DUNNAWAY PART 1

The therapist is ambulating a patient with an above knee amputation. The new prosthesis causes the heel on the involved foot to move laterally at toe-off. Which of the following is the most likely cause of this deviation?

A. Too much internal rotation of the prosthetic knee.
B. Too much external rotation of the prosthetic knee.
C. Too much outset of the prosthetic foot.
D. None of the above would cause this deviation

A. This deviation is commonly referred to as a lateral heel whip. Excessive internal rotation of the prosthetic knee is one of the causes of this deviation. Excessive external rotation of the knee causes a medial heel whip.

A therapist is testing key muscles on a patient who recently suffered a spinal cord injury. The current test assesses the strength of the long toe extensors. Which nerve segment primarily innervates this key muscle group?

A. L2
B. L3
C. L4
D. L5

D.The long toe extensors represent the spinal cord segment L5. The iliopsoas represents L2. The quadriceps is innervated by L3 and the tibialis anterior is innervated by L4.

A patient asks the therapist to explain the function of his medication verapamil (a calcium antagonist). Which of the following points should be conveyed in the therapist’s explanation?

A. Verapamil causes decreased contractility of the heart and vasodilation of the coronary arteries.
B. Verapamil causes decreased contractility of the heart and vasoconstriction of the coronary arteries.
C. Verapamil causes increased contractility of the heart and vasodilation of the coronary arteries.
D. Verapamil causes increased contractility of the heart and vasoconstriction of the coronary arteries

A. Verapamil reduces contractility of the heart and increases coronary artery dilation, resulting in decreased cardiac workload and increased blood flow to the heart muscle.

While assessing the standing posture of a patient, the therapist notes that a spinous process in the thoracic region is shifted laterally. The therapist estimates that T2 is the involved vertebra because he or she notes that it is at the approximate level of the

A. inferior angle of the scapula
B. superior angle of the scapula
C. spine of the scapula
D. xiphoid process of the sternum

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

A patient comes to the therapist because she has noted a pronounced tuft of hair on the center of her spinal column in the lumbar area. The therapist notes no loss in motor or sensory function. This patient most likely has what form of spina bifida?

A. Meningocele
B. Meningomyelocele
C. Spina bifida occulta
D. Syringomyelocele

C. Spina bifida occulta is a benign disorder. It presents with no decrease in function. There is no protrusion of the spinal cord or its associated structures, as in choices A and B.

Persuading a sedentary patient to become more active, the therapist explains the benefits of exercise. Which of the following is an inappropriate list of benefits?

A. Increased efficiency of the myocardium to obtain oxygen, decreased high-density lipoprotein (HDL) and decreased cholesterol.
B. Decreased low-density lipoprotein (LDL), decreased triglycerides, and decreased blood pressure.
C. Increased efficiency of the myocardium to obtain oxygen, decreased cholesterol, and decreased LDL.
D. Both B and C are inappropriate lists.

A. There are many benefits of exercise. Decreased HDL in answer A makes this an inappropriate list of the benefits of exercise. HDL is considered “good” cholesterol. Exercise decreases LDL and increases HDL in the bloodstream.

A therapist instructed to provide electrical stimulation to a patient with a venous stasis ulcer on the right lower extremity. What is the correct type of electrical stimulation to promote wound healing?

A. Biphasic pulsed current
B. Direct current
C. Interferential current
D. Transcutaneous electrical stimulation

B. Direct current is shown to have the greatest benefit in wound healing. Monophasic pulse current has also been shown to have wound healing benefits

While ambulating a stroke patient (right side is the involved side), the therapist notes increased circumduction of the right lower extremity. Which of the following is an unlikely cause of this deviation?

A. Increased spasticity of the right gastrocnemius.
B. Increased spasticity of the right quadriceps.
C. Weak hip flexors.
D. Weak knee extensors.

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

Which of the following is contraindicated to ultrasound at 1.5 watts/cm2 with a 1 MHz sound head?

A. Over a recent fracture site.
B. Over non-cemented metal implant.
C. Over a recently surgically repaired tendon.
D. Over the quadriceps muscle belly

C. A therapist can use ultrasound with all of the other choices. Performing an ultrasound over a cemented metal implant is also a contraindication. However, with any ultrasound techniques, treatment should be stopped if the patient feels pain.

The therapist is treating a 52-year-old woman after right total hip replacement. The patient complains of being self-conscious about a limp. She carries a heavy briefcase to and from work every day. The therapist notes a Trendelenburg gait during ambulation on level surfaces. What advice can the therapist give the patient to minimize gait deviation?

A. Carry the briefcase in the right hand
B. Carry the briefcase in the left hand
C. The patient should not carry a briefcase at all.
D. It does not matter in which hand the briefcase is carried.

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

The supervisor of a rehabilitative facility insists on a weekly meeting to discuss drops in productivity. The supervisor is not concerned with the increased demand placed on the already overworked employees. According to the managerial grid, what is the best classification of this manager?

A. 5.5
B. 9.9
C. 1.9
D. 9.1

D. Managers rates as 9,1 have high concern for productivity and low concern for employees. Manages classified as 5,5 have moderate concern for productivity and employees. Managers classified as 9,9 have a high concern for both. Managers rated as 1,9 have high concern for employees and little concern for productivity

What is the major concern of the physical therapist treating a patient with an acute deep partial thickness burn covering 27% of the total body? The patient was admitted to the intensive care burn unit 2 days ago.

A. Range of motion
B. Fluid retention
C. Helping the family cope with the injured patient.
D. Home modification on discharge.

A. A therapist’s main responsibility with this patient is to maintain range of motion. Fluid retention is an important concern but for other medical staff. Choices C and D will be addressed later in the patient’s course of therapy.

A pitcher is exercising in a clinic with a sports cord mounted behind and above his head. The pitcher simulates pitching motion using the sports cord as resistance. Which proprioceptive neuromuscular facilitation (PNF) diagonal is the pitcher using to strengthen the muscles involved in pitching a baseball?

A. D1 extension
B. D1 flexion
C. D2 extension
D. D2 flexion.

C. The pitcher is moving into D2 extension with the throwing motion. He is strengthening the muscles involved in shoulder internal rotation, adduction, and forearm pronation

The therapist is evaluating a 32-year-old woman for complaints of right hip pain. The patient has injured the strongest ligament of the hip. The therapist places the patient in the prone position on the plinth and passively extends the involved hip. The therapist notes an abnormal amount of increase in passive hip extension. Which of the following ligaments is damaged?

