Meningomyelocele is a form of spina bifida associated with direct involvement of the cauda equina. The muscles that are innervated by the cauda equina usually present with spastic paralysis.
A) Only the first statement is true.
The muscles that are innervated by the cauda equina usually present with flaccid paralysis.
Tissues with high collagen content absorb more ultrasound beam. Therefore, bones absorb the most amount of an ultrasound beam at 1 MHz.
D) Both statements are true.
Conversely, the blood receives the least amount of an ultrasound beam at 1 MHz.
All of the following drugs increase the heart rate, except:
A) Qunidine
Quinidine is an anti-arrhythmic drug.
A myocardial infarction involving the _______________ is most likely to cause cardiogenic shock.
C) Left ventricle
Cardiogenic shock is a rapid decline in cardiac output.
Which of the following is not associated with Broca's aphasia?
D) None of these
Broca's aphasia is also associated with intact ability to understand written or spoken language.
This procedure is performed by injecting a radioactive compound into the person being tested and then forming a picture of the brain with computer that picks up the compound that reaches the brain tissue.
D) Positron emission tomography (PET)
A CT scan provides a detailed image that appears to be a slice of the brain. This image is obtained with highly concentrated x-ray beam.
An MRI picks up radiofrequency waves that are emitted by atomic particles displaced by radio waves in a magnetic field.
An angiogram uses high-contrast dye that reveals the vessels of the brain by x-ray.
A supervisor in an outpatient facility is classified as William Ouchi's theory Z manager. Which of the following is the most appropriate characterization of this manager's beliefs?
D) Making decisions in the group is the best way to accomplish tasks, and encouraging long-term career for the employee is the best.
McGregor Theory X: Workers have low drive, are concerned with their own job security, and do not like to work.
McGregory Theory Y: Work is natural for most people, and workers will use their own self-control to accomplish tasks and will accept responsibility for their own actions.
Herzberg's Two-Factor Theory: There are factors at work that satisfy or dissatisfy an employee.
After arriving at the home of a home health patient, the primary nurse informs the physical therapist that she has activated the emergency medical services. The nurse found the patient in what appears to be a diabetic coma. Which of the following is most likely one of the patient's signs?
A) High blood pressure
Diabetic coma is associated with low blood pressure.
What is the position of choice for SCI patients with uncompromised innervation of the diaphragm who have chronic respiratory difficulty?
B) Semi-Fowler's
All of the following are characteristics of atrophic stage of RSD, except:
D) Pale skin
It should be smooth skin. Pale skin is a characteristic of the dystrophic stage.
A physician has ordered as physical therapist to treat a patient with chronic low back pain. The order is to " increase gluteal muscle function by decreasing trigger points in the quadratus lumborum." What is the first technique that should be used by the physical therapist?
B) All of these
Patients with ideomotor apraxia often can identify objects, but cannot use them correctly on command. Meanwhile, patients with ideational apraxia often cannot identify objects or use them.
D) Both statements are true.
A patient with hamstrings contracture resulting in fixation of the knees into 60° flexion should not keep the leg rests of his/her wheelchair fully elevated. Elevating the leg rests would promote further anterior tilt of the pelvis and increase the weight on the ischial tuberosity, risking a decubitus ulcer.
B) Only the first statement is true.
Elevating the leg rests would promote further posterior tilt of the pelvis and increase the weight on the ischial tuberosity, risking a decubitus ulcer.
Never use an extension cord or adaptor with a plug-in unit. If the adaptor or cord has ground prong, it may cause shock to the patient through a leaking current.
D) Only the first statement is true.
If the adaptor or cord has no ground prong, it may cause shock to the patient through a leaking current.
In a monopolar configuration, one larger electrode is placed over the intended site and a smaller electrode is placed some distance away. The stimulation is perceived by the patient, in this case, only under the larger electrode.
C) Both statements are false.
In a monopolar configuration, one smaller electrode is placedover the intended site and a larger electrode is placedsome distance away. The stimulation is perceived by the patient, in this case, only under the smaller electrode.
Cold decreases spasm by decreasing nerve conduction velocity. Meanwhile, heat decreases spasm by promoting vasodilation.
C) Only the second statement is true.
Cold decreases spasm by decreasing sensitivity of the muscle spindles.
This tool measure the patient's opinion about how much pain is involved with an activity, how much assistance he or she requires to perform a task, and his or her dependence level.
B) Functional status index
All of the following conditions will result in true LLD, except:
B) None of these
Scoliosis causes pelvic imbalance, which may result to apparent LLD.
A 37-year old man fell and struck his left temple area on the corner of a mat table. He begins to bleed profusely but remains conscious and alert. Attempts to stop blood flow with direct pressure to the area of injury are unsuccessful. Of the following, which is an additional area to which pressure should be applied to stop bleeding?
C) Left temporal bone just anterior to the ear
Pressure on the left temporal bone just anterior to the ear helps occlude blood flow from the temporal artery.
A patient is receiving crutch training one day after a right knee arthroscopic surgery. The patient's weight bearing status is toe-touch weight bearing on the right lower extremity. The therapist first chooses to instruct the patient how to perform a correct sit-to-stand transfer. Which of the following is the most correct set of instructions?
D) (1) Slide forward to the edge of the chair; (2) put both crutches in front of you and hold both grips together with the right hand; (3) press on the left arm rest with the left hand and the grips with the right hand; (4) lean forward; (5) stand up, placing your weight on the left lower extremity; (6) place one crutch slowly under the left arm, then under the right arm.
Fingertip prehension involves picking up an object between the thumb pad and either the index or the middle finger. Meanwhile, in lateral prehension, the thumb pad is in contact with the lateral side of the index finger distal to the distal interphalangeal joint.
B) Only the first statement is true.
In lateral prehension, the thumb pad is in contact with the lateral side of the index finger proximal to the distal interphalangeal joint.
A patient with SCI is being treated by a physical therapist in an acute rehabilitation setting. The patient has been involved in a motor vehicle accident that has resulted in complete C8 spinal cord lesion. The patient is a 20-year old man who has expressed concern to the therapist about his future sexual function. Which of the following is the most correct information to convey to the patient?
C) Reflexogenic erection is possible; psychogenic erection is not possible, ejaculation is not possible
Men with high complete spinal cord lesions are able to have psychogenic erections. Meanwhile, men with lower complete lesions are likely to have the capability to have a psychogenic or reflexogenic erection.
D) Only the second statement is true.
Men with high complete spinal cord lesions are able to have reflexogenic erections.
Men with incomplete spinal cord lesions are likely to retain erectile capability much more than men with complete lesions. In addition, men with complete lesions are less likely to have the ability to ejaculate than men with incomplete lesions.
B) Both statements are true.
Iontophoresis uses a direct current to drive medication through the skin by repelling ions. For example, if a medication is positively charged, it can be driven by the cathode.
B) Only the first statement is true.
If a medication is positively charged, it can be driven by the anode. If a medication is negative charged, it can be driven by the cathode.
When a patient with Parkinson's disease has been using levodopa for an extended period, he or she may develop resistance to the medication. Sometimes, a break from the drug for 10 to 15 days may enhance its effectiveness.
B) Only the first statement is true.
Sometimes, a break from the drug for 7 to 10 days may enhance its effectiveness.
Labyrinthe head-righting is tested by holding a child upright and tilting the body slightly forward, backward, and side to side. The infant should be able to hold the head vertical despite the body movement.
A) Both statements are true.
An arthrogenic gait pattern presents with the patient circumducting and elevating the hip on the involved side. This pattern is present with severe stiffness or unfused joint in the involved lower extremity.
A) Only the first statement is true.
This pattern is present with severe stiffness or fused joint in the involved lower extremity.
Acute conditions are usually treated with TENS with a low frequency whereas chronic conditions can be treated with a high frequency. Treatments providing noxious stimulus usually have a longer lasting effect.
B) Only the second statement is true.
Acute conditions are usually treated with TENS with a high frequency whereas chronic conditions can be treated with a low frequency.
Which of the following is incorrect about Paget's disease?
B) The origin of this condition is known.
The origin of Paget's disease (also known as osteitis deformans) is not exactly known.
A therapist is evaluating a patient who suffered brain injury in a motor vehicle accident. The somatosensory cortex is involved, resulting in deficits in sensation in the right upper and lower extremities. The therapist knows from visualizing the homonculus that at least part of the injury is in one of the following locations.
C) Superior left hemisphere of the somatosensory cortex
While evaluating a patient who suffered complete spinal cord lesion, the therapist notes the following strength grades with manual muscle testing: wrist extensors = 3+/5, elbow extensors = 2+/5, and intrinsic muscles of the hand = 0/5. What is the highest possible level of this lesion?
D) C7
A positive Waldron test indicates possible osteochondritis dissecans. A positive Wilson test indicates possible chondromalacia.
A) Both statements are false.
A positive Waldron test indicates possible chondromalacia. A positive Wilson test indicates possible osteochondritis dissecans.
Wilson test is performed by asking the patient to extend the knee in seated position with internal rotation and again with external rotation of the tibia. The test is positive if there is pain with external rotation, but there is no pain with internal rotation of the tibia.
D) Only the first statement is true.
The test is positive if there is pain with internal rotation, but there is no pain with external rotation of the tibia.
Magnesium sulfate is used to decrease muscle spasm. It is a negatively charged medication which is driven through the skin using the negative pole.
A) Only the first statement is true.
It is a positively charged medication which is driven through the skin using the positive pole.
Prone and side-lying positions would encourage flexion of the extremities in children with abnormal amount of extensor tone. In this population, side-lying position allows more efficient cardiovascular function
B) Only the first statement is true.
In this population, prone position allows more efficient cardiovascular function
Which of the following statements about developmental motor control is incorrect?
A) Concentric movement develops before eccentric movement.
Eccentric movement develops beforeconcentric movement.
When the test for superficial abdominal reflex is performed on a patient with no motor neuron lesion, the umbilicus should move toward the stimulus. Unilateral movement suggests upper motor neuron involvement.
C) Only the first statement is true.
Unilateral movement suggests lower motor neuron involvement. Bilateral absence of movement suggest upper motor neuron involvement.
A high school athlete is considering whether to have an anterior cruciate ligament reconstruction. The therapist explains the importance of this ligament, especially in person that is young and athletic. Which of the following statements below is correct in describing part of the function of the anterior cruciate ligament?
