PEAT Series 2 Form B

A patient's skin distal to the mid-calf is darker than the skin proximal to the mid-calf. which of the following examination techniques would MOST efficentyly screen for the expected dysfunction?

a. capillarily refill time

b. venous filling time

c. dorsalis pedis pulse

d. sensory filament testing

b. venous filling time

the pt presents with venous insufficency

which of the following ranges for respiratory rate would be NORMAl for an 8-year-old child?

a. 12 to 20 bpm

b. 18 to 30 bpm

c. 24 to 40 bpm

d. 30 to 60 bpm

b. 18 to 30 bpm

a. 12 to 20 is for an adult

c. normal rnage for a toddler

d. normal range for an infant

which of the following clinical manifestations would MOST likely be associated with right ventricular failure?

a. pulmonary edema

b. jugular venous distention

c. paroxysmal nocturnal dyspnea

d. muscular weakness and fatigue

b. jugular venous distention

The other answers are associated with left ventricular failure

which of the following heart sounds heard in a 70-year-old adult MOSt likely indicates ventricular failure?

a. S1

b. S2

c. S3

d. S4

c. S3

S1 and S2 are normal heart sounds

S4 is for other cardiacmyopathies and coarctation of the aorta but not with LHF

which of the following scenarios BEST describes the effect of climatic conditions on an individual who has exercise-induced asthma?

a. Bronchospasm is facilitated by exercise in a humid environment, compared with a dry environment.

b. Bronchospasm is facilitated by exercise in a warm environment, compared with a cold environment.

c. Bronchospasm is blunted when exercising in a humid environment, compared with a dry environment.

d. Bronchospasm is blunted when exercising in a cold environment, compared with a warm environment.

c. Bronchospasm is blunted when exercising in a humid environment, compared with a dry environment.

Exercise-induced asthma or bronchospasm is exacerbated in cold and dry environments and is blunted when exercising in a humid environment.

A patient has pain in the mid lower abdominal area and low back that is not of musculoskeletal origin. Which of the following diagnoses is MOST likely?

a. enlarged liver

b. inflamed pancreas

c. ruptured gallbladder

d. dissecting aortic aneurysm

d. dissescting aortic aneurysm

a. Liver pain is referred to the right shoulder, upper back, and chest and would not be consistent with the lower abdominal pain

b. While pancreatic pain can refer to the middle or lower back, it tends to be in the epigastric and left upper quadrant region, not in the lower abdomen

c. Gallbladder pain refers to the right shoulder, chest, and upper back regions and would not be consistent with the lower abdominal pain

A patient who has chronic obstructive disease has a respiratory rate of 30 breaths/minute and exhibits prominent use of the upper trapezius and sternocleidomastoid muscles during inspiration. Which of the following interventions is MOST appropriate for the patient?

a. incentive spirometry

b. pursed-lip breathing

c. segmental breathing

d. glossopharyngeal breathing

b. pursed lip breathing

Pursed-lip breathing slows the respiratory rate. The patient has a rapid respiratory rate and overuse of the inspiratory accessory muscles and would, therefore, benefit from techniques to slow down respiration.

a. Incentive spirometry is commonly performed by postoperative patients to reduce the incidence of respiratory complications. This patient is not post surgery, and incentive spirometry does not address the increased respiratory rate.

c. Segmental breathing is used to augment localized lung expansion. Although this patient has signs and symptoms of respiratory distress, segmental breathing will not address the elevated respiratory rate.

d. Glossopharyngeal breathing is used in patients who have high-level tetraplegia to improve respiratory capacity and increase vital capacity. This patient does not have a loss of vital capacity, but rather has an increased respiratory rate and overuse of the accessory inspiratory muscles.

Which of the following options BEST represents a typical respiratory rate for a child who is 1 year old?

a. 15 bpm

b. 30 bpm

c. 45 bpm

d. 60 bpm

b. 30 bpm

Which of the following assessments is MOST accurate in diagnosing and determining the progression of chronic obstructive pulmonary disease?

a. arterial blood gas

b. chest radiograph

c. pulmonary function test

d. maximal exercise test

c. pulmonary function test

Pulmonary function testing, i.e., spirometry, is used to diagnose and monitor the progression of chronic obstructive lung disease. Pulmonary function testing provides information regarding the volume of air the lung contains and information on the different lung capacities. Two forced spirometry measures that can be followed over time include forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC); the ratio of these values decreases as the severity of lung obstruction increases.

a. Blood gas analysis is crucial in the assessment of acid-base balance, ventilation, and oxygenation. Arterial blood gas analysis is used frequently to monitor the condition of patients in critical care to modify respiratory interventions. It is not used for diagnosing or monitoring chronic obstructive lung disease.

b. Although the chest radiograph/x-ray is the predominant test to determine anatomic abnormalities and pathologic processes within the chest, it is not the best diagnostic test. The classic findings associated with chronic obstructive pulmonary disease are typically not seen until the condition is severe. Thus, a chest radiograph is of limited value in diagnosing chronic obstructive pulmonary disease

d. Exercise testing is the single most important noninvasive procedure used in the diagnosis and management of patients who have coronary artery disease. A maximal exercise test may be used to measure functional capacity and to diagnose coronary artery disease, not pulmonary disease, although it can be used to provide information on exercise prescription.

Prior to exercise, a 50-year-old patient has a blood pressure of 135/85 mm Hg and a heart rate of 70 bpm. After walking at a moderate pace, the patient's blood pressure is 155/105 mm Hg and the heart rate is 100 bpm. Which of the following conclusions BEST characterizes the blood pressure response to exercise?

a. Systolic response is normal, diastolic response is normal

b. Systolic response is normal, diastolic response is abnormal

c. Systolic response is abnormal, diastolic response is normal

d. Systolic response is abnormal, diastolic response is abnormal

b. Systolic response is normal, diastolic response is abnormal

A normal systolic blood pressure response is a linear increase with workload. A normal diastolic blood pressure response to exercise is an increase or decrease within 10 mm Hg or no change at all. Given the increase in workload, the 20 mm Hg increase is a normal response for systolic but abnormal for diastolic pressure.

A patient is participating in a total body aerobic exercise program during Phase III cardiac rehabilitation. Given a fixed power output during exercise, which of the following physiological variables will MOST likely occur?

a. Heart rate will be lower during upper extremity exercise as compared to lower extremity exercise.

b. Stroke volume will be lower during lower extremity exercise as compared to upper extremity exercise.

c. Systolic blood pressure will be lower during upper extremity exercise as compared to lower extremity exercise.

d. Rate pressure product will be lower during lower extremity exercise as compared to upper extremity exercise.

d. Rate pressure product will be lower during lower extremity exercise as compared to upper extremity exercise.

The rate pressure produce will be lower for leg exercise and higher for arm exercise due to the effect of higher heart rate and higher systolic pressure.

A physical therapist will MOST likely hear which of the following sounds when auscultating the lungs of a patient who is having an exacerbation of asthma?

a. deep snoring sound

b. high-pitched crowing sound

c. rattling or bubbling sound

d. continuous whistling sound

d. continuous whistling sound

Asthma is a restrictive airway disease with a hallmark wheezing sound on auscultation. The wheezing is often described as a whistling sound.

a. Snoring sounds are created in the upper airway caused by partial obstruction by secretions.

b. A high-pitched crowing sound is more indicative of an upper airway obstruction, which would be common with a tracheal or glottis problem.

c. Rattling/bubbling sounds (rales) are caused by secretions in the lung common in patients who have heart failure.

Which of the following types of medication lowers heart rate during both rest and exertion?

a. loop diuretics

b. beta receptor antagonists

c. alpha-1 receptor antagonists

d. Angiotensin-converting enzyme inhibitors

b. beta receptor antagonists

Beta receptor antagonists cause negative chronotropic and dromotropic effects on the heart, clinically resulting in decreased heart rates at rest and during exertion.

a. Loop diuretics decrease vascular volume and cause reflex tachycardia.

c. Alpha-1 receptor antagonists cause vasodilation and a reflex tachycardia

d. Angiotensin-converting enzyme inhibitors have no effects on heart rate at rest or during exertion

A patient who had a lumbar spinal fusion 2 days ago has developed increased secretions in the left lower lobe. Which of the following postural drainage strategies is MOST effective for clearing the secretions?

a. Left sidelying with the head lower than the feet

b. Left sidelying with the head lower than the feet, with percussion

c. Right sidelying with the head lower than the feet

d. Right sidelying with the head lower than the feet, with percussion

c. Right sidelying with the head lower than the feet

The postural drainage position for the left lower lobe is right sidelying with the head lower than the feet

a. Placing the patient in left sidelying position will drain the right lower lobe

b. Placing the patient in left sidelying position will drain the right lower lobe (p. 543). Percussion is often used in conjunction with postural drainage to dislodge secretions in the underlying lung segment; however, percussion is contraindicated in patients who have a recent spinal fusion

d. The postural drainage position for the left lower lobe is right sidelying with the head lower than the feet (p. 543). Percussion is often used in conjunction with postural drainage to dislodge secretions in the underlying lung segment; however, percussion is contraindicated in patients who have a recent spinal fusion

Following multiple rib fractures on one side and an ipsilateral pneumothorax, which of the following pulmonary function tests is MOST effective to measure the patient's improvement in ventilation?

a. alveolar ventilation

b. inspiratory capacity

c. minute ventilation

d. total lung capacity

b. inspriatory capacity

The patient has a restrictive extrapulmonary condition that will most likely impair lung expansion and the amount of air being mobilized in each ventilation cycle. Inspiratory capacity refers to the largest volume of air that can be inspired in one breath from the resting expiratory level, and it can easily be measured with an incentive spirometer.

a. Alveolar ventilation refers to the volume of air that participates in gas exchange. Unlike inspiratory capacity, alveolar ventilation is not a lung volume test and is not the most effective way to measure improvement in ventilation. Alveolar ventilation measurements should be confirmed by an arterial blood gas test, which can be invasive.

c. Minute ventilation refers to the total volume of air inspired or expired in 1 minute without discrimination between lung expansion or increase in respiratory rate. In this case, the patient could maintain a good minute ventilation by increasing the respiratory rate, which would increase the ventilation effort. (Paz, p. 394) Therefore, minute ventilation would not accurately reflect an improvement in lung expansion in a patient who has the lung condition described in the stem.

d. The total lung capacity refers to the volume of air contained in the lung at the end of maximal inspiration. It requires special equipment to be calculated.

