Online Advantage Answers

1
Correct Answer: 3
Explanation
Time and distance parameters are often used to provide a basic description of gait. Commonly used temporal variables include stance time, single limb and double limb
support time, cadence, and speed. Commonly used distance variables include stride length, step length, width of base of support, and degrees of toe-out.
1.Step length is defined as the distance measured between right heel strike and left heel strike. The average step length for an 18-month-old is 25 centimeters compared to 48
centimeters for a 7-year-old.
2.Stride length is defined as the distance measured between right heel strike and the following right heel strike. The average stride length for an 18-month-old is 50
centimeters compared to 97 centimeters for a 7-year-old.
3.Cadence is defined as the number of steps an individual will walk over a period of time. The average cadence for an 18-month-old is 171 steps per minute
compared to 144 steps per minute for a 7-year-old. The average adult cadence is 110120 steps per minute. Despite the decrease in cadence, the older childs
walking velocity still increases due to the increase in physical stature (e.g., limb length), enhanced fluidity of movement, and greater muscular force.
4.Walking velocity is defined as the speed of ambulation in a given direction. The average walking velocity for an 18-month-old is 42.6 meters per minute
compared to 68.4 meters per minute for a 7-year-old.
Resource: (Cech p. 294)
System: Musculoskeletal System
Content Outline: Physical Therapy Examination
2
Correct Answer: 3
Explanation
Loss of postural control is a common impairment in patients who have had a stroke. The three systems involved in controlling a patients balance are the visual,
somatosensory, and vestibular systems. Removal of sensory input from any of these systems requires greater reliance from the remaining systems to maintain postural
control.
1.Standing on a floor with the eyes closed would result in the absence of sensory input from the visual system. Therefore, the somatosensory and vestibular systems would be
challenged with this test.
2.Standing on a floor with the head tilted backward would result in an alteration in sensory input from the vestibular system (i.e., due to a change in head position). Therefore,
the visual and somatosensory systems would be challenged with this test.
3. Standing on a foam surface with the eyes closed would result in the absence of sensory input from the visual system and an alteration in the sensory input
from the somatosensory system (i.e., due to the compliant foam surface). Therefore, the vestibular system would be maximally challenged since the other two
systems are not providing accurate sensory input.
4.Standing on a foam surface with the head tilted backward would result in an alteration in sensory input from the somatosensory and vestibular systems.
Therefore, the visual system would be maximally challenged, though some sensory input would still be coming from the other two systems.
Resource: (OSullivan p. 231)
System: Neuromuscular and Nervous Systems
3
Correct Answer: 1
Explanation
Peripheral pulses are monitored by palpation with the index and middle finger using light pressure. There are a variety of sites that can be used to monitor pulse including the
temporal, carotid, brachial, radial, femoral, popliteal, and dorsalis pedis arteries.
1. If the therapist suspects a blockage in the femoral artery, a distal pulse site should be used (e.g., popliteal artery, dorsalis pedis artery). A weak or absent
popliteal pulse may indicate impaired flow or a blockage of a more proximal blood vessel (e.g., femoral artery).
2. When determining a patients ankle-brachial index (ABI), the standard procedure is to use a distal pulse site (e.g., dorsalis pedis artery, posterior tibial artery).
The popliteal artery is not typically used. Furthermore, ABI is a measure of blood pressure, not pulse rate.
3. The popliteal artery is often difficult to locate due to its deep location in the popliteal fossa. Because of this, the femoral or dorsalis pedis artery is more
commonly used to assess lower extremity circulation.
4. Beta-blockers are a category of drug that decreases both resting heart rate and heart rate response to exercise. While taking this medication would affect a
patients heart rate, it would do so equally across all pulse sites. This alone would not be a reason to use the popliteal artery for monitoring a patients pulse.
System: Cardiovascular/Pulmonary and Lymphatic Systems
4
Correct Answer: 2
Explanation
After organizing information obtained from the patient history, a physical therapist should perform a systems review. The systems review is a brief examination of the four
main systems of the body (i.e., musculoskeletal, neuromuscular, cardiopulmonary, integumentary) as well as assessment of communication, affect, cognition, and learning
style. Information gained from the systems review should inform what tests and measures will be performed.
1.Assessment of scar formation should be documented in the integumentary section of the systems review. Abnormalities in scar formation may include information about the
scars color, pliability, and texture.
2.Assessment of edema should be documented in the cardiopulmonary section of the systems review. Other cardiopulmonary assessments include heart rate,
blood pressure, and respiratory rate.
3.Assessment of skin color should be documented in the integumentary section of the systems review. Abnormalities in skin color may include pallor, redness or
bruising.
4.Assessment of skin integrity should be documented in the integumentary section of the systems review. Abnormalities in skin integrity may include small
lacerations or the presence of wounds.
Resource: (Guide to Physical Therapy Practice p. 42)
System: Other Systems
5
Correct Answer: 1
Explanation
There are a variety of tests designed to identify unique coordination deficits. The tests are often included as part of a neurological assessment. Physical therapists should be
familiar with how to perform these tests and how to interpret the associated results.
1.Manual resistance to assess muscle strength is often used to test for asthenia. Asthenia refers to generalized weakness, typically secondary to cerebellar
pathology.
2.Marching in place is often used to test for a cerebellar movement disorder. A positive test occurs when a patient is unable to follow the rhythm of the cadence.
3.Alternating finger to nose is often used to test for dysdiadochokinesia. Dysdiadochokinesia refers to the inability to perform rapid alternating movements. This
condition is a result of damage to the cerebellum.
4.Placing the feet on floor markers while walking is often used to test for dysmetria. Dysmetria refers to the inability to control the range of a movement and the
force of muscular activity. This condition is a result of damage to the cerebellum.
Resource: (Roy p. 329)
6
Correct Answer: 2
Explanation
Rhabdomyolysis is a condition where breakdown of striated muscle fibers leads to the release of myoglobin into the bloodstream. Myoglobin is harmful to the kidneys and can
often lead to kidney damage. Rhabdomyolysis occurs with damage to skeletal muscle tissue, particularly following injury.
1.Joint pain and stiffness can occur with rhabdomyolysis, however, joint mobility should not be the most relevant finding since the joint capsule itself is not affected.
2.Diminished muscle performance is associated with rhabdomyolysis due to direct damage to the muscle fibers.
3.Pain, in the form of joint pain and stiffness, can be present with rhabdomyolysis, as well as pain from the precipitating injury, however, it is not the most
relevant finding.
4.Coordination relies on an intact neuromuscular system from the motor cortex to the spinal cord. Rhabdomyolysis involves direct damage to the muscle fibers
and therefore would not impact coordination to the same extent as muscle performance.
Resource: (Goodman - Pathology p. 1243)
Content Outline: Foundations for Evaluation, Differential Diagnosis, and Prognosis
7
Correct Answer: 2
Explanation
Sensory information is carried to the brain via two ascending pathways: the anterolateral spinothalamic system and the dorsal column-medial lemniscal system. The
anterolateral spinothalamic pathway carries nondiscriminative sensations such as pain, temperature, tickle, itch, and sexual sensations. The dorsal column-medial lemniscal
pathway carries discriminative sensations such as discriminative touch, stereognosis, tactile pressure, barognosis, graphesthesia, kinesthesia, proprioception, and vibration.
1.The dorsal column-medial lemniscal pathway is located in the posterior portion of the spinal cord, therefore damage to this part of the spinal cord would cause a loss of
transmission of the discriminative sensations, which do not include pain signals.
2.The anterolateral spinothalamic pathway is located in the anterolateral portion of the spinal cord, therefore damage to this part of the spinal cord would cause a
loss of transmission of the nondiscriminative sensations, which include pain perception (i.e., sharp/dull discrimination). Because this pathway decussates at the
level of the spinal cord, lesions to this tract will cause sensory impairments contralateral to the side of the lesion. Therefore, damage to the left side of the spinal
cord will cause a loss of pain perception on the right side of the body below the level of the lesion.
3.As stated before, damage to the posterior spinal cord would affect the dorsal column-medial lemniscal pathway, and thus the discriminative sensations only.
4.Though the anterolateral spinothalamic pathway is located anteriorly in the spinal cord, damage to the right side of the spinal cord would cause sensory
impairments on the left side of the body.
8
Correct Answer: 1
Explanation
Obstructive lung diseases are diseases of the respiratory tract that produce obstruction to airflow, which can affect the mechanical function and gas exchanging capability of
the lungs. Symptoms of obstructive lung disease commonly include chronic cough, mucus expectoration, wheezing, and dyspnea on exertion.
1.Bronchiectasis is a condition characterized by permanent, abnormal dilation and distortion of the bronchi and bronchioles that is caused by destruction of the
muscular and elastic components of the bronchial walls. Common clinical presentation for this disease includes cough, copious mucopurulent sputum, fetid
breath, recurrent pulmonary infections, and recurrent hemoptysis.
2.Idiopathic pulmonary fibrosis (IPF) is a condition characterized by inflammation and the resulting destruction of the alveolar walls. The destruction of the lung
causes decreased lung compliance, therefore, IPF is a restrictive lung disease.
3.Chronic bronchitis is a condition characterized by hypersecretion of mucus and inflammation within the bronchioles, both of which lead to narrowing of the
airways. This condition does not result in the destruction of the bronchiole walls. Additionally, the condition tends to be transient in response to a trigger (e.g.,
cigarette smoke), as opposed to the more permanent changes seen with bronchiectasis.
4.Emphysema is a condition characterized by the abnormal and permanent enlargement of the distal airways (i.e., alveoli), not the bronchioles. Additionally, a
patient with emphysema will not typically produce large amounts of sputum.
Resource: (Hillegass p. 220)
9
Correct Answer: 3
Explanation
Dysdiadochokinesia refers to the inability to perform rapid, alternating movements. This condition results in inappropriate timing of muscle firing and difficulty with cessation of
ongoing movement. Common tests for dysdiadochokinesia include rapid supination and pronation of the forearms, alternating finger to nose, and altering the speed and
direction of walking.
1.A patient with dysdiadochokinesia may be able to initially maintain rhythm when performing rapid pronation and supination of the forearms, however, this rhythm will quickly
deteriorate as the patient has increasing difficulty modulating the movement.
2.A patient with dysdiadochokinesia may exhibit limited range of motion when performing rapid pronation and supination of the forearms in an attempt to successfully
complete the activity. Limiting the range of motion decreases the complexity of the task and therefore it is often used a compensatory strategy by patients with
dysdiadochokinesia.
3.A patient with dysdiadochokinesia would not necessarily exhibit a rapid onset of fatigue when performing rapid pronation and supination of the forearms. The
condition results from a failure to modulate movement due to the inappropriate timing of muscle firing and not due to muscle fatigue.
4.A patient with dysdiadochokinesia may exhibit slowness of movement when attempting rapid pronation and supination of the forearms in an attempt to
successfully complete the activity. More rapid movement results in reduced rhythm, limited range of motion, and less ability to modulate the required sequential
movement.
10
Correct Answer: 2
Explanation
Amyotrophic lateral sclerosis (ALS) is an adult-onset progressive neurodegenerative disease. It is most commonly characterized by an onset of ascending muscle weakness
beginning in the distal musculature and progressing towards the trunk. Other symptoms may include weakness of the facial muscles and cognitive disturbances.
1.Meningitis is an acute inflammation of the membranes that cover the brain and spinal cord. The condition is caused by a bacterial or viral infection that reaches the
meninges. This condition is not associated with ALS.
2.Pneumonia is an inflammatory condition of the lung that primarily affects the alveoli. The final stages of ALS are characterized by weakness of the respiratory
muscles. This decrease in respiratory function can lead to infection of the lungs (i.e., pneumonia). Death usually occurs within 2-5 years from the onset of the
disease.
3.Deep vein thrombosis (DVT) is the formation of a blood clot in the deep veins of the legs. One of the most common risk factors for DVTs is inactivity or
immobilization, especially after a major surgery. Though a patient with ALS may be immobile secondary to significant muscle weakness, DVT is not a common
cause of death.
4.Septic shock is a condition that results from severe infection and sepsis and leads to multiple organ failure. In severe cases of pneumonia, septic shock may
result, though it is not a common cause of death for patients with ALS.
Resource: (Goodman Pathology p. 1408)
11
Correct Answer: 1
Explanation
Sources vary on their recommendations with regard to the amount of force used during traction, but the optimal amount of force ultimately depends on the patients clinical
presentation, the goals of treatment, and the patient position. Goals of traction may include joint distraction, reduction of disk protrusion, soft tissue stretching, muscle
relaxation, and joint mobilization.
1.Eight pounds would be the most appropriate amount of traction force for the therapist to use. Since this is the patients first treatment, the traction force should
start low (i.e., 8-10 pounds for cervical traction). This will reduce the likelihood of reactive muscle guarding and allow the therapist to determine how well the
patient tolerates traction. The traction force can be increased gradually in subsequent sessions.
2.Sixteen pounds of traction force may be used when the goal of treatment is to stretch soft tissue, decrease muscle spasm or reduce disk protrusion. This
amount of traction force would be too large for the initial treatment session.
3.Twenty-four pounds of traction force may be used when the goal of treatment is joint distraction. Though the goal of this patients treatment is to distract the
joints to relieve compression on the nerve roots, 24 pounds would be too much force for the initial treatment session.
4.Thirty-two pounds of traction force is not typically used when doing cervical traction. This amount of force would be more likely used during the initial session
of treatment for lumbar mechanical traction.
Resource: (Cameron - Physical Agents p. 377)
System: Non-Systems
Content Outline: Equipment and Devices; Therapeutic Modalities
12
Correct Answer: 3
Explanation
Elys test is one of many special tests used to determine limitations in muscular flexibility. The testing procedure requires the patient to lie in a prone position while the
therapist passively flexes the knee. The test is considered positive if there is limited knee flexion range of motion or if the patient hikes the hip off of the table.
1.The iliopsoas is a one-joint muscle that flexes the hip. Though prone positioning would place this muscle on stretch, knee movement would not affect the muscles length
since the muscle does not cross the knee joint.
2.The vastus lateralis is a one-joint muscle that extends the knee. Though knee flexion would place this muscle on stretch, the patient would not hike their hip off of the table
due to tightness of the muscle since it does not cross the hip joint.
3.The rectus femoris is a two-joint muscle that flexes the hip and extends the knee. The length of this muscle is commonly assessed using Elys test since this
test places the leg in a position of hip extension and knee flexion, which would maximally stretch the muscle.
4.The sartorius is a two-joint muscle that flexes, laterally rotates, and abducts the hip and flexes the knee. Therefore, this muscle would be stretched in a position
of hip extension and knee extension. Knee flexion would shorten the muscle and be unlikely to elicit the described response.
Resource: (Dutton p. 797)
13
Correct Answer: 4
Explanation
The Katz Index of Activities of Daily Living (ADL) is a functional assessment that focuses on patient performance and level of assistance required on six different ADL tasks.
The tasks include bathing, dressing, toileting, transferring, continence, and feeding. Each task is graded on a two-point scale: 1 for complete independence and 0 if
assistance is required.
1.Using utensils for feeding would fall under the category of feeding on the Katz Index of ADL. A patient scores a 1 if they are able to feed themselves without assistance.
2.Getting into and out of bed would fall under the category of transferring on the Katz Index of ADL. A patient scores a 1 if they are able to move into and out of bed and
into and out of a chair without assistance.
3.Controlling urination and bowel movements would fall under the category of continence on the Katz Index of ADL. A patient scores a 1 if they are able to independently
control urination and bowel movements (use of a catheter means they are no longer independent).
4.Combing hair is a common grooming task, however, grooming is not an ADL that is assessed with the Katz Index of ADL. Grooming is assessed with other
functional assessments, such as the Functional Independence Measure.
Resource: (Tan p. 99)
14
Correct Answer: 2
Explanation
Dysphagia, the inability to properly swallow, can be a complication of a cerebrovascular accident. Dysphagia is seen with lesions affecting the medullary brainstem, pontine
lesions, and large hemispheric lesions. Following a cerebrovascular accident patients are screened for their ability to swallow. Depending on the severity of the patients
dysphagia, a patients oral intake may be limited to certain textures of food and consistencies of liquids to prevent the risk of aspiration.
1.A patient with dysphagia can aspirate thin liquids such as water. This is a legitimate concern following a cerebrovascular accident. The physical therapist should not provide
the patient with a glass of water before confirming that the patient has already passed a swallowing evaluation.
2.Checking the patients chart for oral intake orders is the most appropriate action for the physical therapist. If the patient has not yet been screened for their
ability to swallow, food and drink is typically withheld due to the risk of aspiration. If the patient has been screened and/or evaluated by a speech therapist, they
will have orders for oral intake including the consistency of liquid that they are able to tolerate.
3.It is possible that this patient has been cleared for thin liquids, however, the question does not provide adequate information to determine the patients oral
intake status. As a result, the therapist should consult the patients medical record.
4.It is not necessary to call the patients physician before checking the medical record for oral intake orders. If the physical therapist has concerns about the
patients ability to swallow and a speech therapy evaluation has not been ordered, then calling the physician to discuss the situation may be appropriate.
15
Correct Answer: 2
Explanation
Central cord syndrome is an incomplete spinal cord lesion that most often results from a cervical hyperextension injury. Symptoms are secondary to damage to the central
aspect of the spinal cord. Patients with central cord syndrome typically present with motor deficits that are more pronounced in the distal upper extremities.
1.Parallel bars provide significant stability for gait training activities, however, given the characteristic upper extremity motor deficits, a patient would likely have difficulty
maintaining sufficient grip on the bars to effectively support upper extremity weight bearing and balance.
2.A rolling walker provides significant stability and allows the patient to ambulate beyond the confines of parallel bars. A wheeled device will allow the patient to
push rather than lift the device requiring less coordination and upper extremity strength. Platform attachments for the upper extremities allow for weight bearing
support through the upper extremities without requiring significant grip strength.
3.A patient with central cord syndrome is unlikely to posses the required coordination and functional grip strength to effectively utilize Lofstrand crutches.
4.Although a standard walker is inherently more stable than a similar rolling device, distal extremity strength and coordination are required for safe use making
this a less desirable option for a patient with central cord syndrome.
Resource: (Umphred p. 462)

System: Non-Systems
16
Correct Answer: 2
Explanation
There are a multitude of medical diagnoses that affect the hip and lower extremity. Physical therapists should be familiar with the clinical presentation and common
interventions employed for each diagnosis.
1.Iliolumbar syndrome, also known as iliac crest pain syndrome, is caused by inflammation or a tear of the iliolumbar ligament. The condition often leads to referred pain in the
pelvis or groin. The patient is often tender to palpation over the iliac crest and pain tends to be exacerbated with sidebending. Use of a foam roller on the lateral leg would not
specifically address the chief complaints associated with this condition.
2.Iliotibial band syndrome is characterized by localized pain approximately two centimeters above the knee joint line over the lateral femoral condyle. The
syndrome can be caused by activities requiring frequent flexion of the knee such as running or cycling which produce an inflammatory reaction. Although the
patient often experiences pain in the knee region, the iliotibial band runs from the iliac crest to the lateral condyle of the tibia. As a result, use of a foam roller over
the lateral leg can be an effective intervention for patients with this condition.
3.Piriformis syndrome refers to a condition in which the piriformis muscle irritates the sciatic nerve causing pain in the buttocks and referred pain along the
course of the sciatic nerve. The primary patient complaint is buttock pain that is made worse by sitting, stair climbing or squatting. Use of a foam roller on the
lateral leg would not specifically address the piriformis muscle since the muscle is located in the buttock region.
4.Trochanteric bursitis refers to inflammation of the trochanteric bursa, which is a pad-like sac that protects the soft tissue structures that cross the posterior
portion of the greater trochanter. The patient is often extremely sensitive to palpation over the bursa and may experience lateral thigh pain that is exacerbated by
activity or periods of prolonged rest. Use of a foam roller on the lateral leg has the potential to increase the patients pain level particularly when the roller is in
close proximity to the bursa.
Resource: (Higgins p. 440)

