NPTE: EXAM 2 ERRORS
A physical therapist administers Phalen's test to a patient diagnosed with a repetitive use injury of the right wrist and hand. As part of the testing procedure the therapist asks the patient to push his wrists together while moving them into a fully flexed position. How long should the patient maintain the test position? 1.10 seconds 2.30 seconds 3.1 minute 4.3 minutes
1 minute Phalen's test is characterized by the examiner flexing the patient's wrists maximally and having the patient hold this position by pushing the wrists together. A positive test is indicated by tingling in the thumb, index finger, middle finger, and lateral half of the ring finger. This result may be indicative of carpal tunnel syndrome caused by compression of the median nerve. The typical protocol for Phalen's test requires that the patient maintain the test position for one minute.
A physical therapy manager informs the staff physical therapists that as part of their annual performance appraisal all physical therapists will be required to demonstrate evidence of primary, secondary, and tertiary prevention activities. Which patient would be the MOST appropriate recipient of tertiary prevention activities? 1.A 21-year-old male diagnosed with C5 tetraplegia 2.A 32-year-old male with a family history of cardiac disease 3.A 43-year-old female medical assistant with a repetitive use disorder 4.A 14-year-old female who is approximately five pounds overweight
1.A 21-year-old male diagnosed with C5 tetraplegia Primary prevention is preventing a target condition in a susceptible or potentially susceptible population, such as with general health promotion efforts. Secondary prevention is decreasing the duration of illness, severity of disease or number of sequelae through early diagnosis and prompt intervention. Tertiary prevention is limiting the degree of disability and promoting rehabilitation and restoration of function in patients with chronic and irreversible conditions. 1.A patient with C5 tetraplegia has a chronic and irreversible condition and would likely be the recipient of tertiary prevention activities.
A physical therapist treats a patient with a wound on the lateral portion of their upper thigh. The therapist plans to use the patient's enzymes to debride devitalized tissue using a moisture retentive dressing. What is this type of intervention BEST termed? 1.Autolytic debridement 2.Enzymatic debridement 3.Mechanical debridement 4.Sharp debridement
1.Autolytic debridement Debridement refers to the removal of unhealthy tissue to promote healing. Debridement can be selective (e.g., sharp, enzymatic, autolytic) or non-selective (e.g., wet-to-dry dressings, wound irrigation, hydrotherapy). 1.Autolytic debridement refers to the use of the body's own mechanisms to remove nonviable tissue. Autolytic debridement establishes a moist wound environment that rehydrates necrotic tissue and eschar, facilitating enzymatic digestion of the nonviable tissue.
A seven-month-old patient with a suspected Wilms tumor is evaluated in physical therapy. Based on normal developmental milestones, which of the following activities would be considered the MOST age appropriate? 1.Independently maintain unsupported sitting 2.Independently pivot while in a sitting position 3.Independently steadies head in supported sitting 4.Independently transition from standing to sitting
1.Independently maintain unsupported sitting A physical therapist should have knowledge of normal growth and development in order to identify delays in reaching developmental milestones. This information is essential when developing an appropriate patient care plan. 1.A normally developing child will typically be able to maintain independent sitting between six and seven months of age. This would be the closest age appropriate activity for the seven-month-old patient described.
A patient with a head injury frequently exhibits aggressive behavior, extreme fearfulness, and an absence of discernible motivation during the rehabilitation process. Involvement from which of the following would BEST explain this finding? 1.Limbic system 2.Peripheral nervous system 3.Somatic nervous system 4.Brainstem
1.Limbic system The limbic system is comprised of the corpus callosum, olfactory tract, mammillary bodies, fornix, thalamic nuclei, amygdala, hippocampus, parahippocampal gyrus, cingulate gyrus, and hypothalamic nuclei. 1.The limbic system lies within the brain and is involved in the control and expression of mood and emotion, processing and storage of recent memory, olfaction, control of appetite, and emotional responses to food.
A patient is referred to an aquatic exercise group for patients with chronic fatigue syndrome. The patient tells the therapist that she is eager to participate because she feels exercising in water will be much easier than it is on land. Which advice would be the MOST appropriate for the patient prior to beginning the first session? 1.Perform as many repetitions of each exercise as you can at your own pace 2.Perform as many repetitions of each exercise as you can keeping pace with the group 3.Perform all of the repetitions of each exercise at your own pace 4.Perform a minimum of half of the repetitions while keeping pace with the group
1.Perform as many repetitions of each exercise as you can at your own pace A physical therapist must recognize that in some circumstances a patient's enthusiasm to begin a new exercise regimen may result in symptom exacerbation. The therapist must therefore assist the patient to understand the anticipated effects of exercise while making sure their goals remain realistic. 1.A patient with chronic fatigue syndrome should be encouraged to participate in exercise at a comfortable pace and within a pain-free range. Regular rest breaks during activity allow muscle groups to recuperate, limiting the risk of overexertion.
