2000 Flashcards

Question

21. The following statements describe the total contact casting, EXCEPT: a. Promote ulcer healing by increasing the weight bearing surface area and allow patient to remain ambulatory b. Are snug-fitting, below knee casts that protect insensitive limbs from repetitive trauma c. Contraindicated for superficial plantar ulcers in the presence of decreased or absent sensation d. Is an effective therapy for healing chronic neuropathic plantar ulcers in individuals with chronic sensory neuropathies e. Contraindicated in deep foot ulcers where abscesses, osteomyelitis or similar deep infection or gangrene is present

Answer 1

c. Contraindicated for superficial plantar ulcers in the presence of decreased or absent sensation Rationale: "Total-contact casting has been shown to be beneficial for the treatment of neuropathic ulcers. It redistributes weight bearing forces, decreases edema, protects the wound and surrounding tissues, decreases shear forces, localizes infection, protects foot from outside contaminants, and provides immobilization of the wound and Charcot joint. TCC cannot be used in infection or ischemia." Answer is C because TCC is actually recommended for plantar ulcers and only contraindicated when there is a presence infection or ischemia. (Braddom 6th ed., p. 473)

Answer 2

c. All of these Rationale: Levator palpebrae superioris is responsible primarily for raising the upper eyelid. Distally, the muscle widens and becomes a tendon sheath known as the levator aponeurosis in the region of the Whitnall ligament. The levator aponeurosis has lateral and medial wings attaching to the respective canthal tendons (NCBI, 2023).

Answer 3

b. At least 15 sec continuous contractions Rationale: creatine phosphate and ATP provide enough energy for muscles to contract maximally for about 15 seconds (Tortora 14 th ed., p.310)

Answer 4

c. Multiple step commands should be used for activities of daily living Rationale: One command should be given at a time, and the second command should not be given until the first task is completed (O'Sullivan 7 th ed., p. 1214).

Answer 5

e. Levator scapulae and rhomboids Rationale: Smaller nerves arise at various levels along the plexus including the dorsal scapular nerve that supplies the rhomboid from the C5 ventral ramus, the long thoracic nerve from the upper trunk, the musculocutaneous nerve from the lateral cord, and the axillary nerve from the posterior cord along with the thoracodorsal nerve. (Braddom 5 th ed., Chap 41, p. 925) Rhomboids are supplied by the dorsal scapular nerve from the anterior ramus, C4, C5 (De Lisa 5 th ed., Chap 1, p. 23)

Answer 6

a. All of these Rationale: (Snell 9 th ed.) The radial artery is the smaller of the terminal branches of the brachial artery. It begins in the cubital fossa at the level of the neck of the radius. It passes downward and laterally, beneath the brachioradialis muscle and resting on the deep muscles of the forearm. In the middle third of its course, the superficial branch of the radial nerve lies on its lateral side. (p. 389) On entering the palm, it curves medially between the oblique and transverse heads of the adductor pollicis and continues as the deep palmar arch. The curve of the arch lies at a level with the proximal border of the extended thumb (p. 403) Immediately entering the palm, the radial artery gives off the arteria radialis indicis, which supplies the lateral side of the index finger, and the arteria princeps pollicis, which divides into two and supplies the lateral and medial sides of the thumb. (p. 403) Anatomic snuffbox - A skin depression that lies distal to the styloid process of the radius. The radial artery can be palpated within the snuffbox as the artery winds around the lateral margin of the wrist to reach the dorsum of the hand (p. 426). Its clinical importance lies in the fact that the scaphoid bone is most easily palpated here and that the pulsations of the radial artery can be felt here (p. 393)

Answer 7

e. Conjunctiva Rationale: Conjunctiva - The superficial surface of the eyelids is covered by skin, and the deep surface is covered by a mucous membrane called the conjunctiva. The conjunctiva is a thin mucous membrane that lines the eyelids and is reflected at the superior and inferior fornices onto the anterior surface of the eyeball. (Snell 9 th ed., p. 550) Cornea - Light enters through the cornea, a transparent dome on the front surface of the eye. The cornea serves as a protective covering and as a weak lens that helps to focus light on the retina at the back of the eye (Kroemer 7 th ed., p. 88) Canaliculus - On the summit of the papilla is a small hole, the punctum lacrimale, which leads into the canaliculus lacrimalis. The papilla lacrimalis projects into the lacus, and the punctum and canaliculus carry tears down into the nose (Snell 9 th ed., p. 550) Tarsal gland - long modified sebaceous glands that pour their oily secretion onto the margin of the lid; their openings lie behind the eyelashes (Snell 9 th ed., p. 550) Lacrima - The more rounded medial angle is separated from the eyeball by a small space, the lacus lacrimalis, in the center of which is a small, reddish yellow elevation, the caruncula lacrimalis (Snell 9 th ed., p. 550)

Answer 8

d. Abductor pollicis brevis, opponens pollicis and flexor pollicis brevis Rationale: The thenar muscles include the abductor pollicis brevis, opponens pollicis, flexor pollicis brevis, and adductor pollicis (acts on the thumb but is not in the thenar eminence). (Tortora 15th ed., p. 375)

Answer 9

b. Digastrics Note: A mnemonic for muscles of mastication is Teeny Mice Make Petite Little Prints = Temporalis, Masseter, Medial Pterygoid, and Lateral Pterygoid. (Tortora 15th ed., p. 344

Answer 10

b. Biceps muscle Rationale: Steindler flexorplasty is a surgical procedure wherein the flexor-pronator mass origin on the medial epicondyle is transferred proximally to the anterior humerus to restore elbow flexion. (Marinello et al., 2019) The Steindler transfer is classically indicated in cases of paralysis of the biceps and brachialis muscles, where the presence of functional hand and strength greater than or equal to M4 of the flexor-pronator muscles of the forearm is essential. (Hussain et al., n.d.)

Answer 11

e. Actin Rationale: In the sliding filament mechanism, the thin filaments slide inward and meet at the center of a sarcomere. They may even move so far inward towards each other that their ends overlap. These thin filaments are made up of actin contractile proteins, making them slide towards each other. (Tortora 14th ed., pg. 302)

Answer 12

b. Association Rationale: Association fibers are axons that connect cortical areas within the same hemisphere. (Standring 39th ed., pg. 411)

Answer 13

a. Passive insufficiency of the knee extensors Rationale: Passive insufficiency of the knee extensors refers to the inability of the knee extensor mm to fully lengthen or stretch when the knee is flexed. In the prone position, the knee is flexed which puts the knee extensor mm in a shortened position. This can limit the ROM during passive knee flexion d/t knee extensors cannot fully lengthen to allow for a greater ROM. (Houglum 6th ed., 142-145)

Answer 14

d. II, III and IV Rationale: II and III are only correct however based on the answer key, it is D. I.INCORRECT. As a result of these movements, which are completed by day 28, the primitive atria and ventricles of the future heart are reoriented to assume their final adult positions. Adult position is the apex directed anteriorly, inferiorly, and to the left. Not exactly the right side is backwards and the left side is forwards (Tortora 15 th ed., p. 696, 727) II.CORRECT. Heart is relatively small, roughly the same size (but not the same shape) as your closed fist. Heart rests on the diaphragm, near the midline of the thoracic cavity. (Tortora 15th ed., p. 696) III.CORRECT. In horizontal face up position, the heart is present between thoracic vertebrae 5 to 8 (T5 to T8). https://socratic.org/questions/59a56dedb72cff5b50e709b0#: ~:text=Explanation%3A,8%20(T5%20to%20T8) IV.INCORRECT. The base of the heart, or the posterior surface, is formed mainly by the left atrium (Snell 9th ed., p 80). Left ventricle forms the apex of the heart (Tortora 15th ed. p. 702) V.INCORRECT. Inferior surface the heart is formed mainly by the right and left ventricles. Right ventricle forms most of the anterior surface of the heart (Tortora 15th ed. p. 702)

Answer 15

c. Attraction and lengthening of myosin cross bridge Rationale: At the onset of contraction, the sarcoplasmic reticulum releases calcium ions (Ca2) into the sarcoplasm. There, they bind to troponin. Troponin then moves tropomyosin away from the myosin binding sites on actin. Once the binding sites are "free," the contraction cycle consists of 4 steps. ● ATP Hydrolysis in the myosin head ● Attachment of myosin to actin to form cross-bridges ● Power stroke ● Detachment of myosin from actin (Tortora 15 th ed., p.305-306 )

Answer 16

a. Fixators Rationale: Fixator- contracts isometrically to stabilize the origin of the prime mover so that it can act efficiently. For example, the muscles attaching the shoulder girdle to the trunk contract as fixators to allow the deltoid to act on the shoulder joint (Snell 9 th ed., p. 8) Synergists: contract and stabilize the intermediate joints. To prevent unwanted movements in an intermediate joint. (Snell 9th ed., p. 8) Antagonist: A muscle that has an action opposite that of the prime mover (agonist) and yields to the movement of the prime mover. (Tortora 15 th ed., glossary) Neutralizers. Muscles that act to prevent an undesired action from one of the movers. (Dutton 4 th ed. P 11)

Answer 17

a. Turn the head to the unaffected side Rationale: Generally, Asymmetric Tonic Neck Reflex (ATNR) has been reported to disappear at five months old. However, previous studies and clinical observations reveal that ATNR may reemerge in patients status post CVA. Moreover, ATNR can be used to promote extensor synergy to facilitate elbow extension in patients with hemiplegia. The mechanism centered on head rotation, wherein there would be an observable increase in elbow extension movement and elbow extension coupling during shoulder adduction movement.

