improves with rest and has some mild morning stiffness. Examination reveals restricted and painful internal rotation of the hip. What is the MOST likely diagnosis? a. Inflammatory arthritis b. Osteoarthritis c. Osteoporotic hip fractures d. Iliopsoas tendinosis

RATIONALE: B. Patients older than 40 years of age with a new episode of hip pain presents evidence of osteoarthritis in 44% of cases. Restricted and painful internal rotation is highly suggestive of osteoarthritis, and three-plane range of motion limitation is less sensitive but more specific.

Your patient has low back pain that you diagnose clinically as degenerative disease of the left side L4-L5 facet. Which lumbar spine projection would best support your clinical impression? a. Right posterior oblique b. Left posterior oblique c. Right lateral d. Left lateral

RATIONALE: B. Posterior oblique views of the lumbar spine demonstrate ipsilateral posterior elements of the vertebra.

A patient is referred to the therapist with a diagnosis of arthritis. What type of arthritis would the therapist expect if the patient presented with the following signs and symptoms? (1) Bilateral wrists and knees are involved, (2) pain at rest and with motion, (3) prolonged morning stiffness, and (4) crepitus. a. The patient has osteoarthritis. b. The patient has rheumatoid arthritis. c. The patient has degenerative joint disease. d. It is not possible to determine with the given information.

RATIONALE: B. Rheumatoid arthritis is a systemic condition commonly involving joints bilaterally. Crepitus can be associated with osteoarthritis or rheumatoid arthritis, but rheumatoid arthritis is the most likely in this case.

Your patient presents with radiating pain down the right posterior leg, which is aggravated by running and seated hip internal rotation. What is the most likely cause? a. Right semimembranosus tendonitis causing posterior leg pain b. Right piriformis syndrome resulting in sciatica c. Lumbar central stenosis with L4 radiculopathy d. Right lumbar intervertebral foramen stenosis with radiculopathy

RATIONALE: B. Right piriformis syndrome resulting in sciatica is the most likely cause. The aggravating activities implicate the piriformis, which becomes an INTERNAL rotator at hip angles above 60 degrees (i.e., in sitting). The pattern of symptoms is consistent with sciatic nerve involvement.

When an adult lumbar spine degenerating disk breaks through either the superior or inferior end plate it is referred to as a(n): a. Napoleon's hat sign b. Schmorl's nodule c. Salter-Harris 5 fracture d. Osteoblastoma

RATIONALE: B. Schmorl's nodules are regions of lucency usually seen at the vertebral end plate where the degenerating disk is penetrating into bone material. Napoleon's hat sign is indicative of severe spondylolysthesis, and a Salter-Harris fracture type 5 is present in the pediatric population only. Osteoblastoma is a benign bone-forming tumor.

A physical therapy examination of an infant with osteogenesis imperfecta should include all of the following except: a. Pain b. Passive ROM c. Caregiver's handling d. Active functional movement

RATIONALE: B. Since pain responses may be unreliable in this population, PROM is contraindicated. AROM may be measured. Functional ROM is the most important measure at this point.

Musculoskeletal MRI "fluid sensitive" sequences include all of the following except: a. STIR b. T1 weighted c. T2 weighted d. Proton density

RATIONALE: B. T1 weighted images favor recording of fast recovery protons such as in fat tissues, which therefore appear as high signal intensity. Fluids on T2 images display mid- to low-signal intensity.

Edema on a T2 weighted MRI image will appear as_____ signal intensity (SI). a. Low signal intensity (SI) b. High signal intensity c. Radiopacity d. Radiolucent

RATIONALE: B. T2 weighted images are "fluid sensitive," meaning that fluid such as edema produces high signal intensity. A common mnemonic used in radiology is "WW II," water is white on T2.

What is correct regarding the atlanto-dens interval? a. The atlanto-dens interval is measured on AP projections. b. The atlanto-dens interval is measured on lateral views. c. An abnormality of the atlonto-dens interval may correlate with compromise of the ligamentum nuchae. d. Normal measurement is the same for adults and children.

RATIONALE: B. The atlanto-dens interval is the distance between the anterior aspect of the dens and the posterior aspect of the anterior neural arch of C1. It is measured only on a lateral projection.

A posterior lateral herniation of the lumbar disc between vertebrae L4 and L5 most likely results in damage to which nerve root? a. L4 b. L5 c. L4 and L5 d. L5 and S1

RATIONALE: B. The fifth lumbar nerve root is impinged because it arises from the spinal column superior to the L4-L5 lumbar disc.

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 diastole. d. The first sound is usually the loudest.

RATIONALE: B. The first sound heard corresponds with the closing of the mitral and tricuspid valves. The second sound corresponds to closing of the aortic and pulmonic valves. Therefore, the first sound is indicative of the onset of ventricular systole, and the second sound is indicative of the onset of ventricular diastole. The first sound is usually lower in pitch and longer than the second.

A therapist is examining a patient with traumatic injury to the left hand. The therapist asks the patient to place the left hand on the examination table with the palm facing upward. The therapist then holds the second, third, and fifth digits in full extension. The patient is then asked to flex the fourth digit. What movement would be expected by a patient with an uninjured hand, and what muscle or muscles is the therapist restricting? a. The fourth finger would flex at the distal interphalangeal (DIP) joint only, and the muscle being restricted would be the flexor digitorum superficialis. b. The fourth finger would flex at the proximal interphalangeal (PIP) joint only, and the muscle being restricted would be the flexor digitorum profundus. c. The fourth finger would flex at the DIP joint only, and the muscles being restricted would be the lumbricals. d. The fourth finger would flex at the PIP joint only, and the muscles being restricted would be the palmar interosseous.

RATIONALE: B. The flexor digitorum profundus has four tendons, each attaching to the distal phalanx. If the three mentioned in the question are restricted, flexion at the distal interphalangeal joint in the normal hand would not be possible.