Content Outline: Interventions
17
Correct Answer: 2
Explanation
Each hemisphere of the brain is divided into five distinct lobes: the frontal, parietal, temporal, occipital, and limbic lobes. Prominent sulci, such as the central sulcus, help to
separate the different lobes. Each lobe of the brain is responsible for distinct brain functions.
1.The prefrontal cortex is located in the anterior portion of the frontal lobe and is responsible for the executive functions, which include memory, reasoning, planning, problem
solving, and execution.
2.The precentral gyrus is located anterior to the central sulcus and is considered the primary motor cortex of the brain. It is involved in the initiation of voluntary
movements, such as reaching towards an object with both hands.
3.The postcentral gyrus is located posterior to the central sulcus and is considered the primary somatosensory cortex of the brain. It is involved with the cortical
processing of tactile and proprioceptive input.
4.The cingulate gyrus is located superior to the corpus callosum and constitutes a portion of the limbic lobe. The limbic lobe is responsible for emotional
responses, drive-related behavior, and memory.
Resource: (Nolte The Human Brain p. 60)
18
Correct Answer: 2
Explanation
Burn management will vary depending on the severity of the injury, which is often determined by the depth of the burn. Full-thickness burns involve damage to the entirety of
the epidermis and dermis and are characterized by a dry, firm, leathery eschar which lacks pliability and is insensate to touch.
1.The goal of treatment for a superficial burn is to provide a wound environment which promotes re-epithelialization. This can be accomplished through the application of a
moisturizing cream.
2.Full-thickness burns are generally treated in the operating room through surgical excision and skin grafting. Therefore, the goal of the therapists treatment is to
prepare the wound for surgery by controlling infection. This can be accomplished through the use of antimicrobial topical agents and proper wound cleansing.
3.The goal of treatment for a partial-thickness burn is to prepare the wound for primary healing. This can be accomplished through wound cleansing and
debridement of the larger, more fragile blisters.
4.The maintenance of a moist wound surface would be more important for the treatment of superficial and partial-thickness wounds since they heal without
surgical intervention. Though maintaining a moist wound surface may be important for full-thickness burns, it does not take precedence over infection control.
Resource: (Sussman p. 412)
19
Correct Answer: 2
Explanation
A physical therapist should have knowledge of normal lung volumes and potential differences between males and females. On average, a healthy adult male has a total lung
capacity of approximately 6000 mL, while a female has a total lung capacity of 4200 mL.
1.Tidal volume (TV) is the amount of air inspired and expired with each breath during quiet breathing and it accounts for approximately 10% of total lung volume. TV for males
is typically 600 mL, while TV for females is typically 500 mL.
2.Inspiratory reserve volume (IRV) is the maximal volume of air that can be inspired after normal TV inspiration and it accounts for approximately 50% of total
lung volume. The IRV is the lung volume with the largest difference between male and female values. IRV for males is typically 3000 mL, while IRV for females is
typically 1900 mL.
3.Expiratory reserve volume (ERV) is the maximal volume of air that can be exhaled after a normal tidal exhalation and it accounts for approximately 15% of total
lung volume. ERV for males is typically 1200 mL, while ERV for females is typically 800 mL.
4.Residual volume (RV) is the volume of gas remaining in the lungs at the end of a maximal expiration and it accounts for approximately 25% of total lung volume.
RV for males is typically 1200 mL, while RV for females is typically 1000 mL.
Resource: (Nyland p. 115)
20
Correct Answer: 1
Explanation
The acute stage of healing is characterized by inflammation, pain, edema, muscle spasm, impaired movement, joint effusion, and decreased use of affected areas. The plan
of care for this stage of healing should include patient education, control of pain, reduction of muscle spasm, maintenance of joint mobility, reduction of swelling, and
maintenance of the function of associated areas.
1.The patient presents with pain, inflammation, and muscle spasm. The most appropriate intervention would be grade I and II joint mobilizations to help control
pain by stimulating mechanoreceptors.
2.Bent over rows with a light handweight would be more appropriate for the subacute stage of healing. Strengthening exercises used during the acute stage will
likely exacerbate the patients symptoms.
3.Doorway stretches for the pectoralis major would be more appropriate for the subacute stage of healing. Stretching exercises used during the acute stage will
likely exacerbate the patients symptoms. More conservative activities such as pain-free passive range of motion would be more appropriate for the acute stage.
4.Proprioceptive neuromuscular facilitation patterns would be more appropriate for the subacute stage of healing. Active range of motion (AROM) exercises at the
site of injury used during the acute stage will likely exacerbate the patients symptoms. AROM exercises used at adjacent joints would be an acceptable
intervention for the acute stage.
Resource: (Kisner p. 319)
21
Correct Answer: 3
Explanation
Transparent film dressings are thin membranes made from transparent polyurethane with water-resistant adhesives. They are highly elastic, conform to a variety of body
contours, and allow for easy visual inspection of the wound since they are transparent.
1.Autolytic debridement refers to the use of the bodys own mechanisms to remove nonviable tissue. Common methods of autolytic debridement include the use of
transparent films, hydrocolloids, hydrogels, and alginates. The transparent film helps to establish a moist wound environment that rehydrates necrotic tissue and eschar,
facilitating enzymatic digestion of the nonviable tissue.
2.Transparent film dressings are permeable to vapor and oxygen, but are largely impermeable to bacteria and water.
3.Transparent film dressings are nonabsorbent and are therefore not indicated in the presence of significant drainage. Other dressings more appropriate to
absorb drainage include alginates and hydrocolloids.
4.Transparent film dressings reduce friction over bony prominences. The dressings form a barrier between the wound bed and therefore serve to resist shearing
and frictional forces.
Resource: (Cameron - Physical Rehabilitation p. 759)
22
Correct Answer: 1
Explanation
There is a predictable pattern of motor activity with each portion of the gait cycle. Possessing knowledge of anticipated motor activity during gait can assist physical therapists
to identify motor and strength abnormalities.
1.The tibialis anterior is primarily responsible for ankle dorsiflexion and inversion. This muscle sustains its motor activity from toe off through the entire swing
phase ending with initial contact. The muscle also continues to be active through the initial portion of the stance phase from initial contact through foot flat.
2.The gluteus medius is primarily responsible for hip abduction and medial rotation. This muscle is active just prior to initial contact and remains active through
the first half of the stance phase.
3.The adductor longus is primarily responsible for hip adduction. This muscle is active during the terminal portion of stance phase and remains active through
the first half of the swing phase.
4.The soleus is primarily responsible for ankle plantar flexion. This muscle is active for approximately 40% of the stance phase. The muscle becomes active after
foot flat and becomes inactive prior to toe off.
Resource: (Shumway-Cook p. 323)
23
Correct Answer: 1
Explanation
Restrictive lung disease (RLD) includes any condition that results in a reduction of lung volume and chest wall compliance. RLD can have a pulmonary or extrapulmonary
etiology. A patient with RLD may present with decreased breath sounds, shortness of breath, ineffective cough, and increased use of accessory muscles.
1.Scoliosis is a potential extrapulmonary etiology of restrictive lung disease. The condition is characterized by lateral curvature of the spine. If a progressive
scoliosis is untreated, the deformity can increase in excess of 60 degrees and cause restrictive lung disease that may result in pulmonary insufficiency,
significant pain, and impairment in lung capacity.
2.Sarcoidosis is a potential pulmonary etiology (not extrapulmonary) of restrictive lung disease. The condition is a systemic disease that is characterized by
granulomatous inflammation throughout the body. The lungs and thoracic lymph nodes are most often involved and typically granuloma formation within these
tissues may progress into fibrosis and result in restrictive lung disease.
3.Tuberculosis is a potential pulmonary etiology (not extrapulmonary) of restrictive lung disease. The condition is an infectious and inflammatory systemic
disease that results in fibrosis within the lungs. Other pulmonary symptoms of this disease include fatigue, an initial non-productive cough, and dyspnea with
exertion.
4.Emphysema is a potential pulmonary etiology (not extrapulmonary) of chronic obstructive pulmonary disease (COPD). Emphysema refers to a pathologic
accumulation of air in the lungs that results in a non-reversible injury and destruction of elastin protein within the alveolar walls. This process causes permanent
enlargement of the air spaces distal to the terminal bronchioles within the lungs. Pulmonary function testing results in an increase in total lung capacity, residual
volume, and functional residual capacity.
24
Correct Answer: 2
Explanation
The minimal clinically important difference is defined as the smallest difference in a measured variable that signifies an important, not trivial, difference in the patients
condition. The determination of the minimal clinically important difference allows physical therapists to better assess the benefit of specific interventions.
1.The smallest difference in those patients observed to have changed is not consistent with the minimal clinically important difference since it is not necessarily associated
with a difference that the patient would perceive as beneficial.
2.The minimal clinically important difference can also be defined as the smallest difference a patient would perceive as beneficial. This value represents a type of
threshold for meaningful improvement in a patients health-related quality of life as measured by what the patient reports.
3.Researchers often focus on statistical significance, however, the smallest difference that could be detected as statistically significant might not be clinically
significant.
4.The smallest difference detectable based on the instruments measurement error may be important information for the physical therapist to be aware of when
interpreting the obtained results, however, it is not consistent with the minimal clinically important difference.
Resource: (Portney p. 112)
System: Non-Systems
Content Outline: Safety and Protection; Professional Responsibilities; Research
25
Correct Answer: 2
Explanation
Knowledge of diagnostic imaging techniques allows therapists to better understand the rationale associated with physician orders for imaging and the interpretation of the
obtained results.
1.Computed tomography is a non-invasive imaging technique that uses cross-sectional images based on x-ray attenuation. Computer enhancement allows the imaging to
have significantly better contrast resolution when compared to conventional x-rays.
2.Fluoroscopy refers to examination by means of the fluoroscope. A fluoroscope allows an examiner to observe the actions of joints, organs or entire systems of
the body. The instrument requires a specific body segment to be placed between a fluorescent screen and an x-ray tube. X-rays from the tube pass through the
body and project images on the screen.
3.Discography is an invasive imaging technique that involves injecting a radiopaque dye into the nucleus pulposus of an intervertebral disc using radiographic
guidance. The technique can be used to identify disruptions of the nucleus pulposus or the annulus fibrosus.
4.Radionuclide scanning is an invasive imaging technique that can be used in conjunction with bone scans to identify areas where there is a high level of bone
turnover relative to the rest of the bone. The technique requires the intravenous injection of chemicals labeled with isotopes.
Resource: (Magee p. 64)
26
Correct Answer: 3
Explanation
Physical therapists should possess a thorough understanding of the typical impact that early identification has on a variety of medical conditions. All members of the health
care team can assist in the recognition of signs and symptoms of commonly encountered medical diagnoses.
1.Spina bifida is a developmental abnormality due to insufficient closure of the neural tube by the 28th day of gestation. This defect usually occurs in the low thoracic, lumbar
or sacral regions. Symptoms are highly variable by type: occulta, meningocele, and myelomeningocele. Spina bifida is detected in utero through blood test and fetal
ultrasound. After birth, the condition is confirmed with x-ray, MRI or CT scan. Early identification of spina bifida will not alleviate the residual impairments.
2.Down syndrome (trisomy 21) is a genetic abnormality consisting of an extra twenty-first chromosome due to an error in cell division. Symptoms of this syndrome include
mental retardation, hypotonia, joint hypermobility, flattened nasal bridge, narrow eyelids with epicanthal folds, flat feet, scoliosis, congenital heart disease, and visual and
hearing loss. Down syndrome is detected in utero through a combination of tests that may include blood test, fetal ultrasound, and amniocentesis. After birth, the condition is
confirmed with a chromosomal karyotype. Early identification of Down syndrome will not alleviate the residual impairments.
3.Phenylketonuria is an autosomal recessive condition in which a mutation occurs in a gene responsible for breaking down the amino acid phenylalanine.
Symptoms will typically present within a few months of birth as the phenylalanine accumulates. If left untreated, severe mental retardation will occur.
Phenylketonuria is treated through dietary restriction of phenylalanine throughout the person's lifetime. Adequate prevention will avoid all manifestations of the
disease. Phenylketonuria is detected through a required screening for all newborns. If the initial screening is positive, further blood and urine tests are required to
confirm the diagnosis.
4.Tay-Sachs disease is an autosomal recessive inherited trait characterized by the absence or deficiency of hexosaminidase A. At approximately six months of
age, the child will start to miss developmental milestones and will continue to deteriorate in motor and cognitive skills. As symptoms progress, the patient
develops significant mental retardation and paralysis, and will usually die by the age of five. Tay-Sachs disease is typically carried out when both parents cannot
be ruled out as carriers. The disease is detected in utero through a combination of tests that may include detecting hexosaminidase A, chorionic villus sampling,
and amniocentesis.
27
Correct Answer: 1
Explanation
Physical therapists must possess knowledge surrounding the effects of aging on exercise tolerance. With normal aging, there is typically greater air space within the alveoli,
decreased surface area for oxygen exchange, decreased force during inspiration, and an overall diminished exercise tolerance.
1.Tidal volume, or the amount of air in a normal resting breath, tends to remain stable over time. Typically, tidal volume is 500 mL (i.e., half of a liter).
2.As a result of the aging process, residual volume can increase by 30-50% due to the loss of alveoli and increasing stiffness of the rib cage.
3.As a result of the aging process, forced vital capacity can decrease by 40-50% due to the loss of alveoli and increasing stiffness of the rib cage. Forced vital
capacity includes the inspiratory reserve volume, expiratory reserve volume, and tidal volume.
4.Inspiratory capacity is the combination of inspiratory reserve volume and tidal volume. As a result of the aging process, there is a decrease in the inspiratory
reserve volume resulting in a decreased inspiratory capacity.
Resource: (Lusardi p. 19)
28
Correct Answer: 2
Explanation
Amyotrophic lateral sclerosis (ALS) is a chronic degenerative disease that produces both upper and lower motor neuron impairments. Although the disease course varies,
studies have found the average duration from onset to death to be between 27 and 43 months.
1.A patients age at the time of onset has the strongest correlation to their prognosis. Patients that are less than 40 years of age at onset have better five-year survival rates
than patients that are older.
2.Bulbar-onset ALS, characterized by dysarthria and dysphagia as the initial symptoms, is seen in 20-30% of cases, while limb-onset ALS is seen in 70-80% of
cases. Bulbar-onset ALS is associated with a less favorable prognosis.
3.Dyspnea (i.e., shortness of breath) is a symptom commonly seen in patients with ALS. Respiratory failure is the most common cause of death in these patients.
Patients that present with dyspnea from the onset have a less favorable prognosis.
4.Riluozole (Rilutek) is a glutamate inhibitor that is currently the primary medication used in the treatment of ALS. Evidence suggests that the effect of this
medication is moderate, extending a patients lifespan two to three months on average.
29
Correct Answer: 3
Explanation
A dynamic ankle-foot orthosis (DAFO) is designed with a long footplate with built-up areas to provide stability and reduce abnormal tone. DAFOs provide biomechanical
changes that allow for improved motion within the trunk, pelvis, and lower extremities.
1.The goal of a DAFO is to decrease hypertonicity of the lower extremity including plantar flexors and allow for improved biomechanics during ambulation. The DAFO
positions the patients foot in neutral and resists motion into plantar flexion and dorsiflexion through its construction of molded plastic and anterior straps.
2.The footplate is designed to run the entire length of the foot. The footplate is built-up in particular areas to enhance stability and also provide sustained pressure that
collectively reduces tone. The effects of the footplate are essential to the success of the DAFO.
3.The DAFO is designed to position the midtarsal and subtalar joints in a neutral position. The construction of the orthosis including the anterior straps serve to
limit dorsiflexion and plantar flexion allowing for total contact throughout the gait cycle. This allows for reduction of abnormal tone and improved mobility.
4.The DAFO is designed to increase medial-lateral stability at the ankle joint within the orthosis. Increasing medial-lateral motion would decrease the overall
effectiveness of the orthotic and allow for tonal influences during gait.
Resource: (Tecklin p. 218)
System: Non-Systems
30
Correct Answer: 4
Explanation
Physical therapists should be knowledgeable about appropriate blood pressure testing procedures and factors which may affect blood pressure values. Factors which may
affect blood pressure include age, physical activity, emotional status, medications, medical conditions, blood volume, testing position, and site of the measurement.
1.The blood pressure cuff must be the proper size to obtain an accurate measurement. A blood pressure cuff that is too narrow in relation to the patients arm circumference
will result in a reading that is inaccurately high.
2.Exercise results in an increase in systolic blood pressure. Blood pressure should drop to its normal resting value within three to five minutes after termination of exercise.
Though more than five minutes has likely elapsed between the patients physical activity and the therapy visit, the recent exercise would not result in a decrease in blood
pressure.
3.Arm positioning may affect a blood pressure reading. When sitting or standing, the patients arm should be resting at the level of the fourth intercostal space. Having the arm
below this position (e.g., at the patients side) would result in an increase in the blood pressure value.
4.The patient is likely dehydrated from vomiting over the course of the past two days. Dehydration (i.e., low blood volume) results in a decrease in resting blood
pressure.
Resource: (Fairchild p. 59)
31
Correct Answer: 4
Explanation
The transversus abdominis is an important muscle that provides increased stability to the lumbar spine during a variety of postures and movements. The transversus
abdominis is activated by asking the patient to take a relaxed breath in and out and then draw the waist line in without taking a breath. The therapist or patient can assess
transversus abdominis activity by palpating immediately distal to the anterior superior iliac spine and lateral to the rectus abdominis. The testing position is typically in supine
with the knees flexed, however, other positions can be utilized if the patient is unable to tolerate the described position.
1.A sidelying position would make it somewhat difficult to palpate the transversus abdominis since the muscle is typically palpated bilaterally and a sidelying position causes
shifting of structures in the trunk and the abdominal cavity.
2.A supine position with legs extended would be an acceptable position to attempt to palpate the transversus abdominis, however, the position creates some inherent tension
in the abdominal musculature and therefore makes it somewhat difficult to palpate the muscle.
3.A supine position with hips and knees flexed to 90 degrees would require either external support or active muscle contraction. Active muscle contraction to maintain this
position would make it impossible for the therapist to palpate the transversus abdominis.
4.Hooklying refers to a position where the patient is lying in supine with their hips and knees bent and the feet flat on the floor with the arms positioned at their
side. The position is ideal for palpation of the transversus abdominis since it places the abdominal muscles on slack and allows for symmetrical palpation.
32
Correct Answer: 4
Explanation
Physical therapists must be cognizant of side effects that may influence treatment when working with patients with epilepsy. General side effects of antiepileptic drugs that can
affect therapy include headache, fatigue, dizziness, vomiting, and cerebellar dysfunction.
1.A therapeutic pool would not be ideal for a patient that is five days status post hip arthroplasty due to the lack of integrity of the incision. The therapeutic pool may have
bright lights, vary in noise level, and present with other environmental risk factors that could precipitate a seizure.
2.The physical therapy gym is often a loud and busy setting that can serve as an environmental stimulus to precipitate a seizure. Although a gym is a desirable setting to work
on many facets of rehabilitation after total hip arthroplasty, a private treatment room would be a more desirable initial setting given the presence of epilepsy.
3.The hallway may be loud, busy or contain bright lights. Although the setting allows for a variety of functional activities (e.g., gait training, mobility training), the presence of
the environmental stimuli increases the risk of seizure activity.
4.Treatment in a private treatment room is the most ideal option for this patient initially secondary to the diagnosis of epilepsy. When possible, it is desirable to
avoid environmental stimuli that facilitate seizure activity. The risk of seizure activity associated with environmental stimuli increases significantly if the epilepsy
is poorly controlled with drug therapy.
Resource: (Ciccone p. 114)
33
Correct Answer: 1
Explanation
The slump test is a neural provocation test performed with the patient in sitting. It consists of a series of progressive active and passive movements including cervical flexion,
trunk flexion, knee extension, and ankle dorsiflexion. With each movement, the therapist asks the patient if they are experiencing symptoms (e.g., radicular pain, numbness,
tingling). If symptoms are not produced, the therapist proceeds to the next movement to increase the amount of dural stretch.
1.Having the knee extended and ankle dorsiflexed would increase dural stretch on the sciatic nerve, though this position would also place stretch on the posterior
musculature of the leg (i.e., hamstrings and calf muscles). Having the patient plantar flex the ankle would release the tension/stretch on all of these structures,
though having the patient slump and flex the neck would increase the tension on the nerve without increasing the stretch on the muscles. Because this resulted
in a decrease in the patients pain, the original pain can likely be attributed to tight musculature.
2.The position of knee extension and ankle dorsiflexion would increase tension on the sciatic nerve. By plantar flexing the ankle, tension would be decreased,
though slumping and flexing the neck would counteract this decrease in tension and maintain dural stretch. Because the patient reported a decrease in
symptoms, it is unlikely that they were experiencing tension on the sciatic nerve with the original test position.
3.The slump test is not necessarily designed to diagnose the exact cause of the patients symptoms, though disk herniation is one of the possible causes. As
stated previously, the patient is more likely experiencing symptoms related to muscular tension as opposed to neural tension.
4.The slump test is not typically used to determine the presence of malingering and there is no information in the scenario that would lead one to believe that the
patient is malingering. The described position would lead to an increase in the stretch on the posterior musculature of the leg and would explain the patients
reported pain.
34
Correct Answer: 3
Explanation
Physical therapists must be aware of precautions and contraindications to exercise. Exercise is contraindicated with a resting systolic pressure greater than 200 mm Hg or
diastolic pressure greater than 110 mm Hg. Dyspnea greater than 45 breaths per minute is also a contraindication to exercise. Although the patients respiratory rate is below
this level, the blood pressure values still warrant consultation with the physician.
1.An exercise program of any type is contraindicated secondary to the patients current blood pressure values.
2.Activities that are less than 3 METs are considered light work and include walking slowly, washing dishes or bathing. Although these activities are relatively low intensity, the
obtained blood pressure values make it inappropriate to engage in an exercise program.
3.The physical therapist should contact the physician since the obtained blood pressure values are contraindications to exercise. The physician will likely need to
follow up with the patient regarding their current medical status.
4.Although the patients blood pressure values do not permit the patient to engage in an exercise program, in the absence of additional relevant medical
information, the blood pressure values do not warrant immediate emergency medical services.
35
Correct Answer: 1
Explanation
The use of specialized dressings to maintain an appropriate wound bed moisture balance is essential to effective wound healing. Therapists must consider the typical exudate
characteristics of a specific wound type when selecting a primary, secondary or combination dressing that will best meet the patients needs.
1.A hydrogel is a moisture retentive primary dressing that provides a moist environment for wound healing. An arterial insufficiency ulcer typically produces
minimal drainage, therefore the use of a hydrogel is appropriate to assist in preventing the wound from dehydrating and impeding the healing process.
2.A transparent film dressing may assist in maintaining a moist wound environment with a minimally draining wound, however, this dressing is typically
recommended for superficial partial-thickness wounds that will heal by primary intention. A wound with the dimensions described would be considered a fullthickness wound that will require intervention to heal by secondary intention.
3.A wet-to-dry gauze dressing provides some moisture to the wound bed on initial application, however, as the dressing dries, the wound bed will typically
dehydrate. This inconsistency in wound bed moisture balance is undesirable and typically impedes wound healing.
4.A calcium alginate dressing is highly absorptive and typically utilized with wounds that produce moderate to heavy exudate. A wound producing minimal
exudate is unlikely to saturate the alginate to the extent necessary for it to form a beneficial hydrophilic gel.
36
Correct Answer: 3
Explanation
A waveform is a graphic representation of the shape, direction, amplitude, duration, and pulse frequency of the electrical current being produced. Therapists should be familiar
with the various characteristics of a waveform to effectively determine which parameters should be used when administering electrical stimulation.
1.Frequency determines the number of pulses delivered through each channel per second. Frequency controls are often labeled as rate and are expressed in pulses per
second or Hertz.
2.A ramp allows current amplitude to gradually increase to a preset maximum and then gradually decrease. Ramp time refers to amount of time it takes to reach the preset
maximum. Ramping is commonly used to make the onset of stimulation more comfortable when performing muscle strengthening.
3.The amplitude of each pulse reflects the magnitude of the current. Amplitude is synonymous with the terms intensity or voltage.
4.The phase duration is the elapsed time between the beginning and end of one phase. With monophasic current it is the time from the initiation of the phase to
its end. For biphasic current the pulse duration is determined by the combined phase durations.
Resource: (Prentice p. 106)
System: Non-Systems
37
Correct Answer: 4
Explanation
Guillain-Barre syndrome is an acute polyneuropathy that primarily affects the peripheral nervous system. The condition often occurs following a relatively benign respiratory or
gastrointestinal illness. Guillain-Barre syndrome is characterized by ascending weakness that begins distally in the lower extremities and progresses towards the trunk.
1.Based on the details of this scenario (i.e., moderate weakness, no respiratory involvement, short hospital stay), it is evident that the patient has a relatively mild case of the
condition. The large majority of patients with Guillain-Barre syndrome will experience a full recovery and are unlikely to need a wheelchair for long-term ambulation.
2.Difficulty with walking secondary to lower extremity weakness is a common symptom of Guillain-Barre syndrome. While the condition is at its peak, the patient may need to
use a wheelchair for transportation within the home or community. However, long-term use of a wheelchair is unlikely for this patient.
3.About 80% of patients with Guillain-Barre syndrome will walk independently at six months. In more severe cases, the patient may depend on some form of assistive device
for home and/or community ambulation, however, this patient is experiencing a relatively mild case of the condition.
4.Approximately 15-20% of patients will experience some long-term residual deficits after being diagnosed with Guillain-Barre syndrome. Because this patient has
a relatively mild case of the condition, it is likely that he will experience a full recovery and not need an assistive device for ambulation.
38
Correct Answer: 1
Explanation
Both rearfoot and forefoot alignment can be assessed with the patient in prone with their feet hanging over the edge of a table. Alignment of these joints will change
depending on whether the patient is in a weight bearing or non-weight bearing position. When in a weight bearing position, malalignment at the foot can have negative effects
on alignment throughout the entire anatomical chain.
1.The depicted image shows a patient with a forefoot varus. When in a weight bearing position, the forefoot varus will no longer be present since the patient will
attempt to position the foot flat so they can ambulate. As a result, the patient will demonstrate a rearfoot valgus and pronation of the foot. Pronation, and thus
flattening of the medial longitudinal arch, results in alignment changes throughout the entire anatomical chain, including medial collapse at the knee and
increased internal rotation at the hip.
2.Genu varum is a physical deformity in which the legs bow outward at the knee. Changes in foot alignment cannot cause genu varum or genu valgum since
these conditions involve true deformity of the knee joints. Pronation of the foot will cause medial collapse of the knee, which is similar in appearance to genu
valgum.
3.Forefoot varus in a non-weight bearing position will result in rearfoot valgus in a weight bearing position. This position leads to pronation, not supination, of the
foot.
4.The depicted image is showing a patient with a forefoot varus. However, when this patient ambulates, the forefoot will be flat to the ground resulting in rearfoot
valgus.
39
Correct Answer: 1
Explanation
The shoulder complex, which consists of the glenohumeral and the scapulothoracic articulation, acts in a coordinated fashion to provide the smoothest and largest range of
motion possible to the upper extremity. Motion available to the glenohumeral joint alone would not account for the full range of elevation of the humerus; the scapulothoracic
articulation contributes the remainder of the range. Movements of the scapulothoracic articulation include elevation/depression, protraction/retraction, and upward/downward
rotation.
1.During shoulder abduction, the scapula upwardly rotates to allow for greater range of motion. The muscles responsible for upward rotation of the scapula
include the upper trapezius, lower trapezius, and serratus anterior.
2.While the upper trapezius and serratus anterior upwardly rotate the scapula, the levator scapulae is responsible for downward rotation of the scapula.
3.While the lower trapezius upwardly rotates the scapula, the pectoralis minor and levator scapulae are responsible for downward rotation of the scapula.
4.While the lower trapezius and serratus anterior upwardly rotate the scapula, the pectoralis minor is responsible for downward rotation of the scapula.
40
Correct Answer: 2
Explanation
Jugular vein distention results from fluid overload when the heart is unable to pump blood efficiently. As the hearts ability to pump is compromised, the fluid backs up into the
lungs and venous system. Assessing distention of the jugular vein is an effective way to evaluate the functioning of the heart.
1.Peripheral arterial disease is a condition characterized by atherosclerotic plaque build-up in the peripheral arteries that causes occlusion of the blood flow to the extremities.
A patient with peripheral arterial disease would experience signs and symptoms of ischemia such as intermittent claudication or skin changes. Jugular vein distention is not
typically observed with this condition.
2.Congestive heart failure is a condition characterized by an inability of the heart to effectively pump blood to meet the demands of the body. When the heart can
no longer effectively pump blood to the body, fluid backs up into the lungs and venous system. A common sign of this type of fluid accumulation is distention of
the jugular vein.
3.Coronary artery disease is a condition characterized by atherosclerotic plaque build-up in the coronary arteries of the heart. Typical signs and symptoms of this
condition include angina and myocardial infarction. Jugular vein distention is not typically observed with this condition.
4.Aortic aneurysm is a condition characterized by the permanent dilation of the aortic wall. Due to the blood flow disturbance through the dilated segment of the
aorta, the formation of thrombi and emboli can result from this condition. Rupture of the aorta may also result from this condition, leading to uncontrolled
hemorrhage and circulatory collapse. Jugular vein distention is not typically observed with this condition.
41
Correct Answer: 2
Explanation
The APGAR scale is a scoring system used to evaluate the physical condition of a newborn infant after delivery. Each of the five signs (i.e., heart rate, respiratory effort,
muscle tone, reflex irritability, color) is scored on a 0-2 scale for a total possible score of 10 points. Scores are usually reported in the first and fifth minutes after delivery. A
score of 8-10 is considered normal indicating that the infant does not require resuscitation.
1.The infant crying is an indication of a good respiratory effort and would receive a score of 2. A slow, irregular respiratory effort would receive a score of 1, while the absence
of breathing would receive a score of 0.
2.A heart rate less than 100 beats per minute would receive a score of 1. A heart rate greater than 100 beats per minute would receive a score of 2, while the
absence of a heart rate would receive a score of 0.
3.Active movement of the arms and legs is an indication of muscle tone and would receive a score of 2. Some flexion of the extremities would receive a score of 1,
while limp or flaccid appearing extremities would receive a score of 0.
4.The infant sneezing in response to stimulation (e.g., suctioning with a syringe after delivery to clear the airway) is an indication of reflex irritability and would
receive a score of 2. A grimace would receive a score of 1 and no response would receive a score of 0.
42
Correct Answer: 4
Explanation
A physical therapist should be able to select specific therapeutic modality parameters based on the desired therapeutic outcome. Parameters of ultrasound include the
frequency, duty cycle, intensity, and duration. A 100% duty cycle (i.e., continuous ultrasound) is used when the treatment objective is to heat the tissue.
1.The frequency of ultrasound is chosen based on the depth of tissue to be treated. The piriformis is a relatively deep structure and therefore a frequency of 1 MHz should be
used. Additionally, 12 minutes is more time than is needed to sonate over the piriformis muscle.
2.A frequency of 1 MHz should be used since the piriformis is a deep structure. However, when using 1 MHz, the intensity needs to be between 1.5 and 2.0 W/cm2 to produce
tissue heating. Additionally, 12 minutes is more time than is needed to sonate over the piriformis muscle.
3.When using ultrasound, an area twice the size of the sound head can be effectively treated in a 5 minute period. As a result, 8 minutes would be adequate to sonate over
the piriformis muscle. A frequency of 3 MHz would not provide the necessary depth to adequately sonate the piriformis muscle.
4.A frequency of 1 MHz should be used since the piriformis is a deep structure. When using 1 MHz, the intensity should be between 1.5 and 2.0 W/cm2 to produce
tissue heating. 8 minutes would be adequate to sonate over the piriformis muscle.
System: Non-Systems
43
Correct Answer: 1
Explanation
Pulmonary edema is a complication of left sided congestive heart failure. Pulmonary edema occurs when a back up of fluid collects in the left atrium and lungs. Symptoms of
pulmonary edema can present suddenly and include extreme shortness of breath, wheezing or gasping, anxiety, coughing, chest pain, irregular pulse, and frothy, blood tinged
sputum. Acute pulmonary edema is a medical emergency.
1.This patient is presenting with signs and symptoms of acute pulmonary edema, which is a medical emergency. This patient requires immediate treatment with
supplemental oxygen and medication. Calling 911 ensures the patient receives immediate medical attention.
2.The patient exhibits tachypnea and coughing due to the fluid back up in the left atrium and lungs. Taking a rest break will not resolve this issue. Immediate
medical attention is indicated.
3.Monitoring vital signs is an important component of an exercise program in order to assess a patients response to activity. However, in this scenario, the
patients described symptoms already warrant immediate medical attention. Vital signs can be assessed after the therapist calls 911.
4.Based on the patients symptoms, exercise should be immediately terminated. Any further demands on the heart will only serve to exacerbate the patients
condition.
44
Correct Answer: 3
Explanation
Peripheral neuropathy can result in foot insensitivity to pain and pressure as well as a loss of intrinsic foot musculature. The loss of foot musculature impairs proprioceptive
input from the foot. Patients who present with diabetic neuropathy may have impairments in both static and dynamic standing balance.
1.A patient with diabetic neuropathy may have difficulty performing activities in single leg stance, however, it would not be the most challenging activity since the patient will
still receive proprioceptive input from the foot that is on the ground.
2.Reaching in and out of the base of support in standing is not the most challenging activity since both feet remain firmly on a flat surface allowing for some proprioceptive
input.
3.Standing on foam with eyes closed would be the most challenging activity for this patient. By having the patient stand on foam, the physical therapist increases
stress on an already compromised somatosensory system. Closing the eyes further challenges the patient by eliminating the visual input that contributes to
sense of position and body in space.
4.Lateral weight shifting is not the most challenging activity since the patient is able to rely on all of the systems that contribute to balance: somatosensory,
visual, and vestibular systems.

