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A patient with complete C4 quadriplegia is working on a program to increase tolerance to the upright position. While on the tilt table, the patient begins to have a pounding headache with flushing and profuse sweating. The physical therapist should FIRST: A. lower the tilt table to a flat position. B. remove the patient from the tilt table and return to room. C. check the patient's catheter. D. check the patient's blood pressure. ---------CORRECT ANSWER-----------------C These are signs of autonomic dysreflexia. Among the most common cause is a distended or irritated bladder. The FIRST step is to remove the noxious stimulus. A 6 year-old child with spastic diplegia is walking in the parallel bars. The child walks with increased trunk and hip flexion. What is the MOST appropriate assistive device for this patient? A. Standard walker B. Forearm crutches
C. Posterior rolling walker D. Bilateral quad canes ---------CORRECT ANSWER-----------------C The use of a posterior walker has been found to encourage a more upright posture during gait and to promote better gait characteristics than does the use of an anterior walker. A standard walker, forearm crutches and bilateral quad canes all emphasize trunk and hip flexion, which is already increased for this child. The physical therapist is teaching a patient with T12 paraplegia to fall. The patient walks with bilateral knee-ankle-foot orthoses and bilateral forearm cuff crutches using a swing-to gait. The MOST appropriate method to use to prevent injury is to: A. have the patient wear a helmet and practice on a soft padded surface. B. give the patient written instructions and illustrations on falling. C. demonstrate and guide the patient through the correct process of falling. D. demonstrate the correct method of falling. ---------CORRECT ANSWER-------------- ---C If patients are skilled in falling, they are less likely to become injured during a fall. The patient demonstrating or performing the task best verifies understanding of a skill. To accomplish this, the patient should be given a demonstration of proper falling technique and then the patient should be allowed to practice while being guided and guarded by the therapist. Without first demonstrating and then allowing the patient to practice, the patient could be placed at risk for injury. Therefore, Options A, B, and D are not adequate to ensure patient safety.
D. desk-style removable arm rests and fixed, elevating leg rests. ---------CORRECT ANSWER-----------------B In order to facilitate transfers utilizing a sliding board, the patient will need both removable armrests and detachable swing-away leg rests. Fixed arm rests make sliding board transfers extremely difficult and unsafe. Any of the other options would not be optimal for this particular patient's needs. A patient who is on bed rest and who exhibits orthostatic hypotension upon standing will MOST likely experience: A. increased venous tone in the lower extremities. B. inadequate ventricular filling during diastole. C. decreased hydrostatic pressure in the capillary beds. D. parasympathetic stimulation of the heart. ---------CORRECT ANSWER--------------- --B Orthostatic hypotension from bed rest occurs as a result of decreased venous tone, which will lead to a pooling of blood in the lower extremities upon standing. The pooling of blood in the lower extremities will reduce the amount of blood returning to the heart decreasing ventricular filling and ultimately decreasing cardiac output. This results in a drop in blood pressure with resultant dizziness. With pooling of blood in the lower extremities, the hydrostatic pressure would increase. To compensate for the decrease in cardiac output, the sympathetic system (not the parasympathetic) would stimulate the heart.
