OT/PT HAAD Simulation 6

1. A patient has been diagnosed with acute synovitis of the temporomandibular joint. Early intervention should focus on:

Application of an intraoral appliance and phonophoresis.

Instruction to eat a soft food diet and phonophoresis.

Joint mobilization and postural awareness.

Temporalis stretching and joint mobilization.

Acute synovitis of the temporomandibular joint is inflammation of the joint that connects the jaw to the skull. To manage this condition, early intervention should focus on reducing the strain on the joint. Instructing the patient to eat a soft food diet helps to minimize the amount of force and stress placed on the joint during chewing. Phonophoresis, which is the use of ultrasound waves to deliver medication into the tissues, can help reduce inflammation and pain in the joint. Therefore, instruction to eat a soft food diet and phonophoresis is the most appropriate early intervention for a patient with acute synovitis of the temporomandibular joint.

Explanation

Acute synovitis of the temporomandibular joint is inflammation of the joint that connects the jaw to the skull. To manage this condition, early intervention should focus on reducing the strain on the joint. Instructing the patient to eat a soft food diet helps to minimize the amount of force and stress placed on the joint during chewing. Phonophoresis, which is the use of ultrasound waves to deliver medication into the tissues, can help reduce inflammation and pain in the joint. Therefore, instruction to eat a soft food diet and phonophoresis is the most appropriate early intervention for a patient with acute synovitis of the temporomandibular joint.

2. A 92 year-old woman presents with hot, red, and edematous skin over the shins of both lower extremities. She also has a mild fever. The MOST likely cause of her symptoms is:

Cellulitis.

Dermatitis

Herpes simplex infection.

Scleroderma.

The symptoms described, including hot, red, and edematous skin over the shins of both lower extremities, along with a mild fever, are consistent with cellulitis. Cellulitis is a bacterial skin infection that commonly affects the lower legs, causing inflammation and swelling. It is more common in older adults and individuals with compromised immune systems. Dermatitis, herpes simplex infection, and scleroderma do not typically present with the combination of symptoms described in the patient.

Explanation

The symptoms described, including hot, red, and edematous skin over the shins of both lower extremities, along with a mild fever, are consistent with cellulitis. Cellulitis is a bacterial skin infection that commonly affects the lower legs, causing inflammation and swelling. It is more common in older adults and individuals with compromised immune systems. Dermatitis, herpes simplex infection, and scleroderma do not typically present with the combination of symptoms described in the patient.

3. A child you are working with in the elementary school system has moderate to severe extensor spasticity and limited head control. The MOST appropriate positioning device would be a:

Prone stander with abduction wedge.

Supine stander with abduction wedge.

Wheelchair with a back wedge and head supports.

Wheelchair with adductor pommel.

The child described in the question has moderate to severe extensor spasticity and limited head control. This means that the child has difficulty maintaining an upright position and controlling their head movements. A wheelchair with a back wedge and head supports would be the most appropriate positioning device in this case. The back wedge will provide support and help maintain an upright position, while the head supports will provide stability and control for the child's head. This combination of supports will help address the child's specific needs and promote proper positioning and comfort.

Explanation

The child described in the question has moderate to severe extensor spasticity and limited head control. This means that the child has difficulty maintaining an upright position and controlling their head movements. A wheelchair with a back wedge and head supports would be the most appropriate positioning device in this case. The back wedge will provide support and help maintain an upright position, while the head supports will provide stability and control for the child's head. This combination of supports will help address the child's specific needs and promote proper positioning and comfort.

4. After mastectomy, a patient cannot accept the loss of her breast. She reports being weepy all the time with loss of sleep. She is constantly tired and has no energy to do anything. The BEST action you can take is:

Observe her closely for possible suicide.

Request her primary physician to refer her for psychological evaluation.

Tell her she’s over-reacting, she has to get on with her therapy.

Tell the nurse case manager to monitor her behavior.

The best action to take in this situation is to request her primary physician to refer her for psychological evaluation. The patient is displaying symptoms of depression, such as being weepy, having loss of sleep, constant tiredness, and lack of energy. These symptoms, along with her difficulty accepting the loss of her breast, indicate a need for psychological support and evaluation. By referring her to a psychologist or psychiatrist, the patient can receive appropriate treatment and support for her emotional well-being.

Explanation

The best action to take in this situation is to request her primary physician to refer her for psychological evaluation. The patient is displaying symptoms of depression, such as being weepy, having loss of sleep, constant tiredness, and lack of energy. These symptoms, along with her difficulty accepting the loss of her breast, indicate a need for psychological support and evaluation. By referring her to a psychologist or psychiatrist, the patient can receive appropriate treatment and support for her emotional well-being.

5. You receive a referral to ambulate a patient who is insulin dependent. In a review of her medical record, you notice her blood glucose level for that day is 310 mg/dL. Your BEST course of action is to:

Ambulate the patient as planned but monitor closely.

Postpone therapy and coordinate with the nurse regarding insulin management and exercise.

Refrain from ambulating the patient, reschedule for tomorrow.

Talk to the nurse about seeing the patient later on that day.

The best course of action is to postpone therapy and coordinate with the nurse regarding insulin management and exercise because a blood glucose level of 310 mg/dL indicates hyperglycemia, which can be dangerous for an insulin-dependent patient during physical activity. It is important to address the high blood glucose level and adjust the patient's insulin management before proceeding with ambulation to ensure their safety and well-being.

Explanation

The best course of action is to postpone therapy and coordinate with the nurse regarding insulin management and exercise because a blood glucose level of 310 mg/dL indicates hyperglycemia, which can be dangerous for an insulin-dependent patient during physical activity. It is important to address the high blood glucose level and adjust the patient's insulin management before proceeding with ambulation to ensure their safety and well-being.

6. It is important to note the status of the pars interarticularis on the X-ray report. A problem with this part of the vertebra could possibly lead to:

Spondylolisthesis with discal herniation.

Spondylolisthesis with possible anterior slippage of the vertebral body.

Spondylolysis resulting in early nerve root compression.

Spondylolysis with early degeneration of the vertebra.

The status of the pars interarticularis on the X-ray report is important because it can indicate the possibility of spondylolisthesis with possible anterior slippage of the vertebral body. Spondylolisthesis refers to the forward displacement of one vertebra over another, and the pars interarticularis is a small bony segment that connects the upper and lower parts of the vertebra. If there is a problem with this part of the vertebra, such as a fracture or defect, it can weaken the connection and potentially lead to spondylolisthesis with anterior slippage.

Explanation

The status of the pars interarticularis on the X-ray report is important because it can indicate the possibility of spondylolisthesis with possible anterior slippage of the vertebral body. Spondylolisthesis refers to the forward displacement of one vertebra over another, and the pars interarticularis is a small bony segment that connects the upper and lower parts of the vertebra. If there is a problem with this part of the vertebra, such as a fracture or defect, it can weaken the connection and potentially lead to spondylolisthesis with anterior slippage.

7. Peer review is an important professional activity. Recently, physical therapists have been the focus of vigorous peer review due to increasing financial pressure imposed by third party payers. An inappropriate use of peer review is to determine whether care:

Should be paid for by a third party payer.

Was appropriate and required the skill of a physical therapist.

Was cost effective.

Was provided by the appropriate personnel.

The correct answer is "was cost effective." Peer review is a process where professionals in the same field evaluate and assess the quality, appropriateness, and effectiveness of care provided by their peers. In this context, physical therapists are being subjected to peer review due to financial pressure from third party payers. The focus of this review is to determine if the care provided by physical therapists is cost effective, meaning if it provides good value for the cost.

Explanation

The correct answer is "was cost effective." Peer review is a process where professionals in the same field evaluate and assess the quality, appropriateness, and effectiveness of care provided by their peers. In this context, physical therapists are being subjected to peer review due to financial pressure from third party payers. The focus of this review is to determine if the care provided by physical therapists is cost effective, meaning if it provides good value for the cost.

8. You are supervising the exercise of cardiac rehabilitation outpatient class on a very hot day, with temperatures expected to be above 90 degrees F. Your class is scheduled for 2 p.m. and the facility is not air conditioned. The strategy that is unacceptable is to:

Change the time of the exercise class to early morning or evening.

Decrease the exercise intensity by slowing the pace of exercise.

Increase the warm-up and cool-down periods to equal the total aerobic interval in time.

Make the exercise intermittent by adding rest cycles

Increasing the warm-up and cool-down periods to equal the total aerobic interval in time is not an acceptable strategy because it does not address the issue of exercising in hot temperatures. While a longer warm-up and cool-down period may be beneficial for overall exercise safety, it does not mitigate the potential risks of exercising in high temperatures. The other options, such as changing the exercise time to cooler parts of the day, decreasing exercise intensity, or adding rest cycles, are all valid strategies to help manage the heat and reduce the risk of heat-related complications during the exercise class.

Explanation

Increasing the warm-up and cool-down periods to equal the total aerobic interval in time is not an acceptable strategy because it does not address the issue of exercising in hot temperatures. While a longer warm-up and cool-down period may be beneficial for overall exercise safety, it does not mitigate the potential risks of exercising in high temperatures. The other options, such as changing the exercise time to cooler parts of the day, decreasing exercise intensity, or adding rest cycles, are all valid strategies to help manage the heat and reduce the risk of heat-related complications during the exercise class.

9. Your 102 year-old patient has been hospitalized for the past three days with an undisclosed ailment. After running numerous tests and finding nothing to explain her increasing weakness and fatigue, the physicians are being pressured to discharge her tomorrow. She lives alone in a first floor apartment. You have determined her ambulation endurance to be only up to 15 feet, not enough to allow her to get from her bed to the bathroom (a distance of 20 feet). You recommend:

A live-in nurse (24 hour coverage) until her condition improves.

A skilled nursing facility placement until her endurance increases.

Environmental changes, a bedside commode, and referral for home health services.

Postponing her discharge until she can complete the needed 20 feet.

The correct answer is to recommend environmental changes, a bedside commode, and referral for home health services. This option addresses the patient's limited ambulation endurance by making necessary modifications to her living environment, such as installing a bedside commode. Referring her for home health services ensures that she receives the necessary medical care and support while remaining in her own home. This option also takes into consideration the patient's current condition and aims to improve her quality of life without the need for a skilled nursing facility or postponing her discharge.

Explanation

The correct answer is to recommend environmental changes, a bedside commode, and referral for home health services. This option addresses the patient's limited ambulation endurance by making necessary modifications to her living environment, such as installing a bedside commode. Referring her for home health services ensures that she receives the necessary medical care and support while remaining in her own home. This option also takes into consideration the patient's current condition and aims to improve her quality of life without the need for a skilled nursing facility or postponing her discharge.

10. A patient with complete C6 quadriplegia should be instructed to initially transfer with a sliding board using:

Pectoral muscles to stabilize elbows, scapular depressors to lift trunk.

Serratus anterior to elevate trunk with shoulder extensors stabilizing.

Shoulder extensors, external rotators, and anterior deltoid to position and lock the elbow.

Triceps, keeping the hands flexed to protect tenodesis grasp.

The correct answer is shoulder extensors, external rotators, and anterior deltoid to position and lock the elbow. This is because these muscles are responsible for stabilizing and positioning the elbow joint during the transfer. The shoulder extensors help to extend the arm, the external rotators rotate the arm outward, and the anterior deltoid assists in flexing and stabilizing the shoulder joint. By using these muscles, the patient can safely transfer using a sliding board.

Explanation

The correct answer is shoulder extensors, external rotators, and anterior deltoid to position and lock the elbow. This is because these muscles are responsible for stabilizing and positioning the elbow joint during the transfer. The shoulder extensors help to extend the arm, the external rotators rotate the arm outward, and the anterior deltoid assists in flexing and stabilizing the shoulder joint. By using these muscles, the patient can safely transfer using a sliding board.

11. A patient has a transtibial amputation and has recently been fitted with a PTB socket. During your initial prosthetic checkout, you instruct the patient to walk several times in the parallel bars. You then have him sit down and take the prosthesis off. You inspect the skin. You would expect no redness in the area of the:

Anterior tibia, tibial crest, and fibular head.

Patellar tendon and tibial tuberosity.

Medial tibial and fibular plateaus.

Distal end of the residual limb.

During the initial prosthetic checkout, the patient is instructed to walk in the parallel bars. The PTB socket is designed to distribute the pressure evenly along the anterior tibia, tibial crest, and fibular head. Therefore, if the socket is properly fitted and aligned, there should be no redness or skin irritation in these areas.

Explanation

During the initial prosthetic checkout, the patient is instructed to walk in the parallel bars. The PTB socket is designed to distribute the pressure evenly along the anterior tibia, tibial crest, and fibular head. Therefore, if the socket is properly fitted and aligned, there should be no redness or skin irritation in these areas.

12. Your patient is 72 and recovering from a right CVA. She tells you she is thirsty and asks you for a can of soda. When you give her the can and instruct her to open it, she is unable to complete the task. Later after the treatment session when she is alone you observe her drinking from the can. You suspect she may have a primary deficit in:

Anosognosia.

Ideational apraxia.

Ideomotor apraxia.

Unilateral neglect.

Ideomotor apraxia is a condition where individuals have difficulty performing purposeful motor actions or tasks despite having the understanding and knowledge of how to perform them. This disorder affects the ability to translate an idea or concept into a coordinated movement. In this case, the patient understands the task of drinking from the soda can but struggles with the motor execution of opening it, indicating ideomotor apraxia.

Explanation

Ideomotor apraxia is a condition where individuals have difficulty performing purposeful motor actions or tasks despite having the understanding and knowledge of how to perform them. This disorder affects the ability to translate an idea or concept into a coordinated movement. In this case, the patient understands the task of drinking from the soda can but struggles with the motor execution of opening it, indicating ideomotor apraxia.