45
Correct Answer: 4
Explanation
The pes anserine is a grouping of three conjoined tendons that all insert on the anteromedial surface of the proximal tibia. Overuse injuries are common in this area and may
lead to pes anserine tendinitis or bursitis.
1.The adductor longus originates on the superior ramus of the pubis and inserts on the medial third of the linea aspera of the femur. This muscle does not cross the knee joint
and therefore is not part of the pes anserine.
2.The semimembranosus originates on the ischial tuberosity and inserts on the medial condyle of the tibia. Though it does insert on the medial tibia, its tendon is not one of
the three tendons that make up the pes anserine.
3.The biceps femoris originates on the ischial tuberosity, sacrotuberous ligament, and along the shaft of the femur and inserts on the fibular head and lateral condyle of the
tibia. This muscle is located in the lateral thigh and therefore is not part of the pes anserine.
4.The sartorius originates on the anterosuperior iliac spine of the pelvis and inserts on the anteromedial proximal tibia. It is one of the three tendons of the pes
anserine, along with the gracilis and semitendinosus.
46
Correct Answer: 4
Explanation
Physical therapists should be aware of the anticipated changes in vital signs from infancy to adulthood. Although there is consensus on the general direction of the change,
the magnitude of the change is highly variable depending on the resource consulted.
1.As a person moves from infancy to adulthood, body temperature values remain relatively constant.
2.As a person moves from infancy to adulthood, heart rate values will generally decrease. Therefore, a newborns heart rate will be higher than an adults heart rate.
3.As a person moves from infancy to adulthood, respiratory rate values will generally decrease. Therefore, a newborns respiratory rate will be higher than an adults
respiratory rate.
4.As a person moves from infancy to adulthood, blood pressure values will generally increase. Therefore, a newborns blood pressure will be lower than, not
higher than, an adults blood pressure.
47
Correct Answer: 4
Explanation
Gait deviations result from many factors including potential weakness of the affected muscle groups, diminished proprioception, impaired trunk control, decreased awareness
of the affected side, and limited range of motion.
1.Flaccidity refers to lacking firmness, resilience or muscle tone, and can be caused by disease or by trauma affecting the nerves associated with the involved muscles.
Flaccidity of the dorsiflexors would make it impossible for the patient to actively dorsiflex the foot which would make toe drag more likely.
2.Inadequate dorsiflexion range of motion would make it difficult and potentially impossible to actively dorsiflex the foot to the extent necessary to clear the toe.
3.Weakness of the dorsiflexors would make it difficult and potentially impossible to actively dorsiflex the foot to the extent necessary to clear the toe.
4.Spasticity is a muscle control disorder that is characterized by tight or stiff muscles. The condition can be caused by an imbalance of signals from the central
nervous system and is often found in patients with traumatic brain injury, stroke, and multiple sclerosis. Spasticity of the dorsiflexors would likely result in the
ankle assuming a dorsiflexed position, making toe drag less likely.
48
Correct Answer: 1
Explanation
Staging is the process of describing the extent to which a cancer has developed by spreading. Stage II cancer is characterized by an increased risk of metastasis due to the
size of the tumor. When treating a patient with cancer, it is important for therapists to be aware of modalities and physical agents that have the ability to cause cancer to
further metastasize.
1.The use of any deep heating agent (e.g., diathermy, ultrasound) is contraindicated over the site of a tumor in a patient with cancer. Deep heating agents increase
blood flow and have the potential to increase the spread of cancer. The relative proximity of the pectoralis major to the active site of cancer makes applying
ultrasound an inappropriate intervention.
2.Active cancer is not a contraindication for the use of cryotherapy. In patients who are undergoing radiation therapy, however, the therapist should use caution
to avoid applying the cold pack over dysvascular tissue or insensate skin.
3.Soft tissue manipulation over a malignant tumor should be avoided due to the potential for metastasis of the cancer. However, the suboccipital muscles are far
enough away from the active site of cancer that these techniques are unlikely to result in metastasis. Additionally, the suboccipital release technique uses a
relatively low level of force so that there would not be a significant increase in blood flow.
4.Taping techniques can be used in patients with shoulder pain to assist them with postural awareness. Active cancer is not a contraindication to the use of
taping.
49
Correct Answer: 1
Explanation
The results of the physical therapy examination should provide the physical therapist with the necessary information to generate a problem list and develop an appropriate
plan of care. Interventions incorporated into the plan of care should be appropriate to accomplish the established therapeutic goals. Oscillatory techniques can be graded on a
5-point scale. Grade I and II mobilizations are performed at the beginning of the available motion without actually reaching the limit of motion. Grade III and IV mobilizations
are performed up to or past the limit of available motion. Grade V oscillatory techniques are termed manipulations.
1.Grade III and IV joint mobilizations are performed primarily to stretch the joint capsule due to a capsular restriction. A restriction in the joint capsule would
result in decreased active and passive range of motion.
2.Decreased active range of motion and normal passive range of motion would more commonly be associated with muscle weakness.
3.Normal active range of motion and decreased passive range of motion would be relatively uncommon. Passive range of motion is often greater than or equal to
the active range of motion.
4.Decreased active range of motion and increased passive range of motion is not uncommon since passive range of motion is often greater than active range of
motion. If the decrease in active range of motion was associated with a capsular restriction, the patient would also exhibit a decrease in passive range of motion.
50
Correct Answer: 4
Explanation
The frequency used for ultrasound is either 1 MHz or 3 MHz and is determined based on the depth of tissue to be treated. For tissue up to 5 centimeters deep, 1 MHz is used.
For tissue 1-2 centimeters deep, 3 MHz is used.
1.The unit W/cm2 is a measurement of intensity, not frequency.
2.A frequency of 1 MHz would be used for treating deeper structures (up to 5 centimeters deep). However, the patella tendon is a superficial structure.
3.The unit W/cm2 is a measurement of intensity, not frequency.
4.A frequency of 3 MHz would be used for superficial structures (1-2 centimeters deep). This would be the appropriate parameter to use since the patellar tendon
is a superficial structure.
System: Non-Systems
51
Correct Answer: 1
Explanation
Nerve conduction velocity (NCV) tests can help detect lesions of a peripheral nerve via abnormalities in the speed of the electrical impulse. Neurapraxia is a class 1 nerve
injury that involves some local compression or blockage of the nerve. These injuries can be caused by trauma to or entrapment of the nerve.
1.A neurapraxia injury will result in either a slowing or cessation of the electrical conduction. It typically affects the nerve at the location in which it is being
compressed (i.e., from elbow to mid-forearm). Conduction above and below the blockage is usually normal.
2.While a neurapraxia injury will result in decreased NCV, it will not affect the nerve at points distal to the mid-forearm. This level of impairment would be more
likely with an axonotmesis or neurotmesis injury.
3.While complete loss of electrical conduction is a possible result of a neurapraxia injury, it would only affect the nerve in the area of the compression (i.e., from
elbow to mid-forearm).
4.Because the nerve is being compressed, the electrical conduction would be abnormal in some way, either slowed or absent.
52
Correct Answer: 3
Explanation
Heat intolerance is a symptom associated with discomfort and excessive sweating in hot or humid environments. With some medical conditions, hot temperatures can cause
an exacerbation of a patients symptoms. Physical therapists should be aware of the various medical conditions for which exercise in a hot environment is contraindicated.
1.Multiple sclerosis is a chronic inflammatory, demyelinating disease of the central nervous system. A common side effect of this condition is intolerance to hot environments,
therefore, patients with multiple sclerosis should avoid exercise in a heated pool.
2.Psoriasis is a chronic, inflammatory, but noninfectious dermatosis that is characterized by erythematous plaques on the skin. Patients with psoriasis often have difficulty
dissipating heat during exercise and therefore should avoid exercise in a heated pool.
3.Hypothyroidism is a deficiency of thyroid hormone that results in an overall slowing of the bodys metabolism. A common side effect of this condition is
intolerance to cold environments, therefore, patients with hypothyroidism would tolerate, and may even benefit from, an exercise program in a heated pool.
4.Graves disease is a common form of hyperthyroidism in which there is an excessive secretion of thyroid hormone resulting in an overall elevation of the bodys
metabolism. A common side effect of this condition is intolerance to hot environments, therefore, patients with Graves disease should avoid exercise in a heated
pool.
53
Correct Answer: 3
Explanation
There are numerous positional assessments of muscle length available to physical therapists. Recognition of abnormal patient postures can assist therapists to address
identified muscle length deficiencies as part of the established plan of care.
1.The clavicular portion of the pectoralis major originates on the anterior surface of the medial half of the clavicle and inserts on the lateral lip of the intertubercular groove of
the humerus. Insufficient muscle length of the clavicular portion of the pectoralis major would not result in the lateral border of the spine of the scapula being positioned above
the surface of the table.
2.The sternal portion of the pectoralis major originates on the anterior surface of the sternum and six costal cartilages and the aponeurosis of the external oblique muscle and
inserts on the lateral lip of the intertubercular groove of the humerus. Insufficient muscle length of the sternal portion of the pectoralis major would not result in the lateral
border of the spine of the scapula being positioned above the surface of the table.
3.The pectoralis minor originates on the third to fifth ribs near the costal cartilages and inserts on the medial border and superior surface of the coracoid process.
The relative tightness of the muscle is determined by the extent to which the shoulder is raised from the table and the amount of resistance felt to downward
pressure on the shoulder.
4.The latissimus dorsi originates on the external lip of the iliac crest and inserts on the intertubercular groove of the humerus. Shortening of the latissimus dorsi
often results in a limitation of shoulder flexion or abduction.
54
Correct Answer: 3
Explanation
Isokinetic testing can be used to provide a physical therapist with objective data on muscle strength and endurance. When performing isokinetic exercise, muscular
contraction is generated with a constant maximal speed and variable load. The reaction force is identical to the force applied to the equipment.
1.Maximum work repetition is the total work in the repetition with the highest torque. Maximum work is determined by multiplying the peak torque and the angular velocity in
the identified repetition. The measure is used to quantify muscular strength.
2.Peak torque is the highest point on the force velocity curve in the best repetition. In some cases, an individual will have to demonstrate a specified percentage (i.e., 80%) of
strength in the involved limb compared to the uninvolved limb prior to returning to limited activity. Peak torque is a measure of muscular strength.
3.Total work is a measure of the total work performed during all of the repetitions instead of simply the best repetition. Specifically the measure is determined by
multiplying the average torque and the angular velocity for all repetitions. Total work would be the best indicator of the patients readiness to return to work since
it examines both endurance and strength.
4.Work fatigue is often assessed by having a patient perform continuous repetitions until there is a 50% decrease in torque production or in some cases by the
percentage of decrease in torque over the length of the test. Work fatigue is a measure of muscular endurance.
55
Correct Answer: 2
Explanation
Twenty percent of pregnant women may experience median nerve symptoms because of compression of the median nerve as a result of fluid retention.
1.The patient does not have a history of a traumatic event (e.g., recent fall or accident) that would likely result in a capitate fracture.
2.Carpal tunnel syndrome is common during pregnancy since the increased fluid retention results in compression of the median nerve. Common symptoms
include numbness and tingling in the median nerve distribution. The symptoms most often gradually disappear after childbirth.
3.Ulnar nerve entrapment is typically symptomatic in the ring and little finger.
4.De Quervains syndrome affects the extensor pollicis brevis and abductor pollicis longus tendons. Patients experience pain resulting from thumb and wrist
motion, along with tenderness and thickening in the area of the radial styloid process.
56
Correct Answer: 3
Explanation
Medial epicondylitis (golfers or swimmers elbow) results from repeated microtrauma to the flexor carpi radialis and/or the humeral head of the pronator teres during pronation
and wrist flexion. Symptoms typically include pain with resisted wrist flexion and resisted pronation and point tenderness over the medial epicondyle. A forearm strap can be
used as a counterforce brace to promote healing by transferring forces to less affected areas of the musculature.
1.Applying the forearm strap distal to the origin of the common extensor tendon at the lateral epicondyle would be a more appropriate when treating lateral epicondylitis.
2.Applying the forearm strap proximal to the origin of the common extensor tendon at the lateral epicondyle would not be beneficial to treat medial or lateral epicondylitis since
the involved muscles originate distally to the forearm strap.
3.Applying the forearm strap distal to the origin of the flexor carpi radialis at the medial epicondyle would be the appropriate location when treating medial
epicondylitis. This action would allow the forearm strap to exert pressure over the area of the flexor carpi radialis and/or the humeral head of the pronator teres
which may distribute forces across a broader area.
4.Applying the forearm strap proximal to the origin of the flexor carpi radialis at the medial epicondyle would not be beneficial to treat medial or lateral
epicondylitis since the involved muscles originate distally to the forearm strap.
Resource: (Brody p. 710)
57
Correct Answer: 3
Explanation
Chronic obstructive pulmonary disease (COPD) is characterized by the presence of airflow obstruction that is typically secondary to chronic bronchitis or emphysema. A
formal exercise program is usually a component of the overall management of the disease process and is most often prescribed secondary to dyspnea and decreased
exercise capacity.
1.The frequency and intensity of the activity are appropriate for cardiovascular training for a patient diagnosed with COPD, however, the upper extremity ergometer would not
be as desirable as activities incorporating large muscles groups (i.e., legs).
2.The activity is appropriate for a patient with COPD, however, the frequency should fall between three to five times per week and the intensity of activity should approximate
11-13 RPE for cardiovascular training of this population.
3.Ambulation is an activity that effectively incorporates large muscle groups. The frequency and intensity of exercise fall within the parameters for cardiovascular
training of this population.
4.Aquatic therapy can incorporate activities emphasizing large muscle groups. The frequency falls within the desired parameters, however, the intensity exceeds
the recommended parameters for patients with COPD.
Resource: (Ehrman p. 381)
58
Correct Answer: 3
Explanation
In an autosomal dominant disorder, the mutated gene is a dominant gene located on one of the non-sex chromosomes (autosomes). A person with an autosomal dominant
disorder presents with a 50% probability of having an affected child with one mutated dominant gene and a 50% probability of having an unaffected child with two normal
recessive genes. Huntingtons disease, Marfan syndrome, myotonic dystrophy, and familial hypercholesterolemia are examples of autosomal dominant disorders.
1.Tay-Sachs disease is an autosomal recessive genetic disorder that causes a progressive degeneration of the central nervous system. It is caused by the absence of an
enzyme called hexosaminidase A. There is no cure for Tay Sachs and it is a terminal disease.
2.Cystic fibrosis (CF) is an autosomal recessive genetic disease of the exocrine glands that primarily affects the lungs, pancreas, liver, intestines, sinuses, and sex organs.
People who have CF inherit two faulty CF genes, one from each parent. A defective gene and its protein product cause the body to produce unusually thick, sticky mucus that
leads to life threatening lung infections, obstructs the pancreas, and inhibits normal digestion and absorption of food. CF is a terminal disease.
3.Huntingtons disease (HD) is a neurological disorder of the central nervous system characterized by degeneration and atrophy of the basal ganglia and cerebral
cortex within the brain. HD is genetically transmitted as an autosomal dominant trait. The disease is usually perpetuated by a person that has children prior to the
normal onset of symptoms. HD is a chronic progressive genetic disorder that is fatal within 15 to 20 years after clinical manifestation.
4.Duchenne muscular dystrophy (DMD) is a progressive neuromuscular degenerative disorder. The mutation of the dystrophin gene causes the symptoms of
DMD. The etiology is inherited as an x-linked recessive trait with the mother serving as the silent carrier. Since it is a recessive trait, only male offspring will
manifest the disorder while female offspring become carriers.
Resource: (Ratliffe p. 241)
59
Correct Answer: 3
Explanation
An incident report is a factual written summary of an adverse event designed to memorialize specific details of the event and to limit future liability of the organization.
Information obtained from the incident report is often used to guide risk management initiatives.
1.The incident report is not considered a legal document in the majority of states and is therefore not included as part of the patients medical record. The incident report is
designed to limit the occurrence of future risk and as a result, the completed document usually is given to the risk manager or risk management committee.
2.The therapist should only report factual information regarding the incident. The role of the involved parties may be further analyzed at a later date by the risk manager or risk
management committee.
3.The therapist should notify the risk manager or immediate supervisor about the incident. This step is an essential component of any incident reporting policy
and ensures that a predetermined chain of events occurs to effectively manage the incident.
4.A therapist should not attempt to identify the cause of the incident since this is the responsibility of the organizations risk manager or designated attorney. The
therapist should, however, reflect on the incident and analyze their own actions.
System: Non-Systems
60
Correct Answer: 4
Explanation
The Fugl-Meyer Assessment of Physical Performance (FMA) is a tool used to assess the motor recovery and motor behavior of a patient following a stroke. The assessment
is divided into several subsections that examine upper extremity function, lower extremity function, balance, sensation, range of motion, and pain.
1.The FMA includes reflex testing for both the upper and lower extremities. Reflex testing for the upper extremity includes the biceps and triceps reflexes.
2.The FMA includes finger-to-nose testing to assess the coordination of the upper extremities. The therapist should examine the speed of movement, the extent of dysmetria,
and the presence of tremor as part of this test.
3.The FMA includes several different assessments of balance. Seated balance without support is initially assessed, followed by bilateral and unilateral standing balance
assessments.
4.A patients strength will likely be affected following a stroke. However, strength testing is not one of the subsections of the FMA.
61
Correct Answer: 3
Explanation
The wound healing process occurs in four overlapping stages that include hemostasis, inflammation, proliferation, and maturation. These phases occur in a predictable
sequence and for specific durations for optimal healing. Factors that interfere with one or more of these phases of healing may lead to impaired tissue repair.
1.Hemostasis is the first phase of wound healing that occurs within minutes of tissue injury. This phase involves three stages, including vasoconstriction, platelet plug
formation, and coagulation, all of which are designed to stop blood loss. This phase is the shortest in duration and overlaps with the inflammatory phase.
2.The inflammatory phase is the second phase of wound healing and is characterized by the typical signs of inflammation: pain, swelling, heat, and redness. This phase is
designed to fight infection via antibodies, white blood cells, enzymes, and growth factors. This phase usually lasts up to four days after the initial injury. Though the scenario
describes a patient with swelling and pain, the patient would not typically be in the inflammatory phase ten days after the injury.
3.The proliferative phase is the third phase of wound healing. In this phase, the wound begins to rebuild with the formation of new granulation tissue. This phase
begins at the end of the inflammatory phase and lasts up until 21 days after the initial injury. The described scenario likely depicts a patient that is in the
proliferative phase of healing.
4.The maturation phase is the fourth (and last) phase of wound healing. This phase involves remodeling of the wound and scar and can last up to two years after
the initial injury.
62
Correct Answer: 3
Explanation
Pain located in the hip may originate from the hip, sacroiliac joint, lumbar spine or any adjacent soft tissue structures. Physical therapists should conduct a thorough
examination to determine the source of a patients hip pain.
1.A femoral neck fracture is a common traumatic injury that occurs secondary to falls, especially in elderly females. A patient with a femoral neck fracture would likely have
severe pain with active movement of the hip. Depending on the location and severity of the fracture, the leg may appear to be shorter. However, the hip would not likely attain
a position of adduction and medial rotation secondary to this injury.
2.A fall may result in a traumatic injury to the sacroiliac joint. Abnormal positioning of this joint can result in small discrepancies in leg length, however, this injury would not
cause the hip to attain an adducted and medially rotated position.
3.Hip dislocation commonly occurs secondary to a fall and results in severe pain and abnormal positioning of the hip. Posterior dislocations of the hip are far
more common than anterior dislocations. A posterior hip dislocation often results in the limb assuming a position of flexion, adduction, and medial rotation. The
abnormal positioning of the hip causes the limb to appear shorter than the contralateral side.
4.Anterior dislocations are far less common than posterior dislocations. Depending on the exact location of dislocation, the hip may be extended or flexed. An
anterior dislocation typically results in the limb assuming a position of lateral rotation, not medial rotation.
63
Correct Answer: 1
Explanation
The tibial nerve is a branch of the sciatic nerve that supplies the muscles of the posterior lower leg (i.e., plantar flexors). The plantar flexors work eccentrically to control
dorsiflexion during midstance and concentrically to propel the body forward during terminal stance and preswing.
1.Weakness of the plantar flexors would result in decreased toe off during the terminal stance and swing phase of gait. Because the patient would have decreased
forward propulsion, the step length on the contralateral side would be shortened.
2.Vaulting occurs when the patient goes up on their toes on the stance leg so that the swing leg can clear the ground. This deviation is more commonly seen in
patients with a leg length discrepancy or those who are trying to avoid toe drag on the contralateral limb.
3.Foot slap occurs when the dorsiflexors are unable to eccentrically control the relative plantar flexion that occurs after initial contact. This deviation is most
commonly due to weakness or paralysis of the dorsiflexors.
4.Toe drag is a deviation that occurs during the swing phase of gait. This deviation is most commonly caused by an inability to perform flexion at the hip, knee,
and/or ankle joints. An inability to flex at these joints results in the swing leg, and thus the foot, not clearing the ground.

