diagnosis of a medial meniscus tear of the right knee. Which of the following signs and symptoms is MOST indicative of this diagnosis
1
. A history of
mechanical locking
is a common symptom of knee medial meniscus tear.
2. Pain is commonly increased, not decreased, with weight-bearing.
3. Swelling would more likely be evident anteriorly, not posteriorly.
4. Quadriceps atrophy is more li
While bending over in standing position with knees extended, a patient exhibits decreased spinal flexion and decreased hip flexion. The findings MOST likely are associated with limitation in which of the following measures
Tightness of the hamstrings causes excessive lumbar flexion, because tight hamstrings restrict the amount of hip flexion.
weakness of toe flexion and ankle inversion. The physical therapist suspects vascular compromise associated with this presentation. Palpation at which of the following locations is MOST likely to reveal diminished arterial pulses in the patient
posterior tibial artery is most likely to be involved in chronic posterior compartment syndrome.
This artery should be palpated
posterior to the medial malleolus
long sitting position
The abdominal muscles are active during a sit-up (with the knees extended) until the spine is completely flexed (head, shoulders, thorax lifted from surface).
In order to come to a long-sitting position, however, the hips must be flexed, and the abdominal
Peripheral arterial disease
correlates most strongly with cigarette smoking. Male gender is also a risk factor.
The patient is experiencing intermittent claudication pain, aching, or cramping of muscles, causing limping.
Ischemia should be strongly suspected when
systolic blood pres
prosthetic
1. A prosthesis that is too short; causes a patient to laterally bend toward the prosthetic side during stance phase.
2. A prosthetic socket that is too small
3. Inadequate prosthesis suspension
4. A locked knee unit
=>the rest cause valuting
pain in the lateral aspect of the proximal forearm. The pain is reproduced with shoulder girdle depression, elbow extension, shoulder medial (internal) rotation, and wrist flexion. The patient's symptoms are relieved when the physical therapist removes th
1. Cubital tunnel syndrome is ulnar nerve entrapment.
Tingling and paresthesias in the medial forearm and hand are typical findings with cubital tunnel syndrome.
2. Pronator teres syndrome is compression of the median nerve.
Although the patient may have
The patient has a forward head and excessive thoracic kyphosis. Which of the following exercises is MOST appropriate
1. A chronic forward head is more likely to result in deep neck flexor weakness.
Strengthening, not stretching, of the deep neck flexors is most appropriate.
2. A chronic forward head and thoracic kyphosis is most likely to shorten the upper trapezius. Up
PRIMARY purpose of pursed-lip breathing is to
1
. A patient with chronic obstructive pulmonary disease has premature collapse of the airways upon exhalation, which leads to air trapping and ultimately poor gas exchange. Breathing out through pursed lips slows the airflow and creates a back pressure,
therapy with medial ankle pain. Examination shows posterior medial malleolar tenderness and a supinated hindfoot at heel strike (initial contact). Which of the following muscles is MOST likely responsible for these impairments
1. The tibialis anterior tendon courses anterior to the medial malleolus and contributes to ankle dorsiflexion and inversion.
2. The soleus inserts into the calcaneus and contributes to plantar flexion of the ankle.
3
.
Supination involves combined moveme
patient becomes short of breath, begins coughing, and expectorates pink, frothy sputum. At this point, the physical therapist should first stop the treatment, then NEXT
sit the patient up, assess vital signs, and call a nurse or physician for further instructions
=The presence of dyspnea and the pink, frothy sputum would suggest the presence of heart failure and resultant pulmonary edema.
Heart failure can occur from poo
therapist observes a patient from behind during bilateral shoulder abduction and notes that the patient's right scapula is more abducted than the left scapula at the end range of movement
1. Tightness of the rhomboid major and minor would promote
downward rotation of the scapula
.
2.
Weakness of the serratus anterior would limit the upward rotation of the scapula
.
3
. The most likely reason for the increase in scapular motion is restricti
level on the Rancho Los Amigos levels of cognitive functioning scale
1
. Localized response-III- is defined as a patient having a localized response and reacting specifically but inconsistently to stimuli.
Responses are delayed and directly related to the type of stimulus present.
2. Confused-agitated response (level IV) i
therapist examining a patient's joint play finds restriction in the direction indicated by the arrow in the photograph. To address the restriction, the therapist should include an intervention to increase which motion of the index finger (2nd digit)?
1
. The therapist is shown performing a volar glide, which is the same joint motion used for finger flexion.
Limited motion in this direction indicates limited ability to perform finger flexion.
