PEAT 1

1. In splinting or immobilization, the functional position of the hand includes wrist:

A. extension, phalangeal flexion, and thumb abduction

B. extension, phalangeal extension and thumb abduction

C. extension, phalangeal flexion and thumb adduction

D. flexion, phalangeal flexion and thumb adduction

A.

The functional position of the wrist and hand describes the position from which the optimal function is most likely to occur. This position is described as

a) slight wrist extension,

b) slight ulnar deviation,

c) fingers flexed at the MCP, PIP & DIP joints and

d) thumb slightly abducted.

1. During pregnancy, which of the following is contraindicated?

A. curl-ups

B. bridging

C. double leg lifts

D. deep breathing with forced expiration

C.

During pregnancy and postpartum period, the stretched abdominal muscles are unable to stabilize the lower back, as the legs are raised. Attempting to perform double leg lifts can overwork the abdominal muscle and cause damage to the spinal joints.

1. A target heart rate is determined for individual entering a training program in order to:

A. regulate exercise intensity

B. estimate energy expenditure

C. control blood pressure and specific heart rate

D. ensure participants exercise at maximal capacity

A.

Exercise intensity can be expressed as O2 uptake during activity. HR and O2 uptake have a relatively lower linear relationship. Therefore, utilizing a target HR will ensure that the appropriate exercise intensity is being achieved. Estimation of energy expenditure requires measurement of O2 consumption that is then calculated into calories metabolized during the activity. BP cannot be controlled at specific HR. Exercising at maximal capacity does not achieve aerobic training benefits and is unsafe for the majority of patient population.

1. A herniated nucleus pulposus at the L3-L4 disc produces which of the following clinical findings?

A. Numbness in the back of the calf and dorsiflexor weakness

B. Numbness in the anteromedial thigh and knee and quadriceps weakness

C. Numbness and weakness in the thigh, legs, feet and/or perineum

D. Numbness in the back of the calf and atrophy of gastrocnemius and soleus

B.

Pressure on the L3 L4 root causes numbness in the anteromedial thigh and knee and quads weakness. Numbness in the back of the calf and dorsiflexor weakness is indicative of L4, L5 and S1 nerve root involvement. Numbness and weakness in the thighs, legs and feet and perineum is indicative of L2 through S1 nerve root involvement. Numbness in the back of the calf and atrophy of gastrocsoleus is indicative of the S1 nerve root involvement.

1. The intervention for a patient with limitation of shoulder flexion and medial rotation includes mobilization. Which glide is the most appropriate for mobilizing this shoulder to specifically increase the restricted motion?

A. Posterior

B. Anterior

C. Medial

D. Lateral

A.

The most appropriate mobilization technique for increasing both shoulder flexion and medial rotation would be posterior (dorsal) glide. Lateral glide may be used as a general joint distraction technique. Medial glide would not be appropriate to increase flexion and medial rotation. Anterior glide is used to increase extension and lateral rotation.

1. Which of the following techniques is MOST appropriate for a patient with low postural tone?

A. Slow regular rocking while sitting on the treatment bolster

B. Continuous pressure to the skin overlying the back muscle

C. Low frequency vibration to the back muscle

D. Joint approximation applied through the shoulder to the trunk

D.

Options A, B & C are techniques used to decrease postural tone, which is not indicated for this patient. Option D is the most appropriate technique for improving low postural tone.

1. Which skin change associated with aging has the GREATEST effect on wound healing?

A. Reduction in sensation

B. Decrease elasticity of the skin

C. Decrease epidermal proliferation

D. Change in pigmentation

C.

Wounds heal via a complex process involving re-epithelialization. With advanced aging, the rate of epidermal proliferation decreases.

1. Which of the following techniques is MOST effective in teaching an IDDM patient about foot care?

A. Reassure the patient that no infection will occur if the directions are followed, then demonstrate procedure

B. Tell patient how foot care is performed, then watch patient's performance

C. Watch patient perform foot inspection and caution him that amputation results from unattended skin problems

D. Have the patient demonstrate a foot inspection, then give feedback on patient's performance

D.

Learning the process of foot care is a psychomotor skill and effective strategies to teach psychomotor skills include repeat demonstration by the patient of the skill followed by feedback from the therapist to highlight what was performed correctly and what areas need improvement. Reassurance about prevention of infection with proper foot care would primarily be a cognitive skill and does not ensure that the patient can effectively perform proper foot care. Options B & C do not include feedback that informs the patient about their performance.

1. For a child with Duchenne muscular dystrophy, the MOST appropriate rehabilitation goal would be:

A. prevention of contractures and determine method of mobility

B. preservation of strength and muscle tone

C. inhibition of abnormal tone and facilitation of normal movement and position reaction

D. facilitation of normal movement and improvement of strength

A.

Goals of PT intervention for a child with DMD are to retard the development of contracture and muscle weakness, which could lead to functional limitations and thus disability. The PT would also play a role in determining the appropriate use of assistive devices that could help maintain the child's mobility such as wheelchairs, walkers and orthoses. Muscle tone changes and decline in strength cannot be prevented since they are results of the disease process.

1. A patient with complete long thoracic nerve injury would have difficulty in:

A. putting hand in the back pocket.

B. bending toward the involved side.

C. taking a deep breath.

D. reaching forward above head.

D.

The long thoracic nerve innervates the serratus anterior muscle. Reaching forward above the head (shoulder flexion) would require the action of serratus anterior, and long thoracic nerve injury would affect the motion. The serratus anterior muscle also works in conjunction with the upper and lower trapezius muscle to upwardly rotate the scapula (abduct) during shoulder flexion. Putting the hand in the back pocket would require scapular adduction. Side bending and deep breathing would not require scapular motion.

1. Outcomes of prenatal exercise program would not include:

A. improved body mechanics

B. application of relaxation technique

C. improve ligament flexibility

D. strengthen pelvic floor musculature

C.

During pregnancy, the ligaments soften due to hormonal influences and allow some degree of separation between joint surfaces. Additional stretching of the ligaments would result in joint instability or injury, and would not be a goal of treatment. The remaining options are all appropriate interventions.

1. Utilization review and peer review are activities that are part of a comprehensive:

A. policy and procedure manual

B. quality improvement program

C. audit cycle

D. performance evaluation

B.

According to the Standards of PT Practice, there should be a written plan of continuous improvement of quality of care. This includes ongoing review and evaluation of the PT services provided. Utilization and peer review are two types of review processes.

1. Which of the following is the BEST documentation exercise of a goal?

A. The therapist will reduce patient's hip flexion contracture to neutral

B. The patient will ambulate 75 feet independently in 3 weeks

C. The therapist will reduce patient's pain from 7/10 to 3/10

D. The patient will understand how to increase ADL in 4 weeks

B.

A goal should include the following elements:

a) Audience; who will exhibit the skill,

b) Behavior; what the person will do,

c) Condition; under what circumstances (the position, the equipment that must be available for the patient to perform the behavior),

d) Degree; how well will the behavior be done,

e) Time span; set an anticipated specific time span in which the goal will be achieved, and

f) Measurable; the outcome must be measurable.

Option B meets all the criteria while the other responses do not.

1. Patient has a limited ankle dorsiflexion following ORIF of distal tibia. Radiographs reveal that the fracture is well healed. Treatment with passive mobilization should include:

A. posterior glide of talus on tibia

B. lateral glide of calcaneus on tibia.

C. posterior glide of tibia on talus

D. anterior glide of talus on tibia.

A.

The trochlea of the talus is convex. Therefore, during dorsiflexion of the ankle, the talus moves posteriorly relative to the tibia. To facilitate movement of dorsiflexion, one would need to perform a posterior glide of the talus on the tibia.

1. A patient who recently and successfully completed a 12 week program of phase III cardiac rehabilitation will MOST likely demonstrate a decrease in:

A. CO2 elimination in maximal work

B. cardiac output in maximal work

C. stroke volume at a given level of submaximal work

D. heart rate at a given level of submaximal work

D.

Aerobic conditioning that occurs during the 12 weeks of cardiac rehab will result in a decrease HR both at rest and with exercise. CO2 elimination and cardiac output would both increase with maximal work. The stroke volume would increase during submaximal work.

