Ther ex practice quiz questions

Priority Problem List

-Place to start - Drives treatment - Documentation - Communication - Re-evaluation - Goal Setting

When a period of continuous immobilization of the elbow is required after trauma or surgery, the elbow often is positioned in only a moderate amount of flexion (20° to 30°) rather than 90° of flexion. This position is selected to: a. Decrease the risk of ulnar neuropathy from compression of the ulnar nerve in the cubital tunnel. b. Decrease the risk of radial neuropathy from compression of the radial nerve in the cubital tunnel. c. Decrease the risk of median nerve neuropathy from compression in the cubital tunnel. d. Decrease the risk of overstretching the lateral collateral ligament complex of the elbow that could cause posterior translation of the radial head.

a. Decrease the risk of ulnar neuropathy from compression of the ulnar nerve in the cubital tunnel.

Progressing resistance and stretching exercises vigorously during the early subacute stage of soft tissue healing: a. Decreases recovery time b. Prolongs the inflammation and promotes adhesion formation. c. Increases the strength of the healing tissues. d. Helps scar tissue resolve more quickly.

a. Decreases recovery time

Hip flexor structural or functional impairment will result in a change in the normal gait cycle. The therapist should suspect hip flexor dysfunction when observing gait and noting a: a. Lengthened stride. b. Posterior lurch of the trunk at foot contact. c. Lateral shift of the trunk over the stance leg when the opposite leg swings. d. Forward flexion of the trunk during weight bearing.

d. Forward flexion of the trunk during weight bearing.

When an exercise involves using the same muscle group to lift and lower a constant load, such as flexing and extending the elbow while standing and holding a weight, which of the following is correct about the effect of this exercise on the tension generated by the musculature? a. Greater muscle tension develops when the weight is lowered (controlled by an eccentric contraction) than when it is lifted and controlled by a concentric contraction. b. When the weight is lowered (controlled by an eccentric contraction), fewer motor units are recruited, and thus less tension is generated, than when the weight is lifted (controlled by a concentric contraction). c. The same tension is generated in the muscle during the lifting and lowering phases of the exercise because the greatest resistance (load) is imposed by the weight at the same point in the ROM. d. Greater energy expenditure is necessary during the eccentric phase of the exercise than during the concentric phase.

a. Greater muscle tension develops when the weight is lowered (controlled by an eccentric contraction) than when it is lifted and controlled by a concentric contraction.

Your patient complains of cervical pain and headaches. You notice that she has a forward head and round back posture. The complaints could be derived from all of the following except: a. Impingement on the neurovascular bundle from sternocleidomastoid muscle tightness. b. Increased tension in the muscles of mastication with associated temporomandibular joint syndrome. c. Irritation of the facet joints in the upper cervical spine. d. Impingement of the suboccipital nerves.

a. Impingement on the neurovascular bundle from sternocleidomastoid muscle tightness.

The most common fracture in the elbow region is a fracture of the head and neck of the radius. All of the following are true about medical management of this injury except: a. Improved ROM is the primary indication for surgery and the primary goal of postoperative rehabilitation following a radial head fracture. b. Open reduction and internal fixation is the preferred technique if stable fixation can be achieved and the patient is a young, active adult. c. Closed reduction is preferred for radial head fractures in children. d. Biomechanical studies demonstrate that implant arthroplasty after a severely comminuted fracture restores stability and kinematics similar to the native radial head

a. Improved ROM is the primary indication for surgery and the primary goal of postoperative rehabilitation following a radial head fracture.

Mrs. B is an 87-year-old resident of Western Hills Skilled Nursing Facility. She sustained a compression fracture of the T12 vertebra several weeks ago when she inadvertently sat down forcefully on a hard chair. Incorporating resistance training that focuses on eccentric exercises of her quadriceps and gluteal muscles in weight-bearing positions (e.g., controlled squatting and partial lunges) represents what principle of therapeutic exercise? a. Specificity of training b. Reversibility of training c. Overflow principle d. Overload principle

a. Specificity of training

Your patient has a forward head posture. On testing (supine-lying), she cannot isolate capital flexion to lift her head when you ask her to flex her neck. Passively you can move the head about 5° into capital flexion and then feel tissue resistance. Based on these supine tests, what muscles are tight and what muscles are weak? a. Tight suboccipital muscles and weak longus capitis and longus colli muscles b. Tight erector spinae and weak sternocleidomastoid muscles c. Tight splenius capitis and splenius cervicis muscles and weak multifidus muscles d. Tight erector spinae and weak suprahyoid and infrahyoid muscles

a. Tight suboccipital muscles and weak longus capitis and longus colli muscles

A balance of bone resorption that equals bone replacement occurs normally during growth and development until peak bone mass is reached. This typically occurs: a. At about age 18 for females and 21 for males. b. During the third decade of life. c. At puberty. d. During the sixth decade of life.

b. During the third decade of life.