Which of the following conditions is MOST likely to cause a left tracheal deviation?

a. right pleural fibrosis

b. right plueral effusion

c. right lobar atelectasis

d. right pneumonectomy

b. right plueral effusion

A tracheal shift occurs away from the side of the abnormality when there is an increase in volume. A pleural effusion will cause an increase in volume. Therefore, a right pleural effusion will cause a left tracheal shift.

a. A tracheal shift occurs toward the side where there is less lung volume; fibrosis in the right lung will decrease lung volume and cause a right tracheal deviation.

c. A tracheal shift occurs toward the side where there is less lung volume; atelectasis in the right lung will decrease lung volume and cause a right tracheal deviation.

d. A tracheal shift occurs toward the side where there is less lung volume; a right-sided pneumonectomy will decrease lung volume and cause a right tracheal deviation.

A patient who is taking warfarin (Coumadin) has an international normalized ratio (INR) of 5. What is the MOST appropriate interpretation of this value?

a. This value is too low, indicating there is increased risk of excessive anticoagulation.

b. This value is too low, indicating the blood is too thick and there is increased risk for clots.

c. The value is too high, indicating there is increased risk of excessive anticoagulation.

d. This value is too high, indicating the blood is too thick and there is increased risk for clots.

c. The value is too high, indicating there is increased risk of excessive anticoagulation.

International normalized ratio is used to assess the adequacy and effectiveness of anticoagulant therapies, such as warfarin (Coumadin). An acceptable ratio during anticoagulant therapy is 2-3.5. If a higher number is noted, then the patient is at risk for excessive bleeding. This can be dangerous and should be noted in individuals undergoing anticoagulation therapy.

A patient who has sacroiliac joint dysfunction will MOST likely experience pain during which of the following activities?

a. sitting

b. lying in prone

c. walking

d. lying in supine

c. walking

Patients who have sacroiliac dysfunction often report pain that is aggravated by prolonged standing, asymmetrical weight-bearing, or stair climbing; pain can also stem from running, long strides, or extreme postures (Frontera). The following findings are likely to be present with a sacroiliac joint dysfunction: pain with walking, ascending or descending stairs; hopping or standing on the involved leg; pain with transitional movements such as rising to standing position from a sitting position or getting in and out of a car; and/or pain that is worsened with long periods of sitting or standing if lumbar lordosis is not maintained (Dutton, pp. 1539-1540). Unbalanced muscle function in the lumbar/pelvic/hip region during walking is most likely to cause pain in someone with sacroiliac joint dysfunction.

A patient has a right shoulder that is higher than the left, and a left iliac crest that is higher than the right. The patient also exhibits a right thoracic rib hump with forward bending of the trunk. Which of the following options BEST describes these findings?

a. left thoracic functional scoliosis

b. right thoracic function scoliosis

c. left thoracic structural scoliosis

d. right thoracic structural scoliosis

d. right throacic structural scoliosis

Structural scoliosis involves irreversible lateral curvature with fixed rotation of the vertebrae. A right thoracic rib hump upon forward bending indicates a right thoracic structural scoliosis.

An adult patient who reports a new onset of back pain had a radiograph that identified wedging of the L1 vertebral body. Which of the following muscle groups would be MOST appropriate to stretch?

a. Shoulder horizontal adductors, shoulder lateral (external) rotators, hip flexors, and hip lateral (external) rotators

b. Shoulder horizontal adductors, shoulder medial (internal) rotators, hip flexors, and hip medial (internal) rotators

c. Shoulder horizontal abductors, shoulder lateral (external) rotators, hip extensors, and hip medial (internal) rotators

d. Shoulder horizontal abductors, shoulder medial (internal) rotators, hip extensors, and hip lateral (external) rotators

b. Shoulder horizontal adductors, shoulder medial (internal) rotators, hip flexors, and hip medial (internal) rotators

The symptoms and radiographic bony changes suggest osteoporosis. Compression fractures are commonly associated with trunk flexion, and symptoms are provoked with flexion activities. Stretching of the antagonist muscles, such as the shoulder horizontal adductors and medial (internal) rotators, hip flexors and medial (internal) rotators is recommended for patients who have compression fractures of the vertebral bodies secondary to osteoporosis.

Which of the following positions would MOST accurately place a joint in a loose-packed position?

a. Hip placed in 0° of abduction

b. Glenohumeral joint placed in 15° of abduction

c. Tibiofemoral joint placed in 25° of flexion

d. Humeroulnar joint placed in 30° of flexion

c. Tibiofemoral joint placed in 25° of flexion

a. The loose-packed position for the hip joint is 30° of flexion (Hoogenboom, p. 344). The resting position of the hip is flexion of 30° and abduction of 30°

b. The loose-packed position for the glenohumeral joint is 55° of abduction (Hoogenboom, p. 344). The resting position is abduction of 55° and horizontal adduction of 30°

d. The loose-packed position for the humeroulnar joint is 70° of flexion

A patient has a negative result on a stress test for the medial collateral ligament. A radiograph shows the coronoid process is inferior to the trochlea. The patient MOST likely has which of the following injuries?

a. varus displacement

b. valgus displacement

c. anterior displacement

d. posterolateral displacement

d. posterolateral displacement

Displacing the coronoid process inferior to the trochlea requires the ulna to be displaced posterolateral to the humerus.

a. A varus displacement at the elbow results in lateral collateral ligament instability but will not result in posterior movement of the coronoid process.

b. A valgus displacement at the elbow will result in a positive stress test for the medial collateral ligament.

c. An anterior displacement at the elbow occurs when the olecranon is displaced anteriorly.

Which of the following mobilizations to the temporomandibular joint would MOST likely improve a limitation in mouth opening?

a. distraction with anterior glide

b. distraction with posterior glide

c. compression with anterior glide

d. compression with posterior glide

a. distraction witn anterior glide

b. Posterior glide is not the appropriate arthrokinematic motion to assist with mouth opening. Posterior glides are appropriate for improving mouth closing.

c. Compression would cause increased joint approximation and potential irritation.

d. Compression would cause further joint irritation.

A patient reports a snapping sensation over the lateral hip when running. Which of the following structures is MOST likely involved?

a. iliopsoas

b. iliotibial band

c. acetabular labrum

d. iliofemoral ligament

b. iliotibial band

A tight iliotibial band riding over the greater trochanter of the femur may cause an external snap that tends to be felt more laterally during hip flexion and extension, such as occurs when running, especially if the hip is in medial (internal) rotation.

a. Slipping of the iliopsoas tendon over the osseous ridge of the lesser trochanter or anterior acetabulum is the most common cause of internal snapping. It occurs at approximately 45° of flexion when the hip is moving from flexion to extension, especially with the hip abducted and laterally (externally) rotated.

c. Acetabular labral tears can also cause a snapping hip sensation. There is generally sharp pain into the groin and anterior thigh, especially with pivoting movements. In this scenario, the snapping is felt over the lateral hip, so an acetabular labral tear is less likely. The pain can be reproduced passively when an extended hip is adducted and laterally (externally) rotated.

d. Internal snapping may be caused by the Iliofemoral ligament slipping and riding over the femoral head. This occurs at approximately 45° of flexion when the hip is moving from flexion to extension, especially with the hip abducted and laterally rotated.

When conducting a 10-meter walk test, appropriate procedure includes which of the following elements?

a. The patient is permitted to use an assistive device.

b. The patient is instructed to walk with feet heel-to-toe.

c. The patient begins the assessment in a seated position.

d. The patient walks until reaching a marker, then turns around.

a. the patient is permitted to use an assistive device

A patient had an uncomplicated total hip arthroplasty using a posterior approach 2 months ago. The patient wishes to return to sexual activity. Which of the following actions would be MOST appropriate for a physical therapist?

a. Educate the patient that sexual activity is not appropriate following a total hip arthroplasty.

b.Educate the patient about how to avoid contraindicated movements during sexual activity.

c. Refer the patient back to the orthopedic surgeon to discuss appropriate sexual positions.

d. Refer the patient back to the primary care physician to discuss alternatives to sexual activity.

b. Educate the patient about how to avoid contraindicated movements during sexual activity.

Posterior hip precautions after a total hip arthroplasty include avoiding hip flexion greater than 90°, medial (internal) rotation of the hip, and adduction of the hip (Magee, p. 698). Sexual activity that does not include these three contraindicated movements is appropriate for a patient after total hip arthroplasty with surgeon approval (Magee, p. 708). A physical therapist has a professional responsibility to educate a patient about the movement precautions related to the return to activities of daily living (including sexual activity)

Which of the following interventions is MOST appropriate for a 12-year-old child who has a history of progressive idiopathic scoliosis and a Cobb angle of 45°?

a. orthotic managment

b. postural correction

c. surgical intervention

d. spinal stabilization exercises

c. surgical intervention

The major indication for spinal fusion is a documented, progressive idiopathic curve and a Cobb angle greater than 40°.

a. Orthotic management is typically indicated for children who have idiopathic scoliosis and who are skeletally immature and have a Cobb angle of 25° to 45°.

b. Postural correction is not sufficient to manage a curve of 45°.

d. Exercise alone is not sufficient to manage a curve of 45°.

