questions I missed on exam PT - test 1
Reflex Grades Include
0- No response 1+- Sluggish or diminished 2+- Active or expected response 3+- More brisk than expected, slightly hyperactive 4+- Brisk and hyperactive with intermittent or transient clonus *Normal older adult with diminished reflexes. *Pt with alcohol, cocaine, or opioid intoxication present with hyperactive.
APGAR score interpretation
0-3: requires resuscitation 4-6: likely requires resuscitation 7-10: normal
lobectomy
removal of a lobe of a lung
sleeve lobectomy
removal of entire lobe and part of bronchus
Empty Can Test
flexion and internal rotation of the shoulder followed by resistance to observe for weakening of the supraspinatus muscle
learn these
glascow coma scale
Hematocrit levels
males 42%-52%; females 37%-47%
Venous partial pressure of oxygen
40 mmHg
.
MS
Crossover Test
- tests acromioclavicular joint - have patient adduct the arm across the chest - pain is a positive test - indicates inflammation or arthritis of the acromioclavicular joint
Infant CPR
1 1/2 inches deep, 100 compressions/minute, 30 compressions & 2 breaths (one-rescuer), 15 chest compressions & 2 breaths (2-rescuer).
adult cpr guidelines
2 hands on sternum, compress 1 1/2 inches-2inches, 30-2 compression to breaths rate, 5 cycles in 2 minutes.
Hemoglobin A1c
4-6% = good glucose control
Venous partial pressure of CO2
46 mmHg
WBC count
5,000-10,000
Correct Answer is 3 Answer Explanation Osgood-Schlatter disease is characterized by a painful bump over the tibial tubercle and pain with sporting activities. This is most common in young children who are very active in sports, particularly males. Hertling D, Kessler RM. Knee. In Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders. 4th Ed. Philadelphia: JB Lippincott; 2006: 487-558.
A 12 year old male athlete is being evaluated by a physical therapist. The patient reports pain with running and has a sharp pain over the patellar tendon, particularly on the tibial tubercle. Which of the following disorders is MOST likely present? 1) Legg-Calvé-Perthes' disease 2) Chondromalacia patellae 3) Osgood-Schlatter disease 4) Pes anserine bursitis
Correct Answer is 2 Answer Explanation The hypomobility is noted at C6 with right side-gliding and pain with left SB and rotation, indicating a closing restriction at the left C5-6 facet joint. Thus, interventions would require assistance with closing (approximation). Neumann DA. Axial Skeleton: Osteology and Arthrology. In Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd Ed. St. Louis, Missouri: Mosby Elsevier; 2010.
A 21-year-old female patient presents with neck pain and stiffness that has gradually worsened over the last two weeks. Upon examination, the patient is noted to have pain with left side bending with left rotation and reports pain on the left at the C5-6 junction. Hypomobility is also noted with right side-gliding of C6. Which of the following techniques will be most appropriate to decrease pain? 1) Closing technique for the mid-thoracic spine. 2) Closing manipulation in extension for C5-C6 3) Gapping manipulation in flexion for C5-C6. 4) Flexion/opening manipulation for mid-thoracic spine
Answer: D Rationale: Ankylosing spondylitis is a rheumatic disease characterized by chronic inflammation of ligaments in the lumbar spine, sacroiliac joint, thoracic spine, and shoulders that usually occur in the teenage years and 20's. Radiographs will show a bamboo spine. Reference: Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 6th ed. Philadelphia: F.A. Davis Co; 2012; Page 446
A 22 year old patient complains of a gradual onset of thoracic and sacroiliac pain. Lumbar ROM is limited to 50%. Patient reports his stiffness is worse in the morning and gradually improves. He recently started a new job at Comcast and has been sitting for long periods of time. Which of the following would you MOST likely suspect? Spinal tumor Thoracic hypomobility Pectoral muscle adaptive shortening Ankylosing spondylitis
Answer: mallet finger Rationale: Option A: There is flexion at the carpometacarpal joint and hyperextension at the metacarpophalangeal joint. The deformity is associated with rheumatoid arthritis and is usually seen in the thumb. Option B - A mallet finger deformity is the result of a rupture or avulsion of the extensor tendon where it inserts into the distal phalanx of the finger. The distal phalanx rests in a flexed position option D: This deformity is the result of a thickening of the flexor tendon sheath (Notta's nodule), which causes sticking of the tendon when the patient attempts to flex the finger. Option C: This deformity results from the loss of intrinsic muscle action and the overaction of the extrinsic (long) extensor muscles on the proximal phalanx of the fingers. The metacarpophalangeal joints are hyperextended, and the proximal and distal interphalangeal joints are flexed. Reference: Magee DJ. Orthopedic Physical Assessment. Sixth ed. St. Louis, Mo: Elsevier Saunders; 2014; 436-440
A 24 y.o. male was training for baseball and hurt his finger while trying to catch the ball. He experienced a sudden sharp pain in his finger, and his finger was swollen immediately. He finished his training and went to the ER with the following presentation. Which of the following deformities does this patient MOST LIKELY have? Zig-Zag deformity Mallet finger deformity Claw finger deformity Trigger finger deformity
Correct Answer is 2 Answer Explanation Worsening with overhead activity and rotator cuff weakness are both important signs of secondary impingement.
A 38-year-old patient reports developing shoulder pain over the last 3 months that is exacerbated by overhead activities. The patient displays poor posture and has rotator cuff musculature that is 25% weaker on the involved upper extremity. Which of the following is MOST likely the source of thepain? 1) Primary impingement 2) Secondary impingement 3) Biceps tendinopathy 4) Anterior capsule instability
Correct Answer is 2 Answer Explanation 1. Arterial ulcers can develop in peripheral arterial disease due to ischemia. 2. Dependent edema occurs from venous insufficiency, not arterial insufficiency. The patient's symptoms of shiny, hairless skin and cramping in his calves are characteristic of peripheral arterial disease. 3. Diminished pulses in the lower extremities is characteristic of arterial occlusion. 4. Occlusion of arteries in peripheral arterial disease can result in gangrene. Goodman, C. C., & Fuller, K. S. (2009). Pathology: Implications for the physical therapist (pp. 617-619). St. Louis: Saunders Elsevier.
A 55-year-old male presents with shiny, hairless skin on bilateral lower extremities and complains of calf pain with standing and walking. Which of the following additional symptoms is this patient LEAST likely to present with? 1) Arterial ulcers 2) Dependent edema 3) Diminished pulses 4) Gangrene
Answer: Heberdens Nodules Rationale: The patient's age and symptoms indicate OA. Nodules on the DIP are called Heberden's nodules and nodules on the PIP are called Bouchard nodules. Absence of systemic systems and morning stiffness lasting less than sixty minutes rule out rheumatoid arthritis, and thus rule out rheumatoid nodules. With neurofibromatosis, the nodules would not be restricted to the DIP joints.
