Peat 1

PEAT I
Practice Questions 1
1. In splinting or immobilization, the functional position of the hand includes wrist:
A. extension, phalangeal flexion, and thumb abduction
B. extension, phalangeal extension and thumb abduction
C. extension, phalangeal flexion and thumb adduction
D. flexion, phalangeal flexion and thumb adduction
2. During pregnancy, which of the following is contraindicated?

A. curl-ups
B. bridging
C. double leg lifts
D. deep breathing with forced expiration
3. A target heart rate is determined for individual entering a training program in order to:
A. regulate exercise intensity
B. estimate energy expenditure
C. control blood pressure and specific heart rate
D. ensure participants exercise at maximal capacity
4. A herniated nucleus pulposus at the L3-L4 disc produces which of the following clinical findings?
A. Numbness in the back of the calf and dorsiflexor weakness
B. Numbness in the anteromedial thigh and knee and quadriceps weakness
C. Numbness and weakness in the thigh, legs, feet and/or perineum
D. Numbness in the back of the calf and atrophy of gastrocnemius and soleus
5. The intervention for a patient with limitation of shoulder flexion and medial rotation includes mobilization. Which glide is the
most appropriate for mobilizing this shoulder to specifically increase the restricted motion?
A. Posterior
B. Anterior
C. Medial
D. Lateral
6. Which of the following techniques is MOST appropriate for a patient with low postural tone?
A. Slow regular rocking while sitting on the treatment bolster
B. Continuous pressure to the skin overlying the back muscle
C. Low frequency vibration to the back muscle
D. Joint approximation applied through the shoulder to the trunk
7. Which skin change associated with aging has the GREATEST effect on wound healing?
A. Reduction in sensation
B. Decrease elasticity of the skin
C. Decrease epidermal proliferation
D. Change in pigmentation
8. Which of the following techniques is MOST effective in teaching an IDDM patient about foot care?
A. Reassure the patient that no infection will occur if the directions are followed, then demonstrate procedure
B. Tell patient how foot care is performed, then watch patient’s performance
C. Watch patient perform foot inspection and caution him that amputation results from unattended skin problems
D. Have the patient demonstrate a foot inspection, then give feedback on patient’s performance
9. For a child with Duchenne muscular dystrophy, the MOST appropriate rehabilitation goal would be:
A. prevention of contractures and determine method of mobility
B. preservation of strength and muscle tone
C. inhibition of abnormal tone and facilitation of normal movement and position reaction
D. facilitation of normal movement and improvement of strength
10. A patient with complete long thoracic nerve injury would have difficulty in:
A. putting hand in the back pocket.
B. bending toward the involved side.
C. taking a deep breath.
D. reaching forward above head.
PEAT 1
2 Practice Questions
11. Outcomes of prenatal exercise program would not include:
A. improved body mechanics
B. application of relaxation technique
C. improve ligament flexibility
D. strengthen pelvic floor musculature
12. Utilization review and peer review are activities that are part of a comprehensive:
A. policy and procedure manual
B. quality improvement program
C. audit cycle
D. performance evaluation
13. Which of the following is the BEST documentation exercise of a goal?

A. The therapist will reduce patient’s hip flexion contracture to neutral
B. The patient will ambulate 75 feet independently in 3 weeks
C. The therapist will reduce patient’s pain from 7/10 to 3/10
D. The patient will understand how to increase ADL in 4 weeks
14. Patient has a limited ankle dorsiflexion following ORIF of distal tibia. Radiographs reveal that the fracture is well healed.
Treatment with passive mobilization should include:
A. posterior glide of talus on tibia
B. lateral glide of calcaneus on tibia.
C. posterior glide of tibia on talus
D. anterior glide of talus on tibia.
15. A patient who recently and successfully completed a 12 week program of phase III cardiac rehabilitation will MOST likely
demonstrate a decrease in:
A. CO2 elimination in maximal work
B. cardiac output in maximal work
C. stroke volume at a given level of submaximal work
D. heart rate at a given level of submaximal work
16. The demographic information on the subject in a research study list a mean age of 32 and median of 35. The difference
between the median and mean indicates:
A. the value of standard deviation score
B. the value of the Z score
C. that the distribution is skewed
D. that the two measures should be average
17. Rocking in quadruped position could be included in physical therapy intervention for a 40 year old patient to increase ROM at
the:
A. hip joint, 1 month post total hip replacement
B. distal radioulnar joint, 2 weeks post fracture of the distal radius
C. glenohumeral joint, 2 months post rotator cuff tear
D. hip joint, 1 week post subcapital fracture of the femoral neck
18. A therapist is treating a young athlete with gastrocnemius muscle strength of fair plus (3+/5). In the prone position, which of
the following exercises is the MOST appropriate to maximize strengthening?
A. Resistive exercises with the knee bent.
B. Resistive exercises with the knee straight.
C. Active exercises with the knee bent
D. Active exercises with the knee straight.
19. Redness on the inferior aspect of the patella upon removal of a patellar tendon bearing prosthesis indicates that the residual
limb:
A. is not far enough into the prosthesis and fewer socks should be worn
B. is not far enough into the prosthesis and additional socks should be worn
C. has slipped too far into the prosthesis and fewer socks should be worn
D. has slipped too far into the prosthesis and additional socks should be worn
20. A therapist is evaluating a patient with an acute lumbar disc protrusion and a right lateral shift of the thoracic spine. Which of
the following findings would be the BEST indicator that the symptoms will respond positively to the PT intervention?
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A. The pain is referred only to the buttock and not the thigh.
B. The patient prefers standing and walking than sitting.
C. There is a decrease in lumbar lordosis.
D. Repeated backward bending centralizes the pain.
21. A therapist evaluates a patient who has lateral epicondylitis. the patient reports a subjective pain of 8/10. The patient also
reports pain and shows weakness with resisted wrist extension. The therapist decides to use ice massage as an intervention.
The MOST appropriate length of time for the ice massage is:
A. ten minutes
B. until the area turns red and patient reports burning sensation
C. until the patient reports that the area is numb
D. no longer than five minutes
22. Following spinal joint mobilization procedure, a patient calls the therapist and reports a minor dull ache in the treated area of
the back that lasted for 2 to 3 hours. Based on this symptom, the therapist should:
A. consider a possible neurological lesion in the area
B. refer the patient back to the physician
C. inform the patient that the response is common
D. add strengthening exercises to the home program.
23. In order to conduct an experimental study on pain in postsurgical orthopedic patients, a therapist randomly assigns patients
into two groups. One group is treated with TENS, heat and exercises; the second receives heat and exercises only. In this
experimental design, TENS is the:
A. continuous variable
B. dependent variable
C. discrete variable
D. independent variable
24. A 90-year-old patient with chronic congestive heart failure has been non-ambulatory and a nursing home resident in the past
year. The patient was recently admitted to the hospital following an episode of dehydration. Which of the following plans for
prophylactic respiratory care is MOST appropriate?
A. Turning, coughing and deep breathing every 1 to 2 waking hours.
B. Vigorous percussion and vibration 4 times a day
C. Gentle vibration, with the foot of the bed elevated once a day.
D. Segmental postural drainage using standard positions throughout the day.
25. Which diagnostic procedure is LEAST likely to confirm suspected disc herniation in a patient with low back pain?
A. MRI scan
B. CAT scan
C. Radiograph
D. Myelogram
26. To help the students apply newly learned skill to clinical practice, the MOST effective action for the clinical instructor to take
is to:
A. point our possible patient situations and discuss how the skill would apply to them.
B. have the students research reference materials and compile a list of the steps required in the acquisition of the skill
C. prepare a list of indications and contraindications for the skill.
D. have the students provide examples of patient situations where the skill would be appropriately applied.
27. It is important to perform cool down exercises immediately following a general aerobic program PRIMARILY in order to
prevent:
A. venous pooling
B. cardiac arrhythmia
C. decrease body temperature
D. muscle tightening
28. The intervention for a patient who has right sciatic pain caused by piriformis compression would NOT include:
A. instruction in mild self-stretching in sitting with the right hip and knee flexed and pressure applied in the medial
direction to the distal thigh with the left arm.
B. contract-relax exercise to the hip external rotators performed with the patient sidelying and the right hip and knee
positioned in 90 degrees of flexion.
C. active resistive strengthening exercise to the piriformis with the patient prone and the knee flexed
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D. application of cold to the area of sciatic nerve irritability
29. A therapist is assigned in the planning and implementation of services for all members of the community. The therapist’s
FIRST step would be to:
A. develop a brochure for distribution to the community.
B. organize a health fair to provide screening for the community.
C. evaluate existing services and community resources.
D. initiate contacts in the medical community to establish prescriptive relationships.
30. To prevent contractures in a patient with an above-knee amputation (transfemoral), emphasis should be placed on designing a
positioning program that maintains ROM in hip:
A. flexion and abduction
B. extension and adduction
C. adduction and lateral rotation
D. flexion and medial rotation.
31. After a long-term history of bilateral lower extremity vascular insufficiency, an otherwise healthy patient had a right above-
knee amputation. For this patient, which of the following is the MOST important factor in establishing long-term goals for
functional walking?
A. Status of the wound at the amputation site.
B. ROM of the right hip.
C. Condition of the left lower extremity
D. Ability to maintain upright posture.
32. A patient is referred to physical therapy complaining of severe pain in the right hip and groin area, which increases during
walking. The patient complains of tenderness when the therapist palpates the area over the right greater trochanter. The
MOST likely cause of the patient’s signs and symptoms is:
A. sacroiliac joint derangement
B. a hip fracture
C. a strain of the adductor longus muscle
D. hip bursitis
33. A therapist is conducting a 12-minute walk test with a patient who has COPD and uses 2 L/min of O 2 by nasal cannula. The
patient’s resting O2 saturation is 91 % and the resting heart rate is 110 bpm. The O 2 flow should be increased if the:
A. patient’s CO2 level starts to increase
B. patient starts to complain of shortness of breath.
C. patient’s O2 saturation falls below 87%.
D. patient’s heart rate is greater than 150 bpm.
34. When working with a neurological patient to ensure that physical therapy services are adequately documented, it is MOST
important to record changes in:
A. muscle tone
B. functional abilities
C. cognitive status
D. quality of movement
35. A patient has right hemiparesis resulting from TBI. When assessing motor control in the right lower extremity with the
patient standing, the therapist finds that the patient cannot extend the hip while flexing the knee or flex the hip while
extending the knee. In which of the following functional activities will this problem be MOST apparent?
A. Shifting weight while standing.
B. Walking sideways.
C. Walking backward.
D. Moving from sitting position to standing position.
36. A patient was injured in a motor vehicle accident two days ago, resulting in quadriplegia at C6 level. When providing PROM
to the UE, which of the following is MOST critical in order to optimize long-term hand function?
A. Passive wrist and finger extension exercise to gain maximum stretch of the finger flexors
B. Passive wrist and finger flexion exercise to gain maximum stretch of the finger extensors.
C. Holding the wrist in flexion when passively extending the fingers.
D. Holding the wrist in extension when passively extending the fingers.
37. An athlete sustained a severe inversion sprain of the right ankle while playing basketball. To provide strapping support for the
ankle, pressure and support should be applied over the tendons of the:
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A. flexor digitorum longus and tibialis posterior
B. gastrocnemius and flexor hallucis longus
C. peroneus longus and brevis
D. tibialis anterior and tibialis posterior.
38. In which of the following conditions would a nerve conduction velocity test be MOST important?
A. Carpal tunnel syndrome
B. Cerebrovascular accident
C. Myotonia
D. Duchenne Muscular Dystrophy
39. When training a patient to increase muscle activity with the use of EMG biofeedback, the therapist should adjust the unit so
that sensitivity:
A. starts at low and increases as the patient shows an increase in muscle activity
B. starts high and decreases as the patient shows an increase in muscle activity
C. remains at approximately mid-range during the entire treatment period.
D. is not set, since this is not necessary for this form of biofeedback.
40. A patient with leukemia has developed thrombocytopenia following a bone marrow transplant. Which of the following
measures are indicative of the status of the thrombocytopenia?
A. T4 lymphocyte count
B. Red blood cell count.
C. Platelet count
D. White blood cell count
41. During a postural examination, the therapist notes that the patient’s patella both point inward when viewed from the front of
the patient. The MOST likely cause of this problem is excessive:
A. femoral anteversion
B. weakness of the vastus medialis
C. genu varum
D. medial tibial torsion
42. A therapist is evaluating a patient who has a vascular lesion in the brainstem affecting the oculomotor nerve. During the
cranial nerve examination, which of the following would be the MOST significant sign?
A. Inability to close the eyelid
B. Medial strabismus
C. Ptosis of the eyelid
D. Constricted pupil
43. For a patient with IDDM who is completing a cardiovascular fitness program, what change in diabetic management is MOST
likely to be instituted as fitness increase?
A. Switching to oral rather than injected medication.
B. Decreasing caloric intake for 2 to 3 hours following the exercise sessions.
C. Decreasing the amount of insulin taken daily.
D. Increasing the amount of insulin taken daily.
44. An elderly patient presents with a sacral pressure ulcer measuring 6 in. x 6 in. The wound has moderate serous fluid drainage
and is loosely covered with necrotic and fibrotic tissue, although there are no indications of infection present. The BEST
method of debridement would be:
A. daily vigorous scrubbing of the wound.
B. wet-to-dry dressings with normal saline 2 times a day.
C. daily wet-to-dry dressings with 1:1 dilute povidone-iodine (Betadine)
D. whirlpool jet agitation 2 times a day.
45. A patient is referred to physical therapy for treatment of tenosynovitis. The patient complains of “pins and needles” sensation
on the palmar surface of the first three fingers. The therapist’s examination reveals a positive Tinel’s sign at the wrist and
good (4/5) grade thumb opposition. Based on these findings, the therapist should suspect:
A. median nerve compression at the wrist
B. ulnar nerve compression distal to the elbow
C. tenosynovitis of abductor pollicis longus
D. thoracic outlet syndrome
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46. A patient has disuse atrophy of the anterior compartment muscle following cast removal after a fracture of the tibia. The
patient has poor (2/5) strength in the ankle dorsiflexors. Electrical stimulation is to be used to enhance dorsiflexor strength in
conjunction with exercise. Initially, which of the following waveform characteristics is MOST appropriate to stimulate the
muscles?
A. Monophasic pulse with a frequency of 110 pps and on/off cycle ration of 3:1
B. Biphasic pulse with a frequency of 30 pps and on/off cycle ratio 1:5.
C. Direct current waveform with an on/off ratio of 1:1
D. Interferential waveform with a beat frequency of 1 pps.
47. A patient is referred to physical therapy with a 20-degree knee flexion contracture following arthroscopic knee surgery a
month ago. All of the following interventions are appropriate EXCEPT:
A. stretching of the semimembranosus muscle
B. strengthening of vastus medialis.
C. inferior gliding of the patella.
D. mobility of the posterior capsule of the knee joint.
48. A patient with a complete SCI is sitting in a wheelchair on a custom made cushion. Pressure relief activities should be
performed:
A. when the patient shows signs of pressure sores
B. every 15 to 20 minutes
C. every 1 to 2 hours
D. if the patient does not have an appropriate cushion.
49. During a review, a patient lacks 10 degrees of passive ankle dorsiflexion. The same degree of limitation is present whether
the knee is flexed of extended. The muscle MOST likely contributing to this restriction is the:
A. gastrocnemius
B. tibialis anterior
C. plantaris
D. soleus
50. Which of the following assignments is MOST appropriate for the physical therapist to delegate to a volunteer?
A. Restocking treatment booths with linens, US gel, massage lotion.
B. Attending a patient who is on a tilt table while the therapist takes a phone call.
C. Transporting a patient who complains of dizziness back to his room.
D. Transferring a patient from the mat to a wheelchair.
51. A patient sustained a severe brain stem injury one week ago and has demonstrated minimal change since the incident. The
patient’s cognitive status is MOST likely to include:
A. a decrease level of arousal
B. a decrease level of intelligence
C. an increase level of agitation
D. an increase level of impulsivity
52. The hospital administrator asks members of the rehabilitation department to develop a comprehensive program to help reduce
the risk of low back injuries. Which of the following would be the FIRST step necessary to develop the program?
A. Include all employees in a lumbar extension exercise class
B. Design a program that meets each department’s functional needs
C. Perform an ergonomic analysis on each workstation
D. Provide pamphlets on proper body mechanics
53. To maximize continuity of patient care, the PT should begin discharge planning when the:
A. physician refers the patient for discharge
B. therapist makes the discharge review of the patient
C. discharge planner requests information pertinent to the patient’s discharge status
D. therapist performs initial review of the patient
54. The PT is positioning a patient for postural drainage. In order to BEST drain the posterior segment of both lower lobes, the
patient should be placed in which of the following positions?