A 13-year-old patient reports groin pain that radiates into the anterior thigh. The patient exhibits an antalgic pattern, and the involved lower extremity is maintained in a laterally (externally) rotated position. Which of the following conditions is MOST likely present?

a. developmental hip dysplasia

b. osgood-schlatter disorder

c. legg-calve-perthes disease

d. slipped capital femoral epiphysis

d. slipped captial femoral epiphysis

Slipped capital femoral epiphysis generally occurs in adolescents. Symptoms include antalgic gait and pain in the groin, knee, or medial thigh. This disorder is more likely to present with antalgic gait and a laterally (externally) rotated lower extremity. When the onset is acute, the adolescent will be unable to bear weight on the affected extremity. Obesity is often a factor in the development of this condition.

a. Undetected childhood developmental hip dysplasia can result in a form of avascular osteonecrosis as early as adolescence or in adulthood. Symptoms typically are hip or groin pain, Trendelenburg gait, limited hip range of motion for medial (internal) rotation, flexion, and abduction, and tenderness to palpation over the hip joint. The femoral head is the most common site of the disorder. Symptoms, when they appear, may be mild initially and increase over time.

b. Osgood-Schlatter disorder is an overuse injury that presents with anterior knee pain. It typically appears between the ages of 9 to 15 years in children who are physically active. The chief symptoms are an ache in the anterior knee and a clear tenderness of the apophysitis upon direct palpation. Muscle contraction will also produce pain. The application of strengthening exercises should not provoke symptoms.

c. The clinical picture of Legg-Calvé-Perthes disease is a typical occurrence between the ages of 3 to 13 years, most commonly in physically active, yet small, boys. The etiology of the disease is unknown. It is an avascular necrosis that disrupts blood flow to the capital femoral epiphysis, progresses through four well-defined stages, and is ultimately self limiting. Children who have Legg-Calvé-Perthes disease often are smaller in stature and may have limb length discrepancies.

A patient reports pain, tingling, and paresis in the anterior chest, scapula, and lateral aspect of the forearm into the hand. Overhead activities aggravate the symptoms. In sitting position, the patient is assessed by extending and laterally (externally) rotating the shoulder, which causes a diminished radial pulse. The findings would be confirmed by a positive result on which of the following tests?

a. roos

b. clunk

c. speed

d. O'Brien

a. Roos

Pain and paresthesias, especially with overhead activity, are consistent with thoracic outlet syndrome (Dutton). The special test described in the stem is the Adson Test; the result indicates that the patient has thoracic outlet syndrome (Magee, p. 344). Roos Test will rule in thoracic outlet syndrome

b. The Clunk Test is performed to confirm a tear of the glenoid labrum (Magee, p. 299). The special test described in the stem is the Adson Test; the result indicates that the patient has thoracic outlet syndrome

c. The Speed Test is performed to confirm biceps tendinitis or partial rupture of the tendon (Magee, p. 299). The special test described in the stem is the Adson Test; the result indicates that the patient has thoracic outlet syndrome

d. The O'Brien Test is performed to identify superior labral tears or proximal biceps impairment (Magee, p. 299). The special test described in the stem is the Adson Test; the result indicates that the patient has thoracic outlet syndrome

During weight bearing, initial compensation for fixed forefoot valgus is provided by:

a. rearfoot supination

b. rearfoot pronation

c. medial (internal) tibial rotation

d. ankle dorsiflexion

a. rearfoot supination

Excessive midtarsal or subtalar supination is the common compensation for forefoot valgus

b. Rearfoot pronation is the compensatory motion for forefoot varus

c. Medial (internal) tibial rotation is the compensatory motion for functional forefoot valgus

d. Increased ankle dorsiflexion would have no effect on the rotary component of forefoot varus or valgus. Primary motions of the talocrural joints are dorsiflexion and plantar flexion. The talocrural joint laterally (externally) rotates with supination and medially (internally) rotates with pronation.

Which of the following interventions would be MOST appropriate for a patient who has a positive sulcus sign?

a. pectoral strengthening

b. rotator cuff strengthening

c. acromioclavicular joint mobilization

d. sternoclavicular joint mpbilization

b. rotator cuff strengthening

A positive sulcus sign is indicative of inferior glenohumeral instability (p. 645). Rotator cuff strengthening will increase the stability of the glenohumeral joint and the ability of the humeral head to stay in the glenoid fossa

Which of the following substitution patterns should be prevented when measuring active forearm pronation?

a. Shoulder medial (internal) rotation and shoulder abduction

b. Shoulder medial (internal) rotation and shoulder adduction

c. Shoulder lateral (external) rotation and shoulder abduction

d. Shoulder lateral (external) rotation and shoulder adduction

a. Shoulder medial (internal) rotation and shoulder abduction

b. Shoulder adduction should be avoided when measuring forearm supination

c. Shoulder lateral (external) rotation should be avoided when measuring forearm supination

d. Shoulder lateral (external) rotation and adduction should be avoided when measuring forearm supination

A patient has an acute lumbar disc herniation and lumbar spondylolisthesis. Which of the following interventions is MOST appropriate?

a. passive trunk extension

b. high-velocity manipulation

c. active trunk flexion exercises

d. spinal stabilization exercises

d. spinal stabilization exercises

Spinal stabilization exercises are indicated to increase trunk stability for patients who have an acute herniated disc and for patients who have spondylolisthesis

a. Although passive trunk extension is indicated for individuals who have an acute lesion and an extension bias (such as a herniated lumbar disc), trunk extension is contraindicated in spondylolisthesis

b. High-velocity manipulation is contraindicated for patients who have a herniated disc, as well as for patients who have spondylolisthesis

c. Although trunk flexion is indicated for individuals who have spondylolisthesis, active trunk flexion is contraindicated for patients who have an acute disc lesion, such as a herniated disc

A patient underwent surgical repair of a superior labrum tear in the shoulder 1 week ago. Which of the following resisted motions should be AVOIDED during physical examination of the patient?

a. forearm pronation

b. forarm supination

c. scapular retraction

d. scapular protraction

b. forearm supination

Resisted forearm supination is performed by active contraction of the biceps brachii and supinator muscles (Dutton, p. 718). The long head of the biceps brachii has firm attachments to the superior labrum of the shoulder (Dutton, p. 595). Resisted contraction of the biceps brachii during the first 3-6 weeks post surgery, when the labrum tear has not yet fully healed, can place excessive strain on the labrum and can cause severe damage to the repaired labrum. Therefore, resisted forearm supination should be avoided during the first 6 weeks, which is the time needed for proper healing of the labrum

The operative report for a patient who had a total hip arthroplasty includes reattachment of the greater trochanter with wire. Which of the following exercises is CONTRAINDICATED for the operative extremity during the acute phase of healing?

a. Active hip flexion to 80° in supine position with the knee flexed

b. Active hip abduction to 40° in sidelying position with the knee extended

c. Active assisted hip extension to neutral in sidelying position with the knee flexed

d. Active assisted hip adduction to neutral in supine position with the knee extended

b. Active hip abduction to 40° in sidelying position with the knee extended

A transtrochanteric surgical approach for total hip arthroplasty involves osteotomy of the greater trochanter at the gluteus medius and minimus insertion, anterior capsulotomy and dislocation, and reattachment of the greater trochanter with wire. Abduction precautions are necessary while these structures heal (p. 730). After trochanteric osteotomy, no resisted abduction and no active isotonic hip abduction against gravity are allowed until the osteotomy has healed

a. Hip flexion up to 90° is permitted with total hip arthroplasty involving trochanteric osteotomy (p. 734). Active hip flexion within precautions is a common exercise in acute rehabilitation after total hip arthroplasty.

c. Hip extension to neutral is permitted with a total hip arthroplasty involving trochanteric osteotomy (p. 734). Assistance to support the lower extremity is important to minimize active hip abduction in the sidelying position.

d. Hip adduction to neutral is permitted with total hip arthroplasty involving trochanteric osteotomy (p. 734). This hip movement is functionally important for sit-to-supine transfers.

In a patient who has glenohumeral joint effusion, which of the following patterns of motion loss is MOST likely to occur?

a. Maximal loss of lateral (external) rotation, moderate loss of abduction, and minimal loss of medial (internal) rotation

b. Maximal loss of lateral (external) rotation, moderate loss of medial (internal) rotation, and minimal loss of abduction

c. Maximal loss of medial (internal) rotation, moderate loss of abduction, and minimal loss of lateral (external) rotation

d. Maximal loss of medial (internal) rotation, moderate loss of lateral (external) rotation, and minimal loss of abduction

a. Maximal loss of lateral (external) rotation, moderate loss of abduction, and minimal loss of medial (internal) rotation

Joint effusion contributes to capsular pattern range of motion loss. In the glenohumeral joint, the capsular pattern of range of motion loss is maximum loss of lateral (external) rotation, moderate loss of abduction, and minimal loss of medial (internal) rotation.

Which of the following muscles should be strengthened in a patient who has an anterior trunk lean during the foot flat (loading response) phase of gait?

a. tibialis anterior

b. iliopsoas

c. quadriceps

d. triceps surae

c. quadriceps

Anterior trunk bending is commonly used to bring the line of force in front of the knee to compensate for weak knee extensors

a. Ankle dorsiflexion weakness can result in inadequate dorsiflexion control during the foot flat (loading response) phase of gait

b. Hip flexor weakness typically results in gait deviations in the swing, not stance, phase of gait

d. Triceps surae weakness can result in inadequate knee extension in stance

A patient has resting DIP joint flexion due to loss of active extension at the DIP. The patient MOST likely has which of the following conditions?

a. mallet finger

b. rhuematoid arthritis

c. flexor digitorum superficialis paralysis

d. middle phalanx dislocation

a. mallet finger

Mallet finger is a resting DIP flexion contracture due to a loss of active extension at the DIP joint.

b. A Z-deformity of the wrist is a pattern of deformity in the rheumatoid arthritic hand. It also causes a swan-neck deformity of the fingers.

c. Deformity from flexor digitorum superficialis paralysis presents as PIP hyperextension and slight flexion of the DIP (swan-neck deformity of the fingers).

d. A middle phalanx dislocation can cause the central slip to be torn and result in a boutonnière deformity, which presents as PIP joint flexion and DIP joint hyperextension.

A patient has a boutonnière deformity that is being treated nonsurgically. To maintain the maximum amount of hand function, which of the following exercises should be performed?

a. Flexion of the DIP joint with the PIP joint supported in extension

b. Extension of the DIP joint with the PIP joint supported in extension

c. Flexion of the PIP joint with the DIP joint supported in flexion

d. Flexion of the PIP joint with the DIP joint supported in extension

a. Flexion of the DIP joint with the PIP joint supported in extension

A boutonnière deformity is a contracture involving PIP joint flexion and DIP joint extension usually due to a central slip; therefore, maintaining active DIP flexion is important for function. The disruption of the central slip causes the lateral bands to slip volarly to the PIP joint axis of motion, creating flexor forces on the PIP joint. The imbalance results in hyperextension of the DIP joint. With this DIP posture, the oblique retinacular ligament is at risk of becoming tight. Maintaining active DIP flexion is essential for functional activities such as grip and manipulation of small objects.

b. A boutonnière deformity is a contracture in which the DIP joint is hyperextended; therefore, extension of the DIP joint would not be helpful.

c. A boutonnière deformity is a contracture involving PIP joint flexion and DIP joint extension; therefore, performing additional PIP flexion is not helpful and may worsen the contracture.

d. A boutonnière deformity is a contracture in which the DIP joint is hyperextended; therefore, flexion of the PIP joint with the DIP joint in extension would not be helpful.