Which of the following accurately represents appropriate guidelines for developing a safe and effective progressive resistance training program for your patient who is age 85? a. High-intensity progressive resistance exercise is contraindicated in patients older than age 80. b. Each session should include warm-up, stretching, functional or sport-specific exercises, and cool-down. c. Strength cannot be gained in patients with low muscle mass, and resistance training will be detrimental. d. Resistance exercises beyond the seventh decade should only be performed as part of an aquatic program to reduce the stress on joints and soft tissue.

b. Each session should include warm-up, stretching, functional or sport-specific exercises, and cool-down.

Your patient describes increased pain in the back in the morning before getting out of bed. The patient should be: a. Advised never to sleep prone. b. Evaluated for sleeping posture and advised in mechanically safe adaptations. c. Advised to sleep in a recliner or with a pillow under her knees to accentuate hip flexion. d. Advised to place a board under a soft mattress.

b. Evaluated for sleeping posture and advised in mechanically safe adaptations.

Which of the following is true about myositis ossificans (heterotopic bone formation) in the elbow region? a. The muscle most often affected in the elbow region is the biceps brachii. b. It is distinguished from traumatic arthritis of the humeroulnar joint in that passive extension is more limited than flexion. c. After the acute inflammatory period, heterotopic bone is laid down within muscle fibers and within the joint. d. Before the bony mass in the muscle has matured, the muscle should be stretched and massaged regularly to prevent a contracture.

b. It is distinguished from traumatic arthritis of the humeroulnar joint in that passive extension is more limited than flexion.

Older adults become less efficient during gait. A common gait deviation that contributes to this inefficiency is: a. Faster gait speed. b. Lack of hip extension. c. Exaggerated heel strike. d. Narrow step width.

b. Lack of hip extension.

Which of the following is a consideration when designing aerobic exercise programs for an older adult population? a. Aerobic exercise is contraindicated after age 80 unless it is performed in water. b. Maximum heart rate is age-related and decreases with age. c. Blood pressure decreases because of increased peripheral vascular resistance. d. Heart rate increases, resulting in greater cardiac stroke volume.

b. Maximum heart rate is age-related and decreases with age.

Your patient reports having had a sudden onset of severe pain in the left posterior thigh yesterday while sprinting. Today he is unable to fully extend his left knee while walking because of pain. Which of the following interventions is most appropriate today? a. Passive knee flexion/extension with the hip flexed to 90° b. Passive knee flexion/extension with the hip positioned in 0° extension c. Active knee flexion but no passive or active extension d. Submaximal resisted knee flexion in the prone-lying position

b. Passive knee flexion/extension with the hip positioned in 0° extension

Which of the following exercises, designed to self-stretch the hamstrings, is the safest and utilizes the most effective stabilization? a. Patient stands, bends forward, keeping both knees straight, and attempts to touch the nose to the thighs. b. Patient stands on one leg, places the other leg on a table, bends forward with the back straight, and reaches toward the foot of the elevated leg. c. Patient sits on the floor in a hurdler's position, keeps the back straight, and reaches toward the foot of the straight leg. d. Patient sits on the floor in a long-sitting position with the knees straight and does a bilateral toe touch.

b. Patient stands on one leg, places the other leg on a table, bends forward with the back straight, and reaches toward the foot of the elevated leg.

Each of the following is true regarding principles of joint protection and energy conservation for a patient with rheumatoid arthritis experiencing a flare of the disease except: a. Stop activities for a period of time when pain or fatigue begins to develop. b. Perform stretching exercises once a day to help maintain joint alignment. c. Increases the strength of the healing tissues. d. Helps scar tissue resolve more quickly

b. Perform stretching exercises once a day to help maintain joint alignment.

Movement during the acute stage of healing following soft tissue injury: a. Is contraindicated. b. Should be passive or assisted and should begin as soon as tolerated within the pain-free range. c. Should include the full ROM in order to prevent adhesions. d. Should begin on the fourth day and be tissue-specific.

b. Should be passive or assisted and should begin as soon as tolerated within the pain-free range.

