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92 Cards in this Set
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- Back
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After an ST-eleated MI 3 days ago, under what circumstance should a pt be administered an exercise test? |
Heart rate equal to 70% each predicted maximum -NOT an exercise test should not be performed by this patient. |
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Newborn examined at birth using the Apgar test. Based on the following results, the PT suspects that neurological complications are likely with an Apgar of: C2 p765 |
3 at 10 minutes, Apgar score is based on heart rate, respiration, muscle tone, reflex irritability (Grimace) and color (appearance). Apgar scores are routinely assigned at one and five minutes and occasionally at 10 minutes post birth. Scores between 0 and 3 at 1 and 5 minutes are extremely low and indicative of the need for resuscitation. Neurological complications are likely with extremely low Apgar scores, particularly at 10 minutes. |
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A PT requested that PTA perform US to the shoulder of the patient. During the session, the patient experience and electrical shock. The PT would be responsible for any injury to the patient if it was a result of: C3 p766 |
The PT having instructed the PTA to use a device that had malfunctioned on the previous day -NOT the PTA failing to use a ground fault interrupt her -NOT faulty circuitry -NOT the patient touching the US device during treatment |
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Initial intervention to improve functional mobility to an individual with a stable humeral neck fracture is: C5 p767 |
Pendulum exercises -NOT Symmetrix for all shoulder musculature – This individual will typically be immobilized with a sling for a period of six weeks. After one week this thing should be removed to have the patient perform pendulum exercises to prevent shoulder stiffness – Resistive exercises including isometrics are not indicated during this early. |
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A patient with unilateral spondylolysis at L 4 is referred for PT. Patient complains of LBP when standing longer than 1 hour. Interventions for the subacute phase strengthening exercises for what mm group? C6 p768 |
Multifidi working from full flexion back to neutral -NOT Multifidi working from neutral to full extension – Performing strengthening exercises to the Multifidi from flexion to neutral will not stress the pars defect |
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The patient has an episode of syncope and the PT attempts to rule out orthostatic hypotension. This is best done by: |
Checking resting BP and HR in supine and sitting, then repeating measurements after the patient stands for 1 minute -NOT checking HR and BP in supine after 5 minutes of rest and then repeating a Semi-Fowler position |
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Patient with Addison's disease referred to PT following hip fracture. The PT recognize the cardinal symptoms of Addison's disease is: C14 p773 |
Think A and A Asthenia: Weakness. Lack of energy and strength. Loss of strength. Myasthenia refers to a loss of muscle strength, as in myasthenia gravis. -NOT weight gain |
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To mobile patient with bilateral hip dislocation is being discharged from an acute pediatric facility. The PT has developed exercise program and now need to instruct the parents. Item for the therapist two sets before instructing the parents is: C15 p 773-4 |
Their degree of anxiety and attention – NOT the home environment – A needs assessment should include a determination of the level of anxiety and ability to attend to the instructions given. If anxiety is high and the parents are unable to attend to the therapist instructions, risk of failure to perform the home exercises correctly is high |
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Nursemaid's Elbow C16
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Radial Head Subluxation |
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ATNR vs STNR C18 |
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PT examination reveals PSIS is low on the left; ASIS is high on the left; standing flexion test shows that the left PSIS moves first and the farthest superiorly; Gillet's test demonstrates that the left PSIS moves inferiorly and laterally less than the right; long sitting test shows that the left malleolus moves short to long; and the sitting flexion test is negative. In light of these findings, the therapist diagnosis is: C21 |
This one right, but it is worth looking at it again: Left posterior rotated innominate Gillet's Test: think "Stork or Flamingo" stance
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Patient presents with partial and full thickness burns on the chest and neck region. The PT decide to apply TENS for debridement to modulate pain. Which TENS mode should provide the best relief? |
Brief intense TENS – NOT modulated TENS -pretty intense TENS is used to provide rapid onset, short-term relief during painful procedures. The pulse rate and pulse to ration are similar to conventional TENS, however the current intensity is increased to the patient's tolerance |
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As a patient demonstrates some out of synergy UE indicative of stage 4 recovery after a left CVA. The PNF pattern that represents the best choice to promote continued recovery of the right UE is: C25 |
Got this right, but not sure why. Chop, reverse chop with right arm bleeding – Both chop and reverse chop patterns with the affected arm out of synergy |
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An elderly individual has limited endurance as a result of a sedentary lifestyle. There is no history of cardio respiratory problems. After an exercise tolerance test, which was negative for coronary heart disease, the best initial exercise prescription for this individual would be: C26 |
60% to 90% HR Max NOT 35% to 50% of VO2 max -initial exercise prescription for an asymptomatic elderly individual with general deconditioning is 60% to 90% of HR Max, which is equivalent to 50% to 85% of the O2 max or 50% to 85% of heart rate reserve. This is been in the established intensity guidelines for Adults for aerobic exercise training. Duration should be discontinuous, and exercise should be performed most days of the week. |
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A PT is examining a patient with COPD GOLD stage III. What would be a clinical finding the PT would expect? C33 |
Muscle wasting -NOT use of supplemental O2 -muscle wasting is a common manifestation of COPD. Supplemental oxygen is typically found in patients in stage four of GOLD, not stage III. |
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Re-examination of a patient with a dermal ulcer over the Cox think reveals a burned exposing the deep fascia. There is no necrotic tissue, exudate is minimal and the borders of the ulcer or diffusely covered with granulation tissue. Previous treatment has included daily whirlpool and wet to dry dressing with normal sailing. Based on these findings, intervention should consist of: C36 |
Irrigation with pressures below 15 psi – NOT calcium alginate dressing – Low pressure gauge and helps to decrease conization and prevent infection -if the ulcer is clean, whirlpool can damage incipient granulation tissue and should be discontinued. Wet to dry dressing help her move necrotic tissue. Calcium alginate is using the presence of heavy exudates, which is not the case here. Hydrogel would be the best because it is not hearing, keeps and protects granulation buds , But since this is listed in conjunction with whirlpool, it is not the correct answer |
