FF: Class Questions

A PT performs the special test shown below. The pt is instructed to stand on one leg with the knee slightly flexed and rotate the body while maintaining balance on the supporting leg. The test is considered positive if the patient reports joint line discomfort or catching. What special test is being performed, and what is the MOST LIKELY diagnosis?

1. Thessaly test, medial meniscus tear

2. McMurray’s test, medial meniscus tear

3. Apley’s test, medial meniscus tear

4. Valgus stress test, MCL tear

1. Thessaly test, medial meniscus tear

❌McMurrays: knee flex+rot, not in WBing

❌Apleys: compression+rot, prone not in WBing

❌Valgus stress test: assesses MCL

The pt has been recommended by the physician to ambulate with PWB. Which would be the MOST APPROPRIATE AD for the weightbearing status advised to the pt?

1. Bilat canes

2. Unilat axillary crutch

3. Unilat Lofstrand crutch

4. Bilat axillary crutches

4. Bilat axillary crutches →approp for PWB and NWB

After several sessions of PT, the pt’s POC now includes mobilizations to increase knee extension in an open chain position. Which mobilization technique is MOST APPROPRIATE for achieving this range of motion?

1. Anterior glide to the tibia

2. Anterior glide to the femur

3. Posterior glide to the tibia

4. Posterior glide to the femur

1. Anterior glide to the tibia

A patient was diagnosed with a stroke that affected the area marked in the image. Which of the following impairments are MOST LIKELY to be seen in this patient?

1. Resting tremors

2. Dystonia

3. Visual field disturbances

4. Dysmetria

4. Dysmetria →cerebellar involvement

❌Basal Ganglia: restring tremors, dystonia

❌Occipital lobe: visual field disturbances

During a baseline examination, the physical therapist examines the patient’s heart sounds. Which valve is being auscultated in the picture shown below?

1. mitral valve

2. pulmonary valve

3. tricuspid valve

4. aortic valve

3. tricuspid valve

think APTM 2245

• Aortic: R 2nd ICS, sternal border

• Pulmonic: L 2nd ICS, sternal border

• Tricuspid: L 4th ICS, sternal border

• Mitral: L 5th ICS, midclavicular line

A patient using a wheelchair needs a ramp to access a building with two steps totaling a rise of 14in. According to the ADA guidelines, what is the minimum ramp length in feet required?

1. 10ft

2. 12ft

3. 14ft

4. 16ft

3. 14ft →every 1in rise req 1ft ramp length

• Each step is typ 7in high, so two steps = 14in total rise

A recreational soccer player reports hip and knee discomfort. On gait examination, there is toe-in throughout stance and swing phases, with patellae facing medially. No structural leg length discrepancy is observed. Which of the following interventions is MOST APPROPRIATE to improve this patient’s functional movement pattern?

1. strengthen hip internal rotators and abductors

2. stretch hip internal rotators and strengthen hip external rotators

3. stretch hip abductors and strengthen internal rotators

4. provide patient education on limiting activity until symptoms resolve

2. stretch hip internal rotators and strengthen hip external rotators

Rationale: The patient’s toe-in gait and medially facing patellae suggest excessive hip internal rotation, often due to femoral anteversion. This causes the foot to point inward and alters knee tracking. Stretching hip internal rotators and strengthening hip external rotators and abductors helps correct this imbalance, improving gait mechanics and reducing symptoms. Strengthening internal rotators or adductors would worsen the pattern, while rest alone does not address the underlying movement dysfunction.

A PT examines a patient with chief concerns of tingling into the 4th and 5th digits along with muscle wasting over the hypothenar eminence. Which of the following testing procedures would be the BEST to assess the integrity of the nerve?

1. Have the pt flex both wrists while holding them for one min

2. Have the pt make a fist around the thumb and perform ulnar deviation

3. Have the pt grasp a piece of paper between their first and second digit while the examiner pulls the paper and monitors the first digit

4. Have the patient perform extension of the third digit of the hand against the examiner resistance

3. Have the pt grasp a piece of paper between their first and second digit while the examiner pulls the paper and monitors the first digit →froment’s sign for ulnar N injury (adductor pollicis weakness)

❌1→Phalen’s for Carpal Tunnel

❌2→Finkelstein for DeQuervains

❌4→Maudsley’s for Lateral Epicondylitis

Which of the following would be the MOST LIKELY diagnosis?

1. Smith’s fracture

2. Colles fracture

3. Scaphoid fracture

4. Dinner fork deformity

1. Smith’s fracture (garden spade deformity) →radius dislocated volarly

❌Colles fracture (dinner fork deformity) →radius dislocated dorsally

Which of the following would be the MOST LIKELY presentation in this patient?

1. Wasting of thenar eminence

2. Wasting of hypothenar eminence

3. Unable to perform little finger adduction

4. Unable to perform index finger extension

1. Wasting of thenar eminence →median N (N/T along lateral 3.5 digits on volar side)

❌Ulnar N: interossei weakness

❌Radial N: finger extensor weakness

The patient has been coming to PT for 4 weeks and has significant improvement in wrist ROM but continues to experience limited end range wrist EXT. Which is the MOST APPROPRIATE intervention?

1. dorsal glide of carpal bones

2. volar glide of carpal bones

3. medial glide of carpal bones

4. lateral glide of carpal boones

2. volar glide of carpal bones

A clinician is evaluating patient with a vague diagnosis of LBP. The patient displays a positive Thomas test. Which sub phase of the gait cycle will MOST LIKELY show limitation in the hip ROM?

1. loading response

2. initial contact

3. midstance

4. terminal stance

4. terminal stance

Rationale: Terminal stance requires maximum hip extension. Patient will either present with anterior trunk lean or excessive lumbar lordosis to compensate for limited hip extension due to hip flexor contracture or tightness.

A PT observes R pelvic hike during swing phase of the R gait cycle. Which of the following conditions is MOST LIKELY to cause the problem?

1. excessive R hip flexion

2. inadequate R knee flexion

3. excessive ankle DF

4. R ankle PF weakness

2. inadequate R knee flexion

Rationale: Possible causes for pelvic hike in wing phase are reduced hip flexion, reduced knee flexion, and/or lack of ankle dorsiflexion. Tightness (not weakness) of the plantarflexors will cause pelvic hike.

Which of the following is MOST LIKELY seen in a patient with facial nerve (CN7) palsy?

1. absent pupillary reflex

2. absence of sensation in the anterior 2/3 of the tongue

3. hyperacusis

4. increased lacrimation

3. hyperacusis

Rationale: Hyperacusis (Option C) is defined as the collapsed tolerance to normal environmental sounds. Facial nerve controls the excessive movements of the stapedius bone and dampens the sound, and its injury can cause hyperacusis. Sensation in anterior 2/3 of tongue is by trigeminal nerve and not by facial nerve. Facial nerve is for taste on anterior 2/3 of the tongue. The efferent arc for Corneal reflex is the facial nerve. Decreased lacrimation is seen with facial nerve palsy.

A pt is evaluated 3mo s/p R ankle fracture. AROM PF 0-10deg, DF 0-20deg. Which joint mobilization technique is MOST APPROPRIATE to improve plantarflexion?

