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1) A patient is performing a Phase I (inpatient) cardiac rehabilitation exercise session. The
physical therapist should terminate low-level activity if which of the following changes
occurs?
1.
2.
3.
4.
The diastolic blood pressure increases to 120 mm Hg.
The respiratory rate increases to 20 breaths per minute.
The systolic blood pressure increases by 20 mm Hg.
The heart rate increases by 20 bpm.
During Phase I (inpatient) cardiac rehabilitation, vital sign parameters with activity that
warrant termination are: diastolic blood pressure of 110 mm Hg or greater, systolic blood
pressure above 210 mm Hg or an increase greater than 20 mm Hg from resting, and a
heart rate that increases beyond 20 bpm above resting. The normal resting respiratory rate
can range from 12 to 20 breaths per minute in adults, so an increase to 20 breaths per
minute with low-level activity would not be a reason to terminate the activity.
2) A patient is being evaluated for possible carpal tunnel syndrome, and a nerve
conduction velocity test is performed. Which of the following findings would MOST
strongly support the diagnosis?
1.
2.
3.
4.
Decreased latency at the elbow.
Decreased latency at the carpal tunnel.
Increased latency at the carpal tunnel.
Increased latency at the forearm.
Nerve conduction above and below the local nerve compression is usually normal. Latency
is typically increased, not decreased, across the carpal tunnel compression site. Nerve
conduction above and below the local nerve compression is usually normal.
3) When examining a patient with a history of alcohol abuse, a physical therapist notes
that the patient demonstrates fine resting tremors and hyperactive reflexes. The patient
reports frequent right upper quadrant pain. Which of the following additional signs is
MOST likely?
1.
2.
3.
4.
Jaundice
Hyperhidrosis
Hypotension
Nocturnal cough
With a history of alcohol abuse and the presence of fine resting tremors and right upper
quadrant pain, the patient is presenting a history and signs and symptoms consistent with
liver disease. Jaundice is a skin change associated with disease of the hepatic system.
Hyperhidrosis can be present with endocrine disorders but is not associated with liver
disease. Hypotension is not listed as a sign of liver disorders. A nocturnal cough can be
associated with rheumatic fever, but is not characteristic of liver disease.
4) Which of the following sensory testing locations corresponds to the C7 nerve root?
1.
2.
3.
4.
Volar aspect of the little finger (5th digit)
Dorsal aspect of the middle finger (3rd digit)
Lateral aspect of the upper arm
Medial aspect of the upper arm
The C7 nerve root supplies sensation in the dorsal middle finger.
5) Which of the following examination findings would be expected in a patient who also
had sustained ankle clonus?
1.
2.
3.
4.
An upgoing great toe when the sole of the foot is stroked
Weakness of ankle plantar flexors with one-repetition strength testing
Absence of sensation to sharp/dull testing over the posterior lower leg
Hyporeflexia when deep tendon reflexes are elicited in the lower leg
Sustained ankle clonus indicates a central nervous system dysfunction, as does the
presence of a Babinski sign (that is, an upgoing great toe with stroking of the plantar foot).
The other options are associated with lower motor neuron problems.
6) A 3-month-old infant has poor midline head control. During evaluation, the physical
therapist notes facial asymmetry and observes that the infant has limitation of cervical
rotation to the left and cervical lateral flexion to the right. A radiology report indicates
premature fusion of the infant’s cranial sutures. The infant MOST likely has:
1.
2.
3.
4.
right congenital muscular torticollis.
left congenital muscular torticollis.
right cervical facet hypomobility.
left cervical facet hypomobility.
The infant exhibits signs of torticollis affecting the right sternocleidomastoid muscle.
Torticollis is named for the side of the limited lateral flexion. Asymmetry and premature
closure of sutures (plagiocephaly) are not typically seen with cervical facet hypomobility in
infants.
7) A patient had a split-thickness skin graft for a partial-thickness burn injury to the upper
extremity. The surgeon has requested range-of-motion exercises for the patient.
Currently, the patient is able to actively move the upper extremity through one-third of
the range of motion for shoulder flexion. Based on this finding, what is the MOST
appropriate action for the physical therapist to take at this time?
1. Defer any range-of-motion exercises until the patient is able to participate more
actively.
2. Begin active assistive range-of-motion exercises.
3. Begin bed mobility training to facilitate increased use of the upper extremity
4. Continue with active range-of-motion exercises.
Deferring any range-of-motion exercises is not a practical choice, as contracture will
develop postoperatively. Because this patient cannot achieve full range of motion by
himself, active assistive range of motion is indicated to prevent contracture postoperatively.
Although bed mobility training is a creative way to possibly increase upper extremity range
of motion, given the acuity of the patient’s surgical wound, the patient would need more
range of motion for this intervention to be more beneficial. Continuing with only active range
of motion would not facilitate adequate increases in range of motion and would not prevent
contractures.
8) Which of the following modalities BEST addresses the cause of calcific tendinitis in the
bicipital tendon?
1.
2.
3.
4.
Sensory level interferential current at 80 Hz to 100 Hz
Iontophoresis with acetic acid at 60 mA/minute
High-volt pulsed electrical stimulation at 200 pps
Diathermy with a parallel treatment set-up
Sensory level interferential current at 80 to 100 Hz does not address the problem itself but
may address any related pain. Iontophoresis with acetic acid can address the cause of
calcific tendinitis, not just the symptoms. High-volt pulsed electrical stimulation at 200 pps
does not address the problem itself but may address any related pain. Diathermy with a
parallel treatment set-up is not the best choice, as deep heat will not address the
pathology.
9) To minimize skin irritation during functional electrical nerve stimulation, a physical
therapist should use:
1.
2.
3.
4.
lower intensity, larger interelectrode distance, and larger electrodes.
lower intensity, larger interelectrode distance, and smaller electrodes.
higher intensity, smaller interelectrode distance, and smaller electrodes.
lower intensity, smaller interelectrode distance, and larger electrodes.
Several things can be done to decrease the current density and the possibility of skin
irritation. These include decreasing the intensity of the stimulation, increasing the interelectrode distance, and using larger electrodes.
10) Manual muscle testing of a patient’s pelvic floor muscles reveals a grade of Poor (2/5).
Which of the following positions is BEST to begin strengthening?
1.
2.
3.
4.
Supine
Standing
Seated
Walking
A grade of Poor (2/5) is defined as full excursion in a gravity-eliminated position. All of the
other options are against gravity positions, which would be inappropriate, given this grade
of weakness.
11) During an examination of elbow strength using manual muscle testing, a patient
supinates the forearm when attempting elbow flexion. Which of the following muscles is
MOST likely doing the major part of the work?
1.
2.
3.
4.
Biceps brachii
Brachialis
Supinator
Brachioradialis
The biceps brachii is both an elbow flexor and supinator, and it is most effective as a
supinator with the elbow flexed to about 90° (approximately the muscle testing position).
The brachialis does not cause supination (only flexion). The supinator does not flex the
elbow. The brachioradialis would move the forearm to a midposition rather than fully
supinating it. Therefore, when the elbow both flexes and supinates, the biceps brachii
would be the most likely muscle causing this action.
12) During evaluation of a patient’s balance, a physical therapist gently pushes the patient
backward slightly and observes how the patient recovers from the perturbation. What
strategy is the patient MOST likely to use to correct for the perturbation?
1.
2.
3.
4.
Knee
Hip
Ankle
Stepping
Regarding options 1 and 2, for larger perturbations, individuals utilize hip and knee muscles
to recover the balance. Regarding option 3, for slight perturbations, most individuals use an
ankle strategy. Ankle musculature is used to control the perturbation and recover the
balance. Regarding option 4, if the perturbation is strong enough to cause the individual’s
center of mass to move outside the base of support, a stepping strategy would be
employed by taking a step and increasing the size of the base of support.
13) Which of the following findings BEST describes normal capillary filling?
1.
2.
3.
4.
Rebound vasodilation after icing
Blood pressure of 120/76 mm Hg
Pulse oximetry measurement of 98%
Blanching of the nail bed with color return in <3 seconds
By definition, the blanching of nail bed with color return in < 3 seconds is normal capillary
refill.
14) Which of the following instructions is MOST appropriate for teaching a patient with C 6
quadriplegia to transfer from a wheelchair to a mat?
1.
2.
3.
4.
Keep fingers extended to give a broader base of support.
Rotate head and shoulders in the same direction as the desired hip motion.
Rotate head and shoulders in the direction opposite to the desired hip motion.
Keep both hands next to the knees to lock the elbows.
The position described creates the necessary force to move the lower body in this transfer,
given the level of the spinal cord injury. Finger extension against resistance would be
difficult for a patient with C6 quadriplegia. The patient’s hands would be kept near the thigh
or hips with one hand on the mat and one on the wheelchair.
15) A patient has a spinal cord injury that resulted in damage to the sacral segments and
disruption of the sacral reflex arc. The patient is MOST likely to have which of the
following characteristics?
1.
2.
3.
4.
Voluntary control of defecation
Tonic contraction of the external anal sphincter
Flaccidity of pelvic floor musculature
Permanent absence of the gastrocolic reflex
The external anal sphincter and pelvic floor muscles are composed of striated muscle
fibers. They receive somatic innervation from sacral cord segments 2 through 4. With
damage to these segments, the sphincter and the pelvic floor muscles remain flaccid. The
individual loses voluntary control of defecation. The gastrocolic reflex, mediated by the
intrinsic nervous system of the GI tract, returns after resolution of spinal shock.
16) A patient who reports double vision has ptosis, lateral strabismus, and a dilated pupil in
the left eye. Which of the following cranial nerve test results is MOST likely to be
abnormal?
1.
2.
3.
4.
Pupillary light reflex
Facial muscle strength
Jaw-jerk reflex
Pain sensation on the face
The cranial nerve involved is the oculomotor nerve. This nerve innervates the medial
rectus, which, if weak, would cause a lateral strabismus. The oculomotor nerve is also
responsible for mediating pupillary constriction and a lesion would cause pupillary dilation.
The ptosis is caused by loss of innervation to the levator palpabrae superioris muscle,
which elevates the eyelid. The double vision would be caused by the inability to move the
eyeball normally, because four of the six ocular muscles are controlled by the oculomotor
nerve. The oculomotor nerve is also important in mediating the pupillary light reflex. The
facial nerve innervates the muscles of facial expression. The trigeminal nerve mediates the
jaw-jerk reflex and pain sensation from the face.
17) In addition to standard precautions, what other precaution should a physical therapist
observe when working with a patient infected with methicillin-resistant Staphylococcus
aureus?
1.
2.
3.
4.
Airborne
Sterile
Droplet
Contact
Since methicillin-resistant Staphylococcus aureus is spread by contact, wearing a face
shield or mask is not necessary. Sterile precautions or techniques are not necessary for the
physical therapist to use with a patient infected with methicillin-resistant Staphylococcus
aureus.
18) The physical therapist is positioning a patient for postural drainage. To BEST drain the
posterior segment of both lower lobes, the patient should be placed in which of the
following positions?
1.
2.
3.
4.
Prone, head down at a 45° angle
Supine, flat surface
Sidelying, head elevated at a 30° angle
Sitting, leaning forward
The best position for draining the posterior segment of both lower lobes would be prone
lying with the head down and the lower extremities and hips elevated to about 45°.
19) Clubbing of the fingers is MOST associated with which of the following pathologies?
1.
2.
3.
4.
Lymphedema
Pulmonary disease
Chronic venous insufficiency
Complex regional pain syndrome
Conditions that chronically interfere with tissue perfusion and nutrition may cause clubbing.
Pulmonary disease is the most predominant cause of digital clubbing, present 75% to 85%
of the time clubbing is noted. Since the other conditions also affect tissue perfusion, they
could contribute to the condition, but are not listed as common findings.
20) A patient who is 8 months pregnant has an abdominal diastasis recti with a separation
of 1.5 in (4 cm). Which of the following exercises would be the MOST appropriate initial
exercise for abdominal strengthening in a supine position?
1. Trunk curls
2. Hooklying head lifts
3. Pelvic-tilt leg sliding
4. Bilateral leg lowering
Trunk curls are contraindicated for a patient with diastasis recti. Supine hooklying head lifts
emphasize the rectus abdominis muscle and are least likely to increase the separation of
the diastasis recti. Pelvic-tilt leg sliding is more advanced than head lifts. Bilateral leglowering is an advanced abdominal strengthening exercise that causes excessive low back
strain and should not be performed during pregnancy.
21) A patient with Parkinson disease has just been admitted to a rehabilitation unit. The
patient is dependent in all transfers and requires moderate assistance of one person to
walk 30 ft (9.1 m) with a standard walker. To facilitate good carryover for activities,
instruction of the family in transfers should occur:
1.
2.
3.
4.
during a home visit after the patient is discharged.
just prior to discharging the patient.
early in the rehabilitation program.
when the family feels ready to take the patient home.
The family should be involved in all stages of planning and treatment. Family involvement
can shorten the rehabilitation process and facilitate the patient’s return to the community. It
is important to have the family involved early in the rehabilitation process rather than wait
until the patient is ready to be discharged.
22) A patient with a right transfemoral prosthesis will be able to maintain the knee in
extension while weight bearing if the center of gravity of the body is shifted so that the
gravitational line falls:
1.
2.
3.
4.
posterior to the axis of the right knee joint.
lateral to the axis of the right knee joint.
anterior to the axis of the right knee joint.
medial to the axis of the right knee joint.
Static alignment for knee stability is established by positioning of the knee so that the
lateral reference line falls anterior to the knee joint.
23) During manual muscle testing of the hip flexors in the sitting position, a patient exhibits
lateral (external) rotation with abduction of the thigh as resistance is applied. The
physical therapist should suspect muscle substitution by the:
1.
2.
3.
4.
sartorius.
tensor fasciae latae.
adductor longus.
semimembranosus.
The sartorius flexes, laterally (externally) rotates, and abducts the hip joint. With resisted
hip flexion, the sartorius will be recruited to perform all three actions, giving the observed
substitution pattern. The tensor fasciae latae is a medial (internal) rotator and flexor of the
hip, so substitution by it would involve medial (internal) rotation and abduction. The
adductor longus would adduct the hip. Substitution by the semimembranosus would cause
hip extension.
24) A physical therapist reads that the interrater reliability of a new hand-held dynamometer
is .93. What is the MOST appropriate interpretation of this value?
1. Similar scores were obtained for a group of subjects when different therapists
measured the subjects
2. Similar scores were obtained for a group of subjects when the same therapist
repeated the measures
3. Dissimilar scores were obtained for a group of subjects when different therapists
measured the subjects.
4. Dissimilar scores were obtained for a group of subjects when the same therapist
repeated the measures.
Interrater reliability concerns variation between two or more raters who measure the same
group of subjects. The reliability coefficient has values from 0.00 to 1.00. A reliability of 1.00
means there was total agreement. Thus a value of .93 means there was a high degree of
agreement on the scores from the dynamometer among several therapists. Agreement of
measures by the same therapist would be intrarater reliability.
25) A physical therapist researcher is developing a study to compare differences in range of
motion outcomes in two groups of patients who have had a total knee arthroplasty. Over
an 8-week period, one group of patients receives outpatient physical therapy 1
time/week and the other group receives outpatient physical therapy 3 times/week. In
this study, what is the dependent variable?
1.
2.
3.
4.
Range of motion
Frequency of visits
Total knee arthroplasty
8 weeks
The dependent variable (ROM) is the factor that is caused by the independent variable
(frequency of visits).
26) Which of the following teaching strategies is MOST appropriate for an older adult patient
with mild dementia?
1.
2.
3.
4.
Use auditory or visual input separately.
Use metaphors to reinforce new concepts.
Establish a consistent pace for teaching.
Present one piece of new information at a time.
To minimize confusion, the patient should be presented with one new item at a time. The
pace of learning should be set by the patient. Visual and auditory input together can
promote learning. Concrete examples are easier to understand than metaphors.
27) A patient with chronic venous insufficiency of the lower extremities is MOST likely to
exhibit:
1. normal superficial veins, no edema, ulceration, and patches of gangrene around the
toes.
2. dilation of superficial veins, edema, and stasis ulceration.
3. no edema, faint dorsalis pedis pulse, and cold, hairless extremities.
4. dilation of superficial veins and edema made worse during sitting or elevation of the
lower extremities.