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There's a picture of a Scottie dog fracture with the following question – the spinal defect shown in the diagram should be management avoidance of lumbar spine: C37 |
Extension NOT rotation or flexion |
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Patient experiences color changes in the skin during position changes of the foot. Elevation, pallor develops and when the limb is positioned in the seated hanging position, hyperemia develops. These changes are indicative of: C41 |
Heariel insufficiency – NOT chronic venous insufficiency – Arterial insufficiency turned by skin color changes during position changes of the foot – termed Rubor of dependency test – Venus insufficiency can be determined by the history, presence of aching calf pain with prolonged standing, a percussion test in standing Trendellenburg test (retrograde filling test). |
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An elderly and frail adult was referred to PT for an examination of balance. Patient has a recent history of at least two in the last six months. Based on knowledge of balance changes in the elderly and scoring of standardized balance measures, the test done at the best indicate increased fall risk are: C42 |
Functional reach of 7 inches – NOT tug result of 13 seconds ??? – All of these instruments can be used to examine functional balance and fall risk of functional reach score of <10 is indicative of increased fall risk The following cut off scores indicate fall risk: Tinnetti/POMA: <19=high fall risk; 19-24= moderate fall risk BERG: < 45 TUG: 13.5+ sec. increased fall
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Patient complains of right upper quadrant pain and tenderness. PT percusses over the costal margin at the point where the lateral border of the rectus muscle intersects with the costal margin. The patient complains of acute pain stops inspiratory effort. This is most likely indicative of: C43 |
Acute cholecystitis – NOT peritoneal inflammation – Percussion over for costovertebral tenderness the reveals a sharp increase in tenderness with a sudden stop aininspiratory effort is a positive Murphy's sign and is indicative of acute Cooley cholecystitis |
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PT is evaluating the needs of the young child diagnosed with Myelodysplasia at the T10 level. PT determines the most beneficial mobility device for this child to use in school is: C45 |
Lightweight wheelchair NOT parapodium – The lightweight wheelchair is the most beneficial to us for this child provides effective and efficient mobility – Parapodium permits standing but does not allow for sufficient mobility for the entire school day |
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Patient has limited right rotation cause by left thoracic facet joint capsular tightness at T6 – 7. The arthrokinematic glide that would most effectively improve right rotation in sitting is: C46 |
Got this one right, but it's worth thinking through again. Superior and anterior glide on the left T6 transverse process |
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EMG activity in the lower extremities during quiet standing is fairly continuous in the: C47 |
Solias and gastrocnemius NOT quadriceps for Morris and anterior to be Alice – Soleus and gastrocnemius muscles oppose the dorsi-flexion moment that exist at the angle as a result of the line of gravity which falls slightly anterior to the lateral malleolus. This fairly continues activity is crucial for maintaining balance during quiet standing. |
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A PT is beginning manual lymph drainage for patient recently diagnosed with lymphedema. Initially, proper bandaging for this condition requires a: C49 |
Short stretch compression wrap – NOT gause wrap – A short stretch wrap has a low resting pressure and high working pressure. This means it has enough pressure to enhance lymphatic return at rest, improve the activity of the lymphangion and facility increase return during mm pumping activities |
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Elderly patient found unconscious with diagnosis of CVA. Examination by PT reveals normal sensation and movement on the right side of the body with impaired sensation (touch, pressure, proprioception) and paralysis on the left side of the body. Left side of the lower face and trunk or similarly impaired. Most likely location of the CVA is: C50 |
Got this one right, but worth a review. Right parietal lobe |
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The loss of sensory function in peripheral neuropathy is among the first notable symptoms. If more than one nerve is involved, the sensory loss typically appears as: C 51 |
Got this one bright, but worth a review Stocking and glove distribution of the lower and upper extremities |
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PT is supervising a phase 2 cardiac rehab class of 10 patients. One of the patients, who is being monitored with radio telemetry, is having difficulty. The PT decide to terminate the patient exercise session upon observing: C52 |
A second-degree intraventricular heart block – NOT 1 mm ST segment depression, upsloping Criteria for reducing exercise intensity or termination according to the American College of sports medicine include: 1. onset of angina and other symptoms of exertional intolerance 2. systolic BP >/=240 mmHg; diastolic BP >=110 mmHg 3. > 1-mm S segment depressinm horizontal or downsloping 4. increased frequency of ventricular arrhythmias 5. 2nd-degree or 3rd-degree AV block or other significant electrocardiogram (ECG) diturbances |
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The torque output produced in the sitting position during isokinetic exercise involving the hamstrings is: C58 |
Higher than the torque actually generated by the contracting hamstrings – NOT lower than the work actually generated by hamstrings – Gravity- produced torque adds to the force generated by the hamstrings when they contract, giving a higher torque output than is actually produced by the muscle (gravity assisted exercise). Testing values may be misleading; software is available to correct the effects of gravity |
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The manual therapy technique appropriate to correct the closing restriction of T5 on T6 is: C 59 |
Central posterior anterior pressure at a 60° angle on the spinous process of T6 while stabilizing T5 – NOT Center PA pressure at a 45° angle on the spinous process of T5 while stabilizing T6 Think about the superior transfers processes: BUM BUL BUM |
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A patient with a significant history of coronary artery disease is currently taking atropine. Based on knowledge of the effects of this medicine, the therapist expects: C 61 |
Increased heart rate and contractility at rest NOT with the static hypertension – Atropine is an anti-cholinergic agent –it blocks the acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the central nervous system. It produces an increase in heart rate and contractility and is used to treat symptomatic sinus bradycardia and exercise induced bronchospasm |
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A nine-year-old boy with Duchenne's MD is referred for home care. The PT should begin the examination by: C 66 |
Asking the child and his parents to describe the boys most serious functional limitations NOT asking the parents to outline the boys past rehabilitation success – The child and his parents play an important part in determining the patients functional limitations, disability and future interventions. Taking the role initial history is important to determining what other components of the examination would be appropriate. – The other choices may indeed be appropriate; however, performing the INTERVIEW 1st helps decide which examination tools are needed |