1. anterior glide of the talus on the tibia

2. lateral glide of the calcaneus on the talus

3. medial glide of the calcaneus on the tibia

4. posterior glide of the talus on the tibia

1. anterior glide of the talus on the tibia

Rationale: Dorsiflexion and plantarflexion occur at the talocrural joint, where the convex talus articulates with the concave tibia and fibula. Based on the convex–concave rule, the roll and glide occur in opposite directions. To improve plantarflexion, an anterior glide of the talus is performed. Option B improves inversion. Option C improves eversion. Option D improves dorsiflexion

A clinician is testing shoulder AROM and asks the patient to move the shoulder into full IR; during this motion, which direction will the humerus slide in?

1. anterior

2. superior

3. inferior

4. posterior

4. posterior

Rationale: During medial (internal) rotation of the shoulder at the glenohumeral (GH) joint, the head of the humerus moves on the glenoid fossa. Due to the convex-concave rule, the humeral head (convex) will slide in the opposite direction. According to convex concave rule at shoulder ---> Convex on concave = roll and glide occurs in opposite direction. A posterior glide improves IR.

During examination of the shoulder, a patient demonstrated limited and painful shoulder flexion ROM. Which of the following joint mobilization techniques is MOST APPROPRIATE?

1. Large amplitude oscillations performed at the beginning of the ROM in an anterior direction

2. Small amplitude oscillation into tissue resistance up to the limit of available motion in an anterior direction

3. Large amplitude oscillations within the available ROM in a posterior direction

4. Small amplitude oscillations into tissue resistance at the limit of available joint motion in a posterior direction

3. Large amplitude oscillations within the available ROM in a posterior direction

❌1/2—wrong direction glide

❌4—grade 4 mob (for ROM, not pain)

PT examination reveals that the L PSIS low+ASIS high. Which of the following is the BEST intervention?

1. Stretching the R hip flexors to correct R anterior rotated innominate

2. Strengthening of L hip flexors to correct L posterior rotated innominate

3. Stretching the L hip extensors to correct L posterior rotated innominate

4. Strengthening the R hip extensors to correct R posterior rotated innominate

3. Stretching the L hip extensors to correct L posterior rotated innominate

• Always stretch before strengthening!!

While examining the patient, the PT notices a drop of the L hip during R midstance. INjury to which nerve is MOST LIEKLY the cause of the impairment?

1. R inferior gluteal nerve

2. R superior gluteal nerve

3. R femoral nerve

4. R obturator nerve

2. R superior gluteal nerve →L4-S1

• R GMed weakness

What would be the MOST APPROPRIATE treatment for this impairment?

1. Stand on R leg and abduct L leg

2. Stand on L leg and extend R leg

3. Stand on R leg and flex R leg

4. Stand on L leg and flex R leg

1. Stand on R leg and abduct L leg

Rationale: Stick to the plane! Work in frontal plane and best choice is CKC for the RLE. Stabilize on weak side, move left leg into abduction will increase strength more than abduction on the right.

Which of the following mobilization techniques is MOST APPROPRIATE to improve the limited hip external rotation ROM?

1. anterior glide to femur

2. posterior glide to femur

3. superior glide to femur

4. inferior glide to femur

1. anterior glide to femur →convex femur moves on concave acetabulum (opp roll/glide)

❌2. post glide—improves flex

❌3. superior glide—improves ADD

❌4. inferior glide—improves ABD

A PT is evaluating muscle function during gait. During which phase do the hamstring muscles contract eccentrically?

1. initial swing

2. terminal swing

3. midstance

4. terminal stance

2. terminal swing

Rationale: HS most elongated when hip flex+knee ext (think stretching position)

❌1. InSw - needs knee flexion (conc)

❌3. MidSt (HS not getting elongated enough)

❌4. TmSt (HS not getting elongated enough)

A patient comes to an outpatient clinic reporting neck problems. Which of the following exercise combinations is MOST APPROPRIATE for a patient who has a forward head posture?

1. strengthen the deep cervical flexors and stretch the SCMs and upper cervical extensors

2. strengthen the deep cervical flexors and SCMs and stretch the upper cervical extensors

3. strengthen the cervical extensors and stretch the SCMs and deep cervical flexors

4. strengthen the cervical extensors and SCMs and stretch the deep cervical flexors

1. strengthen the deep cervical flexors and stretch the SCMs and upper cervical extensors

Upper Crossed Syndrome- Forward head posture

• Tight: UT, levator, pecs, SCM

• Weak: DNF, LT, serratus

To unlock the knee, when going from position A to B as shown in the image, which of the following motions is MOST LIKELY to occur?

1. Lateral rotation of the femur on the tibia

2. Medial rotation of the femur on the tibia

3. Lateral rotation of the tibia on the femur

4. Medial rotation of the tibia on the femur

1. Lateral rotation of the femur on the tibia

Rationale: During knee flexion (From A to B) in a closed-chain movement, the femur undergoes lateral  rotation on the tibia. This rotation allows the knee to unlock and flex into the squat position.

Excessive upward rotation of the L scapula is noted as the pt attempts shoulder abduction. Which of the following muscles is NOT LIKELY to contribute to excessive scapular rotation?

1. Weakness of serratus anterior

2. Weakness of lower trap

3. Weakness of rhomboid major and minor

4. Weakness of pectoralis major

3. Weakness of rhomboid major and minor →downward rotator

Rationale: Rhomboids is a downward rotator. If weak, it is not able to control the upward rotation, hence an excessive movement of upward rotation occurs. Strengthening the rhomboids would be the most appropriate intervention to improve downward rotation. Serratus anterior and lower trapezius are upwards rotators and they should have been tight to cause excessive upward rotation. Pec major does not cause rotation at the Scapula.

A PT is initiating passive and assisted movements for a patient who underwent surgical repair of a full-thickness RCT 6d ago. Which of the following positions is MOST APPROPRIATE for the patient?

1. Patient in sitting with arm abducted 70deg with slight flexion

2. Patient in supine with arm abducted 45deg with slight flexion

3. Patient in sitting with arm abducted 15deg with slight flexion

4. Patient in supine with arm abducted 90deg with slight flexion

2. Patient in supine with arm abducted 45deg with slight flexion

❌1/3—early post-op supine»sitting for better stabilization

❌4—too soon based on 1wk post-op status (may damage repair)

On examination, which special test is MOST LIEKLY to be positive in this patient?

1. Anterior drawer test

2. Kleiger’s test

3. Thompson test

4. Talar tilt test

3. Thompson test →achilles tendon rupture (+ demos no PF)

❌Anterior drawer—ATFL/ACL injury 

❌Kleiger’s—Tibiofibular injury 

❌Talar tilt—For CFL and deltoid sprain

The pt underwent R achilles tendon repair and returned to the PT clinic at 2wks wearing a CAM boot. Which intervention would most likely be CONTRAINDICATED in the initial phase of rehab?

1. hip and knee strengthening

2. ankle muscle setting exercises

3. heel raises in standing

4. ambulation training with CAM boot

3. heel raises in standing

Pt now 6wks post-op and able to fully WB. Which of the following shoe modifications would be MOST APPROPRIATE for the patient?