64
Correct Answer: 2
Explanation
Subacromial calcium deposits reduce the space between the acromion and head of the humerus. Depending on the size, these deposits may damage the supraspinatus
tendon during shoulder mobility leading to tendonitis or tearing.
1.Various agents may be utilized for anti-inflammatory applications of iontophoresis including hydrocortisone and dexamethasone. The polarities of these two agents are
positive and negative, respectively.
2.The use of acetic acid with iontophoresis is typically utilized to assist in softening abnormal calcium deposits so that they may be more easily re-absorbed by
the body. The polarity of acetic acid is negative.
3.The application of iontophoresis with zinc oxide may be utilized to facilitate tissue repair and wound healing. The polarity of zinc oxide is positive.
4.Various agents may be utilized to reduce pain with iontophoresis including salicylate and lidocaine. The polarities of these two agents are negative and positive,
respectively.
System: Non-Systems
65
Correct Answer: 4
Explanation
When selecting a specific type of splint, there are a number of variables that need to be carefully considered. These variables include location, level of acuity, tone, range of
motion, and therapeutic objective.
1.A serial splint is a form of corrective splint utilized to immobilize a joint in order to increase range of motion while correcting a deformity such as a soft tissue contracture. The
information provided does not indicate that the patient has a restriction in range of motion.
2.A dynamic splint typically includes a spring or elastic component utilized to exert force on a joint. This force may be utilized to facilitate passive or assisted movement of a
joint or to resist movement in the direction opposite the line of pull. Dynamic splints are not typically indicated when treating acute conditions.
3.A functional splint is typically utilized to support, protect, and stabilize a joint during specific activities (e.g., holding a writing or eating utensil) in order to improve efficiency
and functional performance of a task. A functional splint is a viable option to assist the patient while working, however, the patients level of acuity and the intensity of pain
makes this option less desirable at the present time.
4.A resting splint is typically utilized to maintain a joint in an appropriate position during an acute exacerbation of symptoms allowing the joint to rest while
limiting the risk of contracture development. A resting splint would be the most appropriate option given the patients level of acuity and the intensity of the pain.
66
Correct Answer: 1
Explanation
Hypotonia is characterized by abnormally low resistance to passive stretch. Hypotonia is thought to be caused by a disruption in afferent input from the stretch receptors.
Another possible cause is a decrease in the cerebellums ability to provide a facilitatory influence on the motor system. Muscles may feel abnormally soft and flaccid and deep
tendon reflexes may be diminished.
1.Pathology of the cerebellum is primarily characterized by motor impairments that affect the ability to perform accurate, smooth, controlled movements.
Examples of these impairments include ataxia, asthenia, dysarthria, dysdiadochokinesia, dysmetria, hypotonia, nystagmus, and tremor.
2.Patients with traumatic brain injury often have abnormalities in tone, though they more likely will demonstrate hypertonia. These patients typically exhibit
spasticity or rigidity (e.g., decorticate, decerebrate).
3.Patients with a basal ganglia disorder often demonstrate motor deficits which may include slowness of movement, extraneous movements or alterations in
posture and muscle tone. These patients tend to exhibit rigidity (e.g., leadpipe, cogwheel) as opposed to hypotonia. Other impairments include athetosis, chorea,
bradykinesia, dystonia, hemiballismus, and tremor.
4.Huntingtons disease is a basal ganglia disorder that is primarily characterized by choreiform movements. As stated before, these patients are more likely to
exhibit hypertonia (i.e., rigidity).
67
Correct Answer: 3
Explanation
The patella tendon bearing (PTB) socket is designed as a total contact socket to allow for maximum distribution of the load. The socket has a substantial indentation over the
area of the patella tendon and is aligned into slight flexion to enhance weight bearing on the patellar tendon. A SACH (solid ankle cushion heel) foot is a non-articulated foot
assembly that offers limited ankle motion.
1.Inadequate suspension is typically not an issue with a PTB socket. A patient may have supracondylar suspension built into the socket or may use a cuff or strap to ensure
that movement within the prosthesis is not problematic.
2.Since the SACH foot is a non-articulated assembly, it is not possible that the foot would exhibit excessive ankle motion. This may be more evident in an articulated foot with
multiple axes if the bumpers or other components of the joint begin to fail.
3.Limited ankle motion is the greatest expected limitation of a patellar tendon bearing prosthesis with a SACH foot. A SACH foot does not allow for medial-lateral
motion and provides a limited amount of plantar flexion during early stance.
4.The pylon typically allows for only minimal adjustment in order to improve comfort and the fluidity of gait. For example, with a PTB prosthesis, the pylon aligns
with the socket creating slight flexion to enhance weight bearing on the patellar tendon. The pylon alignment would not provide the greatest limitation during
gait, even if there was some malalignment present.
68
Correct Answer: 4
Explanation
There are several types of sensation that a physical therapist will evaluate including superficial, deep (proprioceptive), and combined cortical sensations. Superficial
sensations include temperature, light touch, and pain. Deep sensations include proprioception, kinesthesia, and vibration. Combined cortical sensations include bilateral
simultaneous stimulation, stereognosis, two-point discrimination, barognosis, and localization of touch.
1.Superficial sensations are typically evaluated first. If there is impairment found within the superficial sensations, the therapist can expect impairment of the deep and
combined cortical sensations as well. The superficial sensation of light touch must be sufficiently intact in order to perform reliable testing of stereognosis and other combined
cortical sensations. The presented image does not relate to testing of superficial sensations.
2.Deep sensations such as kinesthesia, proprioception, and vibration are all closely related, however, should be tested individually. Testing includes position matching,
identification and extent of movement, and perceiving vibratory sensation. The presented image does not relate to testing of deep sensations.
3.Proprioceptive sensations is synonymous with deep sensations and would not be tested as shown in the presented image.
4.Combined cortical sensations are interpretative sensory functions that require superficial and deep sensations to be intact in order to reliably measure cortical
sensation. Stereognosis is a combined cortical sensation that allows for the identification of a common object solely through touch. In this particular example,
the patient would have intact stereognosis if she was able to identify that the object in her hand was a pencil.
69
Correct Answer: 1
Explanation
A seated row is a common upper extremity exercise performed with the patient positioned in long sitting. The patient pulls the handles toward the chest while maintaing an
erect position of the torso. After achieving a position where the hands touch the patients side, the patient slowly allows the elbows to extend and returns to the starting
position.
1.The biceps brachii originates on the coracoid process of the scapula and supraglenoid tubercle of the scapula and insert on the radial tuberosity and bicipital
aponeurosis. The biceps brachii acts to flex the elbow and supinate the forearm. The muscle is not active during the seated row exercise and would be more
active in exercises emphasizing elbow flexion and forearm supination.
2.The latissimus dorsi originates on the external lip of the iliac crest and inserts on the intertubercular groove of the humerus. The latissimus dorsi acts to
adduct, extend, and medially rotate the arm. The muscle assists the shoulder to extend during the seated row exercise.
3.The posterior deltoid originates on the inferior lip of the posterior border of the spine of the scapula and inserts on the deltoid tuberosity of the humerus. The
posterior deltoid acts to extend and abduct the shoulder. The muscle assists the shoulder to extend during the seated row exercise.
4.The rhomboids originate on the nuchal ligaments and spinous processes of the C7-T5 vertebrae and insert on the medial border of the scapula. The rhomboids
act to adduct and rotate the scapula downward. The muscle assists the scapula to adduct during the seated row exercise.
Resource: (Coburn p. 298)
70
Correct Answer: 1
Explanation
The zygapophyseal joints are synovial joints covered with hyaline cartilage between the superior articular process of one vertebra and the inferior articular process of the
vertebra directly above it. There are two facet joints involved in each spinal segment.
1.Cervical flexion is characterized by the upper facets sliding up and anteriorly on the lower facets. This action serves to open the joint.
2.Cervical extension is characterized by the upper facets sliding down and posteriorly on the lower facets. This action serves to close the joint.
3.Cervical sidebending is characterized by the upper facet sliding down and posteriorly on the side towards the movement. The facet on the side opposite the
movement moves up and anteriorly.
4.Cervical rotation is characterized by the upper facet sliding down and posteriorly on the side towards the movement. The facet on the side opposite the
movement moves up and anteriorly.
71
Correct Answer: 2
Explanation
Primitive and tonic reflexes are normally present during infancy and are gradually integrated throughout early development by the central nervous system. Physical therapists
should be familiar with the stimulus, response, and age of integration of common pediatric reflexes.
1.The crossed extension reflex requires a noxious stimulus to the ball of the foot with the extremity fixed in extension. The reflex is tested in the supine position. The normal
response is flexion of the test leg while the contralateral leg extends and adducts. The onset of the reflex is 28 weeks of gestation and integration occurs at 1-2 months.
2.The flexor withdrawal reflex requires a noxious stimulus to the sole of the foot (i.e., pin prick). The reflex can be tested in a supine or sitting position. The
normal response is toe extension, ankle dorsiflexion, and uncontrollable flexion of the entire leg. The onset of the reflex is 28 weeks of gestation and integration
occurs at 1-2 months.
3.The positive support reflex requires contact to the ball of the foot in upright standing. The normal response is rigid extension of the lower extremities with the
trunk moving into extension. The onset of the reflex is at birth and integration occurs at 2 months.
4.The protective extension reflex requires displacement of the center of gravity outside the base of support. The normal response is the arms or legs extend and
abduct to protect the body against falling. The onset of the reflex is 4-6 months for the arms and 6-9 months for the legs. The reflex persists throughout life.
72
Correct Answer: 3
Explanation
Metabolic bone disorders are a group of disorders characterized by abnormalities of bone growth and/or density. Often, these conditions are caused by abnormalities in
mineral levels (e.g., vitamin D, calcium, phosphorus, magnesium). These disorders include osteoporosis, osteopenia, osteomalacia, rickets, and Pagets disease.
1.Osteopenia is a condition characterized by low bone mineral density and is considered a precursor to osteoporosis, which is characterized by a more significant loss of bone
mineral density. Though osteopenia is a condition in which bones become less dense, they would not appear larger in size on an x-ray.
2.Osteomalacia is a condition characterized by a softening of the bones secondary to a vitamin D deficiency. This deficiency results in a reduced rate of bone
formation. Though an x-ray may reveal bones that are less dense, they would not appear larger in size.
3.Pagets disease is a condition characterized by inflammation of the bones that causes abnormal bone remodeling. Bone is resorbed and formed at an increased
rate and in a disorganized fashion. This results in bones that are larger, less dense, more vascular, and more prone to fracture.
4.Rickets is a condition similar to osteomalacia in which there is softening of the bones. Due to this defect, an x-ray would show bowing of the long bones, as
well as widening of the bones at the metaphyseal ends. Though the bones may appear larger in certain areas, rickets is not the best answer since it is a condition
primarily seen in children.
Resource: (Goodman Differential Diagnosis p. 442)
73
Correct Answer: 2
Explanation
Salter-Harris fractures are epiphyseal fractures involving the growth plate. The growth plate is a hyaline cartilage plate in the metaphysis at each end of a long bone. SalterHarris fractures are relatively common in children and potentially problematic since they can result in premature closure of the growth plate and therefore limb shortening or
abnormal growth. There are nine types of Salter-Harris fractures with type II accounting for nearly 75% of the reported fractures.
1.A comminuted fracture is an unstable fracture characterized by two or more fragments of bone.
2.An epiphyseal fracture is a fracture of the epiphysis or growth plate. This type of fracture is especially common in children since the growth plates are the last
portion of the bone to ossify. This type of injury is often classified using the Salter-Harris classification scale.
3.A hairline fracture is characterized by minimal trauma to the bone and surrounding soft tissue. The fracture is considered an incomplete fracture with no
significant bone displacement. The fracture is considered to be stable.
4.An impaction fracture occurs when one fragment of bone is driven into another. The most common impaction fracture is a tibial plateau fracture in adults.
74
Correct Answer: 2
Explanation
A maximal exercise test is performed under a strict protocol in a performance lab. A formal protocol is used with specific increases in the speed and intensity of exercise while
the volume and oxygen concentration of inspired and expired air is measured. Although a maximal exercise test is considered the gold standard for measuring aerobic
capacity, the utility of the test is limited in many individuals whose performance may be limited by pain or fatigue rather than exertion. A variety of submaximal exercise tests
have been developed to meet the needs of individuals with various functional limitations and disabilities.
1.Maximal exercise testing and submaximal exercise testing can be used effectively to assist physicians to make a medical diagnosis. For example, the Bruce Treadmill Test
is a submaximal exercise test designed to diagnose coronary heart disease.
2.Maximal exercise testing is the only method to determine maximum oxygen consumption. Submaximal exercise testing can only be used to predict maximum
oxygen consumption.
3.Maximal exercise testing and submaximal exercise testing can be used to assess the effectiveness of medical interventions. For example, the Six-Minute Walk
Test is a submaximal exercise test that can be used to determine a patients functional exercise capacity initially and at some future point following the
established medical intervention.
4.Maximal exercise testing and submaximal exercise testing can be used effectively to measure the effects of pharmacological agents. For example, the Rockport
Fitness Test can be used to estimate maximum oxygen consumption across a range of age groups and fitness levels. The effect of medication on the exercise
response can be examined by reviewing the obtained results.
Resource: (American College of Sports Medicine p. 341)
75
Correct Answer: 1
Explanation
The dosage measured in mA-min is determined by multiplying the current amplitude by the duration of treatment.
1.A current amplitude of 2.5 mA with a treatment time of 20 minutes would result in a dosage of 50 mA-min.
System: Non-Systems
76
Correct Answer: 4
Explanation
Isokinetic testing can be used to provide a physical therapist with objective data on muscle strength and endurance. When performing isokinetic exercise muscular contraction
is generated with a constant maximal speed and variable load. The velocity of muscle shortening during concentric exercise is inversely proportional to the force exerted by
the muscle.
1.A value of 75 ft-lbs of force at 60 degrees per second is approximately 63 percent of the 120 ft-lbs generated at 240 degrees per second. The amount of force would
increase when moving to a slower speed since velocity and force are inversely related with isokinetic exercise.
2.A value of 105 ft-lbs of force at 60 degrees per second is approximately 88 percent of the 120 ft-lbs generated at 240 degrees per second. The amount of force would
increase when moving to a slower speed since velocity and force are inversely related with isokinetic exercise.
3.A value of 135 ft-lbs of force at 60 degrees per second is 13 percent greater than the 120 ft-lbs generated at 240 degrees per second. The amount of force would typically
increase by significantly more than 13% when moving from 240 to 60 degrees per second.
4.A value of 165 ft-lbs of force at 60 degrees per second is 38 percent greater than the 120 ft-lbs generated at 240 degrees per second. The amount of force would
typically increase by approximately 40% when moving from 240 to 60 degrees per second.
77
Correct Answer: 1
Explanation
Cystic fibrosis is an inherited disease characterized by abnormal salt transport. Cystic fibrosis affects every organ system that has epithelial surfaces. Advances in treatment,
including aerosolized antibiotics, mucus-thinning agents, anti-inflammatory medications, chest physical therapy, enzyme supplements, and nutrition programs, have helped to
extend the average life expectancy for patients with cystic fibrosis.
1.The most prominent symptoms in cystic fibrosis relate to pulmonary and pancreatic (i.e., gastrointestinal) involvement. Abnormal salt transport results in
mucus accumulation in various organs. In the lungs, failure to clear secretions causes the small airways to become obstructed and can result in infection. In the
pancreas, mucus accumulation blocks the exocrine ducts and results in pancreatic insufficiency.
2.Patients with cystic fibrosis will not typically experience impairments of the cardiovascular system.
3.Patients with cystic fibrosis will not typically experience impairments of the urinary system, though males with this condition often have impairments of the
reproductive system.
4.Patients with cystic fibrosis will not typically experience impairments of the integumentary system. While the patient may have salty tasting skin, there is not
typically any pathology of the skin.
78
Correct Answer: 4
Explanation
Injury to motor nerves can result in a variety of symptoms including muscle atrophy, weakness, fasciculation or paralysis. Injury to sensory nerves can result in pain,
numbness, sensitivity, tingling or burning.
1.The axillary nerve (C5-C6) originates from the posterior cord of the brachial plexus at the level of the axilla. The nerve innervates the deltoid, teres minor, and long head of
the triceps brachii muscles.
2.The long thoracic nerve (C5-C7) descends behind the brachial plexus and the axillary vessels. The nerve innervates the serratus anterior muscle.
3.The spinal accessory nerve (C3-C4) innervates the sternocleidomastoid and trapezius muscles. The nerve is the eleventh of twelve cranial nerves.
4.The suprascapular nerve (C5-C6) originates from the upper trunk of the brachial plexus. The nerve innervates the infraspinatus and supraspinatus muscles.
79
Correct Answer: 2
Explanation
Bilateral carpal tunnel syndrome, caused by compression of the median nerve in the carpal tunnel, is a common finding with a variety of systemic conditions, especially with
metabolic and endocrine disorders. Most patients are diagnosed between 35 and 55 years of age, with a greater prevalence in women.
1.Rheumatoid arthritis is a systemic condition that can potentially cause bilateral carpal tunnel syndrome, secondary to the chronic inflammation in the joints. However, the
patients age and gender makes the development of carpal tunnel syndrome less likely.
2.Diabetes is a systemic condition that can potentially cause bilateral carpal tunnel syndrome. Most patients with carpal tunnel syndrome are females between
the ages of 35 and 55. Women near the age of menopause are especially prone to this condition due to hormonal changes that affect the soft tissues at the wrist.
3.Carpal tunnel syndrome is a compression of the median nerve, therefore, surgery affecting the ulnar nerve would not increase the risk for carpal tunnel
syndrome. Additionally, the patients gender makes the development of carpal tunnel syndrome less likely.
4.Though osteoporosis increases the likelihood of wrist fractures, which could lead to carpal tunnel syndrome, the condition itself is not directly related to carpal
tunnel syndrome. Additionally, the patients age makes the development of carpal tunnel syndrome less likely.
80
Correct Answer: 1
Explanation
Nystagmus is abnormal eye movement that entails nonvolitional, rhythmic oscillation of the eyes. The speed of movement is faster in one direction than the other direction. A
patient with nystagmus often experiences vertigo, nausea, and oscillopsia (movement of objects viewed). There are multiple forms of nystagmus based on the underlying
etiology.
1.Central nystagmus is either bidirectional or unidirectional, presents with mild vertigo, and may be chronic. Central nystagmus occurs with a central lesion of the
brainstem/cerebellum and is not inhibited by visual fixation on an object.
2.Peripheral nystagmus is unidirectional and incorporates slow and fast phases. There is typically significant vertigo with symptoms that may last minutes to
weeks, however, the time period is finite. Peripheral nystagmus occurs with a peripheral vestibular lesion and is inhibited by visual fixation on an object.
3.Positional nystagmus is induced by a change in head position. The semicircular canals stimulate the nystagmus that typically lasts only a few seconds.
4.Spontaneous nystagmus is caused by an imbalance of vestibular signals to the oculomotor neurons. This causes a constant drift in one direction that is
countered by a quick movement in the opposite direction. Spontaneous nystagmus typically occurs after an acute vestibular lesion and lasts approximately 24
hours.
81
Correct Answer: 4
Explanation
Buoyancy is a property of water defined as the upward force that works opposite to gravity. The principle of buoyancy is significant in physical therapy because it can provide
relative weightlessness to patients experiencing joint-related pain or patients with weight bearing restrictions.
1.A patient submerged to their knees in the pool would be approximately 75% weight bearing.
2.A patient submerged to the anterior superior iliac spines would be approximately 50% weight bearing.
3.A patient submerged to the xiphoid process would be approximately 33% weight bearing. Though this option is closest to the 20% weight bearing figure, it still exceeds the
restrictions set by the doctor.
4.A patient submerged to the C7 vertebra would be approximately 10% weight bearing. This option most closely meets the weight bearing restrictions without
exceeding them.
82
Answer: 1
Explanation
Restrictive lung conditions are characterized by a decrease in lung volumes and capacities, though airflow rates remain unchanged. Restrictive lung disease may result from
pathology of any system in the body that causes a decrease in chest wall or lung compliance. Decreased compliance results in a diminished ability to expand the lungs
resulting in smaller lung volumes and capacities.
1.Asthma is a chronic inflammatory disease of the airways that is triggered by a variety of stimuli. When an individual comes into contact with these stimuli,
widespread narrowing of the airways occurs and restricts airflow. Because of the obstruction of the airways, asthma is considered an obstructive lung disease.
2.Pulmonary edema, fluid within the lungs, is a possible cardiovascular cause of restrictive lung disease. With fluid in the alveoli and interstitial spaces, lung
compliance decreases.
3.A spinal cord injury is a possible neuromuscular cause of restrictive lung disease. Paralysis or paresis of the inspiratory and expiratory muscles results in
decreased chest wall compliance.
4.Ankylosing spondylitis, a chronic inflammatory disease of the spine, is a possible musculoskeletal cause of restrictive lung disease. The inflammatory process
results in immobility within the vertebral joints, leading to decreased compliance of the chest wall.
83
Correct Answer: 3
Explanation
A steppage gait occurs as a form of compensation for weakness or paralysis of the dorsiflexor muscles. A patient with a steppage gait tends to excessively flex the hip and
knee in an effort to clear the foot.
1.A steppage gait involves weakness of the dorsiflexors and therefore would not result in instability at the knee. As a result, the use of a KAFO would not be warranted.
2.A steppage gait involves weakness of the dorsiflexors and therefore would not result in instability at the hip and knee. As a result, the use of a HKAFO would not be
warranted.
3.An AFO is the most appropriate intervention to address dorsiflexor weakness and prevent toe drag/foot drop.
4.A knee immobilizer is not indicated for dorsiflexor weakness. Knee immobilizers are often prescribed post-operatively to protect the operated limb until
quadriceps strength improves.
System: Non-Systems
84
Correct Answer: 1
Explanation
The coordination examination generally focuses on movement capabilities in five different areas: reciprocal or alternate motion, movement composition or synergy, movement
accuracy, fixation or limb holding, and postural stability. Many of these movement capabilities can be assessed by examining a patients gait.
1.Dysmetria is the inability to judge the distance or range of a movement. A patient with dysmetria would be unable to judge the length of their steps during gait,
thus they would have difficulty placing their feet on floor markers while ambulating.
2.Dysdiadochokinesia is the impaired ability to perform rapid alternating movements. A patient with dysdiadochokinesia would be unable to alter speed while
ambulating since it requires a rapid change in the movement of the limbs. A patient with bradykinesia (i.e., decreased amplitude and velocity of movement) may
also demonstrate this impairment.
3.Dysdiadochokinesia is the impaired ability to perform rapid alternating movements. A patient with dysdiadochokinesia would be unable to alter direction while
ambulating since it requires a rapid change in the movement of the limbs. A patient with bradykinesia (i.e., decreased amplitude and velocity of movement) may
also demonstrate this impairment.
4.Bradykinesia is a decreased amplitude and velocity of voluntary movement. It may be demonstrated as decreased arm swing and trunk motion during gait, slow
and shuffling gait, difficulty initiating or changing direction of movement or difficulty stopping a movement once begun.
85
Correct Answer: 1
Explanation
A visual analogue scale is a tool used to assess pain intensity using a 10-15 cm line with the left anchor indicating no pain and the right anchor indicating the worst pain you
can have. The level of perceived pain is indicated on the line and is reassessed frequently over the course of physical therapy to qualify changes in the pain level and to
assess progress.
1.The left anchor of a visual analogue pain scale is often described as no pain, pain free or the absence of pain.
2.Mild pain is defined as not acute or serious. The term mild pain would be more appropriately used on a verbal descriptor scale where a patient may be asked to
point to a term that best matches their pain (e.g., slight pain, mild pain, moderate pain, severe pain).
3.Weak pain is characterized as not strong or lacking force. This would correspond to a rating on the lower portion of the visual analogue scale, but would not be
used as an anchor definition.
4.Faint pain is characterized as lacking strength or vividness. This would correspond to a rating slightly above the visual analogue scales left anchor.
86
Correct Answer: 3
Explanation
A pleural effusion is an extrapulmonary restriction that impairs lung expansion and reduces pulmonary ventilation, causing restrictive lung disease. Restrictive lung disease is
characterized by a reduction in lung volumes due to impaired lung expansion. Patients with restrictive lung disease present with decreased chest mobility, decreased breath
sounds, shortness of breath, hypoxemia, a rapid and shallow breathing pattern, respiratory muscle weakness, ineffective cough, and increased use of accessory muscles.
1.Vital capacity is the maximum volume of air that a person can expel from the lungs after a maximum inhalation (VC = IRV+TV+ERV). Vital capacity is reduced in patients
with restrictive lung disease since inspiratory capacity (IC = IRV+TV) is decreased.
2.Total lung capacity is the volume of air in the lungs following a maximal inhalation. Total lung capacity tends to be reduced in patients with restrictive lung disease since the
lungs ability to expand and take air in is impaired.
3.In patients with restrictive lung disease all lung volumes are decreased without reducing airflow since patients have normal airway resistance. FEV1/FVC would
most likely be unaffected since measurements of expiratory flow tend to be preserved in patients with restrictive lung disease.
4.Inspiratory capacity (IC = IRV+TV) will be reduced in patients with restrictive disorders since the lungs ability to take in air is impaired.
87
Correct Answer: 2
Explanation
Practice refers to repeated performance of an activity in order to learn or perfect a skill. Physical practice allows for direct physical experience and kinesthetic stimulation to
assist with acquisition of the skill. Mental practice is the cognitive rehearsal of a task or experience without any physical movement.
1.Distributed practice occurs when the amount of rest time between trials is equal to or is greater than the amount of practice time for each trial. This type of practice allows
the patient to receive adequate rest and avoids fatigue which may result in greater risk of injury.
2.Massed practice occurs when the practice time per trial is greater than the amount of rest between trials. This type of practice can place a patient at greater risk
of injury due to motor fatigue that can result from increased practice time.
3.Constant practice occurs with practice of a given task under a uniform condition. In this scenario, a task becomes extremely predictable (i.e., rote) and
therefore the relative safety risk does for the patient not increase.
4.Variable practice occurs with practice of a given task under differing conditions. This model increases the ability to adapt and generalize the learning process,
however, it does not significantly increase the safety risk since the task itself remains the same.
Resource: (Shumway-Cook p. 36)
88
Correct Answer: 2
Explanation
Muscle testing is often a standard component of an examination and can be useful for both differential diagnosis and the treatment of musculoskeletal and neuromuscular
conditions. Physical therapists should be aware of standard methods of assessing muscle strength and interpreting the results. Manual muscle testing grades range from zero
(0/5) to normal (5/5) based on the ability to move a body segment through range with and without varying levels of resistance.
1.The latissimus dorsi is tested with the patient in a prone position. The test arm is extended at the shoulder. The therapist provides pressure against the forearm in the
direction of abduction and slight flexion of the arm.
2.The lower trapezius is tested with the patient in a prone position. The test arm is abducted at the shoulder to approximately 150 degrees with slight lateral
rotation with the elbow extended. The therapist provides pressure against the forearm in a downward direction.
3.The pectoralis major is tested with the patient in a supine position. The test arm is flexed to 90 degrees at the shoulder with slight medial rotation and elbow
extension. Pressure is applied against the forearm in the direction of horizontal abduction.
4.The upper trapezius is tested with the patient in a sitting position. The shoulder is elevated with lateral flexion of the head and neck with the head rotated away
from the side being tested. The therapist provides pressure by placing one hand on the shoulder and the other hand on the head, directing pressure to reduce
the approximation of the head and the shoulder.
Resource: (Kendall p. 330)
89
Correct Answer: 4
Explanation
An extension lag at the knee is characterized by greater passive knee extension range of motion than active knee extension range of motion. The difference in the passive
and active extension range of motion values is used to quantify the amount of the lag. Common causes of an extension lag are muscle weakness, inhibition by pain or
apprehension.
1.The physical therapist was able to passively move the patients knee from 90 degree of knee flexion to 15 degrees of knee flexion. If the the patient was able to actively
move the knee from 90 degrees of knee flexion to 5 degrees of hyperextension, the active motion would be greater than the passive motion and there would not be an
extension lag.
move the knee from 90 degree of knee flexion to 10 degrees of knee flexion, the active motion would be greater than the passive motion and there would not be an extension
lag.
move the knee from 90 degree of knee flexion to 15 degrees of knee flexion, the active motion would be equivalent to the passive motion and there would not be an extension
lag. The patient would have a deficit in knee extension range of motion, however, this would not constitute an extension lag since the active and passive motion are the same.
4.The physical therapist was able to passively move the patients knee from 90 degree of knee flexion to 15 degrees of knee flexion. If the the patient was able to
actively move the knee from 90 degree of knee flexion to 25 degrees of knee flexion, the passive motion would be greater than the active motion and the patient
would exhibit a 10 degree extension lag.
90
Correct Answer: 1
Explanation
Gouty arthritis is a condition characterized by excess uric acid in the blood that results in the formation of crystals within the joints, which triggers a painful inflammatory
response. Gouty arthritis can affect any of the joints in the body, though it commonly affects the peripheral joints of the lower extremities.
1.A high intake of meat and seafood has been associated with an increased risk of developing gouty arthritis, whereas a high intake of low-fat dairy products and
vitamin C have been associated with a decreased risk of developing the condition. Modification of a patients diet is effective in preventing the onset of the
condition or controlling the symptoms in the long term, though it would not be effective in controlling an acute exacerbation.
2.Intraarticular injection of corticosteroids is a common treatment for acute exacerbations of gouty arthritis. Corticosteroids help relieve the symptoms of gout by
decreasing inflammation and pain.
3.The use of a knee immobilizer may be indicated for the treatment of an acute exacerbation of gouty arthritis. The immobilizer allows the joint to be rested and
protected to prevent further exacerbation during the acute phase. Use of an assistive device (e.g., crutches) may also be indicated.
4.Administration of anti-inflammatory medications is a common treatment for acute exacerbations of gouty arthritis. Anti-inflammatory medications help relieve
the symptoms of gout by decreasing inflammation and pain.
91
Correct Answer: 2
Explanation
The Tinetti Performance Oriented Mobility Assessment (POMA) is a tool used to screen patients and identify if there is an increased risk for falling. The tool is scored from 0-2
for each criteria with a maximum score of 12. The tool has a combined maximum total of 28 with the risk of falling increasing as the total score decreases. A total score less
than 19 indicates a high risk for a fall.
1.The Functional Reach test is a single task screening tool used to assess standing balance and risk of falling. A person is required to stand upright with a static base of
support. A yardstick is positioned to measure the forward distance that a patient can reach without moving the feet. Three trials are performed and averaged together. A
patient that falls below the age appropriate range for functional reach has an increased risk for falling.
2.The first section of the Tinetti Performance Oriented Mobility Assessment (POMA) assesses balance through sit to stand and stand to sit from an armless chair,
immediate standing balance with eyes open and closed, tolerating a slight push in the standing position, and turning 360 degrees. The second section assesses
gait at normal speed and at a rapid, but safe speed. Items scored in this section include initiation of gait, step length and height, step asymmetry and continuity,
path, stance during gait, and trunk motion.
3.The Berg Balance scale is a tool designed to assess a patients risk for falling. There are fourteen tasks, each scored on an ordinal scale from 0-4. These tasks
include static activities, transitional movements, and dynamic activities in sitting and standing positions. The maximum score is a 56 with a score less than 45
indicating an increased risk for falling. This tool can be used as a one-time examination or as an ongoing tool to monitor a patient who may be at risk for falls.
4.The Timed Get Up and Go test is a functional performance screening tool used to assess a persons level of mobility and balance. The person initially sits in a
supported chair with a firm surface, transfers to a standing position, and walks approximately 10 feet. The patient must then turn around without external support,
walk back towards the chair, and return to a sitting position. The patient is scored based on amount of postural sway, excessive movements, reaching for
support, side stepping or other signs of loss of balance. Patients who are independent can complete the multi-task process in 10 seconds or less. Patients that
require 30 seconds or more are at a high risk for a fall.
92
Correct Answer: 1
Explanation
A ramp cannot have a grade greater than 8.3%. This grade is equivalent to one inch of rise for every 12 inches of run. Ramp width must be at least 36 inches and must not
exceed a rise of 30 inches in any single run.
1.One inch of rise and twelve inches of run (8.3% grade) reflects the maximum grade of a ramp.
2.One inch of rise and nine inches of run (11.1% grade) exceeds the maximum grade of a ramp.
3.One inch of rise and six inches of run (16.7% grade) exceeds the maximum grade of a ramp.
4.One inch of rise and three inches of run (33.3% grade) exceeds the maximum grade of a ramp.
Resource: (Minor p. 20)
System: Non-Systems
93
Correct Answer: 1
Explanation
The quadrilateral socket was the design of choice for a patient status post transfemoral amputation until the late 1980s. The total contact design of the quadrilateral socket
allows for primary weight bearing through the flat posterior shelf. The anterior-posterior dimension of the socket tends to be more narrow than the medial-lateral dimension.
1.Typically, the quadrilateral socket produces a wide base of support that results in a Trendelenburg gait towards the prosthetic side. The quadrilateral socket
aligns the femur into abduction as opposed to the adduction angle that exists normally. The wide medial-lateral dimension allows the socket to displace laterally
during midstance and tends to decrease the efficiency of the gluteus medius muscle.
2.Circumduction of the prosthesis during swing phase often results from actual excessive length of the prosthesis or a functional leg length discrepancy due to
inadequate prosthetic fit. Factors that can result in this type of deviation include inadequate suspension of the socket, excessive length of the prosthesis or a
prosthetic knee unit that is locked in extension or set with excessive resistance to knee flexion.
3.Knee instability at heel strike on the prosthetic side can result from factors including prosthetic foot alignment that is set into excessive dorsiflexion, a stiff
SACH heel, weak hip extensors or shortening of the hip flexors.
4.Vaulting on the non-prosthetic side is a compensation used in order to provide clearance of the prosthetic limb during swing phase. The patient will plantar flex
the non-prosthetic foot during stance in order to clear the prosthetic limb. Factors that result in this deviation are similar to those identified with circumduction.
94
Correct Answer: 3
Explanation
Coronary artery disease is a condition characterized by a narrowing or blockage of the coronary arteries. Risk factors for coronary artery disease include age, cigarette
smoking, sedentary lifestyle, obesity, hypertension, dyslipidemia, and prediabetes.
1.The probability of developing coronary artery disease increases with age, however, females are at less relative risk than males. A sedentary lifestyle increases the relative
risk of developing coronary artery disease.
2.Females are at less relative risk than males for developing coronary artery disease. The established risk threshold for women is equal to or greater than 55 years.
Individuals with high density lipoprotein levels less than 40 mg/dl increases the relative risk of developing coronary artery disease.
3.Males are at more relative risk than females for developing coronary artery disease. The established risk threshold for males is equal to or greater than 45 years.
Individuals with a total serum cholesterol of greater than 200 mg/dl increases the relative risk of developing coronary arter y disease.
4.Males are at more relative risk than females for developing coronary artery disease. Obesity increases the relative risk for developing coronar y artery disease,
2
however, a body mass index of 26 kg/m is considered overweight, not obese.

95
Correct Answer: 3
Explanation
The Lachman test is a special test used to determine anterior instability of the knee secondary to an ACL tear. Despite its relatively high level of sensitivity, there are still
several reasons that false-negatives can occur when the Lachman test is being performed.
1.The Lachman test is performed with 20-30 degrees of knee flexion, therefore the patient would not need to flex the knee to 90 degrees. The anterior drawer test, however, is
performed at 90 degrees of flexion. Patients that have an acute ACL injury may have difficulty assuming this position which is one of the reasons why the anterior drawer test
is less desirable than the Lachman test.
2.The presence of a posterior cruciate ligament (PCL) tear would not limit positive findings for the Lachman test. A combined ACL/PCL injury would typically allow for greater
sagittal plane instability and therefore would make a positive finding for the Lachman test more likely.
3.Protective muscle guarding commonly occurs following any acute injury. Spasm of the hamstrings would limit extension of the knee and anterior translation of
the tibia on the femur. The therapist may get a negative Lachman test when in fact an ACL tear is present (i.e., false negative).
4.Spasm of the quadriceps would be more likely to affect flexion of the knee and posterior translation of the tibia on the femur. This would be more likely to
impact tests which assess posterior instability of the knee.
96
Correct Answer: 1
Explanation
Duchenne muscular dystrophy (DMD) is a progressive neuromuscular degenerative disorder that results from a mutation of the dystrophin gene. Symptoms of DMD manifest
once fat and connective tissue begin to replace muscle that has been destroyed in the disease process. DMD occurs in childhood and progresses rapidly to affect cardiac
muscle and respiratory muscles in the later stages of the disease.
1.Over time children with Duchenne muscular dystrophy develop a restrictive pulmonary disorder that results in weakness and contracture of the respiratory
muscles. These impairments lead to diminished ventilation and an inability to mobilize secretions which can cause pulmonary complications such as pneumonia
and in severe cases, death. Scoliosis is also a common complication that contributes to ventilatory impairment and improper positioning. By the age of 18, it is
likely that this patient is no longer ambulatory, making respiratory compromise more likely.
2.In children with Duchenne muscular dystrophy the ability to ambulate deteriorates up to the ages of ten to twelve years secondary to progressive muscle
weakness. Most children with Duchenne muscular dystrophy do not ambulate past the age of twelve.
3.It is more likely in the later stages of Duchenne muscular dystrophy that the student will be dependent with transfers using a mechanical lift or a sliding board. It
is possible that if joint mobility and postural alignment have been maintained over time that a stand pivot transfer can be performed with assistance, however, it
is not the most likely for the student at this stage of the disease.
4.As the disease progresses, the goals of therapy include range of motion, prevention of contracture/deformity, positioning, pain management, breathing
exercises, postural drainage, and the use of wheelchair or adaptive equipment. Given the degenerative course of the disease, strength gains are not expected and
progressive resistive exercises are not indicated for this patient.
97
Correct Answer: 4
Explanation
Physical therapists should possess a thorough understanding of the typical clinical presentation of a variety of medical conditions. This knowledge should include the age of
onset of symptoms.
1.Phenylketonuria is an autosomal recessive condition in which a mutation occurs in a gene responsible for breaking down the amino acid phenylalanine. Symptoms will
typically present within a few months of birth as the phenylalanine accumulates. If left untreated, severe mental retardation will occur.
2.Spina bifida is a developmental abnormality due to insufficient closure of the neural tube by the 28th day of gestation. This defect usually occurs in the low thoracic, lumbar
or sacral regions and affects the central nervous, musculoskeletal, and urinary systems. Symptoms associated with spina bifida include motor loss below the level of the
defect in the spinal cord, sensory deficits, and hydrocephalus. Symptoms are typically apparent at birth or shortly thereafter.
3.Tay-Sachs disease is an autosomal recessive inherited trait characterized by the absence or deficiency of hexosaminidase A. At approximately six months of age, the child
will start to miss developmental milestones and will continue to deteriorate in motor and cognitive skills. As symptoms progress, the patient develops significant mental
retardation and paralysis, and will usually die by the age of five.
4.Wilson's disease is an autosomal recessive inherited trait that produces a defect in the body's ability to metabolize copper. The copper accumulates over time
within the brain, liver, cornea, kidney, and other tissues. Symptoms do not typically appear until four to six years of age.

98
Correct Answer: 3
Explanation
Bed rest results in a number of significant central and peripheral changes in the cardiovascular system. Physical therapists must be aware of these changes and carefully
monitor relevant objective and subjective data during patient care sessions.
1.Stroke volume refers to the volume of blood ejected by each contraction of the left ventricle. Prolonged bed rest results in decreased inflow into the left ventricle which
results in decreased stroke volume. Some of the change in stroke volume can be attributed to a decrease in plasma volume during bed rest which decreases left ventricular
filling pressure.
2.Cardiac output refers to the amount of blood pumped from the left or right ventricle per minute. It is equal to the product of stroke volume and heart rate. Cardiac output
decreases with prolonged bed rest since the increased heart rate cannot fully compensate for the decreased stroke volume.
3.Maximal and submaximal heart rate increase with prolonged bed rest. The increase is believed to be a result of increased sensitivity of beta-adrenergic cardiac
receptors and increased sympathetic secretion of norepinephrine.
4.Maximum oxygen consumption (VO2max) is generally considered the best indicator of cardiorespiratory endurance and aerobic fitness. Maximum oxygen
consumption decreases with prolonged bed rest, however, the magnitude of the change is dampened because of the compensatory increase in maximal and
submaximal heart rate.
Resource: (Nyland p. 14)
99
Correct Answer: 1
Explanation
Sundowning is a term used to describe disorientation, agitation or general worsening of mental symptoms that occur specifically at dusk or nightfall. Sundowning is extremely
common among individuals with dementia. It is thought to be associated with impaired circadian rhythm, environmental factors, stress, and impaired cognition.
1.Light therapy or the exposure to bright lights, may reduce some sundowning symptoms, especially when used in combination with exercise and proper
nutrition. Light therapy may change the patient's circadian rhythm resulting in patients with dementia becoming less agitated and confused.
2.Naps during daytime hours are discouraged for patients that exhibit sundowning. Instead patients are encouraged to increase their activity level during the day
to promote fatigue and the ability to sleep at night. Activity assists to alleviate some of the symptoms of sundowning.
3.Patients with sundowning are encouraged to increase their general activity level in order to promote fatigue and the ability to sleep at night.
4.Patients that experience sundowning should participate in planned activities in order to reduce the likelihood of behavioral disruptions, including agitation.
Patients should be mentally engaged during the day whenever possible and adhere to a structured daily schedule in order to avoid the effects of sundowning.
100
Correct Answer: 3
Explanation
An oropharyngeal airway is a semicircular, minimally flexible, curved piece of hard plastic. When inserted the device extends from outside the lips, over the tongue and into
the pharynx. The device is used to maintain airway patency in an unconscious patient.
1.Coughing diminishes the probability of an airway obstruction by removing secretions. As a result, an inability to cough increases the likelihood of oral airway use.
2.Excessive drooling results in an increased amount of fluid in the patients mouth. As a result, the abnormal amount of fluid increases the likelihood of oral airway use.
3.The gag reflex assists patients to independently clear the airway. The presence of an increased gag reflex would not increase the likelihood of oral airway use
since the individual would readily exhibit the gag response which would assist to clear the airway.
4.Labored breathing is a sign of some type of respiratory difficulty. Any impairment in the respiratory system can impair a patients ability to clear the airway. As a
result, labored breathing increases the likelihood of oral airway use.
101
Correct Answer: 1
Explanation
Cerebral palsy is a term used to define upper motor neuron deficits that occur in the perinatal period. Spastic diplegia is a type of cerebral palsy in which the lower limbs are
more involved than the upper limbs. The lower limbs will tend to be weaker and present with spasticity.
1.The childs foot will be in a position of increased plantar flexion due to the shortened Achilles tendons. The child is most likely to hyperextend the knee in an
attempt to drive the heel into the ground and achieve a foot flat position.
2.It is unlikely that the child will compensate with excessive knee flexion since this would result in the heel traveling further from the ground, increasing the
degree of plantar flexion.
3.The Achilles tendons are shortened bilaterally, resulting in increased plantar flexion at the ankle. The child will not be able to achieve excessive dorsiflexion
because of the shortened position of the Achilles tendons.
4.The child may circumduct the leg when ambulating because of the increased plantar flexion at the ankles in order to clear the foot, however, the deviation would
not be performed with the goal of achieving a foot flat position.