The patient with the least chance of survival of the following injuries is an: a. 18-month-old male, s/p 40% total body surface area (TBSA), third-degree scald b. 13-year-old male, s/p 60% TBSA, indeterminate flame burns with inhalation injury c. 8-year-old female, s/p motor vehicle accident MVA with 20% deep burns to face, neck, chest, hands, and pelvic fractures d. 4-year-old male, s/p 80% TBSA, severe sunburn with blisters

RATIONALE: B. The injuries of the patient in choice B, involve the lungs. This patient would not have a good chance of being weaned from the ventilator. The other choices are medical emergencies, but choice B has the least chance of survival.

A therapist is beginning an examination of a 34-year-old woman with a diagnosis of carpal tunnel syndrome. Part of the evaluation consists of grip strength testing. To accurately test strength of the flexor digitorum profundus, where should the grip dynamometer's adjustable handle be placed? a. 1 inch from the dynamometer's nonadjustable handle b. 3 inches from the dynamometer's nonadjustable handle c. .5 inches from the dynamometer's nonadjustable handle d. 4 inches from the dynamometer's nonadjustable handle

RATIONALE: B. The last position (3 inches) of the grip strength dynamometer tests the extrinsic muscles of the hand (muscles located in the forearm). The closer positions test the intrinsic muscles.

A patient presents to an outpatient facility with complaints of pain in the groin area (along the medial left thigh). With manual muscle testing of the involved lower extremity, a therapist determines the following: hip flexion = 4+/5, hip extension = 4+/5, hip abduction = 4+/5, hip adduction = 2+/5, hip internal rotation = 2+/5, and hip external rotation = 2+/5. Which nerve on the involved side is most likely injured? a. Lateral cutaneous nerve of the upper thigh b. Obturator nerve c. Femoral nerve d. Ilioinguinal nerve

RATIONALE: B. The oburator nerve innervates the adductor brevis, adductor longus, adductor magnus, oburator externus, and gracilis muscles. Choice A has no motor function. Choice C innervates the sartorius, pectineus, iliacus, and quadriceps femoris. The ilioinguinal nerve innervates the obliquus internus abdominis and transversus abdominis.

A patient with decreased function of the gluteus minimus is referred to physical therapy for gait training. During the examination, the therapist places the patient in prone position and instructs the patient to extend the hip. Knowing that the gluteus minimus is extremely weak, which of the following is most likely to happen? a. The patient will abduct the hip more than usual when attempting to perform hip extension. b. The patient will externally rotate the hip excessively when attempting to perform hip extension. c. The patient will excessively flex the knee when attempting to perform hip extension. d. The patient will not have difficulty performing straight hip extension.

RATIONALE: B. The patient is prone to excessive external rotation when attempting to extend the involved hip because the gluteus minimus counteracts the lateral rotational force created by the gluteus maximus.

A 14-year-old girl with right thoracic scoliosis is referred to physical therapy. The therapist should expect which of the following findings? a. Left shoulder high, left scapula prominent, and right hip high b. Left shoulder low, right scapula prominent, and left hip high c. Right shoulder high, right scapula prominent, and right hip high d. Right shoulder low, right scapula prominent, and left hip high

RATIONALE: B. The patient probably has a low left shoulder, prominent right scapula, and high left hip.

A grasp that is often used to control tools or other objects is the: a. Hook grasp b. Power grasp c. Lateral pinch d. Tip pinch

RATIONALE: B. The power grasp often is used to control tools or other objects. The hook grasp is used when strength of grasp must be maintained to carry objects. Lateral pinch is used to exert power on or with a small object. Opposition of the thumb tip and the tip of the index finger, forming a circle, describes the tip pinch which is used to get small objects.

While assessing the standing posture of a patient, the therapist notes that a spinous process in the thoracic region is shifted laterally. The therapist estimates that T2 is the involved vertebra because he or she notes that it is at the approximate level of the: a. Inferior angle of the scapula b. Superior angle of the scapula c. Spine of the scapula d. Xiphoid process of the sternum

RATIONALE: B. The superior angle of the scapula commonly rests at the same level as vertebra T2. The spine of the scapula is approximately at T3. The inferior angle of the scapula and xiphoid process represent T7.

During examination of a patient, the therapist observes significant posterior trunk lean at initial contact (heel strike). Which of the following is the most likely muscle that the therapist needs to focus on during the exercise session in order to minimize this gait deviation? a. Gluteus medius b. Gluteus maximus c. Quadriceps d. Hamstrings

RATIONALE: B. This gait deviation is caused by the patient leaning back to decrease the flexion moment created at the hip at initial contact. The gluteus maximus is most responsible for counteracting this flexion moment.

A physical therapist is examining 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

RATIONALE: 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 the 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.

What motion takes place at the lumbar spine with right lower extremity single limb support during the gait cycle? a. Left lateral flexion b. Right lateral flexion c. Extension d. Flexion

RATIONALE: B. To maintain balance, the lumbar spine must laterally flex toward the supporting lower extremity during single-limb support.

What is the MOST common myofascial pain syndrome of the low back? a. Piriformis b. Quadratus lumborum c. Iliopsoas d. Tensor fascia latae

RATIONALE: B. Travell and Simons report that myofascial pain syndrome of the quadratus lumborum muscle is the most common myofascial pain syndrome of the lower back.

A physical therapist performs the following test during an examination: With the patient lying in supine position, the therapist traces a diamond shape around the patient's umbilicus with a sharp object. What reflex is being assessed, and what is the significance if the patient's umbilicus does not move in response to the stimulus provided by the therapist? a. Cremaster reflex, suggests upper motor neuron involvement b. Superficial abdominal reflex, suggests upper motor neuron involvement c. Cremaster reflex, suggests lower motor neuron involvement d. Superficial abdominal reflex, suggests lower motor neuron involvement

RATIONALE: B. When the test is performed on a patient with no motor neuron lesion, the umbilicus should move toward the stimulus. Unilateral movement suggests lower motor neuron involvement. A cremaster reflex is performed by stroking the medial thigh of a male with a sharp object. A normal response consists of superior movement of the scrotum on the ipsilateral side. An abnormal response is absence of scrotal movement on one side, which indicates possible lower motor neuron involvement. Bilateral absence of movement indicates upper motor neuron involvement.