A physical therapist works with a two-year-old patient with arthrogryposis multiplex congenita. During the examination the therapist decides not to utilize standardized developmental assessment tools. What is the MOST likely rationale for this decision? 1.Range of motion and strength limitations may preclude the patient from reaching developmental milestones 2.Decreased intelligence will not allow the patient to follow the necessary instructions to perform the activities within the assessment 3.Spasticity is typically too severe to perform the activities within the assessment 4.A significant risk for fractures with assessment activities that require mobility
1.Range of motion and strength limitations may preclude the patient from reaching developmental milestones An infant born with arthrogryposis multiplex congenita (AMC) will have multiple contractures and may have fibrous bands that developed in place of muscle. A patient with AMC should have a normal life expectancy and is typically of normal intelligence. 1.Standardized developmental assessment tools typically reflect poorly for patients with AMC since range of motion and strength limitations preclude the achievement of many motor milestones. Motor milestones are missed or skipped, but the patient is able to adapt in order to attain movement and functional mobility.
A physical therapist examines a patient's position sense by passively moving the patient's fourth digit up and down with their eyes closed. The patient is then required to inform the therapist how the digit was positioned (i.e., up or down). Assuming the patient does not possess position sense, what is the probability that the patient could answer the therapist's questions correctly on two consecutive trials? 1.10% 2.25% 3.50% 4.75%
2.25% When performing a sensory examination, the patient is often asked to choose between one of two possible choices (e.g., up or down, sharp or dull, yes or no). Because the patient has a good chance of guessing correctly on a single trial, it is important that the therapist perform several trials and administer the stimuli randomly to improve the accuracy of the test. The probability of the patient guessing correctly on two consecutive trials (i.e., up or down) would be 25% since 0.5 x 0.5 = 0.25 x 100 = 25%.
A 74-year-old female is referred to physical therapy with a diagnosis of osteoporosis. The medical chart indicates that the patient sustained a vertebral fracture at T11, which according to recent diagnostic imaging is now sufficiently healed. Assuming the patient has been cleared for an exercise program, which of the following exercises would be contraindicated? 1.Prone back extension 2.Abdominal curls 3.Knee extension with resistance 4.Step-ups
2.Abdominal curls The vertebral bodies, hips, ribs, radius, and femur are the most common fracture sites for patients with osteoporosis. Vertebral compression fractures present with symptoms of back pain, posture change, loss of height, and functional impairments. Spinal flexion exercises (e.g., abdominal curls) are contraindicated for patients with osteoporosis. Flexion of the spine results in compressive forces on the anterior portion of the vertebral bodies, which is where compression fractures most commonly occur.
A physical therapist treats a patient following a lower extremity amputation. The patient is currently one week post amputation and has a post-operative rigid dressing. Which of the following is NOT a benefit of the rigid dressing? 1.Limits the development of post-operative edema in the residual limb 2.Allows for daily wound inspection and dressing changes 3.Allows for earlier fitting of a definitive prosthesis 4.Allows for earlier ambulation with the attachment of a pylon and foot
2.Allows for daily wound inspection and dressing changes A rigid dressing, usually made from plaster of Paris or fiberglass, does not allow for wound inspection or dressing changes. The rigid dressing is applied in the operating room and remains on the residual limb approximately 7-14 days until the sutures are removed and proper shaping occurs. A rigid dressing does not allow for wound inspection and dressing changes since the rigid dressing remains on the residual limb for an extended period of time. An elastic bandage or a shrinker would be examples of soft dressings that allow for frequent wound inspection and dressing changes.
A note in the medical record indicates that a patient's wound is not healing properly secondary to wound desiccation. What would be the MOST appropriate intervention for this patient's wound? 1.Application of an alginate dressing 2.Application of a hydrogel dressing 3.Enzymatic debridement 4.Surgical closure with sutures
2.Application of a hydrogel dressing Wound desiccation, the drying out of wound tissues, is one of many factors that may impede healing of a wound. Other factors include infection, necrosis, dehiscence, maceration, and edema. Wounds that have desiccated tissues should be treated with specific dressings that will help restore the moisture level within the wound bed. Hydrogels are a group of wound dressings that can both provide moisture to dry wounds and absorb moisture from lightly exuding wounds. They are most commonly used on wounds that are dry and contain slough. The increase in moisture can help break down necrotic tissues and enhance the process of autolytic debridement.
A physical therapist examines a patient diagnosed with arteriosclerosis obliterans who has developed a lower extremity ulcer. Which of the following is MOST likely to be observed during the examination? 1.Dependent edema 2.Delayed capillary refill 3.Copious exudate 4.Rubor with elevation
2.Delayed capillary refill Arteriosclerosis obliterans is synonymous with arterial insufficiency and is associated with atherosclerotic disease. Wounds that develop as a result of decreased arterial perfusion are most commonly observed on the distal lower extremities around the ankles and over bony prominences such as the malleoli and tips of the toes. Capillary refill is typically assessed distally (e.g., tip of finger or toe). The narrowing of vessels associated with arteriosclerosis obliterans reduces perfusion to distal tissues subsequently delaying capillary refill when pressure is applied to blanch the tissue.
A physical therapist uses a tilt table with a patient who has been bedbound to acclimate the patient to vertical positioning. When using the tilt table, which of the following would NOT be considered a sign or symptom of intolerance to vertical positioning? 1.Hypotension 2.Elevated body temperature 3.Lower extremity edema 4.Dizziness
2.Elevated body temperature A tilt table can benefit patients who need physiological accommodation to upright positioning by slowly introducing them to a vertical position. Signs and symptoms associated with intolerance to upright positioning include excessive changes in blood pressure or heart rate, changes in consciousness, excessive sweating, lower extremity edema, a decrease or loss of the pedal pulses, numbness or tingling, changes in skin color, nausea, and vertigo. Elevated body temperature is not typically seen as an indicator of poor tolerance to vertical positioning. This sign would be more indicative of an infection or heat illness.
