Practice Questions
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B1 C8 II A physical therapy plan of care for a child with spastic cerebral palsy who is three years old chronologically chronologically and cognitively but at a six monthold gross developmental developmental level level would include! include! A" reaching reaching for a blac# blac# and white white ob$ect while while in the the supine supine position" position" B" reaching reaching for a multicolor multicolored ed ob$ect ob$ect while in an unsupporte unsupported d standing standing position" position" C" visually visually trac#ing trac#ing a blac# blac# and white white ob$ect ob$ect held nine nine inches inches from his face" face" %" reaching for a multicolored multicolored ob$ect ob$ect while in an unsupported& guarded guarded sitting sitting position" position" B' C1 II A patient is receiving grade III mobili(ations to regain normal midthoracic extension" After three sessions he complains of locali(ed pain that persists for greater than ') hours" *he therapist+s treatment treatment would! A" change to grade II II mobili(ations mobili(ations to reduce the $oint and and soft tissue irritation" B" change change to grade grade I, mobili mobili(atio (ations ns to stretch stretch throug through h the pain" pain" C" change to selfstretching selfstretching activities activities because because the patient patient does does not tolerate mobili(ation" %" continue with with grade III mobili(ations mobili(ations followed by a cold pac# to the thoracic spine" spine" B- C. II A therapist therapist wishes to use behavior modification techni/ues as part of a plan of care to help shape the behavioral responses of a patient recovering from traumatic brain in$ury" *he B0* form of intervention is to! A" allow the the patient patient enough enough time for for selfcorr selfcorrecti ection on of the behavior behavior"" B" encourage encourage the staff staff to tell the patient patient which which behaviors behaviors are correct correct and which which are not" C" repriman reprimand d the patient patient every time time an undesirab undesirable le behavior behavior occurs" occurs" %" use fre/uent fre/uent reinf reinforce orcements ments for for all desire desired d behaviors" behaviors" B) C' III 2hich is 34* a useful intervention for a patient with multiple sclerosis who presents with a primary deficit of dysmetria5 A" iso#ineti iso#ineticc training training using low resista resistance nce at fast movemen movementt speeds" speeds" B" P36 patter patterns ns using carefu carefully lly graded graded resistance resistance and and slow reversa reversals" ls" C" pool thera therapy py using using moderat moderatee water water temper temperature atures" s" %" weight weight cuffs cuffs to distal extremit extremities ies during during functional functional trainin training" g" B7 C III A patient suffered fractures of C) and C7 following trauma received in a motor vehicle accident" 9aximum stabili(ation of his cervical spine can B0* be achieved with a! A" four fourpos poste terr orthos orthosis" is" B" halo halo orth orthos osis is"" C" 9ilw 9ilwau au#e #eee orth orthos osis is"" %" soft soft coll collar ar"" B C- II A patient had been on oxygen& but it was discontinued by physician order yesterday" %uring physical therapy& therapy& the patient becomes short of breath and re/uests re/uests supplemental supplemental oxygen" *he *he patient+s patient+s a4' is measured at :;<" *he decision decision that is 34* appropriate appropriate is! A" admini administe sterr suppl suppleme ementa ntall 4'" B" allow allow the patien patientt to to rest rest"" C" contin continue ue to monito monitorr a4 a4'" '" %" encourage encourage an effic efficient ient breathing breathing pattern" pattern" B. C' I A patient presents presents with wea#ness and atrophy of the biceps brachii resulting from an open fracture of the humerus" *he therapist+s therapist+s examination includes needle electromyography of the biceps" *he muscle response anticipated after the needle is inserted and prior to as#ing the patient to contract the muscle is! A" elec electr tric ical al sile silenc nce" e" B" fibril fibrillat lation ion potent potential ials" s" C" inte interf rfer eren ence ce patte pattern rns" s" %" polyp polyphas hasic ic potent potential ials" s"
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Practice Questions
B8 C) II A new staff physical therapist on the oncology unit of a large medical center receives a referral for strengthening and ambulation for women with ovarian cancer" he is undergoing radiation therapy following a surgical hysterectomy" =er current platelet count is 1.&;;;" *he 94* appropriate treatment activity for this patient at this time is! A" pass passiv ivee >49 >49 exer exerci cise se"" B" progressi progressive ve stair stair climbin climbing g using using weight weighted ed belts" belts" C" resistan resistance ce training training at -;< -;< one repetiti repetition on max" max" %" resistan resistance ce training training at 7;< 7;< one repetiti repetition on max" max" B: C1 II An office wor#er& who is a longterm smo#er now with emphysema& is referred to physical therapy" =e complains of increased pain and tingling in both hands after sitting at his des# for longer than one hour" *he 94* effective effective physical therapy intervention is! A" mobili(ation of the first rib and stretching stretching of middle trape(ius muscle muscle due to to longterm postural changes" changes" B" strengthening of the upper upper trape(ius and pectoralis pectoralis ma$or muscles for early thoracic thoracic outlet syndrome syndrome symptoms" symptoms" C" stretching of scalenes scalenes and sternocleidomastoid sternocleidomastoid muscles muscles for early thoracic thoracic outlet outlet syndrome symptoms" %" stretching of the pectoralis ma$or and and rhomboid muscles due to longterm longterm postural postural changes" changes" B1; C8 II A patient with diabetes is exercising" =e reports feeling wea#& di((y& and somewhat nauseous" *he therapist notices that he is sweating profusely and is unsteady on his feet"" *he therapist+s therapist+s immediate course of action would be to! A" call for for emergency emergency servic services es as he is having having an insulin insulin reaction reaction"" B" have a nurse administ administer er an insulin insulin in$ection in$ection for his developin developing g hyperglycem hyperglycemia" ia" C" immediat immediately ely administe administerr orange orange $uice for his developi developing ng hypoglyce hypoglycemia" mia" %" insist insist that he sit sit down until until his orthosta orthostatic tic hypoten hypotension sion resolves resolves"" B11 C' II A patient with postpolio syndrome has started attending an aerobic exercise program as an outpatient" 2hen she does not show up for her scheduled session& the therapist telephones to find out what is wrong" he says that she is very tired and has not been able to get out of bed for the last two days" =er muscles ache and she is afraid to continue with the exercise class" *he therapist+s B0* course of action regarding exercise is to! A" decrease the fre/uency to once a wee# wee# for an hour session& #eeping the intensity moderate" moderate" B" decrease decrease the intensi intensity ty and duration duration but maint maintain ain a fre/uency fre/uency of - times? times?wee# wee#"" C" discharge her from the program program since exercise is counterproductive counterproductive in postpolio syndrome" syndrome" %" reschedul reschedulee her exercise exercise wor#outs wor#outs for early early morning morning when she is less fatigue fatigued" d" B1' C. III A physical therapy student is on a final clinical rotation" *he supervising physical therapist becomes aware that the student tends to process information all at once& not in an ordered stepbystep manner" *he therapist+s therapist+s best strategy to ensure ade/uate learning for this student is to! A" focus focus the student student on learning learning important important relations relationships hips and concepts concepts"" B" focus focus the student student on ob$ective ob$ective infor informati mation on and interrel interrelatio ationship nships" s" C" provide provide reallife reallife example exampless that lin# learning learning to personal personal experie experiences" nces" %" redirect redirect the student student to process process informa information tion in a stepbyst stepbystep ep manner" manner" B1- C. II A : yearold falls and brea#s his hip" =e undergoes a total hip replacement at the local medical center" *he physician orders physical therapy two days after surgery" *he patient is covered by 9edicare and is still in an acute care facility" *he appropriate fre/uency of treatment would be! A" daily" B" ever every y oth other er day day" C" three three to to four four time timess per per wee#" wee#" %" two two times times per per day& day& ) days days per per wee#" wee#"
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Practice Questions
B8 C) II A new staff physical therapist on the oncology unit of a large medical center receives a referral for strengthening and ambulation for women with ovarian cancer" he is undergoing radiation therapy following a surgical hysterectomy" =er current platelet count is 1.&;;;" *he 94* appropriate treatment activity for this patient at this time is! A" pass passiv ivee >49 >49 exer exerci cise se"" B" progressi progressive ve stair stair climbin climbing g using using weight weighted ed belts" belts" C" resistan resistance ce training training at -;< -;< one repetiti repetition on max" max" %" resistan resistance ce training training at 7;< 7;< one repetiti repetition on max" max" B: C1 II An office wor#er& who is a longterm smo#er now with emphysema& is referred to physical therapy" =e complains of increased pain and tingling in both hands after sitting at his des# for longer than one hour" *he 94* effective effective physical therapy intervention is! A" mobili(ation of the first rib and stretching stretching of middle trape(ius muscle muscle due to to longterm postural changes" changes" B" strengthening of the upper upper trape(ius and pectoralis pectoralis ma$or muscles for early thoracic thoracic outlet syndrome syndrome symptoms" symptoms" C" stretching of scalenes scalenes and sternocleidomastoid sternocleidomastoid muscles muscles for early thoracic thoracic outlet outlet syndrome symptoms" %" stretching of the pectoralis ma$or and and rhomboid muscles due to longterm longterm postural postural changes" changes" B1; C8 II A patient with diabetes is exercising" =e reports feeling wea#& di((y& and somewhat nauseous" *he therapist notices that he is sweating profusely and is unsteady on his feet"" *he therapist+s therapist+s immediate course of action would be to! A" call for for emergency emergency servic services es as he is having having an insulin insulin reaction reaction"" B" have a nurse administ administer er an insulin insulin in$ection in$ection for his developin developing g hyperglycem hyperglycemia" ia" C" immediat immediately ely administe administerr orange orange $uice for his developi developing ng hypoglyce hypoglycemia" mia" %" insist insist that he sit sit down until until his orthosta orthostatic tic hypoten hypotension sion resolves resolves"" B11 C' II A patient with postpolio syndrome has started attending an aerobic exercise program as an outpatient" 2hen she does not show up for her scheduled session& the therapist telephones to find out what is wrong" he says that she is very tired and has not been able to get out of bed for the last two days" =er muscles ache and she is afraid to continue with the exercise class" *he therapist+s B0* course of action regarding exercise is to! A" decrease the fre/uency to once a wee# wee# for an hour session& #eeping the intensity moderate" moderate" B" decrease decrease the intensi intensity ty and duration duration but maint maintain ain a fre/uency fre/uency of - times? times?wee# wee#"" C" discharge her from the program program since exercise is counterproductive counterproductive in postpolio syndrome" syndrome" %" reschedul reschedulee her exercise exercise wor#outs wor#outs for early early morning morning when she is less fatigue fatigued" d" B1' C. III A physical therapy student is on a final clinical rotation" *he supervising physical therapist becomes aware that the student tends to process information all at once& not in an ordered stepbystep manner" *he therapist+s therapist+s best strategy to ensure ade/uate learning for this student is to! A" focus focus the student student on learning learning important important relations relationships hips and concepts concepts"" B" focus focus the student student on ob$ective ob$ective infor informati mation on and interrel interrelatio ationship nships" s" C" provide provide reallife reallife example exampless that lin# learning learning to personal personal experie experiences" nces" %" redirect redirect the student student to process process informa information tion in a stepbyst stepbystep ep manner" manner" B1- C. II A : yearold falls and brea#s his hip" =e undergoes a total hip replacement at the local medical center" *he physician orders physical therapy two days after surgery" *he patient is covered by 9edicare and is still in an acute care facility" *he appropriate fre/uency of treatment would be! A" daily" B" ever every y oth other er day day" C" three three to to four four time timess per per wee#" wee#" %" two two times times per per day& day& ) days days per per wee#" wee#"
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Practice Questions
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B1) C- I A patient is ta#ing a drug from the sympathomimetic sympathomimetic group& albuterol @Proventil" 2hat is the 94* important effect effect of this medication5 A" enhance enhance bronchial bronchial smooth smooth muscle muscle contraction contraction and airway airway resistanc resistance" e" B" increase increase airway airway resistan resistance ce and exercisein exerciseinduce duced d bronchial bronchial dilation" dilation" C" reduce reduce airway resist resistance ance and exerci exercisein seinduce duced d bronchospas bronchospasm" m" %" reduce reduce bronchial bronchial constriction constriction and hyperten hypertension sion that accompa accompanies nies exercise" exercise" B17 C III A physical therapist decides to exercise a patient with fibromyalgia using a/uatic therapy" *he patient is moderately deconditioned from months of inactivity and has a history of a mild myocardial infarction ) years ago" =ydrostatic pressure exerted by the water can be expected to! A" increase increase cardiova cardiovascul scular ar demands demands at rest and and with exercis exercise" e" B" increase increase resist resistance ance as as speed speed of moveme movement nt increase increases" s" C" provide provide $oint $oint unloading unloading and and enhance enhance ease ease of active active movement movement"" %" reduce reduce effusi effusion on and and assist assist venous venous return" return" B1 C II A therapist therapist determines a patient is wal#ing with a bac#ward trun# lean as he ta#es full weight on his right leg" =e also demonstrates great difficulty going up ramps" *he B0* intervention to remediate his problem is to! A" strengthe strengthen n hip extensors extensors through through bridgi bridging" ng" B" strengthe strengthen n #nee extensors extensors with with weights& weights& using 8;< one repetit repetition ion maximum" maximum" C" stretch stretch hip abductors abductors throu through gh sidelyin sidelying g positionin positioning" g" %" stretch stretch hip hip flexor flexorss through through prone prone lying" lying" B1. C) II If a patient has developed a thic# eschar secondary to a full thic#ness burn& the antibacterial agent 94* effective effective for infection control is! A" nitr nitrof ofur ura( a(on one" e" B" Panafil" C" silv silver er nitr nitrat ate" e" %" ulf ulfamy amylon" lon" B18 C8 I An 8: yearold has gradually lost much of his functional vision over the last ) years" =e complains his vision is foggy and he has difficulty reading" =e mista#es images directly in front of him& especially in bright light" =e does better wal#ing across a room and is able to locate items in his environment with his peripheral vision when items are located to both sides" Based on his descriptions& the therapist suspects he may be presenting with! A" bitemp bitempora orall hemian hemianops opsia" ia" B" cata catara ract cts" s" C" glaucoma" ma" %" homony homonymou mouss hemian hemianops opsia" ia" B1: C' II 6ollowing a traumatic brain in$ury& in$ury& a patient is inconsistently oriented to time and place" he is unable to remember recent events and shows little or no carryover for new learning" *he P>I9A> P>I9A> goal of rehabilitation at this stage of recovery is to promote! A" environmen environmental tal and daily structur structuree with consistency consistency of cognitive cognitive stimuli" stimuli" B" increase increased d arousal and attentio attention n through through the use of sensory stimula stimulation tion techni/u techni/ues" es" C" independe independence nce in problem problem solving solving s#ills s#ills in varying varying environm environments" ents" %" varying varying daily tas#s tas#s and structure structure to increase increase ease ease of cognitive cognitive retrieva retrieval" l" B'; C' II A patient incurred a right C,A one month ago" he demonstrates moderate tone in her left upper extremity @predominantly flexor tone" =er ma$or problem at this time is a lac# of voluntary movement control and her left upper extremity shows minimal active movement with 1?)inch subluxation of the shoulder" An An appropriate initial activity would be! A" P36 %' %' flexion flexion patter pattern& n& left left upper upper extremity extremity"" B" /uadru /uadruped ped&& roc#ing roc#ing from from side side to side" side" C" sitting& sitting& left left active active shoulder shoulder protract protraction ion with with extended extended arm" %" sitting& sitting& weight weight bearing bearing on extended extended left left arm& weight weight shifting shifting"" ---8.8-:"doc
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Practice Questions
B'1 C. III A therapist conducts a study of the effectiveness of hot and cold in treating patients with pain" =e recruits ';; patients for each treatment group" *he pain instrument he uses has a possible total score of 7;& with 7; being the worst pain" =is data analysis reveals that Droup A @heat @heat modalities has a mean score of -- with a standard deviation of 1"; while Droup B @cold modalities had a mean of -7 with a standard deviation of ";" Based on this data the conclusion one should reach is! A" cold has has a greater greater effe effect ct on pain pain relief relief than than heat" heat" B" heat has a greater greater effect effect on pain pain relief relief than than cold" cold" C" the spread spread of scores with with cold treatmen treatmentt demonstrat demonstrates es variabili variability ty is greater" greater" %" the spread spread of scores scores with heat treatment treatment demonstrates demonstrates variability is greater" greater" B'' C1 I *he therapist in the photograph is testing which muscle5
A" B" C" %"
ante anteri rior or delt deltoi oid" d" midd middle le delt deltoi oid" d" supr supras aspi pina natu tus" s" uppe upperr trape trape(i (ius us""
B'- C II A patient presents with pain and instability of the left foot?an#le secondary to poliomyelitis with more recent development of progressive postpolio muscle atrophy" In this case& a plastic solid an#lefoot orthosis is an appropriate prescription in order to! A" control control excessi excessive ve amounts amounts of #nee #nee flexion flexion during during swing" swing" B" maintain maintain dorsifle dorsiflexion xion throughou throughoutt swing swing"" C" provide provide modest assista assistance nce to dorsiflexio dorsiflexion n while restrict restricting ing plantar plantar flexion" flexion" %" restri restrict ct all moveme movement" nt" B') C1 I A patient is referred to physical therapy following an anterior dislocation of the right shoulder" A possible possible positive examination finding as the result of this trauma would be! A" positi positive ve drop drop arm test" test" B" posi positi tive ve 3eer 3eer test test"" C" wea# wea# delt deltoi oids ds"" %" wea# wea# rho rhomb mboi oids ds"" B'7 C8 I A - monthold infant is being examined at an early intervention program" *he therapist therapist is having difficulty flexing the right upper extremity to remove the infant+s clothing" *his tas# is made more difficult if! A" the infan infantt is turned turned into sidelying sidelying on the the left" left" B" the infant infant sits sits up with with support support of the head head in a neutral neutral positi position" on" C" the infant+ infant+ss head head is is turned turned to the the left" left" %" the infan infant+s t+s head is is turned turned to to the right" right"
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Practice Questions