Answer 18

a. I, II, III and V Rationale: I. Correct. Red blood cells (erythrocytes) are exclusively produced in the bone marrow and pass through several stages of development before reaching maturity. Erythropoiesis comprises stages of proerythroblast, basophilic erythroblast, polychromatophilic erythroblast, orthochromatic erythroblast, and reticulocyte erythrocytes. (Guyton 13th ed. p. 446). II. Correct. Erythrocytes have a plasma membrane that encloses mainly a single protein, hemoglobin. (Standring 41th ed. p. 78) III. Correct. Erythrocytes are made up mostly of hemoglobin and have a basic biconcave shape with a lipid bilayer membrane. (Standring 41th ed. p. 78) IV. Incorrect. Red cells have an average life span of approximately 120 days (about four months), however, only approximately 2.4 million new cells are produced per second in the human body. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006275/d Blood Cells Die? - PMC (nih.gov) V. Correct. RBCs are primarily produced in the bone marrow. They are also produced in the spleen (a major lymphatic organ) until the fifth month of prenatal development, after which bone marrow is mainly responsible for hematopoiesis. https://www.medicalnewstoday.com/articles/320698Anatom y, function, and disease (medicalnewstoday.com)

Answer 19

e. Pitting edema is detected by pressing over the area; excess synovial fluid is assessed by balloting the fluid Rationale: Pitting edema is characterized by the accumulation of fluid in interstitial space. This is detected by pressing a finger over the swollen area, resulting in an indentation (pit) that may persist for a period of time upon the pressure being released. On the other hand, synovial thickening or joint effusion refers to the accumulation of excess fluid within a joint capsule. This is assessed by a technique known as "balloting" or "ballotement", which is commonly used in knee joints.

Answer 20

a. I, III and V Rationale: (Ref. of I-III is (Tortota, 15th ed. Chap 18, p. 639-643) I. Microscopic spherical sacs called thyroid follicles make up most of the thyroid gland. The wall of each follicle consists primarily of cells called follicular cells. The follicular cells produce two hormones: thyroxine, which is also called tetraiodothyronine because it contains four atoms of iodine, and triiodothyronine (Ty) which contains three atoms of iodine. T3 and T4 together are also known as thyroid hormones. II. Parathyroid hormone is the major regulator of the levels of calcium magnesium, and phosphate ions in the blood. III. Thyroid hormones are also required for growth of the skeletal system: They promote formation of ossification centers in developing bones, synthesis of many bone proteins, and secretion of growth hormone (GH) and insulin-like growth factors (IGFs). Deficiency of thyroid hormones during fetal devel-opment, infancy, or childhood causes severe mental retardation and stunted bone growth. IV. and V: The superior thyroid artery (STA) arising from the external carotid artery (ECA), and the inferior thyroid artery (ITA) branching from the thyrocervical trunk create the blood supply to the thyroid gland. The STA and ITA anastomose bilaterally at the thyroid gland giving this organ a dual blood supply. (NCBI, Anatomy, Head and Neck, Thyroid Arteries)

Answer 21

d. Chest pain Rationale: Those who do have warning signs of MI may have severe unrelenting chest pain described as "crushing pain" lasting 30 or more minutes that is not alleviated by rest or by nitroglycerin. This chest pain may radiate to the arms, throat, and back, persisting for hours (Goodman, 5th ed. Chap 6, p. 252)

Answer 22

a. II, III and V Rationale: Contents of the Anterior Fascial Compartment of the Forearm Muscles: A superficial group, consisting of the pronator teres, the flexor carpi radialis, the palmaris longus, and the flexor carpi ulnaris; an intermediate group consisting of the flexor digitorum superficialis; and a deep group consisting of the flexor pollicis longus, the flexor digitorum profundus, and the pronator quadratus Nerve supply to the muscles: All the muscles are supplied by the median nerve and its branches, except the flexor carpi ulnaris and the medial part of the flexor digitorum profundus, which are supplied by the ulnar nerve. (Snell 9th ed, Chap 9, p. 384)

Answer 23

a. Referred pain in the C7-C8 dermatome Rationale: - Chronic pain in anterior shoulder, pain in abduction/external rotation, painful over bicipital groove. Biceps brachii (musculocutaneous nerve from lateral cord: C5, C6) (Cuccurullo 4th ed., p. 34 & 150) (Physical Medicine and Rehabilitation Board Review) - Lesion involves the long tendon in the bicipital groove beneath or just distal to the transverse humeral ligament. Swelling in the boney groove is restrictive and compounds and perpetuates the problem. (Kisner 6th ed., p. 563) - Clinically, palpation of the tendon and pain produced with resisted supination while the elbow is flexed and held against the trunk (Yergason's test) or with resistance of forward flexion with the elbow extended and supinated (Speed's test) are indicative of tendonitis. (De Lisa 5th ed., p. 911)

Answer 24

e. II, III and V Rationale: The spleen is roughly the size of a clenched fist and is located in the left, superior corner of the abdominal cavity. The spleen filters blood instead of lymph. Cells within the spleen detect and respond to foreign substances in the blood and destroy worn-out red blood cells. Lymphocytes in the white pulp can be stimulated in the same manner as in lymph nodes. (Seeley's Essentials of Anatomy and Physiology 9th ed., p. 388-389). Options I and IV describe the Liver.

Answer 25

c. The anterolateral portion of the talar dome becomes palpable as the lateral malleolus rotates out from under the ankle mortise when the foot is dorsiflexed Rationale: - If the individual stands with the patella pointing straight forward with the knee in the sagittal plane, it is easy to realize as it is palpated that the lateral malleolus lies in a more posterior position than the medial malleolus. (p. 477) - The anterior aspect of the dome may be palpated with the subject's ankle passively placed in plantarflexion; the dome is palpated immediately distal to the articulation between the tibia and talus. (p. 478) - Proximal to the malleolus, the peroneus longus tendon lies slightly posterior to that of the brevis and may be palpated at this location in some individuals. Distal to the malleolus, the peroneus longus tendon is held down close to the bone. It lies on the plantar side of the peroneus brevis tendon but the two are difficult to differentiate until they split at the cuboid at which point the longus tendon traverses the plantar foot to its insertion and the brevis ends at the styloid process of the fifth metatarsal. (p. 505-507) - On the lateral aspect of the foot, the peroneal tubercle of the calcaneum can be palpated about 1 in. (2.5 cm) below and in front of the tip of the lateral malleolus. Above the tubercle, the tendon of peroneus brevis passes forward to its insertion on the prominent tuberosity on the base of the 5th metatarsal bone. Below the tubercle, the tendon of peroneus longus passes forward to enter the groove on the under aspect of the cuboid bone. (Snell Clinical Anatomy by Region 9th ed., p. 525-526) - Under calcaneum, the lateral surface is almost flat. On its anterior part is a small elevation called the peroneal tubercle, which separates the tendons of the peroneus longus and brevis muscles. (Snell Clinical Anatomy by Region 9th ed., p. 475)

Answer 26

e. Evaluates patient's response to treatment and determines progress toward accomplishment of functional outcome Rationale: When the treatment program is to be terminated, the caregiver should evaluate and measure the patient's functional outcomes and compare them with the expected outcomes, and the home treatment program should be reviewed and finalized (Pierson and Fairchild 5 th ed., p.12). The primary responsibility of the caregiver regarding termination of treatment is reevaluation of the client's progress and comparing it with the expected functional outcomes, documents follow-up was not mentioned.

Answer 27

e. It divides into a superficial branch, a deep branch and an intermediate branch Rationale: All except "E." are correct. The radial nerve, not the ulnar nerve, divides into a superficial and deep branch because the ulnar nerve's branches are called posterior cutaneous and palmar cutaneous branches. (Snell's Clinical Anatomy 6th ed., p.369)

Answer 28

a. The hyaline cartilage is rich in blood vessels Rationale: The unique characteristic of a synovial joint is the presence of a space called a synovial cavity or joint cavity between the articulating bones. The articular capsule is composed of two layers, an outer fibrous membrane and an inner synovial membrane. The synovial fluid of a synovial joint functions include reducing friction by lubricating the joint, absorbing shocks, and supplying oxygen and nutrients to and removing carbon dioxide and metabolic wastes from the chondrocytes within articular cartilage (Tortora 14th ed, pages 261-263).