With venous insufficiency, the limbs would be edematous and the superficial veins would
be dilated. If the venous insufficiency is not corrected, ulceration could develop. Options 1
and 3 are ruled out because they indicate no edema. Option 4 is not correct because the
condition is relieved by sitting or leg elevation.
28) A patient with muscular dystrophy was removed from mechanical ventilation 1 day ago.
The patient is currently unable to independently clear secretions, despite receiving
instruction in the bronchopulmonary hygiene techniques of positioning, percussion,
shaking, and vibration. Which of the following interventions is MOST appropriate to help
this patient clear the secretions?
1.
2.
3.
4.
Nasotracheal suctioning
Manual costophrenic assist
Supplemental oxygen
Inspiratory muscle training
While nasotracheal suctioning is a viable option to clear a patient’s secretions, it is usually
the last resort when a patient does not have an artificial airway. So if a manual
costophrenic assist doesn’t work, then suctioning may be needed. Any patient who has
been receiving mechanical ventilation will likely have some respiratory muscle
deconditioning. However, with superimposed neuromuscular disease, the respiratory
muscle weakness will be further exacerbated. Therefore, providing manual assist at the
lower ribs during cough will assist the patient in successfully clearing secretions.
Supplemental oxygen can help a patient’s ventilatory muscle endurance but does not
ensure that the patient will be able to generate enough force during the cough. Inspiratory
muscle training would be beneficial for this patient, but not at this acute stage just after
removal of ventilation. Once secretions are under control, then muscle training can begin.
29) An older adult patient had a total hip arthroplasty following a hip fracture from a fall in
his home. The patient lived alone and 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 after acute rehabilitation is
completed. The physical therapist’s MOST appropriate action is to:
1. advise the family that the patient should determine his own discharge environment.
2. recommend a team conference with the patient and his family to discuss discharge
plans.
3. schedule a home visit to determine if home modifications are needed before
discharge.
4. implement a treatment plan with a long-term goal of discharge to home.
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 for placement of the patient. The best time
for such a meeting would be prior to discharge, because such meetings are difficult to
arrange after discharge. 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.
30) Which of the following reasons is the PRIMARY purpose for applying statistical
analyses to single-subject research?
1.
2.
3.
4.
To substantiate visual analysis of graphically displayed data
To determine whether observed changes are real or chance occurrences
To advocate changes in intervention methods
To establish credibility for the intervention technique
Data analysis in single-subject research is based on evaluation of measurements within
and across design phases, to determine if behaviors are changing and if observed changes
during intervention are associated with the onset of treatment. While visual analysis of
graphic display of data is the most commonly used data analyses method in single-subject
design, statistical analysis provides a more quantitative approach to determine whether
observed changes are real or chance occurrences.
31) Upon removal of a wet-to-dry dressing from a patient’s draining wound, a physical
therapist observes that the skin immediately surrounding the wound is macerated. What
should the therapist recommend for future wound care?
1.
2.
3.
4.
Continue using the current dressing type.
Make the dressing more absorbent.
Leave the dressing on longer between dressing changes.
Change to a pressure-type dressing.
Macerated tissue results from excessive moisture. A more absorbent dressing would soak
up the excessive moisture and prevent the maceration.
32) A 50-year-old patient had an uncomplicated open repair of a rotator cuff tear 2 weeks
ago. The patient asks the physical therapist when the shoulder will be normal again.
Which of the following expected outcome time frames MOST accurately addresses this
patient’s question?
1.
2.
3.
4.
3 weeks to lift a 5-lb (2.3-kg) object
3 weeks to sleep on the involved side
3 months to lift the upper extremity overhead to reach into a cabinet
3 months to play golf
Three weeks is too early to lift 5-lb (2.3-kg) objects. Three weeks is too early to sleep on
the involved side. Usually by 8 to 12 weeks, a patient who has had an uncomplicated open
repair of a rotator cuff 2 weeks ago is able to actively elevate the arm to functional heights.
Three months is too early to play golf.
33) A physical therapist is preparing to evaluate a patient who had a closed reduction with
cast fixation for an ankle fracture 1 day ago and currently has non-weight-bearing
status. The patient reports foot pain in the injured extremity. Based on the patient’s
report, which of the following procedures should the physical therapist perform?
1.
2.
3.
4.
Gait examination
Transfer abilities
Capillary refill in toes
Blood pressure examination
Since the patient is non-weight-bearing, transfer abilities and gait examination are less
likely to yield information regarding the cause of foot pain. With regard to capillary refill in
toes, complications of cast fixation may include swelling and, if severe, compartment
syndrome. Improperly fitted casts and/or patients leaving limbs in a dependent position can
result in painful swelling that creates occlusion to distal blood flow. Testing capillary refill is
an easy test to examine distal extremity perfusion. Blood pressure changes could cause
changes in perfusion to distal extremities, but it would be very difficult to measure lower
extremity blood pressure with the cast on.
34) Which of the following motions are MOST restricted with a hip capsular pattern?
1.
2.
3.
4.
Medial (internal) rotation and abduction
Lateral (external) rotation and abduction
Extension and adduction
Flexion and lateral (external) rotation
The capsular pattern of restriction at the hip is loss of medial (internal) rotation and
abduction, followed by a loss of flexion and extension; loss of lateral (external) rotation is
insignificant.
35) The parent of a 4-year-old child who has myelomeningocele is interested in obtaining
orthoses for the child’s gait training. The child has an L 1 neurological level lesion. Which
of the following orthoses is the MOST appropriate selection for the physical therapist to
discuss with the parent?
1.
2.
3.
4.
Hip-knee-ankle-foot with locked hips
Reciprocating-gait
Knee-ankle-foot with a pelvic band
Ankle-foot
Options 1, 3, and 4 would provide insufficient orthotic support for the child to walk. A child
with an L1 lesion can walk only with support of reciprocating gait orthoses or thoracic
lumbar sacral orthosis.
36) A patient who has rheumatoid arthritis comes to physical therapy with signs of muscle
atrophy, ecchymosis, puffy cheeks, and a diagnosis of osteoporosis. Which of the
following medications is the patient MOST likely receiving?
1.
2.
3.
4.
Penicillin (Ampicillin)
Prednisone (Deltasone)
Acetylsalicylic acid (aspirin)
Gold salts
Prednisone is a glucocorticoid that exhibits the side effects described in the stem. The
primary side effect of penicillin is an allergic reaction, such as skin rashes and difficulty
breathing. The primary side effect of aspirin is gastritis. The primary side effect of gold
therapy is diarrhea, irritation of oral mucosa, and skin rashes.
37) Regular aerobic exercise lasting at least 30 minutes should be MOST beneficial in
decreasing the pathology associated with which of the following conditions?
1.
2.
3.
4.
Type 1 diabetes
Type 2 diabetes
Multiple sclerosis
Amyotrophic lateral sclerosis
Exercise is a major contributor in controlling hyperglycemia in type 2 diabetes by improving
skeletal muscle glucose transport and whole-body glucose homeostasis. Regular exercise
can help the body respond to insulin and is known to be effective in managing blood
glucose. Exercise can lower blood glucose and possibly reduce the amount of medication
needed to treat diabetes, or even eliminate the need for medication. Exercise has not been
shown to improve glycemic control for the person with type 1 diabetes. Patients with
degenerative neuromuscular diseases such as multiple sclerosis should use caution when
exercising to avoid excessive fatigue, which can result in permanent losses in strength.
Respiratory system impairment in individuals with multiple sclerosis and amyotrophic lateral
sclerosis may lead to poor tolerance of intense aerobic exercise.
38) A patient has been receiving physical therapy for a large wound on the lower leg. After 3
weeks of treatment, the wound is free of necrotic tissue, but a copious amount of
exudate is present. Which of the following dressings is MOST appropriate for the wound
at this time?
1.
2.
3.
4.
Saline-saturated gauze
Semipermeable film
Gauze impregnated with zinc oxide
Hydrocolloid paste
Saline-saturated gauze is not advised to control copious amounts of drainage.
Semipermeable film cannot absorb copious amounts of exudate. Gauze impregnated with
zinc oxide has not been shown to be beneficial. Hydrocolloid paste is the only option given
that would be appropriate for managing wounds with high levels of exudate.
39) A patient with a right transtibial prosthesis describes right-knee buckling in the foot flat
(loading response) stance phase of gait. Which of the following conditions in the patient
is MOST likely present to cause this problem?
1.
2.
3.
4.
Excessive plantar flexion
Stiff heel cushion
5Low shoe heel
Excessive foot inset
Excessive prosthetic plantar flexion can cause insufficient knee flexion. A stiff heel cushion
can cause excessive knee flexion and therefore buckling. A low prosthetic shoe heel can
cause delayed knee flexion. Excessive prosthetic foot inset can cause excessive lateral
thrust.
40) Which of the following recommendations is MOST appropriate for a patient with
gastroesophageal reflux disease?
1.
2.
3.
4.
Sit upright for at least 10 minutes after a meal.
Lie on the right side before performing exercises.
Head-lifting exercises should be performed in the upright position.
Activities that require the supine position should be performed before a meal.
Exercises that require a supine position should be performed before eating so that the
stomach is relatively empty. The recommended time to remain upright after a meal is 3
hours. Head lifting in supine is the recommended exercise to strengthen the upper
esophageal sphincter muscle. If performed in upright, the head falls into gravity and the
exercise is no longer resistive. A patient should lie on the left side to reduce reflux, because
lying on the right side makes it easier for acid to flow into the esophagus, since the lower
esophagus bends to the left and this straightens out with right sidelying.
41) A physical therapist is completing an examination of an inpatient with multiple
comorbidities who had a total knee arthroplasty 2 days ago. The therapist observes a
bluish discoloration of the toes on the operative extremity. This finding should be
documented as:
1.
2.
3.
4.
cyanosis.
deep vein thrombosis.
Raynaud disease.
cardiac pathology.
Cyanosis is described in the stem. Although this finding often accompanies cardiac /
pulmonary pathology or may occur with hematological or central nervous system disorders,
the objective description is cyanosis.
42) A physical therapist is evaluating a 70-year-old female patient who reports the onset of
midthoracic pain after working in a garden for several hours. The presence of which of
the following history items should increase the therapist’s suspicion of a thoracic
compression fracture in the patient?
1.
2.
3.
4.
Bowel and bladder dysfunction
Smoking and prolonged steroid use
Hypertension and diabetes
Emphysema and hormone replacement therapy
Bowel and bladder dysfunction are related to spinal cord/upper motor neuron dysfunction.
Smoking and steroids can weaken bone and increase the likelihood for a compression
fracture. Hypertension and diabetes are not risk factors for a compression fracture. By
themselves, neither emphysema nor hormone replacement therapy increases the likelihood
of a compression fracture.
43) Which of the following modalities is MOST appropriate for decreasing pain and
increasing tissue extensibility prior to active hand exercises in a patient with rheumatoid
arthritis?
1.
2.
3.
4.
Cold gel pack
Direct contact ultrasound
Continuous short-wave diathermy
Paraffin wax bath
Paraffin wax baths are used in the nonflare phases to decrease pain and increase tissue
extensibility in patients with rheumatoid arthritis. The increase in collagen extensibility
associated with heating may decrease pain perception and increase tolerance for and
participation in active exercise. Option 1 is incorrect because cyrotherapy (cold gel pack)
decreases tissue extensibility. Options 2 and 3 are incorrect because these modalities are
not easily applied over areas with thin soft tissue (hands and fingers). Paraffin allows for
even distribution of heat to fingers (all joints).
44) Which of the following trunk strengthening exercises is BEST for a patient to help
minimize the complications associated with osteoporosis?
1.
2.
3.
4.
Flexion
Rotation
Extension
Lateral flexion
Trunk extension is the safest exercise for patients with osteoporosis and is necessary,
given the high risk for kyphosis with vertebral fractures. The other trunk motions are
contraindicated for patients with osteoporosis.
45) A physical therapist is working on progressive functional mobility with a patient who had
a transverse colectomy 2 days ago. The patient has developed a low grade fever. What
is the MOST appropriate examination for the therapist to perform prior to continuation of
the patient’s intervention?
1.
2.
3.
4.
Heart rate
Blood pressure
Respiratory rate
Auscultation
Changes in heart rate, blood pressure, or respiratory rate can accompany fever, but none
of those measurements will help in delineating the cause of the fever. Common causes of
immediate postoperative fevers are atelectasis or pneumonia. Auscultation of the lungs
would help the therapist in delineating this as a cause of the fever and determining the
appropriate physical therapy intervention.
46) A patient is entering a cardiac rehabilitation program. The physical therapist should
FIRST ask the patient to:
1.
2.
3.
4.
describe the correct aspects of exercise demonstrated by the therapist.
list problems associated with poor nutritional habits.
identify the harmful effects of smoking with regard to cardiac disease.
describe the type of angina that the patient experiences.
In order to best intervene with a patient who has had cardiac dysfunction, a full examination
and evaluation are necessary to properly form a treatment plan. An important aspect of the
examination is ascertaining the type of angina that the patient experiences so that the
therapist will know how to prevent angina with exercise or recognize it if it does occur
during the treatment session. The other options provided are all outcomes that would occur
after the patient has completed a cardiac rehabilitation program.
47) A physical therapist who works in a home health agency is treating a patient with
diabetes mellitus. The patient reports that he is no longer taking insulin. The therapist’s
FIRST course of action should be to:
1.
2.
3.
4.
instruct the patient in the proper technique for injection of insulin.
contact the patient’s home health nurse.
tell the patient’s family to report this information to the physician.
have the patient perform a urine glucose test while the therapist is in the home.
Contacting the patient’s home health nurse is the appropriate first course of action because
of the possible safety risk associated with the patient’s not taking insulin. Injections and
glucose testing would go beyond the scope of practice for physical therapy. Placing the
responsibility on the family would not be appropriate because of the gravity of the situation.
48) A measurable objective for a community education program on proper exercise
techniques would be for participants to:
1.
2.
3.
4.
understand the importance of a sufficient warm-up period.
list five stretching techniques that can be used when warming up.
overcome lower extremity problems and adhere to a regular exercise program.
appreciate the effects of increasing intensity of exercise on heart rate.
Objectives must be measurable, and the specific behavior expected should be stated.
Understanding, overcoming, and appreciating elude tangible measurement, while listing
five techniques is an activity that can be documented and is therefore measurable.
49) While ascending stairs, an older adult patient leans forward with increased hip flexion.
Which of the following muscles is being used to BEST advantage with this forward
posture?
1.
2.
3.
4.
Rectus femoris
Tensor fasciae latae
Semitendinosus
Lumbar paraspinal
The hamstrings are hip extensors that are more active when the hip is in flexion, especially
in functional activities such as stair climbing. In this case, the patient flexes the hip, placing
the semitendinosus on stretch and increasing its moment arm and increasing its ability to
produce hip extension. Therefore, the patient is leaning forward to maximize the ability of
the hamstrings to extend the hip during the stair climbing activity. The other muscles listed
would not benefit as much from the increased hip flexion.
50) The authors of a research article describe a favorable study outcome as insignificant
because the study results were not statistically significant. The insignificant finding
would MOST likely be due to poor research methods if which of the following study
characteristics was present?
1.
2.
3.
4.
Small sample size
Small within-group variance
85% analysis power
Controlled alpha level
A small sample size can be linked to errors in statistical conclusions because there may not
be enough participants to allow application of the findings to all patients in the population of
interest. The within-group variance being smaller enables less overlapping of sample
distributions. Greater than 80% analysis power is linked with a higher probability that study
conclusions are accurate. An inflated alpha level (i.e., noncontrolled) results in a higher
level of statistical significance and greater probability of a type 1 error.
51) As a patient progresses in learning a new motor skill, there should be a resultant
increase in which of the following types of feedback?
1.
2.
3.
4.
Tactile
Visual
Intrinsic
Verbal
As learning progresses, feedback should progress from extrinsic (which included tactile,
visual, verbal) to intrinsic feedback from the muscle spindle and joint receptors.
52) A patient is undergoing a treadmill stress test. The appearance of abnormally wide,
irregularly spaced QRS complexes on the electrocardiogram represents:
1.
2.
3.
4.
ventricular depolarization.
premature ventricular contractions.
atrial fibrillation.
atrial repolarization.
The QRS complex represents ventricular contraction. Atrial contraction is represented by
the P wave. When an area of the ventricle becomes irritable and develops an ectopic foci,
the ventricle will depolarize prematurely before the normal conduction sequence (e.g., prior
to SA node firing in the atria) and presents as a wide, irregularly spaced QRS complex. In
normal ventricular depolarization, the QRS would be narrow and regularly spaced and atrial
fibrillation would appear as the P wave changes. Atrial repolarization occurs within the QRS
complex and is not normally visible on EKG.