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B' C. III A therapist therapist has been as#ed to give an inservice presentation to staff nurses on safe guarding techni/ues" In order to best prepare for this this tal#& the therapist therapist should! A" provide a /uestionnaire /uestionnaire to a random sampling sampling of participants one wee# before before the scheduled scheduled presentation" presentation" B" provide provide a /uestionnai /uestionnaire re to all participa participants nts two wee#s wee#s before the schedul scheduled ed session" session" C" survey survey the audien audience ce a day befor beforee the schedu scheduled led session session"" %" survey survey the audience audience at at the scheduled scheduled session" session" B'. C' III *he patient with left hemiplegia would be least li#ely to respond in therapy if the motor learning strategies emphasi(ed! A" encourage encouragement ment of the the patient patient to slow slow down" down" B" maximum maximum use of demons demonstrat tration ion and gesture" gesture" C" maximu maximum m use use of verbal verbal cues" cues" %" simplification?restructur simplification?restructuring ing of the environment environment including removal of all clutter" clutter" B'8 C- II A twowee# twowee# old infant born at '. wee#s gestation with hyaline membrane disease is referred for a physical therapy consult" 3ursing reports reports that the child child desaturates to to 8)< with handling handling and has minimal minimal secretions secretions at present" *he physical physical therapist should! A" delegate to a physical therapist assistant for for a maintenance maintenance program program of manual techni/ues for secretion clearance" clearance" B" perform manual manual techni/ues for secretion secretion clearance& ' to ) hours daily& daily& to maintain airway airway patency" patency" C" provide provide suggestion suggestionss to nursing for positio positioning ning for optimal optimal motor motor developme development" nt" %" put the P* consult consult on hold as the the child is too too ill to tolerat toleratee exercise" exercise" B': C1 II A patient sustained sustained a valgus stress to his left #nee while s#iing" =is orthopedist found a positive 9c9urray+s 9c9urray+s test& and a positive Eachman+s Eachman+s stress test" =e has been sent to physical therapy therapy for conservative conservative management management of his dysfunction" dysfunction" *he subacute phase of physical therapy intervention should emphasi(e! A" closedchain functional functional strengthening strengthening of the /uadriceps /uadriceps femoris and hamstrings hamstrings emphasi(ing emphasi(ing regaining terminal #nee extension" B" closedchain functional functional strengthening strengthening of the /uadriceps /uadriceps femoris and hip abductors abductors to promote promote regaining regaining terminal #nee extension" C" openchain exercises exercises of the the hip extensors extensors and hamstrings hamstrings to inhibit anterior anterior translation translation of the the femur on the tibia" %" openchain strengthening strengthening of the /uadriceps /uadriceps femoris and hip adductors adductors to inhibit inhibit anterior anterior translation translation of the tibia on the femur" B-; C8 I *he most enthusiastic visual trac#ing by a neonate would be elicited by! A" a blac# and white white face& with a red nose& held held approximately nine nine inches from the infant+s infant+s eyes& moved moved hori(ontally" hori(ontally" B" a multicolore multicolored d clown+s clown+s face& held held 1' inches away away and moved hori(onta hori(ontally lly"" C" a multicolor multicolored ed spinning spinning top placed placed 17 inches inches from from the infant+ infant+ss eyes" eyes" %" a red ring ring on a string& string& held six inches away from the infant+s infant+s eyes eyes and moved hori(ontally" hori(ontally" B-1 C' II A 1) yearold patient with traumatic traumatic brain in$ury has a convulsive sei(ure during a therapy session" he lost consciousness and presents with tonicclonic convulsions of all extremities" *he therapist+s therapist+s B0* response is to! A" initiate initiate rescue rescue breathing breathing immedia immediately tely and call call for help to restrain restrain her" her" B" position in sidelying& chec# for an an open airway& airway& and immediately immediately call for emergency emergency assistance" assistance" C" position position in supine supine with head head supported supported with with a pillow and and wait out out the sei(ure" sei(ure" %" wrap her her limbs with with a sheet so she she can+t can+t hurt herself herself and and position position in supine" supine" B-' C. II A therapist wants to #now whether 3%* handling techni/ues produces an improvement in independent rolling that lasts longer than -; minutes" In this study rolling is the! A" cont contro roll var varia iabl ble" e" B" depe depend nden entt var varia iabl ble" e" C" inde indepe pend nden entt varia variabl ble" e" %" inte interv rven enin ing g vari variab able le"" B-- C- I ---8.8-:"doc
Practice Questions
A computer programmer& with no significant past medical history& presents to the emergency room with complaints of fever& sha#ing chills and a worsening productive cough" =e has chest pains over the posterior base of his left thorax which is made worse on inspiration" 2hich of the following is 34* an appropriate physical finding for this patient5 A" asymmetrical breathing" B" crac#les over the posterior aspect of his left thorax" C" limited chest excursion" %" slowed respiratory rate" B-) C II A patient is demonstrating genu valgum during standing and wal#ing" *his problem can be effectively controlled by prescribing a #neean#lefoot orthosis with! A" anterior #nee cap strap" B" posterior plastic shell" C" pretibial and suprapatellar anterior bands" %" /uadrilateral brim" B-7 C) I A ' yearold patient is confined to bed following a severe stro#e& he has '7 year history of diabetes and diabetic neuropathy in both lower extremities" %uring an examination of sensory and integumentary integrity& the therapist identifies an ischemic necrosis on the lateral side of the right foot in the region of the fifth metatarsal head" =ypoesthesia is found in both feet and she is not able to sense a 7";. emmes2einstein monofilament in the right forefoot" *he therapist+s interpretation is that! A" protective sensation of the foot is lost at the 1; g force level" B" the foot is insensate with protective sensation loss at the .7 g force level" C" the patient in unable to perceive sharp?dull sensation" %" the patient still has normal protective sensation in the right foot" B- C7 III A patient strained his lower bac# muscles three wee#s ago and now complains of pain @?1;" Fpon examination& the therapist identifies bilateral muscle spasm from *1;E)" *he therapist elects to apply interferential current to help reduce pain and spasm" *he 94* APP>4P>IA*0 electrode configuration to choose in this case would be! A" four electrodes with current flow diagonal to the spinal column" B" four electrodes with current flow perpendicular to the spinal column" C" two electrodes with current flow parallel to the spinal column" %" two electrodes with current flow perpendicular to the spinal column" B-. C8 I An infant has $ust begun to pulltostand through #neeling& still demonstrates plantar grasp in standing& and is independent in sitting including all protective extension reactions" *his infant+s chronological age is approximately! A" 7 months" B" .8 months" C" :1; months" %" 1'1) months" B-8 C1 II A sixtyfive year old male retired bus driver has an increasing fre/uency of low bac# pain over the last 1; years" =e states that 3AI%s help to relieve his symptoms but there is always a nagging type pain" =e reports significant stiffness in the morning which dissipates by noon after exercising and wal#ing his dog" Pain is exacerbated with fre/uent lifting and bending activities as well as sitting for long periods" Physical therapy intervention should emphasi(e! A" $oint mobili(ation& soft tissue mobili(ation& and flexion exercises" B" modalities to reduce pain& $oint mobili(ation& and lumbar extension exercises" C" modalities to reduce pain& postural reeducation and dynamic stabili(ation exercises" %" postural reeducation& soft tissue mobili(ation& and dynamic stabili(ation"
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Practice Questions
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B-: C. III A therapist is orienting a new physical therapy aide in transfer techni/ues" Initial consideration would be to! A" as# about previous wor# and other experiences related to transferring individuals" B" determine specific goals for teaching the techni/ues" C" give a computer simulated instructional program before actual Ghands onH training ta#es place" %" provide an organi(ed series of tal#s dealing with patient safety during transfers" B); C. II An elderly patient with diabetes and bilateral lower extremity amputation is to be discharged from an acute care hospital two wee#s post surgery" *he incisions on his residual limbs are not healed and continue to drain" =e is unable to transfer because the venous graft sites in his upper extremities are painful and not fully healed" =is endurance outofbed is limited" *he 94* appropriate discharge destination for this patient would be! A" custodial care facility" B" home" C" rehabilitation hospital" %" s#illed nursing facility" B)1 C' I A patient currently being seen for low bac# pain awo#e one morning with drooping left facial muscles and excessive drooling" =e was recovering from a cold and had experienced an earache in his left ear during the previous ' days" *he therapist suspects a Bell+s Palsy which can be confirmed by examining! A" corneal reflex and stretch reflexes of facial muscles" B" taste over the anterior tongue and having the patient raise his eyebrows and puff chee#s" C" taste over the posterior tongue and having the patient protrude the tongue" %" trigger points for pain& especially over the *9" B)' C I A physical therapist assistant is assigned to ambulate a .' yearold patient with Par#inson+s disease" *he therapist instructs the P*A to watch for! A" an abnormally wide base of support" B" decreased trun# rotation with shorter steps" C" unsteady& uneven gait with staggering steps to one side" %" wider strides and increased double support time" B)- C- I A patient with congestive heart failure is on a regimen of diuretics and calcium channel bloc#ers" *he potential sideeffects of these medications that the physical therapist should be alert for include! A" decreased electrolytes and electrical instability evidenced by increased arrhythmias" B" gastrointestinal upset and extreme fatigue" C" orthostatic hypotension and di((iness" %" reflex tachycardia and unstable blood pressure" B)) C1 II A patient with a traumatic in$ury to her right hand had a flexor tendon repair to the fingers" Physical therapy intervention following this type of repair would begin! A" within a few days following surgery to preserve tendon gliding" B" within a few days following surgery to allow for early initiation of strengthening exercises" C" after the splint is removed in '- wee#s to allow full active range of motion of all affected $oints" %" after the splint is removed in ) wee#s to allow ample healing time for the repaired tendon" B)7 C8 I An 8: yearold community dwelling elder fell in her home and suffered multiple fractures of her right arm including Colles+ fracture of her right wrist& and humeral fracture of her right shoulder" he is hospitali(ed for open reduction& internal fixation of her right radius" 2hich is 34* an expected finding with this patient5 A" decreased pain and tenderness at the fracture sites" B" increased li#elihood of developing complications li#e pneumonia" C" mental confusion following hospitali(ation and surgery" %" slower healing time with prolonged rehabilitation"
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Practice Questions
B) C' I *he therapist suspects a patient recovering from a middle cerebral artery stro#e is exhibiting a pure hemianopsia" *his can be examined using a! A" distance acuity chart placed on a welllighted wall at patient+s eye level '; feet away B" penlight held inches from the eyes and moved inward toward the face" C" penlight held approximately 1' inches from the eyes and moved to the extremes of ga(e right and left" %" visual confrontation test with a moving finger" B). C I A patient is recovering from a left tibial amputation and complains of numbness and tingling affecting his dorsal foot and big toe" *his is driving him cra(y because he #nows the limb is gone" *he therapist suspects the source of his discomfort is most li#ely pressure from residual limb wrapping affecting the! A" common peroneal nerve" B" medial calcaneal nerve" C" sural nerve" %" tibial nerve" B)8 C. II A therapist investigated the accuracy of pulse oximeter estimates during exercise" Correlational analysis measured the strength of the relationship between two types of earprobee/uipped pulse oximeters during heavy cycle exercise under hypoxic conditions" *he investigator found measured arterial oxyhemoglobin saturation @<=b4' levels to have a correlation of "8: at high saturation but only "8 at low saturation levels" *he results of this study suggest! A" accuracy of the measurements increases at higher saturation levels" B" both machines are highly accurate at all saturation levels" C" both machines are only moderately accurate" %" during heavy exercise& oxygen saturation levels should be interpreted cautiously" B): C1 I A college soccer player sustained a hyperextension #nee in$ury when #ic#ing the ball" *he patient was ta#en to the emergency room of a local hospital and was diagnosed with #nee sprain" =e was sent to physical therapy the next day for aggressive rehabilitation" As part of the examination to determine the type of treatment plan to implement& the therapist conducted the test shown in the figure" Based on the test picture& the therapist is examining the integrity of the!
A" B" C" %"
anterior cruciate ligament" iliotibial band" medial meniscus" posterior cruciate ligament"
B7; C1 II A patient is seen in physical therapy ' days post motor vehicle accident" *he chief complaints are headaches& di((iness& nec# pain with guarding& and a sensation of a lump in the throat" Plain film xrays were read as negative" *he therapist should refer this patient for! A" a second series of plain film xrays B" C* scan" C" myelogram" %" *' 9>I"
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Practice Questions
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B71 C7 II A patient with an acutely sprained an#le will be treated by immersion into an ice water bath" *he therapist should tell the patient to expect in order! A" aching& numbness& and burning& followed by intense cold" B" burning& intense cold& and aching& followed by numbness" C" intense cold& burning& and aching& followed by numbness" %" numbness& aching& and intense cold& followed by burning" B7' C8 III A :) yearold patient with cancer is admitted to a local hospital& he is given an Advanced Care 9edical %irective to review and sign" Duidelines for this document include specifying the rights of the individual patient to! A" be informed of a facility+s right to modify the format and implementation schedule of the document" B" be informed of the right to ma#e decisions regarding their medical care upon admission" C" establish mental competence for decision ma#ing& with signing witnessed by two adults" %" insist on contraindicated palliative treatment even if the ultimate outcome is death" B7- C' II A patient is recovering from stro#e" At ) months he is ambulating with a straight cane for household distances" In the clinic& when his cane is ta#en away and he practices ambulating with no assistive device& recurvatum is observed that worsens with continued wal#ing" *he therapist+s B0* strategy is to! A" give him a JA64 to control the hyperextension and have him use a hemi wal#er" B" give him a small based /uad cane to improve his stability and have him practice A>49 in supine" C" practice isolated small range /uadriceps eccentric control wor# in standing and continue with the straight cane" %" put him on a Cybex and wor# on increasing /uadriceps tor/ue output at higher loads and increasing speeds" B7) C II A patient recovering from an incomplete spinal cord in$ury at the E- level @AIA cale % ambulates with bilateral Eofstrand crutches" =e remar#s that he has great difficulty going down ramps and reports his #nees wobble and are unsteady" An appropriate intervention for this problem would be! A" biofeedbac# training to reduce a #nee extensor spasticity" B" progressive resistance training for the /uadriceps" C" prolonged icing to reduce hamstring pain" %" stretching using a posterior resting splint for tight plantar flexors" B77 C. III It is illegal to release patient information without obtaining the patient+s consent to! A" another healthcare provider involved in the care of the patient" B" the insurance company that is paying for the patient+s treatment" C" the patient+s employer when the condition is wor#related" %" the referring physician when there is a referral relationship" B7 C III 2ith respect to the wor#er+s sitting postures in the 6igure& the greatest reduction in lumbar spine compression forces would be achieved by!
A" B" C" %"
decreasing the chair bac#restseat angle to 87 degrees" eliminating armrests on the chair" increasing the angle between the seat pan and bac#rest to between :;11; degrees" using a ' inch gel seat cushion" ---8.8-:"doc
1;
Practice Questions
B7. C1 I A baseball pitcher has been sent to physical therapy with progressive posterior shoulder pain and wea#ness of the shoulder abductors and lateral rotators" *he therapist notices muscle wasting superior and inferior to the scapular spine" *he patient+s problem is 94* EIJ0E attributable to damage involving the! A" long head of the biceps brachii" B" scalene muscles" C" spinal accessory nerve" %" suprascapular nerve" B78 C. III 3ursing homes that receive 9edicare reimbursement for eligible residents are re/uired by law to provide for rehabilitation services including physical therapy based on! A" diagnostic categories @%>Ds" B" needs assessment performed by a physical therapist" C" referral from a physician" %" referral from the nurse case manager" B7: C' II A patient is recovering from surgical resection of an acoustic neuroma" he presents with symptoms of di((iness& vertigo& hori(ontal nystagmus& and postural instability" *o address these problems& her physical therapy plan of care should incorporate! A" =allpi#e exercises to improve speed in movement transitions" B" prolonged bed rest to allow vestibular recovery to occur C" repetition of movements and positions that provo#e di((iness and vertigo" %" strengthening exercises focusing on spinal extensors" B; C I A patient is beginning her ambulation training with a right above#nee prosthesis" *he therapist notices that during early swing the heel rises excessively" A possible cause is! A" amputee pain" B" too little tension in the extension aid" C" too much #nee friction" %" too much tension in the extension aid" B1 C) II A therapist is treating a :- yearold patient in the home environment" Fpon arrival& the therapist notices that the patient is confused and s#in color and turgor are poor" *he patient reports of an intestinal bug for the last few days with fre/uent vomiting and diarrhea" *he therapist+s B0* course of action is to! A" cancel therapy for today& carefully document the findings and notify the physician" B" give the patient water and notify the physician immediately" C" monitor vital signs& if => is not elevated& get the patient up and wal#ing" %" notify the family& and insist that the patient should not be alone until the illness is over" B' C- II A patient who is 7 wee#s postmyocardial infarction is participating in a cardiac rehabilitation program" *he therapist is monitoring responses to increasing exercise intensity" *he indicator that exercise should be immediately terminated is! A" 1"7 mm of downsloping * segment depression" B" appearance of a P,C on the 0CD" C" pea# exercise => greater than 1);" %" systolic blood pressure greater than 1); mm =g or diastolic BP greater than 8; mm =g" B- C8 II An infant who was -- wee#s gestational age at birth and is now - wee#s chronological age demonstrates colic" In this case& the B0* intervention the physical therapist could teach the mother is! A" fast vestibular stimulation" B" neutral warmth" C" stro#ing and tapping" %" visual stimulation with a colored ob$ect"
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Practice Questions
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B) C' I A therapist is treating a patient with Browne/uard syndrome that resulted from a gun shot wound" *he therapist+s examination should reveal! A" loss of motor function and pain and temperature sensation with preservation of light touch and position sense below the level of the lesion" B" loss of upper extremity function& @cervical tract involvement with preservation of lower extremity function @lumbosacral tract involvement" C" sparing of tracts to sacral segments with preservation of perianal sensation& and active toe flexion" %" ipsilateral wea#ness and loss of position sense and vibration below the lesion level with contralateral loss of pain K temperature sensation" B7 C. II A patient is recovering from stro#e and presents with moderate impairments of the left upper and lower extremities" *he therapist+s goal today is to instruct him in a standpivot transfer to his affected side so he can go home on a wee#end pass" =is wife is attending today+s session and will be assisting him on the wee#end" *he B0* choice for teaching this tas# is to! A" demonstrate the tas#& then have the caregiver practice with the patient" B" demonstrate the tas#& then practice with the patient" C" practice the tas# first with the caregiver& then with the patient" %" practice the tas# first with the patient& then with the caregiver" B C. III A .8 yearold currently in an acute care facility recovering from fractures of the spine and hip" =is 9edicare Part A benefits have come to an end and he is soon to be discharged" 9edicare Part B will 34* cover! A" durable medical e/uipment needed for the patient in his home" B" home health agency rehabilitation services" C" outpatient therapy services in a private therapy practice" %" outpatient therapy services in an acute care facility" B. C I 2hen using a patellartendon bearing prosthesis& a patient will experience excessive #nee flexion in early stance if the! A" foot position is inset too much" B" foot position is outset too much" C" soc#et is aligned too far bac# or tilted posteriorly" %" soc#et is aligned too far forward or tilted anteriorly" B8 C- II A chronic smo#er developed carcinoma of the lung" 6ollowing a right pneumonectomy& postoperative physical therapy intervention should include! A" breathing exercises to both sides of the thorax to maintain ade/uate aeration" B" percussion in all postural drainage positions" C" sha#ing in all postural drainage positions" %" sustained maximal inspiration training with an incentive spirometer" B: C II A physical therapist has to order a wheelchair for a patient with a *:1; spinal cord in$ury who wishes to engage in sports activities" *he wheelchair 2IEE 34* need! A" a high bac#" B" a low bac#" C" removable arm rests" %" swingaway footrests" B.; C1 II A patient complains of persistent wrist pain after painting her house three wee#s ago" *he patient demonstrates signs and symptoms consistent with deQuervain+s tenosynovitis" An appropriate special test which can be used to confirm the diagnosis is! A" Craig+s test" B" 6in#elstein+s test" C" 6roment+s sign" %" Phalen+s test" ---8.8-:"doc
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Practice Questions
B.1 C8 II An adaptive wheelchair for a child with moderate spastic /uadriplegic cerebral palsy would include! A" a pommel to #eep hips abducted" B" movable chairbac# to allow for extension of the hips and trun#" C" movable footrests to allow an#les to plantarflex" %" pads on the seat to #eep hips adducted" B.' C' I A .- yearold with persistent balance difficulty and a history of recent falls @' in the last - months is referred for physical therapy examination and evaluation" %uring the initial session it is crucial to examine! A" cardiovascular endurance during a minute wal#ing test" B" level of dyspnea during functional transfers" C" sensory losses and sensory organi(ation of balance" %" spinal musculos#eletal changes secondary to degenerative $oint disease" B.- C. III A patient with adhesive capsulitis of the shoulder sustains a fracture of the shoulder during treatment provided by the P*A" *he fracture occurred while the P*A was mobili(ing the shoulder $oint& which was part of the plan of care established by the P*" After the incident& the P*A told the P* that she was not familiar with the mobili(ation techni/ues to the shoulder" >esponsibility in this case falls on! A" both the P* and the P*A are responsible for establishing effective communication regarding the s#ills and competencies of the P*A" B" neither the P* nor the P*A are responsible for the fracture& it is an accepted ris# associated with $oint mobili(ation" C" the P* who is solely responsible for assessing the competence of the P*A under their supervision" %" the P*A who is responsible for informing their supervising P* whenever they are unfamiliar or uncomfortable with any treatment procedure" B.) C. III A patient is referred for physical therapy with a diagnosis of second degree an#le sprain" *he therapist is busy writing a discharge summary when the patient with the an#le sprain arrives for his scheduled appointment" *he physical therapist assistant on staff #nows the patient as he had treated the patient previously for a similar in$ury" *he physical therapist should! A" as# the physical therapist assistant to commence the examination" B" as# the physical therapist assistant to examine the patient+s P>49 to speed up the process" C" complete the written discharge summary at another time and examine the patient" %" tell the patient to wait until the following day for a complete examination" B.7 C1 I %uring a postural screen for a patient complaining of low bac# pain the therapist notices that the #nees are in genu recurvatum" Possible contributory postures would include! A" an#le dorsiflexion and hip abduction" B" an#le plantarflexion and anterior pelvic tilt" C" forefoot varus and posterior pelvic tilt" %" lateral tibial torsion and anterior pelvic tilt" B. C1 I After treating a patient for trochanteric bursitis for one wee#& the patient has no resolution of pain and is complaining of problems with gait" After reexamination the therapist finds wea#ness of the /uadriceps femoris& and altered sensation at the greater trochanter" *his is most li#ely due to! A" degenerative $oint disease of the hip" B" E) nerve root compression" C" E7 nerve root compression" %" sacroiliac dysfunction"
