PEAT #1 Flashcards

Question

Which of the following options BEST describes a normal response to the cremasteric reflex test? 1.Skin tenses in the gluteal area. 2.Ipsilateral scrotum elevation 3.Contraction of the anal sphincter muscles 4.Umbilicus moves down and toward area being stroked.

Answer 1

1. Tensing of the skin in the gluteal area is due to the gluteal reflex, which is evoked by stroking the back. The gluteal reflex comes from nerve roots of L4–L5, S1–S3. 2. For the cremasteric reflex text, the patient lies in supine position while the examiner strokes the inner side of the upper thigh with a pointed object. The test result is negative if the scrotal sac on the tested side pulls up. Unilateral absence of this response indicates a lower motor neuron lesion between L1 and L2. 3. Contraction of the anal sphincter muscles is due to the superficial anal reflex. The examiner tests the superficial anal reflex by touching the perianal skin. A normal result is shown by contraction of the anal sphincter muscles. This reflex comes from the S2–S4 nerve roots. 4. Movement of the umbilicus down and toward the area being stroked is due to the superficial abdominal reflex. The examiner uses a pointed object to stroke each quadrant of the abdomen of the supine patient in a triangular fashion around the umbilicus. Absence of the reflex (movement of the skin) indicates an upper motor neuron lesion; unilateral absence indicates a lower motor neuron lesion from T7–L2, depending on where the absence in noted, as a result of segmental innervation.

Answer 2

1. Frequent feedback is detrimental when learning a skill and would not be done first when teaching a new skill (p. 263). 2. Massed practice is less effective than distributed practice and would not be done first (p. 255). 3. It may be best to tailor written instructions to fit the patient's learning needs (p. 212). 4. It is best to identify and use the patient's preferred learning style (p. 24).

Answer 3

1. Patients who have a history of long-term nonsteroidal antiinflammatory drug use should be monitored for signs and symptoms of bleeding. Pain occurring within 1-3 hours of eating is typical in duodenal ulcers. The pain occasionally radiates to the mid thoracic back and right upper quadrant, including the right shoulder. Right shoulder pain alone may occur as a result of blood within the peritoneal cavity. Melena (dark, tarry stools) and coffee-ground vomitus are indicative of bleeding. Referral to a physician is warranted. (pp. 877-878) 2. Although gastritis is a common adverse effect of nonsteroidal antiinflammatory drugs and is associated with epigastric pain and loss of appetite, pain is much less common than with ulcer disease. Coffee-ground vomitus is not typically associated with gastritis. (pp. 875-876) 3. Irritable bowel syndrome typically presents with prolonged abdominal pain that is relieved by bowel movements. Changes in stool associated with irritable bowel syndrome include hard, loose, or watery stool, rather than melena (dark, tarry stools), alterations in stool frequency, or difficulty in having a bowel movement. Left lower quadrant pain with constipation and diarrhea are commonly associated with this condition. (p. 891) 4. An inflammation of the appendix typically presents with a classic sequence of abdominal pain with vomiting (not coffee-ground vomitus, which is indicative of bleeding), low-grade fever, anorexia, and nausea. Pain associated with appendicitis is constant and may shift within 12 hours to the right lower quadrant at the McBurney point. Melena (dark stools) and pain referred to the right shoulder are not typically associated with appendicitis. (pp. 904-905)

Answer 4

1. Use of a hip strategy is more appropriate for activities such as tandem and single limb stance (Umphred). 2. Use of a hip strategy is more appropriate for activities such as tandem and single limb stance (Umphred). 3. Small perturbations backward (anterior to posterior) would create a forward weight-shift, then a return to midline in response (O'Sullivan). 4. The ankle strategy is appropriate for small perturbations on a stable surface (Umphred). Small perturbations forward (posterior to anterior) would create a backward weight-shift, then a return to midline in response (O'Sullivan).

Answer 5

1. Advanced ankylosing spondylitis would cause loss of chest wall excursion, which compromises breathing. Aerobic exercise done consistently would be most important in order to optimize efficiency of oxygen transport and maintain cardiopulmonary function. (pp. 1333, 1337) 2. Balance exercises would likely be used for a patient who has ankylosing spondylitis, but they would not be as important as maintaining cardiopulmonary function in those who have advanced stages of this disease. In addition, activities requiring high levels of balance might need to be avoided to reduce risk of falls. (p. 1337) 3. Stretching and aerobic exercise would be more important than light resistance exercise for a patient who has advanced ankylosing spondylitis and likely fusion of involved joints. Energy conservation would also take precedence over resistance exercise. (p. 1337) 4. High-intensity and high-impact exercise should be avoided by a patient who has advanced ankylosing spondylitis, because intense exercise can potentially exacerbate the inflammatory process and be potentially harmful. Low-intensity aerobic exercise is recommended instead. (p. 1337)

