PEAT 2009(SET A)
1. A patient is performing a Phase I (inpatient) cardiac rehabilitation exercise session. The physical therapist should
terminate low-level activity if which of the following changes occurs?
1. The diastolic blood pressure increases to 120 mm Hg.
2. The respiratory rate increases to 20 breaths per minute.
3. The systolic blood pressure increases to 175 mm Hg.
4. The heart rate increases by 18 bpm.
Correct Answer: 1
During Phase I (inpatient) cardiac rehabilitation, vital sign parameters with activity that warrant termination are: diastolic blood
pressure of 110 mm Hg or greater, systolic blood pressure above 210 mm Hg or an increase greater than 20 mm Hg from
resting, and a heart rate that increases beyond 20 bpm above resting. The normal resting respiratory rate can range from 12 to
20 breaths per minute in adults, so an increase to 20 breaths per minute with low-level activity would not be a reason to
terminate the activity.
Paz JC, West MP. Acute Care Handbook for Physical Therapists. 2nd ed. Butterworth-Heinemann. 2002: 62-69
2. A patient is being evaluated for possible carpal tunnel syndrome, and a nerve conduction velocity test is performed.
Which of the following findings would MOST strongly support the diagnosis?
1. Decreased latency at the elbow
2. Decreased latency at the carpal tunnel
3. Increased latency at the carpal tunnel
4. Increased latency at the forearm
Correct Answer: 3
Nerve conduction above and below the local nerve compression is usually normal. Latency is typically increased, not decreased,
across the carpal tunnel compression site. Nerve conduction above and below the local nerve compression is usually normal.
O’Sullivan SB, Schmitz TJ. Physical Rehabilitation: Assessment and Treatment. 5th ed. FA Davis. 2007: 296-297
3. When examining a patient with a history of alcohol abuse, a physical therapist notes that the patient demonstrates
fine resting tremors and hyperactive reflexes. The patient reports frequent right upper quadrant pain. Which of the
following additional signs is MOST likely?
1. Jaundice
2. Hyperhidrosis
3. Hypotension
4. Nocturnal cough
Correct Answer: 1
With a history of alcohol abuse and the presence of fine resting tremors and right upper quadrant pain, the patient is presenting a
history and signs and symptoms consistent with liver disease. Jaundice is a skin change associated with disease of the hepatic
system. Hyperhidrosis can be present with endocrine disorders but is not associated with liver disease. Hypotension is not listed
as a sign of liver disorders. A nocturnal cough can be associated with rheumatic fever, but is not characteristic of liver disease.
Goodman CC, Synder TEK. Differential Diagnosis for Physical Therapists, 4th ed. Saunders. 2007: 297, 409, 414, 468
4. Which of the following sensory testing locations corresponds to the C 7 nerve root?
1. Volar aspect of the little finger (5th digit)
2. Dorsal aspect of the middle finger (3rd digit)
3. Lateral aspect of the upper arm
4. Medial aspect of the upper arm
Correct Answer: 2
The C7 nerve root supplies sensation in the dorsal middle finger.
Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders, 4th ed. Lippincott, Williams & Wilkins. 2006: 78
5. Which of the following examination findings would be expected in a patient who also had sustained ankle clonus?
1. An upgoing great toe when the sole of the foot is stroked
2. Weakness of ankle plantar flexors with one-repetition strength testing
3. Absence of sensation to sharp/dull testing over the posterior lower leg
4. Hyporeflexia when deep tendon reflexes are elicited in the lower leg
Correct Answer: 1
Sustained ankle clonus indicates a central nervous system dysfunction, as does the presence of a Babinski sign (that is, an
upgoing great toe with stroking of the plantar foot). The other options are associated with lower motor neuron problems.
Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders, 4th ed. Lippincott Williams & Wilkins. 2006: 85-87
6. A 3-month-old infant has poor midline head control. During evaluation, the physical therapist notes facial asymmetry
and observes that the infant holds the head in cervical rotation to the left and cervical lateral flexion to the right. A
radiology report indicates premature fusion of the infant’s cranial sutures. The infant MOST likely has:
1. right congenital muscular torticollis.
2. left congenital muscular torticollis
3. right cervical facet hypomobility.
4. left cervical facet hypomobility.
Correct Answer: 1
The infant exhibits signs of torticollis affecting the right sternocleidomastoid muscle. Torticollis is named for the side of the
affected sternocleidomastoid. Asymmetry and premature closure of sutures (plagiocephaly) are not typically seen with cervical
facet hypomobility in infants.
Campbell SK, Vander Linden DW, Palisanso RJ. Physical Therapy for Children, 3rd ed. WB Saunders. 2006: 359-380
7. A patient had a split-thickness skin graft for a partial-thickness burn injury to the upper extremity. The surgeon has
requested range-of-motion exercises for the patient. Currently, the patient is able to actively move the upper extremity
through one-third of the range of motion for shoulder flexion. Based on this finding, what is the MOST appropriate
action for the physical therapist to take at this time?
1. Defer any range-of-motion exercises until the patient is able to participate more actively.
2. Begin active assistive range-of-motion exercises.
3. Begin bed mobility training to facilitate increased use of the upper extremity.
4. Continue with active range-of-motion exercises.
Correct Answer: 2
Deferring any range-of-motion exercises is not a practical choice, as contracture will develop postoperatively. Because this
patient cannot achieve full range of motion by himself, active assistive range of motion is indicated to prevent contracture
postoperatively. Although bed mobility training is a creative way to possibly increase upper extremity range of motion, given the
acuity of the patient’s surgical wound, the patient would need more range of motion for this intervention to be more beneficial.
Continuing with only active range of motion would not facilitate adequate increases in range of motion and would not prevent
contractures.
O’Sullivan SB, Schmitz TJ. Physical Rehabilitation, 5th ed. FA Davis Company. 2007: 1108
8. Which of the following modalities BEST addresses the cause of calcific tendinitis in the bicipital tendon?
1. Sensory level interferential current at 80 Hz to 100 Hz
2. Iontophoresis with acetic acid at 60 mA/minute
3. High-volt pulsed electrical stimulation at 200 pps
4. Diathermy with a parallel treatment set-up
Correct Answer: 2
Sensory level interferential current at 80 to 100 Hz does not address the problem itself but may address any related pain.
Iontophoresis with acetic acid can address the cause of calcific tendinitis, not just the symptoms. High-volt pulsed electrical
stimulation at 200 pps does not address the problem itself but may address any related pain. Diathermy with a parallel treatment
set-up is not the best choice, as deep heat will not address the pathology.
Prentice WM. Therapeutic Modalities in Rehabilitation. 3rd ed. McGraw-Hill. 2005: 173
9. To minimize skin irritation during functional electrical nerve stimulation, a physical therapist should use:
1. lower intensity, larger interelectrode distance, and larger electrodes.
2. lower intensity, larger interelectrode distance, and smaller electrodes.
3. higher intensity, smaller interelectrode distance, and smaller electrodes
4. lower intensity, smaller interelectrode distance, and larger electrodes.
Correct Answer: 1
Several things can be done to decrease the current density and the possibility of skin irritation. These include
decreasing the intensity of the stimulation, increasing the inter-electrode distance, and using larger electrodes.
Cameron MH. Physical Agents in Rehabilitation. 2nd ed. Saunders. 2003: 242
10. Manual muscle testing of a patient’s pelvic floor muscles reveals a grade of Poor (2/5). Which of the following
positions is BEST to begin strengthening?
1. Supine
2. Standing
3. Seated
4. Walking
Correct Answer: 1
A grade of Poor (2/5) is defined as full excursion in a gravity-eliminated position. All of the other options are against gravity
positions, which would be inappropriate, given this grade of weakness.
Hall CM, Thein-Brody L. Therapeutic Exercise: Moving Toward Function, 2nd ed. Lippincott Williams & Wilkins. 2005: 413
11. During an examination of elbow strength using manual muscle testing, a patient supinates the forearm when
attempting elbow flexion. Which of the following muscles is MOST likely doing the major part of the work?
1. Biceps brachii
2. Brachialis
3. Supinator
4. Brachioradialis
Correct Answer: 1
The biceps brachii is both an elbow flexor and supinator, and it is most effective as a supinator with the elbow flexed to
about 90° (approximately the muscle testing position). The brachialis does not cause supination (only flexion). The
supinator does not flex the elbow. The brachioradialis would move the forearm to a midposition rather than fully
supinating it. Therefore, when the elbow both flexes and supinates, the biceps brachii would be the most likely muscle
causing this action.
12. During evaluation of a patient’s balance, a physical therapist gently pushes the patient backward slightly and
observes how the patient recovers from the perturbation. What strategy is the patient MOST likely to use to correct for
the perturbation?
1. Knee
2. Hip
3. Ankle
4. Stepping
Correct Answer: 3
Regarding options 1 and 2, for larger perturbations, individuals utilize hip and knee muscles to recover the balance. Regarding
option 3, for slight perturbations, most individuals use an ankle strategy. Ankle musculature is used to control the perturbation
and recover the balance. Regarding option 4, if the perturbation is strong enough to cause the individual’s center of mass to
move outside the base of support, a stepping strategy would be employed by taking a step and increasing the size of the base of
support.
Shumway-Cook A, Woollacott MH. Motor Control. 3rd ed. Lippincott Williams & Wilkins. 2007: 167-169
13. Which of the following findings BEST describes normal capillary filling?
1. Rebound vasodilation after icing
2. Blood pressure of 120/76 mm Hg
3. Pulse oximetry measurement of 98%
4. Blanching of the nail bed with color return in <3 seconds
Correct Answer: 4
By definition, the blanching of nail bed with color return in < 3 seconds is normal capillary refill.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. WB Saunders. 2007: 201
14. Which of the following instructions is MOST appropriate for teaching a patient with C6 quadriplegia to transfer from
a wheelchair to a mat?
1. Keep fingers extended to give a broader base of support.
2. Rotate head and shoulders in the same direction as the desired hip motion.
3. Rotate head and shoulders in the direction opposite to the desired hip motion.
4. Keep both hands next to the knees to lock the elbows.
Correct Answer: 3
The position described creates the necessary force to move the lower body in this transfer, given the level of the spinal cord
injury. Finger extension against resistance would be difficult for a patient with C6 quadriplegia. The patient’s hands would be kept
near the thigh or hips with one hand on the mat and one on the wheelchair.
O’Sullivan SB, Schmitz TJ. Physical Rehabilitation: Foundations and Techniques, 5th ed. FA Davis. 2007: 962, 974
15. A patient has a spinal cord injury that resulted in damage to the sacral segments and disruption of the sacral reflex
arc. The patient is MOST likely to have which of the following characteristics?
1.
2.
3.
4.
Voluntary control of defecation
Tonic contraction of the external anal sphincter
Flaccidity of pelvic floor musculature
Permanent absence of the gastrocolic reflex
Correct Answer: 3
The external anal sphincter and pelvic floor muscles are composed of striated muscle fibers. They receive somatic innervation from sacral cord
segments 2 through 4. With damage to these segments, the sphincter and the pelvic floor muscles remain flaccid. The individual loses
voluntary control of defecation. The gastrocolic reflex, mediated by the intrinsic nervous system of the GI tract, returns after resolution of spinal
shock.
Somers MF. Spinal Cord Injury: Functional Rehabilitation, 2nd ed. Prentice Hall. 2001, pp. 14-9 to 14-11
16. A patient who reports double vision has ptosis, lateral strabismus, and a dilated pupil in the left eye. Which of the following
cranial nerve test results is MOST likely to be abnormal?
1. Pupillary light reflex
2. Facial muscle strength
3. Jaw-jerk reflex
4. Pain sensation on the face
Correct Answer: 1
The cranial nerve involved is the oculomotor nerve. This nerve innervates the medial rectus, which, if weak, would cause a lateral strabismus.
The oculomotor nerve is also responsible for mediating papillary constriction and a lesion would cause papillary dilation. The ptosis is caused
by loss of innervation to the levator palpabrae superioris muscle, which elevates the eyelid. The double vision would be caused by the inability
to move the eyeball normally, because four of the six ocular muscles are controlled by the oculomotor nerve. The oculomotor nerve is also
important in mediating the pupillary light reflex. The facial nerve innervates the muscles of facial expression. The trigeminal nerve mediates the
jaw-jerk reflex and pain sensation from the face.
Blumenfeld H. Neuroanatomy Through Clinical Cases. Sinauer. 2002: 530-537
17. In addition to standard precautions, what other precaution should a physical therapist observe when working with a patient
infected with methicillin-resistant Staphylococcus aureus?
1. Airborne
2. Sterile
3. Droplet
4. Contact
Correct Answer: 4
Since methicillin-resistant Staphylococcus aureus is spread by contact, wearing a face shield or mask is not necessary. Sterile precautions or
techniques are not necessary for the physical therapist to use with a patient infected with methicillin-resistant Staphylococcus aureus.
Paz JC, West MP. Acute Care Handbook for Physical Therapists, 2nd ed. Butterworth-Heinemann. 2002: 615
18. The physical therapist is positioning a patient for postural drainage. To BEST drain the posterior segment of both lower lobes,
the patient should be placed in which of the following positions?
1. Prone, head down at a 45° angle
2. Supine, flat surface
3. Sidelying, head elevated at a 30° angle
4. Sitting, leaning forward
Correct Answer: 1
The best position for draining the posterior segment of both lower lobes would be prone lying with the head down and the lower extremities and
hips elevated to about 45°.
Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy, 4th ed. Mosby. 2006: 343
19. Clubbing of the fingers is MOST associated with which of the following pathologies?
1. Lymphedema
2. Pulmonary disease
3. Chronic venous insufficiency
4. Complex regional pain syndrome
Correct Answer: 2
Conditions that chronically interfere with tissue perfusion and nutrition may cause clubbing. Pulmonary disease is the most predominant cause
of digital clubbing, present 75% to 85% of the time clubbing is noted. Since the other conditions also affect tissue perfusion, they could
contribute to the condition, but are not listed as common findings.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 556
20. A patient who is 8 months pregnant has an abdominal diastasis recti with a separation of 1.5 in (4 cm). Which of the following
exercises would be the MOST appropriate initial exercise for abdominal strengthening in a supine position?
1. Trunk curls
2. Hooklying head lifts
3. Pelvic-tilt leg sliding
4. Bilateral leg lowering
Correct Answer: 2
Trunk curls are contraindicated for a patient with diastasis recti. Supine hooklying head lifts emphasize the rectus abdominis muscle and are
least likely to increase the separation of the diastasis recti. Pelvic-tilt leg sliding is more advanced than head lifts. Bilateral leg-lowering is an
advanced abdominal strengthening exercise that causes excessive low back strain and should not be performed during pregnancy.
Kisner C, Colby LA. Therapeutic Exercise, 5th ed. FA Davis. 2007: 812
21. A patient with Parkinson disease has just been admitted to a rehabilitation unit. The patient is dependent in all transfers and
requires moderate assistance of one person to walk 30 ft (9.1 m) with a standard walker. To facilitate good carryover for activities,
instruction of the family in transfers should occur:
1. during a home visit after the patient is discharged.
2. just prior to discharging the patient.
3. early in the rehabilitation program.
4. when the family feels ready to take the patient home.
Correct Answer: 3
The family should be involved in all stages of planning and treatment. Family involvement can shorten the rehabilitation process and facilitate
the patient’s return to the community. It is important to have the family involved early in the rehabilitation process rather than wait until the
patient is ready to be discharged.
Umphred DA. Neurological Rehabilitation. 5th ed. Mosby. 2007: 133-134
22. A patient with a right transfemoral prosthesis will be able to maintain the knee in extension while weight bearing if the center of
gravity of the body is shifted so that the gravitational line falls:
1. posterior to the axis of the right knee joint.
2. lateral to the axis of the right knee joint.
3. anterior to the axis of the right knee joint.
4. medial to the axis of the right knee joint.
Correct Answer: 3
Static alignment for knee stability is established by positioning of the knee so that the lateral reference line falls anterior to the knee joint.
Seymour R. Prosthetics and Orthotics Lower Limb and Spinal. Lippincott, Williams & Wilkins. 2002: 105
23. During manual muscle testing of the hip flexors in the sitting position, a patient exhibits lateral (external) rotation with
abduction of the thigh as resistance is applied. The physical therapist should suspect muscle substitution by the:
1. sartorius.
2. tensor fasciae latae.
3. adductor longus.
4. semimembranosus.
Correct Answer: 1
The sartorius flexes, laterally (externally) rotates, and abducts the hip joint. With resisted hip flexion, the sartorius will be recruited to
perform all three actions, giving the observed substitution pattern. The tensor fasciae latae is a medial (internal) rotator and flexor of the
hip, so substitution by it would involve medial (internal) rotation and abduction. The adductor longus would adduct the hip. Substitution
by the semimembranosus would cause hip extension.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. McGraw-Hill. 2004: 689
24. A physical therapist reads that the interrater reliability of a new hand-held dynamometer is .93. What is the MOST
appropriate interpretation of this value?
1. Similar scores were obtained for a group of subjects when different therapists measured the subjects.
2. Similar scores were obtained for a group of subjects when the same therapist repeated the measures.
3. Dissimilar scores were obtained for a group of subjects when different therapists measured the subjects.
4. Dissimilar scores were obtained for a group of subjects when the same therapist repeated the measures.
Correct Answer: 1
Interrater reliability concerns variation between two or more raters who measure the same group of subjects. The reliability coefficient
has values from 0.00 to 1.00. A reliability of 1.00 means there was total agreement. Thus a value of .93 means there was a high degree
of agreement on the scores from the dynamometer among several therapists. Agreement of measures by the same therapist would be
intrarater reliability.
Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice, 3rd ed. Pearson-Prentice Hall. 2009: 87-88.
25. A physical therapist researcher is developing a study to compare differences in range of motion outcomes in two groups of
patients who have had a total knee arthroplasty. Over an 8-week period, one group of patients receives outpatient physical
therapy 1 time/week and the other group receives outpatient physical therapy 3 times/week. In this study, what is the
dependent variable?
1. Range of motion
2. Frequency of visits
3. Total knee arthroplasty
4. 8 weeks
Correct Answer: 1
The dependent variable (ROM) is the factor that is caused by the independent variable (frequency of visits).
Domholdt E. Rehabilitation Research, 3rd ed. WB Saunders. 2005: 70
26. Which of the following teaching strategies is MOST appropriate for an older adult patient with mild dementia?
1. Use auditory or visual input separately.
2. Use metaphors to reinforce new concepts.
3. Establish a consistent pace for teaching.
4. Present one piece of new information at a time.
Correct Answer: 4
To minimize confusion, the patient should be presented with one new item at a time. The pace of learning should be set by the patient.
Visual and auditory input together can promote learning. Concrete examples are easier to understand than metaphors.
Umphred DA. Neurological Rehabilitation, 5th ed. Mosby. 2007: 912
27. A patient with chronic venous insufficiency of the lower extremities is MOST likely to exhibit:
1. normal superficial veins, no edema, ulceration, and patches of gangrene around the toes.
2. dilation of superficial veins, edema, and stasis ulceration.
3. no edema, faint dorsalis pedis pulse, and cold, hairless extremities.
4. dilation of superficial veins and edema made worse during sitting or elevation of the lower extremities.
Correct Answer: 2
With venous insufficiency, the limbs would be edematous and the superficial veins would be dilated. If the venous insufficiency is not
corrected, ulceration could develop. Options 1 and 3 are ruled out because they indicate no edema. Option 4 is not correct because the
condition is relieved by sitting or leg elevation.
O'Sullivan SB, Schmitz TJ. Physical Rehabilitation. 5th ed. FA Davis Company. 2007: 652-653
28. A patient with muscular dystrophy was removed from mechanical ventilation 1 day ago. The patient is currently unable to
independently clear secretions, despite receiving instruction in the bronchopulmonary hygiene techniques of positioning,
percussion, shaking, and vibration. Which of the following interventions is MOST appropriate to help this patient clear the
secretions?