A patient has restricted left rotation at the C5-C6 level. When performing a unilateral posterior-anterior joint mobilization, placement of the physical therapist's hand at which of the following locations is MOST likely to increase left rotation?

a. Left posterior articular pillar at C5

b. Left posterior articular pillar at C6

c. Right posterior articular pillar at C5

d. Right posterior articular pillar at C6

c. Right posterior articular pillar at C5

Anterior mobilization at the C5 posterior aspect of the articular pillar would produce rotation of the C5 vertebra to the left, increasing left rotation at C5-C6.

a. Mobilization with hand placement at the left posterior articular pillar at C5 would produce an increase in right rotation at C5-C6.

b. Mobilization with hand placement at the left posterior articular pillar at C6 would produce an increase in right rotation at C6-C7.

d. Mobilization with hand placement at the right posterior articular pillar at C6 would produce increased left rotation at C6-C7.

A patient has an acute onset of low back pain and left lower extremity pain. Further testing reveals left lower extremity pain reproduced at 40° with a straight leg raise test and an Achilles reflex of 1+. The patient MOST likely has which of the following conditions?

a. lateral dis herniation

b. large central disc herniation

c. left lateral spinal stenosis

d. right lumbar structural scolisos

1. lateral disc herniation

Disc herniations are associated with acute pain in the back and leg (unilaterally) (Magee, p. 560). Lower extremity symptoms elicited with straight leg raise testing are suggestive of a lateral disc herniation

b. A large central disc herniation would be more likely to reproduce pain in the back during the straight leg test. Lower extremity symptoms elicited with straight leg raise testing are suggestive of a lateral disc herniation.

c. Spinal stenosis is associated with an insidious, not acute, onset as well as bilateral, not unilateral, symptoms

d. Scoliosis is associated with insidious onset and would not be associated with a positive result for the straight leg test

An otherwise healthy patient has advanced osteoarthritis in the medial compartment of the right knee. Which of the following gait deviations is MOST likely to be observed during stance phase on the right lower extremity?

a. left trunk lean

b. right trunk lean

c. forward trunk lean

d. backward trunk lean

b. right trunk lean

Patients who have advanced osteoarthritis in the medial compartment of the knees frequently lean ipsilaterally, bringing the center of mass laterally. This transfers load more to the lateral compartment of the knee and promotes an external frontal plane knee moment that is more valgus, which also unloads the medial compartment of the knee.

a. A left trunk lean would shift more external load onto the medial compartment and increase medial compartment pressure in a patient who has advanced osteoarthritis in the medial compartment of the knee

c. Although a forward trunk lean can decrease the compressive load on the whole knee through decreasing the external knee flexion moment and transferring it to the hip, it does not unload the medial compartment more than any other compartment of the knee and also is not seen as frequently as an ipsilateral lean with unicompartmental arthritis of the medial compartment of the knee

d. A backward trunk lean shifts the center of mass backward, which increases the external knee flexion moment and increases the load on the entire knee. This deviation is not likely to be seen in a patient whose symptoms are aggravated by any knee joint compressive force.

A patient demonstrates excessive pronation from midstance to terminal stance (heel off). Which of the following muscles is MOST likely weak?

a. tibialis posterior

b. extensor digitorum

c. fibularis longus

d. extensor hallicus longus

1. tibialis posterior

Excessive pronation during midstance to terminal stance (heel off) can be caused by a weak tibialis posterior muscle. Pronation occurs with hindfoot eversion. The tibialis posterior muscle produces ankle inversion, which can counteract ankle eversion.

b. The extensor digitorum extends the MTP and IP joints of the lateral four digits and is not a key mover of the ankle into plantarflexion and inversion (p. 1121). Weakness of this muscle would not be expected to contribute to excessive pronation during gait.

c. Contraction of the fibularis (peroneus) longus produces eversion, which this patient is already displaying. Therefore, weakness of this muscle is not likely to be contributing to excessive pronation.

d. The extensor hallucis longus produces extension at the MTP and IP joints of the great toe and is not a key mover of the ankle into inversion and eversion. Weakness of this muscle would not be expected to cause excessive pronation.

Which of the following cervical motions places the LEAST amount of compression on the vertebral artery as it courses through the cervical spine?

a. flexion

b. extension

c. contralateral rotation

d. contralateral side flexion

a. flexion

The vertebral artery is vulnerable to compression as it courses through the transverse foramen of C6-C1. The order of cervical positions that put the most to least stress on the artery are rotation-extension-traction, rotation-extension, rotation alone, side flexion alone, extension alone, and flexion alone. Flexion is the least stressful on the vertebral artery.

A patient has limited movements throughout the arc of forearm supination and pronation due to moderate to severe pain. Which of the following manual therapy techniques to the proximal radioulnar joint is MOST appropriate to perform initially?

a. With the patient positioned in 5° of supination and 90° of elbow flexion, perform small-amplitude mobilizations at the beginning of the available range of motion.

b. With the patient positioned in 10° of supination and 70° of elbow flexion, perform large-amplitude mobilizations at the end of the range of motion.

c. With the patient positioned in 35° of supination and 70° of elbow flexion, perform large-amplitude mobilizations in the middle of the range of motion.

d. With the patient positioned in full supination and full elbow extension, perform small-amplitude mobilizations at the end of the range of motion.

c. With the patient positioned in 35° of supination and 70° of elbow flexion, perform large-amplitude mobilizations in the middle of the range of motion.

Small-amplitude mobilizations performed at the beginning of the available range of motion and large-amplitude movement in the middle of the range of motion are used for pain relief and to induce an analgesic effect. This patient has a pain-dominant joint condition. It is best to mobilize a joint with a pain-dominant condition in an open-packed position, which is 35° of supination and 70° of elbow flexion for the proximal or superior radioulnar joint.

A patient who has a boggy end-feel with passive knee extension MOST likely has which of the following conditions?

a. arthritis

b. hemarthrosis

c. meniscal displacement

d. patellofemoral syndrome

b. hemarthrosis

A boggy end-feel is produced by fluid or blood in the joint.

a. Arthritis would be associated with an empty end-feel, if the condition is significant in nature.

c. Meniscal displacement would bring about a springy end-feel.

d. Patellofemoral syndrome would present with pain and possibly an empty end-feel.

A patient who has a transfemoral amputation should perform which of the following movement patterns when being taught to pick up an object from the floor while wearing a prosthesis?

a. Place both lower extremities at the same level and weight-bear through both extremities while reaching for the object.

b. Place the affected lower extremity forward and weight-bear through the affected lower extremity while bending forward to reach for the object

c. Place the affected lower extremity forward and weight-bear through the unaffected lower extremity while bending forward to reach for the object.

d. Place the unaffected lower extremity forward and weight-bear through the unaffected lower extremity while bending forward to reach for the object.

d. Place the unaffected lower extremity forward and weight-bear through the unaffected lower extremity while bending forward to reach for the object.

The correct way of picking up an object from the floor is to put the unaffected extremity forward and put body weight on the unaffected extremity while bending and reaching for the object on the floor.

A newborn infant who has a positive result on the Ortolani Test is MOST likely to have which of the following conditions?

a. femoral anteversion

b. hip dysplasia

c. metatarsus adductus

d. talipes equinovarus

b. hip dysplasia

The Ortolani Test is used to detect the presence of a dislocated hip. The Ortolani Test elicits the sensation of the already dislocated hip. A "clunk" is felt as the dislocated femoral head reduces into the acetabulum.

A patient's posterior superior iliac spines are at the same height as the anterior superior iliac spines. Which of the following tests would be MOST appropriate for further investigation of this finding?

a. Measurement of leg length

b. Muscle length testing of the hip flexors

c. Muscle length testing of the hamstring muscles

d. Measurement of lumbar flexion range of motion

c. Muscle length testing of the hamstring muscles

The normal pelvic angle is 30°. The posterior superior iliac spines should be slightly higher than the anterior superior iliac spines (pp. 1036-1039). A decreased pelvic angle indicates a posterior pelvic tilt, which is associated with decreased hamstring muscle length

a. Leg length discrepancy will lead to uneven changes from side to side. The anterior superior iliac spine and the posterior superior iliac spine will be higher on the long leg.

b. Anterior pelvic tilt would indicate tight hip flexors. This would be seen as the anterior superior iliac spines being much lower than the posterior superior iliac spines (greater than 30°)

d. Forward trunk flexion can assist with detecting scoliosis, a condition which would present with one pelvis being higher on one side, thus involving both the posterior superior iliac spine and the anterior superior iliac spine

A patient reports the recent onset of acute neck pain that radiates to the dorsum of the right forearm. Examination findings include a positive result on the Spurling neck compression test and pain with right cervical side bending. Which of the following interventions would be MOST appropriate for the patient?

a. manual cervical traction

b. cervical range of motion exercises

c. strengthening of the cervical flexors

d. application of a heat pack to the cervical spine

a. manual cervical traction

Neck pain radiating to a unilateral arm along with a positive result on the Spurling neck compression test and pain with right cervical side bending are signs and symptoms consistent with cervical radiculopathy (p. 1313). It is recommended that cervical traction be used for patients with acute neck pain that is radiating to the upper limb in order to relieve compression on the nerve (

b. Although patients should be encouraged to maintain joint mobility as tolerated, avoidance of symptom-provoking positions and immediate control of pain and symptoms may be the most appropriate intervention in the acute stage

c. Although strengthening of the deep cervical flexors is a recommended intervention in the subacute stage of healing for individuals who have neck pain (p. 1303), control of pain symptoms is the most appropriate intervention in the acute stage

d. Ice, not heat, is typically used in the acute phase of healing for analgesia and inflammation reduction