Answer 6

1. The stem describes a patient who recently developed psoriasis (pp. 449-450). Bluish discoloration of the digits with cold exposure is associated with Raynaud disease (p. 255). 2. The stem describes a patient who recently developed psoriasis (pp. 449-450). The dermal effects associated with systemic lupus erythematosus include a major skin reaction often resulting from exposure to sun. This may include a red, scaly rash. (p. 445). 3. The stem describes a patient who recently developed psoriasis, a systemic disease hallmarked by silver scaled papules and plaques in the scalp, elbows, knees, back, and buttocks. It is a systemic disease that can result in erosive arthritis, particularly in the DIP joints of the hands. (pp. 449-450) 4. The stem describes a patient who recently developed psoriasis, a systemic disease hallmarked by silver scaled papules and plaques in the scalp, elbows, knees, back, and buttocks. It is a systemic disease that can result in erosive arthritis, particularly in the DIP joints of the hands. Hip joints typically are not involved in psoriasis. (pp. 449-450)

Answer 7

1. Debris in the right posterior semicircular canal produces symptoms of transient upbeating nystagmus and/or right ocular torsion. 2. Debris in the right superior semicircular canal produces symptoms of persistent downbeating nystagmus and/or right ocular torsion. 3. The canalith repositioning maneuver for the left posterior semicircular canal is performed to move free-floating debris in the posterior semicircular canal back into the vestibule, thus resolving the signs and symptoms of nystagmus and dizziness. Debris in the left posterior semicircular canal produces symptoms of transient upbeating nystagmus and/or left ocular torsion. 4. Debris in the left superior semicircular canal produces symptoms of persistent downbeating nystagmus and/or left ocular torsion.

Answer 8

1. This is a normal response in a patient who has chronic obstructive pulmonary disease and as such would not require discontinuation of the exercise session. Since elevated heart rates with increased hypoxemia are an expected compensatory response in patients who have pulmonary disease, there is no reason to cease exercise unless some other type of medical emergency exists. 2. During acute exercise, patients who have chronic obstructive pulmonary disease experience elevated heart rates and blood pressures with incremental exercise. The patient's response is an expected compensatory response, and exercise can continue as prescribed with continued monitoring of vital signs. 3. Since elevated heart rates with increased hypoxemia are an expected compensatory response in patients who have pulmonary disease, there is no reason to refer the patient back to the physician unless there is some other type of medical emergency. 4. This is an expected compensatory response in a patient who has chronic obstructive pulmonary disease and as such would not require discontinuation of the exercise session. There is no reason to refer the patient to the emergency department unless there is some other type of medical emergency.

Answer 9

1. External validity is the degree to which the results of a study can be generalized to another situation. In this option, the only change in the procedure is the model of the electrical stimulation machine. External validity should be maximized in this situation. 2. The generalizability (external validity) of the findings is only high for patients from the same population (those who have acute disc herniation). 3. The generalizability (external validity) of the findings is only high for patients from the same population (those who have acute disc herniation). 4. The generalizability (external validity) of the findings is only high for patients from the same population (those who have acute disc herniation).

Answer 10

1. A lesion of the right middle cerebral artery, which affects the right parietal lobe, typically produces impairment of spatial perception (p. 600). 2. Ataxia involving the limbs and gait occurs with damage to the cerebellum, involving the vertebrobasilar arteries (p. 603). 3. Visual agnosia occurs with damage to the left occipital lobe from a lesion of the posterior cerebral artery (p. 601). 4. A memory defect is a characteristic of damage to the inferomedial area of the temporal lobe either bilaterally or only on the dominant side of the brain (usually the left side). Damage to the posterior cerebral artery is implicated. (p. 601)

Answer 11

1. Axial extension or chin retraction may assess the mobility of the upper cervical spine but not the function of the deep neck flexors. Axial extension causes excessive shear in the mid-cervical spine. 2. The longus colli and longus capitis are deep neck flexors. The craniocervical flexion test or the deep neck flexor endurance test is included in the examination of these muscles. 3. The cervical compression test is used to stress the ability of the neck to tolerate passive loading; it is not a test of muscle strength. 4. Neck flexion range of motion is not specific for the deep neck flexors and can be achieved with gravity assist (in sitting position) or with the superficial neck flexors such as the sternocleidomastoid.

Answer 12

1. Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Continuous mode (or 100% duty cycle) produces thermal effects compared to pulse mode (p. 185). Research indicates that a frequency of 3 MHz results in a higher maximal temperature than 1 MHz despite delivering a lesser depth of penetration (p. 175). Furthermore, higher intensities produce higher temperature increases in tissues (p. 175). 2. Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Continuous mode (or 100% duty cycle) produces thermal effects, compared to pulsed mode (p. 185). Research indicates that a frequency of 3 MHz results in a higher maximal temperature than 1 MHz despite delivering a lesser depth of penetration (p. 175). Furthermore, higher intensities produce higher temperature increases in tissues (p. 175). 3. Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Pulsed mode (less than 100% duty cycle) produces nonthermal effects, compared to continuous mode (p. 185). 4. Energy delivery to the tissues with the use of ultrasound is a function of various parameters, including intensity, frequency, and duty cycle. Pulsed mode (less than 100% duty cycle) produces nonthermal effects, compared to continuous mode (p. 185).