13. A 29 year-old woman fractured her right midtibia in a skiing accident three months ago. After cast removal, a severe foot drop was noted. The patient desires to try electrical stimulation orthotic substitution. You would set up the functional electrical stimulation to contract the appropriate muscles during:

Foot flat.

Push off.

Swing phase.

Toe off.

The correct answer is "swing phase." During the swing phase of the gait cycle, the foot is lifted off the ground and swung forward. In a patient with foot drop, the muscles responsible for dorsiflexion (lifting the foot) are weak or paralyzed, leading to difficulty in clearing the foot during the swing phase. Functional electrical stimulation can be used to contract the appropriate muscles during the swing phase to help lift the foot and improve gait.

Explanation

The correct answer is "swing phase." During the swing phase of the gait cycle, the foot is lifted off the ground and swung forward. In a patient with foot drop, the muscles responsible for dorsiflexion (lifting the foot) are weak or paralyzed, leading to difficulty in clearing the foot during the swing phase. Functional electrical stimulation can be used to contract the appropriate muscles during the swing phase to help lift the foot and improve gait.

14. A student you are supervising is on final affiliation following completion of academic training. He is overheard discussing a patient’s history in the elevator. When you later point this out to the student, he tells you he was unaware of any hospital policy regarding confidentiality. Your BEST analysis of this situation is that:

Compliance was not a realistic expectation since he just arrived at this facility.

He should be expected to value patient confidentiality.

Now that he is aware of confidentiality restrictions he should do better the next time.

The correct answer suggests that now that the student is aware of confidentiality restrictions, he should be expected to improve his behavior in the future. This implies that the student's lack of knowledge about the hospital policy was the reason for his inappropriate behavior. It also indicates that the student should be able to understand the importance of patient confidentiality and make an effort to adhere to it after being made aware of the policy.

Explanation

The correct answer suggests that now that the student is aware of confidentiality restrictions, he should be expected to improve his behavior in the future. This implies that the student's lack of knowledge about the hospital policy was the reason for his inappropriate behavior. It also indicates that the student should be able to understand the importance of patient confidentiality and make an effort to adhere to it after being made aware of the policy.

15. A patient recently diagnosed with fibromyalgia and chronic fatigue immune system dysfunction demonstrates a loss of interest in all activities and outlets. She is not eating well and is having problems sleeping. Recently she has talked about suicide as her only hope. Your BEST course of action is to:

Call her physician, saying that you cannot do anything for this patient until her psychological outlook is better.

Discuss her need for medications with her husband.

Immediately contact her primary physician.

Present a positive attitude and tell her she will feel better soon.

The best course of action is to discuss her need for medications with her husband. This is because the patient is displaying symptoms of depression, such as loss of interest in activities, poor appetite, and sleep problems. Additionally, she has mentioned suicidal thoughts as her only hope. By involving her husband in the discussion about medications, it ensures that the patient has a support system and someone who can help monitor her mental health and ensure she is taking the necessary steps to receive appropriate treatment.

Explanation

The best course of action is to discuss her need for medications with her husband. This is because the patient is displaying symptoms of depression, such as loss of interest in activities, poor appetite, and sleep problems. Additionally, she has mentioned suicidal thoughts as her only hope. By involving her husband in the discussion about medications, it ensures that the patient has a support system and someone who can help monitor her mental health and ensure she is taking the necessary steps to receive appropriate treatment.

16. A 23 year-old college volleyball player complains of moderate pain resulting from a left hamstring strain four weeks ago. The focal point of pain and tightness is noted where a hematoma developed initially. The specific massage technique that would be MOST beneficial in this case is:

Friction.

Kneading.

Stroking

Tapotement.

Stroking would be the most beneficial massage technique in this case. Stroking involves long, gentle, and rhythmic movements over the affected area. This technique can help improve blood circulation, reduce muscle tension, and promote relaxation. Since the volleyball player has a left hamstring strain with a focal point of pain and tightness where a hematoma developed, stroking can help alleviate the pain, increase blood flow to the area, and promote healing.

Explanation

Stroking would be the most beneficial massage technique in this case. Stroking involves long, gentle, and rhythmic movements over the affected area. This technique can help improve blood circulation, reduce muscle tension, and promote relaxation. Since the volleyball player has a left hamstring strain with a focal point of pain and tightness where a hematoma developed, stroking can help alleviate the pain, increase blood flow to the area, and promote healing.

17. A 14 year-old boy with advanced Duchenne muscular dystrophy is administered a pulmonary function test. The value that is UNLIKELY to show any deviation from normal is:

FEV1.

Functional residual capacity.

Total lung capacity.

A. vital capacity.

FEV1, or forced expiratory volume in 1 second, is a measure of the amount of air a person can forcefully exhale in one second. In advanced Duchenne muscular dystrophy, the muscles involved in breathing become weak, leading to a decrease in lung function. Therefore, it is unlikely that FEV1, which measures the ability to forcefully exhale, would show any deviation from normal in this patient. The other measures, functional residual capacity, total lung capacity, and vital capacity, are all measures of lung volume and are more likely to show deviations from normal in a patient with advanced Duchenne muscular dystrophy.

Explanation

FEV1, or forced expiratory volume in 1 second, is a measure of the amount of air a person can forcefully exhale in one second. In advanced Duchenne muscular dystrophy, the muscles involved in breathing become weak, leading to a decrease in lung function. Therefore, it is unlikely that FEV1, which measures the ability to forcefully exhale, would show any deviation from normal in this patient. The other measures, functional residual capacity, total lung capacity, and vital capacity, are all measures of lung volume and are more likely to show deviations from normal in a patient with advanced Duchenne muscular dystrophy.

18. A 10 year-old presents with pain and limited ROM following surgical repair of the medial collateral ligament and anterior cruciate ligaments. The modality that would be CONTRAINDICATED in this case is:

Interferential current.

Shortwave diathermy.

Transcutaneous electrical stimulation.

Ultrasound.

Shortwave diathermy is contraindicated in this case because it produces heat deep within the tissues. Since the patient has recently undergone surgical repair of ligaments, the application of heat can potentially increase inflammation and delay the healing process. Therefore, shortwave diathermy should be avoided to prevent further pain and limited range of motion.

Explanation

Shortwave diathermy is contraindicated in this case because it produces heat deep within the tissues. Since the patient has recently undergone surgical repair of ligaments, the application of heat can potentially increase inflammation and delay the healing process. Therefore, shortwave diathermy should be avoided to prevent further pain and limited range of motion.

19. The most appropriate school physical therapy intervention to use during class for a child with decreased sitting balance, but normal tone would be to:

Adapt a desk and wheelchair to provide adequate sitting balance.

Use a prone-stander.

Use a sidelyer.

Use a therapeutic ball to promote sitting balance.

The most appropriate school physical therapy intervention to use during class for a child with decreased sitting balance, but normal tone would be to use a sidelyer. A sidelyer is a positioning device that allows the child to lie on their side, providing support and stability while still allowing them to engage in classroom activities. This intervention helps to maintain a proper sitting position and prevent the child from falling or losing balance. It is a suitable option for a child with decreased sitting balance as it provides the necessary support without restricting their movement or independence.

Explanation

The most appropriate school physical therapy intervention to use during class for a child with decreased sitting balance, but normal tone would be to use a sidelyer. A sidelyer is a positioning device that allows the child to lie on their side, providing support and stability while still allowing them to engage in classroom activities. This intervention helps to maintain a proper sitting position and prevent the child from falling or losing balance. It is a suitable option for a child with decreased sitting balance as it provides the necessary support without restricting their movement or independence.

20. You have recently attended a professional conference on myofascial release. You wish to share this information with your colleagues during an inservice session. You BEST initial activity is to:

Ask your colleagues about their current level of knowledge using a brief questionnaire.

Determine the best sequence for the learning units within your presentation.

Provide a comprehensive packet of handouts when you begin the first inservice session.

Select a suitable time and place for your lecture.

The best initial activity to share the information from the professional conference on myofascial release with colleagues during an inservice session is to provide a comprehensive packet of handouts when you begin the first inservice session. This allows colleagues to have all the necessary information and resources at hand to follow along and refer back to later. It also ensures that everyone starts with the same foundation of knowledge, regardless of their current level of understanding. Asking about their current level of knowledge or determining the best sequence for learning units can be done after providing the handouts. Selecting a suitable time and place for the lecture is important, but it is not the best initial activity for sharing the information.

Explanation

The best initial activity to share the information from the professional conference on myofascial release with colleagues during an inservice session is to provide a comprehensive packet of handouts when you begin the first inservice session. This allows colleagues to have all the necessary information and resources at hand to follow along and refer back to later. It also ensures that everyone starts with the same foundation of knowledge, regardless of their current level of understanding. Asking about their current level of knowledge or determining the best sequence for learning units can be done after providing the handouts. Selecting a suitable time and place for the lecture is important, but it is not the best initial activity for sharing the information.

21. Which of the following is NOT an appropriate reason to terminate a maximum exercise tolerance test for a patient with pulmonary dysfunction?

ECG monitoring reveals diagnostic ischemia.

PaO2 decreases 20 mmHg.

Patient reaches age-predicted maximal heart rate.

Patient states he is maximally short of breath.

A decrease in PaO2 (partial pressure of oxygen in arterial blood) is a common response during exercise for patients with pulmonary dysfunction. It is not considered an appropriate reason to terminate a maximum exercise tolerance test because it is expected and does not pose an immediate threat to the patient's health. The other options, such as diagnostic ischemia, reaching age-predicted maximal heart rate, and being maximally short of breath, are all valid reasons to terminate the test as they indicate potential risks or limitations for the patient.

Explanation

A decrease in PaO2 (partial pressure of oxygen in arterial blood) is a common response during exercise for patients with pulmonary dysfunction. It is not considered an appropriate reason to terminate a maximum exercise tolerance test because it is expected and does not pose an immediate threat to the patient's health. The other options, such as diagnostic ischemia, reaching age-predicted maximal heart rate, and being maximally short of breath, are all valid reasons to terminate the test as they indicate potential risks or limitations for the patient.

22. A patient diagnosed with cervical radiculitis has been referred to you for mechanical traction. You are applying the traction using the cervical halter for 5 minutes at 20° neck flexion using 10 pounds. The patient complains of pain in the area of the TMJ. You should:

Change the angle of pull.

Decrease the traction poundage.

Decrease the treatment time.

Discontinue the treatment.

The patient's complaint of pain in the area of the TMJ suggests that the traction is causing discomfort or aggravating the condition. Decreasing the treatment time would reduce the duration of the traction and potentially alleviate the pain in the TMJ area. Changing the angle of pull or decreasing the traction poundage may not directly address the issue of TMJ pain. Discontinuing the treatment altogether may not be necessary if reducing the treatment time can provide relief.

Explanation

The patient's complaint of pain in the area of the TMJ suggests that the traction is causing discomfort or aggravating the condition. Decreasing the treatment time would reduce the duration of the traction and potentially alleviate the pain in the TMJ area. Changing the angle of pull or decreasing the traction poundage may not directly address the issue of TMJ pain. Discontinuing the treatment altogether may not be necessary if reducing the treatment time can provide relief.

23. On the first day following a cesarean delivery, the physical therapist’s initial intervention would consist of teaching the new mother:

Ankle exercises to prevent thrombophlebitis.

Assisted ambulation.

Assisted breathing and coughing and pelvic floor exercises.

Partial sit-ups and pelvic floor exercises.

After a cesarean delivery, the new mother may experience decreased lung capacity and difficulty breathing due to the surgery. Assisted breathing and coughing exercises can help improve lung function and prevent complications such as pneumonia. Additionally, pelvic floor exercises are important for strengthening the muscles that support the bladder, uterus, and bowels, which may have been weakened during pregnancy and delivery. Therefore, teaching the new mother assisted breathing and coughing exercises, as well as pelvic floor exercises, would be the appropriate initial intervention for a physical therapist.

Explanation

After a cesarean delivery, the new mother may experience decreased lung capacity and difficulty breathing due to the surgery. Assisted breathing and coughing exercises can help improve lung function and prevent complications such as pneumonia. Additionally, pelvic floor exercises are important for strengthening the muscles that support the bladder, uterus, and bowels, which may have been weakened during pregnancy and delivery. Therefore, teaching the new mother assisted breathing and coughing exercises, as well as pelvic floor exercises, would be the appropriate initial intervention for a physical therapist.

24. Following an episode of adhesive capsulitis of the right shoulder, a 52 year-old with a history of left CVA now exhibits reflex sympathetic dystrophy affecting the right upper extremity. The intervention that should be AVOIDED in this case is:

Graduated active exercises.

Massage to reduce edema.

Passive manipulation to the shoulder.

Passive ROM exercises.

Reflex sympathetic dystrophy (RSD) is a condition characterized by chronic pain, swelling, and changes in skin color and temperature. It is believed to be caused by dysfunction of the sympathetic nervous system. In this case, the patient has RSD affecting the right upper extremity following adhesive capsulitis (frozen shoulder) of the right shoulder and a history of left cerebrovascular accident (CVA). Massage to reduce edema should be avoided because it can potentially exacerbate the symptoms of RSD by increasing blood flow and aggravating the sympathetic dysfunction. Graduated active exercises, passive manipulation to the shoulder, and passive ROM exercises may be beneficial in improving range of motion and reducing stiffness in the affected shoulder.