Whiplash injury from a rear-end collision would tear which of the following ligaments? a. Posterior longitudinal ligament (PLL) b. Anterior longitudinal ligament (ALL) c. Ligamentum nuchae d. Ligamentum flavum

RATIONALE: B. Whiplash injury includes hyperextension of cervical vertebrae that may tear the anterior longitudinal ligament that limits extension of the cervical spine. All of the other ligaments limit flexion of the cervical spine; accordingly, they may be torn in hyperflexion injuries.

A therapist is screening a patient complaining of pain at the anterior left shoulder region. The pain is increased when the examiner instructs the patient to position the left arm by his side with the elbow flexed at 90 degrees and to actively supinate the forearm against resistance (provided by the examiner). What test is being performed? a. Froment's sign b. Yergason's test c. Waldron test d. Wilson test

RATIONALE: B. Yergason's test detects tendinitis of the long head of the biceps. Froment's sign is a test to determine adductor pollicis weakness due to ulnar nerve dysfunction. In the Waldron test, the patient performs squats while the therapist assesses the patella region for crepitus or pain. A positive test indicates possible chondromalacia. A positive Wilson test indicates possible osteochondritis dissecans. The test is performed by asking the patient to extend the knee in the seated position with internal rotation and again with external rotation of the tibia. The test is positive if there is pain with internal rotation and no pain with external rotation of the tibia.

A patient presents to an outpatient physical therapy clinic with a 140 degrees kyphoscoliotic curve. What is the therapist's greatest concern? a. The patient's complaint of low back pain b. Gait deviations c. Pulmonary status d. Poor upright standing posture

RATIONALE: C. A curve greater than 120 degrees is often associated with restrictive lung dysfunction. The other factors listed are not life threatening.

Morton's neuroma is usually located between which metatarsal heads? a. First and second b. Second and third c. Third and fourth d. Fourth and fifth

RATIONALE: C. A painful neuroma in the space between the third and the fourth metatarsal heads is a Morton's neuroma.

Which of the following is the normal end-feel perceived by an examiner assessing wrist flexion? a. Bone to bone b. Soft tissue approximation c. Tissue stretch d. Empty

RATIONALE: C. A tissue stretch end-feel is also felt with ankle dorsiflexion. An example of a bone-to-bone end-feel is with knee or elbow extension. Knee flexion is an example of soft tissue approximation. In an empty end-feel, a patient stops the movement due to pain.

A therapist is treating a patient with a venous insufficiency ulcer over the medial mallelous. The wound is moist and not infected. The involved lower extremity is swollen, and the patient reports no pain around the wound. The physician has ordered wound care 3 times/week. Which of the following should be used in intervention of this wound? a. Whirlpool b. Sharp debridement c. Intermittent compression pump d. Hot packs to the wound

RATIONALE: C. A warm whirlpool with the lower extremity in a dependent position is likely to increase the edema. The addition of moist heat is contraindicated for the same reason. There is no need for sharp debridement on a clean wound. A compression pump is often used for increased edema in the extremities.

A patient is positioned by the therapist with the cervical spine rotated to the right. The patient then extends the neck as the therapist externally rotates and extends the right upper extremity. The patient is then instructed to hold a deep breath. The radial pulse is palpated in the right upper extremity by the therapist. What type of special test is this, and for what condition is it testing? a. Adson's maneuver, cervical disc herniation b. Lhermitte's sign, cervical disc herniation c. Adson's maneuver, thoracic outlet syndrome d. Lhermitte's sign, thoracic outlet syndrome

RATIONALE: C. Adson's maneuver tests for thoracic outlet syndrome. Lhermitte's sign tests for dural irritation in the cervical spine.

A mother comes to a therapist concerned that her 4-month-old infant cannot sit up alone yet. Which of the following responses is the most appropriate for the therapist? a. "Your infant probably needs further examination by a specialist because, although it varies, infants can usually sit unsupported at 2 months of age." b. "Your infant probably needs further examination by a specialist because, although it varies, infants can usually sit unsupported at 3 months of age." c. "This is probably nothing to be concerned about because, although it varies, most infants can sit unsupported at 8 months of age." d. "This is probably nothing to be concerned about because, although it varies, most infants can sit unsupported at 5 months at age."

RATIONALE: C. Although sources vary widely, a child can sit unsupported usually between 4 and 8 months of age. Choices A and B are incorrect. Choice D would possibly cause the parent to worry prematurely.

Of the following, which is the earliest period after surgery that an 18-year-old boy who received an uncomplicated partial meniscectomy of the right knee can perform functional testing, such as a one-leg hop test, for distance? a. 1 week after surgery b. 2 weeks after surgery c. 6 weeks after surgery d. 12 weeks after surgery

RATIONALE: C. At 1 to 2 weeks after surgery, the patient has an inflamed knee, and no functional testing can take place. Six weeks is an appropriate amount of time to allow inflammation to decrease enough for functional testing. Patients who have received a partial meniscectomy do not require as much healing time as patients who have received a meniscus repair.

Which impairment occurs in carpal tunnel syndrome? a. Atrophy of the hypothenar eminence b. Paresthesias over the dorsal aspect of the hand c. Decreased resisted thumb abduction d. Decreased resisted forearm pronation

RATIONALE: C. Atrophy of the hypothenar eminence is a sign of ulnar nerve lesion, while paresthesias over the dorsal aspect of the hand are symptoms of radial nerve lesion. Decreased resisted thumb abduction and forearm pronation are signs of median nerve lesion, but the motor branches of pronator teres and pronator quadratus arise before the median nerve enters the carpal tunnel.

The therapist is assessing a patient's strength in the right shoulder. The patient has 0 degrees of active shoulder abduction in the standing position. In the supine position, the patient has 42 degrees of active shoulder abduction and 175 degrees of pain-free passive shoulder abduction. What is the correct manual muscle testing grade for the patient's shoulder abduction? a. 3-/5 (fair -) b. +5 (poor+) c. 2-/5 (poor -) d. 1/5 (trace)

RATIONALE: C. Because the patient does not have 50% of normal range of motion in the gravity eliminated position, 2-/5 is the appropriate grade. Some therapists argue that this is an example of a 1-/5 grade. Sources used in preparation of this exam indicate that there is no grade of 1/5 with manual muscle testing.