A physical therapist working in an outpatient physical therapy department receives a referral to treat a 10-year-old girl with excessive femoral anteversion. Upon assessing the patient's lower extremity range of motion, which of the following would the therapist MOST likely identify? 1.Increased hip lateral rotation 2.Increased hip medial rotation 3.Increased hip flexion and increased hip medial rotation 4.Increased hip extension and increased hip lateral rotation
2.Increased hip medial rotation Anteversion of the hip is measured by the angle formed between the femoral neck and femoral condyles. At birth, it is approximately 30 degrees, and decreases to 8-15 degrees by adulthood. A patient with excessive anteversion often displays "toeing-in" during gait. Because the hip rests in a medially rotated position with excessive anteversion, the patient will have increased medial rotation.
A patient diagnosed with cystic fibrosis ingests supplemental enzymes with meals and snacks each day to assist with the breakdown and absorption of fats and proteins. Impairment of which anatomical structure would MOST warrant the use of supplemental enzymes in this scenario? 1.Kidneys 2.Pancreas 3.Gallbladder 4.Jejunum
2.Pancreas Cystic fibrosis (CF) pathology results in an elevation of sodium chloride concentration, pancreatic enzyme deficiency, and overproduction of thick mucus and secretions that impede normal systemic functions. CF impacts multiple body systems, however, the respiratory and gastrointestinal systems are typically most affected by the disease process. The pancreas secretes numerous digestive enzymes (e.g., trypsin, chymotrypsin, lipase, amylase) which assist in the breakdown of fats, proteins, and carbohydrates in the gastrointestinal system facilitating absorption. Without enzymatic supplements, patients with pancreatic insufficiency due to CF are at a high risk for developing malabsorption conditions.
A physical therapist works with a patient diagnosed with anterior interosseous syndrome. While examining the patient, what activity would the therapist expect to be the MOST difficult for the patient to perform? 1.Wrist ulnar deviation with the thumb tucked inside a closed fist 2.Pinching together the tips of the index finger and thumb 3.Opposition 4.Resisted wrist extension with the elbow flexed to 90 degrees
2.Pinching together the tips of the index finger and thumb Anterior interosseous syndrome is characterized by an injury to the anterior interosseous nerve, a branch of the median nerve which is sometimes pinched or entrapped as it passes between the two heads of the pronator teres muscle. This leads to pain and functional impairment of the flexor pollicis longus, the lateral half of the flexor digitorum profundus, and the pronator quadratus muscles. Injury to the anterior interosseous nerve is commonly assessed by having the patient pinch together the tips of the index finger and thumb. Because the flexor pollicis longus is affected, a pinch deformity will be present. The distal interphalangeal joints of the fingers will extend instead of flexing. The resulting pinch is pulp-to-pulp instead of tip-to-tip.
A 32-year-old female presents with decreased joint play of the glenohumeral joint that is limiting her medial rotation range of motion. What is the MOST appropriate mobilization technique to improve the patient's glenohumeral medial rotation? 1.Caudal glide 2.Posterior glide 3.Anterior glide 4.Long axis distraction
2.Posterior glide The glenohumeral joint consists of a convex surface (humerus) moving on a concave surface (glenoid fossa). When a convex surface moves on a concave surface, the glide occurs in the direction opposite the movement of the segment. A posterior glide would be used to increase glenohumeral medial rotation. During medial rotation, the arm moves in an anterior direction while the convex joint surface moves in a posterior direction.
A 30-year-old female informs a therapist that she recently has experienced pain and a feeling of heaviness in her right upper extremity. The therapist notes temperature changes in the right arm and hand along with a positive Adson maneuver. Which of the following interventions would be the MOST appropriate for this patient? 1.Strengthening of the scapulothoracic muscles 2.Postural correction 3.Cervical traction 4.Shoulder immobilization
2.Postural correction Thoracic outlet syndrome is a condition that results from compression of the nerves and/or arteries that pass through the thoracic outlet. The thoracic outlet is the space between the first thoracic rib, the clavicle, and the superior border of the scapula. Thoracic outlet syndrome can occur secondary to postural changes of the head and neck, causing compression of the nerve fibers of the brachial plexus and the subclavian artery and vein. Symptoms can include tingling and numbness of the arm and forearm, pallor, coldness, and cyanosis in the fingers. Interventions should be focused on attention to posture, relieving inflammation, and muscle relaxation/stretching. 2.Thoracic outlet syndrome commonly occurs in people who maintain a forward flexed or stooped posture. As a result, postural corrections are often an extremely important intervention.
An 11-year-old competitive cheerleader sustains a grade III sprain of the anterior cruciate ligament during a failed stunt. Due to the patient's age, the orthopedic surgeon has recommended conservative management including physical therapy and activity restrictions. What is the MOST likely rationale for foregoing surgery and pursuing conservative management? 1.Non-compliance with post-operative activity restriction 2.Tibial growth plate disruption during surgery 3.Ligamentous healing without surgical intervention 4.Adjacent structure providing sufficient joint stability
2.Tibial growth plate disruption during surgery Anterior cruciate ligament (ACL) reconstruction is often deferred in adolescents until the tibial epiphysis closes and the patient reaches skeletal maturity. The risk of growth plate disruption during reconstructive ACL surgery is a significant factor considered with young athletes. Although conservative management may carry increased risk of injury to adjacent structures (e.g., MCL, meniscus) in the short term, growth plate disruption can lead to lifelong orthopedic deficits.
