Scorebuilder exam 3 (200spmogsvar)

B1. A physical therapist is treating a child with spastic cerebral palsy who is 3 years old cognitively but at a 6-month-old gross developmental level. What is an appropriate treatment activity for this child?

1. Reaching for a multicolored object while in an unsupported standing position.

2. Reaching for a multicolored object while in an unsupported, guarded sitting position.

3. Visually tracking a black and white object held 9 inches from his/her face.

4. Reaching for a black and white object while in the supine position.

2. Reaching for a multicolored object while in an unsupported, guarded sitting position.

B2. A patient is receiving mobilizations to regain normal mid thoracic extension. After three sessions, the patient complains of localized pain that persists for greater than 24 hours. What is the therapist's BEST option?

1. Change mobilizations to gentle, low-amplitude oscillations to reduce the joint and soft tissue irritation.

2. Continue with current mobilizations, followed by a cold pack to the thoracic spine.

3. Place the physical therapy on hold and resume in 1 week.

4. Change to self-stretching activities, because the patient does not tolerate mobilization.

1. Change mobilizations to gentle, low-amplitude oscillations to reduce the joint and soft tissue irritation.

B3. A therapist wishes to use behavior modification techniques as part of a plan of care to help shape the behavioral responses of a patient recovering from traumatic brain injury (TBI). What intervention is the BEST to use?

1. Use frequent reinforcements for all desired behaviors.

2. Encourage the staff to tell the patient which behaviors are correct and which are not.

3. Reprimand the patient every time an undesirable behavior occurs.

4. Allow the patient enough time for self-correction of the behavior.

1. Use frequent reinforcements for all desired behaviors.

B4. A patient with multiple sclerosis (MS) presents with dysmetria in both upper extremities. Which of the following interventions is the BEST choice to deal with this problem?

1. 3-lb weight cuffs to wrists during activities of daily living (ADL) training.

2. Isokinetic training using low resistance and fast movement speeds.

3. Pool exercises using water temperatures greater than 85 degrees F.

4. Proprioceptive neuromuscular facilitation (PNF) patterns using dynamic reversals with carefully graded resistance.

4. Proprioceptive neuromuscular facilitation (PNF) patterns using dynamic reversals with carefully graded resistance.

B5. Knee capsular tightness has limited a patientís ability to attain full flexion. An INITIAL intervention a physical therapist can employ to restore joint motion should emphasize sustained mobilization in the loosepacked position. Which of the following is the BEST choice to use?

1. Anterior glide and external rotation of the tibia.

2. Posterior glide and external rotation of the tibia.

3. Posterior glide and internal rotation of the tibia.

4. Anterior glide and internal rotation of the tibia.

3. Posterior glide and internal rotation of the tibia.

B6. A patient recovering from cardiac transplantation for end-stage heart failure is referred for exercise training. The patient is receiving immunosuppressive drug therapy (cyclosporine and prednisone). What guidelines should the therapist follow when implementing an exercise program for this patient?

1. Require longer periods of warm-up and cool-down.

2. Require short bouts of exercise.

3. Eliminate all resistance training.

4. Require a frequency of 2-3 times/week.

1. Require longer periods of warm-up and cool-down.

B7. A patient presents with weakness and atrophy of the biceps brachii resulting from an open fracture of the humerus. The therapist reads a report of needle electromyography (EMG) of the biceps. What is the anticipated muscle response after the needle is inserted and prior to active contraction?

1. Polyphasic potentials.

2. Interference patterns.

3. Electrical silence.

4. Fibrillation potentials.

3. Electrical silence.

B8. A new staff physical therapist (PT) on the oncology unit of a large medical center receives a referral for strengthening and ambulation for a woman with ovarian cancer. She is undergoing radiation therapy after a surgical hysterectomy. Her current platelet count is 17,000. What intervention is indicated for this patient at this time?

1. Active range-of-motion (AROM) exercises and activities of daily living (ADLs) exercises.

2. Aerobic exercise 3-5 days/week at 40-60% oxygen uptake reserve.

3. Resistance training at 60%, one repetition maximum.

4. Progressive stair climbing using a weighted waist belt.

1. Active range-of-motion (AROM) exercises and activities of daily living (ADLs) exercises.

B9. A patient complains of increased pain and tingling in both hands after sitting at a desk for longer than 1 hour. The diagnosis is thoracic outlet syndrome (TOS). Which treatment would be the MOST effective physical therapy intervention?

1. Cardiovascular training using cycle ergometry to reduce symptoms of TOS.

2. Stretching program for the pectoralis minor and scalenes.

3. Strengthening program for the scalenes and sternocleidomastoids.

4. Desensitization by maintaining the shoulder in abduction, extension, and external rotation with the head turned toward the ipsilateral shoulder.

2. Stretching program for the pectoralis minor and scalenes.

B10. A patient with diabetes is exercising. The patient reports feeling weak, dizzy, and somewhat nauseous. The therapist notices that the patient is sweating profusely and is unsteady when standing. What is the therapist's BEST immediate course of action?

1. Insist that the patient sit down until the orthostatic hypotension resolves.

2. Have a nurse administer an insulin injection for developing hyperglycemia.

3. Have the patient sit down and administer orange juice for developing hypoglycemia.

4. Call for emergency services; the patient is having an insulin reaction.

3. Have the patient sit down and administer orange juice for developing hypoglycemia.

B11. A patient with postpolio syndrome started attending a supervised outpatient exercise program. The patient failed to show up for follow-up sessions. The patient reported increased muscle pain and being too weak to get out of bed for the past 2 days. The patient is afraid to continue with the exercise class. What is the therapist's BEST course of action regarding the patient's exercise program?

1. Discharge the patient from the program because exercise is counterproductive in postpolio syndrome.

2. Reschedule exercise workouts for early morning when there is less fatigue.

3. Decrease the intensity and duration, but maintain a frequency of 3 times/week.

4. Decrease the frequency to once a week for an hour session, keeping the intensity moderate.

3. Decrease the intensity and duration, but maintain a frequency of 3 times/week.

B12. A therapist has elected to use continuous inductive coil short wave diathermy (SWD) as one of the interventions in managing hip pain. Use of other thermal or electrical modalities were either ineffective or contraindicated. Which patient would be a candidate for use of short wave diathermy?

