NPTE Practice w/Explanations Pt. 1

A physical therapist examines a three-year-old patient diagnosed with a genetic condition which affects collagen synthesis. The patient bruises easily and has a lifelong history of pathological fractures. What is the patient's MOST likely diagnosis?

1.Osteomalacia

2.Osteopetrosis

3.Pediatric osteoporosis

4.Osteogenesis imperfecta

4.Osteogenesis imperfecta

Pathological fractures associated with milder presentations of osteogenesis imperfecta (OI) may raise suspicions of child abuse before a formal diagnosis is made. More severe forms of OI are typically diagnosed early in the child's life with fractures sustained either in utero or during birth.

Milder presentations of OI (types I and IV) are inherited as autosomal dominant traits while more severe forms (types II and III) are inherited as autosomal recessive traits. The condition is characterized by bone fragility that is linked to an abnormality in the synthesis of type I collagen.

A patient diagnosed with rheumatoid arthritis is referred to physical therapy. The physical therapist observes bilateral thumb deformities characterized by metacarpophalangeal joint flexion with interphalangeal hyperextension. Which deformity is MOST consistent with the described presentation?

1.Boutonniere

2.Swan neck

3.Mallet finger

4.Dupuytren

Boutonniere

boutonniere deformity may occur in the fingers or thumb as a result of trauma or progressive arthritic changes. In patients diagnosed with rheumatoid arthritis, boutonniere deformity is the most commonly occurring thumb deformity.

1.In the thumb, chronic synovitis eventually forces the metacarpophalangeal (MCP) joint into a flexed position. The associated palmar displacement causes tension on the extensor mechanism of the interphalangeal (IP) joint resulting in hyperextension. In the fingers, this deformity presents with flexion in the proximal interphalangeal (PIP) joint and extension of the distal interphalangeal (DIP) joint.

A physical therapist works with a patient recovering from surgery on gait activities on a level surface. Which value represents the MAXIMUM amount of knee flexion required to complete the described activity?

1.0-90 degrees

2.0-60 degrees

3.0-30 degrees

4.0-20 degrees

2.0-60 degrees

The gait cycle is comprised of a stance phase and swing phase. Each phase has anticipated motion that is expected throughout the cycle for each joint. Stance phase accounts for 60 percent of the gait cycle and swing phase accounts for 40 percent. Many functional activities (e.g., stair climbing) may require more than 60 degrees of knee flexion.

A patient requires 0-60 degrees of knee flexion with gait on a level surface. The greatest amount of knee flexion is required from the initial swing to midswing.

A 28-year-old female with low back pain is referred to physical therapy. The patient indicates that her pain started the previous weekend after painting a ceiling and currently is localized on the left side of her low back. The patient states the pain is better when sitting in a "slouched" posture and is worse during periods of prolonged standing. An examination reveals a positive quadrant test and positive Kemp's test on the left. Based on the presented information, which structures are MOST likely involved?

1.Right thoracic facets

2.Left thoracic facets

3.Left lumbar facets

4.Right lumbar facets

Left lumbar facets

The facet joints are likely to be stressed in positions of spinal extension, especially when combined with a rotation and/or lateral flexion component (e.g., position used when painting overhead). Flexion (i.e., slouched posture) will relieve the pain since pressure is taken off of the facet joints. The quadrant test and Kemp's test are tests which are used to indicate pathology of the facet joints.

During the quadrant test or Kemp's test, the patient extends and laterally flexes or rotates to the side of pain. This causes maximal narrowing of the intervertebral foramen and stress on the facet joint. Since the patient had a positive test when moving to the left, the left lumbar facet joints are likely the source of the pain.

A patient experiences left lower extremity sciatica secondary to posterior derangement of the L5 disk. The patient tolerated a prone on elbows position without an increase in symptoms, however, after performing the exercise shown in the video the patient reports increased radicular pain in the left lower extremity. What would be the physical therapist's MOST appropriate response?

1.Instruct the patient to assume a prone position

2.Instruct the patient to assume a prone on elbows position

3.Instruct the patient to assume a standing extension position

4.Discontinue the extension progression

2.Instruct the patient to assume a prone on elbows position

Centralized pain is often considered to be a positive outcome during an extension progression. Patients may experience discomfort during positioning, however, an increase in radiating symptoms warrants reassessment of the appropriateness of the intervention.

The prone press-up position may have been initiated prematurely. Returning to the non-exacerbating prone on elbows position should assist the therapist to determine how to best proceed with the patient's care (e.g., more time accommodating to prone on elbows position or discontinuing the extension progression).

An individual with declining health due to unhealthy lifestyle choices plans to engage in an independent exercise program designed to improve their cardiovascular health. Which form of self-monitoring would be the MOST appropriate for the individual to utilize when exercising?

1.Metabolic equivalents

2.Systolic blood pressure

3.Rate of perceived exertion

4.Respiration rate

There are a variety of subjective and objective methods available to monitor exercise intensity. The most appropriate method for a given clinical scenario is influenced by a number of variables including measurement purpose, medical status, patient's abilities, setting, and equipment available.

Patients can utilize a perceived exertion scale, such as Borg's Rating of Perceived Exertion (RPE) Scale, as a subjective means of self-monitoring during exercise. The RPE quantifies the subject's overall sense of effort by quantifying the amount of strain or level of exertion the patient is experiencing during activity.

After palpating several peripheral pulse sites a physical therapist concludes that a patient has a strong pulse at the popliteal artery, but a weak pulse at the dorsalis pedis artery. Which medical finding identified during exercise would be MOST likely based on the patient's current status?

1.Orthopnea

2.Deep vein thrombophlebitis

3.Intermittent claudication

4.Venous thrombosis

Intermittent claudication

Palpation of peripheral arteries is used to assess perfusion of the extremities in addition to pulse rate. Patients with diabetes or peripheral vascular disease often have diminished blood flow to the hands and feet and may experience intermittent claudication pain when the circulation is inadequate to meet the metabolic demands of the tissues.

A strong popliteal artery pulse and weak dorsalis pedis artery pulse suggests that blood flow between these sites is diminished, perhaps from atherosclerosis. This patient could be expected to experience intermittent claudication, or pain in the calf muscles caused by ischemia during exercise.

A special test confirms the presence of a sensory disturbance affecting the fourth and fifth digits of the hand. What form of testing would MOST likely have been used to generate the positive test?

1.Resisted testing

2.Tapping

3.Joint mobility testing

4.Reflex testing

Tapping

Testing using Tinel's sign occurs with the patient positioned in sitting with the elbow in slight flexion. The therapist taps directly over the accessible portion of the ulnar nerve at the elbow. A positive test is indicated by a tingling sensation in the ulnar nerve distribution of the forearm, hand, and fingers. A positive test may be indicative of ulnar nerve compression or compromise.

Tinel's sign requires the therapist to tap with the index finger between the olecranon process and the medial epicondyle. A positive test is indicated by a sensory disturbance in the ulnar nerve distribution.

A physical therapist examines the lower extremity of a patient with a transtibial amputation. During the examination the therapist determines the patient has weak (2/5) adductors and normal (5/5) abductors. Based on the patient's clinical presentation, what position might the lower extremity tend to favor in standing?

1.Adduction

2.Abduction

3.Adduction and lateral rotation

4.Abduction and medial rotation

Abduction

Patients status post amputation are especially prone to contracture formation, making patient education on appropriate positioning an integral component of the plan of care. Large discrepancies in the strength of different muscle groups can lead to abnormal positioning of the limbs and the development of contractures.

Due to the relative strength of the abductors in relation to the adductors, the lower extremity would tend to assume an abducted position.

A physical therapist examines a patient diagnosed with suspected arterial occlusive disease. The therapist identifies a number of findings consistent with the diagnosis including absent femoral pulse, dependent rubor, and intermittent claudication in the buttocks, hamstrings, and calf muscles. What is the MOST likely site of occlusion?

