NPTE 1

A patient is 12 weeks post talus fracture and has a chief complaint of catching her toe during gait since the removal of the boot cast. Evaluation demonstrates limited ankle dorsiflexion, leg atrophy, and ankle weakness. The physical therapy plan should FIRST emphasize:

1. mobilization of the talocrural joint.

2. stretching the tibialis anterior.

3. strengthening the gastrocnemius.

4. fitting for an ankle-foot orthosis (AFO).

1. mobilization of the talocrural joint.

A patient has an irregularly shaped wound at the left medial malleolus. The skin around the wound is darkened. The underlying cause of this wound is MOST likely:

1. lymphedema.

2. venous insufficiency.

3. cellulitis.

4. osteomyelitis.

2. venous insufficiency.

A 6-year-old patient with juvenile rheumatoid arthritis involving the cervical spine, bilateral hips, knees, and ankles is referred to the physical therapy department. The patient has developed contractures of all involved joints and continues to complain of morning stiffness. A gait deviation that the physical therapist is likely to observe is:

1. increased cadence.

2. increased plantar flexion range at toe-off (preswing).

3. decreased hip extension at terminal stance.

4. decreased anterior pelvic tilt throughout the gait cycle.

3. decreased hip extension at terminal stance.

A chart review of an adult female patient indicates a hematocrit value of 42% following minor elective surgery. This value is indicative of:

1. anemia.

2. inflammation.

3. infection.

4. normal findings.

4. normal findings.

A physical therapist uses underwater ultrasound as part of the intervention to treat a patient with an ankle injury. The MOST appropriate mode of application is to immerse the patient's ankle in a:

1. whirlpool filled with degassed water and hold the transducer underwater directly on the skin.

2. metal basin filled with mineral oil and hold the transducer underwater approximately 1 in (2.54 cm) away from the body surface.

3. ceramic basin filled with glycerin and move transducer underwater directly on the skin.

4. plastic basin filled with tap water and move the transducer approximately 0.25 in (0.17 cm) away from the body surface.

4. plastic basin filled with tap water and move the transducer approximately 0.25 in (0.17 cm) away from the body surface.

A physical therapist is treating a patient who had a traumatic brain injury 3 weeks ago. The patient is confused and agitated. Physical therapy evaluation found decreased lower extremity coordination and strength. Which of the following would be the MOST appropriate intervention?

1. Participating in biofeedback training for lower extremity muscles with supervision

2. Walking in parallel bars with supervision

3. Participating in an aerobics group exercise class for 30 minutes

4. Performing lower extremity exercises while following a written handout

2. Walking in parallel bars with supervision

A patient is referred to physical therapy with a history of ulnar nerve entrapment at the level of the hamate. Which of the following would be the MOST specific exercise to improve this patient's strength deficits?

1. Practice pinching between thumb (1st digit) and the tip of the index finger (2nd digit).

2. Squeeze hand grip with elastic-band resistance.

3. Oppose thumb (1st digit) to the metacarpal phalangeal joint of each finger (2nd through 5th digits).

4. Squeeze therapy putty between the sides of the fingers.

4. Squeeze therapy putty between the sides of the fingers.

A 14-year-old baseball player reports shoulder pain of insidious onset. The patient displays apprehension when the shoulder is passively positioned in abduction and full external (lateral) rotation. Which of the following pathologies is MOST likely present in this individual?

1. Adhesive capsulitis

2. Atraumatic instability

3. Acromioclavicular separation

4. Superior labral tear

2. Atraumatic instability

Which of the following is the MOST appropriate technique to improve the flexibility of the hip flexors?

1. Active hip extension to end range, followed by isometric hip flexion

2. Resisted hip extension using cuff weights, followed by active hip flexion

3. Placing the patient in prone with pillows positioned under the abdomen

4. Gentle, sustained passive hip extension

4. Gentle, sustained passive hip extension

A patient had a ruptured right middle cerebral artery aneurysm that was repaired. Which of the following functional limitations would the patient MOST likely exhibit?

1. Horizontal nystagmus

2. Ataxic gait

3. Apraxia

4. Rigidity

3. Apraxia

A patient experiences abnormal sensation on the lateral edge of the left foot. Muscle testing reveals weakness of the left hip abductors. Which combination of nerve root levels is MOST likely affected?

1. L2-L3

2. L3-L4

3. L5-S1

4. S2-S3

3. L5-S1

A physical therapist is examining a 50-year-old patient who sustained a right Colles fracture following a fall 6 weeks ago. The patient has a sedentary lifestyle and has rheumatoid arthritis that has been treated with steroids. Which of the following factors will have the GREATEST impact on the patient's fracture healing?