1. Nasotracheal suctioning
2. Manual costophrenic assist
3. Supplemental oxygen
4. Inspiratory muscle training
Correct Answer: 2
While nasotracheal suctioning is a viable option to clear a patient’s secretions, it is usually the last resort when a patient does not have
an artificial airway. So if a manual costophrenic assist doesn’t work, then suctioning may be needed. Any patient who has been receiving
mechanical ventilation will likely have some respiratory muscle deconditioning. However, with superimposed neuromuscular disease, the
respiratory muscle weakness will be further exacerbated. Therefore, providing manual assist at the lower ribs during cough will assist the
patient in successfully clearing secretions. Supplemental oxygen can help a patient’s ventilatory muscle endurance but does not ensure
that the patient will be able to generate enough force during the cough. Inspiratory muscle training would be beneficial for this patient,
but not at this acute stage just after removal of ventilation. Once secretions are under control, then muscle training can begin.
DeTurk WE, Cahalin LP. Cardiovascular and Pulmonary Physical Therapy: An Evidence-based Approach. McGraw-Hill Medical
Publishing Division. 2004: 615-616
26. Which of the following teaching strategies is MOST appropriate for an older adult patient with mild dementia?
1. Use auditory or visual input separately.
2. Use metaphors to reinforce new concepts.
3. Establish a consistent pace for teaching.
4. Present one piece of new information at a time.
Correct Answer: 4
To minimize confusion, the patient should be presented with one new item at a time. The pace of learning should be set by the patient.
Visual and auditory input together can promote learning. Concrete examples are easier to understand than metaphors.
Umphred DA. Neurological Rehabilitation, 5th ed. Mosby. 2007: 912
27. A patient with chronic venous insufficiency of the lower extremities is MOST likely to exhibit:
1. normal superficial veins, no edema, ulceration, and patches of gangrene around the toes.
2. dilation of superficial veins, edema, and stasis ulceration.
3. no edema, faint dorsalis pedis pulse, and cold, hairless extremities.
4. dilation of superficial veins and edema made worse during sitting or elevation of the lower extremities.
Correct Answer: 2
With venous insufficiency, the limbs would be edematous and the superficial veins would be dilated. If the venous insufficiency is not
corrected, ulceration could develop. Options 1 and 3 are ruled out because they indicate no edema. Option 4 is not correct because the
condition is relieved by sitting or leg elevation.
O'Sullivan SB, Schmitz TJ. Physical Rehabilitation. 5th ed. FA Davis Company. 2007: 652-653
28. A patient with muscular dystrophy was removed from mechanical ventilation 1 day ago. The patient is currently unable to
independently clear secretions, despite receiving instruction in the bronchopulmonary hygiene techniques of positioning,
percussion, shaking, and vibration. Which of the following interventions is MOST appropriate to help this patient clear the
secretions?
1. Nasotracheal suctioning
2. Manual costophrenic assist
3. Supplemental oxygen
4. Inspiratory muscle training
Correct Answer: 2
While nasotracheal suctioning is a viable option to clear a patient’s secretions, it is usually the last resort when a patient does not have
an artificial airway. So if a manual costophrenic assist doesn’t work, then suctioning may be needed. Any patient who has been receiving
mechanical ventilation will likely have some respiratory muscle deconditioning. However, with superimposed neuromuscular disease, the
respiratory muscle weakness will be further exacerbated. Therefore, providing manual assist at the lower ribs during cough will assist the
patient in successfully clearing secretions. Supplemental oxygen can help a patient’s ventilatory muscle endurance but does not ensure
that the patient will be able to generate enough force during the cough. Inspiratory muscle training would be beneficial for this patient,
but not at this acute stage just after removal of ventilation. Once secretions are under control, then muscle training can begin.
DeTurk WE, Cahalin LP. Cardiovascular and Pulmonary Physical Therapy: An Evidence-based Approach. McGraw-Hill Medical
Publishing Division. 2004: 615-616
29. An older adult patient had a total hip arthroplasty following a hip fracture from a fall in his home. The patient lived alone
and was previously able to perform all activities of daily living independently. He has been admitted to a skilled nursing facility
for rehabilitation. The patient’s goal is to return home. His family believes he should be admitted to a long-term care facility for
his own safety after acute rehabilitation is completed. The physical therapist’s MOST appropriate action is to:
1. advise the family that the patient should determine his own discharge environment.
2. recommend a team conference with the patient and his family to discuss discharge plans.
3. schedule a home visit to determine if home modifications are needed before discharge.
4. implement a treatment plan with a long-term goal of discharge to home.
Correct Answer: 2
The best answer would be for the therapist to recommend a team conference. That conference would bring together members of the
health care team, as well as the patient and family members, to arrive at joint decision for placement of the patient. The best time for
such a meeting would be prior to discharge, because such meetings are difficult to arrange after discharge. Allowing the patient to
determine his own discharge environment may be fine if there are no safety concerns; however, a decision whether or not the patient is
competent to make that decision must be made first. Scheduling a home visit or the implementation of a treatment plan for home care
would be premature until a decision on placement has been made.
May BJ. Home Health and Rehabilitation, 2nd ed. FA Davis. 1999: 248-259; White BS, Truax D. The Nurse Practitioner in Long-Term
Care, 1st ed. Jones and Bartlett Publishers. 2007: 466
30. Which of the following reasons is the PRIMARY purpose for applying statistical analyses to single-subject research?
1. To substantiate visual analysis of graphically displayed data
2. To determine whether observed changes are real or chance occurrences
3. To advocate changes in intervention methods
4. To establish credibility for the intervention technique
Correct Answer: 2
Data analysis in single-subject research is based on evaluation of measurements within and across design phases, to determine if
behaviors are changing and if observed changes during intervention are associated with the onset of treatment. While visual analysis of
graphic display of data is the most commonly used data analyses method in single-subject design, statistical analysis provides a more
quantitative approach to determine whether observed changes are real or chance occurrences.
Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice, 3rd ed. Pearson-Prentice Hall, 2009, pp. 254-255.
31. Upon removal of a wet-to-dry dressing from a patient’s draining wound, a physical therapist observes that the skin
immediately surrounding the wound is macerated. What should the therapist recommend for future wound care?
1. Continue using the current dressing type.
2. Make the dressing more absorbent.
3. Leave the dressing on longer between dressing changes.
4. Change to a pressure-type dressing.
Correct Answer: 2
Macerated tissue results from excessive moisture. A more absorbent dressing would soak up the excessive moisture and prevent the
maceration.
Kloth LC, McCulloch JM. Wound Healing: Alternatives in Management. 3rd ed. FA Davis Company. 2002: 177
32. A 50-year-old patient had an uncomplicated open repair of a rotator cuff tear 2 weeks ago. The patient asks the physical
therapist when the shoulder will be normal again. Which of the following expected outcome time frames MOST accurately
addresses this patient’s question?
1. 3 weeks to lift a 5-lb (2.3-kg) object
2. 3 weeks to sleep on the involved side
3. 3 months to lift the upper extremity overhead to reach into a cabinet
4. 3 months to play golf
Correct Answer: 3
Three weeks is too early to lift 5-lb (2.3-kg) objects. Three weeks is too early to sleep on the involved side. Usually by 8 to 12 weeks, a
patient who has had an uncomplicated open repair of a rotator cuff 2 weeks ago is able to actively elevate the arm to functional heights.
Three months is too early to play golf.
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation, 2nd ed. Mosby. 2003: 171-179
33. A physical therapist is preparing to evaluate a patient who had a closed reduction with cast fixation for an ankle fracture 1
day ago and currently has non-weight-bearing status. The patient reports foot pain in the injured extremity. Based on the
patient’s report, which of the following procedures should the physical therapist perform?
1. Gait examination
2. Transfer abilities
3. Capillary refill in toes
4. Blood pressure examination
Correct Answer: 3
Since the patient is non-weight-bearing, transfer abilities and gait examination are less likely to yield information regarding the cause of
foot pain. With regard to capillary refill in toes, complications of cast fixation may include swelling and, if severe, compartment syndrome.
Improperly fitted casts and/or patients leaving limbs in a dependent position can result in painful swelling that creates occlusion to distal
blood flow. Testing capillary refill is an easy test to examine distal extremity perfusion. Blood pressure changes could cause changes in
perfusion to distal extremities, but it would be very difficult to measure lower extremity blood pressure with the cast on.
Paz JC, West MP. Acute Care Handbook for Physical Therapists. 2nd ed. Butterworth-Heinemann. 2002: 220-223, 371
34. Which of the following motions are MOST restricted with a hip capsular pattern?
1. Medial (internal) rotation and abduction
2. Lateral (external) rotation and abduction
3. Extension and adduction
4. Flexion and lateral (external) rotation
Correct Answer: 1
The capsular pattern of restriction at the hip is loss of medial (internal) rotation and abduction, followed by a loss of flexion and
extension; loss of lateral (external) rotation is insignificant.
Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders, 4th ed. Lippincott Williams & Wilkins.
35. The parent of a 4-year-old child who has myelomeningocele is interested in obtaining orthoses for the child’s gait training.
The child has an L1 neurological level lesion. Which of the following orthoses is the MOST appropriate selection for the
physical therapist to discuss with the parent?
1. Hip-knee-ankle-foot with locked hips
2. Reciprocating-gait
3. Knee-ankle-foot with a pelvic band
4. Ankle-foot
Correct Answer: 2
Options 1, 3, and 4 would provide insufficient orthotic support for the child to walk. A child with an L 1 lesion can walk only with support of
reciprocating gait orthoses or thoracic lumbar sacral orthosis.
Lusardi MM, Nielsen CC. Orthotics and Prosthetics in Rehabilitation, 2nd ed. Saunders Elsevier. 2007: 256-258
36. A patient who has rheumatoid arthritis comes to physical therapy with signs of muscle atrophy, ecchymosis, puffy cheeks,
and a diagnosis of osteoporosis. Which of the following medications is the patient MOST likely receiving?
1. Penicillin (Ampicillin)
2. Prednisone (Deltasone)
3. Acetylsalicylic acid (aspirin)
4. Gold salts
Correct Answer: 2
Prednisone is a glucocorticoid that exhibits the side effects described in the stem. The primary side effect of penicillin is an allergic
reaction, such as skin rashes and difficulty breathing. The primary side effect of aspirin is gastritis. The primary side effect of gold
therapy is diarrhea, irritation of oral mucosa, and skin rashes.
Ciccone CD. Pharmacology in Rehabilitation. 4th ed. FA Davis. 2007: 423-426
37. Regular aerobic exercise lasting at least 30 minutes should be MOST beneficial in decreasing the pathology associated
with which of the following conditions?
1. Type 1 diabetes
2. Type 2 diabetes
3. Multiple sclerosis
4. Amyotrophic lateral sclerosis
Correct Answer: 2
Exercise is a major contributor in controlling hyperglycemia in type 2 diabetes by improving skeletal muscle glucose transport and wholebody glucose homeostasis. Regular exercise can help the body respond to insulin and is known to be effective in managing blood
glucose. Exercise can lower blood glucose and possibly reduce the amount of medication needed to treat diabetes, or even eliminate the
need for medication. Exercise has not been shown to improve glycemic control for the person with type 1 diabetes. Patients with
degenerative neuromuscular diseases such as multiple sclerosis should use caution when exercising to avoid excessive fatigue, which
can result in permanent losses in strength. Respiratory system impairment in individuals with multiple sclerosis and amyotrophic lateral
sclerosis may lead to poor tolerance of intense aerobic exercise.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 354, 10271028, 1043-1044
38. A patient has been receiving physical therapy for a large wound on the lower leg. After 3 weeks of treatment, the wound is
free of necrotic tissue, but a copious amount of exudate is present. Which of the following dressings is MOST appropriate for
the wound at this time?
1. Saline-saturated gauze
2. Semipermeable film
3. Gauze impregnated with zinc oxide
4. Hydrocolloid paste
Correct Answer: 4
Saline-saturated gauze is not advised to control copious amounts of drainage. Semipermeable film cannot absorb copious amounts of
exudate. Gauze impregnated with zinc oxide has not been shown to be beneficial. Hydrocolloid paste is the only option given that would
be appropriate for managing wounds with high levels of exudate.
Kloth LC, McCulloch JM. Wound Healing: Alternatives in Management, 3rd ed. FA Davis. 2002: 243
39. A patient with a right transtibial prosthesis describes right-knee buckling in the foot flat (loading response) stance phase of
gait. Which of the following conditions in the patient is MOST likely present to cause this problem?
1. Excessive plantar flexion
2. Stiff heel cushion
3. Low shoe heel
4. Excessive foot inset
Correct Answer: 2
Excessive prosthetic plantar flexion can cause insufficient knee flexion. A stiff heel cushion can cause excessive knee flexion and
therefore buckling. A low prosthetic shoe heel can cause delayed knee flexion. Excessive prosthetic foot inset can cause excessive
lateral thrust.
Seymour R. Prosthetics and Orthotics: Lower Limb and Spinal. 2nd ed. Lippincott, Williams & Wilkins. 2002: 204
40. Which of the following recommendations is MOST appropriate for a patient with gastroesophageal reflux disease?
1. Sit upright for at least 10 minutes after a meal.
2. Lie on the right side before performing exercises.
3. Head-lifting exercises should be performed in the upright position.
4. Activities that require the supine position should be performed before a meal
Correct Answer: 4
Exercises that require a supine position should be performed before eating so that the stomach is relatively empty. The recommended
time to remain upright after a meal is 3 hours. Head lifting in supine is the recommended exercise to strengthen the upper esophageal
sphincter muscle. If performed in upright, the head falls into gravity and the exercise is no longer resistive. A patient should lie on the left
side to reduce reflux, because lying on the right side makes it easier for acid to flow into the esophagus, since the lower esophagus
bends to the left and this straightens out with right sidelying.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 631, 634-635
41. A physical therapist is completing an examination of an inpatient with multiple comorbidities who had a total knee
arthroplasty 2 days ago. The therapist observes a bluish discoloration of the toes on the operative extremity. This finding
should be documented as:
1. cyanosis.
2. deep vein thrombosis.
3. Raynaud disease.
4. cardiac pathology.
Correct Answer: 1
Cyanosis is described in the stem. Although this finding often accompanies cardiac / pulmonary pathology or may occur with
hematological or central nervous system disorders, the objective description is cyanosis.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. WB Saunders. 2007: 202
42. A physical therapist is evaluating a 70-year-old female patient who reports the onset of midthoracic pain after working in a
garden for several hours. The presence of which of the following history items should increase the therapist’s suspicion of a
thoracic compression fracture in the patient?
1. Bowel and bladder dysfunction
2. Smoking and prolonged steroid use
3. Hypertension and diabetes
4. Emphysema and hormone replacement therapy
Correct Answer: 2
Bowel and bladder dysfunction are related to spinal cord/upper motor neuron dysfunction. Smoking and steroids can weaken bone and
increase the likelihood for a compression fracture. Hypertension and diabetes are not risk factors for a compression fracture. By
themselves, neither emphysema nor hormone replacement therapy increases the likelihood of a compression fracture.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. WB Saunders. 2003: 876-877
43. Which of the following modalities is MOST appropriate for decreasing pain and increasing tissue extensibility prior to
active hand exercises in a patient with rheumatoid arthritis?
1. Cold gel pack
2. Direct contact ultrasound
3. Continuous short-wave diathermy
4. Paraffin wax bath
Correct Answer: 4
Paraffin wax baths are used in the nonflare phases to decrease pain and increase tissue extensibility in patients with rheumatoid
arthritis. The increase in collagen extensibility associated with heating may decrease pain perception and increase tolerance for and
participation in active exercise. Option 1 is incorrect because cyrotherapy (cold gel pack) decreases tissue extensibility. Options 2 and 3
are incorrect because these modalities are not easily applied over areas with thin soft tissue (hands and fingers). Paraffin allows for even
distribution of heat to fingers (all joints).
Michlovitz SL, Nolan TP. Modalities for Therapeutic Intervention, 4th ed. F.A. Davis. 2005: 70, 71, 76, 193
44. Which of the following trunk strengthening exercises is BEST for a patient to help minimize the complications associated
with osteoporosis?
1. Flexion
2. Rotation
3. Extension
4. Lateral flexion
Correct Answer: 3
Trunk extension is the safest exercise for patients with osteoporosis and is necessary, given the high risk for kyphosis with vertebral
fractures. The other trunk motions are contraindicated for patients with osteoporosis.
Goodman CC, Boissonnault WG, Fuller KS: Pathology: Implications for the Physical Therapist, 2nd Ed. Saunders
45. A physical therapist is working on progressive functional mobility with a patient who had a transverse colectomy 2 days
ago. The patient has developed a low grade fever. What is the MOST appropriate examination for the therapist to perform prior
to continuation of the patient’s intervention?
1. Heart rate
2. Blood pressure
3. Respiratory rate
4. Auscultation
Correct Answer: 4
Changes in heart rate, blood pressure, or respiratory rate can accompany fever, but none of those measurements will help in delineating
the cause of the fever. Common causes of immediate postoperative fevers are atelectasis or pneumonia. Ausculation of the lungs would
help the therapist in delineating this as a cause of the fever and determining the appropriate physical therapy intervention.
Goodman CC, Boissonault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. WB Saunders. 2003: 560-561, 599
46. A patient is entering a cardiac rehabilitation program. The physical therapist should FIRST ask the patient to:
1. describe the correct aspects of exercise demonstrated by the therapist.
2. list problems associated with poor nutritional habits.
3. identify the harmful effects of smoking with regard to cardiac disease.
4. describe the type of angina that the patient experiences.
Correct Answer: 4
In order to best intervene with a patient who has had cardiac dysfunction, a full examination and evaluation are necessary to properly
form a treatment plan. An important aspect of the examination is ascertaining the type of angina that the patient experiences so that the
therapist will know how to prevent angina with exercise or recognize it if it does occur during the treatment session. The other options
provided are all outcomes that would occur after the patient has completed a cardiac rehabilitation program.
Irwin S, Tecklin JS. Cardiopulmonary Physical Therapy, 4th ed. Mosby. 2004: 91-92
47. A physical therapist who works in a home health agency is treating a patient with diabetes mellitus. The patient reports that
he is no longer taking insulin. The therapist’s FIRST course of action should be to:
1. instruct the patient in the proper technique for injection of insulin.
2. contact the patient’s home health nurse.
3. tell the patient’s family to report this information to the physician.
4. have the patient perform a urine glucose test while the therapist is in the home.
Correct Answer: 2
Contacting the patients home health nurse is the appropriate first course of action because of the possible safety risk associated with the
patient&8217s not taking insulin. Injections and glucose testing would go beyond the scope of practice for physical therapy. Placing the
responsibility on the family would not be appropriate because of the gravity of the situation.
Scott R. Legal Aspects of Documenting Patient Care for Rehabilitation Professionals. 3rd ed. Jones and Bartlett Publishers. 2006: 106
48. A measurable objective for a community education program on proper exercise techniques would be for participants to:
1. understand the importance of a sufficient warm-up period.
2. list five stretching techniques that can be used when warming up.
3. overcome lower extremity problems and adhere to a regular exercise program.
4. appreciate the effects of increasing intensity of exercise on heart rate.
Correct Answer: 2
Objectives must be measurable, and the specific behavior expected should be stated. Understanding, overcoming, and appreciating
elude tangible measurement, while listing five techniques is an activity that can be documented and is therefore measurable.
Wurzbach ME. Community Health Education and Promotion, 2nd ed.
49. While ascending stairs, an older adult patient leans forward with increased hip flexion. Which of the following muscles is
being used to BEST advantage with this forward posture?
1. Rectus femoris
2. Tensor fasciae latae
3. Semitendinosus
4. Lumbar paraspinal
Correct Answer: 3
The hamstrings are hip extensors that are more active when the hip is in flexion, especially in functional activities such as stair climbing.