1. The demographic information on the subject in a research study list a mean age of 32 and median of 35. The difference between the median and mean indicates:

A. the value of standard deviation score

B. the value of the Z score

C. that the distribution is skewed

D. that the two measures should be average

C.

A normally distributed sample has a median and mean that are equal in value. In that type of distribution, the median and mean would be at the halfway point. One half of the scores (50%) would be distributed above the median and one half below. If the median and mean are not of equal value, the distribution is skewed. If the median is of a higher value than the mean, the distribution is to the left, if lower, it is skewed to the right. The standard deviation is a measure of variability of the mean. The z score is a standard score with a mean of zero and a standard deviation of 1. Averaging the two measures would not be appropriate or meaningful.

1. Rocking in quadruped position could be included in physical therapy intervention for a 40 year old patient to increase ROM at the:

A. hip joint, 1 month post total hip replacement

B. distal radioulnar joint, 2 weeks post fracture of the distal radius

C. glenohumeral joint, 2 months post rotator cuff tear

D. hip joint, 1 week post subcapital fracture of the femoral neck

C.

Increasing hip flexion is usually contraindicated for THA at 1 month. The quadruped position would not be allowed for a patient at 2 weeks post distal radius fracture. There are no precautions for the patient 2 months following a rotator cuff tear as the motions in quadruped rocking would be synonymous with the glenohumeral motions that need to be increased and are achieved in a closed chain position.

1. A therapist is treating a young athlete with gastrocnemius muscle strength of fair plus (3+/5). In the prone position, which of the following exercises is the MOST appropriate to maximize strengthening?

A. Resistive exercises with the knee bent.

B. Resistive exercises with the knee straight.

C. Active exercises with the knee bent

D. Active exercises with the knee straight.

B.

With a muscle grade of fair plus, the patient should not need active assistive exercise. Resistive exercise against gravity would be most appropriate to strengthen this muscle. Since the gastrocnemius in a shortened position and lesser its ability to produce tension. Therefore, exercising with knee straight put the gastrocnemius on a stretch, increasing its ability to produce tension.

1. Redness on the inferior aspect of the patella upon removal of a patellar tendon bearing prosthesis indicates that the residual limb:

A. is not far enough into the prosthesis and fewer socks should be worn

B. is not far enough into the prosthesis and additional socks should be worn

C. has slipped too far into the prosthesis and fewer socks should be worn

D. has slipped too far into the prosthesis and additional socks should be worn

D.

The residual limb is pistoning up and down because the socket diameter is too large or the suspension system is inadequate, resulting in skin friction. The addition of more socks will enhance fit.

1. A therapist is evaluating a patient with an acute lumbar disc protrusion and a right lateral shift of the thoracic spine. Which of the following findings would be the BEST indicator that the symptoms will respond positively to the PT intervention?

A. The pain is referred only to the buttock and not the thigh.

B. The patient prefers standing and walking than sitting.

C. There is a decrease in lumbar lordosis.

Repeated backward bending centralizes the pain

D.

The fact that backward bending is centralizing the pain is an indicator that the nucleus of the disc is being moved centrally and the pressure is being taken off the nerve root. Centralization of the pain is also a good indicator for PT intervention.

1. A therapist evaluates a patient who has lateral epicondylitis. the patient reports a subjective pain of 8/10. The patient also reports pain and shows weakness with resisted wrist extension. The therapist decides to use ice massage as an intervention. The MOST appropriate length of time for the ice massage is:

A. ten minutes

B. until the area turns red and patient reports burning sensation

C. until the patient reports that the area is numb

D. no longer than five minutes

C.

Ice massage is usually applied to control pain, edema and inflammation. In this case, the ice would be used for pain relief and to reduce inflammation, if present. The dosage for ice massage is determined by the patient's response, and usually applied until the patient experiences analgesia or reported numbness over the area of massage. Although 5 to 10 minutes may be a usual time for the response to occur, the dosage depends on the patient's response, not the exact time. The patient will usually feel the following sequential sensations during the massage: cold, burning, aching and then finally numbness. The desired effect is numbness, not aching. The skin may turn white, however, the desired effect is numbness or pain reduction and not skin color.

1. Following spinal joint mobilization procedure, a patient calls the therapist and reports a minor dull ache in the treated area of the back that lasted for 2 to 3 hours. Based on this symptom, the therapist should:

A. consider a possible neurological lesion in the area

B. refer the patient back to the physician

C. inform the patient that the response is common

D. add strengthening exercises to the home program.

C.

Joint mobilization procedures may cause some soreness. The therapist should inform the patient of this response to treatment. The patient should re-evaluate the patient and could alter the treatment by waiting an extra day before the next treatment or by decreasing the dosage. There would not be a need to refer to the physician. The additional exercises would not alter the response and there would be no indication of neurological involvement with the reported symptom.

1. In order to conduct an experimental study on pain in postsurgical orthopedic patients, a therapist randomly assigns patients into two groups. One group is treated with TENS, heat and exercises; the second receives heat and exercises only. In this experimental design, TENS is the:

A. continuous variable

B. dependent variable

C. discrete variable

D. independent variable

D.

The independent variable can be thought of as the cause or treatment and the dependent variable can be thought of as the effect or response. In this case, the TENS is the treatment or independent variable. Continuous and discrete variables are methods of quantifying variables.

1. A 90-year-old patient with chronic congestive heart failure has been non-ambulatory and a nursing home resident in the past year. The patient was recently admitted to the hospital following an episode of dehydration. Which of the following plans for prophylactic respiratory care is MOST appropriate?

A. Turning, coughing and deep breathing every 1 to 2 waking hours.

B. Vigorous percussion and vibration 4 times a day

C. Gentle vibration, with the foot of the bed elevated once a day.

D. Segmental postural drainage using standard positions throughout the day.

A.

A patient who is bed bound and immobile will be prone to developing atelectasis (partial collapse of lung tissue); which can lead to pneumonia. Frequent position changes with deep breathing and coughing will help prevent development of atelectasis. Given that this patient is elderly and does not have diagnosis of secretion retention, vigorous percussion and vibration is not indicated. Vibration with the head down or standard postural drainage positions will not be tolerated in this elderly patient with chronic CHF.

1. Which diagnostic procedure is LEAST likely to confirm suspected disc herniation in a patient with low back pain?

A. MRI scan

B. CAT scan

C. Radiograph

D. Myelogram

C.

Radiographs are in orthopedics to detect bony abnormalities. Soft tissue defects such as disc herniations would not show up on the radiograph. MRI scans are used to assess degenerative diseases, infarction, tumor, hemorrhage and congenital anomalies. Myelography is used to assess bone displacement, disc herniation, cord compression or tumor. Computed tomography (CAT scan) is used to assess the density, displacement of abnormality of the ventricular system and gray and white matter.

1. To help the students apply newly learned skill to clinical practice, the MOST effective action for the clinical instructor to take is to:

A. point our possible patient situations and discuss how the skill would apply to them.

B. have the students research reference materials and compile a list of the steps required in the acquisition of the skill

C. prepare a list of indications and contraindications for the skill.

D. have the students provide examples of patient situations where the skill would be appropriately applied.

D.

Behavioral objective should be learner centered, outcome oriented, specific, and measurable. Option D is the only one that is learner (student) oriented and specific to a situation. Options A & C require action by the clinical instructor, not the student. Option C, which may be a step in the process is not as learner centered or outcome centered as option D.

1. It is important to perform cool down exercises immediately following a general aerobic program PRIMARILY in order to prevent:

A. venous pooling

B. cardiac arrhythmia

C. decrease body temperature

D. muscle tightening

A.

During aerobic exercise, there is vascular dilation that occurs in order to optimize blood flow and the venous system relies on muscular pumping in order to return blood back to the heart. Without a cool-down period, there would be no muscular pumping and therefore blood would pool in the venous system. Cardiac arrhythmia may occur as well, but is less likely in someone without cardiac disease. Cessation of activity by itself would result in gradual decrease in body temperature and specific exercises are not necessary. Muscle tightening may occur as a result of metabolites accumulating in the circulatory system, but this would occur as a result of the venous pooling.