A patient diagnosed with fibromyalgia reports that her physician has prescribed a selective serotonin reuptake inhibitor to assist in managing her symptoms. This agent belongs to which pharmaceutical class? 1.Anticonvulsant 2.Alpha-2 adrenergic agonist 3.Antidepressant 4.Muscle relaxant
3.Antidepressant The use of antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), has been shown to be effective in managing many symptoms associated with fibromyalgia, even in patients without a psychiatric co-morbidity. Although typically associated with psychiatric management, antidepressant agents (e.g., amitriptyline, SSRIs) have been widely and effectively utilized to assist in reducing sleep disturbances and chronic pain complaints associated with fibromyalgia. SSRIs are classified as antidepressants.
A physical therapist treats a patient diagnosed with Guillain-Barre syndrome in an acute care hospital. Based on the condition's typical clinical presentation, what should the therapist anticipate that the patient will demonstrate? 1.Cognitive dysfunction 2.Hyperreflexia 3.Incoordination 4.Normal sensation
3.Incoordination Patients diagnosed with Guillain-Barre syndrome will typically present with muscle weakness, clumsiness, and dyskinesia.
Which hypertension category is MOST consistent with the patient's measured blood pressure value? 142/85 1.Elevated blood pressure 2.Stage 1 hypertension 3.Stage 2 hypertension 4.Hypertensive crisis
3.Stage 2 hypertension The American Heart Association and the American College of Cardiology established standards for high blood pressure. Blood pressure categorization according to the current criteria includes normal, elevated, stage 1 hypertension, stage 2 hypertension, and hypertensive crisis. 1.Elevated blood pressure is defined as systolic blood pressure of 120-129 mm Hg and diastolic blood pressure less than 80 mm Hg. 2.Stage 1 hypertension is defined as systolic blood pressure of 130-139 mm Hg or diastolic blood pressure of 80-89 mm Hg. 3.Stage 2 hypertension is defined as systolic blood pressure of at least 140 mm Hg or diastolic blood pressure of at least 90 mm Hg. 4.Hypertensive crisis is defined as systolic blood pressure greater than 180 mm Hg and/or diastolic blood pressure greater than 120 mm Hg.
A patient expresses to her therapist that despite exercise and a reasonable diet, she continues to gain weight, experiences muscle weakness, and frequently becomes fatigued. After listening to the patient, the therapist recommends that the patient make an appointment with her physician. Which medical condition is MOST consistent with the described clinical scenario? 1.Graves' disease 2.Crohn's disease 3.Addison's disease 4.Cushing's syndrome
4.Cushing's syndrome Cushing's syndrome is a form of hypercortisolism. Common symptoms include weight gain with abnormal adipose tissue distribution (e.g., "buffalo hump," central obesity disproportionate to upper extremity limbs), fatigue, and muscle weakness.
Computed tomography reveals that a patient admitted to the hospital two days ago sustained a stroke involving the left middle cerebral artery. Based on the identified area of involvement, which of the following would the patient LEAST likely demonstrate? 1.Apraxia 2.Aphasia 3.Right hemiparesis 4.Neglect
4.Neglect Patients status post stroke differ widely in their approach to processing information and in their behaviors depending on which hemisphere of the brain was affected. Individuals with left hemisphere damage demonstrate difficulties in communication and in processing information sequentially. They are often described as cautious, anxious, and disorganized and they tend to be realistic in the awareness of their problems. Neglect is the inability to register and integrate stimuli and perceptions from one side of the body or environment and is not due to sensory loss. This impairment is more common with right hemisphere damage.
A patient with a history of chronic supraspinatus tendonitis is diagnosed with a partial rotator cuff tear. The therapist is hopeful that additional tearing can be prevented by engaging in a formal physical therapy program. Which short-term goal is the MOST appropriate based on the therapist's stated objective? 1.Patient will demonstrate normal shoulder strength with manual muscle testing. 2.Patient will demonstrate full and pain-free active shoulder range of motion. 3.Patient will demonstrate pain-free shoulder mobility with overhead activities. 4.Patient will demonstrate normal scapular stability with reaching tasks.
4.Patient will demonstrate normal scapular stability with reaching tasks. Scapular stabilization during shoulder activity must be addressed early in order to support successful attainmentof the additional treatment goals. Without appropriate scapular stabilization, the patient will likely continue to experience humeral head elevation with reaching tasks. This action results in impingement symptoms and can result in additional tearing of the rotator cuff.
A physical therapist provides an inservice on the ability of a specific test to correctly identify individuals with balance deficits who are at risk for falling. The therapist's review of literature concluded that the test correctly identifies individuals with balance deficits that are at risk for falling 93% of the time. Which term is MOST consistent with the presented test information? 1.Internal consistency 2.Specificity 3.External validity 4.Sensitivity
4.Sensitivity Physical therapists must be aware of the relative strengths and weaknesses of specific outcome measures. An outcome measure with high sensitivity (i.e., 93%) allows the therapist to better understand the relevance of the obtained results. Sensitivity refers to the percentage of people who test positive for a specific disease or deficit among a group of people who have the disease or deficit.