1. A morbidly obese patient.

2. A patient with Type 1 diabetes who uses an insulin pump.

3. An 11 year-old boy with a slipped capital femoral epiphysis.

4. A patient with ankylosing spondylitis on high doses of NSAIDS and DMARDS.

4. A patient with ankylosing spondylitis on high doses of NSAIDS and DMARDS.

B13. A patient is recovering from open heart surgery (sternotomy and coronary artery bypass). The PT is supervising the patient's outpatient exercise program at 8 weeks postsurgery. What guidelines should be followed regarding the use of moderate to heavy weights during resistance training?

1. Should include upper body exercises only.

2. Is contraindicated during the first two months.

3. Should be based on 60%-80%, one repetition maximum initially.

4. Can be included if resistance training is once a week.

2. Is contraindicated during the first two months.

B14. A patient with asthma is taking a drug from the sympathomimetic group, albuterol (Ventolin). What is the MOST important effect of this medication?

1. Increases airway resistance and decreases secretion production.

2. Reduces airway resistance by reducing bronchospasm.

3. Increases heart rate (HR) and BP to enhance a training effect during aerobic activity.

4. Reduces bronchial constriction and high blood pressure (BP) that accompanies exercise.

2. Reduces airway resistance by reducing bronchospasm.

B15. A PT decides to exercise a patient with lower extremity lymphedema using aquatic therapy. Hydrostatic pressure exerted by the water can be expected to do which of the following?

1. Increase cardiovascular demands at rest and with exercise.

2. Reduce effusion and assist venous return.

3. Provide joint unloading and enhance ease of active movement.

4. Increase resistance as speed of movement increases.

2. Reduce effusion and assist venous return.

B16. A therapist determines that a patient is walking with a backward trunk lean with full weight on the right leg. The patient also demonstrates great difficulty going up ramps. What is the BEST intervention to remediate this problem?

1. Strengthen hip extensors through bridging.

2. Stretch hip abductors through side-lying positioning.

3. Strengthen knee extensors with weights, using 80%, one repetition maximum.

4. Stretch hip flexors through prone-lying positioning.

1. Strengthen hip extensors through bridging.

B17. A patient has developed a thick eschar secondary to a full-thickness burn. What is the antibacterial agent MOST effective for infection control for this type of burn?

1. Sulfamylon.

2. Nitrofurazone.

3. Panafil.

4. Silver nitrate.

1. Sulfamylon.

B18. An elderly person has lost significant functional vision over the past 4 years and complains of blurred vision and difficulty reading. The patient frequently mistakes images directly in front of her, especially in bright light. When walking across a room, the patient is able to locate items in the environment using peripheral vision when items are located to both sides. Based on these findings, what is the visual condition this patient is MOST likely experiencing?

1. Glaucoma.

2. Cataracts.

3. Homonymous hemianopsia.

4. Bitemporal hemianopsia.

2. Cataracts.

B19. A patient presents with complaints of pain and difficulty with ADL that is consistent with carpal tunnel syndrome. What is the BEST test to identify the cause of symptoms in this patient?

1. Pronator teres syndrome test.

2. Ulnar nerve tension test.

3. Allen's test.

4. Phalen's test.

4. Phalen's test.

B20. A patient incurred a right CVA 1 month ago and demonstrates moderate spasticity in the left upper extremity (predominantly increased flexor tone). The major problem at this time is a lack of voluntary movement control. There is minimal active movement, with ¼ inch subluxation of the shoulder. What initial treatment activity is the BEST choice for this patient?

1. Sitting, left active shoulder protraction with extended elbow and shoulder flexed to 90°.

2. Sitting, weight bearing on extended left upper extremity, weight shifting.

3. Quadruped, rocking from side to side.

4. PNF D2 flexion pattern, left upper extremity.

2. Sitting, weight bearing on extended left upper extremity, weight shifting.

B21. An athlete sustains a twisting injury of the knee while playing basketball. The physical therapist suspects a meniscus injury. What is the BEST choice of special tests to confirm this diagnosis?

1. Lachman and anterior drawer tests.

2. Joint line tenderness and Thessaly test.

3. Noble compression and Ely's tests.

4. Varus and valgus stress tests.

2. Joint line tenderness and Thessaly test.

B22. The therapist in the photograph (empty can test) is testing which muscle?

1. Upper trapezius.

2. Middle deltoid.

3. Supraspinatus.

4. Anterior deltoid.

3. Supraspinatus

B23. During an examination, a patient demonstrates large-amplitude, sudden flailing motions of the arm and leg on one side of the body with primary involvement of axial and proximal joint muscles. What clinical term BEST describes the patient's behaviors?

1. Chorea.

2. Intention tremor.

3. Hemiballismus.

4. Athetosis.

3. Hemiballismus.

B24. A patient is referred to physical therapy after an antero-inferior dislocation of the right shoulder. What positive examination finding is expected as a result of this dislocation?

1. Weak rhomboids.

2. Positive drop arm test.

3. Positive Neer's test.

4. Weak deltoids.

4. Weak deltoids.

B25. A team of researchers investigates the use of constraint-induced movement therapy on patients with chronic stroke (> 1 year poststroke) using a multicenter randomized controlled trial (RCT). What are the specific characteristics of this type of research design?

1. A sample of convenience for the intervention group.

2. Alternating experimental and control conditions for a subject.

3. Random assignment to an experimental or control group.

4. Random assignment to matched cohort groups.

3. Random assignment to an experimental or control group.

B26. An elderly individual with a history of falls in the home (four in the past 2 months with minor injury) is referred to physical therapy as a result of these falls. Which test is the BEST to evaluate gait, strength, and balance?

1. 30 Second Chair Stand.