1. The intervention for a patient who has right sciatic pain caused by piriformis compression would NOT include:

A. instruction in mild self-stretching in sitting with the right hip and knee flexed and pressure applied in the medial direction to the distal thigh with the left arm.

B. contract-relax exercise to the hip external rotators performed with the patient sidelying and the right hip and knee positioned in 90 degrees of flexion.

C. active resistive strengthening exercise to the piriformis with the patient prone and the knee flexed

D. application of cold to the area of sciatic nerve irritability

C.

The piriformis muscle functions as an external rotator of the hip and it is thought that the tight piriformis muscle may compress the sciatic nerve causing pain. Passive internal rotation and resisted external rotation may be painful. Intervention would call for stretching of the piriformis muscle, not strengthening it. Modalities such as ice may also be helpful to decrease the inflammation.

1. A therapist is assigned in the planning and implementation of services for all members of the community. The therapist's FIRST step would be to:

A. develop a brochure for distribution to the community.

B. organize a health fair to provide screening for the community.

C. evaluate existing services and community resources.

D. initiate contacts in the medical community to establish prescriptive relationships.

C.

The most appropriate first step (pre-planning) would be to evaluate existing services within the community and work out a budget for the project. Options A & B, although important, are things that would most likely be done after the practice is up and running. Option D may be done early on in the planning process, but would follow option C.

1. To prevent contractures in a patient with an above-knee amputation (transfemoral), emphasis should be placed on designing a positioning program that maintains ROM in hip:

A. flexion and abduction

B. extension and adduction

C. adduction and lateral rotation

D. flexion and medial rotation.

B.

Following an above knee amputation (transfemoral), the residual limb has tendency to develop contractures in the hip flexors and abductors. Therefore, it is particularly important that the patient be positioned so as to maintain full ROM in hip extension and adduction.

1. After a long-term history of bilateral lower extremity vascular insufficiency, an otherwise healthy patient had a right above-knee amputation. For this patient, which of the following is the MOST important factor in establishing long-term goals for functional walking?

A. Status of the wound at the amputation site.

B. ROM of the right hip.

C. Condition of the left lower extremity

D. Ability to maintain upright posture.

C.

The left limb must function as the main support limb. Any treatment strategy for ambulation must ensure that the remaining limb is optimally functioning and that the limb is healthy. While the other factors are relevant, the integrity of the remaining limb is the greatest concern for this patient establishing long term functional goals.

1. A patient is referred to physical therapy complaining of severe pain in the right hip and groin area, which increases during walking. The patient complains of tenderness when the therapist palpates the area over the right greater trochanter. The MOST likely cause of the patient's signs and symptoms is:

A. sacroiliac joint derangement

B. a hip fracture

C. a strain of the adductor longus muscle

D. hip bursitis

D.

Signs and symptoms of hip bursitis include the following: severe pain over the bursa area, with pain aggravated by active motion including activities such as walking. Signs and symptoms of a sacroiliac joint derangement include pain directly over the region of the joint and in the low back, in addition to pain with walking. Signs and symptoms of hip fracture will include the following: severe pain in the groin area and tenderness occurs in the area anterior to the femoral neck. An adductor longus muscle strain would not cause tenderness over the greater trochanter.

1. A therapist is conducting a 12-minute walk test with a patient who has COPD and uses 2 L/min of O2 by nasal cannula. The patient's resting O2 saturation is 91 % and the resting heart rate is 110 bpm. The O2 flow should be increased if the:

A. patient's CO2 level starts to increase

B. patient starts to complain of shortness of breath.

C. patient's O2 saturation falls below 87%.

patient's heart rate is greater than 150 bpm

C.

A fall in oxygen saturation below 87% is equivalent to a partial pressure of 55 mmHg of oxygen in the blood, which is considered to be moderately hypoxemic (low O2 levels). This situation would require increased oxygen levels in order to be rectified. A rise in carbon dioxide level would not be alleviated by increased oxygen levels. Complaints of shortness of breath can come from a variety of causes and would not necessarily be alleviated by increased oxygen levels. An increased heart rate to 150 bpm may be a normal response to this activity and would not necessarily require increased oxygen levels.

1. When working with a neurological patient to ensure that physical therapy services are adequately documented, it is MOST important to record changes in:

A. muscle tone

B. functional abilities

C. cognitive status

D. quality of movement

B.

All documentation about physical therapy services should readily translate the physical findings (impairment) into functional abilities/limitations.

1. A patient has right hemiparesis resulting from TBI. When assessing motor control in the right lower extremity with the patient standing, the therapist finds that the patient cannot extend the hip while flexing the knee or flex the hip while extending the knee. In which of the following functional activities will this problem be MOST apparent?

A. Shifting weight while standing.

B. Walking sideways.

C. Walking backward.

D. Moving from sitting position to standing position.

C.

Of the four options, backward walking is the only one that requires hip extension with concurrent knee flexion and hip flexion with knee extension.

1. A patient was injured in a motor vehicle accident two days ago, resulting in quadriplegia at C6 level. When providing PROM to the UE, which of the following is MOST critical in order to optimize long-term hand function?

A. Passive wrist and finger extension exercise to gain maximum stretch of the finger flexors

B. Passive wrist and finger flexion exercise to gain maximum stretch of the finger extensors.

C. Holding the wrist in flexion when passively extending the fingers.

Holding the wrist in extension when passively extending the fingers

C.

This patient needs to have functional benefits of tenodesis by allowing the finger flexors to shorten with the wrist extended; therefore, PROM of the finger flexors should be performed with the wrist in non-functional position of flexion. People with C6-C7 quadriplegia use the tenodesis grasp. This allows the fingers to flex with wrist extension and to open with wrist flexion.

1. An athlete sustained a severe inversion sprain of the right ankle while playing basketball. To provide strapping support for the ankle, pressure and support should be applied over the tendons of the:

A. flexor digitorum longus and tibialis posterior

B. gastrocnemius and flexor hallucis longus

C. peroneus longus and brevis

D. tibialis anterior and tibialis posterior.

C.

With an inversion injury, the tendons of peroneus longus and brevis can become strained. Swelling with an inversion strain usually occurs over the anterolateral part of the ankle. Compression and support is most beneficial by placing tape stirrups on the lateral side of the ankle, over the tendons of the peroneus longus and brevis and pulling the ankle into slight eversion.

1. In which of the following conditions would a nerve conduction velocity test be MOST important?

A. Carpal tunnel syndrome

B. Cerebrovascular accident

C. Myotonia

D. Duchenne Muscular Dystrophy

A.

Nerve conduction velocity testing is most useful in the evaluation of peripheral nerve or lower motor neuron status. Therefore, since carpal tunnel syndrome is the only one of the conditions that directly involves a peripheral nerve, it would be the most appropriate choice. A cerebrovascular accident is an upper motor neuron disorder. Both myotonia and Duchenne muscular dystrophy are primary muscle disorders.

1. When training a patient to increase muscle activity with the use of EMG biofeedback, the therapist should adjust the unit so that sensitivity:

A. starts at low and increases as the patient shows an increase in muscle activity

B. starts high and decreases as the patient shows an increase in muscle activity

C. remains at approximately mid-range during the entire treatment period.

is not set, since this is not necessary for this form of biofeedback

B.

Increasing the sensitivity makes the biofeedback unit more sensitive to electrical potentials from muscles. As the sensitivity is decreased, it takes more electrical activity to trigger the biofeedback unit (i.e. provide an audio visual cue to the patient). For use in muscle re-education, the unit should be most sensitive during the initial treatment so that the patient is able to recruit enough motor units to trigger the unit. As the patient is able to recruit more motor units, the sensitivity is decreased which would require the patient to activate more motor units.

1. A patient with leukemia has developed thrombocytopenia following a bone marrow transplant. Which of the following measures are indicative of the status of the thrombocytopenia?

A. T4 lymphocyte count

B. Red blood cell count.

C. Platelet count

D. White blood cell count

C.

Thrombocytopenia is an acute or chronic disease in the number of platelets in the circulation. The T4 lymphocyte count is used to assess immune status in patients with HIV or AIDS. The red blood cell count is utilized to assess for presence of anemia and the white blood cell count would be examined to determine presence of infection or degree of immunosuppression.