A. Prone, head down at 45 degree angle
B. Supine, flat surface
C. Side lying, head elevated 30 degree angle
D. Sitting, leaning forward
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55. A MMT of a patient sustained a gunshot wound just superior to the elbow joint reveals specific muscle weakness from a
partial median nerve injury. The PT intervention for this patient would MOST likely include strengthening activities for wrist
flexion and forearm:
A. pronation, finger flexion, thumb adduction
B. pronation, finger flexion, thumb opposition
C. supination, finger abduction, thumb opposition
D. supination, finger abduction, thumb extension
56. A patient who has a piriformis syndrome is referred to TP for review and intervention. The patient’s history includes THR on
the right side 2 years ago. Because of the THR, which of the following should only be used with precaution?
A. TENS
B. Continuous us
C. Hot packs
D. Massage to the right hip
57. A patient presents with adhesive capsulitis of the shoulder joint. The ROM examination reveals restricted external rotation
and abduction of the shoulder. The FIRST mobilization procedure that should be done for this patient is:
A. posterior glide
B. distraction
C. anterior glide
D. external rotation
58. A patient sustained a severe TBI 3 months ago. During the exam of passive ROM, the therapist notices decrease passive knee
extension and moderate hamstring spasticity. Palpation reveals a firm mass on the lateral aspect of the joint. The therapist
should refer the patient to a physician for a review of probable:
A. osteogenic sarcoma
B. patellar fracture
C. osteomyelitis
D. heterotopic ossification
59. A patient complains of anterolateral shoulder pain with insidious onset. Examination shows full passive ROM, pain on
passive lateral rotation and pain on resistive internal rotation. These signs are consistent with a diagnosis of:
A. bicipital tendonitis
B. supraspinatus tendonitis
C. subscapularis tendonitis
D. infraspinatus tendonitis
60. A measurable objective for a community education program exercise techniques would be for participants to:
A. understand the importance of sufficient warm-up period
B. list five stretching techniques that can be used when warming up
C. overcome LE problems and adhere to a regular exercise program
D. appreciate the effects of increasing intensity of exercise on heart rate
61. During MMT of the hip flexors in the sitting position, a patient exhibits lateral rotation and abduction of the thigh as
resistance is applied. The PT should suspect substitution by:
A. sartorius
B. tensor fascia latae
C. adductor longus
D. semimembranosus
62. A PT is treating a patient who has lymphedema in the right LE. The therapist decides to use mechanical, intermittent
pneumatic compression as an intervention, using a sleeve that covers the foot, leg and thigh. The therapist measures BP at
135/85 mm Hg. At first treatment session, the MOST appropriate inflation pressure for the sleeve is:
A. 20 mm Hg
B. 60 mm Hag
C. 100 mm Hg
D. 140 mm Hg
63. A patient is entering a cardiac rehabilitation program. The PT should FIRST ask the patient to:
A. describe the correct aspect of exercise demonstrated by the therapist
B. list problems associated with nutritional habits
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C. identify the harmful effects of smoking with regards to cardiac disease
D. describe the type of angina that the patient experience
64. A PT receives a telephone call from a woman who identifies herself as a friend of one of the therapist’s patients. She wants to
know how the patient is doing and if he will be able to go up and down the stairs, because she wants to take him home for a
weekend visit. What should the therapist do?
A. Discuss the patient’s program and functional status with the caller
B. Invite the caller to observe the patient’s next therapy session
C. Refuse to discuss the patient’s status unless the patient’s permission is obtained
D. Refer the caller to the patient’s social worker
65. The parents of a 1-month old child with myelomeningocele report that the child has been increasingly irritable and has
changed sleeping patterns over the past three days. The child has also been vomiting. Which of the following is the MOST
appropriate action for the therapist to take?
A. Refer to immediate medical follow-up
B. Instruct the parents to monitor head circumference daily
C. Advise the parents to watch the child for worsening symptoms
D. Take the head circumference measurements to compare to subsequent visits
66. A therapist is setting up a home program of ES for a patient who has Bell’s palsy. Which of the following muscles should be
stimulated as part of the home program?
A. Sternocleidomastoid
B. Masseter
C. Temporalis
D. Frontalis
67. A patient is lying supine with his hips and knees extended and hands behind his head. The patient is able to raise his head,
shoulder and thorax from the treatment table, but is unable to come to a complete long-sitting position. The PT should target
which muscle for strengthening program?
A. Iliopsoas
B. External abdominal oblique
C. Quadratus lumborum
D. Upper rectus abdominis
68. A 14-month old child with spastic diplegia is up on his tiptoes with his toes curled when held in supported standing. This
position is characteristic of a:
A. proprioceptive placing reaction
B. moro reflex
C. plantar grasp reflex
D. traction response
69. A therapist is developing a gait training program for a patient following a THA of the right hip. The proper instructions and
rationale for crutch training utilizing one crutch include holding the crutch in:
A. right hand to decrease activity in the right hip abductors
B. right hand to facilitate action in the right hip abductors
C. left hand to decrease action in the right hip abductors
D. left hand to facilitate action in the right hip abductors
70. Following trauma at C5 spinal cord level, a patient was admitted to the hospital. 24 hours later, the patient shows no reflexes,
sensation, or voluntary motor activity below the level of injury. These findings indicate:
A. the presence of spasticity
B. decerebrate rigidity
C. spinal shock
D. a lower motor neuron lesion
71. A right handed woman is being examined by the PT for right sided weakness in her UE and LE. The muscle tone is hypotonic
and she is ataxic during walking. She has a history of hypertension and alcoholism. Passive ROM with DTR show
hyporefexia. She has an intention tremor when she tries to pick up an object from a table, and exhibits difficulty performing
the finger to nose test. Where is the MOST probable area of the lesion?
A. Right side, cervical spinal cord
B. Left side, cerebral hemisphere
C. Left side, substantia nigra
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D. Right side, cerebellar hemisphere
72. A patient sustained a gunshot wound to the distal posterior thigh that resulted in complete severance of the common peroneal
nerve. Which of the following exercise is necessary in the early rehabilitation period to prevent contracture formation?
A. Active plantarflexion, inversion and toe extension
B. Passive dorsiflexion, eversion and toe extension
C. Active dorsiflexion, eversion and toe flexion
D. Passive plantarflexion, eversion and toe flexion
73. A patient with mild closed head injury and bilateral femur fracture requires instructions in a LE exercise program. In order to
plan the most effective teaching methods for this patient, what would be the MOST critical to assess at the initial visit?
A. Comprehension of written, verbal and demonstrated instructions
B. Short tem memory capacity
C. Hearing and vision
D. Any personality changes compared to the patient’s premorbid status
74. A patient with right above-knee prosthesis will be able to maintain the knee in extension while weight bearing if the center of
gravity of the body is shifted so that the gravitational line falls:
A. posterior to the axis of the right knee joint
B. lateral to the axis of the right knee joint
C. anterior to the axis of the right knee joint
D. medial to the axis of the right knee joint
75. In order for a patient with bilateral BKA to maximize balance in a wheelchair, the rear wheels should be positioned more:
A. laterally
B. posteriorly
C. anteriorly
D. inferiorly
76. An initial PT evaluation performed on an elderly patient who is 1 day post total hip arthroplasty (non-cemented) using a
posterolateral approach. The patient has no complicating medical history and was active and independent preoperatively.
Which of the following activities is NOT an appropriate goal for the first week of therapy?
A. Active-assistive positioning of the left hip to 60 degrees of flexion
B. Active left hip abduction in right sidelying
C. Independent bed mobility with use of a trapeze
D. Walking with moderate assistance with a standard walker to 25 feet (7.6 meters)
77. A patient with frequent tension headaches has been referred to physical therapy for instruction in a program of progressive
relaxation exercises. Which of the following is MOST essential in a program of progressive relaxation to reduce muscle
tension?
A. Release of tension by suggestion and persuasion
B. Passive exercise in quiet surrounding to relieve tension
C. General massage using deep stroking and kneading of tense muscle
D. Recognition of the sensation of tension and release
78. On the fourth day of PT treatment, a patient who has had an ORIF for a hip fracture develops a large ecchymosis over the
unaffected hip. The patient has MOST likely developed:
A. a hemangioma
B. a complication of anticoagulant therapy
C. a hematocele
D. deep vein thrombophlebitis
79. A patient who is exercising on a bicycle ergometer in the cardiac rehabilitation unit is being monitored with electrocardiogram
leads. During the exercise, the ST segment becomes depressed by 2 mm. If the cardiologist has given no specific guidelines,
the PT should:
A. terminate the session immediately
B. reduce the resistance load
C. instruct the patient to slow down
D. direct the patient to continue as before
80. A patient slips, falls and cuts her arm in the clinic. The cut is bleeding and the patient is alert and well oriented. In
performing first aid for the patient, the FIRST action that the PT should take is to:
A. don a pair of gloves
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B. clean the cut with an antiseptic
C. check the patient’s BP
D. cover the cut with sterile dressing
81. A PT is working with patient who is aware that he is terminally ill. What is the MOST appropriate intervention when the
patient wants to talk about his prognosis?
A. Discourage discussion of death or dying
B. Refer the patient for pastoral counseling
C. Relate the therapist’s experiences with other patients
D. Encourage the patient’s statement of feelings
82. Prior to starting an exercise training program, a patient with cardiac problems who is receiving beta blocking medication
should receive an explanation of the:
A. greater benefits from cardiovascular exercise to be achieved at lower rather than at higher metabolic level
B. need to use measures other than heart rate to determine intensity of exercise
C. need for exercise training sessions to be more frequent but of shorter duration
D. need for longer warm-up periods and cool-down periods during an exercise session
83. A clean, well granulating stage II pressure ulcer with minimal serous drainage is MOST appropriately dressed with:
A. a non-adherent dressing
B. a packed dressing
C. topical medication only
D. dry-to-dry gauze
84. A PT examines a patient who complains of foot pain while jogging. The examination sows that the patient has excessive foot
pronation and forefoot varus. The therapist decides to try a temporary orthotics insert in the patient’s running shoe. Which of
the following would be the MOST appropriate orthotics insert?
A. A lateral forefoot post under the fifth metatarsal head
B. A lateral rearfoot post under the calcaneus placing it in everted position
C. A wedge placed under the instep of the medial foot just beneath the head of the talus
D. A medial post just proximal to the first metatarsal head
85. A patient with chronic adhesive capsulitis of the shoulder is to be treated with joint mobilization to increase joint range of
motion. Which of the following would be the MOST appropriate to increase shoulder abduction?
A. Distraction with inferior glide
B. Anterior glide with internal rotation
C. Superior glide with approximation
D. Distraction with posterior glide
86. An 8-year-old child who has juvenile rheumatoid arthritis is developing bilateral knee flexion contractures. Which of the
following would be the LEAST appropriate action?
A. Exercises to increase joint mobility
B. Ultrasound to the hamstring insertions to increase tissue extensibility
C. Progressive weight bearing by walking in a therapeutic pool to increase endurance
D. Exercise to increase quadriceps strength
87. Although knee motion occurs primarily in one plane, tibial rotation is possible when the knee is positioned in 90 degrees or
more of flexion because in this position the:
A. condyles of the femur glide posteriorly on the condyles of the tibia
B. hamstrings act as rotating force
C. patella deviates inferiorly
D. tension on the ligaments is decreased
88. A PT is screening a young adult patient for a possible right thoracic, left lumbar structural scoliosis. The postural deviation
commonly seen with this diagnosis would be:
A. spinous processes of the thoracic spine rotated to the right
B. high left shoulder
C. posteriorly protruding scapula to the right
D. prominent right posterior rib cage
PEAT 1
89. A postural correction program for a patient with forward head, kyphosis, and increased lumbar lordosis would include all of
the following EXCEPT:
A. strengthening of the scapular protractors
B. strengthening the thoracic erector spinae muscles
C. lengthening the short suboccipital muscles
D. lengthening the lumbar erector spinae muscles
90. A patient in the eighth month of pregnancy presents with numbness and tingling of the left hand except the fifth digit. She
demonstrates edema of the hand and fingers, a positive Tinel’s sign at the wrist, and a good (4/5) muscle test grade of the wrist
and finger flexors. The MOST appropriate intervention would be:
A. a wrist splint to position the wrist in full extension
B. a hot pack followed by tendon gliding exercises
C. resistive exercises for the wrist and finger flexors
D. frequent rest and elevation of the left upper extremity
91. An exercise program for a patient with Parkinson’s disease would MOST likely include exercise to:
A. decrease movement of the upper extremities and trunk
B. increase trunk flexor strength
C. improve balance reactions and reciprocation
D. stretch back extensor muscle
92. If a BK prosthesis has an excessively firm heel wedge, the patient is MOST likely to walk with:
A. excessive knee flexion in early stance
B. premature knee flexion in late stance
C. insufficient knee flexion in early stance
D. excessive knee flexion in late stance
93. A patient who has COPD is being treated with a regimen that includes pursed lip breathing exercise. The PRIMARY purpose
of the pursed lip breathing is to:
A. help prevent collapse of pulmonary airways during exhalation thereby reducing air trapping
B. decrease the removal of CO2 during ventilation
C. increase the residual volume of respiration so that more O2 is available for body metabolism
D. stimulate further mobilization of mucous secretions to higher air passages where they can be expectorated
94. A patient with a diagnosis of cervical radiculopathy reports numbness of the right little finger. The therapist would MOST
likely find a diminished DTR in the:
A. biceps brachii
B. deltoid
C. triceps brachii
D. brachioradialis
95. A therapist is planning a patient education program for a group of patients with chronic LBP. To increase the likelihood that
the patients will utilize the proper body mechanics at the work site, the therapist should:
A. ask patients to demonstrate the use of proper body mechanics
B. provide a reference list of articles describing body mechanics
C. ask patients to describe actions they do that increase their back pain
D. provide information on the frequency of low back injuries due to improper body mechanics
96. A patient presents with hemiparesis and demonstrate a foot drop during swing phase of gait. It would be MOST appropriate
to administer FES to the tibialis anterior and the:
A. gastrocnemius
B. tibialis posterior
C. extensor digitorum longus
D. peroneus longus
97. A PT is treating a patient with iontophoresis. If the current is set at 4 mA, the duration at 15 minutes, and the dexamethasone
solution at 0.4%, with an electrode area of 4 cm2, how would the therapist record the current dosage?
A. 0.16 mA.mg
B. 16 mA/cm2
C. 0.60 mg/min
D. 60 mA.min
PEAT 1
98. An elderly patient has diabetic neuropathy. Upon examination he shows marked mediolateral instability of the left ankle
while walking. The patient also has fluctuating edema and glove-and-stocking sensory loss in both legs. The MOST
appropriate orthotics aid would be:
A. a double-upright ankle foot orthosis
B. hip to toe shoes
C. a prefabricated plastic, solid ankle-foot orthosis
D. a spiral ankle foot orthosis
99. A 25-year-old patient with cystic fibrosis has been experiencing successful mobilization of thickened secretions by standard
percussion and postural drainage. During the current treatment session, the patient coughs up sputum that has small, brownish
streak of blood. The PT should:
A. percuss more vigorously in an attempt to clear out any other blood that is present in the airways
B. perform postural drainage in upright positions for this type of patient only
C. continue treatment with little modification unless more blood is noted
D. stop the treatment and send the patient to the emergency room
100. Which of the following should be recommended for a patient following a medial meniscectomy if the PT plans to exercise the
quadriceps femoris against accommodating resistance?
A. Knee bends through half of the range
B. Knee extension with sandbag in the ankle
C. Knee extension on an isokinetic exercise device
D. Straight leg raising with a sling suspension
101. In a suction socket prosthesis, the primary function of the valve in the lower and medial part of the socket is to permit air to:
A. remain during the stance phase of gait
B. remain during the swing phase of gait
C. escape during the swing phase of gait
D. escape during the stance phase of gait
102. A patient with chronic venous insufficiency of the LE would MOST likely exhibit:
A. normal superficial veins, no edema, ulceration and patches of gangrene around the toes
B. dilation of superficial veins, edema, stasis ulceration
C. no edema, cold, hairless LE, faint dorsalis pedis pulse
D. dilation of superficial veins, edema made worse during sitting or leg elevation
103. Following removal of a long leg cast, a patient has limited knee flexion. The MOST appropriate direction of patellar
mobilization would be:
A. distal
B. lateral
C. proximal
D. medial
104. Which lower extremity PNF pattern is MOST appropriate for a patient who needs strengthening of the tibialis posterior?
A. Hip extension, abduction and medial rotation with ankle plantarflexion and eversion
B. Hip flexion, adduction and lateral rotation with ankle dorsiflexion and inversion
C. Hip extension, adduction and lateral rotation with ankle plantarflexion and inversion
D. Hip flexion, abduction and medial rotation with ankle dorsiflexion and eversion
105. A patient is referred to PT with a diagnosis of low back pain. Radiographic studies, including MRI, have rules out the
presence of disc pathology. The patient complains of continuous back pain that radiates towards the thorax and anteriorly into
the abdominal region. The therapist should consider which of the following areas as a potential source of discomfort?
A. Dura mater
B. Diaphragm
C. Kidney
D. Urinary bladder
106. An adult patient who was involved in a motor vehicle accident has sustained multiple traumas, including fractured ribs on the
right side. The patient is unconscious, intubated and on a mechanical ventilator in the ICU. Chest radiographs show the
development of an infiltrate in the lower lobe during the past two days. Rales and ronchi are heard over the right lower lung
fields. Which chest program is MOST appropriate?