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Practice Questions
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B.. C) I A patient in chronic renal failure is being seen in physical therapy for deconditioning and decreased gait endurance" *he therapist needs to schedule the patient+s sessions around dialysis which is received - mornings a wee#" *he patient is also hypertensive and re/uires careful monitoring" *he therapist+s B0* approach is to ta#e blood pressure! A" every minute during activity& using the shunt arm" B" in the seated position when activity has ceased" C" in the supine position& using the shunt arm" %" pre and post activities& using the nonshunt arm" B.8 C II A patient is recovering from a fracture of both tibia and fibula in the right lower leg which has been casted" *he referral is for gait training& nonweightbearing on right lower extremity" *he safest gait pattern for this patient to use is a! A" fourpoint" B" swingto" C" threepoint" %" twopoint" B.: C. II A therapist wishes to determine the effectiveness of *03 on the relief of pain in a group of '; patients with phantom limb pain" he recruits her patients over a ' year period" All receive a wee# intervention" he finds that 1' patients with phantom pain got pain relief while 8 had no relief" *he B0* conclusion that can be reached is that this! A" Eevel 1 randomi(ed controlled trial provides conclusive evidence of the effectiveness of *03" B" Eevel ' cohort design allows small but definitive conclusions to be reached" C" Eevel - casecontrol study provides limited confidence in the effectiveness of *03" %" Eevel )& a /uasiexperimental study& provides only /uestionable evidence of treatment effectiveness" B8; C- II 6ollowing a postmyocardial infarction& a patient is a new admission to a Phase - cardiac rehabilitation program" %uring the initial exercise session his 0CD responses are continuously monitored via radio telemetry" *he therapist notices three P,Cs occurring in a run with no P wave" *he 94* appropriate action to ta#e is to! A" continue the exercise session but monitor closely" B" have him sit down and rest for a few minutes before resuming exercise" C" modify the exercise prescription by decreasing the intensity" %" stop the exercise and notify the physician immediately" B81 C' I A patient with left hemiplegia is able to recogni(e his wife after she is with him for awhile and tal#s to him& but he is unable to recogni(e the faces of his children when they come to visit" *he children are naturally very upset by their father+s A" anosognosia" B" ideational apraxia" C" somatognosia" %" visual agnosia" B8' C8 I A home care therapist receives a referral to evaluate the fall ris# potential of an 8' yearold community dwelling elder" =e has fallen three times in the last four months with no history of fall in$ury except for minor bruising" =e is currently ta#ing a number of medications" *he drug E0A* li#ely to contribute to his increased fall ris# is! A" Buffered aspirin" B" %igoxin" C" 0lavil" %" 3itroglycerin" B8- C1 II A patient complains of foot pain when first arising which eases with ambulation" *he therapist finds that symptoms can be reproduced in weightbearing and running on a treadmill" 0xamination reveals pes planus and pain with palpation at the distal aspect of the calcaneus" 0arly management would include! A" modalities to reduce pain B" prescription for a customi(ed orthosis" C" strengthening of an#le dorsiflexors" %" use of a resting splint at night" ---8.8-:"doc
1)
Practice Questions
B8) C III A patient with a complete *1; paraplegia resulting from a spinal cord in$ury is ready to begin community wheelchair training" *he therapist+s goal is to teach him how to do a wheelie so he can manage curbs" *he B0* training strategy is to instruct the patient to! A" grasp the handrims posteriorly and pull them forward abruptly and forcefully" B" lean bac#ward while moving the hands slowly bac#ward on the rims" C" place his hand on the top of the handrims to steady the chair while he throws his head and trun# forward" %" throw his head and trun# bac#ward to rise up on the large wheels" B87 C- I A physical therapist should be alert to recogni(e the signs and symptoms associated with the onset of aspiration pneumonia" 4f the following& the patient 94* susceptible to develop this form of pneumonia is one with! A" a circumferential burn of the thorax associated with significant pain" B" a complete spinal cord lesion at *' with diminished coughing ability" C" amyotrophic lateral sclerosis with dysphagia and diminished gag reflex" %" severe scoliosis with compression of internal organs" B8 C II A patient demonstrates /uadriceps wea#ness @)?7 and difficulty descending stairs" *he B0* intervention to regain functional strength in the /uadriceps is! A" iso#inetic exercise& at - degrees?second" B" maximum isometric exercise& at )7 and :; degrees of #nee extension" C" partial s/uats progressing to lunges" %" progressive resistance exercises& .;< 1 >9& - sets of 1;" B8. C' I Independent community ambulation as the primary means of functional mobility is a realistic functional expectation for a patient with the highest level of spinal cord in$ury at! A" high lumbar @*1'E1" B" low lumbar @E)E7" C" low thoracic @*:1;" %" midthoracic @**:" B88 C7 II A patient presents with multiple fractures of both hands and wrists as a result of a mountain bi#e accident" 3ow five wee#s later& the patient currently has vertigo& limited wrist and finger motion& and dry scaly s#in over the involved areas" *he physical agent 94* appropriate to select in this case would be! A" contact ultrasound" B" functional electrical stimulation" C" hot pac#s" %" paraffin" B8: C II A patient is 8' yearsold and demonstrates a history of recent falls @two in the last two months and mild balance instability" *he therapist+s referral is to examine the patient and recommend an assistive device as needed" Based on the patient+s history& it would be B0* to select a! A" a folding reciprocal wal#er" B" front wheel rolling wal#er that folds" C" hemi wal#er" %" standard& fixed frame wal#er" B:; C1 III 6ollowing surgery& a patient develops a stiff pelvis and limited pelvic?lower trun# mobility" *he therapist elects to use sitting exercises on a therapy ball to correct these impairments" In order to improve lower abdominal control& the ball would have to move! A" bac#ward& producing anterior tilting of the pelvis" B" bac#ward& producing posterior tilting of the pelvis" C" forward& producing anterior tilting of the pelvis" %" forward& producing posterior tilting of the pelvis"
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Practice Questions
17
B:1 C' I A patient presents with wea#ness in his right lower leg - wee#s following a motor vehicle accident" =e complains of spontaneous twitching in the muscles of the lower leg" *he therapist visually inspects both limbs and determines that muscle bul# is reduced on the involved right limb" Dirth measurements confirm a 1 inch difference in the circumference of the right leg measured ) inches below the patella" %eep tendon reflexes and tone are diminished" Based on these signs and symptoms the therapist concludes the patient is exhibiting! A" a peripheral nerve in$ury" B" brainstem dysfunction affecting extrapyramidal pathways" C" DuillainBarrL syndrome" %" pyramidal trac# dysfunction above the decussation in the medulla" B:' C' I A patient with syringomyelia was found on physical examination to have impairment of pain and temperature sensation of the face but preservation of light touch" *his dissociated sensory loss in the face can be explained by involvement of! A" the main sensory nucleus of C3 ," B" the mesencephalic nucleus of C3 ," C" the nucleus of the tractus solitarius of C3 ,II" %" the spinal nucleus of C3 ," B:- C- II A patient with bacterial pneumonia has crac#les and whee(es at her left lateral basal segment and decreased breath sounds throughout" he in on ) liters of oxygen by nasal cannula which brings her a4' to :;<" >espiratory >ate is '8" *he intervention that would be I3APP>4P>IA*0 to use in this case is! A" breathing exercises encouraging expansion of the left lateral basilar thorax" B" percussion to the appropriate area on the left lateral basilar thorax" C" sha#ing over the appropriate area on the left lateral basilar thorax" %" standard postural drainage for the lateral basal segment& left lower lobe" B:) C8 I A therapist receives a referral to see an elderly patient in the ICF recovering from a severe case of pneumonia" *he therapist recogni(es his disorientation is due to delirium rather than dementia because! A" he demonstrates persistent personality changes" B" he has hallucinations throughout the day" C" his level of arousal is significantly depressed" %" his symptoms are intermittent" B:7 C. II A comparison of the effects of exercise in water& on land& or combined on the rehabilitation outcome of patients with intra articular anterior cruciate ligament reconstructions revealed that less $oint effusion was noted after 8 wee#s in the water group" An appropriate statistical test to compare the girth measurements of the three groups is! A" analysis of covariance" B" analysis of variance" C" chi s/uare" %" pearman rho" B: C' II A patient has a recent history of stro#es @' in the past ) months" =e demonstrates good return of his right lower extremity and is wal#ing with a straight cane" *he therapist is concentrating on improving his balance and independence in gait" Fnfortunately his speech recovery is lagging behind his motor recovery" =e demonstrates a severe fluent aphasia" *he B0* strategy to use during physical therapy is! A" consult with the speech pathologist to establish a communication board" B" demonstrate and gesture to get the idea of the tas# across" C" have the family present to help interpret during P* sessions" %" utili(e verbal cues& emphasi(ing consistency and repetition"
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1
Practice Questions
B:. C I An individual is wal#ing with an above#nee prosthesis and demonstrates terminal swing impact" *he therapist suspects! A" insufficient #nee friction" B" the hip flexors are wea#" C" the prosthesis is externally rotated" %" too little tension in the extension aid" B:8 C) II A patient was burned over );< of his body in an industrial accident" =e has full thic#ness burns over his anterior trun# and nec# and superficial partial thic#ness burns over his shoulders" *he 94* appropriate procedures to stabili(e this patient out of positions of common deformity include! A" a cervical thoracic lumbosacral orthosis @C*E4 used during all upright activities" B" plastic cervical orthosis and axillary splints utili(ing an airplane position" C" soft cervical collar with an intrinsic plus hand splint" %" splints utili(ing a flexed position for the shoulders and body $ac#et for the trun#" B:: C1 I A 1 yearold patient& seen in the emergency room& was placed in a short leg cast following a severe rightsided Drade III an#le sprain" he is immediately referred to physical therapy for gait training using crutches" he complains that her right great toe is numb and she cannot lift her toes" *his problem 94* EIJ0E is a result of! A" anxiety and hyperventilation in anticipation of using crutches" B" compression of the common peroneal nerve" C" compression of the medial plantar nerve" %" compression of the posterior tibial artery resulting in vascular insufficiency" B1;; C' III 2hich intervention would be E0A* li#ely used to improve leftsided neglect in a patient with left hemiplegia5 A" bridging with both arms positioned in extension at the sides" B" hoo#lying& lower trun# rotation& and lightly resisted #nee roc#s" C" rolling& supine to sidelying on right& using a P36 lift pattern" %" sitting& with hands forward resting on large ball& weight shifting moving ball to the left" B1;1 C. III A patient with traumatic brain in$ury has been receiving inpatient physical therapy for the past two months has not demonstrated meaningful improvement in functional status" *he patient+s care is covered by 9edicare" *he therapist has informed both the physician and the family of his lac# of progress" *he family insists that the therapist continue to treat the patient& and the physician will continues to certify the patient for more physical therapy" *he therapist should! A" continue to provide the care both the family and the referring physician demandM it is the physician+s responsibility to determine the appropriateness of physical therapy" B" modify treatment goals in a manner that will allow the therapist to demonstrate that the treatment is achieving progress towards reasonable goals" C" provide the family 9edicare notification of noncoverage information& and carefully explain it& and their options& which could include paying for the care outofpoc#et" %" refer the patient to another clinic that is willing to continue treatment despite lac# of functional improvement" B1;' C- II A patient with C4P% reports to his fourth outpatient pulmonary rehabilitation session complaining of nausea& gastric upset and feeling $ittery" *he patient reports no change in pulmonary symptoms" *he physical therapist records the following set of vital signs! temperature :8"N6& heart rate 11; beats?min& and irregular blood pressure 17;?8& respiratory rate ';" Breath sounds show no change from baseline" *he therapist chec#s the medical record and finds that the patient has no history of gastric disease" =e is presently ta#ing theophylline& ,entolin& and Amcort" *he physical therapist should! A" call the patient+s physician and report signs of theophylline toxicity" B" have the patient increase his use of ,entolin to improve respiratory status" C" have the patient stop his use of Amcort until he can schedule an appointment with his physician" %" send the patient home and have him notify the physician of his current symptoms"
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Practice Questions
1.
B1;- C8 I *he therapist is treating a one yearold child with %own syndrome at home and notices decreasing strength in the extremities with nec# pain and limited nec# motion" %*>s are 1O" *he therapist+s suspects! A" atlantoaxial subluxation with lemniscal impingement" B" atlantoaxial subluxation with spinal cord impingement" C" lower motor neuron signs consistent with %own syndrome" %" upper motor neuron signs consistent with %own syndrome" B1;) C' I 2hich of the following causative factors is 34* li#ely to produce shoulder pain in hemiplegia5 A" flaccid paralysis with loss of seating action of rotator cuff muscles" B" passive range of motion while emphasi(ing scapulohumeral rhythm" C" spastic retraction with depression and downward rotation of scapula" %" traction and gravitational forces acting on a depressed& downwardly rotated scapula" B1;7 C I 2hile gait training a patient recovering from a cerebral vascular accident& the therapist observes the #nee on the affected side going into recurvatum during stance phase" *he 94* EIJ0E cause of this deviation can be attributed to! A" severe spasticity of the hamstrings or wea#ness of the gastrocnemiussoleus" B" wea#ness of both the gastrocnemiussoleus and pretibial muscles" C" wea#ness of the gastrocnemiussoleus or spasticity of the pretibial muscles" %" wea#ness or severe spasticity of the /uadriceps" B1; C) II our examination of the pressure ulcer pictured on the patient+s heel reveals dry eschar without edema& erythema& fluctuance or drainage" *he patient is afebrile" *he B0* recommendation regarding intervention for this ulcer is! A" en(ymatic debridement" B" need for an arterial bypass graft" C" sharp debridement" %" use of an A64 with heel pressure relief" B1;. C. II A therapist has completed a study investigating the relationship between ratings of perceived exertion @>P0 and type of testing modality! arm ergometry versus leg ergometry" *he therapist finds a correlation ;"7: with the arm testing while the correlation is ;".: with the leg testing" Interpretation of these results is that! A" both arm and leg ergometry are highly correlated with >P0" B" both arm and leg ergometry are only moderately correlated with >P0" C" leg ergometry is highly correlated with >P0 while arm ergometry is only moderately correlated" %" the common variance of both types of testing is only ''<" B1;8 C1 II A patient has a diagnosis of left #nee degenerative $oint disease" =e complains of leftsided #nee pain of two months duration" =e has been followed by outpatient physical therapy for three wee#s" *he patient feels his condition is worsening as pain has increased during weight bearing activities and he can no longer fully extend his left #nee" 0xamination findings include! increased swelling& decreased #nee A>49 into extension& and an antalgic gait" *he physical therapist should! A" continue physical therapy for another two wee#s because there is uncertainty if the patient understands or is complying with the home exercise program" B" continue therapy for another wee# to ensure that all interventions have been attempted and then return the patient to the referring physician" C" immediately return the patient to the referring physician with documentation indicating that treatment was ineffective" %" tell the patient to see an orthopedic surgeon for possible immediate surgical intervention"
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Practice Questions
B1;: C7 III *wo months ago& a patient had an inversion sprain affecting the calcaneofibular and anterior talofibular ligaments of the right an#le" *he an#le is still painful& very limited in motion and slightly tender to the touch" As part of P* intervention& ultrasound treatment parameters should consist of! A" continuous F 1 9=(" B" continuous F - 9=(" C" pulsed F 1 9=(" %" pulsed F - 9=(" B11; C' III In 3eurodevelopmental *reatment @3%* of the patient recovering from stro#e& therapy would 34* include! A" facilitation of early movement in synergistic patterns followed /uic#ly by movement training in outofsynergy patterns" B" facilitation of selective movement control in outofsynergy patterns" C" functional activities emphasi(ing bimanual tas#s and reintegration of the hemiplegic side" %" reduction of spasticity and abnormal reflex activity through positioning and handling techni/ues" B111 C8 II A ) yearold child with moderate spastic diplegia is referred to physical therapy for an adaptive e/uipment evaluation" 2hich apparatus would be inappropriate to recommend5 A" bilateral JA64+s" B" posture control wal#er @posterior wal#er" C" prone stander %" tone reducing A64s" B11' C II A patient is recovering from a left C,A" =e is wearing a plastic #neean#lefoot orthosis to stabili(e his right foot" %uring gait analysis the therapist observes lateral trun# bending toward the right as he bears weight on the right leg at midstance" *he B0* choice to correct this problem is! A" provide a lift on the shoe of the involved leg" B" strengthen hamstrings on the right side" C" strengthen hip flexors on the right side" %" strengthen the hip abductors on the right side" B11- C1 II A ten yearold male who plays catcher on his baseball team complains of bilateral #nee pain which is exacerbated with forceful /uadriceps contraction" =e has also noticed pain and swelling at the distal attachment of the patellar tendon" 0ffective early physical therapy intervention should include! A" A>49 exercises to prevent contracture" B" casting followed by decreased loading of the #nee" C" decreased loading of the #nee by the /uadriceps femoris muscle" %" modalities to decrease inflammation" B11) C- II An 8- yearold patient has a decubitus ulcer of - months duration on his lateral an#le" *he an#le is swollen& red& and painful with a moderate to high amount of wound drainage @exudate" *he B0* dressing for this wound is! A" calcium alginate dressings" B" gau(e dressings" C" hydrogel dressings" %" semipermeable film dressings" B117 C1 I A patient was diagnosed with a bulging disc at the right E71 spinal level without nerve root compression" *he manifestation of this problem 94* EIJ0E to be documented is! A" centrali(ed gnawing pain with loss of postural control during lifting activities" B" centrali(ed gnawing pain with uncompensated gluteus medius gait" C" radicular pain to the right great toe with a compensated gluteus medius gait" %" radicular pain to the right great toe with difficulty sitting for long periods"
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Practice Questions
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B11 C' II =igh level training for an individual recovering from traumatic brain in$ury who demonstrates >ancho Cognitive 6unction Eevel ,II should focus on! A" involving the patient in decision ma#ing and monitoring for safety" B" providing a high degree of environmental structure to ensure correct performance" C" providing assistance as needed using guided movements during training" %" providing maximum supervision as needed to ensure successful performance and safety" B11. C II *o correct for the problem of a forward festinating gait in a patient with Par#inson+s disease& the therapist could! A" increase cadence using a metronome" B" increase stride length using floor mar#ers" C" use a heel wedge" %" use a toe wedge" B118 C III A patient presents with difficulty with fast movement speeds and fatigues easily" *he therapist decides on a strength training program that specifically focuses on improving fasttwitch fiber function" *he optimal exercise prescription to achieve this goal is! A" high intensity wor#loads for long durations" B" high intensity wor#loads for short durations" C" low intensity wor#loads for long durations" %" low intensity wor#loads for short durations" B11: C' I *he therapist is called to the traumatic brain in$ury unit to examine a new patient" Among the findings& are ptosis and miosis of the right eye with loss of facial sweating" *he therapist suspects! A" loss of parasympathetic function of the oculomotor nerve" B" sympathetic nerve damage consistent with Argyll>obertson pupil" C" sympathetic nerve damage consistent with autonomic dysreflexia" %" sympathetic nerve damage consistent with =orner+s syndrome" B1'; C8 II A physical therapy functional goal for a 7 yearold child with a very high lumbar lesion myelomeningocele @E' level and minimal cognitive involvement would be! A" community ambulation with a reciprocating gait orthosis @>D4 and Eofstrand crutches" B" community ambulation with =JA64s and Eofstrand crutches" C" household ambulation with a reciprocating gait orthosis @>D4 and Eofstrand crutches" %" household ambulation with JA64s and rollator wal#er" B1'1 C. II A patient with multiple sclerosis is part of a national study testing the effectiveness of a new medication" *he patient reports that the pill she is ta#ing ma#es her feel much better and allows her to move easier" At the conclusion of the study it is revealed that she was part of the control group" =er responses are 94* li#ely due to! A" =awthorne effect" B" placebo effect" C" pretesttreatment interference" %" sampling bias" B1'' C- I *he therapist is reading a recent report of arterial blood gas analysis with the following values! 6raction of inspired oxygen @6i4' ;"'1& Pa4' 7- mm=g& PaC4' -; mm=g& p= .")8& Bicarbonate ion ') m0/?l *his would indicate that the patient is in! A" metabolic acidosis" B" metabolic al#alosis" C" respiratory acidosis" %" respiratory al#alosis"