102
Correct Answer: 2
Explanation
A patient with an amputation should utilize a wheelchair that has adaptations specific to the amputation in order to allow for safe and effective propulsion and wheelchair
management.
1.A lowered seat may be more appropriate to facilitate mobility for patients with hemiplegia. This is often necessary to allow the patient to assist with propulsion using the
unaffected lower extremity.
2.Patients with lower extremity amputations require adjustment of the rear wheel axle posteriorly to widen the base of support of the chair and compensate for the
loss of lower extremity weight.
3.Patients that have unilateral upper extremity strength typically require a one arm drive that allows both wheels to be propelled from one side of the wheelchair.
4.A semi-reclining or fully reclining wheelchair is not typically used for a patient status post amputation since the patient does not have sufficient weight
anteriorly secondary to the amputation.
System: Non-Systems
103
Correct Answer: 2
Explanation
Multiple sclerosis is characterized by demyelination of the myelin sheaths that surround the nerves within the brain and spinal cord. These patches of demyelination decrease
the efficiency of nerve impulse transmission. Symptoms of multiple sclerosis vary based on the location and the extent of demyelination.
1.Lesions within the corticospinal tract present with signs and symptoms of upper motor nerve involvement including paresis, spasticity, exaggerated tendon reflexes,
involuntary flexor and extensor spasms, clonus, Babinskis sign, exaggerated cutaneous reflexes, and loss of precise autonomic control.
2.Lesions in the cerebellar tracts can result in ataxia, postural and intention tremors, hypotonia, and truncal weakness.
3.Lesions within the frontal lobe can result in cognitive impairments including impaired attention and concentration, slowed processing, impaired short-term
memory, and impaired executive functioning.
4.Lesions within the spinothalamic tract can result in sensory deficits and neuropathic pain.
104
Correct Answer: 3
Explanation
An appropriately designed exercise program for a patient with end stage renal disease has the potential to improve quality of life, endurance, and functional abilities. The
individuals clinical condition and response to exercise provides the most essential information when determining the specific parameters of exercise.
1.Autonomic dysfunction may limit maximal age-predicted heart rate by as much as 20-40 beats per minute in patients with end stage renal disease. As a result, it is more
appropriate to monitor exercise intensity using a rate of perceived exertion scale.
2.Administering a formal exercise stress test prior to initiating exercise is not typically necessary prior to administering an exercise program for a patient with end stage renal
disease. Muscle fatigue typically limits the testing procedures necessary for formal exercise testing and therefore the data generated is of limited value.
3.General exercise guidelines for patients with end stage renal disease include exercise four to six times per week at low intensities. Research demonstrates that
individuals who exercise on dialysis and non-dialysis days have greater improvements in exercise tolerance and peak VO 2max.
4.Progressively increasing the duration of exercise is desirable for patients with end stage renal disease, however, 60-90 minutes is excessive. A duration of 30
minutes is a more realistic goal.
105
Correct Answer: 3
Explanation
Primitive reflexes are normally present during infancy and are integrated by the central nervous system at an early age. Infants with abnormal reflex activity may have
movement difficulties and subsequent delays in the normal developmental progression.
1.The palmar grasp reflex is elicited by placing an object (e.g., a finger) across the infants palm. If the reflex is present, the infants fingers will flex around the object. Grasping
is not necessary for the infant to be able to breastfeed.
2.The Moro reflex is elicited by allowing the infants head to suddenly change position in relation to the trunk, such as the head dropping into extension. If the reflex is present,
the infant will first extend and abduct the arms, followed by flexing and adducting the arms across the chest. A change in head position would not occur while the infant is
breastfeeding.
3.The rooting reflex is elicited by stroking the cheek of the infant. If the reflex is present, the infant will open their mouth and turn their head towards the side of
the stimulus. When breastfeeding, the touch of the mothers breast to the infants cheek stimulates the infant to turn the head and begin feeding.
4.The symmetrical tonic neck reflex is elicited with flexion or extension of the head. If the reflex is present, the infant will flex the arms and extend the legs when
the head is in flexion. If the head is in extension, the infant will extend the arms and flex the legs. The absence of this reflex would not affect the infants ability to
breastfeed.

106
Correct Answer: 1
Explanation
Physical therapists routinely have to multi-task, however, as part of this process therapists need to be able to prioritize the importance of selected activities.
1.Pre-operative instruction most often occurs in close proximity to a scheduled surgical procedure. As a result, delaying the pre-operative instruction may result
in the patient not receiving the necessary instruction or the surgery being delayed or cancelled.
2.It is important to document exercise activities using a flow sheet or other suitable tracking form, however, the activity can be deferred without immediate
consequence.
3.It is important to submit all order forms for equipment or other devices in a timely manner. This need is particularly important in todays health care
environment due to the reduced length of stay. Despite the importance, this would not supersede the need to complete the pre-operative instruction.
4.The physical therapist should read and, if necessary, respond to the note from the staff dietician, however, this would not supersede the need for the direct
patient care activity.
Resource: (Code of Ethics)
107
Correct Answer: 3
Explanation
Degenerative diseases of the central nervous system can affect gray matter and/or white matter and are characterized by the slow deterioration of body functions that are
controlled by the brain and spinal cord. Knowledge of the pathology of a specific disease can assist the therapist to identify relevant clinical symptoms.
1.The pathology of Parkinsons disease consists of destruction of the dopamine-producing cells within the basal ganglia.
2.The pathology of Huntingtons disease is not definitive, however, often consists of tissue changes within the brain including atrophy of the basal ganglia and enlargement of
the ventricles.
3.The pathology of amyotrophic lateral sclerosis primarily consists of destruction of the motor neurons in the anterior horn cells of the spinal cord. Degeneration
of motor cells may also be present in the brainstem and cerebral cortex.
4.The pathology of multiple sclerosis consists of axonal demyelination and sclerotic plaques found throughout the brain and spinal cord.
108
Correct Answer: 3
Explanation
Total hip precautions refer to the mobility limitations patients are asked to adhere to in order to decrease the risk of joint dislocation following total hip arthroplasty (THA). The
specific length of time patients are asked to observe these precautions may vary depending on the surgeon and rehabilitation outcomes.
1.Patients who have undergone a posterior approach THA are advised not to adduct their surgical limb past midline. While sleeping on the right side without a pillow for lower
extremity support may increase the risk of adducting beyond midline, the patient is unlikely to to do so while sleeping on the affected left side.
2.Patients are advised not to flex the hip beyond 90 degrees. Depending on the patients balance, standing to don pants may increase the risk of falling. However, with regard
to THA precautions, this activity can be performed with the assistance of a reaching device to avoid excessive hip flexion.
3.Patients are advised not to flex the hip beyond 90 degrees. Patients must understand that this also applies to a flexed hip position resulting from forward trunk
flexion. The combined effect of the elevated lower extremity position and the trunk flexion required to reach the shoe laces would likely exceed the recommended
range of motion.
4.Patients are advised not to internally rotate the hip joint and are often advised not to cross the legs in any way. However, resting the left foot on the right knee
while sitting in a reclined position involves hip abduction and external rotation and therefore does not specifically place the patient at risk.
System: Non-Systems
109
Correct Answer: 4
Explanation
The patellofemoral joint is formed by the convex patella and the concave trochlear groove of the femur. The patella slides superiorly in knee extension and inferiorly in knee
flexion. Often when using open chain kinetic exercise therapists allow exercise from 40-90 degrees since the increased surface contact between the patella and the femur
helps to disperse patellofemoral joint reaction forces.
1.At 0 degrees of knee flexion the patella is not in direct contact with the femur and instead rests on the supratrochlear fat pad.
2.At 30 degrees of knee flexion the inferior aspect of the patella contacts the uppermost portion of the femoral condyles and contact begins between the lateral femoral
condyle and the lateral facet of the patella. The amount of contact area on the patella at 30 degrees of knee flexion is approximately 2.0 cm2.
3.At 60 degrees of knee flexion the area of patella contact increases and shifts from inferior to superior. The amount of contact area on the patella at 60 degrees of knee
flexion is approximately 3.1 cm2.
4.At 90 degrees of knee flexion all portions of the patella have experienced some form of contact with the femur with the exception of the odd facet. The amount
2
of contact area on the patella at 90 degrees of knee flexion is approximately 4.7 cm .

110
Correct Answer: 2
Explanation
Postural drainage is a passive technique in which the patient is placed in positions that allow gravity to help drain retained secretions from the lungs. The goal of treatment is
to mobilize the secretions from the smaller, peripheral segments to the larger, more central airways. Several of the techniques require Trendelenburg (head down) positioning,
which may be contraindicated in certain patient populations (e.g., patients with uncontrolled hypertension).
1.To treat the apical segments of the upper lobes, the patient is positioned in sitting.
2.To treat the posterior segments of the lower lobes, the patient is positioned prone in the Trendelenburg position. Because of the patients uncontrolled
hypertension, the treatment position would have to be modified. Leaving the head of the bed flat would be an appropriate modification to the standard treatment
procedure.
3.To treat the anterior segment of the right upper lobe, the patient is positioned in supine, flat on the treatment table.
4.To treat the superior segment of the lower lobes, the patient is positioned in prone, flat on the table.
Resource: (Frownfelter p. 315)
Your 111
Correct Answer: 2
Explanation
Congenital torticollis is a condition that causes the neck to involuntarily unilaterally contract to one side secondary to contraction of the sternocleidomastoid muscle. The head
is laterally flexed toward the contracted muscle while the chin faces the opposite direction. A physical therapy plan of care for a patient with congenital torticollis includes
patient and caregiver education, passive stretching, active strengthening, positioning, and modalities.
1.Duchenne muscular dystrophy is a progressive disorder caused by the absence of the gene required to produce the muscle proteins dystrophin and nebulin. This results in
cell membranes weakening, destruction of myofibrils, and loss of muscle contractility. A physical therapy plan of care for a patient with Duchenne muscular dystrophy often
includes passive stretching and is more likely to restrict resistive exercise.
2.Down syndrome (trisomy 21) is a genetic abnormality consisting of an extra twenty-first chromosome due to an error in cell division. An important clinical
manifestation of Down syndrome is atlantoaxial instability that exists secondary to general hypotonicity and laxity of soft tissue structures. As a result, passive
stretching of the head and neck is often contraindicated.
3.Juvenile rheumatoid arthritis is a common chronic rheumatic disease in children that results in inflammation of the joints and connective tissues. A physical
therapy plan of care for a patient with juvenile rheumatoid arthritis often includes passive and active range of motion, however, during exacerbations there may
be a precaution to stretching.
4.Cystic fibrosis is an inherited disease that affects the ion transport of the exocrine glands resulting in impairment of the hepatic, digestive, respiratory, and
reproductive systems. In addition to cardiopulmonary rehabilitation, a physical therapy plan of care for a patient with cystic fibrosis often includes general
exercise and stretching to optimize overall function.
Resource: (Campbell p. 300)
112
Correct Answer: 4
Explanation
The likelihood ratio (i.e., odds ratio) is a measure of the odds of an event happening in one group compared to the odds of the same event happening in another group.
Likelihood ratios provide physical therapists with estimates of how well examination procedures measure what they are intended to measure (i.e., the presence or absence of
a medical condition).
1.A likelihood ratio of 0.8 indicates a minimal decrease in the likelihood of disease. The similarity of 0.8 to 1.0 (i.e., no change in the likelihood of disease) makes the 0.8 value
relatively unimportant.
2.A likelihood ratio of 1.0 indicates that there is no change in the likelihood of disease. Stated differently, the true positive and false positive rates are the same.
3.A likelihood ratio of 2.8 indicates a small increase in the likelihood of disease.
4.A likelihood ratio of 10.4 indicates a large and often conclusive increase in the likelihood of disease.
System: Non-Systems
113
Correct Answer: 1
Explanation
Thoracic outlet syndrome occurs when there is neurovascular compromise to fibers of the brachial plexus, subclavian vascular supply, and/or the axillary artery. The Allen test
is commonly utilized for patients with thoracic outlet syndrome. Symptoms of thoracic outlet syndrome include diffuse pain in the arm, sensory changes in the fingers and
throughout the upper extremity, muscle wasting and weakness, edema, and discoloration.
1.Poor posture including rounded shoulders and a forward head position contributes to thoracic outlet syndrome by shortening the soft tissue structures in the
neck and upper chest. Postural modification is one of the initial physical therapy interventions to address thoracic outlet syndrome.
2.The soft tissue structures of the upper chest, including the pectoralis minor and pectoralis major muscles, are more likely to be shortened in a patient with
thoracic outlet syndrome. As a result, stretching the pectoralis minor and pectoralis major muscles is likely to be more beneficial.
3.The rhomboids are typically stretched and weakened in a patient with thoracic outlet syndrome due to rounded shoulders and a forward head posture. As a
result, strengthening the muscles of the upper back including the rhomboids, trapezius, and levator scapulae is likely to be more beneficial.
4.Iontophoresis introduces ions into the body through the skin by means of continuous direct current. Iontophoresis is typically not used in the treatment of
thoracic outlet syndrome, however, can be used to treat inflammation, muscle spasm, pain, and myositis ossificans.
114
Correct Answer: 1
Explanation
Patients with chronic venous insufficiency often experience ulcer formation in the lower extremities secondary to chronic edema and fluid stasis. Treatment often consists of
some form of compression therapy to help move fluid from the periphery back to the heart. For patients with mixed disease (i.e., venous and arterial insufficiency), special
treatment considerations must be made.
1.Ankle pumps in supine would be the most appropriate intervention for this patient since the patient has both venous and arterial insufficiency. Active movement
of the ankle helps move fluid back to the heart via the muscle pump mechanism. The supine position is appropriate since dependent positioning will have a
negative effect on the patients level of edema, while positioning in elevation will have a negative effect on the patients arterial insufficiency.
2.Retrograde massage is an appropriate intervention for helping to reduce edema in the lower extremity. However, having the patient positioned with the leg
elevated would be problematic. Arterial insufficiency makes it more difficult for blood to reach the distal lower extremities, thus the patient would likely
experience pain with the leg elevated due to lack of blood flow.
3.Use of a pneumatic compression device is a precaution for patients with mixed disease. Though it would help clear fluid from the lower extremity, the
compression would also decrease the arterial systems ability to move blood to the distal lower extremity. This is particularly relevant in a patient with a history of
arterial insufficiency.
4.While active movement uses the muscle pump mechanism to move fluid from the periphery back to the heart, a patient ambulating on a treadmill may actually
experience an increase in edema due to the dependent positioning. Additionally, this level of activity will likely result in intermittent claudication secondary to the
presence of arterial insufficiency.
Resource: (Frownfelter p. 508)
115
Correct Answer: 2
Explanation
Custom compression garments are utilized with severe burns that are at risk for developing hypertrophic scarring. The compression facilitates smooth scar formation by
promoting a balance between the mechanisms of collagen lysis and synthesis. Compression garments also help to support circulation to damaged areas.
1.15 mm Hg is an inadequate amount of compression to facilitate the desired scar remodeling.

2.25 mm Hg is within the typical range of compression recommended for custom garments used to facilitate scar remodeling following a significant burn.
Compression garments are typically used with deep partial-thickness and full-thickness burns and worn 23 hours per day. Garments should be replaced every
three to six months.
3.45 mm Hg is an excessive amount of compression to be worn consistently over the healing area of a burn. Too much compression may compromise healing by
causing unnecessary shear forces and impaired circulation in areas of healing tissue.
4.55 mm Hg is an excessive amount of compression to be worn consistently over the healing area of a burn. Too much compression may compromise healing by
causing unnecessary shear forces and impaired circulation in areas of healing tissue.
116
Correct Answer: 2
Explanation
Nerve conduction velocity (NCV) testing involves stimulation of motor or sensory nerves to determine the speed of electrical conduction. Any superficial peripheral nerve can
be tested. Commonly tested nerves include the ulnar, median, fibular, tibial, radial, femoral, sciatic, and sural nerves. Results from NCV testing can help healthcare providers
determine if there is pathology of a specific nerve.
1.While age of the patient will have an effect on NCV, gender has not been shown to have a significant effect.
2.Age and temperature are the two most influential factors for NCV. At birth, the NCV is half of the eventual adult value. NCV decreases slightly after age 35, and
shows significant differences after age 70. Lower temperatures also decrease NCV. The skin temperature should be at least 35 degrees Celsius (95 degrees
Fahrenheit) for the upper extremity or 32 degrees Celsius (90 degrees Fahrenheit) for the lower extremity for the NCV testing to be considered valid.
3.While age of the patient will have an effect on NCV, ethnicity has not been shown to have a significant effect.
4.While temperature of the limb will have an effect on NCV, gender has not been shown to have a significant effect.
117
Correct Answer: 3
Explanation
It is important for a physical therapist to collect as much information as possible about a patients present pain. Information related to the type of pain, location, frequency,
duration, and pattern can be extremely useful when engaging in differential diagnosis activities.
1.Acromioclavicular joint arthritis would be more likely to present with pain in the superior shoulder region. The patient usually reports increased pain with active movement
especially when attempting to move the affected arm across their chest since this motion compresses the acromioclavicular joint. The condition is common in patients who are
long term weightlifters or who perform a great deal of overhead work.
2.Biceps tendinitis would be more likely to present with pain in the anterior shoulder region. Patients generally report the feeling of a deep ache directly in the front or
sometimes on top of the shoulder. The ache may spread down into the biceps muscle and is usually made worse with overhead activities or lifting heavy objects. Resting the
shoulder typically reduces the pain.
3.Cervical radiculopathy would be the most likely to present with pain in the posterior shoulder region. This often occurs due to loss of cervical lordosis with
paravertebral muscle spasm. The increased muscular activity often produces tenderness and pain in the posterior neck and shoulder region. The pain may also
extend into the arm or even the chest. Despite the variable presentation of pain, cervical radiculopathy is the most likely condition of the listed options to produce
pain in the posterior shoulder region.
4.A rotator cuff tear would be more likely to present with pain in the anterior shoulder region or in the arm. The patient usually presents with pain with palpation of
the musculotendinous junction of the involved muscle and/or with stretching or resisted contraction of the muscle. Pain often increases at night resulting in
difficulty sleeping on the affected side.
118
Correct Answer: 2
Explanation
A variety of physical conditions can result in increased tone. Hypertonia is often observed in upper motor neuron disorders involving the pyramidal and extrapyramidal tracts.
Hypertonia can present as either spasticity or rigidity.
1.Irradiation refers to the overflow or spread from stronger to weaker muscles.

2.Reciprocal inhibition describes when a muscle on one side of a joint is stimulated while the muscle on the opposing side of the joint is inhibited. Stated
differently, facilitation of the agonist results with simultaneous inhibition of the antagonist. In the presented scenario, the presence of the extensor tone does not
allow the extensors to relax or lengthen which inhibits the ability of the flexors to contract.
3.Successive induction refers to an increased response of the agonist resulting after contraction of its antagonist.
4.Rhythmic initiation is a facilitation technique that begins with voluntary relaxation followed by passive movement through increments in range. This is followed
by active-assistive movements progressing to resisted movements.
119
Correct Answer: 2
Explanation
Pulse pressure is calculated by taking the systolic blood pressure and subtracting the diastolic blood pressure. Elevated pulse pressures (greater than 60 mm Hg) are
associated with higher cardiovascular morbidity and mortality rates.
1.A pulse pressure of 30 mm Hg would be approximately 10 mm Hg less than the typical pulse pressure. This value is slightly lower than the anticipated value and would not
be associated with higher cardiovascular morbidity and mortality.
2.A pulse pressure of 40 mm Hg is consistent with the typical pulse pressure in a healthy adult population. A systolic blood pressure of 120 mm Hg and a
diastolic blood pressure of 80 mm Hg would result in a pulse pressure of 40 mm Hg (120 mm Hg - 80 mm Hg).
3.A pulse pressure of 80 mm Hg would be approximately 40 mm Hg greater than the typical pulse pressure and would be associated with higher cardiovascular
morbidity and mortality. 80 mm Hg would be more consistent with the anticipated diastolic blood pressure of an adult.
4.A pulse pressure of 120 mm Hg would be approximately 80 mm Hg greater than the typical pulse pressure and would be associated with higher cardiovascular
morbidity and mortality. 120 mm Hg would be more consistent with the anticipated systolic blood pressure of an adult.
120
Correct Answer: 2
Explanation
Although specific rehabilitation protocols may vary slightly based on the size of the tear and the surgeons preferences, a physical therapist should possess knowledge of
rehabilitative activities that are appropriate for the various phases of a generalized post-operative progression.
1.Active shoulder range of motion is typically deferred for at least one month following the repair of a large rotator cuff tear. Shoulder isometric exercises may be performed
with the shoulder in a neutral position either with or without use of a sling for additional positional support.
2.Active range of motion at the elbow and wrist as well as grip strength exercises are desirable post-operatively to assist in limiting disuse atrophy. Many of these
exercises are performed with the upper extremity comfortably supported in a sling. Shoulder pendulum exercises are typically among the first interventions
introduced to a patient following a rotator cuff repair.
3.Passive shoulder range of motion is typically included in the early phases of post-operative rotator cuff repair protocols. Although scapular stabilization is an
important component of rehabilitation, resisted exercises targeting these muscles would likely require some degree of resisted shoulder mobility which is
typically contraindicated at such an early stage of healing.
4.Passive shoulder range of motion is typically included in the early phases of post-operative rotator cuff repair protocols. Resisted shoulder exercises
emphasizing internal and external rotation are not appropriate based on the patients post-operative status.

121
Correct Answer: 1
Explanation
Adhesive capsulitis refers to an inflammation and adherence of the articular capsule of the shoulder. The condition is more common in women than in men and tends to
appear in the fourth, fifth, and sixth decades of life.
1.Adhesive capsulitis is characterized by adherence of the articular capsule resulting in limited joint play and restricted active and passive movement, most often
in a capsular pattern. The patients primary limitation in motion (i.e., lateral rotation and abduction) is consistent with the capsular pattern of the glenohumeral
joint.
2.Bicipital tendonitis refers to an inflammatory process involving the long head of the biceps. Symptoms include aching in the front or on top of the shoulder that
is usually made worse with overhead activities or lifting heavy objects. Bicipital tendonitis would not typically result in a limitation of motion.
3.Symptoms associated with a rotator cuff tear typically occur immediately following a specific incident instead of in a gradual fashion. A rotator cuff tear
produces limitations in strength, but not necessarily limitations of motion.
4.Subacromial bursitis refers to the inflammation of the bursa which lies between the acromion and the head of the humerus. Symptoms are consistent with
impingement and include pain with subsequent weakness and stiffness. Subacromial bursitis does not typically result in a limitation of motion.
122
Correct Answer: 4
Explanation
Reliability is the extent to which a measure is free from error. It can be thought of as reproducibility or dependability. Estimates of reliability depend on the type of reliability
including: test-retest reliability, rater reliability, alternate forms reliability, and internal consistency. This question assesses the reproducibility of goniometric measurements by
two different individuals, therefore, refers to intertester reliability.
1.Alternate forms reliability refers to the degree to which two or more versions of a test or measurement are considered to be equivalent or parallel. Because goniometric
measurement is the only form of measurement in this example, alternate forms reliability is not applicable.
2.Internal consistency reflects the degree to which different items or questions on questionnaires, written examinations, and interviews, for example, measure the same
characteristic and nothing else. Because goniometric measurement is not an item or question on a written test or questionnaire, internal consistency is not applicable
3.Intratester reliability is the extent to which one tester can obtain the same measurement on multiple occasions of measuring the same variable. Because two different
individuals measured elbow flexion with a goniometer, intratester reliability is not applicable.
4.Intertester reliability is the extent to which two or more individuals obtain the same measurement for a given variable, which is applicable in this case.
123
Correct Answer: 3
Explanation
The amount of drainage and the color of the drainage from a chest tube are important variables for the physical therapist to monitor. A change with either variable could signify
fresh bleeding, infection, empyema or a variety of other medical conditions.
1.A hemothorax refers to an accumulation of blood or fluid in the pleural cavity between the chest wall and lung. A hemothorax could potentially produce a significant amount
of drainage.
2.Open chest surgery would likely produce a significant amount of drainage. The color of the drainage would initially be bright red and gradually become more serous.
3.A pneumothorax refers to a collapse of the lung caused by a collection of air in the pleural space. Drainage from a pneumothorax is generally limited to small
amounts of fluid caused by trauma associated with insertion of the chest tube.
4.The amount of drainage associated with trauma is highly variable based on the severity of the actual incident. Trauma often produces a hemothorax which can
result in significant amounts of drainage.
124
Correct Answer: 2
Explanation
There are a variety of postures and activities included in the developmental progression that are commonly used as the focus for functional training during rehabilitation.
These postures and activities include prone on elbows, quadruped, bridging, sitting, kneeling, half-kneeling, modified plantigrade, and standing. The quadruped posture
involves the patient positioned on their hands and knees.
1.The quadruped position involves the patient weight bearing through their knees. The flexed position at the knees helps to decrease extensor tone at this joint.
2.The quadruped position involves the patient weight bearing through their wrists. The extended position at the wrists would help to decrease flexor tone, not
extensor tone, at this joint.
3.The quadruped position involves the patient weight bearing through their hips and shoulders, resulting in increased stability at these joints.
4.The quadruped position involves the patient weight bearing through their elbows. The extended position at the elbows helps to decrease flexor tone at this joint.

