Form Section 1 pta

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

1 1. Anterior scalene or pectoralis minor tightness from this posture can impinge the neurovascular bundle, causing thoracic outlet syndrome (p. 331). 2. Overuse injury of the wrist is unrelated to this postural presentation (p. 835). 3. The ulnar nerve is well protected above the elbow. Injury most often occurs at the elbow or wrist. (pp. 761-762, 853) 4. Overuse injury of the elbow is unrelated to this postural presentation (p. 755). Dutton

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

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

A patient with normal urine control reports not being able to reach the toilet in time due to muscle weakness and joint pain. Which type of incontinence BEST describes the patient's condition? 1. Functional 2. Stress 3. Urge 4. Overflow

1 1. Functional incontinence occurs in people who have normal urine control but who have difficulty reaching a toilet in time because of muscle or joint dysfunction (p. 987). 2. Stress incontinence is the loss of urine during activities that increase intraabdominal pressure such as coughing, lifting, or laughing (p. 988). 3. Urge incontinence is the sudden unexpected urge to urinate and the uncontrolled loss of urine. Urge incontinence is often related to reduced bladder capacity or detrusor instability. (p. 988) 4. Overflow incontinence is the constant leaking of urine from a bladder that is full but unable to empty (p. 991). Pathology Goodman

During examination of a patient, a physical therapist notes bradycardia. The patient reports constipation and cold intolerance. Which of the following conditions is the MOST likely cause of the sign and symptoms? 1. Hypothyroidism 2. Hyperthyroidism 3. Hyperparathyroidism 4. Hypoparathyroidism

1 1. Hypothyroidism is consistent with signs and symptoms of bradycardia, constipation, and cold intolerance. 2. Hyperthyroidism causes diarrhea, rather than constipation. 3. Hyperparathyroidism is not associated with bradycardia. 4. Hypoparathyroidism is associated with arrhythmias and either constipation or diarrhea. DDX Goodman

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

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

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

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

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

1 1. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They may initially use a sliding board to assist transfers, but in the long term they should be able to independently perform a sit pivot transfer. 2. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They should be able to independently transfer and not need a sliding board in the long term. 3. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They would not have adequate lower extremity strength to perform a standing pivot transfer. 4. Patients who have an injury at the T10 level or below have partial to full innervation of trunk musculature and fully innervated upper extremities. They should be able to independently transfer and not need a mechanical lift. O Sullivan

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

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

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

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

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

1 1. Small-amplitude oscillations before the onset of tissue resistance are appropriate for pain modulation. 2. Small-amplitude oscillations into tissue resistance are more appropriate for joint stiffness, not pain. 3. Large-amplitude oscillations into tissue resistance are more appropriate for joint stiffness. 4. Large-amplitude oscillations at the end of tissue resistance are for end range joint restrictions and are too aggressive for patients who have pain. Duttons

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

1 1. Symptoms of dermatitis include lack of fever, itching, normal temperature of the lower extremities, inflammation, tenderness to touch, presence of vesicles and crusting, and either unilateral or bilateral distribution (Bryant, pp. 178, 211). 2. Although the patient's limb is painful, the other reported findings are not consistent with cellulitis. Signs of cellulitis include fever, elevated temperature of the lower extremities, erythema, inflammation, tenderness, one or a few bullae, no lesions, and unilateral distribution. (Bryant, p. 237; Sussman, p. 376) 3. Atrophie blanche is characterized by white, scar-like areas associated with pain at rest and when standing (Sussman, p. 376). Affected areas present as smooth white plaques (Bryant, p. 210). 4. Superficial venous thrombosis is characterized by pain and tenderness along the affected vein, usually the saphenous vein. Crusting of the skin is not a feature of this condition. (Goodman, pp. 647, 649)

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

1 1. The assessment of posture in a wheelchair begins with the pelvis and its relationship to its adjacent segments. 2. The pelvis, not the lower extremities, should be considered first when evaluating wheelchair seating. 3. The pelvis, not the head, should be considered first when evaluating wheelchair seating. 4. The pelvis, not the spine, should be considered first when evaluating wheelchair seating. Meeting the PT needs of children