A patient who fell onto a lower extremity has acute, diffuse pain and tightness in the lower leg. The pain is relieved by rest and increases with activity and stretching. Bone scan images are negative, and muscle strength is grossly normal. The patient MOST likely has which of the following conditions?

a. tibial osteosarcoma

b. tibial stress fracture

c. compartment syndrome

d. achillies tendon rupture

c. compartment syndrome

Compartment syndrome of the lower leg presents with diffuse pain and tightness, relief of pain with rest and increase in pain with activity. Stretching also increases the pain. Bone scans and radiographs are often negative

a. A patient who has osteosarcoma of the lower leg would report deep pain with radiation that is not relieved with rest. A bone scan would be positive, not negative

b. A patient who has a tibial stress fracture would have acute, deep, and localized pain in the lower leg along with a positive bone scan

d. A patient who has an Achilles tendon rupture will have sharp, acute pain. Plantar flexion muscle strength will not be normal

A patient who has a 5° plantar flexion contracture is MOST likely to demonstrate which of the following gait deviations?

a. foot slap

b. early heel rise

c. knee buckling during midstance

d. contralateral pelvic drop

b. early heel rise

A plantar flexion contracture will not allow the patient's trunk to progress from behind the ankle to in front of the ankle as normally occurs in midstance

a. Foot slap is caused by weakness of the ankle dorsiflexors, not by a plantar flexion contracture

c. Tight heel cords would pull the knee into recurvatum, not cause the knee to buckle. Closed-chain knee flexion is associated with increased dorsiflexion.

d. A contralateral pelvic drop at midstance is a compensation for a weak gluteus medius on the stance leg

Nerve damage associated with a mid-shaft fracture of the humerus is MOST likely to result in weakness of which of the following muscles?

a. dorsal interossei

b. flexor digitorum superficialis

c. pronator quadratus

d. extensor carpi radialis longus

d. extensor carpi radialis longus

The radial nerve is in direct contact with the shaft of the humerus and may be injured following a mid shaft fracture (pp. 684-685). The extensor carpi radialis longus is innervated by the radial nerve

a. The dorsal interossei are innervated by the ulnar nerve (p. 777). The ulnar nerve may be damaged by a distal humerus fracture but not by a mid shaft fracture

b. The flexor digitorum superficialis is innervated by the median nerve (p. 749). This nerve may be injured by a distal fracture of the humerus but not a mid shaft fracture

c. The pronator quadratus is innervated by the median nerve (p. 749). This nerve may be injured by a distal fracture of the humerus but not by a mid shaft fracture

Which of the following examination techniques is CONTRAINDICATED 1 week following ulnar collateral ligament reconstruction at the elbow?

a. shoulder lateral (external) rotation ROM

b. wrist extension ROM

c. grip strength testing

d. scapular mobility

a. shoulder lateral (external) ROM

Shoulder lateral (external) rotation creates valgus stresses at the elbow. This should be avoided because valgus forces stress the ulnar collateral ligament.

b. Active wrist motion is encouraged following ulnar collateral ligament reconstruction.

c. Gripping activities are encouraged in the early stages following an ulnar collateral ligament reconstruction.

d. The ulnar collateral ligament of the elbow does not attach on or near the scapula, and motion of the scapula does not load the ulnar collateral ligament of the elbow.

During isometric testing of the right quadriceps, a patient is able to achieve a strong muscle contraction with pain reported. The patient MOST likely has which of the following conditions?

a. Complete rupture of the quadriceps tendon

b. Minor lesion of the quadriceps tendon

c. Compression of the femoral nerve

d. Disuse atrophy of the lower extremity

b. Minor lesion of the quadriceps tendon

A minor lesion of the quadriceps muscle or tendon will result in a strong and painful isometric contraction.

a. Complete rupture would result in weak (not strong) contraction and painless isometric testing.

c. Disorder in the nervous system will result in weak (not strong) and painless isometric testing.

d. Disuse atrophy will lead to weak and painless isometric testing.

A patient was struck from behind in a motor vehicle accident 2 days ago. The patient has cervical pain and limitations in right cervical rotation. Radiographs are unremarkable. In addition to use of a cervical collar, which of the following interventions would be MOST appropriate for the patient?

a. Use of modalities to diminish pain and guarding

b. Performance of exercise to address movement loss

c. Performance of mechanical cervical traction for pain management

d. Performance of cervical manipulation to address movement loss

a. Use of modalities to diminish pain and guarding

The accident occurred 2 days ago, placing the timing of the injury in the acute stage of recovery. The primary goal in the acute stage is to diminish pain and muscle guarding, for instance with the use of modalities.

b. The accident occurred 2 days ago, placing the timing of the injury in the acute stage of recovery. The primary goal in the acute stage is to diminish pain and muscle guarding, for instance with the use of modalities (p. 1321). If active range of motion exercise is initiated too early, it may lead to delays in healing due to the presence of continued myalgia and muscle guarding secondary to pain

c. There is no evidence supporting the use of cervical mechanical traction for the treatment of whiplash associated disorders

d. Although early manual therapy in the form of soft tissue mobilization may be beneficial to decrease pain in the acute stage, higher grade mobilization/manipulation should be initiated only when pain and muscle guarding has subsided

A physical therapist is testing the strength of a patient's latissimus dorsi with the patient in prone position and the arms at the side with the palms facing the ceiling. Following instruction in the desired motion, the patient lifts the arm off the table through full range. The patient should take which of the following actions NEXT?

a. Extend the arm while seated without back support.

b. Repeat the motion while turning the palm downward.

c. Repeat the motion while the therapist adds resistance.

d. Extend the arm while in sidelying position with the upper arm supported.

c. Repeat the motion while the therapist adds resistance.

The patient has demonstrated at least Fair (3/5) strength in the latissimus dorsi, so the physical therapist should add resistance to determine whether the patient has greater strength.

A 13-year-old boy has a shorter lower extremity with ipsilateral thigh and hip pain. When walking, the patient is MOST likely to maintain the involved hip in which of the following positions?

a. flexion

b. abduction

c. medial (internal) rotation

d. lateral (external) rotation

d. lateral (external) rotation

Slipped capital femoral epiphysis is the most common hip disorder of adolescents. Presentation is more common in males than females and occurs between the ages of 10-17 years. Pain is commonly reported in the thigh and hip with limited hip medial (internal) rotation, abduction, and flexion, and adductor spasm. Antalgic gait and lateral (external) rotation of the involved hip are likely to be observed.

A patient reports falling on the shoulder and experiencing superior shoulder pain. The pain is reproduced by passive shoulder horizontal adduction. Which of the following ligaments is MOST likely injured?

a. coracohumeral

b. coracoclavicular

c. inferior glenohumeral

d. superior glenohumeral

b. coracoclavicular

The coracoclavicular ligament, along with the acromioclavicular ligament, stabilizes the acromioclavicular joint (Dutton, p. 587). Injury to the acromioclavicular joint occurs from trauma, such as a fall on the shoulder, as in this patient's history (Neumann, p. 129). The acromioclavicular joint is stressed with passive shoulder horizontal adduction

A patient's examination reveals weakness with scapular upward rotation and protraction. Which of the following nerves is MOST likely affected?

a. axillary

b. subscapular

c. suprascapular

d. long thoracic

d. long throacic

The long thoracic nerve innervates the serratus anterior, which is responsible for upward rotation and protraction of the scapula

a. The axillary nerve innervates the deltoid and teres minor. The deltoid is primarily responsible for shoulder flexion, abduction, and extension. The teres minor is responsible for shoulder lateral (external) rotation and horizontal abduction.

b. The subscapular nerve innervates the teres major, which is responsible for shoulder extension, medial (internal) rotation, and adduction

c. The suprascapular nerve innervates the supraspinatus and infraspinatus. The infraspinatus is responsible for shoulder lateral (external) rotation and horizontal abduction. The supraspinatus is responsible for shoulder abduction and lateral (external) rotation.

A patient sustained a nerve injury just below the inguinal ligament. Which of the following gait deviations is the patient MOST likely to demonstrate?

a. Increased posterior lean of the trunk in midstance

b. Increased medial (internal) rotation of the thigh during midswing

c. Hyperextension of the knee during stance phase

d. Excessive ankle plantar flexion during foot flat (loading response)

c. Hyperextension of the knee during stance phase

The nerve that lies below the inguinal ligament is the femoral nerve. The femoral nerve provides innervation for the quadriceps musculature. When the quadriceps are weak, there will be a compensatory motion of the femur by action of the gluteus musculature to pull the femur posteriorly. This will result in the knee ground reaction force being in front of the knee axis, thus providing an extensor moment.

a. An increased posterior lean of the trunk occurs to realign the ground reaction line posterior to the hip joint. This is observed when there is hip extensor weakness.

b. Increased medial (internal) rotation is caused by weakness of the lateral (external) rotators or adaptive shortening of the iliotibial band.

d. Ankle plantar flexion during foot flat (loading response) is controlled by the gastrocnemius, which is not innervated by the femoral nerve.

A patient reports an insidious onset of pain on the plantar surface of the foot, as well as forefoot burning, cramping, and numbness between the third and fourth metatarsal heads. The pain is reproduced when the metatarsal heads are squeezed together. The patient MOST likely has which of the following conditions?

a. freiberg disease

b. anterior tarsal syndrome

c. morton neuroma

d. sesamoiditis

c. morton neuroma

The symptoms described in the stem are consistent with Morton neuroma, a mechanical entrapment neuropathy of the interdigital nerve

a. Freiberg disease, which commonly involves avascular necrosis of the second metatarsal epiphysis, leads to collapse of the osteochondrotic deformity. Symptoms include pain localized to the metatarsal head and exacerbated with activity, range of motion limitations, joint swelling, and occasional plantar callosity under the second metatarsal head. Neurological signs, such as those described in the stem, are not attributable to Freiberg disease

b. Patients who have anterior tarsal syndrome report deep aching pain in the medial and dorsal aspect of the foot, burning around the nail of the great toe, and pins-and-needles sensations that are exacerbated with plantar flexion. These symptoms are not consistent with the description in the stem

d. Sesamoiditis presents with pain on weight-bearing and swelling of plantar soft tissue. Passive dorsiflexion of the metatarsophalangeal joint while palpating the sesamoids exacerbates pain. Neurological signs, such as those observed in the patient described in the stem, are not commonly associated with this condition

A patient sustained an injury to the cerebellar cortex. Which of the following functions would MOST likely be diminished?

a. initiation of movement

b. upper extremity strength

c. upper extremity sensation

d. rapid alternating arm movements

d. rapid alternating arm movements

Rapid alternating arm movements test for dysdiadochokinesia, the term used to indicate impaired ability to perform these movements. Patients who have cerebellar lesions would be most likely to experience this impairment.