125
Correct Answer: 2
Explanation
Numerous therapeutic modalities may be employed to improve both the quality and patient tolerance of a soft tissue stretch. The application of a tissue heating modality (e.g.,
continuous ultrasound, superficial moist heat) will most directly influence the viscoelasticity of the plantar fascia.
1.Pulsed ultrasound is unlikely to generate the necessary tissue heating required to increase the viscoelasticity of the plantar fascia.
2.Because of the superficial orientation of the plantar fascia, the application of moist heat prior to stretching interventions will positively impact viscoelasticity
and improve the overall quality of the stretch.
3.Iontophoresis may be used to assist with pain management when treating plantar fasciitis, however, the intervention will not specifically impact viscoelasticity
of the fascia.
4.Ice massage is frequently utilized to reduce the painful symptoms associated with plantar fasciitis, however, it is typically applied following manual
interventions and will not improve the viscoelasticity of the fascia.
Resource: (Michlovitz p. 7)
System: Non-Systems
126
Correct Answer: 4
Explanation
Resistance exercise, either as a strength or endurance training program, can have a large impact on many systems of the body. When the body is challenged with a greater
than expected but appropriate amount of resistance, there is an acute reaction of physiological response to the load. Over time, the training produces a chronic physiological
response.
1.Lengthening of a muscle is a result of active and sustained stretching to a particular muscle group. Neither strength training or endurance training directly results in
lengthening of a muscle.
2.An increase in the mitochondrial density (size) and volume (overall numbers) occurs as an adaptation to an endurance training program. The mitochondrial density actually
decreases with strength training resulting from reduced oxidative capacity of the muscle with higher intensity loads.
3.Training needs to follow the overload principle to bring about muscle hypertrophy. Muscle hypertrophy occurs with lifting medium to heavy weights. Endurance training
occurs with lifting light weights with high repetitions and does not bring about a hypertrophic response. Heavier weights produce an overload response resulting in muscle
enlargement so that the muscle becomes better prepared for the task.
4.Both strength and endurance training programs promote physiological adaptations of increased tensile strength of tendons, ligaments, and connective tissue. It
is theorized that tendon and ligament tensile strength increases in response to resistance training in order to support the adaptive strength and size changes that
occur in the muscles. Connective tissue will thicken to improve support to the enlarged fibers.
127
Correct Answer: 3
Explanation
Raynauds disease (or Raynauds phenomenon) is a condition characterized by intermittent episodes during which small arteries in the extremities constrict causing pallor and
cyanosis of the digits. These episodes generally occur in response to cold temperature or strong emotion.
1.Due to the constriction of small arteries and arterioles of the extremities, pallor and cyanosis of the digits is generally the initial symptom seen with an episode of Raynauds
disease.
2.Due to the lack of blood flow to the distal extremities, patients experiencing an episode of Raynauds disease may experience pain in the digits.
3.Digital clubbing is a deformity of the fingers and nails characterized by thickening of the distal finger. It is associated with disease of the lungs and/or heart and
is often the result of chronic tissue hypoxia. This condition is not associated with Raynauds disease.
4.As the vasospasm ends during an episode of Raynauds disease, there is a period of hyperemia where oxygenated blood rushes back into the capillaries of the
digits. This results in an intense redness (i.e., rubor) and throbbing of the digits.
128
Correct Answer: 1
Explanation
Automatic postural strategies are automatic motor responses that are used to maintain the center of gravity over the base of support. These responses occur in a predictable
pattern based on the direction and magnitude of the perturbation. The hip strategy involves shifting the center of mass by flexing or extending the hips.
1.A forward sway requiring a hip strategy would result in activation of the abdominals and the quadriceps. The hip strategy relies on a proximal pattern of muscle
activation meaning that the abdominals would initially be activated followed by the quadriceps.
2.The hamstrings would be activated as a result of backward sway that requires a hip strategy, however, the paraspinals would be activated first since they are
proximal muscles.
3.A backward sway that requires a hip strategy would result in activation of the paraspinals and hamstrings. The paraspinals would initially be activated followed
by the hamstrings.
4.The quadriceps would be activated as a result of forward sway that requires a hip strategy, however, the abdominals would be activated first since they are
proximal muscles.
129
Correct Answer: 1
Explanation
The Valsalva maneuver is a technique characterized by a forcible exhalation with a closed glottis, nose, and mouth. The maneuver results in an increase in intra-thoracic and
intra-abdominal pressure and a subsequent decrease in venous return and arterial blood pressure. When the breath is released, there is an exaggerated response to
compensate for the drop in blood pressure via a marked increase in heart rate and blood pressure.
1.Flaccid bladder is a condition characterized by an inability of the detrusor muscles to contract when the bladder is full. The Valsalva maneuver causes an
increase in intra-thoracic and intra-abdominal pressure and can be effectively used in these patients to assist with bladder emptying.
2.Congestive heart failure is a condition characterized by an inability of the heart to pump enough blood to meet the needs of the body. Due to the significant
increase in blood pressure that occurs following the Valsalva maneuver, this technique should be avoided in patients with a cardiac impairment.
3.Herniated disk is a condition characterized by a tear in the outer, fibrous layer (i.e., annulus fibrosus) of the intervertebral disk which allows the inner, softer
layer (i.e., nucleus pulposus) to bulge out. Because the Valsalva maneuver increases intrathoracic pressure, the patients symptoms could potentially be
exacerbated due to the increased pressure on the intervertebral disk and/or spinal nerve.
4.Peripheral vascular disease is a condition characterized by obstruction of the large arterial vessels in the periphery. The use of the Valsalva maneuver would
not be beneficial for a patient with peripheral vascular disease since it results in an increase in intra-thoracic and intra-abdominal pressure and a subsequent
increase in arterial blood pressure.
130
Correct Answer: 3
Explanation
Children who walk with a crouched gait have excessive hip flexion, knee flexion, and ankle dorsiflexion throughout the stance phase of gait. These gait deviations may be a
result of weakness, hypotonia or lower extremity spasticity.
1.A solid ankle-foot orthosis is indicated for patients who require total immobilization at the ankle-foot complex in order to improve stability or function in standing and during
gait. By locking the ankle-foot complex in dorsiflexion, this orthotic limits hyperextension of the knee during stance. Patients with neuromuscular problems such as
hypertonicity, postural instability, ataxia, hypotonia or rheumatoid arthritis often benefit from this type of orthotic.
2.A knee-ankle-foot orthosis extends from above the knee to the bottom of the foot. It is used for children who present with significant lower extremity weakness, such as
children with spina bifida. This orthotic provides stability at the knee joint, however, it will not specifically assist in improving knee extension.
3.An anterior floor reaction ankle-foot orthosis uses the ground reaction forces as the source of sagittal plane stability at the knee joint during stance. This type
of orthotic places the ankle in a position of plantar flexion, which creates a knee extension moment during stance. When a child walks with a crouched gait
pattern the ground reaction force vector passes behind the knee joint at midstance, resulting in excessive knee flexion. With the ankle in a plantar flexed position,
the tibia is prevented from advancing over the foot causing the ground reaction force to pass anterior to the knee earlier in the stance phase, creating a knee
extension moment.
4.A supramalleolar orthosis is a plastic insert that extends from the heel to the ball of the foot and above the level of the malleoli. This orthotic stabilizes the heel
and supports the subtalar joint in a neutral position which allows for dorsiflexion and plantar flexion, while limiting lateral motion. Supramalleolar orthoses are
used for children with hypotonicity, such as with Down syndrome.
131
Correct Answer: 2
Explanation
Airway clearance techniques are manual or mechanical techniques used to facilitate clearance of secretions from the airways. These techniques include postural drainage,
percussion, vibration, cough techniques, manual hyperinflation, and airway suctioning.
1.Pursed lip breathing is a breathing technique which requires the patient to inhale through the nose and exhale through pursed lips. This technique is used to decrease
respiratory rate, increase tidal volume, relieve dyspnea, improve exercise tolerance, and prevent airway collapse. This technique is not used to help clear airway secretions.
2.Active cycle of breathing is a series of maneuvers used by the patient to help clear airway secretions. The maneuvers involve repeated diaphragmatic breathing
and thoracic expansion exercises followed by a forced expiratory technique.
3.Segmental breathing (i.e., thoracic expansion exercise) is a technique used to improve regional ventilation in patients with pulmonary disease and to prevent
and treat pulmonary complications after surgery. This technique is not used to help clear airway secretions.
4.Inspiratory muscle training is a technique used to increase the strength and endurance of the muscles of inspiration. With this technique, the patient uses a
handheld breathing training device to provide resistance to inspiration. This technique is not used to help clear airway secretions.
132
Correct Answer: 2
Explanation
A patient interview provides a physical therapist with an opportunity to assess patient cognition. This approach is often more appropriate than relying on a previous entry in the
medical record, particularly with a patient status post surgery.
1.It is important to review a patients medical record prior to the initial examination so that the therapist has an understanding of past medical history, current medical status,
physician orders, and any precautions or contraindications, however, this is not the optimal choice for assessment of the patients cognitive status.
2.Conducting a patient interview allows the therapist to evaluate the patients cognitive status through a routine screening of person, place, and time or through
more extensive testing such as the Mini Mental State Examination.
3.A physical examination would focus on a patients physical attributes and impairments. Items such as muscle strength, range of motion, and anthropometric
measurements are examples of common components of a physical examination.
4.Consultation with family members may assist in certain scenarios, however, cannot replace direct screening of the patient when assessing cognition.
Resource: (Goodman - Differential Diagnosis p. 36)
133
Correct Answer: 4
Explanation
The proximal row of carpal bones from lateral to medial consists of the scaphoid, lunate, triquetrum, and pisiform. The distal row of carpal bones from lateral to medial consists
of the trapezium, trapezoid, capitate, and hamate. The carpal bones articulate with each other at synovial joints and are connected via ligaments to form a compact mass.
1.The trapezium is located on the lateral side of the carpus between the scaphoid and the first metacarpal. It is distinguished by a deep groove on its palmar surface.
2.The trapezoid is the smallest carpal bone in the distal row and is noted for its wedge shaped form. The inferior surface of the bone articulates with the proximal end of the
second metacarpal bone and the superior surface articulates with the scaphoid.
3.The lunate is located in the center of the proximal row between the scaphoid and the triquetrum. The lunate is distinguished by its crescent-like outline.
4.The triquetrum is located on the medial side of the proximal row of carpals between the lunate and pisiform. The triquetrum is the third most often fractured
carpal bone. The pisiform is located within the flexor carpi ulnaris tendon and lies immediately superior to the triquetrum.
134
Correct Answer: 1
Explanation
Superficial reflexes are involuntary muscle contractions that follow stimulation of the skin usually by stroking or scratching. Examples of superficial reflexes include the
abdominal reflex, cremasteric reflex, corneal reflex, and normal plantar response.
1.Superficial reflexes are graded as present or absent, although asymmetry should be noted. True asymmetry is almost always pathological.
2.Deep tendon reflexes are graded on an ordinal scale from 0-4+. 0 = no response, 1+ = diminished/depressed response, 2+ = active normal response, 3+ =
brisk/exaggerated response, and 4+ = very brisk/hyperactive; abnormal response.
3.Hypoactive, normal, and hyperactive are general terms to describe the relative responsiveness of deep tendon reflexes to stimulation. Hyperactive reflexes are
often associated with upper motor neuron disorders while hypoactive reflexes are often associated with lower motor neuron disorders.
4.Manual muscle testing grades range from zero (0/5) to normal (5/5) based on the ability to move a body segment through range with and without varying levels
of resistance. Specifically, manual muscle test grades include zero (0), trace (1), poor (2), fair (3), good (4), and normal (5).
135
Correct Answer: 2
Explanation
An entrance ramp that has one inch of vertical rise for every six inches of ramp length would not satisfy the 1:12 (rise:run) minimum ratio identified in the Americans with
Disabilities Act (ADA).
1.Hardwood floors allow for easier propulsion, turning, and function with the wheelchair. Floor surfaces must be firm, stable, and slip resistant. A patient would expect
increased difficulty using a wheelchair on carpet or outside terrain.
2.An entrance ramp designed with one inch of vertical rise for every six inches of ramp length would be twice as steep as the 1:12 (rise:run) minimum ratio. The
1:12 ratio allows for a maximum ramp grade of 8.3 percent.
3.A threshold of one-quarter inch is an acceptable height as a transition surface. Thresholds with beveled edges up to one-half inch are permissible.
4.Pedestal type sinks would not serve as an architectural barrier since the underside of the sink is open and allows for close wheelchair access. A sink encased
with a vanity style cabinet would be more restrictive.
System: Non-Systems
136
Correct Answer: 4
Explanation
There are a multitude of special tests performed in a variety of different positions. It is critical that the specific parameters of each special test are precisely followed to ensure
the accuracy of the obtained data.
1.Apleys test is performed with the patient positioned in prone with the test knee flexed to 90 degrees. The therapist stabilizes the patients femur using one hand and places
the other hand on the patients heel. The therapist medially and laterally rotates the tibia while applying a compressive force through the tibia. A positive test is indicated by
pain or clicking and may be indicative of a meniscal lesion.
2.Craigs test is performed with the patient positioned in prone with the test knee flexed to 90 degrees. The therapist palpates the posterior aspect of the greater trochanter
and medially and laterally rotates the hip until the greater trochanter is parallel with the table. The degree of femoral anteversion corresponds to the angle formed by the lower
leg with the perpendicular axis of the table. Normal anteversion for an adult is 8-15 degrees.
3.The peroneal tendon dislocation test is performed with the patient in prone with the knee flexed to 90 degrees. The patient is asked to actively dorsiflex and plantar flex the
ankle along with eversion against the therapists resistance. If the tendon subluxes from behind the lateral malleolus, the test is considered positive. The test can also be
performed with the patient in prone, although is classically performed with the patient in prone with the knee flexed to 90 degrees.
4.The Thompson test is performed with the patient positioned in prone with the feet extended over the edge of a table. The therapist asks the patient to relax and
proceeds to squeeze the muscle belly of the gastrocnemius and soleus muscles. A positive test is indicated by the absence of plantar flexion and may be
indicative of a ruptured Achilles tendon.
137
Correct Answer: 3
Explanation
A physical therapist must be able to discern gastrointestinal pathology and modify treatment based on patient presentation. Ulcerative colitis is a form of inflammatory bowel
disease of unknown etiology and is considered an autoimmune condition. This pathology is restricted to the mucosa and submucosa of the large intestine and involvement
extends uniformly and continuously throughout the colon and rectum.
1.Crohns disease is a form of inflammatory bowel disease with a chronic and unpredictable course. It typically affects all layers of the intestinal wall and is characterized by
diseased areas separated by normal, unaffected tissue (unlike ulcerative colitis that presents with continuous, uniform involvement of only the mucosa and submucosa
layers). Crohns disease can affect any segment of the intestinal tract, unlike ulcerative colitis that is restricted to the colon and rectum. Fissures and fistulas are also common
with Crohns disease.
2.Irritable bowel syndrome (IBS) refers to a chronic condition that is non-inflammatory and can occur anywhere within the intestines. IBS is characterized by abnormal
intestinal contractions and an exaggerated gastrocolic reflex resulting from impaired motility, stress, visceral hypersensitivity, and abnormal processing of the nervous system.
3.Ulcerative colitis can occur at any age but is most common between 10 to 40 years of age. Inflammation of the mucosa results in small erosions and
subsequent ulceration. Diarrhea is often severe and chronic, however, unlike Crohns disease, ulcerative colitis does not present with fissures or fistulas.
4.Transmural inflammatory disease is characterized by inflammation that encompasses all layers of the intestinal wall. This inflammatory process is
discontinuous where inflamed areas are separated by normal, unaffected tissue.
138
Correct Answer: 1
Explanation
An equinus gait pattern is characterized by excessive plantar flexion of the ankle. This type of gait pattern is most often caused by excessive activity of the gastrocnemius, a
plantar flexion contracture or weak dorsiflexors.
1.The gastrocnemius acts to plantar flex the ankle and therefore excessive activity of the muscle would contribute to an equinus gait. The gastrocnemius is
innervated by the tibial nerve (S1-S2).
2.The tibialis posterior acts to plantar flex the ankle, however, weakness of the muscle would tend to promote a dorsiflexed position of the ankle. The tibialis
posterior is innervated by the tibial nerve (L5-S1).
3.The tibialis anterior acts to dorsiflex the ankle and therefore excessive activity of the muscle would promote a dorsiflexed position of the ankle. The tibialis
anterior is innervated by the deep peroneal nerve (L4-S1).
4.The flexor digitorum longus acts to plantar flex the ankle, however, weakness of the muscle would tend to promote a dorsiflexed position of the ankle. The
flexor digitorum longus is innervated by the tibial nerve (L5-S1).
139
Correct Answer: 4
Explanation
A total hip arthroplasty is performed as a result of progressive and severe osteoarthritis or other hip pathology that produces pain and disability. A posterolateral approach
leaves the abductor muscles intact, however, it penetrates the posterior capsule resulting in post-operative joint instability. In order to prevent dislocation of the femoral head
component, the patient should avoid excessive hip flexion greater than 90 degrees, hip adduction, and hip medial rotation.
1.Hip flexion should be avoided at angles greater than 90 degrees since this results in stress on the weakened posterior capsule of the hip joint and increases the risk for hip
dislocation. This patient should not bend over in a sitting position to don and doff their shoes since this would increase hip flexion past 90 degrees.
2.Hip medial rotation should be avoided since this motion places stress on the weakened posterior capsule and results in the femoral head component assuming a position
where it may dislocate. Hip medial rotation would not assist this patient to independently don and doff their shoes.
3.Knee extension is not a precaution for this patient, however, if the knee was extended the patient would have to flex the hip greater than 90 degrees to reach their feet.
4.Hip lateral rotation places the femoral head component in a stable position following a posterolateral approach. Improved range of motion into lateral rotation
should be emphasized in order to maximize function for this patient. The patient can laterally rotate their hip and place their foot on their opposite knee with the
hip flexed less than 90 degrees in order to safely don and doff their shoes.
140
Correct Answer: 2
Explanation
A percutaneous transluminal coronary angioplasty (PTCA) is a revascularization procedure performed in patients with atherosclerosis of the coronary arteries. The procedure
involves the insertion of a balloon-equipped catheter into the coronary arteries. The balloon is inflated in the lumen of an artery to break up the atherosclerotic plaques and
make the artery more patent.
1.To gain access to the coronary arteries, the surgeon will use a peripheral arterial access site such as the femoral artery. The balloon-equipped catheter is advanced from
this point to the site of the lesion.
2.The PTCA procedure is indicated for stenotic lesions that are not too large (i.e., not completely occluded). In order for the procedure to be effective, the balloonequipped catheter needs a space for the balloon to inflate in to. A coronary artery bypass graft procedure would be more likely for patients that have complete
occlusion of a coronary artery.
3.Some of the other procedures that may be performed in conjunction with a PTCA include coronary arthrectomy and endoluminal stent placement. A stent is a
spring-like device that is inserted into the artery to help maintain its patency after a PTCA.
4.Generally there are no postoperative movement restrictions with a PTCA. Patients can be ambulatory within a matter of hours following the procedure.
141
Correct Answer: 3
Explanation
Compartment syndrome is a condition associated with increased tissue pressure in a specific muscular compartment. The condition is most commonly seen in the lower leg,
especially in the anterior compartment. Compartment syndrome is characterized by pain with exertion, swelling, decreased sensation, and diminished pulses.
1.The tibial nerve is a branch of the sciatic nerve that is located in the posterior lower leg. The nerve primarily innervates the plantar flexors of the ankle. Compartment
syndrome would be unlikely to affect the structures in the posterior compartment.
2.The sural nerve is a sensory branch of the tibial nerve. As stated previously, this nerve is located posteriorly in the lower leg and would not likely be affected by compartment
syndrome.
3.The deep peroneal nerve is a branch of the common peroneal nerve, located in the anterior lower leg. Because of its location, this nerve is commonly affected
with compartment syndrome. Compression of this nerve can result in a steppage gait due to difficulty performing dorsiflexion.
4.The superficial peroneal nerve is a branch of the common peroneal nerve, located in the lateral lower leg. Lateral compartment syndrome does exist, although it
is relatively rare.
142
Correct Answer: 3
Explanation
Following a complete spinal cord injury, patients are likely to express anxiety and concern regarding their significantly altered level of functional independence. In order to
appropriately address a patients questions, it is essential for the physical therapist to possess knowledge of the anticipated functional outcomes associated with each level of
injury.
1.Patients diagnosed with higher levels of tetraplegia (e.g., C1-C5) are typically dependent on the assistance of a caregiver for both upper and lower body dressing. Patients
who are not cognitively impaired should be encouraged to participate in the activity by offering verbal direction.
2.Patients diagnosed with mid-level tetraplegia (e.g., C6) are typically able to perform lower extremity dressing in bed with minimal assistance from a caregiver. Upper
extremity dressing in bed is typically performed with modified independence (e.g., use of a reacher).
3.Patients diagnosed with lower levels of tetraplegia (e.g., C7-C8) are typically able to perform both upper and lower extremity dressing tasks in bed with modified
independence (e.g., use of a shoehorn).
4.Depending on the level of injury, patients diagnosed with paraplegia (e.g., T1 or lower) may demonstrate modified independent or independent upper and lower
extremity dressing abilities either in bed or seated.
143
Correct Answer: 3
Explanation
There are a number of variables a physical therapist must consider when scheduling patient treatment sessions. Failure to provide the patient with adequate spacing between
sessions can result in chronic soreness, lethargy or even acute trauma. The relative intensity of strengthening exercises results in 2-3 days per week being the recommended
frequency.
1.The number of repetitions in each set may supply the therapist with a general sense of the total work performed and the therapeutic objective. However, it would not assist
the therapist in determining when to schedule the next training session.
2.The amount of weight in one repetition maximum supplies the physical therapist with a general sense of the patients lower extremity strength, but would not assist the
therapist in determining when to schedule the next training session.
3.Activities designed to increase lower extremity strength place large amounts of stress on the body and as a result often require 48 hours between sessions
involving the same muscle group. Therefore, the amount of time between the sessions is the most important variable to consider when scheduling the next
training session.
4.The type of resistance training (e.g., weights, resistive bands) may influence how the patient tolerates treatment including the level of delayed onset muscle
soreness. Although this is a relevant factor to consider when scheduling the next training session, patient tolerance is highly individualized and is often not
accurately predicted based solely on the type of resistance training.
Resource: (Tan p. 176)
144
Correct Answer: 2
Explanation
Shoulder flexion occurs in the sagittal plane around a medial-lateral axis. The motion requires the glenohumeral joint and the scapulothoracic articulation to work in a
coordinated fashion.
1.The upper trapezius acts to assist with scapula elevation. The muscle does not function to protract the scapula on the thorax during during active flexion of the humerus.
The muscle is more likely to be active in upwardly rotating the scapula. The upper trapezius is innervated by the accessory nerve.
2.The serratus anterior acts to protract and upwardly rotate the scapula on the thorax during active flexion of the humerus. The serratus anterior is innervated by
the long thoracic nerve.
3.The rhomboids act to adduct and downwardly rotate the scapula and therefore would not play an active role in producing scapula protraction. The muscle is
more likely to be active in arm extension or puling activities which require scapula retraction. The rhomboids are innervated by the dorsal scapular nerve.
4.The middle trapezius acts to adduct the scapula and therefore would not play an active role in producing scapula protraction. The muscle is more likely to be
active in arm extension or puling activities which require scapula retraction. The middle trapezius is innervated by the accessory nerve.
145
Correct Answer: 2
Explanation
The onset of numerous conditions affecting neurological and musculoskeletal structures may be linked to viral infections (e.g., trigeminal neuralgia, post-herpetic neuralgia). A
physical therapist should be familiar with both the typical etiology and differentiating characteristics of such conditions.
1.The onset of amyotrophic lateral sclerosis (ALS) and its neuromuscular signs and symptoms are not associated with viral etiology. Patients with ALS typically present with
distal to proximal patterns of weakness.
2.Guillain-Barre syndrome is an autoimmune condition resulting in the demyelination of peripheral nerves. The onset of symptoms is usually preceded by a viral
infection such as the Epstein-Barr virus, human immunodeficiency virus, influenza or cytomegalovirus. Patients with Guillain-Barre syndrome typically present
with distal to proximal patterns of weakness.
3.Lyme disease is caused by exposure to bacteria spread by ticks. Symptoms may include muscle pain, stiffness, weakness, and paralysis depending on the
stage at which the disease is diagnosed and the subsequent treatment intervention.
4.Post-herpetic neuralgia may include symptoms of pain, itching, sensory disturbances, and muscle weakness or paralysis depending on the location and extent
of nerve injury. Post-herpetic neuralgia is most commonly associated with the herpes zoster virus that causes chicken pox in children and shingles in adults.
146
Correct Answer: 1
Explanation
For patients experiencing acute symptoms of lateral epicondylitis, initial treatment interventions should attempt to decrease complaints of pain and inflammation, as well as
minimize the risk of disuse atrophy and tissue shortening.
1.In the acute inflammatory phase, a patient with lateral epicondylitis is likely to self-limit mobility increasing the risk of muscle atrophy and contracture. Active,
passive, and active-assisted range of motion activities are recommended to restore joint and tissue mobility without exacerbating the inflammatory process.
2.Strengthening activities should be deferred until inflammation and pain complaints have been addressed. Patients should first exhibit full active range of motion
with minimal complaints of pain and tenderness before significant strength and endurance interventions are initiated.
3.As the acute inflammatory phase subsides, the patient should begin activities that emphasize restoration of strength, endurance, and proprioception to assist in
reducing the risk of reinjury. Beginning these activities prior to regaining full range of motion and reducing pain may exacerbate the inflammatory phase and
delay healing.
4.Restoration of a patients prior level of function is typically the long term goal of physical therapy interventions for lateral epicondylitis and is attained through
an appropriate progression of interventions addressing inflammation, range of motion, strength, endurance, proprioception, and functional retraining.
147
Correct Answer: 3
Explanation
A basic understanding of commonly utilized laboratory tests assists in the diagnosis and monitoring of patients with cardiovascular pathology. Failure to effectively interpret
the results of relevant laboratory testing can pose a significant risk to patient safety.
1.Cardiac biomarkers are biomarkers measured to evaluate heart function. Cardiac enzyme studies measure the levels of creatine phosphokinase (CK) and the protein
troponin in the blood. CK-MB is a relatively specific test for myocardial infarction.
2.Prothrombin time is the amount of time it takes plasma to clot after the addition of tissue factor. The prothrombin time and its derived measures of prothrombin ratio and
international normalized ratio are measures of the extrinsic pathways of coagulation. Patients on anticoagulants such as Warfarin (i.e., Coumadin) may require frequent
monitoring of prothrombin time.
3.Serum electrolytes are electrically charged minerals that help move nutrients into and wastes out of the bodys cells, maintain a healthy water balance, and help
stabilize the bodys acid level. Serum electrolytes commonly assessed are potassium, sodium, calcium, and magnesium. Diuretics can lead to significantly
lowered potassium levels, and to a lesser extent, sodium levels.
4.A serum cholesterol test (i.e., lipid panel, lipid profile) measures the amount of cholesterol and triglycerides in the blood in order to determine the risk of
atherosclerosis. A complete lipid profile includes the measurement of four types of lipids in the blood: total cholesterol, high-density lipoprotein (HDL)
cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides.
148
Correct Answer: 3
Explanation
Creatine kinase MM is a cytoplasmic enzyme of muscle that is released with trauma to skeletal muscle. CK-MM can be elevated in diseases that affect skeletal muscle
including rhabdomyolysis, myasthenia gravis, muscular dystrophy, and poliomyelitis. The child is presenting with signs consistent with a diagnosis of Duchenne muscular
dystrophy.
1. Impaired respiratory function is a common complication of muscular dystrophy, however, it is an impairment that presents over time and is unlikely to be observed in a fouryear-old child.
2. Dystonia is a syndrome of sustained muscle contractions that frequently causes twisting, abnormal postures, and repetitive movements. Dystonia may be seen in patients
with Parkinsons disease, cerebral palsy, and encephalitis, but is not seen in children with Duchenne muscular dystrophy.
3. Gowers sign is a maneuver where the child walks their hands up their legs in an attempt to get the weight of the trunk posterior to the hip joints in order to
achieve standing. Gowers sign is seen in children with muscular dystrophy who perform this maneuver to compensate for weakened lumbar and gluteal
muscles.
4. A four-year-old child with a diagnosis of Duchenne muscular dystrophy may begin to walk on their toes because of tightness of the posterior calf muscles and
weakness of the anterior musculature. However, contractures at this point in the disease process are not likely.
149
Correct Answer: 1
Explanation
Raynauds disease is a condition that causes arteries supplying blood to the skin to narrow resulting in diminished circulation. Symptoms include pallor, rubor, cyanosis, and
numbness and tingling in the digits and hand. Females are up to five times more likely than males to be diagnosed with Raynauds disease.
1.Females are more likely than males to be diagnosed with Raynauds disease. Peak incidence is between the ages of 20 and 49 years.
2.Females are more likely than males to be diagnosed with Raynauds disease, however, a 57-year-old is at lower risk than a 25-year-old.
3.Males are less likely than females to be diagnosed with Raynauds disease, however, a 27-year-old is at greater risk than a 55-year-old.
4.Males are less likely than females to be diagnosed with Raynauds disease. A 55-year-old is at lower risk than a 27-year-old.
150
Correct Answer: 2
Explanation
There are four natural curvatures in the spine: two anterior curvatures (i.e., lordosis) in the cervical and lumbar regions and two posterior curvatures (i.e., kyphosis) in the
thoracic and sacral regions. Abnormalities in these curvatures affect the alignment of other joints and the length and strength of the associated musculature. A flat back
posture is characterized by the loss of the normal lordosis in the lumbar spine.
1. A posterior pelvic tilt is commonly associated with a flat back posture. As the lumbar spine flattens, the pelvis posteriorly rotates.
2. Flat back posture would be more commonly associated with a strong rectus abdominis muscle. Posterior rotation of the pelvis puts the rectus abdominis into a
shortened position. Weakness would more commonly be found in muscles that are lengthened.
3. An elongated iliopsoas is commonly associated with a flat back posture. Because the iliopsoas originates anteriorly on the pelvis and inserts on the femur,
posterior pelvic rotation would place this muscle in a lengthened position.
4. Tight hamstrings are commonly associated with a flat back posture. Because the hamstrings originate posteriorly on the pelvis and insert on the femur,
posterior pelvic rotation would place this muscle in a shortened position.