A. Ischiofemoral ligament
B. Iliofemoral ligament (Y ligament of Bigelow)
C. Pubofemoral ligament
D. Ligamentum teres

B. The Iliofemoral ligament is the strongest ligament in the hip that prevents extension. It is the ligament most likely to be compromised in this scenario.

While obtaining the history from a 62-year-old woman weighing 147 pounds, the therapist discovers that the patient has a history of rheumatoid arthritis. The order for outpatient physical therapy includes continuous traction due to a L2 disc protrusion. What is the best course of action for the therapist?

A. Follow the order.
B. Consult with the physician because rheumatoid arthritis is a contraindication.
C. Apply intermittent traction instead of continuous traction.
D. Use continuous traction with the weight setting at 110 pounds.

B. Answers A and C are incorrect because rheumatoid arthritis is a contraindication for continuous or intermittent traction. Answer D is incorrect for the above reason as well as the fact that a 110-pound setting is too great for a 147-pound patient.

The therapist in an outpatient physical therapy clinic receives an order to obtain a shoe orthotic for a patient. After evaluating the patient, the therapist finds a stage I pressure ulcer on the first metatarsal head. Weight-bearing surfaces need to be transferred posteriorly. Which orthotic is the most appropriate for this patient?

A. Scaphoid pad.
B. Thomas heel.
C. Metatarsal pad
D. Cushion heel.

C. Metatarsal pads successfully transfer weight onto the metatarsal shafts of this patient. A Thomas heel and a scaphoid pad are for patients with excessive pronation. A cushion heel absorbs shock at contact

On examination of a cross section of the spinal cord of a cadaver, the examiner notes plaques. The finding is most characteristic of what condition?

A. Parkinson’s disease
B. Myasthenia gravis
C. Multiple sclerosis.
D. Dementia.

C. Parkinson’s disease and dementia are disorders involving the brain. Myasthenia gravis is a problem with acetylcholine receptors at the neuromuscular junction

Which of the following actions places the greatest stress on the patellofemoral joint?

A. When the foot first contacts the ground during the gait cycle.
B. Exercising on a stair stepper machine.
C. Running down a smooth decline of 30 o
D. Squats to 120 o of knee flexion.

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

A therapist working at a hospital calls another therapist in an outpatient facility to provide a brief history of a patient who is scheduled to leave the hospital and receive outpatient therapy. The acute care therapist states that the patient received an injury to the somatic sensory association cortex in one hemisphere. From this information only, the outpatient therapist knows that the patient will most likely

A. ignore someone talking to him or her on the involved side
B. be unable to find one of his or her extremities.
C. have no trouble putting on clothes.
D. be unable to understand speech

B. A deficit in this region of the brain usually results in the inability to locate an extremity. This patient would have trouble putting on clothes

A patient recently diagnosed with multiple sclerosis presents to a physical therapy clinic. The patient asks the therapist what she needs to avoid with this condition. Which of the following should the patient avoid?

A. Hot tubs.
B. Slightly increased intake of fluids.
C. Application of ice packs.
D. Strength training.

A. The danger in using a hot tub for a person with multiple sclerosis is that it may cause extreme fatigue. There is no need to avoid the other activities listed

The therapist is evaluating a patient with a diagnosis of cerebral palsy. The therapist notes that all of the extremities and the trunk are involved. Further assessment also reveals that the lower extremities are more involved than the upper extremities and that the right side is more involved than the left. This patient most likely has which classification of cerebral palsy?

A. Spastic hemiplegia.
B. Spastic triplegia.
C. Spastic quadriplegia.
D. Spastic diplegia.

D. A child with spastic diplegia most often presents with the lower extremities and trunk more involved than the upper extremities. Also one side is often more involved than the other side.

A therapist is treating a 35-year-old man diagnosed with lumbar disc degeneration in an outpatient clinic. Through conversation with the patient, the therapist learns that he is also being treated by a chiropractor for cervical dysfunction. What is the best course of action by the therapist?

A. Continue with the current treatment plan and ignore the chiropractor’s treatment.
B. Ask the patient what the chiropractor is doing and try the same approach.
C. Stop physical therapy at once and consult with the referring physician.
D. Contact the chiropractor to coordinate his or her plan of care with the physical therapy plan of care

D. In the ideal situation, the therapist should coordinate his or her plan of care with the chiropractor in case the problems are related

A therapist is mobilizing a patient’s right shoulder. The movement taking place at the joint capsule is not completely to end range. It is a large amplitude movement from near the beginning of available range to near the end of available range. What grade of mobilization according to Maitland, is being performed?

A. Grade I
B. Grade II
C. Grade III
D. Grade IV

B. Grade I is a small oscillating movement at the beginning of range. Grade III is a large movement up to the end of available range. Grade IV is a small movement at the end of available range

While observing the ambulation of a 57-year-old man with an arthritic right hip, the therapist observes a right lateral trunk lean. Why does the patient present with this gait deviation?

A. To move weight toward the involved hip and increase joint compression force.
B. To move weight toward the uninvolved hip and decrease joint compression force.
C. To bring the line of gravity closer to the involved hip joint.
D. To take the line of gravity away from the involved hip joint.

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

The therapist has given a patient an ultraviolet treatment. The patient calls the therapist the next day with complaints of peeling and itching. These signs and symptoms resolve three days later (a total of 4 days after treatment). What dosage did the patient receive?

A. Suberythemal dose
B. Minimal erythemal dose.
C. First-degree erythemal dose.
D. Third-degree erythemal dose.

C. A Suberythemal dose of ultraviolet treatment is not enough to cause reddening of the skin. A minimal erythemal dose leads to slight itching and reddening. A third-degree erythema is a more severe reaction with blister and edema formation

Which of the following duties cannot be legally performed by a physical therapist assistant?

A. Confer with a doctor about a patient’s status.
B. Add 5 pounds to a patient’s current exercise protocol.
C. Allow a patient to increase in frequency from 2times/week to 3 times/week.
D. Perform joint mobilization

C. A physical therapist assistant (PTA) can do all of the listed options except the frequency or duration as prescribed by a therapist or physician. Choice B allows the PTA to work within the protocol established by the physical therapist.

The therapist is treating a track athlete who specializes in sprinting and wants to increase his or her speed on the track. To accomplish this goal, the plan of care should include activities to develop fast-twitch muscle fibers. Characteristics of this type of fiber include:

A. Fatigues slowly, fiber colors appear red and used more in aerobic activity.
B. Fatigues quickly, fiber colors appear white and used in anaerobic activity.
C. Fatigues quickly, fiber colors appear white and used more in aerobic activity.
D. Fatigues slowly, fiber colors appear white, and used more in anaerobic activity.