A physical therapist is assessing the posture of a 12-year-old female with cystic fibrosis. All of the following are common postural abnormalities except: a. Thoracic kyphosis b. Forward head posture c. Scapular retraction d. Cervical lordosis

RATIONALE: C. Children with cystic fibrosis commonly have cervical lordosis resulting from thoracic kyphosis. This leads to the scapulae and shoulders to be pushed forward and anteriorly.

A child loses balance and falls down whenever she tries to catch a ball thrown in her direction; otherwise the child can sit, stand, and walk well. The physical therapist would determine that the child has a problem with: a. Development of higher-level balance skills b. Active reactions c. Anticipatory postural control d. Labyrinthine head righting

RATIONALE: C. Children with limited anticipatory postural control have difficulty catching, reaching, or throwing in any posture, as a result of a poor feed-forward control. Protective reactions are mainly to protect the infant from a fall. A problem with development of higher-level balance skills is evidenced by inability to stand on one limb, walk on a balance beam, or hop.

Cortical bone appears as ______ on virtually all MRI sequences because of low water content. a. Radiopaque b. Radiolucent c. Low signal intensity d. High signal intensity

RATIONALE: C. Cortical bone has little water or fat so few hydrogen nuclei are available to record radiofrequency signal in MRI images.

A springy block end-feel in a joint is indicative of: a. Normal end feel b. An inflamed capsule c. A meniscal tear d. An unstable joint

RATIONALE: C. Cyriax's classical description describes the obvious cause of a springy end-feel as being that of a torn part of a meniscus in the knee engaging between the bone ends, blocking extension.

A therapist is examining a patient who complains of frequent foot, ankle, and knee pain. The therapist asks the patient to assume a standing position with the knees slightly flexed. The therapist then demonstrates active bilateral foot pronation to the patient. When asked to perform this task, the patient has difficulty. Which of the following limitations is a possible cause of the patient's difficulty in performing this task? a. Restriction limiting plantar flexion and lateral rotation of the talus b. Restriction limiting dorsiflexion and medial rotation of the talus c. Restriction limiting eversion of the calcaneus and medial rotation of the talus d. Restriction limiting inversion of the calcaneus and lateral rotation of the talus

RATIONALE: C. During pronation of the feet, the calcaneus everts, and the talus medially rotates and plantar flexes.

A commonly encountered MRI sequence in PT practice is FS PD FSE. This sequence is most often used to display: a. Abnormal fat tissues b. Brain trauma or haemorrhage c. Orthopedic pathology d. Details of cortical bone

RATIONALE: C. FS (fat saturation) PD (proton density) FSE (fast spin echo) sequences are excellent for evaluation of articular cartilage, joint structures, and edema and are therefore quite common in orthopedic evaluation.

Signs and symptoms of hypertrophic burn scar include all of the following except: a. Increasing itching and redness in a healed burn b. Increasing difficulty in achieving a full stretch of the burned area c. Fever and malaise d. Raised edges around a newly healed graft

RATIONALE: C. Fever and malaise might be signs of infection or other medical complications. They are not signs of hypertrophic scarring.

Normal high SI tissues on T1 weighted images include: a. Acute edema b. CSF c. Fat d. Synovial fluid

RATIONALE: C. High signal intensity of a T1 weighted image corresponds to fat tissues.

A physical therapist is ordered to examine 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. Decreased amplitude of motor unit action potential b. Decreased duration of motor unit action potential c. Decreased sensory evoked potentials d. Decreased polyphasic action potentials

RATIONALE: C. In performing these tests on patients who have this disorder, sensory potentials are generally unchanged. Motor unit potentials are increased in amplitude and duration because of variable impulse conduction time in sprouting axon terminals. Increased polyphasic potentials are usually found with increased duration.

While observing the ambulation of a 57-year-old man with an arthritic right hip, the therapist observes a right lateral trunk lean. Why does the patient present with this gait deviation? a. To move weight toward the involved hip and increase joint compression force b. To move weight toward the uninvolved hip and decrease joint compression force c. To bring the line of gravity closer to the involved hip joint d. To take the line of gravity away from the involved hip joint

RATIONALE: C. Leaning the trunk over the involved hip decreases joint reaction force and strain on the hip abductors. These factors together decrease pain in the involved hip.

Which radiologic terms are incorrectly paired? a. Density/opacity b. Density/sclerosis c. Lucency/high density d. Lucency/low density

RATIONALE: C. Lucent areas on x-ray are regions of low density.

A physical therapist is reviewing the chart of a 24-year-old woman with a diagnosis of L2 incomplete paraplegia. The physician noted that the left quadricep tendon reflex is 2+. What does this information relay to the therapist? a. No active quadricep tendon reflex b. Slight quadricep contraction with reflex testing c. Normal quadricep tendon reflex d. Exaggerated quadricep tendon reflex

RATIONALE: C. No activity = 0. Slight contraction = 1+. Normal response = 2+. Exaggerated response = 3+. Severely exaggerated = 4+.

A physical therapist is working with a patient who has chronic obstructive pulmonary disease. If the patient's level of oxygen being carried by arterial blood is measured, a PaO2 finding of _____ ____ is considered normal. a. 35 to 45 mm Hg b. 60 to 80 mm Hg c. 80 to 100 mm Hg d. 100 to 120 mm Hg

RATIONALE: C. Normal PaO2 ranges from 80 to 100 mm Hg and is an important determinant of when it is safe to exercise a patient either with or without supplemental oxygen. PaO2 is determined by examining the concentration of oxygen present in arterial blood. Understanding the parameters under which a patient may safely perform exercise is important.

Which one of the following conditions is characterized by reduced osteoclastic bone resorption? a. Paget's disease of the bone b. Osteoporosis c. Osteopetrosis d. Osteomalacia

RATIONALE: C. Osteopetrosis is a genetic disorder characterized by osteoclast dysfunction that leads to excessive osteoid tissue formation. Paget's disease is an acquired disease in which the osteoclast dysfunction initially causes excessive removal of bone (osteolysis). Osteomalacia is the softening of bone due to poor and delayed calcification. Osteoporosis is due to more than one etiological factor, acquired and genetic, accompanied by reduced amount of osteoid tissue.