1. Patient's age

2. Rheumatoid arthritis

3. Steroid usage

4. Sedentary lifestyle

3. Steroid usage

A physical therapist is evaluating a patient who reports shoulder pain during overhead activities. During active shoulder abduction on the affected side, the patient demonstrates diminished scapular upward rotation. Weakness of which of the following muscles is MOST likely to contribute to this dysfunction?

1. Upper trapezius

2. Posterior deltoid

3. Rhomboids

4. Teres major

1. Upper trapezius

A patient with a left tibial fracture is restricted to 25% weight-bearing. The patient is currently walking with a single axillary crutch on the left side. Which of the following is the MOST appropriate action for the physical therapist?

1. Have the patient use a walker instead of a crutch.

2. Have the patient use 2 axillary crutches.

3. Switch the crutch to the patient's right side.

4. Prescribe a quad cane to use on the left side.

2. Have the patient use 2 axillary crutches.

A patient in a persistent vegetative state in a nursing home has developed a Stage 2 ischial pressure injury. The pressure injury has not improved after 4 weeks of standard wound care treatment. The physical therapist should recommend a consultation with:

1. an orthotist to investigate lower extremity bracing.

2. a nutritionist to investigate level of protein.

3. a respiratory therapist to administer oxygen therapy.

4. a surgeon to perform a skin flap.

2. a nutritionist to investigate level of protein.

The patient whose feet are shown in the photograph is a waitress who reports 5/10 pain at the anterior calcaneus on the plantar aspect of the left foot. Pain is worse early in the morning and during weight-bearing activities throughout the day. Which of the following associated findings would result in the GREATEST delay in recovery?

1. Fibularis (peroneus) brevis strength of Fair plus (3+/5) and 0° to 10° ankle dorsiflexion range of motion

2. Tibialis posterior strength of Good (4/5) and 0° to 10° ankle dorsiflexion range of motion

3. Body mass index of 36 kg/m2 and 0° to 35° ankle plantar flexion range of motion

4. Body mass index of 36 kg/m2 and 0° to 25° hallux extension range of motion

4. Body mass index of 36 kg/m2 and 0° to 25° hallux extension range of motion

To assess an anterior tibiofibular ligament injury, which of the following tests is MOST appropriate?

1. Talar tilt with the ankle in neutral dorsiflexion

2. Anterior drawer at the ankle with the ankle in neutral dorsiflexion

3. Compression of the shafts of the tibia and fibula at mid calf

4. Squeezing the calf with the ankle in neutral dorsiflexion

3. Compression of the shafts of the tibia and fibula at mid calf

Paraffin would be MOST beneficial for a patient with which of the following conditions?

1. Edematous wrist 1 week following carpal tunnel surgery

2. Swollen elbow resulting from rheumatoid arthritis exacerbation

3. Aching fingers resulting from chronic osteoarthritis

4. Painful hand resulting from early-stage complex regional pain syndrome

3. Aching fingers resulting from chronic osteoarthritis

A patient has a positive result on the test shown in the photograph (Anterior Drawer test). During the subacute phase of treatment, the MOST appropriate intervention for the patient is independent performance of which of the following exercises?

1. Lower extremity partial squats

2. Open kinetic chain knee extension

3. Straight leg raises

4. Plyometric exercises

1. Lower extremity partial squats

A patient with chronic low back pain had a baseline Oswestry Disability Questionnaire score of 60 points. Three weeks later, the score was 8 points. With regard to the patient's current self-reported level of disability, which of the following courses of action should the physical therapist pursue NEXT?

1. Continue physical therapy until the patient returns to a score of 60.

2. Instruct the patient in a functional conditioning program to prepare for discharge.

3. Immediately refer the patient to the emergency department.

4. Have the patient return to the physician within the next few days.

2. Instruct the patient in a functional conditioning program to prepare for discharge.

The resting heart rate of a 32-year-old runner is measured at 46 bpm. Which of the following explanations for this heart rate is MOST likely?

1. The individual has a hypotensive disorder.

2. The rate is secondary to an increased stroke volume.

3. The individual has an atrioventricular block.

4. Endurance training has stimulated the sympathetic nervous system.

2. The rate is secondary to an increased stroke volume.

A patient reports fatigue, proximal upper extremity weakness, and double vision that increases in intensity as the day progresses. The patient demonstrates bilateral ptosis of the eyelids, difficulty chewing, dysphagia, and inability to raise the eyebrows. Which of the following conditions is MOST likely present?

1. Bell palsy

2. Myasthenia gravis

3. Trigeminal neuralgia

4. Amyotrophic lateral sclerosis

2. Myasthenia gravis

When is the BEST time to determine a patient's baseline respiratory pattern?

1. While the patient is unaware of the observation

2. While the patient is providing a medical history

3. After measuring the patient's heart rate

4. After measuring the patient's blood pressure

1. While the patient is unaware of the observation

A physical therapist is evaluating a 55-year-old male patient with low back pain. The therapist asks the patient if he has noticed any changes in bowel or bladder function. The patient reports he is having difficulty initiating urination. This symptom is MOST often a result of which of the following conditions?