A 59-year old teacher who is right hand dominant complains of stiffness in the neck and right hand (especially in the 1st CMC) upon waking in the morning. It subsides within thirty minutes as she moves around the house and performs some household chores. There is no associated history of other systemic symptoms, although she has noticed some bumps on her DIP joint. The presence of outgrowths can be documented as which of the following? Heberden's nodules Rheumatoid nodules Bouchard's nodules Neurofibromatosis
Answer: B Rationale: Apical and Posterior segments of the upper lobes can be drained in the sitting position. Anterior segment is drained in supine. Superior segment is drained in prone. R middle lobe is drained in the side lying position.
A 62 year old male with a 20 year history of smoking, DM II, HTN stage 1 and COPD presents with cough and expectoration. On auscultation the therapist finds presence of crepitus. Which of the following lobes can be drained MOST EFFICIENTLY in the sitting position? - R Apical Segments of Upper lobe and R Superior Segments of Lower lobes - L Apical Segment of Upper lobe and R Posterior Segment of Upper lobes - L Apical Segment of Upper lobe and R Middle lobe - R Apical segment of Upper lobe and R Anterior segment of Upper lobe
Correct Answer is 2 Answer Explanation ABI values less than 0.90 indicate PAD. 1 is a normal reading. 3 is a sign of metabolic/respiratory acidosis. 4 is a sign of metabolic/respiratory alkalosis.
A patient being treated by a physical therapist has peripheral artery disease. Which of the following values would be MOST indicative of this condition? 1) Ankle-Brachial Index greater than 1.00 2) Ankle-Brachial Index less than 0.90 3) Blood pH lower than 7.35 4) Blood pH greater than 7.45
Correct Answer is 3 Answer Explanation 1 Mitral valve prolapse is most commonly associated with a triad of symptoms that include dyspnea, profound fatigue not correlated with exercise or stress, and palpitations. 2. Mitral valve prolapse is most commonly associated with a triad of symptoms that include dyspnea, profound fatigue not correlated with exercise or stress, and palpitations. 3. Orthopnea, shortness of breath when lying down, is characteristic of congestive heart failure and obstructive sleep apnea. 4. Mitral valve prolapse is most commonly associated with a triad of symptoms that include dyspnea, profound fatigue not correlated with exercise or stress, and palpitations. Goodman, C. C., & Fuller, K. S. (2009). Pathology: Implications for the physical therapist (pp. 597). St. Louis: Saunders Elsevier.
A 63-year-old female complains of chest muscle spasms and intermittent sternal pain that last several seconds and is sharp in nature. She reports that these symptoms occur frequently for a few weeks at a time and then disappear completely but return several weeks later. Upon auscultation of the heart, the physical therapist can hear a "murmur." Based on the clinical findings, which of the following symptoms would this patient LEAST likely report? 1) Dyspnea 2) Fatigue 3) Orthopnea 4) Palpitations
Correct Answer is 2 Answer Explanation The patient in the scenario presents with signs and symptoms consistent with vascular intermittent claudication. An ABI of 0.94-0.75 is indicative of mild arterial disease and intermittent claudication. O'Sullivan, S. B., & Schmitz, T. J. (2007). Physical rehabilitation (6th ed. Pp 932-934). Philadelphia, PA: F.A. Davis.
A 63-year-old male patient presents with complaints of burning bilateral leg pain and cramping. The pain improves with rest and worsens with leg elevation and walking more than 10 minutes at a time. His symptoms do not change with trunk or pelvis movement. Which of the following examination findings is the therapist MOST likely to observe during his physical examination? 1) 2+ dorsal pedal pulse bilaterally 2) Ankle-brachial index (ABI) of 0.80 3) Ankle-brachial index (ABI) of 1.1 4) Positive Homan's sign
Answer A Rationale: Due to peripheral neuropathy, this patient is more dependent on their vision and vestibular systems. Patients depending on vision become unstable in conditions 2, 3, 5 & 6 where we either close the eyes, or have a conflict between vision and the vestibular system. With conditions 1 and 4, the patient will have the opportunity to rely on the visual system and maintain balance.
A 65 year old patient with diabetic neuropathy presents to the clinic with a complaint of frequent falls especially at night. Which of the following conditions of the Sensory Organization Test is this patient MOST LIKELY to score poorly? (view) Conditions 5 and 6 Conditions 1 and 3 Conditions 2 and 4 Conditions 4 and 6
Correct Answer is 4 Answer Explanation The activity should be terminated as the patient is showing an inappropriate exercise response. Some other inappropriate responses could be; persistent dyspnea, dizziness or confusion, pain, excessive fatigue, ataxia, pulmonary rales. O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. D Heart disease In Physical Rehabilitation (5th ed., p.599 ). Philadelphia, PA: F. A. Davis.
A 69-year-old female, who is being seen in cardiac rehab phase II, is completing exercise on the treadmill. After 3 mins of graded activity, she begins to demonstrate pallor, sweating and increased calf pain. What should the therapist do NEXT? 1) Check oxygen saturations 2) Continue 3) Reduce the workload 4) Stop activity
Correct Answer is 1 Answer Explanation This patient is status post mitral valve replacement, which requires median sternotomy precautions for 4-6 weeks post-operative. The correct answer describes in detail median sternotomy precautions, which is the most important plan of care consideration. Lescher, P.J. Pathology for the Physical Therapy Assistant. 1st Ed. Philadelphia, PA: F.A. Davis; 2011:105-106.
A 70 year-old male patient status post Mitral Valve Replacement 3 weeks ago. The patient will be participating in physical therapy today for the first time. Which of the following is the most important to consider when developing the patient's plan of care? 1) Ensuring the patient avoids overhead shoulder flexion/abduction, scapular retraction, pushing/pulling over 10 lbs, excessive coughing, and driving 2) Medication check prior to therapeutic exercises 3) Monitoring blood pressure before, during, and after exercise 4) Observation of patient's gait for fall risk
Answer: Posterior glide Rationale: The shoulder joint follows the concave-convex rule. The convex humerus moves on the concave glenoid fossa. To be able to reach the back of the pant on the opposite side, the IR range has to be improved. Thus, posterior glide of the GH joint is appropriate. Anterior glide is used to increase extension or ER ROM. Caudal glide of GH is used to increase abduction of the GH joint.
A patient complains of the inability to slip the belt through the belt loops at the back of his pants. He is unable to reach his right hand to the left side on the back to complete the task. Which of the following mobilization techniques would be MOST APPROPRIATE to complete this task? Glenohumeral anterior glide Glenohumeral posterior glide Glenohumeral caudal glide Glenohumeral superior glide
Answer: D Rationale: L2-L3 nerve compression leads to weak hip flexors. Hence excessive hip flexion will not be seen at the initial and mid-swing phase of the gait cycle. Options A: Hip flexion is passively generated by a backward movement of the trunk Option B: Abdominals are used during initial swing to advance the swing leg Option C: Semicircular movement combining hip flexion, hip abduction, and forward rotation of the pelvis to compensate for hip flexor weakness.