C) The anterior cruciate ligament prevents excessive posterior roll of the femoral condyles during flexion of the femur at the knee joint.
The tectorial membrane extends from the posterior arch of C1 to the posterior margin of the foramen magnum. The posterior atlanto-occipital membrane extends from the posterior part of C1 to the base of the occiput.
D) Both statements are false.
The posterior atlanto-occipital membrane extends from the posterior arch of C1 to the posterior margin of the foramen magnum. The tectorial membrane extends from the posterior part of C1 to the base of the occiput.
In pivot shift test, the patient lies in supine position and the therapist applies a valgus stress with the lower leg internally rotated while passively flexing and extending the knee. A positive test is associated with instability in this motion.
C) Both statements are true.
The talus is situated somewhat laterally to the midline of the foot. This tarsal bone transmits weight to the rest of the bones of the foot.
B) Only the second statement is true.
The talus is situated somewhat medially to the midline of the foot.
The talus is palpated just anterior and lateral to the medial malleolus. Pronation is excessive lateral deviation of the talus, and supination is excessive medial deviation.
C) Only the first statement is true.
Supination is excessive lateral deviation of the talus, and pronation is excessive medial deviation.
A 17-year old athlete has just received PCL reconstruction. The therapist is attempting to explain some of the characteristics of the PCL. Which of the following is an incorrect information?
B) The posterior bands of the PCL are tightest in full knee flexion
The posterior bands of the PCL are tightest in full knee extension.
A physical therapist is speaking to a group of avid tennis players. The group asks how to prevent tennis elbow. Which of the following is an incorrect information?
C) Begin the backhand stroke in shoulder abduction and internal rotation.
Begin the backhand stroke in shoulder adduction and internal rotation.
Which of the following is not part of the triangular fibrocartilage complex of the wrist?
A) Sheath of flexor carpi ulnaris
It should be sheath of extensor carpi ulnaris.
Which of the following is the correct method to test for interossei muscular tightness of the hand?
B) Passively flex the PIP joints with the MCP joints in extension, then passively flex the PIP joints with the MCP joints in flexion. Record the difference in PIP joint passive flexion.
Which of the following muscle tendons commonly sublux in patients who suffer from rheumatoid arthritis?
D) Extensor carpi ulnaris
The extensor carpi ulnaris is frequently subluxed after rupture of the triangular fibrocartilage complex of the wrist. Subluxation leads to many mechanical changes in the wrist common in patients with rheumatoid arthritis.
Tarsal tunnel syndrome is caused by compression of the posterior tibial nerve as it travels through the tarsal tunnel. The tarsal tunnel is formed by the medial malleolus, medial collateral ligament, and talus.
D) Only the first statement is true.
The tarsal tunnel is formed by the medial malleolus, medial collateral ligament, talus, and calcaneus.
Normally, the ankle requires 20° or more of dorsiflexion for a person to run and ascend/descend stairs properly. Meanwhile, independent ambulation with a normal gait pattern only requires 10° of dorsiflexion.
A) Both statements are true.
The muscle spindles are responsible for the stretch reflex. When a muscle is stretched too quickly, the muscle spindles cause the muscle to contract and lengthen.
C) Only the first statement is true.
When a muscle is stretched too quickly, the muscle spindles cause the muscle to contract and shorten.
The Golgi tendon organs are responsible for the stretch reflex. When a tendon is stretched too quickly, these receptors causes the muscle to relax.
C) Only the second statement is true.
The Golgi tendon organs are responsible for the inverse stretch reflex.
When the hindfoot is pronated, the forefoot can compensate for the uneven terrain. If the hindfoot is supinated, the forefoot is also likely to supinate and possibly cause damage to the lateral ankle ligaments.
C) Both statements are true.
Ruffini endings are located at joint capsules, ligaments, and deep layers of the epidermis. Meanwhile, Meissner's corpuscles are located in the dermis.
B) Only the second statement is true.
Ruffini endings are located at joint capsules, ligaments, and deep layers of the dermis.
A patient presents to physical therapy with a long-standing diagnosis of bilateral pes planus. The therapist has given the patient custom-fit orthotics. After using the orthotics for 1 week, the patient complains of pain along the first metatarsal. The therapist decides to use joint mobilization techniques to decrease the patient's pain. In which direction should the therapist mobilize the 1st metatarsal?
B) Inferiorly
In response to a pronated subtalar joint, the forefoot undergoes a supination twist and the first ray dorsiflexes. Because the distal 1st cuneiform is convex and the proximal 1st metatarsal is concave, inferior mobilization of the 1st metatarsal should be performed.
A patient with severe knee flexion contracture has a line of gravity that is anterior to the hip, posterior to the knee, and posterior to the ankle. This causes a flexion moment at the hip, knee, and ankle.
D) Only the second statement is true
A patient with severe knee flexion contracture has a line of gravity that is anterior to the hip, posterior to the knee, and anterior to the ankle.
A patient with hammer toes exhibits hyperextension of the DIP and MTP joints and flexion of the PIP joints. With this deformity, callus formation is typically seen at the distal tips of the toes, the superior surfaces of the IP joints, and the metatarsal shafts.
A) Only the first statement is true.
With this deformity, callus formation is typically seen at the distal tips of the toes, the superior surfaces of the IP joints, and the metatarsal heads.
A physical therapist is beginning a gait evaluation. During heel strike to foot flat on the right lower extremity, which of the following does not normally occur?
B) The left side of the thorax initiates movement in the direction of travel.
The right shoulder and thorax begin to move forward at heel strike (initial contact).
An Unna boot is a cotton gauze covered with sulfur dioxide, gelatin, and calamine. It is put on like an ACE wrap and is left to harden overnight, resisting edema because of its rigidity.
D) Only the second statement is true.
An Unna boot is a cotton gauze covered with zinc oxide, gelatin, and calamine.
Isometric exercises in the shortest range of the extensor muscles are used to begin strengthening. In contrast, flexor muscles should be strengthened in middle-to-shortened range, because they most often work near their end-range.
C) Only the first statement is true.
In contrast, flexor muscles should be strengthened in middle-to-lengthened range, because they most often work near their end-range.
A 4-year old child diagnosed with osteosarcoma of the distal femur is schedule for resection of the distal third of the femur. Which of the following statements about possible surgical interventions is incorrect?
A) A hip disarticulation would allow for normal active play through a prosthesis.
A hip disarticulation would not allow for normal active play even with a prosthesis.
A patient who underwent an acromioplasty 8 weeks ago presents with complaints of pain when reaching overhead and during the last 30° of shoulder flexion. End-range pain is also felt when using PROM into shoulder horizontal adduction, flexion, and abduction. Which of the following treatments would be most helpful for this patient?
B) AC joint mobilization with upper extremity in 140° of shoulder flexion
It should be GH joint mobilization for posterior and inferior capsule.
A patient sustained a Colles fracture of the wrist. Her cast was removed and she now lacks wrist extension. To increase her passive closed chain wrist extension, mobilize the:
A) Concave distal radius on convex proximal carpals
If the goal of the joint mobilization is to increase the patient's open chain wrist extension, the convex proximal carpals should be mobilized on the concave distal radius.
The incentive spirometry provides visual feedback of maximal expiratory efforts. However, it should only be used during acute episodes of COPD due to risk of air-trapping with long-term use.
C) Only the second statement is true.
The incentive spirometry provides visual feedback of maximal inspiratory efforts.
Atrial fibrillation is a relative contraindication for therapy. Exercise should start at a lower intensity and be progressed slowly if the ventricular rate remains uncontrolled.
B) Only the first statement is true.
Exercise should start at a lower intensity and be progressed slowly if the ventricular rate remains controlled.
You are performing an examination and providing intervention to a patient diagnosed with hemophilia. You have confirmed hemostasis has been achieved after an acute bleed in the right knee. What finding/s will indicate that active resistive exercises can be initiated?
D) 90° of knee flexion
Active resistive exercises may be initiated if the knee has at least 90° of flexion and less than 15° of flexion contracture.
You are treating a client that recently had SCI at C5. The best piece of equipment to help the client with feeding, hygiene, grooming, writing, and driving a power wheelchair would be:
A) Mobile arm supports
Mobile arm supports would be the best choice because they can be mounted on the wheelchair and will allow for the most ease of movement in a safe manner.
A patient with C6 tetraplegia would be unable to use a trigger reacher or loops during lower extremity dressing because he/she does not have a functional grasp. The universal cuff would be of no benefit to grip and don pants as it could only be used for closure with an additional device such as button hook or zipper pull.
C) Both statements are true.
During physical therapy sessions, the physical therapist protects the tenodesis of a patient with C6 tetraplegia. What positioned must be maintained during upper extremity weight bearing and why?
D) Maintained finger flexion to protect extrinsic finger flexors
Tenodesis is passive insufficiency of the extrinsic finger flexors. Preserving extrinsic finger flexor tightness is essential to maintaining passive insufficiency.
Which of the following is incorrect about the PT management of an infant with brachial plexus injury?
C) It is no longer recommended that the arm be splinted in abduction and internal rotation because of the risk of causing shoulder dislocation.
It is no longer recommended that the arm be splinted in abduction and external rotation because of the risk of causing shoulder dislocation.
The most common deformity after a severe burn involving the lower extremity includes the following, except:
B) None of these
Hip flexion contracture is also likely with a lower extremity burn.
As pregnancy advances, oxygen and carbon dioxide have more challenge transferring from the air to cells. Pregnant women compensate for this by breathing more deeply and with decreased frequency.
A) Only the first statement is true.
Pregnant women compensate for this by breathing more deeply and with increased frequency.
Use of functional electrical stimulation in patients with longstanding spinal cord injury does not improve:
B) Osteopenia
The physical therapist has decided to use FES in order to help a spinal cord injured patient to ambulate. What is the lowest spinal injury level that FES would be considered?
A) T11-T12
A prerequisite for FES is an upper motor neuron lesion. Patients with flaccid paralysis are not suitable candidates for FES. The cauda equina begins below T11-T12.
Positional traction is used to alleviate pressure on an entrapped spinal nerve, which is usually a unilateral occurrence. Side-lying position on the painful side with a pillow placed under the lumbar spine is commonly used.
A) Only the first statement is true.
Side-lying position on the nonpainful side with a pillow placed under the lumbar spine is commonly used.