Which of the following is the MOST appropriate intervention for a patient with juvenile rheumatoid arthritis who is experiencing painful swelling of both knees? A. Resistive exercises B. Stretching to prevent contractures C. Gentle, active exercises D. Walking program ---------CORRECT ANSWER-----------------C All of the options, except for gentle, active exercises, are precautions or contraindications for this patient. A patient who has left hemiparesis exhibits shoulder subluxation on the affected side. The patient has a demand-type cardiac pacemaker. Which of the following interventions should be used ONLY with extreme caution? A. Manual resisted exercise on the nonaffected side B. Active exercise on the affected upper extremity C. Functional electrical stimulation to the affected side D. Biofeedback to the affected side ---------CORRECT ANSWER-----------------C Electrical stimulation for patients with demand-type pacemakers is often listed as a contraindication. However, even though it is often listed as a contraindication in textbooks, research studies apparently have not substantiated the suspected risks. Nonetheless, it should only be applied with caution and close supervision in these patients. Exercise, unless very strenuous,
A. 0.16 mA-mg B. 16 mA/cm C. 0.60 mg/min D. 60 mA-min ---------CORRECT ANSWER-----------------D The current dosage for iontophoresis is calculated by multiplying the current ( mA) by the duration (15 minutes). In this case the calculation would yield a value of 60 mA-min. None of the other options use the correct values. An elderly patient has a diabetic neuropathy. Upon examination, the patient shows marked mediolateral instability of the left ankle while walking. The patient also has fluctuating edema and glove-and-stocking sensory loss in both of the lower extremities. The MOST appropriate orthotic aid is: A. a double-upright metal ankle-foot orthosis. B. high-top shoes. C. a prefabricated plastic solid ankle-foot orthosis D. a spiral ankle-foot orthosis. ---------CORRECT ANSWER-----------------A The double upright metal ankle foot orthosis (AFO) would provide the best support for the mediolateral instability and would allow for changes in leg volume. The plastic, solid AFO would not provide as much mediolateral support and because of its conformation to the leg it would not be advisable for patients who are experiencing changes in leg volume due to the edema. High top shoes would not provide enough support. The spiral AFO would not provide needed stability to the ankle and the design would not be indicated when a patient has fluctuating edema in the leg.
A 25 year-old patient with cystic fibrosis has been experiencing successful mobilization of thickened secretions by standard percussion and postural drainage. During the current treatment session, the patient coughs up sputum that has a small, brownish streak of blood. The physical therapist should: A. percuss more vigorously in an attempt to clear out any other blood that is present in the airways B. perform postural drainage in upright positions for this type of patient only. C. continue treatment with little modification, unless more blood is noted. D. stop the treatment and send the patient to the emergency room. --------- CORRECT ANSWER-----------------C Hemoptysis or the coughing up of blood can be benign or severe and can be a common occurrence in the cystic fibrosis population secondary to the pathophysiological processes in their pulmonary system. In general, a small amount of hemoptysis that occurs occasionally or is non-persistent hemoptysis is benign. The "brownish" color indicates either venous blood or old blood. In this situation, if the hemoptysis does not persist, then it is appropriate to continue treatment without modification. If the blood was larger in amount and fresher (denoted by a bright red color), then the treatment should be discontinued. The presence of blood in the sputum should not warrant more vigorous chest percussion, until it is deemed appropriate to continue with the session. Since this situation is a benign scenario, alteration of the drainage position is not necessary, and there is no need to send the patient to the emergency room
The weakness is in the flexors of the fourth and fifth digits at the distal interphalangeal joint (2/5). The other fingers show normal strength (5/5). This weakness would indicate a problem with the flexor digitorum profundus, since the distal joints are involved. The flexor digitorum profundus is innervated by both the median and ulnar nerves. The flexor digitorum profundus muscles flexing the index and middle fingers are innervated by the median nerve. The flexor digitorum profundus muscles flexing the ring and little fingers are innervated by the ulnar nerve. Therefore, since the ring and little fingers are involved, the lesion would have to be involving the ulnar nerve. The flexor digitorum profundus to the fourth and fifth fingers is innervated by the ulnar nerve roots C8 and T1. An elderly man who lives alone fell in his