1. normal shoes

2. shoes with 1-1.5cm heel lift

3. shoes with lower than the regular heel

4. shoes with 5cm heel lift

2. shoes with 1-1.5cm heel lift →allows slight PF to reduce strain on healing achilles tendon

❌1/4—excessive DF. strains repaired tendon

❌3—excessive PF, not recommended/beneficial at 6wks post-op

Pt presents with reduced hip mobility, particularly hip EXT. The PT notes that the patient experiences greater hip extension when the knee is extended compared to when the knee is flexed. What is the MOST LIKELY cause of the reduced hip extension with knee flexion?

1. Passive insufficiency of the hamstrings

2. Passive insufficiency of the gluteus maximus

3. Active insufficiency of the hamstrings

4. Active insufficiency of the rectus femoris

3. Active insufficiency of the hamstrings

Rationale: Active Insufficiency occurs when a 2-jt muscle can’t shorten enough to produce full ROM at both joints simultaneously. The hamstrings cross both the hip and knee joints. When the knee is flexed and the hip is extended, the hamstrings are shortening at both the knee and the hip. This dual action can lead to active insufficiency of the hamstrings because they are unable to generate sufficient force in this overly shortened state. In contrast, when the knee is extended, the hamstrings are lengthened over the knee, which allows them to contract more effectively at the hip, thus improving hip extension. Passive insufficiency of the hamstrings: This occurs when a muscle cannot lengthen enough to allow full range of motion at both joints it crosses.

A worker reports of difficulty gripping their tools tightly, and they repeatedly fall from their hand. On exam, the PT notices they can grip the tools tightly with their wrist in extension, but struggles to do so with the wrist in flexion. What is the MOST LIKELY cause of this issue?

1. Passive insufficiency of both flexor digitorum profundus and extensor digitorum

2. Passive insufficiency of flexor digitorum and active insufficiency of extensor digitorum

3. Active insufficiency of flexor digitorum profundus and passive insufficiency of extensor digitorum

4. Active insufficiency of both flexor digitorum profundus and extensor digitorum

3. Active insufficiency of flexor digitorum profundus and passive insufficiency of extensor digitorum

Rationale: When the wrist is flexed, the flexor digitorum profundus becomes shortened, limiting its ability to generate force for gripping. This is active insufficiency, The extensor digitorum is in a stretched position when the wrist is flexed, reducing its ability to extend the fingers efficiently. This is passive insufficiency. The flexor digitorum profundus (finger flexors) becomes actively insufficient, and the extensor digitorum (finger extensors) becomes passively insufficient, both contributing to the worker's difficulty gripping with the wrist in flexion.

A pt reports foot pain during running with excessive foot pronation. Which of the following orthotic interventions would MOST LIKELY benefit this patient?

1. medial post under first metatatsal head

2. cushion heel

3. lateral post under 5th metatarsal head

4. posterior leaf spring

1. medial post under first metatarsal head

Rationale: Correction of the overpronation can be done by a medial post placed just proximal to the first metatarsal head. This approach involves bringing the ground up to meet the foot. A post under the fifth metatarsal head would accentuate the problem. Cushion heel can be used for plantar fasciitis and a posterior leaf spring is used for a foot drop. Posterior leaf spring  is used in weak dorsiflexors conditions.

Which of the following is MOST APPROPRIATE to measure the increased metabolic demand placed on the heart?

1. Systolic blood pressure

2. Rate product pressure

3. Diastolic blood pressure

4. Heart rate

2. Rate product pressure = myocardial O2 demand (HR*SBP)

• Measures how hard heart working; useful in evaluating cardiac fxn during exs or stress testing

• Higher RPP = incr cardiac workload and oxygen consumption

A PT is administering the 6MWT to assess the aerobic capacity of this patient. Which of the following statements regarding the test is MOST ACCURATE?

1. The PT must walk with the pt to observe SpO2 on the pulse oximeter

2. “Warm-up” or practice test should not be performed immediately before the test

3. The patient is allowed to take rest/breaks with the timer paused

4. The results of this test help to determine the cause of dyspnea

2. “Warm-up” or practice test should not be performed immediately before the test

Rationale: If a practice test is done, wait for at least 1 hour before the second test. The SpO2 should not be used for constant monitoring during the exercise. The technician must not walk with the patient to observe the SpO2. The patient is allowed to slow down, stop and rest as necessary but the timer continues to run. The 6MWT does not determine peak oxygen uptake, diagnose the cause of dyspnea on exertion, or evaluate the causes or mechanisms of exercise limitation.

Which of the following categories is the MOST APPROPRIATE description for this type of hypertension?

1. Normal

2. Elevated

3. Prehypertension

4. Stage 1

4. Stage 1

Pre-hypertension is not used as a category any more based on the revised guidelines.

• Normal: <120/80

• Elevated: 120-129 / <80

• Stage 1: 130-139 / 80-89

• Stage 2: >140 / >90 mm Hg

• Hypertensive crisis: >180 / >120 (req prompt med changes if no other indications of problems OR immediate hospitalization if S/S organ damage)

A healthy patient is working out on a stationary bike in an outpatient PT clinic. After the first four minutes of constant-load and submax exs, the VO2 reaches steady state. What does this indicate?

1. Levels of lactic acid in the blood has reached steady state

2. The ATP demand is being met aerobically

3. The exercise should be discontinued immediately

4. The respiratory rate is insufficient to meet the ATP demand

2. The ATP demand is being met aerobically

Rationale: Initially ATP produced by anaerobic pathways and after steady state is reached, ATP is produced aerobically. The volume of oxygen (not necessarily RR) needs to be sufficient to meet ATP demands. 

• Aerobic exercise: Uses oxygen for energy. Performed at moderate intensity over a long duration. (ex: jogging, cycling, swimming). Builds endurance and improves cardiovascular health.

• Anaerobic exercise: Does not rely on oxygen; uses stored energy (glycogen/ATP). Done at high intensity for a short duration (ex: sprinting, heavy lifting, HIIT). Builds strength, power, and muscle mass.

A person goes for a hiking expedition. The base camp is at an altitude of 10,000ft above sea level. What are the INITIAL responses during their first few days at this altitude?

1. Increased respiratory rate, increased heart rate, increased cardiac output and no significant change in stroke volume

2. Decreased respiratory rate, decreased heart rate, decreased cardiac output and increased stroke volume

3. Increased respiratory rate, decreased heart rate with decreased cardiac output and increased stroke volume

4. Increased respiratory rate, increased heart rate with decreased cardiac output and decreased stroke volume

1. Increased respiratory rate, increased heart rate, increased cardiac output and no significant change in stroke volume

Rationale: At high altitudes, the body experiences hypoxia due to lower oxygen levels. The initial response includes an increase in respiratory rate (hyperventilation) to improve oxygen intake. The heart rate also increases (tachycardia) to enhance oxygen delivery to tissues. Initially, cardiac output  increases because of the increased heart rate, while stroke volume typically remains unchanged.

During aquatic therapy, a patient is immersed to the level of sternoclavicular notch. Which of the following is the MOST EXPECTED physiological response of aquatic tehrapy?