2. Stops Walking While Talking.

3. Four Square Step Test.

4. Timed Up and Go.

4. Timed Up and Go.

B27. A therapist is treating a patient with left hemiplegia and profound visuospatial perceptual deficits. What is the BEST strategy to use initially to assist this patient in the relearning of motor tasks?

1. Simplify and restructure the environment and minimize distractions.

2. Maximize use of demonstration and gesture.

3. Minimize use of verbal cues.

4. Encourage independent practice.

1. Simplify and restructure the environment and minimize distractions.

B28. A 2-week-old infant born at 27 weeks gestation with hyaline membrane disease is referred for a physical therapy consult. Nursing reports that the child "desaturates to 84% with handling" and has minimal secretions at present. What is the therapist's BEST course of action?

1. Provide suggestions to nursing for positioning for optimal motor development.

2. Put the PT consult on hold because the child is too ill to tolerate exercise.

3. Delegate to a physical therapy assistant (PTA) a maintenance program of manual techniques for secretion clearance.

4. Perform manual techniques for secretion clearance, 2-4 hours daily, to maintain airway patency.

1. Provide suggestions to nursing for positioning for optimal motor development.

B29. A patient sustained a valgus stress to the left knee while skiing. The orthopedist found a positive McMurray's test and a positive Lachman's stress test. The patient has been referred to physical therapy for conservative management of this problem. What is the BEST intervention for the subacute phase of rehabilitation?

1. Open-chain exercises of the hip extensors and hamstrings to inhibit anterior translation of the femur on the tibia.

2. Closed-chain functional strengthening of the quadriceps femoris and hamstrings, emphasizing regaining terminal knee extension.

3. Closed-chain functional strengthening of the quadriceps femoris and hip abductors to promote regaining terminal knee extension.

4. Open-chain strengthening of the quadriceps femoris and hip adductors to inhibit anterior translation of the tibia on the femur.

2. Closed-chain functional strengthening of the quadriceps femoris and hamstrings, emphasizing regaining terminal knee extension.

B30. A patient with pain in the left lateral face and head is found to have limited active and passive mouth opening range of motion. However, passive lateral deviation is full to both sides. What is the likely reason for the limitation in mouth opening range of motion?

1. An anteriorly displaced disc with reduction in the left temporomandibular joint.

2. Decreased flexibility in the muscles of mastication on the left.

3. Capsular restriction of the left temporomandibular joint.

4. An anteriorly displaced disc without reduction in the left temporomandibular joint.

2. Decreased flexibility in the muscles of mastication on the left.

B31. A patient with TBI has a convulsive seizure during a therapy session. The patient has lost consciousness and presents with tonic-clonic convulsions of all extremities. What is the therapist's BEST response?

1. Position in supine-lying with head supported with a pillow, and wait out the seizure.

2. Wrap the limbs with a sheet to prevent self-harm, position in supine-lying, and call for emergency assistance.

3. Position in side-lying, check for an open airway, and immediately call for emergency assistance.

4. Initiate rescue breathing immediately and call for help to restrain the patient.

3. Position in side-lying, check for an open airway, and immediately call for emergency assistance.

B32. Falls are the number one cause of injuries in the elderly. Fall prevention programs include safety education and modifying the environment to reduce falls. Which of the following is NOT a primary concern when evaluating the home environment?

1. Carpet edges, throw rugs, raised floorboards.

2. Lighting in stairways, bedrooms, and bathrooms.

3. Grab bars in the bathroom mounted 48 inches from the floor or tub floor.

4. Nonstick surfaces in the bathtub and shower.

3. Grab bars in the bathroom mounted 48 inches from the floor or tub floor.

B33. An adult with no significant past medical history presents to the emergency room with complaints of fever, shaking chills, and a worsening productive cough. The patient has chest pains over the posterior base of the left thorax, which are made worse on inspiration. What would be an expected physical finding for this patient?

1. Symmetrical breathing.

2. Crackles over the left thorax.

3. Increased chest excursion.

4. Slowed respiratory rate.

2. Crackles over the left thorax.

B34. A patient is referred to physical therapy for functional gait difficulties. The patient is unable to take a normal step and drags the left foot. Examination reveals muscle weakness with fasciculations in the left lower leg. What other signs and symptoms should the therapist examine?

1. Decreased tone and hyporeflexia.

2. Muscle spasms and positive Babinski.

3. Increased tone and hyperreflexia.

4. Dyssynergia and timing deficits.

1. Decreased tone and hyporeflexia.

B35. An elderly patient with hyperthyroidism is referred to physical therapy following a period of prolonged bedrest. What should the therapist be alert for when monitoring exercise of this patient?

1. Decreased heart rate and blood pressure.

2. Tachycardia and dyspnea.

3. Muscle weakness and joint pain.

4. Arrhythmias and bradycardia.

2. Tachycardia and dyspnea.

B36. A patient strained the lower back muscles 3 weeks ago, and now complains of pain (6/10). Upon examination, the therapist identifies bilateral muscle spasm from T10-L4. The therapist elects to apply interferential current to help reduce pain and spasm. What is the BEST electrode configuration in this case?

1. Four electrodes, with current flow perpendicular to the spinal column.

2. Two electrodes, with current flow perpendicular to the spinal column.

3. Four electrodes, with current flow diagonal to the spinal column.

4. Two electrodes, with current flow parallel to the spinal column.

3. Four electrodes, with current flow diagonal to the spinal column.

B37. An infant is diagnosed with an extended Erb's paralysis (brachial plexus injury). What would the physical therapy examination of this infant MOST LIKELY reveal?

1. Involvement of muscles innervated by C5-C6 nerves with additional loss of elbow and finger extension.

2. Involvement of muscles innervated by C4-C8 nerves.

3. Intact shoulder and elbow movements but loss of wrist flexion.

4. Involvement of muscles innervated by C8 and T1.

1. Involvement of muscles innervated by C5-C6 nerves with additional loss of elbow and finger extension.

B38. A retired bus driver has experienced increasing frequency of low back pain over the past 10 years. The patient states that nonsteroidal anti-inflammatory drugs (NSAIDs) help to relieve the symptoms, but there is always a nagging-type pain. The patient reports significant stiffness in the morning that dissipates by noon after exercising and walking. Pain is exacerbated with frequent lifting and bending activities, as well as sitting for long periods. What should the physical therapy plan of care emphasize?