53) While working in a private practice clinic, a physical therapist observes a patient fall in
the parking lot outside the office. The patient sustains a severe laceration to the
forearm. The therapist secures a pressure dressing to the wound site but notes that
blood is soaking through the dressing and the bandage. Which of the following actions
should the therapist perform NEXT?
1.
2.
3.
4.
Elevate the limb and apply pressure to the wound.
Remove the dressing and bandage and start over with a tighter bandage.
Apply additional dressings and bandages and apply pressure to the brachial artery.
Call the patient’s physician and arrange transportation for medical care.
Elevation and pressure is the correct next step in controlling bleeding. Removal of the
dressing and bandage would potentially irritate the wound and increase the hemorrhage.
Elevation and pressure should be applied first, before additional dressings, bandages, and
pressure to the brachial artery. While calling the patient’s physician to arrange
transportation for medical care may be necessary, it does not immediately control the
bleeding.
54) A physical therapist is conducting a reflex text as shown in the photographs. The arrow
indicates the path of the applied stimulus. The results of the test are MOST likely to
indicate:
1.
2.
3.
4.
a peripheral nerve injury.
a lesion of the anterior horn cells.
a normal response.
an injury to the spinal cord.
The therapist is testing for a positive Babinski sign. When the Babinski sign is positive, the
toes flare at the end of the test. The presence of a positive Babinski sign indicates an upper
motor neuron lesion such as a spinal cord injury. If no upper motor neuron lesion is
present, the toes will flex. The only upper motor neuron lesion is injury to the spinal cord.
Peripheral nerve injuries and lesions of the anterior horn cells are lower motor neuron
lesions.
55) The work modification (standing) shown in the photograph is MOST appropriate for a
patient with which of the following pathologies?
1.
2.
3.
4.
Central lumbar stenosis
Deep vein thrombosis
Thoracolumbar scoliosis
Posterolateral lumbar disc bulge
The photograph shows a standing desk/work station. A patient with stenosis will do better
in sitting, not standing. A patient with a deep vein thrombosis will need to move, not be
stationary. A scoliosis alone does not warrant a standing work station. Sitting increases
intradiscal pressure, so standing is often preferred to sitting.
56) A long-distance runner comes to physical therapy with insidious onset of lower leg pain.
The patient’s examination results reveal weakness of toe flexion and ankle inversion.
The physical therapist suspects vascular compromise associated with this presentation.
Palpation at which of the following locations is MOST likely to reveal diminished arterial
pulses in the patient?
1.
2.
3.
4.
Dorsal aspect of the foot
Posterior to the lateral malleolus
Posterior to the medial malleolus
Lateral aspect of the popliteal fossa
The posterior tibial artery is most likely to be involved in chronic posterior compartment
syndrome, which is described in the question. This artery should be palpated posterior to
the medial malleolus. The dorsal aspect of the foot is the site for palpation of the dorsalis
pedis pulse. The dorsalis pedis artery is not involved in posterior compartment syndrome.
The palpation site posterior to the lateral malleolus is used to access the fibular (peroneal)
artery. The fibular (peroneal) artery is not involved in posterior compartment syndrome.
Palpation in the popliteal fossa is a poor choice of palpation location in association with
posterior compartment syndrome. The popliteal artery may be palpated here, but the
compartment syndrome manifestations are distal to this site.
57) During an intervention session with a patient with a recent onset of hemiplegia, a
physical therapist plans to focus on transfers to and from a wheelchair, a bathtub, and
an automobile. Which of the following methods should be MOST effective for long-term
retention of these skills?
1.
2.
3.
4.
Practice the activities in random order.
Sequence the activities from easiest to most difficult.
Allow the patient to determine the sequence of activities.
Establish a predictable but variable practice sequence.
It has been determined that a critical factor in improving learning is that the subject must do
something different on consecutive trials. Therefore the traditional approach for retraining
by practicing one skill repeatedly is not the most effective. It is believed that having a
patient practice a number of tasks in random order would probably be more successful for
long-term retention. The other options do not provide for randomization of the activities and
are therefore less likely to provide for long-term retention.
58) A patient is lying supine with hips and knees extended and hands behind the head. The
patient is able to raise the head, shoulders, and thorax from the treatment table but is
unable to come to a complete long-sitting position. What muscle should the physical
therapist target for a strengthening program?
1.
2.
3.
4.
Iliopsoas
External abdominal oblique
Quadratus lumborum
Upper rectus abdominis
The abdominal muscles are active during a sit-up (with the knees extended) up until the
spine is completely flexed (head, shoulders, thorax lifted from surface). In order to come to
a long-sitting position, however, the hips must be flexed, and the abdominals cannot
perform this action because they do not cross the hip joint. Therefore, the hip flexors
(iliopsoas among others) would have to complete this motion. The inability to achieve a
long-sitting position would suggest weakness in the iliopsoas muscle.
59) A patient has medication-induced Cushing syndrome. Which of the following
physiological problems is a common manifestation of this disorder?
1.
2.
3.
4.
Hypotension
Hyperkalemia
Muscle catabolism
Decreased protein metabolism
Corticosteroid-induced myopathies are common after prolonged use of the drug, and they
are common in the proximal musculature of the extremities. The other options are the
opposite of symptoms commonly found with steroid-induced conditions. Usually there are
problems with hypertension, hypokalemia, and increased protein metabolism.
60) A 90-year-old patient with chronic congestive heart failure has been nonambulatory and
has resided in a nursing home for the past year. The patient was recently admitted to
the hospital after an episode of dehydration. Which of the following plans for
prophylactic respiratory care is MOST appropriate?
1.
2.
3.
4.
Turning, coughing, and deep breathing every 1 to 2 waking hours
Vigorous percussion and vibration 4 times/day
Gentle vibration with the foot of the bed elevated 1 time/day
Segmental postural drainage using standard positions throughout the day
A patient who is immobile and restricted to bed is at risk for developing atelectasis (partial
collapse of lung tissue), which can then lead to pneumonia. Frequent position changes with
deep breathing and coughing will help prevent development of atelectasis. Given that this
patient is elderly and does not have a diagnosis of secretion retention, vigorous percussion
and vibration is not indicated. Vibration with the head down or standard postural drainage
positions will not be tolerated in this elderly patient with chronic congestive heart failure.
61) Which of the following joint mobilizations would be MOST effective for improving a
patient’s ability to progress into terminal stance?
1.
2.
3.
4.
Posterior glide of the talus on the tibia
Posterior glide of the calcaneus on the talus
Plantar glide of the 1st proximal phalanx on the metatarsal
Dorsal glide of the 1st proximal phalanx on the metatarsal
Extension of the 1st metatarsophalangeal joint is needed in terminal stance. The distal
metatarsal is convex. The proximal portion of the articulating phalanx is concave. According
to the convex-concave rule, when a therapist moves a concave joint surface on a convex
joint surface, the concave joint surface is moved in the same direction as the range-of-
motion limitation. Therefore, the appropriate accessory glide is a dorsal glide of the
proximal phalanx on the metatarsal. Posterior glide of the talus on the tibia and plantar
glide of the 1st proximal phalanx on the metatarsal promote plantar flexion. Posterior glide
of the calcaneus on the talus is not as relevant for terminal stance, which involves the 1st
MTP joint.
62) A physical therapist is examining muscle strength in a patient. The patient is asked to
move the leg along the path indicated by the arrow shown in the photograph and to hold
the leg in place while the therapist applies resistance to the leg. The patient moves
through the range of motion shown and is able to take maximal resistance. Intervention
should address which of the following problems?
1.
2.
3.
4.
Tightness of the hip medial (internal) rotators
Weakness of the gluteus minimus and medius
Correction of the right lateral (external) trunk shift
Piriformis weakness
The fact that the patient has normal muscle strength of the hip lateral (external) rotators
along with limitation of range of motion indicates either tightness of the medial (internal)
rotators or hip capsule tightness. The gluteus medius and minimus are medial (internal)
rotators of the hip. The trunk shift is a normal substitution pattern found in individuals who
lack hip range of motion. The problem is related to the hip, not the trunk. The patient’s
piriformis shows normal strength, so it is not weak.
63) A patient with a complete thoracic spinal cord injury is sitting in a wheelchair on a
custom-made cushion. Pressure relief activities should be performed:
1.
2.
3.
4.
when the patient shows signs of pressure sores.
every 15 to 20 minutes.
every 1 to 2 hours.
if the patient does not have an appropriate cushion.
A patient with a thoracic spinal cord level injury is able to perform independent pressure
relief strategies and should complete pressure relief every 15 to 20 minutes.
64) Which of the following lower extremity findings is MOST likely to be the FIRST sign of
vascular occlusive disease?
1.
2.
3.
4.
Edema of the legs and ankles
Brown discoloration at the ankles
Increased cyanosis when legs are dependent
Lack of hair on the toes
Poor hair growth is characteristic for arterial disease due to inadequate cellular nutrition.
The first sign of arterial disease is often loss of hair on the toes. Edema may be present
with advanced cases of arterial disease. Increased cyanosis with legs in the dependent
position is present in advanced disease. Brownish discoloration at the ankles is
characteristic of chronic venous disorders.
65) A physical therapist is teaching a patient who has recently undergone knee surgery to
use a cane while descending stairs without a railing. The patient has partial weightbearing status on the right. Which of the following instructional methods should the
therapist use to teach the patient this activity?
1. The therapist stands behind the patient, and the patient descends with the cane and
left leg first.
2. The therapist stands beside the patient, and the patient descends with the right leg
first and then the cane.
3. The therapist stands below the patient, and the patient descends with the cane and
right leg first.
4. The therapist stands behind the patient, and the patient descends with the left leg
first.
Options 1, 2, and 4 are neither safe nor appropriate. When descending stairs, it is generally
best for the therapist to be positioned below the patient as protection from falling. However,
the patient should always descend stairs leading with the involved leg, the right leg in this
case, and the cane.
66) A patient with low back pain also reports constipation, occasional nausea and vomiting,
and unexplained weight loss. The pain worsens when the patient is supine and
decreases when the patient leans forward when sitting. The sclerae are yellow. The
signs and symptoms are MOST consistent with which of the following disorders?
1.
2.
3.
4.
Appendicitis
Cholecystitis
Pancreatic carcinoma
Irritable bowel syndrome
Pancreatic cancer is characterized by nonspecific and vague symptoms, which can include
nausea, weight loss, pain radiating to the back or back pain alone, and jaundice. Sitting up
and leaning forward may provide some relief by taking pressure off the pancreas. Irritable
bowel syndrome is characterized by abdominal pain with constipation and diarrhea, nausea
and vomiting, but not referred back pain or jaundice. Cholecystitis is an inflammation of the
gallbladder and typically produces right upper quadrant abdominal pain. There may be
nausea and vomiting, weight loss, and jaundice. However, the pain is referred to the upper
back or right shoulder, not the low back. There is also anorexia, nausea and vomiting with
appendicitis, but the pain is present generally over the right lower quadrant. Bending
forward may worsen the symptoms because of the resultant increase in intraabdominal
pressure.
67) Excessive upward rotation of the right scapula is noted when a patient attempts to
perform shoulder flexion. Which of the following exercises is MOST appropriate to help
correct the excessive scapular rotation?
1.
2.
3.
4.
Right scapular protraction against resistance with the right arm at 90° of flexion
Bilateral scapular elevation with the upper extremities at 180° of flexion
Wall push-ups with an isometric hold at end range with the elbows extended
Bilateral scapular adduction with the upper extremities medially (internally) rotated
and adducted across the back
Excessive upward rotation of the scapula can result from weakness of the rhomboids and
latissimus dorsi (downward rotators). The scapular adduction with medial (internal) rotation
and adduction of the arm would require action by those muscles. Option 1 would help
strengthen the serratus anterior, an upward rotator of the scapula. Option 2 would activate
the upper trapezius as well as the rhomboids, and, since the upper trapezius is also an
upward rotator of the scapula, this would not be the best exercise to use. Option 3 would
also help strengthen the serratus anterior, which would tend to aggravate the problem.
68) Which of the following diagnoses is MOST associated with urinary incontinence?
1.
2.
3.
4.
Orchitis
Testicular cancer
Testicular torsion
Benign prostatic hyperplasia
The nodular hyperplasia that occurs with benign prostatic hyperplasia causes obstruction of
the urethra, resulting in urinary frequency and urge incontinence. Testicular torsion,
orchitis, and testicular cancer are not associated with urinary dysfunction.
69) A physical therapist is working on transfers with a patient who had a brainstem
cerebrovascular accident. The patient has ataxia in all four extremities and a high level
of extensor tone in the lower extremities. The patient has fair to good trunk control.
Which of the following transfers is BEST for this patient?
1.
2.
3.
4.
Squat pivot
Sliding board
Standing pivot
Dependent tuck
A squat-pivot transfer avoids full lower extremity extension, thus minimizing lower extremity
extensor tone. A sliding-board transfer is not appropriate with a high level of ataxia in the
upper extremities. A standing-pivot transfer is not appropriate because it may increase the
extensor tone in the lower extremities. A dependent tuck transfer does not encourage
active patient participation or promote independence.
70) A physical therapist wants to examine the relationship between lower extremity manual
muscle test grades and five ranked categories of functional ambulation ability in a group
of older adults. Which of the following statistics is MOST appropriate for testing this
relationship?
1.
2.
3.
4.
Paired t test
Pearson product-moment correlation (r)
Mann-Whitney U test
Spearman rho (rs)
The research question is one of relationship or correlation between measures, not
comparison of group means, so the t test and the Mann-Whitney U test are not appropriate.
Because the data for both variables are ranked (ordinal), Spearman rho (Spearman rank
correlation coefficient) should be used. This is the nonparametric analog of the Pearson
correlation coefficient (r). The Pearson r requires continuous, not ordinal, data.
71) In a research study, a correlation coefficient of .30 was found for the relationship
between two variables. Which of the following interpretations of this finding is MOST
appropriate?
1. The variables have a low correlation.
2. Thirty percent of the variability in one variable can be accounted for by the other
variable.
3. There are no significant differences between the variables.
4. There is low positive predictive value between the variables.
A correlation coefficient of .26 to .49 is considered low.
72) Which of the following conditions is the MOST likely cause of a reduced vital capacity in
a patient who has quadriplegia at the C5–C6 level?
1. Decreased anterolateral chest expansion resulting from paralysis of the external
intercostal muscles
2. Inability of the patient to generate a negative intrapleural pressure secondary to a
denervated diaphragm
(1) A relatively high resting position of the diaphragm resulting from paralysis of
the abdominal muscles(by kate assumed this word is the missing one)
3. Reduced rib-cage elevation due to paralysis of the anterior scalene and
sternocleidomastoid muscles
The rib cage would not be able to expand normally during inspiration due to weakness of
the external intercostal muscles, which are innervated by thoracic nerve segments. With a
spinal cord lesion at the C5–C6 level, the diaphragm would still receive innervation from the
phrenic nerve (C4). The anterior scalene (C4–C6) would be partially innervated and the
sternocleidomastoid (C2–C3) would be fully innervated. The abdominal muscles would not
be innervated since they receive their innervation from thoracic nerve segments. Paralysis
of the abdominal muscles would cause the diaphragm to assume a low resting position.
73) A physical therapist places electrodes on a patient to monitor surface electromyographic
activity. The electrode placement shown in the photograph is MOST appropriate to
monitor which of the following muscles?
1.
2.
3.
4.
Tensor fasciae latae
Sartorius
Rectus femoris
Gluteus minimus
The electrode placement in the photograph is the best placement for the tensor fasciae
latae. The electrodes are placed over the muscle belly and lined up parallel to the muscle
fibers. The sartorius is found more distally and medially and following the direction of the
muscle fibers. The rectus femoris is found more distally and central to the thigh. The
gluteus minimus is a deep muscle that cannot be easily monitored directly by surface
electromyography.
74) A physical therapist places a patient on a strength training program for the lower
extremities. The mode of exercise is a double-leg press unit using free weights. After 1
week, the patient shows a 10-lb (4.5-kg) increase in the amount of weight the patient is
able to lift. What is the MOST likely cause of the patient’s increase in strength?
1.
2.
3.
4.