Pulling the spine into full cervical flexion is the best way to stretch the posterior cervical musculature. Full cervical flexion also reduces tension on the facet joint capsules.
D) Both statements are false.
Pulling the spine into slight cervical flexion is the best way to stretch the posterior cervical musculature. Slight cervical flexion also reduces tension on the facet joint capsules.
You administer cervical traction to a patient in your clinic to help stretch the tight soft tissues along the posterior aspect of her neck. She responds well to the initial treatment so you arrange for her to lease a home cervical traction unit to continue this treatment on a daily basis. In what position would you instruct her to place the traction unit to produce the optimal effect?
D) At an upward angle that slightly flexes her neck
If you apply a cold pack or ice massage over a patient's biceps muscle for 5 to 10 minutes before a session of resistive exercise, what change would you expect to see in that muscle?
A) An immediate increase in isometric strength
Long-term cooling may reduce muscle strength as well as muscle tone. Although cold therapy may reduce the amount of delayed onset muscle soreness, the modality would need to be applied immediately after the exercise session, not before it.
Cement and plastic are rapidly heated by ultrasound, so it should be avoided over tissues with these types of implants. Ultrasound can interfere with a cardiac pacemaker when applied over the chest or lower back.
A) Only the first statement is true.
Ultrasound can interfere with a cardiac pacemaker when applied over the chest or upper back.
Bony tissue has low attenuation for ultrasound due to both absorption and reflection. If you are moving the sound head too slowly or using a unit with a high BNR, the heating effect may be more concentrated over the bone tissue and cause deep aching pain.
C) Only the second statement is true.
Bony tissue has high attenuation for ultrasound due to both absorption and reflection.
All of the following are considered nonthermal effects of ultrasound, except:
A) Increase in nitric dioxide synthesis
It should be increase in nitric oxide synthesis. Other nonthermal effects of ultrasound are increase in histamine release and increase in rate of protein synthesis. All of these effects promote wound healing.
According to the inverse square law, the intensity of an ultraviolet or infrared lamp is greatest when the lamp is positioned closer to the body part being treated. According to the cosine law, the intensity of the lamp is greatest when the lamp is positioned perpendicular to the body part being treated.
D) Both statements are true.
A laser emits light that has a specific wavelength, has less divergence from its source, and has waves that travel in a noncoherent manner. Low-powered lasers are non-destructive because they are not in the ionizing range of the electromagnetic spectrum.
B) Only the second statement is true.
A laser emits light that has a specific wavelength, has less divergence from its source, and has waves that travel in a coherent manner.
Why do most NMES protocols recommend frequency settings between 30 and 50 pulses per second?
B) It produces smooth, tetanic muscle contraction without excessive fatigue.
Muscle tetany is usually achieved at a pulse rate between 30 and 50 Hz. Because a smooth contraction is desired for muscle strengthening or range of motion, most NMES protocols include frequency settings in this range. A muscle contraction can be elicited at lower frequency settings, but it will only present as a twitch response. Higher frequency settings can be used if the goal of the treatment is to fatigue a muscle that is in spasm.
When using NMES, when would you want to use a long rise/ramp time?
B) When stimulating the antagonist of a hypertonic (spastic) muscle
When using NMES to help reduce spasticity, many protocols stimulate the antagonist of the spastic muscle because it is usually in a weakened state. However, if the stimulus is brought on too quickly by using fast rise/ramp time, it may cause a quick stretch to the spastic muscle, thus exacerbating the problem.
The subluxed humerus is usually displaced anteriorly and inferiorly. Thus, when applying electrical stimulation, supraspinatus and posterior deltoid muscles are usually stimulated simultaneously to help reverse the subluxed position.
A) Both statements are true.
If you are using electrical stimulation to limit edema formation in an acutely injured joint, the amplitude should be adjusted to produce a:
D) Sensory response only
When the injury is acute and the edema is still forming, stimulation should be kept at the sensory level to avoid further injury to the tissues. Sensory-level stimulation is all that is needed to affect the cell permeability changes that helps reduce the edema formation.
Threshold is the amount of current required for voltage to increase past a critical limit, typically 10 mV higher than the resting value. This results in initiating a process whereby the positive feedback from the sodium current inactivates even more sodium channels, and this eventually leads to the generation of an action potential.
A) Both statements are false.
Threshold is the amount of current required for voltage to increase past a critical limit, typically 15 mV higher than the resting value. This results in initiating a process whereby the positive feedback from the sodium current activates even more sodium channels, and this eventually leads to the generation of an action potential.
Pulsed current is a unidirectional or bidirectional flow of charged particles that periodically ceases for a finite period of time. A period of electrical silence is the hallmark characteristic of a pulsed current.
B) Both statements are true.
Direct current is the uninterrupted flow of charged particles, allowing for continuous transmission of the medication and assure maximum ion transfer per unit of applied current. Pulsed, alternating, and interferential currents are less effective in meeting the need of causing a local medication effect.
D) Both statements are true.
The hamstring muscles function to reduce or prevent anterior translation of the femur during terminal knee extension. In an ACL deficient knee, rehabilitation should be geared towards recruiting the hamstrings first before the quadriceps during functional activities.
C) Only the second statement is true.
The hamstring muscles function to reduce or prevent anterior translation of the tibia during terminal knee extension.
Electrical stimulation can promote epithelial cell migration, increased capillary permeability, and increased macrophages. Symmetric waveforms have been show to be more effective than asymmetric waveforms, indicating that polarity may play a role in healing.
C) Only the first statement is true.
Asymmetricwaveforms have been show to be more effective than symmetric waveforms, indicating that polarity may play a role in healing. Biphasic waveforms appear to be more effective than monophasic waveforms.
Your patient has spasticity of the biceps brachii on the left as a result of stroke. You chose to use electrical stimulation to temporarily decrease the effects of hypertonicity in order to work on ADL activities. Your objective in applying the current is to:
B) Stimulate the ipsilateral triceps
Physiologically, the stimulation of ipsilateral triceps would result in reciprocal inhibition of the biceps via the Ia inhibition pathway.
A pelvic belt that is angled at 90° with the sitting surface limits the patient's voluntary efforts to extend the trunk because of increased tone. This angle also allows the patient to actively tilt the pelvis anteriorly, which is a functional movement that does not need to be restricted.
A) Only the second statement is true.
A pelvic belt that is angled at 90° with the sitting surface limits the patient's involuntary efforts to extend the trunk because of increased tone.
Which statement would be documented in the "plan" portion of a SOAP note?
D) In order to return to work, patient will demonstrate increase of 10# of grasp in left hand in 3 weeks.
Direct pressure is the first line of defense for external hemorrhage. If it is unsuccessful, then elevation and tourniquets are added sequentially.
C) Only the first statement is true.
If it is unsuccessful, then elevation and pressure applied to pulse pressure points are added sequentially. Tourniquets are used as a last resort.
A contraindicated activity for a child with osteogenesis imperfecta would be:
B) Pull-to-sit maneuver
A pull-to-sit maneuver would put undue stress on the upper extremities. Rather, the child should be facilitated by supporting the child around the shoulders as he attempts to sit up.
The catheter bag should always be below the level of the waist. This will keep urine in the catheter line from moving back into the patient's urinary tract and causing infection.
A) Both statements are true.
While exercising, a patient with T4 paraplegia should have:
A) All of these
Your patient is on antipsychotic drug therapy. During your therapy session, you notice a number of adverse reactions. The most severe one requiring immediate attention by a physician is:
A) Increased body temperature with some muscle rigidity
This could be the beginning of a malignant hyperthermia, which requires immediate drug treatment since it could be fatal.
Which of the following is incorrect about the effects of smoking on a person's health?
B) Tar causes cancers and sarcoidosis.
Tar causes cancers and emphysema.
All of the following are manifestations of thrombotic thrombocytic purpura, except:
C) Iron-deficiency anemia
It should be hemolytic anemia.
Stevens-Johnson syndrome starts with nonspecific lower respiratory tract infection, cough, aching, headaches, feverishness, followed by a red rash across the face and the trunk. The rashes later spread to other body parts, then the top layer of the epidermis starts to peel off.
A) Only the second statement is true.
Stevens-Johnson syndrome starts with nonspecific upper respiratory tract infection, cough, aching, headaches, feverishness, followed by a red rash across the face and the trunk.
Oxygen flow rates are prescribed by the physician and should not be altered by the physical therapist. Exercise should be stopped if the patient's oxygen saturation falls below 85%.
B) Both statements are true.
If complete return of the triceps function has not returned by 2 months of age, the infant should be referred to a brachial plexus specialty center. More urgent referrals are needed for infants with Horner's syndrome and complete paralysis.
D) Only the first statement is true.
If complete return of the biceps function has not returned by 2 months of age, the infant should be referred to a brachial plexus specialty center.
Which of the following is not a manifestation of slipped capital femoral epiphysis?
D) Decreased flexion, adduction, and internal rotation ROM
It should be decreased flexion, abduction, and internal rotation ROM.
If you wanted to determine how well the items on a test or survey relate to each other, you would be analyzing that instrument's
C) Internal consistency
Internal consistency is a form of reliability that assesses the degree to which a set of items in an instrument measure a similar trait.
Why is a random sample more desirable than other methods of sampling when designing an experimental study?
B) Data are more likely to be normally distributed.
Random sampling is more likely to result in a representative sample; thus, the data from that sample are more likely to be normally distributed and not skewed. This is important because one of the underlying assumptions for the use of parametric statistics is normal distribution of data.
Which of the following factors is inversely related to statistical power in a research study?
A) Amount of variance in outcome measures(s)
Statistical power increases with larger sample sizes, higher alpha levels, and greater effect sizes; it tends to be lower when data variances are higher.
Alpha level refers to the level of insignificance used when testing a hypothesis. This is represented by p value provided in the data analysis.
C) Only the second statement is true.
Alpha level refers to the level of significance used when testing a hypothesis.
A type I statistical error occurs when one incorrectly accepts a null hypothesis. Meanwhile, a type II statistical error occurs when one incorrect rejects a null hypothesis.
C) Both statements are false.
A type I statistical error occurs when one incorrectly rejects a null hypothesis. Meanwhile, a type II statistical error occurs when one incorrect accepts a null hypothesis.
Predictive validity is the ability of a test to predict some future performance or occurrence. Criterion validity is the degree to which one test measure correlates with another measure, usually the gold standard.
B) Only the first statement is true.