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Practice Questions
B1'- C) III A -' yearold patient is referred to a cardiac exercise group following a mild m yocardial infarction" 6rom her inta#e /uestionnaire the therapist learns she has *ype I @I%%9 diabetes& controlled with twice daily insulin in$ections" In order to minimi(e the ris# of a hypoglycemic event during exercise& the therapist should have the patient! A" avoid exercise during periods of pea# insulin activity" B" exercise daily for );7; minutes to achieve proper glucose control" C" have the patient decrease her carbohydrate inta#e for ' hours before the exercise session" %" monitor blood glucose levels carefully every wee# during the rehabilitation program" B1') C8 II An 87 yearold resident of a community nursing home is diagnosed with Al(heimer+s type dementia" In formulating a plan of care& it is important to understand that the patient! A" can usually be trusted to be responsible for her daily care needs" B" can usually be trusted with transfers with appropriate positioning of the wheelchair" C" is more li#ely to remember current experiences then past ones" %" will li#ely be resistant to activity training if unfamiliar activities are used" B1'7 C' III A patient is having difficulty learning how to transfer from mat to wheelchair" *he patient $ust can+t seem to get the idea of how to coordinate this movement" In this case& the 94* effective use of feedbac# during early motor learning is! A" focus on guided movement and proprioceptive inputs" B" focus on #nowledge of performance and proprioceptive inputs" C" focus on #nowledge of results and visual inputs" %" provide feedbac# only after a brief @7 second delay" B1' C III A patient presents with pain and paresthesias over the first two metatarsal heads of her right foot" Pain is worse after prolonged periods of weight bearing" he typically wears shoes with - inch heels and pointed toes" *he B0* intervention is a! A" pad placed distal to the metatarsal heads" B" pad placed proximal to the metatarsal heads" C" scaphoid pad to support the medial longitudinal arch" %" *homas heel to support the medial longitudinal arch" B1'. C1 II A patient developed right throbbing shoulder pain after painting the #itchen" Passive and active glenohumeral motions increase pain" *he B0* initial intervention for this acute shoulder condition is! A" correction of muscle imbalances to allow healing of right shoulder supraspinatus tendinitis" B" modalities to reduce pain and inflammation as the result of subdeltoid bursitis" C" rotator cuff strengthening exercises to allow A%E function following biceps tendinitis" %" stretching of the pectoralis minor muscle following acromioclavicular $oint inflammation" B1'8 C) I A patient has a 7 year history of AI%" *he case wor#er reports a gradual increase in difficulty with wal#ing" *he patient rarely goes out anymore" A referral to P"*" is initiated" 0xamination findings reveal typical neuromuscular changes associated with AI%" *hese deficits would li#ely include! A" motor ataxia and paresis with pronounced gait disturbances" B" paraplegia or tetraplegia" C" progressive rigidity and a#inesia with severe balance disturbances" %" widespread sensory loss resulting in sensory ataxia" B1': C. III A new graduate physical therapist has an appointment for a $ob interview with =uman >esources at a large teaching hospital" he is well dressed& has a professional typewritten resume& and is prompt for her '!;; p"m" appointment" *he interviewer should A,4I% discussing! A" benefits of wor#ing in a large teaching hospital" B" health insurance and vacation policy" C" the applicant+s marital status" %" wor# hours and sic# time"
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Practice Questions
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B1-; C8 III A therapist is treating a two yearold child with %own syndrome who fre/uently uses a 2 sitting position" *he main reason to discourage 2 sitting in this child is that it may cause! A" abnormally low tone because of reflex activity" B" developmental delay of normal sitting" C" femoral antetorsion and medial #nee stress" %" hip subluxation and lateral #nee stress" B1-1 C' I A :' yearold patient is being examined for signs of stro#e" 2hen tested for twopoint discrimination on his right hand& he is unable to tell whether the therapist is touching him with one or two points" *he therapist determines that there is impaired function in the! A" anterior spinothalamic tract or thalamus" B" dorsal column?lemniscal pathways or somatosensory cortex" C" lateral spinothalamic tract or somatosensory cortex" %" spinal lemniscus or ventral posterolateral nucleus of the thalamus" B1-' C- II A .7 yearold patient has a history of two myocardial infarctions and one episode of recent congestive heart failure" =e also has claudication pain in the right calf during his exercise tolerance test" An I3I*IAE exercise prescription that B0* deals with his problems is wal#ing! A" daily& using interval training for 1; to 17 minute periods" B" five times a wee# using continuous training& for ; minutes" C" three times a wee# using continuous training& for ); minute sessions" %" three times a wee# using interval training& for -; minute periods" B1-- C. III A valid informed consent for research purposes should include a number of elements" *he one that is 34* essential is! A" a statement ensuring the sub$ect+s commitment to participate for the duration of the study" B" all potential benefits of participation" C" all reasonable and foreseeable ris#s and discomforts" %" an understandable explanation of the purpose and procedures to be used" B1-) C) II A patient demonstrates postpartum sacral pain" *he patient complains pain is increased with prolonged wal#ing& ascending or descending stairs& and rising from sittostand" Fpon examination& the therapist finds a laterally tilted pelvic with restricted mobility" A standing ipsilateral flexion #inetic test reveals movement of the PI cranially with hip hi#ing" *he intervention that is 34* appropriate for this problem is! A" cryotherapy and *03 for relief of pain and muscle spasm" B" increasing nonweightbearing and stabili(ation using a lumbosacral orthosis" C" increasing weight bearing tolerance with the temporary use of a sacroiliac belt" %" mobili(ation of the sacroiliac $oint to restore alignment and mobility" B1-7 C7 III A patient has severe low bac# pain as a result of chopping wood and has been receiving ultrasound and strengthening exercises to the low bac# for two wee#s" *he therapist has also been applying *03 and decides to have the patient use *03 at home" As a safety precaution& it is important to instruct the patient to perform a daily chec# of the! A" electrodes and electrode $ac#s" B" electrodes and leads" C" s#in and electrodes" %" s#in and leads" B1- C III A tiltinspace wheelchair has been ordered for a patient with C) /uadriplegia" *his type of chair is ordered to! A" facilitate handgrip and propulsion" B" improve leg position and lower extremity edema" C" improve positioning for pressure relief or extensor spasms" %" improve the patient+s ability to relieve pressure and transfer independently"
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Practice Questions
B1-. C8 II An 8' yearold female has low vision" he recently returned home from a ' wee# hospitali(ation for stabili(ation of her diabetes" *he therapist+s goal is to mobili(e her and increase her ambulation level and safety" *he B0* intervention strategy for this patient is to! A" practice wal#ing in areas of high illumination and low clutter" B" #eep window shades wide open to let in as much light as possible" C" practice wal#ing by having her loo# at her feet at all times" %" color code stairs with pastel shades of blue and green to highlight steps" B1-8 C- I *he patient has a history of angina pectoris and limited physical activity" As the patient participates in the second exercise class the therapist suspects that angina is unstable and may be indicative of a preinfarction state" *he therapist determines this by the presence of! A" angina of increasing intensity that is unresponsive to the nitroglycerin or rest" B" angina that responds to rest and interval training but not to continuous training C" arrhythmias of increasing fre/uency& especially atrial arrhythmias" %" prolonged cessation of pain following the administration of nitroglycerin for angina" B1-: C' III A patient with a left C,A has left him hemiparetic on the right side" In his current stage of recovery& he demonstrates strong and dominant hemiplegic synergies in the leg" 2hich activity would 34* be helpful to brea# up these synergies5 A" foot tapping in a sitting position" B" weight shifts in #neeling" C" assuming the bridging position" %" rolling from the hoo#lying position using lower extremity %1 flexion P36 pattern" B1); C. III Criteria have been established by 9edicare that designate a patient as homebound and allow for home physical therapy services to be approved" *he criterion that does 34* apply in determining homebound status is! A" dependency on others for all transportation needs" B" inability to safely leave home unattended" C" ambulation for short distances causing dyspnea and chest pain" %" leaving the home three times a wee# to receive dialysis" B1)1 C I A patient with an above#nee prosthesis is wal#ing by swinging the prosthesis out to the side in an arc during swing of the amputated limb" *he therapist suspects the prosthesis may have! A" a stiff #nee mechanism" B" an excessively low lateral wall" C" an unstable #nee unit" %" insufficient support from the anterior wall" B1)' C) II An 8. yearold patient has been hospitali(ed for three wee#s following a surgical resection of carcinoma of the colon" =e is very wea# and the therapist is instructing him in ambulation with a wal#er" =e complains of pain in his left shoulder which is aggravated by weight bearing when using the wal#er" *he therapist decides to! A" notify the physician immediately" B" apply pulsed ultrasound to decrease pain" C" apply heat in the form of a hot pac# prior to ambulation" %" ambulate the patient in the parallel bars considering age and diagnosis" B1)- C7 II A college athlete sprained the left an#le ) days ago" *he patient complains of pain @)?1;& and there is moderate swelling which is getting worse" At this time& which intervention would be B0* to use5 A" cold?intermittent compression combination with the limb elevated" B" intermittent compression followed by elevation" C" contrast baths followed by limb elevation" %" cold whirlpool& followed by limb elevation"
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Practice Questions
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B1)) C1 I A patient diagnosed with left lateral epicondylitis has no resolution of symptoms after two wee#s of treatment" *he therapist begins a reexamination and finds the left biceps reflex is 1O" *he therapist should 30* perform a complete examination of the! A" midcervical region" B" cervicalthoracic region" C" upper cervical region" %" cervicocranial region" B1)7 C- II An obese patient who is .; pounds overweight is recovering from a mild myocardial infarction and needs cardiovascular conditioning" *he exercise class will be used in con$unction with a dietary program to promote weight reduction" *he 94* appropriate exercise prescription for this patient is! A" wal#ing& intensity set at 7;< target heart rate" B" $ogging& for 1; minutes at ) miles per hour" C" wal#ing& intensity set at .7< of heart rate reserve" %" swimming& intensity set at .7< agead$usted heart rate" B1) C1 I A patient underwent a total hip replacement @*=> four months ago" *he patient is now referred to physical therapy for gait evaluation" *he patient demonstrates shortened stride length on the right" *his patient 94* EIJ0E has! A" contracted hip flexors" B" contracted hamstrings" C" wea#ened hip flexors" %" wea#ened /uadriceps" B1). C8 III A child with spastic cerebral palsy is having difficulty releasing food from her hand into her mouth" 4nce the child has brought the food to the mouth it would be helpful for the caregiver to! A" give a /uic# stretch to the finger extensors" B" passively extend the fingers" C" slowly stro#e the finger extensors in a distal to proximal direction" %" slowly stro#e the finger flexors in a distal to proximal direction" B1)8 C' II A patient with amyotrophic lateral sclerosis presents with early signs of progressive muscle wea#ness and muscle cramping" =e also has minimal spasticity in his lower extremities" *he therapist+s I3I*IAE exercise prescription should focus on! A" active exercises since resistive exercises are contraindicated" B" low intensity general conditioning exercises" C" maximi(ing exercise and activity" %" P>49 exercise to maintain $oint flexibility since active exercise is contraindicated" B1): C II In reference to the figure& when lifting a constant load using either a stoop lift or s/uat lift posture& the most significant contributing factor for increasing the lumbar spine compression forces is!
A" B" C" %"
performing the lift with the lumbar spine in a #yphotic posture using a stoop lift techni/ue" performing the lift with the lumbar spine in a neutral position rather than a lordotic posture" the distance of the load from the base of the spine" the height of the load from the ground" ---8.8-:"doc
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Practice Questions
B17; C1 II 3early two months ago& a patient noticed that she had left shoulder pain after wal#ing her dog" *his pain has progressively worsened" he now is unable to move her left upper extremity overhead while performing activities of daily living" An orthopedic surgeon diagnosed her problem as adhesive capsulitis" *he 94* effective direction for glenohumeral mobili(ation for this patient would be! A" anterior inferior translatory glides" B" anterior superior translatory glides" C" posterior inferior translatory glides" %" posterior superior translatory glides" B171 C8 I A .: yearold patient is referred to physical therapy for an examination of his functional mobility s#ills and safety in the home environment" *he family reports the patient is demonstrating increasing forgetfulness and some memory deficits" 6rom the examination& the therapist would expect to find! A" impairments in shortterm memory" B" periods of agitation and wandering& especially in the late afternoon" C" periods of fluctuating confusion" %" significant impairments in longterm memory" B17' C' I A therapist is examining a patient with vestibular dysfunction" *he patient is as#ed to assume a long sitting position with the head turned slightly to one side" *he therapist then /uic#ly moves the patient bac#ward so that the head is extended over the end of the table approximately -;N below hori(ontal" *he maneuver causes di((iness and vertigo" *he therapist reports these findings as! A" a negative positional test" B" a positive Clinical *est for ensory Interaction in Balance @C*IB" C" a positive =allpi#e maneuver" %" a positive sharpened >omberg test" B17- C. III A therapist is instructing a patient with a transfemoral lower extremity amputation in prosthetic gait training" *he therapist determines that learning is going well because the patient+s errors are decreasing and overall endurance is improving" *he B0* strategy to promote continued motor learning at this point in the patient+s rehabilitation is to! A" have the patient continue to practice in the parallel bars until all errors are extinguished" B" have the patient practice wal#ing in varying environments" C" intervene early whenever errors appear before bad habits become firmly entrenched" %" provide continuous feedbac# after every wal#ing trial" B17) C- III All of the following would be appropriate home physical therapy interventions for a young patient with cystic fibrosis except! A" autogenic drainage for secretion removal once or twice daily B" functional activities to increase endurance - to 7 times per wee#" C" secretion removal techni/ues by the parents to all lobes once or twice a day" %" using the a capella device in postural drainage positions one or twice a day B177 C) II A 77 yearold is referred to a woman+s health clinic with problems of stress incontinence" he reports loss of control that began with coughing or laughing but now reports she has problems even when she exercises @she does aerobics - times a wee#" *he B0* intervention for this patient is! A" behavioral modification techni/ues to reward proper voiding on schedule" B" biofeedbac# one hour a wee# to achieve appropriate sphincter control" C" functional electrical stimulation three times a wee#" %" Jegel exercises several times a day"
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Practice Questions
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B17 C' I A . yearold patient suffered a cerebral thrombosis four days ago" he presents with the following symptoms! decreased pain and temperature sensation of the ipsilateral faceM nystagmus& vertigo& and nauseaM dysphagia& ipsilateral =orner+s syndrome& and contralateral loss of pain and temperature sensation of the body" *he 94* EIJ0E site of the thrombosis is the! A" internal carotid artery" B" midbasilar artery" C" posterior cerebral artery" %" posterior inferior cerebellar artery" B17. C7 II A patient with a two inch stage II decubitus ulcer over the left lateral malleolus is referred for physical therapy" *he therapist notes a greenish& pungent exudate at the wound site" *he therapist decides to use electrical stimulation" *he B0* choice of polarity and electrode placement is! A" anode placed in the wound" B" anode placed proximal to wound" C" cathode placed in the wound" %" cathode placed proximal to wound" B178 C- III >unning on a level gym surface is an appropriate Phase ' outpatient cardiac rehabilitation activity for some patients because the 90* level is of! A" high intensity @17 90*s and useful for high functioning patients" B" low intensity& @below 7 90*s with little s#ill variability between individuals expected" C" moderate intensity& @1- 90*s with moderate s#ill variability between individuals" %" moderate intensity& @8: 90* and can be easily alternated with wal#ing at 7 90*s" B17: C) II A '. yearold woman presents with a complete *1; paraplegia" An extensive neurological wor#up has failed to reveal a specific cause for her paraplegia" =er physician has determined that she has a conversion disorder" %uring physical therapy it would be B0* to! A" focus on the underlying causes for the paralysis in an empathetic manner" B" initiate functional training consistent with her level of in$ury" C" initiate >49 and strength training while she receives psychological counseling" %" use functional electrical stimulation as a means of demonstrating to her that the muscles function" B1; C. III A certified cardiopulmonary clinical specialist& was moved off the coronary care unit to treat a patient who had a surgical repair of a lacerated index finger flexor tendon" *he therapist had dealt almost exclusively with patients with cardiovascular diseaseM however& the department was very shortstaffed" %uring the treatment the patient felt a GpopH which was the result of a rupture of the newly repaired tendon" *he physical therapist in this case should have! A" refused to treat this patient" B" re/uested more time to read the literature about this repair" C" treated the patient as re/uested" %" used heat prior to the treatment" B11 C8 I 2hich is 34* considered a normal finding during an examination of a newborn infant5 A" continuous tremulousness" B" dramatic s#in color changes with change of state" C" response decrement to repetitive stimuli" %" symmetry in range of motion" B1' C I A patient comes into an outpatient clinic using a wheelchair with excessive leg length from the seat to the foot plate" *he therapist suspects this is the cause of his! A" excessive forward leaning" B" excessive weight bearing on the ischial seat" C" sacral sitting and sliding forward in the chair" %" uneven thigh weight distribution" ---8.8-:"doc
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Practice Questions
B1- C) I A patient presents with a large sacral decubitus ulcer that is purulent and draining" *he therapist needs to ta#e a representative sample of the infected material in order to obtain a laboratory culture" *he 94* appropriate method to culture this wound is to obtain samples from the! A" dressing and exudate in the wound" B" dressing& exudate& and surrounding bed linen" C" exudate in the wound and the surrounding tissues" %" exudate in the wound" B1) C- III A Phase ' outpatient cardiac rehabilitation program uses circuit training with different exercise stations for the 7; minute program" 4ne station uses arm ergometry" 6or arm exercise as compared to leg exercise& at a given wor#load& the therapist can expect! A" both => and systolic?diastolic BP will be higher" B" exercise capacity is reduced due to higher stro#e volumes" C" => will be higher while systolic BP will be lower" %" the principal change is higher systolic and diastolic BP" B17 C. II A therapist wants to determine whether a treatment was effective in reducing lower extremity edema in a group of patients with peripheral vascular edema" ,olumetric measurements using a water displacement method is selected as the outcome measure" *he data was compared to a control group receiving no treatment" Analysis of this data is B0* done by employing! A" A" chi s/uare" B" B" A34,A" C" Pearson+s product moment" %" ttest" B1 C8 II In planning a physical activity program for an elderly patient with Al(heimer+s disease& it is 94* important that the daily activities! A" are changed daily to meet the need for variety" B" are highly structured to reduce anxiety and confusion" C" promote involvement and interest through maximum stimulation" %" provide maximum opportunities for ma#ing choices" B1. C' III A patient has a complete spinal cord in$ury at the level of C" *he therapist is instructing the family in exercises to maintain passive range of motion" *he therapist wants the family to focus on! A" #eeping all muscles fully ranged through normal >49" B" #eeping muscles fully ranged& with hyperflexibility in the low bac# extensors and hamstrings C" limiting range of motion in the shoulders to promote stability" %" ranging individual muscles according to specific functional needs" B18 C. III A physical therapist and physical therapist assistant are conducting a cardiac rehabilitation class for twenty patients" *he therapist is suddenly called out of the room" *he 94* appropriate procedure in this situation is to! A" have the patients switch to less intense exercise until the therapist returns" B" have the P*A supervise the class in cooldown activities" C" have the P*A supervise the class using the outlined exercise protocol until the therapist returns" %" terminate the exercises and have the patients monitor their pulses until the therapist returns" B1: C1 III *he most efficient intervention to regain biceps brachii strength if the muscle is chronically inflamed and has a painful arc of motion is! A" active concentric contractions through partial range of motion" B" active eccentric contractions in the painfree range" C" iso#inetic exercises through the full range of motion" %" isometric exercises at the end range of movement only"