A. Manual hyperventilation and suctioning while positioned on the left side
B. Positioning supine for suctioning, followed by manual hyperventilation while positioned on the left side
PEAT 1
C. Suctioning, percussion and vibration while positioned on the right side
D. Positioning on the left side for deep breathing exercises only
107. A patient who has RA comes to PT with signs of muscle atrophy, ecchymosis, puffy cheeks and a diagnosis of osteoporosis.
This patient is MOST likely receiving a high dosage of:
A. penicillin
B. prednisone
C. aspirin
D. gold salts
108. A PT is examining a patient who has difficulty making a fist. The muscle test show the following: flexors of the 2 nd to 5th
digits at the PIP are normal (5/5); flexors of the 2 nd and 3rd digits at the DIP are normal (5/5); flexors of the 4 th and 5th digits at
the DIP are poor (2/5). These findings are consistent with a lesion of the
A. median nerve C8-T1
B. median nerve C5-C6
C. ulnar nerve C5-C6
D. ulnar nerve C8-T1
109. An elderly man who lives alone fell in his home, sustaining a hip fracture, which necessitated a THR. The patient was
previously able to perform all ADLs independently. He has been admitted to a skilled nursing facility for rehabilitation. The
patient’s goal is to return home. His family believes he should be admitted to a long-term care facility for his own safety once
acute rehabilitation is completed. The therapist’s MOST appropriate action is to:
A. advise the family that the patient should determine his own discharge environment
B. recommend a team conference with the patient and his family to discuss discharge plans
C. schedule a home visit to determine if home modifications are needed before discharge
D. implement a treatment plan with a long term goal of discharge to home
110. During LE exercise, a patient with incomplete C6 quadriparesis reports a new onset of tingling and numbness in both hands.
MMT reveals that overall strength has decreased by one grade. In this situation, the therapist’s MOST appropriate course of
action is:
A. modify the exercise program to accommodate change in strength
B. apply an ice massage prior to exercise
C. continue LE therapeutic exercise and use facilitation techniques to stimulate more activity
D. discontinue all exercises and notify the physician
111. In early management of a patient with partial peripheral nerve injury, the goal of the PT intervention will MOST likely be to
prevent:
A. nerve degeneration
B. spasticity and increase muscle tone
C. muscle atrophy
D. contractures and adhesions
112. A PT is developing an educational program for individuals with LE peripheral neuropathies due to diabetes. Which of the
following is the MOST important information for the PT to recommend for the prevention of injury to the foot?
A. Orthosis to support the extremity
B. Use of proper footwear
C. Moisturizing the skin to prevent dryness
D. Exercise parameter
113. Elevating a patient’s LE for less than 1 minute produces a noticeable pallor of the foot, followed by delayed reactive
hyperemia in a dependent position. These signs are indicative of:
A. an intact circulatory system
B. arterial insufficiency
C. venous insufficiency
D. acute arterial occlusion
114. While ascending stairs, an elderly patient leans forward with increased hip flexion. Which of the following muscles are being
used to the BEST advantage with this forward posture?
A. Rectus femoris
B. Tensor fascia lata
C. Gluteus maximus
D. Lumbar paraspinal
PEAT 1
115. A therapist is treating a patient with moderately well controlled type I diabetes. One of the goals is to help regulate her insulin
dosage through therapeutic exercise. In establishing an exercise program, the therapist should be aware that regular exercise
will generally:
A. lower blood glucose levels and decrease amount of insulin required
B. lower blood glucose levels and increase amount of insulin required
C. raise blood glucose levels and decrease amount of insulin required
D. raise blood glucose levels and increase amount of insulin required.
116. A PT recognizes that departmental education materials are written on a reading level that is too difficult for some of the
patients. The PT can help the patients better understand the materials by:
A. including illustrations and a larger print
B. including illustrations and a simpler sentence structure
C. reducing the number of syllables and lengthening the sentences.
D. using a larger print format to present specific medical terminology
117. An inpatient PT department has only one PT and one PTA on duty due to staff illness. A patient with which of the following
is MOST appropriate for the therapist to delegate to the assistant?
A. Ataxia, who is undergoing a trial to determine an appropriate assistive device
B. Hemiparesis, whose initial review has not been completed
C. Multiple sclerosis, so is receiving gait training with a rolling walker
D. Alzheimer’s disease, who is easily agitated during the initial gait training
118. During inspiration, a patient demonstrates increased upper chest expansion with retraction of the epigastric area. The PT
should suspect weakness of the:
A. scalene muscle
B. diaphragm
C. rectus abdominis
D. intercostal muscles
119. The brother of a patient who was recently discharged from the hospital’s outpatient PT department telephones on the patient’s
behalf to request a copy of the patient’s medical record. The therapist should explain to the patient’s brother that the medical
record is the property of the:
A. patient’s family and can be released to the bother upon request
B. patient’s insurer now and that the request for a copy must be made in writing to the insurer
C. hospital and the patient can be released only with written authorization from the patient
D. hospital and can be released only with written authorization from the patient’s physician
120. A PT is examining a patient for a possible LE weakness. PROM is within normal limits. The patient is seated. When the
patient tries to dorsiflex and invert his right foot, he is unable to move it through the full ROM and is unable to take any
resistance applied by the therapist. During the subsequent gait examination, the therapist would MOST likely expect the
patient to display which of the following?
A. Normal gait, with no deviations
B. Increased right hip flexion during swing phase
C. Throwing the trunk backward, on the right side, shortly after the initial contact
D. Lateral bending toward the right side during midstance
121. A patient is referred for PT with a diagnosis of chondromalacia patella. The PT decides to include quads setting and SLR as
part of the home exercise program because:
A. the vastus medialis muscle is primarily responsible for terminal knee extension
B. quads setting and SLR help improve patellar tracking
C. Patellofemoral compression forces are increased when the knee is extended
D. the vastus medialis muscle is preferentially activated during SLR.
122. A patient with low back pain has been undergoing treatment for two sessions. The patient tells the therapist that today the
pain is centralizing with the extension exercises, but is intense as it was at the first treatment session. The patient is frustrated
by this reaction. The therapist’s most appropriate response would be:
A. continue with the present program
B. eliminate the extension exercises
C. consult the patient’s physician about the situation
D. progress to trunk flexion exercises
123. Which of the following statements does NOT document patient outcome?
PEAT 1
A. The patient propelled his wheelchair independently after 4 weeks
B. The patient demonstrated independent performance of home program after 2 weeks
C. The patient walks 100 feet with minimal assistance after one week
D. The patient attended PT sessions 3x a week for 2 weeks
124. Which of the following is the MOST likely cause of reduced vital capacity in a patient who has quadriplegia at C5-C6 level?
A. Decreased anterolateral chest expansion resulting from paralysis of the external intercostals
B. Inability of the patient to generate a negative intrapleural pressure secondary to a denervated diaphragm
C. A relatively high resting position of the diaphragm resulting from paralysis of abdominal muscles
D. Reduced rib cage elevation due to paralysis of the anterior scalene and sternocleidomastoid muscles
125. An attorney calls the PT department seeking information on the status of his client, a patient who is undergoing rehabilitation
following total knee surgery. The patient’s physical therapist should:
A. refer the attorney to the patient’s insurance carrier
B. describe the patient’s current status
C. require written authorization from the patient to release information
D. obtain verbal permission from the patient to release information
126. Involving interdisciplinary team members in making decisions about continuity of patient care has all of the following benefits
EXCEPT:
A. promoting each individual’s commitment to, and responsibility for, the decisions that have been made by the group
B. discouraging one or two members from being in control and having all the authority
C. enabling decisions regarding quality of care to be made quickly
D. promoting quality of care by including several aspects of the patient’s care
127. Instruction in energy conservation and joint protection should be provided to the patient with rheumatoid arthritis because:
A. the joints may be predisposed to damage by overuse
B. fatigue often masks joint pain
C. phagocytes remove more pannus in resting joint
D. activity of the antigen-antibody complex is diminished with rest
128. In which of the following is independence the MOST realistic long-term goal for a patient with a complete spinal cord lesion
at C8?
A. Effective cough technique
B. Rolling from side to side
C. Transfer from bed to wheelchair
D. Ambulation with forearm crutches
129. A physical therapist examines a patient with multiple sclerosis who is in the period of exacerbation. The patient is
independent with bed mobility, can sit unassisted at the edge of the bed, and requires physical assistance to stand with a
walker. Which of the following ADL activities is the MOST important for the initial intervention?
A. Wheelchair propulsion up a 10 foot ramp
B. Wheelchair transfers
C. Walking with an assistive device
D. Tub transfers
130. When examining a patient who had a baby 3 days ago by vaginal delivery, the physical therapist notices that the patient has a
2-cm. diastasis of the rectus abdominis. To address this problem, the patient should:
A. perform partial sit-ups, supporting her abdominal muscles with her hands while lifting her head in the supine position
B. not perform exercises until the diastasis heals spontaneously
C. perform sit-ups with knees bent and arms behind the head
D. perform partial sit-ups with the legs straight and arms in front
131. To minimize skin irritation during functional electrical nerve stimulation, the physical therapist should use:
A. lower intensity, larger inter-electrode distance and larger electrodes
B. lower intensity, larger inter-electrode distance and smaller electrodes
C. higher intensity, smaller inter-electrode distance and smaller electrodes
D. lower intensity, smaller inter-electrode distance and larger electrodes
132. A patient is doing active and resistive exercises on a mat table in the physical therapy department. After 15 minutes, the
patient becomes short of breath, begins coughing and expectorates pink, frothy sputum. At this point, the physical therapist
should first stop the treatment, then:
PEAT 1
A. assess vital signs, let the patient rest a few minutes with the feet elevated, and ten resume with a less vigorous program
B. sit the patient up, assess vital signs and call a nurse or physician for further instructions
C. lay the patient supine, transfer the patient to stretcher and return the patient to the nursing unit
D. lay the patient down flat, call for assistance and begin cardiopulmonary resuscitation
133. When evaluating a wheelchair positioning of a child with cerebral palsy, the therapist should FIRST examine the position of
the child’s:
A. pelvis
B. legs
C. head
D. spine
134. A patient who sustained a mild CVA 3 weeks ago is being prepared by the physical therapist for discharge to home and an
adult day program. To facilitate the discharge plan, the MOST appropriate health professional for the therapist to consult with
is the:
A. skilled nursing coordinator
B. occupational therapist
C. medical social worker
D. primary physician
135. For a patient with a right middle lobe pneumonia, the proper bronchial drainage position is supine with the body:
A. one-quarter turned to the left and foot of the bed raised 14 inches
B. one-quarter turned to the right and bed flat
C. three-quarters turned to the left and head of the bed raised 14 inches
D. three-quarters turned to the right and foot of the bed raised 14 inches
136. To avoid the appearance of increased motion, which movement must be prevented during goniometric measurement of
shoulder abduction?
A. Upward rotation of the scapula
B. Medial rotation of the shoulder
C. Lateral rotation of the shoulder
D. Lateral flexion of the trunk to the opposite side
137. A patient who receive organ transplantation 4 years ago demonstrates progressive weakness and is referred to physical therapy
for strengthening exercises. In reviewing the medical history, the therapist learns that the patient takes prednisone and
immunosuppressive drugs. Which of the following would the therapist MOST likely need to consider?
A. Isokinetic strengthening will be preferable for this patient
B. The patient may have limited ROM from increased bone mass
C. The patient will need to be treated in an isolation room
D. Muscle strengthening may be limited in this patient
138. A therapist examines a high school athlete in the training room. After removing the adhesive strapping from the athlete’s
ankle, the therapist discovers that the athlete has developed an open weepy rash on the instep of the foot. The therapist should
FIRST:
A. apply moist heat to the foot
B. send the patient to the hospital emergency room
C. use more pre-wrap with the next joint taping
D. refer the patient to the team physician
139. A patient who sustained a left below-knee amputation 3 weeks ago is being evaluated for possible ambulation with prosthesis.
Which of the following factors is MOST relevant?
A. Size of the right residual limb scar
B. Length of the right residual limb
C. Proficiency in previous prosthetic use
D. Severity of phantom pain
140. The results of a developmental screening of a 4-month old infant indicate a possible right hip dislocation. The presence of
which of the following are the MOST consistent with this diagnosis?
A. Pelvic obliquity, apparent pain on movement of the right hip, and decreased hip abduction on the left side
B. Asymmetrical gluteal folds, femoral telescoping and limited hip abduction on the right side
C. Decreased active movement of the right hip, increased femoral neck retroversion, and atrophy of the gluteus maximus on
the right side
PEAT 1
D. Hip flexion contracture on the right side, apparent leg length discrepancy, and inability to tolerate supported sitting
141. A 14-month old child with brachial nerve palsy has motor and sensory loss in the right upper extremity in the areas innervated
by C5 & C6. Which of the following activities is MOST difficult to accomplish with the affected upper extremity?
A. Pushing a wagon
B. Carrying a teddy bear in the crook of the arm
C. Holding a raisin in the palm of the hand
D. Grasping a cup
142. A therapist is treating a patient who has been diagnosed with a nerve root impingement on his right side due to narrowing of
the intervertebral foramen between L4 & L5. The therapist decides to use mechanical, lumbar traction an intervention. Which
of the following positions, on a traction table, would be the MOST appropriate to relieve pressure on the nerve root?
A. Supine, hips & knees flexed
B. Supine, with hips and knees straight and laterally shifted to the right
C. Prone, hips and knees straight
D. Sidelying on the right with a bolster between the table and the patient
143. A prone standing board has been recommended for a 5-year old child with severe hypotonia. The PRIMARY purpose for the
use of a prone stander is to:
A. promote weight bearing
B. reinforce an exaggerated positive support reflex
C. prevent hip dislocation
D. increase hip and knee ROM
144. A patient who is transported to the physical therapy department in a wheelchair complains of severe, bilateral lower extremity
pain. A purple discoloration of both feet is observed. The pain is relieved when the patient’s feet are raised just above the
horizontal plane. These signs are MOST indicative of:
A. arterial insufficiency
B. intermittent claudication
C. venous insufficiency
D. a psychosomatic episode
145. A patient who completes a Phase I cardiac rehabilitation program should be expected to achieve:
A. independence in self-monitored walking
B. increased aerobic capacity to physical activity
C. modification of risk factors
D. increased blood pressure at a given workload
146. A therapist has been working with a patient who has a spinal cord injury. To document that the patient has been educated
about skin care, the therapist should record that the patient:
A. is unable to tolerate more than 1 hour in a wheelchair
B. has good strength of the scapular depressors and elbow extensors
C. is able to state 3 causes of skin breakdown
D. is able to perform 10 push-ups in the wheelchair
147. A 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:
A. increasing the heart rate
B. decreasing the heart rate
C. an irregular heart rhythm
D. increasing systolic BP
148. A patient complains of pain lateral to the coracoid process. When palpating the shoulder to assess the possible cause of the
pain, starting at the coracoid process and moving laterally, the therapist would expect to find the following sequence of
structures:
A. lesser tuberosity, biceps tendon, greater tuberosity
B. greater tuberosity, biceps tendon, lesser tuberosity
C. lesser tuberosity, coracobrachialis tendon, greater tuberosity
D. greater tuberosity, coracobrachialis tendon, lesser tuberosity
149. A factor that MUST be considered in designing an exercise program for a patient with angina pectoris is that when the arms
are exercised:
PEAT 1
A. angina occurs at a lower heart rate than when exercising the legs
B. heart rate and BP rise more steeply in relation to workload than when exercising the legs
C. pulmonary ventilation increases less rapidly than when exercising the legs
D. angina occurs at higher workloads than when exercising the legs
150. A patient spilled boiling water on the right arm when reaching for a pan on the stove. The forearm, elbow and lower half of
the upper arm appear blistered and red, with some subcutaneous swelling and pain on touch. To facilitate optimal function,
the therapist should PRIMARILY emphasize:
A. ROM exercises to the right hand, wrist and elbow
B. application of compression dressings
C. sterile whirlpool to the right upper extremity
D. splinting of the right arm in full elbow extension
151. A therapist wishes to study the effect of cold compression on PROM in a group of 10 patients. The plan is to apply this
compress to the hamstring muscles once a day for 5 days. Which of the following experimental designs is the MOST
appropriate for this type of study?
A. For both the experimental and control groups, gather data from the patient record
B. For both the experimental and control groups, measure ROM of both groups on day 5
C. For both the experimental and control groups, measure ROM on days 1 and 5
D. For the experimental groups, measure ROM everyday. For the control group, measure ROM on days 1 and 5.
152. During an examination of elbow strength using MMT, the patient supinates the forearm when attempting elbow flexion.
Which of the following muscles is MOST likely doing the major part of the work?
A. Biceps brachii
B. Brachialis
C. Supinator
D. Brachioradialis
153. A therapist is treating a patient for limitation of motion following knee surgery several weeks ago. The patient’s passive knee
extension is lacking 15 degrees from full extension, and knee flexion is limited to 95 degrees. Both movements have capsular
end feel. Which of the following mobilization techniques is the MOST appropriate for increasing knee flexion?