Concurrent validity is the degree to which one test measure correlates with another measure, usually the gold standard. Predictive validity and concurrent validity are both forms of criterion validity.
If you wanted to compare balance measures in older adults who do and do not have a history of falling, which statistical test would be most appropriate to use?
A) Independent (unpaired) t-test
You are comparing two independent groups on a single, ratio level measure. Thus, a parametric test is appropriate. In this case, it would be an independent t-test.
If you wanted to classify a group of women as having normal bone density, low bone density, or osteoporosis, based on measures of their age, height loss, and activity level, what type of statistical analysis would you use?
C) Discriminant analysis
When the predictor variable is a category or classification, discriminant analysis is the best type of regression analysis to use.
Stratified samples represent subgroups of a population, from which subjects are randomly recruited. In cluster sampling, an equal proportion of subjects are recruited from each subgroup.
B) Only the first statement is true.
In quota sampling, an equal proportion of subjects are recruited from each subgroup.
What is the purpose of doing a power analysis when you are planning an experimental study?
B) To help you determine an appropriate sample size
During the planning stage of a study, a power analysis is used to help determine the optimal number of subjects to recruit in order to avoid the possibility of committing a type II statistical error. The investigator has little control over any of the factors that affect power (i.e. group variance, effect size of outcome measure, and alpha level), with the exception of the alpha level, which is usually set at 0.05 to reduce the risk of committing a type I error.
A cumulative scale in which a higher rating assumes all levels of measure below it is called:
D) Guttman scale
A semantic differential scale asks respondents to rate perceptions of a concept or characteristic on a 7-point scale that includes opposites descriptors at each end of the scale.
When you might use a coefficient of variation (CV) to describe the variability of a set of measurements?
D) When you want to compare the variability in multiple variables that have different units of measure
A coefficient of variation (CV) is a standardized measure of variation that is based on the standard deviation of a measure, divided by its mean, and multiplied times 100. Thus, it can be used to compare variability in a set of variables, or outcomes, that have different units of measure.
What do statistical measures of "central tendency" represent?
B) The average value in a distribution of numbers
Measures of central tendency are descriptive statistics that represent average values in a distribution of scores. These measures include the mean, median, and mode.
When one tail in a curve is longer than the other, the distribution is said to be skewed. The direction of skewness is determined by the longer tail.
A) Both statements are true.
Scatter plots illustrate the relationship of two variables, one plotted on the x-axis and the other plotted on the y-axis. A perfect relationship is illustrated by a diagonal line from one corner of the graph to the opposite corner.
C) Both statements are true.
An intraclass correlation coefficient is best for determining inter- or intrarater reliability of a numeric measure. A phi coeffficient is sometimes used to analyze test-retest reliability, but it cannot account for the systematic measurement errors.
B) Only the first statement is true.
A Pearson correlation coeffficient is sometimes used to analyze test-retest reliability, but it cannot account for the systematic measurement errors. A phi coefficient is used to correlate two dichotomous (i.e. categorical) measures.
What correlational statistic is used to establish the internal consistency of a multi-itemed instrument?
B) Cronbach alpha
Intraclass correlation coefficient is used to determine intra- and interrater reliability.
Phi coefficient is used to correlate two dichotomous (i.e. categorical) measures.
Pearson product moment correlation may be used to determine test-retest reliability, but it cannot account for systematic measurement errors.
What is the diagnostic advantage of having a highly sensitive test?
D) When the test is negative, you can confidently rule out that diagnosis.
According to the rules of SpPin and SnNout, a test with high specificity (Sp) that is positive (P) will help rule in (in) a diagnosis. A test with high sensitivity (Sn) that is negative (N) will help rule out (out) a diagnosis.
When comparing the means between two groups of subjects, you discover that there is significant difference between the variances of your outcome measure in those groups. What does this result tell you?
A) You should use a nonparametric statistical test to analyze your data.
Homogeneity of variance is one of the underlying assumptions of parametric statistics. When group variances are significantly different, then this assumption has been violated and you should run the nonparametric version of that statistical test, if that option is available.
Using a regression analysis, a physical therapy instructor analyzes the effects of multiple predictors of academic success on the students' final GPA. The analysis produces an R2 (coefficient of determination) value of 0.36. How should the instructor interpret this statistic
D) The predictor variable accounts for 36% of the variance in the students' GPA.
The multiple correlation coefficient (R) reflects the combined relationship of these predictor variables to GPA. When squared, the coefficient of determination (R2) reflects the percentage of variance in the dependent variable (in this case, GPA) that is accounted for by the predictor variables (in this case, 36%). No p values are provided to assess the significance of this regression model. Likewise, no R is provided, although this can be determined by taking the square root of R2, which would be 0.60, a correlation of only moderate strength.
Which of the following graphic methods is most commonly used to analyze the data in a single-subject research study?
D) Two-standard deviation band method
The mean and standard deviation of an outcome measure is calculated from multiple baseline measures. Additional measures taken during and/or after the treatment phase are then compared to these baseline measures. Those measures that fall outside the range of normal variance (i.e. two standard deviations) are attributed to the treatment effect.
Which of the following graphic methods can be used to illustrate test-retest reliability?
C) Limits of agreement graphs
Which of the following graphic methods are used to help determine optimal cut-off scores in studies that establish test validity?
B) Receiver operating curves
The combined effect of two or more independent variables on one or more dependent variable is known as the ___________ effect.
C) Interaction
The interaction effect is identified in an ANOVA table using an "X; for example, the interaction between group and treatment effect would be indicated as "Group X Treatment".
You have performed as study investigating the influence of gender on cutting mechanics. Your dependent variable is peak knee valgus moment (a continuous variable) and your independent variable is gender (a nominal variable). What is the most appropriate statistic to evaluate your data?
C) Independent samples t-test
Independent samples t-test is the most appropriate evaluation. Given the data described, a t-test is the best test. Because the groups are not matched (males and females), an independent samples t-test is the best.
A patient on calcium channel blocker therapy might complain during therapy sessions about all of the following, except:
A) Tremors
Based on recent studies in children with traumatic brain injury, you would expect to see recovery slow down after ______ in a child with severe injury.
B) 1 year
Talwin and Stadol are examples of which opiate analgesic class?
A) Agonist-antagonist
All of the following organs are protected by the thoracic cage, except:
D) Pancreas
The thoracic cage protects the liver, spleen, adrenal glands, and upper part of stomach and kidneys.
A "window" in computerized tomography terminology refers to:
D) CT machine setting for enhancement of contrast
Bone, brain, soft tissue, or lung are common CT windows.
Where in the tissues does nutrient exchange take place?
D) Interstitial spaces
The vessels of various sizes provide transmission conduits for body fluids, but the exchange described takes place between the cell surfaces and the interstitial fluid.
A geriatric patient using OTC cimetidine might experience all of the following, except:
A) Orthostatic hypotension
Cimetidine is an H2 blocker that blocks acid-releasing H2 receptors in the stomach.
In calcaneovalgus, the forefoot is lateral, the hindfoot is in valgus, and the foot is in full dorsiflexion. In congenital vertical talus, the forefoot is plantarflexed, the hindfoot is dorsiflexed, and the foot bends at the instep.
D) Only the first statement is true.
In congenital vertical talus, the forefoot is dorsiflexed, the hindfoot is plantarflexed, and the foot bends at the instep.
The lateral femoral condyle is the most common site of osteochondritis dissecans. However, this condition may occur in the femoral capital epiphysis.
A) Only the second statement is true.
The medial femoral condyle is the most common site of osteochondritis dissecans.
The screwhome mechanism that is present in the last 20° of knee extension stresses the tibial collateral ligament. Side-lying hip abduction also stresses this ligament.
A) Only the first statement is true.
Side-lying hip adduction also stresses the tibial (medial) collateral ligament.
As a cardiopulmonary specialist observing a patient's x-ray, you note radiolucency within the lung fields. This is most likely to be:
B) Normal air density lung
Radiolucency refers to low density areas such as the lung. The lung is normally radiolucent.
Nerve regeneration occurs at a pace of ____ per month.
D) 1 inch
The highest level of SCI at which you would expect a client to become independent in all self-care and driving with equipment would be:
D) C6
A client with C6 injury would have control of the head, neck, diaphragm, deltoids, biceps, and wrist extensors, giving the client enough function to complete the activities.
The left posterior oblique cervical spine projection specifically allows study of what anatomic structures?
B) Right side intervertebral foramina
Posterior oblique views of the cervical spine demonstrate contralateral intervertebral foramina.
Which of the following adverse reactions experienced during antiviral drug treatment might be encountered most frequently during therapy?
A) Neuralgia and myopathies
For some drugs, it is important to ask the patient to drink a lot of water during strenuous exercise to prevent dehydration and drug precipitations in the kidneys.
Which of the following hormones stimulate ovulation in the female?
C) Luteinizing hormone
During pre-ovulatory phase of the menstrual cycle, follicle-stimulating hormone is the dominant hormone. The feedback mechanism of high levels of estradiol cause a midcycle surge in luteinizing hormone. About 24 hours after the surge in luteinizing hormone, the follicle ruptures and ovulation occurs. Luteinizing hormone also maintains the function of corpus luteum in the post-ovulatory phase.
Your patient has low back pain that you diagnose clinically as a degenerative disease of the left side L4-L5 facet. Which lumbar spine projection would best support your clinical impression?
D) Left posterior oblique
Posterior oblique views of the lumbar spine demonstrate ipsilateral posterior elements of the vertebra.
The ulnar collateral ligament of the elbow is injured during which phase of the baseball pitch?
D) Acceleration
The acceleration is the phase where maximum valgus stress is placed on the elbow and the ulnar collateral ligament.
The speed of muscle contraction is directly related to the resting length of the muscle fiber. Meanwhile, the force of muscle contraction depends upon the cross-sectional diameter.
B) Both statements are true.
A patient complains of pain in the ear. What structure does not refer to the ear?
A) Anterior digastric trigger point
The anterior digastric trigger point refers to the incisors of the mandible.
When discussing magnetic resonance imaging images, all observations of tissue appearance should be described in terms of:
C) Signal intensity
MRI images are produced by radiofrequency signals. All visual findings are referred to in terms of signal intensity.
Side effects of progestin include all of the following, except:
A) Possible mild androgenic effects
Progestine is a progesterone and will not produce male secondary sex characteristics.