home, sustaining a hip fracture, which necessitated a total hip arthroplasty. The patient was previously able to perform all activities of daily living independently. He has been admitted to a skilled nursing facility for rehabilitation. The patient's goal is to return home. His family believes he should be admitted to a long-term care facility for his own safety once acute rehabilitation is completed. The physical therapist's MOST appropriate action is to: A. advise the family that the patient should determine his own discharge environment. B. recommend a team conference with the patient and his family to discuss discharge plans. C. schedule a home visit to determine if home modifications are needed before discharge. D. implement a treatment plan with a long-term goal of discharge to home. --------
- CORRECT ANSWER-----------------B
The best answer would be for the therapist to recommend a team conference. That conference would bring together members of the health care team as well as the patient and family members, to arrive at joint decision as to the placement of this patient. The best time for such a meeting would be prior to discharge, because after discharge it is difficult to arrange such meetings. Allowing the patient to determine his own discharge environment may be fine if there are no safety concerns, however a decision whether or not the patient is competent to make that decision must be made first. Scheduling a home visit or the implementation of a treatment plan for home care would be premature until a decision on placement has been made. During lower extremity exercise, a patient with incomplete C6 quadriparesis reports a new onset of tingling and numbness in both hands. A manual muscle test reveals that overall strength has decreased by 1 grade. In this situation, the MOST appropriate action for the physical therapist to take is to: A. modify the exercise program to accommodate the change in strength. B. apply an ice massage prior to exercise C. continue the lower extremity therapeutic exercise and use facilitation techniques to stimulate more activity. D. discontinue all exercise and notify the physician immediately. ---------CORRECT ANSWER-----------------D Sudden tingling or the hands and weakness of muscle groups are alarming signs of cord compression. The concern is that the spinal cord is sustaining further injury. The exercise may be exacerbating or causing these signs. This is considered a medical emergency and the physician should be immediately advised.
A larger print will not simplify the meaning, nor will lengthening the sentences. Only Option B, the choice of illustrations and a simpler sentence structure, is correct. During inspiration, a patient demonstrates increased upper chest expansion with retraction of the epigastric area. The physical therapist should suspect weakness of the: A. scalene muscles. B. diaphragm. C. rectus abdominis. D. intercostal muscles. ---------CORRECT ANSWER-----------------B Normally, as the diaphragm descends with inspiration, it places increased pressure on the abdominal contents with a resultant distension of the epigastric area. Weakness of the diaphragm would decrease the distension and may result in a compensatory increase in upper chest expansion to improve ventilation. The scalene muscles act to elevate or stabilize the clavicle during inspiration. The rectus abdominus is a stabilizer during inspiration and assists with forced expiration. The intercostal muscles act to stabilize the thoracic cage during ventilation. A patient with low back pain has been undergoing treatment for 2 sessions. The patient tells the physical therapist that today the pain is centralizing with the extension exercises, but is as intense as it was at the first treatment session. The
patient is frustrated by this reaction. The MOST appropriate response of the therapist is to : A. continue with the present program. B. eliminate the extension exercises C. consult the patient's physician about the situation D. progress to trunk flexion exercises ---------CORRECT ANSWER-----------------A With an extension exercise program, centralization indicates that the patient is improving, even though the pain may be just as intense as it was. Even though the patient may feel frustrated, he is actually improving; and therefore the therapist should continue with the extension exercise program. There is no need to call the physician at this point, since the centralization is perfectly normal. Although trunk flexion may be used later in the intervention, it would not be indicated at this point because extension is working. During pregnancy, which of the following exercises is CONTRAINDICATED? A. Curl-ups B. Bridging C. Double leg lifts D. Deep breathing with forced expiration ---------CORRECT ANSWER-----------------C. During pregnancy and postpartum, the stretched abdominal muscles are unable to stabilize the lower back as the legs are raised. Attempting to perform double leg lifts can overwork the abdominal muscles and cause damage to spinal joints.