1. Modalities to reduce pain, postural reeducation, and dynamic stabilization exercises.

2. Postural reeducation, soft tissue mobilization, and dynamic stabilization.

3. Modalities to reduce pain, joint mobilization, and lumbar extension exercises.

4. Joint mobilization, soft tissue mobilization, and flexion exercises.

2. Postural reeducation, soft tissue mobilization, and dynamic stabilization.

B39. A patient presents to physical therapy with a primary complaint of low back pain and right lower extremity radicular symptoms extending distally to the calf of 2 weeks duration. Current pain intensity is rated as 2/10 with rest and 5/10 during lumbar extension movements. What is the strongest prognostic indicator for achieving favorable clinical outcome?

1. 2/10 pain intensity with rest.

2. Current symptom duration (2 weeks).

3. Lower extremity radicular symptoms.

4. 5/10 pain intensity during lumbar extension.

3. Lower extremity radicular symptoms.

B40. An elderly patient with diabetes and bilateral lower extremity amputation is to be discharged from an acute care hospital 2 weeks postsurgery. The incisions on the residual limbs are not healed and continue to drain. The patient is unable to transfer because the venous graft sites in the upper extremities are painful and not fully healed. Endurance out-of-bed is limited. What is the BEST choice of discharge destination for this patient?

1. Skilled nursing facility.

2. Custodial care facility.

3. Home.

4. Rehabilitation hospital.

1. Skilled nursing facility.

B41. A patient currently being seen for low back pain awoke one morning with drooping left facial muscles and excessive drooling. The patient was recovering from a cold and had experienced an earache in the left ear during the previous 2 days. The therapist suspects Bell's palsy. What cranial nerve test can confirm this diagnosis?

1. Taste over the posterior tongue, and having the patient protrude the tongue.

2. Taste over the anterior tongue, and having the patient raise the eyebrows and puff the cheeks.

3. Corneal reflex and stretch reflexes of facial muscles.

4. Trigger points for pain, especially over the temporomandibular joint (TMJ).

2. Taste over the anterior tongue, and having the patient raise the eyebrows and puff the cheeks.

B42. A PTA is assigned to ambulate a patient with a 10-year history of Parkinson's disease (PD). What should the PT instruct the PTA to watch for?

1. Wider steps and increased double support time.

2. An abnormally wide base of support.

3. Decreased trunk rotation with shorter steps.

4. Unsteady, uneven gait with veering to one side.

3. Decreased trunk rotation with shorter steps.

B43. A patient with congestive heart failure (CHF) is on a regimen of diuretics (chlorothiazide). What are the potential adverse effects of this medication that the PT should be alert for?

1. Hyperkalemia and premature ventricular contractions (PVCs).

2. Myalgia and joint pains.

3. Orthostatic hypotension and dizziness.

4. Reflex tachycardia and unstable BP.

3. Orthostatic hypotension and dizziness.

B44. A patient with a traumatic injury to the right hand had a flexor tendon repair to the fingers. When should physical therapy intervention begin following this type of repair?

1. After the splint is removed in 4-6 weeks to allow ample healing time for the repaired tendon.

2. After the splint is removed in 2-3 weeks to allow full AROM of all affected joints.

3. Within a few days after surgery to allow for early initiation of strengthening exercises.

4. Within a few days after surgery to preserve tendon gliding.

4. Within a few days after surgery to preserve tendon gliding.

B45. A female patient complains of intermittent pain in the right sacroiliac region. There was an insidious onset approximately 4 months ago. Pain has gradually worsened and is now fairly constant and does not vary much with activity or movement. Active motion assessment of the lumbar spine reveals no change in symptoms with movement. Sacroiliac provocation tests are negative. The patient is mildly tender over the right sacroiliac region. What is the MOST likely diagnosis for this patient?

1, Sacroiliac joint sprain.

2. Multifidus muscle strain.

3. Ovarian cyst.

4. Right L5/S1 facet joint arthrosis.

3. Ovarian cyst.

B46. The therapist suspects that a patient recovering from a middle cerebral artery stroke is exhibiting a pure hemianopsia. What test should be used to confirm the hemianopsia?

1. Penlight held approximately 12 inches from the eyes and moved to the extremes of gaze right and left.

2. Penlight held 6 inches from the eyes and moved inward toward the face.

3. Visual confrontation test with a moving finger.

4. Distance acuity chart placed on a well-lighted wall at patient's eye level 20 feet away.

3. Visual confrontation test with a moving finger.

B47. An overweight adult patient complains of right anterior hip and knee pain while walking, especially when weight bearing on the right. Lumbar AROM is normal and pain free. Right hip AROM and PROM are limited compared to the left. Right knee AROM and PROM are full and pain free. There is no pain with resisted testing at the right hip or right knee. The scouring test reproduces the patient's hip and knee symptoms. Hip joint distraction relieves these symptoms. Based on the above findings, what is the MOST likely diagnosis?

1. Trochanteric bursitis.

2. Patellofemoral syndrome.

3. Piriformis strain.

4. Hip degenerative joint disease.

4. Hip degenerative joint disease.

B48. A therapist investigated pulse oximetry during exercise. Correlational analysis measured the strength of the relationship between two types of ear probe—equipped pulse oximeters during heavy cycle exercise under hypoxic conditions. The investigator found measured arterial oxyhemoglobin saturation (%HbO2) levels to have a correlation of 0.89 at high saturation but only 0.68 at low saturation levels. How should the therapist interpret these results?

1. During heavy exercise, oxygen saturation levels should be interpreted cautiously.

2. Both devices are highly accurate at all saturation levels.

3. Accuracy of the measurements increases at higher saturation levels.

4. Both devices are only moderately accurate.

3. Accuracy of the measurements increases at higher saturation levels.

B49. A college soccer player sustained a hyperextension knee injury when kicking the ball. The patient was taken to the emergency room of a local hospital and was diagnosed with "knee sprain." The player was sent to physical therapy the next day for rehabilitation. As part of the examination to determine the type of treatment plan to implement, the therapist conducted the test shown in the figure (Lachman's test). Based on the test picture, the therapist is examining the integrity of which structure?