1. decreased cardiac output

2. increased venous return

3. increased heart rate

4. increased VO2 response

2. increased venous return →2/2 incr hydrostatic pressure of water, incr CO and SV

• Everything else decreases (HR, SBP, VO2 response to exercise)

A pt’s chart states that they have been taking beta-blockers for the past 5yrs. Which of the following statements is correct regarding an exercise training program?

1. Greater benefits from cardiovascular exercise to be achieved at lower SBP rather than at higher SBP levels

2. Need to use measures other than HR to determine intensity of exercise

3. Greater benefits from cardiovascular exercise to be achieved at lower HR than at higher HR lvls

4. Need for longer warm-up periods and cool down periods during exercise sessions

2. Need to use measures other than HR to determine intensity of exercise

• Beta blockers BLUNT HR →use RPE scale

• Longer warm up and cool down ideal but for cardiac transplant

A patient recently completed a 10wk aerobic condition program. Compared to their initial evaluation, which of the following responses would MOST LIKELY be observed after the program?

1. slower HR recovery following exercise

2. higher resting RR

3. higher BP

4. lower resting HR

4. lower resting HR →2/2 incr SV and enhanced parasympathetic tone

• also faster HR recovery, decr resting RR and BP at submax workloads (reliable indicator of improved fitness)

A patient reports SOB and fatigue. Which valve is being auscultated in the picture?

1. tricuspid valve

2. pulmonary valve

3. mitral valve

4. aortic valve

2. pulmonary valve

APTM 2245

• Aortic— Rt 2nd IC space at sternal border

• Pulmonary— Lt 2nd IC space at sternal border

• Tricuspid— Lt 4th IC space at sternal border

• Mitral—Lt 5th IC space at mid clavicular line

A clinician is performing cardiac auscultation and hears a “dub” sound. Which of the following is associated with this heart sound?

1. closing of bicuspid and tricuspid valves

2. opening of bicuspid and tricuspid valves

3. closing of aortic and pulmonary valves

4. abnormal heart rate

3. closing of aortic and pulmonary valves

❌1/2—closure mitral and tricuspid valves = “lub” S1 heart sound

S4 is most commonly heard in patients with HTN, left ventricular hypertrophy, increased left ventricular end diastolic pressure, pulmonary hypertension, and pulmonary stenosis. S3 is the common in CHF which is an indication of a insufficient left ventricular which occurs as blood continuously fill a relaxed left ventricle during early diastole.

A pt presents with speech difficulties such that their speech is slow and laborious. They frequently omit small grammatical words, such as “is” and “the”, while speaking. However, they seem to understand the spoken language quite well. Based on this information, which of the following conditions does the patient MOST LIKELY have?

1. Wernicke’s aphasia

2. Broca’s aphasia

3. Global aphasia

4. Lesion to CN V

2. Broca’s aphasia

Rationale:

• Broca's aphasia: non-fluent, expressive aphasia (difficulty with speech production)

• Wernicke's aphasia: fluent but nonsensical speech, receptive aphasia (difficulty understanding)

• Global aphasia: severe impairments in both speech production and comprehension, which is inconsistent with the patient’s preserved comprehension abilities.

• CN V lesion will not cause Aphasia.

During assessment of pupillary light reflex, when the light is shone into the L eye, the L pupil constricts, and the R pupil remains dilated. What is the MOST LIKELY explanation for these findings?

1. R optic nerve damage

2. L optic nerve damage

3. R oculomotor nerve damage

4. L oculomotor nerve damage

3. R oculomotor nerve damage

Rationale:

• In the pupillary light reflex, when light is shone into one eye, both the IL and CL eye responses should occur.

• When light is shone into the right eye, both pupils constrict, indicating that the sensory input from the right eye (via the right optic nerve) and the motor output to both pupils (via the oculomotor nerves) are functioning correctly.

• When light is shone into the left eye, only the left pupil constricts, and the right pupil remains dilated. This suggests that the sensory input from the left eye is intact (as the left pupil constricts directly), but the consensual response is impaired.

• This pattern indicates damage to the right oculomotor nerve. The right oculomotor nerve is responsible for constriction of the right pupil in response to light shone in either eye. If the right oculomotor nerve is damaged, the right pupil will not constrict in response to light shone in the left eye, leading to the observed finding of the left pupil constricting but the right pupil remaining dilated.

A pt presents with lesion to CN V (trigeminal) and CN VII (facial). Considering the location of lesion, which other nerve is MOST LIKELY to be affected?

1. CN III (oculumotor)

2. CN IX (glossopharyngeal)

3. CN VIII (vestibulocochlear)

4. CN XII (hypoglossal)

3. CN VIII (vestibulocochlear)

Rationale:

• CN V (Trigeminal) and CN VII (facial) are both located in the pons and so is CN VIII (Vestibulocochlear)

• CN III (Oculomotor) is in the Midbrain and CN IX (Glossopharyngeal) and XII (Hypoglossal) are in the medulla

• Ophthalmic nerve (V1), Maxillary nerve (V2), and Mandibular nerve (V3).

A patient presents to a TMJ specialist for jaw pain. On exam, there’s weakness of the masseter and temporalis muscles on the same side, and their jaw deviates to the R when they open their mouth. Sensory exam revealed reduced sensation over R lower jaw+chin. Which of the following functions is MOST LIKELY impaired along with this presentation due to the nerve damage described?

1. Smiling

2. Chewing

3. Swallowing

4. Moving tongue

2. Chewing →triCHEWminal nerve

❌1. Smiling—facial (CN7)

❌3. Swallowing—glossopharyngeal and vagus (CN9/10)

❌4. Moving tongue—hypoglossal (CN12)

A pt reports experiencing sudden onset mild hearing loss on L side. Rinne’s test was consistent with bone conduction greater than air conduction on both sides. Weber’s test findings show sound was louder in the L ear. Which of the following is MOST APPROPRIATE?

1. R side sensorineural hearing loss

2. L side conduction hearing loss

3. R side conduction hearing loss

4. L side sensorineural hearing loss

2. L side conduction hearing loss

Rationale: BC > AC === Conductive hearing loss; 

Using mnemonic CANS – with conductive hearing loss, sound is LOUD in affected ear i.e. left ear;

In the Weber test, a tuning fork is placed on the forehead. If the sound is localized by the patient to the contralateral side of the involved ear, then the hearing loss is sensorineural. In unilateral conductive loss, the sound is localized to the involved side. In Rinne test, vibrating tuning fork is placed on mastoid bone, then close to ear canal. Normal finding include sound heard longer through air than bone. With Conductive loss, sound heard through bone is equal to or longer than air; with Sensorineural loss: sound heard longer through air. The results of these two tests are used together to differentiate a sensorineural loss from a conductive loss.

A pt presents with concerns of difficulty speaking and swallowing. Upon exam, the pt’s tongue deviates to the R when protruded, and there is noticeable atrophy of the R side of the tongue. What is the MOST LIKELY diagnosis related to the findings observed and which CN is affected?

1. R vagus nerve (CN X) lesion

2. L hypoglossal nerve (CN XII) lesion

3. R hypoglossal nerve (CN XII) lesion

4. L facial nerve (CN VII) lesion

3. R hypoglossal nerve (CN XII) lesion →weakness and atrophy on SAME side

Considering the pt’s presentation, which lobe is MOST LIKELY affected?