A. Anterior glide of the tibia on the femur
B. Posterior glide of the tibia on the femur
C. Superior glide of the patella
D. Posterior glide of the femur on the tibia
154. A patient has pain, swelling and tenderness in the medial border of the hand. The patient also shows changes in the color and
temperature of the skin, hyperhidrosis and progressive joint stiffness in the wrist and hand. The MOST likely cause of the
patient’s signs and symptoms is:
A. cervical disc disease
B. raynaud’s phenomenon
C. reflex sympathetic dystrophy
D. carpal tunnel syndrome
155. When considering a special test for orthopedic assessment of a client, the validity of the test is important because the:
A. results of the test can be standardized
B. test measures what it is supposed to measure
C. results of the test are reproducible
D. test can be accurately performed by someone else
156. A patient sustained a Colle’s fracture 8 weeks ago and has been in a cast since that time. Immediately after cast removal, the
physical therapy intervention for the wrist and hand should MOST appropriately include:
A. passive and active assistive ROM exercises
B. progressive resistive exercises
C. grade 4 mobilization techniques
D. return to pre-fracture level of activity
157. A patient with TBI is receiving outpatient physical therapy. The therapist notices that the patient becomes agitated during
therapy sessions. To which of the following professionals should the patient be referred for assessment and diagnosis?
A. Occupational therapist
B. Neuropsychologist
C. Vocation counselor
PEAT 1
D. Speech-language pathologist
158. While a patient is walking in the parallel bars, the therapist observes that the pelvis drops down on the side opposite the stance
extremity. This gait deviation is an indication of weakness of the hip:
A. abductors of the swing extremity
B. adductors of the swing extremity
C. abductors of the stance extremity
D. adductors of the stance extremity
159. A client on a weight loss program has been walking 3 days a week for 15 minutes for the past 3 weeks. To progress the
exercise program, which of the following will MOST likely accomplish the weight loss goal?
A. Maintain the current walking speed and increase the duration to 30 minutes
B. Increase the walking speed and keep the duration to 15 minutes
C. Walk 4 days a week and decrease the duration to 10 minutes.
D. Changing from walking 3 days to jogging 1 day a week for 20 minutes
160. When treating a patient with ankylosing spondylitis, the muscle requiring the MOST emphasis for strengthening exercises are
the:
A. pectorals
B. hip flexors
C. back extensors
D. abdominals
161. A 3-month old child has motor and sensory loss in the right upper extremity in the areas innervated by the C5 and C6 spinal
nerves. The cause of this birth injury MOST likely is:
A. hemiplegia
B. Erb-Duchenne paralysis
C. Spinal Cord Injury
D. Klumpke’s paralysis
162. During examination of the jaw opening pattern of the patient with TMJ problem, the therapist notes early protrusion of the
mandible. Which of the following mandibular movements MOST likely caused the protrusion?
A. Condylar translation
B. Mandibular depression
C. Condylar rotation
D. Lateral glide
163. A patient with multiple sclerosis is referred for physical therapy at home. Before going home, the patient requires training in
bathing, dressing and eating. Adaptive devices maybe needed to accomplish this. The therapist should recommend that the
patient be seen by:
A. a social worker
B. an orthotist
C. an occupational therapist
D. a home health nurse
164. A child who has cerebral palsy has been receiving physical therapy once a week for the past month. During the 4 th visit, the
therapist instructs the parents in a daily exercise program for the child, including stretching techniques. The BEST method to
ensure correct implementation and carry over of the program is for the therapist to:
A. reassess the patient’s ROM one month after instructing the parents
B. review the parent’s written notes on the child’s progress
C. demonstrate the exercises for the parents and ask them to return for a program check in one week
D. ask the parents to demonstrate the exercises and to return for a program check in one week
165. An otherwise healthy inpatient is referred to physical therapy following total hip arthroplasty. The patient reports persistent
low energy levels. What medical record information will prove the GREATEST clarification of the complaint?
A. CO2 value
B. Hematocrit value
C. Creatinine level
D. Blood urea nitrogen (BUN) level
166. Excessive upward rotation of the right scapula is noted when the patient attempts to perform shoulder flexion. Which of the
following exercises is MOST appropriate to help correct the excessive scapular rotation?
PEAT 1
A. Right scapular protraction against resistance with the right arm at 90 degrees of flexion
B. Bilateral scapular elevation with the upper extremity at 180 degrees of flexion
C. Wall push-ups with an isometric hold at the end range with the elbows extended
D. Bilateral scapular adduction with the arms medially rotated and adducted across the back
167. A patient with Parkinson’s disease has just been admitted to the rehabilitation unit. The patient is dependent in all transfers
and requires moderate assistance of one person to walk 30 feet with standard walker. In order to facilitate good carry over for
activities, instruction of the family in transfers should occur:
A. during a home visit after the patient is discharged
B. just prior to discharging the patient
C. early in the rehabilitation program
D. when the family feels ready to take the patient home
168. A patient had final approval and checkout of a permanent prosthesis 2 weeks ago. The patient now complains to the therapist
that the prosthesis is too heavy. The patient will benefit MOST from:
A. an evaluation of socket fit by the prosthetist
B. a prescription from the physician for lighter weight prosthesis
C. reevaluation of hip strength by the therapist
D. adding a fork strap attachment to the prosthesis
169. A patient with left hemiparesis is being discharged from the rehabilitation center. The therapist has been unsuccessful in
getting the family’s cooperation to instruct them in transfers, bed mobility, and safety precautions. The MOST appropriate
action for the therapist to take is to:
A. educate the patient so she can tell others how to assist her
B. contact social services and arrange for a team and family meeting
C. refer the patient for home care and document appropriate interventions
D. write a home program and give it to the family
170. A patient has a history of neck pain that is aggravated by long periods of sitting. The pain becomes progressively worse by
evening. ROM and strength of the neck and shoulder are within normal limits. Sensation and reflexes are intact in both UE.
The patient has a forward head and excessive thoracic kyphosis. The MOST appropriate exercise program would include:
A. stretching of the neck flexors and pectoral strengthening
B. upper traps strengthening and pectoral stretching
C. pectoral strengthening and rhomboid stretching
D. rhomboid strengthening and axial neck extension
171. A patient is being examined for medial epicondylitis. With this diagnosis, the therapist would MOST likely expect to find
pain over the:
A. origin of flexor digitorum profundus with resisted finger flexion
B. origin of pronator teres muscle with active pronation
C. medial epicondyle with passive wrist flexion
D. insertion of the triceps brachii with passive elbow extension
172. In treating a patient who has had recurrent anterior shoulder dislocation, the therapist should AVOID which of the following
extreme shoulder motions?
A. adduction and external rotation
B. abduction and external rotation
C. hyperextension and internal rotation
D. abduction and internal rotation
173. During the examination of a patient with carpal tunnel syndrome, the therapist will MOST likely find:
A. paresthesia of the medial palmar surface of the hand
B. weakness of finger extension of the lateral three digits
C. paresthesia of the lateral three digits
D. weakness in wrist flexion and ulnar deviation
174. Upon removal of a wet-to-dry dressing from a draining wound, the therapist observes that the skin immediately surrounding
the wound is macerated. What should the therapist recommend for future wound care?
A. Continue using current dressing type
B. Make the dressing more absorbent
C. Leave the dressing on longer between dressing changes
D. Change to a pressure type dressing
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175. A patient’s severe knee sprain resulted from medial rotation of the femur on the tibia with simultaneous application of a
valgus force while the foot was placed on the ground. Which structures are MOST likely to be involved?
A. Medial collateral ligament, medial meniscus and anterior cruciate ligament
B. Medial collateral ligament, lateral collateral ligament and posterior cruciate ligament
C. Lateral collateral ligament, medial meniscus and anterior cruciate ligament
D. Medial collateral ligament, lateral meniscus and posterior cruciate ligament
176. A patient with Guillain-Barre syndrome experiencing progressive paralysis is admitted to the ICU. As a member of the
interdisciplinary team managing this patient’s care, the MOST appropriate physical therapy intervention would be to:
A. alter the patient’s mechanical ventilation settings
B. develop patient’s medication schedule
C. perform airway clearance techniques
D. discuss the patient’s medical prognosis with the family
177. A patient is performing a phase I cardiac rehabilitation exercise session. The therapist should terminate low level activity in
which of the following value changes from resting level?
A. The diastolic BP increases to 120 mmHg
B. The respiratory rate increases to 20 breaths per minute
C. The systolic BP increases by 20 mmHg
D. The heart rate increases by 20 beats per minute
178. A therapist is preparing to teach a patient who has Guillain-Barre syndrome to transfer from wheelchair to a mat table. The
patient weighs 150 lbs., she has poor (2/5) grade in both of her lower extremities and fair (4/5) grade in her left upper
extremity; her right upper extremity has normal (5/5) strength. Which of the following would be the MOST appropriate
assisted transfer for the initial session of this patient?
A. Two person lift on her right side
B. Sliding board transfer to her right side
C. A hydraulic lift from her wheelchair to the mat
D. Full, standing pivot transfer to her right side
179. A patient with complete C4 quadriplegia is working on a program to increase tolerance to the upright position. While on the
tilt table, the patient begins to complain of a pounding headache, with flushing and profuse sweating. The therapist should
FIRST:
A. lower the tilt table to a flat position
B. remove the patient from tilt table and return to room
C. check the patient’s catheter
D. check the patient’s BP
180. In physical therapy program planning for geriatric patients, an important age-related change that should be taken into
consideration is:
A. the inability to learn new motor tasks
B. decrease pain sensation
C. decrease motivation
D. the inability to select alternative movement strategies
181. To achieve maximum reaction of lymphedema following a mastectomy in the upper extremity by means of a massage, it is
MOST important that:
A. local heat be applied before the massage
B. the upper arm be massaged before the forearm
C. the hand be massaged before the forearm
D. the massage strokes occur in a centrifugal direction
182. A 6-year-old child with spastic diplegia is walking in the parallel bars. The child walks with increased trunk and hip flexion.
What would be the MOST appropriate assistive device?
A. Standard walker
B. Forearm crutches
C. Posterior rolling walker
D. Bilateral quad canes
183. A physical therapist is teaching a patient with T12 paraplegia to fall. The patient walks with bilateral KAFO and bilateral
forearm crutches using swing to gait. The MOST appropriate method to use to prevent injury would be to:
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A. have the patient wear a helmet and practice on a soft padded surface
B. give the patient written instructions and illustrations on falling
C. demonstrate and guide the patient through the correct process of falling
D. demonstrate the correct method of falling
184. A patient with a diagnosis of complete SCI at C4-C5 demonstrates a weak cough mechanism. Which of the following
techniques would MOST effectively augment coughing?
A. Manual pushing against the upper abdomen
B. Positioning the patient in prone
C. Pursed-lip breathing
D. Interrupting the expiratory air stream
185. A patient is referred for recommendation regarding purchase of a wheelchair. The measurements of the patient while sitting
are 16 inches across the widest point of the hips and 18 inches from the rear of the buttocks to the popliteal crease. Which of
the following wheelchair dimensions are BEST suited for this patient’s needs?
A. Seat width and seat depth of 18 inches
B. Seat width of 18 inches and seat depth of 16 inches
C. Seat width and seat depth of 16 inches
D. Seat width of 16 inches and seat depth of 18 inches
186. A physical therapist is designing an exercise program for a healthy, elderly individual. Which of the following types of
exercise is MOST stressful to the cardiovascular system?
A. Upper limb ergometry
B. Spinal ROM exercise
C. Quadriceps setting exercise
D. Lower limb diagonal PNF patterns
187. Which of the following techniques is MOST important prior to discharge for a patient who has had myocardial infarction?
A. Ascend a flight of stairs before discharge
B. Perform prescribed exercises without angina
C. Return to normal daily activity level
D. Take a radial pulse reliably before discharge
188. A therapist is evaluating a patient for a wheelchair prescription. The patient, who lives alone in a small apartment, has
bilateral lower extremity weakness and is unable to stand to transfer. Trunk strength and upper extremity strength are normal
and the patient can transfer independently with a sliding board. The MOST appropriate prescription for this patient is a
wheelchair with:
A. fixed, adjustable-height arm rests and detachable foot rests
B. removable arm rests and detachable swing-away leg rests
C. fixed arm rests and removable leg rests
D. desk-style removable arm rests and fixed elevating leg rests
189. A patient is undergoing a treadmill stress test. The appearance of abnormally wide, irregularly spaced QRS complexes on the
ECG represents:
A. ventricular depolarization
B. premature ventricular contractions
C. atrial fibrillation
D. atrial repolarization
190. A patient who is on bed rest exhibits orthostatic hypotension upon standing will MOST likely experience:
A. increase venous tone in the lower extremity
B. inadequate ventricular filling during diastole
C. decrease hydrostatic pressure in the capillary beds
D. parasympathetic stimulation of the heart
191. Treatment of a patient with hemophilia who has a subacute hemarthrosis of the knee will initially include:
A. active assistive ROM exercise to the knee
B. instruction of the patient for weight bearing to tolerance
C. gentle resistive ROM exercise to the knee
D. continuous immobilization of the knee in an extension splint
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192. Which of the following is the MOST appropriate intervention for a patient with juvenile rheumatoid arthritis who is
experiencing painful swelling of both knees?
A. Resistive exercises
B. Stretching to prevent contractures
C. Gentle active exercises
D. Walking program
193. Which of the following is the MOST appropriate home program for a patient with chronic lateral epicondylitis?
A. Using a forearm cuff to increase loading on the extensor tendons
B. Performing exercises for wrist strength and stretching
C. Administering iontophoresis with dexamethasone and xylocaine
D. Doing friction massage of the brachioradialis tendon
194. A therapist who works in a home health agency is treating a patient with diabetes mellitus. The patient tells the therapist that
he is no longer taking his insulin. The therapist’s FIRST course of action should be to:
A. instruct the patient in proper technique for injecting insulin
B. contact the patient’s home health nurse
C. tell the patient’s family to report this information to the physician
D. have the patient perform a urine glucose test while the therapist is in the home
195. Which of the following methods is appropriate for handling a 1-year-old child with cerebral palsy who exhibits strong
extensor tone in the trunk and extremities?
A. Carrying the child in a sitting position
B. Carrying the child over one’s shoulder
C. Keeping contact with the back of the child’s head
D. Picking the child up under the arms
196. A patient with left hemiparesis exhibits shoulder subluxation on the affected side. The patient has a demand-type cardiac
pacemaker. Which of the following interventions should be used only with extreme caution?
A. Manual resistive exercise on the non-affected side
B. Active exercise on the affected upper extremity
C. Functional electrical stimulation to the affected side
D. Biofeedback to the affected side
197. A 5-year-old patient with a closed head injury is exhibiting behavior consistent with the confused agitated level of cognitive
function. During physical therapy intervention, the patient becomes combative. Which of the following techniques would be
MOST effective in calming the patient?
A. Providing brief moving touch to the face and turning on the patient’s favorite musical tape
B. Maintaining touch to the shoulders and brightening the room by opening curtains
C. Removing the patient from the current treatment environment and placing the patient in a quiet setting
D. Wrapping the patient in a blanket and rocking the patient rapidly
198. The MOST appropriate therapeutic exercise to stretch the neck muscles for the patient with an acute right sided torticollis is:
A. right rotation and right lateral flexion
B. left rotation and right lateral flexion
C. left rotation and left lateral flexion
D. right rotation and left lateral flexion
199. A therapist evaluates a 65-year-old patient with psoriasis for treatment with ultraviolet radiation. The patient’s history
includes the following: total hip arthroplasty 1 year ago; penicillin allergy: calcium supplements since menopause; daily
tetracycline use for the past 2 weeks for a urinary tract infection. Which of these factors should alert the therapist to use extra
caution when applying ultraviolet light?
A. Arthroplasty with a metal implant
B. Daily tetracycline use
C. Penicillin allergy
D. Long-standing calcium supplement use
200. Which of the following instructions is MOST appropriate for teaching a patient with C6 quadriplegia to transfer from a
wheelchair to a mat?
A. “Keep your fingers extended, to give a broader base of support”
B. “Rotate your head and shoulders in the same direction to the desired hip motion”
C. “Rotate your head and shoulders in the direction opposite to the desired motion”
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D. “Keep both hands next to your knees to lock your elbows”
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25 Answers
1. A. The functional position of the wrist and hand describes the position from which the optimal function is most likely to
occur. This position is described as a) slight wrist extension, b) slight ulnar deviation, c) fingers flexed at the MCP, PIP &
DIP joints and d) thumb slightly abducted.
2. C. During pregnancy and postpartum period, the stretched abdominal muscles are unable to stabilize the lower back, as the
legs are raised. Attempting to perform double leg lifts can overwork the abdominal muscle and cause damage to the spinal
joints.
3. A. Exercise intensity can be expressed as O2 uptake during activity. HR and O2 uptake have a relatively lower linear
relationship. Therefore, utilizing a target HR will ensure that the appropriate exercise intensity is being achieved. Estimation
of energy expenditure requires measurement of O 2 consumption that is then calculated into calories metabolized during the
activity. BP cannot be controlled at specific HR. Exercising at maximal capacity does not achieve aerobic training benefits
and is unsafe for the majority of patient population.