Muscle fiber hypertrophy
Neurological adaptation
Hyperplasia of the muscle fibers
Increase in the amount of actin and myosin
Strength increase in muscle is due to a number of factors, including neurological adaptation
and muscle fiber hypertrophy with an increase in actin and myosin. Hyperplasia in humans
is still controversial. Long-term changes in muscle strength are due to all of the factors
listed. However, short-term changes, such as changes in 1 week, are most likely to due to
neurological factors such as more efficient motor unit recruitment, autogenic inhibition, and
more efficient co-activation of muscle groups.
75) A physical therapist is considering the use of phonophoresis as part of an intervention
plan. Which of the following steps is the correct FIRST step in the decision-making
process to use phonophoresis?
1.
2.
3.
4.
Outline the therapeutic goals and outcomes.
Select the appropriate coupling agent and medication.
Decide on the dosimetry by choosing the appropriate mode and frequency.
Determine if there are any contraindications.
Although all of options are involved in the decision-making process, the determination of
contraindications is the first thing to consider, because all other options are unnecessary if
the patient has other pathologies that could be a contraindication.
76) A physical therapist is evaluating a patient who has shoulder pain. The patient notices
the shoulder pain at work when stocking shelves that are overhead. The pain is not
apparent when stocking shelves at waist or chest level. The patient MOST likely has
weakness in which of the following muscles?
1.
2.
3.
4.
Pectoralis minor
Upper trapezius
Deltoid
Rhomboid major
Weakness in the pectoralis minor would not cause restriction of the scapula but would likely
cause scapular hypermobility. Weakness in the upper trapezius would decrease upward
rotation of the scapula during shoulder flexion and abduction. The more the shoulder is
elevated, the more noticeable this would be. The decreased scapular movement would
increase the predisposition toward impingement. Weakness in the deltoid would cause the
humerus to move downward, not upward, during shoulder elevation. Weakness in the
rhomboid major would not cause restriction of the scapula, but would likely cause scapular
hypermobility.
77) A patient who sustained a mild cerebrovascular accident 3 weeks ago is being prepared
by a physical therapist for discharge to home and an adult day program. To facilitate the
discharge plan, the MOST appropriate health professional for the therapist to consult
with is the:
1.
2.
3.
4.
skilled nursing coordinator.
occupational therapist.
medical social worker.
primary physician.
Medical social service staff deal with home situations and financial supports and act as a
resource director on behalf of the patient. Social services would be the most appropriate
choice to help arrange and coordinate rehabilitative services for the patient while the
patient is at home. Although nurses, occupational therapists, physical therapists, and
physicians may all be involved with direct patient care, they would not be the most
appropriate for this level of discharge planning.
78) In a research study, a physical therapist performs the same goniometric measurement
on the same group of control subjects during two consecutive testing sessions. This
process is used to demonstrate which of the following measurement properties?
1. External validity
2. Instrument reliability
3. Intrarater reliability
4. Interrater reliability
Intrarater reliability describes the repeatability of measurements made by one person
(repeatability within that person).
79) Sensory-level electrical stimulation is MOST appropriate for a patient with which of the
following conditions?
1.
2.
3.
4.
Chronic low back pain of somatic origin
Acute ankle sprain with edema
Supraspinatus tendonitis
Active Raynaud syndrome
Regarding chronic low back pain of somatic origin, the patient has a chronic problem, so
will most likely require motor-level stimulation, because it provides a longer-lasting
analgesia. There is no evidence to indicate that sensory-level stimulation is effective in the
treatment of edema. For edema reduction, rhythmic muscle contraction is preferred.
Iontophoresis is more appropriate than sensory-level electrical stimulation for treatment of a
tendonitis, because it involves the delivery of anti-inflammatory medications. Raynaud
syndrome is a condition in which the smallest arteries that bring blood to the fingers or toes
constrict when exposed to cold or from an emotional upset. Sensory-level stimulation over
nerve roots and trunks can increase peripheral vasodilatation.
80) A patient with which of the following diagnoses would MOST likely benefit from pursedlip breathing during exercise?
1.
2.
3.
4.
Peripheral vascular disease
Congestive heart failure
Emphysema
Sarcoidosis
Peripheral vascular disease is a vascular problem, not a pulmonary problem. Congestive
heart failure may lead to pulmonary problems, but not obstructive problems. Emphysema is
an obstructive lung disease, for which pursed-lip breathing may be beneficial. Sarcoidosis
is a restrictive lung disease for which pursed-lip breathing is not beneficial.
81) A patient has a history of neck pain that is aggravated by long periods of sitting and
becomes progressively worse by evening. Range of motion and strength of the neck
and shoulders are within normal limits. Sensation and reflexes are intact in both upper
extremities. The patient has a forward head and excessive thoracic kyphosis. The
MOST appropriate exercise program should focus on:
1.
2.
3.
4.
stretching of the neck flexors and pectoral strengthening.
upper trapezius strengthening and pectoral stretching.
pectoral strengthening and rhomboid stretching.
rhomboid strengthening and axial neck retraction.
The history suggests that prolonged improper positioning of the cervical spine resulted in
neck pain. A chronic forward head and kyphosis results in hyperextension in the upper
cervical spine and excessive flexion in the upper thoracic spine. Further muscle length
adaptation occurs with tight anterior muscles and stretched posterior muscles. Treatment
should include correction of muscle weakness or imbalance. Rhomboid strengthening and
axial neck extension are the only options that are both correct.
82) A patient suspected of having hypoglycemia is MOST likely to show which of the
following signs?
1.
2.
3.
4.
Fruity smelling breath
Thirst, nausea, and vomiting
Dry, crusty mucous membranes
Difficulty speaking and concentrating
A common mental state manifestation of hypoglycemia is difficulty speaking and
concentrating, whereas in hyperglycemia there is outright confusion. The other options are
all signs of hyperglycemia and not signs of hypoglycemia.
83) A patient is limited in shoulder abduction, as shown in the displayed radiograph. Which
of the following mobilization techniques is MOST likely to assist the patient in achieving
increased shoulder abduction?
1.
2.
3.
4.
Posterior glide
Anterior glide
Inferior glide
Superior glide
Neither posterior glide, anterior glide, nor superior glide, would improve abduction. The
radiograph shows limitation of glenohumeral motion causing the reduction in shoulder
abduction. Inferior glide assists with improving abduction.
84) Which of the following assignments is MOST appropriate for a physical therapist to
delegate to a volunteer?
1.
2.
3.
4.
Restocking treatment booths with linens, ultrasound gel, and massage lotion
Attending a patient who is on a tilt table while the therapist takes a phone call
Transporting a patient who reports dizziness back to the patient's room
Transferring a patient from the mat table to a wheelchair
The restocking of treatment booths with supplies is the only option that does not involve
direct patient contact or care and thus is the MOST appropriate activity to delegate to a
volunteer. Although volunteers may at times be involved with patient care activities (i.e.,
transporting patients), the patients in the situations described in options 2, 3, and 4 are at
potential risk and would require supervision by someone other than a volunteer.
85) A physical therapist is teaching a motor skill to a patient with chronic hemiplegia. Which
of the following teaching approaches should be MOST emphasized?
1.
2.
3.
4.
Habituation
Sensitization
Compensatory strategy
Recovery of normal movement
A patient with chronic hemiplegia is unlikely to recover normal function. Compensatory
strategies are used when there is a permanent loss of function which prevents reacquiring
normal movement patterns. Habituation is a decrease in responsiveness that occurs as a
result of repeated exposure to a nonpainful stimulus. In the acute patient, the emphasis is
on recovery of normal function, but this patient has a chronic condition. Sensitization is an
increased responsiveness following a threatening or noxious stimulus.
86) A patient has low back and leg pain, with symptoms extending to the bottom of the foot.
During the physical therapy examination, the patient does not report leg pain in the first
test position (photograph #1) but reports a severe increase in symptoms in the second
test position (photograph #2). Which of the following conclusions is MOST likely?
1.
2.
3.
4.
The pain is the result of a herniated disc.
The patient may be displaying nonorganic symptoms.
The symptoms are the result of an inflamed sciatic nerve.
The hamstrings are in a facilitated state of contraction.
Because sitting knee extension and the straight-leg raise culminate in essentially identical
positions, symptomatic responses to the two types of maneuvers should be similar. If the
patient had a symptomatic herniated disc, both positions would result in a similar symptom
increase. If the patient had an irritated sciatic nerve, both positions would result in a similar
symptom increase. If the patient had a facilitated hamstring, both positions would result in a
similar symptom response.
87) A patient is referred for recommendations regarding purchase of a wheelchair. The
measurements of the patient while sitting are 16 in (40.6 cm) across the widest point of
the hips and 18 in (45.7 cm) from the rear of the buttocks to the popliteal crease. Which
of the following wheelchair dimensions would be BEST suited for this patient’s needs?
1.
2.
3.
4.
Seat width and seat depth of 18 in (45.7 cm)
Seat width of 18 in (45.7 cm) and seat depth of 16 in (40.6 cm)
Seat width and seat depth of 16 in (40.6 cm)
Seat width of 16 in (40.6 cm) and seat depth of 18 in (45.7 cm)
The seat width should be slightly wider than the width of the widest body part, and the
depth should come to within 1 inch of the popliteal fossa.
88) A physical therapist is initiating intervention with a postoperative patient who is taking 20
mg of oral oxycodone (Oxycontin) for pain relief. In planning an intervention for this
patient, the physical therapist should anticipate that:
1.
2.
3.
4.
the patient may be hypertensive.
the medication may trigger cardiac arrhythmias in the patient.
the patient will have an increased likelihood for developing diarrhea.
the patient may demonstrate respiratory depression.
Regarding the patient being hypertensive, the opposite is likely. Orthostatic hypotension is
a potential side effect. Arrhythmias are not listed as a recognized side effect of opioids.
Regarding developing diarrhea, gastrointestinal motility is decreased, so the opposite effect
of constipation is a frequent problem. Opioids tend to make the medullary chemoreceptors
less responsive to carbon dioxide, thus slowing down respiratory rate and inducing a
relative hypoxia and hypercapnia. The respiratory response to exercise may be blunted.
89) During which of the following scenarios would gloves be required to comply with
standard precautions?
1.
2.
3.
4.
During all patient care in the hospital setting
Performing range of motion on a patient with acquired immunodeficiency syndrome
Massaging the neck of a patient with hepatitis C
Changing an infant’s diaper in a pediatric setting
Gloves are required only during contact with blood or body fluids, not during patient care
that does not involve coming in contact with blood or body fluids. Gloves are required
whenever changing an infant’s diapers, because this activity involves coming into contact
with body fluids.
90) Which of the following structures is indicated by the arrow in the radiograph?
1.
2.
3.
4.
Intertubercular groove
Greater tubercle
Lesser tubercle
Coracoid process
The structure indicated by the arrow is the greater tubercle. The arm is medially (internally)
rotated in this radiograph.
91) Which of the following descriptions accurately reports a NORMAL patient response to
deep tendon reflex testing?
1.
2.
3.
4.
2 or plus (+)
3 or plus (++)
0 or minus (-)
1 or minus (-)
A normal response is 2 or plus (+). Minus (-) or 0 indicates an absent reflex, and minus (-)
or 1 indicates a diminished response. Plus (++) or 3 indicates an exaggerated response,
and plus (+++) or 4 indicates clonus.
92) A patient presents with weakness throughout the right lower extremity with normal
strength on the left side. Sensory testing shows a loss of pressure sensation over the
right thigh and leg and a loss of pain and temperature sensation over the left thigh and
leg. The patient has a positive Babinski sign on the right. Which of the following
associated findings is MOST likely to be found during further examination of this
patient?
1.
2.
3.
4.
The presence of clonus in the left ankle
Marked atrophy in the right lower extremity muscles
Spasticity in the left lower extremity
Increased deep tendon reflexes on the right side
The presence of clonus would be on the right side, not the left side. Spasticity would be on
the right side, not the left side. This is a case of hemisection of the spinal cord, BrownSéquard syndrome. The lesion is on the right side of the spinal cord, and it is an upper
motor neuron lesion (positive Babinski sign) with damage to the corticospinal tract,
posterior columns, and lateral spinothalamic tract. Upper motor neuron spinal cord lesions
present with hyperactive tendon reflexes (in this case on the right side), clonus, and
spasticity ipsilateral to the side of the lesion. Pressure sensation is lost on the ipsilateral
side, and pain and temperature are lost contralateral to the side of the lesion due to the
crossing of those fibers in the spinal cord.
93) While a physical therapist is performing transfer training from bed to chair with a patient
who had a total knee arthroplasty 2 days ago, the electrocardiograph monitor alarms
and the therapist notes that premature ventricular contractions have developed. What is
the therapist’s BEST course of action at this time?
1. Position the patient on a stable surface and discontinue physical therapy for the
day.
2. Continue the transfer to the chair and monitor the patient’s oxygen saturation
levels.
3. Continue the transfer to the chair and immediately notify the nurse about the
premature ventricular contractions.
4. Position the patient on a stable surface and determine the stability of the premature
ventricular contractions.
Option 1 would apply only after the therapist has done further analysis of the situation.
Monitoring oxygen saturation is useful but not the most immediate thing to monitor. The
therapist should monitor the electrocardiogram and blood pressure of the patient. Although
notifying the nurse is something the therapist should do, this should be done after an initial
evaluation of the stability of premature ventricular contractions. Onset of premature
ventricular contractions can be benign or stable. Less than six contractions/minute is
generally stable, while greater than six contractions/minute is considered less stable. A
physical therapist should be able to determine this stability.
94) Which of the following postural drainage positions is MOST appropriate for a patient
who has aspiration pneumonia in the right middle lobe and who had a craniotomy 2
days ago?
1. Right sidelying with one-quarter turn toward supine
2. Left sidelying with one-quarter turn toward supine with head of bed down
approximately 20°
3. Right sidelying with one-quarter turn toward supine with head of bed down
approximately 20°
4. Left sidelying with one-quarter turn toward supine
Option 1 is incorrect because the traditional position to drain the right middle lobe is left
sidelying, not right sidelying. Option 2 is the traditional drainage position for right middle
lobe, but does not take into account the intracranial pressure issues. Option 3 is the
traditional drainage position for LEFT middle lobe but does not take into account the
intracranial pressure issues. The traditional position to drain the right middle lobe is left
sidelying with one-quarter turn toward supine, head of bed down approximately 20°.
However, because of the recent craniotomy, the patient’s increased intracranial pressure is
a major issue to monitor and keep stable. Therefore, this traditional position should be
modified to flat sidelying, as described in option 4.
95) To help students apply a newly learned skill to clinical practice, the MOST effective
action for the clinical instructor to take is to:
1. point out possible clinical situations and discuss how the skill would apply to them.
2. have the students research reference materials and compile a list of the steps
required to acquire the skill.
3. prepare a list of indications and contraindications for the skill.
4. have the students provide examples of clinical situations where the skill would be
appropriately applied.
Behavioral objectives should be learner centered, outcome oriented, specific, and
measurable. Option 4 is the only one that is learner (student) centered and specific to a
situation. Options 1 and 3 require action by the clinical instructor, not the student. Option 2,
which may be a step in the process, is not as learner centered or outcome centered as
Option 4.
96) During the shoulder examination of a patient, a physical therapist notes the presence of
a capsular pattern without radicular pain. To help establish the cause of the capsular
pattern, the therapist should NEXT:
1. perform axial compression on the cervical spine to check for nerve root
compression.
2. ask the patient if there has been any prior trauma to the shoulder joint.
3. check for a painful arc during active range of motion.
4. examine the shoulder for a rotator cuff tear.
A nerve root impingement commonly gives radicular pain. One of the most common causes
of a capsular pattern in the shoulder is traumatic arthritis following injury to the shoulder.
The capsular pattern may gradually develop over time. A painful arc is often associated
with a noncapsular pattern such as seen with bursitis or tendonitis at the shoulder. A torn
rotator cuff is associated with weakness and loss of active shoulder elevation.
97) A patient had knee surgery 4 weeks ago. Which of the following neuromuscular
electrical stimulation parameters would be MOST appropriate to use for strengthening
the patient’s quadriceps muscle?
1.
2.
3.
4.