1. Bladder cancer

2. Stress incontinence

3. Prostate enlargement

4. Renal failure

3. Prostate enlargement

A nonathletic male patient reports occasional brief palpitations that occur in the absence of pain, dizziness, or light-headedness. The patient has no personal or familial history of heart disease and is otherwise healthy. Which of the following factors is the MOST likely source of the palpitations?

1. Gender

2. Sedentary activity level

3. Excess caffeine intake

4. Cardiac abnormality

3. Excess caffeine intake

A patient admitted to the hospital with a diagnosis of exacerbation of heart failure is preparing for discharge to home. Which of the following clinical characteristics would be MOST important to monitor as part of the home program?

1. Blood pressure and fatigue level

2. Heart rate and cough productivity

3. Presence of cyanosis and diaphoresis

4. Presence of shortness of breath and dependent edema

4. Presence of shortness of breath and dependent edema

A patient's leg has the skin changes shown in the photograph (Red, dry, splotchy rash). Further examination reveals the presence of similar lesions on the opposite extremity, elbows, knees, and scalp. The patient MOST likely has which of the following conditions?

1. Melanoma

2. Lyme disease

3. Scleroderma

4. Psoriasis

4. Psoriasis

Which of the following factors is MOST important when considering footwear for a patient with diabetes?

1. Leather soles and heels

2. Selection of a shoe without laces

3. Snug fit around the heel

4. Non-leather material uppers

3. Snug fit around the heel

Which of the following findings is CONSISTENT with low risk for development of metabolic syndrome?

1. Triglyceride level of 135 mg/dL (1.5 mmol/L)

2. Blood pressure reading of 135/85 mm Hg

3. Fasting blood glucose level of 126 mg/dL (7.0 mmol/L)

4. Waist measurement of 41 in (104.1 cm)

1. Triglyceride level of 135 mg/dL (1.5 mmol/L).

Triglyceride level below 150 mg/dL is normal.

A patient who has meralgia paresthetica has been referred to physical therapy. Which of the following clinical features is MOST likely to be assessed by the physical therapist during the examination?

1. Strength of the adductor longus

2. Strength of the quadriceps femoris

3. Sensation of the superior medial aspect of the thigh

4. Sensation of the lateral aspect of the thigh

4. Sensation of the lateral aspect of the thigh

A patient who has diabetes mellitus reports a progressive loss of shoulder mobility. A physical therapist performs the test shown in photographs A and B. Which of the following conditions is MOST likely being assessed?

1. Functional horizontal adduction

2. Posterior capsule tightness

3. Acromioclavicular joint tightness

4. Scapular dyskinesia

2. Posterior capsule tightness

A patient who has chronic obstructive pulmonary disease becomes short of breath when walking 5 feet (1.5 m) with a rolling walker. Which of the following techniques would be MOST appropriate in order to increase the distance the patient is able to walk without becoming short of breath?

1. Incentive spirometry

2. Pacing

3. Diaphragmatic breathing

4. Segmental breathing

2. Pacing

Which of the following procedures is MOST appropriate for measuring a wound that has well-defined margins?

1. Clean the skin around the wound, place a nonsterile ruler on the wound to obtain measurements, and then clean the ruler for future use.

2. Clean the skin around the wound, place a nonsterile ruler on the wound to obtain measurements, and then discard the ruler after use.

3. Place a nonsterile ruler close to the wound to obtain measurements and then clean the ruler for future use.

4. Place a nonsterile ruler close to the wound to obtain measurements and then discard the ruler after use.

4. Place a nonsterile ruler close to the wound to obtain measurements and then discard the ruler after use.

A patient with weakness of the muscle group being tested in the photograph (Quadriceps) would have the MOST difficulty with which of the following activities?

1. Stepping up on a curb

2. Walking on a level surface

3. Sitting up from a reclining position

4. Bringing the trunk forward in sitting position

1. Stepping up on a curb

A patient has been prescribed warfarin (Coumadin) following total hip arthroplasty. Which of the following over-the-counter medications listed in the patient's medical history at the first postoperative visit would be of GREATEST concern to a physical therapist?

1. Diphenhydramine (Benadryl)

2. Cetirizine (Zyrtec)

3. Omeprazole (Prilosec)

4. Acetylsalicylic acid (Aspirin)

4. Acetylsalicylic acid (Aspirin)

The condition shown for the patient's left hand in the photograph (Flat index finger during A-Okay position) is MOST likely caused by entrapment of which of the following nerves?

1. Anterior interosseous nerve

2. Radial nerve

3. Posterior interosseous nerve

4. Ulnar nerve

1. Anterior interosseous nerve

A patient reports upper extremity numbness and tingling that extends from the neck to the thumb and index finger (1st and 2nd digits). Which of the following shoulder positions would MOST likely exacerbate the patient's symptoms?