B. Choice B describes fast twitch muscle fibers. Choice A describes slow twitch fibers. Choices C and D are incorrect answers

A physical therapist should place the knee in which of the following positions to palpate the lateral collateral ligament (LCL)?

A. Knee at 60 o of flexion and the hip externally rotated.
B. Knee at 20 o of flexion and the hip at neutral.
C. Knee at 90 o of flexion and hip externally rotated.
D. Knee at 0 o and the hip at neutral

C. The lateral collateral ligament of the knee is best palpated with the patient in the sitting position. The patient then places the foot of the involved lower extremity on the knee of the uninvolved lower extremity. This maneuver places the involved knee in 90 o of flexion and hip in external rotation

The therapist receives an order to treat a 42-year-old man admitted to the hospital 3 days ago with a stab wound to the left lower thoracic spine. The patient is unable to move the left lower extremity and cannot feel pain or temperature differences in the right lower extremity. What is the most likely type of lesion?

A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Central cord syndrome
D. The patient is equally as likely to have anterior cord syndrome as he is to have Brown-Sequard syndrome.

B. The question describes a hemisection of the spinal cord, which is classified as a Brown-Sequard lesion. Anterior spinal cord injuries present with loss of motor function and insensitivity to pain and temperature bilaterally. Central cord injuries are characterized by loss of function in the upper extremities and normal function in the trunk and lower extremities.

The therapist is working in an outpatient cardiac rehabilitation facility. A 50-year-old healthy man inquires about the correct exercise parameters for increasing aerobic efficiency. Which of the following is the most correct information to convey to this individual?

A. Exercise at 50-85% of maximal volume of oxygen utilization (VO2)
B. Exercise with heart rate between 111 and 153 beats/minute.
C. Exercise at approximately 170 beats/minute.
D. A and B are correct.

D. Choices A and B are correct exercise parameters for a healthy person. Choice B has the patient exercising at 65-90% of his age-adjusted maximal heart rate. Choice C is the patient’s age-adjusted maximal heart rate.

The therapist is treating a patient with a T4 spinal cord injury when the patient suddenly complains of a severe headache. The therapist also notes that the patient’s pupils are constricted and that the patient is sweating profusely. Which of the following is the best course of action for the therapist?

A. Try to find a probable source of noxious stimulus and position the patient supine with feet elevated.
B. Try to find a probable source of noxious stimulus and position the patient with upper trunk elevated and legs lowered.
C. Try to find a probable source of noxious stimulus and place the patient in a sidelying position.
D. Try to find a probable source of noxious stimulus and position the patient in prone position.

B. The patient is experiencing autonomic dysreflexia. The correct actions are to find the probable cause of the noxious stimulus and to lower the patient’s blood pressure by inducing orthostatic hypotension. Patients with spinal cord injury above the level of T6 can experience this problem

What lobe of the lungs is the therapist attempting to drain if the patient is in the following position? Resting on the left side rolled ¼ turn back, supported with pillows, and the foot of the bed raised 12-16 inches.

A. Right middle lobe – lingular segment.
B. Left upper lobe – lingular segment
C. Right upper lobe – posterior segment
D. Left upper lobe – posterior segment.

A. Choice B is drained by resting on the right ¼ turn to the back, and foot of the bed elevated 12-16 inches. Choices C and D are drained with patient in long sitting position or leaning forward over the pillow in sitting position

A therapist has been treating a patient who received a rotator cuff surgical repair with sessions consisting only of passive range of motion (for an extended period). The patient has just returned from a follow-up doctor’s visit with an additional order to continue with passive range of motion only. Which of the following is the best course of action for the therapist?

A. Continue with passive range of motion as instructed, and call the physician to consult with him or her about the initiation of active range of motion.
B. Begin active range of motion within the pain-free range, and continue passive range of motion.
C. Continue passive range of motion, and do not question the physician’s decision.
D. Perform passive range of motion and any other exercise that is within the normal protocol for this diagnosis.

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

A 25-year-old woman has been referred to a physical therapist by an orthopedist because of low back pain. The therapist is performing an ultrasound at the L3 level of the posterior back when the patient suddenly informs the therapist that she is looking forward to having her third child. On further investigation, the therapist discovers that the patient is in the first trimester of pregnancy. Which of the following is the best course of action for the therapist?

A. Change the settings of the ultrasound from continuous to pulsed.
B. Continue with the continuous setting because first trimester pregnancy is not a contraindication.
C. Cease treatment, notify the patient’s orthopedic physician, and document the mistake.
D. Send the patient to the gynecologist for an immediate sonogram.

C. The therapist should notify the referring physician. The mistake should be documented and the patient informed. The referring physician can determine the need for a consultation with him or her or an obstetrician.

A 20-year-old woman is referred to a therapist with a diagnosis of recurrent ankle sprains. The patient has a history of several inversion ankle sprains within the past year. No edema or redness is noted at this time. Which of the following is the best treatment plan?

A. Gastrocnemius stretching, ankle strengthening, and ice.
B. Rest, ice, compression, elevation and ankle strengthening.
C. Ankle strengthening and a proprioception program.
D. Rest, ice, compression, elevation and gastrocnemius stretching.

C. Patients with recurrent ankle sprains benefit from proprioceptive exercises. Choices B and D are not indicated because of the lack of acute signs and symptoms. Choice A is a good plan, but not the most correct because there is no mention of proprioception.

The therapist is treating a patient in an outpatient facility for strengthening of bilateral lower extremities. During the initial assessment, the patient reveals that he has a form of cancer but is reluctant to offer any other information about his medical history. After 1 week of treatment, the therapist is informed by the physician that the patient has Kaposi’s sarcoma and AIDS. Which of the following is the best course of action for the therapist?

A. Cease treatment of the patient, and inform him than an outpatient facility is not the appropriate environment for a person with his particular medical condition.
B. Continue treatment of the patient in the gym, avoiding close contact with other patients and taking appropriate universal precautions.
C. Continue treatment of the patient in the gym as before, taking appropriate universal precaution.
D. Cease treatment, but do not confront the patient with the knowledge of his HIV status.