Answer 29

a. Tension generated in skeletal muscles is a direct function of the magnitude of overlap between the actin and myosin filaments Rationale: As a muscle either shortens or lengthens beyond that resting position, its ability to produce force decreases because the number of crossbridges declines when the muscle fiber moves out of its resting length. Active tension declines as the muscle shortens because there are fewer cross-bridges available between the actin and myosin fibers. When a sarcomere is at its shortest position, there are no remaining cross-bridges available. Likewise, as the muscle lengthens, the actin and myosin fibers move farther apart until crossbridges do not connect between the actin and myosin sufficiently to produce tension (Brunnstroms 6th ed, page 137)

Answer 30

d. Pivot Rationale: (tortora 14th ed, page 269) a.) A ball-and-socket joint or spheroid joint consists of the ball-like surface of one bone fitting into a cuplike depression of another bone b.) In a saddle joint or sellar joint, the articular surface of one bone is saddle-shaped, and the articular surface of the other bone fits into the "saddle" as a sitting rider would sit c.) Wheel and axle joint is not a type of synovial joint- or any other joint in the human body. It is a descriptive mechanism that relates to different gross movement function of the body d.) In a pivot joint, or trochoid joint, the rounded or pointed surface of one bone articulates with a ring formed partly by another bone and partly by a ligament. A pivot joint is uniaxial because it allows rotation only around its own longitudinal axis. Examples of pivot joints are the atlanto-axial joint, in which the atlas rotates around the axis and permits the head to turn from side-to-side as when you shake your head "no" e.) In a hinge joint, or ginglymus joint (JIN-gli-mus), the convex surface of one bone fits into the concave surface of another bone

Answer 31

a. Quadrates lumborum Rationale: AS is a rheumatic disease characterized by chronic inflammation of the ligaments in the lumbar and spinal areas. The sacroiliac joints are affected nearly 100% of the time, followed by the neck (75%), lumbosacral area (50%), and hips and heels (30%). Intervention for this includes: extension approach, exaggerate lumbar lordosis, and segmental and global stabilization. Segmental and global trunk stabilization and scapular stabilization exercises are mandatory to strengthen the muscles surrounding the spine. The quadratus lumborum (lateral and deep portion) is considered as both a segmental and global trunk muscle surrounding the spine. (Kisner, 6th, p. 446, 468, 470, 417)

Answer 32

d. All of these Rationale: The discs form strong joints, permit various movements of the vertebral column, and absorb vertical shock. Under compression, they flatten and broaden. (Tortora, 15th, p. 217) Their physical characteristics permit them to serve as shock absorbers when the load on the vertebral column is suddenly increased, as when one is jumping from a height. The semifluid nature of the nucleus pulposus allows it to change shape and permits one vertebra to rock anteriorly or posteriorly on another, as in flexion and extension of the vertebral column. (Snell, 9th, p. 689-690)

Answer 33

e. Some posterior movement Rationale: The PCL extends superiorly, anteriorly, and medially from tibia to femur. It is the primary stabilizer of the knee against posterior movement of the tibia on the femur, it checks extension and hyperextension. (Magee, 6th, Chap 12, p. 807)

Answer 34

c. Transports the ulnar nerve and finger flexor tendons from the forearm to the hand Rationale: The flexor retinaculum and carpal bones form a narrow space called the carpal tunnel. Through this tunnel pass the median nerve and tendons of the flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis longus muscles. (Tortora 2017, chap 11 p. 371)

Answer 35

c. I, IV and V Rationale: [I] Liver is the heaviest gland of the body, weighing about 1.4 kg (about 3 lb) in an average adult. Of all of the organs of the body, it is second only to the skin in size: [1] largest external organ - skin [2] largest internal organ - liver (Tortora, 2017, chap 24 p. 922) [II] Occupies most of the right hypochondriac and part of the epigastric regions of the abdominopelvic cavity (Tortora, 2017, chap 24 p. 922) [III] Spleen produces lymphocytes, especially in response to invading pathogens. (Spleen | SEER Training (cancer.gov)) [IV] The liver is inferior to the diaphragm (Tortora, 2017, chap 24 p. 922). It lies almost entirely under the cover of the ribs and costal cartilages and extends across the epigastric region (Snell 9ed, chap 5 p. 157). [V] Liver is especially important in maintaining a normal blood glucose level. When blood glucose is low, the liver can break

Answer 36

d. Collateral ligament Rationale: [A] The proximal end of the tibia is expanded into a lateral condyle and a medial condyle. The slightly concave condyles are separated by an upward projection called the intercondylar eminence [C] Anteroposterior stability is provided by the cruciate ligaments; [D] Mediolateral stability is provided by the medial (tibial) and lateral (fibular) collateral ligaments

Answer 37

b. Coracoacromial Rationale: The three joints of the pectoral girdle are the sternoclavicular joint, coracoclavicular joint, and acromioclavicular joint. (https://www.ncbi.nlm.nih.gov/books/NBK534836/).

Answer 38

e. Hilus Rationale: The mediastinal (medial) surface of each lung contains a region, the hilum, through which bronchi, pulmonary blood vessels, lymphatic vessels, and nerves enter and exit (Tortora, 14th Ed., Chapter 23, p. 852).

Answer 39

d. Disabilities Rationale: ● Disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. ● Impairment is any loss or abnormality of psychological, physiological or anatomical structure or function.

Answer 40

. Choroid plexus

Answer 41

c. Proprioceptor Rationale: MICROSCOPIC STRUCTURE ● Free nerve endings (nonencapsulated) - Bare dendrites associated with pain, thermal, tickle, itch, and some touch sensations. ● Encapsulated nerve endings - Dendrites enclosed in connective tissue capsule for pressure, vibration, and some touch sensations. ● Separate cells - Receptor cells synapse with first-order sensory neurons; located in retina of eye (photoreceptors), inner ear (hair cells), and taste buds of tongue (gustatory receptor cells). RECEPTOR LOCATION AND ACTIVATING STIMULI ● Exteroceptors - Located at or near body surface; sensitive to stimuli originating outside body; provide information about external environment; convey visual, smell, taste, touch, pressure, vibration, thermal, and pain sensations. ● Interoceptors - AKA Visceroreceptors. Located in blood vessels, visceral organs, and nervous system; provide information about internal environment; impulses usually are not consciously perceived but occasionally may be felt as pain or pressure. ● Proprioceptors - Located in muscles, tendons, joints, and inner ear; provide information about body position, muscle length and tension, position and motion of joints, and equilibrium (balance). TYPE OF STIMULUS DETECTED ● Mechanoreceptors - Detect mechanical stimuli; provide sensations of touch, pressure, vibration, proprioception, and hearing and equilibrium; also monitor stretching of blood vessels and internal organs. ● Thermoreceptors - Detect changes in temperature. ● Nociceptors - Respond to painful stimuli resulting from physical or chemical damage to tissue. ● Photoreceptors - Detect light that strikes the retina of the eye. ● Chemoreceptors - Detect chemicals in mouth (taste), nose (smell), and body fluids. ● Osmoreceptors - Sense osmotic pressure of body fluids. Some also contain tactile receptors called corpuscles of touch or Meissner corpuscles (M-IS-ner), nerve endings that are sensitive to touch.

Answer 42

d. Depolarization Rationale: (Tortora 15 th Ed., p. 422-426) Action Potential: or impulse is a sequence of rapidly occurring events that decrease and reverse the membrane potential and then eventually restore it to the resting state. An action potential has two main phases: a depolarizing phase and a repolarizing phase. ● Repolarization- the membrane potential is restored to the resting state of −70 mV. F ● Impulse conduction- starts at the initial segment of the axon and is self-propagating wave of electrical negativity that passes rapidly along the surface of the plasma membrane. This impulse is self-propagated, and its size and frequency do not alter. Once the nerve impulse has spread over a given region of plasma membrane, another action potential cannot be elicited immediately. ● Ionization- is the process of giving up or gaining electrons. ● Depolarization- negative membrane potential becomes less negative, reaches zero, and then becomes positive. Stimulus causes depolarization. ● Irradiation- ionizing radiation of various kinds, can be a potent teratogen.

Answer 43

d. Even in later stages, paralysis and muscle atrophy of the segment involved does not occur Rationale: Syringomyelia, which is due to a developmental abnormality in the formation of the central canal, most often affects the brainstem and cervical region of the spinal cord. At the site of the lesion, there is cavitation and gliosis in the central region of the neuraxis. The following characteristic signs and symptoms are found: 1. Loss of pain and temperature sensations in dermatomes on both sides of the body related to the affected segments of the cord. This loss commonly has a shawl like distribution caused by the interruption of the lateral spinothalamic tracts as they cross the midline in the anterior gray and white commissures. The patient commonly complains of accidental burning injuries to the fingers. 2. Tactile discrimination, vibratory sense, and proprioceptive sense are normal. The reason is that the ascending tracts in the posterior white column are unaffected. 3. Lower motor neuron weakness is present in the small muscles of the hand. It may be bilateral, or one hand may suffer before the other. As the lesion expands in the lower cervical and upper thoracic region, it destroys the anterior horn cells of these segments. Later, the other muscles of the arm and shoulder girdles undergo atrophy. 4. Bilateral spastic paralysis of both legs may occur, with exaggerated deep tendon reflexes and the presence of a positive Babinski response. These signs are produced by the further expansion of the lesion laterally into the white column to involve the descending tracts. 5. Horner syndrome may be present. This is caused by the interruption of the descending autonomic fibers in the reticulospinal tracts in the lateral white column by the expanding lesion.

