Question 1:

A patient is receiving mobilizations to regain normal mid-thoracic extension. After three sessions, the patient complains of localized pain that persists for greater than 24 hours. The therapist’s treatment should:

Choices:

1.Continue with current mobilizations, followed by a cold pack to the thoracic spine.

2.Place the physical therapy on hold and resume in 1 week.

3.Change mobilizations to gentle, low-amplitude oscillations to reduce the joint and soft tissue irritation.

4.Change to self-stretching activities, because the patient does not tolerate mobilization.

Correct Answer: 3

Rationale:

Changing to low amplitude oscillations will promote a decrease in pain and tissue irritation. If pain persists for over 24 hours, the soft tissue and joint irritation may progress. Continuing the current mobilizations or placing therapy on hold is not appropriate based on the patient’s response. Self-stretching will improve osteokinematic motion but not arthrokinematic motion, making it an inappropriate modification.

Question 2:

A therapist wishes to use behavior modification techniques as part of a plan of care to help shape the behavioral responses of a patient recovering from traumatic brain injury (TBI). The BEST form of intervention is to:

Choices:

1.Reprimand the patient every time an undesirable behavior occurs.

2.Use frequent reinforcements for all desired behaviors.

3.Allow the patient enough time for self-correction of the behavior.

4.Encourage the staff to tell the patient which behaviors are correct and which are not.

Correct Answer: 2

Rationale:

Behavioral modification is best achieved through the use of positive reinforcements for all desired behaviors. Reprimanding negative behaviors or allowing self-correction is not effective behavior modification. Encouraging staff to tell the patient which behaviors are correct lacks the positive reinforcement needed to shape behavior effectively.

Question 3:

A patient recovering from cardiac transplantation for end-stage heart failure is referred for exercise training. The patient is receiving immunosuppressive drug therapy (cyclosporine and prednisone). The therapist recognizes that this patient will:

Choices:

1.Require longer periods of warm-up and cool-down.

2.Be unable to perform resistance training.

3.Require a frequency of 2-3 times/week.

4.Require short bouts of exercise.

Correct Answer: 1

Rationale:

A patient recovering from cardiac transplantation will require longer periods of warm-up and cool-down because physiological responses to exercise and recovery take longer. Resistance training can be performed at low to moderate intensity, and aerobic exercise should be done 4-6 times/week, progressively increasing the duration from 15 to 60 minutes per session.

Question 4:

A patient presents with weakness and atrophy of the biceps brachii resulting from an open fracture of the humerus. The therapist’s examination includes needle electromyography (EMG) of the biceps. The muscle response anticipated after the needle is inserted and prior to asking the patient to contract the muscle is:

Choices:

1.Fibrillation potentials.

2.Electrical silence.

3.Polyphasic potentials.

4.Interference patterns.

Correct Answer: 2

Rationale:

Inserting an EMG needle into a normal muscle causes a burst of electrical activity (insertional activity), after which the muscle produces no sound (electrical silence). Fibrillation potentials are seen in relaxed denervated muscle, and polyphasic potentials are produced in contracted muscle undergoing reorganization.

Question 5:

A patient with diabetes is exercising. The patient reports feeling weak, dizzy, and somewhat nauseous. The therapist notices that the patient is sweating profusely and is unsteady when standing. The therapist’s BEST immediate course of action is to:

Choices:

1.Call for Emergency Services; the patient is having an insulin reaction.

2.Have a nurse administer an insulin injection for developing hyperglycemia.

3.Insist that the patient sit down until the orthostatic hypotension resolves.

4.Administer orange juice for developing hypoglycemia.

Correct Answer: 4

Rationale:

Hypoglycemia, or abnormally low blood glucose, results from too much insulin (insulin reaction). It requires accurate assessment of symptoms and prompt intervention. Have the patient sit down and give an oral sugar (e.g., orange juice). Emergency Services are generally not needed, and profuse sweating does not usually accompany orthostatic hypotension.

Question 6:

A patient with postpolio syndrome started attending a supervised outpatient exercise program. The patient failed to show up for follow-up sessions. The patient reported increased muscle pain and being too weak to get out of bed for the past 2 days. The patient is afraid to continue with the exercise class. The therapist’s BEST course of action regarding exercise is to:

Choices:

1.Decrease the intensity and duration, but maintain a frequency of 3 times/week.

2.Discharge the patient from the program because exercise is counterproductive in postpolio syndrome.

3.Decrease the frequency to once a week for an hour session, keeping the intensity moderate.

4.Reschedule exercise workouts for early morning when there is less fatigue.

Correct Answer: 1

Rationale:

Clinical manifestations of postpolio syndrome include myalgias, new weakness, atrophy, and excessive fatigue with minimal activity. Nonexhaustive exercise and general body conditioning are indicated. A change in the exercise prescription (intensity and duration) is warranted. Exercising to the point of fatigue and exhaustion is not recommended, and once-a-week frequency is too little to be beneficial. Rescheduling to early morning does not address the need to change the exercise prescription. Stopping exercise completely will not help the patient.

Question 7:

A patient is taking a drug from the sympathomimetic group, albuterol (Ventolin). What is the MOST important effect of this medication?