A PT is assessing a patient with a chief complaint of low back pain and a diagnosis of L2-L3 nerve compression. Which of the following gait deviations at the hip and pelvis are NOT to be expected in this patient? - Trunk lurches backward and toward the unaffected stance leg from heel off to mid swing - Posterior tilt of the pelvis during initial swing - Semicircle movement of the hip during swing—combining hip flexion, hip abduction and forward rotation of the pelvis - Excessive hip flexion at initial and mid swing
Answer: 40.5% Rationale: According to rule of nines: anterior chest and trunk= 18%, right arm anteriorly= 4.5%, anterior legs= 9%+9%= 18%
A fireman was brought to the ER with burns on his anterior chest and trunk, anterior right arm, and bilateral anterior legs. Which of the following accurately describes the area of distribution of the burn? 20.5% 40.5% 36% 54%
Correct Answer is 4 Answer Explanation A low hematocrit will likely lead to lightheadedness and will interfere with physical therapy intervention. No exercise is permitted with HCT < 25%. The other values are normal or borderline normal.
A male patient in the intensive care unit is being treated for multiple trauma injuries after a motor vehicle accident. A physical therapist is reviewing the most recent lab results. Which of the following would be the GREATEST indication to postpone therapeutic exercise until consulting with the attending physician? 1) Venous partial pressure O2 40 mmHg 2) Hemoglobin A1C 5.1 % 3) White Blood Cell Count 10,000 cells/mL 4) Hematocrit 22%
Correct Answer is 4 Answer Explanation Bullae are air pockets in the lung that form from tissue destruction as a result of cancer, COPD, emphysema, etc.
A patient has just undergone a procedure to remove an air pocket from the lung that has resulted from several years of COPD. What is the term for this type of procedure? 1) Lobectomy 2) Pneumonectomy 3) Sleeve lobectomy 4) Bullectomy
Correct Answer is 1 Answer Explanation Left sided heart failure leads to swelling in the lungs as the blood "backs up." Anasarca is generalized swelling and is a symptom of right-sided heart failure. Ascites is abdominal swelling and is a symptom of right-sided heart failure. Hepatomegaly is a symptom of right-sided heart failure.
A patient in the intensive care unit is receiving treatment for heart failure. Which of the following characteristics is MOST indicative of left-sided heart failure? 1) Dyspnea 2) Anasarca 3) Ascites 4) Hepatomegaly
Correct Answer is 3 Answer Explanation "1. Avoid sustained tight gripping - incorrect answer, this is a part of the American Association of Cardiovascular and Pulmonary Rehabilitation's (AACVPR) accepted guidelines for resistance training. 2. Exercise large muscle groups before small - incorrect answer, this is a part of the American Association of Cardiovascular and Pulmonary Rehabilitation's (AACVPR) accepted guidelines for resistance training. 3. Focus on an RPE (rating of perceived exertion) of 13-15 - correct answer, the recommended RPE for resistance training is from 11-13 (light to somewhat hard) 4. Stop exercise with any warning of concerning or uncomfortable signs and symptoms - incorrect answer, this is a part of the American Association of Cardiovascular and Pulmonary Rehabilitation's (AACVPR) accepted guidelines for resistance training. O'Sullivan, Susan B. and Schmitz, Thomas J. (2007). Physical Rehabilitation (p. 621). (5th ed.). Philadelphia, PA: F.A. Davis Company."
A patient is about to begin a strength training regimen in an outpatient physical therapy session. The patient had a myocardial infarction 3 months ago. Given that the patient recently had a cardiac event, which of the following is NOT an accepted guideline for treating cardiac patients in a strength routine? 1) Avoid sustained tight gripping 2) Exercise large muscle groups before small 3) Focus on an RPE (rating of perceived exertion) of 13-15 4) Stop exercise with any warning of concerning or uncomfortable signs and symptoms
Correct Answer is 2 Answer Explanation Moderate intensity exercise can be prescribed using approximately 40% to 60% of the peak VO2 achieved on an exercise tolerance test (ETT). Vigorous intensity exercise would be approximately 60% or greater of the peak VO2 achieved on an ETT. Patients with mild to moderate pulmonary disease may be able to exercise for a period of time at these intensities to produce a training effect. O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. D. (2019). Section II Clinical Intervention Strategies for Rehabilitation. In Physical Rehabilitation (7th ed., p. 451). Philadelphia, PA: F. A. Davis.
A patient is being led through an exercise tolerance test (ETT) to determine the percent of VO2 peak values. Which of the following VO2 peak values BEST represents moderate intensity graded exercises? 1) 30% to 50% of peak VO2 2) 40% to 60% peak VO2 3) 50% to 70% VO2 4) 60% or greater VO2
Correct Answer is 4 Answer Explanation Shoulder rotation, especially external rotation, is the MOST helpful at strengthening the rotator cuff, which will be the MOST helpful at treating subacromial bursitis. Scapular retraction would strengthen the shoulder retractors, including the rhomboids and trapezius. Shoulder flexion would strengthen the deltoid and biceps primarily. Shoulder shrugging would strengthen the scalenes and trapezius. O’Sullivan SB, Schmitz TJ, Fulk GD. Chapter 24 Burns. O’Sullivan SB, Schmitz TJ, Fulk GD. eds. Physical Rehabilitation. 7th ed. Philadelphia, PA: F.A. Davis Company; 2019
A patient is being treated for difficulty with overhead activities and subacromial bursitis. Which of the following strengthening activities will be MOST helpful? 1) Scapular retraction exercises 2) Shoulder flexion exercises 3) Shoulder shrugging exercises 4) Shoulder rotation exercises
Correct Answer is 1 Answer Explanation This is the correct answer. Beta blockers work on the beta-adrenergic receptors to decrease sympathetic responses to stress, primarily the heart rate. The Borg Scale should represent Heart Rate divided by 10. Thus there is a disparity in heart rate and exertion, indicating a blunted heart rate. Cohen M, Grimes K, Vogel W. Cardiovascular Medications. In Hillegass, E. Essentials of Cardiopulmonary Physical Therapy. 3rd Ed. St. Louis, Missouri: Elsevier; 2011: 465-514.
A patient is receiving cardiac rehab and has a heart rate of 110 during moderate intensity exercise. The patient reports a 16 on the Borg RPE scale. Which class of heart medications is MOST likely present? 1) Beta Blockers 2) Angiotensin-Converting Enzyme (ACE) Inhibitors 3) Calcium Channel Blockers 4) Angiotensin II Receptor Blockers
Correct Answer is 3 Answer Explanation This is characteristic of a grade II hamstring injury, which invoices a partial tear of the muscle.
A patient is recovering from a Grade II hamstring tear. Which of the following BEST describes this type of injury? 1) Mild pain or tightness in the hamstring muscle, especially when stretched or contracted. 2) Burning pain immediately after injury, inability to walk, and significant bruising over the hamstring. 3) Immediate pain with injury, painful with stretching, and significant bruising over the hamstring. 4) Severe pain over the anterior leg, especially with deep knee flexion, with significant bruising over the quadriceps.