1. Lateral (external) rotation with abduction

2. Medial (internal) rotation with abduction

3. Lateral (external) rotation with adduction

4. Medial (internal) rotation with adduction

1. Lateral (external) rotation with abduction

An exercise session that includes 25 minutes of continuous practice and 5 minutes of rest BEST represents which of the following types of practice?

1. Massed

2. Distributed

3. Blocked

4. Random

1. Massed

A physical therapist is testing the strength of a patient's latissimus dorsi with the patient in prone position and arms at the side with palms facing the ceiling. Following instruction in the desired motion, the patient lifts the arm off the table after first turning the palm downward. The therapist should ask the patient to do which of the following actions NEXT?

1. Repeat the motion with the palm upward.

2. Extend the arm while seated without back support.

3. Repeat the motion while the therapist adds resistance.

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

1. Repeat the motion with the palm upward.

Which of the following locations of pain is MOST consistent with bladder infection?

1. Groin

2. Sacral area

3. Lower buttocks

4. Suprapubic area

4. Suprapubic area

A patient's electrocardiogram shows a junctional rhythm. The patient's heart rate is 60 bpm and regular. Which of the following waves will MOST likely be absent from the rhythm strip?

1. P

2. R

3. S

4. T

1. P

The asymmetrical position in the photograph (Scapular winging) is MOST likely due to a lesion in which of the following nerves?

1. Long thoracic

2. Spinal accessory

3. Axillary

4. Dorsal scapular

1. Long thoracic

A patient has a left thoracolumbar scoliosis. Pelvic landmarks are symmetrical. Which of the following muscles will MOST likely be tight?

1. Right hip abductors

2. Left latissimus dorsi

3. Right quadratus lumborum

4. Left iliocostalis lumborum

3. Right quadratus lumborum

A patient who has hypothyroidism is MOST likely to exhibit which of the following signs or symptoms?

1. Ptosis

2. Muscle ache

3. Dysphagia

4. Tachycardia

2. Muscle ache

A patient who sustained a traumatic brain injury and is unable to follow commands has been referred for physical therapy evaluation. When the physical therapist arrives at bedside, the patient is agitated. Which of the following actions should the therapist take INITIALLY?

1. Carefully observe the patient's spontaneous behavior.

2. Postpone the assessment until the patient has become calm.

3. Apply soft restraints to calm the patient before assessment.

4. Proceed with the assessment regardless of the patient's agitated state.

1. Carefully observe the patient's spontaneous behavior.

A patient with severe arthritis of the hips and knees is able to partially stand but cannot clear the armrest of the wheelchair adequately during stand-pivot transfers. Which of the following strategies is BEST to facilitate the transfer?

1. Design a therapy program for increasing strength of the lower extremities.

2. Design a therapy program for improving active range of motion of the lower extremities.

3. Recommend that the family acquire a wheelchair with removable armrests.

4. Recommend that the family acquire a mechanical lift for transfers.

3. Recommend that the family acquire a wheelchair with removable armrests.

Which of the following activities should be the PRIMARY emphasis of a physical therapy treatment program for a child who has athetoid cerebral palsy?

1. Facilitating cocontraction patterns and encouraging control in voluntary movement gradation

2. Increasing muscle strength using progressive resistive exercises

3. Facilitating use of primitive reflexes to perform gross motor tasks

4. Preventing development of contractures and ensuring full voluntary range of motion

1. Facilitating cocontraction patterns and encouraging control in voluntary movement gradation

A patient has acute rheumatoid arthritis involving the wrist joints. Which of the following interventions is MOST appropriate?

1. Resistive exercises to end range

2. Functional fine motor tasks

3. Splints with wrists in neutral position

4. Passive stretching exercises

3. Splints with wrists in neutral position

A patient who has a history of heart disease is being treated for left glenohumeral dysfunction. The patient reports left upper quadrant pressure that continues after joint mobilization has ceased. Which of the following actions is MOST appropriate for the physical therapist?

1. Assess the patient's cervical spine nerve root integrity.

2. Have the patient perform relaxation exercises and inquire about cardiac symptoms.

3. Stop the treatment and monitor the patient's vital signs.

4. Resume joint mobilization at a lower intensity and reassess the patient's status.

3. Stop the treatment and monitor the patient's vital signs.

Which of the following laboratory values should a physical therapist monitor when treating a patient who is taking warfarin (Coumadin)?

1. Hemoglobin

2. Red blood cell count

3. International normalized ratio

4. Erythrocyte sedimentation rate

3. International normalized ratio.

Therapeutic anticoagulation requires an INR of 2 to 3. As the INR increases above these values, the risk of bleeding during activity is increased.

Initial examination of a patient reveals paresthesia over the hypothenar eminence. The MOST probable cause of this condition is:

1. carpal tunnel syndrome.