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

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

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

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

A patient who has bicipital tendinopathy is MOST likely to experience pain with which of the following maneuvers? 1. Resisted shoulder flexion with the forearm supinated and the elbow flexed to 15° 2. Passive shoulder medial (internal) rotation and abduction with 90° of elbow flexion 3. Passive shoulder flexion greater than 90° with application of light pressure on the acromion 4. Resisted shoulder extension with the elbow extended and the shoulder abducted to 90° and medially (internally) rotated

1 1. This movement describes the Speed test, which is diagnostic of bicipital tendinopathy. 2. This movement describes the Hawkins test, which is diagnostic of impingement syndrome. 3. This movement describes the Neer test, which is diagnostic of impingement syndrome. 4. This movement describes the empty can test, which is diagnostic of supraspinatus tendinopathy. Delisa Physical Medicine and Rehab

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

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

Which of the following home programs is MOST appropriate for a patient who has chronic lateral epicondylalgia? 1. Using a forearm cuff to increase loading on the extensor tendons 2. Performing exercises for wrist strength and stretching 3. Administering iontophoresis with dexamethasone (Decadron) and lidocaine (Xylocaine) 4. Doing friction massage of the brachioradialis tendon

2 1. A forearm cuff is thought to decrease the muscle loading (p. 756). 2. Lateral epicondylalgia is caused by overuse of the wrist extensors that originate on the lateral epicondyle of the humerus, especially the extensor carpi radialis brevis. If the lateral epicondylalgia is at a chronic stage, conditioning of the extensor muscles and sustained grip activities will be most effective in long-term management. (p. 756) 3. Iontophoresis would not be appropriate for a home program and is more appropriate for acute lateral epicondylalgia (p. 755). 4. Friction massage of the brachioradialis would not be appropriate since the extensor carpi radialis brevis muscle is usually the muscle that is affected. Dutton

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

2 1. A mechanical lift will promote total dependence for the patient, which should not be necessary in this case. 2. With normal sitting balance and normal upper body strength, this patient should be able to participate significantly with transfers, thereby easing much of the strain on the caregiver and allowing transfers to be done with assistance of only one person. 3. A one-person lift transfer performed by the caregiver does not allow the patient to participate by using existing abilities. 4. The description of the patient's lower extremities indicates that the patient is not likely to be a good candidate for a stand pivot transfer. Fairchild Principles and Techniques of Pt care

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

2 1. Hamstrings are primarily knee flexors. They can be secondary hip extensors but would be tested with the knee extended, not flexed. (p. 242) 2. The gluteus maximus is the primary hip extensor muscle tested in this manner (p. 216). 3. Lumbar erector spinae extend the trunk on the legs. They do not attach on the femur and have no impact on hip extension. (pp. 43-44) 4. Gluteus medius weakness would be assessed by testing hip abduction in sidelying position (p. 223). MMT book

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

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

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

2 1. Pes cavus is an atypically high arched foot type, common in neuromuscular conditions such as Charcot-Marie-Tooth disease. It is not typical in the newborn infant. (Magee, pp. 910-911) 2. At birth, an infant's knees are bowlegged (genu varum) to accommodate for the flexed position in utero. The legs and hips gradually straighten until they reach a neutral alignment between the first and second years. (Palisano, p. 105) 3. At birth, an infant's legs are bowlegged to accommodate for the flexed position in utero. If infants were in genu valgum, it would not allow sufficient hip and knee flexion to attain the flexed posture. With genu valgum, the femur lies in relative medial (internal) rotation and adduction. (Palisano, p. 105) 4. Talipes equinovarus, also referred to as "clubfoot", is a congenital deformity of the foot seen in newborns. It is not a normal condition. The foot appears smaller due to the hypoplastic skeletal features of the bones. Surgical intervention or serial casting is required to correct this condition. (Palisano, pp. 307-308) Campbell Magee

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

2 1. Povidone-iodine is usually used as a skin preparation to prevent surgical site infection. It can be used in acute traumatic wounds. A Stage 3 pressure injury is an example of a chronic wound. (Sussman, p. 518) 2. Sterile normal saline is the appropriate initial agent used to clean a wound (Sussman, p. 518). 3. Use of silver sulfadiazine may be indicated if infection is present. However, it is not indicated in the initial treatment. (Sussman, p. 513) 4. Zinc oxide is used in dental fillings and in local surface treatment for various skin disorders but not for chronic pressure injuries (Mosby's, p. 1913). Mosby Dictionary of Medicine