Answer: morton's neuroma Rationale: Morton's Neuroma is gradual in onset with no known cause. The symptoms include pain on the sole of the foot which increases with WB with overpressure into toe extension during passive ROM. AROM is full and pain free with intact strength. The foot may be pronated with low arches with pain present in the web spaces of the toes. Morton's test is usually positive i.e. squeezing the metatarsal head reproduces the pain. Pain in plantar fasciitis is present on the insertion of the plantar fascia on the calcaneus and weak intrinsic muscles of the foot. Retrocalcaneal bursitis pain is usually just above the insertion site of the Achilles tendon on the calcaneus. Midfoot sprain involves a history of trauma or high-impact activity with generalized pain on the midfoot.
A patient presents to the clinic with a chief complaint of pain on the sole of the foot. The patient's symptoms were gradual in onset with no history of trauma. Weight-bearing on the affected extremity and hyperextending the great toe aggravate the symptoms. Tenderness is present in the web spaces of the toes with pressure. The patient has full pain-free AROM and 5/5 strength with no increase in symptoms during testing. Which of the following is the MOST LIKELY diagnosis for this condition? Plantar fasciitis Retrocalcaneal bursitis Morton's neuroma Midfoot sprain
Correct Answer is 1 Answer Explanation The Neer Test is a test for subacromial impingement and is typically associated with the painful arc. Boissonnault WG. Primary Care for the Physical Therapist: Examination and Triage. 2nd Ed. St. Louis, Missouri: Mosby Elsevier; 2010: 19.
A patient presents to the clinic with right shoulder pain and complains of difficulty reaching overhead, with pain especially from 60-120 degrees of shoulder flexion. Which special test would be MOST informative for this set of symptoms? 1) Neer Test 2) Empty Can Test 3) Crossover Test 4) Push Off Test
Correct Answer is 1 Answer Explanation Swan neck deformity would be the MOST accurate answer choice. Boutonniere deformity is just opposite of the Swan Neck. Mallet finger involves just flexion of the DIP joint. De Quervain syndrome is tenosynovitis of the extensor pollicis brevis and abductor pollicis longus as they pass under the fascial sheath that covers the two tendons. Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd Ed. St. Louis, Missouri: Mosby Elsevier; 2010: 282-287.
A patient presents with rheumatoid arthritis and finger pain. The 2nd digit has a flexed metacarpophalangeal joint, hyperextended proximal interphalangeal joint, and a flexed distal interphalangeal joint. Which of the following is the MOST accurate description of the position? 1) Swan neck deformity 2) Boutonniere deformity 3) Mallet finger deformity 4) De Quervain syndrome
Correct Answer is 1 Answer Explanation After a heart transplant, there is no longer any sympathetic innervation to the heart, blunting the effect of exercise on heart rate. After several minutes of activity, the heart will then respond to circulating catecholamines and increase gradually.
A patient who has received a heart transplant is undergoing cardiac rehabilitation with a physical therapist. Which of the following descriptions BEST represents the cardiovascular effects that occur when this person begins exercising? 1) No initial change in heart rate followed by a gradual increase after several minutes. 2) Immediate increase in heart rate that gradually stabilizes after several minutes. 3) No initial change in heart rate followed by a gradual decrease after several minutes. 4) Immediate decrease in heart rate that gradually stabilizes after several minutes.
Answer: Stage 2 Rationale: Symptoms of rigidity and postural instability are cardinal symptoms of Parkinson's disease. Parkinson's disease is classified with the Hoehn and Yahr scale. Hoehn and Yahr Level II indicates minimal bilateral or midline involvement with no balance impairment. Reference: O'Sullivan SB, Schmitz TJ, Fulk GD. Physical Rehabilitation. Sixth ed. Philadelphia: F.A. Davis Co; 20144: pg 817
A patient with a diagnosis of Parkinson's Disease is referred to an outpatient PT clinic. He is beginning to show signs of bilateral involvement, but has had no falls so far. Which of the following is the MOST APPROPRIATE stage of Hoehn-Yahr classification? Hoehn and Yahr stage III Hoehn and Yahr stage V Hoehn and Yahr stage I Hoehn and Yahr stage II
Correct Answer is 2 Answer Explanation High diastolic blood pressure does not allow the blood to be pumped efficiently out of the heart and subsequently reduces stroke volume. Preload is the end-diastolic pressure and drives blood into the atria. Stroke volume or heart rate would be somewhat correct. If stroke volume x heart rate (cardiac output) is sufficient, all is well. This is often a problem in patients with congestive heart failure.
A patient with congestive heart failure is having great difficulty with activities of daily living. Which of the following cardiac factors is MOST likely the cause of such difficulty? 1) Preload 2) Afterload 3) Stroke volume 4) Heart rate
Correct Answer is 3 Answer Explanation Prone with the two pillows under the hips and treatment table flat is the most appropriate position for the lower lobe's superior segments bilaterally. Crouch, R. Pulmonary Rehabilitation. In Hillegass, E. Essentials of Cardiopulmonary Physical Therapy. 3rd Ed. St. Louis, Missouri: Elsevier; 2011: 638-658.
A patient with cystic fibrosis is receiving postural drainage and percussion for the right lower lobe's superior segments. What is the MOST appropriate patient position? 1) Supine on a wedge with the left shoulder elevated and the head lower than the pelvis. 2) Supine on a wedge with the right shoulder elevated and the head lower than the pelvis. 3) Prone with the two pillows under the hips and treatment table flat 4) Supine with the two pillows under the knees and treatment table flat
answer: B Rationale: With an injury to the musculocutaneous nerve, the patient is unable to flex the elbow with the forearm supinated and may have some instability in the shoulder with atrophy of the flexor surface of the upper arm. The sensory supply of the musculocutaneous nerve is to the lateral aspect of the forearm. Rationale: Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. 6th ed. Philadelphia: F.A. Davis Co; 2012; 378-379
A patient with subluxation of the shoulder presents to the PT clinic. During evaluation, the therapist notices atrophy of the flexor surface of the upper arm along with weakness of elbow flexion with a supinated forearm. Which of the following findings will MOST LIKELY be associated with this finding? - Loss of 2-point discrimination on the lateral aspect of the upper arm - Loss of 2-point discrimination on the lateral aspect of the forearm - Loss of 2-point discrimination on the posterior aspect of the arm - Loss of 2-point discrimination on the posterior aspect of the forearm
Correct Answer is 3 Answer Explanation Both of these signs are normal responses to the stress test. Hillegass E. Electrocardiography. In Hillegass, E. Essentials of Cardiopulmonary Physical Therapy. 3rd Ed. St. Louis, Missouri: Elsevier; 2011: 288-330.