1. R parietal lobe

2. L temporal lobe

3. L frontal lobe

4. R occipital lobe

1. R parietal lobe

❌2/3—L hemineglect and sensation loss so lesion has to be on R

❌4—occipital lobe assists vision, no deficits in case description

Considering that the pt has a lesion to spinal accessory N, which of the following will MOST LIKELY be seen?

1. inability to extend the spine

2. inability to shrug shoulders

3. inability to push up from chair

4. inability to extend the arm beyond neutral

2. inability to shrug shoulders →innervate UT/SCM (SB+opp rot also affected)

Based on the pt’s assessment, which of the following functions are expected to be intact in this case?

1. ability to taste from anterior tongue

2. ability to smile

3. pupillary light reflex

4. ability to open eyelids

4. ability to open eyelids →intact bc CN3 not involved

❌1/2—smile and taste ant tongue = facial (CN7)

❌3—pupillary reflex = optic (CN2)

A clinician is performing spirometry to assess the lung function of patient. After a normal exhalation, the clinician asks the patient to exhale the maximal amount of air they can. Which of the following parameters is being assessed with this action?

1. inspiratory capacity

2. expiratory reserve volume

3. total lung capacity

4. tidal volume

2. expiratory reserve volume

❌TV=normal inhale+exhale each quiet breath

❌IC=max air that can be inhaled after normal tidal exhalation (TV+IRV)

❌TLC=TV +IRV +ERV +RV

A patient diagnosed with idiopathic pulmonary fibrosis has been participating in PT in the hospital. Which of the following is MOST LIKELY to be seen on a pulmonary function test?

1. increased tidal volume

2. decreased inspiratory reserve volume

3. increased residual volume

4. increased functional residual capacity

2. decreased inspiratory reserve volume

Rationale: All lung volumes are decreased in restrictive conditions. With COPD, RV, FRC and TLC increases

Which of the following changes are MOST LIKELY seen on pulmonary function tests during exacerbation of symptoms?

1. increased FEV1 and reduced RV

2. reduced FEV1 and reduced RV

3. increased FEV1 and increased RV

4. reduced FEV1 and increased RV

4. reduced FEV1 and increased RV

• COPD = obstructive so air can’t get OUT

• Dec FEV1 2/2 airway narrowing (<80% predicted value)

• Inc FRC and RV 2/2 air trapped

According ot the GOLD classification, how would a PT classify the patient’s severity of COPD?

1. very severe

2. severe

3. moderate

4. mild

3. moderate

During examination, the PT finds that a patient has a weak wet cough. Which is MOST APPROPRIATE to help this patient clear secretions?

1. assisted coughing in the supine position

2. postural drainage in the sidelying position

3. huffing

4. mechanical percussion

3. huffing

Rationale: Patient has the ability to cough so we want to train/facilitate it further.

• 3— Huffing is a gentler form of coughing used to remove secretions. with an open glottis (opening between the vocal cords) while exhaling without pursing lips. This is similar to fogging the mirror. Huffing makes it easier to move mucus out of the lungs and stabilizes airways, prevents collapse.

• 1— is used for weak abdominals in SCI and not applicable in this condition.

• 2— Postural drainage facilitates drainage of secretions to the level of the segmental bronchus only. In addition, a cough is needed to clear secretions.

• 4— Percussion helps mobilize secretions from the periphery of the lungs; however, it does not improve to clear the secretions.

During a pulmonary exam, the clinician hears low-pitched sounds over the lateral border of the scapula. Which of the following sounds is the clinician auscultating?

1. vesicular sounds

2. bronchial sounds

3. broncho-vesicular sounds

4. tracheal sounds

1. vesicular sounds →soft/low pitch normal breath sounds throughout lungs (best heard at lung bases)

❌2. bronchial—heard over manubrium

❌3. broncho-vesicular—medium pitched w/ equal ins+exp heard over 1st/2nd interspace anteriorly b/w scapulae

❌4. tracheal—heard over trachea

Which of the following high-pitched breath sounds is MOST LIKELY associated with the diagnosis of CHF?

1. rhonchi

2. wheeze

3. crackles

4. pleural rub

3. crackles

❌rhonchi—low pitch

❌wheeze—asthma/COPD

❌pleural rub—pneumonia

During a pulmonary exam, the PT places the stethoscope on the patient’s thorax and asks the patient to say “E”, but hears an “A” sound instead. What is the MOST LIKELY diagnosis?

1. bronchial asthma

2. lobectomy

3. pneumonia

4. pneumothorax

3. pneumonia

• aka “egophony” 2/2 lung consolidation

• pneumonia inflames air sacs →consolidate w/fluid or pus →enhances sound transmission

The PT is reviewing the chart of an ICU patient. Based on the following lab report, the pt MOST LIKELY has been diagnosed with an uncompensated form of which condition?

1. metabolic acidosis

2. respiratory alkalosis

3. respiratory acidosis

4. metabolic alkalosis

2. respiratory alkalosis

• Norm pH 7.35-7.45 →high pH means alkalosis

• Norm PaCO2 35-45 →low means respiratory issue

• Norm HCO3 22-26 →norm in case

A patient, who is a chronic smoker, is diagnosed with COPD and undergoes ABG analysis. The PT is MOST LIKELY to see which of the following changes in the ABG report?

1. decreased PaCO2, increased PaO2, and decreased pH

2. decreased PaCO2, decreased PaO2, and increased pH

3. increased PaCO2, increased PaO2, and increased pH

4. increased PaCO2, decreased PaO2, and decreased pH

4. increased PaCO2, decreased PaO2, and decreased pH

• air trapped in COPD (can’t get OUT)

• CO2 builds up, Lower O2 →strongly drives pH to be acidic or lower

Presence of which of the following signs is MOST INDICATIVE of a lesion distal to the anterior horn cell?

1. Positive Babinski, presence of spasticity and foot drop

2. Negative Babinski, decrease in muscle tone and sensation

3. Increase in muscle tone and no change in sensation, presence of resting tremor

4. Presence of intentional tremors and nystagmus

2. Negative Babinski, decreased in muscle tone and sensation

• UMN: +Babinski, exaggerated cutaneous reflexes/incr reflexes, disuse atrophy, synergy, incr tone

• LMN: fasciculations, neurogenic atrophy, hyporeflexia, dec/absent cutaneous reflexes

• Cerebellar: intentional tremor

• BG: resting tremor

Which of the following is MOST LIKELY to be seen in a patient with diagnosis of Parkinson’s disease?

1. increased trunk rotation

2. increased step width

3. anosmia

4. macrographia

3. anosmia

❌1—trunk rotation reduced 2/2 rigidity and bradykinesia

❌2—NBOS shuffling gait

❌4—micrographia (small handwriting, not enlarged writing)

According to the Hoehn and Yahr classification of disability, which of the following classification of disability is the MOST APPROPRIATE about Stage III?

1. inability to walk without rollator

2. confined to wheelchair

3. may be able to live independently and continue employment

4. balance not impaired

3. may be able to live independently and continue employment

❌1—rollator use is stage 4

❌2—WC use is stage 5

❌4—balance not impaired with stages 1/2

During the PT session, the clinician notices that the patient with Parkinson’s disease suddenly begins twitching their lips and performs involumtary snake-like motions with their arms. What could be the cause of present symptoms?