151
Correct Answer: 3
Explanation
Perception is the mechanism by which the brain interprets sensory information received from the environment. Perception is commonly altered in patients sustaining a stroke
involving the right hemisphere.
1.Topographical disorientation involves difficulty comprehending the relationship of one location to another. Having a patient navigate in the hospital using written directions or
a map would be an appropriate method to screen for this condition.
2.Form-constancy dysfunction involves difficulty attending to subtle variations or changes in form such as a size variation of the same object. Having a patient attempt to
identify a familiar object when it is placed on its side would be an appropriate method to screen for this condition.
3.Figure-ground discrimination dysfunction involves difficulty distinguishing the foreground from the background in a complex visual array. Having the patient
pick forks out of a drawer of disorganized silverware would be an appropriate method to screen for this condition.
4.Right-left discrimination dysfunction involves difficulty understanding and using the concepts of right and left. Having the patient point to left and right body
parts after receiving verbal instruction would be an appropriate method to screen for this condition.
152
Correct Answer: 3
Explanation
During the first year of life an infant progresses through various stages of voluntary prehension. Initial patterns involve the fingers only. Later patterns rely on the use of the
distal phalanges and thumb in a precise, specialized manner.
1.The palmar grasp allows for an object to be secured in the center of the palm. All fingers are flexed and the thumb does not participate in the grasp. The hand is pronated
and the wrist tends to remain in neutral. Although objects can be small, the infant grasps objects with the whole hand since they lack the ability to use more precise
movements. This type of grasp is used by an infant that is approximately 6 months.
2.The scissors grasp occurs between the thumb and side of the index finger that remains somewhat flexed. The distal thumb joint is slightly flexed with the proximal joint
extended. Thumb adduction emerges as a stronger component with the scissors grasp. This type of grasp is used by an infant that is approximately 8 months.
3.The pincer grasp relies on the full opposition of the pad of the thumb and the pad of the index finger to secure an object. The infant can perform the pincer
grasp more readily when using a firm surface. This type of grasp is used by an infant that is approximately 10-11 months.
4.A superior pincer grasp is differentiated from the pincer grasp, in that the tip of the finger and tip of the thumb secure the object with opposition. This type of
grasp is used by an infant that is approximately one year of age.
153
Correct Answer: 3
Explanation
Transmission-based precautions are designed to protect health care workers from patients with highly transmissible pathogens that can be spread by direct contact, droplets
of moisture or airborne particles. Contact precautions are required when working with a patient with MRSA.
1.When treating a patient with contact precautions, it is necessary to minimize patient transport outside of their room. As a result, it would be more appropriate to treat this
patient in their room than in the therapy gym.
2.When treating a patient with contact precautions, it is necessary to minimize patient transport outside of their room. This is also true when treating patients with droplet or
airborne precautions.
3.When treating a patient with contact precautions, it is more appropriate to treat the patient in their room than in the therapy gym. To prevent the spread of
MRSA, the therapist should don a gown and gloves upon entering the room.
4.While it is appropriate for the therapist to wear a gown and gloves, it would not be necessary to wear a mask when treating a patient with contact precautions.
Wearing a mask is only necessary when treating a patient with droplet or airborne precautions.
System: Non-Systems
154
Correct Answer: 1
Explanation
Physical therapists can gather valuable information on exacerbating and relieving symptoms through a range of motion screening. The obtained information can assist the
therapist to gain a clearer clinical picture of the mechanical and non-mechanical factors contributing to the patients current condition.
1.Facet joints (i.e., zygapophyseal joints) are formed by the right and left superior articular facets of one vertebra and the right and left inferior articular facets of
an adjacent superior vertebra. Facet joint arthropathy may cause stiffness in the back and increased pain with movement, however, the pain is typically localized
to the affected structures and would not radiate down the leg. Flexion tends to result in facet gapping resulting in diminished symptoms.
2.Vascular claudication produces a cramping type pain in the buttock, thighs or calves caused by impaired blood flow often associated with atherosclerosis.
Patients with vascular claudication typically experience increased symptoms with activity regardless of the direction of movement and diminished symptoms with
rest.
3.Piriformis syndrome refers to a persistent, severe radiating low back and buttock pain spanning from the sacrum to the hip and posterior thigh. The primary
symptom is sciatic paresthesia due to nerve entrapment as the sciatic nerve passes under or through the piriformis muscle. Patients with piriformis syndrome
often experience increased symptoms with activities that compress the sciatic nerve such as sitting for long periods of time or climbing stairs.
4.A disk herniation results from a tear in the annulus fibrosis of an intervertebral disk allowing the nucleus pulposus to bulge out beyond the damaged outer
rings. This often compresses spinal nerve roots and causes radiating symptoms down the leg. Patients with a disk herniation often experience diminished
symptoms with extension of the spine since the motion results in the migration of the nucleus pulposus toward the center of the disk.
155
Correct Answer: 3
Explanation
Latex allergy is a reaction to certain proteins found in natural rubber latex. The reaction can range from mild to very severe. Recognition of the signs and symptoms
associated with a latex allergy can help prevent a more severe reaction from occurring. Some individuals are more at risk due to repetitive exposure, multiple surgeries, other
allergies or selected respiratory conditions.
1.Irritant contact dermatitis is a relatively common, nonallergic response that presents as dry, itchy, irritated areas on the skin around the area of contact. The condition is the
most common occupational skin disorder and is often produced by exposure of the hands to soaps, cleansers, and solvents. The described systemic reaction is not consistent
with irritant contact dermatitis.
2.Allergic contact dermatitis typically develops within a few days of exposure in areas that were exposed directly to the allergen. Certain allergens (e.g., neomycin), however,
penetrate intact skin poorly and therefore the onset of dermatitis may be delayed. Skin reactions are usually confined to the area of contact without systemic reactions.
3.A latex reaction can occur in individuals who are allergic to latex after being in contact with the latex in rubber gloves or by inhaling airborne latex particles
which are released when latex gloves are removed. Latex allergy symptoms can range from mild to severe depending on the degree of sensitivity and the amount
of latex allergen. Latex allergy may cause allergic reactions ranging from sneezing or a runny nose to anaphylaxis.
4.Urticaria refers to hives which are raised often itchy, red welts on the surface of the skin. They are usually present as a response to an allergic reaction to food
or medicine. Hives are variable in size and may get bigger, spread or join together to form larger areas of flat, raised skin. Urticaria is a common reaction to a latex
allergy, however, it would not explain the patients current situation.
156
Correct Answer: 1
Explanation
The latissimus dorsi originates on the external lip of the iliac crest and inserts on the intertubercular groove of the humerus. Shortening of the latissimus dorsi often results in a
limitation of shoulder flexion or abduction. The muscle acts to adduct, extend, and medially rotate the arm. The muscle is innervated by the thoracodorsal nerve.
1.Lordosis refers to an excessive curvature of the spine in an anterior direction, usually identified in the cervical or lumbar spine. Under normal circumstances, a
patient should be able to perform complete shoulder flexion without an increase in lumbar lordosis, however, with adaptive shortening of the latissimus dorsi the
patient may not have full shoulder flexion and therefore attempts to compensate for the limitation by increasing the amount of lumbar lordosis. Increased lumbar
lordosis assists the patient to achieve additional shoulder flexion range due to the insertion of the latissimus dorsi on the external lip of the iliac crest.
2.Decreasing the amount of lumbar lordosis would result in additional shortening of the latissimus dorsi and as a result would exaggerate any observed limitation
in shoulder flexion.
3.Kyphosis refers to an excessive curvature of the spine in a posterior direction, usually identified in the thoracic spine. The relative extent of thoracic kyphosis
present would not significantly influence the amount of shoulder flexion present in the described testing procedure due to the origin and insertion of the
latissimus dorsi.
4.The relative extent of thoracic kyphosis present would not significantly influence the amount of shoulder flexion present in the described testing procedure due
to the origin and insertion of the latissimus dorsi.
157
Correct Answer: 4
Explanation
Hemodialysis is a treatment process for patients with advanced and permanent kidney failure. Kidney failure creates excess toxic waste, increased blood pressure, retention
of excess body fluids, and a decrease in red blood cell production. Hemodialysis removes the blood from the body along with waste, excess sodium, and fluids. The process
cleanses the blood and returns it to the body. A patient requires this process on average three times per week.
1.The measure of heart rate is highly variable when a patient is receiving hemodialysis secondary to fluid shifts and vascular adaptations to fluid loss during treatment.
Autonomic dysfunction can limit heart rate significantly and therefore intensity should be measured using rating of perceived exertion (RPE).
2.Blood pressure will vary in patients on hemodialysis. Hypertension may exist prior to dialysis secondary to fluid retention and hypotension can exist immediately following
hemodialysis. Blood pressure, however, is not a direct measure of exercise intensity.
3.Respiratory rate should be monitored to ensure that the patient is not hyperventilating or holding their breath during exercise, however, respiratory rate is not a measure of
exercise intensity.
4.RPE is the most appropriate method to measure the intensity of exercise with a patient receiving dialysis. Exercise intensity can vary significantly, however, the
patient should work towards approximately 20-30 minutes of low-level exercise using RPE to monitor the intensity of the exercise performed.
Resource: (Ehrman p. 275)
158
Correct Answer: 4
Explanation
Physical therapists should be knowledgeable of the appropriate measures to take when a patient is having a seizure to ensure their safety. The objectives are to protect the
patient from injury and to protect the patients modesty.
1.It is desirable to have the patient in a safe location and position. However, restraining the patients movements could actually lead to further injury to the patient and/or
therapist.
2.Unless the patient experiences cardiopulmonary arrest, cardiopulmonary resuscitation (CPR) is rarely needed after a seizure. After the seizure has stopped, the therapist
should monitor the patients pulse and breathing. If the pulse or breathing does not return, the therapist should begin CPR.
3.The therapist should ensure that the patients airway remains patent. However, the therapist should not place any objects in the patients mouth since the objects may create
a choking hazard.
4.It is important for the therapist to monitor the patients respiratory rate. If the patient stops breathing for an excessive amount of time following the seizure, the
therapist should begin CPR.
System: Non-Systems
159
Correct Answer: 1
Explanation
Acute unilateral vestibular hypofunction is the second most common cause of vertigo. Viral infection is a common cause of this condition, usually affecting the vestibular nerve
unilaterally. The clinical manifestations of this condition include sudden onset of rotatory vertigo, spontaneous horizontal nystagmus, nausea, and vomiting.
1.The vestibulo-ocular reflex is the connection between the vestibular and visual systems which allows for conjugate movement of the eyes as a result of head
movement. When one side of the system is damaged, as in the presence of unilateral vestibular hypofunction, this reflex would be abnormal. When the reflex is
abnormal, there is a loss of gaze stabilization with head movement.
2.An audiogram (i.e., test of hearing) typically confirms the presence of low-frequency hearing loss. Hearing loss is not a symptom associated with unilateral
vestibular hypofunction, however, it is often associated with a diagnosis of Menieres disease.
3.Magnetic resonance imaging can be used when a central cause for vertigo, such as a brainstem lesion, is suspected. Unilateral vestibular hypofunction would
be considered a peripheral cause of vertigo.
4.The Dix-Hallpike maneuver is an assessment procedure which uses specific head positions and movements to elicit symptoms of vertigo. This procedure is
used to confirm the presence of benign paroxysmal positional vertigo.
160
Correct Answer: 1
Explanation
Passive stretching activities are commonly employed in a rehabilitation program to improve range of motion. A muscle should be stretched in the opposite direction as the
muscles action in order to increase muscle length.
1.The subscapularis originates on the subscapular fossa of the scapula and inserts on the lesser tubercle of the humerus. The muscle is innervated by the
subscapular nerve. The subscapularis acts primarily to medially rotate the shoulder. As a result, passive lateral rotation of the humerus would stretch the
subscapularis.
2.The posterior deltoid originates on the inferior lip of the posterior border of the spine of the scapula and inserts on the deltoid tuberosity of the humerus. The
muscle is innervated by the axillary nerve. The posterior deltoid acts to extend and laterally rotate the shoulder. As a result, passive lateral rotation of the
humerus would not stretch the posterior deltoid.
3.The infraspinsatus originates on the medial two-thirds of the infraspinous fossa of the scapula and inserts on the greater tubercle of the humerus and shoulder
joint capsule. The muscle is innervated by the suprascapular nerve. The infraspinatus acts to laterally rotate the shoulder joint and stabilize the head of the
humerus in the glenoid cavity. As a result, passive lateral rotation of the humerus would not stretch the infraspinatus.
4.The teres minor originates on the upper two-thirds of the dorsal surface of the lateral border of the scapula and inserts on the greater tubercle of the humerus.
The muscle is innervated by the axillary nerve. The teres minor acts primarily to laterally rotate the shoulder. As a result, passive lateral rotation of the humerus
would not stretch the teres minor.
161
Correct Answer: 1
Explanation
A pan splint is used to stabilize the hand in a functional position usually involving slight extension of the wrist. Spasticity refers to an abnormal increase in muscle tone. The
condition may be associated with sustained muscle contractions, involuntary muscle spasms, and exaggerated deep tendon reflexes that make movement difficult or
uncontrollable. An agonist refers to a contracting muscle that is resisted or counteracted by another muscle termed the antagonist.
1.Positioning the wrist in extension would provide a sustained stretch to the wrist flexors. The position would result in activation of the Golgi tendon organs that
serve to reduce spasticity in the agonist and facilitate activity in the antagonist.
2.Positioning the wrist in extension would provide a sustained stretch of the wrist flexors, however, the position would not increase activity of the agonist.
3.Positioning the wrist in flexion would likely increase the amount of spasticity in the wrist flexors. The purpose of the described intervention was to diminish
spasticity in the wrist flexors.
4.Positioning the wrist in flexion would likely exacerbate the amount of spasticity in the wrist flexors. The purpose of the described intervention was to diminish
spasticity in the wrist flexors.
Resource: (Gutman p. 186)
162
Correct Answer: 1
Explanation
A physical therapist must be aware of signs and symptoms associated with emergent conditions. It is the responsibility of the therapist to ensure patient safety, but to also
respond to emergent needs of others within the workplace including co-workers and visitors.
1.Crushing chest pain or tightness, which may radiate and is present for greater than 30 minutes, is typically the hallmark symptom of a myocardial infarction
(MI). Other signs and symptoms may include anxiety, dyspnea, syncope, nausea, arrhythmia, diaphoresis, and an impending sense of doom.
2.Complaints of dull chest pain or tightness, which may be accompanied by a burning sensation (i.e., heartburn), are often associated with gastroesophageal
reflux disease (GERD). GERD, however, does not typically cause diaphoresis or dyspnea.
3.Chest pain complaints associated with pneumothorax are typically described as sharp or sudden, are somewhat localized, and do not present substernally.
Dyspnea complaints may be mild to severe depending on the size of the pneumothorax.
4.A pulmonary embolism (PE) of significant size may simulate a MI with common symptoms including chest pain, anxiety, dyspnea, and a sense of doom. A
patient with PE would be unlikely to present with vagal related symptoms (e.g., nausea, diaphoresis), however, would commonly exhibit cyanosis.
163
Correct Answer: 1
Explanation
Physical therapists treat patients with multiple myeloma in order to decrease the effects of the cancer. Fatigue is a hallmark of the disease process along with skeletal muscle
wasting and risk for pathologic fractures. Therapists play an important role throughout the progression of the disease in order to minimize effects from the cancer and maintain
function and strength.
1.The primary symptoms of multiple myeloma include fatigue, bone pain, and muscular weakness. Low-level exercise and fall prevention should be considered
the primary focus of physical therapy in order to improve the patients overall activity level and avoid pathologic fractures which can be life threatening.
2.Edema is not typically a clinical manifestation of multiple myeloma. Mobility training is appropriate once the patient demonstrates adequate endurance to lowlevel activity.
3.Contractures are not typically a clinical manifestation of multiple myeloma. Strengthening is appropriate in the form of short duration low-level exercise and can
assist with decreasing overall fatigue.
4.Bone pain is a primary symptom of multiple myeloma and can vary in intensity from mild to severe. Pain can decrease with medical management of the cancer,
however, subsequent bone destruction increases the risk of pathologic fracture and pain. Range of motion limitation is not typically a clinical manifestation of
multiple myeloma.
164
Correct Answer: 1
Explanation
Electromyography (EMG) is the recording of electrical activity of a muscle and its motor unit. The motor unit action potential will be abnormal when there is damage to the
nerve or muscle. Types of abnormal potentials include fibrillation potentials, positive sharp waves, fasciculations, and polyphasic potentials.
1.Fibrillation potentials are abnormal spontaneous potentials that occur when the muscle is at rest. They are believed to arise from the spontaneous
depolarization of a single muscle fiber. They are not visible through the skin. Fibrillation potentials are often indicative of lower motor neuron disorders and are
less commonly seen in myopathic diseases.
2.Fasciculations are spontaneous potentials that occur when the muscle is at rest and are not definitively considered abnormal since they are also found in
normal individuals. They are often seen with anterior horn cell degeneration, chronic peripheral nerve lesions, nerve root compression, and muscle spasms or
cramps. They are visible through the skin, commonly seen as a small muscular twitch.
3.Insertional activity describes the spontaneous potentials seen on EMG when the needle electrode is inserted into the muscle. These spontaneous potentials are
considered normal.
4.Polyphasic potentials are abnormal potentials that are seen during voluntary contraction of a muscle. They are characterized by motor unit potentials that have
five or more phases (one to four phases is considered normal). These abnormal potentials are indicative of myopathies, peripheral nerve involvement, and nerve
root compression.
165
Correct Answer: 2
Explanation
Examination of the home environment is often an important part of a patients discharge process. Environmental intervention strategies may include adaptive or assistive
devices (e.g., grab bars, eating utensils), safety devices (e.g., lighting, sensing devices), structural alterations (e.g., widening doors, installing ramps), modification or altered
location of objects (e.g., door locks, moving furniture), and task modification (e.g., visual or auditory cueing, energy conservation).
1.All indoor stairwells should have handrails. The handrails should extend a minimum of 12 inches past the top and bottom of the stairs for added safety.
2.Ideally, steps should not be greater than 7 inches in height. Steps that are greater than 7 inches high make stair navigation increasingly difficult for people with
a handicap.
3.Steps should have a minimum depth of 11 inches to allow for adequate foot placement when navigating stairs.
4.Steps should have a nonslip surface to improve traction. Carpeting or the use of abrasive strips on a slippery surface can help to improve traction.
System: Non-Systems
166
Correct Answer: 1
Explanation
It is important for a physical therapist to be aware of blood values and specifically white blood cell count prior to treatment. Immunocompromised patients are extremely
susceptible to opportunistic infections and other medical complications.
1.Neutrophils are a classification of leukocytes (white blood cells) that digest various foreign materials and are referred to as the first line of hematologic defense
against invading pathogens. Neutropenia refers to a neutrophil count below normal laboratory reference values. This condition places a patient at risk for
developing a serious infection. The longer the neutropenia exists, the more likely the patient is to develop a significant infection.
2.Anemia refers to hemoglobin and hematocrit levels below normal gender specific laboratory reference values. Symptoms may include dyspnea, heart
palpitations, and dizziness. Patients who are anemic are advised to change positions slowly, rest frequently during activity, and allow themselves full nights of
sleep.
3.Leukocytosis is defined as an increase in the number of leukocytes in the blood that results from normal protective responses as well as pathological
conditions. Increased production of white blood cells may occur to fight infection or as a reaction to a drug, bone marrow disease or an immune system
disorder. This condition does not promote opportunistic infection.
4.Thrombocytopenia refers to platelet levels below normal reference laboratory values. Patients with thrombocytopenia will bleed and bruise very
easily. Precautions include avoiding contact sports, working with or around sharp objects, and tight fitting clothing or accessories.
Resource: (Goodman-Pathology p. 692)
166
Correct Answer: 1
Explanation
It is important for a physical therapist to be aware of blood values and specifically white blood cell count prior to treatment. Immunocompromised patients are extremely
susceptible to opportunistic infections and other medical complications.
1.Neutrophils are a classification of leukocytes (white blood cells) that digest various foreign materials and are referred to as the first line of hematologic defense
against invading pathogens. Neutropenia refers to a neutrophil count below normal laboratory reference values. This condition places a patient at risk for
developing a serious infection. The longer the neutropenia exists, the more likely the patient is to develop a significant infection.
2.Anemia refers to hemoglobin and hematocrit levels below normal gender specific laboratory reference values. Symptoms may include dyspnea, heart
palpitations, and dizziness. Patients who are anemic are advised to change positions slowly, rest frequently during activity, and allow themselves full nights of
sleep.
3.Leukocytosis is defined as an increase in the number of leukocytes in the blood that results from normal protective responses as well as pathological
conditions. Increased production of white blood cells may occur to fight infection or as a reaction to a drug, bone marrow disease or an immune system
disorder. This condition does not promote opportunistic infection.
4.Thrombocytopenia refers to platelet levels below normal reference laboratory values. Patients with thrombocytopenia will bleed and bruise very
easily. Precautions include avoiding contact sports, working with or around sharp objects, and tight fitting clothing or accessories.
Resource: (Goodman-Pathology p. 692)
167
Correct Answer: 4
Explanation
Accurate assessment of a patients pain is critical in establishing a successful treatment plan. Descriptors of pain can provide valuable information to assist in the physical
therapy diagnosis of a patient.
1.Pain originating from bone is often described as deep, achy or boring.

2.Pain from muscle or fascia is often described as dull, achy, sore, burning or cramping.
3.Neuropathic pain is often described as sharp, shooting, tingling, burning or numbness.
4.Vascular pain is often described as throbbing, tingling, cold, burning or stabbing.
168
Correct Answer: 3
Explanation
Positioning is an important aspect of the physical therapy plan of care for patients who present with synergistic patterns as a result of a cerebrovascular accident. Proper
positioning out of the synergistic patterns will promote motor function, improve sensory awareness, maintain normal joint mobility, prevent musculoskeletal deformities, limit
the potential for pressure ulcers, and improve respiratory and oromotor function.
1.Placing a squeezable ball in the palm of the involved hand will stimulate the finger and wrist flexors, pulling the hand into a more flexed posture by facilitating the palmar
grasp. A resting hand splint would be a more appropriate treatment option.
2.Positioning the involved lower extremity with the foot against a footboard provides a constant stimulus for the patient to push against. This can result in increased spasticity
at the ankle joint. A resting foot splint or sneakers worn in bed would be a more appropriate treatment option.
3.The involved upper extremity should be positioned in shoulder external rotation, elbow extension, forearm supination, wrist extension, and finger extension.
The upper extremity should be elevated to assist with venous return. Small towel rolls can be placed under the scapula to increase protraction and decrease the
effects of muscle spasticity and tightness.
4.With a flexor synergy pattern the scapula is retracted and elevated. Scapula protraction is indicated to decrease the effects of muscle spasticity and tightness.
Resource: (Martin p. 295)
169
Correct Answer: 3
Explanation
Osteoporosis is a metabolic bone disorder where the rate of bone resorption accelerates while the rate of bone formation slows down. This reduction of bone mass decreases
the overall bone density and strength. The disease is more common in women and in particular postmenopausal women who are not taking hormone replacement therapy.
1.Physical activity is critical throughout the lifespan to maintain and possibly increase peak bone mass. The effect of exercise on slowing the decline of bone mineral density
later in life has been found to be only modest. Regular activity has been found to decrease the incidence of hip fractures in individuals greater than 65 years of age.
2.A dietary analysis is an important component of a comprehensive plan of care for a patient with osteoporosis. Thisis important at all ages and in particular with
postmenopausal women who require more than 1,500 mg of calcium daily. Adequate levels of Vitamin D are also necessary to assist in the absorption of dietary calcium. A
dietary analysis would be expensive to implement and analyze and would be heavily influenced by a variety of other factors other than the presence or absence of
osteoporosis.
3.Measuring a persons height is an inexpensive and relatively reliable method to screen for osteoporosis. Patients with osteoporosis often lose height due to a
reduction in bone mass, postural changes (e.g., kyphosis, Dowagers hump), and vertebral compression fractures.
4.A urinalysis screening would be of minimal benefit since osteoporosis is a metabolic bone disorder and the primary effect of the condition is on the
musculoskeletal system.
170
Correct Answer: 3
Explanation
Physical therapists must select the appropriate rate, rhythm, and intensity of mobilization techniques. Graded oscillation techniques using grades III and IV are commonly
used to stretch the joint capsule. Physical therapists should carefully assess how patients tolerate treatment and make modifications to the plan of care as needed.
1.Administering active stretching activities would be an acceptable intervention, however, would not likely be as effective as mobilization activities given the presence of a
capsular restriction. The absence of current pain or any additional data suggesting the patient did not tolerate the treatment makes it reasonable to continue with mobilization.
2.Instructing the patient in passive stretching activities would be an acceptable intervention, however, would not likely be as effective as mobilization activities given the
presence of a capsular restriction. The absence of current pain or any additional data suggesting the patient did not tolerate the treatment makes it reasonable to continue
with mobilization.
3.It is not unusual for patients to experience some level of discomfort or pain following grade III and IV mobilizations. The fact that the pain resolved the following
day warrants continuing with mobilization.
4.The absence of a red flag or a change in medical status makes it unnecessary to contact the referring physician.
171
Correct Answer: 1
Explanation
An Unna boot is an example of a semirigid compression bandage made of zinc oxide impregnated gauze. The boot is capable of providing a sustained compression force of
35-40 mm Hg.
1.An Unna boot is commonly used to treat venous ulcers that present with edema. The Unna boot consists of impregnated gauze strips that are applied wet and
then dry into a non-elastic and non-expandable porous mold. The zinc oxide is indicated since it is used with healing of ulcerations and open wounds.
2.A plaster of Paris or fiberglass cast is an example of a device that is applied to provide protection and promote stability of a body part.
3.Transparent film is an example of a dressing that can provide absorption for minimal amounts of drainage and promote oxygen exchange. Transparent film is
highly elastic, conforms to a variety of body contours, and allows for visual inspection of the wound since it is transparent.
4.A dynamic splint is an example of a device that applies a low-load constant stretch in order to improve range of motion or the position of a joint.
172
Correct Answer: 2
Explanation
Neuromuscular diseases refer to disorders which affect any part of the motor unit from the anterior horn cell to the muscle itself. These disorders are often characterized by
which part of the motor unit is affected (e.g., anterior horn cell, peripheral nerve, neuromuscular junction, muscle). Weakness is a symptom common to all neuromuscular
diseases.
1.Down syndrome is a genetic disorder caused by an extra copy of the 21st chromosome. This disorder affects multiple systems of the body, but some of the more common
symptoms include delays in physical growth, characteristic facial feature abnormalities, and intellectual disability. Though hypotonia and weakness are symptoms commonly
seen with Down syndrome, toe walking and pseudohypertrophy of the calf muscle are not associated with this disorder.
2.Duchenne muscular dystrophy is an x-linked inherited disorder which is characterized by muscle degeneration. The onset of the disease typically occurs
between two and five years of age. Early symptoms include falling, difficulty getting up from the floor, toe walking, clumsiness, and an increase in the size of
several muscle groups (i.e., pseudohypertrophy).
3.Spinal muscular atrophy (SMA) is an autosomal recessive disorder that results from the loss of anterior horn cells. This disorder can be classified into three
different types based on the childs functional abilities. Symptoms vary widely depending on the type of SMA, but all types are characterized by weakness and
mobility impairments. Toe walking and pseudohypertrophy of the calf muscle are not associated with this disorder.
4.Spina bifida is a neural tube birth defect that results in neuromuscular impairments. This condition is characterized by bladder/bowel issues, orthopedic
abnormalities (e.g., clubfoot, hip dislocation), hydrocephalus, and leg weakness or paralysis. Toe walking and pseudohypertrophy of the calf muscle are not
associated with this condition.
173
Correct Answer: 3
Explanation
A mechanical ventilator is a device that makes it easier for patients to breathe until they are capable of breathing completely on their own. The device is most commonly used
to deliver oxygen, eliminate carbon dioxide, and decrease the work of breathing. Physical therapists must be familiar with the various alarms used on mechanical ventilators to
ensure patient safety.
1.A change in patient position would be more likely to cause the high pressure alarm to activate. When the high pressure alarm sounds it indicates that the ventilator has met
resistance to deliver the tidal volume and requires more pressure to inflate the lungs.
2.A pneumothorax refers to an abnormal collection of air in the pleural cavity. Pressure from the pneumothorax impedes the lungs ability to inflate and as a result is more
likely to cause the high pressure alarm to activate.
3.The low pressure alarm of a mechanical ventilator is activated when the ventilator has no resistance to inflate the lung. This is most often associated with a
patient being disconnected from the ventilator or a leak in the ventilator circuit.
4.Coughing increases intrathoracic pressure and is therefore more likely to cause the high pressure alarm to activate.
Resource: (Perry p. 606)
174
Correct Answer: 2
Explanation
The plantar fascia is a multilayered fibrous aponeurosis that originates on the medial calcaneal tubercle and splits into five bands that ultimately insert into the bases of the
proximal phalanges of the toes.
1.The Windlass test can be used to determine the presence of plantar fasciitis. This test is performed by passively dorsiflexing the great toe with the patient in standing. If the
patient has plantar fasciitis, they will likely experience pain at the base of the calcaneus, not at the base of the great toe.
2.A positive Windlass test is indicated by pain elicited at the medial calcaneal tubercle. The Windlass test attempts to mimic the changes experienced by the
medial longitudinal arch during the stance phase of gait due to dorsiflexion of the great toe.
3.When the great toe is dorsiflexed, the plantar fascia is lengthened and tightens. As the plantar fascia tightens, the height of the medial longitudinal arch would
actually increase, not decrease.
4.During dorsiflexion of the great toe, the plantar fascia winds around the metatarsal head and tightens. This tightening of the plantar fascia shortens the distance
between the calcaneus and metatarsal heads (i.e., Windlass mechanism) which elevates the medial longitudinal arch and provides increased support to the foot.
Although this phenomenon may be observed during the Windlass test, a positive test is specifically pain elicited at the medial calcaneal tubercle.
175
Correct Answer: 4
Explanation
Hormone replacement therapy (HRT), including estrogen and progestin replacement, is commonly prescribed for the treatment of menopausal symptoms and
osteoporosis. Benefits of hormone replacement therapy in this population include prevention of osteoporosis and fractures, reduction in hot flash frequency, and improvement
in atrophic vaginitis and urinary tract infections.
1.Hormone replacement therapy can reduce bone loss and increase bone density in the spine and hips. As a result, there is a reduction in the risk of compression fractures in
postmenopausal women receiving hormone replacement therapy.
2.Studies suggest women going through menopausal transition who are experiencing depression may benefit from hormone replacement therapy, however, this claim remains
controversial. Regardless, depression is not a risk factor associated with hormone replacement therapy.
3.Studies suggest women going through menopausal transition who are experiencing memory loss may benefit from hormone replacement therapy, however, this claim
remains controversial. Regardless, memory loss is not a risk factor associated with hormone replacement therapy.
4.The risks of participating in hormone replacement therapy include stroke, pulmonary embolus, deep vein thrombosis, gallbladder disease, and a small increase
in breast cancer. Each woman should consult with a physician to discuss the benefits and risks of hormone replacement therapy, and should reevaluate their
decision periodically to ensure the benefits continue to favor hormone use.