In this case, the patient flexes the hip, placing the semitendinosus on stretch and increasing its moment arm and increasing its ability to
produce hip extension. Therefore, the patient is leaning forward to maximize the ability of the hamstrings to extend the hip during the
stair climbing activity. The other muscles listed would not benefit as much from the increased hip flexion.
Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Physical Rehabilitation. Mosby. 2002: 417-420
50. The authors of a research article describe a favorable study outcome as insignificant because the study results were not
statistically significant. The insignificant finding would MOST likely be due to poor research methods if which of the following
study characteristics was present?
1. Small sample size
2. Small within-group variance
3. 85% analysis power
4. Controlled alpha level
Correct Answer: 1
A small sample size can be linked to errors in statistical conclusions because there may not be enough participants to allow application
of the findings to all patients in the population of interest. The within-group variance being smaller enables less overlapping of sample
distributions. Greater than 80% analysis power is linked with a higher probability that study conclusions are accurate. An inflated alpha
level (i.e., noncontrolled) results in a higher level of statistical significance and greater probability of a type 1 error.
Domholdt E. Rehabilitation Research, 3rd Ed. Saunders. 2005: 294-301
51. As a patient progresses in learning a new motor skill, there should be a resultant increase in which of the following types of
feedback?
1. Tactile
2. Visual
3. Intrinsic
4. Verbal
Correct Answer: 3
As learning progresses, feedback should progress from extrinsic (which included tactile, visual, verbal) to intrinsic feedback from the
muscle spindle and joint receptors.
Hall CM, Thein-Brody L. Therapeutic Exercise, 2nd ed. Lippincott Williams, & Wilkins. 2005: 152
52.A patient is undergoing a treadmill stress test. The appearance of abnormally wide, irregularly spaced QRS complexes on
the electrocardiogram represents:
1. ventricular depolarization.
2. premature ventricular contractions.
3. atrial fibrillation.
4. atrial repolarization.
Correct Answer: 2
The QRS complex represents ventricular contraction. Atrial contraction is represented by the P wave. When an area of the ventricle
becomes irritable and develops an ectopic foci, the ventricle will depolarize prematurely before the normal conduction sequence (e.g.,
prior to SA node firing in the atria) and presents as a wide, irregularly spaced QRS complex. In normal ventricular depolarization, the
QRS would be narrow and regularly spaced and atrial fibrillation would appear as the P wave changes. Atrial repolarization occurs within
the QRS complex and is not normally visible on EKG.
Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy. 4th ed. Mosby. 2006: 179
53.While working in a private practice clinic, a physical therapist observes a patient fall in the parking lot outside the office.
The patient sustains a severe laceration to the forearm. The therapist secures a pressure dressing to the wound site but notes
that blood is soaking through the dressing and the bandage. Which of the following actions should the therapist perform
NEXT?
1. Elevate the limb and apply pressure to the wound.
2. Remove the dressing and bandage and start over with a tighter bandage.
3. Apply additional dressings and bandages and apply pressure to the brachial artery.
4. Call the patient’s physician and arrange transportation for medical care.
Correct Answer: 1
Elevation and pressure is the correct next step in controlling bleeding. Removal of the dressing and bandage would potentially irritate the
wound and increase the hemorrhage. Elevation and pressure should be applied first, before additional dressings, bandages, and
pressure to the brachial artery. While calling the patient’s physician to arrange transportation for medical care may be necessary, it does
not immediately control the bleeding.
American Red Cross. First Aid: Responding to Emergencies. American Red Cross; 2005: 160
54.A physical therapist is conducting a reflex text as shown in the photographs. The arrow indicates the path of the applied
stimulus. The results of the test are MOST likely to indicate:
1.
2.
3.
4.
a peripheral nerve injury.
a lesion of the anterior horn cells.
a normal response.
an injury to the spinal cord.
Correct Answer: 4
The therapist is testing for a positive Babinski sign. When the Babinski sign is positive, the toes flare at the end of the test. The presence
of a positive Babinski sign indicates an upper motor neuron lesion such as a spinal cord injury. If no upper motor neuron lesion is
present, the toes will flex. The only upper motor neuron lesion is injury to the spinal cord. Peripheral nerve injuries and lesions of the
anterior horn cells are lower motor neuron lesions.
Paz JC, West MP. Acute Care Handbook for Physical Therapists, 2nd ed. Butterworth-Heinemann. 2002: 297
55.The work modification (standing) shown in the photograph is MOST appropriate for a patient with which of the following
pathologies?
1.
2.
3.
4.
Central lumbar stenosis
Deep vein thrombosis
Thoracolumbar scoliosis
Posterolateral lumbar disc bulge
Correct Answer: 4
The photograph shows a standing desk/work station. A patient with stenosis will do better in sitting, not standing. A patient with a deep
vein thrombosis will need to move, not be stationary. A scoliosis alone does not warrant a standing work station. Sitting increases
intradiscal pressure, so standing is often preferred to sitting.
McKenzie R, May S. The Lumbar Spine Mechanical Diagnosis & Therapy, 2nd ed. Spinal Publications. 2003: 234-240; Goodman CC,
Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 151
56.A long-distance runner comes to physical therapy with insidious onset of lower leg pain. The patient’s examination results
reveal weakness of toe flexion and ankle inversion. The physical therapist suspects vascular compromise associated with this
presentation. Palpation at which of the following locations is MOST likely to reveal diminished arterial pulses in the patient?
1. Dorsal aspect of the foot
2. Posterior to the lateral malleolus
3. Posterior to the medial malleolus
4. Lateral aspect of the popliteal fossa
Correct Answer: 3
The posterior tibial artery is most likely to be involved in chronic posterior compartment syndrome, which is described in the question.
This artery should be palpated posterior to the medial malleolus. The dorsal aspect of the foot is the site for palpation of the dorsalis
pedis pulse. The dorsalis pedis artery is not involved in posterior compartment syndrome. The palpation site posterior to the lateral
malleolus is used to access the fibular (peroneal) artery. The fibular (peroneal) artery is not involved in posterior compartment syndrome.
Palpation in the popliteal fossa is a poor choice of palpation location in association with posterior compartment syndrome. The popliteal
artery may be palpated here, but the compartment syndrome manifestations are distal to this site.
Palastanga N, Field D, Soames R. Anatomy and Human Movement: Structure and Function, 3rd ed. Butterworth-Heinemann. 1998: 570;
Magee DJ. Orthopedic Physical Assessment, 4th ed. Saunders. 2002: 820; Reid DC. Sports Injury Assessment and Rehabilitation.
Churchill Livingstone. 1992: 288-289
57.During an intervention session with a patient with a recent onset of hemiplegia, a physical therapist plans to focus on
transfers to and from a wheelchair, a bathtub, and an automobile. Which of the following methods should be MOST effective
for long-term retention of these skills?
1. Practice the activities in random order.
2. Sequence the activities from easiest to most difficult.
3. Allow the patient to determine the sequence of activities.
4. Establish a predictable but variable practice sequence
Correct Answer: 1
It has been determined that a critical factor in improving learning is that the subject must do something different on consecutive trials.
Therefore the traditional approach for retraining by practicing one skill repeatedly is not the most effective. It is believed that having a
patient practice a number of tasks in random order would probably be more successful for long-term retention. The other options do not
provide for randomization of the activities and are therefore less likely to provide for long-term retention.
Shumway-Cook A, Woollacott M. Motor Control: Translating Research into Clinical Practice, 3rd ed. Lippincott Williams & Wilkins.
2007:36-37
58.A patient is lying supine with hips and knees extended and hands behind the head. The patient is able to raise the head,
shoulders, and thorax from the treatment table but is unable to come to a complete long-sitting position. What muscle should
the physical therapist target for a strengthening program?
1. Iliopsoas
2. External abdominal oblique
3. Quadratus lumborum
4. Upper rectus abdominis
Correct Answer: 1
The abdominal muscles are active during a sit-up (with the knees extended) up until the spine is completely flexed (head, shoulders,
thorax lifted from surface). In order to come to a long-sitting position, however, the hips must be flexed, and the abdominals cannot
perform this action because they do not cross the hip joint. Therefore, the hip flexors (iliopsoas among others) would have to complete
this motion. The inability to achieve a long-sitting position would suggest weakness in the iliopsoas muscle.
Kendall FP, McCreary EK, Provance PG, et al. Muscles: Testing and Function. 5th ed. Lippincott Williams & Wilkins. 2005: 205
59.A patient has medication-induced Cushing syndrome. Which of the following physiological problems is a common
manifestation of this disorder?
1. Hypotension
2. Hypercalemia
3. Muscle catabolism
4. Decreased protein metabolism
Correct Answer: 3
Corticosteroid-induced myopathies are common after prolonged use of the drug, and they are common in the proximal musculature of
the extremities. The other options are the opposite of symptoms commonly found with steroid-induced conditions. Usually there are
problems with hypertension, hypocalemia, and increased protein metabolism.
Goodman C, Snyder T. Differential Diagnosis for Physical Therapists, 4th ed. Saunders-Elsevier. 2007: 94-95
60.A 90-year-old patient with chronic congestive heart failure has been nonambulatory and has resided in a nursing home for
the past year. The patient was recently admitted to the hospital after an episode of dehydration. Which of the following plans
for prophylactic respiratory care is MOST appropriate?
1. Turning, coughing, and deep breathing every 1 to 2 waking hours
2. Vigorous percussion and vibration 4 times/day
3. Gentle vibration with the foot of the bed elevated 1 time/day
4. Segmental postural drainage using standard positions throughout the day
Correct Answer: 1
A patient who is immobile and restricted to bed is at risk for developing atelectasis (partial collapse of lung tissue), which can then lead
to pneumonia. Frequent position changes with deep breathing and coughing will help prevent development of atelectasis. Given that this
patient is elderly and does not have a diagnosis of secretion retention, vigorous percussion and vibration is not indicated. Vibration with
the head down or standard postural drainage positions will not be tolerated in this elderly patient with chronic congestive heart failure.
Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy. 4th ed. Mosby. 2006: 509
61.Which of the following joint mobilizations would be MOST effective for improving a patient’s ability to progress into terminal
stance?
1. Anterior glide of the talus on the tibia
2. Posterior glide of the calcaneus on the talus
3. Plantar glide of the 1st proximal phalanx on the metatarsal
4. Dorsal glide of the 1st proximal phalanx on the metatarsal
Correct Answer: 4
Extension of the 1st metatarsophalangeal joint is needed in terminal stance. The distal metatarsal is convex. The proximal portion of the
articulating phalanx is concave. According to the convex-concave rule, when a therapist moves a concave joint surface on a convex joint
surface, the concave joint surface is moved in the same direction as the range-of-motion limitation. Therefore, the appropriate accessory
glide is a dorsal glide of the proximal phalanx on the metatarsal. Anterior glide of the talus on the tibia and plantar glide of the 1st
proximal phalanx on the metatarsal promote plantar flexion. Posterior glide of the calcaneus on the talus is not as relevant for terminal
stance, which involves the 1st MTP joint.
Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders, 4th ed. Lippincott, Williams & Wilkins. 2006: 578-579, 614615.
62.A physical therapist is examining muscle strength in a patient. The patient is asked to move the leg along the path indicated
by the arrow shown in the photograph and to hold the leg in place while the therapist applies resistance to the leg. The patient
moves through the range of motion shown and is able to take maximal resistance. Intervention should address which of the
following problems?
1.
2.
3.
4.
Tightness of the hip medial (internal) rotators
Weakness of the gluteus minimus and medius
Correction of the right lateral (external) trunk shift
Piriformis weakness
Correct Answer: 1
The fact that the patient has normal muscle strength of the hip lateral (external) rotators along with limitation of range of motion indicates
either tightness of the medial (internal) rotators or hip capsule tightness. The gluteus medius and minimus are medial (internal) rotators
of the hip. The trunk shift is a normal substitution pattern found in individuals who lack hip range of motion. The problem is related to the
hip, not the trunk. The patient’s piriformis shows normal strength, so it is not weak.
Kendall FP, McCreary EK, Provance PG, et al. Muscles: Testing and Function. 5th ed. Lippincott, Williams & Wilkins. 2005: 374, 429
63.A patient with a complete thoracic spinal cord injury is sitting in a wheelchair on a custom-made cushion. Pressure relief
activities should be performed:
1. when the patient shows signs of pressure sores.
2. every 15 to 20 minutes.
3. every 1 to 2 hours.
4. if the patient does not have an appropriate cushion.
Correct Answer: 2
A patient with a thoracic spinal cord level injury is able to perform independent pressure relief strategies and should complete pressure
relief every 15 to 20 minutes.
Ryan SE, Sladyk K. Ryan's Occupational Therapy Assistant: Principles, Practice Issues, and Techniques. Slack. 2005: 234; Somers M.
Spinal Cord Injury, 2nd ed. Appleton and Lange. 2001: 103
64.Which of the following lower extremity findings is MOST likely to be the FIRST sign of vascular occlusive disease?
1. Edema of the legs and ankles
2. Brown discoloration at the ankles
3. Increased cyanosis when legs are dependent
4. Lack of hair on the toes
Correct Answer: 4
Poor hair growth is characteristic for arterial disease due to inadequate cellular nutrition. The first sign of arterial disease is often loss of
hair on the toes. Edema may be present with advanced cases of arterial disease. Increased cyanosis with legs in the dependent position
is present in advanced disease. Brownish discoloration at the ankles is characteristic of chronic venous disorders.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. Saunders. 2007: 310, 311, 315
65.A physical therapist is teaching a patient who has recently undergone knee surgery to use a cane while descending stairs
without a railing. The patient has partial weight-bearing status on the right. Which of the following instructional methods
should the therapist use to teach the patient this activity?
1. The therapist stands behind the patient, and the patient descends with the cane and left leg first.
2. The therapist stands beside the patient, and the patient descends with the right leg first and then the cane.
3. The therapist stands below the patient, and the patient descends with the cane and right leg first.
4. The therapist stands behind the patient, and the patient descends with the left leg first.
Correct Answer: 3
Options 1, 2, and 4 are neither safe nor appropriate. When descending stairs, it is generally best for the therapist to be positioned below
the patient as protection from falling. However, the patient should always descend stairs leading with the involved leg, the right leg in this
case, and the cane.
Minor SM, Minor MA. Patient Care Skills, 5th ed. Prentice Hall. 2006: 375
66.A patient with low back pain also reports constipation, occasional nausea and vomiting, and unexplained weight loss. The
pain worsens when the patient is supine and decreases when the patient leans forward when sitting. The sclerae are yellow.
The signs and symptoms are MOST consistent with which of the following disorders?
1. Appendicitis
2. Cholecystitis
3. Pancreatic carcinoma
4. Irritable bowel syndrome
Correct Answer: 3
Pancreatic cancer is characterized by nonspecific and vague symptoms, which can include nausea, weight loss, pain radiating to the
back or back pain alone, and jaundice. Sitting up and leaning forward may provide some relief by taking pressure off the pancreas.
Irritable bowel syndrome is characterized by abdominal pain with constipation and diarrhea, nausea and vomiting, but not referred back
pain or jaundice. Cholecystitis is an inflammation of the gallbladder and typically produces right upper quadrant abdominal pain. There
may be nausea and vomiting, weight loss, and jaundice. However, the pain is referred to the upper back or right shoulder, not the low
back. There is also anorexia, nausea and vomiting with appendicitis, but the pain is present generally over the right lower quadrant.
Bending forward may worsen the symptoms because of the resultant increase in intraabdominal pressure.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 651, 662, 697,
701
67.Excessive upward rotation of the right scapula is noted when a patient attempts to perform shoulder flexion. Which of the
following exercises is MOST appropriate to help correct the excessive scapular rotation?
1. Right scapular protraction against resistance with the right arm at 90° of flexion
2. Bilateral scapular elevation with the upper extremities at 180° of flexion
3. Wall push-ups with an isometric hold at end range with the elbows extended
4. Bilateral scapular adduction with the upper extremities medially (internally) rotated and adducted across the back
Correct Answer: 4
Excessive upward rotation of the scapula can result from weakness of the rhomboids and latissimus dorsi (downward rotators). The
scapular adduction with medial (internal) rotation and adduction of the arm would require action by those muscles. Option 1 would help
strengthen the serratus anterior, an upward rotator of the scapula. Option 2 would activate the upper trapezius as well as the rhomboids,
and, since the upper trapezius is also an upward rotator of the scapula, this would not be the best exercise to use. Option 3 would also
help strengthen the serratus anterior, which would tend to aggravate the problem.
Hislop HJ, Montgomery J. Daniels and Worthingham’s Muscle Testing: Techniques of Manual Examination, 8th ed. WB Saunders. 2007:
73-84
68.Which of the following diagnoses is MOST associated with urinary incontinence?
1. Orchitis
2. Testicular cancer
3. Testicular torsion
4. Benign prostatic hyperplasia
Correct Answer: 4
The nodular hyperplasia that occurs with benign prostatic hyperplasia causes obstruction of the urethra, resulting in urinary frequency
and urge incontinence. Testicular torsion, orchitis, and testicular cancer are not associated with urinary dysfunction.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 732, 738, 739,
740
69.A physical therapist is working on transfers with a patient who had a brainstem cerebrovascular accident. The patient has
ataxia in all four extremities and a high level of extensor tone in the lower extremities. The patient has fair to good trunk
control. Which of the following transfers is BEST for this patient?
1. Squat pivot
2. Sliding board
3. Standing pivot
4. Dependent tuck
Correct Answer: 1
A squat-pivot transfer avoids full lower extremity extension, thus minimizing lower extremity extensor tone. A sliding-board transfer is not
appropriate with a high level of ataxia in the upper extremities. A standing-pivot transfer is not appropriate because it may increase the
extensor tone in the lower extremities. A dependent tuck transfer does not encourage active patient participation or promote
independence.
Greenwood R, Barnes M, Mcmillan T, Ward C, eds. Handbook of Neurological Rehabilitation. 2nd ed. Psychology Press. 2003: 159-161
70.A physical therapist wants to examine the relationship between lower extremity manual muscle test grades and five ranked
categories of functional ambulation ability in a group of older adults. Which of the following statistics is MOST appropriate for
testing this relationship?
1. Paired t test
2. Pearson product-moment correlation (r)
3. Mann-Whitney U test
4. Spearman rho (rs)
Correct Answer: 4
The research question is one of relationship or correlation between measures, not comparison of group means, so the t test and the
Mann-Whitney U test are not appropriate. Because the data for both variables are ranked (ordinal), Spearman rho (Spearman rank
correlation coefficient) should be used. This is the nonparametric analog of the Pearson correlation coefficient (r). The Pearson r requires
continuous, not ordinal, data.
Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice, 3rd ed. Pearson-Prentice Hall. 2009, p. 531
71.In a research study, a correlation coefficient of .30 was found for the relationship between two variables. Which of the
following interpretations of this finding is MOST appropriate?
1. The variables have a low correlation.
2. Thirty percent of the variability in one variable can be accounted for by the other variable.
3. There are no significant differences between the variables.
4. There is low positive predictive value between the variables.
Correct Answer: 1
A correlation coefficient of .26 to .49 is considered low.
Domholdt E. Rehabilitation Research, 3rd ed. WB Saunders. 2005: 358
72.Which of the following conditions is the MOST likely cause of a reduced vital capacity in a patient who has quadriplegia at
the C5–C6 level?