B. The patient can be successfully treated by using universal precautions. The patient should be treated in a relatively isolated area because of his weakened immune system. The diagnosis of AIDS with Kaposi’s sarcoma is an indication that the patient’s immune system is weak. Gloves should be used if the patient’s sarcomas are open; otherwise, hand washing before and after patient contact is appropriate.

A patient reports to therapy stating that his “sugar is too high” for exercise. What is the minimal blood glucose level that is considered too high for a diabetic patient to begin exercise?

A. 300 mg/dl
B. 400 mg/dl
C. 300 g/dl
D. 400 g/dl

A. A blood sugar value of 300 mg/dl is a contraindicated level for therapeutic exercise.

The therapist is ordered to evaluate a patient in the intensive care unit. The patient appears to be in a coma and is totally unresponsive to noxious, visual and auditory stimuli. What rating on the Rancho Los Amigos Cognitive Functioning Scale is most appropriate?

A. I
B. III
C. IV
D. VI

A. I- No response. II- Generalized response III – Localized responses IV – Confused agitated. V – Confused inappropriate. VI – confused appropriate. VII – Automatic appropriate. VIII – Purposeful and appropriate.

A patient presents to an outpatient physical therapy clinic with a severed ulnar nerve in the upper extremity. What muscle is still active and largely responsible for the obvious hyperextension at the metacarpophalangeal (MCP) joints of the involved hand?

A. Dorsal interossei
B. Volar interossei
C. Extensor carpi radialis brevis
D. Extensor digitorum

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

A physician notes a vertebral fracture in the X-ray of a patient involved in a car accident. The fractured vertebra has a bifid spinous process. Which of the following vertebrae is the most likely to be involved?

A. Fourth lumbar vertebra
B. Fifth cervical vertebra
C. Twelfth thoracic vertebra
D. First sacral vertebra.

B. Bifid spinous processes are found only in the cervical spine

The therapist routinely places ice on the ankle of a patient with an acute ankle sprain. Ice application has many therapeutic benefits. Which of the following is the body’s first response to application of ice?

A. Vasoconstriction of local vessels
B. Decreased nerve conduction velocity
C. Decreased local sensitivity.
D. All occur simultaneously.

A. Local vasoconstriction is the first response. Nerve conduction velocity decreases after approximately 5 minutes of ice application.

The therapist is evaluating a patient with left-side visual field deficits in both eyes. A lesion at what location may cause this defect?

A. At the optic chiasm.
B. At the right side optic tract.
C. At the left side optic nerve
D. At the right side optic nerve

B. A lesion at choice A would cause bitemporal heteronymous hemianopsia. A lesion at choice C would cause left eye blindness, and a lesion at D would cause right eye blindness.

According to the Joint Commission on Accreditation of Health Care Organizations (JCAHO), a sentinel event is

A. A patient who is seriously injured at a facility.
B. An employee who is seriously injured at a facility.
C. A JCAHO surveyor who finds a major error in a facility’s billing policies.
D. A JCAHO surveyor who finds a major error in the structure of a facility (e.g., not enough handicap parking, not enough wheel chair ramps).

A. A patient seriously injured in a hospital or a hospital-owned facility is a sentinel event. Other choices might be JCAHO violations but only A is a sentinel event.

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

A. Lateral cutaneous nerve of the upper thigh.
B. Obturator nerve
C. Femoral nerve.
D. Ilioinguinal nerve

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

The therapist is treating a male patient for a second-degree acromioclavicular sprain. The patient has just finished the doctor’s prescription of 3 sessions/week for 4 weeks. The therapist is treating the patient with iontophoresis (driving dexamethasone), deltoid-strengthening exercises, pectoral strengthening exercises, and ice. The patient reports no decline in pain level since the initial evaluation. Which of the following is the best course of action for the therapist?

A. Phone the doctor and request continued physical therapy.
B. Tell the patient to go back to the doctor because he is not making appropriate progress.
C. Discharge the patient because he will improve on his own.
D. Take the problem to the supervisor of the facility.

B. The patient should have made adequate progress in this period with this protocol. Because of the lack of progress, the patient needs further evaluation by the physician.

The protocol for a cardiac patient states that the patient should not exceed 5 metabolic equivalents (METS) with any activity at this stage of recovery. Which of the following activities would be inappropriate for the patient?

A. Cycling 11 miles per hour
B. Walking 4 miles per hour.
C. Driving a car.
D. Weeding a garden.

A. Choice A is approximately 6-7 METs. Choice B is approximately 4-6 METs. Choice C is approximately 2 METs. Choice D is approximately 3-5 METs

Which of the following is a correct statement about Medicare?

A. Medicare Part A is only for patients over 85 years old
B. Medicare Part B is only for patients 65 – 84 years old.
C. Medicare Part A is only for inpatient treatment.
D. Medicare Part B is only for use in long-term facilities

C. Medicare Part A is used for inpatient treatment and Part B for outpatient treatment. Medicare Part A or B can be used for home health treatment; part B being is when the patient does not have part A.

A mother comes to a therapist concerned that her 4-month-old infant cannot sit up alone yet. Which of the following responses is the most appropriate for the therapist?

A. “Your infant probably needs further evaluation by a specialist because, although it varies, infants can usually sit unsupported at 2 months of age”.
B. “Your infant probably needs further evaluation by a specialist because, although it varies, infants can usually sit unsupported at 3 months of age”.
C. “This is probably nothing to concerned about because, although it varies, most infants can sit unsupported at 8 months of age”.
D. ”This is probably nothing to be concerned about because, although it varies, most infants can sit unsupported at 5 months of age”.

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

A therapist decides to buy two ultrasound machines from a sales representative. The representative offers the therapist a free steak dinner at a local restaurant as a toke of appreciation. What is the best course of action for the therapist?

A. Refuse the dinner gracefully
B. Take his or her family out to eat.
C. Offer to take the representative out to dinner.
D. Take a local doctor out to dinner and discuss the benefits of using this type of ultrasound

A. It is unethical to take gifts from anyone.

While observing a patient with posttraumatic brain injury (TBI), the therapist notes an increase in left ankle plantar flexion during loading response (heel strike to foot flat) of the involved lower extremity. With this particular patient, the left side is the involved side. Which of the following is not a likely cause of this deviation?

A. Spasticity of the left gastrocnemius
B. Hypotonicity of the left tibialis anterior.
C. Leg length discrepancy.
D. Left quadriceps hypertonicity.