When performing an examination on a patient after traumatic spinal cord injury to determine the American Spinal Injury Association (ASIA) sensory level of injury a clinician tests: a. Proprioception b. Kinesthesia c. Pain d. Reflexes

RATIONALE: C. Pain as measured by pinprick and light touch are used to determine sensory level for ASIA guidelines.

A physical therapist is examining a patient reporting knee pain. The patient is positioned in a prone position, and the physical therapist passively flexes the knee to end range. Based on the examination technique, which of the following structures would not be expected to limit movement? a. Joint capsule b. Vastus intermedius c. Sciatic nerve d. Rectus femoris

RATIONALE: C. Passive flexion of the knee would be expected to place stress on the muscles acting to extend the knee and the joint capsule. The only tissue structure that would be placed on "slack" would be the sciatic nerve, which runs along the posterior aspect of the femur.

Degenerative arthritic changes viewed on x-ray images may typically include all of the following except: a. Subchondral sclerosis b. Osteophyte formation c. Periarticular osteopenia d. Loss of joint space

RATIONALE: C. Periarticular osteopenia is a classic sign of rheumatoid arthritis due to hyperperfusion due to inflammation of the synovium.

The left posterior oblique (LPO) cervical spine projection specifically allows study of what anatomic structures? a. Intervertebral disk b. Left side intervertebral joints c. Right side intervertebral foramina d. Left side intervertebral foramina

RATIONALE: C. Posterior oblique views of the cervical spine demonstrate contralateral intervertebral foramina.

While evaluating a shoulder split tau inversion recovery (STIR) sequence MRI study, you note increased SI on the images within the region. This suggests: a. Fibrosis b. Organized hematoma c. Edema or effusion d. Calcification of the tendon

RATIONALE: C. STIR, a common MRI sequence seen in orthopedic PT practice (split tau inversion recovery), is extremely fluid sensitive so edema will be observed as a region of high signal intensity.

An MRI study of the shoulder typically includes three anatomic planes of study. Image slices taken perpendicular to the long axis of the scapular spine are identified as what plane of study? a. Coronal oblique b. Axial c. Sagittal oblique d. Lateral

RATIONALE: C. Shoulder studies are based on the scapular plane, a sagittal study that is also called a sagittal oblique study; it will display images oriented perpendicular to the long axis of the scapular spine.

A high repetition time (TR) combined with low echo time (TE) setting noted on the scout film would indicate what common orthopedic sequence? a. T1 b. T2 c. Proton density d. STIR

RATIONALE: C. TR and TE settings will vary with PD sequences, but the universal finding is high TR and low TE.

A patient presents to an outpatient clinic with complaints of shoulder pain. The therapist observes a painful arc between 70 degrees and 120 degrees of active abduction in the involved shoulder. This finding is most indicative of what shoulder pathology? a. Rotator cuff tear b. Acromioclacivular joint separation c. Impingement d. Labrum tear

RATIONALE: C. The "painful arc" is most indicative of shoulder impingement. The soft tissues of the shoulder are pinched under the acromion process at approximately 60 degrees to120 degrees of abduction. Pain throughout abduction active range of motion suggests acromioclavicular joint dysfunction.

An infant is able to transition from quadruped to sitting, demonstrate protective extension reactions in all directions except backwards, and pivots on belly in a prone position. This infant is demonstrating gross motor skills at what chronologic age? a. 3 to 4 months b. 5 to 6 months c. 7 to 8 months d. 11 to 12 months

RATIONALE: C. The 7 to 8 months old will be able to transfer from quadruped to sitting; pivot on belly in a prone position; and demonstrate protective extension reactions downward, sideways, and forward. Backward reactions will begin around 9 months.

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. Postural sway test b. Nonequilibrium test c. Romberg test d. One-legged stance test

RATIONALE: C. 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. Postural sway tests involve the patient standing on a computerized platform and electronically measuring the amount of sway the patient exhibits. One-legged stance tests obviously involve the patient attempting to stand on one leg during the test.

Your patient presents with a nerve injury that causes the thenar eminence to be flattened because of muscle atrophy. The thumb is adducted and extended. You would want to test the muscles supplied by the: a. Ulnar nerve b. Antebrachial nerve c. Median nerve d. Radial nerve

RATIONALE: C. The ape or simian hand described is indicative of a median nerve palsy.

A therapist is assessing radial deviation range of motion at the wrist. The correct position of the goniometer should be as follows: the proximal arm is aligned with the forearm and the distal arm is aligned with the third metacarpal. What should be used as the axis point? a. Lunate b. Scaphoid c. Capitate d. Triquetrum

RATIONALE: C. The capitate is the axis.

When comparing the gait cycle of young adults to the gait cycle of older adults, what would a therapist expect to find? a. The younger population has a shorter step length. b. The younger population has a shorter stride length. c. The younger population has a shorter period of double support. d. The younger population has a decrease in speed of ambulation.

RATIONALE: C. The geriatric population would have a longer period of double support in an attempt to maintain balance. They also would have a shorter step and stride length.

25-year-old football player fell on his shoulder vertically and violently stretched his neck in the opposite direction. He was later diagnosed with a brachial plexus injury (Erb-Duchenne paralysis). His arm is hanging at his side in medial rotation in the "waiter's tip" position. What results are expected from the neurologic examination? a. Paralysis of the deltoid, triceps, wrist extensors (long and short carpi radialis), and finger extensors b. Paralysis of all intrinsic muscles of the hand, flexors muscles (claw hand), loss of sensation over C8-T1 dermatomes, and Horner's syndrome c. Hypesthesia over C5-C6 and weakness of the deltoid, supraspinatus and infraspinatus, biceps, and brachioradialis muscles d. Klumpke paralysis caused by forced hyperabduction of the arm

RATIONALE: C. The mechanism of injury indicates implication of the superior plexus of C5-C6, causing diffuse arm weakness not fitting typical radicular presentation (involvement of one myotome). Nerve regeneration is still possible when only the endonurium and capillary complex are disrupted ("a burner"). However, when the perineurium (funiculus) or epinurium is disrupted (brachial neuropraxia), useful regeneration is not expected. This requires urgent neurosurgical intervention to prevent permanent neurologic deficit.