Choices:

1.Increases airway resistance and decreases secretion production.

2.Reduces airway resistance by reducing bronchospasm.

3.Reduces bronchial constriction and high blood pressure (BP) that accompanies exercise.

4.Increases heart rate (HR) and BP to enhance a training effect during aerobic activity.

Correct Answer: 2

Rationale:

Sympathomimetics are a class of drugs that mimic the effects of stimulation of body organs and structures by the sympathetic nervous system. Albuterol (Ventolin) has the primary action of reducing airway resistance by decreasing bronchospasm. Albuterol decreases airway resistance and has no effect on the volume or consistency of airway secretions. The primary effects of albuterol are on β2 receptors in the bronchiole smooth muscle. It may also have an effect on β1 receptors, producing cardiovascular adverse reactions of increased BP and tachycardia.

Question 8:

If a patient has developed a thick eschar secondary to a full-thickness burn, the antibacterial agent MOST effective for infection control is:

Choices:

1.Silver nitrate.

2.Sulfamylon.

3.Panafil.

4.Nitrofurazone.

Correct Answer: 2

Rationale:

Sulfamylon penetrates through eschar and provides antibacterial control. Silver nitrate and nitrofurazone are superficial agents that attack surface organisms. Panafil is a keratolytic enzyme used for selective debridement, not for deep infection control.

Question 9:

An elderly person has lost significant functional vision over the last 4 years and complains of blurred vision and difficulty reading. The patient frequently mistakes images directly in front, especially in bright light. When walking across a room, the patient is able to locate items in the environment using peripheral vision when items are located to both sides. Based on these findings, the therapist suspects:

Choices:

1.Glaucoma.

2.Homonymous hemianopsia.

3.Cataracts.

4.Bitemporal hemianopsia.

Correct Answer: 3

Rationale:

Cataracts cause a clouding of the lens, resulting in a gradual loss of vision. Central vision is lost first, then peripheral vision. Glaucoma produces the reverse symptoms: loss of peripheral vision occurs first, then central vision, progressing to total blindness. Hemianopsia is a field defect in both eyes that often occurs following a stroke. There was no mention of cerebrovascular accident (CVA) in the question.

Question 10:

A therapist conducts a study of the effectiveness of hot and cold in treating patients with pain. Two hundred patients are recruited for each treatment group. The pain instrument used has a possible total score of 50, with 50 being the worst pain. Data analysis reveals that group A (heat modalities) has a mean score of 33 with a standard deviation of 1, whereas group B (cold modalities) had a mean of 35 with a standard deviation of 6. Based on these data, the conclusion one should reach is:

Choices:

1.Heat has a greater effect on pain relief than cold.

2.The spread of scores with cold treatment demonstrates that variability is greater.

3.Cold has a greater effect on pain relief than heat.

4.The spread of scores with heat treatment demonstrates variability is greater.

Correct Answer: 2

Rationale:

The spread of scores with cold treatment (standard deviation of 6) indicates that this treatment produces more variable effects than the heat treatment. All other conclusions cannot be determined based on the data presented and the statistical analysis provided.

Question 11:

A patient presents with pain and instability of the left foot/ankle secondary to poliomyelitis, with more recent development of progressive postpolio muscle atrophy. In this case, a plastic solid ankle-foot orthosis (AFO) is an appropriate prescription in order to:

Choices:

1.Provide modest assistance to dorsiflexion while restricting plantar flexion.

2.Control excessive amounts of knee flexion during stance.

3.Maintain dorsiflexion throughout swing.

4.Restrict all movement.

Correct Answer: 4

Rationale:

A solid AFO is indicated for severe pain or instability, as it limits all foot and ankle movement. Other choices do not adequately address these problems. Dorsiflexion assistance during swing can be provided by a posterior leaf spring device, and excessive knee flexion during stance can be controlled using an anterior stop that limits dorsiflexion.

Question 12:

A patient is referred to physical therapy after an anteroinferior dislocation of the right shoulder. A possible positive examination finding as the result of this trauma would be:

Choices:

1.Weak rhomboids.

2.Positive drop arm test.

3.Weak deltoids.

4.Positive Neer’s test.

Correct Answer: 3

Rationale:

Because of the anatomical position of the axillary nerve, it can be damaged by an anteroinferior dislocation at the glenohumeral joint, resulting in weak deltoids. The drop arm test evaluates the integrity of the rotator cuff, and the Neer test evaluates shoulder impingement. The rhomboids are innervated by the dorsal scapular nerve, which is medial and posterior to the shoulder joint.

Question 13:

The patient with left hemiplegia would be LEAST likely to respond in therapy if the motor learning strategies emphasized:

Choices:

1.Maximum use of verbal cues.

2.Encouraging the patient to slow down.

3.Simplification/restructuring of the environment, including removal of all clutter.

4.Maximum use of demonstration and gesture.

Correct Answer: 4

Rationale:

The patient with left hemiplegia typically demonstrates visuospatial perceptual deficits. Maximum use of demonstration and gesture would be inappropriate to assist this patient in the relearning of motor tasks. The other choices are all valid motor learning strategies that can be used to assist the patient with left hemiplegia.