1 to 4 pps, 100 microseconds
1 to 4 pps, 350 microseconds
40 to 50 pps, 350 microseconds
100 pps, 100 microseconds
The pulse width of 100 microseconds makes it difficult to achieve a strong enough motor
response. A 1 to 4 pps frequency may lead to a twitch motor response, but not tetany,
which is needed for strengthening. The correct answer requires a frequency that will lead to
tetany (something above about 30 Hz) and a long enough pulse width to recruit motor
fibers (usually something greater than 200 microseconds). Therefore, of the options, 40 to
50 pps with a pulse width of 350 microseconds is the best. Option 4 describes the typical
parameter for conventional transcutaneous electrical nerve stimulation for acute pain
management. However, the pulse width of 100 microseconds makes it difficult to achieve a
motor response, and the higher frequency of 100 pps leads to rapid fatigue.
98) A patient is asked to grip a white card between the thumb (1st digit) and index finger (2nd
digit) with both hands. The physical therapist pulls on the card in the direction of the
arrow shown. As the therapist pulls on the card the patient’s right thumb flexes at the
interphalangeal joint. The results indicate weakness in which of the following muscles?
1.
2.
3.
4.
Flexor pollicis longus
Abductor pollicis brevis
Adductor pollicis
Extensor pollicis longus
The test shown in the photograph is the Froment test. Both thumbs (1 st digits) should stay
extended during the test. If the thumb (1st digit) flexes, it is indicative of weakness of the
adductor pollicis with substitution by the flexor pollicis longus, which is usually due to a
lesion of the ulnar nerve.
99) During the gait evaluation of a patient, a physical therapist notices that the patient
laterally bends excessively toward the right side during the midstance phase on the
right. For the therapist to test the suspected muscle for Normal strength (5/5), the
patient should FIRST be positioned:
1.
2.
3.
4.
prone with the knee straight.
supine with the knee bent.
seated with the hip flexed to 110°.
sidelying on the left side.
Prone with the knee straight would be used to test for a Poor (2/5) grade. Supine with knee
bent is used to isolate the gluteus maximus. Seated hip flexion is used to test the hip flexor
muscle strength. The most likely cause of laterally bending toward the stance limb is
abductor weakness on the stance side. The lateral bending helps compensate for weak
abductors. The right abductors would be tested from a left sidelying position for Fair (3/5) or
greater strength.
100) A patient with a cerebellar stroke has received functional balance training for 4
weeks. Which of the following tests is MOST appropriate to measure the effectiveness
of the physical therapy intervention?
1.
2.
3.
4.
Romberg Test
Berg Balance Scale
Fugl-Meyer Assessment
Barthel Index
Although the Romberg Test is a measure of the role of vision in balance, it alone would not
be the most appropriate measure for functional balance. The Berg Balance Scale is an
objective measure of static and dynamic balance abilities and consists of 14 commonly
performed functional tasks; therefore, it is the most appropriate tool to use as a measure of
intervention effectiveness. The Fugl-Meyer Assessment is appropriate for cortical strokes
and would not be the most appropriate for a cerebellar stroke. It is not as comprehensive in
balance tasks as the Berg Balance Scale. The Barthel Index is a more global instrument
and is not as focused on functional balance as the Berg Balance Scale.
101) A patient in the eighth month of pregnancy has numbness and tingling of the left
hand, except for the little finger (5th digit). She demonstrates edema of the hand and
fingers, a positive Tinel sign at the wrist, and a Good (4/5) muscle test grade of the wrist
and finger flexors. The MOST appropriate intervention is:
1.
2.
3.
4.
a wrist splint to position the wrist in full extension.
a hot pack followed by tendon gliding exercises.
resistive exercises for the wrist and finger flexors.
frequent rest and elevation of the left upper extremity.
Compression on the median nerve (carpal tunnel syndrome) is occurring, most likely as a
result of swelling associated with the individual being in the eight month of pregnancy. In
this case, rest and elevation would do the most to decrease the edema and relieve the
symptoms. The wrist should not be positioned in full extension. Initial conservative
treatment sometimes includes cock-up splinting to hold the wrist in neutral to 10° of
extension, but not full extension. Although tendon gliding exercises may be used, heat
would not be indicated since it may increase the edema. Resistive exercises for the wrist
and fingers may aggravate the compression in the carpal tunnel.
102) Which of the following locations corresponds to the sensory function of the nerve
root exiting between the third and fourth lumbar vertebrae?
1.
2.
3.
4.
Lateral knee joint line
Medial knee joint line
Plantar aspect of the heel
Dorsal web space between the first and second toes
The L3 nerve root exits between the third and fourth lumbar vertebrae and supplies sensory
information from the region of the medial knee joint line.
103) An inpatient physical therapy department has only one physical therapist and one
physical therapist assistant on duty, due to staff illness. Treatment of a patient with
which of the following conditions and circumstances is MOST appropriate for the
therapist to delegate to the assistant?
1.
2.
3.
4.
Ataxia, who is undergoing a trial to determine an appropriate assistive device
Hemiparesis, whose initial evaluation has not been completed
Multiple sclerosis, who is receiving gait training with a rolling walker
Alzheimer disease, who is easily agitated and is receiving initial gait training
A physical therapist would be required to perform the initial evaluation, plan of care,
reevaluations, modifications to the plan of care, and discharge plans for the patient. The
patient who is stable and has an existing program would be the most appropriate patient to
be delegated to the assistant. Therefore, the patient who has multiple sclerosis and who
has an established gait training program would be the most appropriate. The other three
patients are receiving their initial treatments.
104) When considering special tests for orthopedic assessment, selection of a test with
adequate validity is important because the:
1.
2.
3.
4.
results of the test can be standardized.
test measures what it is supposed to measure.
results of the test are reproducible.
test can be accurately performed by someone else.
Option 2 is the definition of validity. Options 3 and 4 refer to reliability measures. Option 1 is
incorrect because results can be standardized even though they are not valid.
105) A patient who recently had bilateral transtibial amputations wants to have a ramp
built to travel from the back deck of his house to the pool in his wheelchair. The vertical
distance from the door to the ground level is 5 ft (1.5 m). Which of the following ramp
specifications is BEST for the patient?
1.
2.
3.
4.
One continuous ramp, 60 ft (18 m) long
One continuous ramp, 30 ft (9 m) long
Two ramps, each 60 ft (18 m) long, connected by a level area
Two ramps, each 30 ft (9 m) long, connected by a level area
One continuous ramp that is 60 ft (18 m) long is too long of a run without a level area to
rest. One continuous ramp that is 30 ft (9 m) long is too steep a slope. Two ramps, each 60
ft (18 m) long, even if connected by a level area, would be unnecessarily long. The rise
should not be greater than 30 in (76 cm) for any one run and should be 1 ft (.3 m) in length
per each 1 in (2.5 cm) rise.
106) A physical therapist is developing an exercise program for an older adult to improve
routine health maintenance and fitness. The patient has a history of a right ankle
fracture 15 years ago, aortic aneurysm repair 3 years ago, and open-heart surgery for a
valve replacement 6 years ago. Which of the following activities is
CONTRAINDICATED?
1.
2.
3.
4.
Aquatic exercise for 30 minutes
Cycling at 60% of maximum heart rate
Endurance exercise using basic calisthenics
Weight lifting at 50% of maximum voluntary contraction
Resistive exercise is contraindicated for a patient with a history of aortic aneurysm, even
after surgical repair.
107) Which of the following home programs is MOST appropriate for a patient with
chronic lateral epicondylitis?
1. Using a forearm cuff to increase loading on the extensor tendons
2. Performing exercises for wrist strength and stretching
3. Administering iontophoresis with dexamethasone (Decadron) and lidocaine
(Xylocaine)
4. Doing friction massage of the brachioradialis tendon
Lateral epicondylitis is caused by overuse of the wrist extensors that originate on the lateral
epicondyle of the humerus, especially the extensor carpi radialis brevis. If the lateral
epicondylitis is at a chronic stage, conditioning of the extensor muscles and sustained grip
activities will be most effective in long-term management. A forearm cuff is thought to
decrease the muscle loading. Iontophoresis would not be appropriate for a home program.
Friction massage of the brachioradialis would not be appropriate since the extensor carpi
radialis brevis muscle is usually the one affected.
108) A patient is receiving mechanical intermittent cervical traction with an on/off duty
cycle of 20 seconds/10 seconds. The patient reports increased pain each time the
traction unit cycles on, which then subsides over the duration of the on time. Which of
the following modifications to the duty cycle is MOST appropriate?
1.
2.
3.
4.
Increase the off time to 20 seconds.
Increase the on time to 25 seconds.
Decrease the off time to 5 seconds.
Decrease the on time to 15 seconds.
When patients have severe symptoms, it is often useful to have increased on and off times
to reduce the movement caused by the cycling. Increasing the off time allows for longer
recovery time prior to re-initiating the traction and reduces the cycling. As the pain
symptoms decrease, the relaxation time can be decreased. Options 2, 3, and 4 do not
allow for a longer off or recovery period.
109) Which of the following arterial blood gas readings indicates acidemia?
1.
2.
3.
4.
7.3
7.4
7.45
7.5
Normal range of arterial blood gas is a pH between 7.35 and 7.45. A pH of 7.35 or lower
indicates acidemia, also called an acidotic state.
110) A patient with testicular cancer is most likely to report which of the following signs or
symptoms INITIALLY?
1.
2.
3.
4.
Back pain
Pain referred to the groin
Swelling of superficial lymph nodes
Diffuse testicular pain and swelling
The most common initial sign is enlargement of the testis with diffuse testicular pain,
swelling or hardness. Back pain may be present, as well as pain referred to the groin or
swelling of superficial lymph nodes, but testicular pain and swelling are the most common
predominant symptoms initially.
111) Which of the following positions is BEST to assess the length of a patient’s rectus
femoris muscle?
1.
2.
3.
4.
Sidelying with tested hip in flexion
Supine with tested hip and knee in flexion
Prone with tested knee in flexion
Sidelying with tested hip in extension
Option 1 does not mention the knee position and has the hip flexed, which shortens the
rectus femoris. Option 2 has the hip flexed, which shortens the rectus femoris. Prone with
the knee in flexion keeps the hip in neutral and does not allow the hip to flex. This position
is used in the Ely test. Option 4 has the hip in the correct position, but does not mention the
knee position.
112) What is the closed packed position of the wrist?
1.
2.
3.
4.
Flexion with ulnar deviation
Flexion with radial deviation
Extension with ulnar deviation
Extension with radial deviation
The closed packed position for the radiocarpal joint is full extension with radial deviation.
The closed packed position for the mid carpal joint is extension with radial deviation.
113) A patient fell while rock climbing 2 days ago. The fall resulted in a fracture of the
right ankle, requiring an open reduction and internal fixation. The patient also sustained
a nerve injury that resulted in significant weakness in the muscles in the right C 6–C7
myotome. The patient is restricted to non-weight-bearing status on the right lower
extremity. Which of the following assistive devices is MOST appropriate for the patient?
1.
2.
3.
4.
Axillary crutches
Wheelchair
Standard walker
Forearm crutches
The axillary crutches, standard walker, and forearm crutches all require adequate strength
in the elbow extensors and latissimus dorsi, especially due to the non-weight-bearing status
of the patient. The non-weight-bearing status on the right could indicate any of the options;
however, because the patient has weakness of the muscles in the C6–C7 dermatome, the
patient would have difficulty using any assistive device that requires use of the elbow
extensors and latissimus dorsi muscles. Therefore, the best option is the wheelchair,
because it provides mobility.
114) A physical therapist is examining the feet of a patient with type 2 diabetes. Which of
the following tests is BEST to determine the patient’s risk for developing foot ulceration?
1.
2.
3.
4.
Pain sensation
Pressure threshold
Two-point discrimination
Temperature awareness
Pressure thresholds using nylon filaments are the most sensitive and specific. Several
studies support the use of the 10-gram (Semmes-Weinstein 5.07) nylon filament as the
threshold for protective sensation. Patients unable to feel a 10-gram nylon filament are
considered unable to protect their feet from injury and are at risk of ulceration.
115) A physical therapist is planning a three-session educational series on physical
therapy evaluation of the low back for fourth-year medical students. Which of following
activities is MOST important to include in the first session?
1.
2.
3.
4.
An overview of the material that will be covered in all three sessions
A pretest to determine the level of knowledge of the participants
Active participation of the students in a low back evaluation
A complete demonstration of a low back evaluation
An overview presented on the first day would imply that the therapist is not going to modify
the series to the students’ current knowledge level, which may be ascertained from the
pretest. It is most important for the physical therapist to know what level of knowledge the
students have. Although active participation is important for learning in every session,
neither it, nor a complete demonstration of a low back evaluation, is most important to
include in the first session.
116) A physical therapist reads in a report that a child has a standard score of -2.0 on a
measure of development. Which of the following interpretations of this score is BEST?
1. The child’s score is well below the mean score, compared to other children’s
scores.
2. The child’s score is close to the mean score, compared to other children’s scores.
3. The child is doing better on this measure than approximately 85% of children.
4. The child is doing worse on this measure than approximately 85% of children.
A standard score, or z-score, relates to the number of standard deviation units a score is
above or below a mean. Standard scores are often used in developmental measures
because they are a useful comparison to a larger or normal group. A standard score of -2.0
is well below the mean because two standard deviation units below the mean indicates that
only 2.27% of children have scored lower or, stated conversely, that 97.73% of children
scored better. At -1.0 standard deviation units, 84.14% of children scored better.
117) A patient with an L4–L5 posterolateral herniated nucleus pulposus is MOST likely to
have sensory deficits in which of the following locations?
1. Medial knee
2. Over the popliteal fossa
3. Plantar aspect of the fifth toe
4. Dorsum of the great toe
The medial knee is the L3 dermatome. The popliteal fossa is S2 dermatome. The plantar
foot is S1 or S2. A posterolateral disc bulge at L4–L5 will most likely affect the L5 nerve root
and the dermatome for the L5 nerve root. The L5 dermatome includes the dorsal aspect of
the great toe. The dorsal area of the great toe is consistently included in the L 5 dermatome.
118) A 72-year-old patient reports bilateral calf pain which gets progressively worse while
walking. The pain episodes have been gradually increasing in frequency and severity,
after an insidious onset 2 years ago. Sitting decreases the patient’s symptoms. Which of
the following pathologies is the MOST likely cause of the patient’s leg pain?
1.
2.
3.
4.
Lumbar foraminal stenosis
Gluteal artery claudication
Herniated nucleus pulposus
Deep vein thrombosis
Lumbar stenosis by definition causes lower extremity symptoms with extension activities,
and stenosis is more common in an older population. Gluteal artery claudication would
cause buttock pain, not calf pain. This patient is relatively too old for a herniated nucleus
pulposus, and most cases of herniated nucleus pulposus do not involve bilateral symptoms.
Nothing given in the patient’s history would increase the likelihood of a deep vein
thrombosis.
119) A patient with Guillain-Barré syndrome who is experiencing progressive paralysis is
admitted to an intensive care unit. Which of the following interventions is MOST
appropriate for a physical therapist to perform as a member of the interdisciplinary team
managing the patient’s care?
1.
2.
3.
4.
Alter the patient’s mechanical ventilation settings.
Develop the patient’s medication schedule.
Perform airway clearance techniques.
Discuss the patient’s medical prognosis with the family.
The key phrase in this question is “interdisciplinary.” Of all the options provided, only airway
clearance is within the scope of practice for physical therapists. Patients with Guillain-Barré
syndrome may experience respiratory muscle fatigue or paralysis and are susceptible to
pulmonary infection. Pulmonary hygiene is a critical role in their care.
120) A physical therapist examining wrist-joint play finds restriction in the direction
indicated by the arrow. The therapist should suspect a decrease in which joint motion?
1. Radial deviation
2. Ulnar deviation
3. Flexion
4. Extension
The therapist is shown performing an ulnar glide, which is the same joint motion used for
radial deviation. Limited motion in this direction indicates limited ability to perform radial
deviation.
121) Which of the following nervous system complications would indicate the poorest
prognosis for a patient with acquired immunodeficiency syndrome (AIDS)?
1.
2.
3.
4.
Toxoplasmosis
Leukoencephalopathy
Myelopathy
Polyneuropathy
Although all of the options are serious complications in patients with AIDS, multifocal
leukoencephalopathy is the most serious, and death occurs in a few months after it is
diagnosed.
122) Which of the following examination findings is consistent with dehydration?
1.
2.
3.
4.
Poor turgor
Dependent edema
Pitting edema
Hypertension
Poor skin turgor is one of the signs of dehydration. The skin, when lifted up between the
fingers, does not return to its original position in a rapid manner.