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Elderly patient presents with a stage III decubitus ulcer on the plantar surface of the right foot. After a series of conservative intervention with limited success, the PT chooses to apply electrical stimulation for tissue repair. The best choice for electrical current in this case is: C 70 |
High volt monophasic pulsed current – NOT low voltage, biphasic pulsed current – Because high-volt pulsed current is a monophasic, the unidirectional current, the Uni directional produce a therapeutic affect the active (treatment) electrode. A (-) charge (polarity) should be applied for a BACTERICIDAL affect or a (+) charge give to promote WOUND HEALING. |
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Patient recovering from a stroke demonstrate hemiparesis of the right UE with moderate flexion and extension synergies (flexion stronger than extension). The PT goal is to strengthen the shoulder muscles first to produce elevation of the arm. Best method to achieve this goal is to promote: C 72 |
Shoulder flexion with elbow extension -NOT shoulder abduction with elbow flexion – Obligatory hemiplegic synergies are present and should not be reinforced. -Shoulder flexion with elbow extension is the correct choice. -It is an out of synergy combination that strengthen the shoulder flexors needed to stabilize that shoulder in an elevated position. In sitting, bending forward with Elder Street and hand touching floor is a good example of an early activity to promote this |
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PT shines a light into a patient's eye and observes the pupil constrict. This is a test of the function of the: C 73 |
Occulomotor nerve NOT optic nerve -The pupillary reflex (contrition of the pupil) is a function of the deferent portion of the oculomotor nn. CN 3 |
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Patient is referred to PT after exercise tolerance test; tested positive had to be terminated at seven minutes. Based on the PT's knowledge, the therapist expects the patient may have exhibited: C 74 |
This one right, but worth review. ST segment depression from baseline of 3 mm horizontal or downsloping depression – Positive exercise tolerance test or graded exercise test indicates myocardial ischemia with increasing exercise intensity. The optimal test duration is 8 to 12 minutes that can be terminated if symptoms of exercise intolerance is evident. ACSM indicates these include: ECG changes from baseline (>2 mm or downsloping; ST segment depression, or > 2 mL ST segment elevation). |
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College soccer player sustained a hyperextension me injury and kicking the ball diagnosed with a knee sprain, sent to physical therapy for rehab. As part of the exam PT conducts a test shown in the figure which is a anterior drawer test or Lockman's test. The type of exercise indicated in the acute phase of treatment is: C 75 |
Closed chain terminal knee extension exercises NOT pooping teen terminal extension exercises – Positive test here is laxity of the ACL. Close chain extension exercises are safe and effective secondary to the dynamic stability inherent with this type of exercise – Open-chain knee extension may place excessive load on the ACL. |
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Patient with grade 3 diabetic ulcer being treated with calcium alginate dressing. This type of dressing can be expected to: C 76 |
Facilitate autolytic debridement and absorb exudate NOT restrict bacteria from the wound, while supporting the tissues -Moisture retentive occlusive dressings such as calcium alginate are recommended for use on executing wounds (grade 3 ulcer) . They maintain a moist environment, absorb exudate, provide debridement, reduce pain at the wound site will promote it faster healing (re-epithelialization |
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Patient with a history of CAD and recent MRI is exercising in an IP cardiac rehab program. The therapist observes the following. The best course of action is to: C79 |
Got this right, but worth reviewing Have the patience sit down, continue monitoring and notify the physician immediately -this tracing shows PVCs multifocal (originating from different irritable ventricle focus). These multiform PVCs posied dental danger of deteriorating into ventricular tachycardia and ventricular fibrillation or cardiac standstill. Because the heart is demonstrating a high degree of irritability, the best course of action is to stop the exercise, have the patient down, continue monitoring carefully and notify medical staff immediately |
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Following initial functional exam using the FIM, patient is found require minimal contact assist transferring sit to stand and bed to wheelchair. These results are best reported as: C 82 |
Got this right, but worth reviewing FIM level 4; complete activity with 75% or more of the effort 1: Total Assistance 7: Total Indpenedence
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Patient is sent to PT with diagnosis of frozen shoulder – most affected mobilization technique for restricted shoulder abduction is: C 84
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Inferior glide at 55° of abduction NOT inferior glide at 95° of after – and inferior glide at 95° would be outside the normal glenohumeral joints resting position, so this technique would not be optimal |
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Presents with insidious onset of pain the jaw referred to the head and neck regions. As best the patient him a call, it may be related to biting into something hard. Cervical range of motion is limited in flexion by 20°, cervical lateral flexion is limited to the left by 10°. Mandibular depression is 10 mm deviation to the left, protrusion is 4 mm, and lateral deviation is 15 mm to the right and 6 mm to the left. Based on these findings the diagnosis for this patient would be: C 85 |
Ligamentous pattern of TMJ on the left NOT cervical spine and TMJ capsular restrictions on the left – The capsule ligamentous pattern of the TMJ is limited on opening, lateral Deviation greater to the uninvolved side and deviation on opening to the involved side. Normal parameters for TMJ measures are 25 to 35 mm functional and 35 to 50 mm normal, Normal protrusion is 3 to 5 mm and normal lateral deviation is 10 to 15 mm. Review information on symptoms of TMJ |
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Patient presents with supraspinous tendinitis. Therapist applies ultrasound. Decides to treat the supraspinatus tendon w/ US; therapist should place the shoulder joint in: C 88 |
Abduction and internal rotation NOT 80 duction and internal action – 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 |
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During an exam therapist observes in the regular area the skin on patients shoulder 7 mm in diameter. Patient reports it is always been there, but is more prominent lately and the color has changed, now ranging from black to bed. The therapist documents this finding as: C 89 |
Atypical dysplastic nevus NOT a wheal -A nevus is a common mole. A changing nevus (atypical dysplastic nevus) that presents with asymmetry, your regular borders, variations in color, diameter >6 mm, and elevation is indicative of malignant melanoma. -Wheal: a red, swollen mark left on flesh by a blow or pressure (almost like a hive) -Papule: a solid raised lesion that has distinct borders and is less than 1 cm in diameter (almost like a pimple)