2. C8 nerve root involvement.

3. de Quervain tenosynovitis.

4. pronator teres syndrome.

2. C8 nerve root involvement.

The rationale for using superficial heat prior to exercise includes all of the following EXCEPT:

1. increasing core temperature.

2. increasing tissue temperature.

3. promoting relaxation.

4. reducing pain.

1. increasing core temperature.

A person with spina bifida uses a knee-ankle-foot orthosis to:

1. provide support for muscle incoordination.

2. facilitate muscular activity.

3. prevent development of muscle contractures.

4. substitute for the lack of muscle activity.

4. substitute for the lack of muscle activity.

Shoulder pain during the test shown in the photograph (Hawkins-Kennedy) MOST likely indicates which of the following pathologies?

1. Anterior glenohumeral instability

2. Cubital tunnel syndrome

3. Shoulder impingement syndrome

4. Thoracic outlet syndrome

3. Shoulder impingement syndrome

Patients with advanced emphysema experience difficulty in breathing during exercise because of:

1. hypocapnia.

2. atrophy of secondary breathing muscles.

3. alveolar dilation.

4. damage to the phrenic nerve.

3. alveolar dilation.

A therapist is treating a patient who recently had a myocardial infarction. At the beginning of treatment, blood pressure was 120/80 mm Hg and heart rate was 90 beats/min. Midway through treatment, blood pressure was 130/84 mm Hg and heart rate was 105 beats/min. The BEST action for the therapist to take is to:

1. continue with treatment.

2. increase the intensity of treatment.

3. stop the treatment, and notify the physician.

4. decrease the intensity of the next treatment.

1. continue with treatment.

After 1 week of a progressive resistance exercise training program, an individual demonstrates significant strength gains. The MOST likely explanation for the observed strength gains is:

1. an increased ratio of fast- to slow-twitch fibers.

2. improved neuromuscular recruitment.

3. muscle-fiber hyperplasia.

4. muscle hypertrophy.

2. improved neuromuscular recruitment.

A home health physical therapist is working with a patient who had a myocardial infarction 2 weeks ago. The patient reports interrupted sleep, increased swelling of the feet, and shortness of breath. The patient's heart rate is 120 bpm and respiratory rate, 28 breaths/minute. Auscultation reveals crackles in both lung bases. The therapist should suspect:

1. acute congestive heart failure.

2. pneumonia in bilateral lower lobes.

3. atelectasis.

4. renal failure.

1. acute congestive heart failure.

A patient with a transtibial amputation is being treated by a physical therapist for gait training with a prosthesis. The patient reports tingling and shooting pain at the end of the residual limb. The pain occurs whether or not the patient is wearing the prosthesis. The pain is MOST likely caused by which of the following?

1. A neuroma

2. Inadequate prosthetic tibial relief

3. Distal soft-tissue adhesions

4. Osteomyelitis

1. A neuroma

A physical therapist is obtaining the medical history of a patient with amyotrophic lateral sclerosis. Which of the following is MOST important to ask about in order to determine the prognosis for this patient?

1. Swallowing difficulties

2. Cognitive deficits

3. Bowel and bladder function

4. Neck pain

1. Swallowing difficulties

A physical therapist is examining a patient with low back pain which began 2 months ago while mopping the floor at work. The patient has pain radiating to the buttocks and posterior thigh, has limited lumbar spine range of motion, is unable to perform repeated movements into lumbar flexion, and can only tolerate standing for 5 minutes. Based on this information, which of the following is the MOST appropriate goal for this patient to be met in 2 weeks?

1. Demonstrate normal lumbar spine flexion range of motion.

2. Be able to bend forward 20 times without an increase in leg pain.

3. Return to work with no job modifications.

4. Stand for 10 to 15 minutes without an increase in leg pain.

4. Stand for 10 to 15 minutes without an increase in leg pain.

When compared to maximal oxygen uptake values obtained in a lower extremity exercise test, values obtained in an upper extremity exercise test are typically:

1. 30% to 40% lower.

2. the same.

3. 10% to 20% higher.

4. 30% to 40% higher.

1. 30% to 40% lower.

Which of the following muscles is MOST likely to demonstrate postural weakness in the patient shown in the photograph (Rounded shoulders and forward head)?

1. Long thoracic extensors

2. Pectoralis minor muscles

3. Sternocleidomastoid muscles

4. Suboccipital extensors

1. Long thoracic extensors

A physical therapist is examining a 4-year-old child with a history of prematurity and developmental delay. To determine if the child has age-appropriate gross motor skills, the therapist's assessment should include:

1. kicking a rolling ball, catching a small ball, and hopping on one foot.

2. kicking a stationary ball, fast walking, and walking with assistance on stairs.

3. dribbling a basketball, riding a bicycle, and skipping.