Question 14:

A 2-week-old infant born at 27 weeks gestation with hyaline membrane disease is referred for a physical therapy consult. Nursing reports that the child “desaturates to 84% with handling” and has minimal secretions at present. The PT should:

Choices:

1.Provide suggestions to nursing for positioning for optimal motor development.

2.Perform manual techniques for secretion clearance, 2-4 hours daily, to maintain airway patency.

3.Put the PT consult on hold, because the child is too ill to tolerate exercise.

4.Delegate to a physical therapy assistant (PTA) a maintenance program of manual techniques for secretion clearance.

Correct Answer: 1

Rationale:

Excessive handling of a premature infant can cause oxygen desaturation. It is in the best interests of the infant to limit the number of handlers. The PT’s role should be to assist nursing in developing positioning schedules, positions for feeding, infant stimulation activities, etc. There is little information provided that would necessitate the PT or PTA to be a direct caregiver to this child.

Question 15:

A patient with TBI has a convulsive seizure during a therapy session. The patient has lost consciousness and presents with tonic-clonic convulsions of all extremities. The therapist’s BEST response is to:

Choices:

1.Initiate rescue breathing immediately and call for help to restrain the patient.

2.Position in side-lying, check for an open airway, and immediately call for emergency assistance.

3.Position in supine with head supported with a pillow, and wait out the seizure.

4.Wrap the limbs with a sheet to prevent self-harm, position in supine, and call for emergency assistance.

Correct Answer: 2

Rationale:

This is an emergency situation. To prevent aspiration, turn the head to the side or position in side-lying. Check to see whether the airway is open and wait for tonic-clonic activity to subside before initiating artificial ventilation, if needed. Supine positioning can be life-threatening if the tongue falls backward to restrict the airway. Rescue breathing and restraining the patient are not indicated.

Question 16:

A therapist wants to know whether neurodevelopmental treatment (NDT) handling techniques produce an improvement in independent rolling that lasts longer than 30 minutes. In this study, rolling is the:

Choices:

1.Independent variable.

2.Dependent variable.

3.Intervening variable.

4.Control variable.

Correct Answer: 2

Rationale:

The dependent variable is the change or difference in behavior (in this example, rolling) that results from the intervention. NDT handling is the independent variable. The terms intervening and control are not used to correctly define the study.

Question 17:

An elderly patient is confined to bed after a severe stroke. The patient has a 25-year history of diabetes and diabetic neuropathy in both lower extremities. During an examination of sensory and integumentary integrity, the therapist identifies an ischemic necrosis on the lateral side of the right foot in the region of the fifth metatarsal head. Hypoesthesia is found in both feet, and the patient is not able to sense a 5.07 Semmes-Weinstein monofilament in the right forefoot. The therapist’s interpretation is that:

Choices:

1.The patient still has normal protective sensation in the right foot.

2.Protective sensation of the foot is lost at the 10-g force level.

3.The foot is insensate with protective sensation loss at the 75-g force level.

4.The patient is unable to perceive sharp/dull sensation.

Correct Answer: 2

Rationale:

The neuropathic limb is prone to the development of neuropathic ulcers. Examination is facilitated by the use of Semmes-Weinstein monofilaments. The 5.07 monofilament provides 10 g of force and is indicative of protective sensation loss. This patient does not have normal protective sensation. Monofilaments are used to examine pressure sensation and do not reveal any information about sharp/dull sensation.

Question 18:

A patient strained the lower back muscles 3 weeks ago, and now complains of pain (6/10). Upon examination, the therapist identifies bilateral muscle spasm from T10–L4. The therapist elects to apply interferential current to help reduce pain and spasm. The BEST electrode configuration to choose in this case would be:

Choices:

1.Two electrodes, with current flow parallel to the spinal column.

2.Two electrodes, with current flow perpendicular to the spinal column.

3.Four electrodes, with current flow diagonal to the spinal column.

4.Four electrodes, with current flow perpendicular to the spinal column.

Correct Answer: 3

Rationale:

The crisscrossed electrode configuration allows (1) a greater area to be treated and (2) current interference to occur between the frequencies of the two circuits because of the diagonal pattern. A crisscrossed electrode configuration is needed to create interferential current. None of the other electrode configurations facilitates the flow of current diagonal to the spinal column, which would cause the frequencies to intersect.

Question 19:

A therapist is orienting a new physical therapy aide in transfer techniques. Initial consideration would be to:

Choices:

1.Provide an organized series of talks dealing with patient safety during transfers.

2.Determine specific goals for teaching the techniques.

3.Give a computer-simulated instructional program before actual “hands-on” training takes place.

4.Ask about previous work and other experiences related to transferring individuals.

Correct Answer: 4

Rationale:

The therapist’s initial analysis of the learner should identify the current level of knowledge and skills about transfer techniques. The therapist can then build on this information to plan appropriate educational goals and teaching methods. Determining specific goals or strategies without an adequate needs assessment is counterproductive.