D. Increased spasticity of the left gastrocnemius causes an increase in plantarflexion. Hypotonicity of the tibialis anterior causes a foot drop due to the inability to dorsiflex actively. Leg length discrepancy should be evaluated in the initial assessment. This is a possibility in any patient, regardless of the diagnosis. The least likely cause of this deficit is a hypertonic left quadriceps, which most likely would cause an increase in dorsiflexion on the involved side in an effort to decrease the functional leg length.

A therapist working in an outpatient physical therapy clinic evaluates a patient with a diagnosis of rotator cuff bursitis. The physician’s order is to evaluate and treat. During the evaluation the following facts are revealed: Active shoulder flexion = 85 o with pain; Passive shoulder flexion = 177 o ; Active shoulder abduction = 93 o with pain; Passive shoulder abduction = 181 o ; Active external rotation = 13 o ; Passive external rotation = 87 o ; Drop arm test = positive; Impingement test = negative; Biceps tendon subluxation test = negative; Sulcus sign = negative. Of the following, which is the best course of action?

A. Treat the patient for 1 week with moist heat application, joint mobilization, and strengthening. then suggest to the patient that he or she return to the physician if there are no positive results.
B. Treat the patient for 1 week with ultrasound, strengthening, and ice. Then suggest to the patient that he or she return to the physician if there are no positive results.
C. Treat the patient for 1 week with a home exercise program, strengthening, passive range of motion by the therapist, and ice. Then suggest to the patient that he or she return to the physician if there are no positive results.
D. Treat the patient for 1 week with strengthening, a home exercise program, and ice. Then suggest to the patient that he or she return to the physician if there are no positive results.

D. The patient most likely has a rotator cuff tear. Choices A and B are incorrect because there is no need for heating modalities. Choice C is wrong because the patient has full passive range of motion; thus there is no need for stretching provided by the therapist at this point.

A patient’s lawyer calls the therapist requesting his or her client’s clinical records. The lawyer states that he or she needs the records to pay the patient’s bill. What is the best course of action?

A. Tell the lawyer either to have the patient request a copy of the records or to have the patient sign a medical release.
B. Fax the needed chart to the lawyer.
C. Mail a copy of the chart to the patient.
D. Call the patient and tell him or her of the recent development.

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

A local plant asks a therapy team to perform a study of its workers. The study needs to determine the frequency of lung cancer in workers who insulate the inside area of an electrical oven appliance. Using company files, the therapy team studies all past employees with this job description. The employees were initially free of lung cancer, as determined by a routine physician’s examination required by the plant. The team records from these files the frequency with which each one of the employees developed lung cancer. What type of study is the therapy team performing?

A. Historical prospective
B. Historical cohort
C. Case control
D. A & B

D. A and B are the same type of study. The records of the factory are used to determine the frequency of disease. In a case-control study the people are selected based on whether or not they have a disease, then the frequency of the possible cause of the disease in the past is studied

CORF is an abbreviation for which of the following?

A. Certified Owner of a Rehabilitation Facility
B. Certified Outpatient Rehabilitation Facility
C. Control Organization for Rehabilitation Facilities.
D. Corporation for Organization of Rehabilitation Facilities.

B. A CORF is a classification of a type of outpatient facility.

The therapist is crutch training a 26-year-old man who underwent right knee arthroscopy 10 hours ago. The patient’s weight bearing status is toe-touch weight-bearing on the right lower extremity. If the patient is going up steps, which of the following is the correct sequence of verbal instructions?

A. “Have someone stand below you while going up, bring the left leg up first, then the crutches and the right leg”.
B. “Have someone stand above you while going up, bring the left leg up first, then the crutches and the right leg”.
C. “Have someone stand below you while going up, bring the right leg up first, then the crutches and left leg”.
D. “Have someone stand above you while going up, bring the right leg up first, then the crutches and the right leg”

A. Choice A is the correct gait sequence for ascending stairs in the given scenario. A caregiver should stand below the patient because the patient is most likely to fall down the stairs. This same rule holds true for descending stairs

A 35-year-old woman with a diagnosis of lumbar strain has a physician’s prescription with a frequency and duration of 3 sessions/week for 6 weeks. The physical therapy evaluation reveals radiculopathy into the L5 dermatome of the right lower extremity, increased radiculopathy with lumbar flexion, decreased radiculopathy with lumbar extension, poor posture, and hamstring tightness bilaterally at 60 o . What is the best course of treatment?

A. Lumbar traction, hot packs, and ultrasound.
B. McKenzie style lumbar extensions, a posture program, hamstring stretching, and a home exercise program.
C. McKenzie style lumbar extensions, a posture program, hamstring stretching, home program, hot packs, and ultrasound.
D. Lumbar traction, hot packs, ultrasound, and hamstring stretching.

B. Hot packs are no indicated because there is no mention of abnormal muscle tone. The entire lumbar area is too much surface area for ultrasound. An argument could be made for lumbar traction, but it is paired with heating modalities all of the answers.

A therapist is examining a 3-year-old child who is positioned as follows: supine, hips flexed to 90 o , hips fully adducted, and knees flexed. The therapist passively abducts and raises the thigh, applying an anterior shear force to the hip joint. A click at 30 o of abduction is noted by the therapist. What orthopedic test is the therapist performing, and what is its significance?

A. Ortolani’s test – hip dislocation
B. Apley’s compression/distraction test – cartilage damage
C. McMurray test – cartilage damage
D. Piston test – hip dislocation.

A. Ortolani’s test is used to detect a congenitally dislocated hip in an infant. Choices B and C are common meniscus damage tests for the knee. Choice D is performed by placing the infant in supine position with the hip at 90 o of flexion and slight abduction and knee flexed to 90 o . The examiner then moves the infant’s hip anterior and posterior in an effort to detect abnormal joint mobility.

A teenager comes to an outpatient facility with complaints of pain at the tibial tubercle when playing basketball. The therapist notices that the tubercles are abnormally pronounced on bilateral knees. What condition does the patient most likely have?

A. Jumper’s knees.
B. Anterior cruciate ligament sprain.
C. Osgood-Schlatter disease.
D. A & C

C. Osgood-Schlatter disease is severe tendinitis of the patellar tendon. It is characterized by pronounced tibial tubercles. The increased size of the tubercles is attributed to the patella tendon pulling away from its insertion. Jumper’s knees (or normal patella tendinitis) does not necessarily present with tubercle enlargement.

What is the best way to first exercise the postural (or extensor) musculature when it is extremely weak to facilitate muscle control?