1. Iliotibial band.

2. Posterior cruciate ligament.

3. Anterior cruciate ligament.

4. Medial meniscus.

3. Anterior cruciate ligament.

B50. A patient is seen in physical therapy 2 days after a motor vehicle accident. The chief complaints are headaches, dizziness, neck pain with guarding, and a "sensation of a lump in the throat." Plain film x-rays were read as negative. The therapist should refer this patient for what type of imaging?

1. Second series of plain film x-rays.

2. T2 magnetic resonance imaging (MRI).

3. Computed tomography (CT) scan.

4. Myelogram.

3. Computed tomography (CT) scan.

B51. Upper extremity function in a patient with traumatic brain injury is examined using finger-to-nose testing. Movements are irregular and not easily reversed. As speed is increased movement become more disorganized. What are these findings indictive of?

1. Brainstem dysfunction.

2. Lower motor neuron weakness.

3. Cerebellar dysfunction.

4. Upper motor neuron weakness.

3. Cerebellar dysfunction.

B52. A patient presents with a persistently downwardly rotated and adducted scapula during humeral elevation. The plan of care includes stretching and strengthening to improve range of motion. What muscles should be stretched and strengthened?

1. Stretching rhomboid muscles and strengthening serratus anterior muscle.

2. Stretching pectoralis major and strengthening rhomboid muscles.

3. Stretching pectoralis minor and strengthening trapezius muscles.

4. Stretching serratus anterior and strengthening levator scapula and lower trapezius.

1. Stretching rhomboid muscles and strengthening serratus anterior muscle.

B53. A patient is recovering from stroke and, at 4 months, is ambulating with a straight cane for household distances. During outpatient physical therapy, the therapist has the patient practice walking with no assistive device. Recurvatum is observed that worsens with continued walking. What is the therapist's BEST choice for intervention?

1. Give the patient a small-based quad cane (SBQC) to improve stability and have him/her practice AROM in supine.

2. Exercise the quadriceps using isokinetic resistance at higher loads and increasing speeds.

3. Practice isolated small-range quadriceps eccentric control work in standing and continue with the straight cane.

4. Give the patient a KAFO to control the hyperextension and a hemi walker.

3. Practice isolated small-range quadriceps eccentric control work in standing and continue with the straight cane.

B54. A patient recovering from an incomplete spinal cord injury at the L3 level (ASIA scale D) ambulates with bilateral Lofstrand crutches. The patient reports great difficulty going down ramps with unsteady, wobbly knees. What is the BEST intervention to use with this patient?

1. Prolonged icing to reduce hamstring pain.

2 Stretching using a posterior resting splint for tight plantar flexors.

3. Progressive resistance training for the quadriceps.

4. Biofeedback training to reduce knee extensor spasticity.

3. Progressive resistance training for the quadriceps.

B55. Under HIPAA rules, to whom is it illegal to release protected health information (PHI) without a competent patient's consent?

1. A State Agency responsible for investigating suspected abuse.

2. The insurance company that is paying for the patient's treatment.

3. Another health care provider involved in the care of the patient.

4. The patient's spouse.

4. The patient's spouse.

B56. With respect to a worker's sitting posture, which change provides the greatest reduction in lumbar spine compression forces?

1. Eliminating armrests on the chair.

2. Decreasing the chair backrest-seat angle to 85°.

3. Increasing the chair backrest-seat angle to between 90° and 110°.

4. Using a 2-inch gel seat cushion.

3. Increasing the chair backrest-seat angle to between 90° and 110°.

B57. A baseball pitcher is referred to physical therapy with progressive posterior shoulder pain and weakness of the shoulder abductors and lateral rotators. The therapist notices muscle wasting superior and inferior to the scapular spine. Damage to which of the following structures is the MOST likely cause?

1. Spinal accessory nerve.

2. Scalene muscles.

3. Suprascapular nerve.

4. Long head of the biceps brachii.

3. Suprascapular nerve.

B58. An elderly patient presents with severe COPD, GOLD stage 4. Which of the following physical examination findings would the therapist expect to find?

1. Kyphosis with an increased thoracic excursion.

2. Barreled chest with a decreased thoracic excursion.

3. Pectus excavatum with an increased thoracic excursion.

4. Pectus carinatum with decreased thoracic excursion.

2. Barreled chest with a decreased thoracic excursion.

B59. A patient is recovering from surgical resection of an acoustic neuroma and presents with symptoms of dizziness, vertigo, horizontal nystagmus, and postural instability. To address these problems, what should the physical therapy plan of care incorporate?

1. Repetition of movements and positions that provoke dizziness and vertigo.

2. Hallpike's exercises to improve speed in movement transitions.

3. Strengthening exercises focusing on spinal extensors.

4. Prolonged bedrest to allow vestibular recovery to occur.

1. Repetition of movements and positions that provoke dizziness and vertigo.

B60. A physical therapist is treating a patient with diabetic peripheral neuropathy. The patient recently began taking Lyrica (pregabalin). During a monofilament exam of the feet the therapist notices circumferential marks bilaterally at the level of the malleoli after the socks are removed. The patient is complaining of increased difficulty ambulating long distances. In this situation, what is the therapist's BEST course of action?

1. Contact the physician about possible development of congestive heart failure.

2. Begin manual lymphatic drainage for secondary lymphedema.

3. Complete the examination and instruct in proper skin care precautions.

4. Educate the patient about the risks of foot ulceration.

1. Contact the physician about possible development of congestive heart failure.

B61. A patient presents to the clinic with pain and decreased function of the right shoulder. A full tear of the right rotator cuff musculature is suspected. Which special test will provide the most valid and reliable information confirming this diagnosis?