A physical therapist is performing a treadmill exercise stress test using the Bruce protocol. During stage 3 of the test, the P wave increases in height, and the S-T segment begins to become significantly upsloping. What is the MOST appropriate course of action? 1) Stop the test and refer patient to a physician. 2) Lower the stage back to stage 2 and monitor for improved electrocardiographic indicators. 3) Continue with the test without any modification, monitoring for symptoms of cardiac distress. 4) Discontinue the test, and monitor the patient's vital signs for 10 minutes.
Correct Answer is 3 Answer Explanation The O'Brien's test is MOST indicative of SLAP tears. Hertling D, Kessler RM. Assessment of Musculoskeletal Disorders and Concepts of Management. In Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders. 4th Ed. Philadelphia: JB Lippincott; 2006: 61-108.
A physical therapist examines a patient and determines that the patient has a positive Active Compression test (O'Brien's Test). Which of the following pathologies is MOST implicated? 1) Rotator cuff tear 2) Biceps tendonitis 3) Superior labral tear 4) Acromioclavicular joint sprain
Correct Answer is 4 Answer Explanation 1. Obstructive lung disorders are characterized by detrimental changes to the airways of the lungs. Forced expiratory volume in 1 second (FEV1) reflects the status of the airways of the lungs. In patients with obstructive disorders, FEV1 is 70% or less of the total FVC (FEV1/FVC < 70%). Since the airways are altered with obstructive diseases, they are considered flow impairments since air has difficulty leaving the airways. Additionally, an SCI would not cause an obstructive disorder as airways are not affected by SCIs, rather they have altered lung expansion due to respiratory muscle weakness. 2. Lung volumes are normal or increased with obstructive disorders, not impaired. 3. Restrictive lung disorders are characterized by difficulty expanding the lungs and a reduction in lung volumes. They can be due to neuromuscular disorders (such as SCI), alteration to the chest wall (such as burns or scoliosis) and/or stiffening/fibrosis of the lungs themselves. While the patient in the question is suffering from a restrictive disease, it is characterized by a volume impairment due to decreased lung expansion, not a flow impairment. Additionally, patients with restrictive disorders have a normal (>70%) FEV1 to FVC ratio as their FVC is usually decreased. 4. This is the correct answer. Weak muscles of respiration lead to decreased chest wall and lung expansion. Restrictive disorders are characterized as having normal flow and abnormal lung volumes. O'Sullivan, S. B., & Schmitz, T. J. (2007). Physical rehabilitation (6th ed. Pp 494-495). Philadelphia, PA: F.A. Davis.
A physical therapist is assessing a 2-year-old patient diagnosed with an ASIA A C5 spinal cord injury. The patient's Forced Expiratory Volume in 1 second (FEV1) to Forced Vital Capacity (FVC) ratio (FEV1:FVC) is measured as 85%. The patient has weakness of his diaphragm and intercostals. Which of the following descriptions BEST describes the type of respiratory disorder experienced by this patient? 1) Obstructive-Flow impairment 2) Obstructive-Volume impairment 3) Restrictive-Flow impairment 4) Restrictive-Volume impairment
Correct Answer is 1 Answer Explanation 1. Ejection fraction of 40% - Correct answer, this ejection fraction would be considered moderate Risk, an ejection fraction of less than 30% is high risk 2. Exercise induced ST-segment elevation greater than 2 mm - incorrect answer, this is high risk 3. Premature ventricular complex (PVCs) appearing with exercise - incorrect answer, this is high risk 4. Survivor of cardiac arrest - incorrect answer, this is high risk O'Sullivan, Susan B. and Schmitz, Thomas J. (2007). Physical Rehabilitation (p. 612-616). (5th ed.). Philadelphia, PA: F.A. Davis Company.
A physical therapist is assessing a patient's risk for increased morbidity and mortality before participation in a cardiopulmonary rehabilitation program. Which of the following conditions would NOT qualify the patient as high risk? 1) Ejection fraction of 40% 2) Exercise induced ST-segment elevation greater than 2 mm 3) Premature ventricular complex (PVCs) appearing with exercise 4) Survivor of cardiac arrest
Correct Answer is 1 Answer Explanation Constant pain without any relation to position is a key indicator of spinal cancer. Goodman C. Pain Types and Viscerogenic Pain Patterns. In Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th Ed. Philadelphia, PA: Saunders, W.B.; 2007: 110-174.
A physical therapist is evaluating a patient with back pain. The patient reports having pain that has increased steadily over the last 2 months and is constant and unremitting. The pain radiates into both lower extremities. The patient also feels marked weakness throughout the right lower extremity. What is the MOST appropriate initial treatment? 1) Discontinue treatment and refer patient to primary care physician for further testing. 2) Begin a program of core strengthening, focusing on transversus abdominis training and progressing toward a long term stabilization program. 3) Instruct the patient in appropriate lower extremity exercises to improve leg strength, focusing on the right leg. 4) Initiate piriformis stretching as tolerated and instruct the patient in self mobilization techniques to improve mobility throughout the lumbar spine.
Correct Answer is 4 Answer Explanation Tibialis anterior weakness and sensory loss along the anterior leg below the knee are the most common signs of L4 nerve root entrapment. Hertling D. Lumbar Spine. In Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders. 4th Ed. Philadelphia: JB Lippincott; 2006: 843-934.
A physical therapist is evaluating a patient with pain that radiates throughout his lower extremities. The patient has significant foot drop while ambulating and complains of numbness and tingling extending from the great toe up to the knee along the anterior leg. What is the MOST likely pathology underlying these symptoms? 1) Sciatic nerve entrapment 2) Deep peroneal nerve inflammation 3) Tibial nerve entrapment 4) L4 nerve root entrapment
Correct Answer is 1 Answer Explanation "1. nterior basal segments of the lower lobe-Correct. The positioning described above is appropriate to provide postural drainage treatment for this lobe. 2. Apical segments of the upper lobe-Incorrect. The patient would be positioned in sitting with a flat bed to treat this lobe. 3. Posterior basal segments of the lower lobe-Incorrect. The patient would be in a prone position to treat this lobe. 4. Right middle lobe-Incorrect. The foot of the bed would be elevated 16 inches to treat this lobe. O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. D. (2014). Physical rehabilitation. Philadelphia: F.A. Davis Company. P. 515, 516f. "
A physical therapist is performing postural drainage on a patient. The therapist uses a cupped hand position over the patient's lower ribs as the patient rests in a side-lying position. A pillow is under the patient's knees with the foot of the bed raised 20 inches. Which of the following lobes of the lung is the therapist MOST likely treating? 1) Anterior basal segments of the lower lobe 2) Apical segments of the upper lobe 3) Posterior basal segments of the lower lobe 4) Right middle lobe
Correct Answer is2 Answer Explanation1. Atrial fibrillation - incorrect, an atrial fibrillation is characterized by erratic quivering or twitching of the atrial muscle with a QRS complex 2. Atrial flutter - this is the correct answer, in the presence of Atrial flutter, f waves will be seen in a sawtooth pattern in place of P waves. 3. Ventricular flutter - incorrect, this is characterized by reading the QRS complex 4. Ventricular tachycardia - incorrect, this is characterized by the reading the QRS complex Hamm, L., Berra, K., & Kavanagh, T. (Eds.). AACVPR cardiac rehabilitation resource manual: Promoting health and preventing disease. (2006). (pp. 91-98). 6th edition. Chicago, IL: Human Kinetics.