Which structure is most poorly studied or assessed on an AP lumbar spine projection? a. Intervertebral disk height of superior lumbar vertebra b. Superior end plates c. Pars interarticularis d. Inferior end plates

RATIONALE: C. The pars interarticularis is superimposed on the vertebral body in the AP projection and therefore nearly impossible to visualize.

A therapist is examining the gait pattern of a patient and notes that the pelvis drops inferiorly on the right during the midswing phase of the right lower extremity. The patient also leans laterally to the left with the upper trunk during this phase. Which of the following is the most likely cause of this deviation? a. Weak right gluteus medius b. Weak right adductor longus c. Weak left gluteus medius d. Weak left adductor longus

RATIONALE: C. The pelvis is dropping on the right side because the left gluteus medius is weak. The patient also may lean toward the left hip joint to move the center of gravity, making it easier to hold up the right side of the pelvis.

A physical therapist is beginning a gait examination. During heel strike to foot flat on the right lower extremity, which of the following does not normally occur? a. The left side of the pelvis initiates movement in the direction of travel. b. The right femur medially rotates. c. The left side of the thorax initiates movement in the direction of travel. d. The right tibia medially rotates.

RATIONALE: C. The right shoulder and thorax begin to move forward at heel strike (initial contact).

A 48-year-old woman is being examined 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 in the right upper extremity reveals the following data: flexion = 4/5, extension = 3+/5, abduction = 3+/5, adduction = 4/5, internal rotation = 3+/5, and external rotation = 3+/5. Manual muscle testing in the left upper extremity reveals the following data: 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

RATIONALE: 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.

A patient is placed in supine position with the knee in 90 degrees of flexion. The foot is stabilized by the therapist's body on the examination table. The therapist then wraps his fingers around the proximal tibia so that the thumbs are resting along the anteromedial and the anterolateral margins. The therapist then applies a force to pull the tibia forward. What special test is being performed? a. Pivot shift b. Lachman's test c. Anterior drawer d. Posterior drawer

RATIONALE: C. The tests in Choices A, B, and C assess the integrity of the anterior cruciate ligament. The pivot shift test is performed with the patient in supine position. The therapist applies a valgus stress with the lower leg internally rotated while passively flexing and extending the knee. A positive test is associated with instability with this motion. Lachman's test is similar to the anterior drawer test, but the knee is in slight flexion. In performing a posterior drawer test, the positioning is the same as for performing an anterior drawer test, but a posterior force is applied to the tibia to assess posterior cruciate ligament integrity. When performing these tests, the therapist is assessing the end-feel and amount of joint play to determine the integrity of the ligament.

The therapist is performing an orthopedic test that involves (1) placing the patient in a side-lying position, (2) placing the superior lower extremity in hip extension and hip abduction, (3) placing the knee of the superior lower extremity in 90 degrees of flexion, and (4) allowing the superior lower extremity to drop into adduction. Failure of the superior lower extremity to drop indicates a tight a. Iliopsoas b. Rectus femoris c. Iliotibial band d. Hamstring

RATIONALE: C. This is called Ober's test, which screens for a tight iliotibial band.

A patient reports throbbing pain in the lower extremities accompanied by trophic changes and diminished pulses. The pain is aggravated by activity and was not influenced by spinal movements. What source of pain is most likely responsible for these complaints? a. Peripheral neuropathy b. Restless leg syndrome c. Vascular pain d. Neurogenic pain

RATIONALE: C. This scenario describes vascular claudication. The lack of pain or symptoms with spinal movements rules out peripheral neuropathy. Neurogenic pain is usually represented by a stocking distribution around the ankle, and restless leg syndrome occurs during periods of rest only.

A patient is in prone position with his head rotated to the left side. The left upper extremity is placed at his side and fully internally rotated. The left shoulder is then shrugged toward the chin. The therapist then grasps the midshaft of the patient's left forearm. The patient is then instructed to "try to reach your feet using just your left arm." This movement is resisted by the therapist. This test is assessing the strength of what muscle? a. Upper trapezius b. Posterior deltoid c. Latissimus dorsi d. Triceps brachii

RATIONALE: C. This test assesses the strength of the latissimus dorsi. One of the functions of the latissimus is to push up from a sitting position. This test simulates that movement.

A physical therapist is examining a patient who complains of posterior ankle pain. The patient is positioned prone with the feet extended over the edge of the mat. The therapist squeezes the involved gastrocnemius over the middle third of the muscle belly. What test is the therapist performing? What indicates a positive test? a. Thompson's test, plantar flexion of the ankle b. Homan's test, plantar flexion of the ankle c. Thompson's test, no ankle movement d. Homan's test, no ankle movement

RATIONALE: C. Thompson's test checks the integrity of the Achilles' tendon. When this test is performed on an ankle with no dysfunction, squeezing the gastrocnemius causes passive plantar flexion of the ankle.

You are performing an examination on a 2-month-old infant diagnosed with Klumpke's palsy. The classic physical findings of a Klumpke's palsy are: a. Lack of forearm supination, elbow extension, and wrist flexion b. Lack of forearm supination, elbow flexion, and wrist extension c. Lack of shoulder external rotation, elbow flexion, and wrist extension d. Lack of elbow extension, forearm pronation, and wrist flexion

RATIONALE: D. A Klumpke's palsy involves injury to the lower roots, C8-T1 (occasionally C7 is also involved) and results in weakness of the triceps, forearm pronators, and wrist flexors.

You are examining a child with a fractured distal femur. The fracture begins at the medial aspect of the distal diaphyseal region, progresses distal-laterally through the metaphysis, epiphyseal plate, and epiphyseal region, exiting into the knee joint surface. This would be classified as a Salter Harris type ____ fracture. a. 1 b. 2 c. 3 d. 4

RATIONALE: D. A Salter-Harris IV fracture passes through both the metaphyseal and epiphyseal portions of the bone along with, of course, the epiphyseal plate.

A physical therapist begins gait training for a patient with bilateral knee flexion contractures at 30 degrees at a long-term care facility. The therapist knows that the patient will have a forward trunk lean during gait because the patient's line of gravity: a. Is anterior to the hip b. Is anterior to the knee c. Is posterior to the ankle d. Is posterior to the hip

RATIONALE: D. A patient with severe knee flexion contractures has a line of gravity that is anterior to the hip, posterior to the knee, and anterior to the ankle. This causes a flexion moment at the hip, knee, and ankle.