1. Decreased anterolateral chest expansion resulting from paralysis of the external intercostal muscles
2. Inability of the patient to generate a negative intrapleural pressure secondary to a denervated diaphragm
3. A relatively high resting position of the diaphragm resulting from paralysis of the abdominal muscles
4. Reduced rib-cage elevation due to paralysis of the anterior scalene and sternocleidomastoid muscles
Correct Answer: 1
The rib cage would not be able to expand normally during inspiration due to weakness of the external intercostal muscles, which are
innervated by thoracic nerve segments. With a spinal cord lesion at the C5–C6 level, the diaphragm would still receive innervation from
the phrenic nerve (C4). The anterior scalene (C4–C6) would be partially innervated and the sternocleidomastoid (C2–C3) would be fully
innervated. The abdominal muscles would not be innervated since they receive their innervation from thoracic nerve segments. Paralysis
of the abdominal muscles would cause the diaphragm to assume a low resting position.
Lin VW, Cardenas DD, et al. Spinal Cord Medicine. 1st ed. Demos Medical Publishing. 2003: 159
73.A physical therapist places electrodes on a patient to monitor surface electromyographic activity. The electrode placement
shown in the photograph is MOST appropriate to monitor which of the following muscles?
1.
2.
3.
4.
Tensor fasciae latae
Sartorius
Rectus femoris
Gluteus minimus
Correct Answer: 1
The electrode placement in the photograph is the best placement for the tensor fasciae latae. The electrodes are placed over the muscle
belly and lined up parallel to the muscle fibers. The sartorius is found more distally and medially and following the direction of the muscle
fibers. The rectus femoris is found more distally and central to the thigh. The gluteus minimus is a deep muscle that cannot be easily
monitored directly by surface electromyography.
Reese NB. Muscle and Sensory Testing, 2nd ed. Saunders. 2005: 279
74.A physical therapist places a patient on a strength training program for the lower extremities. The mode of exercise is a
double-leg press unit using free weights. After 1 week, the patient shows a 10-lb (4.5-kg) increase in the amount of weight the
patient is able to lift. What is the MOST likely cause of the patient’s increase in strength?
1. Muscle fiber hypertrophy
2. Neurological adaptation
3. Hyperplasia of the muscle fibers
4. Increase in the amount of actin and myosin
Correct Answer: 2
Strength increase in muscle is due to a number of factors, including neurological adaptation and muscle fiber hypertrophy with an
increase in actin and myosin. Hyperplasia in humans is still controversial. Long-term changes in muscle strength are due to all of the
factors listed. However, short-term changes, such as changes in 1 week, are most likely to due to neurological factors such as more
efficient motor unit recruitment, autogenic inhibition, and more efficient co-activation of muscle groups.
Wilmore JH, Costill DL. Physiology of Sport and Exercise. 3rd ed. Human Kinetics. 2004: 90-97
75.A physical therapist is considering the use of phonophoresis as part of an intervention plan. Which of the following steps is
the correct FIRST step in the decision-making process to use phonophoresis?
1. Outline the therapeutic goals and outcomes.
2. Select the appropriate coupling agent and medication.
3. Decide on the dosimetry by choosing the appropriate mode and frequency.
4. Determine if there are any contraindications.
Correct Answer: 4
Although all of options are involved in the decision-making process, the determination of contraindications is the first thing to consider,
because all other options are unnecessary if the patient has other pathologies that could be a contraindication.
Belanger A. Evidence Based Guide to Therapeutic Physical Agents. Lippincott Williams & Wilkins. 2002: 250
76.A physical therapist is evaluating a patient who has shoulder pain. The patient notices the shoulder pain at work when
stocking shelves that are overhead. The pain is not apparent when stocking shelves at waist or chest level. The patient MOST
likely has weakness in which of the following muscles?
1. Pectoralis minor
2. Upper trapezius
3. Deltoid
4. Rhomboid major
Correct Answer: 2
Weakness in the pectoralis minor would not cause restriction of the scapula but would likely cause scapular hypermobility. Weakness in
the upper trapezius would decrease upward rotation of the scapula during shoulder flexion and abduction. The more the shoulder is
elevated, the more noticeable this would be. The decreased scapular movement would increase the predisposition toward impingement.
Weakness in the deltoid would cause the humerus to move downward, not upward, during shoulder elevation.Weakness in the rhomboid
major would not cause restriction of the scapula, but would likely cause scapular hypermobility.
Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes. Mosby. 2002: 222-226
77.A patient who sustained a mild cerebrovascular accident 3 weeks ago is being prepared by a physical therapist for
discharge to home and an adult day program. To facilitate the discharge plan, the MOST appropriate health professional for the
therapist to consult with is the:
1. skilled nursing coordinator.
2. occupational therapist.
3. medical social worker.
4. primary physician.
Correct Answer: 3
Medical social service staff deal with home situations and financial supports and act as a resource director on behalf of the patient.
Social services would be the most appropriate choice to help arrange and coordinate rehabilitative services for the patient while the
patient is at home. Although nurses, occupational therapists, physical therapists, and physicians may all be involved with direct patient
care, they would not be the most appropriate for this level of discharge planning.
Sladyk K, Ryan SE. Ryan's Occupational Therapy Assistant: Principles, Practice Issues, and Techniques. 4th ed. Slack. 2005: 502
78.In a research study, a physical therapist performs the same goniometric measurement on the same group of control
subjects during two consecutive testing sessions. This process is used to demonstrate which of the following measurement
properties?
1. External validity
2. Instrument reliability
3. Intrarater reliability
4. Interrater reliability
Correct Answer: 3
Intrarater reliability describes the repeatability of measurements made by one person (repeatability within that person).
Domholdt E. Rehabilitation Research, 3rd ed. Saunders. 2005: 256-257
79.Sensory-level electrical stimulation is MOST appropriate for a patient with which of the following conditions?
1. Chronic low back pain of somatic origin
2. Acute ankle sprain with edema
3. Supraspinatus tendonitis
4. Active Raynaud syndrome
Correct Answer: 4
Regarding chronic low back pain of somatic origin, the patient has a chronic problem, so will most likely require motor-level stimulation,
because it provides a longer-lasting analgesia. There is no evidence to indicate that sensory-level stimulation is effective in the treatment
of edema. For edema reduction, rhythmic muscle contraction is preferred. Iontophoresis is more appropriate than sensory-level electrical
stimulation for treatment of a tendonitis, because it involves the delivery of anti-inflammatory medications. Raynaud syndrome is a
condition in which the smallest arteries that bring blood to the fingers or toes constrict when exposed to cold or from an emotional upset.
Sensory-level stimulation over nerve roots and trunks can increase peripheral vasodilatation.
Kitchen S. Electrotherapy: Evidence-Based Practice, 11th ed. Elsevier Churchill Livingstone. 2002: 260
80.A patient with which of the following diagnoses would MOST likely benefit from pursed-lip breathing during exercise?
1. Peripheral vascular disease
2. Congestive heart failure
3. Emphysema
4. Sarcoidosis
Correct Answer: 3
Peripheral vascular disease is a vascular problem, not a pulmonary problem. Congestive heart failure may lead to pulmonary problems,
but not obstructive problems. Emphysema is an obstructive lung disease, for which pursed-lip breathing may be beneficial. Sarcoidosis
is a restrictive lung disease for which pursed-lip breathing is not beneficial.
Irwin S, Tecklin JS. Cardiopulmonary Physical Therapy, 4th ed. Mosby. 2004: 310
81.A patient has a history of neck pain that is aggravated by long periods of sitting and becomes progressively worse by
evening. Range of motion and strength of the neck and shoulders are within normal limits. Sensation and reflexes are intact in
both upper extremities. The patient has a forward head and excessive thoracic kyphosis. The MOST appropriate exercise
program should focus on:
1. stretching of the neck flexors and pectoral strengthening.
2. upper trapezius strengthening and pectoral stretching.
3. pectoral strengthening and rhomboid stretching.
4. rhomboid strengthening and axial neck retraction.
Correct Answer: 4
The history suggests that prolonged improper positioning of the cervical spine resulted in neck pain. A chronic forward head and
kyphosis results in hyperextension in the upper cervical spine and excessive flexion in the upper thoracic spine. Further muscle length
adaptation occurs with tight anterior muscles and stretched posterior muscles. Treatment should include correction of muscle weakness
or imbalance. Rhomboid strengthening and axial neck extension are the only options that are both correct.
Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. FA Davis. 5th ed. 2007: 399
82.A patient suspected of having hypoglycemia is MOST likely to show which of the following signs?
1. Fruity smelling breath
2. Thirst, nausea, and vomiting
3. Dry, crusty mucous membranes
4. Difficulty speaking and concentrating
Correct Answer: 4
A common mental state manifestation of hypoglycemia is difficulty speaking and concentrating, whereas in hyperglycemia there is
outright confusion. The other options are all signs of hyperglycemia and not signs of hypoglycemia.
Goodman C, Snyder T. Differential Diagnosis for Physical Therapists, 4th ed. Saunders-Elsevier. 2007: 353-359
83.A patient is limited in shoulder abduction, as shown in the displayed radiograph. Which of the following mobilization
techniques is MOST likely to assist the patient in achieving increased shoulder abduction?
1.
2.
3.
4.
Posterior glide
Anterior glide
Inferior glide
Superior glide
Correct Answer: 3
Neither posterior glide, anterior glide, nor superior glide, would improve abduction. The radiograph shows limitation of glenohumeral
motion causing the reduction in shoulder abduction. Inferior glide assists with improving abduction.
Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques. FA Davis. 5th ed. 2007: 122
84.Which of the following assignments is MOST appropriate for a physical therapist to delegate to a volunteer?
1. Restocking treatment booths with linens, ultrasound gel, and massage lotion
2. Attending a patient who is on a tilt table while the therapist takes a phone call
3. Transporting a patient who reports dizziness back to the patient's room
4. Transferring a patient from the mat table to a wheelchair
Correct Answer: 1
The restocking of treatment booths with supplies is the only option that does not involve direct patient contact or care and thus is the
MOST appropriate activity to delegate to a volunteer. Although volunteers may at times be involved with patient care activities (i.e.,
transporting patients), the patients in the situations described in options 2, 3, and 4 are at potential risk and would require supervision by
someone other than a volunteer.
Umphred D, Carlson C. Neurorehabilitation for the Physical Therapists Assistant. Slack. 2006: 4-6
85.A physical therapist is teaching a motor skill to a patient with chronic hemiplegia. Which of the following teaching
approaches should be MOST emphasized?
1. Habituation
2. Sensitization
3. Compensatory strategy
4. Recovery of normal movement
Correct Answer: 3
A patient with chronic hemiplegia is unlikely to recover normal function. Compensatory strategies are used when there is a permanent
loss of function which prevents reacquiring normal movement patterns. Habituation is a decrease in responsiveness that occurs as a
result of repeated exposure to a nonpainful stimulus. In the acute patient, the emphasis is on recovery of normal function, but this patient
has a chronic condition. Sensitization is an increased responsiveness following a threatening or noxious stimulus.
Shumway-Cook A, Woollacott M. Motor Control: Translating Research into Clinical Practice, 3rd ed. Lippincott Williams & Wilkins. 2007:
24, 40
86.A patient has low back and leg pain, with symptoms extending to the bottom of the foot. During the physical therapy
examination, the patient does not report leg pain in the first test position (photograph #1) but reports a severe increase in
symptoms in the second test position (photograph #2). Which of the following conclusions is MOST likely?
1.
2.
3.
4.
The pain is the result of a herniated disc.
The patient may be displaying nonorganic symptoms.
The symptoms are the result of an inflamed sciatic nerve.
The hamstrings are in a facilitated state of contraction.
Correct Answer: 2
Because sitting knee extension and the straight-leg raise culminate in essentially identical positions, symptomatic responses to the two
types of maneuvers should be similar. If the patient had a symptomatic herniated disc, both positions would result in a similar symptom
increase. If the patient had an irritated sciatic nerve, both positions would result in a similar symptom increase. If the patient had a
facilitated hamstring, both positions would result in a similar symptom response.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. McGraw-Hill. 2004: 361
87.A patient is referred for recommendations regarding purchase of a wheelchair. The measurements of the patient while
sitting are 16 in (40.6 cm) across the widest point of the hips and 18 in (45.7 cm) from the rear of the buttocks to the popliteal
crease. Which of the following wheelchair dimensions would be BEST suited for this patient’s needs?
1. Seat width and seat depth of 18 in (45.7 cm)
2. Seat width of 18 in (45.7 cm) and seat depth of 16 in (40.6 cm)
3. Seat width and seat depth of 16 in (40.6 cm)
4. Seat width of 16 in (40.6 cm) and seat depth of 18 in (45.7 cm)
Correct Answer: 2
The seat width should be slightly wider than the width of the widest body part, and the depth should come to within 1 inch of the popliteal
fossa.
Minor SM, Minor MA. Patient Care Skills, 5th ed. Prentice Hall. 2006: 189-190
88.A physical therapist is initiating intervention with a postoperative patient who is taking 20 mg of oral oxycodone (Oxycontin)
for pain relief. In planning an intervention for this patient, the physical therapist should anticipate that:
1. the patient may be hypertensive.
2. the medication may trigger cardiac arrhythmias in the patient.
3. the patient will have an increased likelihood for developing diarrhea.
4. the patient may demonstrate respiratory depression.
Correct Answer: 4
Regarding the patient being hypertensive, the opposite is likely. Orthostatic hypotension is a potential side effect. Arrhythmias are not
listed as a recognized side effect of opioids. Regarding developing diarrhea, gastrointestinal motility is decreased, so the opposite effect
of constipation is a frequent problem. Opioids tend to make the medullary chemoreceptors less responsive to carbon dioxide, thus
slowing down respiratory rate and inducing a relative hypoxia and hypercapnia. The respiratory response to exercise may be blunted.
Ciccone CD. Pharmacology in Rehabilitation, 4th ed. FA Davis. 2007: 185
89.During which of the following scenarios would gloves be required to comply with standard precautions?
1. During all patient care in the hospital setting
2. Performing range of motion on a patient with acquired immunodeficiency syndrome
3. Massaging the neck of a patient with hepatitis C
4. Changing an infant’s diaper in a pediatric setting
Correct Answer: 4
Gloves are required only during contact with blood or body fluids, not during patient care that does not involve coming in contact with
blood or body fluids. Gloves are required whenever changing an infant’s diapers, because this activity involves coming into contact with
body fluids.
Pierson FM, Fairchild SL. Principles and Techniques of Patient Care, 4th ed. Saunders. 2008: 37
90.Which of the following structures is indicated by the arrow in the radiograph?
1.
2.
3.
4.
Intertubercular groove
Greater tubercle
Lesser tubercle
Coracoid process
Correct Answer: 2
The structure indicated by the arrow is the greater tubercle. The arm is medially (internally) rotated in this radiograph.
Magee DJ. Orthopedic Physical Assessment. 4th ed. Saunders. 2002: 297-301
91.Which of the following descriptions accurately reports a NORMAL patient response to deep tendon reflex testing?
1. 2 or plus (+)
2. 3 or plus (++)
3. 0 or minus (-)
4. 1 or minus (-)
Correct Answer: 1
A normal response is 2 or plus (+). Minus (-) or 0 indicates an absent reflex, and minus (-) or 1 indicates a diminished response. Plus
(++) or 3 indicates an exaggerated response, and plus (+++) or 4 indicates clonus.
Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders, 4th ed. Lippincott Williams & Wilkins. 2006: 86-87
92.A patient presents with weakness throughout the right lower extremity with normal strength on the left side. Sensory testing
shows a loss of pressure sensation over the right thigh and leg and a loss of pain and temperature sensation over the left
thigh and leg. The patient has a positive Babinski sign on the right. Which of the following associated findings is MOST likely
to be found during further examination of this patient?
1. The presence of clonus in the left ankle
2. Marked atrophy in the right lower extremity muscles
3. Spasticity in the left lower extremity
4. Increased deep tendon reflexes on the right side
Correct Answer: 4
The presence of clonus would be on the right side, not the left side. Spasticity would be on the right side, not the left side. This is a case
of hemisection of the spinal cord, Brown-Séquard syndrome. The lesion is on the right side of the spinal cord, and it is an upper motor
neuron lesion (positive Babinski sign) with damage to the corticospinal tract, posterior columns, and lateral spinothalamic tract. Upper
motor neuron spinal cord lesions present with hyperactive tendon reflexes (in this case on the right side), clonus, and spasticity
ipsilateral to the side of the lesion. Pressure sensation is lost on the ipsilateral side, and pain and temperature are lost contralateral to
the side of the lesion due to the crossing of those fibers in the spinal cord.
Blumenfeld H. Neuroanatomy Through Clinical Cases. Sinauer. 2002: 66, 231, 235
93.While a physical therapist is performing transfer training from bed to chair with a patient who had a total knee arthroplasty 2
days ago, the electrocardiograph monitor alarms and the therapist notes that premature ventricular contractions have
developed. What is the therapist’s BEST course of action at this time?
1. Position the patient on a stable surface and discontinue physical therapy for the day.
2. Continue the transfer to the chair and monitor the patient’s oxygen saturation levels.
3. Continue the transfer to the chair and immediately notify the nurse about the premature ventricular contractions.
4. Position the patient on a stable surface and determine the stability of the premature ventricular contractions.
Correct Answer: 4
Option 1 would apply only after the therapist has done further analysis of the situation. Monitoring oxygen saturation is useful but not the
most immediate thing to monitor. The therapist should monitor the electrocardiogram and blood pressure of the patient. Although
notifying the nurse is something the therapist should do, this should be done after an initial evaluation of the stability of premature
ventricular contractions. Onset of premature ventricular contractions can be benign or stable. Less than six contractions/minute is
generally stable, while greater than six contractions/minute is considered less stable. A physical therapist should be able to determine
this stability.
Irwin S, Tecklin JS. Cardiopulmonary Physical Therapy, 4th ed. Mosby. 2004: 332
94.Which of the following postural drainage positions is MOST appropriate for a patient who has aspiration pneumonia in the
right middle lobe and who had a craniotomy 2 days ago?
1. Right sidelying with one-quarter turn toward supine
2. Left sidelying with one-quarter turn toward supine with head of bed down approximately 20°
3. Right sidelying with one-quarter turn toward supine with head of bed down approximately 20°
4. Left sidelying with one-quarter turn toward supine
Correct Answer: 4
Option 1 is incorrect because the traditional position to drain the right middle lobe is left sidelying, not right sidelying. Option 2 is the
traditional drainage position for right middle lobe, but does not take into account the intracranial pressure issues. Option 3 is the
traditional drainage position for right middle lobe but does not take into account the intracranial pressure issues. The traditional position
to drain the right middle lobe is left sidelying with one-quarter turn toward supine, head of bed down approximately 20°. However,
because of the recent craniotomy, the patient’s increased intracranial pressure is a major issue to monitor and keep stable. Therefore,
this traditional position should be modified to flat sidelying, as described in option 4.
Paz JC, West MP. Acute Care Handbook for Physical Therapists. 2nd ed. Butterworth-Heinemann. 2002: 694
95.To help students apply a newly learned skill to clinical practice, the MOST effective action for the clinical instructor to take
is to:
1. point out possible clinical situations and discuss how the skill would apply to them.
2. have the students research reference materials and compile a list of the steps required to acquire the skill.
3. prepare a list of indications and contraindications for the skill.
4. have the students provide examples of clinical situations where the skill would be appropriately applied.
Correct Answer: 4
Behavioral objectives should be learner centered, outcome oriented, specific, and measurable. Option 4 is the only one that is learner
(student) centered and specific to a situation. Options 1 and 3 require action by the clinical instructor, not the student. Option 2, which
may be a step in the process, is not as learner centered or outcome centered as Option 4.
Shepard KF, Jensen GM, eds. Handbook of Teaching for Physical Therapists. 2nd ed. Butterworth-Heinimann. 2002: 234
96.During the shoulder examination of a patient, a physical therapist notes the presence of a capsular pattern without radicular
pain. To help establish the cause of the capsular pattern, the therapist should NEXT:
1. perform axial compression on the cervical spine to check for nerve root compression.
2. ask the patient if there has been any prior trauma to the shoulder joint.
3. check for a painful arc during active range of motion.