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

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

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

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

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

2 1. Vertebrobasilar insufficiency is associated with drop attacks, transient blindness, and dysarthria. 2. A patient who has a central vestibular system lesion, in particular a cerebellar lesion, may have pure vertical nystagmus that oscillates at equal speeds (pendular nystagmus). In addition, abnormal smooth pursuits and abnormal saccadic eye movements are symptoms associated with a central vestibular lesion. 3. Peripheral vestibular lesions are associated with intermittent nystagmus that will incorporate slow and fast phases (jerk nystagmus) and with normal smooth pursuit and saccades. 4. Peripheral vestibular lesions, including posterior semicircular canalithiasis, are associated with intermittent nystagmus that will incorporate slow and fast phases (jerk nystagmus) and with normal smooth pursuit and saccades. O Sullivan

Which of the following conditions is a CONTRAINDICATION for mechanical traction of the cervical spine? 1. Muscle spasm 2. Rheumatoid arthritis 3. Hypomobility of the spine 4. Decreased upper extremity sensation

2 1. Gentle intermittent traction may assist in decreasing muscle spasm and the resultant spinal compressive forces. 2. Joint capsules, ligaments, and bones are fragile in patients with rheumatoid arthritis (RA). A patient with RA is subject to atlantoaxial subluxation or to developing instability next to areas of hypomobility. 3. Longitudinal traction force provides a gliding separation of the facets, general capsular stretch, and opening of the intervertebral foramen. Traction can improve range of motion. 4. Reduction of neurological deficits may result from improved conduction in large-diameter myelinated afferent and efferent nerve fibers. Mechanical traction can release pressure on nerve fibers, thereby increasing nerve conduction. Manual for Physical Agents

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

3 1. A decreased Achilles tendon reflex implicates S1. Paresthesias at the lateral aspect of the lower extremity involve L5-S1. 2. Foot intrinsics are innervated at the S1-S2 level. 3. The L4 nerve root exits at the L4-L5 level. Weak ankle dorsiflexors, diminished knee jerk, and paresthesias along the medial calf and ankle are the only combination of signs and symptoms listed that could all be a result of L4 nerve root compromise. 4. This combination of signs and symptoms would occur with nerve root involvement at the S1-S2 level. Magee

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

3 1. Muscle performance testing is normal, thus subscapularis disorder is not likely (p. 476). 2. Stiffness of the pectoralis minor would lead to impairments in activities requiring upward rotation and posterior tilting of scapula (p. 474). 3. Posterior capsular stiffness would decrease medial (internal) rotation, which is required for reaching the hand behind the back (p. 612). 4. Acromioclavicular joint arthrosis is most likely to limit horizontal adduction and overhead motions (p. 675). Dutton

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

3 1. Osteoarthritis is typically characterized by dull, achy pain in weight-bearing joints (e.g., hips, knees, etc.) (pp. 1304-1306). 2. Polymyositis presents as symmetric proximal muscle weakness with malaise and weight loss. There is no joint involvement. (p. 1247) 3. Gout's typical presentation is severe joint pain, occurring at night, typically in the first metatarsophalangeal joint. Signs and symptoms also include erythema, warmth, and extreme tenderness and hypersensitivity of the affected joint. (p. 1345) 4. Rheumatoid arthritis presents with symmetrical joint inflammation and pain with subluxations (pp. 1319-1322). Pathology Book, Goodman

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

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

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

3 1. The mode of action described does not occur with angiotensin-converting enzyme inhibitors (p. 472). 2. The mode of action described is for beta-blockers, which are another medication used to treat hypertension (p. 470). 3. Angiotensin-converting enzyme inhibitors produce vasodilation, reduce peripheral vascular resistance, and increase venous capacitance (p. 472). 4. Angiotensin-converting enzyme inhibitors produce vasodilation, reduce peripheral vascular resistance, and increase venous capacitance (p. 472). Therefore this option is incorrect since it states an action is decreasing venous capacitance. Hillegass