What motions should not be stretched early in the rehabilitation after an open rotator cuff repair?
D) Horizontal adduction, extension, and internal rotation
Horizontal adduction, extension, and internal rotation would stretch the tissues that are early in the healing process. Care must be taken not to damage these structures in the anterior capsule.
Swimmer's shoulder
A) Is an impingement syndrome
Swimmer's shoulder is an impingement of the greater tuberosity against the anterior acromial arch and coracoacromial ligament.
What is a temporomandibular reciprocal click?
D) Clicking that occurs during opening and closing
Temporomandibular reciprocal click is clicking that occurs during opening and closing. Reciprocal clicking is caused by the disc being displaced partially anteriorly. The condyle slides under the disc and clicks into its normal position during opening then slips back out during closing.
Which of the following benzodiazepine medications is most properly indicated for outpatient-based treatment of convulsive disorders?
C) Klonopin
Klonopin is indicated as a first-line agent for treatment of convulsive disorders. Valium may be used in emergency room settings to treat status epilepticus, but it is not a first-line agent for outpatient care.
Which radiologic terms are incorrectly paired?
D) Lucency/high density
Lucent areas on x-ray are regions of low density.
Cholinergic agonists stimulate muscarinic receptors and cause the following, except:
C) Mydriasis
It should be miosis. Cholinergic agonists may also cause sweating and salivation.
The NDT approach advocates the use of reflex-inhibiting patterns to inhibit spasticity. Finger and thumb adduction are key to controlling spasticity by facilitating extensor tone and inhibiting flexor tone.
A) Only the first statement is true.
Finger and thumb abduction are key to controlling spasticity by facilitating extensor tone and inhibiting flexor tone.
Which orthopedic complication is not probable in a child with tetraplegic spinal cord injury?
D) Shoulder subluxation
The following are structures responsible for pronator teres syndrome, except:
C) Arcade of Frohse
It should be flexor digitorum arcade.
A patient on cancer chemotherapeutic drugs might experience all of the following adverse reactions, except:
B) Constipation with fecal impact
All listed adverse reactions can occur due to suppression of platelet and RBC formation and liver damage, but GI problems include diarrhea, which can often be severe.
Musculoskeletal MRI "fluid sensitive" sequences include all of the following, except:
D) T1 weighted
T1 weighted images favor recording of fast recovery protons such as in fat tissues, which therefore appear as high signal intensity. Fluids on T2 images display mid- to low-signal intensity.
A lesion before the optic chiasm will cause loss of vision in both fields. The visual field affected will be opposite to the side of the lesion.
B) Only the second statement is true.
A lesion after the optic chiasm will cause loss of vision in both fields. A lesion before the optic chiasm will cause loss of vision in the fields on the same side.
GABA is one of the main inhibitory neurotransmitters in the CNS. Some sedative, anxiolytics, skeletal muscle relaxants, and anticonvulsants cause their therapeutic effects by decreasing its actions.
B) Only the first statement is true.
Some sedative, anxiolytics, skeletal muscle relaxants, and anticonvulsants cause their therapeutic effects by increasing its actions.
Your patient has limited knee flexion in the preswing phase of the gait. You suspect the following:
B) Plantarflexor spasticity
Spastic plantarflexors would produce excessive plantarflexion and also knee extension throughout the stance phase, and prevent adequate passive knee flexion in preswing. The hamstrings are not responsible for knee flexion in preswing phase of gait. Plantarflexor weakness would cause tibial forward collapse and therefore excessive knee flexion. Dorsiflexors are not responsible for knee flexion in preswing.
The right adrenal gland is in contact with the inferior vena cava. Meanwhile, the left adrenal gland is in contact with the anterior wall, the stomach, and the body-tail of the pancreas.
A) Only the first statement is true.
Meanwhile, the left adrenal gland is in contact with the posterior wall, the stomach, and the body-tail of the pancreas.
Which of the following is true regarding myelodysplasia?
B) Embryologically, myelodysplastic lesions can be related to either abnormal nervous system neurolation or canalization.
Myelodysplasia can involve the entire spinal cord, not just the anterior cord. Teratogens are any agents that cause structural abnormality during pregnancy. Excessive alcohol and drug intake have been shown to cause myelodysplasia. Although the lower spinal region is more likely to be affected in myelodysplasia, it can refer to defects in any part of the spinal column.
Ballistic movements of the arms and legs are characterized by:
D) Reciprocal activation of antagonist muscles
Lithium has a very small margin of safety and can be quickly over- or underdosed requiring frequent drug blood level determinations. Ataxia, fine tremors, increased deep tendon reflexes, confusion, and later seizures are indications of lithium overdose.
B) Both statements are true.
What is the difference in testing motor function when examining for a nerve root deficit versus a peripheral nerve deficit?
A) In peripheral nerve deficit, the motor weakness is evident more rapidly when applying resistance compared with nerve root deficit.
A lesion of a peripheral nerve produces a complete paralysis of the muscles innervated by this nerve. Weakness is immediately apparent when testing the motor function. A lesion of a unique nerve root produces paresis of the myotome (group of muscles innervated by a single nerve root) innervated by this nerve root. Some time is necessary for the weakness to become apparent when testing for motor function. The isometric contraction must be held for a minimum of 5 seconds.
Your patient complains of neck pain and peripheral symptoms. Radiographs revealed narrowing of the C4-C5 intervertebral foramen. The nerve root most likely involved would be the:
D) C5 nerve root
A physical therapy examination of an infant with osteogenesis imperfecta should include all of the following, except:
B) Passive ROM
Since pain responses may be unreliable in this population, PROM is contraindicated.
A physical therapist is assessing the skin integrity over ischial tuberosities of a 17-year old female with spastic cerebral palsy after being transferred out of the wheelchair. The therapist notes the wound extends to the bone. The therapist would stage this pressure sore as:
B) Stage IV
A stage IV pressure sore is a full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures.
What is the correct order of scar formation?
C) Inflammatory, granulation, fibroplastic, maturation
A patient presents with anterior knee pain. Which of the following cannot be the source of pain?
D) Patella cartilage
Every structure in the knee has pain fibers, except the articular cartilage.
Foot drop following total hip arthroplasty most likely indicates:
C) Traction neuropraxia
Traction from operative positioning, retractor placement, or lengthening of the leg leads to most cases of sciatic traction neuropraxia and foot drop.
Which is true about the hip joint?
B) With its capsular pattern of restriction, flexion is the most restricted in the hip joint.
Excessive femoral anteversion in children may result in all of the following, except:
C) None of these
An angle of 170°-175° in the frontal plane taken on the lateral side of the knee is considered:
B) Normal
As the knee extends and the patella moves superiorly in the trochlear groove, the sulcus angle ___________ making the patefemoral joint _______ stable.
C) Increases; less
Which of the following is false regarding the biomechanics of a person with patellofemoral pain?
A) Patella baja increases patellar instability.
An superior patella (as in patella alta) will move the patella out of the trochlear groove.
Slipped capital femoral epiphysis is the most common condition is adolescent boys (10 to 16 years old). Traumatic slipped capital femoral epiphysis is considered a Salter-Harris type IV epiphyseal fracture.
A) Only the first statement is true.
Traumatic slipped capital femoral epiphysis is considered a Salter-Harris type I epiphyseal fracture.
Which of the following muscles is not typically involved in hip muscle strain, tendinosis, or tendonitis?
C) None of these
All of the following may be part of the clinical picture of a child in the first 48 hours after onset of osteomyelitis, except:
D) Radiographs are positive for signs of infection and avascular necrosis.
Osteomyelitis is a rapid infection of the bone in adolescents often in the distal femur or proximal tibia. Radiographic changes are not seen until 7-14 days after onset.
A physical therapist is completing an MMT on a patient with lateral hip pain. The standing alignment reveals anterior pelvic tilt and associated hip flexion. During the MMT of the right posterior gluteus medius, which substitution is likely to occur?
B) Increase in hip flexion angle to substitute with the tensor fascia latae
Patients tend to posteriorly rotate the pelvis to substitute with tensor fascia latae or the gluteus minimus. These muscles are medial rotators, not lateral rotators like the posterior gluteus medius. The lateral hamstrings are not hip abductors.
Osgood-Schlatter's disease is primarily:
C) An injury to the apophyseal cartilage
Osgood-Schlatter's disease is not an inflammatory condition.
Black line tibial stress fractures occur on the posterior cortex. They can be extremely difficult to heal and require intramedullary rodding to achieve union.
C) Only the second statement is true.
Black line tibial stress fractures occur on the anterior cortex.
Injury to the collateral ligaments or the retinaculum will not cause bleeding inside the joint as these structures are extraarticular. Injury to the cruciate ligaments do not usually get immediate swelling unless accompanied by a meniscal tear.
A) Both statements are true.
A patient is being treated with an antiarrhythmic drug. The drug might cause all of the following adverse reactions, except:
D) Joint and muscle pain
A patient under the influence of local anesthetic therapy might experience all of the following, except:
D) Increased blood pressure
A local anesthetic might leak into the general blood circulation and can affect the cardiac (bradycardia, hypotension) and central nervous (restlessness, tremors, seizures) systems. It can also interfere with the functions of the sensory nerves and motor neurons.
Aspirin and clopidogrel (Plavix) fall into which class of antithrombotics?
C) Platelet aggregator inhibitors
Aspirin and clopidogrel act as anti-clotting/anticoagulant medications by preventing platelets from clumping together, thereby making it harder to form a clot.
Fine synergistic control of neck flexors and extensors in the upright position typically appears in the
B) Second month
Coffee ground emesis or melena are generally associated with liver disease. Meanwhile, gastrointestinal disorders tend to create gray-colored stools and dark urine.
C) Both statements are false.
Coffee ground emesis or melena are generally associated with gastrointestinal disorders. Meanwhile, liver disease tends to create gray-colored stools and dark urine.
The use of magnesium-containing antacids results to:
B) Muscle weakness
The use of magnesium-containing antacids can lead to muscle weakness because of the interference with the neurotransmitter-releasing action of calcium at neuromuscular junction.
A patient on combination contraceptive medication might experience all of the following, except:
A) Joint or muscle pain
Which of the following are common signs and symptoms seen by a patient using OTC diphenhydramine?