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Practice Questions
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B1.; C7 III %uring an ultrasound treatment the patient flinches and states that a strong ache was felt in the treatment area" *o address this patient+s concern& it would be B0* to! A" add more transmission medium" B" decrease the ultrasound fre/uency" C" decrease the ultrasound intensity" %" increase the si(e of the treatment area" B1.1 C. III *he Bac# to 2or# Center& which speciali(es in wor# conditioning& is scheduled for an accrediting site survey" *he appropriate agency to conduct this program is the! A" Commission on Accreditation of >ehabilitation 6acilities @CA>6" B" %epartment of =ealth K =uman ervices" C" oint Commission on Accreditation of =ealth Care 4rgani(ations @CA=4" %" 4ccupational afety K =ealth Administration @4=A" B1.' C) II A patient is recovering from deep partial thic#ness burns over the posterior thigh and calf which are now healed" *he therapist+s examination reveals local tenderness with swelling and pain on movement in the hip area" 2hile palpating the tissues the therapist detects a mass" *he therapist+s B0* course of action is to! A" continue with >49 exercises but proceed gently" B" report these findings promptly to the physician" C" use petrissage to wor# on this area of focal tenderness" %" use >IC0 to /uiet down the inflammatory response" B1.- C8 I A 1; monthold @corrected age infant born at '- wee#s gestational age suffered Drade III intraventricular hemorrhage prenatally and was on a ventilator for ' months after birth" %uring a physical therapy examination& increased resistance to passive movement is noted in all extremities& but most mar#edly in the lower extremities" *he infant will probably be diagnosed with! A" ataxic cerebral palsy" B" spastic diplegic cerebral palsy" C" spastic hemiplegic cerebral palsy" %" spastic /uadriplegic cerebral palsy" B1.) C- I 0CD changes that occur with exercise in an individual with myocardial ischemia and coronary artery disease would be expected to include! A" bradycardia with * segment depression greater than - mm below baseline" B" significant arrhythmias early on in exercise with a shortened Q>" C" significant tachycardia early on in exercise with * segment elevation" %" tachycardia at a relatively low intensity of exercise with * segment depression" B1.7 C1 II A )7 yearold female patient with long term postural changes exhibits an excessive forward head and complains of pain and di((iness when loo#ing upward" *he 94* effective physical therapy intervention is! A" anterior cervical muscle stretching and postural reeducation to relieve vertebral artery compression" B" posterior cervical muscle stretching and postural reeducation to relieve vertebral artery compression" C" upper cervical Drade III mobili(ation to reduce pressure on the cervical spinal nerves" %" upper cervical $oint mobili(ation Drade II and postural reeducation to reduce compression of the cervical sympathetic ganglia" B1. C I A patient has an above#nee prosthesis with a prosthetic foot that includes a plantar flexion bumper" %uring ambulation the therapist decides that the bumper is too stiff" *his decision is based on the presence of! A" foot slap at midstance" B" high heel rise at toeoff" C" lateral foot rotation at heel stri#e" %" swing phase whip"
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Practice Questions
B1.. C- III %uring the course of the physical therapy treatment in the ICF& a radial artery line gets pulled @comes out of the artery" *he 6I>* thing the physical therapist should do is! A" elevate the arm above heart level to stop the bleeding" B" place a blood pressure cuff on the involved extremity and inflate the cuff until the bleeding stops" C" push the code button in the patient+s room as this is a cardiac emergency" %" reinsert the arterial catheter into the radial artery and chec# the monitor for an accurate tracing" B1.8 C' I A patient suffers a C,A resulting in right hemisphere damage" *his patient will 94* EIJ0E exhibit! A" hesitancy& re/uiring more feedbac# and support" B" negative& selfdeprecating comments and fre/uent depression" C" poor $udgment with increased safety issues" %" slow& cautious behaviors" B1.: C) II A patient with a methicillinresistant staphylococcal infection @9>A has been discharged from an isolation setting as an inpatient and is now returning to physical therapy as an outpatient" *he precaution that needs to be adhered to is that! A" direct contact with the patient should be avoided" B" open wounds must be contained within a dressing" C" treatment should be performed in an isolated private room" %" whirlpool for wound care should be avoided" B18; C1 I After examining a patient who was referred to physical therapy for posterior thoracic pain& the therapist finds no musculos#eletal causes for the patient+s symptoms" Pain may be referred to this thoracic region from the! A" appendix" B" gall bladder" C" heart" %" ovary" B181 C III An 8' yearold patient with a transfemoral amputation is being fitted with a temporary prosthesis containing a AC= prosthetic foot" *his prosthetic foot! A" absorbs energy through a series of bumpers& permitting sagittal plane motion only" B" allows full sagittal and frontal plane motion" C" allows limited sagittal plane motion with a small amount of mediolateral motion" %" is an articulated foot with multiplanar motion" B18' C8 II An 8' yearold patient demonstrates significant proprioceptive losses in both lower extremities& distal greater than proximal" *he B0* strategy to assist in compensatory gait training is to have him! A" count out loud during each step" B" loo# at his feet for placement while wal#ing" C" practice wal#ing on smooth tile floors" %" use light touch down support on available furniture" B18- C- I A patient is being seen for shortness of breath" 3otable on physical examination is a deviated trachea to the left" 2hich of the following processes would account for such a finding5 A" left pleural effusion" B" left pneumothorax" C" right hemothorax" %" right lung collapse"
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B18) C7 II A patient complains of pain @.?1; in the shoulder region secondary to acute subdeltoid bursitis" As part of the plan of care during the acute phase& the therapist elects to use conventional *03 which will modulate the pain primarily through! A" ascending inhibition" B" descending inhibition" C" gate control mechanisms" %" stimulation of endorphins" B187 C1 I A construction wor#er describes a sudden onset of bac# pain while trying to lift a heavy barrel with another wor#er" =e describes his pain as constant& unremitting at an intensity of 1;?1; over the last three days" =e is unable to wor#& but can drive himself to the clinic for treatment" 9edication has not influenced his symptoms" =e states he has never had any other bac#related symptoms in the past" 94* EIJ0E involved in his symptomatology is! A" discal dysfunction" B" early degenerative osteoarthritis" C" neoplastic disease" %" secondary gain" B18 C- I 6ollowing myocardial infarction& a patient was placed on medications which included a betaadrenergic bloc#ing agent" 2hen monitoring this patient+s response to exercise& the therapist expects this drug will cause heart rate to! A" be low at rest and rise linearly as a function of increasing wor#load" B" be low at rest and rise very little with exercise" C" increase proportionally to changes in diastolic blood pressure" %" increase proportionally to changes in systolic blood pressure" B18. C. III A therapist is wor#ing in an outpatient clinic that has provider contracts with many types of insurance plans" A large percentage of the clinic+s patients have insurance coverage that has a contract that pays a flat rate of reimbursement per episode of care" *he supervisor tells the therapist never to treat these patients for more than five visits" *he therapist should! A" ignore the supervisor and treat the patients at the fre/uency and duration appropriate for their condition" B" #eep trac# of all patients insured by this plan& and ma#e certain they average less than or e/ual to five visits in aggregate" C" resign from the clinic and report the supervisor to the state+s licensing board" %" spea# to the supervisor about concerns that this policy conflicts with the Code of 0thics" B188 C) III A patient has a '; year history of diabetes" Changes include vascular insufficiency and diminished sensation of both feet with poor healing of a superficial s#in lesion" It is important that he understand the precautions and guidelines on foot care for people with diabetes" 2hich of the following is 34* appropriate for a therapist to stress5 A" inspect the s#in daily for inflammation& swelling& redness& blisters& or wounds" B" use daily hot soa#s and moisturi(e the s#in" C" wash the feet daily with mild soap& dry thoroughly& and hydrate with moisturi(ing lotion" %" wear $ogging shoes that allow ade/uate room and change shoes fre/uently" B18: C1 I After completing an examination of a patient with shoulder pain& the physical therapist concludes that the cause is subscapularis tendinitis" *his clinical finding supportive of this conclusion is! A" pain provo#ed with active glenohumeral external rotation" B" pain provo#ed with passive glenohumeral external rotation" C" painful resisted shoulder adduction" %" tenderness at the greater tubercle of the humerus" B1:; C1 II A nineteen yearold male soccer player sustained a Drade II inversion an#le sprain two wee#s ago" Intervention in the early subacute phase of rehabilitation would most li#ely include! A" closedchain lower extremity strengthening and proprioceptive exercises" B" functional soccerrelated drills" C" mobili(ation at the talocrural and subtalar $oints" %" plyometricbased exercise program" ---8.8-:"doc
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Practice Questions
B1:1 C7 II A patient is referred for outpatient care following a tendon transfer of the extensor carpi radialis longus" *he muscle strength tests poor @'?7 in spite of previous intensive therapy" *he therapist elects to apply biofeedbac# to assist in progressively increasing active motor recruitment" Initially& the 09D biofeedbac# protocol should consist of! A" high detection sensitivity with recording electrodes placed closely together" B" high detection sensitivity with recording electrodes placed far apart" C" low detection sensitivity with recording electrodes placed closely together" %" low detection sensitivity with recording electrodes placed far apart" B1:' C8 I A therapist receives a home care referral from the nurse case manager" An 8' yearold has lost functional independence after the recent death of his wife" =is past medical history includes stro#e with minimal residual disability" Currently he no longer goes out of his house and rarely even gets out of his chair anymore" %uring the initial session the therapist determines that depression may be the cause of his increasing inactivity based on the presence of! A" complaints of increasing di((iness and palpitations" B" low scores on the Deriatric %epression cale" C" sleep apnea and weight gain" %" weight loss and social withdrawal" B1:- C. III A ); yearold has been laid off his construction $ob for the last two years" =e has a wife who is a homema#er and seven small children" *hey are currently on welfare" 2hile ra#ing leaves he has a stro#e and is admitted to the hospital" In this case& the third party payer that would provide assistance is! A" 9edicaid" B" 9edicare Part A" C" ocial ecurity" %" 2or#er+s Compensation B1:) C- I A patient has been on bedrest for two days following revasculari(ation surgery involving a triple coronary artery bypass graft" %uring his therapy session the therapist notices increased tenderness in the patient+s calf" *he therapist should immediately examine for! A" any swelling in the calf or an#le" B" bradycardia" C" =oman+s sign" %" lowered body temperature" B1:7 C1 I A patient referred for *9 dysfunction states that she has had three episodes of her $aw loc#ing in an open position" *he 94* EIJ0E cause of her problems is! A" disc displacement" B" entrapment of the retrodiscal lamina" C" impingement of the temporomandibular ligament" %" lateral pterygoid muscle spasm" B1: C) II A ' yearold patient is referred to physical therapy after a fall and 4>I6 for a fracture of her right wrist" %uring the initial examination& the therapist observes that her s#in and eyes have a yellowish hue" *he therapist+s B0* course of action is to! A" continue with the treatment& a yellowish hue is an expected finding -) days post 4>I6" B" document the findings and consult with the surgeon immediately following treatment" C" send a copy of the examination results to the referring surgeon emphasi(ing the s#in hue" %" treat her problem with whirlpool and massage and reevaluate s#in color post treatment"
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Practice Questions
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B1:. C1 II A .7 yearold inpatient received a cemented total hip replacement two days ago" *he physical therapy plan of care should have as its number one priority! A" active range of motion exercises and early ambulation using a wal#er& nonweightbearing" B" passive range of motion exercises and gait training using crutches& weightbearing to tolerance" C" patient education regarding positions and movements to avoid" %" proper techni/ue for transferring to the toilet" B1:8 C. III A patient is referred by an orthopedist with a diagnosis of impingement syndrome of the shoulder" *he initial P* examination reveals signs and symptoms that are not consistent with this diagnosis and are more consistent with thoracic spine pain and dysfunction" *he therapist treats the patient consistent with P* findings without communicating with the referring physician" 9onths later the therapist is sued by the patient+s estate" *he patient died of undiagnosed metastatic lung cancer" *he therapist is! A" not legally licensed to diagnose metastatic cancer& therefore cannot be held responsible for the patient+s death" B" not responsible for the incorrect diagnosis because treatment was appropriate for the P* findings" C" responsible for communicating findings to the referring physician when the findings are inconsistent with a referring physician+s diagnosis" %" responsible for ma#ing the diagnosis of possible cancer consistent with the P* examination of the patient" B1:: C7 III A patient with tage II primary lymphedema of the right lower extremity is referred for physical therapy" 0xamination reveals increased limb girth with s#in folds?flaps evident" An important component of lymphedema management is manual lymphatic drainage" *his procedure should include! A" decongesting the distal portions of the limb first and wor#ing proximally" B" decongesting the proximal portions of the limb first and wor#ing distally" C" decongesting the trun# after the limb segments" %" deep tissue friction massage for several minutes on fibrotic areas" B';; C II A patient with a 1; year history of multiple sclerosis demonstrates -O extensor tone in both lower extremities" *he therapist needs to order a wheelchair" It would be B0* to recommend a! A" electric wheelchair with toe loops" B" standard wheelchair with a -; degree reclining bac#" C" standard wheelchair with elevating leg rests" %" tiltinspace wheelchair with a pelvic belt"
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Practice Questions
B1 C8 II >eaching for a multicolored ob$ect while in an unsupported& guarded sitting position" *he appropriate tas# would include the six month gross developmental level activity of wor#ing on unsupported sitting @standing and supine are not appropriate choices" *he use of a multicolored ob$ect is more appropriate than a bland and white ob$ect for a three year cognitive level" B' C1 II Change to grade II mobili(ations to reduce the $oint and soft tissue irritation" Changing to grade II mobili(ations will allow the soft tissue structures to more slowly adapt to mobili(ation" If pain persists for over ') hours& the soft tissue and $oint irritation may progress" Drade I, mobili(ation techni/ues will cause further irritation and not allow the soft tissues to adapt to the stretch" elf stretching is not as efficient as mobili(ation techni/ues and would not be the optimum treatment strategy" B- C. II Fse fre/uent reinforcements for all desired behaviors Behavioral modification is best achieved through use of positive reinforcements for all desired behaviors" 3egative behaviors should be ignored" elf correction is not a form of behavior modification" B) C' III Iso#inetic training using low resistance at fast movement speeds" %ysmetria is a coordination problem in which the patient is unable to $udge the distance or range of movement @overshoots or undershoots a target" Adding resistance @weights& water resistance or manual resistance with P36 can assist the patient in slowing down the movement and achieving better control" Eow resistance& fast speed iso#inetic training is contraindicated" B7 C III =alo orthosis 9aximum stabili(ation of the cervical spine can be achieved with the use of a halo orthosis" It contains a ring that is attached to the s#ull by four screws& four uprights that connect the ring to thoracic ban# or thoracic plastic $ac#et" B C- II Administer supplemental 4' 4xygen should only be used with a physician+s order" ince the patient+s a4' is above 88<& there is not a clear indication for its use" Allowing the patient to recover from exercise through rest and breathing exercises& the patient+s oxygen level should return to baseline @assuming that it fell from baseline to :;<" *he oxygen levels and patient symptoms should be noted in the medical record" B. C' I 0lectrical silence Inserting an 09D needle into a normal muscle causes a burst of electrical activity @meridional activity" After which the muscle produces no sound @electrical silence" 6ibrillation potentials are spontaneous activity seen in relaxed denervated muscle and polyphasic potentials are produced in the contracted muscle undergoing reorgani(ation" B8 C) II Passive >49 exercise >esistive exercise is contraindicated in patients with significant bony metastases& osteoporosis& or low platelet count @R';&;;; to '7&;;;" B: C1 II tretching of scalenes and sternocleidomastoid muscles for early thoracic outlet syndrome symptoms" Patients with emphysema typically present with hypertrophy of the accessory breathing muscles to include the scalenes which can compress the neurovascular structures at the thoracic outlet" B1; C8 II Immediately administer orange $uice for his developing hypoglycemia =ypoglycemia& an abnormally blood glucose& results from too much insulin @insulin reaction" It re/uires accurate assessment of symptoms and proper intervention" =ave him sit down and give him an oral sugar @e"g"& orange $uice" 4nce the patient is stabili(ed& the physician should be notified" Profuse sweating does not usually accompany orthostatic hypotension"
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Practice Questions
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B11 C' II %ecrease the intensity and duration but maintain a fre/uency of - times?wee#" Clinical manifestations of postpolio syndrome include myalgias& new wea#ness as well as atrophy& and excessive fatigue with minimal activity" 3onexhaustive exercise and general body conditioning are indicated but should be submaximal in intensity" *he patient should not exercise to the point of fatigue and exhaustion" A change in the exercise prescription is warranted" B1' C. III Provide reallife examples that lin# learning to personal experience" *he student learns best using an intuitive or global learning style" *he student processes information all at once and will learn best if information is connected to personal experiences and is present in practical& reallife experiences" *he other choices are appropriate choices for an analytical?ob$ective type of learner" B1- C. II %aily *his patient is over 7 years old and covered by 9edicare for his health care" *he patient must receive therapy daily @at least 7. days per wee# for reimbursement in an inpatient acute care hospital setting" B1) C- I >educe airway resistance and exerciseinduced bronchospasm ympathomimetics are a class of drugs that mimic the effects of stimulation of body organs and structures by the sympathetic nervous system" Albuterol is an antiasthmatic medication used to promote bronchodilation" Its primary effects are on Beta ' receptors in the bronchiole smooth muscle" It may also have an effect on Beta 1 receptors& producing cardiovascular adverse reactions @hypertension and tachycardia& chest pain& increased BP& sweating& and blanching of the s#in" Chronic use can lead to loss of bronchodilation and paradoxical bronchoconstriction" B17 C III >educe effusion and assist venous return" *he pressure exerted by water on an immersed ob$ect is e/ual on all surfaces @Pascal+s law" As the depth of immersion increases& so does hydrostatic pressure" Increased pressure limits effusion& assists venous return& and can induce bradycardia" *he other choices do not related directly to hydrostatic pressure" Buoyancy of water provides an environment of relative weightlessness& and assists in $oint unloading and active movement" =ydromechanics& movement of water molecules& increases the resistance of water as peed of movement increases" =ot water immersion @S -7;C can increase cardiovascular demands at rest and with exercise" B1 C II trengthen hip extensors through bridging Bac#ward trun# lean @gluteus maximus gait is the result of a wea# gluteus maximus" It will cause increased difficulty going up stairs or ramps" 6unctional training exercises such as bridging are indicated" B1. C) II ulfamylon ulfamylon penetrates through eschar and provides antibacterial control" ilver nitrate and nitrofura(one are superficial agents that attach surface organisms" Panafil is a #eratolytic en(yme used for selective debridement" B18 C8 I Cataracts Cataracts& a clouding of the lens& results in a gradual loss of visionM central vision is lost first& then peripheral" Dlaucoma produces the reverse symptoms! loss of peripheral vision is first& then central& progressing to total blindness" =emianopsia is a field defect in both eyes which often occurs following sto#e" *here was no mention of C,A in the /uestion" B1: C' II 0nvironmental and daily structure with consistency of cognitive stimuli" *he patient demonstrates recovery consistent with a confused state @>ancho Eos Amigos Eevels of Cognitive 6unction ,?,I" *he main focus should be on providing environmental and daily structure to reduce distractions and help the patient process stimuli" 2ith memory deficits and little carryover for new learning& functional independence is not a realistic goal at this stage of recovery" 2or#ing on improving arousal and attention levels may be appropriate for patients functional at lower cognitive recovery levels& Eevel I?II"