1. Patient has skipped his levodopa dose

2. Patient is at peak levodopa dose

3. Patient is in honeymoon period

4. Patient is in the off state of levodopa

2. Patient is at peak levodopa dose

The twitching lips and invol snake-like arm motions are likely a manifestation of dyskinesia (common side effect of PD treatment), particularly at peak doses of levodopa

Which of the following clinical findings is MOST CHARACTERISTIC of Multiple Sclerosis?

1. Symmetrical distal muscle weakness with sensory loss in a glove-and-stocking pattern

2. Sudden onset of flaccid paralysis with absent reflexes

3. Visual disturbances, fatigue, and limb weakness that vary in intensity over time

4. Resting tremor and bradykinesia with unilateral onset

3. Visual disturbances, fatigue, and limb weakness that vary in intensity over time →chr demyelinating disorder

❌1—Peripheral neuropathy

❌2—GBS

❌4—Parkinson’s

A patient with ALS has weakness of all extremities and gets fatigued very easily while doing activities of daily living. Which of the following will be CONTRAINDICATED for this patient to maintain mobility and function as much as possible?

1. recommending soft foam collar for neck

2. taking frequent breaks during activities

3. recommended HKAFO and walking for ambulation

4. slow, prolonged stretches and ROM exercises for upper and lower extremities

3. recommended HKAFO and walking for ambulation

Rationale: Weight of the device is an important factor to consider in decision making, while also considering which device will ensure optimal function and safety. Wheeled walkers, which do not require the patient to lift the device, are usually recommended. It is also important to consider the weight of the orthosis as individuals with ALS will have energy expenditure issues, and it may be more fatiguing for the patient to ambulate with a heavy orthosis than to ambulate without the impairment being corrected. For this reason, a KAFO is not recommended. Head drooping forward can lead to impairment in ambulation and feeding. Patients may compensate by increasing lordosis as they attempt to maintain their posture during ambulation. For mild to moderate cervical weakness, a soft foam collar may be worn during specific activities. Physical therapists can perform and instruct caregivers in slow prolonged stretches and passive ROM exercises to address spasticity. Educating on activity pacing and importance of taking frequent breaks is essential.

A patient with GBS is in rehab and is beginning to regain some muscle strength. Which of the following is the MOST APPROPRIATE initial intervention to address muscle weakness and functional recovery?

1. High-intensity interval training to rapidly increase muscle strength and endurance

2. Progressive resistance exercises with a focus on low-mod intensity and high repetitions

3. Functional task-specific training with a focus on activities like running and jumping

4. Continuous passive motion exercises to maintain joint range of motion without muscle engagement

2. Progressive resistance exercises with a focus on low-mod intensity and high repetitions

Rationale: In the recovery phase of Guillain-Barré Syndrome, the goal is to gradually rebuild muscle strength and functional ability while avoiding overexertion. Progressive resistance exercises at a low to moderate intensity and high repetitions help in strengthening muscles safely as the patient regains strength. High-intensity interval training and complex activities like running and jumping may be too strenuous and premature, while continuous passive motion exercises do not sufficiently engage the muscles needed for functional recovery

Which of the following diagnosis is the patient MOST LIKELY expected to have?

1. ALS

2. GBS

3. MS

4. Cerebellar tumor

3. MS

❌UMN signs so either ALS/MS, rule out GBS

❌ALS does not have sensory deficits

❌Cerebellar tumor does not cause inc’d tone

The PT decides to assess the patients pupillary reflexes. On shining light into the pt’s L eye, both pupils constrict; however, on shining light into the pt’s R eye, both pupils paradoxically dilate. Which of the following is MOST LIKELY diagnosis and cause of this presentation?

1. Marcus Gunn pupil; Lesion to R CN II

2. Cataract; Lesion to R CN III

3. Cataract; Lesion to L CN II

4. Marcus Gunn pipil; Lesion to L CN III

1. Marcus Gunn pupil; Lesion to R CN II

❌2/3—Cataracts is clouded lens, would not cause abn dilation

❌4—MGP assoc’d w/CN2 not 3

Which of the following is the MOST APPROPRIATE recommendation for this patient?

1. Exercise sessions should be scheduled at the same time every day in the evening for consistency

2. Rest breaks and activity pacing should be incorporated based on the patient’s symptoms

3. During pool therapy, the temperature of the water should be 87°F

4. Balance and proprioceptive training must be avoided to prevent falls during rehabilitation

2. Rest breaks and activity pacing should be incorporated based on the patient’s symptoms

MS pts = heat intol +fatigue!!

❌1—exs sessions should alt days and during optimal times e.g., AM (core temp lowest, before fatigue!!)

❌3—pool should be <85°F

❌4—helps control ataxic mvts (tremor, dysmetria)

A patient with a diagnosis of L MCA is MOST LIKELY to have which of the following signs and symptoms?

1. excessive weakness of the RLE

2. neglect of the L side of the body

3. L homonymous hemianopsia

4. Inability to understand words spoken by the therapist

4. Inability to understand words spoken by the therapist

❌1—LE weakness = ACA stroke

❌2—Hemi neglect = R stroke

❌3—Homonymous hemianopsia = PCA stroke

A patient presents with sudden onset of weakness on one side of the body. When asked, they were unable to name their friend who accompanied them to the hospital. During assessment, they were able to write a sentence perfectly but was unable to read their sentence. A lesion in which of the following is the MOST LIKELY cause of this symptom?

1. Superior division of MCA

2. Central territory of PCA

3. Inferior division of MCA

4. Peripheral territory of PCA

4. Peripheral territory of PCA →dyslexia w/o agraphia

❌1—superior MCA = Broca’s aphasia

❌3—inferior MCA = Wernicke’s aphasia

❌2—central PCA = thalamic pain

With respect to the upper extremity, which of the following MOST ACCURATELY describes the position at rest?

1. forearm pronation with wrist and finger flexion and thumb abduction

2. forearm supination with wrist extension finger flexion, thumb adduction

3. shoulder in adduction and internal rotation and thumb adduction

4. shoulder abducted, externally rotated, elbow flexed, forearm supinated

3. shoulder in adduction and internal rotation and thumb adduction

Rationale: Position at rest is the position due to spasticity. For upper extremity spasticity the shoulder is abducted and internally rotated, elbow is flexed, forearm is pronated, wrist and fingers are flexed, thumb is adducted.

The pt has extreme spasticity, and she demonstrates flexion synergy patterns of the UE while attempting to move her UE. Which is MOST LIKELY to be seen when she lifts her arm and what is the appropriate classification per the Brunnstrom staging?

1. shoulder ER, abducted, elbow and wrist flexed and forearm supinated; Stage III

2. shoulder IR, adducted, elbow and wrist flexed and forearm supinated; Stage III

3. shoulder ER, abducted, elbow and wrist extended, and forearm pronated; Stage IV

4. shoulder IR, abducted, elbow and wrist flexed and forearm pronated; Stage V

1. shoulder ER, abducted, elbow and wrist flexed and forearm supinated; Stage III

Rationale: Stage III– increase spasticity and synergy. Flexion Synergy pattern for upper extremity is shoulder external rotation, abduction, elbow flexed, forearm supinate, wrist and fingers flexed.