4. catching a large ball, riding a tricycle, and running short distances.

1. kicking a rolling ball, catching a small ball, and hopping on one foot.

A physical therapist is examining a patient by using the test shown in the photograph (Apprehension test). Which of the following structures is MOST likely injured?

1. Anterior glenohumeral joint

2. Long head of the biceps brachii

3. Supraspinatus tendon

4. Glenohumeral labrum

1. Anterior glenohumeral joint

A physical therapist is conducting a graded exercise stress test of an apparently healthy adult using a treadmill. The test should be discontinued if which of the following events occurs?

1. Heart rate continues to increase throughout the test.

2. Borg rating of perceived exertion is reported as 13/20.

3. Diastolic blood pressure reaches 120 mm Hg.

4. Significant redness of the skin and perspiration are observed.

3. Diastolic blood pressure reaches 120 mm Hg.

A 4-year-old child who received a diagnosis of spinal muscular atrophy at age 9 months is referred for home physical therapy. The child is unable to sit without upper extremity support but rolls independently. The child has bilateral hip and knee flexion contractures that make use of the child's standing frame uncomfortable. Which of the following interventions are MOST appropriate for physical therapy?

1. Teach parents airway clearance techniques, encourage upper extremity strengthening to prepare for wheelchair self-propulsion, and switch to using a modified prone stander.

2. Teach parents lower extremity stretching and strengthening exercises, adapt the standing frame to accommodate contractures, and encourage supported walking.

3. Teach parents proper transfers, facilitate upright positioning in kneeling and standing positions, and refer to an orthopedist for serial casting to address contractures.

4. Teach the

4. Teach the parents range of motion exercises and positioning, encourage play in prone and sitting positions, and order customized seating insert for a power wheeled mobility device.

In determining the prognosis of an individual with a traumatic brain injury, which of the following variables is MOST associated with higher level of life satisfaction?

1. Independence in bowel care

2. Being unmarried

3. Age less than 20 years

4. Rapid initial recovery from injury

1. Independence in bowel care

A patient in an intensive care unit is intubated and is being treated with a mechanical ventilator. The patient would be UNABLE to participate in which of the following interventions?

1. Pursed-lip breathing training

2. Diaphragmatic breathing training

3. Deep breathing exercises

4. Lateral costal expansion exercises

1. Pursed-lip breathing training

A patient is referred to physical therapy after a quadriceps contusion. After good initial progress with rehabilitation, the patient reports sharp pain of the anterior thigh and progressive loss of knee flexion. Which of the following conditions is MOST likely present?

1. Avascular necrosis of the femur

2. Osteochondritis dissecans

3. Slipped capital femoral epiphysis

4. Myositis ossificans

4. Myositis ossificans

A patient being evaluated for a C4-C5 herniated disc also reports having periodic dizziness. Which of the following actions should the physical therapist perform INITIALLY?

1. Ask questions about the precipitating factors for the dizziness.

2. Ask questions about sensory changes.

3. Assess deep tendon reflexes of the upper extremities.

4. Assess the integrity of the vertebral artery system.

1. Ask questions about the precipitating factors for the dizziness.

A mother reports that her 6-month-old infant has had vomiting and diarrhea over the last 2 days. Which of the following signs would be the MOST accurate indication of severe dehydration?

1. Decreased respiratory rate

2. Sunken fontanelle

3. Warm hands and feet

4. Loud crying when touched

2. Sunken fontanelle

Which of the following types of practice is MOST appropriate for long-term motor learning for a patient with a cerebrovascular accident?

1. Varied task practice with variable time intervals

2. Task practice of one activity for 15 minutes with 10-minute rest

3. Practice of a variety of related skills in blocks of 5 minutes

4. Partial task practice with patient-preferred time intervals

1. Varied task practice with variable time intervals

A patient is asked to perform a previously demonstrated hamstring stretch for a physical therapist. The patient, referring to pictures of the stretch in the home exercise program, comfortably performs the stretch at end range for 60 seconds, while maintaining a posterior pelvic tilt. To ensure the most effective stretch during future performance, the therapist should make which of the following changes?

1. Decrease the intensity of the stretch.

2. Instruct the patient in proper stretch duration.

3. Provide re-direction on proper body alignment.

4. Provide visual aids to cue the patient to perform the exercise regularly.

3. Provide re-direction on proper body alignment.

A physical therapist is treating a person who had a cerebrovascular accident and is unable to support full weight on the affected lower extremity. The patient's primary goal is to return to walking independently. Which of the following is the MOST effective intervention?

1. Upright supported standing in a frame, progressing to independent standing

2. Mobility training emphasizing independence in a wheelchair

3. Treadmill training with a harness and partial body-weight support

4. Walking with an ankle-foot orthosis and standard cane

3. Treadmill training with a harness and partial body-weight support

Examination of a patient with balance dysfunction reveals the following:

Romberg test: positive

Gait: wide-based, slow, with decreased trunk rotation

Loss of balance when asked to turn head while walking

No sign of ataxia

Based on these findings, which of the following diagnoses isMOSTlikely correct?