Answer 44

b. There is no loss of associated muscle reflex Rationale: A: Along the entire length of the spinal cord are attached 31 pairs of spinal nerves by the anterior1 or motor roots and the posterior or sensory roots. Each root is attached to the cord by a series of rootlets, which extend the whole length of the corresponding segment of the cord. Each posterior nerve root possesses a posterior root ganglion, the cells of which give rise to peripheral and central nerve fibers. (Snell Clinical Neuroanatomy 7 th Ed., p. 4) B: Each posterior root has a swelling, the posterior (dorsal) root ganglion, which contains the cell bodies of sensory neurons. The anterior (ventral) root and rootlets contain axons of motor neurons, which conduct nerve impulses from the CNS to effectors (muscles and glands). (Tortora 15 th Ed., p. 450) C: Each posterior nerve root possesses a posterior root ganglion, the cells of which give rise to peripheral and central nerve fibers. (Snell Clinical Neuroanatomy 7 th Ed., p. 4) D: Symptoms of pain arise from pressure of a swollen disc or swollen tissues against pain-sensitive structures (ligaments, dura mater, blood vessels around nerve roots) or from the chemical irritants of inflammation if there is herniated disc material. Neurological signs arise from pressure against the spinal cord or nerve roots. The only true neurological signs and symptoms are specific myotome weaknesses and specific dermatome sensory changes. Radiating pain in a dermatomal pattern, increased myoelectric activity in the hamstrings, decreased straight-leg raising, and depressed deep tendon reflexes can also be associated with referred pain stimuli from spinal muscles, interspinous ligaments, the disc, and facet joints and therefore are not true signs of nerve root pressure. (Kisner 6 th Ed., p. 441-442) E: Posterior root consists of bundles of nerve fibers, called afferent fibers, that carry nervous impulses to the central nervous system. Because these fibers are concerned with conveying information about sensations of touch, pain, temperature, and vibration, they are called sensory fibers. (Tortora 15 th Ed., p. 450)

Answer 45

a. Tension is generated in the muscle fibers resulting in either shortening, lengthening or maintaining length Rationale: Muscle contraction is said to be isometric when the muscle does not shorten during contraction and isotonic when it does shorten but the tension on the muscle remains constant throughout the contraction. (Guyton and Hall 13th Ed,. p.83)

Answer 46

b. Increase in frequency of activation of each functioning motor unit Rationale: Fatigue results mainly from inability of the contractile and metabolic processes of the muscle fibers to continue supplying the same work output. (Guyton and Hall 13th Ed,. p.86)

Answer 47

b. Discuss how two objects are similar Rationale: Abstraction involves the ability to understand the meanings of words beyond the literal interpretation. This ability can be tested through such tasks as asking a patient to identify similarities between objects (example: "how are an apple and an orange both alike." One would expect an abstract answer such as "fruit", as opposed to a concrete answer such as that they are both round. (Brown University, The Mental Status Examination)

Answer 48

a. Optic nerve Rationale: Cranial nerve II is developmentally a cerebral vesicle evagination, not a peripheral nerve. The microscopic anatomy of CN II is significantly different from that of CN VIII

Answer 49

b. 12 pairs of cranial nerve and 31 pairs of spinal nerves Rationale: Cranial nerves and their ganglia—12 pairs that exit the skull through the foramina. Spinal nerves and their ganglia—31 pairs that exit the vertebral column through the intervertebral foramina (8 Cervical, 12 Thoracic, 5 Lumbar, 5 Sacral, 1 Coccygeal) (Snell's Clinical Neuroanatomy 7th edition, p. 4).

Answer 50

c. Muscle spindle Rationale: Slight stretching of a muscle stimulates sensory receptors in the muscle called muscle spindles. The spindles monitor changes in the length of the muscle. In response to being stretched, a muscle spindle generates one or more nerve impulses that propagate along a somatic sensory neuron through the posterior root of the spinal nerve and into the spinal cord (Tortora).

Answer 51

a. Trochlear nerve Rationale: Trochlear nerve palsy is the most common cause for vertical extraocular muscle weakness and vertical diplopia. Danchaivijitr, C., & Kennard, C. (2004). Diplopia and eye movement disorders. Journal of Neurology, Neurosurgery & Psychiatry, 75(suppl 4), iv24-iv31. The trochlear nerve supplies the superior oblique muscle, which rotates the eye downward and laterally. In lesions of the trochlear nerve, the patient complains of double vision on looking straight downward, because the images of the two eyes are tilted relative to each other. This is because the superior oblique is paralyzed, and the eye turns medially as well as downward. In fact, the patient has great difficulty in turning the eye downward and laterally. (Snell's Clinical Neuroanatomy 7th ed., p. 360)

Answer 52

b. The afferent side of the arc begins with muscle stretch receptors whose cell bodies are in the central root ganglia Rationale: In the spinal cord, reflex arcs play an important role in maintaining muscle tone, which is the basis for body posture. The receptor organ is situated in the skin, muscle, or tendon. The cell body of the afferent neuron is located in the posterior root ganglion, and the central axon of this first-order neuron terminates by synapsing on the effector neuron. (Snell's Clinical Neuroanatomy 7th ed., p. 162)

Answer 53

d. Periods of impairment followed by full or partial remission of symptoms Rationale: Relapsing-remitting MS (RRMS) is the most common course, affecting approximately 85% of patients with MS. It is characterized by discrete attacks or relapses, defined as periods of acute worsening of neurological function. Relapses are followed by remissions, defined as periods without disease progression and partial or complete abatement of signs and symptoms. (O'Sullivan, 6th ed., p. 722)

Answer 54

c. Knowledge of results Rationale: Knowledge of results focuses on the end of the performance, for example, the performer's score, time or position. It is sometimes called terminal feedback. Knowledge of performance focuses on how well the athlete performed, not the end result.

Answer 55

c. Merkel's disks Rationale: Merkel's disks are responsible for the following: (Delisa) ● low intensity touch, velocity of touch, ability to perceive continuous contact of object with skin/ constant indentation of the skin (pressure), recognition of texture ● below the epidermis in hairless smooth (glabrous) skin with a high density in the fingertips ● important role in both two-point discrimination and localization of touch

Answer 56

a. Meningitis Rationale: Common etiologies of CP occuring during the prenatal period include maternal infection (Molnar) ● STORCH: Syphilis, Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex Virus

Answer 57

b. Both respond in a seemingly identical way to transcutaneous stimulation Rationale: The somatic nervous system consists of both afferent (sensory) and efferent (motor) nerves. Sensory nerves generate sensory perceptions, while motor nerves lead to muscle contractions. Information from the periphery is detected by sensory receptors and coveted as electrical signals back to the central nervous system. Information in the form of electrical impulses is relayed to and from the CNS (brain and spinal cord) to the neuromuscular junction (NMJ), which converts electrical signals into chemical signals allowing for muscle contraction.

Answer 58

a. Spinal accessory nerve

Answer 59

Numbness or pain that can radiate distally Rationale: CTS also causes radiating pain, however numbness typically doesn't radiate, it is only felt on a certain area upon putting pressure and a segment and releasing it. (orthoinfo.aaos.org)

Answer 60

b. Sensory and motor function is mediated by this nerve Rationale: The lateral femoral cutaneous nerve (LFCN) is a purely sensory nerve that is derived from L2-L3 caudad to the ilioinguinal nerve. (Kenneth D. Candido, Honorio T. Benzon, Chapter 76 - Lumbar Plexus, Femoral, Lateral Femoral Cutaneous, Obturator, Saphenous, and Fascia Iliaca Blocks,Editor(s): Honorio T. Benzon, Srinivasa N. Raja, Robert E. Molloy, Spencer S. Liu, Scott M. Fishman,

Answer 61

d. Produces flaccid paralysis at the level of the lesion Rationale: Occlusion of the anterior spinal artery may produce the following signs and symptoms ● Loss of motor function (paraplegia) below the level of the lesion occurs due to bilateral damage to the corticospinal tracts. ● Bilateral thermoanesthesia and analgesia occur below the level of the lesion due to bilateral damage to the spinothalamic tractss ● Weakness of the limb muscles may occur due to damage of the anterior gray horns in the cervical or lumbar regions of the cord. ● Loss of bladder and bowel control occurs due to damage of the descending autonomic tracts. ● Position sense, vibration, and light touch are normal due to preservation of the posterior white columns that are supplied by the posterior spinal arteries (Snell's Neuroanatomy, 7th ed. Ch 17, p. 487)

Answer 62

Rationale: Dystonia is a sustained posturing that can affect small or large muscle groups. (Braddom, Ch 1, p. 16)

Answer 63

Ratio: Amyotrophic lateral sclerosis (ALS) results from the death of lower motor neurons in the spinal cord and brainstem, and of upper motor neurons (Betz cells) in the motor cortex. The loss of lower motor neurons results in denervation of muscles, muscular atrophy (the "amyotrophy" of the condition), weakness, and fasciculations, while the loss of upper motor neurons results in paresis, hyperreflexia, and spasticity, along with a Babinski sign. An additional consequence of upper motor neuron loss is degeneration of the corticospinal tracts in the lateral portion of the spinal cord ("lateral sclerosis"). Sensation usually is unaffected, but cognitive impairment does occur, sometimes as a frontotemporal dementia.