The L4 deep tendon reflex is elicited at the: a. Achilles tendon b. Femoral tendon c. Medial hamstring tendon d. Patella tendon

RATIONALE: D. According to Hoppenfeld, the patella deep tendon reflex muscles (the quadriceps muscle group) are innervated by the L4 nerve root via the femoral nerve.

A physical therapist is beginning an examination of a patient with a diagnosis of "knee strain." Range of motion limitation does not follow the normal capsular pattern of the knee. Which of the following are possible causes of the restriction in range of motion? a. Ligamentous adhesions b. Internal derangement c. Extra-articular lesions d. All of the above

RATIONALE: D. All of the choices are capable of causing a noncapsular pattern.

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

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

A patient presents to an outpatient physical therapy clinic with a severed ulnar nerve of the right upper extremity. What muscle is still active and largely responsible for the obvious hyperextension at the metacarpophalangeal (MCP) joints of the involved hand? a. Dorsal interossei b. Volar interossei c. Extensor carpi radialis brevis d. Extensor digitorum

RATIONALE: D. An ulnar nerve-compromised hand presents as a "claw" hand after a prolonged amount of time because of atrophy of the interossei. The extensor digitorum takes over and pulls the MCPs in hyperextension.

A scaphoid fracture is suspected on plain film x-ray but not clearly demonstrated. The imaging technology most commonly employed for further evaluation and diagnosis is: a. Positron emission tomography b. MRI c. Plain film x-ray with contrast media d. Computerized tomography

RATIONALE: D. CT is excellent for study of occult fractures and is the imaging modality of choice if plain film x-ray findings are inconclusive.

During your cranial nerve examination of extraocular muscle function, you note that your patient has vertical nystagmus during smooth pursuits. You suspect: a. Lesion of optic nerve (cranial nerve II) b. Posterior canal BPPV c. Acoustic neuroma d. Central nervous system lesion

RATIONALE: D. Central nervous system lesion. Central nervous system nystagmus has a more vertical component. Peripherally generated nystagmus is typically horizontal and rotary in nature. A lesion of optic (cranial nerve II) would cause only sensory changes. It has no motor component. BPPV would not be triggered with testing because no head motions are occurring. An acoustic neuroma would also not cause nystagmus during smooth pursuit, as no head motion is occurring.

An outpatient physical therapist is gait-training a patient recently discharged from the hospital. The inpatient therapist's notes describe a decrease in left stride length due to pain with weight bearing on the right lower extremity. The outpatient therapist knows that the patient's gait deviation is an abnormally short: a. Distance from the left heel strike and the successive right heel strike b. Amount of time between the left heel strike and the successive right heel strike c. Amount of time in stance phase on the left lower extremity d. Distance between the left heel strike and the successive left heel strike

RATIONALE: D. Choice D is the length of stride during one gait cycle. Choice A describes a decreased step length, choice B describes a decrease in step duration, and choice C describes a decrease in single-limb support time.

While ambulating a stroke patient (the right side is the involved side), the therapist notes increased circumduction of the right lower extremity. Which of the following is an unlikely cause of this deviation? a. Increased spasticity of the right gastrocnemius b. Increased spasticity of the right quadriceps c. Weak hip flexors d. Weak knee extensors

RATIONALE: D. Choices A, B, and C would increase the functional length of the right lower extremity and possibly cause a circumduction during gait. Choice D would not change the functional leg length.

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 the patient exhibits decreased anterior pelvic tilt. What should the physical therapist do during the second trial? a. The therapist should correct the deviation verbally before the lift. b. The therapist should correct the deviation with manual contact during the lift. c. The therapist should correct the deviation both verbally and manually during the lift. d. The therapist should not attempt to correct the lift.

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

To decrease the risk of hypoglycemia in a patient with type 1 insulin-dependent diabetes, which of the following is inappropriate? a. Eat or drink a snack high in carbohydrates 30 minutes before exercise. b. Exercise muscles that have not had an insulin injection recently. c. A carbohydrate snack for each 30 to 45 minutes of exercise. d. Exercise at the peak time of insulin effect.

RATIONALE: D. Exercising at the peak time of insulin effect causes hypoglycemia. Insulin causes the liver to decrease sugar production. The body needs increased levels of blood glucose during exercise.

A two-month-old infant is diagnosed with left congenital muscular torticollis, which has resulted in plagiocephaly. This would result in: a. Flattening of the left frontal and left occipital regions b. Flattening of the right frontal and left occipital regions c. Flattening of the right frontal and right occipital regions d. Flattening of the left frontal and right occipital regions

RATIONALE: D. Left torticollis and resultant plagiocephaly would cause flattening of the left frontal and right occipital regions with bulging of the opposite areas.

During therapy, a patient with Parkinson's disease on levodopa/carbidopa therapy might experience all of the following except: a. The "off" phase b. Dizziness c. Involuntary movements d. Marked bradycardia

RATIONALE: D. LevoDOPA/carbidopa can cause all of the listed effects except bradycardia. Due to the off-effect the patient might have to be scheduled at times when he or she is in the on-phase of the drug.

On plain film x-ray a black or dark gray lesion within a normally white region such as cortical bone would be termed a region of: a. Density b. Opacity c. Sclerosis d. Lucency

RATIONALE: D. Lucency refers to an area of low density (i.e., molecular weight), thus producing a black or dark gray lesion within normal dense bone. A lytic lesion would be identified as lucent.

When discussing magnetic resonance imaging (MRI) images, all observations of tissue appearance should be described in terms of: a. Lucency b. Window c. Density d. Signal intensity

RATIONALE: D. MRI images are produced by radiofrequency signals. All visual findings are referred to in terms of signal intensity.

A physical therapist is performing electromyographic testing. During a maximal output test of the patient's quadricep muscle, 25% of the motor unit action potential is polyphasic. What is the significance of this finding? a. It is normal in the quadricep. b. It is normal in the triceps brachii, not in the quadricep. c. It is normal in the biceps brachii, not in the quadricep. d. It is abnormal in any muscle.