Your patient describes posterior cervical pain and headaches that get progressively worse throughout each workday. She is a computer programmer, plays tennis on the weekends, and is an aerobic walker in the evenings. Your evaluation reveals a person who is physically fit with well-balanced flexibility and strength. Your treatment emphasis will be: a. Stretching the short suboccipital, levator, and scalene muscles. b. Teaching tension-reducing postures and modification of chair, desk, and computer heights. c. Teaching proper warm-up exercises and progressing her aerobic program to running. d. Changing her sleeping posture and pillow height.

b. Teaching tension-reducing postures and modification of chair, desk, and computer heights.

Which of the following combinations of activities best describes a balanced multidimensional exercise program designed for the older adult to emphasize healthy living? a. Passive range of motion (PROM), ambulation, resistance training with less than 5 pounds for the arms and less than 10 pounds for the legs b. Low-impact aerobics, water resistance exercises, active range of motion (AROM) c. Aerobics, flexibility, strengthening, balance d. Unweighted rowing, bicycling, neutral incline treadmill walking

c. Aerobics, flexibility, strengthening, balance

Each of the following principles is important when designing a therapeutic exercise program to correct hip muscle length/strength imbalances except: a. When stretching the hip musculature, the spine and pelvis must be stabilized against the force. b. Contraction of the muscle opposite the range-limiting muscle (i.e., contracting the antagonist of the tight muscle) to assist with the stretching maneuver has the benefit of training the antagonist muscle to function in any newly gained range. c. Because of the functional demands placed on the lower extremities, it is more important to have full hip ROM than to have "normal" strength of hip musculature. d. Strengthening exercises should include closed-chain exercises to prepare for functional activities in weight-bearing postures.

c. Because of the functional demands placed on the lower extremities, it is more important to have full hip ROM than to have "normal" strength of hip musculature.

If the strength of a muscle is "good" (grade 4/5) and active ROM cannot be done, repetitive muscle setting exercises will accomplish each of the following except: a. Maintain mobility between muscle fibers. b. Develop or maintain an awareness of the sensation of a muscle contraction. c. Increase the strength in the muscle. d. Enhance circulation within the muscle.

c. Increase the strength in the muscle.

Postural stability of the spine is provided by: a. Elasticity of passive restraints. b. Interaction of passive restraints and muscle control. c. Interaction of muscle control modulated by the central nervous system and passive restraints. d. Muscle activity maintaining balance in the neutral zone.

c. Interaction of muscle control modulated by the central nervous system and passive restraints.

A patient has mild joint swelling and pain during active ROM, but resisted tests of the muscles that cross the swollen joints do not cause pain. Your goal is to maintain or possibly increase strength through the available ROM. The most appropriate choice of exercise is: a. Muscle setting exercises at the end of the ROM. b. High-velocity isokinetic exercise. c. Multiple-angle isometric exercise against resistance. d. Eccentric/concentric, closed-chain exercise against body weight throughout the ROM.

c. Multiple-angle isometric exercise against resistance.

You are initiating postoperative treatment for a 78-year-old woman who sustained an intertrochanteric fracture of the proximal femur 3 days ago and immediately underwent open reduction with internal fixation (screw-plate fixation). She has been referred to physical therapy for postoperative exercise and gait/functional training (initially with minimal weight bearing on the operated side). A decision has not yet been made about whether this patient will be discharged directly to home where she lives with her husband or to a subacute skilled nursing facility. Prior to discharge from the hospital during the next few days, which of the following is the lowest priority intervention? a. Gait training with a walker and transfer/bed mobility training b. Active-assistive range of motion (A-AROM), progressing to active range of motion (AROM) of the operated hip c. Open-chain, resistance exercises for the operated lower extremity d. Closed-chain, resisted exercises for the upper extremities and sound lower extremity, emphasizing extension in functional patterns

c. Open-chain, resistance exercises for the operated lower extremity

A 68-year-old female patient with mild osteoarthritis (OA) of the hips and knees and a recent diagnosis of sarcopenia obesity has been referred to you for strength training. What special considerations will be necessary for you to consider when developing a resistance training program for this individual? a. The first priority should be weight loss management to reduce the stress on the joints. The program should be designed to burn more calories than consumed using high-intensity, resistance exercises. b. Limit exercise to three times a week to control the inflammatory response of the OA and instruct the patient that resistance exercise must be performed at very low intensity because of the frailty associated with the sarcopenia. c. Resistance training is indicated for both diagnoses and should be tailored to match frequency, intensity, and duration of exercise to her abilities and goals. d. Resistance training is contraindicated because of the risk factors for potential stress fractures, falls, and cardiac compromise associated with her diagnoses.

c. Resistance training is indicated for both diagnoses and should be tailored to match frequency, intensity, and duration of exercise to her abilities and goals.