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She is working on a cardiac care unit in acute care. After exercising a patient recovering from a ventricular infarct, PT notices fatigue and dyspnea after mild activity. Later that afternoon the therapist notices the patient has a persistent spasmodic cough while lying in bed and rapid heart rate of 140, as well as slight edema in both ankles. The patient appears anxious and irritated. The PT suspects: C 92 |
Left ventricular heart failure NOT right ventricular heart failure – Typical clinical manifestations of left ventricular failure include those described in the case example along with an S3 heart gallop, paroxysmal nocturnal dyspnea, orthopenea and signs and symptoms of pulmonary Adema (marked dyspnea, pallor, cyanosis, diaphoresis, tachypenea, anxiety and agitation). |
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PT is treating a patient with deep partial thickness burns over 35% of the body (chest and arms). Wound cultures reveal a bacterial count in excess of 105 per gram of tissue on the anterior left arm. The PT can reasonably expect that: C95 |
Did wound can converts the area to be full thickness burn NOT the burn area is pain-free because all nerve endings in the dermal tissue were destroyed – A deep partial thickness burn will heal in about 3 to 5 weeks if it does not become infected. An infection typically results in conversion of the wound into a full thickness burn. |
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A patient with complete SCI at the level of T11 is on a bowel program. The primary method of bowel training in this case is use of: C 101 |
Digital stimulation of intact defecation reflexes NOT manual removal of the stool from the rectum -and SCI injury at the level of T11 produces and UMN for spastic bowel with intact spinal defecation reflexes. Bowel and anal sphincter is respond to rectal/anal stimulation, enabling a planned bowel elimination program. |
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Standing with excessive subtalar pronation. The PT exams for possible related motion of: C 104 |
Tibial, moral, and pelvic IR NOT tibial, tomorrow, and pelvic ER * I think of this as an A/B pattern: Ankle valgus, knee varus, ankle valgus |
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Which of the following G.I. sources of paint can refer to the shoulder? C 107 |
Got this correct but worth the review. Spleen or diaphragmatic pain -Esophageal pain can referred to the mid back, head or neck -Colon or appendix pain can referred to the low back, pelvis or sacrum -Gallbladder pain can referred to the mid back and scapular region |
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Patient presents with an acute and painful shoulder impingement. During the exam, the PT find significantly increased muscle guarding around the shoulder girdle with difficulty in accurately assessing joint mobility. Which manual therapy techniques is the best option to use to assist in performing a proper assessment? C111 |
Maitland Grade II oscillations to the glenohumeral joint NOT Maitland Grade IV inferior glide to the glenohumeral joint – Maitland Grades I and II are used to improve joint lubrication/nutrition as well as to decrease pain and muscle guarding. A Grade II oscillation will improve muscle relaxation, allowing a proper assessment of the patient's joint mobility. -Decreasing the mm guarding is the 1st priority before more vigorous interventions are employed. Maitland grades III and IV are used to stretch tight mms, capsule and ligaments in order to improve motion. |
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To increase the step length of a patient with a right transfemoral amputation who is taking an inadequate step with the limb, the therapist should: C 113 |
Provide posterior directed resistance to the right ASIS during stance NOT provide posterior directed resistance to the left ASIS during swing -light resistance and stretch applied to the pelvis (right ASIS) in a posterior direction during mid stance too late stance will facilitate Forward pelvic rotation on that side and enhance the word movement of the Lim 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). Resistance applied to the pelvis during swing may interfere with stepping. |
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Elderly, frail resident of extended care facility has intractable constipation and complains of Domino pain and tenderness. The PT recognizes that the patient may experience pain in the: C 114 |
Anterior hip, groin or thigh region Intractable constipation can cause partial or complete bowel impaction, pain, and tenderness in the lower abdomen. Referred pain is the anterior hip, groin, or thigh. – Pain in the bladder can referred to the medial thigh and leg |
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A patient presents with decreased motion at the at Atlanta-occipital joint. PT wants to use the principles of coupled emotions during spinal therapy technique. When the occiput is bent to the right, the therapist should mobilize C1 into: C 116 |
Got this right, but worth reviewing Rotation to the left – Given the rule of coupled movement in the upper cervical spine, When the occiput is side bent into one direction, C 1 rotates into the opposite direction. Side bending and rotation occur in the same direction from C2 – C 7 regardless of the spine flexion or extension. |
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Patient complains of pain with mouth opening that makes it difficult to eat foods that require chewing. Examination revealed active mouth opening to be with in normal limits of: C 119 |
35 – 44 mm NOT 15 – 24 mm – Average active range of motion is approximately 35 to 50 mm, however – only 25 to 35 mm of opening between the teeth is required for normal every day activity. |
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Patient presents with tingling and parasthesis in the median nerve distribution of the right forearm and hand. The following tests were found negative bilaterally: Adson's, hyperabduction, costoclavicular, Phalen's, and ulner nerve Tinel's test. Based on the information, the diagnoses that is likely is: C 121 |
Pronator teres syndrome NOT carpal tunnel syndrome – All of the special tests are used to determine neurological compromise of the lower trunk and brachioplexus. Special test to rule out pronator teres syndrome are: 1. Passive supination too long need the pronator, which is tight (this but compress the nerve at that level). 2. Active resistance of pronation, which would compress the nerve of that courses through the pronator muscle belly. |
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If the subject vision is blocked either by having the subject close the eyes or by placing a barrier between the part being tested in the subjects eyes, the PT can effectively examine: C 125 |
Sensory integrity NOT discriminative touch and fast pain, but not proprioception refers to conscious relay pathways for discriminative touch, conscious proprioception, fast pain and discriminative temperature. Sensory examination must rule out vision in order to establish the reliability of sensory testing -dealer/visual/somatosensory integration can you stab list only by a series of tests that include both eyes open and eyes closed and by using flat and compliant (foam) or moving surfaces. |
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A patient with hypothyroidism and poor drug compliance is referred to physical therapy following a fall. During exercise, the therapist should be alert for exercise-induced: C 129 |
Myalgia and weakness NOT sinus tachycardia and arrythmias -hypothyroidism results in decreased metabolic rate and is likely to produce exercise – induced myalgia and weakness (rhabdomyolysis). |