2. Extension range of motion would be limited if dorsal glid
patient with end-stage renal disease has significant exercise intolerance
1
. Persons with end-stage renal disease have limitations to exercise due to reduced oxygen-carrying capacity associated with anemia.
2. End-stage renal disease is associated with hypertension.
4. End-stage renal disease is associated with decreased VO2.
patient who has atrophy of the hypothenar eminence of the hand will most likely have the GREATEST difficulty performing which of the following tasks
-The ulnar nerve innervates the muscles in the hypothenar aspect of the palm of the hand, namely the flexor digiti minimi, abductor digiti minimi, and opponens digiti minimi.
-In addition,
the ulnar nerve innervates other intrinsic muscles, including the
nonblanching erythema(redness)
onset of a Stage I pressure ulcer
nerve bias
1. The shoulder abduction, elbow extension, and wrist extension position is for the
median nerve
.
2. The shoulder flexion, elbow flexion, and wrist extension position is for the
ulnar nerve
.
3. Shoulder extension, elbow extension, and wrist flexion is t
knee flexion
- In photograph A, there is more knee flexion present with the hip flexed. In this position, the rectus femoris is on slack across the hip joint, allowing greater range of knee flexion.
- In photograph B, the rectus femoris is stretched over both the knee
primary risk factor for atherosclerosis
- 1 High blood pressure,
2 cigarette smoking,
3 hyperlipidemia are direct or primary risk factors for atherosclerosis
-secondary; stress, obesity, sedentary lifestyle
A patient with idiopathic pulmonary fibrosis completed 6-minute walk test and demonstrates the following results: total walking distance of 1200 ft (366 m) in 6 minutes, heart rate of 82 to 110 bpm (pretest to posttest), blood pressure of 125/80 to 145/85
1. Based on the walk test results, the heart rate and blood pressure have normal physiologic rise in response to exercise and would not indicate cardiovascular pump dysfunction.
2. Although the walk test results do indicate impaired ventilation and respir
close-packed position of the hip
Medial (internal) rotation with extension and abduction
To relieve lateral shoulder and arm pain, a patient elevates the right arm with the elbow bent and rests the right forearm on the head. The patient's symptoms are MOST likely caused by which of the following conditions
C4-C5 disc herniation
-The test described in the stem evaluates for radicular symptoms and involves the C4 or C5 nerve roots.
- If resting the arm on the head relieves the patient's symptoms, a cervical compression problem or nerve root compression should
patient with leukemia has developed thrombocytopenia after a bone-marrow transplant. Which of the following measures is indicative of the status of the thrombocytopenia
1. The T4 lymphocyte count is used to assess immune status in patients with human immunodeficiency virus or acquired immunodeficiency syndrome.
2. The red blood cell count is utilized to assess for presence of anemia.
3
. Thrombocytopenia is an acute or c
The work modification (standing) shown in the photograph is MOST appropriate for a patient with which of the following conditions
-Posterolateral lumbar disc bulge; Sitting increases intradiscal pressure, so standing is often preferred to sitting
-Central lumbar stenosis; A patient with stenosis will do better in sitting, not standing
indicative of developing nerve root signs
1. The Babinski sign is suggestive for central nervous system dysfunction.
2. The Hoffman sign is for cervical myelopathy or upper motor neuron disease.
3. Cogwheel rigidity is a sign of central nervous system dysfunction.
4
. A fading deep tendon reflex
left hip with morning stiffness and hip pain that increases with medial (internal) rotation. The patient demonstrates restriction in hip motion for both medial (internal) rotation and flexion
1. Neoplasm related to the hip will present with bone pain greater on weight-bearing, constant and intense night pain, fever, and weight loss.
2. Fibromyalgia is a noninflammatory systemic condition with reported myofascial pain throughout the body.
3
. H
patient who is being treated for osteoarthritis of the knees reports centralized lower thoracic pain and epigastric pain. The pain is relieved by eating. Which of the following steps would be MOST important in screening for the cause of the new symptoms
1. A psoas abscess would be painful in the right or left lower quadrant and refer pain to the low back.
2. Constipation and diarrhea are symptoms related to the colon, which, when painful, relates to mid-abdominal pain and refers pain to the sacral area.
close-packed position of the radiocarpal joint of the wrist
Extension with radial deviation
In a research study, a correlation coefficient of 0.30 was found for the relationship between two variables. Which of the following interpretations of this finding is MOST appropriate
Correlation is not causation.
When a high correlation exists, an individual's score on one variable is related to the score of the other variable.
