Therex I Exam Answers

How often must a patient be evaluated after the initial evaluation?

Before and after every subsequent treatment

Which of the following is not a part of the subjective history?

Problem list

According to Cyriax's Rule of Tissue Involvement, a patient with lateral ankle pain that is increased during active ankle plantar flexion and at the end-range of passive ankle dorsiflexion can only have

Peroneus longus tendon

What type of muscle contraction is used when performing manual muscle testing?

Isometric

When treating patients in the hospital setting, what is the clinician's most important source for a patient's medical history?

The patient's medical chart, which contains the patient's complete history and

documentation of all care provided by other clinicians

Why is tissue healing generally slow in fibroconnective tissue?

The blood supply to this tissue is poor

How are strains and sprains graded?

Based on the amount of damage to the injured tissue

Which types of fractures are associated with the Salter-Harris Classifications?

Epiphyseal

Pain threshold is often based on the recruitment of ____

A-delta fibers

What pain-decreasing medication temporarily blocks nerve conduction, thus resulting in the loss of sensation?

Lidocaine

The inflammatory response phase of soft tissue healing usually lasts up to how many days?

7 days

At most, how long can the remodeling/maturation phase of tissue healing typically take?

24 months

What is the correct progression order of fracture healing?

Inflammation, soft callus formation, hard callus formation,

bone remodeling

What is the rate of peripheral neuron regeneration after injury?

2 to 4 mm per day

How long does it take for a ruptured tendon to return to preinjury tensile strength?

Ruptured tendon will never return to preinjury tensile strength

How long does the acute phase of bone healing last?

Up to 7 days

What's the purpose of Williams and Anderson's revised stress and injury model?

It can be used to determine when an individual is at greatest risk for injury.

What’s the main difference between the William and Anderson revised stress and injury model and the Weise and Bjornstad integrated of response to the sport injury?

-Williams and Anderson model relies purely on issues and factors from the preinjury state

-Weise-Bojornstad model takes pre- and postinjury factors into account

Which kind of pain is in a patient's control and can be reduced at will?

Benign pain

Which scenario will result in a closing of the gate, thus inhibiting the pain signal from getting to the second-order neuron?

Large-diameter afferent traffic is greater than small diameter

Which of the following are examples of mechanical stimuli that can trigger peripheral nociceptors?

-Direct-force trauma

-Pressure from swelling

____ nerves are large in diameter and transmit information quickly

A beta

____ is pain that originates from visceral organs and can be located far away from

Referred pain

____ is the measurement of the circumference of an extremity or limb

Girth measurement

____ means cell death due to lack of oxygen

Secondary Hypoxic Injury

____ increase in blood vessels diameter. This results in an increase in blood flow

Vasodilation

____ is an anxiety disorder that follows a traumatic stressor

PTSD

____ is the involuntary contraction of muscle fibers (splints and protects the injury)

Spasms

____ is the type of muscle tissue found in the heart

Cardiac

____ consists of past medical history, orthopedic conditions, non-orthopedic conditions, and family history

PPE

What are the 3 phases of soft tissue healing and the progression frames (from text)?

1.) Inflammation = 7 days

2.) Repair/ remodeling = 7-21 days

3.) Remodeling = 21 days-24 months

What are the phases of Kubler-Ross?

-Denial

-Anger

-Bargaining

-Depression

-Acceptance

Which is a contraindication to cold application?

Chronic Wound

Cryotherapy modalities have a temperature range between:

32°F and 65°F

What is the correct order of cooling in tissue?

Skin, Adipose, Fascia, Muscle

Which scenario will result in the greatest decrease of subcutaneous tissue temperature?

Ice bag applied with compression wrap

What is identified when skin has ghost white areas and beet red splotches?

Erythema

How deep are superficial heating agents able to penetrate?

Less than 2 cm

When comparing heat and cold, which of the following accurately describes the effects of heat treatments.

Increased fluid viscosity

In which scenarios is heat indicated?

1.) To encourage tissue healing

2.) To control the inflammatory reaction on its subacute chronic stages

3.) To improve range of motion

Which nerves are most susceptible to cold induced neuropathy?

Ulnar & peroneal

What modality carries the greatest risk of frostbite?

Chemical cold pack

What is the only true benefit from the use of a vapor coolant spray?

Temporary pain relief

How many levels of terry cloth towel should be placed between the skin and moist heat pack?

6

Cold whirlpools can produce which effects?

Decreased muscle spasticity

Which of the following are indications for the use of a moist heat pack?

1.) Subacute injury

2.) Decreased range of motion

3.) Hematoma reduction

Which treatment is best suited for applying cold to injuries involving an irregular surface?

Ice immersion

Which of the following can be defined as using an external force to move a body part through an arc of motion?

PROM

Which of the following isn’t an example of inert tissue?

Tendon

Which of the following is not a reason to avoid ROM exercises?

Decreased neuromuscular control

Which of the following best describes the optimal position to evaluate PROM.

With the joint in a relaxed position

Which type of ROM should be performed early in the rehabilitation process of a postsurgical patient?

PROM

Which of the following structures normal end feels is described as stretching a leather belt because it has a firm end feel with slight give?

Ligament

What structures normal end feel is described as stretchy or rubbery?

Muscle

What end feel is describes when a patient’s range of motion is exceeded with no apparent end feel?

Empty

When should resistance be applied during ROM?

Near the midrange

Which of the following is considered to have an effect on joint of motion?

Muscular strength

What is the appropriate progression of ROM exercise for a postsurgical patient?

PROM, AAROM, AROM, RROM

What is the normal end fell for knee flexion?