1.Iliac artery

2.Femoral artery

3.Popliteal artery

4.Tibial artery

Iliac artery

Occlusive diseases of the blood vessels are a common cause of disability and usually occur secondary to atherosclerosis. Narrowing of the large and medium-sized arteries can cause signs and symptoms such as intermittent claudication with activity, dependent rubor, absent pulses, decreased capillary refill, and pallor with limb elevation.

1.With occlusion of the iliac artery, the femoral pulse and all distal pulses are absent. Claudication is felt in the buttock, hip, thigh, calf, and foot.

A physical therapist reviews the medical record of a patient admitted to a hospital with a restrictive lung disorder. What is the patient's MOST likely diagnosis?

1.Asthma

2.Bronchiectasis

3.Sarcoidosis

4.Chronic bronchitis

Sarcoidosis

Individuals with restrictive lung conditions are unable to fully expand their lungs despite relatively normal airways. This is in contrast to obstructive conditions in which individuals have difficulty exhaling due to either damaged lung tissue or abnormal narrowing of the airways.

Sarcoidosis is a restrictive lung disease in which inflammation occurs in lymph nodes, lungs, liver or other tissues. Over time inflammation produces fibrotic changes in the lung tissue restricting lung expansion and ventilation.

A physical therapist examines a patient diagnosed with an avulsion fracture of the left anterior superior iliac spine. What is the MOST likely scenario associated with this diagnosis?

1.A 14-year-old soccer player who experienced a forceful contraction of the rectus femoris

2.A 13-year-old basketball player who experienced a forceful contraction of the sartorius

3.A 22-year-old sprinter who experienced a forceful contraction of the hamstrings

4.A 40-year-old hockey player who experienced a direct blow to the ilium

A 13-year-old basketball player who experienced a forceful contraction of the sartorius

Physical therapists must be aware of the anatomy of the pelvis and risk factors commonly associated with avulsion fractures. Avulsion fractures typically occur more frequently in skeletally immature athletes since there is relative weakness of the growth plate compared to bone, muscle, and tendon.

A 13-year-old athlete is in a high-risk population for an avulsion fracture and the sartorius originates on the anterior superior iliac spine. An avulsion fracture commonly occurs with vigorous athletic activities, such as basketball, which requires rapid acceleration and deceleration.

A physical therapist instructs a patient with complex regional pain syndrome in a home exercise program. Which of the following is the MOST appropriate intensity and duration guideline for the program?

1.Pain free activities, short periods of time

2.Pain free activities, extended periods of time

3.Exacerbating activities, short periods of time

4.Exacerbating activities, extended periods of time

Pain free activities, short periods of time

A patient with complex regional pain syndrome must utilize pain tolerance to guide interventions in order to avoid symptom exacerbation which can significantly delay healing.

1.Therapeutic activities that are part of a patient's home care routine (e.g., stress loading, desensitization techniques) should be performed frequently, for short periods of time, and to the patient's tolerance. The patient should be encouraged to perform only activities that are pain free in order to limit the risk of symptom exacerbation.

A physical therapist prepares to instruct a patient in diaphragmatic breathing. Which of the following conditions would MOST warrant the use of this intervention?

1.Hyperoxemia

2.Bradypnea

3.Atelectasis

4.Consolidation

Atelectasis

Diaphragmatic breathing is a breathing technique that can decrease the work of breathing by lowering respiratory rate, increasing tidal volume, and decreasing the use of accessory muscles of respiration by facilitating use of the diaphragm. Patient instructions for diaphragmatic breathing are as follows: "Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain as still as possible. Feel your abdomen gently rise into your hand. Exhale through pursed lips; let the hand on your abdomen descend, while the hand on your upper chest remains still."

Atelectasis is a condition in which one or more areas of the lungs collapse or do not inflate properly. Treatment varies based on the cause of the atelectasis, however, it often includes breathing exercises such as diaphragmatic breathing, changing positions, and airway clearance techniques to assist with lung expansion.

A patient is diagnosed with sciatica secondary to a posterior derangement of the L5 disk. After assuming a prone press-up position in a sequence of trunk extension exercises, the patient reports increased centralization of symptoms in the lower back. The physical therapist's MOST appropriate response would be to instruct the patient to do which of the following?

1.Return to a prone position

2.Return to a prone on elbows position

3.Continue to provide feedback regarding symptom changes

4.Discontinue all activities that emphasize extension

Continue to provide feedback regarding symptom changes

Centralized pain is considered a desirable outcome of the end-range loading achieved during a prone press-up. Patients may experience increased discomfort or limited range of motion if the gluteal muscles are not relaxed during this activity. The physical therapist should cue the patient to relax these muscles in order to best delineate symptom reports.

Recession of radicular signs and centralization of pain complaints are considered a positive sign with regard to the described diagnosis. The physical therapist should reassure the patient that centralization of symptoms is desirable and continue to monitor the patient's response.

A 65-year-old female was referred to physical therapy for mobilization of her left wrist. The patient sustained a Colles' fracture eight weeks ago and although the fracture is well healed the patient continues to experience significant wrist stiffness. What technique would be the MOST appropriate to help improve extension at the radiocarpal joint?

1.Glide the lunate and capitate anteriorly in relation to the radius

2.Glide the triquetrum and lunate anteriorly in relation to the head of the ulna

3.Glide the lunate and scaphoid anteriorly in relation to the radius

4.Glide the scaphoid and capitate posteriorly in relation to the radius

Glide the lunate and scaphoid anteriorly in relation to the radius

The radiocarpal joint consists of a convex surface moving on a concave surface. As a result, joint mobilization occurs in the direction opposite the movement of the extremity. Since the purpose of the mobilization is to increase wrist extension (i.e., posterior direction), the force should be in an anterior direction.

The appropriate direction for the mobilization would be anterior. The lunate and scaphoid directly articulate with the radius and would be the most appropriate bones to use when mobilizing the joint.

A physical therapist assists a member of the nursing staff to measure the ankle-brachial index (ABI) of a patient recently admitted to the hospital due to complications from diabetes. After conducting the measurement the ABI is determined to be 1.44. What is the MOST likely interpretation of the test?

1.The patient has moderate arterial insufficiency

2.The patient has arterial calcification

3.The patient has superior peripheral tissue perfusion

4.The patient's ABI is within normal limits

The patient has arterial calcification

The ABI is a measurement which compares the blood pressures of the upper and lower extremities. The measurement is used to assess lower extremity tissue perfusion and the presence of arterial insufficiency.

Arterial calcification is commonly seen in patients with diabetes. When measuring the ABI, the calcification makes it more difficult to compress the arteries resulting in falsely high ABI measurements. ABI values over 1.4 generally indicate that arterial calcification is present.

A physical therapist uses the Braden Scale to quantify a patient's risk for developing a pressure ulcer. After administering the test the therapist determines that the patient scored an eleven. Based on the results, which of the following would BEST characterize the patient's risk for developing a pressure ulcer?

1.At risk

2.Moderate risk

3.High risk

4.Very high risk

High risk

The Braden Scale is a standardized tool for assessing an individual's risk of developing pressure injuries. Individuals are scored in the categories of sensory perception, moisture, activity, mobility, nutrition, and friction/shear. The total scores range from 6-23 with recommended intervention protocols for each established level of risk.

Individuals scoring between 10-12 on the Braden Scale are considered at high risk for developing a pressure ulcer.

A physical therapist administers air to a patient's lungs using a bag-valve-mask resuscitation device. What is the MOST immediate method to determine if the air is reaching its target area?