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Researchers (the Ottawa panel) utilized meta-analysis to identify the evidence for aerobic fitness exercise in the management of fibromyalgia. 13 randomized, controlled trials (RCTS) and 3 controlled clinical trials (cohort studies and case controlled studies) were selected. The main difference between the two types of trials is the: C 130 |
Use of randomization of subjects NOT length of the studies -the main difference between the two types of trial is randomization of subjects in experimental and control groups -Meta-Analysis involves the combining of a series of independent, previously published studies of similar purpose to yield a larger target population. -RCTS are used and can be either single center or multiple center trials. A cohort study is a prospective study involving a group of participants with a similar condition. Comparison is made with a matched group that does not have the condition. -Duration length of studies are not distinguishing factors between the two types of studies. |
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A patient with an SCI at the level of T1 (Asia a) is in the community phase of mobility training. In order for the patient to navigate a 4 inch height curb with the wheelchair, the therapist tells the patient to: C 131 |
Lift the front casters ascend in a wheel position NOT descend backwards with the trunk upright and arms hooked around the push handles. -is our ascended in the wheelie position (front casters lifted and moving first). Individuals must learn to use momentum and a strong push to elevate the front casters of the chair (wheelie position) and propelled wheelchair of the curb. |
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What does this test assess the integrity of? C 133 |
Right, but good review Anterior talofibular ligament |
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s/p meniscal repair, pt wants to know when walking can commence following surgery. Earliest would be: C 135 |
End of post surgical week 3 -after a meniscal repair, patient should be nonweightbearing for 3 to 6 weeks. – As a meniscus is still going to the healing process they can be damaged if weight-bearing occurs before 3 weeks. |
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R shoulder cuff tendinitis; findings of a work site ergonomic assessment indicate that the worker is required to perform repetitive reaching activities above shoulder height. Most appropriate modification would be: C 136 |
-Reposition the height of the shelf and items to below shoulder height. -NOT allow the worker to take more freq. rests to avoid overuse. -workstations should be designed to accommodate the persons who actually work on the job. Workstations should be easily adjustable and designed to be comfortable for the worker. In this case, lowering the height of the shelf for frequent use is best. – Taking more frequent rest or providing a different chair does not eliminate the essential problem of repetitive overhead reaching that is causing the shoulder tendinitis. Using a standing desk would eliminate overhead reach but is not as practical as lowering shelf. In the workplace individuals cannot be expected to stand all day long. |
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Has a 5th rib that is stuck in position of maximal inspiration. Which technique is best to improve the rib mobility and assisted in returning to its resting position? C 137 |
Maitland Grade 4 mobilization of the head of the rib at the costovertebral joint in the SUPERIOR direction. -NOT Maitland Grade 4 mobilization of the head of the rib at the costovertebral joint any inferior direction -inspiration, the lateral portion of the rent up in the head 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. |
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* A teenager presents to the clinic with vague left hip and groin pain that worsens with weight-bearing. The PT's examination reveals limited and painful hip internal rotation, antalgic gait, and a week gluteus medias. Based upon this clinical presentation, most likely diagnosis is: C 141 |
Slipped Capital Femoral Epiphysis (SCFE) -NOT Legg-Calve' -Perthes Disease -the SCE age range is 10 to 16 years of age, and the male to female ratio is 3:1. -the incidence of left hip to right hip is to: one, with 30% bilateral. – The best examinations finding include pain that worsens with weight bearing, limited and painful hip IR, and weak hip abductors AGE is the helpful hint here: Think "Teenagers Slip" -Legg Calve' - Perthes disease is avascular necrosis of the femoral head with insidious onset between 3–12 years of age. The male to female ratio is 4:1. the clinical presentation is antalgic gait, disuse atrophy and of the hip and thigh muscles, and painful limitation of abduction and internal rotation. The gluteus medius muscle strain would present with more specific vocal pain and pain with muscular contraction |
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A patient with a transfer more amputation and and above me prosthesis demonstrates knee instability while standing. The patient's knee buckles easily when performing weight shift. The therapist suspects the cause of this problem is a: C 142 |
I got this right, but it is worth reviewing. Prosthetic knee set too far anterior to the TKA line. -in order to increase stability of the knee, the prosthetic knee is normally aligned posterior to a line extending from the trochanter to the ankle (TKA line). A knee set anterior to the TKA line will buckle easily. |
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An older adult at risk for falls has undergone a structured home-based exercise program that consists of standing balance training and strengthening exercises. The measure that can best show improvement is: C 143 |
Balance test – NOT performance oriented mobility assessment/Tinnetti – The Burg balance is a 14 item test of static and dynamic balance in sitting and standing. And also examine sick to stand and stand to sit transitions. Does not include items examine gait. Gait was not part of this person's training program. |
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A group of 10 patients is recruited into the study investigating the effects of relaxation training on blood pressure (BP). One group of patients is scheduled to participate in a supervised cardiac rehabilitation program that includes relaxation 3 times a week for 12 weeks. The other group of patients is instructed to perform activities as usual. At the conclusion of the study, there was no significant difference between groups; blood pressure decreased significantly in both groups. The investigator can reasonably conclude: C 146 |
The activities of the non-rehabilitation group were not properly monitored and may account for these results – NOT both groups had BPs initially so high that reductions should've been expected -to ensure adequate control, the researcher set a time to remove the influence of any variable other than the independent variable in order to evaluate its affects on the dependent variable. In the study the investigator did not adequately investigate the activities of the control group. The small number of subjects they also have contributed to the lack of significance. |
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PT is examining a patient newly diagnosed with MS. Patient experiences and intense shock like pain throughout the body in the neck is possibly flexed. The therapist recognizes these findings as: C 147 |
Got this one right, worth revisiting. -Lhermitte's sign -Lhermitte's sign, also called Lhermitte's phenomenon or "barber chair sign", is often one of the first symptoms mentioned by people newly diagnosed with MS. |
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Which cluster of examination findings could indicate that a pt is in decompensated heart failure. C 148 |