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B'; C' II itting& weight bearing on extended left arm& weight shifting itting& weight bearing and roc#ing on an extended left arm will help to decrease the flexor tone" It also provides $oint compression @approximation at the shoulder which will help maintain shoulder position and stimulate stabili(ing muscles" Quadruped is too strenuous for this patient at this time and the other two activities demand more voluntary control than this patient currently demonstrates" B'1 C. III *he spread of scores with cold treatment demonstrates variability is greater" *he spread of scores with cold treatment @standard deviation of "; indicates that this treatment produces more variable effects that the heat treatment" All other conclusions cannot be determined based on the data presented and the statistical analysis used" B'' C1 I upraspinatus *he muscle being tested is the supraspinatus" *he emptycan position puts the supraspinatus muscle it its most effective position for contraction" 2ea#ness may be a result of inflammation& neuropathy of the suprascapular nerve or from a tendon tear B'- C II >estrict all movement" A solid an#lefoot orthosis is indicated with severe pain or instabilityM it allows no movement" *he other choices do not address these problems" B') C1 I 2ea# deltoids %ue to the anatomical position of the axillary nerve& it can be damaged by an anteriorinferior dislocation at the glenohumeral $oint" A drop arm test evaluates the integrity of the rotator cuff" A 3eer *est evaluates impingement of the shoulder" *he rhomboids are innervated by the dorsal scapular nerve" Anatomically& the dorsal scapular nerve is medial and posterior to the shoulder $oint" B'7 C8 I *he infant+s head is turned to the right *urning the infant+s head to the right will probably elicit the A*3> with extension of the right upper extremity" *his will not facilitate removal of the clothing" B' C. III Provide a /uestionnaire to all participants two wee#s before the scheduled session" A /uestionnaire to all participants represents the best method of needs assessment in this situation" Eeaving the survey to the day of or day before the presentation does not allow for ade/uate advanced planning to meet the group+s needs" B'. C' III 9aximum use of demonstration and gesture" *he patient with left hemiplegia typically demonstrates visuospatial perceptual deficits" 9aximum use of demonstration and gesture would be inappropriate to assist this patient in the relearning of motor tas#s" B'8 C- II Provide suggestions to nursing for positioning for optimal motor development" 0xcessive handling of a premature infant can cause oxygen desaturation" It is in the best interests of the infant to limit the number of handlers" At present& there is little information provided that would necessitate the physical therapist or P*A to be a direct caregiver to this child" In this instance& the physical therapist+s role should be to assist nursing in developing positioning schedules& positions for feeding& infant stimulation activities& etc" B': C1 II Closedchain functional strengthening of the /uadriceps femoris and hamstrings emphasi(ing regaining terminal #nee extension" *he evaluation is suggestive of an unhappy trial in$ury" Closed chain exercises are emphasi(ed during the subacute phase to enhance functional control of the muscles surrounding the #nee" *erminal extension must be achieved during this stage if normal function is to occur" All other choices do not promote terminal #nee extension"
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B-; C8 I A blac# and white face& with a red nose& held approximately nine inches from the infant+s eyes& moved hori(ontally" A neonate sees blac#& white& and red most clearly with a fixed focal length of approximately nine inches" B-1 C' II Position in sidelying& chec# for an open airway& and immediately call for emergency assistance" *his is an emergency situation" In order to prevent aspiration& turn the head to the side or position in sidelying" Chec# to see if the airway is open& wait for tonicclonic activity to subside before initiating artificial ventilation if needed" B-' C. II %ependent variable" *he dependent variable is the change of difference in behavior @in this example& rolling that results from the intervention @3%* handling techni/ues or independent variable" B-- C- I lowed respiratory rate Crac#les are typical finding with an infiltrate" ince the patient is having pain& thoracic expansion would li#ely be limited and asymmetrical" 2ith a lower than normal tidal volume& a respiratory rate would have to be elevated& not slowed& to maintain an ade/uate minute ventilation @respiratory rate times tidal volume T minute ventilation" B-) C II Posterior plastic shell" Denu valgum can be controlled in a #neean#lefoot orthosis with a properly fitter posterior plastic shell" 4lder braces may utili(e a valgus correction strap which wraps around the medial #nee and buc#les around the lateral upright" B-7 C) I Protective sensation of the foot is lost at the 1; g force level" *he neuropathic limb is prone to the development of neuropathic ulcers" 0xamination is facilitated by the use of emmes 2einstein monofilaments" *hree si(es of monofilaments are typically used! @1 the )"1. monofilament provides 1 g of force and is indicative of normal sensation& @' the 7";. monofilament provides 1; g of force and is indicative of protective sensation loss& and @- the "1; monofilament provides .7 g of force and reveals a severely insensate foot" 9onofilaments are used to examine pressure sensation @a single point perception test and do not reveal any information about sharp?dull sensation" B- C7 III 6our electrodes with current flow diagonal to the spinal column" *he crisscrossed electrode configuration allows! @1 a greater area to be treated and @' current interference to occur between the fre/uencies of the two circuits because of the diagonal pattern" B-. C8 I :1; months" *he :1; monthold will be able to pulltostand& have all protective extension reactions& but since he is not yet wal#ing& may still exhibit plantar grasp in the standing position" B'8 C1 II Postural reeducation& soft tissue mobili(ation& and dynamic stabili(ation" *his is a long term degenerative and postural dysfunction which is manageable with medication and proper physical activity" *herefore& the most effective use of treatment time should emphasi(e regaining normal postural alignment and functional A%E" B-: C. III As# about previous wor# and other experiences related to transferring individuals" *he therapist+s initial analysis of the learner should identify the current level of #nowledge and s#ills about transfer techni/ues" *he therapist can then build on this information to plan appropriate educational goals and teaching methods"
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B); C. II #illed nursing facility A s#illed nursing facility is the best facility because the patient continues to re/uire nursing care for his open wounds" Initiation of physical therapy when this patient is able is also available" %ischarge to home would be premature& as he is unable to transfer" Custodial care involves medical or nonmedical care that does not see# a cure" A rehabilitation hospital is not appropriate at this time as the patient cannot actively participate in rehabilitation - hours per day" B)1 C' I *aste over the anterior tongue and having the patient raise his eyebrows and puff chee#s" Bell+s palsy is a lower motor neuron lesion affecting the branches of the facial nerve& C3 ,II" 0xamination of the motor function of the muscles of facial expression @i"e"& raise eyebrows& show teeth& smile& close eyes tightly& puff chee#s and taste over the anterior tongue will reveal deficits of C3 ,II function" *aste over the posterior tongue is a function of C3 I @glossopharyngeal" trength of tongue protrusion is a function of C3 II @hypoglossal" Pupillary reflexes are a function of C3 II @optic" B)' C I %ecreased trun# rotation with shorter steps" Dait changes characteristic of Par#inson+s disease include loss of arm swing and reciprocal trun# movements& shuffling gait& and festinating cadence @an abnormal and involuntary increase in the speed of wal#ing" B)- C- I 4rthostatic hypotension and di((iness *he adverse side effects that diuretics or calcium channel bloc#ers have in common are orthostatic hypotension and di((iness" *hese represent a safety ris# during functional training and gait" B)) C1 II 2ithin a few days following surgery to preserve tendon gliding" 0arly passive and active assistive exercises promote collagen remodeling to allow free tendon gliding" 2hen rehabilitation is delayed by several wee#s& adhesions form which restrict free tendon gliding" B)7 C8 I %ecreased pad and tenderness at the fracture sites" 6racture healing in elderly clients is slower& and typically results in longer rehabilitation times than for young clients" =ospitali(ation and surgery fre/uently cause disorientation and mental confusion as well as complications from prolonged inactivity @e"g"& pneumonia" Pain and tenderness are not decreased at the fracture site" B) C' I ,isual confrontation test with a moving finger" ,isual field is examined using the confrontation test" *he patient sits opposite the therapist and is instructed to maintain his or her ga(e on the therapist+s nose" *he therapist slowly brings a target @moving finger or pen in the patient+s field of view alternately from the right or left sides" *he patient indicates when and where he first sees the target" %istance acuity vision is tested using a nellen eye chart at a distance of '; feet" 4cular pursuit is tested using a penlight moved in an = patter7n to the extremes of ga(e" Convergence is tested using a penlight and rulerM the patient #eeps the penlight in focus as it moves inward from a distance of ) or inches" B). C I Common peroneal nerve ensation to the dorsum of the foot and big toe is supplied by the superficial peroneal nerve& a branch of the common peroneal nerve" *he sural nerve is a distal branch of the tibial nerve which supplies the bac# of the leg and the lateral side of the foot and little toe" *he medial calcaneal nerve is also a branch of the tibial nerve which supplies the heel and medial sole of the foot" Phantom limb sensation @sensation of a limb that is no longer there usually occurs in the immediate postoperative phase and can be stimulated by external pressure @residual limb wrapping or rigid dressing" It typically dissipates over time though some patients may experience the sensation of the rest of their life" *his is a common finding and should not interfere with prosthetic rehabilitation" B)8 C. II Accuracy of the measurements increases at higher saturation levels" *he result of the study indicates that the correlation between the two types of oximeters was high when oxygen saturation levels were high @"8: but only moderate @"8 at low oxygen saturation levels"
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B): C1 I Anterior cruciate ligament" *he test shown in the figure is the Eachman+s test to determine the integrity of the anterior cruciate ligament" *he posterior cruciate is examined using the posterior drawer and reverse Eachman+s test" *he medial meniscus is examined using the 9c9urray+s and Apley+s tests" *he I*P is tested using the 3oble compression test" B7; C1 II C* scan *he primary concern of the therapist is to rule out strong suspicions of an upper cervical spine fracture" Plain films& already ta#en& did not show any fracture which is not uncommon" *he *' 9>I and myelogram are not as specific for assessing bony anatomy as the C* scan" C* scan is still preferred for assessing cortical bone especially spinal fractures" B71 C7 II Intense cold& burning& and aching& followed by numbness" *he stimulation of the cold receptors produces the perception of cold as the cold modality on the s#in" *he burning and aching sensation is due to the intensity perceived as the tissue temperature decreases" As the transmission of the signals from the s#in receptors slow and finally ceases& numbness is produced" B7' C8 III Be informed of the right to ma#e decisions regarding their medical care upon admission" Advance Care 9edical %irectives are mandated by federal law& the Patient elf%etermination Act of 1::;" Patients receiving care from hospitals& nursing facilities& hospices& home health care agencies and health maintenance organi(ations that receive federal 9edicare or federalstate 9edicaid funds must be informed on admission of their right to ma#e decisions regarding their medical care" *he facility cannot alter these guidelines" 0stablishing mental competence is not routinely re/uired" Physicians cannot be mandated to give a contraindicated treatmentM the patient can however refuse a recommended treatment even if it leads to death" B7- C' II Practice isolated small range /uadriceps eccentric control wor# in standing and continue with the straight cane" 0ccentric /uadriceps control wor# @closedchair exercises is indicated in order to reduce recurvatum" 4pen chain exercises @Cybex& A>49 do not ade/uately address the functional demands of gait" *he use of BQC or hemiwal#er will not correct the problem" A JA64 is inappropriate to stabili(e the #nee which can be effectively stabili(ed using either an A64 or wedish #nee cage" *he use of an orthosis should be considered only as a last resort" B7) C II Progressive resistance training for the /uadriceps" A spinal cord in$ury at the level of E- affects #nee extensors" AIA cale % means the in$ury is incomplete with at least half of the #ey muscles below the neurological level having a muscle grade of - or more" A wea# #nee will wobble or buc#le& going down stairs or ramps" It is the result of wea# /uadriceps or #nee flexor contracture" trengthening exercises using progressive resistance training for the /uadriceps is indicated" Biofeedbac# training may reduce #nee extensor spasticity but this may only increase #nee instability and is not indicated in this case" B77 C. III *he patient+s employer when the condition is wor#related" *hose individuals involved in the care of the patient& a legal guardian @power of attorney& or the patient+s payer have legal right to information regarding a patient+s care without obtaining the patient+s consent for releasing information" B7 C III Increasing the angle between the seat pan and bac#rest to between :;11; degrees" 9aximal reduction of lumbar disc pressures can be achieved by increasing the an#le between the seat pan and bac#rest to between :;11; degrees& using armrests for support or adding a lumbar support" Combining the effects of all three provides the best solution" B7. C1 I uprascapular nerve 9icrotrauma to the suprascapular nerve can occur with repetitive activities involving shoulder Gcoc#ingH and follow through resulting in inflammation and muscle wea#ness of the muscles supplied by the suprascapular nerve @the supraspinatus and infraspinatus muscles"
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B78 C. III 3eeds assessment performed by a physical therapist" 4ther professionals @physician& nurse can refer a patient for evaluation& but determination of need must be performed by a licensed physical therapist" B7: C' II >epetition of movements and positions that provo#e di((iness and vertigo" In patients with unilateral vestibular pathology& habituation training @use of positions and movements that evo#e symptoms will encourage the vestibular system to recalibrate" Dood recovery can generally be expected with gradual progression of exercises" =allpi#e maneuver is used for assessment& and is not a set of exercises" B; C I *oo little tension in the extension aid" 0xcessive heel rise during early swing can be caused by inade/uate #nee friction or too little tension in an extension aid" B1 C) II Dive the patient water and notify the physician immediately" *his patient is exhibiting signs of dehydration" =is confusion is a poor sign and re/uires immediate action! get some fluids into him and notify his physician immediately" B' C- II 1"7 mm of downsloping * segment depression" *he upper limit for exercise intensity prescribed for patients post 9I is based on signs and symptoms" 4f the choices& only * segment depression @greater than 1"; mm of hori(ontal or downsloping depression is a significant finding& representative of myocardial ischemia" Both => and BP are expected to rise @the levels of 1); and 1);?8; are significant for most patients" *he appearance of a singe P,C is also not significant since P,Cs can occur in individuals without cardiac abnormalities" B- C8 II 3eutral warmth *he infant is still too developmentally immature for any of the stimuli other than neutral warmth" 3eutral warmth is a calming stimulusM all of the other choices would li#ely increase arousal of the infant" B) C' I Ipsilateral wea#ness and loss of position sense and vibration below the lesion level with contralateral loss of pain and temperature sensation" Browne/uard syndrome is a hemisection of the spinal cord characteri(ed by ipsilateral wea#ness and loss of position and vibration sensation below the level of the lesionM there is also contralateral loss of pain and temperature sensation a few segments below the level of the lesion" 4ther choices describe an anterior cord syndrome @choice AM central cord syndrome @choice BM or sacral sparing @choice C" B7 C. II %emonstrate the tas#& then practice with the patient" *o ensure optimal motor learning& first demonstrate the tas# at ideal performance speeds" *his provides the patient with an appropriate reference of correction @cognitive map of the tas#" *hen use guided practice with the patient to ensure safety and successful performance" Caregivers should become involved only after initial practice of the tas# with the patient and the safety of the patient can be assured" B C. III =ome health agency rehabilitation services" 9edicare Part B covers doctors+ services& outpatient services& physical therapy private practice services& and durable medical e/uipment" >ehabilitation services from a home health agency are covered under 9edicare Part A" B. C I oc#et is aligned too far forward or tilted anteriorly" In a P*B prosthesis& the soc#et is normal aligned in slight flexion to enhance loading on the patellar tendon" If it is aligned incorrectly @too far anterior or excessively flexed& it will result in excessive #nee flexion in early stance"
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B8 C- II ustained maximal inspiration training with an incentive spirometer" ustained maximal inspiration is an appropriate part of a plan of care" Percussion and sha#ing are indicated& but not to both sides& since pneumonectomy removes the entire lung" Chest tubes are not a contraindication to the use of these techni/ues" *here is no point in teaching breathing exercises to the right thorax as there is no lung underneath" B: C II A high bac# At *:*1; this patient has partial innervation of the abdominals @innervated **1' and full innervation of the upper extremities" A manual wheelchair with a standard bac# height @midscapular height is appropriate for this patient" If the patient chooses to engage in sports& a lower bac# can improve functional ability" A high bac# wheelchair is appropriate for patients with poor trun# stability or extensor spasms" wingaway footrests and removable arm rests are necessary for ease of transfers and can be removed for sports activities as necessary" B.; C1 II 6in#elstein+s test 6in#elstein+s test is specific for reproducing the pain associated with deQuervain+s tenosynovitis of the abductor pollicis longus and extensor pollicis brevis" 6roment+s sign is used to identify ulnar nerve dysfunction" Phalen+s test identifies median nerve compression in the carpal tunnel" Craig+s test identifies an abnormal femoral antetorsion angle which you hopefully eliminated firstU B.1 C8 II A pommel to #eep hips abducted" =ip abduction should be facilitated in sitting while hip adduction& extension of the hips& and plantarflexion of an#les should be inhibited" B.' C' I ensory losses and sensory organi(ation of balance" A critical component of balance control is sensory input from somatosensory& visual and vestibular receptors and overall sensory organi(ation of inputs" Initial examination should address these elements before moving on to assess the motor components of balance @e"g"& postural synergies" *he Clinical *est for ensory Integration in Balance @humwayCoo#& =ora# is an appropriate instrument" Cardiovascular endurance and level of dyspnea during functional transfers are appropriate elements to examine but should occur after #ey elements of balance are examined @sensory components and integrationM synergistic elements" B.- C. III *he P* who is solely responsible assessing the competence of the P*A under their supervision" *he P* is solely responsible for assessing the competence of all personnel under their supervision" 6urthermore& it is the responsibility of the supervising P* to exercise sound $udgment when delegating responsibility to less s#illed personnel" B.) C. III Complete the written discharge summary at another time and examine the patient" *he physical therapist assistant can perform assigned physical therapy interventions under the onsite supervision of P*" It is the obligation of the physical therapist to examine this scheduled patient in a timely manner and determine the plan of care" *his tas# cannot be delegated" B.7 C1 I An#le plantarflexion and anterior pelvic tilt" A common contributory problem or correlated motion for genu recurvatum is an#le plantarflexion due to shortened gastrocnemius muscles" Alterations occurring up the #inetic chain include anterior pelvic tilt to maintain the center of gravity over the feet" B. C1 I E) nerve root compression *he positive findings are consistent with a E) nerve root compression" 2ea#ness of only one muscle group is not a common finding for %% or I d ysfunction"