1.Identify the extent of pupil dilation

2.Determine if the patient's chest is rising

3.Examine the color of the patient's skin

4.Determine if air is escaping from the patient's nostrils

Determine if the patient's chest is rising

Use of the bag-valve-mask requires instruction and practice. The mask should be applied to the face with one hand with the other hand used to compress the bag. Each breath should be delivered over two seconds. It is critical to maintain an airtight seal when delivering each breath.

If sufficient ventilation is being provided using the bag-valve-mask, the patient's chest will visibly rise.

A physical therapist reviews the results of blood glucose testing for a patient with diabetes mellitus. Which value would be MOST representative of the anticipated normal blood glucose value prior to eating a meal?

1.60 mg/dL

2.90 mg/dL

3.160 mg/dL

4.250 mg/dL

90 mg/dL

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar levels that result from defects in insulin secretion, the actions of insulin or both. A blood glucose test measures the amount of glucose in the blood. Glucose comes from carbohydrates and is the main source of energy used in the body.

The anticipated blood glucose level for a patient before a meal (preprandial) is 70-130 mg/dL. A value of 90 mg/dL would fall within the specified range.

A physical therapist examines a two-month-old infant with suspected hip dysplasia. The therapist positions the patient in supine with the hips and knees flexed and moves the lower extremity into abduction using gentle pressure which creates an audible clunking sound. What is the interpretation of this maneuver?

1.A positive Ortolani test

2.A positive Clarke's sign

3.A negative Barlow test

4.A negative tripod sign

A positive Ortolani test

Congenital hip dysplasia, also known as developmental dysplasia, is a condition characterized by malalignment of the femoral head within the acetabulum. The condition typically develops during the last trimester in utero. Testing for this condition may include the Ortolani test, Barlow test, and diagnostic ultrasound.

1.When performing the Ortolani test, the patient is positioned in supine with the hips flexed to 90 degrees and the knees flexed. The therapist abducts the patient's hips and applies gentle pressure to the greater trochanters until resistance is felt at approximately 30 degrees. A positive test is indicated by a click or a clunk and may be indicative of a dislocation being reduced.

A physical therapist examines a patient in an outpatient setting that was recently diagnosed with testicular cancer. The male's appearance is tall with long legs and sparse body hair. The patient notes infertility due to a genetic disorder related to sex chromosomes. What condition is MOST likely responsible for these findings?

1.Turner syndrome

2.Trisomy 13

3.Down syndrome

4.Klinefelter syndrome

Klinefelter syndrome

Klinefelter syndrome is a chromosome disorder that affects the sex chromosomes whereby males are born with an extra X chromosome (XXY). Increased maternal age slightly increases the incidence of this condition.

Klinefelter syndrome is characterized by abnormal body proportions including tall stature, abnormally large breasts, infertility, and sexual issues. This condition increases the risk for breast and testicular cancers, autoimmune disorders, and depression. Lifespan is typically not affected by the syndrome, but can be altered due to certain associated conditions.

A physical therapist works with a patient on vertical positioning using a tilt table. During the session, the patient suddenly begins to demonstrate signs of intolerance to being upright. Which symptom would be LEAST anticipated?

1.Bradycardia

2.Dizziness

3.Nausea

4.Syncope

Bradycardia

A tilt table is a commonly used piece of equipment used for patients who need to acclimate to vertical positioning. The tilt table allows for gradual elevation from a horizontal to an upright position.

1.Bradycardia refers to a sinus rhythm with a heart rate of less than 60 beats per minute. Heart rate is typically significantly higher in a vertical position since the heart has to work against gravity. As a result, the patient would be more likely to exhibit tachycardia.

A physical therapist treats a patient status post biceps tendon repair. The patient complains of continued difficulty lowering a bag of groceries as shown in the video. In this activity, what would the biceps brachii be performing?

1.Cocontraction

2.Concentric contraction

3.Eccentric contraction

4.Isometric contraction

Eccentric contraction

When lowering the bag of groceries from the treatment table to the floor (simulating home kitchen environment), the patient's elbow would be extending, moving from a position of relative elbow flexion to one of relative elbow extension.

An eccentric contraction occurs when the muscle produces tension while lengthening. Since the arm is moving into an extended position, the biceps would be lengthening.

A physical therapist prepares to write a S.O.A.P. note after performing gait training activities with a patient status post total hip arthroplasty. In which section should the statement "I'm getting a little dizzy, I better sit down" be included?

1.Subjective

2.Objective

3.Assessment

4.Plan

Subjective

The S.O.A.P. note is the most commonly used format for writing daily notes. It includes four sections of information: subjective, objective, assessment, and plan.

1.This statement should be included in the subjective section of the S.O.A.P. note. The subjective section contains any statements or reports made by the patient or the patient's caregivers.

A physical therapist has been treating an adolescent with spina bifida for the last four months. Recently the therapist has noticed emerging hypertonicity of the bilateral lower extremities and possible progression of the patient's scoliotic curve. During a recent session the patient mentions that they have been experiencing low back pain and sporadic urinary incontinence. Which pathology is MOST likely based on the patient's clinical presentation?

1.Syringomyelia

2.Tetralogy of Fallot

3.Posterior cord syndrome

4.Tethered cord syndrome

Tethered cord syndrome

A physical therapist should be familiar with the typical clinical presentation of a variety of medical conditions. This knowledge can assist the therapist to implement an effective plan of care based on the unique needs of the patient or determine that consultation is required.

Tethered cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. These attachments cause an abnormal stretching of the spinal cord causing metabolic changes and ischemia of the neural tissue. Rapid progression of scoliosis and increased tone are cardinal signs of tethering of the spinal cord. Once suspected, myelography is required to confirm the diagnosis. Surgical release is recommended in most cases as soon as the patient is diagnosed in order to avoid permanent neurological damage. This disorder is closely linked to spina bifida.

A physical therapist prepares to apply a triangular bandage to a patient. Which medical diagnosis would be the MOST likely based on the type of bandage utilized?

1.Lymphedema

2.Shoulder subluxation

3.Transtibial amputation

4.Lateral ankle sprain

Shoulder subluxation

A triangular bandage is a large piece of cloth cut or formed into a triangle. The bandage is most often used as a temporary sling to support the weight of a patient's upper extremity.

A shoulder subluxation involves a temporary, partial dislocation of the shoulder. The injury may result in significant pain and difficulty actively moving the arm. As a result, immobilization using a triangular bandage may be desirable.

A 30-year-old female is seen in physical therapy secondary to benign paroxysmal positional vertigo. Which of the following physical therapy treatments would MOST benefit this patient?

1.Dix-Hallpike maneuver

2.Canalith repositioning maneuvers

3.Singular neurectomy

4.Gaze stability exercises

Canalith repositioning maneuvers

Benign paroxysmal positional vertigo (BPPV) is an intense and intermittent vertigo that occurs in relation to rapid movement of the head in a particular direction. The condition is believed to be a mechanical disorder of the labyrinths. Canaliths develop and float into the semicircular canals causing the brain to interpret their presence as an intense rotation of the head.

Canalith repositioning maneuvers are a highly effective treatment for BPPV and are designed to dislodge the provoking canaliths. This treatment technique attempts to move the canalith debris out of the affected semicircular canal and back to the otolith. Canalith repositioning maneuvers begin in the Dix-Hallpike position to provoke vertigo. Repeated head rolling utilizes gravity to assist with movement of the debris. Treatment continues until no further nystagmus is noted.

The muscles of the pelvic floor support and maintain the position of the bladder, uterus, and rectum within the pelvic cavity. Which ligament also assists in maintaining the position of the uterus?

1.Suspensory ligament

2.Ovarian ligament

3.Inguinal ligament

4.Round ligament

Round ligament

In the pelvic cavity, the position of the uterus is maintained by the broad, round, and uterosacral ligaments. The broad ligaments attach to the lateral borders of the uterus and extend to the pelvic walls. The round ligament attaches to the side of the uterus, below the uterine tube, and extends to the labia majora. The uterosacral ligaments attach to the posterior uterus and extend to the deep fascia and sacral periosteum.