1. During a postural examination, the therapist notes that the patient's patella both point inward when viewed from the front of the patient. The MOST likely cause of this problem is excessive:

A. femoral anteversion

B. weakness of the vastus medialis

C. genu varum

D. medial tibial torsion

A.

The most common cause of inwardly pointing or "squinting patellae" is excessive femoral anteversion. Although there is normally 8-15 degrees of femoral anteversion, an excessive amount leads to squinting patellae and toeing in. The other options would all have a tendency to cause the patella to point outward during standing.

1. A therapist is evaluating a patient who has a vascular lesion in the brainstem affecting the oculomotor nerve. During the cranial nerve examination, which of the following would be the MOST significant sign?

A. Inability to close the eyelid

B. Medial strabismus

C. Ptosis of the eyelid

D. Constricted pupil

C.

The oculomotor nerve innervates the levator palpebrae superioris muscle that elevates the upper eyelid and the pupillary constrictor muscle. Therefore, a lesion of the oculomotor nerve would make it difficult, if not impossible for the patient to fully raise the lid (open the eye) and would cause a condition termed ptosis. In addition, the eye may not react to light and therefore may not show pupillary constriction when light is directed into the eye. Inability to fully close the eye would be seen with a lesion of the facial nerve (Bell's palsy). Medial strabismus would be caused by damage to the abducens nerve, innervating the lateral rectus causing a medial strabismus.

1. For a patient with IDDM who is completing a cardiovascular fitness program, what change in diabetic management is MOST likely to be instituted as fitness increase?

A. Switching to oral rather than injected medication.

B. Decreasing caloric intake for 2 to 3 hours following the exercise sessions.

C. Decreasing the amount of insulin taken daily.

D. Increasing the amount of insulin taken daily.

C.

Exercise has been shown to increase sensitivity of insulin receptors therefore leading to a decrease in the amount required. Administration of medication is dictated by tolerance and efficacy of the medication and would not necessarily be altered by exercise. In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 - 48 hours after exercise, therefore increasing caloric intake, particularly carbohydrates, would be essential.

1. An elderly patient presents with a sacral pressure ulcer measuring 6 in. x 6 in. The wound has moderate serous fluid drainage and is loosely covered with necrotic and fibrotic tissue, although there are no indications of infection present. The BEST method of debridement would be:

A. daily vigorous scrubbing of the wound.

B. wet-to-dry dressings with normal saline 2 times a day.

C. daily wet-to-dry dressings with 1:1 dilute povidone-iodine (Betadine)

D. whirlpool jet agitation 2 times a day.

B.

Wet-to-dry dressings are indicated for necrotic tissue needing debridement. The moderate amount of drainage would require more frequent (i.e., BID) dressing changes. Vigorous scrubbing of the wound could damage friable tissue. Betadine can be cytotoxic. Whirlpool would not be effective in removing necrotic tissue

1. A patient is referred to physical therapy for treatment of tenosynovitis. The patient complains of "pins and needles" sensation on the palmar surface of the first three fingers. The therapist's examination reveals a positive Tinel's sign at the wrist and good (4/5) grade thumb opposition. Based on these findings, the therapist should suspect:

A. median nerve compression at the wrist

B. ulnar nerve compression distal to the elbow

C. tenosynovitis of abductor pollicis longus

D. thoracic outlet syndrome

A.

The median nerve supplies sensory innervation to the palmar surface of the thumb, index and middle fingers. A positive Tinel's sign (eliciting a paresthesia while tapping over the carpal tunnel at the wrist) and weakness of the opponens pollicis muscle are indicative of carpal tunnel syndrome. Ulnar nerve compression would cause sensory and motor changes in the little and ring fingers, not the thumb. Tenosynovitis of the abductor pollicis longus muscle would most likely reveal a positive Finklestein's test (stretching of the abductor muscle) with pain over the dorsum of the hand. Thoracic outlet syndrome would most likely reveal with special tests that cause alteration of radial pulse.

1. A patient has disuse atrophy of the anterior compartment muscle following cast removal after a fracture of the tibia. The patient has poor (2/5) strength in the ankle dorsiflexors. Electrical stimulation is to be used to enhance dorsiflexor strength in conjunction with exercise. Initially, which of the following waveform characteristics is MOST appropriate to stimulate the muscles?

A. Monophasic pulse with a frequency of 110 pps and on/off cycle ration of 3:1

B. Biphasic pulse with a frequency of 30 pps and on/off cycle ratio 1:5.

C. Direct current waveform with an on/off ratio of 1:1

D. Interferential waveform with a beat frequency of 1 pps.

B.

The most efficient stimulus would be one that causes tetany in the muscle without causing fatigue. The biphasic waveform at 30 pps best fit this stimulus. The 100 pps stimulus rate may cause fatigue, which would be undesirable. The interferential waveform at the frequency of 1 pps is too low and the direct current would not be appropriate because it would not cause tetany. In addition, an on/off cycle of 1:5 would allow adequate recovery time for the muscles between successive contractions.

1. A patient is referred to physical therapy with a 20-degree knee flexion contracture following arthroscopic knee surgery a month ago. All of the following interventions are appropriate EXCEPT:

A. stretching of the semimembranosus muscle

B. strengthening of vastus medialis.

C. inferior gliding of the patella.

D. mobility of the posterior capsule of the knee joint.

C.

A 20 degrees knee flexion contracture means that the knee is unable to complete the last 20 degrees of extension. This limitation of motion can be caused by several factors including tightness of the hamstrings (semimembranosus), restriction in the posterior capsule of the knee, and weakness in the quadriceps femoris muscle (vastus medialis). Restriction of patellar movement may also be a factor, however the proper glide technique to increase knee extension would be a superior (not inferior) glide of the patella.

1. A patient with a complete SCI is sitting in a wheelchair on a custom made cushion. Pressure relief activities should be performed:

A. when the patient shows signs of pressure sores

B. every 15 to 20 minutes

C. every 1 to 2 hours

D. if the patient does not have an appropriate cushion.

B.

A patient with thoracic spinal cord level injury is able to perform independent pressure relief strategies and should be complete every 15 to 20 minutes.

1. During a review, a patient lacks 10 degrees of passive ankle dorsiflexion. The same degree of limitation is present whether the knee is flexed of extended. The muscle MOST likely contributing to this restriction is the:

A. gastrocnemius

B. tibialis anterior

C. plantaris

D. soleus

D.

The soleus originates on the tibia and fibula and inserts onto the calcaneus, crossing only the ankle joint. Therefore, it will have an effect on the ankle whether the knee is flexed or extended.

1. Which of the following assignments is MOST appropriate for the physical therapist to delegate to a volunteer?

A. Restocking treatment booths with linens, US gel, massage lotion.

B. Attending a patient who is on a tilt table while the therapist takes a phone call.

C. Transporting a patient who complains of dizziness back to his room.

D. Transferring a patient from the mat to a wheelchair.

A.

The restocking of treatment booths with supplies is the only option which does not involve direct patient contact or care, and thus is the MOST appropriate activity to delegate to a volunteer. Although volunteers may at times be involved with patient care activities (i.e., transporting patients), the patients in the above situations pose a potential risk and would require supervision by someone other than a volunteer.

1. A patient sustained a severe brain stem injury one week ago and has demonstrated minimal change since the incident. The patient's cognitive status is MOST likely to include:

A. a decrease level of arousal

B. a decrease level of intelligence

C. an increase level of agitation

D. an increase level of impulsivity

A.

A state of alertness to the internal and external environment must be maintained for a motor or mental activity to occur. The brainstem reticular activating system brings about the state of general arousal. To proceed from a state of general arousal to one of "selective attention" requires the communication of information to and from the cortex, the thalamus, and the limbic system and its modulation over the brainstem and spinal pattern generators.

1. The hospital administrator asks members of the rehabilitation department to develop a comprehensive program to help reduce the risk of low back injuries. Which of the following would be the FIRST step necessary to develop the program?

A. Include all employees in a lumbar extension exercise class

B. Design a program that meets each department's functional needs

C. Perform an ergonomic analysis on each workstation

D. Provide pamphlets on proper body mechanics

C.