A physical therapist is reading a patient's electrocardiogram (ECG) output during a submaximal exercise test being performed on a treadmill. Upon further inspection of the electrocardiogram, the therapist notes the presence of small f-waves and the absence of a p-wave. Based on this information, which of the following arrhythmias is MOST likely present? 1) Atrial fibrillation 2) Atrial flutter 3) Ventricular flutter 4) Ventricular tachycardia
Correct Answer is 2 Answer Explanation "1. Activity pacing-Incorrect. This is an appropriate intervention, allowing patients with COPD to break up activities into manageable chunks which don't provoke symptoms. 2. Diaphragmatic breathing-Correct. Training accessory muscles of breathing may be more beneficial for patients with chronic pulmonary dysfunction. 3. Lower extremity strength training-Incorrect. This intervention is appropriate and can help lessen weakness which results from COPD. 4. Pursed-lip breathing-Incorrect. This intervention is appropriate and results in more effective gas exchange for patients with COPD. O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. D. (2014). Physical rehabilitation. Philadelphia: F.A. Davis Company. P. 518."
A physical therapist is treating a patient in a long-term care setting with chronic obstructive pulmonary disease. Which of the following interventions is the least appropriate? 1) Activity pacing 2) Diaphragmatic breathing 3) Lower extremity strength training 4) Pursed-lip breathing
Correct Answer is 3 Answer Explanation A stopwatch for the TUG or 6 MWT would be MOST useful. These are excellent tests in determining function in a community ambulator. White DJ. Musculoskeletal Examination. In O’Sullivan SB, Schmitz TJ. Physical Rehabilitation. 5th Ed. Philadelphia, PA: F.A. Davis Company; 2007: 121-158.
A physical therapist is treating an individual recovering from a total knee replacement. The therapist desires to make an objective measure regarding the functional household ambulation status of this individual. Which of the following devices would be MOST useful? 1) Goniometer 2) Treadmill 3) Stopwatch 4) Stairs
Correct Answer is 3 Answer Explanation" 1. Patients with disease that compromise the oxygen transport system, such as peripheral vascular disease, cancer, or other cardiopulmonary diseases will require extended rest breaks during exercise to recover appropriately. 2. Patients with disease that compromise the oxygen transport system, such as peripheral vascular disease, cancer, or other cardiopulmonary diseases will require extended rest breaks during exercise to recover appropriately. 3. Patients with disease that compromise the oxygen transport system, such as peripheral vascular disease, cancer, or other cardiopulmonary diseases will require extended rest breaks during exercise to recover appropriately. 4. Patients with disease that compromise the oxygen transport system, such as peripheral vascular disease, cancer, or other cardiopulmonary diseases will require extended rest breaks during exercise to recover appropriately. This applies to intra- and inter-session recovery periods. Stopping the treatment session may hinder progress if the patient requires a rest break between exercise and is not in need of a medical referral. "Colby, Lynn Allen; Kisner, Caroline. Therapeutic Exercise Foundations and Techniques (6th ed., p. 163)"
A physical therapist working in the outpatient setting is treating a patient with a relevant past medical history of peripheral vascular disease. During treatment, the patient reports feeling fatigued with the exercise and would like to rest. Which of the following should the physical therapist do NEXT? 1) Encourage the patient to continue with exercise 2) Give the patient a short rest break before continuing 3) Give the patient an extended rest break before continuing 4) Stop treatment and adjust the plan of care
Correct Answer is 2 Answer Explanation The inferior vena cava travels along the right side of the spinal column. Because it is a low pressure system, the venous blood can be occluded by the weight of the fetus. Thus, care must be taken to decrease the pressure on the inferior vena cava in supine. In general, pregnant patients should avoid a full flat supine position, however, many treatment necessitate a supine position, thus placing pillows under the right side of the body will help offload the inferior vena cava during treatment.
A pregnant patient is being treated for low back pain. When placing the patient supine on the plinth, which of the following positions is MOST appropriate? 1) Supine with pillows under the left hip 2) Supine with pillows under the right hip 3) Supine with the head slightly elevated 4) Supine with the feet slightly elevated
Correct Answer is 4 Answer Explanation 30:2 for 1 rescuer and 15:2 for 2 rescuers.
According to the American Red Cross, what is the appropriate ratio of chest compressions to rescue breaths for infants during single rescuer cardiopulmonary resuscitation (CPR)? 1) 15 compressions: 2 breaths 2) 20 compressions: 2 breaths 3) 25 compressions: 2 breaths 4) 30 compressions: 2 breaths
Answer: optic chiasm Rationale: The deficit shown in the image is bitemporal hemianopsia which is caused due to a lesion in the optic chiasm. L optic nerve damage would cause monocular vision. R optic tract lesion would cause C/L homonymous hemianopsia. Lesion in the L occipital lobe would cause C/L homonymous hemianopia with macular sparing.
After a stroke, a patient's visual field is as shown in the picture. Which of the following is the MOST LIKELY location of the lesion? L optic nerve R optic tract Optic chiasm L occipital lobe
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Cardio questions
secondary impingement
FUNCTIONAL IMPINGEMENT ISSUE Dynamic: Relative narrowing of outlet secondary to abnormal humeral head movement with activity something else is causing impingement, perhaps their activities, posture, lack of dynamic stability, or muscle imbalances are causing the humeral head to shift in its center of rotation and cause impingement. The most simple example of this is weakness of the rotator cuff.
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Hoehn and Yahn
answer : D Rationale: Full thickness burns are white or tan and are usually anesthetic with poor circulation. A: Deep partial thickness burns have broken blisters and are sensitive to pressure but insensitive to light touch and blanch with slow capillary refill. B: Epidermal burns are erythematous with no blisters. C: Superficial partial thickness burns are erythematous and blanch with quick capillary refill.