1. Drop arm test.

2. Yergason's test.

3. Neer's impingement test.

4. Clunk test.

1. Drop arm test.

B62. A patient who is 5 weeks post-myocardial infarction (MI) is participating in a cardiac rehabilitation program.The therapist is monitoring responses to increasing exercise intensity. Which finding is an indication that exercise should be immediately terminated?

1. 1.5 mm of downsloping ST segment depression.

2. Peak exercise HR > 140.

3. Appearance of a PVC on the electrocardiogram (ECG).

4. Systolic BP > 140 mm Hg or diastolic BP > 80 mm Hg.

1. 1.5 mm of downsloping ST segment depression.

B63. An infant who was 39 weeks gestational age at birth and is now 3 weeks chronological age demonstrates colic. In this case, what is the BEST intervention the PT should teach the mother?

1. Stroking and tapping.

2. Swaddling or wrapping.

3. Visual stimulation with a colored object.

4. Bouncing and fast rocking.

2. Swaddling or wrapping.

B64. A therapist is treating a patient with Brown-Séquard syndrome that resulted from a gunshot wound. Which of the following would the therapist expect to find during the examination?

1. Sparing of tracts to sacral segments with preservation of perianal sensation and active toe flexion.

2. Loss of motor function and pain and temperature sensation with preservation of light touch and proprioception below the level of the lesion.

3. Loss of motor function below the level of the lesion primarily in the upper extremities.

4. Ipsilateral loss of motor function, ipsilateral loss of light touch and proprioception, and contralateral loss of pain and temperature.

4. Ipsilateral loss of motor function, ipsilateral loss of light touch and proprioception, and contralateral loss of pain and temperature.

B65. A patient is recovering from stroke and presents with moderate impairments of the left upper and lower extremities. The PT's goal today is to instruct the patient in a stand-pivot transfer to the more affected side so the patient can go home on a weekend pass. The spouse is attending today's session and will be assisting the patient on the weekend. What is the BEST choice for teaching this task?

1. Practice the task first with the patient then with the caregiver.

2. Demonstrate the task, then have the caregiver practice with the patient.

3. Practice the task first with the caregiver, then with the patient.

4. Demonstrate the task, and then practice with the patient.

4. Demonstrate the task, and then practice with the patient.

B66. A patient presents with low back pain of insidious onset. Based on the history and subjective complaints, the patient appears to have a dysfunction of a lumbar facet joint. What clinical test should be utilized to confirm this diagnosis?

1. McKenzie's side glide test.

2. Stork standing test.

3. Slump test.

4. Lumbar quadrant test.

4. Lumbar quadrant test.

B67. When using a patellar tendon-bearing (PTB) prosthesis, a patient experiences excessive knee flexion in early stance. What is the MOST likely cause of this problem?

1. Socket is aligned too far back or tilted posteriorly.

2. Foot position is inset too much.

3. Socket is aligned too far forward or tilted anteriorly.

4. Foot position is outset too much.

3. Socket is aligned too far forward or tilted anteriorly.

B68. A patient presents with bluish discoloration of the skin and nail beds of the fingers and toes. Palms are also cold and moist. What is the MOST likely cause of these changes?

1. Carotenemia.

2. Hypothyroidism.

3. Cyanosis.

4. Liver disease.

3. Cyanosis.

B69. An outpatient physical therapist is examining a patient who underwent a total knee arthroplasty 2 weeks ago. The patient reports that the entire leg has started swelling in the past 2 days. On examination there is pitting edema throughout the lower leg and foot with tenderness throughout the mid calf. Girth measurements reveal a 3.5 cm increase in the size of the mid calf in the symptomatic leg. What recommendation should the physical therapist make to the patient?

1. Rest, ice, and elevate the affected lower extremity.

2. Go home and monitor symptoms. Phone the physician if there is no improvement in 24 hours.

3. Go immediately to the emergency department.

4. Go to the physician's office after the therapy session for further assessment.

3. Go immediately to the emergency department.

B70. A patient complains of persistent wrist pain after painting a house 3 weeks ago. The patient demonstrates signs and symptoms consistent with de Quervain's tenosynovitis. What special test can be used to confirm the diagnosis?

1. Finkelstein's test.

2. Phalen's test.

3. Froment's sign.

4. Craig's test.

1. Finkelstein's test.

B71. As part of the chart review, the physical therapist views the patient's most current chest film. Based on this film (hyperinflated lungs, flattened diaphragm), what is the MOST likely examination finding?

1. Increased lateral costal expansion.

2. Increased subcostal angle.

3. Decreased inspiration:expiration (I:E) ratio.

4. Decreased mediate percussion.

2. Increased subcostal angle.

B72. An elderly patient with persistent balance difficulty and a history of recent falls (two in the past 3 months) is referred for physical therapy examination and evaluation. During the initial examination, what should the therapist examine first?

1. Level of dyspnea during functional transfers.

2. Cardiovascular endurance during a 6-minute walking test.

3. Sensory losses and sensory organization of balance.

4. Spinal musculoskeletal changes secondary to degenerative joint disease (DJD).

3. Sensory losses and sensory organization of balance.

B73. To reduce an elderly individual's chronic forward head posturing in standing and sitting, what muscles are likely shortened and should be stretched?

1. Middle trapezius and rhomboid muscles.

2. Rectus capitis anterior muscles.

3. Longus capitis and longus colli muscles.

4. Rectus capitis posterior major and minor.

4. Rectus capitis posterior major and minor.

B74. What are the major benefits of using the 6-Minute Walk Test as an outcome measure?

1. Accurately documents maximal exercise capacity.

2. Provides good correlation with functional abilities.

3. Allows determination of severity of lung disease.

4. Provides determination of peak oxygen uptake.

2. Provides good correlation with functional abilities.

B75. A patient is seen in a physical therapy clinic after sustaining a deep laceration of the right buttock. During the standing portion of the physical examination, the therapist observes a positive Trendelenburg sign. What did the therapist see?