Which of the following therapeutic activities is the MOST appropriate for an infant who has a C5-C6 brachial plexus injury?

a. Open-hand batting of an object with finger extension and abduction

b. Reaching with shoulder medial (internal) rotation and forearm pronation

c. Reaching with shoulder lateral (external) rotation and forearm supination

d. Grasping an object with thumb (1st digit) adduction and metacarpophalangeal joint flexion

c. Reaching with shoulder lateral (external) rotation and forearm supination

A C5-C6 brachial plexus injury (also known as Erb palsy) will result in weakness of the shoulder abductors, flexors, and rotators as well as the forearm supinators. Therefore, activities encouraging these motions should be emphasized during physical therapy.

A patient who has an acute ankle sprain is being instructed in non-weight-bearing gait with crutches prior to discharge from the emergency department. Which of the following approaches by the physical therapist would MOST effectively facilitate learning?

a. Give verbal instructions in how to use the crutches.

b. Provide photographs of someone using crutches.

c. Have the patient verbally repeat the instructions and demonstrate use of the crutches.

d. Demonstrate use of the crutches and provide the patient with written instructions.

c. Have the patient verbally repeat the instructions and demonstrate use of the crutches.

When learning a new task, the patient is in the cognitive stage of learning. An effective training strategy in this stage is to have the patient verbalize task components and requirements (O'Sullivan). In the first stage, the goal of the learner is to understand the task dynamics

Which of the following objective findings is MOST likely to be present in a patient who has Parkinson disease at Hoehn and Yahr Stage 4?

a. atrial fibrillation

b. erratic respiration

c. increased chest excursion

d. paroxysmal atrial tachycardia

b. erratic respiration

Erratic breathing is associated with Parkinson disease due to dyskinetic movement patterns of the muscles of respiration.

A patient reports vertigo and nausea after rolling in bed. The symptoms last for 30 seconds. The patient has a positive response on the Hallpike-Dix test. To decrease symptoms, which of the following interventions would be MOST effective?

a. habituation exercises

b. brandt-daroff exercises

c. gaze stabilization treatment

d. canalith repositioning treatment

d. canalith repositioning treatment

The patient has symptoms that are consistent with benign paroxysmal positional vertigo due to canalithiasis, specifically, nausea and vertigo with movement, symptoms lasting 30 seconds or less, and a positive result on the Hallpike-Dix test (p. 332). Canalith repositioning treatment is the most appropriate evidence-based intervention for canalithiasis

A patient reports pain and swelling in the medial aspect of the elbow and tingling in the ring and little fingers (4th and 5th digits). Examination reveals a positive result on the elbow flexion test. The patient MOST likely has which of the following conditions?

a. c5 radiculopathy

b. medial epicondylagia

c. cubital tunnel syndrome

d. olecranon bursitis

c. cubital tunnel syndrome

The symptoms described in the stem are classic signs of cubital tunnel syndrome, which is entrapment of the ulnar nerve. This condition results in symptoms of tingling in the ring and little fingers (4th and 5th digits).

a. A C5 radiculopathy can present with neurological symptoms from the superior aspect of the shoulder to the lateral aspect of the arm. The patient may also have decreased strength of the deltoid muscle with a potential loss of the brachioradialis reflex.

b. In medial

epicondylalgia, pain will be in the anterior medial elbow region, there will be pain with pronation and wrist flexion, and there is no numbness or tingling

d. Olecranon bursitis would likely cause pain and swelling in the posterior aspect of the elbow

Which of the following tests is MOST appropriate to perform when assessing the effect of a child's disability on the child's caregivers?

a. school functional assessment

b. pediatric evaluation of disability inventory

c. Bruininks-Oseretsky Test of Motor Proficiency

d. Peabody Developmental Motor Scale

b. Pediatric Evaluation of Disability Inventory

The Pediatric Evaluation of Disability Inventory (PEDI) is a 197-item inventory that is used to detect the functional limitations on participation of the patient and the need for assistance by the caregivers.

a. The School Functional Assessment is used to assess and monitor the performance of children in functional tasks and activities in elementary school social and academic settings. It does not have a section on caregivers' need for assistance.

c. The Bruininks-Oseretsky Test of Motor Proficiency is a test of fine motor control, manual coordination, body coordination, strength, and agility. It does not have a section on caregivers' need for assistance.

d. The Peabody Developmental Motor Scale can be used to assess changes in gross and fine motor skills and is appropriate for children up to age 5 years. It does not have a section on caregivers' need for assistance.

A patient who has upper motor neuron syndrome is MOST likely to exhibit which of the following signs?

a. clonus

b. severe muscular atrophy

c. fasciculations and fibrillations

d. hypoactive deep tendon reflexes

a. clonus

b. Severe muscular atrophy is characteristic of lower motor neuron syndrome

c. Fasciculations and fibrillations are characteristic of lower motor neuron syndrome

d. Hypoactive deep tendon reflexes are characteristic of lower motor neuron syndrome

A 4-year-old child shows no interaction with peers and has increased sensitivity to sound and touch, and poor eye contact. Which of the following techniques would be BEST for physical therapy in the child's preschool?

a. change activities frequently

b. provide structured routines

c. allow the child to select activities freely

d. incorporate high levels of sensory stimulation

b. provide structured routines

The child demonstrates the signs of autism spectrum disorder. Young children with autism spectrum disorder have been shown to prefer and thrive in structured, predictable environments.

a. Children with autism spectrum disorders respond best with a high degree of structure and predictable routines.

c. While it is important to allow for free movement and improvisational activities, children who have autism spectrum disorders respond best with a high degree of structure. For low-functioning children (as described in the stem), more prompting may be required to optimize outcomes.

d. Odd or exaggerated responses to sensory stimuli are common in autistic children. Too much sensory stimulation may be overwhelming.

A patient who has an L2 radiculopathy with motor weakness would MOST likely demonstrate which of the following ipsilateral gait abnormalities?

a. Pelvic drop during the swing phase of gait

b. Hip lateral (external) rotation during the swing phase of gait

c. Genu valgum during the stance phase of gait

d. Posterior trunk bending in the stance phase of gait

b. Hip lateral (external) rotation during the swing phase of gait

A patient with an L2 radiculopathy would demonstrate weakness in the hip flexors. The iliopsoas is innervated by L2-L4, which would cause the patient's hip flexion to be weak and allow muscle substitution to occur. Lateral (external) rotation may be used to facilitate hip flexion in swing phase, using the adductors as flexors, if the true hip flexors are weak.

a. A pelvic drop during the swing phase of gait is indicative of gluteus medius weakness and is known as Trendelenburg gait (Lippert, p. 392). The gluteus medius is innervated by L4-S1

c. Dynamic genu valgum during the stance phase of gait can occur due to weakness of the ipsilateral gluteus medius (Kisner, p. 794). The gluteus medius is innervated by L4-S1

d. Posterior trunk bending indicates a weakness of the hip extensors and is known as gluteus maximus gait or rocking horse gait (Lippert, pp. 391-392). The gluteus maximus is innervated by L5-S2 (Lippert, p. 307). A posterior trunk lean from initial contact to loading response is the result of either hip extensor weakness, hip flexor contracture, or inadequate hip flexion in the swing limb. Therefore, a posterior trunk bend during stance suggests either the ipsilateral gluteus maximus is weak or the contralateral hip flexors are weak. (Dutton, p. 292) The stem asks for ipsilateral.

To improve sitting posture and lower extremity dressing ability for a patient who has tetraplegia, which of the following procedures would be MOST appropriate for a physical therapist to perform?

a. Stretch the lower trunk muscles and the hamstrings.

b. Allow the hamstrings and the lower trunk muscles to tighten.

c. Allow the hamstrings to tighten and stretch the lower trunk muscles.

d. Allow the lower trunk muscles to tighten and stretch the hamstrings.

d. Allow the lower trunk muscles to tighten and stretch the hamstrings.

Individuals who have tetraplegia benefit from having tight lower trunk muscles to improve stability in sitting position and hamstring length to allow 100° of straight leg raise to improve the ability to sit in long sitting position and to dress the lower extremities.

a. Although the hamstrings must be sufficiently long to allow 100° of straight leg raise, individuals who have tetraplegia benefit from having tight lower trunk muscles to improve sitting stability.

b. Although individuals who have tetraplegia will benefit from tightness in the lower trunk muscles, the hamstrings must be sufficiently long to allow a 100° straight leg raise to improve the ability to sit in long sitting position and to dress the lower extremities.

c. Individuals with tetraplegia benefit from tightness of the lower trunk muscles to improve stability in sitting position. Hamstring length to allow 100° straight leg raise improves the ability to long sit and dress lower extremities.

Which of the following scenarios MOST likely indicates that a patient has a unilateral lesion of the semicircular canals on the right side?

a. The patient is able to maintain gaze on a target when the head is flexed to 30° and manually rotated quickly to the left side.

b. The patient is able to maintain gaze on a target when the head is flexed to 30° and manually rotated quickly to the right side.

c. The patient is unable to maintain gaze on a target when the head is flexed to 30° and manually rotated to quickly the left side.

d. The patient is unable to maintain gaze on a target when the head is flexed to 30° and manually rotated quickly to the right side.

d. The patient is unable to maintain gaze on a target when the head is flexed to 30° and manually rotated quickly to the right side.

The head thrust test is used to examine semicircular canal (SCC) function. A patient who has a unilateral lesion or a pathology of the central vestibular neurons will not be able to maintain gaze when the head is rotated quickly toward the side of the lesion.