A nurse notifies a physical therapist that a patient with respiratory acidosis has been placed on hold. Which of the following symptoms is LEAST likely based on this condition? 1.Dyspnea 2.Restlessness 3.Anxiety 4.Vomiting
4.Vomiting Respiratory acidosis is associated with a decrease in pulmonary ventilation which increases the concentration of carbon dioxide, hydrogen, and carbonic acid. Pathologies which may reduce pulmonary ventilation include damage to the medulla, obstruction of the airways (e.g., neoplasm, pneumonia, chronic obstructive pulmonary disease), loss of lung surface ventilation (e.g., pulmonary fibrosis, pneumothorax), weakness of the respiratory muscles (e.g., spinal cord injury, Guillain-Barre syndrome) or overdose of respiratory depressant drugs. Vomiting is a symptom more commonly associated with an acid-base imbalance (i.e., either acidosis or alkalosis) which is metabolic in origin.
A physical therapist prepares to measure the amount of femoral anteversion present in a patient referred to physical therapy. Which patient would the therapist expect to exhibit the GREATEST amount of anteversion? 1.A 42-year-old female status post anterior cruciate ligament reconstruction surgery 2.A 32-year-old male with trochanteric bursitis 3.A 9-year-old female with patella femoral syndrome 4.A 23-year-old male with anterior compartment syndrome
A 9-year-old female with patella femoral syndrome Anteversion of the hip is measured by the angle made by the femoral neck with the femoral condyles and is commonly assessed using Craig's test. At birth, the mean angle is approximately 30 degrees. In adults, the mean angle is 8-15 degrees. A 9-year-old female would have the greatest amount of anteversion. At this adolescent age the bones are still growing, so the amount of anteversion would not yet have reached adult values.
A physical therapist demonstrates various types of lifting techniques for a patient participating in a work hardening program. What should the therapist incorporate when using a power lift technique? 1.A partial squat maintaining a lumbar lordosis and anterior pelvic tilt 2.A squat or stoop using a posterior pelvic tilt to flatten the low back 3.A stance using just one leg, similar to a golfer who is picking up a golf ball 4.A stance with trunk flexion while maintaining straight legs
A partial squat maintaining a lumbar lordosis and anterior pelvic tilt Explanation There are a variety of lifting methods, all of which focus on the position of the lumbar spine and how it is maintained throughout the lift. The lumbar spine is prone to injury during lifting activities, making proper instruction on lumbar spine position of primary importance. 1.With a power lift, the patient performs only a partial squat, with the hips remaining above the level of the knees. The patient should maintain the lumbar spine in lordosis with a slight anterior pelvic tilt.
A physical therapist attempts to assess the integrity of the olfactory nerve by asking a patient to identify a familiar object by smell. Which testing procedure would be the MOST appropriate? 1.Assess both nostrils simultaneously with the patient's eyes open 2.Assess one nostril at a time with the patient's eyes open 3.Assess both nostrils simultaneously with the patient's eyes closed 4.Assess one nostril at a time with the patient's eyes closed
Assess one nostril at a time with the patient's eyes closed There are 12 pairs of cranial nerves, all of which carry sensory information, motor information or both. An examination of the cranial nerves should be performed with suspected lesions of the brain, brainstem, and cervical spine. Cranial nerve I is the olfactory nerve which is responsible for the sensation of smell. To test the integrity of the olfactory nerve, the therapist should assess one nostril at a time while the patient's eyes are closed.
A patient diagnosed with myogenous temporomandibular pain is referred to physical therapy by an oral surgeon. Which of the following conditions is MOST likely associated with the patient's diagnosis? 1.Otitis 2.Bruxism 3.Epistaxis 4.Subluxation
Bruxism Temporomandibular joint dysfunction (TMD) is typically characterized as either myogenous (e.g., muscle spasm or trauma) or arthrogenous (e.g., degeneration, chronic dislocations) depending on the underlying pathology. Bruxism is a clinical term referring to an unconscious clenching or grinding of the teeth. This action produces additional stress within the muscles of mastication which may manifest as pain, fatigue, and spasm. Bruxism is a common condition associated with myogenous TMD.
A patient comes into an outpatient clinic for his physical therapy appointment reporting jaw pain and shortness of breath that came on suddenly and has not resolved. The therapist notices that the patient is diaphoretic. What is the MOST appropriate physical therapist action? 1.Continue with treatment 2.Assess the patient's vital signs 3.Contact the referring physician 4.Call 911
Call 911 Jaw pain, shortness of breath, dizziness, lightheadedness, diaphoresis, and nausea are commonly associated with angina and may be indicative of cardiac tissue ischemia. Ischemia occurs when myocardial oxygen demand is greater than supply. If ischemia is not medically managed in a timely manner, injury to the myocardial tissue will lead to infarction or heart attack. The symptoms the patient is presenting with are consistent with cardiac ischemia and would be considered a medical emergency. Calling 911 has the greatest potential to minimize cardiac tissue injury and prevent infarction.