A. Isometrically.
B. Concentrically.
C. Eccentrically.
D. Is kinetically.

A. Isometric exercises in the shortest range of the extensor muscle are used to begin strengthening. In contract, weak flexor muscles should be strengthened in the middle-to-lengthened range, because they most often work near their end range.

A patient presents to physical therapy with complaints of pain in the right hip due to osteoarthritis. Which of the following is not true about this type of arthritis?

A. Causes pain usually symmetrically because it is a systemic condition.
B. Not usually more painful in the morning.
C. This type of arthritis commonly involves the distal interphalangeal joint.
D. Mainly involves weight-bearing joints.

A. Choice A describes rheumatoid arthritis, a systemic condition. All of the other choices are signs and symptoms of osteoarthritis (OA). Sometimes OA can involve symmetrical joints, but it is not systemic.

Which of the following is observed by the therapist if a patient is correctly performing an anterior pelvic tilt in standing position?
A. Hip extension and lumbar flexion.
B. Hip flexion and lumbar extension.
C. Hip flexion and lumbar flexion.
D. Hip extension and lumbar extension

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

Which of the following is used to treat a patient referred to physical therapy with a diagnosis of Dupuytren’s contracture?

A. Knee continuous passive motion (CPM)
B. Work simulator set for squatting activities.
C. Hand splint.
D. A two-pound dumbbell

C. Dupuytren’s contracture is a progressive thickening of the palmar aponeurosis of the hand. The progression is gradual, and the interphalangeal joints are pulled into flexion.

If the line of gravity is posterior to the hip joint in standing, on what does the body first rely to keep the trunk from moving into excessive lumbar extension?

A. Iliopsoas muscle activity
B. Abdominal muscle activity
C. Anterior pelvic ligaments and the hip joint capsule.
D. Posterior pelvic ligaments and the hip joint capsule.

C. In static standing the line of gravity is posterior to the hip joint. The body relies on the anterior pelvic ligaments and the hip joint capsule. The iliopsoas may be recruited at times, but anterior ligaments are used first to keep the trunk from extending in static stance.

The therapist receives a referral to evaluate a patient with a boutonniere deformity. With this injury, the involved finger usually presents in the position of

A. Flexion of the proximal interphalangeal (PIP) joint and flexion of the distal interphalangeal (DIP) joint.
B. Extension of the PIP joint and flexion of the DIP joint.
C. Flexion of the PIP joint and extension of the DIP joint.
D. Extension of the PIP joint and extension of the DIP joint.

C. Answer B describes a swan-neck deformity.

Which of the following is the most important to assess first during an evaluation of a patient with a recent stroke?

A. Sensory status
B. Motor control
C. Mental status.
D. Ambulation potential

C. Mental status is the first item to assess. A therapist must first determine whether the patient is able to provide a reliable subjective history. It is also important to know whether the patient can follow a 1 or 2-step command beginning a formal evaluation. The other choices should be assessed later in the evaluation

A therapist receives an order to evaluate a 72-year-old woman who has suffered a recent stroke. The therapist needs to focus on pregait activities. Which of the proprioceptive neuromuscular facilitation (PNF) diagonals best encourages normal gait?

A. D1
B. D2
C. PNF is contraindicated
D. Pelvic PNF patterns only.

A. The therapist would use a PNF D1 diagonal to encourage the combined movements of hip flexion, adduction, and knee flexion. The diagonal also encourages the combined movements of hip adduction and extension. This is a combination of muscle activity most needed for gait.

A therapist receives an order to evaluate and treat a 76-year-old woman who was involved in a motor vehicle accident 2 days ago. The patient’s vehicle was struck in the rear by another vehicle. The patient has normal sensation and strength in bilateral lower extremities but paralysis and loss of sensation in bilateral upper extremities. Bowel and bladder function are normal. The patient most likely has what type of spinal cord injury?

A. Anterior cord syndrome.
B. Brown-Sequard syndrome.
C. Central cord syndrome.
D. There is no evidence of an incomplete spinal cord lesion.

C. This scenario describes a central cord lesion. It is common in the geriatric population after cervical extension injuries (such as whiplash).

A patient living in a nursing home with Medicare Part A as the source of reimbursement is treated by physical therapy only. What is the required minimal frequency of physical therapy treatment?
A. Once a week
B. Three times a week
C. Five times a week
D. There is no required time frame

C. Medicare requires that a patient living in a nursing home with Part A as the main source of reimbursement receive 5 days/week of skilled treatment. In this scenario, the physical therapist must see the patient 5 days/week because it is the only skilled service required by the patient.

At what point in the gait cycle is the center of gravity the lowest?

A. Double support.
B. Terminal swing.
C. Deceleration.
D. Midstance

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

An 87-year-old woman presents to an outpatient physical therapy clinic complaining of pain in the left sacroiliac joint. The examination reveals higher left anterior superior iliac spine (ASIS) than the right ASIS, shorter leg length on the left side (measured in supine position), and left side posterior superior iliac spine (PSIS) lower than the right PSIS. In what position should you place the patient to perform the correct sacroiliac mobilization of the left innominate?

A. Right sidelying
B. Supine
C. Prone
D. None of the above

D. The answer is none of the above because the sacroiliac joint of an 87-year-old woman is most often fused.

A therapist is working in an outpatient rehabilitation facility. A female patient presents with an order for occupational therapy to evaluate and treat a diagnosis of carpal tunnel syndrome. The occupational therapist (OT) brings to the attention of the physical therapist (PT) that the patient’s insurance will not reimburse for occupational therapy services. What is the best course of action?

A. Allow the OT to treat the patient and the PT to sign off on his or her work.
B. Tell the patient that she will have to pay out of pocket for OT services.
C. Call the doctor’s office and obtain an order for PT, then allow the PT to treat the patient.
D. Tell the patient to return to her doctor to obtain a PT order.

C. Answer A is incorrect because the order is for occupational, not physical therapy, and under than order the patient has to be treated by an occupational therapist. Answer B is incorrect because it is unlikely that a patient will agree to paying out of pocket or be able to afford the expense of occupational therapy services. Answer D is incorrect because the problem can be solved by telephone without making the patient schedule another doctor’s appointment. Answer C is correct because it would take about 5 minutes to obtain a verbal order, and therapy can begin right away

The home health physical therapist arrives late at the home of a patient for a treatment session just as the occupational therapist has finished. The patient is angry because the sessions are so close together. The patient becomes verbally abusive toward the physical therapist. The most appropriate response to the patient is:

A. “I’m sorry I’m late, but you must try to understand that I am extremely busy”.
B. “I know you are aggravated. It is inconvenient when someone does not show up when expected. Let’s just do our best this session and I will make an effort to see that we do not have PT and OT scheduled so close together from now on”.
C. “You have to expect visits at any time of the day with home health”.
D. “The OT and I did not purposefully come so close together. I apologize, please let’s now begin therapy”.