Recent advances in arthroscopy of the hip now allow all of the following procedures to be performed using this less invasive technique except: a. Microfracture to stimulate fibrocartilage growth. b. Acetabular labral repair. c. Resurfacing arthroplasty. d. Capsulorrhaphy for capsular laxity.

c. Resurfacing arthroplasty.

All of the following are recommendations of the National Osteoporosis Foundation for ways to prevent osteoporosis except: a. Maintain a diet rich in calcium and vitamin D. b. Routinely participate in weight bearing and aerobic exercises. c. Strengthen the core and protect the spine with flexion exercises (curls and sit-ups). d. Stop smoking and decrease excessive alcohol consumption.

c. Strengthen the core and protect the spine with flexion exercises (curls and sit-ups).

Your patient describes having cervical and upper thoracic pain progressing throughout the day at work where she works by reaching forward and overhead on an assembly line. On evaluation you determine she is experiencing "stretch weakness" from prolonged postural positioning. The treatment program you design should primarily include all of the following except: a. Posture training for safe body mechanics. b. Muscular endurance and strengthening. c. Stretching for the involved postural muscles. d. Environmental adaptations for ergonomic relief and protection.

c. Stretching for the involved postural muscles.

You are modifying a home exercise program for a patient recovering from an episode of medial epicondylitis. Although pain has subsided, there is evidence of mild limitation of motion and pain when the involved muscle-tendon unit is placed on a stretch and overpressure is applied at the end of the available ROM. To fully lengthen the muscle-tendon unit typically involved in medial epicondylitis, have the patient perform a self-stretch by using the opposite hand to: a. Flex and ulnarly deviate the wrist and flex the fingers while the elbow is extended and the forearm is pronated. b. Flex and radially deviate the wrist and flex the fingers while the elbow is extended and the forearm is supinated. c. Extend and ulnarly deviate the wrist and extend the fingers while the elbow is extended and the forearm is pronated. d. Extend and radially deviate the wrist and extend the fingers while the elbow is extended and the forearm is supinated.

d. Extend and radially deviate the wrist and extend the fingers while the elbow is extended and the forearm is supinated.

Your patient has an "extensor lag" of the MP joint. The exercise of choice to remediate this problem is which of the following? a. While stabilizing the IP joints of one finger in extension, passively extend the MP joint of that finger. b. Have the patient move actively from the straight fist position to the tabletop position of the hand. c. Have the patient move actively from the full fist position of the hand to the tabletop position. d. Have the patient move actively from the full fist position of the hand to the hook fist position.

d. Have the patient move actively from the full fist position of the hand to the hook fist position.

Each of the following is true about the use of early controlled motion after tendon repair in the hand and forearm except: a. When ROM exercises are initiated, they are performed within a protected range to minimize the risk of excessive stress on the repair site and gapping of the repaired tendon ends. b. It has been shown to increase the tensile strength of the scar at the repair site more effectively than the use of prolonged immobilization after a surgical repair. c. It is thought to improve synovial fluid diffusion, thereby improving tendon nutrition and promoting tendon healing. d. It is used more often after extensor tendon repair than after flexor tendon repair.

d. It is used more often after extensor tendon repair than after flexor tendon repair.

Which of the following are risk factors for secondary osteoporosis? a. Low body weight b. Family history of osteoporosis c. Caucasian or Asian descent d. Long-term use of corticosteroids

d. Long-term use of corticosteroids

Which of the following types of active exercises are the most appropriate to use first during the acute phase of healing after a muscle injury? a. Submaximal isokinetic concentric exercise at slow velocities b. Active ROM exercises c. Multiple-angle isometrics against manual resistance d. Low-intensity muscle setting

d. Low-intensity muscle setting

During the repair process following tissue injury, the newly developing collagen fibrils are: a. Ready to withstand normal stresses by 3 weeks. b. Slow to be deposited. c. Laid down in alignment exactly replicating the fibers that were damaged. d. Thin and unorganized.

d. Thin and unorganized.

Which of the following forms of resistance training is most appropriate for a 9-year-old child with weakness of the elbow musculature as the result of an elbow sprain, followed by several weeks of elbow immobilization combined with daily active (nonresisted) ROM? a. High-load, low-repetition biceps curls on equipment specifically designed to adjust to a child's body proportions b. . Low-load, high-repetition biceps curls on equipment usually used by the adult patient population c. Supervised exercise by unlicensed support personnel d. Underhand bilateral toss of a weighted ball

d. Underhand bilateral toss of a weighted ball