Explanation

Reflex sympathetic dystrophy (RSD) is a condition characterized by chronic pain, swelling, and changes in skin color and temperature. It is believed to be caused by dysfunction of the sympathetic nervous system. In this case, the patient has RSD affecting the right upper extremity following adhesive capsulitis (frozen shoulder) of the right shoulder and a history of left cerebrovascular accident (CVA). Massage to reduce edema should be avoided because it can potentially exacerbate the symptoms of RSD by increasing blood flow and aggravating the sympathetic dysfunction. Graduated active exercises, passive manipulation to the shoulder, and passive ROM exercises may be beneficial in improving range of motion and reducing stiffness in the affected shoulder.

25. To prepare a patient with an incomplete T12 paraplegia for ambulation with crutches, the upper quadrant muscles that would be MOST important to strengthen include the:

Deltoid, coracobrachialis, and brachialis.

Middle trapezius, latissimus, dorsi and triceps.

Lower trapezius, latissimus dorsi, and triceps.

Upper trapezius, rhomboids, and levator scapulae.

To prepare a patient with an incomplete T12 paraplegia for ambulation with crutches, it is important to strengthen the muscles that provide stability and support to the upper body. The middle trapezius, latissimus dorsi, and triceps are all muscles that contribute to the movement and stability of the upper quadrant. Strengthening these muscles would help the patient maintain balance and control while using crutches for ambulation.

Explanation

To prepare a patient with an incomplete T12 paraplegia for ambulation with crutches, it is important to strengthen the muscles that provide stability and support to the upper body. The middle trapezius, latissimus dorsi, and triceps are all muscles that contribute to the movement and stability of the upper quadrant. Strengthening these muscles would help the patient maintain balance and control while using crutches for ambulation.

26. A patient with active tuberculosis is referred for physical therapy. Which of the following is NOT an appropriate precaution?

Have the patient wear a tight fitting mask while being treated in his room.

Insure that the patient is in a private, negative pressurized room.

Wash hands upon entering and leaving the patient’s room.

Wear a tight fitting mask while treating the patient.

The correct answer is "insure that the patient is in a private, negative pressurized room." This is not an appropriate precaution because a private, negative pressurized room is actually an appropriate precaution for a patient with active tuberculosis. It helps to prevent the spread of the disease to others by ensuring that any airborne particles are contained within the room. The other options, such as having the patient wear a tight fitting mask and washing hands, are appropriate precautions to prevent the transmission of tuberculosis.

Explanation

The correct answer is "insure that the patient is in a private, negative pressurized room." This is not an appropriate precaution because a private, negative pressurized room is actually an appropriate precaution for a patient with active tuberculosis. It helps to prevent the spread of the disease to others by ensuring that any airborne particles are contained within the room. The other options, such as having the patient wear a tight fitting mask and washing hands, are appropriate precautions to prevent the transmission of tuberculosis.

27. During a cervical spine examination you observe restricted left rotation of the C7-T1 spinal level. After stabilizing the thoracic spine, your hand placement for mobilization to improve left rotation should be at the:

Posterior left C6 articular pillar.

Posterior left C7 articular pillar.

Posterior right C7 articular pillar.

T1 spinous process.

The correct answer is posterior right C7 articular pillar. During a cervical spine examination, restricted left rotation of the C7-T1 spinal level indicates a dysfunction in the right C7 articular pillar. To improve left rotation, mobilization should be performed at the posterior right C7 articular pillar. This will help to restore normal range of motion and alleviate the restriction.

Explanation

The correct answer is posterior right C7 articular pillar. During a cervical spine examination, restricted left rotation of the C7-T1 spinal level indicates a dysfunction in the right C7 articular pillar. To improve left rotation, mobilization should be performed at the posterior right C7 articular pillar. This will help to restore normal range of motion and alleviate the restriction.

28. A 72 year-old woman is being treated for depression following the death of her husband. She is currently taking antidepressant medication (tricyclics) and has a recent history of a fall. You suspect the precipitating cause of the fall can be attributed to side effects of her medication resulting in:

Cardiac arrhythmias

Dyspnea.

Hyperalertness.

Postural hypotension

The correct answer is cardiac arrhythmias. Tricyclic antidepressant medications can have side effects on the cardiovascular system, including the potential to cause cardiac arrhythmias. This can increase the risk of falls, especially in older adults who may already have underlying cardiovascular issues. Dyspnea, hyperalertness, and postural hypotension are not typically associated with the side effects of tricyclic antidepressants.

Explanation

The correct answer is cardiac arrhythmias. Tricyclic antidepressant medications can have side effects on the cardiovascular system, including the potential to cause cardiac arrhythmias. This can increase the risk of falls, especially in older adults who may already have underlying cardiovascular issues. Dyspnea, hyperalertness, and postural hypotension are not typically associated with the side effects of tricyclic antidepressants.

29. 1. A 46 year-old patient presents with a flatfoot deformity with abduction of the forefoot in relation to the weight bearing line. The forefoot is inverted to the varus position when inspected from the frontal plane. Corrections for this foot deformity would NOT include a:

Metatarsal bar.

Scaphoid pad.

Thomas heel.

UCBL insert.

A Thomas heel is not used for correcting a flatfoot deformity with abduction of the forefoot and inversion of the varus position. A Thomas heel is a wedge-shaped heel extension that is used to decrease tension on the Achilles tendon and calf muscles. It is typically used for conditions such as Achilles tendinitis or calf muscle strains. In this case, the deformity requires correction of the arch and alignment of the forefoot, which would be addressed with a metatarsal bar, scaphoid pad, or UCBL insert.

Explanation

A Thomas heel is not used for correcting a flatfoot deformity with abduction of the forefoot and inversion of the varus position. A Thomas heel is a wedge-shaped heel extension that is used to decrease tension on the Achilles tendon and calf muscles. It is typically used for conditions such as Achilles tendinitis or calf muscle strains. In this case, the deformity requires correction of the arch and alignment of the forefoot, which would be addressed with a metatarsal bar, scaphoid pad, or UCBL insert.

30. A patient with COPD has developed respiratory acidosis. You instruct the physical therapy student who is participating in her care to monitor the patient closely for:

Dizziness or syncope

Dyspnea, anxiety, or disorientation.

Muscle twitching or tetany.

Tingling or numbness.

Respiratory acidosis occurs when there is an excess of carbon dioxide in the blood due to inadequate ventilation. This can lead to a decrease in oxygen levels and an increase in carbon dioxide levels, causing symptoms such as dizziness or syncope (loss of consciousness). Monitoring for these symptoms is important as they indicate worsening respiratory acidosis and the need for immediate intervention to improve ventilation and oxygenation.

Explanation

Respiratory acidosis occurs when there is an excess of carbon dioxide in the blood due to inadequate ventilation. This can lead to a decrease in oxygen levels and an increase in carbon dioxide levels, causing symptoms such as dizziness or syncope (loss of consciousness). Monitoring for these symptoms is important as they indicate worsening respiratory acidosis and the need for immediate intervention to improve ventilation and oxygenation.

31. An appropriate fine motor behavior that should be established by 9 months of age would be the ability to:

Build a tower of 4 blocks.

Hold a cup by the handle while drinking.

Pick up a raisin with a fine pincer grasp.

Transfer objects from one hand to another.

By 9 months of age, infants should have developed the fine motor skills necessary to build a tower of 4 blocks. This involves using their fingers and hands to grasp and manipulate the blocks, demonstrating coordination and control. Holding a cup by the handle while drinking requires gross motor skills, not fine motor skills. Picking up a raisin with a fine pincer grasp and transferring objects from one hand to another are also important fine motor skills, but building a tower of blocks is a more complex task that demonstrates a higher level of fine motor development.

Explanation

By 9 months of age, infants should have developed the fine motor skills necessary to build a tower of 4 blocks. This involves using their fingers and hands to grasp and manipulate the blocks, demonstrating coordination and control. Holding a cup by the handle while drinking requires gross motor skills, not fine motor skills. Picking up a raisin with a fine pincer grasp and transferring objects from one hand to another are also important fine motor skills, but building a tower of blocks is a more complex task that demonstrates a higher level of fine motor development.

32. A 62 year-old patient has chronic obstructive pulmonary disease. The MOST likely pulmonary test result would be:

Decreased functional residual capacity.

Decreased residual volume.

Increased total lung capacity.

Increased vital capacity.

Patients with chronic obstructive pulmonary disease (COPD) often have airway obstruction and increased air trapping, leading to decreased functional residual capacity (FRC). FRC is the volume of air remaining in the lungs after a normal exhalation and is decreased in COPD due to the inability to fully exhale. Decreased residual volume (RV) and increased total lung capacity (TLC) are not typically seen in COPD. Increased vital capacity (VC) may occur in COPD as a compensatory response to decreased FRC, but it is not the most likely result. Therefore, the most likely pulmonary test result in a 62 year-old patient with COPD would be decreased functional residual capacity.

Explanation

Patients with chronic obstructive pulmonary disease (COPD) often have airway obstruction and increased air trapping, leading to decreased functional residual capacity (FRC). FRC is the volume of air remaining in the lungs after a normal exhalation and is decreased in COPD due to the inability to fully exhale. Decreased residual volume (RV) and increased total lung capacity (TLC) are not typically seen in COPD. Increased vital capacity (VC) may occur in COPD as a compensatory response to decreased FRC, but it is not the most likely result. Therefore, the most likely pulmonary test result in a 62 year-old patient with COPD would be decreased functional residual capacity.

33. A 42 year-old homemaker presents with acute lateral epicondylitis following participation in a local tennis tournament. Pain is 9/10. The MOST appropriate initial intervention for this problem is:

Cold intermittent compression three times per week.

Cold whirlpool daily until the pain subsides

Fluidotherapy three times per week

Ice massage B.I.D. until the pain subsides

The most appropriate initial intervention for acute lateral epicondylitis is cold whirlpool daily until the pain subsides. Cold therapy helps reduce inflammation and pain by constricting blood vessels and reducing blood flow to the affected area. Whirlpool therapy provides a combination of cold therapy and gentle massaging action, which can help alleviate pain and promote healing. Daily treatment with cold whirlpool is recommended to effectively manage the symptoms of acute lateral epicondylitis.

Explanation

The most appropriate initial intervention for acute lateral epicondylitis is cold whirlpool daily until the pain subsides. Cold therapy helps reduce inflammation and pain by constricting blood vessels and reducing blood flow to the affected area. Whirlpool therapy provides a combination of cold therapy and gentle massaging action, which can help alleviate pain and promote healing. Daily treatment with cold whirlpool is recommended to effectively manage the symptoms of acute lateral epicondylitis.

34. A 55 year-old male electrician is unable to pull wire overhead due to a painless inability to reach past 80 degrees of right shoulder abduction. He has had numerous previous episodes of right shoulder pain over the last ten years which were diagnosed as shoulder tendinitis. Early subacute physical therapy intervention should focus on:

Active assistive pulley exercises.

Gentle grade III translatory glenohumeral mobilizations.

Modalities to reduce pain and inflammation.

Resistance exercises for the affected supraspinatus muscle.

The correct answer is gentle grade III translatory glenohumeral mobilizations. This intervention is appropriate because the patient has a painless inability to reach past 80 degrees of right shoulder abduction, indicating a restriction in the glenohumeral joint. Gentle grade III translatory mobilizations can help improve joint mobility and increase the range of motion in the shoulder. This intervention is more suitable than active assistive pulley exercises, modalities to reduce pain and inflammation, or resistance exercises for the supraspinatus muscle, as these interventions do not specifically address the joint restriction.

Explanation

The correct answer is gentle grade III translatory glenohumeral mobilizations. This intervention is appropriate because the patient has a painless inability to reach past 80 degrees of right shoulder abduction, indicating a restriction in the glenohumeral joint. Gentle grade III translatory mobilizations can help improve joint mobility and increase the range of motion in the shoulder. This intervention is more suitable than active assistive pulley exercises, modalities to reduce pain and inflammation, or resistance exercises for the supraspinatus muscle, as these interventions do not specifically address the joint restriction.

35. A 54 year-old factory worker injured his right arm in a factory press with damage to the ulnar nerve at the elbow. A diagnostic EMG was performed with evidence of spontaneous fibrillation potentials. In this case, the physical therapy plan of care should consider that:

Axonotmesis is occurring.

Denervation atrophy has occurred.

Reinnervation is complete.

Reinnervation is in process.

Based on the information provided, the diagnostic EMG showing evidence of spontaneous fibrillation potentials indicates that there is damage to the ulnar nerve at the elbow. Axonotmesis refers to a nerve injury where the axons are damaged but the connective tissue surrounding the nerve remains intact. Spontaneous fibrillation potentials are characteristic of axonotmesis, indicating ongoing muscle fiber denervation and subsequent muscle wasting. Therefore, in this case, the physical therapy plan of care should consider that axonotmesis is occurring.

Explanation

Based on the information provided, the diagnostic EMG showing evidence of spontaneous fibrillation potentials indicates that there is damage to the ulnar nerve at the elbow. Axonotmesis refers to a nerve injury where the axons are damaged but the connective tissue surrounding the nerve remains intact. Spontaneous fibrillation potentials are characteristic of axonotmesis, indicating ongoing muscle fiber denervation and subsequent muscle wasting. Therefore, in this case, the physical therapy plan of care should consider that axonotmesis is occurring.

36. The Director of Physical Therapy from a large teaching hospital is asked to develop an operating budget for the upcoming fiscal year. The item that would NOT be included in an operating budget is:

A treadmill purchase.

Equipment maintenance.

Housekeeping supplies.

Long distance telephone calls.

The operating budget for a hospital typically includes expenses related to the daily operations and functioning of the facility. This includes equipment maintenance to ensure that all medical equipment is in proper working condition, long distance telephone calls for communication purposes, and even a treadmill purchase if it is necessary for physical therapy services. However, housekeeping supplies, although important for maintaining cleanliness and hygiene, would generally be categorized under the facility's maintenance budget rather than the operating budget.