Answer 64

Ratio: Destruction of the optic chiasm prevents the crossing of impulses from the nasal half of each retina to the opposite optic tract. Therefore, the nasal half of each retina is blinded, which means that the person is blind in the temporal field of vision for each eye because the image of the field of vision is inverted on the retina by the optical system of the eye; this condition is called bitemporal hemianopsia. Such lesions frequently result from tumors of the pituitary gland pressing upward from the sella turcica on the bottom of the optic chiasm. (Guyton and Hall Textbook of Medical Physiology 13th Ed. p.665)

Answer 65

Ratio: Presence of TLR with prone position causes increased flexor tone/flexion of all limbs; with supine: increased extensor tone/extension of all limbs. Thus, inability to flex the neck in supine position. (O'Sullivan-Physical Rehabilitation 6th Ed. p. 177)

Answer 66

A Rationale: People with PD tend to have difficulty using these canes - they provide less stability because not all points touch the ground at the same time. Hand grips should be comfortable. Adjust the cane height for best support. Hiking sticks or poles are also helpful and can help maintain better posture while walking.

Answer 67

A. Rationale: SLR 1 - flexion and adduction of hip with knee flexion and ankle DF; SLR 2 - hip flexion and knee extension, ankle DF, foot ev., toe ext.; SLR 3 - hip flexion and knee extension, ankle DF, foot inv.,; SLR 4 - flexion and IR, knee extension, and ankle PF with foot inv.

Answer 68

C. Rationale: Sodium ions that have diffused to the interior of the cell during the action potentials and potassium ions that have diffused to the exterior must be returned to their original state by the Na+-K+ pump. Because this pump requires energy for operation, this "recharging" of the nerve fiber is an active metabolic process, using energy derived from the ATP energy system of the cell. (Guyton & Hall 13e., p. 70)

Answer 69

Rationale: At a high level, the brain can be divided into the cerebrum, brainstem and cerebellum ( Source)

Answer 70

E. Process of Elimination

Answer 71

A. Rationale: On average, damaged nerves can grow back at a rate of about 1 inch per month or 1 millimeter per day (Source )

Answer 72

Rationale: Parkinson's syndrome The main symptoms of Parkinson disease are tremors, bradykinesia, and rigidity. (Braddom, p. 1020)

Answer 73

C. Rationale: A variety of feedback sources are used to monitor movement including visual, vestibular, proprioceptive, and tactile inputs. (Sullivan, p.168)

Answer 74

Rationale: Parkinson's disease is defined by (1) degeneration of dopaminergic neurons in the basal ganglia in the pars compactus of the substantia nigra that produce dopamine and (2) as the disease progresses and neurons degenerate, the presence of cytoplasmic inclusion bodies, called Lewy bodies. (Sullivan, p. 810)

Answer 75

A. Rationale: Damage to the spinothalamic tracts results in loss of sense of pain and temperature on the side contralateral (opposite) to the lesion. This loss begins several dermatome segments below the level of injury [O'Sullivan 7th ed., pg. 860]

Answer 76

Rationale: - Type A fibers: typical large and medium sized myelinated fibers of spinal nerves [Guyton 13th ed., pg. 599]. - Type C fibers: small unmyelinated nerve fibers that conduct impulses at low velocities [Guyton 13th ed., pg. 599]

Answer 77

D. Rationale: When the sound pressure exceeds 140 Pa, the ear experiences pain [Kroemer 7th ed., pg. 107]

Answer 78

A. ● Pacinian corpuscles are widely distributed throughout the body and are abundant in the demis, subcutaneous tissues, ligaments, joint capsules, pleura, peritoneum, nipples, and external genitalia. They are rapidly adapting mechanoreceptors particularly sensitive to pressure and vibration. ● Merkel discs are found in hairless skin (e.g., fingers) and in hair follicles. They are slowly adapting touch receptors that transmit information about thedegree of pressure exerted on the skin, such as when one is holding a pen. ● Meissner's corpuscles are located in the dermal papillae of the skin, especially that of the palm of the hand and sole of the foot. They are very sensitive to touch and are responsible for two-point tactile discrimination. ● Ruffini corpuscles are located in the dermis of hairy skin. They are slowly adapting mechanoreceptors that respond when the skin is stretched.

Answer 79

B. Rationale: When testing ROM of SH ext, position the pt in prone, with the face turned away from the shoulder being tested. A pillow is not used under the head. Place the shoulder in 0 degrees of abduction, adduction, and rotation. Position the elbow in slight flexion so that tension in the long head of the biceps brachii muscle will not restrict the motion. Place the forearm in 0 degrees of supination and pronation so that the palm of the hand faces the body (Measurement of Joint Motion by Norkin 4th ed, p. 66).

Answer 80

A. Rationale: Waddell et al. developed a series of tests to differentiate between organic and non-organic back pain. 1. Superficial skin tenderness to light pink over wide area of lumbar spine 2. Deep tenderness over wide area, often extending to thoracic spine, sacrum, or pelvis 3. LBP on axial loading of spine in standing 4. Acetabular rotation simulation 5. SLR test positive (distracted SLR discrepancy) when specifically tested, but not when pt is seated c knee ext to test Babinski reflex 6. Abnormal neurological (motor or sensory) patterns (regional sensory disturbance) 7. Overreaction References: Magee p. 593; Physiopedia

Answer 81

C. Rationale: Daniel and Worthingham's Muscle Testing Techniques of Manual Examination (8th ed) - Hislop, Montgomery

Answer 82

Rationale: Two forearm crutches offer better stability and support compared to a single cane or walker. They allow the patient to bear weight through their arms while still maintaining some mobility.

Answer 83

B. Rationale: Antagonist: Any muscle that opposes the action of the prime mover is an antagonist. For example, the biceps femoris opposes the action of the quadriceps femoris when the knee joint is extended. Bprime mover can contract, the antagonist muscle must be equally relaxed; this is brought about by nervous reflex inhibition. (Snell, 9th ed)

Answer 84

C. Rationale: The primary muscles holding the head of the humerus in the glenoid cavity are called the rotator cuff muscles which include the infraspinatus, subscapularis, supraspinatus, and teres minor (Seeley's Anaphy 11th ed., pp. 341)

Answer 85

B and E Rationale: The range of hyperextension is 40° to 60° and is limited by the superior & middle glenohumeral ligaments. (Brunnstrom 6th ed, p.182) With 90° of lateral rotation, the greater tubercle rotates behind the acromion so active abduction increases to approximately 90°, where it becomes limited by active insufficiency of the deltoid muscle. (Brunnstrom 6th ed, p. 181)

Answer 86

D. Rationale: In disclosure of record contents, when requested by the patient or by someone who could act in his behalf which must be made in writing. If for Insurance and Other Claims, First, a check-up should be made in the accounting department to ascertain payment of patient's bill. If any balance is still due, an arrangement of security for payment should be made in relation to the insurance or other claim.

Answer 87

Rationale: A triangular bandage is most often used as a temporary sling to support the weight of a pt's UE. (Pierson & Fairchild 5 th ed., p.334)

Answer 88

E. Rationale: Tasks related to patient and client services must be assigned to the physical therapy aide by the physical therapist, or where allowable by law the physical therapist assistant, and may be performed by the aide only under direct personal supervision. Direct personal supervision requires that the physical therapist, or where allowable by law the physical therapist assistant, be physically present and immediately available to supervise tasks that are related to patient and client services. (APTA, 2019)

Answer 89

A Rationale: The ultrasound machine should only be transferring sound energy to the body. The machine itself runs on electricity. If the machine is in good working order, the electrical current shouldn't be transferred to the body. Ultrasound is generated by applying a high-frequency alternating electrical current to the crystal in the transducer of an ultrasound unit. The crystal is made of a material with piezoelectric properties, causing it to respond to the alternating current by expanding and contracting at the same frequency at which the current changes polarity. The property of piezoelectricity, or the ability to generate electricity in response to a mechanical force or to change sha

Answer 90

A. Rationale: Each CPE/CPD Council shall, upon a majority vote if its members, exercise powers and functions which shall include, but not be limited, to the following: ● Accept, evaluate, and approve applications for accreditation of CPE/CPD providers; ● Accept, evaluate, and approve applications for accreditation of CPE/CPD programs, activities or sources as to their relevance to the profession and determine the number of CPE/CPD credit units to be earned on the basis of the contents of the program, activity or source as submitted by the CPE/CPD provider; ● Accept, evaluate, and approve applications for exemptions from CPE/CPD requirements; ● Monitor periodically the implementation of programs, activities or sources; ● Assess periodically and upgrade the criteria for accreditation of CPE/CPD providers and CPE/CPD programs, activities or sources; and ● Perform such other related functions that may be incidental to the implementation of the CPE/CPD programs or policies.

Answer 91

A. Rationale: Injury to the ulnar nerve may result in ulnar nerve palsy, which is indicated by an inability to abduct or adduct the fingers, atrophy of the interosseous muscles of the hand, hyperextension of the metacarpophalangeal joints, and flexion of the interphalangeal joints, a condition called claw hand (Tortora, 6th ed)

Answer 92

A. Rationale: The main input to the ANS comes from autonomic (visceral) sensory neurons. Mostly, these neurons are associated with interoceptors, sensory receptors located in blood vessels, visceral organs, muscles, and the nervous system that monitor conditions in the internal environment.