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

Nerve conduction velocity/EMG studies of motor nerves are NOT able to differentiate: a. Peripheral nerve disease from anterior horn cell disease b. The specific location cord, nerve, root, plexus, or peripheral nerve c. Neuromuscular junction disease from peripheral nerve disease d. The specific cause or nature of the neural lesion

RATIONALE: D. Nerve conduction/EMG studies are useful for identifying the possible injury site along the lower motor nerve reflex but cannot provide a definitive clinical diagnosis.

Osteoarthritis may be differentiated from rheumatoid arthritis (RA) on x-ray by the observation of: a. Loss of joint space b. Periarticular osteopaenia c. Asymmetric joint involvement d. Osteophyte formation

RATIONALE: D. Osteophyte formation is typical of osteoarthritis, whereas loss of bone density is observed in RA.

Where is the most common site of fracture in osteoporosis? a. Metacarpals b. Skull c. Proximal radius d. Vertebral bodies

RATIONALE: D. Osteoporosis affects all bones of the body, but most commonly it produces symptoms in the major weight-bearing bones.

Which of the following actions places the greatest stress on the patellofemoral joint? a. When the foot first contacts the ground during the gait cycle b. Exercising on a stair-stepper machine c. Running down a smooth decline of 30 degrees d. Squats to 120 degrees of knee flexion

RATIONALE: D. Patellofemoral joint reaction forces increase as the angle of knee flexion and quadriceps muscle activity increase. Choice D involves the greatest knee flexion angle and quadriceps activity.

As a cardiopulmonary specialist observing a patient's chest x-ray you note radiolucency within the lung fields. This is most likely to be: a. Heterotopic ossification b. Tuberculosis c. Collapse of lung d. Normal air density lung

RATIONALE: D. Radiolucency refers to low density areas such as the lung. The lung is normally radiolucent.

An overweight 12-year-old presents with hip pain and weight-bearing difficulties. These symptoms presented rapidly following physical activity. On examination, limping is observed and passive ranges of motion are limited and painful. Which of the following is the MOST probable diagnosis? a. Legg-CalvesPerthes disease b. Transient hip synovitis c. Congenital hip dysplasia d. Slipped femoral capital epiphysis

RATIONALE: D. Slipped femoral capital epiphysis is the most common hip condition in adolescent boys (10 to 16 years old). Fifty percent of cases present with a traumatic history. Traumatic slipped femoral capital epiphysis is considered a Salter-Harris type I epiphyseal fracture.

The therapist is performing an orthopedic test on a 25-year-old man with the chief complaint of low back pain. The patient has a positive Thomas test. With this information, what might the therapist need to include in the treatment plan? a. Stretching of the hip abductors b. Stretching of the hip adductors c. Stretching of the hip extensors d. Stretching of the hip flexors

RATIONALE: D. The Thomas test is a screen to determine whether the hip flexors are too tight.

A tennis player receives a surgical repair of the annular ligament. Where should the therapist expect to note the most edema? a. Radial ulnar joint b. Olecranon bursa c. Ulnohumeral joint d. Lateral triangle

RATIONALE: D. The lateral triangle (composed of the radial head, olecranon process, and lateral epicondyle) is the most likely of the choices to exhibit joint edema. Joint edema is common after a surgical procedure.

The alar ligament stress test is considered positive if: a. Laxity is felt in neutral b. Laxity is felt in extension c. Laxity is felt in flexion d. Laxity is felt in both flexion and extension

RATIONALE: D. The test is only considered positive if it is lax in two or more planes. This is due to the variation of direction of the fibers as they connect to the alar ligament.

Upon observation, the patient has unilateral LEFT facial weakness. He is unable to smile or show his teeth on the left side. However, he is able to raise his left eyebrow. The physical therapist suspects: a. Peripheral cranial nerve 5 lesion b. Central cranial nerve 5 lesion c. Peripheral cranial nerve 7 lesion d. Central cranial nerve 7 lesion

RATIONALE: D. The therapist suspects central cranial nerve 7 lesion because the facial nerve 7 innervates the motions described. A peripheral lesion results in complete loss to one side of the face. Sparing of the frontalis is a sign of a central lesion due to bilateral corticobulbar innervation of that muscle.

A "window" in computerized tomography (CT) terminology refers to: a. Lucent regions of the lung b. Lytic lesions of bone c. Hounsfeld units d. CT machine setting for enhancement of contrast

RATIONALE: D. The window of CT images refers to the tissue density range being computer enhanced. Bone, brain, soft tissue, or lung are common CT windows.

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% to 80% of the target heart rate 3 times/week. b. Begin exercise with levels of 1.5 METs and increase slowly 3 times/week. c. Exercise at 75% to 80% of the target heart rate 7 times/week. d. Begin exercise with levels of 1.5 METs and increase slowly 7 times/week.

RATIONALE: D. This patient has moderate lung disease. Because the intensity of exercise is low, frequency should be increased to 5 to 7 times/week.

A therapist is examining 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

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

The therapist is treating a patient who received an above-elbow amputation 2 years ago. The prosthesis has a split cable that controls the elbow and the terminal device. With this type of prosthesis, the patient must first lock the elbow to allow the cable to activate the terminal device. This is accomplished with what movements? a. Extending the humerus and elevating the scapula b. Extending the humerus and retracting the scapula c. Extending the humerus and protracting the scapula d. Extending the humerus and depressing the scapula.

RATIONALE: D. To lock the elbow with this type of prosthesis, the patient must extend the humerus and depress the scapula.

A physical therapist is conducting a screening examination on a patient with a suspected upper motor neuron lesion. In the presence of an upper motor neuron lesion, deep tendon reflexes will be: a. Hypoactive b. Absent c. Diminished d. Hyperactive

RATIONALE: D. Upper motor neuron lesions involve damage to neural pathways above the level of the motor neuron. Such lesions typically result in a constellation of symptoms that include increased or hyperactive deep tendon reflexes, the appearance of pathologic reflexes, tonal increases, and weakness. Muscle wasting is not common. Increased deep tendon reflexes can be one finding in determining the need for referral or differential diagnosis.