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

3 1. The normal blood pressure response to increased exercise intensity consists of a progressive increase in systolic blood pressure and no change or a slight decrease in diastolic blood pressure (ACSM, pp. 125, 128). 2. The normal blood pressure response to increased exercise intensity consists of a progressive increase in systolic blood pressure and no change or a slight decrease in diastolic blood pressure (ACSM, pp. 125, 128). A slight increase in diastolic blood pressure would not be cause for termination of exercise. 3. A drop in systolic blood pressure is considered an abnormal test response (ACSM, pp. 125, 127). Criteria for terminating exercise include exercise hypotension (drop in systolic blood pressure of 20 mm Hg or more) (Frownfelter, p. 280). 4. This is a normal response. A drop in systolic blood pressure is considered an abnormal test response (ACSM, pp. 125, 127).

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

3 1. The patient has concerning symptoms suggestive of heart failure. Heart rate would not be most important measure because right ventricular heart failure is not associated with acute changes to heart rate. Right ventricular failure is due to the sustained elevation in pulmonary arterial hypertension. (Goodman, pp. 593-595) 2. Capillary refill is used to assess for surface arterial blood flow (Myers, p. 208). Edema is associated with venous insufficiency (Myers, p. 236). 3. The patient has concerning symptoms suggestive of heart failure. The classic signs include peripheral pitting edema, weight gain, jugular vein distention, diminished appetite, right upper quadrant discomfort, and a ventricular gallop (S3) heart sound (Hillegass, pp. 87, 98). Assessing the heart sounds would be of value for the medical diagnosis or for determining whether consultation with another health care professional is needed. 4. The ankle-brachial index is performed to assess for arterial disease and is designed to test the potential loss of profusion in the lower extremities (O'Sullivan, p. 586). Clinical manifestations of arterial disease include pain, pallor, paralysis, diminished pulses, hair loss, and thin shiny skin (Goodman, pp. 639-640). Venous insufficiency is represented by edema, hemosiderin staining of the skin, and normal arterial pulses (Goodman, pp. 655-656). The patient could have secondary venous issues, but the ankle-brachial index would not be indicated as an additional testing measure.

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

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

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

3 1. The tibialis posterior plantar flexes and inverts the foot. Ankle plantar flexion and eversion would strengthen the fibularis (peroneus) longus and brevis. (pp. 213, 854) 2. The tibialis posterior plantar flexes and inverts the foot. Ankle dorsiflexion and inversion would strengthen the tibialis anterior. (pp. 212-214, 854) 3. The tibialis posterior plantar flexes and inverts the foot. Hip extension, adduction, and lateral (external) rotation, with ankle plantar flexion and inversion requires the specific action of that muscle. (pp. 212-214, 854) 4. The tibialis posterior plantar flexes and inverts the foot. Ankle dorsiflexion and eversion would strengthen the fibularis (peroneus) tertius. (pp. 212-214, 854) Ther Ex book

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

4 1. A deep vein thrombosis corresponds to the leg pain and possibly swelling, but symptoms would typically be unilateral. 2. A myocardial infarction corresponds to shortness of breath but typically does not result in swelling acutely. A myocardial infarction could result in the development of heart failure, which would result in these symptoms, but this is a secondary result, not a primary result. 3. A pulmonary embolism would result in shortness of breath, usually not changed by position, and typically cardiac arrest. 4. Typical signs of heart failure include dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and peripheral edema. Cardio and Pulm PT: Evidence to Practice

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

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

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

4 1. Orthotic intervention, usually with a thoracolumbosacral orthosis, is helpful in maintaining improved trunk position for functional activities. For children with progressive spinal deformities, orthotic intervention is continued until the child reaches a sufficient age (10+ years) to allow surgical fusion of the spine. (Palisano, pp. 547-548) 2. Stretching programs have not been found to halt or improve scoliosis. If stretching exercises are performed, they should focus on the iliopsoas and low back extensors and lateral trunk flexors on the concave side of the curvature. (Goodman, pp. 1167-1168) 3. This child is too young for surgery for scoliosis. The ideal minimum age for spinal fusion is 10 to 11 years old in girls and 12 to 13 years old in boys. Long spinal fusions before the skeletal age of 10 result in greater loss of trunk height and an increased frequency of instrumentation failure. (Palisano, pp. 547-548) 4. Orthotic intervention, usually with a thoracolumbosacral orthosis, is helpful in maintaining improved trunk position for functional activities. For children with progressive spinal deformities, orthotic intervention is continued until the child reaches a sufficient age (10+ years) to allow surgical fusion of the spine (Palisano, pp. 547-548) and is indicated for a curvature 25° to 45° (Goodman, p. 1167). Campbell Pt for Children