Which of the following descriptions of motor behavior BEST represents a patient in the late phase of motor learning of an upper extremity reaching task?

a. experimentation with a reaching strategy

b. ability to focus on a secondary task while reaching

c. inconsistent performance of the reaching task

d. fast improvement with reaching performance

b. ability to focus on a secondary task while reaching

Ability to focus on a secondary task occurs during late learning.

a, c and d: all happen in early learning stages

Compression of which of the following nerves is MOST likely to result in weakness of the flexor pollicis brevis, sensory disturbance of the thumb and index finger (1st and 2nd digits), and diminished grip strength?

a. ulnar

b. radial

c. deep posterior interosseus

d. median

d. median

Median nerve involvement can produce motor weakness of the flexor pollicis brevis, sensory loss in the thumb and index finger (1st and 2nd digits), and weakness in grip strength

a. Ulnar nerve involvement does not impact sensation of the thumb and index finger (1st and 2nd digits)

b. Radial nerve involvement does not impact flexor pollicis brevis function or sensation of the thumb and index finger (1st and 2nd digits)

c. Deep posterior interosseus nerve involvement does not impact flexor pollicis brevis function or have a sensory component

A child who has a myelomeningocele at the T7 level has a new onset of vomiting, lethargy, irritability, headache, and increased seizure frequency. What is the MOST likely cause of these signs and symptoms?

a. latex allergy

b. tethered cord

c. shunt dysfunction

d. chiari II malfunction

c. shunt dysfunction

At least 85% of children who have myelomeningocele have hydrocephalus, and 80% to 90% will require a shunt, especially those with high-level lesions. Shunt dysfunction is common, and therapists should be familiar with signs and symptoms for early detection. Early warning signs include the clinical manifestations described in the stem.

a. Latex allergy is a common problem in patients who have myelomeningocele (73%), but symptoms generally include watery and itchy eyes, sneezing, hives, and rash

b. Tethered cord is a common development in patients who have myelomeningocele, but symptoms typically include spasticity, increased tone, buttock pain, increasing scoliosis, and weakened leg musculature

d. Although Chiari II malformation is commonly the cause of hydrocephalus, 2% to 3% of children who have myelomeningocele show significant impairment from Chiari II malformation (Tecklin, pp. 249-250). Symptoms associated with Chiari malformation generally include stridor, apnea, swallowing difficulty, and ataxia but could also include seizure

An otherwise healthy patient sustained a compression injury to the obturator nerve. When testing hip abduction, the patient is MOST likely to achieve which of the following strength grades?

a. zero (0/5)

b. trace (1/5)

c. good (4/5)

d. normal (5/5)

d. Normal (5/5)

The obturator nerve innervates the adductor longus, adductor brevis, adductor magnus, gracilis, and obturator externus, whose action is to adduct the hip. A lesion of the obturator nerve would not affect hip abduction

A patient who has Bell palsy would benefit MOST from strengthening of which of the following muscles?

a. masseter

b. temporalis

c. lateral pterygoid

d. frontalis

d. frontalis

Bell palsy involves paralysis of the facial nerve (CN VII) (pp. 136-137). A facial nerve (CN VII) injury will impair the strength of the frontalis, because the frontalis is innervated by the temporal branch of the facial nerve (CN VII)

a. The masseter is a masticatory muscle that is innervated by the trigeminal nerve (CN V) (p. 238). A facial nerve (CN VII) injury will have no effect on the masseter.

b. The temporalis is innervated by the trigeminal nerve (CN V) (p. 238). A facial nerve (CN VII) injury will have no effect on the temporalis.

c. The lateral pterygoid is innervated by the trigeminal nerve (CN V) (p. 238). A facial nerve (CN VII) injury will have no effect on the lateral pterygoid.

Which of the following methods is MOST appropriate for handling a 1-year-old child who has cerebral palsy and who exhibits strong extensor tone in the trunk and extremities?

a. carrying the child in a sitting position

b. carrying the child over one's shoulder

c. keeping contact with the back of the child's head

d. picking the child up under the upper extremities

1. carrying the child in a sitting position

The sitting position promotes visual attending, use of the upper extremities, and social interaction (Martin, pp. 98-100). A flexed posture is preferred so the shoulders are forward. A child who exhibits extensor posturing should be carried in a symmetric position that does not allow axial hyperextension and keeps the hips and knees flexed

A patient displays upbeating and right torsional nystagmus during a right-sided Dix-Hallpike Test. The patient MOST likely has a pathological condition affecting which of the following structures?

a. left posterior canal

b. left horizontal canal

c. right posterior canal

d. right horizontal canal

c. right posterior canal

The Dix-Hallpike Test is the most common test to confirm benign paroxysmal positional vertigo. The right posterior canal would be identified with symptoms of upbeating and right torsional nystagmus. Lowering the head backward and to the side allows the debris in the posterior canal to fall to its lowest position, activating the posterior canal and resulting in eye movement and vertigo.

Which of the following ASIA Impairment Scale levels is MOST appropriate to assign to a patient who has a C7 spinal cord injury with only intact anal sensation?

a. A

b. B

c. C

d. D

b. B

ASIA Impairment Scale B is the appropriate classification for a patient's spinal cord injury if the patient has anal sensation.

A patient who has amyotrophic lateral sclerosis has an anterior deltoid manual muscle test grade of Poor plus (2+/5) and 175° of passive shoulder flexion. Which of the following exercises is MOST appropriate for the patient?

a. Resisted shoulder flexion at 40% of the one-repetition maximum in sidelying position

b. Resisted shoulder flexion at 80% of the one-repetition maximum in sidelying position

c. Passive shoulder flexion range of motion exercises in sidelying position

d. Active shoulder flexion range of motion exercises in sidelying position

d. Active shoulder flexion range of motion exercises in sidelying position

Because the patient has Poor (2+/5) muscle strength and a diagnosis of amyotrophic lateral sclerosis, it is likely that strength training will not improve muscle strength. Exercise that overstress a muscle in a patient who has amyotrophic lateral sclerosis has a high likelihood of causing overuse weakness and further decline. Sidelying shoulder flexion promotes range of motion in the functional pattern needed in an antigravity position and is the most appropriate exercise for this patient, since it is not likely to induce unwanted secondary complications.

a. Resistance training, even at low intensities, is not appropriate for a patient who has amyotrophic lateral sclerosis due to the increased risk of overuse weakness in patients with a manual muscle test grade less than Fair (3/5). With a grade of Poor plus (2+/5), the most appropriate interventions are active range of motion, passive exercises if a restriction exists, or submaximal aerobic exercises.

b. Resistance training at this intensity for a patient who has amyotrophic lateral sclerosis is not appropriate given the high likelihood of overuse weakness. Moderate resistance training would be appropriate (60% of the one-repetition maximum) if the muscle grade was greater than Fair (3/5).

c. The patient has normal passive shoulder flexion (175°) (Dutton). Active range of motion exercises, not passive, would be appropriate to promote functional return and slow further strength loss

A patient reports weakness and tingling in the lower extremities over the past 2 weeks. The physical therapist suspects that the patient may have Guillain-Barré syndrome. Which of the following examination findings would MOST likely occur with this diagnosis?

a. Hypertonicity in the affected muscles

b. Presence of clonus with rapid passive foot dorsiflexion

c. Diminished tendon reflexes

d. ataxic gait pattern

c. Diminished tendon reflexes

Guillain-Barré syndrome is a lower motor neuron disorder. Diminished reflexes are expected with lower motor neuron disease.

a, b, and d: UMN symptoms

A physical therapist is assessing a patient's orientation to gravity while the patient is in a prone stander. The therapist should be aware that the orientation to gravity:

a. affects the perception of sensation

b. is a measure of function

c. determines the degree of ROM avaliable

d. influences muscle tone throughout the trunk and extremities

d. influences muscle tone throughout the trunk and extremities.

Tone presentation can vary depending on patient position and interaction of tonic reflexes.

A patient reports complete sensation loss in the C6 dermatome, but has Normal (5/5) muscle strength in all upper extremity muscles. The patient MOST likely has a lesion in which of the following locations?

a. Dorsal root ganglia of C6

b. Ventral root ganglia of C6

c. Posterior interosseous nerve

d. Medial antebrachial cutaneous nerve

a. Dorsal root ganglia of C6

The dorsal roots are purely afferent nerves with no motor component (

b. The ventral root ganglia of C6 contains purely efferent nerves with no sensation component

c. Injury to the posterior interosseous nerve would result in motor loss without sensory loss

d. The medial antebrachial cutaneous nerve of the forearm is innervated by C8-T1, not C6

A patient who has a T3 spinal cord injury (ASIA Impairment Scale A) becomes flushed and exhibits diaphoresis and bradycardia. The patient also reports having a headache. Which of the following actions is MOST appropriate for a physical therapist?

a. loosen the patients pants

b. lie the patient flat on a mat table

c. clamp the patients urinary catheter

d. apply an abdominal binder to the patient

a. loosen the patients pants

The patient's presentation is consistent with autonomic dysreflexia. One of the common irritants or causes is tight or restrictive clothing below the level of the lesion. It is important to loosen any restrictive clothing if a patient presents with autonomic dysreflexia.

A patient has limited cervical mobility, headaches, and pain with cervical rotation, extension, and lateral side bending. The patient also reports numbness in the right hand and walks with a wide base of support. Which of the following conditions is MOST likely present?

a. cervical myelopathy

b. cervical radiculopathy

c. brachial plexus injury

d. TIA

a. cervical myelopathy

Cervical myelopathy is an injury to the spinal cord that would present with upper motor neuron symptoms, including ataxic gait with a wide base of support, as well as headaches. Symptoms would also not follow a straight nerve root dermatome/myotome pattern.

b. Cervical radiculopathy would indicate a nerve root lesion. Symptoms would include pain with cervical range of motion; however, upper motor neuron symptoms related to gait and headaches would not be present with a nerve root lesion.

c. A brachial plexus injury would not result in any changes to gait, and there would be no pain present in the neck. Symptoms would be more isolated to the shoulders.

d. A transient ischemic attack could result in neurological symptoms in the hand as well as impairments in balance and ataxic gait. However, cervical range of motion would not be limited or painful with a transient ischemic attack.