4. examine the shoulder for a rotator cuff tear.
Correct Answer: 2
A nerve root impingement commonly gives radicular pain. One of the most common causes of a capsular pattern in the shoulder is
traumatic arthritis following injury to the shoulder. The capsular pattern may gradually develop over time. A painful arc is often associated
with a noncapsular pattern such as seen with bursitis or tendonitis at the shoulder. A torn rotator cuff is associated with weakness and
loss of active shoulder elevation.
Magee DJ. Orthopedic Physical Assessment. 4th ed. Saunders. 2002: 5-7; Ombregt L, Bisschop P, ter Veer HJ. A System of Orthopedic
Medicine. Churchill Livingstone. 2003: 305-307
97.A patient had knee surgery 4 weeks ago. Which of the following neuromuscular electrical stimulation parameters would be
MOST appropriate to use for strengthening the patient’s quadriceps muscle?
1. 1 to 4 pps, 100 microseconds
2. 1 to 4 pps, 350 microseconds
3. 40 to 50 pps, 350 microseconds
4. 100 pps, 100 microseconds
Correct Answer: 3
The pulse width of 100 microseconds makes it difficult to achieve a strong enough motor response. A 1 to 4 pps frequency may lead to a
twitch motor response, but not tetany, which is needed for strengthening. The correct answer requires a frequency that will lead to tetany
(something above about 30 Hz) and a long enough pulse width to recruit motor fibers (usually something greater than 200
microseconds). Therefore, of the options, 40 to 50 pps with a pulse width of 350 microseconds is the best. Option 4 describes the typical
parameter for conventional transcutaneous electrical nerve stimulation for acute pain management. However, the pulse width of 100
microseconds makes it difficult to achieve a motor response, and the higher frequency of 100 pps leads to rapid fatigue.
Hecox B, Mehreteab TA, Weisberg J, Sanko J. Integrating Physical Agents in Rehabilitation, 2nd ed. Pearson Prentice Hall. 2006: 285286
98.A patient is asked to grip a white card between the thumb (1st digit) and index finger (2nd digit) with both hands. The
physical therapist pulls on the card in the direction of the arrow shown. As the therapist pulls on the card the patient’s right
thumb flexes at the interphalangeal joint. The results indicate weakness in which of the following muscles?
1.
2.
3.
4.
Flexor pollicis longus
Abductor pollicis brevis
Adductor pollicis
Extensor pollicis longus
Correct Answer: 3
The test shown in the photograph is the Froment test. Both thumbs (1st digits) should stay extended during the test. If the thumb (1st
digit) flexes, it is indicative of weakness of the adductor pollicis with substitution by the flexor pollicis longus, which is usually due to a
lesion of the ulnar nerve.
Magee DJ. Orthopedic Physical Assessment, 4th ed. WB Saunders. 2002: 398
99.During the gait evaluation of a patient, a physical therapist notices that the patient laterally bends excessively toward the
right side during the midstance phase on the right. For the therapist to test the suspected muscle for Normal strength (5/5), the
patient should FIRST be positioned:
1. prone with the knee straight.
2. supine with the knee bent.
3. seated with the hip flexed to 110°.
4. sidelying on the left side.
Correct Answer: 4
Prone with the knee straight would be used to test for a Poor (2/5) grade. Supine with knee bent is used to isolate the gluteus maximus.
Seated hip flexion is used to test the hip flexor muscle strength. The most likely cause of laterally bending toward the stance limb is
abductor weakness on the stance side. The lateral bending helps compensate for weak abductors. The right abductors would be tested
from a left sidelying position for Fair (3/5) or greater strength.
Magee DJ. Orthopedic Physical Assessment, 4th ed. WB Saunders. 2002: 868-869
100.A patient with a cerebellar stroke has received functional balance training for 4 weeks. Which of the following tests is
MOST appropriate to measure the effectiveness of the physical therapy intervention?
1. Romberg Test
2. Berg Balance Scale
3. Fugl-Meyer Assessment
4. Barthel Index
Correct Answer: 2
Although the Romberg Test is a measure of the role of vision in balance, it alone would not be the most appropriate measure for
functional balance. The Berg Balance Scale is an objective measure of static and dynamic balance abilities and consists of 14 commonly
performed functional tasks; therefore, it is the most appropriate tool to use as a measure of intervention effectiveness. The Fugl-Meyer
Assessment is appropriate for cortical strokes and would not be the most appropriate for a cerebellar stroke. It is not as comprehensive
in balance tasks as the Berg Balance Scale. The Barthel Index is a more global instrument and is not as focused on functional balance
as the Berg Balance Scale.
O'Sullivan SB, Schmitz TJ. Physical Rehabilitation. 5th ed. FA Davis. 2007: 257-258
101.A patient in the eighth month of pregnancy has numbness and tingling of the left hand, except for the little finger (5th
digit). She demonstrates edema of the hand and fingers, a positive Tinel sign at the wrist, and a Good (4/5) muscle test grade
of the wrist and finger flexors. The MOST appropriate intervention is:
1. a wrist splint to position the wrist in full extension.
2. a hot pack followed by tendon gliding exercises.
3. resistive exercises for the wrist and finger flexors.
4. frequent rest and elevation of the left upper extremity.
Correct Answer: 4
Compression on the median nerve (carpal tunnel syndrome) is occurring, most likely as a result of swelling associated with the individual
being in the eight month of pregnancy. In this case, rest and elevation would do the most to decrease the edema and relieve the
symptoms. The wrist should not be positioned in full extension. Initial conservative treatment sometimes includes cock-up splinting to
hold the wrist in neutral to 10° of extension, but not full extension. Although tendon gliding exercises may be used, heat would not be
indicated since it may increase the edema. Resistive exercises for the wrist and fingers may aggravate the compression in the carpal
tunnel.
Elder MG. Obstetrics and Gynaecology. 1st ed. London: Imperial College Press. 2002: 127; Dutton M. Orthopaedic Examination,
Evaluation & Intervention. McGraw-Hill. 2004: 643-644
102.Which of the following locations corresponds to the sensory function of the nerve root exiting between the third and fourth
lumbar vertebrae?
1.
2.
3.
4.
Lateral knee joint line
Medial knee joint line
Plantar aspect of the heel
Dorsal web space between the first and second toes
Correct Answer: 2
The L3 nerve root exits between the third and fourth lumbar vertebrae and supplies sensory information from the region of the medial
knee joint line.
Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders, 4th ed. Lippincott Williams & Wilkins. 2006: 78
103.An inpatient physical therapy department has only one physical therapist and one physical therapist assistant on duty,
due to staff illness. Treatment of a patient with which of the following conditions and circumstances is MOST appropriate for
the therapist to delegate to the assistant?
1. Ataxia, who is undergoing a trial to determine an appropriate assistive device
2. Hemiparesis, whose initial evaluation has not been completed
3. Multiple sclerosis, who is receiving gait training with a rolling walker
4. Alzheimer disease, who is easily agitated and is receiving initial gait training
Correct Answer: 3
A physical therapist would be required to perform the initial evaluation, plan of care, reevaluations, modifications to the plan of care, and
discharge plans for the patient. The patient who is stable and has an existing program would be the most appropriate patient to be
delegated to the assistant. Therefore, the patient who has multiple sclerosis and who has an established gait training program would be
the most appropriate. The other three patients are receiving their initial treatments.
Umphred D, Carlson C. Neurorehabilitation for the Physical Therapists Assistant. Slack. 2006: 4-6
104.When considering special tests for orthopedic assessment, selection of a test with adequate validity is important because
the:
1. results of the test can be standardized.
2. test measures what it is supposed to measure.
3. results of the test are reproducible.
4. test can be accurately performed by someone else.
Correct Answer: 2
Option 2 is the definition of validity. Options 3 and 4 refer to reliability measures. Option 1 is incorrect because results can be
standardized even though they are not valid.
Hicks C. Research Methods for Clinical Therapists: Applied Project Design and Analysis, 4th ed.
105. patient who recently had bilateral transtibial amputations wants to have a ramp built to travel from the back deck of his
house to the pool in his wheelchair. The vertical distance from the door to the ground level is 5 ft (1.5 m). Which of the
following ramp specifications is BEST for the patient?
1. One continuous ramp, 60 ft (18 m) long
2. One continuous ramp, 30 ft (9 m) long
3. Two ramps, each 60 ft (18 m) long, connected by a level area
4. Two ramps, each 30 ft (9 m) long, connected by a level area
Correct Answer: 4
One continuous ramp that is 60 ft (18 m) long is too long of a run without a level area to rest. One continuous ramp that is 30 ft (9 m)
long is too steep a slope. Two ramps, each 60 ft (18 m) long, even if connected by a level area, would be unnecessarily long. The rise
should not be greater than 30 in (76 cm) for any one run and should be 1 ft (.3 m) in length per each 1 in (2.5 cm) rise.
Minor SM, Minor MA. Patient Care Skills, 5th ed. Prentice Hall. 2006: 417
106.A physical therapist is developing an exercise program for an older adult to improve routine health maintenance and
fitness. The patient has a history of a right ankle fracture 15 years ago, aortic aneurysm repair 3 years ago, and open-heart
surgery for a valve replacement 6 years ago. Which of the following activities is CONTRAINDICATED?
1. Aquatic exercise for 30 minutes
2. Cycling at 60% of maximum heart rate
3. Endurance exercise using basic calisthenics
4. Weight lifting at 50% of maximum voluntary contraction
Correct Answer: 4
Resistive exercise is contraindicated for a patient with a history of aortic aneurysm, even after surgical repair.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. Saunders. 2007, p. 295
107.Which of the following home programs is MOST appropriate for a patient with chronic lateral epicondylitis?
1. Using a forearm cuff to increase loading on the extensor tendons
2. Performing exercises for wrist strength and stretching
3. Administering iontophoresis with dexamethasone (Decadron) and lidocaine (Xylocaine)
4. Doing friction massage of the brachioradialis tendon
Correct Answer: 2
Lateral epicondylitis is caused by overuse of the wrist extensors that originate on the lateral epicondyle of the humerus, especially the
extensor carpi radialis brevis. If the lateral epicondylitis is at a chronic stage, conditioning of the extensor muscles and sustained grip
activities will be most effective in long-term management. A forearm cuff is thought to decrease the muscle loading. Iontophoresis would
not be appropriate for a home program. Friction massage of the brachioradialis would not be appropriate since the extensor carpi radialis
brevis muscle is usually the one affected.
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd ed. Mosby. 2003: 104-112
108.A patient is receiving mechanical intermittent cervical traction with an on/off duty cycle of 20 seconds/10 seconds. The
patient reports increased pain each time the traction unit cycles on, which then subsides over the duration of the on time.
Which of the following modifications to the duty cycle is MOST appropriate?
1. Increase the off time to 20 seconds.
2. Increase the on time to 25 seconds.
3. Decrease the off time to 5 seconds.
4. Decrease the on time to 15 seconds.
Correct Answer: 1
When patients have severe symptoms, it is often useful to have increased on and off times to reduce the movement caused by the
cycling. Increasing the off time allows for longer recovery time prior to re-initiating the traction and reduces the cycling. As the pain
symptoms decrease, the relaxation time can be decreased. Options 2, 3, and 4 do not allow for a longer off or recovery period.
Cameron MH. Physical Agents in Rehabilitation, 2nd ed. Saunders. 2003: 328
109.Which of the following arterial blood gas readings indicates acidemia?
1. 7.3
2. 7.4
3. 7.45
4. 7.5
Correct Answer: 1
Normal range of arterial blood gas is a pH between 7.35 and 7.45. A pH of 7.35 or lower indicates acidemia, also called an acidotic state.
Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy, 4th ed. Mosby Elsevier, 2006, pp. 158-160
110.A patient with testicular cancer is most likely to report which of the following signs or symptoms INITIALLY?
1. Back pain
2. Pain referred to the groin
3. Swelling of superficial lymph nodes
4. Diffuse testicular pain and swelling
Correct Answer: 4
The most common initial sign is enlargement of the testis with diffuse testicular pain, swelling or hardness. Back pain may be present, as
well as pain referred to the groin or swelling of superficial lymph nodes, but testicular pain and swelling are the most common
predominant symptoms initially.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 240
111.Which of the following positions is BEST to assess the length of a patient’s rectus femoris muscle?
1. Sidelying with tested hip in flexion
2. Supine with tested hip and knee in flexion
3. Prone with tested knee in flexion
4. Sidelying with tested hip in extension
Correct Answer: 3
Option 1 does not mention the knee position and has the hip flexed, which shortens the rectus femoris. Option 2 has the hip flexed,
which shortens the rectus femoris. Prone with the knee in flexion keeps the hip in neutral and does not allow the hip to flex. This position
is used in the Ely test. Option 4 has the hip in the correct position, but does not mention the knee position.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. McGraw-Hill. 2004: 698
112.What is the closed packed position of the wrist?
1. Flexion with ulnar deviation
2. Flexion with radial deviation
3. Extension with ulnar deviation
4. Extension with radial deviation
Correct Answer: 4
The closed packed position for the radiocarpal joint is full extension with radial deviation. The closed packed position for the mid carpal
joint is extension with radial deviation.
Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders, 4th ed. Lippincott Williams & Wilkins. 2006: 1028
113.A patient fell while rock climbing 2 days ago. The fall resulted in a fracture of the right ankle, requiring an open reduction
and internal fixation. The patient also sustained a nerve injury that resulted in significant weakness in the muscles in the right
C6–C7 myotome. The patient is restricted to non-weight-bearing status on the right lower extremity. Which of the following
assistive devices is MOST appropriate for the patient?
1. Axillary crutches
2. Wheelchair
3. Standard walker
4. Forearm crutches
Correct Answer: 2
The axillary crutches, standard walker, and forearm crutches all require adequate strength in the elbow extensors and latissimus dorsi,
especially due to the non-weight-bearing status of the patient. The non-weight-bearing status on the right could indicate any of the
options; however, because the patient has weakness of the muscles in the C6–C7 dermatome, the patient would have difficulty using any
assistive device that requires use of the elbow extensors and latissimus dorsi muscles. Therefore, the best option is the wheelchair,
because it provides mobility.
Choi H, Sugar R, Fish DE, Shatzer M, Kraback B. Physical Medicine and Rehabilitation Pocketpedia. Lippincott Williams & Wilkins.
2003: 30-31
114.A physical therapist is examining the feet of a patient with type 2 diabetes. Which of the following tests is BEST to
determine the patient’s risk for developing foot ulceration?
1. Pain sensation
2. Pressure threshold
3. Two-point discrimination
4. Temperature awareness
Correct Answer: 2
Pressure thresholds using nylon filaments are the most sensitive and specific. Several studies support the use of the 10-gram (SemmesWeinstein 5.07) nylon filament as the threshold for protective sensation. Patients unable to feel a 10-gram nylon filament are considered
unable to protect their feet from injury and are at risk of ulceration.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 358
115.A physical therapist is planning a three-session educational series on physical therapy evaluation of the low back for
fourth-year medical students. Which of following activities is MOST important to include in the first session?
1. An overview of the material that will be covered in all three sessions
2. A pretest to determine the level of knowledge of the participants
3. Active participation of the students in a low back evaluation
4. A complete demonstration of a low back evaluation
Correct Answer: 2
An overview presented on the first day would imply that the therapist is not going to modify the series to the students’ current knowledge
level, which may be ascertained from the pretest. It is most important for the physical therapist to know what level of knowledge the
students have. Although active participation is important for learning in every session, neither it, nor a complete demonstration of a low
back evaluation, is most important to include in the first session.
Falvo D. Effective Patient Education: A Guide to Increased Compliance, 3rd ed. Aspen Publishers. 2004: 77-78
116.A physical therapist reads in a report that a child has a standard score of -2.0 on a measure of development. Which of the
following interpretations of this score is BEST?
1. The child’s score is well below the mean score, compared to other children’s scores.
2. The child’s score is close to the mean score, compared to other children’s scores.
3. The child is doing better on this measure than approximately 85% of children.
4. The child is doing worse on this measure than approximately 85% of children.
Correct Answer: 1
A standard score, or z-score, relates to the number of standard deviation units a score is above or below a mean. Standard scores are
often used in developmental measures because they are a useful comparison to a larger or normal group. A standard score of -2.0 is
well below the mean because two standard deviation units below the mean indicates that only 2.27% of children have scored lower or,
stated conversely, that 97.73% of children scored better. At -1.0 standard deviation units, 84.14% of children scored better.
Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice, 3rd ed. Pearson-Prentice Hall. 2009: 400-402.
117.A patient with an L4–L5 posterolateral herniated nucleus pulposus is MOST likely to have sensory deficits in which of the
following locations?
1. Medial knee
2. Over the popliteal fossa
3. Plantar aspect of the fifth toe
4. Dorsum of the great toe
Correct Answer: 4
The medial knee is the L3 dermatome. The popliteal fossa is S2 dermatome. The plantar foot is S1 or S2. A posterolateral disc bulge at
L4–L5 will most likely affect the L5 nerve root and the dermatome for the L5 nerve root. The L5 dermatome includes the dorsal aspect of
the great toe. The dorsal area of the great toe is consistently included in the L5 dermatome.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. McGraw-Hill. 2004: 186; Moore KL, Dalley AF. Clinically Oriented
Anatomy. 5th ed. Lippincott Williams & Wilkins. 2006: 504
118.A 72-year-old patient reports bilateral calf pain which gets progressively worse while walking. The pain episodes have
been gradually increasing in frequency and severity, after an insidious onset 2 years ago. Sitting decreases the patient’s
symptoms. Which of the following pathologies is the MOST likely cause of the patient’s leg pain?
1. Lumbar foraminal stenosis
2. Gluteal artery claudication
3. Herniated nucleus pulposus
4. Deep vein thrombosis
Correct Answer: 1
Lumbar stenosis by definition causes lower extremity symptoms with extension activities, and stenosis is more common in an older
population. Gluteal artery claudication would cause buttock pain, not calf pain. This patient is relatively too old for a herniated nucleus
pulposus, and most cases of herniated nucleus pulposus do not involve bilateral symptoms. Nothing given in the patient’s history would
increase the likelihood of a deep vein thrombosis.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. McGraw-Hill. 2004: 1213
119.A patient with Guillain-Barré syndrome who is experiencing progressive paralysis is admitted to an intensive care unit.
Which of the following interventions is MOST appropriate for a physical therapist to perform as a member of the
interdisciplinary team managing the patient’s care?
1. Alter the patient’s mechanical ventilation settings.
2. Develop the patient’s medication schedule.
3. Perform airway clearance techniques.
4. Discuss the patient’s medical prognosis with the family.
Correct Answer: 3
The key phrase in this question is “interdisciplinary.” Of all the options provided, only airway clearance is within the scope of practice for
physical therapists. Patients with Guillain-Barré syndrome may experience respiratory muscle fatigue or paralysis and are susceptible to
pulmonary infection. Pulmonary hygiene is a critical role in their care.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. WB Saunders. 2003: 1159-1161
120.A physical therapist examining wrist-joint play finds restriction in the direction indicated by the arrow. The therapist
should suspect a decrease in which joint motion?
1.
2.
3.
4.
Radial deviation
Ulnar deviation
Flexion
Extension
Correct Answer: 1
The therapist is shown performing an ulnar glide, which is the same joint motion used for radial deviation. Limited motion in this direction
indicates limited ability to perform radial deviation.
Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques, 5th ed. FA Davis. 2007: 131-132
121.Which of the following nervous system complications would indicate the poorest prognosis for a patient with acquired
immunodeficiency syndrome (AIDS)?
1. Toxoplasmosis
2. Leukoencephalopathy
3. Myelopathy
4. Polyneuropathy
Correct Answer: 2
Although all of the options are serious complications in patients with AIDS, multifocal leukoencephalopathy is the most serious, and
death occurs in a few months after it is diagnosed.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. Saunders. 2007: 523
122.Which of the following examination findings is consistent with dehydration?