176
Correct Answer: 4
Explanation
A patient with gluteus medius weakness may demonstrate difficulty with contralateral foot clearance during the midswing phase of gait and attempt to compensate with an
excessive ipsilateral trunk lean. The deficit is typically more evident at slower speeds of gait since faster speeds reduce stance time and subsequently the duration of time the
muscle has to act as a stabilizer.
1.Ipsilateral hip hiking is typically observed as a compensatory mechanism utilized to assist in clearing the toes during the swing phase of the gait cycle. Hip hiking may be
associated with an ipsilateral foot drop or a significant leg length discrepancy.
2.Contralateral hip hiking is often utilized as a strengthening exercise for a weak gluteus medius muscle. A patient may begin the exercise in a gravity-eliminated supine
position and progress to standing.
3.An ipsilateral hip drop is not typically associated with muscle weakness, however, may be observed in a patient with a significant leg length discrepancy. With respect to the
shorter limb, the ipsilateral hip will typically drop during the stance phase as the contralateral hip hikes allowing that limb to clear the floor as it swings through.
4.During open chain activities the gluteus medius acts as a hip abductor. However, during the stance phase of gait (i.e., closed chain activity), the muscle acts to
stabilize the pelvis and prevent contralateral hip drop.
177
Correct Answer: 1
Explanation
Footwear can be an important item to assess when treating patients with foot and ankle pathologies. Footwear modifications can redistribute forces, improve stability, relieve
pain, and accommodate for deformities and areas of increased pressure.
1.Mortons neuroma refers to an injury to nerves between the toes which results in thickening and pain. The nerves most commonly affected are located between
the third and fourth toes. A common cause of Mortons neuroma is shoes that are too tight in the forefoot. This problem is made worse with high heels. Shoes
with a larger toe box and without a high heel can assist to reduce or potentially alleviate the patients symptoms.
2.Plantar fasciitis refers to inflammation of the plantar fascia at the proximal insertion on the medial tubercle of the calcaneus. Plantar fasciitis is often associated
with an excessive amount of pronation or prolonged duration of pronation. Possible interventions include orthotics, arch support, heel cup, shock absorbing
inserts, night splints, modalities, stretching, and strengthening exercises.
3.Peroneal tenosynovitis refers to inflammation of the peroneal tendons. The peroneus longus and brevis tendons are located posterior to the lateral malleolus
and are the structures most commonly affected. This condition is typically associated with activities requiring repetitive ankle motion that result in overuse,
trauma or recurrent ankle sprains. Possible interventions include activity management, orthotics, lateral heel wedge, modalities, range of motion, and
strengthening exercises.
4.Tarsal tunnel syndrome is a compression neuropathy where the tibial nerve is compressed as it travels through the tarsal tunnel which is located posterior to
the medial malleolus. Tarsal tunnel syndrome is commonly associated with flat feet or pronation since this increases pressure in the tunnel region often
resulting in nerve compression. Possible interventions include orthotics, rigid arch support, and modalities.
178
Correct Answer: 2
Explanation
Health care providers should be aware of the physical, emotional, and psychological consequences associated with sexual harassment. Federal and state laws protect health
care providers from being harassed by patients who persist in making verbal or physical advances. When harassment is identified, health care providers should take
immediate action to protect themselves and stop the harassment.
1.The patients reaction (i.e., laughing) indicates that the patient may not fully understand the therapists desire to terminate the unacceptable behavior. Although the log
detailing any potential future harassment is potentially beneficial, it is more important for the therapist to be clear on the expected patient behavior.
2.Explaining that you are serious and want the behavior to stop builds upon the therapists initial comment and reinforces the need to terminate the unacceptable
behavior. If the patient does not change their behavior, the action establishes the groundwork for more formal action.
3.Formally reporting the harassment to the human resource department may be slightly premature since the therapist has not yet been explicit in their desire to
stop the harassment and there is not yet a pattern of offensive behavior.
4.Requesting that the patient is reassigned to another therapist is a viable strategy if the patients behavior persists, however, addressing the topic in a more
direct manner should occur first. This action provides the patient with a better opportunity to learn that their behavior is unacceptable.
System: Non-Systems
179
Correct Answer: 3
Explanation
Normal healing times can be predicted based on the depth of tissue injury. These times are considered to be guidelines which may be significantly altered by the onset of
infection or an especially large burn area.
1.An infected deep partial-thickness wound may have healing impeded to such an extent that grafting is eventually indicated. However, the graft procedure would not be
carried out in the presence of an active infection due to the risk of additional complications.
2.Although an infection may delay wound healing, grafting is not typically indicated for superficial partial-thickness wounds. If well protected, a wound of this depth will typically
heal on its own within three weeks without surgical intervention.
3.A deep partial thickness wound will typically heal within three to five weeks. In the absence of infection, however, wounds of this depth that are slow to heal
may require grafting to more effectively facilitate wound closure.
4.A large superficial partial-thickness wound can reasonably be expected to require a longer healing time than wounds with smaller surface areas. Given the
typical healing times associated with this degree of tissue damage, 50% healing within a 10-day period would be considered favorable and appropriate.
180
Correct Answer: 1
Explanation
Pubic symphysis separation is a painful condition that can occur during pregnancy or the birthing process due to the increased joint mobility around the pelvis and the
significant force placed on the joint during delivery. This pubic dysfunction results in pain during gait and weight bearing activities, as well as during active abduction of the
lower extremities.
1.Women with pubic symphysis separation will have pain during gait and weight bearing activities. The use of an assistive device, often a walker, is helpful in the
acute phase to limit pain and allow for independent functional mobility. A trochanteric belt is often used during ambulation to provide external support at the
pelvis.
2.Kegel exercises are prescribed for strengthening the muscles of the pelvic floor. Pregnancy, childbirth, and surgery can weaken the pelvic floor musculature
and cause incontinence. Kegel exercises would not be indicated to treat a separated pubic symphysis.
3.Lumbar stabilization exercises are indicated for women with pubic symphysis separation in the subacute phase (i.e., 6 to 12 weeks postpartum). This would not
be the most appropriate intervention for this patient prior to discharge home.
4.Progressive resistive exercises with elastic tubing may be indicated for this patient in the subacute phase, but would not be the most appropriate intervention in
the acute phase prior to discharge from the hospital.
Resource: (Boissonnault p. 344)
181
Correct Answer: 1
Explanation
The 90-90 straight leg raising test is a commonly utilized gross assessment of hamstrings length. Normal flexibility of the hamstrings would result in the patient being able to
actively extend the knee within 20 degrees of full knee extension.
1.The 90-90 straight leg raising test requires the patient to actively extend the knee as much as possible from the described test position. The therapist can
quantify the relative position of the knee by measuring the amount of knee flexion at the end of the active movement.
2.The 90-90 straight leg raising test requires the patient to maintain the hip in 90 degrees of flexion throughout the entire testing procedure. Failure to maintaing
the hip in the test position would invalidate the obtained results.
3.The 90-90 straight leg raising test is an active assessment of hamstrings length and therefore it would not be necessary for the therapist to passively extend the
patients knee.
4.The 90-90 straight leg raising test is an active assessment of hamstrings length and therefore it would not be necessary for the therapist to passively extend the
patients knee. In addition, the testing procedure requires the patient to maintain the hip in 90 degrees of flexion.
182
Correct Answer: 1
Explanation
Tuberculosis is an infectious, inflammatory disease that affects the lungs and can spread to involve lymph nodes and other organs. For patients who have documented or
suspected infections that are highly transmissible, transmission-based precautions are in place in addition to the standard precautions used during all patient care activities.
Transmission based precautions include contact, airborne, and droplet precautions.
1.Airborne precautions reduce the risk of airborne transmission of infectious agents through evaporated droplets in air or dust particles. A patient with this type
of infection will be in a negative pressure room. A negative pressure room includes a ventilation system that generates negative pressure to allow air into the
room, but prevents infected air from escaping. Anyone entering the room will wear respiratory protection. Tuberculosis is an example of an infection that is
transmitted through an airborne mode.
2.The described patient will most likely be on airborne precautions, but will not be in a positive pressure room. Positive pressure rooms are used for patients with
compromised immune systems, such as patients who have HIV. A positive pressure system filters the air before delivery with a HEPA filter and then pumps the
air into the isolation room at high pressure which forces air from the isolation room into the hallway.
3.Droplet precautions reduce the risk of droplet transmission of infectious agents through contact of the mucous membranes of the mouth and nose, contact with
the conjunctivae, and through coughing, sneezing, talking or suctioning. These infectious agents do not suspend in the air and will travel only three feet or less.
A mask should be worn when working within three feet of the patient. Examples of infectious agents transmitted by droplet mode include pneumonia and
influenza.
4.Contact precautions reduce the risk of transmission of infectious agents through direct or indirect contact. Examples of infectious agents that can be
transmitted through contact include Clostridium difficile, scabies, zoster, and multi-drug resistant bacteria. A physical therapist working with a patient on contact
precautions will wear gloves and a gown.

System: Non-Systems
183
Correct Answer: 3
Explanation
The primary ligaments of the glenohumeral joint include the superior, middle, and inferior glenohumeral ligaments and the coracohumeral ligament. These ligaments play an
important role in providing stability to the shoulder. The function of these ligaments vary depending on the position of the shoulder.
1.The superior glenohumeral ligaments primary role is to limit inferior translation when the shoulder is adducted. It also limits external rotation when the shoulder is in 0-45
degrees of abduction.
2.The middle glenohumeral ligaments primary role is to limit external rotation when the shoulder is in 45-90 degrees of abduction.
3.The inferior glenohumeral ligaments primary role is to support the humeral head above 90 degrees of abduction. The ligament is the most important stabilizing
structure of the shoulder for patients that engage in overhead activities. The inferior glenohumeral ligament has an anterior and posterior band. The anterior
band tightens on lateral rotation and the posterior band tightens on medial rotation. The inferior glenohumeral ligament would most likely be limiting the patients
range of motion because the shoulder is in 100 degrees of abduction (i.e., over 90 degrees).
4.The coracohumeral ligaments primary role is to limit inferior translation as well as limit external rotation when the shoulder is in less than 60 degrees of
abduction.
184
Correct Answer: 1
Explanation
The tonic labyrinthine reflex results in changes in tone based on head position and the heads relationship to gravity. This reflex is present at birth and is typically integrated by
six months of age. When a child is positioned in supine, the tonic labyrinthine reflex causes an increase in extensor tone, impairing the childs ability to flex against gravity.
Conversely, when the child with a persistent reflex is positioned in prone there is an increase in flexor tone, limiting the childs ability to lift their head against gravity.
1.The trunk flexion and hip flexion achieved by positioning the child in supine with the upper trunk on a wedge and legs over a bolster counteracts the extensor
tone elicited by the tonic labyrinthine reflex. This is the best position for the child to eliminate the influence of the reflex and facilitate upper extremity reaching.
2.Positioning the child in supine with the legs and trunk extended will activate the supine tonic labyrinthine reflex and will increase extensor tone. The increase in
extensor tone will inhibit the child from flexing the upper extremity to perform reaching activities.
3.Positioning the child in prone with a pillow under the abdomen will promote an increased flexor tone associated with a persistent prone tonic labyrinthine reflex.
This position will not facilitate the childs ability to participate in upper extremity reaching activities.
4.Positioning the child in prone with the legs and trunk extended will result in increased flexor tone associated with a persistent tonic labyrinthine reflex. This
position will not allow the child to participate in reaching activities.
Resource: (Martin p. 136)
185
Correct Answer: 3
Explanation
A deep vein thrombosis is a blood clot that forms in a vein with the potential to dislodge as an embolism and travel until it blocks an artery. There are various risk factors for
acquiring a deep vein thrombosis.
1.Varicose veins are swollen, twisted, and sometimes painful veins near the surface of the skin that have filled with an abnormal collection of blood. Varicose veins have a
weak association with acquiring a deep vein thrombosis.
2.Prolonged liver disease can often produce prolonged clotting times, reduced clearance of fibrin degradation products, and thrombocytopenia. It is hypothesized that the
impairment of normal hemostasis acts to protect against acquiring a deep vein thrombosis.
3.Major surgery on the hip, knee, leg, calf, abdomen or chest significantly increases the risk of acquiring a deep vein thrombosis. Symptoms of a deep vein
thrombosis include swelling of the lower extremity, pain, sensitivity, and warmth over the area of the clot.
4.Tobacco use has a weak association with acquiring a deep vein thrombosis. Other risk factors include advanced age, obesity, infection, and air travel.
186
Correct Answer: 1
Explanation
To ensure patient safety during gait training activities, therapists must be able to appropriately direct patients in sequences that maintain weight bearing restrictions with
normal gait mechanics and protect the affected lower extremity.
1.When descending stairs, the crutches and the involved lower extremity move first. The uninvolved lower extremity does the work of lowering the body to the
next step.
2.The sequence described would require the involved left lower extremity to bear full weight while lowering the body to the next step. The patient is partial weight
bearing and cannot perform full weight bearing activities.
3.Although the patient would lead with the left lower extremity when descending stairs, the crutches would need to be lowered prior to or simultaneously with the
left lower extremity. If the crutches are not moved, damage to the axilla may occur since the axillary support of the crutches can cause compression in the axilla
region.
4.The sequence described would require the involved left lower extremity to bear full weight as it lowers the body to the next step. If the crutches are not moved
prior to lowering the body, damage to the axilla may occur since the axillary support of the crutches can cause compression in the axilla region.
System: Non-Systems
187
Correct Answer: 3
Explanation
An associated reaction is an involuntary and automatic movement of a body part as a result of an intentional active or resistive movement in another body part. Neurological
impairment allows for such associated reactions.
1.Synergies are considered primitive patterns that occur at the spinal cord level as a result of the hierarchical organization of the central nervous system. Reinforcing synergy
patterns is rarely utilized in neurological rehabilitation.
2.Souques phenomenon involves raising the involved upper extremity above 100 degrees with elbow extension in order to produce extension and abduction of the fingers.
3.Raimistes phenomenon involves facilitating hip abduction or hip adduction of the involved lower extremity with applied resistance to the uninvolved lower
extremity in the same direction.
4.Homolateral synkinesis occurs when a flexion pattern of the involved upper extremity facilitates flexion of the involved lower extremity.
Resource: (DeMyer p. 584)
188
Correct Answer: 2
Explanation
Diastasis recti is the separation of the rectus abdominis in the midline at the linea alba. Due to the size of the separation (i.e., four centimeters), aggressive abdominal
strengthening exercises should be avoided. If the size of the separation is less than two centimeters, more provocative exercises can be attempted. When exercising, the
patient should wrap a sheet around the trunk at the level of the separation to approximate the separated muscle.
1.Lower trunk rotation is an exercise performed in hooklying where the patient simultaneously rotates both knees down toward the floor. Exercises involving trunk rotation
should be avoided since the rotation may lead to further separation of the rectus abdominis.
2.A head lift in hooklying would be the most appropriate exercise for the patient since the exercise allows for only modest strengthening of the rectus abdominis
while minimizing the influence of the obliques (i.e., muscles of rotation). This exercise has the lowest risk of further separating the rectus abdominis, especially if
a sheet is used to approximate the muscle.
3.Though abdominal curls focus on strengthening the rectus abdominis while minimizing engagement of the obliques, a full abdominal curl would be too
aggressive for a patient with a four-centimeter separation. Once the separation is two centimeters or less, more aggressive exercises may be attempted.
4.Diagonal abdominal curls would be an inappropriate exercise for the patient. Not only is an abdominal curl too aggressive, the diagonal abdominal curl is even
more advanced since it requires rotation, and thus engagement of the oblique muscles.
189
Correct Answer: 2
Explanation
Congestive heart failure is a progressive condition in which the heart cannot maintain a normal cardiac output to meet the bodys demands for blood and oxygen. Heart failure
often develops after other conditions have damaged or weakened the heart. The ventricles weaken and dilate to the point that the heart cant pump efficiently.
1.Left ventricular hypertrophy often results from increased arterial pressure associated with hypertension. Although hypertension can contribute to the development of
congestive heart failure, it is not likely to be the primary symptom given the patients past medical history.
2.Fluid overload associated with renal insufficiency often contributes to the development of congestive heart failure. The fact that the medical record includes a
history of renal insufficiency makes fluid overload the most relevant symptom.
3.Pulmonary embolism can produce severe hypoxemia impacting the lungs and resulting in elevated pulmonary artery pressures. Although pulmonary embolism
can contribute to the development of congestive heart failure, it is not likely to be the primary symptom given the patients past medical history.
4.Valvular stenosis or incompetent valves can result in myocardial hypertrophy. Although valvular stenosis can contribute to the development of congestive heart
failure, it is not likely to be the primary symptom given the patients past medical history.
190
Correct Answer: 1
Explanation
There are a variety of muscles of the face that can be effectively assessed by having the patient attempt to make a specific facial expression associated with the muscle. The
vast majority of muscles assessed using this technique are innervated by the facial nerve.
1.The frontalis raises the eyebrows, wrinkling the forehead, as in the expression of surprise or fright.
2.The corrugator supercilii draws the eyebrows together, as in frowning.
3.The mentalis raises the skin on the chin. This action causes the lips to appear as if they are protruding or that an individual was pouting.
4.The zygomaticus major draws the angle of the mouth upward and outward, as in smiling.
191
Correct Answer: 1
Explanation
Discharge planning begins at the physical therapy evaluation and continues throughout the plan of care as goals and outcomes are achieved. Discharge planning should
include patient, family or caregiver education, plan for follow-up or continuation of care through the appropriate agency, a home exercise program, and evaluation and
modification of the home environment to ensure safety.
1.This patient is most appropriate for discharge home since they are at their prior level of function and a level of modified independence with all mobility. Since
this patient is walking household distances, home physical therapy is more appropriate than outpatient therapy. Given the patients history of falls in the home,
home physical therapy is indicated to evaluate the home environment for fall risks and maximize the patients safety with mobility.
2.A skilled nursing facility is not indicated for this patient since they are functioning at their prior level of function. The patient is able to function independently in
the home setting, which eliminates the need for skilled nursing care.
3.An inpatient rehabilitation setting is not indicated for this patient since they are able to be independent in the home setting. Patients who are discharged to
inpatient rehabilitation settings require access to 24-hour medical care. This patient does not require that level of services.
4.Home is the appropriate discharge recommendation for the patient, however, outpatient services are not the most appropriate since the patient is only
ambulating household distances. The patient will also benefit from a home environmental assessment because of the history of falling.
System: Non-Systems
192
Correct Answer: 3
Explanation
The bench press is a commonly used exercise that functions to strengthen the pectoralis major, anterior deltoid, serratus anterior, pectoralis minor, and triceps brachii.
Physical therapists must be able to adapt specific exercises to the unique needs of each patient.
1.The bench press should be performed with a pronated grip rather than a supinated grip. The patient should grasp the bar with the hands slightly wider than shoulder width
apart.
2.The elbows are typically fully extended at the conclusion of the upward movement of the bench press. As a result, this action does not serve to limit the amount of stress on
the anterior capsule of the shoulder.
3.In a typical bench press the patient is instructed to lower the bar until it touches the chest at approximately nipple level. As a result, ensuring that the bar does
not contact the chest serves to reduce the amount of stress on the anterior capsule of the shoulder. Therapists should attempt to avoid instructing patients with
known or suspected shoulder pathology in exercises that place the arms and hands behind the plane of the shoulder.
4.The head should remain in contact with the bench at all times during a bench press. Attempting to lift the head is a common substitution pattern that should be
avoided since it has the potential to jeopardize patient safety.
193
Correct Answer: 4
Explanation
Pusher syndrome (or ipsilateral pushing) is an abnormal motor behavior commonly seen in patients who have had a stroke. The motor behavior is characterized by the patient
actively pushing toward the hemiparetic side. Attempts by the therapist to correct the patient's posture result in the patient pushing more strongly to the hemiparetic side. A
patient with pusher syndrome is at an increased risk for falling.
1.Pusher syndrome is not characterized by impairments in balance, but rather a misperception in the patient's body orientation in relation to gravity. Therefore, working on
balance reactions would not be helpful in correcting this patient's sitting posture. Having this patient sit on a therapy ball would also place them at a significant risk for a fall.
2.As stated previously, pusher syndrome in not characterized by balance impairments. Furthermore, working on balance in a standing position would not be ideal since the
patient is having issues with their posture in a seated position.
3.Using cues to have a patient attend to one side is commonly used in patients with unilateral neglect. A patient with right hemisphere damage would normally have left-sided
neglect, therefore, the cues given would be on the left side of the body. The scenario does not describe a patient with left-sided neglect.
4.A patient with pusher syndrome has a misperception of their own body orientation in relation to gravity. Use of a mirror can be helpful for the patient to visually
see their current body orientation and be able to correct accordingly. When correcting to an upright posture, the therapist should have the patient actively move
into position instead of passively moving the patient.
194
Correct Answer: 3
Explanation
Diabetes insipidus is a rare disorder that results from antidiuretic hormone (ADH) deficiency where the kidney tubules fail to resorb water. Injury to the hypothalamus or the
posterior pituitary gland can result in this disorder. Symptoms include excessive secretion of diluted urine, polydipsia, nocturia, hypotension, and dehydration.
1.Excessive secretion of growth hormone after normal completion of body growth in an adult is termed acromegaly. If there is excessive production of growth hormone in a
child, the disorder is termed gigantism.
2.Type 1 diabetes mellitus (DM) is a multi-system disease with both biochemical and anatomical consequences. There is persistent hyperglycemia due to diminished or
absent production of insulin. In type 1 DM, insulin is functionally absent due to the destruction of the beta cells of the pancreas where the insulin would normally be produced.
3.Diabetes insipidus may present with serious side effects that can be life threatening. Fluid replacement is required to compensate for the significant loss of
fluid. Without exogenous administration of ADH and fluid replacement, the patient may experience rapid dehydration, shock, and death.
4.Hyperthyroidism occurs when there is excessive levels of thyroid hormones in the bloodstream. Symptoms can include an increase in nervousness, excessive
sweating, weight loss, hypermetabolism, and tachycardia. Treatment may include pharmacological intervention, radioactive iodine, and surgery.
195
Correct Answer: 3
Explanation
Opposition involves rotation of the carpometacarpal joint of the thumb in order to align the thumb pad with one or all of the digit pads. Opposition of the thumb is found in most
grasp patterns and allows for execution of a variety of activities such as turning a door knob.
1.Cylindrical grasp is used when holding a cylindrically shaped object such as a can of soda or soup. This grasp involves thumb opposition, finger adduction and flexion.
2.Pad-to-pad prehension is used when holding onto a coin. This grasp involves thumb opposition and slight flexion of the thumb joints. It also involves finger flexion at the
metacarpophalangeal and proximal interphalangeal joints and either flexion or extension of the distal interphalangeal joints of the fingers.
3.Hook grasp is used when holding onto a briefcase handle or purse. This grasp involves the metacarpophalangeal joints in neutral, with finger flexion at both
the proximal and distal interphalangeal joints. The thumb is positioned in extension with this grasp and would not be affected by the inability to perform
opposition.
4.Spherical grasp is used when holding onto a round object such as a softball or an apple. This grasp involves thumb opposition and finger flexion and
abduction.
196
Correct Answer: 4
Explanation
Proprioceptive neuromuscular facilitation (PNF) is a treatment approach developed by Kabat, Knott, and Voss in which movement patterns are diagonal and spiral in nature. It
is directed at improving function, performance, and coordinated movement and is commonly used to treat patient with musculoskeletal and/or neuromuscular deficits.
1.The PNF approach uses movement patterns that are diagonal and spiral in nature rather than straight plane (i.e., cardinal plane) movements.
2.When naming the various PNF patterns (e.g., D1 flexion), the pattern is named according to the action that is occurring at the proximal joint.
3.Though many of the PNF patterns are unilateral patterns (e.g., D1 flexion), bilateral patterns and trunk patterns can also be used (e.g., chopping patterns).
4.PNF patterns are diagonal and spiral (i.e., rotational) in nature. For example, the D1 flexion pattern involves external rotation of the shoulder and supination at
the forearm.
197
Correct Answer: 1
Explanation
Torticollis refers to shortening of the sternocleidomastoid muscle. This condition is characterized by ipsilateral lateral flexion and rotation toward the contralateral side. Infants
who present with torticollis tend to have shortening throughout the trunk and lower extremities on the affected side.
1.Play in prone is important in infants to strengthen the cervical and trunk musculature and promote normal development. By placing the toys on the infants right
side, the therapist is facilitating elongation of the left side, which is most likely shortened.
2.By placing the toys on the infants left side, the therapist is facilitating trunk flexion on the left side, which will further shorten the lateral musculature.
3.At four months of age, it is unlikely that this infant has the postural control to reach in and out of the base of support in sitting. Assuming typical development,
an infant sits independently by 6 months, but is not expected to have the pelvic and trunk control to weight shift and move freely in this position.
4.Passive range of motion exercises to the cervical spine may be indicated to stretch the sternocleidomastoid muscle, however, when working with infants it is
most effective to facilitate active stretching through play activities. By promoting an active stretch, the infant is less resistive to the intervention and stretching
can occur naturally throughout the day.
Resource: (Long p. 190)
198
Correct Answer: 3
Explanation
Conditions that affect the heart valves increase the workload of the heart and require the heart to pump harder to maintain adequate blood flow. For patients affected by these
conditions, initial symptoms usually involve fatigue. As the condition progresses, symptoms of heart failure (e.g., dyspnea) usually appear.
1.Pericarditis is a condition characterized by inflammation of the pericardium, the layer that covers the outside of the heart. Signs and symptoms of this condition include
angina, dyspnea, malaise, and myalgia.
2.Coronary artery disease is a condition characterized by a narrowing or blockage of the coronary arteries which are the vessels that supply blood to the heart. Signs and
symptoms of this condition include angina and, if it progresses, myocardial infarction.
3.Endocarditis is a condition characterized by inflammation of the cardiac endothelium, the layer that lines the inside of the heart. This condition may result in
damage to the aortic, tricuspid or mitral valve. Signs and symptoms include musculoskeletal symptoms such as arthralgia, arthritis, low back pain, and myalgia.
4.Congestive heart failure is a condition characterized by the hearts inability to pump enough blood to meet the demands of the body. Signs and symptoms of
this condition are dependent upon which side of the heart is affected, but generally include fatigue, dyspnea, and edema.
199
Correct Answer: 1
Explanation
Hydrocephalus is an increase of cerebrospinal fluid (CSF) within the ventricles of the brain typically due to poor resorption, obstruction of flow or excessive production of CSF.
The majority of patients with spina bifida experience hydrocephalus. Successful treatment typically includes surgical placement of a shunt.
1.Physical therapists working with patients with hydrocephalus must be aware of symptoms of the condition as well as shunt malfunction. Immediate medical
intervention is often necessary to alleviate the excessive fluid within the brain. Failure to act in a timely manner can result in coma and/or death. Symptoms of
potential shunt malfunction include irritability, lethargy, headache, seizures, vomiting, incontinence, and confusion.
2.A lower motor neuron disease is characterized by a lesion that affects nerves or their axons at or below the level of the brainstem, usually within the final
common pathway. Symptoms include flaccidity or weakness of the involved muscles, decreased tone, fasciculations, muscle atrophy, and decreased or absent
reflexes.
3.Shock is caused by insufficient circulating blood volume. In addition to shallow breathing and a rapid pulse, a person can experience altered mental status,
decreased urine output, cool and clammy skin, and thirst. Shock is a life threatening condition if not treated in a timely manner.
4.Allergic reactions are sensitivities to allergens that come into contact with the skin, nose, eyes, respiratory tract, and gastrointestinal tract. Common symptoms
of a mild allergic reaction include hives, itching, nasal congestion, rashes and red or watering eyes. Anaphylaxis is a sudden and severe life-threatening allergic
reaction that occurs within minutes of exposure and requires immediate medical attention.
200
Correct Answer: 1
Explanation
A total knee arthroplasty is a procedure performed for patients with progressive and disabling pain in the knee joint, such as severe osteoarthritis. Regaining normal joint
range of motion is important following a total knee arthroplasty in order to normalize the gait pattern. A goal of 90 degrees of knee flexion and full knee extension is often
established for patients prior to leaving an inpatient setting.
1.Following a total knee arthroplasty the quadriceps muscles can be inhibited by pain, joint edema, and muscle weakness. Quadriceps inhibition can contribute to
increased knee flexion during the stance phase of gait. Quadriceps strengthening is an important aspect of the physical therapy plan of care following total knee
arthroplasty. This option promotes improved knee extension range of motion through passive extension, strengthens the knee extensors, and improves knee
extension during gait.
2.Placing a pillow under the knee following a total knee arthroplasty should be avoided. This position shortens the knee flexors and inhibits achievement of full
range of motion into knee extension.
3.Active knee flexion exercises in sitting is indicated to improve knee flexor strength and range of motion, however, it will not address the quadriceps
strengthening and knee extension range of motion that is needed to improve the patients gait.
4.Isometric gluteal setting exercises strengthen the hip extensor musculature and may be indicated for this patient, however, it will not directly influence the
amount of knee flexion present during the stance phase of gait.

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1

Resource: (Umphred p. 462)

Resource: (Higgins p. 440)

Resource: (OSullivan p. 591)

Resource: (Dutton p. 281)

however, a body mass index of 26 kg/m is considered overweight, not obese.

Resource: (Goodman - Pathology p. 517)

Resource: (OSullivan p. 265)

Resource: (Tecklin p. 26)

of contact area on the patella at 90 degrees of knee flexion is approximately 4.7 cm .

1.15 mm Hg is an inadequate amount of compression to facilitate the desired scar remodeling.

1.Irradiation refers to the overflow or spread from stronger to weaker muscles.

Resource: (Dutton p. 569)

Resource: (OSullivan p. 415)

Resource: (Magee p. 983)

1.Pain originating from bone is often described as deep, achy or boring.

Resource: (Goodman - Pathology p. 988)

Resource: (Fairchild p. 31)

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