A patient being treated for a right lower extremity venous stasis ulcer arrives for an outpatient visit complaining of a fever. While removing the wound dressing, the therapist discovers partially healed cat scratches and warm, bright red skin on the patient's right foot and ankle. Which diagnosis is MOST likely responsible for the patient's new symptoms? 1.Contact dermatitis 2.Deep vein thrombosis 3.Cellulitis 4.Wound infection
Cellulitis Cellulitis typically presents unilaterally as a diffuse area of bright red, warm skin often accompanied by a fever and localized tenderness. Medical attention is necessary for confirmation of the diagnosis and appropriate antibiotic intervention. Cellulitis is a bacterial infection of the skin that typically occurs following a break in the skin (e.g., scratch, puncture, insect bite). Symptoms include localized skin warmth, tenderness, and marked redness often accompanied by fever. Patients with venous insufficiency and lymphedema are particularly susceptible to cellulitis and should be educated regarding risk reduction practices. Medical attention is necessary as antibiotic treatment is required to resolve the infection.
A physical therapist examines a 22-year-old patient with cystic fibrosis. The patient was admitted to the hospital after experiencing an acute pulmonary exacerbation. Which scenario would allow the therapist to administer percussion? 1.Untreated pneumothorax 2.Hemoptysis occurring 12 hours ago 3.Chest tube inserted in the right lateral thorax 4.Platelet count of 15,000 per mm3
Chest tube inserted in the right lateral thorax Percussion refers to a rhythmical clapping with a cupped hand applied over an affected lung segment. Percussion is used to loosen retained secretions. A chest tube is not a contraindication to percussion. The therapist can safely percuss around the chest tube, avoiding any tender areas near the tube's insertion. Also, a patient with cystic fibrosis is likely to benefit from percussion to areas of the chest not near the tube in order to treat all affected lobes of the lungs.
A physical therapist treats a 22-year-old male athlete rehabilitating from shoulder surgery. As part of the patient's treatment plan the therapist utilizes a proprioceptive neuromuscular facilitation (PNF) pattern that incorporates shoulder flexion, abduction, and lateral rotation. Which PNF pattern is MOST consistent with the described intervention? 1.D1 flexion 2.D1 extension 3.D2 flexion 4.D2 extension
D2 flexion Proprioceptive neuromuscular facilitation (PNF) is a therapeutic exercise approach which combines functional patterns of movement with techniques of neuromuscular facilitation to elicit motor responses. There are four patterns of movement for both the upper extremity and lower extremity. D2 flexion is characterized by shoulder flexion, abduction, and lateral rotation.
A physical therapist prepares to examine a patient recently admitted to the hospital after sustaining burns over approximately 30 percent of their total body surface area. Which systemic effect would be LEAST likely based on the patient's current status? 1.Release of histamine and bradykinin 2.Development of a hypometabolic state 3.Increase in capillary permeability 4.Peripheral and splanchnic vasoconstriction
Development of a hypometabolic state The release of cytokines and other inflammatory mediators at the affected burn site results in specific systemic effects when burns reach more than 25 percent of the total body surface area. A hypometabolic state would not be associated with the described burn. The basal metabolic rate can increase up to three times its original rate with a severe burn. Burn hypermetabolism causes increased oxygen consumption, negative nitrogen and potassium balance, excessive muscle wasting, glucose intolerance, sodium retention, and peripheral leukocytosis.
A patient attempts to turn a wheelchair on a landing area connecting two separate sections of a ramp. What are the minimum dimensions of the landing area according to the Americans with Disabilities Act? 1.Three feet by three feet 2.Four feet by four feet 3.Five feet by five feet 4.Six feet by six feet
Five feet by five feet The Americans with Disabilities Act establishes minimum criteria for ramps in order to ensure that individuals in wheelchairs can safely traverse the ramp. A landing area on a ramp refers to the level surface connecting two unique sections of the ramp. The area must be sufficient in size to allow the patient to rest on a level surface and successfully turn the wheelchair. A landing area that is five feet by five feet is the specified minimum size of a landing area according to the Americans with Disabilities Act. A landing area is required with any ramp that has more than 30 consecutive feet of horizontal run.
A 40-year-old male diagnosed with ankylosing spondylitis is referred to physical therapy. What is the LEAST appropriate intervention to incorporate into the patient's plan of care? 1.Extension exercises 2.Flexion exercises 3.Aquatic therapy 4.Aerobic exercise
Flexion exercises Ankylosing spondylitis (AS) is a systemic condition that is characterized by inflammation of the spine and larger peripheral joints. The chronic inflammation causes destruction of the ligamentous-osseous junction with subsequent fibrosis and ossification. Symptoms of AS can include current and insidious episodes of low back pain, morning stiffness, impaired spinal extension, and limited range of motion. Flexion exercises are typically contraindicated in the treatment of AS. Physical therapy intervention should include postural exercises emphasizing extension, general range of motion, pain management, and energy conservation techniques.
A physical therapist reviews the results of pulmonary function testing obtained from a patient with a restrictive lung disease. Which value would be LEAST affected based on the patient's medical condition? 1.Residual volume (RV) 2.Total lung capacity (TLC) 3.Forced vital capacity (FVC) 4.Forced expiratory volume in one second/forced vital capacity (FEV1/FVC)
Forced expiratory volume in one second/forced vital capacity (FEV1/FVC) Restrictive lung disease refers to a classification of disorders caused by a pulmonary or extrapulmonary restriction that produces impairment in lung expansion and an abnormal reduction in pulmonary ventilation. Pathogenesis includes a decrease in lung and chest wall compliance, a decrease in lung volumes, and an increase in the work of breathing. Forced expiratory volume in one second (FEV1) refers to the maximum volume of air exhaled in one second. The ratio between FEV1 and FVC volumes is often calculated to assist in determining the severity of a patient's lung condition. The ratio is commonly expressed as a percentage ((FEV1/FVC) * 100). The FEV1/FVC ratio remains relatively unchanged in a restrictive lung disease since FEV1 is not affected to the same extent as it is in obstructive lung disease. In obstructive lung disease, the FEV1/FVC ratio is diminished since the FEV1 is significantly reduced while the FVC remains normal or near normal.