1. The right side of the pelvis dropped when the right foot was lifted off the ground.

2. The right side of the pelvis dropped when the left foot was lifted off the ground.

3. The left side of the pelvis dropped when the right foot was lifted off the ground.

4. The left side of the pelvis dropped when the left foot was lifted off the ground.

4. The left side of the pelvis dropped when the left foot was lifted off the ground.

B76. After treating a patient for trochanteric bursitis for 1 week, the patient has no resolution of pain and is complaining of problems with gait. After reexamination, the therapist finds weakness of the quadriceps femoris and altered sensation at the greater trochanter. What is the MOST likely cause of the problems?

1. L5 nerve root compression.

2. Sacroiliac (SI) dysfunction.

3. L4 nerve root compression.

4. Degenerative joint disease (DJD) of the hip.

3. L4 nerve root compression.

B77. A patient in chronic renal failure is being seen in physical therapy for deconditioning and decreased gait endurance. The therapist needs to schedule the patient's sessions around dialysis, which is received three mornings a week. What guidelines should the therapist follow when taking the patient's blood pressure?

1. Every minute during walking, using the nonshunt arm.

2. Pre- and postactivities, using the nonshunt arm.

3. In sitting when activity has ceased, using the shunt arm.

4. In the supine position, using the shunt arm.

2. Pre- and postactivities, using the nonshunt arm.

B78. A patient who is currently being treated for low back pain arrives for therapy complaining of pain across the middle of the right chest and back. When the therapist inspects the skin, clustered vesicles are apparent in a linear arc. The surrounding skin is hypersensitive. What is the MOST likely diagnosis?

1. Herpes simplex infection.

2. Psoriasis.

3. Dermatitis.

4. Herpes zoster infection.

4. Herpes zoster infection.

B79. The physical therapist is examining the muscle length of the patient's left hip and knee. What muscle length test is being shown in the picture below?

1. FABER test.

2. Thomas test.

3. Noble test.

4. Ober test.

2. Thomas test.

B80. After a myocardial infarction (MI), a patient is a new admission to a phase 3 hospital-based cardiac rehabilitation program. During the initial exercise session, the patient's ECG responses are continuously monitored via radio telemetry. The therapist notices three PVCs occurring in a run with no P wave. What action should the therapist take?

1. Modify the exercise prescription by decreasing the intensity.

2. Stop the exercise and notify the physician immediately.

3. Continue the exercise session, but monitor closely.

4. Have the patient sit down and rest for a few minutes before resuming exercise.

2. Stop the exercise and notify the physician immediately.

B81. A patient with left hemiplegia is able to recognize his wife after she is with him for a while and talks to him but is unable to recognize the faces of his children when they come to visit. The children are naturally very upset by their father's behavior. What is the BEST explanation for his problem?

1. Somatognosia.

2. Anosognosia.

3. Visual agnosia.

4. Ideational apraxia.

3. Visual agnosia.

B82. A home care PT receives a referral to evaluate the fall risk potential of an elderly community-dweller with chronic coronary artery disease (CAD). The patient has fallen three times in the past 4 months, with no history of fall injury except for minor bruising. The patient is currently taking a number of medications. What is the drug that is MOST likely to contribute to dizziness and increased fall risk?

1. Colace.

2. Albuterol.

3. Nitroglycerin.

4. Coumadin sodium.

3. Nitroglycerin.

B83. A patient complains of foot pain when first arising that eases with ambulation. The therapist finds that symptoms can be reproduced in weight bearing and running on a treadmill. Examination reveals pes planus and pain with palpation at the distal aspect of the calcaneus. What is the BEST choice for early intervention?

1. Prescription for a customized orthosis.

2. Strengthening of ankle dorsiflexors.

3. Modalities to reduce pain.

4. Use of a resting splint at night.

4. Use of a resting splint at night.

B84. A patient with a T10 paraplegia (ASIA A) resulting from a spinal cord injury is ready to begin community wheelchair training. The therapist's goal is to teach the patient how to do a wheelie in order to manage curbs. What is the BEST training strategy to instruct the patient in performing a wheelie?

1. Place a hand on the top of the handrims to steady the chair while throwing the head and trunk forward.

2. Throw the head and trunk backward to rise up on the large wheels.

3. Lean backward while moving the hands slowly backward on the rims.

4. Grasp the handrims posteriorly, and pull them forward abruptly and forcefully.

4. Grasp the handrims posteriorly, and pull them forward abruptly and forcefully.

B85. A PT should be alert to recognize the signs and symptoms associated with the onset of aspiration pneumonia. Which patient diagnosis is the MOST susceptible to develop this form of pneumonia?

1. A circumferential burn of the thorax associated with significant pain.

2. Severe scoliosis with compression of internal organs, including the lungs.

3. Amyotrophic lateral sclerosis (ALS) with dysphagia and diminished gag reflex.

4. A complete spinal cord lesion at T2 with diminished coughing ability and forced vital capacity (FVC).

3. Amyotrophic lateral sclerosis (ALS) with dysphagia and diminished gag reflex.

B86. A patient demonstrates quadriceps weakness (4/5) and difficulty descending stairs. What is the MOST appropriate intervention to regain functional strength in the quadriceps?

1. Progressive resistance exercises, 70% 1 repetition maximum, three sets of 10.

2. Partial squats, progressing to lunges.

3. Maximum isometric exercise, at 45 degrees and 90 degrees of knee extension.

4. Isokinetic exercise, at 36/sec.

2. Partial squats, progressing to lunges.

B87. Independent community ambulation as a primary means of functional mobility is a realistic functional expectation for some patients with complete spinal cord injury (ASIA A). What level of injury would allow for this?

1. Low lumbar (L4-5).

2. Low thoracic (T9-10).

3. Midthoracic (T6-9).

4. High lumbar (T12-L1).

1. Low lumbar (L4-5).

B88. A sports physical therapist (PT) is working with a high school hockey player with history of Crohn's disease. He has history of small bowel resection. The sports PT knows he is at highest risk for which type of arthritis?