B. Answer B is the most empathetic response. It also lets the patient know that the therapists will make an effort to prevent the problem from recurring

Which of the following is not an acceptable long-term goal for a patient with a complete C7 spinal cord injury?

A. Independence with dressing
B. Driving an automobile.
C. Balance a wheelchair for 30 seconds using a “wheelie”.
D. Independence with performing a manual cough.

C. Answer A is incorrect because the patient should be able to learn how to be independent with activities of daily living. Answer B is incorrect because the patient can learn to drive an automobile independently with the assist of hand control. Answer C is the correct answer because the patient may use momentum to negotiate a curb. Total balance of a wheelchair using a wheelie is an unrealistic goal.

A 17-year-old football player is referred to the outpatient physical therapy clinic with a diagnosis of a recent third-degree medial collateral ligament sprain of the knee. The patient wishes to return to playing football as soon as possible. Which of the below is the best protocol?

A. Fit the patient with a brace that prevents him from actively moving the knee into the last available 20 o of extension. Prescribe general lower extremity strengthening with the exception of sidelying hip adduction.
B. Do not fit the patient with a brace. All lower extremity strengthening exercises are indicated.
C. Fit the patient with a brace that prevents him from actively moving the knee into the last available 20 o of extension. Avoid all open-chain strengthening for the lower extremity.
D. Do not fit the patient with a brace. Prescribe general lower extremity strengthening with the exception of sidelying hip adduction.

A. The screw home mechanism that is present in the last few degrees of terminal knee extension stresses the MCL. Sidelying hip adduction also places the MCL in position of stretch.

The therapist is working in a nursing home. The company for which the therapist works requires that therapists be at least 75% efficient. The therapist realizes that he or she cannot effectively treat the patients in the given time frame. What is the best course of action?

A. Work until the 75% limit is up and cease treatment.
B. Work with the patients until the 75% limit is up and complete paperwork for the rest of the 8 hour working day.
C. Quit the job and find a company that does not require the 75% limit.
D. Go to the immediate supervisor in an attempt to alleviate the problem

D. Answer A is incorrect because any way to solve this problem without denying needed therapy needs to be explored first.

Answer B is incorrect because the therapist may be donating a considerable amount of time. This solution is not profitable for the therapist and is likely to cause an uncomfortable working atmosphere.
Answer C is incorrect because the matter may be resolved without quitting.

Answer D is correct because the immediate supervisor may be able to assist the therapist in coming to an agreement between the therapist and the company that employs them.

In an attempt to establish a home exercise program the therapist gives a patient written exercises. After 1 week, the patient returns and has not performed any of the exercises. After further questioning, the therapist determines that the patient is illiterate. What is the best course of action?

A. Go over the exercises in a one-on-one review session.
B. Give the patient a picture of the exercises.
C. Give a copy of the exercises to a literate family member
D. All of the above

D. This answer is correct because patients need a written home program with diagrams and instructions. One-on-one teaching is also necessary to ensure that the patient understands the program. Bringing in another family member is also definitely advisable to assist the patient with program at home.

How often does the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) survey hospitals?

A. Once per year
B. Every 2 years
C. Every 3 years
D. Every 4 years

C. The Joint Commission surveys hospitals once every 3 years.

What is the closed-packed position of the shoulder?

A. Internal rotation and abduction
B. External rotation and abduction
C. Internal rotation and adduction
D. External rotation and adduction

B. The area of contact between the humerus and the glenoid fossa is maximal in this position.

A 42-year-old receptionist presents to an outpatient physical therapy clinic complaining of low back pain. The therapist decides that postural modification needs to be part of the treatment plan. What is the best position for the lower extremities while the patient is sitting?

A. 90° of hip flexion, 90° of knee flexion, and 10° of dorsiflexion
B. 60° of hip flexion, 90° of knee flexion, and 0° of dorsiflexion
C. 110° of hip flexion, 80° of knee flexion, and 10° of dorsiflexion
D. 90° of hip flexion, 90° of knee flexion, and 0° of dorsiflexion.

D. This position places the least amount of stress on the lumbar spine in the sitting position.

The therapist works in a cardiac rehabilitation setting. Which of the following types of exercises are most likely to be harmful to a 64-year-old man with a history of myocardial infarction?

A. Concentric
B. Eccentric
C. Aerobic
D. Isometric

D. Performing isometric exercises places too much load on the left ventricle of the heart for many cardiac patients.

A 50-year-old man has a persistent cough, purulent sputum, abnormal dilation of bronchi, more frequent involvement of the left lower lobe than the right, hemoptysis, and reduced forced vital capacity. What is the most likely pulmonary dysfunction?

A. Chronic bronchitis
B. Emphysema
C. Asthma
D. Bronchiectasis

D. These are signs and symptoms of patient with bronchiectasis

The following is a long-term goal for a patient with spinal cord injury: independence in performing a manual cough without applying pressure to the abdomen. This goal is the most challenging and obtainable for a patient with a complete lesion at which of the following spinal cord levels?

A. C5
B. C7
C. T2
D. T10

B. A patient with a spinal cord injury at the C5 level would apply pressure to the abdomen to perform a cough. A patient with an injury in the T2 level and T10 level should be able to perform a cough independently, but this goal would be most challenging and obtainable for a patient an injury at the level of C7.

When ordering a customized wheelchair for a patient, the therapist determines that the pelvic belt needs to be positioned so that it allows active anterior pelvic tilt. What is the best position for the pelvic belt in relation to the sitting surface?

A. 30°
B. 45°
C. 60°
D. 90°

D. A belt that angled at 90 o with the sitting surface limits the patient’s involuntary efforts to extend the trunk because of increased tone. This angle also allows the patient to actively tilt the pelvis anteriorly, which is a functional movement that does not need to be restricted.

When should a physical therapist begin discharge planning for a patient admitted to a rehabilitation unit with a diagnosis of a recent stroke?

A. At the first team meeting
B. At the last team meeting
C. Two weeks before discharge
D. After the initial evaluation by the physical therapist.

D. After the therapist assesses the patient for the first time, he or she needs to begin discharge planning. This is true for an assessment of any patient, not just in the inpatient rehabilitation setting

Which of the following neural fibers are the largest and fastest?