A physical therapist examines a patient's dehisced surgical wound and determines that the patient would benefit from a dressing with antimicrobial properties. The therapist contemplates using cadexomer iodine powder or silver alginate dressings since both have the desired antimicrobial benefits. However, after reviewing the patient's medical record, the therapist elects to use silver alginate. Which medical diagnosis would be MOST likely to have influenced the therapist's decision? 1.Addison's disease 2.Graves' disease 3.Crohn's disease 4.Paget's disease
Graves' disease A physical therapist must be aware of a patient's medical history and potential contraindications in order to select the most appropriate interventions. Cadexomer iodine has absorptive and antimicrobial properties similar to silver alginate dressings and is available in a variety of forms. Graves' disease is the most common form of hyperthyroidism. Because of iodine's role in the thyroid's hormone production, the use of wound care products containing iodine are generally contraindicated for persons with thyroid disorders.
A physical therapist working in the neonatal intensive care unit reads the medical record of an infant born prematurely at 28-weeks gestation. The infant's APGAR scores for the first and fifth minutes are 1 and 3 respectively. What does the APGAR scale measure? 1.Heart rate, respiratory effort, muscle tone, reflex irritability, and color 2.Heart rate, respiratory effort, crying, muscle tone, and body weight 3.Appearance, heart rate, respiratory effort, eye opening, reflex irritability 4.Heart rate, crying, eye opening, body weight, and grasp reflex
Heart rate, respiratory effort, muscle tone, reflex irritability, and color The APGAR scale is a scoring system used to evaluate the physical condition of newborn infants after delivery. Each of the five signs is scored on a 0-2 scale for a total possible score of 10 points. Scores are usually reported in the first and fifth minutes after delivery. A score of 8-10 is considered normal and the infant does not require resuscitation. 1.The APGAR scale evaluates the infant according to appearance (color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration (respiratory effort).
A physical therapist treats a patient diagnosed with multiple sclerosis using Frenkel's exercises. What is the PRIMARY purpose of this intervention? 1.Improve endurance 2.Improve strength 3.Improve coordination 4.Improve flexibility
Improve coordination Symptoms of multiple sclerosis vary based on the type of disease, location, extent of demyelination, and degree of sclerosis. Initial symptoms include visual problems, paresthesias, sensory changes, clumsiness, weakness, ataxia, balance dysfunction, and fatigue Decreased coordination is a common finding in patients with multiple sclerosis. Frenkel's exercises, originally designed for sensory ataxia, are commonly used in the treatment of multiple sclerosis. The exercises consist of a series of gradual progressive activities designed to increase coordination. Frenkel's exercises require a high degree of mental concentration and effort. If successful, they allow for regaining control of movement through cognitive compensatory strategies.
A patient reports that sleeping on his stomach reduces his lower extremity sciatic radicular pain complaints, but makes his lower back more uncomfortable. What is the MOST likely etiology of the patient's sciatic radiculopathy? 1.Piriformis tightness 2.L5 disk herniation 3.Lumbar spinal stenosis 4.Spondylolisthesis
L5 disk herniation Often when seeking a position of comfort, a patient may inadvertently assume a truly therapeutic position. The physical therapist should recognize that the patient's pain centralizes in prone positioning indicating that an extension progression may be a beneficial component of the plan of care. An L5 disk herniation may produce sciatic pain symptoms. Prone positioning often results in decreased radicular complaints and increased centralization of discomfort.
An elderly resident of an assisted living facility's memory impairment wing repeatedly folds baskets of clean laundry each day. What is the PRIMARY purpose of the resident engaging in the described task? 1.Maintaining the resident's fine motor skills 2.Maintaining the resident's sense of purposefulness 3.Challenging the resident's cognition by learning new skills 4.Keeping the resident's attention in order to allow staff to attend to other duties
Maintaining the resident's sense of purposefulness The performance of familiar repetitive tasks can be effective in assisting a patient with dementia to maintain a sense of purpose and has been shown to reduce agitation and restlessness. Staff should consider the individual's personal history in order to select tasks that are routine and relevant for each patient.
A patient with restrictive lung disease undergoes a pulmonary function test in which a decrease in total lung capacity is confirmed. Which additional finding is MOST likely associated with restrictive lung disease? 1.Normal FEV1 and decreased FVC volumes 2.Increased FEV1 and normal FVC volumes 3.Increased FEV1 and increased FVC volumes 4.Decreased FEV1 and normal FVC volumes
Normal FEV1 and decreased FVC volumes The ratio between FEV1 and FVC volumes is often calculated to assist in determining the severity of a patient's lung condition. The ratio is commonly expressed as a percentage ((FEV1 / FVC) * 100). A ratio calculated as 70% or greater is considered normal with lower percentages typically indicative of obstructive conditions. The ratio typically remains normal with restrictive conditions. 1.Restrictive lung conditions typically present with normal FEV1 and decreased FVC volumes as a function of decreased total lung capacity (TLC).