The first step in preparing any education experience is to determine what the needs of the audience are. Since prevention of low back injury is the ultimate goal, assessment of the employee's workstations is an important first step in planning the education program. Simply instructing all employees in lumbar extension exercises is inappropriate without a thorough evaluation of their physical needs. Option B cannot be done unless an assessment of the functional needs has be performed. Providing pamphlets are useful teaching adjunct but would not be the first step to prevent low back pain effectively in this population.

1. To maximize continuity of patient care, the PT should begin discharge planning when the:

A. physician refers the patient for discharge

B. therapist makes the discharge review of the patient

C. discharge planner requests information pertinent to the patient's discharge status

D. therapist performs initial review of the patient

D.

The Standards of Practice of Physical Therapy state that the physical therapist is responsible for establishing a plan of care for the patient based on the evaluation of the examination data and patient needs. The plan of care includes plans for discharge. The implication is that the long-term goals for the patient (discharge plans) are determined when the therapist first sees the patient. It is anticipated that modifications of the plan of care is to be expected depending on the response of the patient to the intervention.

1. The PT is positioning a patient for postural drainage. In order to BEST drain the posterior segment of both lower lobes, the patient should be placed in which of the following positions?

A. Prone, head down at 45 degree angle

B. Supine, flat surface

C. Side lying, head elevated 30 degree angle

D. Sitting, leaning forward

A.

The best position for the patient, to drain the posterior segment of both lower lobes would be prone lying with the head down and lower extremities and hips elevated about 45 degrees.

1. A MMT of a patient sustained a gunshot wound just superior to the elbow joint reveals specific muscle weakness from a partial median nerve injury. The PT intervention for this patient would MOST likely include strengthening activities for wrist flexion and forearm:

A. pronation, finger flexion, thumb adduction

B. pronation, finger flexion, thumb opposition

C. supination, finger abduction, thumb opposition

D. supination, finger abduction, thumb extension

B.

The median nerve innervates the following muscles in the forearm: (1) pronator teres and quadratus, (2) flexor digitorum superficialis, (3) flexor digitorum profundus (index and middle fingers), three (3) thenar muscles (abductor pollicis brevis, opponens pollicis, flexor pollicis brevis). Therefore, a lesion of the median nerve would affect those muscles and their accompanying actions: forearm pronation, finger flexion and thumb opposition. Thumb adduction is accomplished by the adductor pollicis (ulnar nerve). Finger abduction is performed by the dorsal interossei (ulnar nerve). Forearm supination is the action of the supinator (radial nerve) and biceps brachii (musculocutaneous nerve).

1. A patient who has a piriformis syndrome is referred to TP for review and intervention. The patient's history includes THR on the right side 2 years ago. Because of the THR, which of the following should only be used with precaution?

A. TENS

B. Continuous us

C. Hot packs

D. Massage to the right hip

B.

The only one of the above interventions that requires precaution because of total hip replacement is continuous ultrasound. However, that does not mean that ultrasound is contraindicated for this patient. TENS may be used over metal implants. Hot packs and massage would not affect the total hip prosthesis.

1. A patient presents with adhesive capsulitis of the shoulder joint. The ROM examination reveals restricted external rotation and abduction of the shoulder. The FIRST mobilization procedure that should be done for this patient is:

A. posterior glide

B. distraction

C. anterior glide

D. external rotation

B.

For this patient, the first mobilization procedure would be distraction of the glenohumeral joint. The distraction separates the joint surfaces and is used as a test of joint play. The distraction can also help increase joint play. Distraction may also be used in conjunction with the other mobilization techniques listed. Later, mobilization techniques would most likely include anterior glide.

1. A patient sustained a severe TBI 3 months ago. During the exam of passive ROM, the therapist notices decrease passive knee extension and moderate hamstring spasticity. Palpation reveals a firm mass on the lateral aspect of the joint. The therapist should refer the patient to a physician for a review of probable:

A. osteogenic sarcoma

B. patellar fracture

C. osteomyelitis

D. heterotopic ossification

D.

Heterotopic ossification occurs in 10% to 20% of patients with traumatic brain injury. The abnormal bone formation occurs in the soft tissue surrounding major joints. Patients with spasticity are at increased risk. Loss of ROM is characteristic for this problem. Osteogenic sarcoma is less likely. A patellar fracture would not present as a lateral mass.

1. A patient complains of anterolateral shoulder pain with insidious onset. Examination shows full passive ROM, pain on passive lateral rotation and pain on resistive internal rotation. These signs are consistent with a diagnosis of:

A. bicipital tendonitis

B. supraspinatus tendonitis

C. subscapularis tendonitis

D. infraspinatus tendonitis

C.

Pain with resisted medial (internal) rotation and pain with passive lateral (external) rotation is indicative of subscapularis tendonitis. Bicipital tendonitis is suspected if resisted supination is painful when the patient's arm is at the side and the elbow is flexed to 90 degrees. Painful resisted abduction and resisted lateral (external) rotation is indicative of supraspinatus tendonitis. Pain on resisted lateral (external) rotation is indicative of infraspinatus tendonitis.

1. A measurable objective for a community education program exercise techniques would be for participants to:

A. understand the importance of sufficient warm-up period

B. list five stretching techniques that can be used when warming up

C. overcome LE problems and adhere to a regular exercise program

D. appreciate the effects of increasing intensity of exercise on heart rate

B.

Objectives must be measurable and the specific behavior expected should be stated. Understanding, overcoming, and appreciating elude tangible measurement, while listing five techniques is an activity that can be documented and is therefore measurable.

1. During MMT of the hip flexors in the sitting position, a patient exhibits lateral rotation and abduction of the thigh as resistance is applied. The PT should suspect substitution by:

A. sartorius

B. tensor fascia latae

C. adductor longus

D. semimembranosus

A.

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

1. A PT is treating a patient who has lymphedema in the right LE. The therapist decides to use mechanical, intermittent pneumatic compression as an intervention, using a sleeve that covers the foot, leg and thigh. The therapist measures BP at 135/85 mm Hg. At first treatment session, the MOST appropriate inflation pressure for the sleeve is:

A. 20 mm Hg

B. 60 mm Hag

C. 100 mm Hg

D. 140 mm Hg

B.

The recommended dosage for mechanical, intermittent pneumatic compression pressure is between 30 and 80 mmHg (higher for the LE than UE). It is also recommended that the pressure be below the diastolic pressure. Pressures below 30 mmHg are not considered to be effective. Pressures above diastolic can be used with caution. For the first treatment, it would be most appropriate to use a pressure that is considered effective, yet not so high as to cause a potential problem for the patient. If the patient responds positively to the intervention, the higher pressure could be instituted.

1. A patient is entering a cardiac rehabilitation program. The PT should FIRST ask the patient to:

A. describe the correct aspect of exercise demonstrated by the therapist

B. list problems associated with nutritional habits

C. identify the harmful effects of smoking with regards to cardiac disease

D. describe the type of angina that the patient experience

D.

In order to best intervene with a patient who has had cardiac dysfunction, a full examination and evaluation is necessary to properly form a treatment plan. An important aspect of the examination is ascertaining the type of angina that the patient experience so that the therapist will know how to prevent angina with exercise or recognize if it does occur during the treatment session. The other options provided are all outcomes that would occur after the patient has completed a cardiac rehabilitation program.

1. A PT receives a telephone call from a woman who identifies herself as a friend of one of the therapist's patients. She wants to know how the patient is doing and if he will be able to go up and down the stairs, because she wants to take him home for a weekend visit. What should the therapist do?

A. Discuss the patient's program and functional status with the caller

B. Invite the caller to observe the patient's next therapy session

C. Refuse to discuss the patient's status unless the patient's permission is obtained

D. Refer the caller to the patient's social worker

C.

According to the Guide to PT Practice, "Information relating to therapist/patient relationship is confidential and may not be communicated to a third party not involved in that patient's care without the prior written consent of the patient". Option C is the only one that fits these criteria.

1. The parents of a 1-month old child with myelomeningocele report that the child has been increasingly irritable and has changed sleeping patterns over the past three days. The child has also been vomiting. Which of the following is the MOST appropriate action for the therapist to take?

A. Refer to immediate medical follow-up

B. Instruct the parents to monitor head circumference daily

C. Advise the parents to watch the child for worsening symptoms

D. Take the head circumference measurements to compare to subsequent visits

A.