1. Benign paroxysmal positional vertigo

2. Cerebellar lesion

3. Unilateral vestibular lesion

4. Mononeuropathy of the sural nerve

3. Unilateral vestibular lesion

A patient with advanced liver disease has developed severe ascites. This condition will MOST likely have which of the following effects on the patient's respiratory system?

1. Increased residual volume

2. Increased functional residual capacity

3. Decreased inspiratory reserve volume

4. Decreased forced expiratory volume in 1 second (FEV1)

3. Decreased inspiratory reserve volume

Which of the following interventions is MOST appropriate to assist with maintaining bone density for a patient with a history of osteoporosis and previous vertebral fractures?

1. Use of a rowing machine

2. Water aerobics

3. Walking on a treadmill

4. Performing sit-ups on a mat

3. Walking on a treadmill

A patient who has diabetes is exercising and has onset of a headache, blurred vision, and slurred speech. Which of the following conditions is the patient MOST likely experiencing?

1. Hypoglycemia

2. Lipogenic effect of insulin

3. Diabetic ketoacidosis

4. Vitamin B12 deficiency

1. Hypoglycemia

A qualitative research design would be MOST appropriate to address which of the following research questions?

1. What are the causes and number of spinal cord injuries in the United States each year?

2. What are the experiences of patients with spinal cord injuries in returning home and to school?

3. What is the average length of stay in an acute care or rehabilitation facility for patients who have spinal cord injuries?

4. What percentage of patients who have spinal cord injuries achieve their optimal functional outcome within 1 year after injury?

2. What are the experiences of patients with spinal cord injuries in returning home and to school?

Which of the following features are MOST characteristic of a room designed for airborne infection isolation?

1. Negative air pressure, with the direction of the airflow into the room from the adjacent space outside the room

2. Negative air pressure, with the direction of the airflow from the room into the adjacent space outside the room

3. Positive air pressure, with the direction of the airflow into the room from the adjacent space outside the room

4. Positive air pressure, with the direction of the airflow from the room into the adjacent space outside the room

1. Negative air pressure, with the direction of the airflow into the room from the adjacent space outside the room

Which of the following medications is MOST likely to be used to treat the condition of the patient shown in the photograph (rheumatoid arthritis)?

1. Furosemide (Lasix)

2. Metformin (Glucophage)

3. Methotrexate (Trexall)

4. Atenolol (Tenormin)

3. Methotrexate (Trexall)

A patient with pain on the right side of the face also has tenderness at the right temporomandibular joint. A physical therapist notes deviation of the mandible toward the left at the end of the available range of mouth opening. Which of the following additional findings would be MOST expected?

1. Abnormal jaw reflex

2. Indentation behind the left condyle of the mandible

3. Paresthesia in the facial nerve (CN VII) distribution on the right

4. Hypermobility of the right temporomandibular joint

4. Hypermobility of the right temporomandibular joint

Which of the following structures provides thermoregulation for the body by means of insulation?

1. Epidermis

2. Subcutaneous tissue

3. Dermis

4. Deep fascia

2. Subcutaneous tissue

A physical therapist is instructing a patient's care provider on how to perform a bed-to-wheelchair transfer. Which of the following teaching strategies would be MOST appropriate?

1. Have the care provider practice transferring the therapist.

2. Have the care provider observe the therapist perform the transfer with the patient.

3. Explain the transfer while demonstrating and have the care provider practice transferring the therapist.

4. Explain the transfer while demonstrating and have the care provider practice transferring the patient.

4. Explain the transfer while demonstrating and have the care provider practice transferring the patient.

What is the MAXIMUM current density that should be used to initiate iontophoresis when the current amplitude is 10 milliamperes and the conductive surface area is 20 cm2?

1. 0.2 milliamperes/cm2

2. 0.5 milliamperes/cm2

3. 5 milliamperes/cm2

4. 20 milliamperes/cm2

2. 0.5 milliamperes/cm2

To calculate current density, the current amplitude is divided by conductive surface area; therefore, 10/20 = 0.5.

An 80-year-old patient who has left hemiparesis relies heavily on the right extremities for support. The patient has shoulder pain when the left upper extremity is elevated above 60°. Which of the following positions is BEST to facilitate simultaneous upper and lower extremity weight-bearing for the patient?

1. Modified plantigrade

2. Standing with both hands on a wall

3. Bridging

4. Quadruped

1. Modified plantigrade

Which of the following exercise programs is MOST appropriate for a patient who is at Stage IV on the Hoehn and Yahr Classification of Disability scale?