The round ligament attaches to the side of the uterus, below the uterine tube, extending to the labia majora. The ligament functions to maintain the fundus of the uterus in a forward position.

A patient diagnosed with uterine cancer is referred to physical therapy for general deconditioning associated with a recent hysterectomy and the effects of radiation. During a treatment session, the patient reports that her right ankle has been noticeably more swollen than her left ankle since completing radiation. What is the MOST likely cause of the patient's observation?

1.Right-sided heart failure

2.Secondary lymphedema

3.Left-sided heart failure

4.Cyclic idiopathic edema

Secondary lymphedema

Physical therapists must be aware of the potential secondary effects of common medical interventions in order to identify relevant developments that influence the patient's health status.

Oncology interventions including surgery, chemotherapy, and radiation are all known to be potentially disruptive to the lymphatic system.

A physical therapist attempts to assess the patency of a patient's airway who appears to be in distress. Which emergent condition would be MOST likely to make this type of assessment essential?

1.Fracture

2.Autonomic dysreflexia

3.Allergic reaction

4.Heat exhaustion

Allergic reaction

Physical therapists must be familiar with commonly encountered signs and symptoms of emergent medical conditions. Early identification of these signs and symptoms allows quick and decisive action that reduces the probability of an adverse safety event.

A severe allergic reaction may include swelling of the face or mouth, difficulty swallowing or speaking, wheezing and difficulty breathing, chest tightness, altered mental status, and dizziness or syncope. Common allergens include pollen, dust, eggs, shellfish, milk, wheat, soy, nuts, insect stings, chemicals, latex, and medications. Although the allergic reaction may be non life-threatening, checking the airway remains a critical action with any identified allergic reaction. If the airway is compromised, it is necessary to contact emergency medical services and begin cardiopulmonary resuscitation.

A physical therapist works with a patient diagnosed with postural dysfunction who presents with cervical pain and tightness of the upper trapezii. The patient's job requires her to complete a minimum of six hours of data entry on a computer each day. Which modification to the patient's work environment would potentially be the MOST beneficial?

1.Raise the keyboard

2.Lower the keyboard

3.Rest the feet flat on the floor

4.Rest the feet on a foot stool

Lower the keyboard

Physical therapists should be aware of common adaptations to the work environment to achieve a particular therapeutic outcome

Lowering the keyboard would likely prevent shoulder elevation and place the upper trapezii in a relaxed, lengthened position.

A physical therapist designs a research study that examines the influence of a selected training program on cardiovascular endurance. The therapist determines it will be necessary to utilize a control group. What is the PRIMARY purpose of the control group?

1.Serve as a baseline for controlling the effects of the manipulated variable

2.Function to minimize the probability of a Type I error

3.Eliminate the need for a systematic random sample

4.Ensure reliability and validity of collected data

Serve as a baseline for controlling the effects of the manipulated variable

Randomized controlled trials are an accepted way to determine whether an experimental intervention has a significant effect on individuals who receive the new treatment compared to a control group who may receive a standard treatment, no treatment, a placebo, or a sham treatment.

1.The use of a control group is the most effective experimental design for establishing a cause and effect relationship between a treatment (independent variable) and response (dependent variable).

A physical therapist prepares to apply a pneumatic intermittent compression device to a patient diagnosed with venous insufficiency. When applying the device to an extremity, what should the therapist NOT set the pressure of the unit above?

1.Patient's diastolic blood pressure

2.Patient's systolic blood pressure

3.Difference between the patient's diastolic and systolic blood pressure

4.Patient's resting heart rate

Patient's diastolic blood pressure

Venous insufficiency is characterized by an accumulation of fluid in the periphery as a result of lack of physical activity, dysfunction of the venous valves or mechanical obstruction of the veins. Intermittent compression can be effectively used to reduce peripheral edema by assisting to increase venous return to the heart. Most compression units deliver between 30 and 120 mm Hg of inflation pressure.

1.It is recommended that inflation pressure not exceed a patient's diastolic blood pressure since higher pressures may impede arterial circulation. However, inflation pressures must be at least 30 mm Hg, as pressures below this level will not likely affect circulation.

A 66-year-old male status post right CVA is working on activities using the left upper extremity. The patient has minimal movement throughout the extremity and presents with mild left neglect. He can perform gross flexor movements, but does not exhibit active extension of the elbow, wrist, and hand. What should the therapist do when working with the patient?

1.Sit on the right side of the patient to assure that he is attending to the session

2.Avoid providing tactile cues to the patient's involved hand and arm

3.Encourage the patient to look at his left extremity while performing therapeutic activities

4.Compensate by using the right upper extremity instead of the left

Encourage the patient to look at his left extremity while performing therapeutic activities

Strategies that direct the patient's attention to his left side may be effective in reducing the patient's neglect. Visual feedback may provide the patient with useful sensory information regarding movement and use of the involved upper extremity.

When encouraging the patient to look at his left extremity during therapeutic activities, the therapist is addressing the left neglect. As the patient performs interventions to address neglect, it is better to perform particular functional tasks using the left side as opposed to solely reminding the patient to look to the involved side.

A patient is observed using a toothbrush as an eating utensil as shown in the video. Which condition is MOST commonly associated with this type of clinical presentation?

1.Anomia

2.Visual object agnosia

3.Impaired figure ground

4.Cortical blindness

Visual object agnosia

Cortical lesions result in typical perceptual deficits based on the location of the lesion. Common perceptual deficits include agnosia, apraxia, spatial relation disorders, and body image disorders. These deficits often have significant effects on the performance of activities of daily living, such as the ability to use a toothbrush.

Visual object agnosia is the inability of the patient to name, describe or demonstrate the use of an object and is the most common form of agnosia. If the patient had been able to describe and demonstrate the use of the toothbrush, anomia would have been the better option.

A patient who will be undergoing a total mastectomy considers her breast reconstruction options. She reports favoring the procedure that uses her own abdominal muscle and tissue to reconstruct the breast. Which of the following is the MOST likely complication associated with this method of reconstruction?

1.Restricted trunk mobility due to shortened abdominal tissue

2.Necrosis at the donor site due to inadequate blood supply

3.Reduced shoulder mobility due to the muscle flap attachment

4.Low back pain due to weakened abdominal support

4.Low back pain due to weakened abdominal support

The transverse rectus abdominis myocutaneous (TRAM) flap procedure can be performed during the same surgical encounter as the mastectomy and is a widely used option for autogenous breast reconstruction. The cosmetic outcome is similar to an abdominoplasty because the abdominal tissue is used to reconstruct the new breast.

The patient does lose a substantial portion of the structural support of the abdomen since a significant portion of the abdominal tissue is removed. As a result, low back pain due to trunk instability and abdominal hernia due to reduced anterior support are common complications of a TRAM flap procedure.

A physical therapist performs a series of lower extremity manual muscle tests on a patient with suspected unilateral weakness. The therapist preforms one of the tests as depicted in the video. The position is MOST appropriate for testing which of the following?

1.Biceps femoris

2.Gluteus medius

3.Gluteus maximus

4.Hamstrings

Gluteus maximus

Physical therapists should be aware of standard methods for assessing muscle strength including recommended positioning for specific muscles. Manual muscle testing can be useful for both differential diagnosis and the treatment of musculoskeletal and neuromuscular conditions.

The gluteus maximus is tested with the patient positioned in prone. The knee is flexed to 90 degrees or more with the hip extended. Knee flexion allows the therapist to better isolate the muscle by placing the hamstrings on slack. The therapist applies pressure against the lower portion of the posterior thigh in the direction of hip flexion.