Sixty percent (60 %) of children with myelomeningocele develop hydrocephalus after surgical closure of their lesion. Early warning signs of hydrocephalus include: irritability, changes in sleep patterns, and changes in appetite and weight. 80 - 90 % of children who acquire hydrocephalus will require a cerebrospinal fluid shunt. These children require ongoing follow-up by a physician. Given the seriousness of this child's symptoms, the child should immediately be referred for medical follow-up.

1. A therapist is setting up a home program of ES for a patient who has Bell's palsy. Which of the following muscles should be stimulated as part of the home program?

A. Sternocleidomastoid

B. Masseter

C. Temporalis

D. Frontalis

D.

Bell's palsy involves the facial nerve. The frontalis is the only muscle listed that is innervated by the facial nerve. The sternocleidomastoid is innervated by the spinal accessory nerve, and the masseter and temporalis are innervated by the trigeminal nerve.

1. A patient is lying supine with his hips and knees extended and hands behind his head. The patient is able to raise his head, shoulder and thorax from the treatment table, but is unable to come to a complete long-sitting position. The PT should target which muscle for strengthening program?

A. Iliopsoas

B. External abdominal oblique

C. Quadratus lumborum

D. Upper rectus abdominis

A.

The abdominal muscles are active during sit-ups (with knees extended) up until the spine is completely flexed (head, shoulders, thorax lifted from surface). In order to come to a long-sitting position however, the hips must be flexed and the abdominals cannot perform this action because they do not cross the hip joint. Therefore, the hip flexors (iliopsoas among others) would have to complete this motion. The inability to achieve a long-sitting position would suggest weakness in the iliopsoas muscle.

1. A 14-month old child with spastic diplegia is up on his tiptoes with his toes curled when held in supported standing. This position is characteristic of a:

A. proprioceptive placing reaction

B. moro reflex

C. plantar grasp reflex

D. traction response

C.

The plantar grasp reflex is characterized by curling of the toes when the child is held supported in standing. The reflex is normal up to 9 months of age. Delayed integration of this reflex can result in delayed, independent ambulation.

1. A therapist is developing a gait training program for a patient following a THA of the right hip. The proper instructions and rationale for crutch training utilizing one crutch include holding the crutch in:

A. right hand to decrease activity in the right hip abductors

B. right hand to facilitate action in the right hip abductors

C. left hand to decrease action in the right hip abductors

D. left hand to facilitate action in the right hip abductors

C.

Placing a crutch in the left hand reduces the magnitude of the right hip abductor force needed to prevent the pelvis from dropping on the left side during the stance phase on the right. Pushing down on the crutch of the right limb reduces the amount of right hip abductor force needed, which is turn reduces the compression force on the right hip joint. This effect is desirable in patients who have hip abductor weakness or hip pain.

1. Following trauma at C5 spinal cord level, a patient was admitted to the hospital. 24 hours later, the patient shows no reflexes, sensation, or voluntary motor activity below the level of injury. These findings indicate:

A. the presence of spasticity

B. decerebrate rigidity

C. spinal shock

D. a lower motor neuron lesion

C.

Spinal shock occurs as a reaction to spinal cord injury and is characterized by an absence of all reflex activity below the level of the lesion. Depending on the extent of the lesion, the patient may lose all or some of their sensation and motor activity below the level of the lesion. Spasticity is associated with hyperreflexia and increased muscle tone. Spasticity would be expected to develop following the spinal shock stage. Decerebrate rigidity involves sustained contraction of the UE and LE in extension. With a lower motor neuron lesion, the loss of sensation and motor activity would be confined to a much smaller region (depending on the exact lesion) and would not affect all levels below the lesion.

1. Following trauma at C5 spinal cord level, a patient was admitted to the hospital. 24 hours later, the patient shows no reflexes, sensation, or voluntary motor activity below the level of injury. These findings indicate:

A. the presence of spasticity

B. decerebrate rigidity

C. spinal shock

D. a lower motor neuron lesion

D.

The patient's signs and symptoms are reflective of a right-sided cerebellar hemisphere lesion. That is, cerebellar lesions commonly produce hypotonia, hyporeflexia, ataxia and an intention tremor. Cerebellar lesions also produce ipsilateral manifestations in the extremities.

1. A patient sustained a gunshot wound to the distal posterior thigh that resulted in complete severance of the common peroneal nerve. Which of the following exercise is necessary in the early rehabilitation period to prevent contracture formation?

A. Active plantarflexion, inversion and toe extension

B. Passive dorsiflexion, eversion and toe extension

C. Active dorsiflexion, eversion and toe flexion

D. Passive plantarflexion, eversion and toe flexion

B.

The common peroneal nerve innervates the following muscles: peroneus longus and brevis, tibialis anterior, extensor digitorum longus and brevis, peroneus tertius and extensor hallucis longus. Because of the complete severance, all of those muscles would be affected and would not be able to actively contract until regeneration has taken place. Therefore, the patient would completely lose ankle dorsiflexion, eversion and toe extension. Those motions have to be performed passively in order to maintain ROM. Option B is the only one that contains all of the correct actions.

1. A patient with mild closed head injury and bilateral femur fracture requires instructions in a LE exercise program. In order to plan the most effective teaching methods for this patient, what would be the MOST critical to assess at the initial visit?

A. Comprehension of written, verbal and demonstrated instructions

B. Short tem memory capacity

C. Hearing and vision

D. Any personality changes compared to the patient's premorbid status

A.

Option A is the best answer. In option B, if the patient does not initially understand the information, then having short-term memory is irrelevant. For option C, hearing and vision are obviously important but the most critical component is comprehension.

1. A patient with right above-knee prosthesis will be able to maintain the knee in extension while weight bearing if the center of gravity of the body is shifted so that the gravitational line falls:

A. posterior to the axis of the right knee joint

B. lateral to the axis of the right knee joint

C. anterior to the axis of the right knee joint

D. medial to the axis of the right knee joint

C.

Static alignment for knee stability is established by positioning of the knee so that lateral reference line falls anterior to the knee joint.

1. In order for a patient with bilateral BKA to maximize balance in a wheelchair, the rear wheels should be positioned more:

A. laterally

B. posteriorly

C. anteriorly

D. inferiorly

B.

The center of gravity of a person with bilateral above-knee amputation is more posterior that the center of gravity of a person with their LE intact. Setting the back wheels more posteriorly will make the patient more stable in the chair. This adjustment prevents the wheelchair from tipping backward.

1. An initial PT evaluation performed on an elderly patient who is 1 day post total hip arthroplasty (non-cemented) using a posterolateral approach. The patient has no complicating medical history and was active and independent preoperatively. Which of the following activities is NOT an appropriate goal for the first week of therapy?

A. Active-assistive positioning of the left hip to 60 degrees of flexion

B. Active left hip abduction in right sidelying

C. Independent bed mobility with use of a trapeze

D. Walking with moderate assistance with a standard walker to 25 feet (7.6 meters)

B.

Although protocols depend on the surgeon and the approach, it is generally recommended that anti-gravity hip abduction exercises not begin until 5 to 6 weeks post-surgery. Patients are taught to avoid excessive hip flexion, usually beyond 80 degrees. Bed mobility and ambulation would be started 1 to 2 days post-operatively.

1. A patient with frequent tension headaches has been referred to physical therapy for instruction in a program of progressive relaxation exercises. Which of the following is MOST essential in a program of progressive relaxation to reduce muscle tension?

A. Release of tension by suggestion and persuasion

B. Passive exercise in quiet surrounding to relieve tension

C. General massage using deep stroking and kneading of tense muscle

D. Recognition of the sensation of tension and release

D.

Posterior muscle tension is implicated in the development of tension headaches. Positive imagery is recommended as a self-treatment technique, but the awareness of tension and the appreciation of its absence are fundamental. Massage and passive exercise may be relaxing, but the patient must be aware of the sensations of tension to prolong the benefit.

1. On the fourth day of PT treatment, a patient who has had an ORIF for a hip fracture develops a large ecchymosis over the unaffected hip. The patient has MOST likely developed:

A. a hemangioma

B. a complication of anticoagulant therapy

C. a hematocele

D. deep vein thrombophlebitis

B.