Question 20:

An elderly patient with diabetes and bilateral lower extremity amputation is to be discharged from an acute care hospital 2 weeks post-surgery. The incisions on the residual limbs are not healed and continue to drain. The patient is unable to transfer because the venous graft sites in the upper extremities are painful and not fully healed. Endurance out-of-bed is limited. The BEST choice of discharge destination for this patient is:

Choices:

1.Skilled nursing facility.

2.Home.

3.Custodial care facility.

4.Rehabilitation hospital.

Correct Answer: 1

Rationale:

A skilled nursing facility is the best facility because the patient continues to require nursing care for the open wounds. Initiation of physical therapy when this patient is able is also available. Discharge to home would be premature, as the patient is unable to transfer. Custodial care involves medical or nonmedical care that does not seek a cure. A rehabilitation hospital is not appropriate at this time, as the patient cannot actively participate in rehabilitation 3 hours/day.

Question 21:

A patient is recovering from a left tibial amputation and complains of numbness and tingling affecting the dorsal foot and big toe. The patient knows the limb is gone and can’t understand why this is happening. The therapist suspects the source of discomfort is most likely pressure from residual limb wrapping affecting the:

Choices:

1.Medial calcaneal nerve.

2.Tibial nerve.

3.Sural nerve.

4.Common peroneal (fibular) nerve.

Correct Answer: 4

Rationale:

Sensation to the dorsum of the foot and big toe is supplied by the superficial peroneal (fibular) nerve, a branch off the common peroneal (fibular) nerve. Phantom limb sensation, typically occurring in the immediate postoperative phase, can be stimulated by external pressure (residual limb wrapping or rigid dressing). It typically dissipates over time, though some patients may experience it for the rest of their lives. This is a common finding and should not interfere with prosthetic rehabilitation.

Question 22:

A therapist investigated the accuracy of pulse oximeter estimates during exercise. Correlational analysis measured the strength of the relationship between two types of ear probe-equipped pulse oximeters during heavy cycle exercise under hypoxic conditions. The investigator found measured arterial oxyhemoglobin saturation (%HbO2) levels to have a correlation of 0.89 at high saturation, but only 0.68 at low saturation levels. The results of this study suggest:

Choices:

1.Both devices are highly accurate at all saturation levels.

2.Accuracy of the measurements increases at higher saturation levels.

3.During heavy exercise, oxygen saturation levels should be interpreted cautiously.

4.Both devices are only moderately accurate.

Correct Answer: 2

Rationale:

The results of the study indicate that the correlation between the two types of oximeters was high when oxygen saturation levels were high (0.89), but only moderate (0.68) at low oxygen saturation levels. Accuracy was not the same at all saturation levels, and the high correlation during high saturation suggests that the devices are accurate during heavy exercise.

Question 23:

A patient is seen in physical therapy 2 days after a motor vehicle accident. The chief complaints are headaches, dizziness, neck pain with guarding, and a “sensation of a lump in the throat.” Plain film x-rays were read as negative. The therapist should refer this patient for a:

Choices:

1.Second series of plain film x-rays.

2.Myelogram.

3.T2 magnetic resonance imaging (MRI).

4.Computed tomography (CT) scan.

Correct Answer: 4

Rationale:

The primary concern of the therapist is to rule out strong suspicions of an upper cervical spine fracture. CT scan is still preferred for assessing cortical bone, especially spinal fractures. Plain films, already taken, did not show any fracture, which is not uncommon. A second series would not be expected to reveal any new information. The T2 MRI and myelogram are not as specific for assessing bony anatomy as the CT scan.

Question 24:

A patient with an acutely sprained ankle will be treated by immersion into an ice water bath. The therapist should tell the patient to expect in order:

Choices:

1.Aching, numbness, and burning, followed by intense cold.

2.Burning, intense cold, and aching, followed by numbness.

3.Intense cold, burning, and aching, followed by numbness.

4.Numbness, aching, and intense cold, followed by burning.

Correct Answer: 3

Rationale:

Stimulation of the cold receptors produces the perception of intense cold as the cold modality is applied to the skin. The burning and aching sensations are due to the intensity perceived as the tissue temperature decreases. As the transmission of the signals from the skin receptors slows and finally ceases, numbness is produced. The other choices do not portray this sequence of expected sensations.

Question 25:

A patient recovering from an incomplete spinal cord injury at the L3 level (ASIA D) ambulates with bilateral Lofstrand crutches. The patient reports great difficulty going down ramps with unsteady, wobbly knees. An appropriate intervention for this problem would be:

Choices:

1.Prolonged icing to reduce hamstring pain.

2.Biofeedback training to reduce knee extensor spasticity.

3.Progressive resistance training for the quadriceps.

4.Stretching using a posterior resting splint for tight plantar flexors.

Correct Answer: 3

Rationale:

A spinal cord injury at the level of L3 affects knee extensors. ASIA scale D means the injury is incomplete, with at least half of the key muscles below the neurological level having a muscle grade of 3 or more. A weak knee will wobble or buckle going down stairs or ramps. It is the result of weak quadriceps or knee flexor contracture. Strengthening exercises using progressive resistance training for the quadriceps are indicated.