B) Poor coordination and fatigue
Diphenhydramine is an antihistamine that blocks H1 receptors and is being used for allergic conditions (type 1 only). It can cause sedation, dry mouth, blurred vision, contact lens intolerance, constipation, and urinary hesitancy , mostly via its anticholinergic properties which are more pronounced in the elderly.
In first-order kinetics:
C) A constant percentage of the drug is lost/metabolized per unit of time.
First-order kinetics refers to drugs metabolized in half-life patterns. Fifty percent of the active drug is metabolized each half-life.
Which of the following benzodiazepines is properly indicated for relief of anxiety?
D) Xanax
Klonopin is indicated for convulsive disorders and diazepam is for skeletal disorders.
In what way is Flexeril (cyclobenzaprine) somewhat unique among skeletal muscle relaxants that affect the central nervous system?
D) Flexeril shares pharmacologic characteristics with the tricyclic antidepressant agents.
Flexeril is related to tricyclic antidepressant agents and may share some side effects including anticholinergic activity.
A Tylenol with codeine #3 tablet (TC3) contains how much codeine?
A) 30 mg
The old apothecary system used the grain as a unit of weight. One grain is approximately 63 mg. A Tylenol with codeine #4 contains 1 grain, nominally 60 mg. A #3 is half that amount, 30 mg; a #2 contains 15 mg, and a #1 contains 7.5 mg.
An example of the most common first-line diuretic used in the treatment of hypertension would be:
B) Hydrochlorothiazide
Your 31- year old male patient presents with his third episode of extreme pain at the first metatarsophalangeal joint of the right foot. Clinical examination and laboratory results indicate gouty arthritis as the diagnosis. Which is the least appropriate for acute care?
A) Probenicid
Probenicid acts by a different mechanism of action and is used to reduce uric acid synthesis as a means of preventing recurrent attacks rather than treatment of acute attacks of gouty arthritis.
What is true of the thiazolidinediones?
C) Thiazolidinediones decrease insulin receptor site activity.
This newer class of oral hypoglycemic agents exerts its effect at the peripheral insulin receptor, resulting in increased active diffusion of insulin across the cell membrane.
A physical therapist is working with a patient who has chronic obstructive pulmonary disease. If the patient's level of oxygen being carried by arterial blood is measured, a PaO2 finding of _______ is considered normal.
A) 80-100 mmHg
The physical therapist is treating a patient with a history of coronary artery disease. During the treatment, the patient complains of recurring angina that increases when performing activities in standing. The most appropriate course of action by the PT is to:
A) Stop the treatment and call the physician.
Angina is recurring chest pain and is an indication of coronary artery disease. An onset of angina during treatment should be considered an emergency because of the possibility of a heart attack and will need to be addressed by the physician.
Stiffness at the MCP joints following casting:
D) Is caused by tightness of the sagittal bands
Sagittal band tightness can be difficult to resolve, but non-operative treatment remains the treatment of choice.
Temporomandibular anterior disc displacement without reduction occurs between the:
D) Disc and upper joint compartment
The condyle glides anteriorly down the eminence (26 to 50 mm of opening) with the disc in the upper joint compartment. Occasionally the disc is displaced anteriorly, and adhesions may occur that produce an anterior displaced disc without reduction (locked joint).
The alar ligament stress test is considered positive if:
C) Laxity is felt in flexion and extension.
The test is only considered positive if it is lax in two or more planes. This is due to the variation of direction of the fibers as they connect to the alar ligament.
A 35-year old patient presents with complaints of pain and point tenderness slightly anterior to the temporomandibular joint. The tissue that likely is causing the pain is the:
A) Masseter
The masseter muscle (deep portion) is likely the cause of pain. The temporalis tendon is located anterior to the masseter on the coronoid process. The maxillary sinuses are located under the cheeks, and the parotid glands are located on the masseter. Parotid infection involves swelling and problems producing saliva.
An anterior TMJ displacement with reduction would display clicking, and the passive opening will increase with overpressure. Trismus would display normal range of motion of laterotrusion and protrusion.
D) Both statements are true.
Which of the following is false regarding T2-weighted MRI images?
B) Cortical bone displays high signal intensity unless fat-suppression techniques are used.
T2-weighted images show fluid as bright. In addition, fat will show up fairly bright in the bone marrow unless suppressed. Bone has extremely short T2 times and never displays high signal intensity in the absence of pathology (fracture, etc.)
While evaluating a shoulder split tau inversion recovery (STIR) sequence MRI study, you note increased SI on the images within the region. This suggests:
A) Edema or effusion
STIR, a common MRI sequence in orthopedic PT practice, is extremely fluid sensitive, so edema will be observed as a region of high signal intensity.
What is correct regarding atlanto-dens interval?
D) The atlanto-dens interval is measured on lateral views.
The atlanto-dens interval is the distance between the anterior aspect of the dens and the posterior aspect of the anterior neural arch of C1. It is measured only on a lateral projection.
An MRI study of the shoulder typically includes three anatomic planes of study. Image slices taken perpendicular to the long axis of the scapular spine are identified as what plane of study?
C) Sagittal oblique
Shoulder studies are based on the scapular plane. A sagittal study is also called a sagittal oblique study. It will display images oriented perpendicular to the long axis of the scapular spine.
A high repetition time (TR) combined with low echo time (TE) setting noted on the scout film would indicate what common orthopedic sequence?
B) Proton density
TR and TE settings will vary with PD, but the universal finding is high TR and low TE.
Increased bone density viewed on plain film x-rays would appear as _____ bone on T1 weighted MRI images.
C) Low SI
Increased mineral content of the bone will show decreased SI on MRI because of decreased or absent fluid and fat hydrogen nuclei.
On a plain film x-ray, a black or dark gray within a normally white region such as cortical bone would be termed a region of:
B) Lucency
Lucency refers to an area of low density (i.e. molecular weight), this producing a black or dark gray lesion within a normally dense bone. A lytic lesion would be identified as lucent.
A lateral x-ray projection of a dorsal phalangeal avulsion fracture reveals sagittal plane dislocation. What standard view should be ordered to assess possible coronal plane dislocation?
D) PA
A PA view demonstrates coronal plane relationships.
Cortical bone viewed on CT scans within a "bone window" will appear as:
A) High density
A bone window enhances radiographic contrast of bone; therefore, cortical bone appears very radiodense or white.
Which structure is most poorly studied or assessed on an AP lumbar spine projection?
C) Pars interarticularis
The pars interarticularis is superimposed on the vertebral body in the AP projection and therefore nearly impossible to visualize.
The spinolaminar line employed in evaluation of a lateral view of the cervical spine is drawn immediately anterior to the:
B) Posterior aspect of the central canal
The spinolaminar line represents the posterior aspect of the central canal.
Normal articular cartilage appears as __________ on a plain film x-ray.
C) Water or mid-density
Articular cartilage is histologically mostly water and appears as mid-density or water-density.
Your patient has low back pain that you diagnose clinically as degenerative disease on the left side L4-L5 facet. Which lumbar spine projection would best support your clinical impression?
C) Left posterior oblique
Posterior oblique views of the lumbar spine demonstrate ipsilateral posterior elements of the vertebra.
Osteoarthritis may be differentiated from rheumatoid arthritis on x-ray by the observation of:
B) Osteophyte formation
Osteophyte formation is typical of osteoarthritis, whereas loss of bone density is observed in rheumatoid arthritis.
Anteriorly located anatomic structures appear larger than the posterior structures on anteroposterior x-ray projections because of what form of x-ray distortion?
D) Enlargement
Enlargement exaggerates the size of structures located closest to the x-ray beam source.
A patient in an acute care hospital has a catheter inserted into the internal jugular vein. The catheter travels through the superior vena cava and into the right atrium. The device permits removal of blood samples, administration of medication, and monitoring of central venous pressure. The device is best termed:
B) Hickman catheter
An arterial line is a monitoring device consisting of a catheter that is inserted into an artery and attached into the electronic monitoring system. An arterial line is used to measure blood pressure or to obtain blood samples. The device is considered to be more accurate than traditional measures of blood pressure and does not require repeated needle punctures.
A central venous pressure catheter is a plastic intravenous tube used to measure pressure in the right atrium or superior vena cava. Specifically, the device measures pressure associated with the filling of the right ventricle (i.e. diastolic pressure).
A Swan-Ganz catheter is a soft, flexible catheter that is inserted through a vein and eventually into the pulmonary artery. The device is used to provide continuous measurements of pulmonary artery pressure. Patients must attempt to avoid activities that increase pressure on the catheter's insertion site.
A patient classifies the intensity of exercise as a 16 using Borg's (20-point) rating of perceived exertion scale. This classification best corresponds to:
A) 85% of maximum heart rate range
60% of heart rate range corresponds to an RPE of 11-12 (fairly light). 70% of the heart rate range corresponds to an RPE of 13-14 (somewhat hard).
Maximum oxygen consumption decreases with age at a rate of approximately ___ per decade after the age of 25.
C) 10%
A physical therapist completes a respiratory assessment on a patient in an acute care hospital. The examination reveals decreased breath sounds and decreased fremitus. This finding is most indicative of:
B) Pleural effusion
Pulmonary edema, consolidation, and atelectasis are associated with decreased breath sounds and increased fremitus.
Pleural effusion is an accumulation of fluid between the layers of membrane that lines the lungs and the chest cavity.
A physical therapist examines a patient three days following shoulder surgery. The patient complains of general malaise and reports a slightly elevated body temperature during the last twenty-four hours. Physical examination reveals an edematous shoulder that is warm to the touch. A small amount of yellow fluid is observed seeping from the incision. The most appropriate therapist action is:
B) Communicate the information to the referring physician.
Physical therapists must be aware of any signs or symptoms of infection, particularly in patients following surgery. Common signs of infection include elevated body temperature, purulent exudate, swelling, edema, and redness.
A physician orders an electrocardiogram (ECG) for a patient diagnosed with congestive heart failure. The medical record indicates the patient is currently taking digitalis. What effect would you expect digitalis to have on the patient's ECG?
D) Lengthened PR interval
Digitalis prolongs the PR interval on the ECG by increasing conduction time through the AV node.
A physical therapist observes a patient during gait training. The patient has normal strength and equal leg length. As the patient passes midstance he slightly vaults and exhibits early toe off. The most likely cause of this deviation is:
B) Limited dorsiflexion
Limited dorsiflexion will typically result in premature elevation of the heel during midstance. The patient will appear to have a bounce during gait secondary to the gastrocnemius-soleus tightness.