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

4 1. The C8-T1 nerve roots form the median nerve (anterior interosseus), supplying the flexor pollicis longus muscle. A patient who has an avulsion of the C5 and C6 spinal nerve roots will be able to perform distal thumb (1st digit) flexion. (Dutton, p. 83; O'Sullivan, p. 154) 2. The C7-C8 nerve roots form the ulnar nerve and radial nerve (posterior interosseus), supplying the flexor and extensor carpi ulnaris. Therefore, a patient who has an avulsion of the C5 and C6 spinal nerve roots will be able to perform wrist ulnar deviation. (Dutton, pp. 83, 86; O'Sullivan, p. 154) 3. The C5-C8 and T1 nerve roots form the radial nerve, supplying the triceps brachii. Avulsion of the C5 and C6 nerve roots will result in weakness but not functional loss of elbow extension. (Dutton, pp. 81-82; O'Sullivan, p. 154) 4. The C5-C6 nerve roots form the axillary nerve, supplying the deltoid and teres minor. Avulsion of these nerve roots will result in decreased right shoulder abduction. (Dutton, p. 80; O'Sullivan, p. 154)

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

4 1. The cessation of independent walking in boys with Duchenne muscular dystrophy typically occurs by age 10-12 (Palisano, pp. 250-251) or 13 years (Tecklin, p. 355). Therefore, stair climbing is not likely. 2. The cessation of independent walking in boys with Duchenne muscular dystrophy typically occurs by age 10-12 (Palisano, pp. 250-251) or 13 years (Tecklin, p. 355). Therefore, gait training is highly unlikely to be plausible. 3. The transition to adulthood marks a time of continued progressive disability. Assistance with transfers would be required at this stage. (Palisano, p. 254) 4. A 20-year-old patient with Duchenne muscular dystrophy is likely to require a power wheelchair for functional mobility due to the progressive nature of the disease (Tecklin, p. 362). Typically, by age 14 years, boys who have Duchenne muscular dystrophy are not ambulatory and require power-assisted mobility. The transition to adulthood marks a time of continued progressive disability with a greater reliance on assistive technologies such as a power wheelchair (Palisano, p. 254). Ped PT

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

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

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

4 1. This activity characterizes the chronic stage of healing, which involves tissue maturation and remodeling (p. 323). 2. This activity characterizes the subacute stage of healing (p. 320). 3. This response characterizes the subacute stage of healing (p. 317). 4. Pain on active movement is a hallmark of the acute stage of healing (p. 317). Ther Ex Book

A patient's left eye is adducted at rest. During examination of extraocular eye movements, the patient is unable to move the left eye laterally. These findings MOST likely result from a lesion of which of the following nerves? 1. Oculomotor (CN III) 2. Trochlear (CN IV) 3. Trigeminal (CN V) 4. Abducent (CN VI)

4 1. With oculomotor nerve (CN III) injury, the affected eye would have ptosis and lateral deviation (pp. 330-331). 2. With a trochlear nerve (CN IV) injury, the person would have elevation of the involved eye during forward gaze (p. 331) and would not have difficulty with abducting the eye. 3. With trigeminal nerve (CN V) injury, the person would have impaired facial sensation, difficulty with jaw opening, and an impaired corneal reflex (pp. 336-338). 4. With a lesion of the abducent nerve (CN VI), the affected eye is adducted at rest and cannot be abducted (p. 331). Neuroscience Book Remember LR6SO4O3

4 1. A diminished knee reflex is indicative of a herniated disc at the L4 level, which would not be consistent with the symptoms reported by the patient (Agur, p. 367). 2. A diminished ankle reflex is indicative of a herniated disc at the S1 level, which would not be consistent with the symptoms reported by the patient (Agur, p. 367). 3. A weak gastrocnemius is indicative of a herniated disc at the S1 level, which would not be consistent with the symptoms reported by the patient (Agur, p. 367). 4. The patient's symptoms are indicative of a herniated disc at the L5 level, which causes compression of the 5th lumbar nerve root. Sensory deficits extend on the dorsolateral foot as indicated in the photograph. Subsequent motor weakness involves the extensor hallucis longus. (Dutton, pp. 141, 1463; Agur, p. 367) Atlas of Anatomy Dutton