123) A patient who is a waitress reports weakness in the right hand that causes her to
drop dishes at work whenever she is distracted. The patient also reports wrist and hand
pain and numbness over the thenar eminence, both of which occur during the day and
at night. The patient’s thenar muscle strength is Poor (2/5) throughout. Which of the
following long-term physical therapy goals is MOST appropriate for this patient?
1. The goal is to increase tactile sensitivity in 4 weeks, so that the patient is able to
hold objects and not drop dishes at work.
2. The patient will demonstrate decreased pain in the wrist in order to be able to sleep
at night.
3. The long-term goal is to increase strength in the thenar muscles and decrease pain
in the wrist back to normal levels.
4. The patient will demonstrate thenar muscle strength of Good (4/5) grade in 6 weeks
and be able to hold objects in hand while at work.
A well-written goal includes an audience (who), behavior (what will be done), condition
(under what circumstances), and degree (amount of change). The only option that includes
all of these conditions is option 4, “The patient (who) will demonstrate thenar muscle
strength (behavior) of Good (4/5) grade (degree) and be able to hold objects in hand while
at work (condition).” Options 1, 2, and 3, are each missing one or more of the required
elements.
124) A patient with a severe cerebellar lesion can sit independently, can stand with
minimal assistance, and requires moderate assistance of one person to walk safely.
The patient wants to transfer independently from a wheelchair to a bed. Which of the
following transfer techniques is MOST appropriate for the patient?
1.
2.
3.
4.
Standing pivot
Manual pivot
Mechanical lift
Sliding
Standing-pivot transfer requires standing, which the patient is not able to perform safely.
Manual-pivot transfer involves the assistance of another person, so would not allow for
independence. Mechanical-lift transfer involves the assistance of another person, so would
not allow for independence. Sliding transfer is the safest independent technique, because
the patient cannot stand without minimal assistance.
125) A physical therapist is examining a patient who has unilateral lower extremity pain
when walking. The pain is relieved by rest. Which of the following descriptions of
symptom behavior reported by the patient will help the therapist confirm a diagnosis of
intermittent claudication?
1.
2.
3.
4.
Pain relief upon forward bending or sitting
Pain relief upon standing
Cramping pain that occurs at a predictable distance walked
Numbness and tingling that occurs at a predictable distance walked
Pain relief upon forward bending or sitting and pain relief upon standing are more
diagnostic for lumbar origin of pain. Cramping pain that occurs at a predictable distance
walked is a common presentation and clinical manifestation of vascular limitation.
Numbness and tingling that occurs at a predictable distance walked are more indicative of
a neurologic cause of pain rather than a vascular cause.
126) A patient reports dizziness and blurred vision when walking and turning the head to
either the left or the right. The patient has no problem when the head is kept still while
walking. Which of the following systems is MOST likely involved?
1.
2.
3.
4.
Visual
Vestibular
Somatosensory
Musculoskeletal
Since the patient does not have symptoms while looking straight ahead, the visual acuity
(peripheral visual system) does not appear to be at fault. A patient who reports visual
blurring with head motion is experiencing oscillopsia. Oscillopsia is a visual instability with
head movement in which images appear to move or bounce. It is often due to decreased
vestibulo-ocular reflex. No information is given in the question to suggest that the patient is
having difficulty with somatosensory input or that indicates musculoskeletal deficits.
127) A physical therapist is preparing for gait training with a young adult patient with
paraplegia. Which of the following gait training options is MOST appropriate for the
patient’s first session?
1.
2.
3.
4.
Swing-through gait pattern with a walker
Swing-through gait pattern with forearm crutches
Swing-to gait pattern with axillary crutches
Swing-to gait pattern in the parallel bars
Option 1 is an inappropriate assistive device for a young adult with paraplegia. Option 2 is
the ultimate goal of gait training but would be too difficult for the patient’s first attempt.
Option 3 is not the most efficient gait aide for a patient with paraplegia. The first-time
session of gait training for a patient with paraplegia should be in the parallel bars. A swingto gait pattern would be the easiest for the patient to learn initially.
128) A physical therapist is treating a patient with chronic range of motion limitation due to
tight hamstrings. Which of the following applications of ultrasound and stretching is
BEST to restore normal range of motion?
1. Pulsed ultrasound at 1 MHz with onset of stretching 10 minutes after the ultrasound
treatment
2. Pulsed ultrasound at 1 MHz with stretching for 10 minutes during and immediately
after the ultrasound treatment
3. Continuous ultrasound at 1 MHz with onset of stretching 10 minutes after the
ultrasound treatment
4. Continuous ultrasound at 1 MHz with stretching for 10 minutes during and
immediately after the ultrasound treatment
Stretching should be done during and immediately after the ultrasound treatment. 1 MHz
continuous ultrasound provides the greatest thermal effects and would facilitate the stretch.
129) During an initial physical therapy evaluation, a patient reports occasional
breathlessness. Which of the following patient reports indicates the PRIMARY need for
a more thorough pulmonary examination by the physical therapist?
1.
2.
3.
4.
There is paroxysmal nocturnal dyspnea.
The symptoms are relieved by leaning forward.
There has been a recent change in physical activities.
The breathlessness is associated with light-headedness.
Paroxysmal nocturnal dyspnea is common in severe heart disease. Relieving the
breathlessness symptoms by a positional change is suggestive that the problem is
pulmonary in origin. Occasional breathlessness may be expected with a change in physical
activities, but more history should be taken to determine if the change is expected. Lightheadedness is more indicative of a cardiac problem.
130) A 90-year-old hospitalized patient was referred for physical therapy evaluation and
intervention following a C5 fracture secondary to a fall. The patient describes neck pain
and left knee pain but reports no other postinjury changes in the extremities. The
rehabilitation prognosis for the patient should PRIMARILY be based on:
1.
2.
3.
4.
prior level of function.
left knee range of motion.
use of a cervical collar.
upper extremity sensory integrity.
Understanding a patient’s prior level of function is the most critical factor in a patient’s
history to determine a reasonable prognosis, as this information establishes the baseline
for recovery. Although knee range of motion and upper extremity sensory integrity should
be monitored, neither is more critical than prior level of function as a determinant of
prognosis. Although a cervical collar is a potential intervention, its use is not more critical
than prior level of function as a determinant of prognosis.
131) During examination of a patient, a physical therapist visually observes signs of
Charcot disease. Which of the following signs or symptoms would MOST likely be
present and consistent with this diagnosis?
1.
2.
3.
4.
Erythema
Sharp or stabbing pain in the forefoot
Increased sensitivity to touch
Open ulcer over the second metatarsal head
A Charcot joint is painless and usually undetected by the patient secondary to decreased
sensation and neuropathy. Because of the increase in blood flow, patients present with
erythema.
132) A physical therapist is reviewing the medical record of a patient in the intensive care
unit. The patient was admitted the previous night through the emergency department
after a motorcycle accident resulting in a fractured right femur. The therapist notes a
physician’s order for a Doppler study of the left leg. The therapist should:
1. proceed with the evaluation and intervention without any changes.
2. withhold physical therapy until results of the study are obtained and interpreted by
the physician.
3. proceed with the evaluation and limit intervention to transfer to a bedside chair.
4. obtain clearance from the nurse to provide intervention for the patient.
A complete physical therapy evaluation and treatment is contraindicated due to a possible
deep vein thrombosis. A physician’s order for a Doppler study indicates possible deep vein
thrombosis, so the physical therapy should not be conducted until the Dopler study is
completed and the results analyzed by the physician. Transfer from bed to chair is
contraindicated due to possible deep vein thrombosis. The nurse alone should not be
providing clearance, until the Doppler study has been completed and interpreted.
133) A physical therapist is working with an outpatient who had a cerebrovascular
accident and currently lives in an assisted-living facility. Which of the following
statements is the MOST appropriate functional goal for this patient?
1. The patient will be able to don an ankle-foot orthosis with assistance.
2. The patient will independently walk 165 ft (50 m) with a straight cane from the
bedroom to the cafeteria.
3. The patient will have Normal (5/5) strength of the quadriceps muscles.
4. The patient’s balance will improve to be able to independently stand on the involved
lower extremity for 20 seconds.
The goal in option 2 is the only goal that is objective, measurable, and functional. The goals
in options 1, 3, and 4 lack function or specific measurable objective information.
134) A physical therapist is examining a patient with congestive heart disease who takes
diuretics. Which of the following lower extremity conditions is MOST likely?
1.
2.
3.
4.
Pallor
Shiny skin
Pitting edema
Absence of hair growth
When the right side of the heart starts to fail, fluid collects in the feet and lower legs,
causing pitting edema. Pallor, shiny skin, and absence of hair growth are characteristic of
arterial disease, but not associated with congestive heart failure.
135) A physical therapist is examining the integumentary system of a patient and notes
an area of black, hardened eschar on the tip of the first toe. The therapist would MOST
likely conclude that the patient has which of the following conditions?
1.
2.
3.
4.
Frostbite
Diabetes
Only superficial damage of the skin at that site
At least full-thickness damage of the skin at that site
The presence of black necrotic tissue indicates full-thickness loss of the skin. The cause of
the necrosis cannot be determined with the information in the stem.
136) A physical therapist is prescribing an exercise program to assist a patient in a weight
loss program. The patient has type 1 diabetes. The patient should be advised to begin
an exercise session only if the blood glucose level is:
1.
2.
3.
4.
below 60 mg/dL.
above 250 mg/dL.
between 60 and 100 mg/dL.
between 100 and 250 mg/dL.
If a person begins exercise when blood glucose is below 100 mg/dL or above 250 mg/dL,
significant exercise-related complications may result.
137) In planning a physical therapy program for geriatric patients, an important agerelated change that should be taken into consideration is:
1.
2.
3.
4.
the inability to learn new motor tasks.
decreased pain sensation.
decreased motivation.
the inability to select alternative movement strategies.
Neurological changes that are age related include decreased pain and vibratory sensation.
The other changes listed do not normally occur with aging in the absence of pathology.
138) A physical therapist is examining the integumentary system of a patient with dark
skin pigmentation and notices a deepening of the skin color over the left posterior
aspect of the calcaneus. Which of the following findings would indicate a Stage I
pressure ulcer at that site?
1. Decreased skin temperature, compared to the surrounding tissue
2. Increased skin temperature, compared to the surrounding tissue
3. Blanching with applied pressure that returns to previous coloring within 30 seconds
after the removal of pressure
4. Blanching with applied pressure that returns to previous coloring 1 hour after the
removal of pressure
The onset of a Stage I pressure ulcer is characterized by nonblanching erythema and
decreased skin temperature over the site of the ulcer. Because blanching is difficult to
ascertain in patients with dark skin, use of skin temperature for assessment of pressure
ulcers is preferred.
139) A physical therapist is studying the effects of three treatments of ataxia. Patients
were recruited from a local clinic and were randomly assigned to one of the three
treatment conditions. Functional measurements were taken at 6 months after the start
of treatment. Which of the following statistical tests is MOST appropriate for data
analysis in this study?
1.
2.
3.
4.
Factorial analysis of variance
One-way analysis of variance
Independent sample t-test
Repeated-measure t-test
In a single-factor experiment, the one-way analysis of variance is applied when three or
more independent group means are compared. The descriptor one-way indicates that the
design involves one independent variable, which is the case in the present scenario. All
subjects were recruited from the same clinic and underwent the same length of treatment.
The only difference among the three groups of subjects was the treatment group to which
they were assigned.
140) A physical therapist is evaluating the cranial nerves of a child who has a
medulloblastoma. The child’s right eye deviates medially. The child has impairment of
which of the following cranial nerves?
1.
2.
3.
4.
Oculomotor (III)
Trochlear (IV)
Abducens (VI)
Vagus (X)
The oculomotor nerve (III) controls the inferomedial eye muscles. The trochlear nerve (IV)
controls inferolateral eye movement. The abducens nerve (VI) controls lateral eye
movement. Damage to this nerve causes the eyeball to deviate medially due to weakness
of the lateral rectus muscle. The vagus nerve (X) does not control the eye muscles.
141) A physical therapist is preparing to teach a patient with Guillain-Barré syndrome to
transfer from wheelchair to mat table. The patient weighs 150 lb (68 kg) and has Poor
(2/5) strength in both of the lower extremities and Fair (4/5) strength in the left upper
extremity. The right upper extremity has Normal (5/5) strength. Which of the following
assisted transfers is MOST appropriate for the patient’s initial session?
1.
2.
3.
4.
Two-person lift to the right side
Sliding-board transfer to the right side
Hydraulic lift from wheelchair to mat
Full standing-pivot transfer to the right side
Because the patient has significant weakness in both lower extremities, a standing pivot
transfer would not be safe. However, since the patient does have fair to normal upper
extremity strength and is not totally dependent, a hydraulic lift or two-person lift would not
be appropriate because it would not enhance the patient’s functional skills. The most
appropriate transfer method would be for the patient to use a sliding board transfer to the
strongest (right) side.
142) A physical therapist has been working with a patient who has a spinal cord injury. To
document that the patient has been educated about skin care, the therapist should
record that the patient:
1.
2.
3.
4.
is unable to tolerate more than 1 hour in a wheelchair.
has good strength of the scapular depressors and elbow extensors.
is able to state three causes of skin breakdown.
is able to perform 10 push-ups in the wheelchair.
Option 3 is the only one stated clearly in educational terms. The other options are
objectives based on observations.
143) Increased residual volume is LEAST likely to be a finding in pulmonary function
testing of a patient with which of the following conditions?
1.
2.
3.
4.
Atelectasis
Bronchiectasis
Chronic bronchitis
Emphysema
Atelectasis occurs when one or more segments or lobes of the lung is collapsed. It often
occurs following thoracic or upper abdominal surgery, when the patient has a reduced total
lung capacity, functional residual capacity, and residual volume. Bronchiectasis is an
abnormal dilation of the bronchi and bronchioles and results in increased residual volumes.
The primary symptom of chronic bronchitis is chronic productive cough and results in
increased residual volume. Emphysema usually results in significantly increased residual
volumes.
144) During pregnancy, which of the following exercises is CONTRAINDICATED?
1.
2.
3.
4.
Curl-ups
Bridging
Double leg lifts
Deep breathing with forced expiration
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.
145) A patient who is being taught a new motor task is MOST likely to require full
attention to the task and extrinsic feedback during which phase of motor learning?
1.
2.
3.
4.
Cognitive
Associative
Autonomous
Executive
Early learning in the 1st phase of motor learning (the cognitive phase) requires full attention
to the task and extrinsic feedback. As the task is learned, feedback can become more
intrinsic and less attention to task is required.
146) A patient with a recent ankle injury reports anterior ankle pain while walking. Pain is
reproduced ONLY during passive rotation of the lower leg. The patient most likely
sustained which of the following injuries?
1.
2.
3.
4.
Syndesmosis sprain
Calcaneocuboid sprain
Fifth metatarsal fracture
Tibial stress fracture
Option 1 tests the integrity of the tibiofibular syndesmosis. With a positive test result, the
patient will have reproduction of symptoms and in this case, anterior ankle pain. Lateral
(external) rotation of the tibia may potentially compress the calcaneocuboid joint but would
not stress the ligaments. A 5th metatarsal fracture would not present with anterior ankle
pain. Option 4 does not load the tibia and/or muscles enough to provoke pain from a stress
fracture.
147) To avoid the appearance of increased motion, what movement MUST be prevented
during goniometric measurement of shoulder abduction?
1.
2.
3.
4.
Upward rotation of the scapula
Medial (internal) rotation of the shoulder
Lateral (external) rotation of the shoulder
Lateral flexion of the trunk to the opposite side
During measurement of shoulder abduction, the trunk should be kept straight. If the patient
is allowed to laterally flex the trunk, it will give the appearance of increased shoulder
abduction, but the motion would be occurring in the spine and not in the shoulder. Upward
rotation of the scapula and lateral (external) rotation of the shoulder would normally
accompany the motion of shoulder abduction. Medial (internal) rotation of the shoulder
would decrease the available abduction.
148) Which of the following pulmonary function tests measures the average total amount
of air moved during inspiration in a patient with normal breathing?
1.
2.
3.
4.
Vital capacity
Inspiratory capacity
Tidal volume
Inspiratory reserve volume
Vital capacity is measured from maximum inhalation to maximum exhalation. Inspiratory
capacity measures volume with maximal inhalation. Tidal volume measures total volume of
air moved during either inhalation or exhalation over a specific period of time (usually 1
minute) and then divided by the ventilatory rate. Inspiratory reserve volume measures
inspiratory volume beyond normal inspiration.