Which is the MOST APPROPRIATE position while lying on the right side?

1. Head/neck: right scapula protracted; right arm slight abd and ER; elbow extended and forearm supinated, wrist neutral, fingers extended, and thumb abducted

2. Head/neck: neutral, right scapula retracted; right arm slight abd and IR; elbow extended and forearm pronated, wrist neutral, fingers extended, and thumb adducted

3. Head/neck: neutral, right scapula retracted; left arm slight abd and IR; elbow extended and forearm pronated, wrist neutral, fingers extended and thumb adducted

4. Head/neck: neutral, left scapula protracted; left arm slight add and ER; elbow flexed, forearm supinated, wrist extended, fingers flexed, and thumb abducted

1. Head/neck: right scapula protracted; right arm slight abd and ER; elbow extended and forearm supinated, wrist neutral, fingers extended, and thumb abducted

Rationale: L CVA = R hemiparesis. Effective strategies while sidelying on affected side:

• Head/neck: Neutral and symmetrical

• Trunk: Aligned in midline

• More affected UE: Scapular protracted; shoulder forward; arm placed in slight abduction and external rotation; elbow extended, forearm supinated, wrist neutral, fingers extended, and thumb abducted

• More affected LE: Hip extended and knee flexed and supported by pillows. An alternative position is slight hip and knee flexion with pelvic protraction

Upon further exam, the pt seems to be in a heightened state of activity and is making up stories. They are not coordinating with the therapist at all. How would the PT MOST LIKELY classify this patient’s level of cognition?

1. Level VI

2. Level IV

3. Level V

4. Level III

2. Level IV →confused agitated →erratic/non purposeful behavior, incoherent confabulation and verbalizations

❌1. Level VI (confused appropriate) →goal directed behavior but relies on external input, simple commands consistent, demos carryover for all task

❌3. Level V (confused inappropriate) →consistent simple commands, not purposeful responses, random/fragmented and verbalization inappropriate at times with confabulating

❌4. Level III (localized response) →pt reacts specifically but inconsistently to stimuli, inconsistent simple commands (EC, squeeze hand)

Which of the following strategies will be MOST BENEFICIAL while working with the patient?

1. Having a different clinician work with the patient every day so he gets used to meeting new people

2. Involving patient in group therapy so he can make friends

3. Informing the patient two days in advance about what to expect in the next few physical therapy sessions

4. Giving the patient two options and having the patient select one

4. Giving the patient two options and having the patient select one

Rationale: Since the patient is confused and agitated, orienting the patient is important and giving them options is beneficial so they think they are in control. Involving multiple people or doing group therapy will agitate the patient even more and will not be beneficial. Informing the patient 2 days in advance is of no use since patient has memory deficits.

If the patient becomes agitated during a session, what is the best initial response?

1. Leave the patient alone to calm down on their own

2. Use calming techniques to distract the patient

3. Correct the patient to discourage aggressive behavior

4. Restraint the patient to calm them and avoid harm

2. Use calming techniques to distract the patient

Rationale: Gently redirecting after the patient regains control helps refocus their attention without escalating the situation. Confrontation or demanding explanations may increase agitation. Restraint is a last resort and should only be used if the patient is a danger to themselves or others.

A patient presents with lymphedema post mastectomy. All of the following are causes of secondary lymphedema EXCEPT which cause?

1. Infection

2. Milroy’s disease

3. Fibrosis

4. Chronic venous insufficiency

2. Milroy’s disease

Rationale: Milroy's disease is a familial disease characterized by lymphedema, commonly in the legs, caused by congenital abnormalities in the lymphatic system. Disruption of the normal drainage of lymph leads to fluid accumulation and hypertrophy of soft tissues. Milroy’s disease is congenital and is a primary cause of lymphedema. Infection, Fibrosis and Chronic venous insufficiency are secondary causes of lymphedema. Secondary lymphedema is a result of an injury to the lymphatic system. Forms of secondary lymphedema are surgery, inflammation or infection, obstruction, or fibrosis, combined venous-lymphatic dysfunction (chronic venous insufficiency).

A patient with lymphedema presents with notable swelling that is hard and fibrotic, has a positive Stemmer’s sign, and hyperkeratosis of skin. Which of the following stages of lymphedema would the patient MOST LIKELY be in?

1. Stage 0

2. Stage 1

3. Stage 2

4. Stage 3

4. Stage 3

❌0—no edema

❌1—edema w/activity, reduced on elevation

❌2—hard swelling→non pitting brawny, +Stemmer’s sign

A clinician is evaluating a patient with lymphedema and documents it is an “early-stage 2 lymphedema with pitting edema grade 3+”. Which of the following MOST APPROPRIATELY describes the clinical presentation?

1. the indentation produced is greater than 1 inch

2. the indentation on finger pressure lasts for less than 15sec

3. the indentation on finger pressure lasts for 20sec

4. the indentation produced is less than ½ inch

3. the indentation of finger pressure lasts for 20sec →3+ =severe, lasts 15-30sec, ½-1in pitting

• 2+ Indentation is <½in for <15sec (Option B and D)

Which of the following signs would indicate INITIAL development of lymphedema in a patient seen post radical mastectomy with axillary node removal?

1. non-pitting edema of the forearm

2. shallow wound beds on the forearm

3. atrophy of the biceps muscle

4. decreased range of motion of the fingers

4. decreased range of motion of the fingers

❌1—non pitting fibrotic edema is Stage 3

❌2—shallow wound beds in later stages or 2/2 venous insufficiency

❌3—biceps atrophy in later stages 2/2 disuse or musculocutaneous N injury

A clinician is evaluating a patient with lipedema. Which of the following is MOST LIKELY seen as patient’s presentation?

1. Pt is susceptible to bruising of the affected area

2. Pt would have a positive Stemmer’s sign

3. Pt has a high likelihood of developing cellulitis

4. Pt would have asymmetrical involvement of the LE

1. Pt is susceptible to bruising of the affected area

• Lipedema: pain on pressure, susceptible to bruising of affected extremity

• Lymphedema: +Stemmer’s sign, susceptible to cellulitis

When examining the lymph nodes, which presentations are MOST LIKELY to require referral to physician?

1. small (<1cm in diameter), mobile, and non-tender lymph nodes in the axillary region

2. soft and freely moveable lymph nodes in the axillary region

3. firm, non-tender and fixed lymph nodes in the axillary region

4. enlarged (>1cm in diameter), tender, mobile lymph nodes following a recent diagnosis of upper respiratory infection

3. firm, non-tender and fixed lymph nodes in the axillary region

Rationale: Lymph nodes up to 1 cm in diameter of soft-to-firm consistency that move freely and easily without tenderness are considered within normal limits. Lymph nodes more than 1 cm in diameter that are firm and rubbery in consistency or tender are considered suspicious. Enlarged lymph nodes associated with infection are more likely to be tender, soft, and movable than slow-growing nodes associated with cancer.

What would be the BEST way to measure edema around the upper arm?