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B.. C) I Pre and post activities& using the nonshunt arm" A dialysis shunt would interfere with ta#ing BP" Fse the nonshunt arm" Pre and post exercise measurements are appropriateM ta#ing BP during wal#ing would result in inaccurate measurements" B.8 C II *hreepoint A threepoint gait pattern in which both crutches and the involved leg are advanced together is the safest gait pattern to ensure partial or nonweightbearing following a lower extremity fracture" *wopoint and four point are weight bearing gaits" B.: C. II Eevel - casecontrol study provides limited confidence in the effectiveness of *03" *he experimental design includes random assignment into experimental group @receives treatment or control group @no treatment" ac#ett+s Eevels of 0vidence and Drades of >ecommendation are used to define the degree of confidence and scientific rigor of the research" Eevel I studies re/uire large randomi(ed controlled trials @>C*s and provides maximum confidence in the results @Drade of A" Eevel II studies are cohort studies and smaller >C*s and provide good evidence @Drade of C" Eevel - studies& casecontrol studies @as in this example allow some limited confidence in the findings @Drade of B" Eevel ) studies are poor /uality caseseries @Drade of C while Eevel 7 studies are based on expert opinion only @Drade of %" B8; C- II top the exercise and notify the physician immediately" A run of three or more P,Cs occurring se/uentially is ventricular tachycardia" *he rate is very rapid resulting in seriously compromised cardiac output" *his potentially an emergency situation that can deteriorate rapidly into ventricular fibrillation @no cardiac output and cardiac arrest" B81 C' I ,isual agnosia" All of the choices are indicative of perceptual dysfunction" *his patient is most li#ely suffering from visual agnosia which is an inability to recogni(e familiar ob$ects despite normal function of the eyes and optic tracts" 4nce the wife tal#s with him& he is able to recogni(e her by her voice" Ideational apraxia is the inability to perform a purposeful motor act& either automatically or upon command" Anosognosia is the fran# denial& neglect or lac# of awareness of the presence or severity of one+s paralysis" omatognosia is an impairment in body scheme" B8' C8 I Buffered aspirin *here is a long list of ris# factors that may increase an elderly patient+s ris# of falling" Psychotropic drugs @0lavil& =aldol can cause postural hypotension and are strongly lin#ed with falls" %igoxin is used in treating arrhythmias and can induce di((iness& fatigue and confusion" 3itroglycerin is an antianginal drug that can also cause postural hypotension" 4f the medications listed only Buffered aspirin& an 3AI%& is not li#ely to increase fall ris# @adverse side effects include DI disturbances such as stomach pain& heartburn& nausea and vomiting" B8- C1 II Fse of a resting splint at night *he symptoms are suggestive of plantar fasciitis" *he focus of patient management should be on decreasing the irritation to the plantar fascia" *his is most effectively done with a resting night splint" 9odalities to reduce pain offer some symptomatic reliefM however& the pain is not constant" trengthening the dorsiflexors will not change irritation to the plantar fascia" A customi(ed orthosis may be necessary& at a later time& if primary symptoms do not resolve after early management" B8) C III Drasp the handrims posteriorly and pull them forward abruptly and forcefully" A wheelie can be assumed by having the patient place his hands posterior on the handrim and pulling them abruptly and sharply forward" If the patient is unable to lift the casters in this manner& he can throw his head bac# forcefully when he pulls his handrims" An alternate techni/ue is to grasp the handrims anteriorly& pull bac#ward& then abruptly and forcefully reverse the direction of pull" *he therapist can assist by steadying the chair at the patient+s balance point until he learns to ad$ust his position through the use of handrim movements forward and bac#ward"
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B87 C- I Amyotrophic lateral sclerosis with dysphagia and diminished gag reflex" Aspiration pneumonia results from an abnormal entry of fluids or matter @including food into the airways" A patient with AE with an inability to swallow @dysphagia and diminished gag reflex is most susceptible to aspiration pneumonia" 4thers listed may be susceptible to other forms of pneumonia or even& though less li#ely& aspiration pneumonia" B8 C II Partial s/uats progressing to lunges" Closedchain exercises are the most appropriate in this example because of the patient+s difficulty descending stairs" 9oving the body over a fixed distal segment provides loading to muscles& $oints& noncontractile soft tissue while stimulating the sensory receptors needed for stability and balance" 4penchain exercise @all other choices while improving strength does not ade/uately prepare an individual for functional weight bearing" B8. C' I Eow lumbar @E)E7 Patients with low lumbar lesions @E)E7 can be independent and functional with bilateral an#lefoot orthoses and cane" Patients with higher lesions can learn to ambulate with orthoses and crutches but exhibit a high rate of orthotic re$ection in favor of primary wheelchair mobility" >e$ection is due to the high levels of energy expenditure during ambulation" B88 C7 II Paraffin Paraffin bath will provide circumferential heating of the hands and fingers and will aid in softening the s#in" Active exercise& including 60& would be more effective after the application of paraffin as tissue extensibility and pliability would be increased" =ot pac#s or ultrasound using direct contact would not completely cover the area to be treated" B8: C II 6ront wheel rolling wal#er that folds" A rolling wal#er will provide added stability while maintaining gait as a continuous movement se/uence" *he additional benefit of a folding wal#er facilitates mobility in the community" B:; C1 III 6orward& producing posterior tilting of the pelvis" Contraction of the lower abdominals results in posterior tilting of the pelvis and can be achieved with forward or anterior movement of the therapy ball" B:1 C' I A peripheral nerve in$ury" *his patient is exhibiting signs and symptoms of lower motor neuron in$ury @hypotonia& hyporeflexia& paresis& neurogenic atrophy" *he presence of muscle fasciculations is a hallmar# sign of E93 in$ury" Fpper motor neuron lesions @cortex or pyramidal trac#s would result in hypertonicity @=ypotonicity initially during shoc#& hyperreflexia& generali(ed paresis& and variable disuse atrophy" DuillainBarrL is a E93 condition that produces symmetrical and ascending signs" 0xtrapyramidal signs @involuntary movements are not evident in this case" B:' C' I *he spinal nucleus of C3 , yringomyelia is a disease of the spinal cord characteri(ed by the development of cysts or cavities within the cord" *he sensory losses exhibited by this patient are characteristic of spinal cord involvement" *he main sensory nucleus of C3 ,& trigeminal nerve& is located in the pons and connects inferiorly to the spinal nucleus below which extends through the whole length of the medulla into the upper spinal cord as far as C'" ensations of touch and pressure are served by the main sensory nucleus of C3 , @intact in this case while pain and temperature are served by the inferior spinal nucleus @impaired in this case" B:- C- II tandard postural drainage for the lateral basal segment& left lower lobe" *he appropriate postural drainage for the lateral basilar segment of the left lower lobe is in sidelying position with the head of bed tipped in full *rendelenburg" 2ith a respiratory rate of '8 at rest and borderline a4 ' values on ) liters of oxygen& modification of the position is in order"
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B:) C8 I =is symptoms are intermittent" Acutely ill& hospitali(ed elderly patients fre/uently exhibit delirium& a fluctuating attention state" Patients demonstrate a fluctuating course with symptoms of confusion that alternate with lucid intervals" leep?wa#e cycles are disrupted and confusion is typically worse at night" All other choices are signs of dementia" B:7 C. II Analysis of variance" Analysis of variance is a parametric statistical test used to compare three or more treatment groups @in this example& in water& on land or combined exercise groups on a measure of the dependent variable @$oint effusion girth measurements at a selected probability level" Analysis of covariance compares two or more groups but also controls for the effects of an intervening variable" B: C' II %emonstrate and gesture to get the idea of the tas# across" 2ernic#e+s aphasia @fluent aphasia is a central language disorder in which spontaneous speech is preserved and flows smoothly while auditory comprehension is impaired" %emonstration and gesture @visual modalities offer the best means of communicating with this patient" *he family may not better understand the patient than the therapist" B:. C I Insufficient #nee friction" *erminal swing impact refers to the sudden stopping of the prosthesis as the #nee extends during late swing" Possible causes can include insufficient #nee friction or too much tension in the extension aid" Additionally& if the patient with an amputation fears the #nee will buc#le at heel stri#e& he can use forceful hip flexion to extend the #nee" B:8 C) II Plastic cervical orthosis and axillary splints utili(ing an airplane position" *he common deformity for an anterior nec# is flexionM the appropriate positioning device is a firm rigid plastic cervical collar that stresses extension" *he common deformity of the shoulder is adduction and internal rotationM the appropriate position device is an axillary or airplane splint that stresses abduction& flexion and external rotation" Choices that involve hand splints should be ruled out immediately as there is no mention of burns to the hands" A C*E4 would prevent nec# flexion but it does not deal with the potential shoulder deformities" *he C*E4 could also restrict breathing and enhance the ris# of pneumonia" B:: C1 I Compression of the common peroneal nerve" Cutaneous neural innervation to the great toe is via the deep peroneal nerve which is a branch of the common peroneal nerve" 9otor problems of toe extension can also be traced to common peroneal nerve compression" Compromise of the tibial artery could result in paresthesias of the plantar surface of the foot and loss of ability to flex the toes" *he cast must be removed or ad$usted immediately" B1;; C' III Bridging with both arms positioned in extension at the sides" Bridging& with arms positioned at the sides& is a symmetrical activity and would do little to bring attention to the involved hemiplegic side" All of the other activities involve crossing the midline& and focus on moving toward or incorporating the involved left side" B1;1 C. III Provide the family 9edicare Gnotification of noncoverageH information& and carefully explain it and their options& which could include playing for the care outofpoc#et" 9edicare re/uires that physical therapy is s#illed& appropriate and demonstrates progress towards reasonable functional goals" %espite the fact that 9edicare re/uires that the physician responsible for the patient GcertifyH the necessity and appropriateness of physical therapy& that does not absolve the physical therapist from the responsibility of determining whether physical therapy is appropriate" *hat is the sole responsibility of the P*"
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B1;' C- II Call the patient+s physician and report signs of theophylline toxicity" *heophylline is a bronchodilator used to reverse airway obstruction" *he combination of symptoms of irregular heart rate& feeling $ittery and gastric upset is consistent with theophylline toxicity" As theophylline toxicity can cause arrhythmias and sei(ures& the patient+s physician should be notified by the physical therapist rather than wait for the patient to return home to call the physician" It is also li#ely that a blood test will be needed to chec# the theophylline toxicity level and this could be done at the facility" ,entolin @Albuterol is a bronchodilator used in the treatment of asthma or C4P%" Amcort @*riamcinolone is an antiinflammatory agent used to manage bronchial asthma" B1;- C8 I Atlantoaxial subluxation with spinal cord impingement Eigamentous laxity is a hallmar# of %own syndrome and can lead to atlantoaxial subluxation with spinal cord impingement" *his is a medical emergency situation" %ecreased muscle strength and diminished %*>+s are the signs of such a dislocation from loss of cord function" Children with %own syndrome often have low tone and a number of orthopedic abnormalities" In this case& the increasing symptomatology @changes in strength& nec# pain& limited nec# motion is significant for a developing subluxation" B1;) C' I Passive range of motion while emphasi(ing scapulohumeral rhythm" houlder pain in hemiplegia may be caused b y a number of different factors affecting subluxation @Choices A& B& and C" An appropriate treatment intervention involves P>49 with careful attention to maintaining scapulohumeral rhythm" B1;7 C I 2ea#ness or severe spasticity of the /uadriceps evere spasticity of the /uadriceps will pull the #nee strongly into extension and recurvatum" *he patient with a wea# /uadriceps muscle will compensate by fixing the #nee in full extension @recurvatum during stance rather than maintaining the #nee in a small amount of #nee flexion at midstance" B1; C) II Fse of an A64 with heel pressure relief" *he A64 helps to prevent plantarflexion contractures while the heel pressure relief prevents further damage and promotes healing" *he pressure ulcer& based on the examination findings& is stable and needs to be monitored not debrided" Arterial bypass grafts are needed if circulation is compromised" *here is no indication that this is the case" B1;. C. II Eeg ergometry is highly correlated with >P0 while arm ergometry is only moderately correlated" In correlational studies& high correlations range from ;". to O1";; while moderate correlations range from ;"-7 to ;":" Common variance is a representation of the degree that variation in one variable is attributable to another variable and is determined by s/uaring the correlation coefficient" B1;8 C1 II Immediately return the patient to the referring physician with documentation indicating that treatment was ineffective" In this case& it would be best to send the patient bac# to the referring physician with an explanation of what was doneM the ineffectiveness of the treatment& and any suggestions for further follow up" *he therapist should not continue to treat a patient if the therapist feels no further benefit would be derived by continuing care because it contradicts the AP*A+s Duidelines for Professional Conduct" B1;: C7 III Continuous F - 9=( ince the an#le sprain is chronic in nature& the goal is to decrease pain and increase the >49 @tissue extensibility" Increasing the tissue temperature will accomplish these ob$ectives" *his will re/uire the heating effects of ultrasound produced by continuous ultrasound" Because the largest structures are close to the s#in surface& higher fre/uencies are used so that the acoustic energy will be absorbed @attenuated in the superficial layers" B11; C' III 6acilitation of early movement in synergistic patterns followed /uic#ly by movement training in outofsynergy patterns" *he focus of 3%* therapy @Bobath Approach following stro#e is to encourage functional return of normal patterns of movement" *o that end& obligatory synergistic patterns are never encouraged and from the earliest onset of active movement& activities are designed to brea# up the abnormal synergies"
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B111 C8 II Bilateral JA64+s *he #nees would not need to be braced in moderate spastic diplegia& but tone reducing A64+s might be indicated" A posterior wal#er and prone stander may both enhance function" B11' C II trengthen the hip abductors on the right side" *he lateral trun# bending @*rendelenburg gait is the result of wea# hip abductors on the right @a common problem for patients recovering from stro#e" *he other choices do not address the problem of lateral trun# bending" B11- C1 II %ecreased loading of the #nee by the /uadriceps femoris muscle" Baseball catchers must ma#e forceful contractions of the /uadriceps muscles each tome they stand up to throw the ball to the pitcher" *his may precipitate 4sgood chlatter dysfunction in the adolescent boy" 0arly intervention of this condition focuses on reduction of the loading b y the /uadriceps but still retaining normal lower extremity function" B11) C- II Calcium alginate dressings" 2ounds with moderate to high exudate benefit from calcium alginate dressings" *he dressings absorb large amounts of exudate and form a gel which maintains the moist wound environment while maintaining good permeability to oxygen" B117 C1 I Centrali(ed gnawing pain with loss of postural control during lifting activities" %iscal degeneration without nerve root compression would li#ely be exhibited as a centrali(ed gnawing pain with loss of proprioception" B11 C' II Involving the patient in decision ma#ing and monitoring for safety" As patients with *BI recover& structure and guidance must be gradually reduced and patient involvement in decision ma#ing increased" afety must be maintained while increasing levels of independence are fostered" Patients at tage ,II of recovery often exhibit rote movements @robot syndrome indicative of the highly structured training utili(ed for patients during earlier stages of recovery" B11. C II Fse a toe wedge A festinating gait is an abnormal and involuntary increase in the speed of wal#ing in an attempt to catch up with a displaced center of gravity due to the patient+s forward lean" *he most appropriate intervention would be to use a toe wedge which would help to displace the patient+s center of gravity bac#ward" Increasing cadence or stride length would only serve to increase& not decrease& the problem" B118 C III =igh intensity wor#loads for short durations" =igh intensity exercises for shorter durations @less than '; repetitions are needed to train the highly adaptable fasttwitch IIa fibers" B11: C' I ympathetic nerve damage consistent with =orner+s syndrome" In *BI& the oculomotor nerve is vulnerable from a herniated uncus" Compression on the nerve can produce =orner+s syndrome resulting in symptoms of constriction of the pupil @miosis& slight drooping of the eyelid @ptosis& vasodilation of the s#in arterioles& and loss of sweating @anhydrosis" All of these symptoms are the result of an interruption of the sympathetic nerve supply to the head and nec#" An Argyll>obertson pupil is a small pupil of fixed si(e and not reactive to light that is usually caused by interruption of fibers to the parasympathetic nuclei @0dinger2estphal nuclei of the oculomotor nerve" B1'; C8 II =ousehold ambulation with a reciprocating gait orthosis @>D4 and Eofstrand crutches" A child with a very high level myelomeningocele will be able to ambulate for limited @household distances with an >D4 and Eofstrand crutches" Physiological benefits include improved cardiovascular and musculos#eletal function" *he child will not be able to be a community ambulator because of the high energy expenditure necessary with this level of lesion"
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B1'1 C. II Placebo effect In placebo effect& a sub$ect responds to a sham treatment @in this example the patient received a pill that did not contain the drug being tested with positive effects @patient reports she feels much better& moves easier" *he =awthorne effect is the sub$ect+s #nowledge that she is part of a study and that alone might affect her responses" ampling bias in a national study is unli#ely and wouldn+t explain her response" B1'' C- I *his arterial blood gas shows an increased p= which is an al#alosis" It is caused by the low carbon dioxide level& therefore& it is a respiratory al#alosis" *here is no compensation& since the bicarbonate ion is at the baseline level of ') m0/?dE" B1'- C) III Avoid exercise during periods of pea# insulin activity *he patient should monitor blood glucose levels fre/uently when initiating an exercise program and avoid exercise during periods of pea# insulin activity @') hours after in$ection" A carbohydrate snac# should be eaten before and during prolonged exercise bouts" *he physician can also decrease the insulin dose by 1' units" 0xercise should begin with daily sessions& '; minutes twice a day" *he therapist should use >P0 in addition to => to monitor exercise intensity" @ource! AC9+s Duidelines for 0xercise *esting and Prescription& 7 th ed"" B1') C8 II 2ill li#ely be resistant to activity training if unfamiliar activities are used" Activity training is most li#ely to be successful if done with familiar activities" A patient with Al(heimer+s disease cannot be trusted to safely perform independent A%E+s or functional mobility s#ills" 9emory for past events may be retained initially but eventually all memory becomes impaired" B1'7 C' III 6ocus on #nowledge of results and visual inputs" %uring the early stage of motor learning @cognitive stage learners benefit from seeing the whole tas# correctly performed" %ependence of visual inputs is high" %eveloping a reference of correctness @#nowledge of results is critical to ensure early s#ill ac/uisition @cognitive mapping" 6ocus on proprioceptive inputs is important during the middle @associative stage of motor learning" %elayed feedbac# is appropriate during later learning" B1' C III Pad placed proximal to the metatarsal heads" Compression of the digital nerves in the forefoot results in sensory symptoms of pain and paresthesias @metatarsalgia" It is typically the result of excessively tight shoes" *he best intervention is to wear larger shoes with a metatarsal pad placed proximal to the metatarsal heads to elevate the transverse @anterior arch and separate the metatarsals" Custom orthotics can also be molded to decrease load" 2earing of high heels should be discouraged" tretching of plantarflexors may also be helpful" A scaphoid pad and *homas heel are used to support the longitudinal arch and prevent pes valgus and metatarsalgia" B1'. C1 II 9odalities to reduce pain and inflammation as the result of subdeltoid bursitis" Because pain occurs with both A>49 and P>49& bursitis is the most li#ely cause of dysfunction" Initial intervention should focus on reducing pain and inflammation" 9odalities are the best choice" B1'8 C) I 9otor ataxia and paresis with pronounced gait disturbances" Alterations in memory& confusion& and disorientation are characteristic of AI% dementia complex& a common C3 manifestation of =I, infection" 9otor deficits may include ataxia& paresis with gait disturbances& and loss of fine motor coordination" Patients may also develop peripheral neuropathy with distal pain and sensory loss" Paraparesis& not paraplegia might be a finding" B1': C. III *he applicant+s marital status" It is illegal to as# potential applicants their marital status"
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B1-; C8 III 6emoral antetorsion and medial #nee stress" 2 sitting is a stable and functional position& but may cause later orthopedic problems of femoral antetorsion and #nee stress" Children with %own syndrome typically exhibit low tone and hyperextensibility" 2 sitting is not li#ely to affect low tone or reflex activity" =ip subluxation is unli#ely" B1-1 C' I %orsal column?lemniscal pathways or somatosensory cortex" %iscriminative touch is carried in the posterior white columns @fasciculus cuneatus for the upper extremity and fasciculus gracilis for the lower extremity" *he long ascending tracts cross the medulla @sensory decussation and form the medial lemniscus which then travels to the thalamus @ventral posterolateral nucleus and finally to the cortex @post central gyrus" Eoss of twopoint discrimination could result from an insult affecting any of these component parts" Parietal lobe or internal capsule lesions are the most common sites" B1-' C- II %aily& using interval training for 1; to 17 minute periods" An appropriate initial exercise prescription for a patient with a history of C=6 and claudication pain in the right calf should include low intensity exercise @wal#ing& low to moderate duration @1;17 minutes& and higher fre/uencies @daily" *he exercise session should carefully balance activity with rest @interval training" B1-- C. III A statement ensuring the sub$ect+s commitment to participate for the duration of the study" ub$ects may refuse to participate and withdraw from a study at any time" >ecognition of this element must be clearly stated in a valid informed consent" B1-) C) II Increasing nonweightbearing and stabili(ation using a lumbosacral orthosis" Eigamentous laxity and pain during pregnancy secondary to hormonal influences @relaxin most commonly affects the sacroiliac $oint" *his ligamentous laxity continues to occur for up to - months after pregnancy& and leaves the pelvic area vulnerable to in$ury" acroiliac pain is aggravated by prolonged weight bearing and stairs" *he ipsilateral flexion #inetic test @Dillet *est! stand on one leg while flexing the opposite hip assesses mobility of the innominate and ability of the ipsilateral innominate to rotate posteriorly" All the interventions listed can be helpful in this situation except for increasing nonweightbearing time and use of a lumbosacral orthosis which are not mobili(ing techni/ues or activities designed to restore optimal alignment and mobility" B1-7 C7 III #in and electrodes" 0lectrodes must be chec#ed regularly for signs of wear or crac#ing which would ma#e the delivery of electrical current either ineffective and?or unsafe" >epetitive longterm use of electrodes might produce crac#ing or uneven wear& which could develop into Ghot spotsH of increased current density" *he increased current density along with continued placement and removal of the electrodes could cause s#in irritation and brea#down" B1- C III Improve positioning for pressure relief or extensor spasms" A tiltinspace wheelchair has the entire seat and bac# tilted bac#wards as a unit and is prescribed to provide additional postural support& pressure relief& or to prevent extensor spasms from throwing the patient out of the chair" B1-. C8 II Practice wal#ing in areas of high illumination and low clutter" 0ffective intervention strategies for the elderly patient with low vision include ensuring ade/uate lighting" ,ision and safety decrease dramatically in low lighting or with bright glare from sunlit windows" >educing clutter in the home is also an important strategy to improve safety during ambulation" Color coded stairs might be of help if they were well lit and if strong colors& not pastels& were used" B1-8 C- I Angina of increasing intensity that is unresponsive to the nitroglycerin or rest" Preinfarction or unstable angina pectoris is unrelieved by rest or nitroglycerin @measures that typically reduce most angina" *he pain is described as increasing in intensity" Fnstable angina is an absolute contraindication to exercise"