1. Treadmill

2. Elliptical machine

3. Stationary bicycle

4. Stair-climbing machine

3. Stationary bicycle

A patient has significant swelling around the lateral ankle. Radiographs of the ankle reveal no evidence of bone injury. The examination shown in the photograph (Ankle anterior drawer) has a positive result. Which of the following structures is MOST likely injured?

1. Achilles tendon

2. Fibularis (peroneus) brevis tendon

3. Calcaneofibular ligament

4. Anterior talofibular ligament

4. Anterior talofibular ligament

A physical therapist is developing an exercise program for a patient who has upper extremity lymphedema. Which of the following exercises should the patient perform LAST?

1. Elbow flexion

2. Cervical rotation

3. Wrist circumduction

4. Shoulder circumduction

3. Wrist circumduction

Exercises are performed from proximal to distal

A patient reports pain in the posterior lower leg during the test performed in the photograph (Passive SLR). Which of the following conditions is MOST likely present?

1. Herniated disc in the lumbar spine

2. Idiopathic lumbar scoliosis

3. Right-sided lumbar paraspinal muscle strain

4. Osteoarthritis of the lumbar facet joints

1. Herniated disc in the lumbar spine

A patient has an irregular heartbeat of greater than 100 bpm. Which of the following methods is MOST accurate for measuring the patient's heart rate?

1. Auscultate the apical heart rate for at least 60 seconds.

2. Take the radial pulse for 15 seconds and multiply by 4.

3. Measure the carotid pulse for 30 seconds and multiply by 2.

4. Take the radial pulse for 30 seconds and multiply by 2.

1. Auscultate the apical heart rate for at least 60 seconds.

A physical therapist is using lumbar mechanical traction with the patient in supine position for a patient who weighs 180 lb (81.6 kg). The traction weight is initially set to 60 lb (27.2 kg). The patient reports not being able to feel any pull. Which of the following actions is MOST appropriate for the therapist to take?

1. Increase the pull to approximately 50% of the patient's body weight.

2. Switch to manual traction.

3. Substitute 40 lb (18.1 kg) of pull in prone position.

4. Discontinue the treatment.

1. Increase the pull to approximately 50% of the patient's body weight.

Which of the following findings is MOST consistent with the presence of rebound tenderness noted during palpation of the abdomen of a patient who has low back pain?

1. Muscle guarding

2. Superficial reflex

3. Muscle soreness

4. Peritoneal irritation

4. Peritoneal irritation

A 24-month-old child who has a genetic disorder and developmental delay is able to sit independently but can easily be displaced and demonstrates emerging protective reactions and slow trunk-righting reactions in sitting position. Which of the following functional activities is BEST for short-term physical therapy for the child?

1. Pulling up to standing position

2. Obtaining a toy when placed out of reach

3. Holding a toy at midline with both hands

4. Transitioning from sitting to quadruped position

2. Obtaining a toy when placed out of reach

A 4-year-old child who has a plantar flexion contracture is referred for serial casting. The child is tearful and combative, and the parents are frustrated. Which of the following actions is MOST appropriate for the physical therapist?

1. Ask the physician to sedate the child prior to the physical therapy session.

2. Allow the child to cast a doll's leg while the therapist applies a cast to the child.

3. Ask an aide to hold the child down so the therapist can apply the cast.

4. Ask the parents to leave the room while the therapist applies the cast.

2. Allow the child to cast a doll's leg while the therapist applies a cast to the child.

A patient who has pleural effusion is performing segmental breathing exercises. Where should manual counterpressure be applied to encourage expansion of the posterior basal segments of the patient's lower lobes?

1. Lower lateral costal area

2. Posterior lower ribs

3. Anterior midchest

4. Anterior lower ribs

2. Posterior lower ribs

During gait evaluation, a physical therapist notes that a patient demonstrates a shorter step length with the right lower extremity. Which of the following problems is MOST likely the cause of the gait dysfunction?

1. Right iliopsoas contracture

2. Painful left knee

3. Decreased ankle pronation on the right

4. Left gluteus medius weakness

2. Painful left knee

A physical therapist can BEST assess for dysdiadochokinesia by asking the patient to:

1. identify a spoon, a toothbrush, and a comb by touch.

2. bring a toothbrush or a spoon to the mouth repeatedly, using rapid brisk motions.

3. demonstrate how to use a toothbrush, a spoon, or a comb.

4. name familiar objects, such as a toothbrush, a spoon, and a comb.

2. bring a toothbrush or a spoon to the mouth repeatedly, using rapid brisk motions.

A patient who has a C5 spinal cord injury (ASIA Impairment Scale A) suddenly reports light-headedness and ringing in the ears while sitting upright in a wheelchair. Which of the following conditions is MOST likely present?

1. Angina pectoris

2. Deep vein thrombosis

3. Orthostatic hypotension

4. Autonomic dysreflexia

3. Orthostatic hypotension