Joe presents to the clinic with a large burn on his forearm. When the therapist tries to touch it, he does not complain of pain on pressure or light touch. Which of the following is the MOST LIKELY presentation of this wound? - Mixed red, waxy white appearance with blanching and slow capillary refill - Erythematous pink with no blisters - Erythematous with blanching and quick capillary refill -White or tan with no blanching
A1C levels
Normal: below 5.7% Prediabetes: 5.7 to 6.4% Diabetes: 6.5% or above : really effects the periodontium and overall health negatively
Answer: Herpes Zoster aka shingles Rationale: A: Xanthomas are benign fatty fibrous yellow plaques, nodules, or tumors that develop in the subcutaneous layer of skin, often around tendons. The lesion is characterized by the intracellular accumulation of cholesterol and cholesteryl esters. B: Shingles is an outbreak of a rash or blisters on the skin that may be associated with severe pain. The pain is associated with the involved nerve root and associated dermatome and generally presents on one side of the body or face in a pattern characteristic for the involved site. Early signs of shingles include burning or shooting pain and tingling or itching. The rash or blisters are present anywhere from 1 to 14 days. C: Rosacea is a chronic facial skin disorder seen most often in adults between the ages of 30 and 60 years. Features include erythema, flushing, telangiectasia, papules, and pustules affecting the cheeks and nose of the face. D: Maculopapular rashes are associated with secondary syphilis. They appear as a pink, dusky, brownish-red or coppery, indurated, oval or round lesion with a raised border. These are referred to as "copper penny" spots. The lesions do not bleed and are usually painless. They usually appear scattered on the palms or the bottom of the feet but may also present on the face. References: Goodman CC, Heick J, Lazaro RT. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th ed. St. Louis, Missouri: Elsevier; 182-187.
On assessment, the therapist notices redness on the skin as pictured below. Which of the following is the MOST APPROPRIATE description of this finding? Xanthoma Herpes zoster Rosacea due to H. Pylori Maculopapular rashes
Full Can Test
Patient seated. Doctor asks patient to actively raise arm up with palm facing up while doctor applies pressure to the wrist once arm is raised. Pain/weakness: injury/lesion of supraspinatus
Bullectomy
a procedure to remove an air pocket from the lung that has resulted from several years of COPD. Bullae are air pockets in the lung that form from tissue destruction as a result of cancer, COPD, emphysema, etc.
Primary Impingement
STRUCTURAL ISSUE with AC joint flat/ hooked/ curved curved is more likely to cause impingement with rotator cuff usually supraspinatus Injuries to the shoulder joint. Activities such as tennis, swimming, baseball and football that involve repetitive movements of the arm and shoulder. Age. People who are 50 or older are more likely to develop impingement syndrome than younger people.
Modified Ashworth Scale
To test for abnormal tone; apply quick stretch to muscle so it is lengthened quickly 0= no inc. in tone 1= slight inc. in tone, catch and release or minimal resistance at end of ROM when affected part moved in flex or ext 1+= slight inc. in tone, catch, followed by min. resistance t/o remainder (< half) of ROM 2= more marked inc. in tone through most of ROM, but affected parts easily moved 3= considerable inc. in tone, passive mvmt diff. 4= affected parts rigid in flex or ext
Correct Answer is 3 Answer Explanation Effective contraction depends on an intact electrical conduction system that results in depolarization of the myocardium and timely repolarization. In a normal sinus rhythm (NSR) the impulse begins in the sinus node, and travels through the atria, the A-V node, bundle of His, Purkinje fibers, septum, and ventricles. The incorrect option here would be choice C because the ST segment describes the initiation of ventricular repolarization, not depolarization. O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. D. (2019). Section II Clinical Intervention Strategies for Rehabilitation. In Physical Rehabilitation (7th ed., p. 474). Philadelphia, PA: F. A. Davis.
Which of the following LEAST represents a normal sinus rhythm of the heart? 1) The QRS complex denotes electrical flow through the ventricles causing ventricular depolarization 2) The PR segment demonstrates conduction through the AV node 3) The ST segment describes the initiation of ventricular depolarization 4) The T wave illustrates the completion of ventricular repolarization
Correct Answer is 3 Answer Explanation PaCO2 levels are typically between 35-45 mmHg. With decreased PaCO2, the pH of the blood increases, causing alkalosis. 1 is a normal PaO2 value (bottom end). 2 is a normal PaO2 value (top end). 4 is a normal PaCO2 value (top end). Prentice WE. Chapter 6 Electrical Stimulating Currents. Therapeutic Modalities in Rehabilitation. 3rd ed. New York, NY: McGraw-Hill; 2005
Which of the following arterial blood gas values is MOST indicative of respiratory alkalosis? 1) PaO2 80 mmHg 2) PaO2 100 mmHg 3) PaCO2 25 mmHg 4) PaCO2 45 mmHg
Correct Answer is 1 Answer Explanation Lung volumes found in restrictive diseases display decreases in total lung capacity, while lung volumes in obstructive diseases would show a normal or increased total lung capacity. O'Sullivan, S. B., Schmitz, T. J., Fulk, G. D. (2019). Section II Clinical Intervention Strategies for Rehabilitation. In Physical Rehabilitation (7th ed., p. 444). Philadelphia, PA: F. A. Davis.
Which of the following descriptions of lung volumes is MOST reflective of a patient who has a restrictive lung disease? 1) Decreased expiratory reserve volume 2) Decreased tidal volume 3) Increased residual volume 4) Increased vital capacity
Correct Answer is 1 Answer Explanation S1 is created from the closure of the mitral and tricuspid valves during ventricular systole.
Which of the following heart sounds is MOST indicative of closure of the mitral valve? 1) S1 2) S2 3) S3 4) S4
Correct Answer is 2 Answer Explanation 1. Hematocrit of less than 25% is a contraindication to exercise. 2. Hemoglobin of less than 8 is a contraindication to exercise. Hemoglobin of 11 is a normal value. 3. Platelet count of less than 20,000/mm3 is a contraindication to exercise. 4. White blood cell count of less than 5,000/mm3 is a contraindication to exercise. Goodman, C. C., & Fuller, K. S. (2009). Pathology: Implications for the physical therapist (pp. 1650). St. Louis: Saunders Elsevier.
Which of the following laboratory values is NOT a contraindication for exercise? 1) Hematocrit of 22% 2) Hemoglobin of 11 g/dl 3) Platelet count of 10,000/mm3 4) White blood cell count of 4,000/mm3
Correct Answer is 3 Answer Explanation An exercise tolerance test (ETT) can provide objective information to document a patient's functional abilities, document a patient's symptomatology, prescribe safe exercise, document changes in oxygenation during exercise and determine the need for supplemental oxygen, and identify any changes in pulmonary function during exercise performance. An ETT protocol gradually increases exercise intensity to stress the patient with pulmonary dysfunction to their point of limitation. Prescribing any drug medication is outside the practice of a physical therapist. O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. D. (2019). Section II Clinical Intervention Strategies for Rehabilitation. In Physical Rehabilitation (7th ed., p. 450). Philadelphia, PA: F. A. Davis.