4. B. Pressure on the L3 L4 root causes numbness in the anteromedial thigh and knee and quads weakness. Numbness in the
back of the calf and dorsiflexor weakness is indicative of L4, L5 and S1 nerve root involvement. Numbness and weakness in
the thighs, legs and feet and perineum is indicative of L2 through S1 nerve root involvement. Numbness in the back of the
calf and atrophy of gastrocsoleus is indicative of the S1 nerve root involvement.
5. A. The most appropriate mobilization technique for increasing both shoulder flexion and medial rotation would be posterior
(dorsal) glide. Lateral glide may be used as a general joint distraction technique. Medial glide would not be appropriate to
increase flexion and medial rotation. Anterior glide is used to increase extension and lateral rotation.
6. D. Options A, B & C are techniques used to decrease postural tone, which is not indicated for this patient. Option D is the
most appropriate technique for improving low postural tone.
7. C. Wounds heal via a complex process involving re-epithelialization. With advanced aging, the rate of epidermal
proliferation decreases.
8. D. Learning the process of foot care is a psychomotor skill and effective strategies to teach psychomotor skills include repeat
demonstration by the patient of the skill followed by feedback from the therapist to highlight what was performed correctly
and what areas need improvement. Reassurance about prevention of infection with proper foot care would primarily be a
cognitive skill and does not ensure that the patient can effectively perform proper foot care. Options B & C do not include
feedback that informs the patient about their performance.
9. A. Goals of PT intervention for a child with DMD are to retard the development of contracture and muscle weakness, which
could lead to functional limitations and thus disability. The PT would also play a role in determining the appropriate use of
assistive devices that could help maintain the child’s mobility such as wheelchairs, walkers and orthoses. Muscle tone
changes and decline in strength cannot be prevented since they are results of the disease process.
10. D. The long thoracic nerve innervates the serratus anterior muscle. Reaching forward above the head (shoulder flexion)
would require the action of serratus anterior, and long thoracic nerve injury would affect the motion. The serratus anterior
muscle also works in conjunction with the upper and lower trapezius muscle to upwardly rotate the scapula (abduct) during
shoulder flexion. Putting the hand in the back pocket would require scapular adduction. Side bending and deep breathing
would not require scapular motion.
11. C. During pregnancy, the ligaments soften due to hormonal influences and allow some degree of separation between joint
surfaces. Additional stretching of the ligaments would result in joint instability or injury, and would not be a goal of
treatment. The remaining options are all appropriate interventions.
12. B. According to the Standards of PT Practice, there should be a written plan of continuous improvement of quality of care.
This includes ongoing review and evaluation of the PT services provided. Utilization and peer review are two types of
review processes.
13. B. A goal should include the following elements: a) Audience; who will exhibit the skill, b) Behavior; what the person will
do, c) Condition; under what circumstances (the position, the equipment that must be available for the patient to perform the
behavior), d) Degree; how well will the behavior be done, e) Time span; set an anticipated specific time span in which the
goal will be achieved, and f) Measurable; the outcome must be measurable. Option B meets all the criteria while the other
responses do not.
14. A. The trochlea of the talus is convex. Therefore, during dorsiflexion of the ankle, the talus moves posteriorly relative to the
tibia. To facilitate movement of dorsiflexion, one would need to perform a posterior glide of the talus on the tibia.
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26 Answers
15. D. Aerobic conditioning that occurs during the 12 weeks of cardiac rehab will result in a decrease HR both at rest and with
exercise. CO2 elimination and cardiac output would both increase with maximal work. The stroke volume would increase
during submaximal work.
16. C. A normally distributed sample has a median and mean that are equal in value. In that type of distribution, the median and
mean would be at the halfway point. One half of the scores (50%) would be distributed above the median and one half
below. If the median and mean are not of equal value, the distribution is skewed. If the median is of a higher value than the
mean, the distribution is to the left, if lower, it is skewed to the right. The standard deviation is a measure of variability of the
mean. The z score is a standard score with a mean of zero and a standard deviation of 1. Averaging the two measures would
not be appropriate or meaningful.
17. C. Increasing hip flexion is usually contraindicated for THA at 1 month. The quadruped position would not be allowed for a
patient at 2 weeks post distal radius fracture. There are no precautions for the patient 2 months following a rotator cuff tear
as the motions in quadruped rocking would be synonymous with the glenohumeral motions that need to be increased and are
achieved in a closed chain position.
18. B. With a muscle grade of fair plus, the patient should not need active assistive exercise. Resistive exercise against gravity
would be most appropriate to strengthen this muscle. Since the gastrocnemius in a shortened position and lesser its ability to
produce tension. Therefore, exercising with knee straight put the gastrocnemius on a stretch, increasing its ability to produce
tension.
19. D. The residual limb is pistoning up and down because the socket diameter is too large or the suspension system is
inadequate, resulting in skin friction. The addition of more socks will enhance fit.
20. D. The fact that backward bending is centralizing the pain is an indicator that the nucleus of the disc is being moved
centrally and the pressure is being taken off the nerve root. Centralization of the pain is also a good indicator for PT
intervention.
21. C. Ice massage is usually applied to control pain, edema and inflammation. In this case, the ice would be used for pain relief
and to reduce inflammation, if present. The dosage for ice massage is determined by the patient’s response, and usually
applied until the patient experiences analgesia or reported numbness over the area of massage. Although 5 to 10 minutes
may be a usual time for the response to occur, the dosage depends on the patient’s response, not the exact time. The patient
will usually feel the following sequential sensations during the massage: cold, burning, aching and then finally numbness.
The desired effect is numbness, not aching. The skin may turn white, however, the desired effect is numbness or pain
reduction and not skin color.
22. C. Joint mobilization procedures may cause some soreness. The therapist should inform the patient of this response to
treatment. The patient should re-evaluate the patient and could alter the treatment by waiting an extra day before the next
treatment or by decreasing the dosage. There would not be a need to refer to the physician. The additional exercises would
not alter the response and there would be no indication of neurological involvement with the reported symptom.
23. D. The independent variable can be thought of as the cause or treatment and the dependent variable can be thought of as the
effect or response. In this case, the TENS is the treatment or independent variable. Continuous and discrete variables are
methods of quantifying variables.
24. A. A patient who is bed bound and immobile will be prone to developing atelectasis (partial collapse of lung tissue); which
can lead to pneumonia. Frequent position changes with deep breathing and coughing will help prevent development of
atelectasis. Given that this patient is elderly and does not have diagnosis of secretion retention, vigorous percussion and
vibration is not indicated. Vibration with the head down or standard postural drainage positions will not be tolerated in this
elderly patient with chronic CHF.
25. C. Radiographs are in orthopedics to detect bony abnormalities. Soft tissue defects such as disc herniations would not show
up on the radiograph. MRI scans are used to assess degenerative diseases, infarction, tumor, hemorrhage and congenital
anomalies. Myelography is used to assess bone displacement, disc herniation, cord compression or tumor. Computed
tomography (CAT scan) is used to assess the density, displacement of abnormality of the ventricular system and gray and
white matter.
26. D. Behavioral objective should be learner centered, outcome oriented, specific, and measurable. Option D is the only one
that is learner (student) oriented and specific to a situation. Options A & C require action by the clinical instructor, not the
student. Option C, which may be a step in the process is not as learner centered or outcome centered as option D.
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27. A. During aerobic exercise, there is vascular dilation that occurs in order to optimize blood flow and the venous system
relies on muscular pumping in order to return blood back to the heart. Without a cool-down period, there would be no
muscular pumping and therefore blood would pool in the venous system. Cardiac arrhythmia may occur as well, but is less
likely in someone without cardiac disease. Cessation of activity by itself would result in gradual decrease in body
temperature and specific exercises are not necessary. Muscle tightening may occur as a result of metabolites accumulating in
the circulatory system, but this would occur as a result of the venous pooling.
28. C. The piriformis muscle functions as an external rotator of the hip and it is thought that the tight piriformis muscle may
compress the sciatic nerve causing pain. Passive internal rotation and resisted external rotation may be painful. Intervention
would call for stretching of the piriformis muscle, not strengthening it. Modalities such as ice may also be helpful to
decrease the inflammation.
29. C. The most appropriate first step (pre-planning) would be to evaluate existing services within the community and work out
a budget for the project. Options A & B, although important, are things that would most likely be done after the practice is
up and running. Option D may be done early on in the planning process, but would follow option C.
30. B. Following an above knee amputation (transfemoral), the residual limb has tendency to develop contractures in the hip
flexors and abductors. Therefore, it is particularly important that the patient be positioned so as to maintain full ROM in hip
extension and adduction.
31. C. The left limb must function as the main support limb. Any treatment strategy for ambulation must ensure that the
remaining limb is optimally functioning and that the limb is healthy. While the other factors are relevant, the integrity of the
remaining limb is the greatest concern for this patient establishing long term functional goals.
32. D. Signs and symptoms of hip bursitis include the following: severe pain over the bursa area, with pain aggravated by active
motion including activities such as walking. Signs and symptoms of a sacroiliac joint derangement include pain directly over
the region of the joint and in the low back, in addition to pain with walking. Signs and symptoms of hip fracture will include
the following: severe pain in the groin area and tenderness occurs in the area anterior to the femoral neck. An adductor
longus muscle strain would not cause tenderness over the greater trochanter.
33. C. A fall in oxygen saturation below 87% is equivalent to a partial pressure of 55 mmHg of oxygen in the blood, which is
considered to be moderately hypoxemic (low O2 levels). This situation would require increased oxygen levels in order to be
rectified. A rise in carbon dioxide level would not be alleviated by increased oxygen levels. Complaints of shortness of
breath can come from a variety of causes and would not necessarily be alleviated by increased oxygen levels. An increased
heart rate to 150 bpm may be a normal response to this activity and would not necessarily require increased oxygen levels.
34. B. All documentation about physical therapy services should readily translate the physical findings (impairment) into
functional abilities/limitations.
35. C. Of the four options, backward walking is the only one that requires hip extension with concurrent knee flexion and hip
flexion with knee extension.
36. C. This patient needs to have functional benefits of tenodesis by allowing the finger flexors to shorten with the wrist
extended; therefore, PROM of the finger flexors should be performed with the wrist in non-functional position of flexion.
People with C6-C7 quadriplegia use the tenodesis grasp. This allows the fingers to flex with wrist extension and to open with
wrist flexion.
37. C. With an inversion injury, the tendons of peroneus longus and brevis can become strained. Swelling with an inversion
strain usually occurs over the anterolateral part of the ankle. Compression and support is most beneficial by placing tape
stirrups on the lateral side of the ankle, over the tendons of the peroneus longus and brevis and pulling the ankle into slight
eversion.
38. A. Nerve conduction velocity testing is most useful in the evaluation of peripheral nerve or lower motor neuron status.
Therefore, since carpal tunnel syndrome is the only one of the conditions that directly involves a peripheral nerve, it would be
the most appropriate choice. A cerebrovascular accident is an upper motor neuron disorder. Both myotonia and Duchenne
muscular dystrophy are primary muscle disorders.
39. B. Increasing the sensitivity makes the biofeedback unit more sensitive to electrical potentials from muscles. As the
sensitivity is decreased, it takes more electrical activity to trigger the biofeedback unit (i.e. provide an audio visual cue to the
patient). For use in muscle re-education, the unit should be most sensitive during the initial treatment so that the patient is
able to recruit enough motor units to trigger the unit. As the patient is able to recruit more motor units, the sensitivity is
decreased which would require the patient to activate more motor units.
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28 Answers
40. C. Thrombocytopenia is an acute or chronic disease in the number of platelets in the circulation. The T4 lymphocyte count
is used to assess immune status in patients with HIV or AIDS. The red blood cell count is utilized to assess for presence of
anemia and the white blood cell count would be examined to determine presence of infection or degree of
immunosuppression.
41. A. The most common cause of inwardly pointing or “squinting patellae” is excessive femoral anteversion. Although there is
normally 8-15 degrees of femoral anteversion, an excessive amount leads to squinting patellae and toeing in. The other
options would all have a tendency to cause the patella to point outward during standing.
42. C. The oculomotor nerve innervates the levator palpebrae superioris muscle that elevates the upper eyelid and the pupillary
constrictor muscle. Therefore, a lesion of the oculomotor nerve would make it difficult, if not impossible for the patient to
fully raise the lid (open the eye) and would cause a condition termed ptosis. In addition, the eye may not react to light and
therefore may not show pupillary constriction when light is directed into the eye. Inability to fully close the eye would be
seen with a lesion of the facial nerve (Bell’s palsy). Medial strabismus would be caused by damage to the abducens nerve,
innervating the lateral rectus causing a medial strabismus.
43. C. Exercise has been shown to increase sensitivity of insulin receptors therefore leading to a decrease in the amount
required. Administration of medication is dictated by tolerance and efficacy of the medication and would not necessarily be
altered by exercise. In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 - 48 hours
after exercise, therefore increasing caloric intake, particularly carbohydrates, would be essential.
44. B. Wet-to-dry dressings are indicated for necrotic tissue needing debridement. The moderate amount of drainage would
require more frequent (i.e., BID) dressing changes. Vigorous scrubbing of the wound could damage friable tissue. Betadine
can be cytotoxic. Whirlpool would not be effective in removing necrotic tissue
45. A. The median nerve supplies sensory innervation to the palmar surface of the thumb, index and middle fingers. A positive
Tinel’s sign (eliciting a paresthesia while tapping over the carpal tunnel at the wrist) and weakness of the opponens pollicis
muscle are indicative of carpal tunnel syndrome. Ulnar nerve compression would cause sensory and motor changes in the
little and ring fingers, not the thumb. Tenosynovitis of the abductor pollicis longus muscle would most likely reveal a
positive Finklestein’s test (stretching of the abductor muscle) with pain over the dorsum of the hand. Thoracic outlet
syndrome would most likely reveal with special tests that cause alteration of radial pulse.
46. B. The most efficient stimulus would be one that causes tetany in the muscle without causing fatigue. The biphasic
waveform at 30 pps best fit this stimulus. The 100 pps stimulus rate may cause fatigue, which would be undesirable. The
interferential waveform at the frequency of 1 pps is too low and the direct current would not be appropriate because it would
not cause tetany. In addition, an on/off cycle of 1:5 would allow adequate recovery time for the muscles between successive
contractions.
47. C. A 20 degrees knee flexion contracture means that the knee is unable to complete the last 20 degrees of extension. This
limitation of motion can be caused by several factors including tightness of the hamstrings (semimembranosus), restriction in
the posterior capsule of the knee, and weakness in the quadriceps femoris muscle (vastus medialis). Restriction of patellar
movement may also be a factor, however the proper glide technique to increase knee extension would be a superior (not
inferior) glide of the patella.
48. B. A patient with thoracic spinal cord level injury is able to perform independent pressure relief strategies and should be
complete every 15 to 20 minutes.
49. D. The soleus originates on the tibia and fibula and inserts onto the calcaneus, crossing only the ankle joint. Therefore, it
will have an effect on the ankle whether the knee is flexed or extended.
50. A. The restocking of treatment booths with supplies is the only option which does not involve direct patient contact or care,
and thus is the MOST appropriate activity to delegate to a volunteer. Although volunteers may at times be involved with
patient care activities (i.e., transporting patients), the patients in the above situations pose a potential risk and would require
supervision by someone other than a volunteer.
51. A. A state of alertness to the internal and external environment must be maintained for a motor or mental activity to occur.
The brainstem reticular activating system brings about the state of general arousal. To proceed from a state of general arousal
to one of “selective attention” requires the communication of information to and from the cortex, the thalamus, and the limbic
system and its modulation over the brainstem and spinal pattern generators.
52. C. The first step in preparing any education experience is to determine what the needs of the audience are. Since prevention
of low back injury is the ultimate goal, assessment of the employee’s workstations is an important first step in planning the
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Answers 29
education program. Simply instructing all employees in lumbar extension exercises is inappropriate without a thorough
evaluation of their physical needs. Option B cannot be done unless an assessment of the functional needs has be performed.
Providing pamphlets are useful teaching adjunct but would not be the first step to prevent low back pain effectively in this
population.
53. D. The Standards of Practice of Physical Therapy state that the physical therapist is responsible for establishing a plan of
care for the patient based on the evaluation of the examination data and patient needs. The plan of care includes plans for
discharge. The implication is that the long-term goals for the patient (discharge plans) are determined when the therapist first
sees the patient. It is anticipated that modifications of the plan of care is to be expected depending on the response of the
patient to the intervention.
54. A. The best position for the patient, to drain the posterior segment of both lower lobes would be prone lying with the head
down and lower extremities and hips elevated about 45 degrees.