A correlation coefficient of 0.30 indicates a
low correlation
right hemiplegia is unable to avoid obstacles on the right side of the hallway while walking with a walker. During meals, the patient does not eat foods placed on the right side of the plate. Which of the following tests is MOST appropriate to perform
1. Moving the head rapidly while focusing on a fixed target directly in front examines for the
vestibuloocular reflex (VOR) function
.
2
. Ignoring foods on one side of a plate and difficulty orienting to stimuli in a specific area of space are symptoms o
evaluating a hurdler. One week earlier, the patient had to stop suddenly during a race because of sharp, severe buttock pain. The patient now reports pain with straight-leg raising and resisted knee flexion, and swelling in the buttock. The MOST likely ca
1
. An avulsion fracture of the ischial tuberosity is usually reported with an acute traumatic incident. The pain is usually local, but may also radiate down the thigh.
Active or resisted knee flexion would increase the pain.
2. Inferior pubic ramus fract
atrophy in a 36-year-old patient who has partial resection of the musculocutaneous nerve. Girth is BEST measured from which of the following landmarks
3.9 inches (10 cm) proximal to the lateral epicondyle of the humerus;
-musculocutaneous nerve innervates the biceps brachii, brachialis, and coracobrachialis muscles, which are all located in the anterior arm, along with sensory innervations to the latera
patient has difficulty palpating the carotid pulse during exercise. The patient should be instructed in alternate methods of self-monitoring, because repeated palpation is likely to result in
Manual pressure on the carotid sinus can cause a reflexive drop causing decrease in heart rate, blood pressure, or both.
vascular lesion in the brainstem affecting the oculomotor nerve (CN III). During the cranial nerve examination, which of the following signs would be the MOST significant
1.
Inability to fully close the eye would be seen with a lesion of the facial nerve
(CN VII) (Bell palsy).
2. Medial strabismus would be caused by damage to the abducent nerve (CN VI), innervating the lateral rectus, causing a
medial strabismus
.
3
. The
Gait analysis reveals severe genu recurvatum on the left with postpolio. The physical therapist should consider the use of an ankle-foot orthosis to
protect the knee from further damage
=ankle-foot orthosis set in slight dorsiflexion would control knee hyperextension (genu recurvatum).
->This would minimize knee joint damage and pain
pes planus is contributing to the pain. Which of the following orthotic interventions is MOST appropriate for the patient
1A metatarsal pad is used to treat metatarsalgia or a neuroma
2. A heel cup is used similarly to a heel lift.
It is used for better shock absorption, not a fallen arch.
3. A midsole cushion is used on a stiff foot (pes cavus).
4
. Longitudinal arch suppor
a disease-modifying antirheumatic drug used for treatment of rheumatoid arthritis
1
. Gold sodium thiomalate is categorized as a disease-modifying antirheumatic drug (p. 502).
2. Flurbiprofen (Ansaid)
3. Etodolac (Lodine)
4. Acetylsalicylic acid (Aspirin)
=> nonsteroidal anti-inflammatory drug
treadmill for 10 minutes at 3.5 miles (5.6 km) per hour and 0� elevation when she reports a new onset of midthoracic back pain,
aching
*-vascular- in the right biceps muscle, fatigue, weakness, and nausea. Which system is MOST likely implicated
Midthoracic pain and upper extremity pain can be signs of angina in women.
The undue weakness, fatigue, and nausea are concerning for a systemic origin of pain, particularly the cardiovascular system
CN VIII damage
hypersensitivity to sound-titnus- and hearing loss and ringing in ears
patient is performing a strengthening exercise for a weakened muscle as shown in the photograph. The weakness is MOST likely caused by a lesion of which of the following nerves
1. The axillary nerve supplies the deltoid and teres minor muscles.
The deltoid abducts the arm, and the teres minor muscle laterally (externally) rotates the arm.
2. The thoracodorsal nerve supplies the latissimus dorsi muscle, which extends, adducts, an
alpha set at 0.05 was used to determine if a difference between sample and population means was statistically significant. The critical value for rejecting the null hypothesis was 1.645, and the statistical test result was 1.95. The MOST accurate conclusi
statistically significant, and the probability that the observed sample mean could have occurred by chance is less than 5%
gait of a patient with sciatic nerve damage. Which of the following gait deviations is the patient MOST likely to exhibit
1. Femoral nerve involvement is associated with extensor lag.
3
.
Sciatic nerve involvement will cause weakness of the tibialis anterior, resulting in foot drop
. Articular branches of the sciatic nerve distribute to the hip joint, and muscular branches d
work-site evaluation of a person who is using a computer at a workstation
1. Top of screen even with the top of the forehead. However, the monitor should be positioned farther away (16 to 22 in = 41 to 56 cm) to reduce eye strain.