149) A physical therapist is evaluating a patient who has a chest tube. The therapist
accidentally knocks over the collection reservoir. The therapist should return the
reservoir to the upright position and:
1.
2.
3.
4.
hang it on an intravenous pole.
place it on the patient’s bedside table.
hang it from the side of the bed.
contact the physician.
The reservoir must be placed below the level of the heart. Notifying the nurse would be
sufficient. Notifying the physician is unnecessary.
150) A physical therapist is examining a patient with an upper lumbar radiculitis. Which of
the following combinations of movements is MOST likely to reproduce the pain
associated with the radiculitis?
1.
2.
3.
4.
Supine knee extension with hip flexion
Supine knee flexion with hip flexion
Prone knee flexion with hip extension
Prone knee extension with hip extension
Supine knee extension with hip flexion places a stretch on the sciatic nerve, which involves
lower lumbar nerve roots (L4–S3). Knee flexion with hip flexion would not place a stretch on
the femoral nerve. An upper lumbar radiculitis involves the nerve roots that form the
femoral nerve (L2–L4). The femoral nerve can be stretched or provoked, by extending the
hip while flexing the knee. Prone hip extension would place a stretch on the femoral nerve,
but there would be less stretch with the knee in extension than in flexion.
151) A patient with an impairment that limits hip flexion to 105° will benefit MOST from
which of the following assistive devices and modifications to accomplish activities of
daily living?
1.
2.
3.
4.
Elevated chair-seat height
Long-handled reacher
Decreased rise in stair height
Sock aid
Normal sitting requires about 105° of hip flexion, so an elevated chair would not be
necessary. Reaching would not be as restricted as donning socks. The reacher would not
be effective in assisting with shoes and socks and may be overused. Stair climbing requires
about 60° to 70° of hip flexion, and step height modification would not be needed. To reach
to the foot, approximately 120° of hip flexion is required. If a modified procedure is chosen
with the foot across the opposite thigh, at least 110° of hip flexion is still required. With only
105° of hip flexion, the patient would have most difficulty putting on socks.
152) A patient with hemiparesis demonstrates foot drop during the swing phase of gait.
The MOST appropriate application of functional electrical stimulation would be to treat
both the tibialis anterior and which of the following muscles?
1.
2.
3.
4.
Gastrocnemius
Tibialis posterior
Extensor digitorum longus
Fibularis (peroneus) longus
During the swing phase of gait, the foot is dorsiflexed to clear the floor. Muscles active
during this phase of gait are the tibialis anterior, extensor hallucis longus, and the extensor
digitorum longus. The gastrocnemius, tibialis posterior, and fibularis (peroneus) longus are
active during stance phase of gait. Therefore, of the muscles listed, the extensor digitorum
longus is the best choice. If only the tibialis anterior was stimulated, the foot would go into
inversion and dorsiflexion, which could cause the patient to land on the lateral side of the
foot at initial contact, causing injury. Addition of the extensor digitorum longus would bring
the foot up into more dorsiflexion and avoid excessive inversion.
153) A physical therapist plans to study the effect of cold compresses on passive range of
motion in two groups of subjects: an experimental group and a control group. For the
experimental group, the cold compress will be applied to the hamstring muscles 1
time/day for 5 days. Which of the following experimental methods is MOST appropriate
for this study, in order to compare the effect of the cold compresses between the two
groups?
1.
2.
3.
4.
For the experimental group, gather range-of-motion data prior to each treatment.
For both groups, measure range of motion on day 5.
For both groups, measure range of motion on days 1 and 5.
For the experimental group, measure range of motion every day. For the control
group, measure range of motion on days 1 and 5.
The most appropriate design would be a two-group pretest-posttest. Both groups are
measured at the same times, but only the experimental group receives treatment.
Gathering information from patient records may not provide the same accuracy as would be
provided if the researcher had performed all of the measurements directly. Measuring ROM
only on day 5 would not account for any pretest differences between groups. Measuring the
experimental group more frequently than the control group may have an effect on the
dependent variable.
154) A physical therapist is working with a patient who is aware of being terminally ill.
What is the MOST appropriate intervention when the patient wants to talk about the
prognosis?
1.
2.
3.
4.
Discourage discussion of death or dying.
Refer the patient for pastoral counseling.
Relate the therapist’s experiences with other patients.
Encourage the patient’s expression of feelings.
Patients should be encouraged to express their feelings. Comparisons to other patients
who are dying, in an effort to assure the patient he is not alone, takes away from this
patient’s feelings. Denial of death would not be good for the patient, since he must
ultimately cope with the inevitable. Pastoral counseling would be an option, but the
therapist should be ready to listen to the patient, encourage expression of feelings, and
avoid denial.
155) A physical therapist is examining a patient who was unaware of a circular ulcer on
the plantar surface of the second metatarsal head. The patient is noted to have hammer
toes. Which additional findings are MOST likely?
1.
2.
3.
4.
Normal arterial pulses
Increased sweating over the foot
Increased pain with elevation of the foot
Altered biomechanics when weight-bearing
The location of the painless ulcer is characteristic of a neuropathic (diabetic) ulcer. Loss of
sensation renders the patient unaware of the repetitive trauma from altered biomechanics
due to weakness of the intrinsics, which leads to hammer toes, and abnormal pressure on
the plantar foot when weight-bearing. Increased pain with foot elevation is characteristic of
arterial ulcers, which are painful. Normal arterial pulses may be present with a venous
ulcer, but arteries are often calcified with advanced diabetes. A neuropathic foot is warm
and dry.
156) A physical therapist examining wrist-joint play finds restriction in the direction
indicated by the arrow. To address the restriction, the therapist should include an
intervention to increase which motion of the index finger (2 nd digit)?
1.
2.
3.
4.
Flexion
Extension
Abduction
Rotation
The therapist is shown performing a volar glide, which is the same joint motion used for
finger flexion. Limited motion in this direction indicates limited ability to perform finger
flexion.
157) A physical therapist is treating a patient who has diabetes mellitus. Which of the
following information is MOST important to include when educating the patient about the
benefits of exercise?
1.
2.
3.
4.
Blood glucose levels increase during exercise.
Weight training is preferred to aerobic exercise for patients with diabetes.
Exercise can reduce the amount of insulin the patient must administer.
Exercising before meals is recommended for patients with diabetes.
One of the benefits of exercise is improved insulin sensitivity, which reduces the amount of
insulin needed. Blood glucose levels decrease during exercise. Patients with diabetes
should not exercise before meals because this timing increases the risk of hypoglycemia.
Aerobic exercise is just as important for people who have diabetes as for healthy people,
so weight training is not preferable.
158) A patient has pain, edema, and tenderness over the medial border of the hand. The
patient also shows changes in the color and temperature of the skin, hyperhidrosis, and
progressive joint stiffness in the wrist and hand. The MOST likely cause of the patient’s
signs and symptoms is:
1.
2.
3.
4.
cervical disc disease.
Raynaud phenomenon.
complex regional pain syndrome.
carpal tunnel syndrome.
All of these symptoms are indicative of complex regional pain syndrome. Cervical disc
disease does not produce swelling in the hand, color and temperature changes, or
hyperhidrosis. Raynaud phenomenon results in pain, pallor, and coolness, but no
hyperhidrosis. Although carpal tunnel syndrome can also show sympathetic nervous
system abnormalities, compression of the median nerve would refer symptoms to the
lateral border of the hand (thumb area). With carpal tunnel syndrome, the patient may also
display thenar muscle weakness.
159) A physical therapist is planning a patient education program for a group of patients
with chronic low back pain. The therapist should use which of the following strategies to
MOST increase the likelihood that the patients will utilize the proper body mechanics
they learn?
1.
2.
3.
4.
Ask the patients to demonstrate use of proper body mechanics.
Provide a reference list of articles describing body mechanics.
Ask the patients to describe actions they do that increase their back pain.
Provide information on the frequency of low back injuries due to improper body
mechanics.
Evaluation of the patients’ retention of the information presented in the program can be
enhanced by asking the patients questions about the program information, having the
patients ask questions about the program, having the patients demonstrate what they have
learned, and testing the patients about the program material. Option 1 is the only option
that includes one of these techniques. The other options do not require active participation
by the patients and do not address specific interventions.
160) A physical therapist should expect a patient to describe pain associated with a 5year history of rheumatoid arthritis as:
1.
2.
3.
4.
morning pain with stiffness that improves with activity.
pain that is worse at the beginning of an activity.
constant pain that lasts throughout the day.
pain that increases throughout the day.
Chronic inflammatory disorders such as rheumatoid arthritis are often associated with
morning pain and stiffness that decrease throughout the day with activity. Pain that is worse
at the beginning of an activity implies acute inflammation. Constant pain suggests tumors
or a visceral cause. Pain that increases throughout the day indicates increased congestion
in a joint.
161) Use of ice massage to affected area(s) is MOST appropriate for a patient who has
which of the following problems?
1.
2.
3.
4.
Trigger point in the upper trapezius muscle
Spasticity of the plantar flexor muscles after stroke
Exercise-induced soreness of abdominal muscles
Decreased extensibility of bilateral hamstrings muscles
Ice massage is used to treat a small area, such as a trigger point in a muscle. Ice is applied
to produce analgesia and allow for deep pressure massage over the trigger point and
stretching of the muscle. Treating large areas, such as the lower leg (as in option 2), is
done more efficiently with cold baths or cold packs than with ice massage. Cryotherapy
increases stiffness and decreases tissue extensibility (p 76) and so would not be indicated
for stretching hamstrings.
162) A patient presents with sudden onset of weakness of the facial muscles on the right
side. The patient is unable to wrinkle the forehead, smile, pucker the lips, or wrinkle the
nose. There is an absence of tearing in the patient’s right eye, diminished taste
sensation on the right side of the tongue, and dryness of the mouth. The patient’s
corneal reflex is absent on the right but normal on the left, and pinprick and temperature
sensation are normal on both sides of the face. This presentation is characteristic of:
1.
2.
3.
4.
trigeminal neuralgia.
Bell palsy.
left cortical cerebrovascular accident.
oculomotor nerve damage.
Trigeminal neuralgia causes facial pain. All of the signs and symptoms in the question are
indicative of a partial nerve lesion affecting the facial nerve. This type of lesion is Bell palsy.
A left cerebrovascular accident affects only the lower facial muscles below the eye.
Damage to the oculomotor nerve causes paralysis of one or more of the muscles that
moves the eyeball.
163) Which of the following interventions is MOST appropriate for a patient with juvenile
rheumatoid arthritis who is experiencing painful swelling of both knees?
1.
2.
3.
4.
Resistive exercises
Stretching to prevent contractures
Gentle, active exercises
Walking program
All of the options, except for gentle, active exercises, are precautions or contraindications
for this patient.
164) A physical therapist is considering whether the results of a study can be usefully
applied to practice settings other than the one in which the study was conducted. Which
of the following types of validity is of MOST concern in this scenario?
1.
2.
3.
4.
Internal
Construct
Concurrent
External
External validity is concerned with the issue of how the results of the research can be
generalized.
165) Treatment of a patient with hemophilia who has a subacute hemarthrosis of the knee
should INITIALLY include:
1.
2.
3.
4.
active assistive range-of-motion exercise to the knee.
instruction of the patient for weight bearing to tolerance.
gentle resistive range-of-motion exercise to the knee.
continuous immobilization of the knee in an extension splint.
In this stage of hemarthrosis, there is still some bleeding into the joint space, but it is not as
extensive as during the acute phase. Therefore the patient will benefit from range-of-motion
exercise to prevent contracture. The patient may need active-assist, as there may still be
pain or edema in the joint that prevents independent performance of range of motion. The
mechanical trauma of weight bearing to tolerance at this stage may impinge on and
damage the pathologic synovium within the joint. Resistive range of motion is more
appropriate when pain and swelling have subsided and no bleeding is occurring.
Continuous immobilization in the extended position will promote contracture in the
edematous knee.
166) A patient with a traumatic brain injury is being discharged to home after completion
of inpatient rehabilitation. Which of the following assessment tools should be used to
BEST assess the patient’s potential?
1.
2.
3.
4.
Glasgow Outcome Scale
Fugl-Meyer Assessment
Rancho Los Amigos Levels of Cognitive Functioning Scale
Sickness Impact Profile
The Glasgow Outcome Scale is used as a general outcome measure, and in prognostic
studies. The Fugl-Meyer Assessment should be used only with patients who have had a
stroke. The Rancho Los Amigos Levels of Cognitive Functioning is a descriptive scale that
outlines a predictable sequence of cognitive and behavioral recovery as a patient emerges
from a coma. The Sickness Impact Profile is used to measure general health status and is
self-administered; therefore, it would not be useful as a prognostic discharge tool for a
patient with a traumatic brain injury.
167) Which of the following examination findings would MOST likely be positive in a
patient with cauda equina syndrome?
1.
2.
3.
4.
Ankle clonus
Babinski sign
Urinary retention
Positive prone knee flexion test
Cauda equina causes lower motor neuron dysfunction, including urinary retention and
incontinence. Positive Babinski and clonus responses indicate upper motor neuron
dysfunction. A positive prone knee flexion test is more likely with upper lumbar nerve root
impairment.
168) A patient with low back pain has been undergoing treatment for two sessions. During
the current treatment session, the patient tells the physical therapist that 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 therapist's MOST appropriate
response is to:
1.
2.
3.
4.
continue with the present program.
eliminate the extension exercises.
consult the patient’s physician about the situation.
progress to trunk flexion exercises.
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.
169) A patient is receiving physical therapy intervention for rheumatoid arthritis, which is
in remission. Which of the following interventions is MOST appropriate for the patient?
1.
2.
3.
4.
Contract-relax stretching for tight structures
End-range mobilization techniques
Elimination of functional activities of involved parts
Strengthening exercises for weak muscles
Contract-relax stretching for tight structures is not recommended for soft tissues
compromised by rheumatoid arthritis. Grade IV mobilization techniques are contraindicated
for soft tissues compromised by rheumatoid arthritis. The elimination of functional activities
is not required. Strengthening exercises are the most appropriate intervention for a patient
with rheumatoid arthritis in remission.
170) A patient with chest pain from myocardial ischemia will MOST likely exhibit:
1. increased pain upon chest-wall palpation.
2. increased pain with deep breathing.
3. relief with nitroglycerin (Nitrostat) ingestion.
4. relief with antacid ingestion.
Increased pain with chest-wall palpation is more indicative of a musculoskeletal origin of
pain. Increased pain with deep breathing is more indicative of a pulmonary origin of pain.
Nitroglycerin (Nitrostat) is a common vasodilator that is prescribed for patients who have
angina. Ingestion of a vasodilator will improve myocardial blood flow and help relieve
ischemia and its manifestations. Relief of pain with antacid ingestion is more indicative of
referred pain from peptic ulcer disease.
171) During a posture examination, the physical therapist notes that both of the patient’s
patellae point inward when viewed from the front of the patient. The MOST likely cause
of this problem is excessive:
1.
2.
3.
4.
femoral anteversion.
weakness of the vastus medialis.
genu varum.
medial tibial torsion.
The most common cause of inwardly pointing or “squinting patellae” is excessive femoral
anteversion. Although there is normally 8° to 15° of femoral anteversion, an excessive
amount leads to squinting patellae and toeing in. The other options would all have a
tendency to cause the patellae to point outward during standing.
172) Which of the following statements does NOT document patient outcome?
1. The patient propelled his wheelchair independently after 4 weeks.
2. The patient demonstrated independent performance of a home program after 2
weeks.
3. The patient walked 100 ft (30.5 m) with minimal assistance after 1 week.
4. The patient attended physical therapy sessions 3 times/week for 2 weeks.
An outcome measure documents a desired performance or change in the patient’s
condition over time. This may include a description of the patient’s function before, during,
and after intervention. Option 4 does not indicate a change or function but is focused on
attendance.
173) A patient sustained a gunshot wound to the spine in the area of L1. The patient has
weakness of the left lower extremity and inability to move the knee, ankle, or foot. The
patient’s patellar tendon and Achilles tendon reflexes are increased on the left side.
There is also loss of proprioception in the patient’s left ankle and knee, a positive
Babinski sign on the left side, and diminished sensation to pinprick and temperature
changes in the right thigh, leg, and foot. Results of all of the patient’s cranial nerve tests
are normal. These findings are consistent with which of the following injuries?