S4 heart sound, crackles on lung auscultation, increased jugular vein distension -NOT S4 heart sound, crackles on lung auscultation, decreased jugular vein distension -S4 indicates a pathology in the ventricle, as it is present in a patient with heart failure. Crackles on auscultation are often heard in a patient with heart failure because they have compressive atelectasis do the pulmonary edema. When cued to take a deep breath, they can create enough pressure to open the alveoli, which causes the crackling sound, It is possible that a patient in heart failure will also have wheezes if there is significant pulmonary edema causing the alveoli to fill with fluid. With decompensated heart failure, there will be a back-up of fluid throughout the cardiac and pulmonary system, which can extend into the peripheral circulatory sys. this will cause increased distention of the jugular veins. |
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Therapist hand/finger placements for posterioanterior mobilization techniques to improve down-gliding/closure of the T7-8 facet joints should be located at the: C 150
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Transverse process of T8 -NOT spinous process of T8 -axis of motion for the mid thoracic vertebra is above the spinous process and below the transverse process. Therefore, if downgliding/closure of T7 – 8 vertebral segment is required, the therapist's hand placement should be at the transverse process of T8 or the spinous process of T7. -PA pressures on the spinous process in this region of the thoracic spine will cause the spinous process to glide into and compress the spinous process of the segment below, so no arthrokinematic glide will occur. A PA central glide to the transverse process of T7 will increase extension between T6 and T7. |
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A young, otherwise healthy, adult is recovering from a complete spinal cord injury (ASIA A) at the level of L4. Functional expectations for this patient include: C153 |
Ambulation using bilateral AFOs and canes NOT ambulation using bilateral KAFOs and a reciprocal walker -spinal cord lesion at the level of L4 is considered an LMN injury (cauda equina injury). Intact movements include: flexion, hip abduction and extension. Quadriceps become fully innervated at L4. This pt can be expected to be a functional ambulator using bilateral AFO's. |
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A baseball pitcher reports insidious onset of symptoms characteristic of impingement, including catching and popping in the throwing arm. Examination reveals that glenohumeral passive internal rotation is painful and limited to 30°. turnover Tatian is less symptomatic has 130° of passive range. The PT should first: C 157 |
Recommend an MRI – NOT mobilize the glenohumeral joint to increase IR range of motion -The therapist should suspect a labral tear. This is a common finding among pitchers and athletes who do a lot of throwing (especially those who present with abnormal ROM findings and instability symptoms of popping into catching). Although the athlete may present with impingement, an MRI is warranted to fully diagnose the condition and to develop an appropriate treatment plan. |
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Following a hip fx that is now healed, a pt presents w/ weak hip flexors (2/5). All other mms are WFL. During gait, the PT expects that the pt may walk w/: C 161 |
A circumducted gait NOT a backward trunk lean -circumduction is the compensation for weak hip flexors or an inability to shorten the leg (weak knee flexors and ankle DFs). Hip hiking can also compensate for an abnormally long leg (lack of knee flexion and DF) |
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Patient has a very large right-sided bacterial pneumonia. Oxygen level is dangerously low. The body position that would most likely improve the patient's arterial oxygen pressure (PaO2) is: C 164 |
Left sideline with the head of the bed in the flat position NOT right sideline with the head of the bed and flat position – In order to match perfusion and ventilation, the therapist needs to place the unaffected side a gravity dependent position or that of left side-lying |
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An examination of the patient reveals drooping at the shoulder, rotary winning of the scapula, and inability to shrug the shoulder and complaints of aching in the shoulder. Based on these findings, the cause of the symptoms would most likely be due to: C 165 |
A lesion of the spinal accessory nerve – NOT a lesion of the long thoracic nn – Rotary winging occurs when an inferior angle of one scapula is rotated farther from the spine than the inferior angle of the other scapula. The shoulder drooping and inability to shrug he shoulder are secondary to a lesion of the spinal accessory nn (CN XI), which innervates the trapezius mm. -although this type of winging could be found with all of these answers, the findings of shoulder drooping and inability to shrug the shoulder clearly point to a lesion of CN XI. |
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* A patient with spastic hemiplegia is referred to the PT for ambulation training. The patient is having difficulty with standing up from a seated position as a result of co-contraction of the quadriceps and hamstrings during the knee and hip extension phase. The therapist wishes to use biofeedback beginning with simple me extension exercises in the seated position. The plan is to progress to sit to stand training. The initial biofeedback protocol should consist of: C166 |
Low detection sensitivity with recording electrodes placed closely together – NOT high-detection sensitivity with recording electrodes placed far apart -by initially placing the electrodes close together, the PT decreases the likelihood of detecting undesired motor unit from adjacent active muscles (cross talk). -By setting the biofeedback sensitivity (gain) low, the therapist would decrease the amplitude of the signals generated by the hypertonic muscles and keep the EMG output from exceeding a visual and or auditory range (scale). -the other choices failed to use optimal placing of electrodes (electrodes placed far apart) or sensitivity (high detection) to optimize outcomes. -the wider the spacing of electrodes, the more volume of the muscle is monitored. Thus, when targeting a specific muscle, narrow spacing should be used. -when the focus is not on a specific muscle but rather to encourage a general motion flexion shoulder elevation, then a wider spacing of electrodes can be used. In addition, when working with weakness of a muscle in which there is a decreased ability to recruit motor units or there is a decrease in the size and number of motor units, then a wider spacing and a high sensitivity would be used in order ro create an adequate visible sign. |
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Examination of the patient recovering from a stroke reveals loss of pain and temperature sensation on the left side of the face along with loss of pain and temperature sensation on the right side of the body. All other stations are normal. The therapist suspects a lesion in the: C 167 |
This right, but worth reviewing Left posterior lateral Medulla -A lesion in the posterior lateral medulla cause mixed sensory loss (described in this case). Pain and temperature are affected, where as discriminative touch and proprioception are not (the medial lemniscus is not involved). -Sensory loss will be completely collateral (not mixed) only after the discriminative sensory tracks (fasciculus gracilis and fasciculus cuneatus) cross in the upper medulla. Patient with lesions above the medulla (midbrain, cortex for internal capsule) will present with contralateral sensory loss.