Question 26:

Under HIPPA rules, it is illegal to release protected health information (PHI) without a competent patient’s consent to:

Choices:

1.The insurance company that is paying for the patient’s treatment.

2.The patient’s spouse.

3.Another health care provider involved in the care of the patient.

4.Report suspected abuse.

Correct Answer: 2

Rationale:

A spouse does not have the legal right to the patient’s information without the patient’s consent. Those involved in the care of the patient, a legal guardian with power of attorney in situations where the patient is judged mentally incompetent, or the patient’s payer have a legal right to information regarding a patient’s care without obtaining the patient’s consent. The therapist has a positive legal obligation to report suspected abuse whether or not consent is granted.

Question 27:

A baseball pitcher has been sent to physical therapy with progressive posterior shoulder pain and weakness of the shoulder abductors and lateral rotators. The therapist notices muscle wasting superior and inferior to the scapular spine. The patient’s problem is MOST LIKELY attributable to damage involving the:

Choices:

1.Spinal accessory nerve.

2.Long head of the biceps brachii.

3.Scalene muscles.

4.Suprascapular nerve.

Correct Answer: 4

Rationale:

Microtrauma to the suprascapular nerve can occur with repetitive activities involving shoulder cocking and follow-through, resulting in inflammation and muscle weakness of the muscles supplied by the suprascapular nerve (the supraspinatus and infraspinatus muscles). Damage to the spinal accessory nerve will promote weakness and atrophy of the upper trapezius muscle. Damage to the long head of the biceps brachii or scalene muscles will not present with posterior shoulder pain, weakness with shoulder abduction/external rotation, and/or atrophy of the supraspinatus and infraspinatus muscles.

Question 28:

Nursing homes that receive Medicare reimbursement for eligible residents are required by law to provide rehabilitation services, including physical therapy, based on:

Choices:

1.Needs assessment performed by a PT.

2.Referral from a physician or physician assistant.

3.Diagnostic categories (Diagnosis-Related Groups [DRGs]).

4.Referral from the nurse case manager or nurse practitioner.

Correct Answer: 1

Rationale:

Other professionals (physician, nurse practitioner or case manager, physician assistant) can initiate a referral for physical therapy examination and evaluation of a patient. However, the determination of need for services must be performed by a licensed PT. The physician, physician assistant, and nurse case manager can only refer for services. DRGs are a classification system designed to standardize prospective payment for medical care. They are not used to delineate the need for care.

Question 29:

A PT is treating an elderly patient in the home. Upon arrival one day, the therapist notices that the patient is confused and skin color and turgor are poor. The patient reports of an “intestinal bug” for the last few days with frequent vomiting and diarrhea. The therapist’s BEST course of action is to:

Choices:

1.Monitor vital signs; if HR is not elevated, get the patient up and walking.

2.Notify the family, and insist that the patient not be alone until the illness is over.

3.Cancel therapy for today, carefully document the findings, and notify the physician.

4.Give the patient water and notify the physician immediately.

Correct Answer: 4

Rationale:

This patient is exhibiting signs of dehydration associated with prolonged vomiting and diarrhea. Confusion is a red flag and requires immediate action: administer fluids and notify the physician immediately. Giving fluids is the first action the therapist must take. Any other choice jeopardizes the patient’s health.

Question 30:

A patient who is 5 weeks post-MI is participating in a cardiac rehabilitation program. The therapist is monitoring responses to increasing exercise intensity. The indicator that exercise should be immediately terminated is:

Choices:

1.Systolic BP > 140 mm Hg or diastolic BP > 80 mm Hg.

2.Peak exercise HR > 140.

3.1.5 mm of downsloping ST segment depression.

4.Appearance of a PVC on the electrocardiogram (ECG).

Correct Answer: 3

Rationale:

The upper limit for exercise intensity prescribed for patients post-MI is based on signs and symptoms. Of the choices, only ST segment depression (>1.0 mm of horizontal or downsloping depression) is a significant finding, representative of myocardial ischemia. Both HR and BP are expected to rise (the levels of 140 and 140/80 are not significant for most patients). The appearance of a single PVC is also not significant because single PVCs can occur in individuals without a cardiac history.

Question 31:

A patient is recovering from a stroke and presents with moderate impairments of the left upper and lower extremities. The PT’s goal today is to instruct the patient in a stand-pivot transfer to the more affected side so the patient can go home on a weekend pass. The wife is attending today’s session and will be assisting the patient on the weekend. The BEST choice for teaching this task is to:

Choices:

1.Practice the task first with the caregiver, then with the patient.

2.Demonstrate the task, and then practice with the patient.

3.Practice the task first with the patient, then with the caregiver.

4.Demonstrate the task, then have the caregiver practice with the patient.

Correct Answer: 2

Rationale:

To ensure optimal motor learning, first demonstrate the task at ideal performance speeds. This provides the patient with an appropriate reference of correction (cognitive map) of the task. Then use guided practice with the patient to ensure safety and successful performance. Caregivers should become involved only after initial practice of the task with the patient and after the safety of the patient can be assured.