A patient reports low back pain that radiates down one leg below the knee. The patient also reports numbness and tingling in the location shown on the photograph. Which of the following examination findings is MOST likely? 1. Diminished knee reflex 2. Diminished ankle reflex 3. Weakness of the gastrocnemius 4. Weakness of the extensor hallucis longus

1 1. The electrocardiogram change shows 3-mm ST depression, which is indicative of cardiac ischemia and is an indication to stop exercise and notify medical staff. 2. Continuing gait training would endanger the patient. 3. Stopping and resting is appropriate; however, the medical staff should be alerted to this situation first. 4. Continuing gait training, despite some standing rests, could allow the ischemia to progress and endanger the patient. Pathology Goodman

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

1 1. S1 represents closure of the mitral and tricuspid valves, while S2 represents closure of the aortic and pulmonary valves. These are the only two heart sounds that should occur normally. Sounds occurring between S1 and S2 are considered systolic murmurs. 2. S1 represents closure of the mitral and tricuspid valves, while S2 represents closure of the aortic and pulmonary valves. These are the only two heart sounds that should occur normally. 3. Sounds occurring between S2 and S1 are known as diastolic murmurs. The illustration does not show the sound occurring between S2 and S1. 4. S1 represents closure of the mitral and tricuspid valves, while S2 represents closure of the aortic and pulmonary valves. These are the only two heart sounds that should occur normally. Hillegass

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

2 1. The ST segment is not elevated in the photograph of the electrocardiogram (p. 331). 2. Premature ventricular contractions are present in the photograph of the electrocardiogram, as evidenced by the wide QRS complex and absent P wave (p. 325). 3. Acute first-degree atrioventricular block would be represented by a prolonged PR interval, which is not shown in this photograph (p. 323). 4. This electrocardiogram is not consistent with a normal response to exercise, because premature ventricular contractions are present (pp. 312-313). Hillegass Cardio

During a symptom-limited graded exercise test, a patient exhibits the electrocardiogram pattern shown in the photograph. This pattern is indicative of which of the following phenomena? 1. ST segment elevation 2. Premature ventricular contractions 3. Acute first-degree atrioventricular block 4. Normal response to exercise

1 1. Pressure on the spinal cord at L1 would cause signs of upper motor neuron lesions below this level. A sign of upper motor neuron lesion is hyperreflexia. (p. 1494) 2. A weak or absent patellar reflex is expected with nerve root L4 compression (p. 1494). 3. Peripheral nerve injuries, such as a femoral nerve impingement, would result in a diminished patellar reflex (pp. 96-97). 4. Peripheral nerve injuries, such as a cauda equina lesion, would result in a diminished patellar reflex (p. 134). Duttons

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

1 1. The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393). The adductor pollicis is innervated by the ulnar nerve (nerve roots C7-C8, T1) (Magee, p. 399). 2. The pronator quadratus is innervated by the median nerve (Magee, p. 399). The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393). 3. The flexor pollicis longus is innervated by the anterior interosseous nerve, which is a branch of the median nerve (Magee, p. 450). The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393). 4. The abductor pollicis longus is innervated by the posterior interosseus nerve, which is a branch of the radial nerve (Magee, p. 399). The nerve being stretched in the photograph is the ulnar nerve (Kisner, p. 393).

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

3 1. The patient in the photograph exhibits pronation of the feet. Pronation is associated with valgus, not varus, stress at the knee, and pronation of the subtalar joint results in or is caused by medial (internal) rotation of the tibia. 2. The patient in the photograph exhibits pronation of the feet. Pronation is associated with valgus deformity of the knee and medial (internal) rotation of the tibia. 3. The patient in the photograph exhibits pronation of the feet. Pronation is associated with medial (internal) rotation of the tibia and resulting genu valgus. 4. The patient in the photograph exhibits pronation of the feet. Pronation is associated with medial (internal), not lateral (external), rotation of the knee along with valgus stress.

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