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A pt is exercising in a phase 3 OP cardiac rehab program that utilizes circuit training. One of the stations utilizes wts. The pt lifts a 5# wt, holds it for 20 sec., then lowers it slowly. The PT corrects the activity and tells the pt to reduce the length of the static hold, Resistance exercise with static holding can be expected to produce: C170 |
Higher HR and arterial BP NOT reduced normal venous return to the heart and elevated BP -Dynamic exercise facilitates circulation, while isometric (static) exercise hides blood flow, producing higher HRs and arterial BPs. Rise in BP is related to degree of intensity. -Resistance exercise does little to increase oxygen uptake. HR and BP are higher (not lower). The Valsalva maneuver (forced expiration against a closed glottis) that accompanies breath holding produces increased intrathoracic pressure, which in turn hinders normal venous return to the heart. Breath holding is more likely with isometric exercise, but is not always present. |
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A pt complains of pain in the R lower aspect of the lateral rib cage. The CC is intense pain, which also occurs at night. The pain lasts for approx. 15 min and then subsides. There was no mechanism of injury and no pain w/ activity during the day. AROM and PROM of the T spine and costal cage is normal and pain free. Mild tenderness is present inferior to the R lateral ribcage. The most likely dx for this pt would be: C171 |
Systemic disease -this history is an insidious onset, with no injuries and no pain with activity. There is no reproduction of symptoms with the physical exam. This is typically a red flag for a systemic condition that should be referred to a medical doctor. -most musculoskeletal conditions have a mechanism of injury or repetitive stress that initially cause the symptoms. They're also activity related, so certain positions, activities or movement aggravate or relieve the symptoms. |
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A male pt is referred to OP PT for LBP. During the pt interview, he describes a recent inc. difficulty w/ urinating that does not affect his LBP sx. Neurological screening exam is normal and Murphy's sign is (-). Based on this clinical scenario, the pt's LBP sx may be associated w: C174 |
Lower urinary tract NOT kidney -The lower urinary tract can refer sx to the lumbar spine region, and the recent report of increased difficulty w/ urination is a key factor. -A (-) Murphy's sign (percussion in the costoverterbral area) decreases the likelihood of kidney sx. -(-) neurological findings would ryle out the 1st lumbar nn root as a source of sx |
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A PT is reviewing x-rays from a pt with a trimalleolar fx. The best radiographic views to visualize this bony anomaly are: C 176 |
Anterposterior or lateral -NOT oblique and lateral -tri malleolus fracture includes fracture of both malleoli and the posterior rim of the tibia. The anterior posterior view of the ankle demonstrate 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 of the posterior rim of the distal tibia. |
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A patient presents with pain and muscle spasm of the upper back (C7 – T8) extending to the latter border of the scapula. This encompasses a 10 X 10 cm area on both sides of the spine. If the US unit only has a 5 cm² sound head, the therapist should treat: C 177 |
Got this one right, but worth reviewing Each side, allotting five minutes for each section – The total treatment area is too large for the 5 cm² sound had to produce adequate tissue heating. Sonating the two areas independently will allow more time for the tissue temperature to rise during the treatment time in each area. |
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In posturography testing using the Clinical Test for Sensory Integration Balance (CTSIB), patients who sway more or fall under conditions of eyes closed and platform moving (condition 5) or the visual surrounding moving and platform moving (condition 6) are likely to demonstrate: C 179 |
Vestibular deficiency NOT visual dependency -Th CTSIB is (+) for vestibular deficiency with loss of balance on conditions 5 and 6. |
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A pt presents w/ severe, frequent seizures originating in the medial temporal lobes. After bilateral surgical removal of these areas, the plot is unable to remember any new information just prior to the surgery to the present. The pt cannot recall text read minutes ago or remember people previously met. These outcomes are indicative of: C 180 |
Loss of the hippocampus and declarative memory function NOT loss of procedural memory and integration with frontal cortex -declarative memory refers to conscious, explicit or cognitive memory it is a function of the cerebral cortex and the hippo campus. – Procedural memory (unconscious memory or implicit memory) refers to the recall of skills and habits and emotional responses. -it is the result of integrated action of the frontal cortex (neocortex), thalamus and striatum of the basal ganglia. The amygdala is a collection of nuclei in the anteromedial temporal lobe, forming the core of the limbic circuits. It is important for triggering feelings and drive related behaviors. |
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A 14 yo pt presents w/ a BMI of 33 kg/m2 and a hx of limited participation in physical activities is referred for ex. training. The nutritionist has prescribed a diet limiting his caloric intake. The best initial ex. prescription is: C 181 |
2 daily sessions of 30 min at 45%-70% VO2 max NOT 3 weekly sessions of 60 min at 50% Vo2 max -this individual is obese (BMI equal to or greater than 30 kg/m²) and will benefit from exercise increase energy expenditure and diet to reduce caloric take. -mischel exercise prescription should utilize low intensity with longer duration exercise. Splitting the training into two sessions each day is a good choice. The goal is to work toward bringing the target heart rate into a suitable range. Visuals are at increased risk of orthopedic injuries and require close monitoring. |
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A patient is admitted to a hospital after a fall. I reviewed the patient's medical chart reveals a blood pressure of 160/85, triglyceride level 160 mg/dL and a fasting blood level of 115 mg/dL. Waist is 310 pounds. Examination of the patient reveals a rotund man with a 54 inch waistline. These findings are indicative of: C 182 |
