Final Frontier Practice Exam: 1-45

A patient with a tracheostomy presents with sudden dyspnea, cyanosis, and calf cramping. Why is Respiratory Distress the primary suspicion over DVT?

Prioritization (ABC’s). While calf cramping suggests DVT, sudden cyanosis and dyspnea in a tracheostomy patient indicate an immediate, life-threatening airway emergency. Airway and breathing always take priority over localized circulation issues in acute settings.

To improve forearm internal rotation (pronation) at the proximal radioulnar joint, what are the roll and glide directions?

Anterior roll and Posterior glide of the radial head because the radius must cross OVER the ulna.

What are the standard safety parameters for hot pack application (Toweling, Temperature, and Monitoring)?

Toweling: 6–8 layers (standard commercial covers usually count as 2 layers).

Temperature: 158°F – 167°F (hydrocollator range).

Monitoring: Skin check every 5 minutes (Rationale: Heat intensity peaks within 10 minutes).

Differentiate the primary motions of the Talocrural vs. Subtalar joints.

Talocrural: Dorsiflexion/Plantarflexion. Subtalar: Inversion/Eversion.

Anterior drawer test of the ankle assesses what? Position?

ATFL integrity

• Foot: ~20° plantarflexion

• Examiner draws talus anteriorly in mortise

• Positive: pain + excessive anterior translation

Kleiger (external rotation stress) test assesses what?

Syndesmosis + deltoid ligament

• Position: dorsiflexion + external rotation

Ottawa ankle rules: when is imaging indicated?

Malleolar zone pain +:

• tenderness at posterior edge/tip of medial or lateral malleolus
  OR

• unable to bear weight for 4 steps immediately and in clinic

Also:

• navicular tenderness

• base of 5th metatarsal tenderness

Upper extremity flexor synergy pattern (CVA/UMN lesion): What motions are involved?

• Scapula: elevation + retraction

• Shoulder: abduction + external rotation

• Elbow: flexion

• Forearm: supination

• Wrist: flexion

• Fingers: flexion

What foot structure does the arch index assess?

• Measures how much the midfoot contacts the ground compared with the whole footprint

• Arch Index ≥ 0.30: Indicates Pes Planus (Flat Foot).

• Arch Index < 0.21: Indicates Pes Cavus (High Arch).

What is the primary mechanism for the initial increase in heart rate during exercise (up to ~100 bpm)?

Withdrawal of Parasympathetic (Vagal) tone. (SNS activation primarily drives HR increases above the 100 bpm threshold).

What is the specific "safe" pressure range for wound irrigation to prevent tissue damage?

4–15 psi (ideally closer to 4–8 psi). Pressures >15 psi can cause tissue trauma and drive bacteria into the wound bed.

Long-standing type 1 diabetes: what happens to HR response?

In long-standing type 1 diabetes, chronic hyperglycemia can damage autonomic nerves → cardiac autonomic neuropathy. This can impair sympathetic and parasympathetic control of the heart resulting in a fixed heart rate

Blood disorder prefixes: What do they mean?

• Poly- = many → polycythemia = too many RBCs → ↑ blood viscosity, possible hypertension/clot risk

• An- / a- = without/low → anemia = low RBCs/hemoglobin → ↓ oxygen carrying capacity

• Thrombo- = clot → thrombocytopenia = low platelets → bleeding tendency

• Leuko- = white → leukopenia = low WBCs → decreased immune defense

What muscle is being tested in prone with the arm at the side, internally rotated, and lifted off the table?

Latissimus Dorsi (Action: Extension, Adduction, Internal Rotation; Innervation: Thoracodorsal nerve, C6-C8).

How do you differentiate MMT positioning for the Clavicular vs. Sternal heads of the Pectoralis Major?

• Clavicular: 90° abduction → toward opposite shoulder (horizontal adduction).

• Sternal: 120° abduction → toward opposite hip (down and in).

What is the difference between preeclampsia and eclampsia?

Preeclampsia: hypertension ± proteinuria + headache/visual symptoms
Eclampsia: preeclampsia symptoms + seizure

A patient has limited elbow ROM. Which mobilization improves:

• Flexion?

• Extension?

• Flexion = Varus ("in" motion)

• Extension = Valgus ("out" motion)