Question 32:

An elderly and frail individual is referred to physical therapy for mobilization out-of-bed. The therapist performs a skin inspection that reveals a persistent area of redness over the sacrum that is still evident after the patient has been upright for 30 minutes. The therapist recognizes that this is:

Choices:

1.A stage II pressure ulcer.

2.Reactive hyperemia.

3.Eczema.

4.A stage I pressure ulcer.

Correct Answer: 4

Rationale:

A stage I pressure ulcer is characterized by a defined area of persistent redness (in this example). Additional changes include alterations in skin temperature (warmth or coolness), tissue consistency, and sensation (pain or itching). A stage II ulcer involves partial-thickness skin loss with abrasion, blister, or shallow crater. Reactive hyperemia results from temporary occlusion of blood supply to an area and should reverse within a short time as pressure is relieved. Eczema (dermatitis) is a superficial inflammation of the skin caused by allergic exposure and may be characterized by extensive erosions, papules, or vesicles with exudate.

Question 33:

A PT has to order a wheelchair for a patient with a T9-10 spinal cord injury. In order to maximize functional mobility, the wheelchair prescription should include:

Choices:

1.A low back.

2.Swing-away footrests.

3.Standard height back.

4.Removable armrests.

Correct Answer: 3

Rationale:

At T9-10, this patient has partial innervation of the abdominals (innervated T6-12) and full innervation of the upper extremities. A manual wheelchair with a standard back height (mid-scapula height) is appropriate for this patient for everyday use. If the patient chooses to engage in sports, a low back can improve functional ability. Low wheelchair backs may cause problems with fatigue and back pain over the long term. Swing-away footrests and removable armrests enhance ease of transfers, not overall functional mobility.

Question 34:

A patient complains of persistent wrist pain after painting a house 3 weeks ago. The patient demonstrates signs and symptoms consistent with de Quervain’s tenosynovitis. An appropriate special test to confirm the diagnosis is:

Choices:

1.Phalen’s test.

2.Finkelstein’s test.

3.Froment’s sign.

4.Craig’s test.

Correct Answer: 2

Rationale:

Finkelstein’s test is specific for reproducing the pain associated with de Quervain’s tenosynovitis of the abductor pollicis longus and extensor pollicis brevis. Froment’s sign is used to identify ulnar nerve dysfunction. Phalen’s test identifies median nerve compression in the carpal tunnel. Craig’s test identifies an abnormal femoral antetorsion angle, which you hopefully eliminated first.

Question 35:

A patient with adhesive capsulitis of the shoulder sustains a fracture of the shoulder during treatment provided by the PTA. The fracture occurred while the PTA was mobilizing the shoulder joint, which was part of the plan of care established by the PT. The PTA was not familiar with the mobilization techniques to the shoulder. Responsibility in this case falls on:

Choices:

1.The PT, who is solely responsible for assessing the competence of the PTA under his/her supervision.

2.The PTA, who is responsible for informing their supervising PT whenever he/she is unfamiliar or uncomfortable with any treatment procedure.

3.Both the PT and the PTA are responsible for establishing effective communication regarding the skills and competencies of the PTA.

4.Neither the PT nor the PTA is responsible for the fracture; it is an accepted risk associated with joint mobilization.

Correct Answer: 1

Rationale:

The PT is solely responsible for assessing the competence of all personnel under his/her supervision. Furthermore, it is the responsibility of the supervising PT to exercise sound judgment when delegating responsibility to less skilled personnel. The PTA shares responsibility with the PT for good communication and maintaining skills. However, the PT is in the supervisory role and assumes ultimate responsibility (“the buck stops here”). Fractures are not an acceptable risk of joint mobilization.

Question 36:

A patient is referred for physical therapy with a diagnosis of second-degree ankle sprain. The therapist is busy on the telephone when the patient with the ankle sprain arrives for the scheduled appointment. The PTA on staff knows the patient and has treated the patient previously for a similar injury. The PT should:

Choices:

1.Ask the PTA to assess the patient’s passive range of motion (PROM) to speed up the process.

2.Complete non-patient care tasks at another time and examine the patient.

3.Ask the PTA to commence the examination and take over when available.

4.Ask the patient if he/she can wait until the following day for a complete examination.

Correct Answer: 2

Rationale:

It is the obligation of the PT to examine this scheduled patient initially in a timely manner and determine the plan of care. This task cannot be delegated. The PTA can perform assigned physical therapy tests and interventions under the supervision of a PT. Asking the patient to wait another day is not acceptable.

Question 37:

A patient in chronic renal failure is being seen in physical therapy for deconditioning and decreased gait endurance. The therapist needs to schedule the patient’s sessions around dialysis, which is received 3 mornings a week. The patient is also hypertensive and requires careful monitoring. The therapist’s BEST approach is to take BP:

Choices:

1.Pre- and postactivities, using the nonshunt arm.

2.In sitting when activity has ceased, using the shunt arm.

3.In the supine position, using the shunt arm.

4.Every minute during walking, using the nonshunt arm.

Correct Answer: 1

Rationale:

A dialysis shunt would interfere with taking BP. Use the nonshunt arm. Pre- and postexercise measurements are appropriate. The shunt arm cannot be used to take BP. Taking BP in the shunt arm or during walking would result in inaccurate measurements.