Which of the following descriptors BEST differentiates a child who has autism spectrum disorder from a child who has developmental coordination disorder?

a. decreased muscle tone

b. impaired motor coordination

c. restricted, repetitive behaviors

d. decreased participation in organized sports

c. restricted, repetitive behaviors

Children who have autism spectrum disorder and children who have developmental coordination disorder share some impairments, functional limitations, and participation restrictions. Restricted or repetitive behaviors is a specific impairment that is listed for autism spectrum disorder but not listed for developmental coordination disorder.

a. Hypotonia occurs in individuals who have autism spectrum disorder (Palisano, p. 584) and in individuals who have developmental coordination disorder

b. Impaired motor coordination is present in individuals who have autism spectrum disorder (Palisano, p. 585) and in individuals who have developmental coordination disorder

d. Decreased participation in organized sports is observed in individuals who have autism spectrum disorder (Palisano, p. 591) and in individuals who has developmental coordination disorder

During the Clinical Test for Sensory Integration and Balance, a patient demonstrates increased sway when standing on a foam surface with eyes closed and when standing on foam with vision obscured by a dome. The sway is normal during all other conditions. Which of the following patient problems is the MOST likely reason for the findings?

a. Inability to effectively adapt sensory information

b. Inability to use vestibular input for postural control

c. Dependence on the visual system for postural control

d. Dependence on the somatosensory system for postural control

b. Inability to use vestibular input for postural control

Patients who exhibit increased sway when standing on foam with eyes closed and foam with obscured vision demonstrate a vestibular loss pattern.

a. Patients who have a sensory selection problem and are unable to adapt will also exhibit increased sway when standing. Patients who are unable to use vestibular input for postural control are unable to resolve conflicts between vestibular and visual information on a firm surface with vision obscured and when standing on foam with eyes open.

c. Patients who are visually dependent will also exhibit increased sway when standing on a firm surface with eyes closed or with vision obscured.

d. Patients who are dependent upon surface information through the somatosensory system will also have increased sway when standing on foam with eyes open.

A patient who uses bilateral carbon fiber dorsiflexion-assist ankle-foot orthoses is able to ambulate 250 feet (76.2 meters) independently on level surfaces in the clinic without an assistive device. Which of the following progressions would MOST appropriately ensure the patent is in the autonomous stage of motor learning?

a. Limit distractions in the practice setting.

b. Increase distance of ambulation practice trials.

c. Ask the patient to perform a cognitive task during ambulation over level surfaces.

d. Have the patient ambulate on a treadmill at a pace slightly faster than comfortable.

c. Ask the patient to perform a cognitive task during ambulation over level surfaces.

In the autonomous stage of motor learning, the person can perform the task with a minimal level of attention and can perform it in a changing, unpredictable environment. Training strategies include dual-tasking and varying the environment.

Which of the following techniques is MOST appropriate for treatment of a patient who has low postural tone?

a. Slow regular rocking while sitting on a treatment bolster

b. Continuous pressure to the skin overlying the back muscles

c. Low-frequency vibration to the back muscles

d. Joint approximation applied through the shoulders to the trunk

d. Joint approximation applied through the shoulders to the trunk

Of the options listed, joint approximation is the most appropriate technique for improving low postural tone

A patient who has vertigo is observed to have short-duration, upbeating nystagmus with left torsion during the Dix-Hallpike Test. Which of the following interventions is MOST appropriate?

a. liberatory manuever to the left

b. liberatory manueuver to the right

c. canalith repositioning to the left

d. canalith repsoitioning to the right

c. canalith repositioning to the left

Transient nystagmus suggests benign paroxysmal positional vertigo (BPPV) canalithiasis. Left torsion of the eye suggests left posterior semicircular canal involvement (posterior semicircular canals are most often affected in BPPV). The canalith repositioning maneuver is designed to move free-floating debris out of the involved semicircular canal and into the vestibule.

An otherwise healthy young adult who has a C5 spinal cord injury (ASIA Impairment Scale A) is being examined by a physical therapist. Which of the following functional levels is the MAXIMUM that the patient can potentially achieve?

a. Dependent transfer to a wheelchair by using an overhead lift

b. Independent rolling side to side in bed

c. Independent community-level mobility with a manual wheelchair

d. Toilet transfer with a sliding board and assistance

d. Toilet transfer with a sliding board and assistance

A patient who has a C5 spinal cord injury (ASIA Impairment Scale A) can potentially assist with a sliding board transfer with the use of deltoids, biceps, and rhomboids, especially if normal strength is present in all innervated muscles.

a. A patient who has a complete injury to C5 still has innervation to the deltoids, biceps, and rhomboids and would potentially be able perform level surface transfers with assistance.

b. A patient requires innervation to the pectoralis major and teres major to be independent with rolling in bed. An individual who has a C6 spinal cord injury (ASIA Impairment Scale A) would be able to achieve this functional level, but not an individual who has a C5 spinal cord injury.

c. Although an individual with a C5 spinal cord injury (ASIA Impairment Scale A) may be able to propel a manual wheelchair with rim projections on level surfaces, the high energy cost required for long-distance propulsion and maneuvering on unlevel surfaces and curbs in the community makes this functional level difficult to achieve.

A patient who has Parkinson disease has a shuffling gait pattern. To improve gait quality, which of the following activities would be MOST appropriate to perform?

a. Ascending and descending stairs

b. Walking using a metronome to time steps

c. Step training on a treadmill without cues

d. Sidestepping with a braiding pattern

b. Walking using a metronome to time steps

Auditory cues have been shown to improve stride length and velocity in patients who have Parkinson disease. Rhythmic auditory stimuli, such as a metronome, have been shown to improve gait speed, cadence, and stride length.

Which of the following interventions would be the BEST choice to remove wound exudate and loose debris from a sacral wound that exhibits tunneling?

a. sharp debridment

b. wet-to-dry dressings

c. pulsatile lavage with suction

d. acetic acid wound cleanser

c. pulsative lavage with suction

Pulsatile lavage with suction combines wound irrigation with suction and removes the irrigation fluid, wound exudate, and loose debris. It has been found to be advantageous over other interventions since it uses less water and requires less staff support, less cleanup, and less treatment time. It has been shown to increase healing time by rapid removal of contaminants, and it can be used to treat tunneling wounds using special cannula tips.

a. Sharp debridement is considered the reliable/valid (gold) standard of methods for removal of necrotic tissue, but it is not appropriate for wounds with tunneling (when the wound bed cannot be seen). When the purpose of the treatment is to remove excess exudate and debris from the wound, pulsatile lavage with suctioning would be indicated.

b. Wet-to-dry dressing has been used to debride wounds, but it has been found to remove not only necrotic tissue, but also rich endogenous fluids, fibrin, and other cells critical to wound healing. It is often uncomfortable for the patient, causing bleeding and trauma to the wound bed. There is considerable evidence that efficacy of wet-to-dry dressings has not been demonstrated.

d. Acetic acid has been used as a topical solution to treat acute and chronic wounds. The cleanser may negatively affect new cells in the wound bed. Although it may have an antimicrobial effect, it may also have antimitotic (inhibiting mitosis) effects as well. It may adversely affect fibroblasts and epidermal keratinocytes during tissue repair, particularly affecting cells that fill and cover a wound. Acetic acid has been shown to be extremely cytotoxic to cells and caution is recommended in use of these to promote wound healing.

Which of the following skin findings is MOST consistent with a Stage 3 pressure injury?

a. Visibly exposed bone or tendon that is directly palpable

b. A shallow, open ulcer with a red wound bed without slough

c. Visible subcutaneous fat, but no visible bone or tendon

d. Purple-colored skin or the presence of a blood-filled blister

c. Visible subcutaneous fat, but no visible bone or tendon

Subcutaneous fat may be visible but bone, tendon or muscle is not exposed in a Stage 3 pressure injury. In this stage, there is full-thickness tissue loss. The bone/tendon is not visible or directly palpable.

a. An exposed bone or tendon that is visible or directly palpable describes a Stage 4 pressure injury.

b. A shallow open ulcer with a red or pink wound bed without slough describes a Stage 2 pressure injury.

d. A purple localized area of discolored intact skin or a blood-filled blister due to damage to the underlying soft tissue from pressure and/or shear describes a suspected deep tissue injury.

A patient has an irregularly shaped, heavily exudating, superficial ulcer on the medial aspect of the distal leg. Which of the following conditions is MOST likely the cause of this wound?

a. type 2 diabetes

b. chronic venous insuffiency

c. arterial occlusive disease

d. secondary lymphedema

b. chronic venous insuffiency

Venous wounds are typically irregular in shape and highly exudative and frequently develop at the medial distal leg

a. Although type 2 diabetes contributes to both arterial and venous disease (p. 512), it is the sensory changes and repeated stress/pressure on insensate areas that causes ulceration (pp. 515-516). Diabetic ulcers are typically round and deep and have minimal drainage (p. 642). The stem states that the wound is irregular in shape, heavily exudating, and superficial.

c. Arterial ulcers are

typically round in appearance and dry (p. 642). The stem indicates that this wound is irregular in shape and heavily exudating.

d. Wounds that develop as a result of progressive secondary lymphedema are usually a result of cracking of dry skin from chronic fibrosis (p. 682). This wound is irregular in shape and heavily exudating.

Which of the following positions would be MOST appropriate for a patient who sustained burns to the axilla, elbow, and volar (palmar) surface of the hand?

a. Wrist in extension and digits in slight flexion

b. Elbow in slight flexion and forearm in supination

c. Shoulder in abduction and lateral (external) rotation

d. Shoulder in extension and lateral (external) rotation

c. Shoulder in abduction and lateral (external) rotation

Shoulder abduction and lateral (external) rotation is the recommended position because it promotes stretching of the axillary region of the shoulder, which often becomes contracted following a burn.

The BEST way to test if a patient has sufficient protective sensation in the foot to prevent skin breakdown is to use:

a. a feather and brush lightly over the bottom of the foot.

b. monofilaments and test areas exposed to high weight-bearing.

c. a sharp pin prick and test for a painful response.

d. a hot/cold discrimination test and test heat and cold tolerance.

b. monofilaments and test areas exposed to high weight-bearing.

Protective sensation can be reliably measured utilizing monofilaments. Protective sensation in the foot is considered absent if an individual cannot feel the 5.07 monofilament.