Anticoagulation therapy inhibits the synthesis and function of clotting factors and can lead to bruising (ecchymosis) or more severely, hemorrhage. A hemangioma is a benign liver tumor, deep vein thrombosis would result in redness, swelling and warmth in the affected area and most commonly occurs in the calf muscle, not the hip region. A hematocele is a blood cyst.

1. A patient who is exercising on a bicycle ergometer in the cardiac rehabilitation unit is being monitored with electrocardiogram leads. During the exercise, the ST segment becomes depressed by 2 mm. If the cardiologist has given no specific guidelines, the PT should:

A. terminate the session immediately

B. reduce the resistance load

C. instruct the patient to slow down

D. direct the patient to continue as before

A.

An ST segment depression of greater than 1 mm is indicative of myocardial ischemia. Continuing the exercise session could place the patient at serious risk for continued ischemia, which could ultimately lead to myocardial infarction. Therefore, the best response for the therapist would be to stop the exercise session immediately and inform the cardiologist of the patient's response. All the other options would continue to place the patient at risk.

1. A patient slips, falls and cuts her arm in the clinic. The cut is bleeding and the patient is alert and well oriented. In performing first aid for the patient, the FIRST action that the PT should take is to:

A. don a pair of gloves

B. clean the cut with an antiseptic

C. check the patient's BP

D. cover the cut with sterile dressing

A.

Infection control requires that the wound not be contaminated further, and that the health care workers protect themselves from disease by avoiding contact with body fluids. In this case, the patient does not appear to be in life threatening danger, and so the wound should be attended to. Therefore, checking the patient's blood pressure would not be the first ting to do. Once the gloves are donned, cleaning the wound and covering it with a sterile dressing would be appropriate.

1. A PT is working with patient who is aware that he is terminally ill. What is the MOST appropriate intervention when the patient wants to talk about his prognosis?

A. Discourage discussion of death or dying

B. Refer the patient for pastoral counseling

C. Relate the therapist's experiences with other patients

D. Encourage the patient's statement of feelings

D.

Patients should be encouraged to express their feelings. Comparisons to other patients who are dying in an effort to assure the patient is not alone, takes away from this patient's feelings. Denial of death would not be good for the patient, since he must ultimately cope with the inevitable. Pastoral counseling would be an option, but the therapist should be ready to listen to the patient, encourage statement of feelings and avoid denial.

1. Prior to starting an exercise training program, a patient with cardiac problems who is receiving beta blocking medication should receive an explanation of the:

A. greater benefits from cardiovascular exercise to be achieved at lower rather than at higher metabolic level

B. need to use measures other than heart rate to determine intensity of exercise

C. need for exercise training sessions to be more frequent but of shorter duration

D. need for longer warm-up periods and cool-down periods during an exercise session

B.

The patient taking beta-blocking medication will experience a lower heart rate and blood pressure response during exercise as compared to a patient who is not taking this medication. Since the heart rate is lower than anticipated, using heart rate to monitor exercise intensity may not be as accurate. Another measure, such as the Borg Scale (rating of perceived exertion) would be more beneficial. However, even though heart rate and blood pressure would be lower, the patient actually achieves the same metabolic levels during exercise and therefore altering the frequency or duration of exercise is unnecessary. The time for warm-up and cool-down exercises is not to be altered.

1. A clean, well granulating stage II pressure ulcer with minimal serous drainage is MOST appropriately dressed with:

A. a non-adherent dressing

B. a packed dressing

C. topical medication only

D. dry-to-dry gauze

A.

A non-adherent dressing is best choice because any adherence of the dressing to the fragile granulating tissue could cause additional trauma. This is superficial wound, so there would be no need to pack the wound. Since there is some drainage, a covering is preferential to topical medication only.

1. A PT examines a patient who complains of foot pain while jogging. The examination sows that the patient has excessive foot pronation and forefoot varus. The therapist decides to try a temporary orthotics insert in the patient's running shoe. Which of the following would be the MOST appropriate orthotics insert?

A. A lateral forefoot post under the fifth metatarsal head

B. A lateral rearfoot post under the calcaneus placing it in everted position

C. A wedge placed under the instep of the medial foot just beneath the head of the talus

D. A medial post just proximal to the first metatarsal head

D.

Pronation of the foot can be caused by a variety of factors including calcaneal eversion and forefoot varus. Correction of the pronation by an orthosis could include a medial post (wedge) placed just proximal to the metatarsal heads or a medial post under the calcaneus. The approach involves bringing the ground up to meet the foot. A post under the fifth metatarsal head would accentuate the problem, as would a rearfoot post placing the calcaneus in an everted position. If the patient has excessive forefoot varus, a wedge may be placed in the instep in addition to the medial wedge proximal to the metatarsal heads to distribute the load, however, a wedge in the instep by itself would not be the best intervention.

1. A patient with chronic adhesive capsulitis of the shoulder is to be treated with joint mobilization to increase joint range of motion. Which of the following would be the MOST appropriate to increase shoulder abduction?

A. Distraction with inferior glide

B. Anterior glide with internal rotation

C. Superior glide with approximation

D. Distraction with posterior glide

A.

Since most of the joint contracture/adhesion forms in the anterior-inferior portion of the capsule, treatment to mobilize that portion of the capsule is of primary concern. Inferior glide would stretch the inferior portion of the capsule.

1. A patient with chronic adhesive capsulitis of the shoulder is to be treated with joint mobilization to increase joint range of motion. Which of the following would be the MOST appropriate to increase shoulder abduction?

A. Distraction with inferior glide

B. Anterior glide with internal rotation

C. Superior glide with approximation

D. Distraction with posterior glide

B.

Options A, C and D are acceptable interventions for this patient. The epiphyseal areas (growth areas of bones) in children should not be exposed to ultrasound. The application of ultrasound over the knee joint (hamstring insertion) could expose the epiphyseal areas to the ultrasound.

1. Although knee motion occurs primarily in one plane, tibial rotation is possible when the knee is positioned in 90 degrees or more of flexion because in this position the:

A. condyles of the femur glide posteriorly on the condyles of the tibia

B. hamstrings act as rotating force

C. patella deviates inferiorly

D. tension on the ligaments is decreased

D.

When the knee is extended, the medial and lateral collateral ligaments are taut. During knee flexion, the ligaments slacken. Therefore, there is very little tibial rotation when the knee is extended (close packed position) and approximately 40 degrees of axial rotation with the knee flexed. Although the femoral condyles may glide posteriorly (depending on the direction of rotation) on the tibia and the hamstrings may rotate the tibia, the reason the motion is available is due to laxity in the collateral ligaments. Other ligaments such as the cruciates and the joint capsule may add to the stability in the close packed position.

1. A PT is screening a young adult patient for a possible right thoracic, left lumbar structural scoliosis. The postural deviation commonly seen with this diagnosis would be:

A. spinous processes of the thoracic spine rotated to the right

B. high left shoulder

C. posteriorly protruding scapula to the right

D. prominent right posterior rib cage

D.

Scoliosis deformities are named relative to the convexities of the curves, with the apex of the curve defining the vertebral level. In the right thoracic, left lumbar scoliosis, there is a convex curve to the right the thoracic spine and a convex curve to the left in the lumbar spine. In the thoracic spine, the body of the vertebrae rotates to the right (convex side) and the spinous process rotate toward the left (concave side). Along with this transition, the ribs rotate posteriorly on the convex side causing the scapula to become more prominent on the convex side and causing the shoulder to be elevated on the convex side.

1. A postural correction program for a patient with forward head, kyphosis, and increased lumbar lordosis would include all of the following EXCEPT:

A. strengthening of the scapular protractors

B. strengthening the thoracic erector spinae muscles

C. lengthening the short suboccipital muscles

D. lengthening the lumbar erector spinae muscles

A.

With this particular posture, the patient's scapula would be in a protracted (abducted) position, therefore the scapular protractors are already overactive and would require stretching, not strengthening. The kyphosis suggests that the thoracic erector spinae muscles are weak and need strengthening. The lumbar lordosis indicates shortened lumbar erector spinae muscles. Forward head posture suggests that the cervical spine is flexed and the occiput is extended, therefore stretching of suboccipital muscles would be indicated. A TEST-TAKING HINT. Although EXCEPT questions are rarely used on the NPTE, be alert for this type of question and read the responses so that you select the unrelated response.