Which of the following objective information is LEAST likely to be provided following an exercise tolerance test (ETT) in patients with pulmonary disease? 1) Documentation of changes in oxygenation during exercise and determination for supplemental oxygen 2) Documentation of a patient's functional abilities 3) Prescription for respiratory drugs to assist in aerobic activity 4) Prescription for safe exercises
answer: Anosognosia Rationale: Anosognosia is the denial or lack of awareness of the presence or severity of one's paralysis. Right-left discrimination is the inability to identify the right and left sides of one's own body. Somatoagnosia is a lack of awareness of the body structure and relationship of body parts to oneself or to others. Ideational apraxia is the inability to perform a task on motor or on command. Reference: O'Sullivan SB, Schmitz TJ, Fulk GD. Physical Rehabilitation. Sixth ed. Philadelphia: F.A. Davis Co; 2014
While assessing a patient with a R CVA, the therapist asks the patient to fold a piece of paper into half and notices that the patient does not use the L hand at all. On asking the patient what is wrong with the L hand, she says that she slept funny so the hand is not moving for now and that it should be moving by the end of the day. Which of the following is the MOST LIKELY medical diagnosis for this presentation? Right-left discrimination disorder Somatoagnosia Anosognosia Ideational apraxia
Correct Answer is 3 Answer Explanation 3. Discontinue the test and monitor symptoms for 5 minutes. This is the correct answer. While performing an exercise tolerance test (ETT), if the patient begins to exhibit marked differences on the ECG as compared to the resting ECG, this is an indication that the heart is experiencing ischemic stress. A downsloping or depressed ST-segment >1mm is indicative of myocardial stress. The therapist should discontinue the activity and monitor the ECG at rest to determine if the myocardial ischemia is exercise-induced or is present at rest. If the ischemia is persistent, contacting the physician would be warranted. The test should be stopped, and the patient monitored before continuation of the program. Swain, D. P., & Brawner, C. A. (2014). ACSMs resource manual for Guidelines for exercise testing and prescription (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. P.149.
While examining a patient who is in the hospital recovering from a coronary artery bypass graft surgery 4 days ago, the physical therapist chooses to employ an exercise tolerance test. During the test, the patient's ECG displays a sharply downsloping ST-segment of 1.5mm that was not present at rest. Which of the following actions is the MOST appropriate next step? 1) Continue the test, closely monitoring symptoms and ECG. 2) Continue the test at a higher workload and monitor symptoms and ECG. 3) Discontinue the test and monitor symptoms and ECG for 5 minutes. 4) Discontinue the test and contact the physician immediately.
Correct Answer is 3 Answer Explanation Extension activities will exacerbate any pain from this spondylolisthesis. Hertling D. Lumbar Spine. In Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders. 4th Ed. Philadelphia: JB Lippincott; 2006: 843-934.
While examining a patient's lumbar x-ray films, a physical therapist notices that the L5 vertebra is displaced anteriorly on sacrum by approximately 50% of the vertebral body. How will this MOST affect physical therapy if the patient is being treated for low back pain? 1) Emphasize core strengthening, especially in spine neutral 2) Begin progressive gluteal and quad strengthening to assist the lumbopelvic fascia 3) Avoid extension activities, especially in standing 4) Add progressive external oblique training as tolerated to assist proper spinal alignment
Ordinal Answer Explanation Ordinal scales are used to represent data that is comparatively higher or lower than other data. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd Ed. Upper Saddle River, NJ: Prentice-Hall, Inc.; 2000: 52-59.
While treating a patient for cardiac rehab, a physical therapist relies on the Borg Rating of Perceived Exertion Scale (RPE). The Borg RPE Scale is MOST representative of which type of data scale? 1) Nominal 2) Ordinal 3) Ratio 4) Marginal
Answer A Rationale: A Hoehn and Yahn stage III would include impaired righting reflexes, unsteadiness when turning or rising from a chair and the patient can live independently. The patient's most recent fall was rising from the toilet. An appropriate intervention would be to improve the patient's ability to sit to stand. Reference:O'Sullivan SB, Schmitz TJ, Fulk GD. Physical Rehabilitation. Sixth ed. Philadelphia: F.A. Davis Co; 2014: pg 817
You are assessing a patient with Parkinson's disease in the hospital. The patient complains of difficulty turning around and reports he has had 3 falls, with the most recent one occurring while getting up off the toilet at home. The patient is classified as a Hoehn and Yahn III. Which of the following is the MOST appropriate intervention for the initial treatment session? Sit to stand with emphasis on anterior weight shifting Dynamic balance on foam to improve balance reactions Gait training emphasizing starting and stopping Standing on an even surface with eyes closed and feet together
Answer: 2nd degree AV block Rationale: This EKG shows a second degree AV block, and the following EKG strip details how the p-wave is not conducted through the AV node. There is a progressive increase in the PR interval until the beat drops. 3:1 ratio of p waves
You are treating a 35 year old patient with the following Electrocardiogram in inpatient rehabilitation. Which cardiac condition is MOST LIKELY represented below? - Atrial fibrillation - Ventricular tachycardia - Second degree AV block - Third degree AV block
Answer: midbrain Rationale: Cranial nerves IV and III are located in the midbrain. Cranial nerve III is the oculomotor nerve, and damage to the oculomotor nerve causes ptosis (drooping eyelid), dilation of the pupil, and loss of accommodation of the light reflex. Cranial nerve IV is the trochlear nerve. The trochlear nerve's motor innervation is to the superior oblique muscle which is responsible for rotating the eye down and in. Reference: O'Sullivan SB, Schmitz TJ, Fulk GD. Physical Rehabilitation. Sixth ed. Philadelphia: F.A. Davis Co; 2014. Pg 116 also remember: CE MB PONS MEDU 1,2 3,4 5,6,7,8 9,10,11,12
You are treating a patient in inpatient rehabilitation with deficits in pupillary light reflex in the right eye and a failure to look at the nose with the right eye. When testing lateral deviation of the eye, the patient is able to follow the stimulus. No deficits noted in chewing. Which anatomical location is MOST likely affected? Pons Medulla Cerebellum Midbrain
Sensory organization test
a form of posturography that is designed to assess quantitatively an individual's ability to use visual, proprioceptive and vestibular cues to maintain postural stability in stance
burns rule of nine
a method used to estimate the extent and severity of burns rule of nines divides body into 11 areas, each accounting for 9% of thetotal body area plus 1% for the genitals sections of rule of nines (5) head and neck- 9% upper limbs- 18% trunk-36% perineum-1% lower limbs- 36%
Legg-Calve-Perthes Disease
degeneration of femoral head due to avascular necrosis. Risk factors for Legg-Calve-Perthes disease include: Age.: most common 4 and 10 yo 4x in boys than girls white kids possible genetic mutation issue . will see Limping Pain or stiffness in the hip, groin, thigh or knee Limited range of motion of the hip joint Trendelenburg gait possibly Pain that worsens with activity and improves with rest
Osgood-Schlatter disease
inflammation of the tibial tubercle caused by chronic irritation and seen primarily in muscular, athletic adolescents; characterized by swelling and tenderness over the tibial tubercle that increases with exercise. Rest affect leg and possible patella tendon strap to help w/ pain. Will see in boys between the ages of 10 and 15 who play games or sports that include frequent running and jumping.
Neer's Test
subacromial impingement
Push off test
subscapularis
pneumonectomy
the surgical removal of all or part of a lung
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visual deficits