55. B. The median nerve innervates the following muscles in the forearm: (1) pronator teres and quadratus, (2) flexor digitorum
superficialis, (3) flexor digitorum profundus (index and middle fingers), three (3) thenar muscles (abductor pollicis brevis,
opponens pollicis, flexor pollicis brevis). Therefore, a lesion of the median nerve would affect those muscles and their
accompanying actions: forearm pronation, finger flexion and thumb opposition. Thumb adduction is accomplished by the
adductor pollicis (ulnar nerve). Finger abduction is performed by the dorsal interossei (ulnar nerve). Forearm supination is
the action of the supinator (radial nerve) and biceps brachii (musculocutaneous nerve).
56. B. The only one of the above interventions that requires precaution because of total hip replacement is continuous
ultrasound. However, that does not mean that ultrasound is contraindicated for this patient. TENS may be used over metal
implants. Hot packs and massage would not affect the total hip prosthesis.
57. B. For this patient, the first mobilization procedure would be distraction of the glenohumeral joint. The distraction separates
the joint surfaces and is used as a test of joint play. The distraction can also help increase joint play. Distraction may also be
used in conjunction with the other mobilization techniques listed. Later, mobilization techniques would most likely include
anterior glide.
58. D. Heterotopic ossification occurs in 10% to 20% of patients with traumatic brain injury. The abnormal bone formation
occurs in the soft tissue surrounding major joints. Patients with spasticity are at increased risk. Loss of ROM is
characteristic for this problem. Osteogenic sarcoma is less likely. A patellar fracture would not present as a lateral mass.
59. C. Pain with resisted medial (internal) rotation and pain with passive lateral (external) rotation is indicative of subscapularis
tendonitis. Bicipital tendonitis is suspected if resisted supination is painful when the patient’s arm is at the side and the
elbow is flexed to 90 degrees. Painful resisted abduction and resisted lateral (external) rotation is indicative of supraspinatus
tendonitis. Pain on resisted lateral (external) rotation is indicative of infraspinatus tendonitis.
60. B. Objectives must be measurable and the specific behavior expected should be stated. Understanding, overcoming, and
appreciating elude tangible measurement, while listing five techniques is an activity that can be documented and is therefore
measurable.
61. A. The sartorius flexes, externally rotates and abducts the hip joint. With resisted hip flexion, the sartorius will be recruited
to perform all three actions giving the observed substitution pattern. The tensor fascia latae is a medial (internal) rotator
flexor of the hip, so substitution by it would involve medial (internal) rotation and abduction. The adductor longus would
adduct the hip. Substitution by the semimembranosus would cause hip extension.
62. B. The recommended dosage for mechanical, intermittent pneumatic compression pressure is between 30 and 80 mmHg
(higher for the LE than UE). It is also recommended that the pressure be below the diastolic pressure. Pressures below 30
mmHg are not considered to be effective. Pressures above diastolic can be used with caution. For the first treatment, it
would be most appropriate to use a pressure that is considered effective, yet not so high as to cause a potential problem for
the patient. If the patient responds positively to the intervention, the higher pressure could be instituted.
63. D. In order to best intervene with a patient who has had cardiac dysfunction, a full examination and evaluation is necessary
to properly form a treatment plan. An important aspect of the examination is ascertaining the type of angina that the patient
experience so that the therapist will know how to prevent angina with exercise or recognize if it does occur during the
treatment session. The other options provided are all outcomes that would occur after the patient has completed a cardiac
rehabilitation program.
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30 Answers
C. According to the Guide to PT Practice, “Information relating to therapist/patient relationship is confidential and may not be
communicated to a third party not involved in that patient’s care without the prior written consent of the patient”. Option C is the only
one that fits these criteria.
64. A. Sixty percent (60 %) of children with myelomeningocele develop hydrocephalus after surgical closure of their lesion.
Early warning signs of hydrocephalus include: irritability, changes in sleep patterns, and changes in appetite and weight. 80
– 90 % of children who acquire hydrocephalus will require a cerebrospinal fluid shunt. These children require ongoing
follow-up by a physician. Given the seriousness of this child’s symptoms, the child should immediately be referred for
medical follow-up.
65. D. Bell’s palsy involves the facial nerve. The frontalis is the only muscle listed that is innervated by the facial nerve. The
sternocleidomastoid is innervated by the spinal accessory nerve, and the masseter and temporalis are innervated by the
trigeminal nerve.
66. A. The abdominal muscles are active during sit-ups (with knees extended) up until the spine is completely flexed (head,
shoulders, thorax lifted from surface). In order to come to a long-sitting position however, the hips must be flexed and the
abdominals cannot perform this action because they do not cross the hip joint. Therefore, the hip flexors (iliopsoas among
others) would have to complete this motion. The inability to achieve a long-sitting position would suggest weakness in the
iliopsoas muscle.
67. C. The plantar grasp reflex is characterized by curling of the toes when the child is held supported in standing. The reflex is
normal up to 9 months of age. Delayed integration of this reflex can result in delayed, independent ambulation.
68. C. Placing a crutch in the left hand reduces the magnitude of the right hip abductor force needed to prevent the pelvis from
dropping on the left side during the stance phase on the right. Pushing down on the crutch of the right limb reduces the
amount of right hip abductor force needed, which is turn reduces the compression force on the right hip joint. This effect is
desirable in patients who have hip abductor weakness or hip pain.
69. C. Spinal shock occurs as a reaction to spinal cord injury and is characterized by an absence of all reflex activity below the
level of the lesion. Depending on the extent of the lesion, the patient may lose all or some of their sensation and motor
activity below the level of the lesion. Spasticity is associated with hyperreflexia and increased muscle tone. Spasticity would
be expected to develop following the spinal shock stage. Decerebrate rigidity involves sustained contraction of the UE and
LE in extension. With a lower motor neuron lesion, the loss of sensation and motor activity would be confined to a much
smaller region (depending on the exact lesion) and would not affect all levels below the lesion.
70. D. The patient’s signs and symptoms are reflective of a right-sided cerebellar hemisphere lesion. That is, cerebellar lesions
commonly produce hypotonia, hyporeflexia, ataxia and an intention tremor. Cerebellar lesions also produce ipsilateral
manifestations in the extremities.
71. B. The common peroneal nerve innervates the following muscles: peroneus longus and brevis, tibialis anterior, extensor
digitorum longus and brevis, peroneus tertius and extensor hallucis longus. Because of the complete severance, all of those
muscles would be affected and would not be able to actively contract until regeneration has taken place. Therefore, the
patient would completely lose ankle dorsiflexion, eversion and toe extension. Those motions have to be performed passively
in order to maintain ROM. Option B is the only one that contains all of the correct actions.
72. A. Option A is the best answer. In option B, if the patient does not initially understand the information, then having short-
term memory is irrelevant. For option C, hearing and vision are obviously important but the most critical component is
comprehension.
73. C. Static alignment for knee stability is established by positioning of the knee so that lateral reference line falls anterior to
the knee joint.
74. B. The center of gravity of a person with bilateral above-knee amputation is more posterior that the center of gravity of a
person with their LE intact. Setting the back wheels more posteriorly will make the patient more stable in the chair. This
adjustment prevents the wheelchair from tipping backward.
75. B. Although protocols depend on the surgeon and the approach, it is generally recommended that anti-gravity hip abduction
exercises not begin until 5 to 6 weeks post-surgery. Patients are taught to avoid excessive hip flexion, usually beyond 80
degrees. Bed mobility and ambulation would be started 1 to 2 days post-operatively.
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76. D. Posterior muscle tension is implicated in the development of tension headaches. Positive imagery is recommended as a
self-treatment technique, but the awareness of tension and the appreciation of its absence are fundamental. Massage and
passive exercise may be relaxing, but the patient must be aware of the sensations of tension to prolong the benefit.
77. B. Anticoagulation therapy inhibits the synthesis and function of clotting factors and can lead to bruising (ecchymosis) or
more severely, hemorrhage. A hemangioma is a benign liver tumor, deep vein thrombosis would result in redness, swelling
and warmth in the affected area and most commonly occurs in the calf muscle, not the hip region. A hematocele is a blood
cyst.
78. A. An ST segment depression of greater than 1 mm is indicative of myocardial ischemia. Continuing the exercise session
could place the patient at serious risk for continued ischemia, which could ultimately lead to myocardial infarction.
Therefore, the best response for the therapist would be to stop the exercise session immediately and inform the cardiologist of
the patient’s response. All the other options would continue to place the patient at risk.
79. A. Infection control requires that the wound not be contaminated further, and that the health care workers protect themselves
from disease by avoiding contact with body fluids. In this case, the patient does not appear to be in life threatening danger,
and so the wound should be attended to. Therefore, checking the patient’s blood pressure would not be the first ting to do.
Once the gloves are donned, cleaning the wound and covering it with a sterile dressing would be appropriate.
80. D. Patients should be encouraged to express their feelings. Comparisons to other patients who are dying in an effort to
assure the patient is not alone, takes away from this patient’s feelings. Denial of death would not be good for the patient,
since he must ultimately cope with the inevitable. Pastoral counseling would be an option, but the therapist should be ready
to listen to the patient, encourage statement of feelings and avoid denial.
81. B. The patient taking beta-blocking medication will experience a lower heart rate and blood pressure response during
exercise as compared to a patient who is not taking this medication. Since the heart rate is lower than anticipated, using heart
rate to monitor exercise intensity may not be as accurate. Another measure, such as the Borg Scale (rating of perceived
exertion) would be more beneficial. However, even though heart rate and blood pressure would be lower, the patient actually
achieves the same metabolic levels during exercise and therefore altering the frequency or duration of exercise is
unnecessary. The time for warm-up and cool-down exercises is not to be altered.
82. A. A non-adherent dressing is best choice because any adherence of the dressing to the fragile granulating tissue could cause
additional trauma. This is superficial wound, so there would be no need to pack the wound. Since there is some drainage, a
covering is preferential to topical medication only.
83. D. Pronation of the foot can be caused by a variety of factors including calcaneal eversion and forefoot varus. Correction of
the pronation by an orthosis could include a medial post (wedge) placed just proximal to the metatarsal heads or a medial
post under the calcaneus. The approach involves bringing the ground up to meet the foot. A post under the fifth metatarsal
head would accentuate the problem, as would a rearfoot post placing the calcaneus in an everted position. If the patient has
excessive forefoot varus, a wedge may be placed in the instep in addition to the medial wedge proximal to the metatarsal
heads to distribute the load, however, a wedge in the instep by itself would not be the best intervention.
84. A. Since most of the joint contracture/adhesion forms in the anterior-inferior portion of the capsule, treatment to mobilize
that portion of the capsule is of primary concern. Inferior glide would stretch the inferior portion of the capsule.
85. B. Options A, C and D are acceptable interventions for this patient. The epiphyseal areas (growth areas of bones) in children
should not be exposed to ultrasound. The application of ultrasound over the knee joint (hamstring insertion) could expose the
epiphyseal areas to the ultrasound.
86. D. When the knee is extended, the medial and lateral collateral ligaments are taut. During knee flexion, the ligaments
slacken. Therefore, there is very little tibial rotation when the knee is extended (close packed position) and approximately 40
degrees of axial rotation with the knee flexed. Although the femoral condyles may glide posteriorly (depending on the
direction of rotation) on the tibia and the hamstrings may rotate the tibia, the reason the motion is available is due to laxity in
the collateral ligaments. Other ligaments such as the cruciates and the joint capsule may add to the stability in the close
packed position.
87. D. Scoliosis deformities are named relative to the convexities of the curves, with the apex of the curve defining the vertebral
level. In the right thoracic, left lumbar scoliosis, there is a convex curve to the right the thoracic spine and a convex curve to
the left in the lumbar spine. In the thoracic spine, the body of the vertebrae rotates to the right (convex side) and the spinous
process rotate toward the left (concave side). Along with this transition, the ribs rotate posteriorly on the convex side causing
the scapula to become more prominent on the convex side and causing the shoulder to be elevated on the convex side.
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32 Answers
88. A. With this particular posture, the patient’s scapula would be in a protracted (abducted) position, therefore the scapular
protractors are already overactive and would require stretching, not strengthening. The kyphosis suggests that the thoracic
erector spinae muscles are weak and need strengthening. The lumbar lordosis indicates shortened lumbar erector spinae
muscles. Forward head posture suggests that the cervical spine is flexed and the occiput is extended, therefore stretching of
suboccipital muscles would be indicated. A TEST-TAKING HINT. Although EXCEPT questions are rarely used on the
NPTE, be alert for this type of question and read the responses so that you select the unrelated response.
89. D. Compression on the median nerve (carpal tunnel syndrome) is occurring, most likely as a result of swelling associated
with the individual being in the eighth month of pregnancy. In this case, rest and elevation would do the most to decrease the
edema and relieve the symptoms. The wrist should not be positioned in full extension. Initial conservative treatment
sometimes includes cock-up splinting to hold the wrist in neutral to 10 degrees of extension, but not full extension. Although
tendon-gliding exercises may be used, heat would not be indicated since it may increase the edema. Resistive exercises for
the wrist and fingers may aggravate the compression in the carpal tunnel.
90. C. Patients with Parkinson’s disease are characterized by rigidity, bradykinesia, tremor, lack of associated movements,
impaired balance reactions and a flexed posture (kyphosis). Therefore intervention should be directed toward full ROM and
correction of kyphotic posture through back extensor strengthening exercises, balance exercise, and exercises that promote
reciprocal movement. Option C is the only one that includes appropriate exercises.
91. A. Upon heel contact, the heel section compresses partially absorbing the ground impact and thus permitting a controlled
plantarflexion. If the heel is too stiff, upon initial contact, the knee flexes too soon and excessively. An excessively firm heel
wedge would not be a factor in late stance.
92. A. A patient with COPD 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 backpressure, which helps to prevent
the airways from collapsing while exhaling. By exhaling more fully through pursed-lips, more carbon dioxide is removed.
By preventing airway collapse and air trapping in the lungs, the residual volume is actually decreased. Pursed-lipped
breathing helps with ventilation, but does not necessarily assist with secretion mobilization.
93. C. The dermatome providing sensation to the little finger is innervated by the C8 nerve root. The triceps brachii is the only
one of the muscles listed that is also innervated by the C8 nerve root. The biceps brachii, deltoid, and brachioradialis are
innervated by the C5, C6 and sometimes C7 nerve roots.
94. A. Evaluation of the patient’s retention of information presented in the program can be enhanced by asking the patients
questions about the program information, having the patient ask questions about the program, having the patients demonstrate
what they have learned and testing the patient about the program material. Option A is the only one that utilizes one of these
techniques. The other options do not require active participation by the patients; they do not address specific interventions.
95. C. During the swing phase of gait, the foot is dorsiflexed to clear the foot. Muscles active during this phase of gait are the
tibialis anterior, extensor hallucis longus and extensor digitorum longus. The gastrocnemius, tibialis posterior and peroneus
longus are active during the stance phase of gait. Therefore, of the muscles listed, the extensor digitorum longus is the best
choice. If only the tibialis anterior was stimulated, the foot would go into inversion and dorsiflexion, which could cause the
patient to land on the lateral side of the foot at initial contact causing them injury. Addition of the extensor digitorum longus
would bring the foot up into more dorsiflexion and avoid excessive inversion.
96. D. The current dosage for iontophoresis is calculated by multiplying the current (4 mA) by the duration (15 minutes). In this
case, the calculation would yield a value of 60 mA.min. None of the other options use the correct value.
97. A. The double-upright metal ankle foot orthosis would provide the best support for mediolateral instability and would allow
for changes in leg volume. The plastic solid AFO would not provide as much mediolateral support and because of its
conformation of the leg, it would not be advisable for patients who are experiencing changes in leg volume due to edema.
High top shoes would not provide enough support. The spiral AFO would not provide needed stability to the ankle and the
design would not be indicated with a patient has fluctuating edema.
98. C. Hemoptysis or the coughing up of blood can be benign or severe and can be a common occurrence in the cystic fibrosis
population secondary to the pathophysiological processes in their pulmonary system. In general, a small amount of
hemoptysis that occurs occasionally or a non-persistent hemoptysis is benign. The brownish color indicates either venous
blood or old blood. In this situation, if the hemoptysis does not persist, then it is appropriate to continue treatment without
modification. If the blood was larger in amount and fresher (denoted by a bright red color), then the treatment should be
discontinued. The presence of blood in the sputum should not warrant more vigorous chest percussion, until it is deemed
appropriate to continue with the session. Since this situation is a benign scenario, alteration of drainage position is not
necessary, and there is no need to send the patient to the emergency room.
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99. C. Isokinetic exercise device utilize accommodating resistance throughout the range of motion. The other exercises are not
forms of accommodating resistance.
100. D. Air is released during the stance phase of gait, which results in a negative pressure inside the socket to provide a suction
suspension during swing phase.
101. B. With venous insufficiency, the limbs would be edematous, the superficial veins would be dilated and if not corrected
ulceration could develop. Options A and C are ruled out because they indicate no edema. Option D is not correct because
the condition is relieved by sitting or leg elevation.
102. A. In order to improve knee flexion, the therapist needs to address patellar tightness. During flexion at the knee, the
posterior motion of the tibia causes the ligamentum patellae to pull the patella distally and posteriorly. Patellar mobilization
in the distal direction would assist with increasing knee flexion.