A physical therapist treats a five-year-old child immediately before having a new lower leg cast applied. The child has had a new cast each week for the last four weeks. Which medical condition would MOST likely warrant this type of intervention?

1.Wilson's disease

2.Down syndrome

3.Cerebral palsy

4.Phenylketonuria

.Cerebral palsy

Serial casting is a casting technique that is used to improve range of motion at a joint that has developed a contracture. The procedure consists of placing the joint in a submaximal position and then applying a cast. After wearing the cast for a period ranging from several days to a week, it is removed. With each round of casting, the joint should make modest range of motion gains (e.g., 5-7 degrees). Serial casting can last for a few weeks or several months depending on the extent of the contracture and the relative success of the intervention.

Cerebral palsy is an umbrella term used to describe movement disorders due to brain damage that are non-progressive and are acquired in utero, during birth or during infancy. The brain damage decreases the brain's ability to monitor and control nerve and voluntary muscle activity. Abnormal muscle tone, decreased range of motion, and contractures are extremely common with cerebral palsy, making serial casting a viable intervention.

A 36-year-old female who gave birth to three children over the span of nine years is referred to physical therapy during her fourth pregnancy. The patient presents with complaints of involuntary urine leakage when she coughs or sneezes and when she participates in an aerobics class. Which type of incontinence is MOST consistent with the described presentation?

1.Urge

2.Overflow

3.Functional

4.Stress

Stress

Urinary incontinence is defined as an involuntary loss of urine from the bladder. Muscle weakness, neurological disorders, and limited functional abilities are most commonly reported as causative factors.

Stress incontinence is characterized by the inability to hold urine during activities that increase intra-abdominal pressure, such as coughing, sneezing or exercising. Stress incontinence is typically the result of weak or poorly coordinated pelvic floor musculature.

A 62-year-old female with a transtibial amputation is examined in physical therapy. The patient has been using a roll-on silicone liner inside of her prosthesis. What is a potential disadvantage of this type of liner?

1.Increased shear force on the residual limb

2.Reduced padding over bony prominences

3.Potential trauma to the suture line

4.Heat buildup, especially in warmer climates

Heat buildup, especially in warmer climates

The silicone liner does not breathe as well as the fabric shrinker and therefore heat build up can be problematic. The silicone liner allows for a roll-on design that is usually less traumatic to the suture line and more effective in controlling edema.

Silicone liners do not breathe as well as a fabric shrinker and as a result tend to produce a buildup of heat, especially in warmer climates.

A physical therapist administers cardiopulmonary resuscitation (CPR) to a patient who collapsed in the waiting area. The therapist is unable to establish a pulse after three cycles of CPR and therefore prepares to utilize an automated external defibrillation unit (AED). Which action would be the LEAST appropriate when using the device?

1.Wipe the patient's chest dry

2.Apply the pads to the patient's bare chest

3.Analyze the patient's heart rhythm

4.Ask another therapist to stabilize the patient's head when administering the electric shock

Ask another therapist to stabilize the patient's head when administering the electric shock

A patient's chances of survival after cardiac arrest are dramatically increased through early CPR and AED use. An AED unit can analyze a patient's heart rhythm and deliver a shock if necessary. Certain procedures for AED use must be followed to ensure the safety of the rescuers and bystanders.

Asking another therapist to stabilize the patient's head when administering the electric shock could be harmful since the patient would act as an energy pathway, transmitting the shock to the therapist.

A physical therapist employed in an acute care hospital works with a patient three days status post abdominal surgery. While working bedside with the patient on lower extremity exercises in supine, the patient complains of mild dizziness, fatigue, and nausea. What is the MOST immediate physical therapist action?

1.Take the patient's vital signs

2.Assist the patient to a sitting position

3.Contact the supervising physical therapist

4.Call a code

Take the patient's vital signs

Complaints of mild dizziness, fatigue, and nausea are relatively common following surgery and, in the absence of additional complaints, would not be considered signs of an emergent condition. A physical therapist should be able to delineate signs and symptoms of emergent conditions versus usual and expected responses in acute care settings.

1.Physical therapists should recognize common signs and symptoms associated with potentially emergent conditions. This patient's symptoms are not unexpected; by taking the patient's vital signs, further objective data can be obtained to clarify if assistance is needed.

An eight-year-old child begins a trial of serial casting. Which clinical finding would BEST support the use of this type of intervention?

1.Delayed bone healing

2.Insufficient muscle strength

3.Limited range of motion

4.Inadequate bone density

Limited range of motion

Serial casting is a casting technique that is used to improve range of motion at a joint that has developed a contracture. The procedure consists of placing the joint in a submaximal position and then applying a cast. After wearing the cast for a period ranging from several days to a week, it is removed. With each round of casting, the joint should make modest range of motion gains (e.g., 5-7 degrees).

Serial casting is primarily used when a muscle is too short (i.e., lacks the necessary flexibility) to allow functional or fluid movement. The joint is typically casted so that tension is applied to the muscle. Over time the muscle may become longer and allow for improved range of motion.

A physical therapist works with a female patient who is in her third trimester of pregnancy. The patient complains of persistent low back pain, radiating from the sacrum to the hip joint along the sciatic nerve distribution. The therapist determines that tightness in the right piriformis muscle is contributing to the patient's discomfort. In order to stretch the muscle, the patient should be positioned on the patient's left side with the affected hip in what position?

1.Medial rotation and adduction

2.Lateral rotation and adduction

3.Medial rotation and abduction

4.Lateral rotation and abduction

Medial rotation and adduction

The standard position to stretch the piriformis can be modified to accommodate for the physical limitations of pregnancy. Supine stretching is inappropriate for women who are beyond their first trimester of pregnancy due to the weight of the uterus compressing the vena cava and limiting blood flow. The vena cava lies slightly to the right of midline making left sidelying the position of choice to avoid vena cava compression.

1.The piriformis assists in laterally rotating and abducting the thigh, therefore stretching would be performed in the directions of medial rotation and adduction. Tightness or spasm in the piriformis can compress the sciatic nerve causing pain in the described distribution along the low back and buttocks.

A physical therapist employed by a home health agency receives a new referral for a 27-year-old male with a traumatic brain injury. During the examination the patient becomes combative and appears to be extremely agitated. The therapist and the patient's spouse attempt to calm the patient for approximately ten minutes without any success. What is the MOST immediate therapist action?

1.Continue with the examination as planned

2.Attempt to condense the remaining portion of the examination

3.Document the patient's behavior in the medical record

4.Discontinue the treatment session

Discontinue the treatment session

Some patients with traumatic brain injuries exhibit varying levels of agitation and may become combative. For example, a patient classified as Level IV - Confused Agitated on the Rancho Los Amigos Level of Cognitive Functioning Scale is often emerging from a coma and may experience a period of acute post-traumatic agitation. The confusion and disorientation often results in agitation, aggression, noncompliance, and combative behavior. Although this clinical presentation may be "normal," the therapist must take steps to ensure their own safety as well as the safety of the patient.

Because of the patient's combative behavior, it is important for the therapist to discontinue the treatment session. Acting in this manner minimizes the safety risk for all involved parties.

Various assessment tools are used within physical therapy to assess patient prognosis, progression, disease severity, and other patient characteristics. Many assessment tools can be administered to multiple, if not all, patient populations. However, there are some that are disease or population specific.

The Hoehn and Yahr Scale is a classification system specifically designed to stage the functional disability of patients diagnosed with Parkinson's disease. It is used primarily to measure the progressions and severity of the disease through various stages. This scale has five stages, with stage 1 representing early stage Parkinson's disease and stage 5 representing advanced stage Parkinson's disease.