1. Poor turgor
2. Dependent edema
3. Pitting edema
4. Hypertension
Correct Answer: 1
Poor skin turgor is one of the signs of dehydration. The skin, when lifted up between the fingers, does not return to its original position in
a rapid manner.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. WB Saunders. 2007: 495
123.A patient who is a waitress reports weakness in the right hand that causes her to drop dishes at work whenever she is
distracted. The patient also reports wrist and hand pain and numbness over the thenar eminence, both of which occur during
the day and at night. The patient’s thenar muscle strength is Poor (2/5) throughout. Which of the following long-term physical
therapy goals is MOST appropriate for this patient?
1. The goal is to increase tactile sensitivity in 4 weeks, so that the patient is able to hold objects and not drop dishes at work.
2. The patient will demonstrate decreased pain in the wrist in order to be able to sleep at night.
3. The long-term goal is to increase strength in the thenar muscles and decrease pain in the wrist back to normal levels.
4. The patient will demonstrate thenar muscle strength of Good (4/5) grade in 6 weeks and be able to hold objects in hand while at
work.
Correct Answer: 4
A well-written goal includes an audience (who), behavior (what will be done), condition (under what circumstances), and degree (amount
of change). The only option that includes all of these conditions is option 4, “The patient (who) will demonstrate thenar muscle strength
(behavior) of Good (4/5) grade (degree) and be able to hold objects in hand while at work (condition).” Options 1, 2, and 3, are each
missing one or more of the required elements.
Kettenbach G. Writing SOAP Notes. 3rd ed. FA Davis. 2004:147-148
124.A patient with a severe cerebellar lesion can sit independently, can stand with minimal assistance, and requires moderate
assistance of one person to walk safely. The patient wants to transfer independently from a wheelchair to a bed. Which of the
following transfer techniques is MOST appropriate for the patient?
1. Standing pivot
2. Manual pivot
3. Mechanical lift
4. Sliding
Correct Answer: 4
Standing-pivot transfer requires standing, which the patient is not able to perform safely. Manual-pivot transfer involves the assistance of
another person, so would not allow for independence. Mechanical-lift transfer involves the assistance of another person, so would not
allow for independence. Sliding transfer is the safest independent technique, because the patient cannot stand without minimal
assistance.
Umphred DA. Neurological Rehabilitation. 5th ed. Mosby; 2007: 849.
125.A physical therapist is examining a patient who has unilateral lower extremity pain when walking. The pain is relieved by
rest. Which of the following descriptions of symptom behavior reported by the patient will help the therapist confirm a
diagnosis of intermittent claudication?
1. Pain relief upon forward bending or sitting
2. Pain relief upon standing
3. Cramping pain that occurs at a predictable distance walked
4. Numbness and tingling that occurs at a predictable distance walked
Correct Answer: 3
Pain relief upon forward bending or sitting and pain relief upon standing are more diagnostic for lumbar origin of pain. Cramping pain that
occurs at a predictable distance walked is a common presentation and clinical manifestation of vascular limitation. Numbness and
tingling that occurs at a predictable distance walked are more indicative of a neurologic cause of pain rather than a vascular cause.
Paz JC, West MP. Acute Care Handbook for Physical Therapists. 2nd ed. Butterworth-Heinemann. 2002: 388-389
126.A patient reports dizziness and blurred vision when walking and turning the head to either the left or the right. The patient
has no problem when the head is kept still while walking. Which of the following systems is MOST likely involved?
1. Visual
2. Vestibular
3. Somatosensory
4. Musculoskeletal
Correct Answer: 2
Since the patient does not have symptoms while looking straight ahead, the visual acuity (peripheral visual system) does not appear to
be at fault. A patient who reports visual blurring with head motion is experiencing oscillopsia. Oscillopsia is a visual instability with head
movement in which images appear to move or bounce. It is often due to decreased vestibulo-ocular reflex. No information is given in
the question to suggest that the patient is having difficulty with somatosensory input or that indicates musculoskeletal deficits.
O’Sullivan SB, Schmitz TJ. Physical Rehabilitation, 5th ed. FA Davis. 2007: 1010
127.A physical therapist is preparing for gait training with a young adult patient with paraplegia. Which of the following gait
training options is MOST appropriate for the patient’s first session?
1. Swing-through gait pattern with a walker
2. Swing-through gait pattern with forearm crutches
3. Swing-to gait pattern with axillary crutches
4. Swing-to gait pattern in the parallel bars
Correct Answer: 4
Option 1 is an inappropriate assistive device for a young adult with paraplegia. Option 2 is the ultimate goal of gait training but would be
too difficult for the patient’s first attempt. Option 3 is not the most efficient gait aide for a patient with paraplegia. The first-time session of
gait training for a patient with paraplegia should be in the parallel bars. A swing-to gait pattern would be the easiest for the patient to
learn initially.
O'Sullivan SB, Schmitz TJ. Physical Rehabilitation, 5th ed. FA Davis Company. 2007: 980-981
128.A physical therapist is treating a patient with chronic range of motion limitation due to tight hamstrings. Which of the
following applications of ultrasound and stretching is BEST to restore normal range of motion?
1. Pulsed ultrasound at 1 MHz with onset of stretching 10 minutes after the ultrasound treatment
2. Pulsed ultrasound at 1 MHz with stretching for 10 minutes during and immediately after the ultrasound treatment
3. Continuous ultrasound at 1 MHz with onset of stretching 10 minutes after the ultrasound treatment
4. Continuous ultrasound at 1 MHz with stretching for 10 minutes during and immediately after the ultrasound treatment
Correct Answer: 4
Stretching should be done during and immediately after the ultrasound treatment. 1 MHz continuous ultrasound provides the greatest
thermal effects and would facilitate the stretch.
Cameron M: Physical Agents in Rehabilitation: From Research to Practice, 2nd ed. Saunders. 2003:196-197
129.During an initial physical therapy evaluation, a patient reports occasional breathlessness. Which of the following patient
reports indicates the PRIMARY need for a more thorough pulmonary examination by the physical therapist?
1. There is paroxysmal nocturnal dyspnea.
2. The symptoms are relieved by leaning forward.
3. There has been a recent change in physical activities.
4. The breathlessness is associated with light-headedness.
Correct Answer: 2
Paroxysmal nocturnal dyspnea is common in severe heart disease. Relieving the breathlessness symptoms by a positional change is
suggestive that the problem is pulmonary in origin. Occasional breathlessness may be expected with a change in physical activities, but
more history should be taken to determine if the change is expected. Light-headedness is more indicative of a cardiac problem.
Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy, 4th ed. Mosby. 2006: 550
130.A 90-year-old hospitalized patient was referred for physical therapy evaluation and intervention following a C5 fracture
secondary to a fall. The patient describes neck pain and left knee pain but reports no other postinjury changes in the
extremities. The rehabilitation prognosis for the patient should PRIMARILY be based on:
1. prior level of function.
2. left knee range of motion.
3. use of a cervical collar.
4. upper extremity sensory integrity.
Correct Answer: 1
Understanding a patient’s prior level of function is the most critical factor in a patient’s history to determine a reasonable prognosis, as
this information establishes the baseline for recovery. Although knee range of motion and upper extremity sensory integrity should be
monitored, neither is more critical than prior level of function as a determinant of prognosis. Although a cervical collar is a potential
intervention, its use is not more critical than prior level of function as a determinant of prognosis.
Brimer MA, Moran ML. Clinical Cases in Physical Therapy. Butterworth-Heinemann. 2004: 1-3
131.During examination of a patient, a physical therapist visually observes signs of Charcot disease. Which of the following
signs or symptoms would MOST likely be present and consistent with this diagnosis?
1. Erythema
2. Sharp or stabbing pain in the forefoot
3. Increased sensitivity to touch
4. Open ulcer over the second metatarsal head
Correct Answer: 1
A Charcot joint is painless and usually undetected by the patient secondary to decreased sensation and neuropathy. Because of the
increase in blood flow, patients present with erythema.
Sussman C, Bates-Jensen B. Wound Care, 3rd ed. Lippincott Williams & Wilkins. 2007: 437
132.A physical therapist is reviewing the medical record of a patient in the intensive care unit. The patient was admitted the
previous night through the emergency department after a motorcycle accident resulting in a fractured right femur. The
therapist notes a physician’s order for a Doppler study of the left leg. The therapist should:
1. proceed with the evaluation and intervention without any changes.
2. withhold physical therapy until results of the study are obtained and interpreted by the physician.
3. proceed with the evaluation and limit intervention to transfer to a bedside chair.
4. obtain clearance from the nurse to provide intervention for the patient.
Correct Answer: 2
A complete physical therapy evaluation and treatment is contraindicated due to a possible deep vein thrombosis. A physician’s order for
a Doppler study indicates possible deep vein thrombosis, so the physical therapy should not be conducted until the Dopler study is
completed and the results analyzed by the physician. Transfer from bed to chair is contraindicated due to possible deep vein thrombosis.
The nurse alone should not be providing clearance, until the Doppler study has been completed and interpreted.
DeTurk WE, Cahalin LP. Cardiovascular and Pulmonary Physical Therapy: An Evidence-Based Approach. McGraw-Hill Medical
Publishing. 2004: 565
133.A physical therapist is working with an outpatient who had a cerebrovascular accident and currently lives in an assistedliving facility. Which of the following statements is the MOST appropriate functional goal for this patient?
1. The patient will be able to don an ankle-foot orthosis with assistance.
2. The patient will independently walk 165 ft (50 m) with a straight cane from the bedroom to the cafeteria.
3. The patient will have Normal (5/5) strength of the quadriceps muscles.
4. The patient’s balance will improve to be able to independently stand on the involved lower extremity for 20 seconds.
Correct Answer: 2
The goal in option 2 is the only goal that is objective, measurable, and functional. The goals in options 1, 3, and 4 lack function or
specific measurable objective information.
Kettenbach G. Writing SOAP notes. 3rd ed. FA Davis. 2004: 147-148
134.A physical therapist is examining a patient with congestive heart disease who takes diuretics. Which of the following lower
extremity conditions is MOST likely?
1. Pallor
2. Shiny skin
3. Pitting edema
4. Absence of hair growth
Correct Answer: 3
When the right side of the heart starts to fail, fluid collects in the feet and lower legs, causing pitting edema. Pallor, shiny skin, and
absence of hair growth are characteristic of arterial disease, but not associated with congestive heart failure.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. Saunders. 2007: 293, 311
135.A physical therapist is examining the integumentary system of a patient and notes an area of black, hardened eschar on
the tip of the first toe. The therapist would MOST likely conclude that the patient has which of the following conditions?
1. Frostbite
2. Diabetes
3. Only superficial damage of the skin at that site
4. At least full-thickness damage of the skin at that site
Correct Answer: 4
The presence of black necrotic tissue indicates full-thickness loss of the skin. The cause of the necrosis cannot be determined with the
information in the stem.
Sussman C, Bates-Jensen B. Wound Care, 3rd ed. Lippincott Williams & Wilkins. 2007: 340
136.A physical therapist is prescribing an exercise program to assist a patient in a weight loss program. The patient has type 1
diabetes. The patient should be advised to begin an exercise session only if the blood glucose level is:
1. below 60 mg/dL.
2. above 250 mg/dL.
3. between 60 and 100 mg/dL.
4. between 100 and 250 mg/dL.
Correct Answer: 4
If a person begins exercise when blood glucose is below 100 mg/dL or above 250 mg/dL, significant exercise-related complications may
result.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. Saunders. 2007, p. 492
137.In planning a physical therapy program for geriatric patients, an important age-related change that should be taken into
consideration is:
1. the inability to learn new motor tasks.
2. decreased sensation.
3. decreased motivation.
4. the inability to select alternative movement strategies.
Correct Answer: 2
Neurological changes that are age related include decreased sensation. The other changes listed do not normally occur with aging in the
absence of pathology.
Cassel CK, Leipzig RM, Cohen JH, et al. Geriatric Medicine: An Evidence-Based Approach. 4th ed. Springer-Verlag. 2003: 325
138.A physical therapist is examining the integumentary system of a patient with dark skin pigmentation and notices a
deepening of the skin color over the left posterior aspect of the calcaneus. Which of the following findings would indicate a
Stage I pressure ulcer at that site?
1. Decreased skin temperature, compared to the surrounding tissue
2. Increased skin temperature, compared to the surrounding tissue
3. Blanching with applied pressure that returns to previous coloring within 30 seconds after the removal of pressure
4. Blanching with applied pressure that returns to previous coloring 1 hour after the removal of pressure
Correct Answer: 1
The onset of a Stage I pressure ulcer is characterized by nonblanching erythema and decreased skin temperature over the site of the
ulcer. Because blanching is difficult to ascertain in patients with dark skin, use of skin temperature for assessment of pressure ulcers is
preferred
Sussman C, Bates-Jensen B. Wound Care, 3rd ed. Lippincott Williams & Wilkins. 2007, p. 340
139.A physical therapist is studying the effects of three treatments of ataxia. Patients were recruited from a local clinic and
were randomly assigned to one of the three treatment conditions. Functional measurements were taken at 6 months after the
start of treatment. Which of the following statistical tests is MOST appropriate for data analysis in this study?
1. Factorial analysis of variance
2. One-way analysis of variance
3. Independent sample t-test
4. Repeated-measure t-test
Correct Answer: 2
In a single-factor experiment, the one-way analysis of variance is applied when three or more independent group means are compared.
The descriptor one-way indicates that the design involves one independent variable, which is the case in the present scenario. All
subjects were recruited from the same clinic and underwent the same length of treatment. The only difference among the three groups of
subjects was the treatment group to which they were assigned.
Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice, 3rd ed. Pearson-Prentice Hall, 2009, p. 451
140.A physical therapist is evaluating the cranial nerves of a child who has a medulloblastoma. The child’s right eye deviates
medially. The child has impairment of which of the following cranial nerves?
1. Oculomotor (III)
2. Trochlear (IV)
3. Abducens (VI)
4. Vagus (X)
Correct Answer: 3
The oculomotor nerve (III) controls the inferiomedial eye muscles. The trochlear nerve (IV) controls inferiolateral eye movement. The
abducens nerve (VI) controls lateral eye movement. Damage to this nerve causes the eyeball to deviate medially due to weakness of the
lateral rectus muscle. The vagus nerve (X) does not control the eye muscles.
Magee DJ. Orthopedic Physical Assessment, 4th ed. Saunders. 2002: 69
141.A physical therapist is preparing to teach a patient with Guillain-Barré syndrome to transfer from wheelchair to mat table.
The patient weighs 150 lb (68 kg) and has Poor (2/5) strength in both of the lower extremities and Fair (4/5) strength in the left
upper extremity. The right upper extremity has Normal (5/5) strength. Which of the following assisted transfers is MOST
appropriate for the patient’s initial session?
1. Two-person lift to the right side
2. Sliding-board transfer to the right side
3. Hydraulic lift from wheelchair to mat
4. Full standing-pivot transfer to the right side
Correct Answer: 2
Because the patient has significant weakness in both lower extremities, a standing pivot transfer would not be safe. However, since the
patient does have fair to normal upper extremity strength and is not totally dependent, a hydraulic lift or two-person lift would not be
appropriate because it would not enhance the patient’s functional skills. The most appropriate transfer method would be for the patient to
use a sliding board transfer to the strongest (right) side.
Minor MA, Minor SD. Patient Care Skills. 5th ed. Pearson Prentice Hall. 2006: 224-227
142.A physical therapist has been working with a patient who has a spinal cord injury. To document that the patient has been
educated about skin care, the therapist should record that the patient:
1. is unable to tolerate more than 1 hour in a wheelchair.
2. has good strength of the scapular depressors and elbow extensors.
3. is able to state three causes of skin breakdown.
4. is able to perform 10 push-ups in the wheelchair.
Correct Answer: 3
Option 3 is the only one stated clearly in educational terms. The other options are objectives based on observations.
Falvo D. Effective Patient Education: A Guide to Increased Compliance, 3rd ed. Aspen Publishers. 2004: 95-96
143.Increased residual volume is LEAST likely to be a finding in pulmonary function testing of a patient with which of the
following conditions?
1. Atelectasis
2. Bronchiectasis
3. Chronic bronchitis
4. Emphysema
Correct Answer: 1
Atelectasis occurs when one or more segments or lobes of the lung is collapsed. It often occurs following thoracic or upper abdominal
surgery, when the patient has a reduced total lung capacity, functional residual capacity, and residual volume. Bronchiectasis is an
abnormal dilation of the bronchi and bronchioles and results in increased residual volumes. The primary symptom of chronic bronchitis is
chronic productive cough and results in increased residual volume. Emphysema usually results in significantly increased residual
volumes.
Irwin S, Tecklin JS. Cardiopulmonary Physical Therapy
144.During pregnancy, which of the following exercises is CONTRAINDICATED?
1. Curl-ups
2. Bridging
3. Double leg lifts
4. Deep breathing with forced expiration
Correct Answer: 3
During pregnancy and postpartum, the stretched abdominal muscles are unable to stabilize the lower back as the legs are raised.
Attempting to perform double leg lifts can overwork the abdominal muscles and cause damage to spinal joints.
Kisner C, Colby LA. Therapeutic Exercise, 5th ed. FA Davis. 2007: 816
145.A patient who is being taught a new motor task is MOST likely to require full attention to the task and extrinsic feedback
during which phase of motor learning?
1. Cognitive
2. Associative
3. Autonomous
4. Executive
Correct Answer: 1
Early learning in the 1st phase of motor learning (the cognitive phase) requires full attention to the task and extrinsic feedback. As the
task is learned, feedback can become more intrinsic and less attention to task is required.
Hall CM, Thein-Brody L. Therapeutic Exercise, 2nd ed. Lippincott Williams & Wilkins. 2005: 152
146.A patient with a recent ankle injury reports anterior ankle pain while walking. Pain is reproduced ONLY during passive
rotation of the lower leg. The patient most likely sustained which of the following injuries?
1. Syndesmosis sprain
2. Calcaneocuboid sprain
3. Fifth metatarsal fracture
4. Tibial stress fracture
Correct Answer: 1
Option 1 tests the integrity of the tibiofibular syndesmosis. With a positive test result, the patient will have reproduction of symptoms and
in this case, anterior ankle pain. Lateral (external) rotation of the tibia may potentially compress the calcaneocuboid joint but would not
stress the ligaments. A 5<sup>th<sup> metatarsal fracture would not present with anterior ankle pain. Option 4 does not load the tibia
andor muscles enough to provoke pain from a stress fracture.
Magee DJ. Orthopedic Physical Assessment. 4th ed. Saunders. 2002: 804
147.To avoid the appearance of increased motion, what movement MUST be prevented during goniometric measurement of
shoulder abduction?
1. Upward rotation of the scapula
2. Medial (internal) rotation of the shoulder
3. Lateral (external) rotation of the shoulder
4. Lateral flexion of the trunk to the opposite side
Correct Answer: 4
During measurement of shoulder abduction, the trunk should be kept straight. If the patient is allowed to laterally flex the trunk, it will give
the appearance of increased shoulder abduction, but the motion would be occurring in the spine and not in the shoulder. Upward rotation
of the scapula and lateral (external) rotation of the shoulder would normally accompany the motion of shoulder abduction. Medial
(internal) rotation of the shoulder would decrease the available abduction.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention, 2nd ed. McGraw-Hill. 2004: 438-440
148.Which of the following pulmonary function tests measures the average total amount of air moved during inspiration in a
patient with normal breathing?
1. Vital capacity
2. Inspiratory capacity
3. Tidal volume
4. Inspiratory reserve volume
Correct Answer: 3
Vital capacity is measured from maximum inhalation to maximum exhalation. Inspiratory capacity measures volume with maximal
inhalation. Tidal volume measures total volume of air moved during either inhalation or exhalation over a specific period of time (usually
1 minute) and then divided by the ventilatory rate. Inspiratory reserve volume measures inspiratory volume beyond normal inspiration.