103. C. The tibialis posterior plantarflexes and inverts the foot. This pattern requires the specific action of that muscle. The other
patterns do not.
104. C. Pain that is experienced in the thoracic spine can be caused by a variety of pathologic conditions. Low back pain can be
either mechanical or non-mechanical in nature. Pathology in the kidney may refer pain to the lumbar spine (ipsilateral flank),
or upper abdomen. Pathology in the urinary bladder refers to the subpubic or thoracolumbar region. The diaphragm is
innervated by C3, C4 and C5 with the pain normally confused to the C4 dermatome. The negative MRI has ruled out
possible involvement of the dura mater.
105. A. In order to optimally clear the congestion that has developed in the right lower lobe, the patient would need to be
positioned on the left side to allow gravity to help drain the secretions to the proximal airways. This patient is also
unconscious and intubated so in addition to drainage, manual hyperinflation is necessary to provide increased ventilation
which would help mobilize secretions followed by suctioning to clear out secretions. Suctioning first then hyperventilating
while in left sidelying less effective than the order suggested in option A. Positioning on the right side would not drain the
right lower lobe, and also since the patient is lying on the right side, the only place to percuss and vibrate would be on the left
side, which has no pathology. Finally, positioning on the left side with deep breathing will no be effective in mobilizing
secretions, especially since the patient is unconscious and unable to actively perform breathing exercises
106. B. Prednisone is a glucocorticoid that exhibits these side effects. The primary side effect of penicillin is an allergic reaction
such as skin rashes and difficulty breathing. The primary side effect of aspirin is gastritis. The primary side effect of gold
therapy is diarrhea, irritation of oral mucosa and skin rashes.
107. D. The weakness in the flexors of the 4 th and 5th digits at the DIP joint (2/5). The other fingers show normal strength (5/5).
This weakness would indicate a problem with the flexor digitorum profundus, since the distal joints are involved. The FDP is
innervated by both median and ulnar nerves. The median nerve innervates the FDP muscles flexing the index and middle
fingers. The ulnar nerve innervates the FDP muscles flexing the ring and little fingers. Therefore, since the ring and little
fingers are involved, the lesion would have to be involving the ulnar nerve. The FDP to the 4 th and 5th fingers is innervated
by the ulnar nerve roots C8 and T1.
108. B. The best answer would be for the therapist to recommend a team conference. That conference would bring together
members of the health care team as well as the patient and family members, to arrive at joint decision as to the placement of
this patient. The best time for such meeting would be prior to discharge, because after discharge, it is difficult to arrange
such meetings. Allowing the patient to determine his own discharge environment may be fine if there is no safety concern,
however a decision whether or not the patient is competent to make the decision must be made first. Scheduling a home visit
or the implementation of a treatment plan for home care would be premature until a decision on placement has been made.
109. D. Sudden tingling of the hands and weakness of muscle groups are alarming signs of cord compression. The concern is that
the spinal cord sustaining further injury. The exercise may be exacerbating or causing these signs. This is considered a
medical emergency and the physician should be immediately advised.
110. D. The primary physical therapy goal in this case would be joint protection and prevention of contractures and adhesions,
usually through splinting. There is no evidence to suggest that physical therapy can prevent nerve degeneration and muscle
atrophy, as they are the normal effects of a peripheral lesion. Spasticity would not be present in lower motor neuron injury.
111. B. While all of the above would help prevent injury to a diabetic foot, the most important information to provide is about
proper footwear. Ensuring properly fitting footwear would alleviate risk of skin breakdown as well as providing appropriate
cushioning to the articular cartilage of the foot joints that are prone to injury from repetitive trauma and compression.
Orthoses may not be necessary for all patients. Despite moisturizing the skin, if there is improper protection, skin breakdown
can still occur. Exercising within appropriate parameters will not be beneficial if the patient’s footwear is not supportive or
properly fitting.
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112. B. An intact circulatory system can sustain adequate blood flow to an elevated limb. A limb with arterial insufficiency may
not be able to sustain adequate blood flow against gravity. The vasodilatation, caused by local mechanisms, occurs in
response to ischemia. An acute arterial occlusion creates pallor, but because blood flow is blocked, the reactive hyperemia is
impaired.
113. C. The gluteus maximus is a hip extensor that is more active during resisted motions or when the hip is in flexion, especially
in functional activities such as stair climbing. In this case, the patient flexes the hip placing the gluteus maximus in stretch
increasing its ability to produce tension. Therefore, the patient is leaning forward to maximize the ability of the gluteus
maximus to extend the hip during the stair climbing activity. The other muscles listed would not benefit as much from the
increased hip flexion.
114. A. In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 to 48 hours after exercise.
Exercise has been shown to increase sensitivity of the insulin receptors therefore leading to a decrease in the amount of
insulin required.
115. B. A larger print will not simplify the meaning, nor will lengthening the sentences. Only option B, the choice and
illustrations and a simpler sentence structure is correct.
116. C. A physical therapist would be required to perform the initial evaluation, plan of care, re-evaluations, modifications to the
plan of care and discharge plan for the patient. The patient who is stable and on an existing program would be most
appropriate patient to be delegated to the assistant. Therefore, the patient who has multiple sclerosis who is on an established
gait training program would be the most appropriate. The other three patients are receiving their initial treatments.
117. B. Normally, as the diaphragm descends with inspiration, it places increased pressure on the abdominal contents with a
resultant distension of the epigastric area. Weakness of the diaphragm would decrease the distension and may result in a
compensatory increase in upper chest expansion to improve ventilation. The scalene muscles act to elevate or stabilize the
clavicle during inspiration. The rectus abdominis is a stabilizer during inspiration and assists with forced expiration. The
intercostal muscles act to stabilize the thoracic cage during ventilation.
118. C. The medical record is owned by the hospital subject to the patient’s interest in the information it contains. Unless
restricted by state or federal law or regulation, a hospital shall furnish to a patient, or a patient’s representative parts of the
hospital record upon request in writing by the patient or their representative. Option C is the only correct answer in this case,
since it specifies that the patient must authorize the release of information.
119. B. The anterior tibialis shows poor (2/5) grade strength during the examination. Because this muscle is active during swing
phase of gait and shortly after initial contact, one would expect to see gait deviation showing up at those times. Specifically,
the anterior tibialis maintains dorsiflexion of the foot during swing phase and controls plantarflexion after initial contact.
During swing phase, weakness of the anterior tibialis would cause the patient to increase the amount of hip and knee flexion
to prevent toe drag. With weak hip abduction, this patient would be expected to have excessive pelvic rotation. To
compensate, the patient would laterally bend toward the weak (right) side during midstance to help prevent the excessive hip
drop. Throwing the trunk backward after initial contact may be due to weakness of hip extensors (gluteus maximus).
120. B. The patient’s symptoms would be aggravated by exercises that cause increases in patellofemoral joint reaction force. One
of the goals of treatment would be to promote proper patellar tracking. Isometric exercises such as quadriceps setting and
SLR are most often used for strengthening with a diagnosis of chondromalacia patella because they produce smaller
patellofemoral joint reaction forces than some other forms of quadriceps exercises, and thus are less painful. The vastus
medialis is one of the muscles active during quads setting. This muscle tends to pull the patella medially during contraction
and thus acts as a dynamic medial stabilizer, which promotes proper patellar tracking. The vastus medialis is not
preferentially recruited during a straight leg raising, nor it is the only muscle responsible for terminal knee extension.
Patellofemoral compression forces are generally less during SLR than when doing extension exercises with the knee bent.
121. A. With an extension exercise program, centralization indicate that the patient is improving, even through the pain may be
just as intense as it was. Even though the patient may feel frustrated, he is actually improving, and therefore the therapist
should continue with the extension exercise program. There is no need to call the physician at this point, since the
centralization is perfectly normal. Although trunk flexion may be used later in the intervention, it would not be indicated at
this point because extension is working.
122. D. An outcome measure documents a desired performance or change in the patient’s condition over time. This may include
a description of the patient’s function before, during and after intervention. Option D does not indicate a change or function,
but is focused on attendance.
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123. A. The rib cage would not be able to expand normally during inspiration due to weakness of the intercostal muscles, which
are innervated by thoracic nerve segments. With a spinal cord lesion at the C5-C6 level, the diaphragm would still receive
innervation from the phrenic nerve (C4). The anterior scalene (C4-C6) would be partially innervated and the
sternocleidomastoid (C2-C3) would be fully innervated. The abdominal muscles would not be innervated since they receive
their innervation from thoracic nerve segments. Paralysis of the abdominal muscles would cause the diaphragm to assume a
low resting position.
124. C. “Information relating the therapist-patient relationship is confidential and may not be communicated to a third party not
involved in that patient’s care without the prior written consent of the patient”. Option C is the only one that fits these
criteria.
125. C. Inclusion of all members of the health care team into decision-making is important for the patient and provides for
continuity of care for the patient. However, the team approach has some pitfalls such as arranging meetings between team
members, which may be a time consuming process. The team concept would also assume that the team reaches a consensus
that require more time than relying on individual decisions that can be made quickly. Therefore, option C is the best answer
to the question. The other three options are advantages of the team concept.
126. A. Rheumatoid arthritis is a chronic inflammatory disease that affects many body systems including the joint space.
Destruction and subluxation of joints can occur over time secondary to the inflammation that occurs in the synovium.
Fatigue is a common symptom that accompanies RA. Therefore, the patient must get enough rest to avoid excessive fatigue
and to protect the joints from overuse damage. Therefore, education on energy conservation and joint protection is essential
to minimize joint deformity. However, the patient must realize that some activity is good for them to prevent contractures
and maintain strength and endurance. Fatigue and joint pain can and often do co-exist in patients with RA. The pannus in
the joints is actually increased with rest. Rest does not appear to change the activity of the antigen-antibody complex.
127. C. This patient would have functional use of the triceps and finger flexors and would therefore, be independent for all
wheelchair transfers to all surfaces. Coughing would not be limited and would not be a goal. Rolling would be easily
achievable as a short-term goal. Ambulation with forearm crutches would not be a reasonable expectation for this patient.
128. B. Physical therapy intervention should focus on helping the patient obtain maximal functional independence. Wheelchair
transfers are the means to enable the patient to be independently mobile and will be a requirement before more difficult tasks
are performed such as ascending a 10-foot ramp. The patient is presumably too weak to walk at this point in time. Tub
transfer is important, but the wheelchair will be the best means to get the patient to the tub. Therefore, for the initial
intervention session, wheelchair transfers would be the most important.
129. A. Raising just the head activates only the recti muscles, and supporting the abdominal muscle with the hands provides
external support to the stretched abdominal muscles. This is the optimal position to initiate strengthening following delivery
for a patient with diastasis rectus abdominis. Doing exercise would not be appropriate. With no support of the abdominal
muscles, option C and D would be too aggressive at this time.
130. A. Several things can be done to decrease the current density and the possibility of skin irritation. These include decreasing
the intensity of the stimulation, increasing the inter-electrode distance and the use of larger electrodes.
131. B. The presence of Dyspnea and the pink, frothy sputum would suggest the presence of CHF and resultant pulmonary
edema. CHF can occur from poor cardiac muscle function as a result of myocardial infarction. Pulmonary edema occurs
from the backflow of blood from the heart into the pulmonary vessels, increasing pulmonary capillary pressure. The increase
in pulmonary capillary pressure increases fluid movement into the alveoli, which are normally dry. These leads to the
presence of pink, frothy sputum that can be expectorated along the shortness of breath (dyspnea). Positions that increase
blood flow to the heart, such as lying flat, will increase the signs and symptoms. Therefore, the patient should be positioned
with the head up or as in this problem; the patient should be placed in a sitting position to help alleviate the symptoms.
Laying the patient down flat, supine or with the legs elevated would exacerbate the patient’s problems.
132. A. The assessment of posture in a wheelchair begins with the pelvis and its relationship to its adjacent segments. The
orientation and range of mobility of the pelvis in all three planes will in turn determine the alignment and support needed at
the trunk, head and extremities.
133. C. Medical social services deal with home situations, financial supports and acts, as a resource director on behalf of the
patient. Social services would be the most appropriate choice to help arrange and coordinate rehabilitative services for this
patient while they are at home. Although nurses, occupational therapists, physical therapists and physicians may all be
involved with direct patient care, they would not be the most appropriate for this level of discharge planning.
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36 Answers
134. A. In order to place the right middle lobe in an optimal position to drain secretions, a patient would need to be positioned as
stated in option A. Another way this position may be stated is “left sidelying with quarter turn towards supine”. The other
positions do not optimally drain this lobe.
135. D. During measurement of shoulder abduction, the spine should be kept straight. If the patient is allowed to laterally flex the
trunk, it will give the appearance of increased shoulder abduction, but the motion would be occurring the spine and not in the
shoulder. Upward rotation of the scapula and lateral rotation of the shoulder would normally accompany the motion of
shoulder abduction. Medial rotation of the shoulder would decrease the available abduction.
136. D. An adverse side effect of prolonged prednisone use, in this case for 4 years, is muscle degeneration and therefore
achieving increases in muscle strength may be limited. Since muscle strengthening may be limited, then isokinetic exercise
would not necessarily be more beneficial. Prednisone may lead to a decrease in bone density, not an increase. Four years
after transplantation, the patient will have been out in the community and the need for an isolation room is unnecessary.
137. D. The open weeping rash may be infected. Skin infections are easily spread in training from environment, and if not
attended to correctly may infect more people. If an infection were suspected, the precise diagnosis would be made by means
of a culture. There the most appropriate action would be to refer the patient to the team physician. Moist heat increases the
infection by increasing blood flow. An emergency room visit would not be indicated at this time. Occluding the wound with
more pre-wrap creates an environment ideal for infection.
138. C. The previously amputated left limb must function as the main support limb. Any treatment strategy for ambulation must
ensure that the left limb is functioning optimally. While the other factors are relevant, the previous ability of the patient to
ambulate is the greatest concern.
139. B. Physical findings of congenital hip dislocation include asymmetric skin folds of the buttocks and adductor region;
limitation of passive hip abduction; leg length inequality; and telescoping of the flexed and adducted thigh on the pelvis.
140. B. The C5 and C6 myotomes include the biceps brachii, brachialis, brachioradialis and deltoid muscles. The elbow flexors
and supinators (C5-C6) are used to carry a teddy bear in the crook of the arm. Pushing a wagon requires the use of the triceps
(C7-C8). Holding a raisin requires the presence of wrist flexors (C6-C8). Grasping a cup requires finger, thumb and wrist
muscles (C6-C8, T1).
141. A. In order to open up the intervertebral foramen, it would be best to flex or at least flatten the lumbar spine prior to applying
the traction. Of the above options, positioning the patient supine with the hips and knees flexed would be the best way to do
this. Laterally bending the trunk to the left would also open up the foramen, but this is not one of the options. Supine with
hips and knees straight and then laterally shifted to the right would tend to close down the intervertebral foramen. Prone
would also close the foramen. Sidelying with bolster under the right lumbar spine also tends to close the foramen.
142. A. Prone standers are used frequently for children who cannot achieve or maintain upright standing. The benefits from the
physiologic changes associated with weight bearing and from the social and perceptual opportunity to see the environment
from an upright position.
143. C. With arterial insufficiency, elevation increases ischemia and therefore pain. Intermittent claudication is a phenomenon
associated with metabolic demands exceeding the capability of the vascular system to supply adequate blood flow. Placing
the limb in a dependent position increases swelling and therefore possibly pain with venous insufficiency. An objective sign
such as purple discoloration rules out a psychosomatic episode.
144. A. The primary physical therapy goal of phase I cardiac rehabilitation is to achieve a safe and independent level of activity
that can be carried out at home. Increasing aerobic capacity cannot happen until phase III, when cardiac tissue has healed
fully. Modification of risk factors is a life-long process and will not be achieved during a short in-patient stay. Systolic BP,
when exercising, during the in-patient stay should only rise approximately 20 mmHg above resting.
145. C. Option C is the only one stated clearly in education terms. The other options are objectives based on observation.
146. B. Pressure receptor (baroreceptors) are present in the carotid sinus and these receptors respond to changes in BP. An
increase in blood pressure that is sensed by these receptors will stimulate the parasympathetic system to decrease the rate and
force of contraction of the heart in order to help lower the pressure. Repeated palpation in the carotid sinus area may
stimulate an increase in BP and cause this reaction. Therefore increased heart rate and blood pressure are incorrect. Irregular
heart rhythms generally result from electrolyte imbalance and/or ischemia to the conduction system of the heart.
147. A. Starting at the coracoid process and moving laterally, one would palpate the following structures: (1) lesser tuberosity, (2)
biceps tendon and (3) greater tuberosity. Any other order of structure palpation would be incorrect.
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Answers 37
148. B. Heart rate and systolic blood pressure responses are higher for any given workload when performed with the upper
extremity as compared to the lower extremity. Angina is determined by a certain myocardial workload that is represented by
the product of heart rate and systolic blood pressure. Therefore option A cannot be a conclusive statement. Pulmonary
ventilation has less definitive responses but in general would be similar in that upper extremity exercise would cause a
greater ventilatory response than lower extremity exercise would. Since heart rate and blood pressure would be higher at any
given workload with upper extremity exercise, then angina would most likely occur at a lower workload.