Answer 93

A Rationale: During the stance phase the hip abductor muscles are essential to the control of the frontal plane pelvic-on-femoral kinematics during walking. (Neumann Kinesiology of Musculoskeletal System pg 512)

Answer 94

A. Rationale: Testing intervertebral joint motion by palpation seeks information about the range, end-feel, behaviour of pain throughout the range, and the quality of any resistance or muscle spasm which may be present. The passive intervertebral movements are produced by pressure against palpable parts of the vertebra and pressure should be applied at the right speed. The answer is E. because pressure is applied at the palpable parts of the iv joints which is the spinous process and not the muscle. (Maitland Vertebral Manipulation pg. 34-35)

Answer 95

Rationale: Osteotomy is the surgical cutting and realignment of bone, which is usually indicated for OA and it is unnecessary for a tear. Therefore B & D is not appropriate. Arthroplasty is a replacement surgery for joints, in this case replacing the joint is unnecessary. Arthroscopy is the most advantageous among the choices because it involves treating intra-articular disorders that repairs ligament, tendon, capsule, etc. (Kisner 7th ed)

Answer 96

Rationale: Letters B,C, &D discusses the patient's progression in the therapy which is part of the assessment section of SOAP. Letter A can be found or can be included in the findings of an Objective examination. (Kettenbach Writing Patient/Client Notes 4th ed)

Answer 97

A. Rationale: Activities that impose heavy rotational forces on the operated hip are of particular concern and could contribute to long-term loosening and wear of the prosthetic implants. Therefore protecting the prosthesis from unnecessary forces will RETARD premature loosening. (Kisner 7th ed)

Answer 98

D. Rationale: Patient is supine with the shoulder abducted to 90 degrees and the length of the humerus on the test side is supported on the plinth. Forearm is in neutral position (Physiopedia)

Answer 99

B. Rationale: The purpose of the test to assess abdominal muscles and the ability of muscles to maintain the posterior pelvic tilting position against the load (lowering both lower limbs from the verticalposition). Hip flexors and abdominal muscles work eccentrically together to control the lowering of the limb. As the legs lower there is an increase in the resistance to hold the pelvis in position (Physiopedia)

Answer 100

C. Rationale: Hip adduction. Patient position: supine, knee extended. Plane of motion: frontal. Normal range of motion: 0 to 30 degrees. Movements the patient should avoid: trunk rotation. Goniometer placement: axis over knee joint through longitudinal axis of femur, stationary arm remains at 0 degrees, movement arm remains parallel to anterior tibia. (Braddom, 5th ed., p. 30)

Answer 101

C. Rationale: Static splints are designed to maintain a position of choice by immobilizing the joint. Dynamic splints are designed to exercise or mobilize a joint. Serial static splints are applied where joints or soft tissue held in end-range position by stretching into the desired direction of correction and are worn for extended periods of time. Static-progressive splints are made from rigid materials with adjustable parts that allow modification to accommodate increases in ROM by applying low-load force to the tissue. (Orthotics & Prosthetics in Rehabilitation, 3rd ed. - Lusardi, Jorge, Nielsen)

Answer 102

C. Rationale: (Cameron's Physical Agents in Rehab, 4th ed.) ● Convection - Heat transfer through direct contact of a circulating medium with material of a different temperature. ● Evaporation - A material must absorb energy to evaporate and thus change form from a liquid to a gas or vapor. ● Conduction - Heat transfer by conduction occurs only between materials of different temperatures that are in direct contact with each other. ● Radiation - Transfer of energy from one material to another without the need for direct contact or an intervening medium. ● Conversion - Heat transfer by conversion of a nonthermal form of energy, such as mechanical, electrical, or chemical energy, into heat.

Answer 103

Rationale: When measuring hip abduction, the proximal arm is aligned with an imaginary horizontal line extending from one ASIS to the other. (Norkin: Measurement of Joint Motion: Guide to Goniometry 5th ed., p. 262)

Answer 104

C. Rationale: The Thomas test is used to assess a hip flexion contracture. The examiner flexes one of the patient's hips, bringing the knee to the chest to flatten out the lumbar spine and stabilize the pelvis. The patient holds the flexed hip against the chest. If a contracture is present, the patient's straight leg rises off the table, resulting in a muscle-stretch end feel. (Magee 7th ed., p. 820)

Answer 105

A. Rationale: Elevate the wound above the heart and apply firm pressure with a clean compress (such as a clean, heavy gauze pad, washcloth, T-shirt, or sock) directly on the wound. (Harvard Health, 2017. https://www.health.harvard.edu/staying-healthy/emergencie s-and-first-aid-direct-pressure-to-stop-bleeding)

Answer 106

Rationale: Knee is flexed during all components of stance phase except on heel strike. (https://www.massagetherapyreference.com/gait-assessment /)

Answer 107

B. Rationale: Any unusual changes in the patient's condition should be reported to the physician-in-charge. (Article IV Section 2: Responsibilities to Clients Code of Ethics of the PPTA. https://www.philpta.org/code-of-ethics-of-ppta)

Answer 108

E. Rationale: In hip extension PROM exercises with the patient in side-lying, the bottom hand should be under the thigh near the knee with the hand on the anterior surface. The other hand should be stabilizing the pelvis. To allow full range of hip extension, the knee is not flexed at full range to avoid the two-jointed rectus femoris from restricting the range (Kisner, p. 60; Figure 3.15)

Answer 109

C. Rationale: Static stretching is a method wherein soft tissues are elongated past the point of resistance (greatest tolerated strength) and then held in lengthened position of sustained stretch force over a period of time (Kisner, p. 88). Other definition: it is a slow-paced controlled physical activity which involves putting the body part into a comfortable position for elongation without causing pain and in low force for a prolonged duration of time (see: https://www.physio-pedia.com/Stretching)

Answer 110

A. Rationale: Transtibial amputee prosthetic users present with many gait abnormalities (1) abrupt heel contact and rapid knee flexion, (2) prolonged heel contact with knee fully extended, (3) jerky knee motion, (4) lateral trunk shifting, (5) pelvis drop or elevation, (6) prosthetic foot dropping and (7) uneven step length either due to prosthetic causes or anatomical causes (Delisa, p. 2023). There is also a decrease in postural stability in these patients due to lack of active ankle torques, and distorted somatosensory inputs from the amputated side. Other sources of decreased proprioception is the loss of ankle joint and muscles of the lower leg (Arifin et al.; see doi: 10.1155/2014/856279). Aside from normal hip functions, the patient with transtibial amputation also retains the anatomical knee with its motor and sensory functions (O' Sullivan, 1365). Hence, it has potential for very high function. According to Howard et al. (2013), there is a significant reduction in stride length and cadence in below-knee prosthesis users (see: https://doi.org/10.1016/j.gaitpost.2013.04.008). All the choices have been in books and journals except letter A.

Answer 111

D. Rationale: Anterior-inferior tightness limits external rotation of the elevated arm

Answer 112

C. "No information were found using main PT references and published journals"

Answer 113

Rationale: Isokinetic exercise is a form of dynamic exercise in which the velocity of muscle shortening or lengthening and the angular limb velocity is predetermined and held constant by a rate-limiting device known as an isokinetic dynamometer (Fig. 6.9). 57,83,138,200 The term isokinetic refers to movement that occurs at an equal (constant) velocity. (Kisner, 7th ed pp.184)

Answer 114

C. Rationale: Whereas Section 3 of R.A. 6511 pertinently states, in part to wit: "That after the lapse of five continuous years from the year it last paid if the annual registration has never been paid, the delinquent's certificate of registration shall be considered suspended and his name shall be dropped from the annual roster for not having been in good standing and may be reinstated only upon application and payment of the fee herein provided for registration without exaination" (Official Gazette of the Philippines; http://surl.li/kztvo)

Answer 115

E. Rationale: Hip abduction (Gluteus medius and minimus) can be compensated by external rotation and flexion. The patient may try to externally rotate during the motion of abduction. This could allow the oblique action of the hip flexors to substitute for the gluteus medius (Daniel & Worthingham 8th ed., pg 201)

Answer 116

E. Rationale: Because the bronchial tree (exclusive of alveoli) is fully developed before birth, the same 12 bronchial drainage positions used for adults are used for infants and children (Watchie 2nd ed., pg.385) Postural drainage positions: 12 positions based on 12 lung segments (Kisner 5th ed., pg 872-873) ● Right and Left Upper Lobes ○ 1. Anterior apical segments ○ 2. Posterior apical segments ○ 3. Anterior Segments ○ 4. (L) Posterior segment ○ 5. (R) Posterior segment ○ 6. Lingula ○ 7. Middle lobe ● Right and Left Lower 8. Anterior segments ○ 9. Posterior segments ○ 10. (L) Lateral segment ○ 11 (R) Lateral segment ○ 12. Superior Segments

Answer 117

Rationale: A movement that takes place about three main axes, all of which pass through the joint's center of rotation is said to have three degrees of freedom. (Brunnstrom Clinical Kines 6th ed., p.11)

Answer 118

C. Rationale: External rotation of the leg holds the posteromedial capsule tight, and the anterior slide is diminished even if the anterior cruciate is torn. If there is an anterior slide demonstrable, which is equal to that seen with the leg in the neutral position, then both the anterior and posterior cruciates are torn, along with the posteromedial capsule. (Iyer's Clinical Examination in Orthopedics 1st ed., p.67)

Answer 119

B. Rationale: In measuring the ROM of forearm supination, the examiner uses one hand to hold the proximal arm of the goniometer parallel to the anterior midline of the humerus. The examiner's other hand supports the FA while holding the distal arm of the goniometer across the volar surface of the forearm just proximal to the radial and ulnar styloid process. The fulcrum of the goniometer is proximal and medial to the ulnar styloid process. (Norkin 4th ed., p.101)

Answer 120

D. Rationale: Earning a doctoral degree signifies a notable and high level of education and proficiency within a specific domain. Professionals who have successfully achieved a doctoral degree commonly experience extensive and demanding academic and practical preparation, serving as proof of their competence and dedication to their chosen profession. Consequently, numerous regulatory authorities and professional associations acknowledge the significance of a doctoral degree and may offer enduring exemptions or decreased obligations for Continued Professional Education (CPE) to individuals who have attained this level of educational attainment.