Paz JC, West MP. Acute Care Handbook for Physical Therapists, 2nd ed. Butterworth-Heinemann. 2002: 126
149.A physical therapist is evaluating a patient who has a chest tube. The therapist accidentally knocks over the collection
reservoir. The therapist should return the reservoir to the upright position and:
1. hang it on an intravenous pole.
2. place it on the patient’s bedside table.
3. hang it from the side of the bed.
4. contact the physician.
Correct Answer: 3
The reservoir must be placed below the level of the heart. Notifying the nurse would be sufficient. Notifying the physician is unnecessary.
Paz JC, West MP. Acute Care Handbook for Physical Therapists. 2nd ed. Butterworth-Heinemann. 2002: 796-797
150.A physical therapist is examining a patient with an upper lumbar radiculitis. Which of the following combinations of
movements is MOST likely to reproduce the pain associated with the radiculitis?
1. Supine knee extension with hip flexion
2. Supine knee flexion with hip flexion
3. Prone knee flexion with hip extension
4. Prone knee extension with hip extension
Correct Answer: 3
Supine knee extension with hip flexion places a stretch on the sciatic nerve, which involves lower lumbar nerve roots (L4–S3). Knee
flexion with hip flexion would not place a stretch on the femoral nerve. An upper lumbar radiculitis involves the nerve roots that form the
femoral nerve (L2–L4). The femoral nerve can be stretched or provoked, by extending the hip while flexing the knee. Prone hip extension
would place a stretch on the femoral nerve, but there would be less stretch with the knee in extension than in flexion.
Dutton M. Orthopedic Examination, Evaluation, and Intervention. McGraw-Hill. 2004: 361-366
151.A patient with an impairment that limits hip flexion to 105° will benefit MOST from which of the following assistive devices
and modifications to accomplish activities of daily living?
1. Elevated chair-seat height
2. Long-handled reacher
3. Decreased rise in stair height
4. Sock aid
Correct Answer: 4
Normal sitting requires about 105° of hip flexion, so an elevated chair would not be necessary. Reaching would not be as restricted as
donning socks. The reacher would not be effective in assisting with shoes and socks and may be overused. Stair climbing requires about
60° to 70° of hip flexion, and step height modification would not be needed. To reach to the foot, approximately 120° of hip flexion is
required. If a modified procedure is chosen with the foot across the opposite thigh, at least 110° of hip flexion is still required. With only
105° of hip flexion, the patient would have most difficulty putting on socks.
Hall CM, Brody LT. Therapeutic Exercise: Moving Toward Function, 2nd ed. Lippincott Williams & Wilkins. 2005: 439
152.A patient with hemiparesis demonstrates foot drop during the swing phase of gait. The MOST appropriate application of
functional electrical stimulation would be to treat both the tibialis anterior and which of the following muscles?
1. Gastrocnemius
2. Tibialis posterior
3. Extensor digitorum longus
4. Fibularis (peroneus) longus
Correct Answer: 3
During the swing phase of gait, the foot is dorsiflexed to clear the floor. Muscles active during this phase of gait are the tibialis anterior,
extensor hallucis longus, and the extensor digitorum longus. The gastrocnemius, tibialis posterior, and fibularis (peroneus) longus are
active during stance phase of gait. Therefore, of the muscles listed, the extensor digitorum longus is the best choice. If only the tibialis
anterior was stimulated, the foot would go into inversion and dorsiflexion, which could cause the patient to land on the lateral side of the
foot at initial contact, causing injury. Addition of the extensor digitorum longus would bring the foot up into more dorsiflexion and avoid
excessive inversion.
Michlovitz SL, Nolan TP. Modalities for Therapeutic Intervention, 4th ed. FA Davis. 2005: 263
153.A physical therapist plans to study the effect of cold compresses on passive range of motion in two groups of subjects: an
experimental group and a control group. For the experimental group, the cold compress will be applied to the hamstring
muscles 1 timeday for 5 days. Which of the following experimental methods is <b>MOST<b> appropriate for this study, in
order to compare the effect of the cold compresses between the two groups?
1. For the experimental group, gather range-of-motion data prior to each treatment.
2. For both groups, measure range of motion on day 5.
3. For both groups, measure range of motion on days 1 and 5.
4. For the experimental group, measure range of motion every day. For the control group, measure range of motion on days 1 and 5.
Correct Answer: 3
The most appropriate design would be a two-group pretest-posttest. Both groups are measured at the same times, but only the
experimental group receives treatment. Gathering information from patient records may not provide the same accuracy as would be
provided if the researcher had performed all of the measurements directly. Measuring ROM only on day 5 would not account for any
pretest differences between groups. Measuring the experimental group more frequently than the control group may have an effect on the
dependent variable.
Law M, ed. Evidence-Based Rehabilitation. 1st ed. Slack. 2002: 60, 99
154.A physical therapist is working with a patient who is aware of being terminally ill. What is the MOST appropriate
intervention when the patient wants to talk about the prognosis?
1. Discourage discussion of death or dying.
2. Refer the patient for pastoral counseling.
3. Relate the therapist’s experiences with other patients.
4. Encourage the patient’s expression of feelings.
Correct Answer: 4
Patients should be encouraged to express their feelings. Comparisons to other patients who are dying, in an effort to assure the patient
he is not alone, takes away from this patient’s feelings. Denial of death would not be good for the patient, since he must ultimately cope
with the inevitable. Pastoral counseling would be an option, but the therapist should be ready to listen to the patient, encourage
expression of feelings, and avoid denial.
Davis CM. Patient Practitioner Interaction: An Experiential Manual for Developing the Art of Health Care. 4th ed. Slack. 2006: 99, 248
155. A physical therapist is examining a patient who was unaware of a circular ulcer on the plantar surface of the second
metatarsal head. The patient is noted to have hammer toes. Which additional findings are MOST likely?
1. Normal arterial pulses
2. Increased sweating over the foot
3. Increased pain with elevation of the foot
4. Altered biomechanics when weight-bearing
Correct Answer: 4
The location of the painless ulcer is characteristic of a neuropathic (diabetic) ulcer. Loss of sensation renders the patient unaware of the
repetitive trauma from altered biomechanics due to weakness of the intrinsics, which leads to hammer toes, and abnormal pressure on
the plantar foot when weight-bearing. Increased pain with foot elevation is characteristic of arterial ulcers, which are painful. Normal
arterial pulses may be present with a venous ulcer, but arteries are often calcified with advanced diabetes. A neuropathic foot is warm
and dry.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 453
156.A physical therapist examining wrist-joint play finds restriction in the direction indicated by the arrow. To address the
restriction, the therapist should include an intervention to increase which motion of the index finger (2nd digit)?
1.
2.
3.
4.
Flexion
Extension
Abduction
Rotation
Correct Answer: 1
The therapist is shown performing a volar glide, which is the same joint motion used for finger flexion. Limited motion in this direction
indicates limited ability to perform finger flexion.
Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques, 5th ed. FA Davis. 2007: 135
157.A physical therapist is treating a patient who has diabetes mellitus. Which of the following information is MOST important
to include when educating the patient about the benefits of exercise?
1. Blood glucose levels increase during exercise.
2. Weight training is preferred to aerobic exercise for patients with diabetes.
3. Exercise can reduce the amount of insulin the patient must administer.
4. Exercising before meals is recommended for patients with diabetes.
Correct Answer: 3
One of the benefits of exercise is improved insulin sensitivity, which reduces the amount of insulin needed. Blood glucose levels
decrease during exercise. Patients with diabetes should not exercise before meals because this timing increases the risk of
hypoglycemia. Aerobic exercise is just as important for people who have diabetes as for healthy people, so weight training is not
preferable.
Durstine JL, Moore GE. ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities, 2nd ed. Human Kinetics,
2003, p. 137
158.A patient has pain, edema, and tenderness over the medial border of the hand. The patient also shows changes in the
color and temperature of the skin, hyperhidrosis, and progressive joint stiffness in the wrist and hand. The MOST likely cause
of the patient’s signs and symptoms is:
1. cervical disc disease.
2. Raynaud phenomenon.
3. complex regional pain syndrome.
4. carpal tunnel syndrome.
Correct Answer: 3
All of these symptoms are indicative of complex regional pain syndrome. Cervical disc disease does not produce swelling in the hand,
color and temperature changes, or hyperhidrosis. Raynaud phenomenon results in pain, pallor, and coolness, but no hyperhidrosis.
Although carpal tunnel syndrome can also show sympathetic nervous system abnormalities, compression of the median nerve would
refer symptoms to the lateral border of the hand (thumb area). With carpal tunnel syndrome, the patient may also display thenar muscle
weakness.
Saidoff DC, McDonough AL. Critical Pathways in Therapeutic Intervention: Extremities and Spine. Mosby. 2002: 47-57
159.A physical therapist is planning a patient education program for a group of patients with chronic low back pain. The
therapist should use which of the following strategies to MOST increase the likelihood that the patients will utilize the proper
body mechanics they learn?
1. Ask the patients to demonstrate use of proper body mechanics.
2. Provide a reference list of articles describing body mechanics.
3. Ask the patients to describe actions they do that increase their back pain.
4. Provide information on the frequency of low back injuries due to improper body mechanics.
Correct Answer: 1
Evaluation of the patients’ retention of the information presented in the program can be enhanced by asking the patients questions about
the program information, having the patients ask questions about the program, having the patients demonstrate what they have learned,
and testing the patients about the program material. Option 1 is the only option that includes one of these techniques. The other options
do not require active participation by the patients and do not address specific interventions.
Falvo D. Effective Patient Education: A Guide to Increased Compliance, 3rd ed. Aspen Publishers. 2004: 95-96
160.A physical therapist should expect a patient to describe pain associated with a 5-year history of rheumatoid arthritis as:
1. morning pain with stiffness that improves with activity.
2. pain that is worse at the beginning of an activity.
3. constant pain that lasts throughout the day.
4. pain that increases throughout the day.
Correct Answer: 1
Chronic inflammatory disorders such as rheumatoid arthritis are often associated with morning pain and stiffness that decrease
throughout the day with activity. Pain that is worse at the beginning of an activity implies acute inflammation. Constant pain suggests
tumors or a visceral cause. Pain that increases throughout the day indicates increased congestion in a joint.
Magee DJ. Orthopedic Physical Assessment, 4th ed. Saunders. 2002: 5-7
161.Use of ice massage to affected area(s) is MOST appropriate for a patient who has which of the following problems?
1. Trigger point in the upper trapezius muscle
2. Spasticity of the plantar flexor muscles after stroke
3. Exercise-induced soreness of abdominal muscles
4. Decreased extensibility of bilateral hamstrings muscles
Correct Answer: 1
Ice massage is used to treat a small area, such as a trigger point in a muscle. Ice is applied to produce analgesia and allow for deep
pressure massage over the trigger point and stretching of the muscle. Treating large areas, such as the lower leg (as in option 2), is
done more efficiently with cold baths or cold packs than with ice massage. Cryotherapy increases stiffness and decreases tissue
extensibility (p 76) and so would not be indicated for stretching hamstrings.
Michlovitz SL, Nolan TP. Modalities for Therapeutic Intervention. F.A. Davis. 2005, pp 53–55, 76
162.A patient presents with sudden onset of weakness of the facial muscles on the right side. The patient is unable to wrinkle
the forehead, smile, pucker the lips, or wrinkle the nose. There is an absence of tearing in the patient’s right eye, diminished
taste sensation on the right side of the tongue, and dryness of the mouth. The patient’s corneal reflex is absent on the right but
normal on the left, and pinprick and temperature sensation are normal on both sides of the face. This presentation is
characteristic of:
1. trigeminal neuralgia.
2. Bell palsy.
3. left cortical cerebrovascular accident.
4. oculomotor nerve damage.
Correct Answer: 2
Trigeminal neuralgia causes facial pain. All of the signs and symptoms in the question are indicative of a partial nerve lesion affecting the
facial nerve. This type of lesion is Bell palsy. A left cerebrovascular accident affects only the lower facial muscles below the eye.
Damage to the oculomotor nerve causes paralysis of one or more of the muscles that moves the eyeball.
Blumenfeld H. Neuroanatomy Through Clinical Cases. Sinauer. 2002: 482-484
163.Which of the following interventions is MOST appropriate for a patient with juvenile rheumatoid arthritis who is
experiencing painful swelling of both knees?
1. Resistive exercises
2. Stretching to prevent contractures
3. Gentle, active exercises
4. Walking program
Correct Answer: 3
All of the options, except for gentle, active exercises, are precautions or contraindications for this patient.
Kisner C, Colby LA. Therapeutic Exercise: Foundations and Techniques, 5th ed. FA Davis. 2007: 310-313
164.A physical therapist is considering whether the results of a study can be usefully applied to practice settings other than
the one in which the study was conducted. Which of the following types of validity is of MOST concern in this scenario?
1. Internal
2. Construct
3. Concurrent
4. External
Correct Answer: 4
External validity is concerned with the issue of how the results of the research can be generalized.
Domholdt E. Rehabilitation Research, 3rd ed. WB Saunders. 2005: 99
165.Treatment of a patient with hemophilia who has a subacute hemarthrosis of the knee should INITIALLY include:
1. active assistive range-of-motion exercise to the knee.
2. instruction of the patient for weight bearing to tolerance.
3. gentle resistive range-of-motion exercise to the knee.
4. continuous immobilization of the knee in an extension splint.
Correct Answer: 1
In this stage of hemarthrosis, there is still some bleeding into the joint space, but it is not as extensive as during the acute phase.
Therefore the patient will benefit from range-of-motion exercise to prevent contracture. The patient may need active-assist, as there may
still be pain or edema in the joint that prevents independent performance of range of motion. The mechanical trauma of weight bearing to
tolerance at this stage may impinge on and damage the pathologic synovium within the joint. Resistive range of motion is more
appropriate when pain and swelling have subsided and no bleeding is occurring. Continuous immobilization in the extended position will
promote contracture in the edematous knee.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. WB Saunders. 2003: 545, 548550
166.A patient with a traumatic brain injury is being discharged to home after completion of inpatient rehabilitation. Which of
the following assessment tools should be used to BEST assess the patient’s potential?
1. Glasgow Outcome Scale
2. Fugl-Meyer Assessment
3. Rancho Los Amigos Levels of Cognitive Functioning Scale
4. Sickness Impact Profile
Correct Answer: 1
The Glasgow Outcome Scale is used as a general outcome measure, and in prognostic studies. The Fugl-Meyer Assessment should be
used only with patients who have had a stroke. The Rancho Los Amigos Levels of Cognitive Functioning is a descriptive scale that
outlines a predictable sequence of cognitive and behavioral recovery as a patient emerges from a coma. The Sickness Impact Profile is
used to measure general health status and is self-administered; therefore, it would not be useful as a prognostic discharge tool for a
patient with a traumatic brain injury.
O’Sullivan SB, Schmitz TJ. Physical Rehabilitation. 5th ed. FA Davis. 2007: 388, 735, 900-901
167.Which of the following examination findings would MOST likely be positive in a patient with cauda equina syndrome?
1. Ankle clonus
2. Babinski sign
3. Urinary retention
4. Positive prone knee flexion test
Correct Answer: 3
Cauda equina causes lower motor neuron dysfunction, including urinary retention and incontinence. Positive Babinski and clonus
responses indicate upper motor neuron dysfunction. A positive prone knee flexion test is more likely with upper lumbar nerve root
impairment.
Hall CM, Thein-Brody L. Therapeutic Exercise, 2nd ed. Lippincott, Williams & Wilkins. 2005: 390
168.A patient with low back pain has been undergoing treatment for two sessions. During the current treatment session, the
patient tells the physical therapist that the pain is centralizing with the extension exercises but is as intense as it was at the
first treatment session. The patient is frustrated by this reaction. The therapist's MOST appropriate response is to:
1. continue with the present program.
2. eliminate the extension exercises.
3. consult the patient’s physician about the situation.
4. progress to trunk flexion exercises.
Correct Answer: 1
With an extension exercise program, centralization indicates that the patient is improving, even though the pain may be just as intense
as it was. Even though the patient may feel frustrated, he is actually improving; and therefore the therapist should continue with the
extension exercise program. There is no need to call the physician at this point, since the centralization is perfectly normal. Although
trunk flexion may be used later in the intervention, it would not be indicated at this point because extension is working.
McKenzie RA, May S. The Lumbar Spine: Mechanical Diagnosis and Therapy. Spinal Publications. 2003: 592-593
169.A patient is receiving physical therapy intervention for rheumatoid arthritis, which is in remission. Which of the following
interventions is MOST appropriate for the patient?
1. Contract-relax stretching for tight structures
2. End-range mobilization techniques
3. Elimination of functional activities of involved parts
4. Strengthening exercises for weak muscles
Correct Answer: 4
Contract-relax stretching for tight structures is not recommended for soft tissues compromised by rheumatoid arthritis. Grade IV
mobilization techniques are contraindicated for soft tissues compromised by rheumatoid arthritis. The elimination of functional activities is
not required. Strengthening exercises are the most appropriate intervention for a patient with rheumatoid arthritis in remission.
Hall CM, Brody LT. Therapeutic Exercise: Moving Toward Function. 2nd ed. Lippincott Williams & Wilkins. 2005: 234
170.A patient with chest pain from myocardial ischemia will MOST likely exhibit:
1. increased pain upon chest-wall palpation.
2. increased pain with deep breathing.
3. relief with nitroglycerin (Nitrostat) ingestion.
4. relief with antacid ingestion.
Correct Answer: 3
Increased pain with chest-wall palpation is more indicative of a musculoskeletal origin of pain. Increased pain with deep breathing is
more indicative of a pulmonary origin of pain. Nitroglycerin (Nitrostat) is a common vasodilator that is prescribed for patients who have
angina. Ingestion of a vasodilator will improve myocardial blood flow and help relieve ischemia and its manifestations. Relief of pain with
antacid ingestion is more indicative of referred pain from peptic ulcer disease.
DeTurk WE, Cahalin LP. Cardiovascular and Pulmonary Physical Therapy: An Evidence-Based Approach. McGraw-Hill Medical
Publishing. 2004: 273-275
171.During a posture examination, the physical therapist notes that both of the patient’s patellae point inward when viewed
from the front of the patient. The MOST likely cause of this problem is excessive:
1. femoral anteversion.
2. weakness of the vastus medialis.
3. genu varum.
4. medial tibial torsion.
Correct Answer: 1
The most common cause of inwardly pointing or “squinting patellae” is excessive femoral anteversion. Although there is normally 8° to
15° of femoral anteversion, an excessive amount leads to squinting patellae and toeing in. The other options would all have a tendency
to cause the patellae to point outward during standing.
Magee DJ. Orthopedic Physical Assessment. 4th ed. WB Saunders. 2002: 729
172.Which of the following statements does NOT document patient outcome?
1. The patient propelled his wheelchair independently after 4 weeks.
2. The patient demonstrated independent performance of a home program after 2 weeks.
3. The patient walked 100 ft (30.5 m) with minimal assistance after 1 week.
4. The patient attended physical therapy sessions 3 times/week for 2 weeks.
Correct Answer: 4
An outcome measure documents a desired performance or change in the patient’s condition over time. This may include a description of
the patient’s function before, during, and after intervention. Option 4 does not indicate a change or function but is focused on attendance.
Nosse LJ, Friberg DG, Kovacek PR. Managerial and Supervisory Principles for Physical Therapists. 2nd ed. Lippincott Williams &
Wilkins. 2005: 438-439
173.A patient sustained a gunshot wound to the spine in the area of L1. The patient has weakness of the left lower extremity
and inability to move the knee, ankle, or foot. The patient’s patellar tendon and Achilles tendon reflexes are increased on the
left side. There is also loss of proprioception in the patient’s left ankle and knee, a positive Babinski sign on the left side, and
diminished sensation to pinprick and temperature changes in the right thigh, leg, and foot. Results of all of the patient’s cranial
nerve tests are normal. These findings are consistent with which of the following injuries?