2. Elbows bent 90�, top of the screen even with the top of forehead
3. shoulders relaxed with arms
pt education
Explicitly inviting the patient's questions will help ensure that the therapist's information is understood
appropriate test for which of the following conditions
1. The thumb grind test would be more appropriate for evaluating degenerative changes at the carpometacarpal joint.
2. Radiographs are obviously the first test of choice, and physical therapy tests would more likely be either direct palpation of the scaph
measure of myocardial oxygen demand
HRxSBP
In manual muscle testing of the lower trapezius, a physical therapist resists which of the following sets of movements
Scapular depression, adduction, and upward rotation
paralysis of the wrist extensors and long extensors of the digits. The therapist should recognize these symptoms as indications of injury to which nerve
1. The ulnar nerve innervates the
intrinsic hand muscles. Loss of function would be in the hand
(pp. 679, 685-686).
2
. The radial nerve innervates the wrist and finger extensors (pp. 679, 685-686).
3. The musculocutaneous nerve innervates the
elbow flexo
impaired vestibular ocular reflex. Which of the following interventions is BEST for this condition?
1. Habituation exercises are appropriate for treatment of
unilateral peripheral vestibular loss
.
2
.
Gaze-tracking exercises
foster the substitution of visual and somatosensory information to improve gaze and postural stability, as well as balance compen
patient in supine is performing shoulder exercises. Which type of contraction do the triceps undergo as the shoulder moves from 180� toward 90� of flexion
concentric;direction of humeral flexion and extension
patient with a transfemoral amputation is wearing a prosthesis and exhibits lumbar lordosis during push-off of the prosthetic side. Which of the following is the MOST likely cause of the lordosis
1. Medial (internal) rotation of the knee joint is most likely to cause a whip at heel off.
2. An abducted lateral wall is likely to cause the socket to be loose, which can cause circumduction.
3. A stiff heel bumper is needed for heavy or active patients
recreational runner reports a 2-week history of gradually increasing pain in the distal posterior-medial aspect of the lower leg. The pain is present first thing in the morning, eases within a few hours, and increases again at the end of the day. Which of
1
. The stem describes pain in the medial leg and behind the medial malleolus.
Also, the patient has a 2-week history of pain while running.
Running requires eccentric control of pronation
. The tibialis posterior controls inversion(supination) and pronat
Laboratory findings of decreased red blood cell count and increased erythrocyte sedimentation rate are MOST indicative of:
1
. Increase in erythrocyte sedimentation rate and possible anemia are clinical indicators of rheumatoid arthritis (p. 465).
2. Scleroderma is indicated by the presence of Raynaud phenomenon,
3. Fibromyalgia is indicated by the presence of trigger points-
fever and acute hip pain. Radiographic evaluation reveals a lesion in the proximal femur. Which of the following procedures is LEAST helpful in making a differential diagnosis
1. A
biopsy is the definitive diagnostic procedure to identify bone tumors
(p. 1206).
2. A
bone scan (DXA) may be used to identify osteopenia and osteoporosis
(p. 1166).
3
. Electromyogram (EMG) is more helpful for diagnosing neuromuscular disorders (p. 1
The patient in the photograph is unable to tolerate passive lower extremity elevation beyond what is shown. The patient's lower extremity limitation is MOST likely caused by which of the following conditions
-
With the straight leg raise, the hamstrings are stretched across both joints at the same time
.
Because no limitation is noted in the hip or knee joints, the limitation would be due to the hamstrings.
-"Active" would mean that the patient is voluntarily
A patient reports pain over the sacroiliac joint and buttock on the left side. The patient's pain is reproduced with an ipsilateral active straight leg raise-imply hip flexor-sacroiliac compression test, and palpation of the left-imply left problem- sacro
flexors
Which of the following signs and symptoms is MOST likely to be present in an individual with a herniated nucleus pulposus at the L4-L5 level
1
. L5: covers the dorsal area of the foot and innervates the extensor hallucis longus.
Because of the way the nerve roots exit L4-L5, pathology usually affects the L5 nerve root rather than L4 (p. 1338).
2. S1: covers the plantar surface of the foot; L4:
patient with relapsing-remitting multiple sclerosis will MOST likely experience which of the following over time
1. Primary progressive multiple sclerosis is characterized by a continuous, steady decline with or without occasional plateaus.
2. All forms of multiple sclerosis are characterized by either relapses or steady progression of the disease.
3
. Relapsing-rem
Relapsing
(of someone suffering from a disease) suffer deterioration after a period of improvement.