Answer 121

E. Rationale: Straps should not be tightened until they are so tight that a finger can't fit underneath. Properly applied traction should provide controlled and gentle pulling forces, and over-tightening can lead to complications such as skin breakdown or nerve compression. Top of Form

Answer 122

E. Rationale: The statement that the anterior cruciate ligament (ACL) serves as the primary stabilizer of the knee and is composed of the posteromedial and anteromedial bundles is not correct. ACL mainly comprises two bundles: the anteromedial bundle and the posterolateral bundle.

Answer 123

Rationale: Center fulcrum of the goniometer over the lateral epicondyle of the humerus; Align proximal arm with the lateral midline of the humerus, using the center of the acromion process for reference; Align distal arm with the lateral midline of the radius, using the radial head and radial styloid process for reference. (Norkin 4th Ed, pg. 96)

Answer 124

Rationale: The upper motor neuron is a complex of descending systems conveying impulses from the motor areas of the cerebrum and subcortical brain stem to the anterior horn cells of the spinal cord. (Waxman 27th Ed, pg.191)

Answer 125

Rationale: Peroneal nerve palsy may only present with atrophy of its supplied muscles; thereby, pt. will present with a steppage gait characterized by foot drop - has difficulty dorsiflexing the ankle. The patient compensates for the foot drop by lifting the affected extremity higher than normal to avoid dragging the foot. Weak dorsiflexion leads to poor heel strike with the foot slapping on the floor. (Braddom 4th Ed, pg.19)

Answer 126

Rationale: - Tenosynovitis: inflammation of fluid-filled synovium within tendon sheath - Epicondylitis: inflammation of epicondyle - Cystitis: inflammation/ infection of bladder - Tendinitis: inflammation of tendon d/t overuse or rheumatic dse - Stenosis: narrowing of space

Answer 127

E. Rationale: It is fair for the manager to give equal opportunities among all therapy staff. This would also distribute a broader range of knowledge as many people are involved as compared to only prioritizing requests & senior therapists.

Answer 128

D. Rationale: LMNL includes mm atrophy, hyporeflexia, & hypotonia/ flaccidity.

Answer 129

A. Rationale: It is true that a muscle with longer fibers does have a longer working range. However, the amount of muscle length change that occurs as a joint rotates is very strongly dependent on the muscle's moment arm--the perpendicular distance from the muscle insertion to the axis of joint rotation. This idea is illustrated where we have attached a simulated "muscle" using two different moment arms. In A, the moment arm is much less than in B. This means that in A, the muscle will change length much less for a given change in joint angle compared to the same change in joint angle in B. As a result, the active ROM for for the muscle-joint system shown in A will be much greater than that which is shown in B, in spite of the fact that their muscular properties are identical. In fact, in the current example, increasing the moment arm decreased the range of motion from 40° (A) to only 25° (B). (https://muscle.ucsd.edu/refs/musintro/interaction.shtml)

Answer 130

C. Rationale: Trunk continues forward progression relative to foot. Heel rises from ground and limb achieves trailing limb posture. Second half of single limb support. Ends with contralateral initial contact. (O'Sullivan, 6th ed)

Answer 131

D. Rationale: Acc. to Section 12 of RA 5680 PT-OT Law, PTs must work under a physiatrist and they cannot work alone. There is a need for a prescription of exercises from a physiatrist before treating a patient.

Answer 132

A. Rationale: [Kisner 7th ed, pg 734] - Hip adduction and abduction beyond neutral are avoided - Ankle Pumps exercise are used to prevent prevent venous stasis, thrombus formation, and the potential for pulmonary embolism. - Active exercises in functional movement pattern are used to maintain a functional level of strength and muscular endurance in the upper extremities and nonoperated lower extremity

Answer 133

C. Rationale: Pt. is usually independent with power wheelchair with adaptive components such as head, chin, tongue, or sip-and-puff control [Magee 6th ed., pg 921]

Answer 134

Rationale: Hamstring muscles are composed of Biceps Femoris, Semitendinosus and semimembranosus, which are the muscles responsible for knee flexion. [Hislop 8th ed, pg 216]

Answer 135

E. Rationale: There is hereby created a Board of Examiners for Physical Therapists and Occupational Therapists, hereinafter called the Board, to be composed of a chairman and four members who shall be appointed by the President of the Philippines with the consent of the Commission on Appointments. The chairman shall be a physiatrist and for members shall be two professionally qualified occupational therapists and two professionally qualified physical therapists. The physiatrist shall be appointed from the lists of qualified physiatrists, submitted by the society of physical medicine and rehabilitation and the occupational therapists and physical therapists by their respective bona fide national professional organization or association and submitted to the President of the Philippines through the Commissioner of Civil Service (RA 5680 PT/OT Law Section 3)

Answer 136

C. Rationale: Attending school quiz competitions is not included under the general matrix of CPD units (RA 10912 "Continuing Professional Development (CPD) Act of 2016") ● In-service training = Max. of 20 CU for a 12-month period or a fraction thereof upon completion ● Professional chair = 15 CU per year ● Inventions = Full credit units for compliance period ● Study tour/visits = 2 CU/day (maximum of 20 CU/tour)

Answer 137

Rationale: B Increasing the frequency results in increased torque production but concurrently accelerates muscle faeased torque production but concurrently accelerates muscle fatigue.tigue.

Answer 138

B. Rationale: Pts c anemia may experience fatigue, dyspnea, and weakness. Low-level intensity exercises are recommended such as walking, cycling, arm ergometer, and aquatic activities c short durations (10-20 min bouts c rest periods). Daily levels of fatigue should be assessed to prescribe an appropriate level of exercise based on clients' progression or deterioration from their primary condition. (Goodman, 2011 - Exercise Prescription for Medical Conditions - Anemia)

Answer 139

Rationale: Teaching an Effective Cough - 2. Have the patient assume a relaxed, comfortable position for deep breathing and coughing. Sitting or leaning forward usually is the best position for coughing. (Braddom 5th ed.)

Answer 140

C. Rationale: Retraction is accomplished by the actions of the trapezius, rhomboids, and latissimus dorsi mm. The elevation is accomplished by the trapezius, levator scapulae, and rhomboid mm.

Answer 141

E. Rationale: Jt. position should be opp. the anticipated contracture (in this case, PF). (O'Sullivan, 7th ed., p. 1068-1069)

Answer 142

D. Rationale: Insertions of the intrinsics, which also pull from an ulnar direction, contribute to ulnar drift. (O'Sullivan, 7th ed., p. 999)

Answer 143

Rationale: ABER - Ask the pt. to reach behind his head and touch superior medial angle of opp. scapula. ADIR - Reach in front of head and touch opp. acromion OR reach behind back to touch inferior angle of opp. scapula. (Hoppenfeld, p. 21)

Answer 144

A. Rationale: Traditional approach of activity limitations are no longer necessary. Mainstay of txn is antiinflammatory medicine, with focus on hamstring flexibility and moderate-intense quadriceps strengthening. The cases can be severe enough for immobilization of an individual. (Dutton, pg 1011)

Answer 145

Rationale: THe subscapularis is the mm responsible for humeral internal rotation.

Answer 146

Rationale: Mesothelial cells are cells that line the pleura.

Answer 147

C. Rationale: In the ascending loop of Henle, especially the thick segment, sodium, potassium, and chloride are avidly absorbed. However, this portion of the tubular segment is impermeable to water, even in the presence of large amounts of ADH. Therefore, tubular fluid becomes more dilute as it flows up the ascending loop of Henle into the early distal tubule. Regardless of whether ADH is present or absent, fluid leaving the early distal tubular segment is hypo-osmotic. (Guyton & Hall 13th ed., p. 372)

Answer 148

Rationale: Phase 0 of the cardiac action potential is the depolarization phase, where fast sodium channels open. When the cardiac cell is stimulated and depolarized, the membrane potential becomes more positive. Voltage-gated sodium channels (fast sodium channels) open and permit sodium to rapidly flow into the cell and depolarize it. The membrane potential reaches about +20 mV before the sodium channels close. (Guyton & Hall 14th ed., p. 115)

Answer 149

Rationale: Biering-Sorensen fatigue test is similar to the Dynamic Extensor Endurance Test. The patient is placed in prone lying with hips and iliac crests resting on the end of the examining table and the hips and pelvis stabilized with straps. Initially, the patient's hands support the upper body in 30° flexion on a chair/bench. Keeping the spine straight, the examiner instructs the patient to extend the trunk to neutral. The time the patient was able to hold the straight position before fatigue was recorded (i.e., the patient could not hold the position) (Magee 6th ed., p. 580). This test became known as the "Sorensen test" and gained considerable popularity as a tool reported to predict LBP within the next year in males. (Demoulin et al., 2006, https://doi.org/10.1016/j.jbspin.2004.08.002)