149. A. The patient will be reluctant to move the limb because it is painful. ROM is essential to regain and maintain a functional
ROM. In this case, the physical therapist’s primary goal is to restore function with ROM exercises. Compression dressings,
whirlpool and splinting are all acceptable aspects of care that help in restoration of ROM. However, functional ROM would
be the primary goal.
150. C. The most appropriate design would be a two-group pretest-posttest. Both groups are measured at the same time, but only
the experimental group receives treatment. Gathering information from patient records may not provide the same accuracy as
if the researcher had performed all the measurements directly. Measuring ROM only on day 5 would not account for any
pretest differences between groups.
151. A. The biceps brachii is both an elbow flexor and supinator, and it is most effective as a supinator with the elbow flexed to
about 90 degrees (approximately the muscle resting position). The brachialis does not cause supination (only flexion). The
supinator does not flex the elbow. The brachioradialis would move the forearm to midposition rather than fully supinating it.
Therefore, when the elbow both flexes and supinates, the biceps brachii would be the most likely muscle causing this action.
152. B. During normal knee extension, the tibia moves posterior relative to the femur. Therefore, posterior gliding of the tibia
would promote knee flexion. Superior glide of the patella could be used to increase knee extension. Posterior glide of the
femur on the tibia would be used to increase knee extension.
153. C. All of these manifestations are indicative of reflex sympathetic dystrophy syndrome. Cervical disc disease does not
produce swelling in the hand, color and temperature changes or hyperhidrosis. Raynaud’s phenomenon results in pain, pallor
and coolness, but no hyperhidrosis. Although carpal tunnel syndrome can also show sympathetic nervous system
abnormalities, compression of the median nerve would refer symptoms to the lateral border of the hand (thumb area). With
carpal tunnel syndrome, the patient may also display thenar muscle weakness.
154. B. Option B is the definition of validity. Options C and D for reliability measures. Results can be standardized even though
they are not valid.
155. A. The primary physical therapy goal at this time is to restore ROM. Therefore, the most appropriate intervention for that
goal is passive and active assistive ROM exercises. Although gentle joint mobilization techniques may be indicated, grade 4
techniques at this time would not be appropriate. Progressive resistive exercises would come later in the plan of care.
Although the long-term goal would be to return to normal activities, the short-term goal would not.
156. B. Because the problem is a behavioral disorder, the most appropriate person to assess this patient would be a
Neuropsychologist. The Neuropsychologist is trained to assess intellectual, emotional and coping functions of the patient as
well as levels of depression and anxiety. They could also provide consultation to the rehabilitation team members as to how
to deal with the problem.
157. C. The abductors are particularly active during the midstance phase (single limb support) of gait to prevent the contralateral
pelvis from excessive lateral tilting. Weakness of the hip abductors, particularly the gluteus medius, causes the hip to drop
down on the side opposite the weakness. For example, weakness in the right gluteus medius would show up during stance
phase on the right by excessive downward movement (lateral tilt) of the left pelvis. The hip adductors are active during
terminal stance and through midswing and would not play a role in controlling the lateral rotation of the pelvis. The hip
abductors show little activity during swing phase.
158. A. The optimal exercise duration for achieving weight loss with a walking program is 40 to 60 minutes of continuous aerobic
activity. Therefore once a patient is safely tolerating 15 minutes, the best progression is to increase the duration while
maintaining the same intensity or walking speed. Increasing walking speed should only be performed once the patient can
consistently tolerate 20 to 30 minutes of exercise. Decreasing the duration while increasing the frequency of exercise would
not accomplish the goal of 40 to 60 minutes of continuous exercise. A patient who has been walking for only 15 minutes 3
times/week would not be ready to begin jogging and jogging one time per week would be too low of an exercise frequency in
general to achieve by training benefit.
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38 Answers
159. C. Trunk ROM exercises and strengthening to minimize thoracic kyphosis are essential. Persons with ankylosing
spondylitis tend to assume flexed postures. Disproportionately strong pectorals, hip flexors, or abdominals could worsen the
kyphosis.
160. B. A brachial plexus injury that affects the C5 and C6 nerve roots is termed Erb-Duchenne paralysis. A lesion affecting the
C8 and T1 roots is termed Klumpke’s paralysis. Hemiplegia and spinal cord injury would be caused by trauma to the CNS
and would not normally affect just the C5 and C6 nerve roots.
161. A. The protrusion component involves the arthrokinematic movement of anterior condylar translation. Mandibular
depression (jaw opening) involves both condylar rotation and anterior translation. However, this question is asking only
about the protrusion component. Lateral glide involves anterior translation on the contralateral side and spin on the
ipsilateral side.
162. C. The occupational therapist would be the most appropriate member of the health care team to teach the patient the needed
self-care skills. The occupational therapist would also be able to provide the patient with information regarding
modifications to the home environment that would increase the patient’s independence. The occupational therapist could
teach the patient how to use adaptive devices and help with the fabrication of splints or self-care aides.
163. D. The therapist should observe the parents performing the program as instructed to ensure correct implementation. The
parents should return in one week for another demonstration to determine if they can correctly repeat the program as
previously instructed.
164. B. The hematocrit value provides the percentage of red blood cells in plasma. A decrease in the number of red blood cells
(anemia) would lead to a decreased oxygen carrying capacity in the blood and therefore less oxygen to the tissues would lead
to fatigue. The carbon dioxide value would be examined to assess a patient’s respiratory status while creatinine and BUN
levels are examined in relation to kidney function.
165. D. Excessive upward rotation of the scapula can result from weakness of the rhomboids and latissimus dorsi (downward
rotators). The scapular adduction with medial rotation and adduction of the arm would require action by those muscles.
Option A would help strengthen the serratus anterior, an upward rotator of the scapula. Option B would activate the upper
trapezius as well as the rhomboids and since the upper trapezius is also an upward rotator the scapula, this would not be the
best exercise to use. Option C also helps strengthen the serratus anterior, which would tend to aggravate the problem.
166. C. The family should be involved in all stages of planning and treatment. Family involvement can shorten the rehabilitation
process and patient’s return to the community. It is important to have the family involved early in the rehabilitation process
rather than wait until the patient is ready to be discharged.
167. C. A complaint of heaviness likely reflects weakness. The complaint is not the fit or comfort of the prosthesis. So option A
is incorrect. The expense of obtaining a lighter prosthesis is not justified without determining if the solution is strengthening
of the muscle groups, which controls the prosthesis. A fork strap attachment will assist with suspension, but will not reduce
the weight of the prosthesis.
168. B. Of the options above, a social worker (social services) would be the most appropriate person to intervene in this case.
The social worker is trained to help resolve family issues that arise and would be the best person to lead a team of caregivers
and family members in deciding the appropriate action in this case. Educating the patient would only put more burden on
them without guaranteeing results. A referral for home care may be appropriate, but the social worker would be the best
person to make such contact. Writing a home program for the family would not address the need to instruct family members
in person.
169. D. The history suggests that prolonged improper positioning of the cervical spine resulted in neck pain. A chronic forward
head and kyphosis results in hyperextension in the upper cervical spine and excessive flexion in the upper thoracic spine.
Further muscle length adaptation occurs with tight anterior muscles and stretched posterior muscles. Treatment should
include correction of muscle weakness or imbalance. Rhomboid strengthening and axial neck extension are the only options
that are both correct.
170. B. The lesion is most likely a tendonitis involving a muscle or muscles that originate from the medial epicondyle of the
humerus (i.e., pronator teres, palmaris longus, flexor carpi radialis and ulnaris, and flexor digitorum superficialis). Pain
would be elicited with active contraction of the involved muscle (or muscles) or when the muscle/s is/are passively stretched.
Resisted wrist flexion and pronation would cause pain over the origin of the pronator teres. Options A, C and D do not meet
the criteria for eliciting pain.
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Answers 39
171. B. The mechanism that creates an anterior dislocation of the shoulder is forced abduction and lateral (external) rotation of the
shoulder. This frequently results in a tear of the anterior portion of the capsule. Abduction and external rotation may subject
the patient to recurrent subluxations and/or dislocations and should therefore by avoided.
172. C. In carpal tunnel syndrome there is pain and paresthesias in the median nerve distribution of the hand, which includes the
lateral three digits. There is weakness of the abductor pollicis brevis, but not of the wrist flexors or finger extensors.
173. B. Macerated tissue results from excessive moisture. A more absorbent dressing would soak up the excessive moisture and
prevent maceration.
174. A. A combination of valgus, flexion and external rotation forces applied to the knee while the foot is planted on the ground
results in damage to the anterior cruciate ligament, medial collateral ligament and medial meniscus.
175. C. The key phrase in the question is “interdisciplinary”. Of all the options provided, only airway clearance is within the
scope of practice for physical therapists. Patients with Guillain-Barre syndrome may experience respiratory muscle fatigue or
paralysis and are susceptible to pulmonary infection. Pulmonary hygiene is a critical role in their care.
176. A. During phase I (in-patient) cardiac rehabilitation, vital sign parameters with activity that warrant termination are:
diastolic blood pressure of 110 mmHg or greater, systolic blood pressure above 210 mmHg or an increase greater than 20
mmHg from resting and a heart rate that increases beyond 20 beats per minute above resting. The normal resting respiratory
rate can range between 12 to 20 breaths per minute in adults, so an increase to 20 breaths per minute with low-level activity
would not be a reason to terminate the activity.
177. B. Because this patient has significant weakness in both lower extremities, a standing pivot transfer would not be safe.
However, since the patient does have fair to normal upper extremity strength, and is not totally dependent, a hydraulic lift or
two person lift would not be appropriate because it would not be enhancing the patient’s functional skills. The most
appropriate transfer method would be for the patient to use a sliding board transfer to her strongest right side.
178. C. These are signs of autonomic dysreflexia. Among the most common cause is a distended or irritated bladder. The FIRST
step is to remove the noxious stimulus.
179. B. Neurological changes that are age-related include decreased pain and vibratory sensation. The other changes listed do not
normally occur with aging in the absence of pathology.
180. B. Massaging the upper arm before the forearm helps reduce the proximal resistance of lymphatic flow, which will optimize
the flow of fluid or edema from the distal areas. This has been referred to as the “uncorking effect”. Local heat would cause
vasodilation and may increase edema. Massaging the forearm would not allow the “uncorking effect” to occur. The massage
strokes should be from distal to proximal (centripetal) direction.
181. C. The use of posterior walker has been found to encourage a more upright posture during gait and to promote better gait
characteristics than does the use of an anterior walker. A standard walker, forearm crutches and bilateral quad canes all
emphasize trunk and hip flexion, which is already increased for this child.
182. C. If patients are skilled in falling, they are less likely to become injured during a fall. The patient demonstrating or
performing the task best understanding of a skill. To accomplish this, the patient should be given a demonstration of proper
falling technique and then the patient should be allowed to practice while being guided and guarded by the therapist. Without
first demonstration and then allowing the patient to practice, the patient could be place at risk for injury. Therefore, options
A, B & D are not adequate to ensure patient safety.
183. A. In order to cough effectively, the abdominal muscles must contract to expel air forcefully. This patient does not have this
ability; therefore manual force against the abdomen would mimic the action of the abdominal muscles. The prone position
would not assist the cough mechanism in this patient. Both pursed-lipped breathing and interrupting the expiratory air stream
would decrease the force of exhalation and decrease cough effectiveness.
184. B. The seat width should be slightly wider than the width of the widest body part and depth should come to within 1 inch of
the popliteal fossa.
185. A. Heart rate and systolic blood pressure responses are higher for any given workload when performed with the UE as
compared to the LE. Spinal motion does not create much stress on the cardiovascular system. The quadriceps setting and
diagonal patterns are performed with the LE and would produce less cardiovascular stress.
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40 Answers
186. D. There is normal, linear relationship between heart rate and exercise intensity in patients who are not on beta blocker
medication or who are on non-rate responsive pacemakers. Therefore, teaching patients to take their pulse reliably before
discharge is important learning objective to ensure safety with exercise upon discharge. Ascending a flight of stairs before
discharge is only appropriate if the patient needs to negotiate stairs at home, but not as important as pulse monitoring.
Performing exercises without angina can be achieved by monitoring HR with exercise; therefore, taking a pulse is necessary.
Returning to normal daily activity immediately after a myocardial infarction is an unreasonable objective, as it will take 6 to
8 weeks for the myocardium to heal; therefore, activity levels will need to be tempered in order to protect the heart while it is
healing.
187. B. In order to facilitate transfers utilizing a sliding board, the patient will need both removable arm rests and detachable
swing-away leg rests. Fixed arm rests make sliding board transfers extremely difficult and unsafe. Any other options would
not be optimal for this particular patient’s needs.
188. B. The QRS complex represents ventricular contraction. Atrial contraction is represented by the P wave. When an area of
the ventricle becomes irritable and develops an ectopic foci, the ventricle will depolarize prematurely before the normal
conduction sequence (e.g., prior to SA node firing in the atria) and presents a wide, irregularly shaped QRS complex. In
normal ventricular depolarization, the QRS would be narrow and regularly spaced and atrial fibrillation would appear as the
P wave changes. Atrial repolarization occurs within the QRS complex and is not normally visible on EKG.
189. B. Orthostatic hypotension from bed rest occurs as a result of decreased venous tone, which will lead to a pooling of blood in
the LE upon standing. The pooling of blood in the LE will reduce the amount of blood returning to the heart decreasing
ventricular filling and ultimately decreasing cardiac output. This results in drop in BP with resultant dizziness. With pooling
of blood in the LE, the hydrostatic pressure would increase. To compensate for the decrease in cardiac output, the
sympathetic system (not the parasympathetic) would stimulate the heart.
190. A. The stage of hemarthrosis will mean that there is still some bleeding into the joint space, but not as extensively, therefore
the patient will benefit from ROM exercise to prevent contracture. The patient may need active-assist, as there may still be
pain or edema in the joint that prevents independent performance of ROM. The mechanical trauma of weight bearing to
tolerance at this stage may impinge and damage the pathologic synovium within the joint. Resistive ROM is more
appropriate when pain and swelling have subsided and no bleeding is occurring. Continuous immobilization in the extended
position will promote contracture in edematous knee.
191. C. All of the options, except for gentle, active exercises, are precautions or contraindications for this patient.
192. B. Lateral epicondylitis is caused by overuse of wrist extensors that originate on the lateral epicondyle of the humerus,
especially the ECRB. If the lateral epicondylitis is at a chronic stage, conditioning of the extensor muscles and sustained grip
activities will be most effective in long-term management. A forearm cuff is thought the muscle loading. Iontophoresis
would not be appropriate for a home program. Friction massage of the brachioradialis would not be appropriate since the
ECRB muscle is usually the one affected.
193. B. Contacting the patient’s home nurse is the appropriate first course of action because of the possible safety risk associated
with the patient not taking their insulin. Injections and glucose testing would go beyond the scope of practice of physical
therapy. Placing the responsibility on the family would not be appropriate because of the gravity of the situation.
194. A. The sitting position promotes visual attending, use of the UE and social interaction. A child who exhibits extensor
posturing should be carried in a symmetric position that does not allow axial hyperextension and keeps the hips and knees
flexed.
195. C. Electrical stimulation for patients with demand-type pacemakers is often listed as contraindication. However, even
though it is often listed as contraindication in textbooks, research studies apparently have not substantiated the suspected
risks. Nonetheless, it should only be applied with caution and close supervision in these patients. Exercise, unless very
strenuous, would be indicated in this patient. Biofeedback introduces no electrical signals into the body and therefore would
not be contraindicated.
196. C. Sensory inputs such as intermittent music and touching the face, rocking the patient rapidly and brightening the room
elicit arousal. When a child becomes agitated and confused, it is appropriate to reduce the general amount of environment
stimulation. Decreasing auditory and visual activity in the room may help the child focus.
197. D. Isolated contraction of the right sternocleidomastoid muscle would cause the head to rotate the left and side bend (lateral
flexion) to the right. To stretch the muscle, the opposite actions would be performed on the patient by the therapist; rotation
of the head to the right and lateral flexion to the left.
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Answers 41
198. B. Caution should be used in patients who are taking tetracycline, because the drug will enhance the effects of ultraviolet
radiation. Ultraviolet is not contraindicated in these patients, however the dosage of the ultraviolet would probably have to
be adjusted to some lower level. The penicillin allergy, calcium supplements and metal implants would not be affected by
the ultraviolet light. It should be noted that although UV radiation therapy is not common in today’s practice of physical
therapy, therapists should nonetheless be aware of the precautions; and be able to advise patients who may be using UV
radiation at home.
199. C. The position described creates the necessary force to move the lower body in this transfer given the level of SCI. Finger
extension against resistance would be difficult for a patient with C6 quadriplegia. The patient’s hands would be kept near the
thigh or hips with one hand on the mat and one on the wheelchair.
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2. During pregnancy, which of the following is contraindicated?

13. Which of the following is the BEST documentation exercise of a goal?

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