Explanation

The operating budget for a hospital typically includes expenses related to the daily operations and functioning of the facility. This includes equipment maintenance to ensure that all medical equipment is in proper working condition, long distance telephone calls for communication purposes, and even a treadmill purchase if it is necessary for physical therapy services. However, housekeeping supplies, although important for maintaining cleanliness and hygiene, would generally be categorized under the facility's maintenance budget rather than the operating budget.

37. A 38 year-old patient with spinal cord injury is being discharged home after a 2 month course of rehabilitation. In preparation for discharge, you and your team visit the home and find he has 3 standard height steps going into his home. A ramp will have to be constructed for his wheelchair. The recommended length of his ramp should be:

120 inches (10 feet).

192 inches (16 feet).

252 inches (21 feet).

60 inches (5 feet).

The recommended length of the ramp should be 252 inches (21 feet). This is because the patient has 3 standard height steps going into his home, and the recommended slope for a wheelchair ramp is 1:12. This means that for every 1 inch of vertical rise, there should be 12 inches of ramp length. Since the steps are of standard height, which is usually around 7 inches, the ramp should have a length of 7 x 12 = 84 inches to cover the vertical rise. In addition, there should also be a flat landing at the top and bottom of the ramp, each measuring at least 60 inches (5 feet). Therefore, the total recommended length of the ramp is 84 + 60 + 60 = 204 inches (17 feet). However, it is generally recommended to add an additional 2 feet to the ramp length for ease of use, making the total length 252 inches (21 feet).

Explanation

The recommended length of the ramp should be 252 inches (21 feet). This is because the patient has 3 standard height steps going into his home, and the recommended slope for a wheelchair ramp is 1:12. This means that for every 1 inch of vertical rise, there should be 12 inches of ramp length. Since the steps are of standard height, which is usually around 7 inches, the ramp should have a length of 7 x 12 = 84 inches to cover the vertical rise. In addition, there should also be a flat landing at the top and bottom of the ramp, each measuring at least 60 inches (5 feet). Therefore, the total recommended length of the ramp is 84 + 60 + 60 = 204 inches (17 feet). However, it is generally recommended to add an additional 2 feet to the ramp length for ease of use, making the total length 252 inches (21 feet).

38. A 77 year-old patient has been confined to bed for a period of 2 months and now demonstrates limited ROM in both lower extremities. Range in hip flexion is 5º to 115º and knee flexion is 10º to 120º. The MOST appropriate intervention to improve flexibility and ready this patient for standing is:

Dynamic lower extremity splints, applied for 2 hours daily.

Hold-relax techniques followed by passive ROM 3 times a week.

Manual passive stretching, 5 repetitions each joint, 2 times a day.

Mechanical stretching using traction and 5 lb. weights, 2 hours, twice daily.

The most appropriate intervention to improve flexibility and ready this patient for standing is manual passive stretching, 5 repetitions each joint, 2 times a day. This intervention involves the therapist gently moving the patient's joints through their full range of motion without the patient actively participating. Manual passive stretching helps to increase flexibility by elongating the muscles and connective tissues, improving joint mobility, and preventing contractures. This intervention is suitable for a patient who has limited range of motion in both lower extremities due to prolonged bed rest. Dynamic lower extremity splints, hold-relax techniques, and mechanical stretching using traction and weights are not as appropriate in this case.

Explanation

The most appropriate intervention to improve flexibility and ready this patient for standing is manual passive stretching, 5 repetitions each joint, 2 times a day. This intervention involves the therapist gently moving the patient's joints through their full range of motion without the patient actively participating. Manual passive stretching helps to increase flexibility by elongating the muscles and connective tissues, improving joint mobility, and preventing contractures. This intervention is suitable for a patient who has limited range of motion in both lower extremities due to prolonged bed rest. Dynamic lower extremity splints, hold-relax techniques, and mechanical stretching using traction and weights are not as appropriate in this case.

39. A patient was referred to physical therapy complaining of loss of cervical AROM. His X-rays showed DJD at the uncinate processes in the cervical spine. The motion that would be MOST restricted would be:

Extension.

Flexion.

Rotation.

Side-bending

The patient's X-rays showed DJD at the uncinate processes in the cervical spine. DJD, also known as degenerative joint disease, is a condition that causes the breakdown of cartilage in the joints. In the cervical spine, this can lead to the formation of bone spurs and narrowing of the joint space, limiting the range of motion. Extension refers to the backward bending of the neck, and since the uncinate processes are affected by DJD, this motion would be the most restricted for the patient.

Explanation

The patient's X-rays showed DJD at the uncinate processes in the cervical spine. DJD, also known as degenerative joint disease, is a condition that causes the breakdown of cartilage in the joints. In the cervical spine, this can lead to the formation of bone spurs and narrowing of the joint space, limiting the range of motion. Extension refers to the backward bending of the neck, and since the uncinate processes are affected by DJD, this motion would be the most restricted for the patient.

40. You have volunteered to teach a stroke education class on positioning techniques for family members and caregivers. There will be 12 individuals attending this class, ranging in age from 42 to 82. Your BEST choice of teaching methods is to utilize:

Demonstration, practice, and follow-up discussion.

Lecture with some time for questions at the end of the 30 minute session.

Multimedia (slides and overheads) to accompany your oral presentation.

One on one practice with adequate critiquing of performance.

The best choice of teaching methods for a stroke education class with a diverse age range is to utilize multimedia (slides and overheads) to accompany the oral presentation. This method allows for visual aids to enhance understanding and engagement for all participants, regardless of their age. It also provides a structured format that can cater to different learning styles. The combination of oral presentation and visual aids ensures that the information is effectively communicated and retained by the attendees.

Explanation

The best choice of teaching methods for a stroke education class with a diverse age range is to utilize multimedia (slides and overheads) to accompany the oral presentation. This method allows for visual aids to enhance understanding and engagement for all participants, regardless of their age. It also provides a structured format that can cater to different learning styles. The combination of oral presentation and visual aids ensures that the information is effectively communicated and retained by the attendees.

41. An 82 year-old patient and his caregivers should understand the common side effects of the medication that he is taking. He is continually in and out of congestive heart failure and has been taking digitalis (Digoxin) to improve his heart function. You will know he and his caregivers understand the adverse side effects of this medication if they tell you they will contact the patient’s physician if he demonstrates:

Confusion and memory loss.

Involuntary movements and shaking.

Slowed heart rate.

Weakness and palpitations

The correct answer is "confusion and memory loss" because these are common side effects of digitalis (Digoxin) medication. Digitalis can affect the central nervous system and cause cognitive impairment, including confusion and memory loss. It is important for the patient and caregivers to be aware of these side effects and to contact the physician if they occur, as it may indicate a need for dosage adjustment or alternative treatment options. The other options listed, such as involuntary movements and shaking, slowed heart rate, and weakness and palpitations, are not typically associated with digitalis use.

Explanation

The correct answer is "confusion and memory loss" because these are common side effects of digitalis (Digoxin) medication. Digitalis can affect the central nervous system and cause cognitive impairment, including confusion and memory loss. It is important for the patient and caregivers to be aware of these side effects and to contact the physician if they occur, as it may indicate a need for dosage adjustment or alternative treatment options. The other options listed, such as involuntary movements and shaking, slowed heart rate, and weakness and palpitations, are not typically associated with digitalis use.

42. A 45 year-old computer programmer, with no significant past medical history, presents to the emergency room with complaints of fever, shaking chills and a worsening productive cough. He has chest pain over the posterior base of his left thorax which is made worse on inspiration. An anterior-posterior X-ray shows an infiltrate on the lower left thorax at the posterior base. This patient’s chest pain is MOST likely caused by:

Angina.

Infected pleura.

Inflamed tracheobronchial tree.

Trauma to the chest.

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Explanation

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43. A patient with a transfemoral amputation is being fitted with a quadrilateral socket. Areas of pressure tolerance would be expected over the:

Distolateral end of femur and ischial seat.

Gluteals and adductor magnus.

Ischial tuberosity, gluteals, and lateral sides of residual limb.

Perineal area and medial side of femur.

For a patient with a transfemoral amputation fitted with a quadrilateral socket, pressure tolerance is expected over the ischial tuberosity (sitting bone), the gluteal muscles, and the lateral sides of the residual limb. These areas are crucial for distributing pressure, providing comfort, stability, and support when using a prosthetic limb.

Explanation

For a patient with a transfemoral amputation fitted with a quadrilateral socket, pressure tolerance is expected over the ischial tuberosity (sitting bone), the gluteal muscles, and the lateral sides of the residual limb. These areas are crucial for distributing pressure, providing comfort, stability, and support when using a prosthetic limb.

44. Your patient is a 16 year-old recovering from a complete spinal cord injury with C5 quadriplegia. You are performing PROM exercises on the mat when he complains of a sudden pounding headache and double vision. You notice he is sweating excessively, and when you take his BP it is 240/95. Your BEST course of action is to:

Immediately contact the patient’s physician.

Lie the patient down immediately, elevate his legs, then call for a nurse.

Place him in sitting position and continue to monitor BP.

Sit the patient up, check/empty catheter, and then call for emergency medical assistance.

Placing the patient in a sitting position and continuing to monitor their blood pressure is the best course of action in this scenario. The sudden onset of a pounding headache, double vision, excessive sweating, and a significantly elevated blood pressure may indicate autonomic dysreflexia, a potentially life-threatening condition that can occur in individuals with spinal cord injuries. Placing the patient in a sitting position helps to alleviate the increased blood pressure caused by autonomic dysreflexia. Continuing to monitor the blood pressure is important to ensure that it does not continue to rise to dangerous levels.

Explanation

Placing the patient in a sitting position and continuing to monitor their blood pressure is the best course of action in this scenario. The sudden onset of a pounding headache, double vision, excessive sweating, and a significantly elevated blood pressure may indicate autonomic dysreflexia, a potentially life-threatening condition that can occur in individuals with spinal cord injuries. Placing the patient in a sitting position helps to alleviate the increased blood pressure caused by autonomic dysreflexia. Continuing to monitor the blood pressure is important to ensure that it does not continue to rise to dangerous levels.

45. Your examination reveals muscle spasms of the deep hip rotators, which are compressing the sciatic nerve and producing pain in the posterior hip region. The MOST effective setting of ultrasound in this case is:

1 MHz continuous at 1.0 W/cm2.

1 MHz pulsed at 1.0 W/cm2.

3 MHz continuous at 1.0 W/cm2.

3 MHz pulsed at 1.0 W/cm2.

The deep hip rotators are causing muscle spasms that are compressing the sciatic nerve and causing pain in the posterior hip region. Ultrasound therapy can be used to treat this condition. In this case, the most effective setting of ultrasound would be 3 MHz continuous at 1.0 W/cm2. Continuous ultrasound at a higher frequency (3 MHz) is more effective in treating deep tissues, such as the deep hip rotators. The intensity of 1.0 W/cm2 ensures sufficient energy is delivered to the affected area for therapeutic benefits. Pulsed ultrasound or lower frequency ultrasound may not penetrate deep enough or provide enough energy to effectively treat the condition.

Explanation

The deep hip rotators are causing muscle spasms that are compressing the sciatic nerve and causing pain in the posterior hip region. Ultrasound therapy can be used to treat this condition. In this case, the most effective setting of ultrasound would be 3 MHz continuous at 1.0 W/cm2. Continuous ultrasound at a higher frequency (3 MHz) is more effective in treating deep tissues, such as the deep hip rotators. The intensity of 1.0 W/cm2 ensures sufficient energy is delivered to the affected area for therapeutic benefits. Pulsed ultrasound or lower frequency ultrasound may not penetrate deep enough or provide enough energy to effectively treat the condition.

46. A patient with a complete T10 paraplegia is receiving his initial ambulation training. He has received bilateral Craig-Scott knee-ankle-foot orthoses and is being trained with axillary crutches. Since a reciprocal gait pattern is problematic for him, the BEST initial gait pattern to teach him is:

Four-point.

Swing-through.

Swing-to.

Two-point.

The BEST initial gait pattern to teach a patient with complete T10 paraplegia, who is receiving ambulation training with bilateral knee-ankle-foot orthoses and axillary crutches, is the swing-to gait pattern. This gait pattern involves advancing both crutches forward, followed by advancing both lower extremities forward simultaneously. It is suitable for patients who have difficulty achieving a reciprocal gait pattern due to their condition. The swing-to gait pattern allows for better stability and control during ambulation, making it the most appropriate choice for this patient.

Explanation

The BEST initial gait pattern to teach a patient with complete T10 paraplegia, who is receiving ambulation training with bilateral knee-ankle-foot orthoses and axillary crutches, is the swing-to gait pattern. This gait pattern involves advancing both crutches forward, followed by advancing both lower extremities forward simultaneously. It is suitable for patients who have difficulty achieving a reciprocal gait pattern due to their condition. The swing-to gait pattern allows for better stability and control during ambulation, making it the most appropriate choice for this patient.

47. You have determined a patient with a right CVA that you are currently treating has a profound deficit of homonymous hemianopsia. The BEST initial strategy to assist the patient in compensating for this deficit is to:

Make the patient aware of his deficit and teach him to turn his head to the affected left side.

Place items, eating utensils on his left side.

Provide constant reminders, printed notes on his left side, telling him to look to the left.

Rearrange his room so while in his bed his left side is facing the doorway.

The best initial strategy to assist a patient with a profound deficit of homonymous hemianopsia is to provide constant reminders, printed notes on his left side, telling him to look to the left. This strategy helps the patient become aware of the deficit and encourages them to actively compensate for it by consciously directing their attention towards the affected side. Placing items or rearranging the room may provide some assistance, but constant reminders and visual cues are more effective in helping the patient develop compensatory strategies and improve their overall functioning.