D. facilitation of normal movement and improvement of strength. --------- CORRECT ANSWER-----------------A. Goals of PT intervention for a child with Duchenne muscular dystrophy are to retard the development of contracture and muscle weakness, which could lead to functional limitations, and thus, disability. The physical therapist would also play a role in determining the appropriate use of assistive devices that could help maintain the child's mobility such as wheelchairs, walkers and orthoses. Muscle tone changes and declines in strength cannot be prevented since they are results of the disease process. Outcomes of a prenatal exercise program would NOT include A. improved body mechanics. B. application of relaxation techniques. C. improved ligamentous flexibility. D. strengthened pelvic-floor musculature ---------CORRECT ANSWER-----------------C During pregnancy, the ligaments soften due to hormonal influences, and allow some degree of separation between the joint surfaces. Additional stretching of the ligaments could result in joint instability or injury, and would not be a goal of treatment. The remaining options are all appropriate interventions. A patient has limited ankle dorsiflexion following open reduction and internal fixation of the distal tibia. Radiographs reveal that the fracture is well healed. Treatment with passive mobilization should include:
A. posterior glide of the talus on the tibia. B. lateral glide of the calcaneus on the tibia. C. posterior glide of the tibia on the talus. D. anterior glide of the talus on the tibia. ---------CORRECT ANSWER-----------------A The trochlea of the talus is convex. Therefore, during dorsiflexion of the ankle, the talus moves posteriorly relative to the tibia. To facilitate the movement of dorsiflexion one would need to perform a posterior glide of the talus on the tibia. A patient who has recently and successfully completed a 12-week program of Phase III cardiac rehabilitation will MOST likely demonstrate a decrease in: A. carbon dioxide elimination in maximal work B. cardiac output in maximal work. C. stroke volume at a given level of submaximal work. D. heart rate at a given level of submaximal work. ---------CORRECT ANSWER-------- ---------D Aerobic conditioning that occurs during the 12 weeks of cardiac rehabilitation will result in a decrease in heart rate both at rest and with exercise. CO elimination and cardiac output would both increase with maximal work. The stroke volume would increase during submaximal work.
the nerve root. Centralization of the pain is also a good indicator for physical therapy intervention.
- A physical therapist evaluates a patient who has lateral epicondylitis. The patient reports a subjective pain rating of 8/10. The patient also reports pain and shows weakness with resisted wrist extension. The therapist decides to use ice massage as an intervention. The MOST appropriate length of time for the ice massage is: A. 10 minutes. B. until the area turns red, and the patient reports a burning sensation C. until the patient reports that the area feels numb D. no longer than 5 minutes. ---------CORRECT ANSWER-----------------C Ice massage is usually applied to control pain, edema, or inflammation. In this case, the ice would be used for pain relief and to reduce inflammation, if present. The dosage for ice massage is determined by the patient's response, and is usually applied until the patient experiences analgesia or reported numbness over the area of the massage. Although 5 to 10 minutes may be a usual time for the response to occur, the dosage depends on the patient's response, not on an exact time. The patient will usually feel the following, sequential sensations during the massage: cold, burning, aching and then finally numbness. The desired effect is numbness, not aching. The skin may turn white; however, the desired effect is numbness or pain reduction and not skin color.
- To conduct an experimental study on pain in postsurgical orthopedic patients, a physical therapist randomly assigns patients into 2 groups. One group is treated
with transcutaneous electrical nerve stimulation, heat, and exercise; the second receives heat and exercise only. In this experimental design, transcutaneous electrical nerve stimulation is the: A. continuous variable. B. dependent variable C. discrete variable D. independent variable. ---------CORRECT ANSWER-----------------D The independent variable can be thought of as the cause or treatment and the dependent variable can be thought of as the effect or response. In this case the TENS is the treatment or independent variable. Continuous and discrete variables are methods of quantifying variables
- It is important to perform cool-down exercises immediately following a general aerobic exercise program PRIMARILY in order to prevent: A. venous pooling. B. cardiac arrhythmia. C. decreased body temperature D. muscle tightening. ---------CORRECT ANSWER-----------------A During aerobic exercise, there is vascular dilation that occurs in order to optimize blood flow and the venous system relies on muscular pumping in order to return blood back to the heart. Without a cool-down period, there would be no muscular pumping and therefore blood would pool in the venous system. Cardiac