1. A patient in the eighth month of pregnancy presents with numbness and tingling of the left hand except the fifth digit. She demonstrates edema of the hand and fingers, a positive Tinel's sign at the wrist, and a good (4/5) muscle test grade of the wrist and finger flexors. The MOST appropriate intervention would be:

A. a wrist splint to position the wrist in full extension

B. a hot pack followed by tendon gliding exercises

C. resistive exercises for the wrist and finger flexors

D. frequent rest and elevation of the left upper extremity

D.

Compression on the median nerve (carpal tunnel syndrome) is occurring, most likely as a result of swelling associated with the individual being in the eighth month of pregnancy. In this case, rest and elevation would do the most to decrease the edema and relieve the symptoms. The wrist should not be positioned in full extension. Initial conservative treatment sometimes includes cock-up splinting to hold the wrist in neutral to 10 degrees of extension, but not full extension. Although tendon-gliding exercises may be used, heat would not be indicated since it may increase the edema. Resistive exercises for the wrist and fingers may aggravate the compression in the carpal tunnel.

1. An exercise program for a patient with Parkinson's disease would MOST likely include exercise to:

A. decrease movement of the upper extremities and trunk

B. increase trunk flexor strength

C. improve balance reactions and reciprocation

D. stretch back extensor muscle

C.

Patients with Parkinson's disease are characterized by rigidity, bradykinesia, tremor, lack of associated movements, impaired balance reactions and a flexed posture (kyphosis). Therefore intervention should be directed toward full ROM and correction of kyphotic posture through back extensor strengthening exercises, balance exercise, and exercises that promote reciprocal movement. Option C is the only one that includes appropriate exercises.

1. If a BK prosthesis has an excessively firm heel wedge, the patient is MOST likely to walk with:

A. excessive knee flexion in early stance

B. premature knee flexion in late stance

C. insufficient knee flexion in early stance

D. excessive knee flexion in late stance

A.

Upon heel contact, the heel section compresses partially absorbing the ground impact and thus permitting a controlled plantarflexion. If the heel is too stiff, upon initial contact, the knee flexes too soon and excessively. An excessively firm heel wedge would not be a factor in late stance.

1. A patient who has COPD is being treated with a regimen that includes pursed lip breathing exercise. The PRIMARY purpose of the pursed lip breathing is to:

A. help prevent collapse of pulmonary airways during exhalation thereby reducing air trapping

B. decrease the removal of CO2 during ventilation

C. increase the residual volume of respiration so that more O2 is available for body metabolism

D. stimulate further mobilization of mucous secretions to higher air passages where they can be expectorated

A.

A patient with COPD has premature collapse of the airways upon exhalation, which leads to air trapping and ultimately poor gas exchange. Breathing out through pursed-lips slows the airflow and creates a backpressure, which helps to prevent the airways from collapsing while exhaling. By exhaling more fully through pursed-lips, more carbon dioxide is removed. By preventing airway collapse and air trapping in the lungs, the residual volume is actually decreased. Pursed-lipped breathing helps with ventilation, but does not necessarily assist with secretion mobilization.

1. A patient with a diagnosis of cervical radiculopathy reports numbness of the right little finger. The therapist would MOST likely find a diminished DTR in the:

A. biceps brachii

B. deltoid

C. triceps brachii

D. brachioradialis

C.

The dermatome providing sensation to the little finger is innervated by the C8 nerve root. The triceps brachii is the only one of the muscles listed that is also innervated by the C8 nerve root. The biceps brachii, deltoid, and brachioradialis are innervated by the C5, C6 and sometimes C7 nerve roots.

1. A therapist is planning a patient education program for a group of patients with chronic LBP. To increase the likelihood that the patients will utilize the proper body mechanics at the work site, the therapist should:

A. ask patients to demonstrate the use of proper body mechanics

B. provide a reference list of articles describing body mechanics

C. ask patients to describe actions they do that increase their back pain

D. provide information on the frequency of low back injuries due to improper body mechanics

A.

Evaluation of the patient's retention of information presented in the program can be enhanced by asking the patients questions about the program information, having the patient ask questions about the program, having the patients demonstrate what they have learned and testing the patient about the program material. Option A is the only one that utilizes one of these techniques. The other options do not require active participation by the patients; they do not address specific interventions.

1. A patient presents with hemiparesis and demonstrate a foot drop during swing phase of gait. It would be MOST appropriate to administer FES to the tibialis anterior and the:

A. gastrocnemius

B. tibialis posterior

C. extensor digitorum longus

D. peroneus longus

C.

During the swing phase of gait, the foot is dorsiflexed to clear the foot. Muscles active during this phase of gait are the tibialis anterior, extensor hallucis longus and extensor digitorum longus. The gastrocnemius, tibialis posterior and peroneus longus are active during the stance phase of gait. Therefore, of the muscles listed, the extensor digitorum longus is the best choice. If only the tibialis anterior was stimulated, the foot would go into inversion and dorsiflexion, which could cause the patient to land on the lateral side of the foot at initial contact causing them injury. Addition of the extensor digitorum longus would bring the foot up into more dorsiflexion and avoid excessive inversion.

1. A PT is treating a patient with iontophoresis. If the current is set at 4 mA, the duration at 15 minutes, and the dexamethasone solution at 0.4%, with an electrode area of 4 cm2, how would the therapist record the current dosage?

A. 0.16 mA.mg

B. 16 mA/cm2

C. 0.60 mg/min

D. 60 mA.min

D.

The current dosage for iontophoresis is calculated by multiplying the current (4 mA) by the duration (15 minutes). In this case, the calculation would yield a value of 60 mA.min. None of the other options use the correct value.

1. An elderly patient has diabetic neuropathy. Upon examination he shows marked mediolateral instability of the left ankle while walking. The patient also has fluctuating edema and glove-and-stocking sensory loss in both legs. The MOST appropriate orthotics aid would be:

A. a double-upright ankle foot orthosis

B. hip to toe shoes

C. a prefabricated plastic, solid ankle-foot orthosis

D. a spiral ankle foot orthosis

A.

The double-upright metal ankle foot orthosis would provide the best support for mediolateral instability and would allow for changes in leg volume. The plastic solid AFO would not provide as much mediolateral support and because of its conformation of the leg, it would not be advisable for patients who are experiencing changes in leg volume due to edema. High top shoes would not provide enough support. The spiral AFO would not provide needed stability to the ankle and the design would not be indicated with a patient has fluctuating edema.

1. A 25-year-old patient with cystic fibrosis has been experiencing successful mobilization of thickened secretions by standard percussion and postural drainage. During the current treatment session, the patient coughs up sputum that has small, brownish streak of blood. The PT should:

A. percuss more vigorously in an attempt to clear out any other blood that is present in the airways

B. perform postural drainage in upright positions for this type of patient only

C. continue treatment with little modification unless more blood is noted

D. stop the treatment and send the patient to the emergency room

C.

Hemoptysis or the coughing up of blood can be benign or severe and can be a common occurrence in the cystic fibrosis population secondary to the pathophysiological processes in their pulmonary system. In general, a small amount of hemoptysis that occurs occasionally or a non-persistent hemoptysis is benign. The brownish color indicates either venous blood or old blood. In this situation, if the hemoptysis does not persist, then it is appropriate to continue treatment without modification. If the blood was larger in amount and fresher (denoted by a bright red color), then the treatment should be discontinued. The presence of blood in the sputum should not warrant more vigorous chest percussion, until it is deemed appropriate to continue with the session. Since this situation is a benign scenario, alteration of drainage position is not necessary, and there is no need to send the patient to the emergency room.

1. Which of the following should be recommended for a patient following a medial meniscectomy if the PT plans to exercise the quadriceps femoris against accommodating resistance?

A. Knee bends through half of the range

B. Knee extension with sandbag in the ankle

C. Knee extension on an isokinetic exercise device

D. Straight leg raising with a sling suspension

C.

Isokinetic exercise device utilize accommodating resistance throughout the range of motion. The other exercises are not forms of accommodating resistance.