1. circumferential measurement

2. water displacement method

3. doppler US

4. lymphoscintigraphy

1. circumferential measurement →for proximal area lymphedema

❌2—water displacement for distal edema measurement

❌3—doppler for venous insufficiency measurement

❌4—lymphoscintigraphy for lymphatic insufficiency measurement

Which of the following statements is the CORRECT intervention for this patient?

1. the trunk and axilla should be decongested first followed by arm and hand

2. manual lymphatic drainage should involve proximal to distal stroking

3. the hand should be decongested first followed by trunk and axilla

4. affected limbs are bandaged with high-stretch compression bandages

1. the trunk and axilla should be decongested first followed by arm and hand

❌2—dist→prox stroking

❌3—prox→dist drainage!!

❌4—short compression bandages!

PT is developing an exercise program. Which exercise should the pt perform FIRST?

1. elbow flexion

2. cervical rotation

3. shoulder abduction

4. shoulder circumduction

2. cervical rotation

Rationale: Exercises are performed from proximal to distal areas. Cervical rotation (trunk) will be performed before shoulder movement and elbow flexion will be performed last.

A patient presents to the clinic with RLE edema that reduces on elevation of the LE. Which of the following should be AVOIDED for this patient?

1. Treadmill walking

2. Swimming

3. Walking barefoot outdoors

4. Air travel

3. Walking barefoot outdoors →skin breakdown!!

❌4—air travel w/compression garments, periodic walking breaks to reduce swelling 2/2 decr air pressure

❌1/2—recommended

During assessment of skin sensation, which of the following structures are responsible for transmission of pressure and vibration sensation?

1. Meissner corpuscles

2. Krause end bulbs

3. Pacinian corpuscles

4. Ruffini endings

3. Pacinian corpuscles →Pressure and vibration sensory modalities

❌1—Meissner corpuscles = fine/discriminative touch, vibration

❌2—Krause end bulbs = cold sensation

❌4—Ruffini endings = heat sensation

A patient presents with a RLE wound and has h/o painful cramping in the legs, esp after walking for a few minutes. Medical history significant for DM2 and HTN. Which would BEST describe the characteristic of this wound?

1. wound located on the dorsum of toes, base of the wound is pale and necrotic with lack of granulation tissue

2. wound located on the dorsum of the foot, hemosiderin staining present along with fibrosis of dermis

3. wound located on the medial malleolus with swelling of BLEs that is relieved with rest

4. pitting edema in the LEs, numbness and tingling along the hyperkeratosis of the skin

1. wound located on the dorsum of toes, base of the wound is pale and necrotic with lack of granulation tissue →PMH/int claud indicates arterial insufficiency

A PT is treating a patient, who was originally diagnosed with a pressure injury stage 3. The patient presents to the lcinic with ulcer shown below. Which of the following is true?

1. The pressure injury is now an unstageable ulcer

2. The pressure ulcer is now a stage 1 ulcer

3. The pressure ulcer is now a stage 2 ulcer

4. A pressure ulcer can not be back-staged

4. A pressure ulcer can not be back-staged

Rationale: A stage III pressure ulcer is classified as full-thickness tissue loss in which subcutaneous fat is visible but muscle, tendon, and bone are not visible. Once a pressure injury is designated Stage 1, 2, 3, or 4, it remains classified in that stage. Pressure injuries are not back-staged even though they improve.

A pt develops a stage 2 pressure injury over the sacrum and is referred to PT for wound care. Which of the following is the MOST APPROPRIATE initial application to clean the wound?

1. povidone-iodine solution

2. sterile normal saline

3. zinc oxide cream

4. nitrofurazone solution

2. sterile normal saline →initial agent to clean wound

❌1—povidone iodine to prepare skin for surgery

❌3—zinc oxide for dental fillings, local surface treatment of skin disorders

❌4—nitrofurazone for infected burns, skin infections 2/2 skin grafts

A patient has a deep partial-thickness wound with 70% necrosis and 30% granulation tissue. Which of the following is MOST APPROPRIATE wound care option?

1. wet to dry dressings

2. autolytic debridement

3. enzymatic debridement

4. biological debridement

1. wet to dry dressings

• >50% necrotic so need nonselective debridement

• all other options are selective debridement

A patient has a grade 3 pressure ulcer. The wound has excessive amounts of exudate present. Which of the following is the MOST APPROPRIATE dressing to use?

1. hydrofiber dressing

2. hydrocolloid dressing

3. hydrogel dressing

4. transparent film

1. hydrofiber dressing

❌4—transparent film: min drainage

❌2/3—hydrogel/hydrocolloid for min exudate

Which type of burn does this patient have?

1. superficial burn

2. superficial partial-thickness burn

3. deep partial thickness burn

4. subdermal burn

3. deep partial thickness burn

Rationale: Epidermal produces no scar and have intact skin.  Superficial partial-thickness are painful to touch, temperature, have a brisk capillary refill produces minimal scarring. Deep partial-thickness are waxy white, have pain on deep pressure, delayed capillary refill and results in excessive scarring and the development of hypertrophic and keloid scars is a frequent consequence. Subdermal burns are Charred, dry and exposed deep tissue and often require amputation.

Which of the following BEST represents the percentage of body surface area involved?

1. 31.5%

2. 18%

3. 36.5%

4. 45%

1. 31.5%

Rationale: Anterior trunk = 18%

Anterior R LE = 9%

Anterior R UE = 4.5%

During follow-up a few months later, the patient is concerned about a scar on his right arm, as shown below. What is the type of scar seen in this patient?

1. normal scar

2. hypertrophic scar

3. atrophic scar

4. keloid scar

4. keloid scar →excessive scar tissue grows outside original wound margins

❌1—normal scar: flat, similar to skin color

❌2—hypertrophic scar: thick fibrous tissue that remains w/in original wound border

❌3—atrophic scar: sunken, hyperpigmented 2/2 collagen loss (rare)

A PT is examining the gait of a patient and suspects a leg length discrepancy. Which of the following gait deviations is MOST LIKELY seen by the therapist?

1. increased dorsiflexion of the short limb during swing and increased plantarflexion of the long limb during stance

2. decreased knee flexion and increased dorsiflexion of the long limb during stance and increased dorsiflexion of the short limb during swing

3. increased dorsiflexion with early heel rise of the long limb at heel off and increased plantarflexion of the short limb during stance

4. increased plantarflexion of the long limb at heel strike and decreased knee flexion of the short limb during heel off

3. increased dorsiflexion with early heel rise of the long limb at heel off and increased plantarflexion of the short limb during stance

• Compensations: longer leg=more DF to shorten, shorter leg=more PF to lengthen

Following surgery of the R hip, a patient ambulates as shown in the picture. To improve gait pattern, functional electrical stimulation should be initiated for which of the following?

1. R abductors during swing on the R

2. R abductors during stance on the R

3. L abductors during stance on the L

4. L abductors during swing on the L

2. R abductors during stance on the R

Rationale: Patient is demonstrating a left side pelvic drop while walking. A left pelvic drop is caused by weak glut med muscles on the right. The function of the glut med muscle in stance is to maintain the pelvis alignment. To prevent pelvic drop and to improve the gait pattern, functional electrical stimulation (FES) should be given over the weak right hip abductors in stance