Trismus, a condition that is common in patients with head and neck cancer who have had radiation therapy, is due to:
C) Ectopic activity in the trigeminal nerve
Radiation-induced ectopic activity in the trigeminal nerve leads to neuropathic pain, weakness, and spasm of the masseter muscle.
Comparing phenol with botulinum toxin in the treatment of spasticity for children with cerebral palsy, which of the following is true?
C) Phenol is less expensive option but more difficult technically to perform.
Although phenol injections may last longer than botulinum toxin injections, they are more difficult injections to perform and are associated with more side effects.
What is the highest thoracic spine level for which a clam shell brace is effective in immobilizing the lower trunk?
C) T8
The clam shell orthosis is a custom molded body thoracolumbosacral (TLS) body jacket that provides the greatest lower truncal immobilization. It is usually used after thoracolumbar fixations. It is effective on as high as T8.
Which of the following measures will rehabilitation facilities now be required to report to Medicare?
C) Cases of new pressure ulcers
Beginning in 2014, facilities will be required to report urinary catheter associated infections (CAUTI) and new or worsening pressure ulcers during the course of hospitalization. Facilities that fail to comply will incur a 2% payment reduction.
You are performing an EMG/NCS of the upper extremities to evaluate for canal tunnel syndrome and notice that the sensory and motor, median and ulnar latencies are delayed. Your next steps should be:
A) Test the peroneal and sural nerves.
To assess whether a patient has peripheral neuropathy, it is necessary to test sensory and motor nerves in three limbs. Therefore, the peroneal and sural (or any other sensory and motor nerve in the lower extremity) should be performed.
Which of the following is not a predictor of aspiration on bedside swallowing exam?
A) Decreased pharyngeal peristalsis
Decreased pharyngeal peristalsis can be reliably diagnosed on video fluoroscopic swallowing study (VFSS). All of the other answer choices can be appreciated on physical exam. In contrast to the other answer choices, decreased pharyngeal peristalsis can actually protect against aspiration by giving the airway more time to close. Voice changes (either wet or gurgling) can increase the suspicion for aspiration.
High frequency (short wave diathermy) wavelength of 22 meters is
C) 13.56 MHz/second
Biphosphonates prevent fractures by:
A) Inhibiting osteoclasts
During examination of a 2-year old child with mild cerebral palsy, the therapist is encouraged because of the normal developmental milestones for a child of this age have been achieved. This was demonstrated by the child's ability to perform which activity?
C) Go upstairs foot-over-foot
The ability to hop on one foot and stand on tiptoes is normally achieved by 4 years. The ability to jump with two feet is normally achieved by 3 years.
All of the following are classified as personality pattern disturbances, except:
B) Emotionally unstable personality
Emotionally unstable personality is a personality disorder.
Stage one lymphedema is:
C) Non-pitting
Stage 1 (non-pitting edema) is edema that gets worse throughout the day but is almost normal in size by the morning. Stage 2 (pitting edema) is characterized by fibrosis. This marks the beginning of hardening of the skin and an increase in size. In stage 3, the swelling is irreversible and the affected area is very large. The tissue is fibrotic and unresponsive.
6-monoacetylmorphine is a unique metabolite of which substance?
D) Heroin
There are three active metabolites of heroin (diacetylmorphine): 6-monoacetylmorphnie (6-MAM), and the much less active 3-monoacetylmorphine (3-MAM). 6-MAM is then either metabolized into morphine or excreted in the urine. Since 6-MAM is a unique metabolite of heroin, its presence in the urine confirms that heroin was used by the patient.
The most common level of cervical facet joint-mediated pain is:
B) C2-C3
The most common symptomatic level of cervical facet (zygapophyseal) joint pain determined by controlled diagnostic block is C2-C3. The prevalence of C2-C3 facet joint pain has been estimated to be 50% to 53% in patients whose chief complaint is posterior headache after whiplash injury.
For each degree Fahrenheit rise of body temperature, the pulse rate will increase about
A) 10 beats
Which of the following gastrointestinal sources of pain can refer to the shoulder?
D) Spleen or diaphragmatic pain
Esophageal pain can refer to the mid-back, head, or neck. Colon or appendix pain can refer to the low back, pelvis, or sacrum. Gallbladder pain can refer to the mid-back and scapular regions.
Spinal cord injury (SCI) in a cancer patient occurs most commonly from:
A) Spinal metastases
Neoplastic cancer related spinal cord compression comprises up to 14% of new onset.
A patient is recovering from stroke is having difficulty bearing weight on the left leg. The patient is unable to advance the tibia forward and abbreviates the end of the stance phase on the left going directly into the swing phase. The most likely cause of the patient's problem is:
B) Spasticity or contracture of the plantar flexors
Forward advancement of the tibia from mid stance to heel-off is controlled by eccentric contraction of the plantarflexors; from heel-off to toe-off, the plantarflexors contract concentrically. Either spasticity or contracture of the plantarflexors would limit this forward progression. Patients compensate by gong right into swing typically with a circumducted gait or with increased hip and knee flexion because there is no push-off.
Spasticity or contracture of the dorsiflexors is typically not seen, and could not cause this deficit. Weakness of the hip extensors would be evident at heel strike, with a backward lean of the trunk.
A 9-year old sustained C6-C7 spinal cord injury. Three months after the injury, the parent reports that his appetite is lacking and he has apathy, nausea, vomiting, and weakness. The most likely reason for these symptoms is:
A) Hypercalcemia
Hypercalcemia occurs in 25% of such patients 1 to 12 weeks after the injury and is due to bone resorption. Calcium levels above 12 mg/dl can cause the above symptoms. Although depression can cause apathy and loss of appetite, this combination of symptoms including nausea and vomiting is most consistent with hypercalcemia.
All of the following are true regarding F-wave studies, except:
A) The latency of the F-wave is constant.
F-waves are a delayed pure motor response. They are triggered by antidromic activation of motor neurons from peripheral stimulation of a nerve. This stimulation travels antidromically to the anterior horn cell' from there, it proceeds orthodromically to the muscle fiber. This backfiring to the axon is thought to represent a small portion (about 5%) of the orthodromically generated motor response (M-wave) that first occurs with stimulation. F-waves vary in their waveforms and latency and thus are averaged over multiple trials (usually 10). A-waves are seen in chronically injured nerves and represent regeneration or collateral sprouting of a nerve, as the orthodromic response is diverted along a collateral neural branch to circumvent the conventional path. This alternative path has a constant latency and is seen between the M- and the F-wave, with submaximal stimulation.
There is often an inversion of the polar formula.
D) Accompanies full reaction of degeneration
What ultraviolet wavelength will produce reticuloendothelial stimulation?
D) 2900-4000 A
The other wavelengths cause destruction of bacteria, formation of vitamin D, or erythema without pigmentation.
In comparing hypomania to the manic syndrome, the former
A) Is outgoing, flamboyant, reckless, and impulsive
A client two days status post transfemoral amputation demonstrates decreased strength and generalized deconditioning. Which of the following positions should be utilized when wrapping the client's residual limb?
C) Supine
A supine position will ensure client safety and allow the therapist full access to the residual limb.
Needle electrodiagnostic studies evaluate what types of fibers?
C) Only Ia (large, myelinated)
Needle electrodiagnostic studies evaluate only large myelinated Ia fibers. This is the reason that in steroid myopathies (which usually affect type II fibers) the EMG will usually be negative.
A patient with a right transferal amputation is undergoing prosthetic training. What is the best technique to use to improve the patient's shortened step length on the right?
B) Provide posterior-directed resistance to the right ASIS during stance
Light resistance and stretch applied to the pelvis (right ASIS) in a posterior direction during mid-stance to late stance will facilitate forward pelvic rotation on that side and enhance forward movement of the limb during swing.
Anterior-directed resistance functions to pull the hip forward but does little to facilitate active forward limb movement. The gluteals function to stabilize the limb during stance (not advance the limb forward). Manual resistance applied to the pelvis during swing may interfere with stepping.
A patient with peripheral vascular disease presents to physical therapy for evaluation and intervention. The patient used to walk for exercise, but can no longer walk to the mailbox at the end of the driveway without experiencing leg pain. This patient will most likely also have:
B) Pain with legs elevated
Elevating the legs in the presence of arterial insufficiency decreases blood flow, which increases pain. Purple or brown pigmentation of the ski on the legs is associated with venous insufficiency, not arterial insufficiency. Placing the patient's legs in the dependent position facilitates blood flow and reduces pain. Pain with exercise is indicative of intermittent claudication, not deep vein thrombosis, which is associated with a positive Homan's sign.
What is a potential benefit of home oxygen use in patients with chronic obstructive pulmonary disease (COPD)?
D) Reduction in polycythemia
Several benefits of supplemental home oxygen use for COPD patients have been identifies. Home oxygen has been found to reduce polycythemia, improve pulmonary hypertension, reduce subjective effort during activity, prolong survival, improve cognitive function, and reduce rehospitalization. Of course, smoking cessation should be emphasized.
Where should a therapist's hand or fingers be located for posteroanterior mobilization to improve down-gliding or closure of the T7-T8 facet joints?
A) Transverse processes of T8
The axis of motion for mid-thoracic vertebrae is above the spinous processes and below the transverse processes. Therefore, if down-gliding or closure of T7-T8 vertebral segment is required, the therapist's hand placement should be at the transverse processes of T8 or the spinous process of T7.
Massage's horizontal stroking
A) Low back
Horizontal strokes are used for the low back massage.
A patient with COPD has developed respiratory acidosis. The PT instructs a PT student participating in the care to monitor the patient closely for:
D) Diorientation
A patient with respiratory acidosis may present with many symptoms of increased carbon dioxide levels in the arterial blood. Significant acidosis may lead to disorientation, stupor, or coma.
The other choices are signs and symptoms of respiratory alkalosis or decrease of carbon dioxide in the arterial blood.
A patient with a 1-year history of scleroderma is referred for physical therapy to improve functional status and endurance. The patient was recently treated with corticosteroids for a bout of myositis. Examination findings reveal limited ROM and fibrotic soft tissue along with hyperesthesia. What is the best choice for initial intervention?