A physical therapist guards a patient that is descending a flight of stairs with handrails. The patient has left lower extremity weakness due to a tibial plateau fracture eight weeks ago. Assuming the patient descends the stairs according to the normal flow of traffic, what is the MOST appropriate therapist position when guarding the patient?

1.Beside the patient on the involved side

2.Beside the patient on the uninvolved side

3.In front of the patient on the uninvolved side

4.In front of the patient on the involved side

In front of the patient on the involved side

When working on stair navigation with a patient, the therapist must position themselves to ensure the safety of the therapist and the patient in the case of a fall. Whether ascending or descending, the therapist should stand with a staggered stance 1-2 steps down from where the patient is standing. It is generally suggested that the therapist stand on the patient's weaker side, although this will depend on where the handrails are located.

When descending the stairs, the therapist should stand in front of the patient. Since the patient is descending the stairs with the railing on the uninvolved side, it is most appropriate for the therapist to stand on the involved side.

A physical therapist works with a patient recently admitted to a rehabilitation hospital. During the initial session the therapist notes that the patient has significant difficulty with language to the extent that it is extremely difficult for the patient to convey even basic information. Which patient profile would MOST likely exhibit the described finding?

1.A 63-year-old female status post right CVA

2.A 41-year-old female diagnosed with Guillain-Barre syndrome

3.A 32-year-old male with a traumatic brain injury presently classified as confused-appropriate

4.A 52-year-old male status post left CVA

Aphasia is the general term used to describe an acquired communication disorder and is characterized by an impairment in language comprehension, formulation, and/or use. Depending on the location of the lesion, the patient can present with fluent, non-fluent, or global aphasia.

Since the language centers are typically located in the left hemisphere, patients status post left CVA will often have impairments in language.

A physical therapist works with a patient who has a right transtibial and a left transfemoral amputation. The patient is learning to walk up and down stairs with bilateral prostheses. When teaching the patient, which lower extremity should lead when ascending and descending stairs?

1.Transtibial prosthesis when ascending and descending

2.Transfemoral prosthesis when ascending and descending

3.Transtibial prosthesis when ascending, and the transfemoral prosthesis when descending

4.Transfemoral prosthesis when ascending, and the transtibial prosthesis when descending

Transtibial prosthesis when ascending, and the transfemoral prosthesis when descending

With a transtibial amputation, the quadriceps muscle is still intact and functioning. A patient with a transtibial amputation should be able to produce knee extension when ascending stairs and control knee flexion when descending stairs. This is not true for a patient with a transfemoral amputation.

Since the transtibial limb is the only limb which has a functioning quadriceps muscle, the patient should ascend leading with the transtibial prosthesis and descend leading with the transfemoral prosthesis.

A physical therapist instructs a physical therapist assistant to perform neuromuscular electrical stimulation to the wrist extensors of a patient rehabilitating from a wrist injury. After setting up the patient according to the specified parameters provided by the physical therapist, the physical therapist assistant believes the muscle contraction produces too much radial deviation and insufficient wrist extension. What is the MOST appropriate physical therapist assistant action?

1.Increase the current intensity

2.Reposition the electrodes

3.Alter the wave form of the current

4.Discuss the situation with the supervising physical therapist

Reposition the electrodes

A physical therapist assistant is a technically educated health care provider who assists the physical therapist in the provision of physical therapy services. A physical therapist assistant can modify the parameters of an existing intervention within the established plan of care.

Repositioning the electrodes to improve motor recruitment would be the most appropriate option to produce the desired action. Small changes in the location of a surface electrode can significantly influence the quality and direction of movement.

A physical therapist administers an ultrasound treatment using water immersion on a patient rehabilitating from ankle surgery. During the session the therapist notices that air bubbles tend to accumulate on the sonated area of the skin and face of the soundhead. What is the MOST appropriate therapist action?

1.Wipe off the air bubbles on the skin periodically

2.Wipe off the air bubbles on the face of the soundhead periodically

3.Wipe off the air bubbles on the skin and face of the soundhead periodically

4.Avoid wiping off any of the air bubbles

Wipe off the air bubbles on the skin and face of the soundhead periodically

Water immersion is an indirect coupling method requiring the treatment area to be immersed in a basin of water. The transducer should be moved parallel to the treatment surface at a distance of 0.5 - 3 centimeters away from the skin. Indirect coupling techniques are often employed when the treatment area is irregularly shaped or unable to tolerate direct pressure from the transducer.

Air bubbles occurring on the transducer and the patient's skin should be wiped away by the therapist since they will interfere with ultrasound transmission.

A physical therapist demonstrates a D2 flexion proprioceptive neuromuscular facilitation pattern to a patient rehabilitating from an upper extremity injury. As the patient begins the activity, the therapist quickly concludes the patient is growing increasingly confused. Which verbal instruction would be the MOST appropriate to assist the patient to complete the activity correctly?

1.Open your hand and push down and away from your body

2.Open your hand and pull up and away from your body

3.Close your hand and pull up and across your body

4.Close your hand and pull down and across your body

Open your hand and pull up and away from your body

Proprioceptive neuromuscular facilitation (PNF) is an approach to therapeutic exercise which combines functional patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control. There are four diagonal patterns used for both the upper and lower extremities.

This is the correct command used for D2 flexion, which consists of shoulder flexion, abduction, and external rotation; forearm supination; and wrist and finger extension.

A physical therapist reviews the medical record of a patient recently admitted to physical therapy after being diagnosed with adhesive capsulitis. The patient describes an insidious onset of pain and stiffness approximately three months ago. Which patient profile would be MOST likely based on the medical diagnosis?

1.A 58-year-old female with multiple sclerosis

2.A 45-year-old male with peripheral neuropathy

3.A 52-year-old male with a history of recurrent rotator cuff tendonitis

4.A 48-year-old female with diabetes

A 48-year-old female with diabetes

Adhesive capsulitis is characterized by the loss of motion at the glenohumeral joint followed by a gradual stiffness. The condition is most common in individuals between the ages of 40 to 60 with a slightly higher incidence in females. Although largely idiopathic in etiology, persons with conditions such as diabetes, hyperthyroidism, upper extremity paresis, brachial plexus injury, Parkinson's disease, and repetitive strain injuries of the shoulder have a higher overall incidence of adhesive capsulitis.

Three risk factors, age, sex, and diabetes, are represented in this patient profile making it most likely to be associated with a diagnosis of adhesive capsulitis.

A physical therapist is working with a patient who recently had a left middle cerebral artery stroke. Currently, the patient demonstrates minimal active movement on the right side and is having extreme difficulty moving in bed. Which of the following strategies would be MOST useful when initially teaching the patient to roll from supine to left sidelying?

1.Provide detailed verbal cues

2.Use part-practice

3.Avoid knowledge of performance feedback

4.Provide feedback on 100% of the practice trials

Use part-practice

There are several aspects of motor learning which must be considered when teaching a patient a new skill. Some of these motor learning components include type and level of feedback (e.g., knowledge of results, faded feedback), type of cues used (e.g., tactile, verbal), and practice conditions (e.g., massed, blocked, part training).

The use of part practice would be an effective strategy to use, especially since rolling in bed is a task that can easily be broken up into a number of steps. Part practice is useful because it allows the patient to master each step before learning the entire task.

A physical therapist talks with a mother holding her three-month-old infant. During the conversation the mother loses control of the baby's head, suddenly dropping it into extension. What reflex would this action MOST likely elicit?

1.Moro

2.Grasp

3.Tonic labyrinthine

4.Extensor thrust

Moro

Primitive reflexes are normally present during infancy and become integrated by the central nervous system at an early age. Therapists should recognize common primitive reflexes and be aware of the typical age of onset and the age of integration.

1.The Moro reflex is stimulated by a sudden change in the position of the head relative to the trunk. The response is extension and abduction of the arms, hand opening, and crying, followed by flexion and adduction of the arms across the chest. The response begins at 28 weeks of gestation and is typically integrated between five and six months of age.