A physical therapist works with a patient diagnosed with an advanced obstructive pulmonary disease. Which volume or capacity would be LEAST affected based on the patient's diagnosis? 1.Functional residual capacity 2.Residual volume 3.Tidal volume 4.Total lung capacity
Obstructive pulmonary disease refers to a group of lung diseases that block airflow due to narrowing of the bronchial tree. Examples of obstructive pulmonary disease include asthma, chronic bronchitis, and emphysema. Patients with obstructive pulmonary disease have an increased total lung capacity with a significant increase in residual volume. Tidal volume refers to the total volume inspired and expired with each breath during quiet breathing. Tidal volume is minimally impacted with an obstructive pulmonary disease and remains approximately 10% of total lung volume.
A physical therapist provides a six-year-old child with a sticker at the end of each physical therapy session if the child completes her exercise program without complaining that she wants to go home. Which of the following BEST describes this type of action? 1.Operant conditioning 2.Classical conditioning 3.Maslow's hierarchy of needs 4.Procedural learning
Operant conditioning Operant conditioning is an example of associative learning where the learner gains an understanding of the relationship between two stimuli, causal relationships or stimulus and consequence. 1.Operant conditioning is a process where learning occurs when an individual engages in specific behaviors (e.g., failing to complain about wanting to go home) in order to receive certain consequences (e.g., sticker). Examples of specific operant conditioning techniques include positive reinforcement, negative reinforcement, extinction, and punishment.
A physical therapist uses a goniometer to measure range of motion at the thumb. When measuring carpometacarpal abduction, where should the fulcrum of the goniometer be positioned? 1.Over the lateral aspect of the radial styloid process 2.Over the palmar aspect of the first carpometacarpal joint 3.Over the dorsal aspect of the first metacarpophalangeal joint 4.Over the dorsal midline of the proximal phalanx
Over the lateral aspect of the radial styloid process
A physical therapist uses a goniometer to measure range of motion at the thumb. When measuring carpometacarpal abduction, where should the fulcrum of the goniometer be positioned? 1.Over the lateral aspect of the radial styloid process 2.Over the palmar aspect of the first carpometacarpal joint 3.Over the dorsal aspect of the first metacarpophalangeal joint 4.Over the dorsal midline of the proximal phalanx
Over the lateral aspect of the radial styloid process Carpometacarpal abduction and adduction of the thumb occur in the sagittal plane around a medial-lateral axis. To measure this motion, the patient should have their forearm and hand supported on a surface with the forearm midway between pronation and supination. 1.The fulcrum for measuring carpometacarpal abduction is over the lateral aspect of the radial styloid process.
A physical therapist reviews an imaging report obtained from a chest radiograph. When observing the lung fields, which condition would typically result in the LEAST density? 1.Hemothorax 2.Pleural effusion 3.Pneumothorax 4.Pneumonia
Pneumothorax The standard chest radiograph is taken as a posteroanterior (PA) view and a left lateral view with the patient in standing. The chest radiograph can be used to assess the trachea, lungs, heart, mediastinum, and bones. Pneumothorax refers to a collapsed lung caused by air leaking into the space between the lungs and chest wall. The buildup of pressure caused by the air places pressure on the lung causing it to collapse. The collapse results in a less dense empty space in the chest cavity.
A patient confides in their physical therapist that while taking a prescribed sedative they would often consume alcohol. What effect BEST describes the interaction of these two agents? 1.Antagonistic 2.Synergistic 3.Catalyst 4.Toxic
Synergistic The effectiveness of a drug is often altered when it is taken in combination with other drugs. Physical therapists must be aware for the potential for these drug-drug interactions in order to safely and effectively care for patients. A synergistic interaction causes an increase in the effects of one or both of the drugs. Taking a sedative while also drinking alcohol may result in excessive central nervous system depression.
A patient recovering from total hip arthroplasty has Medicare coverage for their insurance. Which portion of this patient's care would MOST likely be covered under Medicare Part B? 1.Inpatient stay at the hospital 2.Prescription medications 3.Therapy at a skilled nursing facility 4.Therapy at the hospital outpatient clinic
Therapy at the hospital outpatient clinic Medicare Part B covers the costs for outpatient services, physician services, preventive services, and medical equipment. Therapy received at an outpatient clinic, even if it is a hospital clinic, would be covered under Medicare Part B.
A physical therapist evaluates a patient that exhibits balance deficits during gait. The therapist elects to use a functional balance test to formally assess the patient's balance. What would be the MOST appropriate assessment to utilize? 1.Dix-Hallpike Test 2.Timed Get Up and Go Test 3.Functional Reach Test 4.Tinetti Performance Oriented Mobility Assessment
Tinetti Performance Oriented Mobility Assessment The Tinetti Performance Oriented Mobility Assessment is a comprehensive assessment tool that has high intertester reliability of 85% and excellent sensitivity of 93% for patients that are at risk for fall. The Tinetti Performance Oriented Mobility Assessment measures balance and gait using an ordinal scale of 0-2. The test has a total possible score of 28. Patients scoring less than 19 are considered to be at high risk for falling.