Explanation

The best initial strategy to assist a patient with a profound deficit of homonymous hemianopsia is to provide constant reminders, printed notes on his left side, telling him to look to the left. This strategy helps the patient become aware of the deficit and encourages them to actively compensate for it by consciously directing their attention towards the affected side. Placing items or rearranging the room may provide some assistance, but constant reminders and visual cues are more effective in helping the patient develop compensatory strategies and improve their overall functioning.

48. At 10 a.m. a physical therapist working on a spinal cord unit is treating a patient with paraplegia at the T3 level. The therapist smells alcohol on his breath and the patient is having difficulty accomplishing a bed-to-chair transfer that was previously done without assistance. In this case the physical therapist should:

Confront the patient and ask if he has been drinking.

Document and report suspicions of alcoholism to the rehabilitation team at the weekly meeting.

Document the findings and immediately inform the patient’s physician about the situation.

Immediately inform the nurse in charge.

The physical therapist should document the findings of smelling alcohol on the patient's breath and the difficulty in accomplishing a previously done transfer. This documentation is important for maintaining an accurate record of the patient's condition and any potential issues. Additionally, the therapist should immediately inform the patient's physician about the situation to ensure appropriate medical intervention and to address any potential safety concerns. This allows the physician to assess the patient's condition and determine the best course of action.

Explanation

The physical therapist should document the findings of smelling alcohol on the patient's breath and the difficulty in accomplishing a previously done transfer. This documentation is important for maintaining an accurate record of the patient's condition and any potential issues. Additionally, the therapist should immediately inform the patient's physician about the situation to ensure appropriate medical intervention and to address any potential safety concerns. This allows the physician to assess the patient's condition and determine the best course of action.

49. A forty-eight year-old female sustained a fracture to her left shoulder. Treatment is proceeding well except that with left shoulder flexion you notice the scapula protract and elevate early and it continues to move excessively. Physical therapy intervention should emphasize:

Glenohumeral mobilization and strengthening of scapular stabilizers to regain normal scapulohumeral movement.

Glenohumeral mobilization, and strengthening of the rotator cuff muscles to regain muscle balance

Scapulothoracic mobilization and strengthening of the pectoralis major and minor muscles to regain normal scapulohumeral rhythm.

Stretching of scapular stabilizers and strengthening of the pectoralis major and minor muscles to regain muscle balance.

The correct answer is scapulothoracic mobilization and strengthening of the pectoralis major and minor muscles to regain normal scapulohumeral rhythm. This is because the patient is experiencing excessive movement of the scapula during shoulder flexion. Scapulothoracic mobilization can help restore normal movement of the scapula, while strengthening the pectoralis major and minor muscles can help improve scapulohumeral rhythm.

Explanation

The correct answer is scapulothoracic mobilization and strengthening of the pectoralis major and minor muscles to regain normal scapulohumeral rhythm. This is because the patient is experiencing excessive movement of the scapula during shoulder flexion. Scapulothoracic mobilization can help restore normal movement of the scapula, while strengthening the pectoralis major and minor muscles can help improve scapulohumeral rhythm.

50. A seventy year-old male retired carpenter who has had long term lumbar pain with a previous diagnosis of degenerative joint disease (DJD) of his lumbar facet joints. He complains of numbness, paresthesias and weakness of his bilateral lower extremities which increase with extended positions or walking greater than 100 feet. His pain persists for hours after assuming a resting position. He reports he can ride his stationary bike for 30 minutes without any problems. Primary physical therapy intervention should include:

Abdominal and back extension strengthening as the result of spondylolysis.

Increasing cardiovascular endurance as the result of degenerative arthritis.

Stretching and limiting extended spinal positions as the result of spinal stenosis.

Traction and limitation of weight bearing positions as the result of discal dysfunction.

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Explanation

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51. A 34 year-old female in her second trimester of pregnancy was sent to physical therapy with complaints of tingling and loss of strength in both of her hands. Her symptoms are exacerbated if she is required to use her keyboard at work for longer than 20 minutes. The MOST appropriate physical therapy intervention would include:

Dexamethasone phonophoresis to the carpal tunnel.

Hydrocortisone iontophoresis to the volar surfaces of both wrists.

Ice packs to the carpal tunnel.

Placing the wrists in resting splints.

The most appropriate physical therapy intervention for a pregnant woman experiencing tingling and loss of strength in both hands, exacerbated by keyboard use, would be hydrocortisone iontophoresis to the volar surfaces of both wrists. This intervention can help reduce inflammation and provide pain relief. Dexamethasone phonophoresis and ice packs may not be suitable during pregnancy, and placing the wrists in resting splints may not address the underlying inflammation causing the symptoms.

Explanation

The most appropriate physical therapy intervention for a pregnant woman experiencing tingling and loss of strength in both hands, exacerbated by keyboard use, would be hydrocortisone iontophoresis to the volar surfaces of both wrists. This intervention can help reduce inflammation and provide pain relief. Dexamethasone phonophoresis and ice packs may not be suitable during pregnancy, and placing the wrists in resting splints may not address the underlying inflammation causing the symptoms.

52. A physical therapist is gait training a patient with left hemiplegia. The patient’s new AFO arrives, but the therapist is overwhelmed with too many patients and asks the physical therapy student to take over. This is the student’s first affiliation (second day) and she has never performed an orthotic checkout for a patient with an AFO. The supervising therapist will be in the same vicinity treating other patients. This task should:

Be considered an advanced task, but allowable for the student to perform as a good learning experience.

Be designated as a more advanced task and more appropriately delegated to another physical therapist.

Not be completed now and the patient sent back to his room.

The student should be able to perform the orthotic checkout for the patient with the AFO as it is considered a routine task. The supervisor will be in the same vicinity treating other patients, so the student can call out to the supervisor if any problems arise. This allows the student to gain valuable experience while still having the support and guidance of the supervisor nearby.

Explanation

The student should be able to perform the orthotic checkout for the patient with the AFO as it is considered a routine task. The supervisor will be in the same vicinity treating other patients, so the student can call out to the supervisor if any problems arise. This allows the student to gain valuable experience while still having the support and guidance of the supervisor nearby.

53. In a research study in which there is a skewed distribution with extreme scores on a balance measure that deviate from the performance of the total group, the MOST accurate representation of central tendency is:

Mean.

Median.

Mode.

Standard deviation

In a skewed distribution with extreme scores, the mean is the most accurate representation of central tendency because it takes into account all the scores in the data set. The mean is calculated by summing all the scores and dividing by the total number of scores. While the extreme scores may pull the mean towards one end of the distribution, it still provides a good measure of the average performance of the total group. The median and mode may be less accurate in this case because they are not as affected by extreme scores. Standard deviation, on the other hand, is a measure of variability and not central tendency.

Explanation

In a skewed distribution with extreme scores, the mean is the most accurate representation of central tendency because it takes into account all the scores in the data set. The mean is calculated by summing all the scores and dividing by the total number of scores. While the extreme scores may pull the mean towards one end of the distribution, it still provides a good measure of the average performance of the total group. The median and mode may be less accurate in this case because they are not as affected by extreme scores. Standard deviation, on the other hand, is a measure of variability and not central tendency.

54. A 95 year-old has recently been admitted to your skilled nursing facility following a fall-related injury (fractured hip with open reduction, internal fixation). Since she lived alone on the second floor, she was unable to return home. She is extremely agitated over her placement here and demonstrates early signs of dementia. She tells you “leave me alone, I just want to get out of here!” An important approach to take while working with this client is to:

Be calm and supportive, using only one or two level commands.

Establish the rules: tell her exactly what she is to do while you are with her.

Use gesture or sign language to communicate with her.

Promise her anything as long as she gets up and walks for you.

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Explanation

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55. A physical therapist is instructing a kindergarten teacher in a behavior management program for a child with developmental disabilities who has been mainstreamed into the regular classroom. The therapist requests that the teacher encourage the child to maintain a head retracted sitting position in the class. The strategy that would be MOST helpful in this situation is to:

Have the teacher encourage the classmates to tell the child to sit up in the chair.

Have the teacher give a smile sticker when the child sits with head retracted for five minutes.

Have the teacher issue a verbal reprimand when the child slumps in the chair.

Train the teacher in manual handling techniques to assist the child in head retraction.

The most helpful strategy in this situation is to have the teacher issue a verbal reprimand when the child slumps in the chair. By doing so, the teacher is providing immediate feedback and correction to the child's behavior, reinforcing the importance of maintaining a head retracted sitting position. This strategy helps to create consistency and reinforces the desired behavior in the classroom setting.

Explanation

The most helpful strategy in this situation is to have the teacher issue a verbal reprimand when the child slumps in the chair. By doing so, the teacher is providing immediate feedback and correction to the child's behavior, reinforcing the importance of maintaining a head retracted sitting position. This strategy helps to create consistency and reinforces the desired behavior in the classroom setting.

56. You have a small area of dermatitis on the back of your hand with moderate exudate. You are scheduled to treat a patient with HIV for management of an open wound. You should:

Continue with treatment as scheduled but wash your hands thoroughly before and after.

Double glove and treat as scheduled.

Refuse to treat that patient.

Use sterile precautions with mask and gloves

The correct answer is to double glove and treat as scheduled. This is because HIV is not transmitted through casual contact or through intact skin. By double gloving, you provide an extra layer of protection against potential exposure to the patient's exudate. Washing your hands thoroughly before and after treatment is also important to maintain good hygiene and prevent the spread of any potential infections. Refusing to treat the patient is not necessary as long as appropriate precautions are taken. Using sterile precautions with a mask and gloves may be excessive for this situation since the risk of transmission is low.

Explanation

The correct answer is to double glove and treat as scheduled. This is because HIV is not transmitted through casual contact or through intact skin. By double gloving, you provide an extra layer of protection against potential exposure to the patient's exudate. Washing your hands thoroughly before and after treatment is also important to maintain good hygiene and prevent the spread of any potential infections. Refusing to treat the patient is not necessary as long as appropriate precautions are taken. Using sterile precautions with a mask and gloves may be excessive for this situation since the risk of transmission is low.

57. A therapist is performing clinical research in which a specific myofascial technique is applied to a patient with chronic back pain. She is using a single case experimental design with an A-B-A-B format. Her research hypothesis states that pain rating scores will decrease with the treatment intervention. Acceptance of this hypothesis would be indicated if:

B is equal to A.

B is greater than A, at the .05 level.

B is greater than A, at the 1.0 level.

B is less than A.

In a single case experimental design with an A-B-A-B format, the therapist is measuring the effect of the myofascial technique on the patient's chronic back pain. The A phase represents the baseline measurement before the treatment intervention, and the B phase represents the measurement during and after the treatment intervention. If the pain rating scores during the B phase are significantly greater than the A phase at the .05 level, it indicates that the treatment intervention has had a positive effect on reducing the patient's pain. Therefore, acceptance of the hypothesis would be indicated if B is greater than A, at the .05 level.

Explanation

In a single case experimental design with an A-B-A-B format, the therapist is measuring the effect of the myofascial technique on the patient's chronic back pain. The A phase represents the baseline measurement before the treatment intervention, and the B phase represents the measurement during and after the treatment intervention. If the pain rating scores during the B phase are significantly greater than the A phase at the .05 level, it indicates that the treatment intervention has had a positive effect on reducing the patient's pain. Therefore, acceptance of the hypothesis would be indicated if B is greater than A, at the .05 level.

58. A 59 year-old ex-machinist demonstrates significant age-related hearing loss, presbycusis. When trying to communicate with this patient you would NOT suspect:

Bilateral hearing loss, at all frequencies since he has had this problem for a number of years.

Decreased language comprehension.

Poor auditory discrimination

Unilateral hearing loss.

The correct answer is bilateral hearing loss, at all frequencies since he has had this problem for a number of years. This is because presbycusis, which is age-related hearing loss, typically affects both ears and all frequencies. It is a gradual and progressive condition that occurs over time due to the natural aging process. Therefore, it would not be unexpected for a 59-year-old individual with presbycusis to have bilateral hearing loss at all frequencies.

Explanation

The correct answer is bilateral hearing loss, at all frequencies since he has had this problem for a number of years. This is because presbycusis, which is age-related hearing loss, typically affects both ears and all frequencies. It is a gradual and progressive condition that occurs over time due to the natural aging process. Therefore, it would not be unexpected for a 59-year-old individual with presbycusis to have bilateral hearing loss at all frequencies.

59. A patient who is terminally ill with cancer is in tears, unable to cope with the changes in her life and with her current hospitalization. You have a referral for gait training so she can be discharged to home under hospice care. The BEST approach for you to take is:

Ask the patient questions so you can gain a detailed history.

Encourage denial so she can cope better with her life’s challenges.

Ignore her tears and focus on her therapy but in a compassionate manner.

Take time now to allow the patient to express her fears and frustrations.

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Explanation

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60. A therapist wants to compare frequencies of carpal tunnel syndrome occurring in different groups of individuals: assembly line workers and computer programmers. The MOST appropriate statistical tool to use for analysis of the data is:

Chi square test.

Normal distribution curve.

Simple one-way ANOVA.

T test.

The most appropriate statistical tool to use for analyzing the frequencies of carpal tunnel syndrome occurring in different groups of individuals (assembly line workers and computer programmers) is the normal distribution curve. This is because the normal distribution curve can provide information about the distribution of data and compare the frequencies between the two groups. It can help determine if the occurrence of carpal tunnel syndrome differs significantly between the two groups and provide insights into the overall pattern of the data.