Soft tissue approximation

According to Cyriax’s method for classifying tissue injury, inert tissue is indicated in which of the following scenarios?

Pain elicited with AROM and PROM in the same direction

Which of the following is not a possible reason for limited ankle dorsiflexion ROM?

Weak gastrocnemius soleus complex

Which of the following muscles would be considered the agonist when attempting to achieve full knee extension.

Rectus femoris

According to the length tension relationship, where do muscles develop their peak force production?

Midrange of motion

Which of the following contractures is more likely to occur following surgical interventions?

Scar tissue contracture

Which of the following tissue properties describes a tissue’s ability to stretch and return to its original resting length?

Elasticity

Which of the following is not a true statement about the Golgi tendon organs?

When stretching for longer than eight seconds, they are overridden by muscles spindles

Which of the following is not considered a factor of stretching that influences tissue elongation?

Hand of the clinician

Recent research studies have determined that elastic changes will be achieved if a stretch is held for less than ____ seconds?

30

Not considered a factor that can affect the stress-strain curve resulting in an increased risk of tissue failure.

Increased activity

Based on current evidence, what type of stretching should be performed before activity that requires high muscular force

Dynamic stretching

Neural techniques, which are aimed at descending mechanical tension on nerves, are performed by slowly elongating the tissue through what type of motion?

Passive range of motion

What is autogenic inhibition?

When high tension is achieved, the muscle must relax

When considering the Concave-Convex Rule, direction of the ____ is determined by whether the moving surface is convex or concave

Slide

Which of the following bones represents the concave portion of the given joint?

Tibia of the talocrural articulation

Arrange the following steps in the order in which they occur during application of sensory TENS.

I. Leave the unit on for 15–30 minutes.

II. Place the electrodes directly on the painful area (nerve root and dermatome) and set the

pulse width and rate according to manufacturer's guidelines.

III. Explain the procedure to the patient, including a description of the expected sensation.

IV. Turn the unit on and increase intensity until the patient feels a pleasant tingling without

muscle contraction.

III, II, IV, I

Please explain the Oscillatory Joint Mobilization grading system for grades 1-4. Grade Amplitude Range of joint play Therapeutic goal

Please explain the parameter scale and what you’ll see from a tissue response for e- stim set-ups that create a twitch, summation, and tonic response.

Parameters (intensity, phase duration, and pulse frequency), and the electrode size and arrangement can produce specific physiological events and target specific tissues twitch is <15 pps is for individual muscle contractions, summation is 15-25 pps is for overlapping contractions and tonic response is 25-40 pps is for sustained contractions

Please explain the strength duration curve.

The strength duration curve describes the relationship between the intensity of an electrical current and the pulse duration needed to stimulate a nerve or muscle. Short pulses require higher intensity to reach the threshold needed to depolarize a nerve. Longer pulse durations require less intensity to reach that threshold. This occurs because of the capacitive resistance of the cell membranes, which makes it harder for a short duration to stimulate unless the intensity is increased

Select 4 contraindications for ultrasound.

-Acute Conditions (Continuous Output)

-Areas of Impaired Circulation

-DVT

-Around the eyes

The typical application of oscillation techniques requires ____ oscillations per second over the length of ____ minute.

One to two; 1 to 2

In which of the following scenarios is the use of therapeutic ultrasound contraindicated?

-Over lumbar region of menstruating female

-Over sites of active infection

-Ischemic area

When applying the Concave-Convex Rule, which of the following is not true when examining open-kinetic chain knee extension?

The slide occurs in the posterior direction.

The clinical effects of thermal ultrasound include:

-Decreased joint stiffness

-pain perception

-viscosity of fluid elements in tissues

One megahertz ultrasound penetrates __________ into the tissue than 3 MHz ultrasound, and therefore deeper

Greater

Which of the following best describes how gliding joint mobilization techniques are applied to the treatment plane?

Application is parallel to the treatment plane in the same direction of the slide

What temperature increase is required to decrease muscle spasm and pain?

2 to 3°C

What is the difference between a motor point vs a trigger point?

To ensure safe application of therapeutic ultrasound, how often should the unit be calibrated?

Once a year

2 Indications and 2 Contraindications for Electrical Stimulation.

-2 indications = tight muscle and pain strengthening

-2 contraindications = hypermobility and circulatory issues, pacemaker

What's the difference between A Beta, A delta, and C-fiber nerve types?

-A-beta: largest diameter, heavily myelinated, fastest conduction

-A-delta: slightly smaller than A-beta fibers, myelinated but not as thick, slightly slower conduction

-C-fiber: smallest fiber, non-myelinated, slowest transmission

Due to summation, at what pulse frequency does individual muscle contractions become less distinguishable?

15 to 25 pps

During direct ultrasound application, a __________ medium is placed between the soundhead and the skin to lubricate and to minimize impedance due to air.

Coupling

Which of the following terms is used to describe the visual range of motion that can be measured with a goniometer?

Swing

In order to maximize the thermal elects of ultrasound, the treatment area should be no more than ____

2x the sound head

Galvanic current is ____

direct current

Intensity, or the rate at which sound wave energy is delivered per unit area, is expressed as:

Watts/cm2

What electrode placement technique utilizes two sets of electrodes, each with its own

channel?

Quadripolar

A nerve’s response to the electrical stimulation is based on what factor(s)? Select all that apply:

-Diameter of the nerve

-Depth of the nerve

-Phase duration of the current

Which of the following conditions would most likely be treated with phonophoresis?

Bicipital tendonitis

When targeting deeper tissues, how should you place the electrodes?

Farther apart