A. C fibers
B. A fibers
C. A and C are equal
D. None of the above

B. A fibers are the largest in diameter and conduct faster than C fibers.

A patient with a diagnosis of a rotator cuff tear has just begun active range of motion. The therapist is strengthening the rotator cuff muscles to increase joint stability and oppose the superior shear of the deltoid. Which of the rotator cuff muscles participate least in opposing the superior shear force of the deltoid?

A. Infraspinatus
B. Subscapularis
C. Teres minor
D. Supraspinatus

D. The subscapularis, teres minor, and infraspinatus muscles oppose the superior pull of the deltoid muscle. The supraspinatus does not oppose the pull of the deltoid but is important because (along with other cuff muscles), it provides a compression force to the glenohumeral joint.

Which of the following is an example of a policy in a physical therapy clinic?

A. No shorts worn in the clinic
B. The correct way to accept a telephone referral
C. The clinic will open at 8:00 AM
D. A and C

D. Policies can be viewed as the rules, and procedures are the ways in which the rules are carried out.

What portion of the adult knee meniscus is vascularized?

A. Outer edges
B. Inner edges
C. The entire meniscus is vascular
D. The entire meniscus is avascular

A. Only the edges of the adult meniscus are vascularized by the capillaries from the synovial membrane and joint capsule.

A 14-year-old girl with right thoracic scoliosis is referred to physical therapy. The therapist should expect which of the following findings?

A. Left shoulder high, left scapula prominent, and right hip high
B. Left shoulder low, right scapula prominent, and left hip high
C. Right shoulder high, right scapula prominent, and right hip high
D. Right shoulder low, right scapula prominent, and left hip high

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

What is the most likely cause of anterior pelvic tilt during initial contact (heel strike)?

A. Weak abdominals
B. Tight hamstrings
C. Weak abductors
D. Back pain

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

To treat effectively most patients with Parkinson’s disease, the therapist should emphasize which proprioceptive neuromuscular facilitation (PNF) pattern for the upper extremities?

A. D2 extension
B. D2 flexion
C. D1 extension
D. D1 flexion

B. D2 flexion patterns support upper trunk extension, which is important for patients with Parkinson’s disease who tend to develop excessive kyphosis.

Which of the following are tests for peripheral arterial involvement in a patient with complaints of calf musculature pain?

A. Claudication time
B. Homan’s sign
C. Percussion test
D. None of the above

A. Claudication is a lack of blood flow. This test is performed by having a patient walk on a treadmill and recording how long the patient can walk before the onset of claudication. Homan’s sign is a test performed to see whether a patient may have a deep vein thrombosis. The percussion test is designed to assess the integrity of the greater saphenous vein

The therapist is asked to evaluate a baseball pitcher’s rotator cuff isokinetically. Which isokinetic evaluation is most appropriate?

A. 190° /second, 180° /second, and 240° /second
B. 30° /second, 60° /second, and 90° /second
C. 60° /second, 120° /second, and 180° /second
D. 180° /second, 240° /second, and 360° /second

D. The fastest settings are appropriate for isokinetic testing. A pitcher’s throwing motion is quite fast. It is better to evaluate with isokinetic speed as close as possible to the speed of the tested activity.

A patient presents to a clinic with decreased tidal volume (TV). What is the most likely cause of this change in normal pulmonary function?

A. Chronic pulmonary disease
B. Restrictive lung dysfunction
C. Both of the above
D. None of the above

B. A decreased tidal volume is caused by a restrictive lung dysfunction. An increased tidal volume is caused by an obstructive lung dysfunction.

The patient is referred by a physician to begin outpatient cardiac rehabilitation. Which of the following is not a contraindication to enter an outpatient program?

A. Resting systolic blood pressure of 210 mmHg
B. Third-degree atrioventricular block
C. Resting ST displacement less than 1 mm.
D. Acute fever

C. ST segment displacement greater than 3 mm is a contraindication. Resting systolic pressure above 200 mmHg is a contraindication.

In order to determine if an exercise session should be terminated, the patient is asked to assess level of exertion using the Borg Rating of Perceived Exertion Scale (RPE). The patient rates the level of exertion as 9 on the 6-19 scale. A rating of 9 corresponds to which of the following?

A. Very, very light
B. Very light
C. Somewhat hard
D. Hard

B. A rating of 9 corresponds with “very light”. A rating of 7 is “very, very light”. A rating of 13 is “somewhat hard”. A rating of 15 is “hard”. A rating of 17 is “very hard”. A rating of 19 is “very, very hard”.

The therapist is treating a patient who has suffered a recent stroke. There is a significant lack of dorsiflexion in the involved lower extremity and a significant amount of medial/lateral ankle instability. The therapist believes than an ankle foot orthosis (AFO) would be beneficial. Which of the following is an appropriate AFO?

A. Solid AFO
B. Posterior leaf spring AFO
C. Hinged solid AFO
D. A or C

D. Choices A and C provide the most medial/lateral ankle support. A posterior leaf spring ankle foot orthosis only provides assistance with dorsiflexion.

The therapist is treating a new patient with a diagnosis of lateral epicondylitis. The therapist decides to use iontophoresis driving dexamethasone. Dexamethasone is an _________ and is administered with the ______.

A. Analgesic, anode.
B. Analgesic, cathode
C. Anti-inflammatory, anode
D. Anti-inflammatory, cathode.

D. Dexamethasone is a common anti-inflammatory drug driven with the negative electrode. Lidocaine is a commonly used analgesic driven with the positive electrode.

At what age does a human have the greatest amount of fluid in the intervertebral disc?

A. 1 year
B. 4 years
C. 7 years
D. 10 years

A. The intervertebral disc has the greatest amount of fluid at the time of birth. The fluid content decreases as a person ages.

During the opening of a patient’s mouth, a palpable and audible click is discovered in the left temporomandibular joint. The physician informs the therapist that the patient has anteriorly dislocated disk. This click most likely signifies:

A. the condyle is sliding anterior to obtain normal relationship with the disk.
B. the condyle is sliding posterior to obtain normal relationship with the disk.
C. the condyle is sliding anterior and losing normal relationship with the disk
D. the condyle is sliding posterior and losing normal relationship with the disk

A. In the case of reciprocal click, the initial click is created by the condyle slipping back into the correct position under the disk with opening of the mouth. In this disorder, the condyle is resting posterior to the disk before jaw opening. With closing the click is caused by the condyle slipping away from the disk.