A physical therapist instructs a patient rehabilitating from a flexor tendon repair to perform the strengthening exercise depicted in the video. What is the PRIMARY objective of this activity?

1.Stretch the lumbricales

2.Stretch the interossei

3.Strengthen the lumbricales

4.Strengthen the interossei

Strengthen the interossei

The lumbricales and interossei are part of the intrinsic muscles of the hand. The lumbricales primarily act to move the digits in the sagittal plane, while the interossei primarily act to move the digits in the frontal plane.

The interossei, specifically the dorsal interossei, act to abduct the index, middle, and ring fingers from midline through the third digit. Providing resistance to abduction would help strengthen the dorsal interossei.

A physical therapist administers an ultrasound treatment to the low back of a patient recently referred to physical therapy. During the treatment the patient suddenly complains of "hot spots" directly under the ultrasound transducer. Which ultrasound parameters are MOST likely to produce this type of subjective complaint?

1.Stationary technique, high beam nonuniformity ratio

2.Dynamic technique, low beam nonuniformity ratio

3.Stationary technique, low beam nonuniformity ratio

4.Dynamic technique, high beam nonuniformity ratio

Stationary technique, high beam nonuniformity ratio

The stationary and dynamic techniques refer to the amount of movement of the soundhead during an ultrasound treatment. The beam nonuniformity ratio (BNR) refers to the ratio of the intensity of the highest peak to that of the average intensity of all peaks.

1.The stationary technique encourages the occurrence of painful hot spots due to the lack of movement of the soundhead. A high BNR results in a greater intensity of the highest peaks and increases the probability that patients will experience painful hot spots.

During auscultation of a patient's chest, a physical therapist hears diminished breath sounds. To help confirm that the lung segment is not fully aerated, how does the therapist decide to test egophony?

1.Palpating the patient's trachea

2.Measuring the excursion of the patient's diaphragm

3.Auscultating over the lung segment while the patient whispers "1, 2, 3"

4.Auscultating over the lung segment while the patient speaks the sound "EEE"

Auscultating over the lung segment while the patient speaks the sound "EEE"

When a pathologic condition of the lungs is suspected because of the increased or decreased transmission of breath sounds, further evaluative measures are recommended.

Egophony is demonstrated when the patient says the long E sound, but the sound that is heard on auscultation is the long A sound. The change in the quality of the sound occurs due to the increase in density of lung tissue due to consolidation from atelectasis, secretions, or some other abnormality.

A physical therapist working with a college basketball team observes a player unexpectedly fall to the ground after making a jump shot. The therapist suspects the player has ruptured his Achilles tendon. When screening the patient, which special test would be the MOST appropriate?

1.O'Brien needle test

2.Anterior drawer test

3.Thompson test

4.Homans' sign

3.Thompson test

A physical therapist must have knowledge of special tests that may be utilized within their scope of practice to assist in making or ruling out a clinical diagnosis when injury is suspected.

The Thompson test assists a physical therapist in making a clinical diagnosis when an Achilles tendon rupture is suspected. The patient is positioned in prone and asked to relax as the therapist squeezes the muscle bellies of the gastrocnemius and soleus. A positive test is indicated by the absence of plantar flexion.

A physical therapist applies a custom fabricated hand splint to a patient that sustained a burn to his right wrist and hand. The splint maintains the wrist in extension, the metacarpophalangeal joints in 75 degrees of flexion, the proximal and distal interphalangeal joints in flexion, and the thumb in abduction. Based on the supplied description of the splint, which area would be MOST susceptible to contracture?

1.Wrist

2.Metacarpophalangeal joints

3.Proximal and distal interphalangeal joints

4.Thumb

Joints are prone to predictable patterns of contracture following a burn-related injury. Hand splints can be made to help position the hand and wrist so that contracture formation will not occur. These splints are characterized by wrist extension, metacarpophalangeal joint flexion, interphalangeal joint extension, and thumb abduction.

The proximal and distal interphalangeal joints are prone to flexion contractures. As a result, the hand splint should place these joints in extension to avoid susceptibility to a flexion contracture.

A physical therapist completes crutch training with a patient who has recently sustained an Achilles tendon rupture. The patient comments that he is trying to decide between undergoing surgical repair of the tendon or pursuing conservative treatment. Which statement is MOST accurate with regard to anticipated outcomes?

1.Surgically managed ruptures typically result in the achievement of higher functional levels and an increased incidence of reinjury.

2.Surgically managed ruptures typically result in the achievement of higher functional levels and a decreased incidence of reinjury.

3.Conservatively managed ruptures typically result in the achievement of higher functional levels and an increased incidence of reinjury.

4.Conservatively managed ruptures typically result in the achievement of higher functional levels and a decreased incidence of reinjury.

Surgically managed ruptures typically result in the achievement of higher functional levels and a decreased incidence of reinjury.

A physical therapist should possess knowledge of the anticipated outcomes associated with various management options for commonly occurring conditions such as an Achilles tendon rupture. This knowledge will assist the therapist in setting appropriate treatment goals and educating the patient regarding realistic outcome expectations.

A surgically managed Achilles tendon rupture will typically allow patients to maximize function while diminishing the risk of reinjury.

A 23-year-old male sustains serious burns to over 30% of his body in a house fire. The burns range from superficial partial-thickness to full-thickness and encompass the majority of the patient's lower extremities. What is the MOST appropriate therapeutic position for the patient?

1.Supine with the knees extended and the toes pointing toward the ceiling

2.Prone with a pillow placed on the dorsum of the feet and ankles

3.Sidelying with the hips and knees slightly flexed using pillows between the legs

4.Hooklying with a pillow placed between the knees

Supine with the knees extended and the toes pointing toward the ceiling

The primary goal of positioning for patients with severe burns is to prevent contractures due to hypertrophic scarring and immobility. As a general rule, joints should be positioned with consideration of future function and in the direction opposite the anticipated direction of contracture.

1.Positioning the patient in supine with the knees extended and the toes pointing toward the ceiling maintains the hips, knees, and ankles in an optimal position and therefore reduces the likelihood of lower extremity contracture.

A patient referred to physical therapy complains of medial knee pain particularly during functional activities. Which condition would MOST likely be associated with pain in this region?

1.Tibial apophysitis

2.Pes anserine bursitis

3.Iliotibial band syndrome

4.Baker's cyst

Pes anserine bursitis

The ability of the patient to localize the pain in an area consistent with the hypothesized medical diagnosis assists the therapist to determine the effectiveness of physical therapy interventions.

Pes anserine bursitis refers to inflammation of the bursa located at the common insertion of the tendons of the sartorius, gracilis, and semitendinosus muscles on the anteromedial portion of the superior tibia. The bursa separates the conjoined tendons from the surface of the tibia. Patients with pes anserine bursitis typically report pain in the immediate area of the bursa.

A physical therapist is treating a patient with a head injury using a proprioceptive neuromuscular facilitation technique to enhance coordination and strength during gait. The therapist has the patient ambulate within the parallel bars while applying resistance to the pelvis during the gait cycle. What does this technique BEST describe?

1.Rhythmic initiation

2.Resisted progression

3.Repeated contractions

4.Hold-relax active movement

Resisted progression

Proprioceptive neuromuscular facilitation (PNF) emphasizes manual contacts and handling techniques. Various PNF exercises focus on levels of motor control including mobility, stability, controlled mobility, and skill. The therapist must utilize a PNF technique that meets the established goals and objectives.

Resisted progression is a technique used to emphasize coordination of proximal components specifically during gait. Resistance is applied to an area such as the pelvis or hips during the gait cycle in order to enhance coordination, strength or endurance. Resisted progression is a PNF exercise utilized at the skill level of motor control.