Explanation

The most appropriate statistical tool to use for analyzing the frequencies of carpal tunnel syndrome occurring in different groups of individuals (assembly line workers and computer programmers) is the normal distribution curve. This is because the normal distribution curve can provide information about the distribution of data and compare the frequencies between the two groups. It can help determine if the occurrence of carpal tunnel syndrome differs significantly between the two groups and provide insights into the overall pattern of the data.

61. A patient with a 10 year history of Parkinson’s disease has been taking L-dopa for the last 5 years. He presents in your clinic with deteriorating function. He is not longer able to transfer or walk independently. During the oral interview, you observe facial grimacing with twitching of the lips and tongue protrusion. He appears restless, with constant dancing, athetoid-like movements of his legs. Your BEST course of action is to:

Complete your evaluation focusing specifically on his main problems of rigidity and bradykinesia.

Document your observations and refer him back to his physician for evaluation of possible dopamine toxicity.

Talk to his wife to see if he is taking any drugs with hallucinogenic effects.

Use isokinetic dynamometry to assess his inability to generate torque output during fast movements.

The patient with a 10-year history of Parkinson's disease has been taking L-dopa for the last 5 years. The presenting symptoms of deteriorating function, inability to transfer or walk independently, facial grimacing with twitching of the lips and tongue protrusion, and athetoid-like movements of the legs indicate worsening rigidity and bradykinesia. Therefore, the best course of action is to complete a thorough evaluation focusing specifically on these main problems to assess the progression of the disease and adjust the treatment plan accordingly.

Explanation

The patient with a 10-year history of Parkinson's disease has been taking L-dopa for the last 5 years. The presenting symptoms of deteriorating function, inability to transfer or walk independently, facial grimacing with twitching of the lips and tongue protrusion, and athetoid-like movements of the legs indicate worsening rigidity and bradykinesia. Therefore, the best course of action is to complete a thorough evaluation focusing specifically on these main problems to assess the progression of the disease and adjust the treatment plan accordingly.

62. A 10-year old with full thickness burns to both arms is developing hypertrophic scars The BEST intervention to manage these scars is:

Custom made pressure garments.

Occlusive dressings.

A. primary excision followed by autografts.

Surgical resection (Z-plasty).

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Explanation

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63. With a traction injury to the anterior division of the brachial plexus you would expect to see weakness of the elbow flexors, wrist flexors and forearm pronators. You would also expect to find additional weakness in:

Forearm supination.

Lateral rotation of the shoulder.

Thumb abduction.

Wrist extension.

With a traction injury to the anterior division of the brachial plexus, there is damage to the nerves that control the muscles responsible for forearm supination. This is because the anterior division of the brachial plexus innervates the muscles that perform forearm supination, such as the biceps brachii and supinator muscles. Therefore, weakness in forearm supination would be expected in this type of injury.

Explanation

With a traction injury to the anterior division of the brachial plexus, there is damage to the nerves that control the muscles responsible for forearm supination. This is because the anterior division of the brachial plexus innervates the muscles that perform forearm supination, such as the biceps brachii and supinator muscles. Therefore, weakness in forearm supination would be expected in this type of injury.

64. A contraindication to initiating joint mobilization on a patient with chronic pulmonary disease may include:

Concurrent inhalation therapy.

Functional chest wall immobility.

Long term corticosteroid therapy.

Reflex muscle guarding.

Functional chest wall immobility refers to the inability of the chest wall to move properly due to factors such as muscle weakness or stiffness. In patients with chronic pulmonary disease, their chest wall may already be compromised, leading to limited movement and decreased lung function. Initiating joint mobilization in such patients can further exacerbate their chest wall immobility and potentially worsen their respiratory condition. Therefore, functional chest wall immobility is a contraindication to initiating joint mobilization in patients with chronic pulmonary disease.

Explanation

Functional chest wall immobility refers to the inability of the chest wall to move properly due to factors such as muscle weakness or stiffness. In patients with chronic pulmonary disease, their chest wall may already be compromised, leading to limited movement and decreased lung function. Initiating joint mobilization in such patients can further exacerbate their chest wall immobility and potentially worsen their respiratory condition. Therefore, functional chest wall immobility is a contraindication to initiating joint mobilization in patients with chronic pulmonary disease.

65. A 72 year-old is recovering at home from a myocardial infarction and percutaneous transluminal coronary angioplasty. As his home care physical therapist, you decide to use pulse oximetry to monitor his responses to exercise. An acceptable oxygen saturation rate (SaO2) to maintain throughout the exercise period is:

A. 50%.

A. 82%.

85%.

92%.

An acceptable oxygen saturation rate to maintain throughout the exercise period for a patient recovering from a myocardial infarction and percutaneous transluminal coronary angioplasty is 82%. This level ensures that the patient is receiving adequate oxygenation during exercise, which is important for their recovery and overall cardiovascular health. Oxygen saturation levels below 82% may indicate inadequate oxygen supply to the tissues, while levels above 82% are considered normal and do not pose any significant risk. Therefore, maintaining an SaO2 of 82% during exercise is the most appropriate choice for this patient.

Explanation

An acceptable oxygen saturation rate to maintain throughout the exercise period for a patient recovering from a myocardial infarction and percutaneous transluminal coronary angioplasty is 82%. This level ensures that the patient is receiving adequate oxygenation during exercise, which is important for their recovery and overall cardiovascular health. Oxygen saturation levels below 82% may indicate inadequate oxygen supply to the tissues, while levels above 82% are considered normal and do not pose any significant risk. Therefore, maintaining an SaO2 of 82% during exercise is the most appropriate choice for this patient.

66. A patient who is to undergo surgery for a chronic shoulder dislocation asks you to explain the rehabilitation following a surgical reconstructive procedure he is scheduled to undergo. Your BEST response is to:

Explain how patients typically respond to the surgery and outline the progression of exercises.

Explain in detail about the surgical procedure.

Refer the patient to a physical therapy clinical specialist who is an expert of shoulder reconstructive rehabilitation.

Tell the patient to ask his surgeon for this information

The best response in this situation is to refer the patient to a physical therapy clinical specialist who is an expert in shoulder reconstructive rehabilitation. This is because the specialist will have the specific knowledge and expertise needed to explain the rehabilitation process following the surgical procedure. They will be able to provide detailed information about how patients typically respond to the surgery and outline the progression of exercises. Referring the patient to the specialist ensures that they receive accurate and tailored information for their specific condition and needs.

Explanation

The best response in this situation is to refer the patient to a physical therapy clinical specialist who is an expert in shoulder reconstructive rehabilitation. This is because the specialist will have the specific knowledge and expertise needed to explain the rehabilitation process following the surgical procedure. They will be able to provide detailed information about how patients typically respond to the surgery and outline the progression of exercises. Referring the patient to the specialist ensures that they receive accurate and tailored information for their specific condition and needs.

67. A patient with multiple sclerosis is agitated, irritated, and tired during treatment. Your BEST response as the P.T. is to:

Begin pool therapy to promote relaxation.

Ignore these behaviors and continue treating.

Reduce the exercise intensity and provide relaxation strategies.

Treat the patient in a cool environment.

The best response as a physical therapist when a patient with multiple sclerosis is agitated, irritated, and tired during treatment is to ignore these behaviors and continue treating. This is because these symptoms are common in multiple sclerosis and may not necessarily indicate a need to stop or modify treatment. By continuing with the treatment, the therapist can help the patient maintain their functional abilities and improve their overall condition.

Explanation

The best response as a physical therapist when a patient with multiple sclerosis is agitated, irritated, and tired during treatment is to ignore these behaviors and continue treating. This is because these symptoms are common in multiple sclerosis and may not necessarily indicate a need to stop or modify treatment. By continuing with the treatment, the therapist can help the patient maintain their functional abilities and improve their overall condition.

68. A wrestler complains of pain (7/10) and limited range of motion of the right shoulder as a result of chronic overuse. You elect to use procaine hydrochloride iontophoresis as part of your intervention for this patient’s problems. To administer this substance, it would be appropriate to use:

Continuous biphasic current with the medication under the anode.

Continuous monophasic current with the medication under the anode.

Continuous monophasic current with the medication under the cathode.

Interrupted monophasic current with the medication under the cathode.

In iontophoresis, a direct current is used to deliver medication through the skin. The medication is typically placed under either the anode (positive electrode) or the cathode (negative electrode). In this case, procaine hydrochloride iontophoresis is being used to relieve pain and limited range of motion in the wrestler's shoulder. To administer the medication, it would be appropriate to use continuous monophasic current with the medication under the cathode. This means that the medication should be placed under the negative electrode, and a continuous, unidirectional current should be applied.

Explanation

In iontophoresis, a direct current is used to deliver medication through the skin. The medication is typically placed under either the anode (positive electrode) or the cathode (negative electrode). In this case, procaine hydrochloride iontophoresis is being used to relieve pain and limited range of motion in the wrestler's shoulder. To administer the medication, it would be appropriate to use continuous monophasic current with the medication under the cathode. This means that the medication should be placed under the negative electrode, and a continuous, unidirectional current should be applied.

69. Hypertrophy is the muscular response to strength training. This can be expected to occur following at least:

1-2 weeks of training.

2-3 weeks of training

3-4 weeks of training

6-8 weeks of training.

Hypertrophy is the process of muscle growth and is a response to strength training. It takes time for the muscles to adapt and grow in size. Therefore, it can be expected to occur after a certain period of consistent training. In this case, the correct answer is 3-4 weeks of training, indicating that it typically takes around a month of regular strength training for hypertrophy to start occurring.

Explanation

Hypertrophy is the process of muscle growth and is a response to strength training. It takes time for the muscles to adapt and grow in size. Therefore, it can be expected to occur after a certain period of consistent training. In this case, the correct answer is 3-4 weeks of training, indicating that it typically takes around a month of regular strength training for hypertrophy to start occurring.

70. A physical therapy plan of care for a newborn with Erb-Klumpke Palsy would NOT include:

Age appropriate movements of the upper extremity.

Gentle ROM after immobilization.

Partial immobilization of limb across abdomen.

Splinting the shoulder in abduction and internal rotation.

A physical therapy plan of care for a newborn with Erb-Klumpke Palsy would not include partial immobilization of the limb across the abdomen. This is because immobilization of the limb can lead to muscle atrophy and stiffness, hindering the recovery process. Instead, age-appropriate movements of the upper extremity would be encouraged to promote muscle strength and coordination. Gentle range of motion exercises after immobilization would also be included to maintain joint mobility. Splinting the shoulder in abduction and internal rotation may be used to prevent contractures and promote proper alignment of the joint.

Explanation

A physical therapy plan of care for a newborn with Erb-Klumpke Palsy would not include partial immobilization of the limb across the abdomen. This is because immobilization of the limb can lead to muscle atrophy and stiffness, hindering the recovery process. Instead, age-appropriate movements of the upper extremity would be encouraged to promote muscle strength and coordination. Gentle range of motion exercises after immobilization would also be included to maintain joint mobility. Splinting the shoulder in abduction and internal rotation may be used to prevent contractures and promote proper alignment of the joint.

71. A 72 year-old patient with a transfemoral amputation is unable to wrap his residual limb. Your BEST course of action is to:

Apply a temporary prosthesis immediately.

Consult with the vascular surgeon about the application of an Unna’s paste dressing.

Redouble efforts to teach proper wrapping.

Use a shrinker.

The best course of action is to redouble efforts to teach proper wrapping because it is important for the patient to learn how to wrap his residual limb correctly. This will help prevent complications such as skin breakdown, edema, and discomfort. Applying a temporary prosthesis immediately may not be appropriate if the patient is not yet able to wrap his residual limb properly. Consulting with a vascular surgeon about the application of an Unna's paste dressing may be considered if there are specific medical concerns, but teaching proper wrapping should still be a priority. Using a shrinker may not be effective if the patient does not know how to wrap his residual limb correctly.

Explanation

The best course of action is to redouble efforts to teach proper wrapping because it is important for the patient to learn how to wrap his residual limb correctly. This will help prevent complications such as skin breakdown, edema, and discomfort. Applying a temporary prosthesis immediately may not be appropriate if the patient is not yet able to wrap his residual limb properly. Consulting with a vascular surgeon about the application of an Unna's paste dressing may be considered if there are specific medical concerns, but teaching proper wrapping should still be a priority. Using a shrinker may not be effective if the patient does not know how to wrap his residual limb correctly.

72. A patient with Parkinson’s disease demonstrates a highly stereotyped gait pattern characterized by impoverished movement. The intervention that would be LEAST appropriate to use with this patient is:

A rolling walker to compensate for impaired balance.

Postural exercises to promote trunk and head extension in sitting and standing.

Range of motion exercises to reduce hip and knee flexion contractures.

Sidelying, upper and lower trunk rotation segmental patterns using the technique of rhythmic initiation.

The correct answer is postural exercises to promote trunk and head extension in sitting and standing. Parkinson's disease is characterized by impaired movement and rigidity, so promoting trunk and head extension may exacerbate these symptoms. The other options - using a rolling walker for balance, range of motion exercises, and segmental patterns using rhythmic initiation - are all appropriate interventions for a patient with Parkinson's disease.

Explanation

The correct answer is postural exercises to promote trunk and head extension in sitting and standing. Parkinson's disease is characterized by impaired movement and rigidity, so promoting trunk and head extension may exacerbate these symptoms. The other options - using a rolling walker for balance, range of motion exercises, and segmental patterns using rhythmic initiation - are all appropriate interventions for a patient with Parkinson's disease.

73. A six year-old boy born with myelomeningocele at the L2 level is referred for physical therapy treatment at home. In determining the physical therapy plan of care, it would NOT be appropriate to emphasize:

Gait training with a reciprocating gait orthosis.

Transfer training from floor to wheelchair.