Answer 150

C. Rationale: The opening of the anal canal to the exterior, called the anus, is guarded by an internal anal sphincter of smooth muscle (involuntary) and an external anal sphincter of skeletal muscle (voluntary). The external anal sphincter is voluntarily controlled. If it is voluntarily relaxed, defecation occurs and the feces are expelled through the anus; if it is voluntarily constricted, defecation can be postponed. (Tortora, 15th ed., pps. 901 & 939)

Answer 151

C. Rationale: 1. The goals of drug therapy in patients with OA are to relieve pain and decrease inflammation when it is present. Oral analgesics, oral and topical NSAIDs, and corticosteroid injections are the primary medications used in OA management. (O'Sullivan, 7th ed., pp. 1014) 2. Joint aspiration (arthrocentesis) and intra-articular and soft tissue corticosteroid injection are important tools in both diagnosis and therapy of many common musculoskeletal problems encountered in primary care. Corticosteroid injection has long been an accepted intervention in managing specific inflammatory conditions of the musculoskeletal system. Intra-articular and soft tissue corticosteroid injection is most appropriately considered as adjuvant t

Answer 152

B. Rationale: Cardiac Output = 70 mL x 70 bpm Cardiac Output = 1,400 mL/min Cardiac Output = Stroke Volume x Heart Rate Cardiac output- Volume ejected per minute (mL/min) Stroke volume- Volume ejected in one beat (mL) Heart rate- Beats per minute (Costanzo 5 th ed., p. 145)

Answer 153

E. Rationale: A typical example of facilitated diffusion is glucose transport which occur when a carrier protein (glucose transporter) move substances in the direction of the chemical or electrical gradient, no energy input is required (Ganong 25 th ed., p. 48)

Answer 154

D. Rationale: PNS stimulation in cardiac muscle results in decreased heart rate & decreased force of atrial contraction. On the other hand, SNS stimulation results in increased heart rate and force of atrial and ventricular contractions. (Tortora 4th ed. pg. 542) Strong stimulation of the parasympathetic nerve fibers in the vagus nerves of the heart can stop the heartbeat for a few seconds, but then the heart "usually" escapes and beats at a rate of 20 to 40 beats/min as long as the parasympathetic stimulation can decrease the strength of heart muscle contraction by 20 % - 30 % (Guyton and Hall, 13 th ed., p. 120)

Answer 155

A. Rationale: When first synthesized in the pancreatic cells, the proteolytic digestive enzymes are in their enzymatically inactive forms (trypsinogen, chymotrypsinogen, procarboxypolypeptidase). They become activated only after they are secreted into the intestinal tract. Trypsinogen is activated by an enzyme called enterokinase, which is secreted by the intestinal mucosa when chyme comes in contact c the mucosa. (Guyton & Hall 13th ed., p. 825)

Answer 156

C. Rationale: A neurotransmitter that causes hyperpolarization of the post-synaptic membrane is inhibitory. Inhibitory postsynaptic potential (IPSP) result from the opening of the K+ channels. When K+ channels open, a large number of potassium ions diffuses outward. The outward flow of K+ ions causes the inside of the postsynaptic cell to become more negative (hyperpolarized) (Tortora 14th ed., p. 427)

Answer 157

Rationale: Diuretics are antihypertensive agents that increase the renal excretion of water and sodium and decrease the volume of fluid in the vascular system. (Ciccone 4th ed., p. 290)

Answer 158

Rationale: Small intestine absorbs about 90% of nutrients and water that pass through the digestive system (Tortora p. 927). The total volume of fluid that enters the small intestine each day—about 9.3 liters (9.8 qt)—comes from ingestion of liquids (about 2.3 liters) and from various gastrointestinal secretions (about 7.0 liters). The small intestine absorbs about 8.3 liters of the fluid; the remainder passes into the large intestine, where most of the rest of it—about 0.9 liter—is also absorbed. Only 0.1 liter (100 mL) of water is excreted in the feces each day (Tortora pp. 935-936).

Answer 159

C. Rationale: The darker middle part of the sarcomere is the A band and a narrow H zone in the center of each A band contains thick but not thin filaments. The I band is a lighter, less dense area that contains the rest of the thin filaments but no thick filaments and a Z disc passes through the center of each I band (Tortora pp 299-300).

Answer 160

The water permeability in the proximal tubule is always high. and water is reabsorbed as rapidly as the solutes. In the ascending loop of Henle, water permeability is always low despite a large osmotic gradient. Water permeability in the last parts of the tubules—the distal tubules, collecting tubules, and collecting ducts can be high or low, depending on the presence or absence of ADH (Guyton p. 352). Normally, about 65 percent of the filtered load of sodium and water and a slightly lower percentage of filtered chloride are reabsorbed by the proximal tubule before the filtrate reaches the loops of Henle (Guyton p. 353). Although the descending part of the thin segment is highly permeable to water, about 20 percent of the filtered water is reabsorbed in the loop of Henle, and almost all of this occurs in the thin descending limb (Guyton p. 354).

Answer 161

E. Rationale: The anal canal has an involuntary internal sphincter and a voluntary external sphincter. The internal sphincter is enclosed by a sheath of striped muscle that forms the voluntary external sphincter (Snell 9th ed., pg. 306)

Answer 162

E. Rationale: In a healthy heart, the period of rapid filling lasts for about the first third of diastole. During the middle third of diastole, only a small amount of blood normally flows into the ventricles. This is blood that continues to empty into the atria from the veins and passes through the atria directly into the ventricles. During the last third of diastole, the atria contract and give an additional thrust to the inflow of blood into the ventricles. This mechanism accounts for about 20% of the filling of the ventricles during each heart cycle. (Guyton 14th ed., pg. 119).

Answer 163

Rationale: A Synapse en passant is a type of synapse found on the axon branch, commonly found on autonomic & visceral sensory neurons

Answer 164

A. Rationale: ADH, when secreted in the body, increases water retention. Therefore, when there is an increase of fluid volume in the body, such as blood, ADH needs to be inhibited in order to decrease the body's fluid volumes (Guyton & Hall 13 ed.).

Answer 165

Rationale: According to Guyton & Hall (13 ed), The life span of lymphocytes are from weeks to months, but some can live up to years (Tortora 15 ed, 678). RBC for 120 days, granulocytes such as eosinophils/neutrophils for 4-5 days, & platelets for 10 days.

Answer 166

Rationale: The VRG contains the botzinger complex, a cluster of neurons believed to be important in generating the rhythm of breathing (Tortora 15 ed).

Answer 167

B. Rationale: The region of the kidney that is responsible for the generation of concentrated or dilute urine is the medulla. The mature renal medulla, the inner part of the kidney, consists of the medullary collecting ducts, loops of Henle. Urinary concentration occurs as the result of water abstraction from the collecting duct as it courses from the cortex to the papillary tip.

Answer 168

D. Rationale: Enterogastric reflex is a nervous reflex whereby stretching of the wall of the duodenum results in inhibition of gastric motility and reduced rate of emptying of the stomach. It is a feedback mechanism to regulate the rate at which partially digested food (chyme) leaves the stomach and enters the small intestine. Receptors in the duodenal wall detect distension of the duodenum caused by the presence of chyme and also raised acidity (i.e. low pH) of the duodenal contents due to excess gastric acid. They send signals via the parasympathetic nervous system, causing reflex inhibition of stomach-wall muscles responsible for the stomach emptying. [https://journals.sagepub.com/doi/abs/10.3181/00379727-2 8-5623?journalCode=ebma]

Answer 169

B. Rationale: The law of specific nerve energies (LOSNE) by Johannes Muller states that the mind has access not to objects in the world but only to our nerves. This law implies that the contents of the mind have no qualities in common with environmental objects but serve only as arbitrary signs or markers of those objects. Müller discovered that sensory organs always "report" their own sense no matter how they are stimulated. Thus, for example, a blow to the eye, which has nothing whatsoever to do with optical phenomena, causes the recipient to "see stars."

Answer 170

Rationale: Calcium is absorbed in the mammalian small intestine by two general mechanisms: a transcellular active transport process, located largely in the duodenum and upper jejunum; and a paracellular, passive process that functions throughout the length of the intestine. [https://pubmed.ncbi.nlm.nih.gov/12520541/]

Answer 171

C. Rationale: The anterior pituitary gland is composed of cell clusters that produce six anterior pituitary hormones and release them into the circulation. Corticotrophs produce the adrenocorticotrophic hormone (ACTH), thyrotrophs produce the thyroid-stimulating hormone (TSH), somatotrophs produce the growth hormone (GH), gonadotrophs produce both follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and lactotrophs produce prolactin (PRL). The clusters of cells that produce the six anterior pituitary hormones are under hypothalamic control. Unlike the posterior pituitary which basically stores hormones produced by the hypothalamus, the hypothalamus regulates the anterior pituitary via secreting "releasing hormones," somatostatin and dopamine. These hormones are secreted directly into the hypophyseal portal circulation that supplies blood to the anterior pituitary. Once reaching their target cell cluster in the anterior pituitary, the releasing hormones either stimulate or inhibit the synthesis and secretion of anterior pituitary hormones. [

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