B) Active range of motion (AROM) exercises and walking in a therapeutic pool
Scleroderma (progressive systemic sclerosis) is a chronic, diffuse disease of connective tissue causing fibrosis of skin, joints, blood vessels, and internal organs. Patients typically demonstrate symmetrical skin thickening and visceral involvement of the gastrointestinal tract, lungs, heart, and kidneys along with hypersensitivity to touch. The best choice for initial intervention is to exercise in the pool. The warmth and buoyancy of the water will enhance the patient's movements and decrease pain.
ECG changes that may occur with exercise in an individual with coronary artery disease (CAD) and prior myocardial infarction (MI) include:
B) Tachycardia at a relatively low intensity of exercise with ST segment depression
The typical exercise ECG changes in the patient with CAD include tachycardia at low levels of exercise intensity. The ST segment becomes depressed (>1 mm is significant). In addition, complex ventricular arrhythmias (multifocal or runs of PVCs) may appear, and are associated with significant CAD and/or poor prognosis.
Chronotropic incompetence is indicated by an HR that fails to rise; bradycardia (slowing of HR) is not expected. ST segment elevation with significant Q waves can occur and is indicative of aneurysm or wall motion abnormality.
A patient with a significant history of coronary artery disease is currently taking atropine. Based on knowledge of this medication, what are the expected effects?
B) Increased HR and contractility at rest
Atropine is an anti-cholinergic agent, producing an increase in HR and contractility and is used to treat symptomatic sinus bradycardia and exercise-induced bronchospasm.
An elderly individual has limited endurance as a result of sedentary lifestyle. There is no history of cardiorespiratory problems. An exercise tolerance test was negative for coronary heart disease. What is the best initial exercise prescription for this individual?
A) 60%-90% HRmax
An appropriate initial exercise prescription for an asymptomatic elderly individual with general reconditioning is 60%-90% of HRmax which is equivalent to 50%-85% of HR reserve.
The other choices are too conservative. The exercise tolerance test has ruled out coronary heart disease.
A patient presents with supraspinatus tendinitis. After the initial cryotherapy, the therapist decides to apply ultrasound (US). In what position should the therapist place the shoulder joint in order to effectively treat the supraspinatus tendon?
B) Abduction and internal rotation
Abduction and internal rotation of the shoulder places the supraspinatus tendon in a good position to apply US by exposing the tendon from under the acromion process.
Men are at high risk for development of metabolic syndrome if they exhibit which of the following symptoms?
A) A waist greater than 40 inches
Criteria for diagnosis of metabolic syndrome include abdominal obesity (waist circumference >40 inches in men or >35 inches in women).
Other criteria include elevated triglycerides (150 mg/dl or higher); low HDL levels (<40 mg/dl in men or <50 mg/dl in women); and a fasting plasma glucose level >110 mg/dl.
A therapist wishes to use behavior modification techniques as part of a plan of care to help shape the behavioral responses of a patient recovering from traumatic brain injury (TBI). What intervention is the best to use?
A) Use frequent reinforcements for all desired behaviors.
Behavioral modification is best achieved through the use of positive reinforcements of all desired behaviors.
Negative behaviors should be ignored, not reprimanded. Self-correction is not a form of behavior modification.
What would a therapist who is examining the breathing pattern of a patient with a complete (ASIA ) C5 spinal cord injury to observe?
C) Rising of the abdomen due to no abdominal muscle tone on the abdominal viscera
The abdominal musculature provides external stability to the abdominal viscera. Without this, the viscera are displaced with respiration.
With an ASIA A injury, the muscle weakness would by symmetric. The diaphragm is innervated by C3-C5 nerve roots, so it will be functioning in this patient. Muscle weakness will cause a restrictive disorder (inability to generate pressure), not an obstructive disorder (air trapping).
The patient has a fifth rib that is "stuck" in the position of maximal inspiration. Which technique is best to improve the rib mobility and assist in returning to its resting position?
B) Maitland grade IV mobilization of the head of the rib at the costovertebral joint in the superior direction
With inspiration, the lateral portion of the ribs moves up and the head moves down; to bring it back to a neutral position, the head needs to glide superiorly, allowing the lateral part of the rib to lower with expiration. Grade IV mobilizations are used to improve joint mobility.
All other choices have either incorrect technique to improve joint mobility or incorrect direction.
A patient with traumatic brain injury presents with hemiparesis. The examination reveals slight cutaneous and proprioceptive impairment, fair (3/5) strength of the shoulder muscles and triceps, and slight spasticity of the biceps. Voluntary control of the patient's left arm has not progressed since admission. The therapist decides to use functional electrical stimulation (FES), placing the active electrode on the triceps to facilitate active extension of the elbow. Which of the following is the best choice of timing sequence for FES in this case?
C) 5-second ramp up, 5-second stimulation, 5-second ramp down
A relatively long ramp time over a 5-second period is used to minimize stimulating the muscle too quickly and increasing spasticity. The ramp-down time has no effect on spasticity.
The other choices have too short or no ramp-up time, and this could increase the spasticity of the biceps.
An advantage for use of an externally-powered UE prosthetic device over a body-powered prosthetic device is
A) Ease of use
An externally-powered prosthesis uses muscle contractions by the child that activates an electrode in the prosthesis. A body-powered prosthesis uses a cable and harness system.
The most efficient intervention to regain biceps brachii strength if the muscle is chronically inflamed and has painful arc of motion is:
D) Active eccentric contractions in the pain-free range
For a muscle that is chronically inflamed, focus should be placed on eccentric contraction, because there is less effort and stress placed on the contractile units than with concentric contractions at the same level of work. The exercise should be performed in the pain-free portion of the range.
A patient with long-term postural changes exhibits an excessive forward head, and complains of pain and dizziness when looking upward. The most effective physical therapy intervention is:
B) Manual therapy techniques to provide pain relief and postural reeducation
Long-term postural changes with forward head posture include shortening of the posterior muscles, potential joint restrictions with possible vertebral artery compromise at the occiput. Restoration of normal movement throughout the cervical region and postural reeducation is the best choice for this condition.
A therapist is reviewing x-rays from a patient with trimalleolar fracture. What are the best radiographic views to visualize this bony fracture?
C) Anteroposterior and lateral
A trimalleolar fracture includes fracture of both malleoli and the posterior rim of the tibia. Anteroposterior view of the ankle demonstrates the distal tibia and fibula, including the medial and lateral malleoli and the head of the talus. The fractures of both malleoli will be visible with this view. The lateral view provides evidence of the fracture at the posterior rim of the distal tibia.
A therapist examining a patient with COPD GOLD stage III. What would be a clinical finding that the therapist would expect for this patient?
D) Muscle wasting
Muscle wasting is a common manifestation of COPD. The cause of muscle wasting is not clear, but it is not simply a malnutrition problem. The results of this muscle wasting are peripheral weakness, impaired functional abilities, poor quality of life, and poor prognostic sign.
An 18-month old child with Down syndrome and moderate developmental delay is being treated at an Early Intervention Program. Daily training activities that should be considered include:
D) Holding and weight shifting in sitting and standing using tactile and verbal cueing
Children with Down syndrome typically present with generalized hypotonicity. The low tone is best managed with weight-bearing activities in anti-gravity postures. Typical responses include widened base of support and co-contraction to gain stability. Verbal cueing for redirection is generally the best form of feedback to use, along with visually guided postural control.
During a cervical spine examination, the PT observes restricted left rotation of the C7-T1 spinal level. After stabilizing the thoracic spine, the PT's hand placement for mobilization to improve left rotation should be at the:
C) Posterior right C7 articular pillar
The most effective hand placement for mobilization into greater left rotation is at the posterior aspect of the right C7 articular pillar because it rotates the C7 vertebra to the left.
Hand placement on the left C6 and C7 articular pillars will promote right rotation. Hand placement on the T1 spinous process will create a posteroanterior glide, which will promote flexion at the T1-T2 segment and extension at C7-T1 segment.
A patient who is 5 weeks post-myocardial infarction is participating in a cardiac rehabilitation program. The therapist is monitoring responses to increasing exercise intensity. The indicator that exercise should be immediately terminated is:
C) 1.5 mm of downslopping ST segment depression
The upper limit for exercise intensity prescribed for patients post-MI is based on signs and symptoms. Of the choices, only ST segment depression (>1.0 mm of horizontal or downslopping depression) is a significant finding, representing of myocardial ischemia.
A patient with decreased motion at occipitoatlantal joint. The PT wants to used the principles of coupled motions that occur in the area of the spine during manual therapy techniques. in order to improve OA mobility, when the occiput is side bent to the right, how should the therapist mobilize C1?
A) Into rotation to the left
Given the rules of coupled movement in the upper cervical spine, when the occiput is side bent to one direction, C1 rotates in the opposite direction. Side-bending and rotation occur in the same direction from C2-C7 regardless if the spine is in flexion or extension.
A physical therapist wants to examine the relationship between the lower extremity manual muscle test grades and five ranked categories of functional ambulation ability in a group of older adults. Which of the following statistics is most appropriate for testing this relationship?
A) Spearman rho
Because the data of both variables are ranked (ordinal), Spearman rho should be used. This is the nonparametric version of the Pearson product moment correlation. The Pearson requires continuous not ordinal data.
In splinting or immobilization, the functional position of the hand includes wrist extension, phalangeal:
B) Flexion, and abduction of the thumb
The functional position of the wrist and hand describes the position from which the optimal function is most likely to occur. This position is described as: slight wrist extension; slight ulnar deviation; fingers flexed at MCP, PIP, and DIP joints; and thumb slightly abducted.
A patient with traumatic brain injury is being discharged to home after completion of inpatient rehabilitation. Which of the following assessment tools should be used to best assess the patient's potential?
A) Glasgow Outcome Scale
The Glasgow Outcome Scale is used as a general outcome measure, and in prognostic studies.
A patient is hospitalized with diabetes and a large stage II plantar ulcer located over the right heel. The patient has been non-weight bearing for the past 2 weeks as a result of the ulcer. What is the best choice for this patient's initial intervention?
A) Clean and debride the wound and apply a hydrogel dressing
A stage II (deep) ulcer involves partial-thickness skin with involvement of epidermis, dermis, or both; it is reversible. Intervention should be directed toward improving perfusion and relieving localized pressure. The wound should be cleaned with an antimicrobial agent, derided of necrotic tissue, and covered with a sterile dressing. Hydrogel dressings maintain moisture in the wound bed, soften necrotic tissue, and support autolytic debridement. Pressure relief is also an important consideration. Techniques of protective foot care should also be taught.