Upper extremity strengthening with weights.

Vigorous range of motion of the lower extremities.

It would not be appropriate to emphasize transfer training from floor to wheelchair because a six-year-old boy with myelomeningocele at the L2 level is likely to have limited lower extremity function and may not be able to independently transfer from the floor to a wheelchair. Therefore, it would be more appropriate to focus on other aspects of physical therapy such as gait training with a reciprocating gait orthosis, upper extremity strengthening with weights, and vigorous range of motion of the lower extremities.

Explanation

It would not be appropriate to emphasize transfer training from floor to wheelchair because a six-year-old boy with myelomeningocele at the L2 level is likely to have limited lower extremity function and may not be able to independently transfer from the floor to a wheelchair. Therefore, it would be more appropriate to focus on other aspects of physical therapy such as gait training with a reciprocating gait orthosis, upper extremity strengthening with weights, and vigorous range of motion of the lower extremities.

74. A patient with a purulent venous insufficiency ulcer near the left medial malleolus is seen at home by a physical therapist. The MOST important goal/intervention for the therapist to try to achieve with this patient is:

Daily changes of elastic wraps to reduce fluid buildup.

Daily warm water baths to improve circulation.

Increase ambulation endurance to hasten wound healing.

Instruct in proper dressing changes and wound care.

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Explanation

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75. Equipment safety is essential in all physical therapy clinics. Regularly scheduling equipment maintenance programs to ensure that all equipment is calibrated, lubricated, and adjusted according to manufacturer’s guidelines is an important element for patient and staff safety. All of the following procedures should be followed to ensure safety EXCEPT:

Conducting educational sessions for staff regarding the indications and contraindications for all equipment.

Documenting all preventive maintenance and keeping this information on file.

Supervising new staff and students in the use of all newly purchased equipment.

Training all staff to do simple repairs on all electrical equipment if a breakdown should occur.

The correct answer is "supervising new staff and students in the use of all newly purchased equipment." This answer is incorrect because it is important to supervise new staff and students in the use of all newly purchased equipment to ensure their safety and proper usage. Supervision is necessary to prevent any accidents or misuse of the equipment. Therefore, this procedure should be followed to ensure safety in the clinic.

Explanation

The correct answer is "supervising new staff and students in the use of all newly purchased equipment." This answer is incorrect because it is important to supervise new staff and students in the use of all newly purchased equipment to ensure their safety and proper usage. Supervision is necessary to prevent any accidents or misuse of the equipment. Therefore, this procedure should be followed to ensure safety in the clinic.

76. A patient is unable to bring her foot up on the next step during a training session on stair climbing. Your BEST course of action to promote active learning is to have the patient:

Balance on the stairs while you passively bring the foot up.

Practice marching in place in the parallel bars.

Practice standing-up from half-kneeling.

Step up onto a low step while in the parallel bars.

The best course of action to promote active learning in this scenario is to have the patient practice standing-up from half-kneeling. This activity requires the patient to actively engage their muscles and coordinate movements to bring their foot up and stand up from a kneeling position. By practicing this movement, the patient will be able to improve their ability to bring their foot up on the next step during stair climbing. The other options mentioned, such as balancing on the stairs while the foot is passively brought up or practicing marching in place, do not specifically target the movement needed for stair climbing.

Explanation

The best course of action to promote active learning in this scenario is to have the patient practice standing-up from half-kneeling. This activity requires the patient to actively engage their muscles and coordinate movements to bring their foot up and stand up from a kneeling position. By practicing this movement, the patient will be able to improve their ability to bring their foot up on the next step during stair climbing. The other options mentioned, such as balancing on the stairs while the foot is passively brought up or practicing marching in place, do not specifically target the movement needed for stair climbing.

77. Following pneumonectomy, an expected change in a patient’s status would NOT include:

Asymmetrical breathing.

Decreased breath sounds.

Deviated trachea.

Increased tidal volume.

After a pneumonectomy, which is the surgical removal of a lung, the patient's breathing pattern may change. However, asymmetrical breathing is not an expected change. Asymmetrical breathing refers to an uneven expansion of the chest during inhalation and exhalation. This is usually a sign of a respiratory problem or lung pathology. In a patient who has undergone a pneumonectomy, the remaining lung will compensate for the loss of the removed lung, leading to a more symmetrical breathing pattern. Therefore, asymmetrical breathing would not be expected in this case.

Explanation

After a pneumonectomy, which is the surgical removal of a lung, the patient's breathing pattern may change. However, asymmetrical breathing is not an expected change. Asymmetrical breathing refers to an uneven expansion of the chest during inhalation and exhalation. This is usually a sign of a respiratory problem or lung pathology. In a patient who has undergone a pneumonectomy, the remaining lung will compensate for the loss of the removed lung, leading to a more symmetrical breathing pattern. Therefore, asymmetrical breathing would not be expected in this case.

78. A twelve-year old female figure skater has been referred to your clinic for treatment for patellar tendinitis. The examination reveals that she is unable to hop on the affected lower extremity due to pain. You decide to refer her back to her pediatrician suggesting that the patient receive an x-ray of her knee. The patient returns for therapy with the x-ray shown in the figure. Your initial intervention should focus on: Magee D (2002). Orthopedic Physical Assessment, 4th ed. Philadelphia, W. B. Saunders, Figure 12-149, page 746, with permission.

Aggressive plyometric exercises with focus on endurance training.

Fitting patient with crutches for non weight-bearing ambulation and initiation of phonophoresis at 3mHz continuous wave using hydrocortisone.

Patient education regarding avoidance of squatting and jumping activities as well as initiation of iontophoresis using dexamethasone.

Patient education regarding avoiding falls onto her affected knee and open chain knee extension exercises to improve quadriceps strength.

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Explanation

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79. A 67 year-old patient is recovering from a left CVA resulting in severe right hemiplegia. Additionally, he has a large diabetic ulcer on his left foot with pitting edema, requiring elevation of that extremity. The MOST appropriate wheelchair prescription for this patient would be a:

Hemiplegic chair.

Lightweight active duty wheelchair.

A. one-arm drive chair.

Powered wheelchair with joystick

The MOST appropriate wheelchair prescription for this patient would be a one-arm drive chair. This type of wheelchair allows the patient to propel themselves using only one arm, which is important in this case since the patient has severe right hemiplegia. The one-arm drive chair would provide the patient with the necessary mobility and independence while accommodating their physical limitations.

Explanation

The MOST appropriate wheelchair prescription for this patient would be a one-arm drive chair. This type of wheelchair allows the patient to propel themselves using only one arm, which is important in this case since the patient has severe right hemiplegia. The one-arm drive chair would provide the patient with the necessary mobility and independence while accommodating their physical limitations.

80. You are instructing a physical therapy student in proper positioning to prevent the typical contractures in the patient with a transtibial amputation. You stress:

Maximize out-of-bed time with sitting in a chair.

Position in prone lying and sitting with full knee extension.

Position in prone-lying with slight knee flexion.

Position in supine with a small pillow under the knee.

The correct answer is to position the patient in prone-lying with slight knee flexion. This position helps to prevent contractures in the patient with a transtibial amputation by maintaining a slight bend in the knee joint. Prone-lying also helps to stretch the hip flexors and prevent hip flexion contractures. This position allows for proper alignment of the residual limb and promotes optimal healing and functional outcomes.

Explanation

The correct answer is to position the patient in prone-lying with slight knee flexion. This position helps to prevent contractures in the patient with a transtibial amputation by maintaining a slight bend in the knee joint. Prone-lying also helps to stretch the hip flexors and prevent hip flexion contractures. This position allows for proper alignment of the residual limb and promotes optimal healing and functional outcomes.

81. A 75 year-old patient with peripheral vascular disease has been referred for conditioning exercise. He demonstrates moderate claudication pain in both legs following a 12 minute walking test. The MOST appropriate exercise frequency and duration for this patient is:

2 times/week, BID 20 minutes/session.

3 times/week, 30 minutes/session.

3 times/week, 60 minutes/session.

5 times/week, BID 10 minutes/session.

The patient has claudication pain, which is caused by reduced blood flow to the legs during exercise. Exercise is an important component of managing peripheral vascular disease, as it can improve blood flow and reduce symptoms. The recommended frequency for exercise in this patient is 3 times per week, as this allows for adequate rest and recovery between sessions. The duration of each exercise session should be 30 minutes, which is a sufficient amount of time to improve cardiovascular fitness without causing excessive strain on the patient's legs.

Explanation

The patient has claudication pain, which is caused by reduced blood flow to the legs during exercise. Exercise is an important component of managing peripheral vascular disease, as it can improve blood flow and reduce symptoms. The recommended frequency for exercise in this patient is 3 times per week, as this allows for adequate rest and recovery between sessions. The duration of each exercise session should be 30 minutes, which is a sufficient amount of time to improve cardiovascular fitness without causing excessive strain on the patient's legs.

82. You are a home therapist treating a patient who underwent a total hip replacement four weeks ago. You notice that the patient arches his lumbar spine in supine. He states that it is uncomfortable and doesn’t remember having the problem before. The patient is unable to maintain a comfortable supine position due to:

Poor abdominal strength.

Tight hamstrings muscles.

Tight iliopsoas muscle.

Tight piriformis muscle.

The patient's inability to maintain a comfortable supine position is likely due to tight hamstrings muscles. Tight hamstrings can cause the patient to arch their lumbar spine in supine, leading to discomfort. The fact that the patient doesn't remember having this problem before suggests that it may be a new issue related to the surgery or recovery process. Poor abdominal strength, tight iliopsoas muscle, and tight piriformis muscle may also contribute to discomfort in supine position, but tight hamstrings muscles are the most likely cause based on the information provided.

Explanation

The patient's inability to maintain a comfortable supine position is likely due to tight hamstrings muscles. Tight hamstrings can cause the patient to arch their lumbar spine in supine, leading to discomfort. The fact that the patient doesn't remember having this problem before suggests that it may be a new issue related to the surgery or recovery process. Poor abdominal strength, tight iliopsoas muscle, and tight piriformis muscle may also contribute to discomfort in supine position, but tight hamstrings muscles are the most likely cause based on the information provided.

83. During your examination of a patient who complains of back pain you found pain with end range AROM into hip flexion, abduction and external/lateral rotation. The structure most likely causing the patient’s pain is the:

Hamstring muscle.

Hip joint.

Piriformis muscle.

SI joint.

The patient's pain with end range AROM into hip flexion, abduction, and external/lateral rotation suggests that the hamstring muscle is the most likely structure causing the pain. The hamstring muscle is responsible for hip extension, knee flexion, and assists in hip rotation. When the hamstring muscle is stretched in these directions, it can cause pain in the back. The other options, including the hip joint, piriformis muscle, and SI joint, do not directly correlate with the specific movements mentioned in the question.

Explanation

The patient's pain with end range AROM into hip flexion, abduction, and external/lateral rotation suggests that the hamstring muscle is the most likely structure causing the pain. The hamstring muscle is responsible for hip extension, knee flexion, and assists in hip rotation. When the hamstring muscle is stretched in these directions, it can cause pain in the back. The other options, including the hip joint, piriformis muscle, and SI joint, do not directly correlate with the specific movements mentioned in the question.

84. You are treating a patient with active hepatitis B infection. Transmission of the disease is best minimized if you:

Avoid direct contact with any part of the patient.

Have the patient wear a gown and mask every time your are in the room.

Have the patient wear gloves to prevent him from touching you.

Wear gloves if there is direct contact with blood or body fluids.

To minimize transmission of hepatitis B, it is best to avoid direct contact with any part of the patient. Hepatitis B is primarily transmitted through contact with infected blood or body fluids. By avoiding direct contact, the risk of coming into contact with these fluids is reduced. Wearing gloves if there is direct contact with blood or body fluids is also important, but it is not the best option for minimizing transmission as it does not address the issue of direct contact. Having the patient wear a gown and mask or wearing gloves to prevent the patient from touching you may provide some protection, but they are not as effective as avoiding direct contact altogether.

Explanation

To minimize transmission of hepatitis B, it is best to avoid direct contact with any part of the patient. Hepatitis B is primarily transmitted through contact with infected blood or body fluids. By avoiding direct contact, the risk of coming into contact with these fluids is reduced. Wearing gloves if there is direct contact with blood or body fluids is also important, but it is not the best option for minimizing transmission as it does not address the issue of direct contact. Having the patient wear a gown and mask or wearing gloves to prevent the patient from touching you may provide some protection, but they are not as effective as avoiding direct contact altogether.

85. A 76 year-old patient exhibits impaired balance. A diagnostic work-up has failed to reveal any specific etiology. An initial intervention for this patient would NOT include:

Limits of stability re-education including postural sway training.

Practice in maintenance of a wide base of support during gait and turns.

Sit-to-stand and stand-to-sit activity training.

Tandem walking and single limb stance.

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Explanation

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86. A diagnosis of bicipital tendinitis has been made following an evaluation of a patient with shoulder pain. The BEST shoulder position to expose the tendon of the long head of the biceps for application of phonophoresis would be:

Abduction.

External/lateral rotation and extension.

Horizontal adduction.

Internal/medial rotation and abduction.

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Explanation

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87. Isokinetic training can best be used in the rehabilitation of patients with stroke during the late stages of recovery to:

Improve initiation of movement.

Improve rate control at faster movement speeds.

Improve rate control at slower movement speeds.

Increase strength of synergy components.

Isokinetic training involves performing exercises at a constant speed throughout the full range of motion. This type of training is beneficial for stroke patients during the late stages of recovery because it helps improve rate control at slower movement speeds. Stroke patients often experience difficulties in controlling their movements, especially at slower speeds. Isokinetic training allows them to practice and improve their ability to control their movements at these slower speeds, which can be crucial for activities of daily living. It helps them regain coordination, stability, and precision in their movements, leading to better overall functional recovery.