Question 38:

A patient who is currently being treated for low back pain arrives for therapy complaining of pain across the middle of the right chest and back. When the therapist inspects the skin, clustered vesicles are apparent in a linear arc. The surrounding skin is hypersensitive. The therapist suspects:

Choices:

1.Herpes simplex infection.

2.Psoriasis.

3.Herpes zoster infection.

4.Dermatitis.

Correct Answer: 3

Rationale:

Herpes zoster is an acute infection caused by reactivation of the latent varicella-zoster virus (shingles). It is characterized by painful vesicular skin eruptions that follow the underlying route of a spinal (in this case) or cranial nerve. Additional symptoms include fever, gastrointestinal disturbances, malaise, and headache. Herpes simplex is an infection caused by the herpes simplex virus. These infections tend to occur on the face (around the mouth and nose). They are sometimes referred to as “cold sores.” Psoriasis is a chronic skin condition characterized by red patches covered by dry silvery scales. Dermatitis is an inflammatory condition of the skin characterized by eruptions (not associated with an underlying route of a nerve).

Question 39:

**After an MI, a patient is a new admission to a phase reclined position, walking with a cane, and sleeping with an abduction pillow are generally safe activities and recommended to maintain hip precautions and promote healing.

Question 57:

A patient with Parkinson’s disease is experiencing difficulty with gait, characterized by short, shuffling steps and a stooped posture. The MOST appropriate intervention to improve gait in this patient is:

Choices:

1.Treadmill training with body weight support.

2.High-intensity resistance training.

3.Aquatic therapy for buoyancy-assisted gait.

4.Gait training with auditory and visual cues.

Correct Answer: 4

Rationale:

For patients with Parkinson’s disease, gait training with auditory and visual cues is highly effective in improving gait patterns, reducing short, shuffling steps, and correcting stooped posture. Treadmill training with body weight support can also be beneficial but is not as directly targeted as gait training with cues. High-intensity resistance training and aquatic therapy can support overall fitness and strength but are not the primary interventions for gait improvement.

Question 58:

A patient with chronic low back pain is referred to physical therapy. The therapist should emphasize which of the following components in the initial exercise program?

Choices:

1.High-intensity aerobic exercises.

2.Core stabilization exercises.

3.Plyometric exercises.

4.Upper body strengthening exercises.

Correct Answer: 2

Rationale:

For patients with chronic low back pain, core stabilization exercises are essential in the initial exercise program. These exercises help to strengthen the muscles supporting the spine and improve posture and functional movement. High-intensity aerobic exercises, plyometric exercises, and upper body strengthening exercises may be beneficial later but are not the primary focus initially.

Question 59:

A patient with a recent stroke presents with right hemiparesis and difficulty performing activities of daily living (ADLs). The MOST appropriate intervention to improve the patient’s independence in ADLs is:

Choices:

1.Task-specific training.

2.Passive range of motion exercises.

3.High-intensity interval training.

4.Aquatic therapy.

Correct Answer: 1

Rationale:

Task-specific training is the most appropriate intervention to improve independence in ADLs for a patient with right hemiparesis following a stroke. This approach involves practicing the specific tasks the patient needs to perform in daily life, thereby enhancing motor learning and functional recovery. Passive range of motion exercises, high-intensity interval training, and aquatic therapy can be supportive but do not directly address ADL independence.

Question 60:

A therapist is designing a fall prevention program for elderly residents in an assisted living facility. The MOST important component to include in the program is:

Choices:

1.High-intensity resistance training.

2.Balance and gait training.

3.Aquatic therapy sessions.

4.Cognitive training exercises.

Correct Answer: 2

Rationale:

The most important component of a fall prevention program for elderly residents is balance and gait training. Improving balance and gait stability directly reduces the risk of falls. High-intensity resistance training and aquatic therapy can be beneficial but do not address balance as specifically. Cognitive training exercises are valuable but not the primary focus for fall prevention.

Question 61:

A patient with rotator cuff tendinitis is referred to physical therapy. The therapist should include which of the following interventions in the initial treatment plan?

Choices:

1.High-resistance shoulder strengthening exercises.

2.Passive range of motion exercises.

3.Plyometric shoulder exercises.

4.Stretching of the pectoral muscles.

Correct Answer: 2

Rationale:

For rotator cuff tendinitis, initial treatment should include passive range of motion exercises to reduce pain and inflammation without stressing the injured tendons. High-resistance shoulder strengthening and plyometric exercises are not appropriate initially as they may exacerbate the condition. Stretching the pectoral muscles can be beneficial but is secondary to addressing the inflamed rotator cuff.

Question 62:

A patient with an acute lumbar disc herniation presents with severe lower back pain and radiculopathy into the right leg. The MOST appropriate initial intervention is:

Choices:

1.High-intensity lumbar strengthening exercises.

2.McKenzie extension exercises.

3.Core stabilization exercises.

4.Manual traction.

Correct Answer: 2

Rationale:

For an acute lumbar disc herniation, McKenzie extension exercises are the most appropriate initial intervention. These exercises help to centralize pain and reduce radiculopathy. High-intensity lumbar strengthening and core stabilization exercises are more suitable for later stages of rehabilitation. Manual traction can be helpful but is not typically the first line of intervention.