1. Complete severance of the spinal cord
2. Injury to the left anterior horn of the spinal cord
3. Injury to the left side of the spinal cord
4. Injury to the central area of the spinal cord
Correct Answer: 3
Complete severance of the spinal cord causes motor and sensory loss on both sides of the body. A lesion of the anterior horn cells
causes a lower motor neuron problem and hyporeflexia. The signs and symptoms presented in the question point to a hemisection of the
spinal cord on the left side, which gives rise to ipsilateral motor and proprioception loss and contralateral loss of pain and temperature.
Also present are hyperreflexia and a positive Babinski sign on the left side. A lesion of the central spinal cord usually spares the motor
tracts.
Blumenfeld H. Neuroanatomy Through Clinical Cases. Sinauer. 2002: 280
174.Which of the following interventions would MOST specifically address expected complications from radiation therapy to
the pelvic region?
1. Anterior hip stretching
2. Splinting while coughing
3. Progressive abdominal strengthening
4. Pelvic stabilization exercises
Correct Answer: 1
Radiation of the pelvic cavity often causes dense pelvic adhesions that can restrict motion due to pain. Of the options, stretching
exercises are most specific to address this complication.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 100-101
175.Which of the following types of patients should have the most detailed and lengthy home exercise program?
1. A patient with acute symptoms
2. A patient with irritable symptoms
3. A patient who has good body awareness
4. A patient who has physical therapy visits once a week
Correct Answer: 4
As the frequency of visits decreases and the time between visits increases, the patient requires a more detailed home program with
specific progression instructions.
Hall CM, Thein-Brody L. Therapeutic Exercise, 2nd ed. Lippincott Williams & Wilkins. 2005: 43-44
176.A physical therapist measures the forced expiratory volume in 1 second (FEV1) of a patient with mild pulmonary
obstructive disease and determines a FEV1/FVC (forced vital capacity) ratio of 60%. The therapist should recognize that the
patient:
1. has a normal FEV1 value.
2. will require careful monitoring during aerobic exercise.
3. should not exercise beyond 60% of the patient’s predicted maximal heart rate.
4. should not perform aerobic exercise without physician approval.
Correct Answer: 2
Regarding option 1, a ratio of 75% is considered normal. Regarding option 2, the patient has a mild disease. Advanced obstructive
disease can have values of 25%. Nonetheless, the patient has mild morbidity, so special precautions should be used. Regarding option
3, the patient has a mild disease and is not yet showing signs of morbidity, so special precautions should not be necessary. There would
be no need to limit heart rate to 60% if the patient tolerates the exercise. An FEV1/forced vital capacity ratio of 60% is a mild loss.
Avoidance of aerobic exercise should not be required, and special physician approval related to a value of 65% should not be necessary.
Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy. 4th ed. Mosby. 2006: 86, 415
177.Which of the following skin color changes is MOST likely to be sign of liver disease?
1. Pallor
2. Jaundice
3. Cyanosis
4. Hyperpigmentation
Correct Answer: 2
Jaundice is a sign of liver disease.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. Saunders. 2007: 409
178.Acquired immunodeficiency syndrome is MOST likely present in a patient with which of the following hematologic
conditions?
1.
2.
3.
4.
CD4 count of 150 cells/mL
High antinucleoprotein antibody titer
High human leukocyte antigen titer
Neutrophil count of less than 5000 cells/mm3
Correct Answer: 1
Patients with AIDS include those who have HIV-1 and a CD4 count below 200 cells/mL. A low neutrophil count or a high ANA or HLA
titer are not specific to the presence of HIV.
Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist, 2nd ed. Saunders. 2003: 165, 1178, 1189
179.A patient with leukemia has developed thrombocytopenia after a bone-marrow transplant. Which of the following measures
is indicative of the status of the thrombocytopenia?
1. T4 lymphocyte count
2. Red blood cell count
3. Platelet count
4. White blood cell count
Correct Answer: 3
Thrombocytopenia is an acute or chronic decrease in the number of platelets in the circulation. The T 4 lymphocyte count is used to
assess immune status in patients with HIV or AIDS. The red blood cell count is utilized to assess for presence of anemia, and the white
blood cell count would be examined to determine presence of infection or degree of immunosuppression.
Paz JC, West MP. Acute Care Handbook for Physical Therapists, 2nd ed. Butterworth-Heinemann. 2002: 412-413
180.Which of the following factors is considered to be a primary risk factor for atherosclerosis?
1. Stress
2. Obesity
3. Cigarette smoking
4. Sedentary lifestyle
Correct Answer: 3
High blood pressure, cigarette smoking, and hyperlipidemia are direct or primary risk factors for atherosclerosis. Secondary risk factors
include age, gender, race, obesity, stress, and activity level.
Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy, 4th ed. Mosby Elsevier, 2006, p. 101
181.Which of the following statements is an appropriately written short-term goal?
1. In 2 weeks, the patient will increase walking distance from 50 ft to 100 ft (15 m to 30 m) with a wheeled walker.
2. The patient will walk 100 ft (30 m) with a wheeled walker and minimal assistance in 3 weeks.
3. In 4 weeks, the patient will walk with minimal assistance 100 ft (30 m) without loss of balance.
4. The patient will increase walking distance from 50 ft to 100 ft (15 m to 30 m) with a wheeled walker independently by discharge.
Correct Answer: 2
Option 1 does not specify the amount of assistance. Option 2 is a measurable, specific, and objective goal. Option 3 does not specify the
device the patient will be using. Option 4 is a goal that is to be achieved by discharge, which would be a long-term goal, not a short-term
goal.
Minor SM, Minor MA. Patient Care Skills, 5th ed. Prentice Hall. 2006: 11-12
182.Which of the following nerves innervates the pelvic floor muscles?
1.
2.
3.
4.
Sciatic
Pudendal
Inferior gluteal
Genitofemoral
Correct Answer: 2
The pelvic floor muscles are innervated by sacral nerve roots S2–S4 through the pudendal nerve. The inferior gluteal nerve is a motor
nerve that innervates the gluteus maximus. The sciatic nerve contains nerve roots from L 4–S3 and innervates multiple muscles in the
lower leg. The genitofemoral nerve, which is from L1–L2, is a cutaneous nerve that is sensory and not motor.
Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles Testing and Function With Posture and Pain, 5th ed.
Lippincott Williams & Wilkins, 2005: 362-363, 369; Hall CM, Brody LT. Therapeutic Exercise: Moving Toward Function, 2nd ed.
Lippincott Williams & Wilkins, 2005: 404
183.A patient with a recent onset of rheumatoid arthritis is MOST likely to report which of the following symptoms?
1. Heat intolerance
2. Malaise and fatigue
3. Tension headaches
4. Nausea and diarrhea
Correct Answer: 2
Malaise and fatigue are common symptoms during the beginning stages of rheumatoid arthritis. Tension headaches, heat intolerance,
and nausea and diarrhea are not associated with rheumatoid arthritis.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. Saunders. 2007: 528-530
184.For a patient with type 1 diabetes who is completing a cardiovascular fitness program, what change in diabetic
management is MOST likely to be instituted as fitness increases?
1. Switching to oral rather than injected medication
2. Decreasing caloric intake for 2 to 3 hours following exercise sessions
3. Decreasing the amount of insulin taken daily
4. Increasing the amount of insulin taken daily
Correct Answer: 3
Exercise has been shown to increase sensitivity of the insulin receptors, leading to a decrease in the amount of insulin required.
Administration of medication is dictated by tolerance and efficacy of the medication and would not necessarily be altered by exercise. In
patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 to 48 hours after exercise; therefore, an
increase in caloric intake, particularly intake of carbohydrates, would be essential.
Irwin S, Tecklin JS. Cardiopulmonary Physical Therapy, 4th ed. Mosby. 2004: 262-263
185.A physical therapist is evaluating a patient who had a cerebrovascular accident and is exhibiting poor foot and ankle
control. When asked to lift the foot more during the midswing phase of gait, the patient dorsiflexes the ankle with excessive
eversion. To correct this problem, facilitory electromyographic biofeedback is MOST likely to be used with which of the
following muscles?
1. Extensor digitorum longus
2. Tibialis anterior
3. Fibularis (peroneus) brevis
4. Flexor hallucis longus
Correct Answer: 2
The patient has too much eversion during the midswing phase. This is probably caused by too much activity in the extensor digitorum
longus or extensor hallucis longus. To correct the situation, the tibialis anterior should be facilitated, because it dorsiflexes and inverts
but doesn’t cause eversion. The fibularis brevis, an everter, would cause plantar flexion of the foot rather than dorsiflexion. The flexor
hallucis longus does not dorsiflex the ankle.
Kolt GS, Snyder-Mackler L. Physical Therapies in Sport and Exercise. Elsevier. 2003: 444
186.What skin change associated with aging has the GREATEST effect on wound healing?
1. Reduction in sensation
2. Decreased elasticity of the skin
3. Decreased epidermal proliferation
4. Change in pigmentation
Correct Answer: 3
Wounds heal via a complex process involving re-epithelialization. With advanced aging, the rate of epidermal proliferation decreases.
Kloth LC, McCulloch JM. Wound Healing Alternatives in Management, 3rd ed. FA Davis. 2002: 83-84
187.Which of the following questions is MOST appropriate for a functional outcome measurement tool?
1. How high can you lift your arm?
2. How long have you had this pain?
3. How often do you walk with a limp?
4. How much does this leg bother you?
Correct Answer: 3
Option 1 does not ask about function. It is an impairment-related question, not a function-related question. Options 2 and 4 do not ask
about function, and even with improvement, neither would relate to function. Option 3 is taken from the Short Musculoskeletal Function
Assessment. It addresses function and can be used as an outcome question.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. McGraw-Hill. 2004: 146
188.A patient has adhesive capsulitis of the shoulder joint. The range-of-motion examination reveals restricted lateral
(external) rotation and abduction of the shoulder. Which of the following mobilization procedures should be performed for the
patient FIRST?
1. Posterior glide
2. Distraction
3. Anterior glide
4. Lateral (external) rotation
Correct Answer: 2
For this patient, the first mobilization procedure would be distraction of the glenohumeral joint. The distraction separates the joint
surfaces and is used as a test of joint play. The distraction can also help increase joint play. Distraction may also be used in conjunction
with the other mobilization techniques listed. Later mobilization techniques would most likely include anterior glide.
Dutton M. Orthopaedic Examination Evaluation and Intervention. McGraw-Hill. 2004: 451-454
189.A patient with right piriformis syndrome is referred to physical therapy for evaluation and intervention. The patient’s
history includes a total hip arthroplasty on the right side 2 years ago. Which of the following interventions requires added
precaution for this patient?
1. Transcutaneous electrical nerve stimulation
2. Continuous ultrasound
3. Hot packs
4. Massage to the right hip
Correct Answer: 2
The only one of the interventions listed that requires precaution because of the total hip replacement is continuous ultrasound. However,
that does not mean that ultrasound is contraindicated for this patient. Transcutaneous electrical nerve stimulation may be used over
metal implants. Hot packs and massage would not affect the total hip prosthesis.
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation. 2nd ed. Mosby. 2003: 456
190. An adult patient who was involved in a motor vehicle accident has sustained multiple traumas, including fractured ribs on
the right side. The patient is unconscious, intubated, and receiving mechanical ventilation in the intensive care unit. Chest
radiographs show the development of an infiltrate in the right lower lobe during the past 2 days. Crackles and wheezing are
heard over the right lower lung fields. Which of the following chest physical therapy programs is MOST appropriate?
1. Manual hyperventilation and suctioning while positioned on the left side
2. Positioning in supine for suctioning, followed by manual hyperventilation while positioned on the left side
3. Suctioning, percussion, and vibration while positioned on the right side
4. Positioning on the left side for deep breathing exercises only
Correct Answer: 1
In order to optimally clear the congestion that has developed in the right lower lobe, the patient should be positioned on the left side to
allow gravity to help drain the secretions to the proximal airways. This patient is also unconscious and intubated, so in addition to
drainage, manual hyperinflation is necessary to provide increased ventilation to help to mobilize secretions, then suctioning to clear the
secretions. Suctioning first then hyperventilating while in left-sidelying is less effective than the order suggested in Option 1. Positioning
on the right side would not drain the right lower lobe, and since the patient is lying on the right side, the only place to percuss and vibrate
would be the left side, which has no pathology. Finally positioning on the left side with deep breathing exercises will not be effective in
mobilizing secretions, especially since the patient is unconscious and unable to actively perform deep breathing exercises.
Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy. 4th ed. Mosby. 2006. 328, 343
191.A physical therapy student’s learning style is described as a preference for active experimentation and concrete
experience. For mastering evaluation of musculoskeletal dysfunction, which of the following educational strategies would be
the LEAST effective approach for the supervising physical therapist to use with this student?
1. Practicing and providing feedback on examination skills
2. Role-playing the interview process
3. Assigning readings about the dysfunction
4. Self-pacing performance of the evaluation
Correct Answer: 3
Practice and feedback of examination skills, role playing the interview process, and self-paced performance involve active learning with
other people in everyday situations. Active learning relies on feeling and intuition rather than logic and reasoning. Readings do not meet
the learning needs of active experimentation or concrete experience.
Shepard K, Jensen G. Handbook of Teaching for Physical Therapists. 2nd ed. Butterworth-Heinemann. 2002: 59
192.A physical therapist is planning a full-immersion hydrotherapy treatment. This treatment is CONTRAINDICATED for which
of the following conditions?
1. Osteoporosis
2. Peripheral edema
3. Exercise-induced asthma
4. Uncontrolled hypertension
Correct Answer: 4
Due to the circulatory adaptations needed, patients with uncontrolled hypertension would not be permitted to use full-immersion
techniques. Full-immersion hydrotherapy results in improvement of edema due to the effects of water pressure, reduced severity of
exercise-induced asthma in comparison to land-based activities, and reduced stress on skeletal areas in osteoporosis.
Cameron M: Physical Agents in Rehabilitation: From Research to Practice, 2nd ed. Saunders. 2003: 274, 280
193.During examination of a patient, a physical therapist notes bradycardia. The patient reports constipation and cold
intolerance. Which of the following conditions is the MOST likely cause of this sign and symptoms?
1. Hypothyroidism
2. Hyperthyroidism
3. Hyperparathyroidsim
4. Hypoparathyroidsim
Correct Answer: 1
Hypothyroidism would most likely cause the signs and symptoms. Hyperthyroidism causes diarrhea, rather than constipation.
Hyperparathyroidism is not associated with bradycardia. Hypoparathyroidism is associated with arrhythmias and either constipation or
diarrhea.
Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists, 4th ed. Saunders. 2007: 477, 483, 485
194.A patient who had a C6 traumatic spinal cord injury 1 month ago reports a severe, pounding headache and restlessness
while standing in a standing frame. The patient’s vital signs indicate hypertension and bradycardia. The MOST appropriate
immediate response of the physical therapist is to:
1. instruct the patient in deep breathing techniques.
2. apply a cervical cold pack.
3. remove the abdominal gait belt.
4. assess for catheter blockage.
Correct Answer: 4
Neither deep breathing techniques nor a cervical cold pack would be an effective response to this emergency situation. Although the
abdominal gait belt might be a contributing factor, it is not the most likely primary cause. This patient scenario is indicative of autonomic
dysreflexia, a pathological reflex. The most common cause is bladder distention or urinary retention, which is likely to be caused by a
urinary catheter blockage.
O’Sullivan SB, Schmitz TJ. Physical Rehabilitation, 5th ed. FA Davis Company. 2007: 943
195. Which of the following lower extremity proprioceptive neuromuscular facilitation patterns is MOST appropriate for a
patient who needs strengthening of the tibialis posterior?
1. Hip extension, abduction, and medial (internal) rotation, with ankle plantar flexion and eversion
2. Hip flexion, adduction, and lateral (external) rotation, with ankle dorsiflexion and inversion
3. Hip extension, adduction, and lateral (external) rotation, with ankle plantar flexion and inversion
4. Hip flexion, abduction, and medial (internal) rotation, with ankle dorsiflexion and eversion
Correct Answer: 3
The tibialis posterior plantar flexes and inverts the foot. This pattern requires the specific action of that muscle. The other patterns do not.
Adler SA, Beckers D, Buck M. PNF in Practice. Springer-Verlag. 1993: 111; O’Sullivan SB, Schmitz TJ. Physical Rehabilitation
Laboratory Manual: Focus on Functional Training. FA Davis. 1st ed. 1999:9
196.A physical therapist is evaluating a patient with low back pain and associated symptoms. Which of the following findings
should cause the therapist to refer the patient back to the physician?
1. Good (4/5) strength of the hamstrings
2. Pain radiating down the back of the thigh into the calf
3. Positive straight-leg test at 60° of hip flexion
4. Saddle anesthesia around the perineum
Correct Answer: 4
Options 1, 2, and 3 are typical with low back pain, and none alone requires immediate referral. Saddle anesthesia around the perineum
is a sign of cauda equine syndrome and usually requires immediate treatment by someone other than a physical therapist.
Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation, 2nd ed. Mosby. 2003: 576, 589
197.Which of the following afferent fiber types transmits information regarding aching pain?
1. Large unmyelinated fibers
2. Small unmyelinated fibers
3. Small myelinated fibers
4. Large myelinated fibers
Correct Answer: 2
Aching pain is transmitted on small, unmyelinated Type C fibers.
Guyton AC, Hall JE. Textbook of Medical Physiology, 11th ed. Saunders. 2006: 598; Hertling D, Kessler RM. Management of Common
Musculoskeletal Disorders, 4th ed. Lippincott, Williams & Wilkins, 2006: 79
198.A therapist is measuring passive knee range of motion in a patient. The measurements obtained are shown in photographs
A and B. The MOST likely cause of the difference in knee range of motion is:
1.
2.
3.
4.
restriction in the knee joint capsule.
tightness in the rectus femoris.
weakness of the hamstrings.
tightness in the vastus medialis
Correct Answer: 2
Capsular restriction would show up in both measurements. In photograph A, there is more knee flexion present with the hip flexed. In this
position the rectus femoris is on slack across the hip joint, allowing greater range of knee flexion. In photograph B the rectus femoris is
stretched over both the knee joint and the hip joint, so tightness in the rectus femoris would restrict knee flexion. Photograph B also
shows hip joint flexion. Hamstring weakness would not affect passive range of motion. Vastus medialis tightness would affect both
measurements.
Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 3rd ed. FA Davis. 2003: 232
199.Which of the following monofilament grades indicates that only protective sensation is intact?
1. 3.61
2. 4.37
3. 5.07
4. 6.65
Correct Answer: 3
The 5.07 monofilament supplies the least amount of force that can be sensed by patients with only protective sensation intact. Ability to
sense only the 6.65 monofilament indicates a loss of protective sensation. Ability to sense the 3.61 and 4.37 monofilaments indicates
fully normal sensation.
O’Sullivan SB, Schmitz TJ. Physical Rehabilitation, 5th ed. FA Davis. 2007: 664
200.Which of the following changes is a result of stimulation of the sympathetic nervous system?
1. Increased blood flow to skin
2. Decreased blood glucose
3. Dilation of bronchioles
4. Rise in heart rate
Correct Answer: 4
The sympathetic nervous system is responsible for adjustments in preparation for emergency situations (fight of flight). With stimulation
of the sympathetic nervous system, the heart rate would rise. Blood flow would be shunted from, not to, the skin. Blood glucose levels
would increase, not decrease, in preparation for increased work. Bronchioles would constrict, not dilate.
Brown SP, Miller WC. Exercise Physiology: Basis of Human Movement in Health and Disease. Lippincott Williams & Wilkins, 2006, p.
237.
.