1. Complete severance of the spinal cord
2. Injury to the left anterior horn of the spinal cord
3. Injury to the left side of the spinal cord
4. Injury to the central area of the spinal cord
Complete severance of the spinal cord causes motor and sensory loss on both sides of the
body. A lesion of the anterior horn cells causes a lower motor neuron problem and
hyporeflexia. The signs and symptoms presented in the question point to a hemisection of
the spinal cord on the left side, which gives rise to ipsilateral motor and proprioception loss
and contralateral loss of pain and temperature. Also present are hyperreflexia and a
positive Babinski sign on the left side. A lesion of the central spinal cord usually spares the
motor tracts.
174) Which of the following interventions would MOST specifically address expected
complications from radiation therapy to the pelvic region?
1.
2.
3.
4.
Anterior hip stretching
Splinting while coughing
Progressive abdominal strengthening
Pelvic stabilization exercises
Radiation of the pelvic cavity often causes dense pelvic adhesions that can restrict motion
due to pain. Of the options, stretching exercises are most specific to address this
complication.
175) Which of the following types of patients should have the most detailed and lengthy
home exercise program?
1.
2.
3.
4.
A patient with acute symptoms
A patient with irritable symptoms
A patient who has good body awareness
A patient who has physical therapy visits once a week
As the frequency of visits decreases and the time between visits increases, the patient
requires a more detailed home program with specific progression instructions.
176) A physical therapist measures the forced expiratory volume in 1 second (FEV 1) of a
patient with mild pulmonary obstructive disease and determines a FEV1/FVC (forced
vital capacity) ratio of 60%. The therapist should recognize that the patient:
1.
2.
3.
4.
has a normal FEV1 value.
will require careful monitoring during aerobic exercise.
should not exercise beyond 60% of the patient’s predicted maximal heart rate.
should not perform aerobic exercise without physician approval.
Regarding option 1, a ratio of 75% is considered normal. Regarding option 2, the patient
has a mild disease. Advanced obstructive disease can have values of 25%. Nonetheless,
the patient has mild morbidity, so special precautions should be used. Regarding option 3,
the patient has a mild disease and is not yet showing signs of morbidity, so special
precautions should not be necessary. There would be no need to limit heart rate to 60% if
the patient tolerates the exercise. An FEV1/forced vital capacity ratio of 60% is a mild loss.
Avoidance of aerobic exercise should not be required, and special physician approval
related to a value of 65% should not be necessary.
177) Which of the following skin color changes is MOST likely to be sign of liver disease?
1.
2.
3.
4.
Pallor
Jaundice
Cyanosis
Hyperpigmentation
Jaundice is a sign of liver disease.
178) Acquired immunodeficiency syndrome is MOST likely present in a patient with which
of the following hematologic conditions?
1.
2.
3.
4.
CD4 count of 150 cells/mL
High antinucleoprotein antibody titer
High human leukocyte antigen titer
Neutrophil count of less than 5000 cells/mm3
Patients with AIDS include those who have HIV-1 and a CD4 count below 200 cells/mL. A
low neutrophil count or a high ANA or HLA titer are not specific to the presence of HIV.
179) A patient with leukemia has developed thrombocytopenia after a bone-marrow
transplant. Which of the following measures is indicative of the status of the
thrombocytopenia?
1.
2.
3.
4.
T4 lymphocyte count
Red blood cell count
Platelet count
White blood cell count
Thrombocytopenia is an acute or chronic decrease in the number of platelets in the
circulation. The T4 lymphocyte count is used to assess immune status in patients with HIV
or AIDS. The red blood cell count is utilized to assess for presence of anemia, and the
white blood cell count would be examined to determine presence of infection or degree of
immunosuppression.
180) Which of the following factors is considered to be a primary risk factor for
atherosclerosis?
1.
2.
3.
4.
Stress
Obesity
Cigarette smoking
Sedentary lifestyle
High blood pressure, cigarette smoking, and hyperlipidemia are direct or primary risk
factors for atherosclerosis. Secondary risk factors include age, gender, race, obesity,
stress, and activity level.
181) Which of the following statements is an appropriately written short-term goal?
1. In 2 weeks, the patient will increase walking distance from 50 ft to 100 ft (15 m to 30
m) with a wheeled walker.
2. The patient will walk 100 ft (30 m) with a wheeled walker and minimal assistance in
3 weeks.
3. In 4 weeks, the patient will walk with minimal assistance 100 ft (30 m) without loss of
balance.
4. The patient will increase walking distance from 50 ft to 100 ft (15 m to 30 m) with a
wheeled walker independently by discharge.
Option 1 does not specify the amount of assistance. Option 2 is a measurable, specific, and
objective goal. Option 3 does not specify the device the patient will be using. Option 4 is a
goal that is to be achieved by discharge, which would be a long-term goal, not a short-term
goal.
182) Which of the following nerves innervates the pelvic floor muscles?
1.
2.
3.
4.
Sciatic
Pudendal
Inferior gluteal
Genitofemoral
The pelvic floor muscles are innervated by sacral nerve roots S 2–S4 through the pudendal
nerve. The inferior gluteal nerve is a motor nerve that innervates the gluteus maximus. The
sciatic nerve contains nerve roots from L4–S3 and innervates multiple muscles in the lower
leg. The genitofemoral nerve, which is from L1–L2, is a cutaneous nerve that is sensory and
not motor.
183) A patient with a recent onset of rheumatoid arthritis is MOST likely to report which of
the following symptoms?
1.
2.
3.
4.
Heat intolerance
Malaise and fatigue
Tension headaches
Nausea and diarrhea
Malaise and fatigue are common symptoms during the beginning stages of rheumatoid
arthritis. Tension headaches, heat intolerance, and nausea and diarrhea are not associated
with rheumatoid arthritis.
184) For a patient with type 1 diabetes who is completing a cardiovascular fitness
program, what change in diabetic management is MOST likely to be instituted as fitness
increases?
1.
2.
3.
4.
Switching to oral rather than injected medication
Decreasing caloric intake for 2 to 3 hours following exercise sessions
Decreasing the amount of insulin taken daily
Increasing the amount of insulin taken daily
Exercise has been shown to increase sensitivity of the insulin receptors, leading to a
decrease in the amount of insulin required. Administration of medication is dictated by
tolerance and efficacy of the medication and would not necessarily be altered by exercise.
In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of
24 to 48 hours after exercise; therefore, an increase in caloric intake, particularly intake of
carbohydrates, would be essential.
185) A physical therapist is evaluating a patient who had a cerebrovascular accident and
is exhibiting poor foot and ankle control. When asked to lift the foot more during the
midswing phase of gait, the patient dorsiflexes the ankle with excessive eversion. To
correct this problem, facilitatory electromyographic biofeedback is MOST likely to be
used with which of the following muscles?
1.
2.
3.
4.
Extensor digitorum longus
Tibialis anterior
Fibularis (peroneus) brevis
Flexor hallucis longus
The patient has too much eversion during the midswing phase. This is probably caused by
too much activity in the extensor digitorum longus or extensor hallucis longus. To correct
the situation, the tibialis anterior should be facilitated, because it dorsiflexes and inverts but
doesn’t cause eversion. The fibularis brevis, an everter, would cause plantar flexion of the
foot rather than dorsiflexion. The flexor hallucis longus does not dorsiflex the ankle.
186) What skin change associated with aging has the GREATEST effect on wound
healing?
1.
2.
3.
4.
Reduction in sensation
Decreased elasticity of the skin
Decreased epidermal proliferation
Change in pigmentation
Wounds heal via a complex process involving re-epithelialization. With advanced aging, the
rate of epidermal proliferation decreases.
187) Which of the following questions is MOST appropriate for a functional outcome
measurement tool?
1.
2.
3.
4.
How high can you lift your arm?
How long have you had this pain?
How often do you walk with a limp?
How much does this leg bother you?
Option 1 does not ask about function. It is an impairment-related question, not a functionrelated question. Options 2 and 4 do not ask about function, and even with improvement,
neither would relate to function. Option 3 is taken from the Short Musculoskeletal Function
Assessment. It addresses function and can be used as an outcome question.
188) A patient has adhesive capsulitis of the shoulder joint. The range-of-motion
examination reveals restricted lateral (external) rotation and abduction of the shoulder.
Which of the following mobilization procedures should be performed for the patient
FIRST?
1.
2.
3.
4.
Posterior glide
Distraction
Anterior glide
Lateral (external) rotation
For this patient, the first mobilization procedure would be distraction of the glenohumeral
joint. The distraction separates the joint surfaces and is used as a test of joint play. The
distraction can also help increase joint play. Distraction may also be used in conjunction
with the other mobilization techniques listed. Later mobilization techniques would most
likely include anterior glide.
189) A patient with right piriformis syndrome is referred to physical therapy for evaluation
and intervention. The patient’s history includes a total hip arthroplasty on the right side 2
years ago. Which of the following interventions requires added precaution for this
patient?
1.
2.
3.
4.
Transcutaneous electrical nerve stimulation
Continuous ultrasound
Hot packs
Massage to the right hip
The only one of the interventions listed that requires precaution because of the total hip
replacement is continuous ultrasound. However, that does not mean that ultrasound is
contraindicated for this patient. Transcutaneous electrical nerve stimulation may be used
over metal implants. Hot packs and massage would not affect the total hip prosthesis.
190) An adult patient who was involved in a motor vehicle accident has sustained multiple
traumas, including fractured ribs on the right side. The patient is unconscious, intubated,
and receiving mechanical ventilation in the intensive care unit. Chest radiographs show
the development of an infiltrate in the right lower lobe during the past 2 days. Crackles
and wheezing are heard over the right lower lung fields. Which of the following chest
physical therapy programs is MOST appropriate?
1. Manual hyperventilation and suctioning while positioned on the left side
2. Positioning in supine for suctioning, followed by manual hyperventilation while
positioned on the left side
3. Suctioning, percussion, and vibration while positioned on the right side
4. Positioning on the left side for deep breathing exercises only
In order to optimally clear the congestion that has developed in the right lower lobe, the
patient should be positioned on the left side to allow gravity to help drain the secretions to
the proximal airways. This patient is also unconscious and intubated, so in addition to
drainage, manual hyperinflation is necessary to provide increased ventilation to help to
mobilize secretions, then suctioning to clear the secretions. Suctioning first then
hyperventilating while in left-sidelying is less effective than the order suggested in Option 1.
Positioning on the right side would not drain the right lower lobe, and since the patient is
lying on the right side, the only place to percuss and vibrate would be the left side, which
has no pathology. Finally positioning on the left side with deep breathing exercises will not
be effective in mobilizing secretions, especially since the patient is unconscious and unable
to actively perform deep breathing exercises.
191) A physical therapy student’s learning style is described as a preference for active
experimentation and concrete experience. For mastering evaluation of musculoskeletal
dysfunction, which of the following educational strategies would be the LEAST effective
approach for the supervising physical therapist to use with this student?
1.
2.
3.
4.
Practicing and providing feedback on examination skills
Role-playing the interview process
Assigning readings about the dysfunction
Self-pacing performance of the evaluation
Practice and feedback of examination skills, role playing the interview process, and selfpaced performance involve active learning with other people in everyday situations. Active
learning relies on feeling and intuition rather than logic and reasoning. Readings do not
meet the learning needs of active experimentation or concrete experience.
192) A physical therapist is planning a full-immersion hydrotherapy treatment. This
treatment is CONTRAINDICATED for which of the following conditions?
1.
2.
3.
4.
Osteoporosis
Peripheral edema
Exercise-induced asthma
Uncontrolled hypertension
Due to the circulatory adaptations needed, patients with uncontrolled hypertension would
not be permitted to use full-immersion techniques. Full-immersion hydrotherapy results in
improvement of edema due to the effects of water pressure, reduced severity of exerciseinduced asthma in comparison to land-based activities, and reduced stress on skeletal
areas in osteoporosis.
193) During examination of a patient, a physical therapist notes bradycardia. The patient
reports constipation and cold intolerance. Which of the following conditions is the MOST
likely cause of this sign and symptoms?
1. Hypothyroidism
2. Hyperthyroidism
3. Hyperparathyroidism
4. Hypoparathyroidism
Hypothyroidism would most likely cause the signs and symptoms. Hyperthyroidism causes
diarrhea, rather than constipation. Hyperparathyroidism is not associated with bradycardia.
Hypoparathyroidism is associated with arrhythmias and either constipation or diarrhea.
194) A patient who had a C6 traumatic spinal cord injury 1 month ago reports a severe,
pounding headache and restlessness while standing in a standing frame. The patient’s
vital signs indicate hypertension and bradycardia. The MOST appropriate immediate
response of the physical therapist is to:
1.
2.
3.
4.
instruct the patient in deep breathing techniques.
apply a cervical cold pack.
remove the abdominal gait belt.
assess for catheter blockage.
Neither deep breathing techniques nor a cervical cold pack would be an effective response
to this emergency situation. Although the abdominal gait belt might be a contributing factor,
it is not the most likely primary cause. This patient scenario is indicative of autonomic
dysreflexia, a pathological reflex. The most common cause is bladder distention or urinary
retention, which is likely to be caused by a urinary catheter blockage.
195) Which of the following lower extremity proprioceptive neuromuscular facilitation
patterns is MOST appropriate for a patient who needs strengthening of the tibialis
posterior?
1. Hip extension, abduction, and medial (internal) rotation, with ankle plantar flexion
and eversion
2. Hip flexion, adduction, and lateral (external) rotation, with ankle dorsiflexion and
inversion
3. Hip extension, adduction, and lateral (external) rotation, with ankle plantar flexion
and inversion
4. Hip flexion, abduction, and medial (internal) rotation, with ankle dorsiflexion and
eversion
The tibialis posterior plantar flexes and inverts the foot. This pattern requires the specific
action of that muscle. The other patterns do not.
196) A physical therapist is evaluating a patient with low back pain and associated
symptoms. Which of the following findings should cause the therapist to refer the patient
back to the physician?
1.
2.
3.
4.
Good (4/5) strength of the hamstrings
Pain radiating down the back of the thigh into the calf
Positive straight-leg test at 60° of hip flexion
Saddle anesthesia around the perineum
Options 1, 2, and 3 are typical with low back pain, and none alone requires immediate
referral. Saddle anesthesia around the perineum is a sign of cauda equine syndrome and
usually requires immediate treatment by someone other than a physical therapist.
197) Which of the following afferent fiber types transmits information regarding aching
pain?
1.
2.
3.
4.
Large unmyelinated fibers
Small unmyelinated fibers
Small myelinated fibers
Large myelinated fibers
Aching pain is transmitted on small, unmyelinated Type C fibers.
198) A therapist is measuring passive knee range of motion in a patient. The
measurements obtained are shown in photographs A and B. The MOST likely cause of
the difference in knee range of motion is:
1.
2.
3.
4.
restriction in the knee joint capsule.
tightness in the rectus femoris.
weakness of the hamstrings.
tightness in the vastus medialis.
Capsular restriction would show up in both measurements. In photograph A, there is more
knee flexion present with the hip flexed. In this position the rectus femoris is on slack
across the hip joint, allowing greater range of knee flexion. In photograph B the rectus
femoris is stretched over both the knee joint and the hip joint, so tightness in the rectus
femoris would restrict knee flexion. Photograph B also shows hip joint flexion. Hamstring
weakness would not affect passive range of motion. Vastus medialis tightness would affect
both measurements.
199) Which of the following monofilament grades indicates that only protective sensation
is intact?
1.
2.
3.
4.
3.61
4.37
5.07
6.65
The 5.07 monofilament supplies the least amount of force that can be sensed by patients
with only protective sensation intact. Ability to sense only the 6.65 monofilament indicates a
loss of protective sensation. Ability to sense the 3.61 and 4.37 monofilaments indicates fully
normal sensation.
200) Which of the following changes is a result of stimulation of the sympathetic nervous
system?
1. Increased blood flow to skin
2. Decreased blood glucose
3. Dilation of bronchioles
4. Rise in heart rate
The sympathetic nervous system is responsible for adjustments in preparation for
emergency situations (fight of flight). With stimulation of the sympathetic nervous system,
the heart rate would rise. Blood flow would be shunted from, not to, the skin. Blood glucose
levels would increase, not decrease, in preparation for increased work. Bronchioles would
constrict, not dilate.