Metabolic syndrome NOT Cushing's syndrome – This patient is exhibiting four of the risk factors of metabolic syndrome (diagnosis is made if three or more are present). -risk factors include: 1. Abdominal obesity: waist circumference > 40" for men and >35" in women 2. Elevated triglycerides: triglyceride levels of 150 mg/dL or higher 3. low HDL cholesterol or being on medication to treat low HDL: HDL level < 40 mg/dL in men or 50 mg/dL in women 4. elevated BP: systolic BP >/=130 mmHg and or diastolic BP >/= 85 mmHg 5. fasting plasma glucose level >100 mg/dL The therapist plan of care should be reflective of the patient's increased risk for heart disease, stroke and diabetes and should assist the patient in lifestyle changes that reduce these risk factors. -no mention is made of absolute insulin deficiency (type one diabetes). Although these are risk factors for heart disease, they do not specifically define are characterized chronic heart disease. Cushing's syndrome (glucocorticoid hormone excess) refers the manifestation hypercortisolism from any cause. Patients typically exhibit around moon face, with protruding abdomen or buffalo hump on the back along with weak muscles and wasting. |
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Patient in an exercise class develops muscle weakness and fatigue. Examination reveals leg cramps and hyporeflexia. The patient also experiences episodes of postural hypotension and dizziness. Abnormalities on the ECG include a flat T-wave, prolonged QT interva and depressed ST segment. These findings are suggestive of: C183 |
Hypokalemia NOT hyponatremia -hypokalemia, decreased potassium in the blood, is characterized by these signs and symptoms. Other possible symptoms include respiratory distress, irritability, confusion or depression and gastrointestinal disturbances. -hyperkalemia is excess potassium in the blood. Hyponatremia is decreased sodium in the blood, and hypocalcemia is decreased calcium in the blood. |
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The patient has experienced swelling in both lower legs (below the knees) since the age of 16 (10 yr history). The referring diagnosis is bilateral lymphedema. Therapist initial examination should include: C 184 |
ABI NOT Rubor of Dependency test -the ABI is helpful to determine the arterial patency or sufficiency. 1.0 indicates normal arterial flow; values between 0.5 and 0.8 indicate moderate compromise while values below 0.5 indicate severe compromise of arterial flow. -adequate arterial blood flow is essential in an application of compression for the team. -2 tests (Ruber of dependency test, systolic BP) are used in the examination of peripheral artery disease. |
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Patient has a 10 year history of Parkinson's disease and his been on levodopa/carbidopa for the past six years. The patient has fallen three times in the past month, resulting in a Colles' fracture. The therapist decides to try postural feedback training using a platform balance training device. The training sequence should focus on: C 187 |
Increasing the limits of stability and improving center of pressure alignment NOT decreasing the limits of stability and improving increasing posterior weight displacement. -the patient with Parkinson's disease significant balance impairment including loss of postural reflexes; decreased length of stability; flexed, stooped posture that alters the center of posture in an anterior direction; freezing; and orthostatic hypotension. Platform balance training should work toward improving the limits of stability and center of posture alignment (the patient should focus on reducing anterior displacement. -the patient is too unstable; decreasing the limits of stability is contra indicated, as is promoting anterior weight displacement |
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A 26-year-old was diagnosed with schizophrenia, disorganized type, at the age of 22 is referred for gait training after a compound fracture of the tibia. Individual recently experienced an exacerbation of the condition. Therapist recognizes this from the patient demonstrated behaviors, which include: C 197 |
Poor ability to perform multi step tasks requiring abstract problem-solving NOT increased fear of going out in public -schizophrenia is characterized by disordered thinking (fragmented thoughts, errors of logic or abstract reasoning, delusions, poor judgment and so forth). -sleep disturbances and flashbacks are common with post dramatic stress disorder. Increased fear of going out in public is Agoura phobia. Pervasive feelings of low self-esteem can a company depression or anxiety disorder. |
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The rehabilitation team is completing a home visit to recommend environmental modifications for a patient who is scheduled to be discharged next week. The patient is wheelchair dependent. The home has not been adapted. Which of the following recommendations is correct? C 198 |
Adding horizontal grab bars in the bathroom position at 34 inches NOT widening the door entrance to 28 inches – Horizontal grab bars should be positioned an optimal height of 33 to 36 inches. – The minimum a ramp grade (hello) is 1:12 – The toilet seat to be raised to a height of 17 to 19 inches – Minimum clearance with for doorways is 32 inches; 36 inches is ideal |
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An examination of gait, the PT observes lateral pelvic tilt on the side of the swing leg during frontal plane analysis. The therapist recognizes this finding functions to: C 199 |
Got this one right, but worth reviewing Reduce peak rise of the pelvis – Lateral pelvic tilt in the frontal plane keeps the peak of the sinusoidal curve lower than it would have been if the pelvis did not drop. Lateral pelvic tilt to the right is controlled by left hip abductors. |
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A group of researchers investigated the effect of tai chi on perceived health status in older, frail adults. The subjects were 269 women who were older than 70 years of age and recruited from five independent senior living facilities. Participants took part in a 48 week single-blind RCT. Perceived health status was measured by five pre-trained testers using the sickness impact profile (SIP). The researchers found significant perceived health benefits. Analysis of the design reveals: C 200 |
Important findings on the affects of tai chi exercise in the frail elderly NOT limited generalizability to a larger population -this study provides important findings on the effects of tai chi. It has a large number of subjects from multiple centers and thus has good generalizability (not limited). The SIT is a gold standard instrument with extensive testing and established validity and reliability. -Errors in reliability are not automatically inherent with multiple testers. Pretrial training reduces the likelihood of errors in reliability. There is no error in validity because of the use of the SIP |