As part of a reassessment for a patient with a Colles' fracture, a physical therapist measures wrist range of motion. The therapist positions the patient in sitting with the involved extremity supported on a treatment plinth. To measure wrist ulnar deviation, what should the movable arm of the goniometer be aligned with?

1.Third metacarpal

2.Capitate

3.Triquetrum

4.Radial styloid process

Third metacarpal

To measure ulnar deviation, the patient should be positioned next to a supporting surface with the shoulder abducted to 90 degrees and resting on the surface. The elbow should be flexed to 90 degrees with the forearm pronated so that the palm is facing the ground. The radius and ulna should be stabilized to prevent compensatory movements at other joints. Normal wrist ulnar deviation range of motion is 30 degrees.

1.The dorsal midline of the third metacarpal should be used to align the movable arm of the goniometer when measuring ulnar deviation.

A physical therapist examines a patient referred to physical therapy with a prescription that reads "evaluate and treat - status post left knee sprain with resultant left lower extremity weakness." While taking a patient history, the therapist identifies complaints of lower extremity weakness, vertigo, visual disturbance, paresthesias in the lower extremities, fatigue, and urinary bladder disturbances. What are these findings MOST consistent with?

1.Lyme disease

2.Parkinson's disease

3.Multiple sclerosis

4.Rheumatoid arthritis

Multiple sclerosis

As part of the examination process, a physical therapist may need to screen for medical disease. To ensure effective and efficient physical therapy treatment, therapists should be able to recognize the signs and symptoms of diseases which may mimic neuromuscular or musculoskeletal conditions.

Multiple sclerosis is a chronic progressive demyelinating disease of the central nervous system characterized by exacerbation of symptoms followed by remissions. Symptoms include visual impairments, muscle weakness, paresthesias, vertigo, fatigue, ataxia, speech impairment, and bowel and bladder dysfunctions.

While evaluating a patient diagnosed with cervical radiculopathy, a physical therapist discovers that a patient cannot differentiate between sharp and dull on the tip of his right thumb. Based on this information, which dermatome would the therapist anticipate being MOST affected?

1.C4

2.C5

3.C6

4.C7

C6

Inability to differentiate sharp and dull sensations may indicate pathology of the nerve root or disk. Sensory disturbances will typically follow patterns of the dermatomal map based on the affected spinal nerve.

The C6 dermatome covers the anterior arm and the radial side of the hand to the thumb and index finger.

A physical therapist administers an electrotherapy treatment for the purpose of muscle reeducation. According to the strength duration curve, which of the following BEST describes the order of nerve fiber recruitment as the amplitude is increased?

1.Motor nerve fibers, sensory nerve fibers, pain nerve fibers

2.Pain nerve fibers, motor nerve fibers, sensory nerve fibers

3.Sensory nerve fibers, motor nerve fibers, pain nerve fibers

4.Motor nerve fibers, pain nerve fibers, sensory nerve fibers

Sensory nerve fibers, motor nerve fibers, pain nerve fibers

The amount of electrical current required to produce an action potential varies with the specific type of nerve fiber and can be represented by the nerve fiber's strength-duration curve.

Sensory fibers require the lowest amplitude to depolarize and pain fibers require the greatest amplitude to depolarize. This sequence (i.e., sensory, motor, pain) is correct as amplitude is increased.

A physical therapist examines the skin of a 42-year-old patient diagnosed with multiple sclerosis. The therapist identifies a pressure ulcer approximately two centimeters in diameter near the patent's left ischial tuberosity. The ulcer looks like an abrasion and appears to involve the entire epidermis. Which ulcer stage is MOST consistent with the described clinical presentation?

1.I

2.II

3.III

4.IV

II

Based on the system created by the National Pressure Ulcer Advisory Panel, pressure ulcers are staged based on their depth and type of tissue damage observed. Pressure ulcers are documented as either stage I, II, III, IV or unstageable.

A stage II pressure ulcer is described as partial-thickness skin loss involving the epidermis or dermis. The superficial ulcer often presents clinically as a blister, abrasion or shallow crater. The scenario described refers to a stage II pressure ulcer.

A 19-year-old male rehabilitating from a tibia fracture sustained in a motor vehicle accident is referred to physical therapy. The patient demonstrates loss of active dorsiflexion and a high stepping gait in which he raises his foot higher than necessary and suddenly brings it down producing a "slapping" sound. What is the MOST likely rationale for the patient's current condition?

1.Severing of the common peroneal nerve

2.Anterior compartment syndrome

3.Hip flexor weakness

4.Calcaneal spurring

Severing of the common peroneal nerve

To effectively analyze gait, physical therapists should possess an understanding of the normal gait cycle, muscle action, and common gait deviations.

1.Severing the peroneal nerve would cause foot slap and dragging of the toe during gait, which would result in a compensatory high-stepping gait pattern.

A physical therapist treats a patient recently admitted to an acute care hospital after being diagnosed with Guillain-Barre syndrome. Which of the following MOST accurately represents the condition's typical prognosis?

1.The majority of patients will experience a full recovery

2.The majority of patients will experience significant residual deficits

3.The majority of patients will not experience any functional return

4.The majority of patients will experience lethal complications

The majority of patients will experience a full recovery

To appropriately set goals and select treatment interventions, a physical therapist must possess knowledge of a condition's typical signs and symptoms, as well as the anticipated progression and prognosis.

1.The reported percentage of patients diagnosed with Guillain-Barre syndrome who fully recover varies somewhat among studies. However, studies consistently report that between 60% and 75% of patients will experience a full recovery.

A morbidly obese patient is referred to physical therapy for treatment of multiple lower extremity venous stasis ulcers. Which etiology is MOST likely associated with the patient's current medical condition?

1.Impedance of normal arterial blood flow to the lower legs secondary to obesity

2.Callus buildup due to sustained pressure secondary to obesity

3.Excessive edema that accumulates in the lower legs secondary to obesity

4.Poor hygiene due to limited ability to perform self-care secondary to obesity

Excessive edema that accumulates in the lower legs secondary to obesity

A morbidly obese patient is referred to physical therapy for treatment of multiple lower extremity venous stasis ulcers. Which etiology is MOST likely associated with the patient's current medical condition?

1.Impedance of normal arterial blood flow to the lower legs secondary to obesity

2.Callus buildup due to sustained pressure secondary to obesity

3.Excessive edema that accumulates in the lower legs secondary to obesity

4.Poor hygiene due to limited ability to perform self-care secondary to obesity

Excessive edema that accumulates in the lower legs secondary to obesity

Discussion of sensitive topics (e.g., morbid obesity) may be uncomfortable for therapists, however, failure to educate the patient on the suspected etiology in a compassionate manner may limit both the effectiveness of care and the patient's overall quality of life.

The excessive soft tissue that accompanies obesity creates mechanical impedance to normal blood flow and alters the pressure gradient between the capillaries and the interstitium. The resultant buildup of excess fluid produces edema which serves to increase tissue tension, diminish tissue perfusion, and increase the risk of developing venous stasis ulcers.

A patient sustains damage to the left medial collateral ligament during a soccer game. The patient's symptoms include tenderness with palpation, minimal bruising, mild effusion, and a negative valgus stress test. Which of the following BEST describes the damage to the involved ligament?

1.Grade I sprain

2.Grade II sprain

3.Grade III sprain

4.Complete rupture

Grade I sprain

To appropriately plan interventions and anticipate therapeutic outcomes, a physical therapist must possess an understanding of the varying degrees of injury which may be sustained by the medial collateral ligament (MCL).

1.A grade I sprain of the MCL is characterized by tenderness to palpation, minimal bruising, and effusion. When compared to the unaffected limb, no significant difference will be noted during valgus stress testing with the knee slightly flexed.