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B1-: C' III 6oot tapping in a sitting position" *he typical lower extremity synergies are effectively bro#en up with @1 #neeling and bridging @combines hip extension from the extensor synergy with #nee flexion from the flexion synergy and @' rolling using P36 %1 flexion patterns @combines flexion from the flexion synergy with adduction from the extension synergy" 6oot tapping in the sitting position is an insynergy activity @dorsiflexion with hip and #nee flexion" B1); C. III %ependency on others for all transportation needs" *he overall re/uirements and /ualifying criteria for homebound care are! 1" Care must be provided in the homeM '" *he patient is confined to the home and re/uires a considerable and taxing effort to leaveM and -" If the patient leaves home he or she is still considered homebound if the absences from home are to receive medical treatment& radiation& dialysis& etc" *he fact that the patient is dependent on others for transportation does not meet the homebound criteria" B1)1 C I A stiff #nee mechanism A prosthesis that is too long or has a #nee mechanism that is too stiff will cause the patient to circumduct or abduct the prosthesis in order to clear the prosthesis and get through swing phase" If it is not compensated& a fall may result" *he other problems will not result in a circumducted gait pattern" B1)' C) II 3otify the physician immediately" *he ris# of metastatic disease is presentM the therapist should notify the physician immediately" 9onitoring or modifying the plan of care to reduce pain should be considered only after consultation with the physician" If metastatic disease is present& the ultrasound would be contraindicated" Ambulating in the parallel bars exerts the same weightbearing forces through the upper extremities as a wal#er" B1)- C7 II Cold?intermittent compression combination with the limb elevated" *he application of cold to decrease pain along with intermittent compression with elevation to facilitate fluid drainage provides the best intervention" Contrast baths and whirlpool place the an#le in a dependent position which might tend to increase edema" B1)) C1 I 9idcervical region" *he patient has symptoms @diminished reflex of a possible left C7 nerve root compression in the midcervical spine" Any reflex change suggests nerve root irritation or compression" Eateral epicondylitis fre/uently involves the extensor carpi radialis brevis which is innervated by spinal nerves emanating from the midcervical region" B1)7 C- II 2al#ing& intensity set at 7;< target heart rate" 4bese individuals are typically sedentary with lower initial levels of physical conditioning" *he initial exercise prescription should focus on a lower intensity exercise progressing to longer durations" =igher intensity exercise @.7< or 87< of heart rate maximum should be avoided initially" ogging is also too intense and may yield additional orthopedic problem" B1) C1 I Contracted hip flexors" Patients are less active after surgery& spend less time in standing and more time in sitting" *he iliopsoas muscles become shortened with increased time in sitting" *he contracted iliopsoas limits the patient+s ability to extend the hip which effectively shortens the stride length on the affected side" B1). C8 III lowly stro#e the finger extensors in a distal to proximal direction" lowly stro#ing the finger extensors will help to facilitate the finger extensors to allow the child to release the food into the mouth"
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B1)8 C' II Eow intensity general conditioning exercises" Patients with AE are at ris# from overwor# in$ury to wea#ened& denervated muscles @a characteristic of E93 disease" 2hile preventing further deconditioning is an important goal& the exercises prescribed should be of mild to moderate intensity and carefully balanced with rest" B1): C II *he distance of the load from the base of the spine 9anual lifting biomechanical models have demonstrated high lumbar spine moments especially when the load is not held close to the body" B17; C1 II Anterior inferior translatory glides" *he diagnosis is left shoulder adhesive capsulitis" Because the restriction of motion occurs in abduction& flexion& and external rotation& anterior inferior translatory glides are most appropriate for this patient based on the concaveconvex mobili(ation concept" B171 C8 I Impairments in shortterm memory 0lderly patients with memory impairments typically demonstrate intact immediate recall @e"g"& can repeat wordsM impairments are often noted in memory for recent events& e"g" 2hy did I come into this room5 or 2ho came to see me yesterday5" Eong term memory is usually intact" B17' C' I A positive =allpi#e maneuver" *he test described is the =allpi#e maneuver" It is positive because the change in position produced the patient+s symptoms" 2hile the C*IB and the sharpened >omberg are also used to assess vestibular function& they can be expected to produce symptoms of dyse/uilibrium @loss of balance" B17- C. III =ave the patient practice wal#ing in varying environments" *his patient demonstrates the associative phase of motor learning @errors are decreasing and movements are becoming organi(ed" It is appropriate to gradually progress this patient toward ambulating in a more open @varied environment" Continuous feedbac# may improve performance but in the long run slows down learning" Practice until errors are extinguished or early intervention& also represent inappropriate strategies for the associative stage of learning" B17) C- III Autogenic drainage for secretion removal once or twice daily" Proper at home interventions include! secretion removal techni/ues including an a capella device or manual techni/ues performed by an adult& and exercise are appropriate interventions for a child with cystic fibrosis" Autogenic drainage which can be helpful in clearing secretions but is not appropriate for a young child as it relies on independent ability to monitor secretion build up in the airways and to ma#e appropriate choices of clearance" B177 C) II Jegel exercises several times a day" ymptoms of stress incontinence can be successfully managed through a variety of techni/ues" Pelvic floor exercises @Jeel exercises are the mainstay of treatment and must be performed daily& several times a day in order to be effective" Biofeedbac# and 0tim offered wee#ly or - times a wee# are not li#ely to be effective due to insufficient fre/uency" A voiding schedule does not address the primary impairment" B17 C' I Posterior inferior cerebellar artery" *his patient presents with lateral medullary @2allenberg+s syndrome which can result from occlusion of the posterior inferior cerebellar artery @PICA which is usually a branch of the vertebral artery" It involves the descending tract and nucleus of C3 ,& the vestibular nucleus and its connections& C3 I and C3 nuclei or nerve fibersM cuneate and gracile nucleiM and spinothalamic tract" An internal carotid artery stro#e produces symptoms of combined middle cerebral and anterior cerebral artery stro#es" *he symptoms in this case clearly indicate brainstem involvement& not cortical involvement"
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B17. C7 II Cathode placed in the wound" It is purported that the bactericidal effect produced by negative current is a result of substrate depletion or alteration of the internal processes of the microorganisms" 3eutrophils are also attracted to the wound area by chemotaxis to purge the bacteria" *he cathode should be placed directly in contact with the wound to cover as much treatment area as possible" B178 C- III 9oderate intensity& @8: 90* and can be easily alternated with wal#ing at 7 90*s" >unning on a flat surface @1' min" per mile is a moderate intensity activity with an energy cost around 8". 90*s" It can be easily alternated with the lower intensity activity of wal#ing @7 90*s to achieve suitable intensities for individual patients" B17: C) II Initiate functional training consistent with her level of in$ury" A conversion disorder @hysterical paralysis represents a real loss of function for the patient" *he therapist should treat this patient the same as any patient with spinal cord in$ury with similar functional deficits" A psychologist or psychiatrist is best able to help the patient understand the cause of her paralysis" *he therapist should be empathetic& however& counseling should not be the main focus of intervention in P*" B1; C. III >efused to treat this patient" 9alpractice is considered professional negligence as a result of wrongs or in$uries that may occur through professional?patient relationships" 3egligence is the failure to do what a reasonable practitioner would have done or not done in a similar circumstance" A supervisor+s re/uest to treat a patient can be refused if the therapist feels it is outside the scope of his?her expertise" B11 C8 I Continuous tremulousness" Continuous tremulousness is an abnormal finding& but occasional tremulousness is not" All the other choices are normal findings in a newborn infant" B1' C I acral sitting and sliding forward in the chair" 0xcessive leg length on a wheelchair can result in sliding forward in the wheelchair to reach the foot plate" *his movement results in a posterior tilt of the pelvis and sacral sitting" B1- C) I 0xudate in the wound" *he specimens must be collected from the wound site with a minimum of contamination by material from ad$acent tissues" *he margins of cutaneous lesions or pressure ulcers are usually contaminated with environmental bacteria" Fsing the dressing for a specimen sample would also contain contaminated tissues" B1) C- III Both => and systolic?diastolic BP will be higher" Arm ergometry uses a smaller muscle mass than leg ergometry resulting in a lower maximal oxygen upta#e" In upper extremity exercise both => and BP will be higher than for the same level of wor# in the lower extremities" B17 C. II ttest" *he data in this study is interval data @values ran# ordered on a scale that has e/ual distances between points on the scale" An appropriate statistic to determine the differences between groups @experimental versus control is a ttest" An A34,A is also appropriate for interval data& and is used for more than two groups" Chi s/uare is appropriate to determine differences between groups if nominal data @ran# ordering with no specific intervals between ran#s is used" Choice C is indicated to determine correlational relationships" B1 C8 II Are highly structured to reduce anxiety and confusion" Patients with dementia @e"g" Al(heimer+s disease benefit from a structured& soothing environment designed to ensure safety and optimal function" *hese patients respond poorly to highly stimulating environments or situations re/uiring greater cognitive s#ills than they possess" B1. C' III ---8.8-:"doc
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>anging individual muscles according to specific functional needs" elective stretching techni/ues are indicated for the patient with spinal cord in$ury" 4verstretching the long finger flexors will result in loss of tenodesis grasp" 4verstretching the bac# extensors will result in loss of sitting stability" B18 C. III =ave the P*A supervise the class using the outline exercise protocol until the therapist returns" *he P*A can supervise the class using the outline exercise protocol approved by the physical therapist" *he P*A should not change the plan of care" B1: C1 III Active eccentric contractions in the painfree range" Iso#inetic& isometric and isotonic exercises do not allow for painfree muscle contractions and can cause further inflammation of the muscle" 6or a muscle that is chronically inflamed& focus should be placed on eccentric contractions since there is less effort and stress placed on the contractile units as compared to concentric contractions at the same level of wor#" B1.; C7 III %ecrease the ultrasound intensity" Acoustical energy is reflected form the bone into the bonetissue interface resulting in rapid tissue temperature elevation and stimulation of the highly sensitive periosteum of the bone" A reduction in intensity is indicated if a strong ache is felt" B1.1 C. III Commission on Accreditation of >ehabilitation 6acilities @CA>6" CA>6 accredits all rehabilitation facilities& including free standing wor# conditioning centers" 4=A and %ept" of == are not accrediting agencies" CA=4 primarily accredits hospitals& hospices and home care agencies" B1.' C) II >eport these findings promptly to the physician" *hese signs and symptoms are characteristic of heterotopic ossification @=4& an abnormal bone growth typically around a $oint" 2hile the etiology is un#nown& its presence can lead to serious >49 limitations" *hese findings should be reported promptly to the physician" 9assage and >49 exercise could exacerbate the condition" Ice does decrease metabolic activityM however& more indepth medical management is re/uired" B1.- C8 I pastic diplegic cerebral palsy" pastic diplegia includes involvement of all four extremities with the lower extremity involvement being more severe" B1.) C- I *achycardia at a relatively low intensity of exercise with * segment depression" *he typical exercise 0CD changes in the patient with coronary artery disease include rapid => at very low levels of exercise intensity" *he * segment becomes depressed @greater than 1 mm is significant and exertional arrhythmias @multifocal or runs of P,Cs are significant may appear" B1.7 C1 II Posterior cervical muscle stretching and postural reeducation to relieve vertebral artery compression" Eongterm postural changes with forward head posture include shortening of the posterior muscles with possible vertebral artery compromise at the occiput" B1. C I Eateral foot rotation at heel stri#e" Bumpers in a single axis prosthetic foot limit motion in either dorsiflexion or plantarflexion" A plantarflexion bumper that is too stiff can cause lateral foot rotation at heel stri#e since the prosthetic foot remains dorsiflexed and the foot pivots"
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B1.. C- III Place a blood pressure cuff on the involved extremity and inflate the cuff until the bleeding stops" A radial arterial line is a catheter placed in the artery itself" If it becomes dislodged during treatment& the artery is now open to bleeding" *his arterial bleeding needs to be stopped immediately& though it is not considered a cardiac emergency" 0ither place a blood pressure cuff above the site of bleeding and inflate the cuff to above systole to stop the bleeding or place enough manual pressure on the site to stop the bleeding" *hen call for help" 0levating the site of bleeding above heart level will not help as this is an arterial bleed" As long as the heart is pumping with ade/uate pressure& the site will continue to bleed" 3ever replace any line that has come disconnected" *he line is no longer sterile and should not be re inserted into the patient" A new sterile catheter will need to be used if the radial line is to be replaced" B1.8 C' I Poor $udgment with increased safety issues" *he patient with left hemiplegia @right C,A will typically demonstrate poor $udgment with numerous safety issues" *he patient with right hemiplegia @left C,A will demonstrate slow& cautious behaviors and re/uire more feedbac# and support" B1.: C) II 4pen wounds must be contained within a dressing" taphylococcal organisms are spread by contact" tandard germicidal cleaning measures @hand washing should be followed" *he therapist should be gloved for all direct contact with an open& draining areas" All e/uipment should be cleaned with an approved germicidal agent before and after use" 2hirlpool may be used" 4pen wounds must be well contained with a dressing" Isolation in a private room is not re/uired" B18; C1 I Dall bladder" %ysfunction of the gall bladder often refers pain to the thorax" *he commonly observed referral pattern of the heart is to the chest and upper extremity& the ovaries to the low bac#& and the appendix to the right lower /uadrant" B181 C III Allows limited sagittal plane motion with a small amount of mediolateral motion" *he AC= foot @solid an#le cushion heel is the most commonly prescribed type of prosthetic foot" It provides for sagittal plane motion @primarily plantarflexion and very limited frontal plane motion @mediolateral motion" B18' C8 II Eoo# at his feet for placement while wal#ing" election of compensatory strategies for sensory losses is dependent upon careful assessment of the sensory systems contributing to balance @somatosensory& visual& vestibular" Control should be refocused to use available intact sensory systems" In this case proprioception is impaired while vision is intact" Fse of counting can aid gait rhythm but not foot placement" Eight touch down support can aid balance but training using available furniture is a bad idea" B18- C- I >ight hemothorax A left pneumothorax and a left pleural effusion ta#e up space in the left thorax" *he air @pneumothorax or the sterile fluid @effusion in the pleural space would push contents of the left hemithorax& including the trachea& to the right" A lung collapse& or a volume loss phenomenon& on the right would pull the trachea over towards the right" A right hemothorax @blood was in the pleural space ta#es up space in the right hemithorax& shifting the trachea to the left" B18) C7 II Date control mechanisms" *he gate control mechanism is activated by the application of conventional @high rate *03& whereas low rate *03& having a stronger stimulus and a longer pulse duration activates the ascending inhibition and endorphin production mechanisms" B187 C1 II econdary gain" A patient who is able to drive to the clinic for treatment and relates a pain level of 1;?1; is not providing consistent sub$ective data" econdary gain in this case& no wor#ing& is a li#ely factor"
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B18 C- I Be low at rest and rise very little with exercise" Betaadrenergic bloc#ing agents @e"g"& propranolol?Inderal are used to treat hypertension& prevent angina pectoris and prevent certain arrhythmias" In individuals ta#ing these drugs& heart rate is low at rest and rises very little with exercise @blunted response" *hese changes therefore invalidate the use of => to monitor exercise responses" A more sensitive measure would >P0 @>atings of Perceived 0xertion" B18. C. III pea# to the supervisor about concerns that this policy conflicts with the Code of 0thics" Although the instructions given by the supervisor may place an individual therapist in conflict with the profession+s Code of 0thics& it is possible that the supervisor is unaware of the principle" pea#ing with the supervisor instead of breaching the Code may facilitate a collegial dialogue leading to appropriate changes in policy in the clinic" B188 C) III Fse daily hot soa#s and moisturi(e the s#in" %aily hot soa#s are contraindicated because of the increased ris# of thermal in$ury" *he patient with diabetes typically has loss of protective sensations and should be taught techni/ues of foot care" All other interventions are correct advice" B18: C1 I Pain provo#ed with passive glenohumeral external rotation" *he subscapularis is an internal rotator of the humerus" It will be painful if passively stretched into external rotation and irritated when contracting or being resisted when the shoulder internally rotates" *he muscle inserts onto the lesser tuberosity of the humerus and play no role in shoulder adduction" B1:; C1 II Closedchain lower extremity strengthening and proprioceptive exercises" *he most effective treatment for this athlete would involve closedchain exercises and proprioceptive training& appropriate interventions for early subacute phase management" *he other choices are not appropriate or timely for early subacute phase management" B1:1 C8 II =igh detection sensitivity is needed to detect low amplitude signals generated by a low number of motor units such as in a wea# extensor carpi radialis longus" 2ide electrode placement would pic# up signals from more than one muscle and might invalidate the procedure" B1:' C8 I 2eight loss and social withdrawal" %epression is associated with symptoms of withdrawal& fatigue and weight loss" *he Deriatric %epression cale is a valid measure of depression in the elderly" =igh& not low scores @above 8 out of a possible -; are indicative of depression" leep apnea is a potentially lethal disorder in which breathing stops to 1; seconds or more& many times a night" It is associated with obesity and anatomical obstruction" B1:- C. III 9edicaid" 9edicaid @a federalstate partnership covers health care for the indigent" 9edicare is a federal program providing care for the elderly @7 and over or for certain chronic illnesses" ocial security does not provide funds for healthcare" B1:) C- I Any swelling in the calf or an#le" %eep vein thrombophlebitis is characteri(ed by signs of inflammation @tenderness& aching& swelling typically in the calf" *achycardia may be present& not bradycardia" light fever can be present& as part of the inflammatory reaction& not lowered temperature" =oman+s sign is pain in the calf perceived with s/uee(ing the calf and dorsiflexion and is no longer considered reliable and lac#s specificity and sensitivity" >apid screening is possible with %oppler ultrasonography while venous duplex scanning is the primary diagnostic test for %,*" B1:7 C1 I %isc displacement" *he $aw becomes loc#ed in an open position when the disc is displaced" *he muscles influence lateral deviation of the $aw with opening" *he retrodiscal lamina cannot get entrapped nor can the temporomandibular ligament become impinged"
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