Explanation

Isokinetic training involves performing exercises at a constant speed throughout the full range of motion. This type of training is beneficial for stroke patients during the late stages of recovery because it helps improve rate control at slower movement speeds. Stroke patients often experience difficulties in controlling their movements, especially at slower speeds. Isokinetic training allows them to practice and improve their ability to control their movements at these slower speeds, which can be crucial for activities of daily living. It helps them regain coordination, stability, and precision in their movements, leading to better overall functional recovery.

88. A forty year-old female cafeteria worker sustained a right-sided injury to her back while playing golf. She was driving the ball when she felt an immediate sharp pain in her right low back. She states that in the morning she is stiff and her pain eases after taking a shower. Based on the above information, the structure MOST likely involved is:

A disc.

A facet joint.

A nerve root.

The arterioles which supply circulation to the spinal cord.

Based on the information provided, the most likely structure involved in the injury is a disc. The immediate sharp pain in the right low back suggests a sudden injury, and the fact that the pain eases after taking a shower indicates that movement and heat alleviate the discomfort. These symptoms are commonly associated with a disc injury, such as a herniated or bulging disc, which can cause localized pain and stiffness in the back.

Explanation

Based on the information provided, the most likely structure involved in the injury is a disc. The immediate sharp pain in the right low back suggests a sudden injury, and the fact that the pain eases after taking a shower indicates that movement and heat alleviate the discomfort. These symptoms are commonly associated with a disc injury, such as a herniated or bulging disc, which can cause localized pain and stiffness in the back.

89. A patient with right hemiparesis has difficulty clearing the affected foot during the swing phase of gait. An appropriate physical therapy intervention for the right lower extremity might include:

Bridging.

Forward step-ups in standing using graduated height steps.

Pushing backward while sitting on a rolling stool.

Sitting on a Swiss ball, alternating lateral side steps and back to neutral.

Pushing backward while sitting on a rolling stool can help improve the clearance of the affected foot during the swing phase of gait. This exercise targets the muscles responsible for hip extension and can help improve the strength and coordination needed for proper foot clearance. Additionally, sitting on a rolling stool adds an element of instability, which can further challenge the patient's balance and proprioception, leading to improved functional outcomes.

Explanation

Pushing backward while sitting on a rolling stool can help improve the clearance of the affected foot during the swing phase of gait. This exercise targets the muscles responsible for hip extension and can help improve the strength and coordination needed for proper foot clearance. Additionally, sitting on a rolling stool adds an element of instability, which can further challenge the patient's balance and proprioception, leading to improved functional outcomes.

90. A 19 year-old patient has a complete spinal cord injury at the level of L1. His primary goal is to walk again. You decide it would be MOST appropriate to recommend that this patient use:

A reciprocating gait orthosis and walker.

A wheelchair, because ambulation is unrealistic.

Bilateral AFOs and Lofstrand crutches.

Bilateral KAFOs with thoracolumbosacral extension control.

Given that the patient has a complete spinal cord injury at the level of L1, it means that there is a loss of motor and sensory function below that level. This type of injury typically results in paraplegia, which significantly impairs the ability to walk. Therefore, recommending a wheelchair is the most appropriate option as ambulation (walking) is unrealistic in this case.

Explanation

Given that the patient has a complete spinal cord injury at the level of L1, it means that there is a loss of motor and sensory function below that level. This type of injury typically results in paraplegia, which significantly impairs the ability to walk. Therefore, recommending a wheelchair is the most appropriate option as ambulation (walking) is unrealistic in this case.

91. A patient is four weeks post myocardial infarction. Resistive exercises using weights are:

Always contraindicated during acute and post-acute phases of cardiac rehabilitation due to expected elevations of BP.

Appropriate if intensities are kept below 40% maximal voluntary contraction.

Appropriate if intensities are kept below 85% maximal voluntary contraction.

Safe during all phases of rehabilitation if judicious monitoring of HR is used.

Resistive exercises using weights are appropriate if intensities are kept below 40% maximal voluntary contraction. This is because during the acute and post-acute phases of cardiac rehabilitation, the patient's blood pressure is expected to be elevated. High-intensity exercises can further increase blood pressure, which can be detrimental to the patient's recovery. Therefore, it is important to keep the intensities below 40% to ensure the safety and well-being of the patient during the rehabilitation process.

Explanation

Resistive exercises using weights are appropriate if intensities are kept below 40% maximal voluntary contraction. This is because during the acute and post-acute phases of cardiac rehabilitation, the patient's blood pressure is expected to be elevated. High-intensity exercises can further increase blood pressure, which can be detrimental to the patient's recovery. Therefore, it is important to keep the intensities below 40% to ensure the safety and well-being of the patient during the rehabilitation process.

92. Two therapists are asked to perform a test on the same group of patients using the Functional Independence Measure (FIM). The results of both sets of measurements reveal differences in therapists’ scores but not in the repeat measurements. This is indicative of a problem in:

Concurrent validity.

Construct validity.

Interrater reliability.

Intrarater reliability.

The fact that the therapists' scores differ but the repeat measurements do not suggests that there is a problem with construct validity. Construct validity refers to the extent to which a test measures the theoretical construct or concept it is intended to measure. In this case, the therapists' scores should be consistent if they are accurately measuring the same construct (functional independence). The differences in scores indicate a lack of consistency or agreement between the therapists, suggesting a problem with construct validity.

Explanation

The fact that the therapists' scores differ but the repeat measurements do not suggests that there is a problem with construct validity. Construct validity refers to the extent to which a test measures the theoretical construct or concept it is intended to measure. In this case, the therapists' scores should be consistent if they are accurately measuring the same construct (functional independence). The differences in scores indicate a lack of consistency or agreement between the therapists, suggesting a problem with construct validity.

93. A physical therapist is working with a patient with metastatic breast cancer who has been told that she has only months to live. She is quite angry and disruptive during therapy. What is the MOST appropriate intervention for this patient?

Allow the patient to express her anger while refocusing her on effective coping strategies.

Forbid all expressions of anger as she is only hurting herself.

Provide honest, accurate information about her illness and rehab plan of care.

Provide opportunities for the patient to question her impending death but limit all expressions of anger.

This answer is not appropriate because it suggests forbidding all expressions of anger, which may not be helpful or realistic for the patient. It is important to allow the patient to express her anger as it is a normal and valid emotion. Instead, the most appropriate intervention would be to allow the patient to express her anger while refocusing her on effective coping strategies. This approach acknowledges and validates her emotions while also providing support and guidance in managing them.

Explanation

This answer is not appropriate because it suggests forbidding all expressions of anger, which may not be helpful or realistic for the patient. It is important to allow the patient to express her anger as it is a normal and valid emotion. Instead, the most appropriate intervention would be to allow the patient to express her anger while refocusing her on effective coping strategies. This approach acknowledges and validates her emotions while also providing support and guidance in managing them.

94. A 72 year-old medically stable individual requires custodial care in the home. She is severely disabled with rheumatoid arthritis and is in a great deal of pain. She presents with significant deformities which limit her functional abilities and is dependent in all basic activities of daily living. A recent exacerbation of her disease has left her bed-bound for the past 2 weeks. Appropriate physical therapy services would be covered by:

Medicaid.

Medicare.

Medigap policies.

Only by HMO or private insurance policies.

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Explanation

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95. The radiographic view shown in the diagram that demonstrates the observed spinal defect is: Twomey L, Taylor J (2000) Physical Therapy of the Low Back, 3rd ed. Philadelphia, Churchill Livingstone, Figure 7-1, page 204, with permission.

Frontal.

Lateral.

Oblique.

Posterolateral.

The radiographic view shown in the diagram is likely a frontal view because it is taken from the front of the body and shows the observed spinal defect in a straight-on perspective. A frontal view is commonly used to evaluate the alignment and structure of the spine.

Explanation

The radiographic view shown in the diagram is likely a frontal view because it is taken from the front of the body and shows the observed spinal defect in a straight-on perspective. A frontal view is commonly used to evaluate the alignment and structure of the spine.

96. An older person with diagnosis of congestive heart failure (CHF) should recognize the symptoms of exertional intolerance. You will know this client is properly informed if she can tell you these symptoms are:

Dizziness, visual blurring especially with turns and quick movements.

Overwhelming weakness with difficulty in standing up and walking.

Severe, uncomfortable chest pain with shortness of breath.

Shortness of breath at rest and with limited activity, and sudden weight gain

The correct answer is dizziness, visual blurring especially with turns and quick movements. This is because these symptoms are indicative of exertional intolerance in a person with congestive heart failure (CHF). Exertional intolerance refers to the inability to tolerate physical activity or exertion, and these symptoms suggest that the person may experience dizziness and visual blurring when performing quick movements or turning. This can be a result of decreased blood flow to the brain due to the compromised heart function in CHF.

Explanation

The correct answer is dizziness, visual blurring especially with turns and quick movements. This is because these symptoms are indicative of exertional intolerance in a person with congestive heart failure (CHF). Exertional intolerance refers to the inability to tolerate physical activity or exertion, and these symptoms suggest that the person may experience dizziness and visual blurring when performing quick movements or turning. This can be a result of decreased blood flow to the brain due to the compromised heart function in CHF.

97. Your patient is having difficulty bearing weight on the left leg. She is unable to advance the tibia forward and abbreviates the end of the stance phase on the left going directly into swing phase. The MOST likely cause of her problem is:

Hip extensor weakness.

Spasticity of the anterior tibialis muscle.

Spasticity or contracture of the plantarflexors.

Weakness or contracture of the dorsiflexors

The patient's inability to bear weight on the left leg and advance the tibia forward suggests a problem with the hip extensor muscles. Hip extensor weakness would result in difficulty in extending the hip and maintaining stability during weight-bearing activities, leading to compensatory strategies such as abbreviating the stance phase and going directly into the swing phase. This explanation is supported by the fact that the other options (spasticity of the anterior tibialis muscle, spasticity or contracture of the plantarflexors, weakness or contracture of the dorsiflexors) do not directly address the patient's inability to bear weight and advance the tibia forward.

Explanation

The patient's inability to bear weight on the left leg and advance the tibia forward suggests a problem with the hip extensor muscles. Hip extensor weakness would result in difficulty in extending the hip and maintaining stability during weight-bearing activities, leading to compensatory strategies such as abbreviating the stance phase and going directly into the swing phase. This explanation is supported by the fact that the other options (spasticity of the anterior tibialis muscle, spasticity or contracture of the plantarflexors, weakness or contracture of the dorsiflexors) do not directly address the patient's inability to bear weight and advance the tibia forward.

98. Long term care for institutionalized elderly who have reduced their financial resources or qualify for low-income status is typically funded by:

Health Maintenance Organizations.

Medicaid.

Medicare.

Social Security Administration.

Medicare is a federal health insurance program in the United States that primarily covers individuals who are 65 years or older. It also covers certain younger individuals with disabilities and those with end-stage renal disease. Medicare provides coverage for various healthcare services, including long-term care for institutionalized elderly individuals who have reduced financial resources. Medicaid, on the other hand, is a joint federal and state program that provides healthcare coverage for low-income individuals, including long-term care services. Therefore, the correct answer is Medicare, not Medicaid.

Explanation

Medicare is a federal health insurance program in the United States that primarily covers individuals who are 65 years or older. It also covers certain younger individuals with disabilities and those with end-stage renal disease. Medicare provides coverage for various healthcare services, including long-term care for institutionalized elderly individuals who have reduced financial resources. Medicaid, on the other hand, is a joint federal and state program that provides healthcare coverage for low-income individuals, including long-term care services. Therefore, the correct answer is Medicare, not Medicaid.

99. A 17 year-old patient is recovering from a complete spinal cord injury, at the level of L2. The expected outcome in this case would MOST likely include:

A spastic or reflex bladder.

Greater loss of arm function than leg function with early loss of pain & temperature sensation.

Some recovery of function since damage is to peripheral nerve roots

The correct answer suggests that the patient is likely to experience a greater loss of arm function compared to leg function. Additionally, they are expected to have an early loss of pain and temperature sensation. This indicates that the injury is affecting the upper motor neurons, which control fine motor movements in the arms. The preservation of light touch, proprioception, and position sense suggests that the injury is not affecting the lower motor neurons or the sensory pathways. Therefore, the expected outcome is a greater loss of arm function with early loss of pain and temperature sensation.

Explanation

The correct answer suggests that the patient is likely to experience a greater loss of arm function compared to leg function. Additionally, they are expected to have an early loss of pain and temperature sensation. This indicates that the injury is affecting the upper motor neurons, which control fine motor movements in the arms. The preservation of light touch, proprioception, and position sense suggests that the injury is not affecting the lower motor neurons or the sensory pathways. Therefore, the expected outcome is a greater loss of arm function with early loss of pain and temperature sensation.

100. A six month-old child was referred to physical therapy for right torticollis. The MOST effective method to stretch the muscle is by positioning the head and neck into:

Extension, left side-bending, and right rotation.

Extension, right side-bending, and left rotation.

Flexion, left side-bending, and left rotation.

Flexion, right side-bending, and left rotation.

The correct answer is flexion, left side-bending, and left rotation. This position will effectively stretch the muscle in the right torticollis. Flexion will help to lengthen the muscle, while left side-bending and left rotation will further stretch and release any tightness or tension in the muscle.

Explanation

The correct answer is flexion, left side-bending, and left rotation. This position will effectively stretch the muscle in the right torticollis. Flexion will help to lengthen the muscle, while left side-bending and left rotation will further stretch and release any tightness or tension in the muscle.

Ot/Pt Haad Simulation 6