1. Osteoarthritis.

2. Reactive arthritis (Reiter's syndrome).

3. Gout.

4. Psoriatic arthritis.

2. Reactive arthritis (Reiter's syndrome).

B89. An elderly, frail patient demonstrates a history of recent falls (two in the past 2 months) and mild balance instability. The therapist's referral is to examine the patient and recommend an assistive device as needed. Based on the patient's history, what device would be of GREATEST benefit?

1. Folding reciprocal walker.

2. Standard, fixed-frame walker.

3. Front wheel rolling walker that folds.

4. Hemi walker.

3. Front wheel rolling walker that folds.

B90. After surgery, a patient develops a stiff pelvis and limited pelvic/lower trunk mobility. The therapist elects to use sitting exercises on a therapy ball to correct these impairments. In order to improve lower abdominal control, what direction should the patient move the ball?

1. Backward, producing anterior tilting of the pelvis.

2. Forward, producing posterior tilting of the pelvis.

3. Forward, producing anterior tilting of the pelvis.

4. Backward, producing posterior tilting of the pelvis.

2. Forward, producing posterior tilting of the pelvis.

B91. A patient presents with weakness in the right lower leg 3 weeks after a motor vehicle accident. The patient complains of spontaneous twitching in the muscles of the lower leg. The therapist visually inspects both limbs and determines that muscle bulk is reduced on the involved right limb. Girth measurements confirm a 1-inch difference in the circumference of the right leg measured 4 inches below the patella. Deep tendon reflexes and tone are diminished. What is the MOST likely cause of the patient's weakness?

1. Peripheral nerve injury.

2. Pyramidal tract dysfunction in the medulla.

3. Guillain-Barré syndrome.

4. Brainstem dysfunction affecting extrapyramidal pathways.

1. Peripheral nerve injury.

B92. An elderly adult patient presents with a history of and subjective complaints consistent with lumbar central spinal stenosis. What is the MOST appropriate clinical test to differentiate spinal stenosis from intermittent vascular claudication?

1. Femoral nerve traction test.

2. Bicycle (van Gelderen's) test.

3. Valsalva's maneuver.

4. Lumbar quadrant test.

2. Bicycle (van Gelderen's) test.

B93. A patient with bacterial pneumonia has crackles and wheezes in the left lateral basal segment and decreased breath sounds throughout. The patient is on 4 L of oxygen by nasal cannula with a resulting arterial oxygen saturation (SaO2) of 90%. Respiratory rate is 28. What is the MOST BENEFICIAL intervention for this case?

1. Postural drainage, percussion, and shaking over the appropriate area on the left lateral thorax for secretion removal.

2. Positioning in left side-lying to improve ventilation/perfusion ratios.

3. Postural drainage, percussion, and shaking to the right basilar segments in order to keep the right lung healthy.

4. Breathing exercises encouraging expansion of the right lateral basilar thorax, because the left side is not currently participating in gas exchange.

1. Postural drainage, percussion, and shaking over the appropriate area on the left lateral thorax for secretion removal.

B94. A therapist receives a referral to see an elderly patient in the intensive care unit (ICU) recovering from a severe case of pneumonia. The patient is confused and disoriented. What criteria would allow the therapist to determine the disorientation is due to delirium rather than dementia?

1. Hallucinations are present throughout the day.

2. Persistent personality changes are evident.

3. Symptoms are intermittent.

4. Level of arousal is significantly depressed.

3. Symptoms are intermittent.

B95. A comparison of the effects of exercise in water, on land, or combined on the rehabilitation outcome of patients with intra-articular anterior cruciate ligament reconstructions revealed that less joint effusion was noted after 8 weeks in the water group. What is the appropriate statistical test to compare the girth measurements of the three groups?

1. Analysis of covariance.

2. Spearman's rho.

3. Chi square.

4. ANOVA.

4. ANOVA.

B96. A patient has a recent history of strokes (two in the past 4 months) and demonstrates good return in the right lower extremity. The therapist is concentrating on improving balance and independence in gait. Unfortunately, speech recovery is lagging behind motor recovery. The patient demonstrates a severe fluent aphasia. What is the BEST strategy to use during physical therapy sessions?

1. Demonstrate and gesture to get the idea of the task across.

2. Have the family present to help interpret during physical therapy sessions.

3. Utilize verbal cues, emphasizing consistency and repetition.

4. Consult with the speech pathologist to establish a communication board.

1. Demonstrate and gesture to get the idea of the task across.

B97. What is a congenital condition in which there is a development of non-progressive contractures affecting one or more areas of the body prior to birth?

1. Arthrogryposis congenita multiplex.

2. Juvenile idiopathic arthritis.

3. Scleroderma (progressive systemic sclerosis).

4. Duchenne muscular dystrophy.

1. Arthrogryposis congenita multiplex.

B98. A patient was burned over 40% of the body in an industrial accident and has full-thickness burns over the anterior trunk and neck and superficial partial-thickness burns over the shoulders. In order to stabilize this patient out of positions of common deformity, what orthotic device would be of GREATEST benefit?

1. Soft cervical collar with an intrinsic plus hand splint.

2. A cervical thoracic lumbosacral orthosis (CTLSO) used during all upright activities.

3. Plastic cervical orthosis and axillary splints utilizing an airplane position.

4. Splints utilizing a flexed position for the shoulders and body jacket for the trunk.

3. Plastic cervical orthosis and axillary splints utilizing an airplane position.

B99. A patient with type 2 diabetes is referred to physical therapy for exercise conditioning. What is a pathophysiologic cause of type 2 diabetes?

1. Metabolic syndrome.

2. Impaired ability of the tissues to use insulin and insulin deficiency.

3. Loss of beta-cell function and insulin deficiency.

4. Pancreatic tumor.

2. Impaired ability of the tissues to use insulin and insulin deficiency.

B100. Which intervention is BEST to improve left-sided neglect in a patient with left hemiplegia?

1. Hook-lying, holding, light resistance to both hip abductors.

2. Rolling, supine to side-lying on right, using a PNF lift pattern.

3. Sitting, with both arms extended, hands resting on support surface, active holding.

4. Bridging with both arms positioned in extension at the sides.

2. Rolling, supine to side-lying on right, using a PNF lift pattern.