Remitting
cancel or refrain from exacting or inflicting
neurogenic pain
1. Throbbing pain is usually vascular.
2. Aching pain is usually musculoskeletal.
3. Agonizing pain can be emotional.
4.
Burning
is a common descriptor of neurogenic pain .
recurrent lateral patellar subluxations. While testing the patient's patellar mobility, the physical therapist notes that the apex of the patella rotates medially during a passive medial patellar glide. Which of the following structures around the patella
- Medial glide would stress lateral structures.
The apex (inferior pole) of the patella is moving, however the base of the patella (superior) is not, causing patellar rotation.
Therefore,
superolateral structures are tight
.
difficulty in raising the right arm. During examination, manual muscle testing of shoulder abduction reveals strength of Good (4/5) without pain. Which of the following is the MOST likely cause of these findings
1. Tendinitis results in painful weakness since it affects a contractile structure (p. 574).
2
. Suprascapular nerve damage; Weakness without pain implicates a nerve injury.
3. Subacromial bursitis is likely to be painful with potential weakness, but may
new ST-segment displacement from baseline and a sinus rhythm of 70 bpm. What is the MOST likely diagnosis
1. Bradycardia is below 60 bpm (p. 340).
2. Anxiety reaction would usually include an increased heart rate (p. 341).
3
. Acute myocardial infarction is associated with either ST elevation or ST depression (p. 357).
patient who has complete loss of vestibular function. As a compensatory strategy, the therapist should work with the patient on exercises that will
improve gaze stability
Standing postural assessment of a patient with spondylolysis reveals an increased lumbar lordosis, shortened hip flexors, and Fair (3/5) strength in the abdominal muscles. Which exercises would be MOST appropriate for this patient
1. Prone press-up would further increase the lumbar lordosis.
3.
When the abdominals are weak, straight leg raising results in back hyperextension
and possibly pain and therefore should be avoided.
4
. When the hip flexors are short, the knees should be f
back hyperextension
cervical extension
increased lumbar lordosis
D/t tight hip flexor
Which of the following strategies is MOST effective for helping a patient with limited recall learn to do three exercises independently
Gradually reducing the feedback (fading schedule) forces the subject to use internal processes of error detection, and results in better delayed retention
Apgar test evaluates heart rate, color, and which additional clinical characteristics?
Respiration, muscle tone, and reflex irritability
=N;here needs more color
=here consist of heart rate and repiration. They go along with
patient with biofeedback to alter the overactivity of the upper trapezius during shoulder flexion
The sensitivity or "gain" should be increased as the patient learns to decrease, or "train out" muscle recruitment.
With increased sensitivity, the patient will work "harder" to not recruit the muscle (inhibition).
-Which of the following conditions must be ruled out when a physical therapist evaluates a patient with nonspecific neck pain?
Myocardial infarction is a viscerogenic cause of nonspecific neck pain
insidious onset of pelvic and hip pain is referred to physical therapy. During the history the patient reports relief of symptoms after passing gas. The patient exhibits full, pain-free hip and lumbar range of motion and normal lower extremity strength. T
1. Pancreatitis will typically be made worse by walking or lying supine (pp. 341-342).
2. A patient with a
herniated nucleus pulposus will typically have loss of lumbar motion and decreased symptoms with lying supine
(p. 110).
3. Sacroiliac dysfunction wi
A patient with type 2 diabetes requires insulin injections. Which of the following factors may augment the effect of insulin
1. Cryotherapy would cause vasoconstriction, thereby slowing down the delivery of insulin, contributing to hyperglycemia.
2
. Aerobic exercise causes vasodilatation by increasing skin blood flow.
This would deliver the insulin more rapidly.
3. Eating befo
two year old child with behavioral and social problems due to mental retardation
1. Mitochondrial disorders result from genetically inherited or spontaneous mutations in the DNA that lead to impaired function of proteins found within the mitochondria.
Symptoms include loss of muscle coordination, muscle weakness, visual and hearing pr
guidelines to prevent the spread of tuberculosis
1. 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
.
This transmission req
back height of a wheelchair extends above the patient's inferior angle of the scapula for what?
Patient has fair trunk control, but is able to independently propel a wheelchair
progressive left hip pain that has become functionally limiting and at times severe. The results of the patient's recent blood and urine analysis were normal, however, abnormalities were identified on x-ray
1
.
Progressive pain complaints are consistent with the typical presentation of osteoarthritis
. Laboratory testing may be utilized to rule out septic arthritis or other inflammatory conditions.
In the absence of abnormal laboratory results, a diagnosis o
therapist observes that another patient appears anxious, diaphoretic, and dyspneic. When questioned the gentleman reports a recent onset of substernal chest pain and nausea
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, diap