Question 63:

A patient with a transtibial amputation is experiencing pain at the distal end of the residual limb. The therapist should assess for:

Choices:

1.Phantom limb pain.

2.Poor prosthetic fit.

3.Neuroma formation.

4.Infection at the incision site.

Correct Answer: 2

Rationale:

Pain at the distal end of the residual limb in a patient with a transtibial amputation is most likely due to a poor prosthetic fit. Phantom limb pain and neuroma formation can also cause pain but are not typically localized to the distal end. Infection at the incision site would present with additional signs such as redness, swelling, and discharge.

Question 64:

A patient with multiple sclerosis is experiencing increased fatigue and weakness during physical therapy sessions. The therapist should:

Choices:

1.Increase the intensity of exercises to build endurance.

2.Schedule therapy sessions during cooler parts of the day.

3.Provide high-intensity interval training.

4.Encourage the patient to rest for extended periods between exercises.

Correct Answer: 2

Rationale:

For patients with multiple sclerosis experiencing fatigue and weakness, scheduling therapy sessions during cooler parts of the day can help manage symptoms. Heat can exacerbate fatigue in these patients. Increasing the intensity of exercises or providing high-intensity interval training can worsen symptoms. Encouraging extended rest periods between exercises can reduce the effectiveness of the session.

Question 65:

A patient with chronic venous insufficiency presents with significant lower extremity edema. The MOST appropriate intervention to reduce edema is:

Choices:

1.High-intensity leg strengthening exercises.

2.Compression therapy.

3.Aquatic therapy.

4.Elevation of the legs.

Correct Answer: 2

Rationale:

Compression therapy is the most appropriate intervention to reduce lower extremity edema in patients with chronic venous insufficiency. Compression helps improve venous return and reduce swelling. High-intensity leg strengthening exercises, aquatic therapy, and leg elevation can be supportive but are not as effective as compression therapy for reducing edema.

Question 66:

A patient with an acute lateral ankle sprain presents with swelling, pain, and limited range of motion. The initial treatment plan should include:

Choices:

1.High-intensity ankle strengthening exercises.

2.Cryotherapy and elevation.

3.Plyometric ankle exercises.

4.Aquatic therapy for buoyancy-assisted movement.

Correct Answer: 2

Rationale:

For an acute lateral ankle sprain, initial treatment should include cryotherapy and elevation to reduce swelling and pain. High-intensity ankle strengthening and plyometric exercises are not appropriate initially as they may exacerbate the injury. Aquatic therapy can be helpful but is not the primary intervention for acute management.

Question 67:

A patient with chronic obstructive pulmonary disease (COPD) is participating in a pulmonary rehabilitation program. The therapist should emphasize which of the following components in the exercise program?

Choices:

1.High-intensity aerobic exercises.

2.Core stabilization exercises.

3.Respiratory muscle training.

4.Upper body strengthening exercises.

Correct Answer: 3

Rationale:

For patients with COPD, respiratory muscle training is essential in the exercise program. This training helps improve breathing efficiency and reduce dyspnea. High-intensity aerobic exercises, core stabilization exercises, and upper body strengthening exercises can be supportive but are not the primary focus for respiratory improvement.

Question 68:

A patient with type 1 diabetes is referred to physical therapy for an exercise program. The therapist should monitor which of the following parameters most closely during the sessions?

Choices:

1.Blood pressure.

2.Heart rate.

3.Blood glucose levels.

4.Respiratory rate.

Correct Answer: 3

Rationale:

For patients with type 1 diabetes, it is crucial to closely monitor blood glucose levels during exercise sessions to prevent hypoglycemia or hyperglycemia. Blood pressure, heart rate, and respiratory rate are also important but secondary to ensuring stable blood glucose levels.

Question 69:

A patient with fibromyalgia is experiencing widespread pain and fatigue. The MOST appropriate intervention to manage these symptoms is:

Choices:

1.High-intensity resistance training.

2.Aerobic exercise at a moderate intensity.

3.Plyometric exercises.

4.Deep tissue massage.

Correct Answer: 2

Rationale:

For patients with fibromyalgia, aerobic exercise at moderate intensity is most effective in managing widespread pain and fatigue. High-intensity resistance training and plyometric exercises can exacerbate symptoms. Deep tissue massage may provide temporary relief but does not address the underlying condition.

Question 70:

A patient with a history of recurrent anterior shoulder dislocations is referred to physical therapy. The initial treatment plan should focus on:

Choices:

1.High-intensity shoulder strengthening exercises.

2.Shoulder immobilization.

3.Gentle range of motion exercises.

4.Plyometric shoulder exercises.

Correct Answer: 3

Rationale:

For patients with a history of recurrent anterior shoulder dislocations, the initial treatment plan should focus on gentle range of motion exercises to maintain mobility without stressing the joint. High-intensity shoulder strengthening and plyometric exercises are not appropriate initially as they may increase the risk of dislocation. Shoulder immobilization may be necessary in the acute phase but is not a long-term solution.