Answer 13

1. Trace (1/5) strength in the anterior tibialis indicates the ankle is unable to move into dorsiflexion, resulting in foot drop (Avers, pp. 284-285). The posterior leaf spring is designed to help lift the foot for adequate clearance during the swing phase of gait (O'Sullivan, p. 1293). 2. A floor (ground) reaction orthosis has an anterior shell that provides a posteriorly directed force to resist knee flexion during stance phase (O'Sullivan, p. 1296). This patient does not need assistance with knee control because the patient has weakness of the tibialis anterior, which affects dorsiflexion of the ankle (Avers, p. 284). 3. A patellar tendon-bearing orthosis is designed to lessen the load on the foot (O'Sullivan, p. 1296). This patient requires assistance with ankle dorsiflexion due to tibialis anterior weakness (Avers, p. 284). 4. A solid ankle-foot orthosis limits all foot and ankle motion (O'Sullivan, p. 1294). This patient requires only assistance with ankle dorsiflexion due to tibialis anterior weakness (Avers, p. 284).

Answer 14

1. Resistance training is an essential component of an exercise program for a patient who has osteoporosis (Moore) and is lacking from this option. Balance training, although helpful in preventing falls, is not most beneficial for maintaining bone density. 2. This question presents two comparisons and asks which is better: 1) treadmill walking or swimming and 2) resistance or balance training. The correct answer is treadmill walking and resistance training. Walking is a beneficial weight-bearing aerobic activity. Resistance training is important to maintain bone mineral density or prevent loss of bone mineral density. (Moore) 3. Swimming, because of the lack of a weight-bearing component, has limited value for a person who has osteoporosis (Goodman). Balance training, although helpful in preventing falls, is not most beneficial for maintaining bone density. 4. Swimming, because of the lack of a weight- bearing component, has limited value for a person who has osteoporosis (Goodman).

Answer 15

1. Transient synovitis is most likely to occur in children younger than the patient described in the stem. Transient synovitis is associated with an active antalgic gait and with pain that is aggravated by medial (internal) rotation but also by abduction, unlike the pattern found with anterior labral tears. (p. 1580) 2. Trochanteric bursitis is more likely to be associated with lateral hip/thigh pain aggravated by lying on the involved side. This condition is more likely to occur in patients age 40-60 years, not in the demographic group of the patient described in the stem. Pain often is enhanced with passive hip adduction and resisted lateral (external) rotation, abduction, and extension. (pp. 945-947) 3. The clinical presentation of anterior acetabular labral tears most often includes pain on passive adduction, flexion, and medial (internal) rotation. The description of mechanism of injury and clinical presentation in the stem are most typical of this injury. (pp. 936-938) 4. Femoral head stress fractures present with a pain pattern similar to the pattern presented in the stem, but pain is increased with weight-bearing. Examination results are often negative except for an empty end-feel with hip rotation and a noncapsular pattern. (p. 952)

Answer 16

1. Pain from urinary calculi results from the ureter contracting in the attempt to dislodge the calculi. 2. Pain from urinary calculi is more likely to result from obstruction in the ureter than from obstruction in the urethra. 3. Pain from urinary calculi results from obstruction in the ureter, not the bladder. 4. Pain from urinary calculi results from obstruction in the ureter, not the kidneys.

Answer 17

1. Restricting fluid intake would result in dehydration, which is not a viable treatment option for incontinence. 2. The time intervals between voiding should be increased to suppress urges. 3. The detrusor muscle should be relaxed or inhibited in patients who have urge incontinence. 4. The patient is describing signs of urge incontinence with possible detrusor contractions. Relaxation training is helpful to decrease bladder contractions.

Answer 18

1. The patient is struggling to show improvements, and the therapist's assessment is that the patient will have deficits that will prevent the patient from becoming more independent with mobility. Continuing treatment for 2 more weeks is not a good use of resources. 2. Recommending transfer back to the hospital is inappropriate because the patient does not show any significant decline warranting a hospital admission. The patient is struggling to show improvements, and the therapist's assessment is that the patient will have deficits that will prevent the patient from becoming more independent with mobility. 3. A revision in the plan of care is indicated if the patient progresses more slowly than expected. Each modification must be evaluated in terms of overall effect on the plan of care. Family and caregiver education/training is a component of effective discharge planning. The caregiver should understand the proper use of any relevant assistive equipment and appropriate transfer and guarding techniques and should use correct body mechanics. 4. The family/caregiver and patient may be at risk for possible injury if not instructed in the proper body mechanics and transfer techniques.

Answer 19

1. Traction is contraindicated in the presence of instability, which is implied by the diagnosis of a labral tear (p. 378). 2. Ultrasound with a 3-MHz frequency will only penetrate superficial tissue and will only cover a small area; therefore, it is not appropriate to treat the injury in question (p. 184). 3. Cryotherapy reduces chemical mediators being released in order to modulate pain. Ice packs are helpful in the initial, or acute, stage of healing but are not as effective in later stages of healing. (p. 4). 4. Sensory-level electrical stimulation can cover a large area and is effective for treating chronic pain (p. 7).

Answer 20

1. An annular disc tear is more common in an older population and more common in the lumbar region. 2. A compression fracture is more likely in older patients who have osteoporosis. 3. The stem describes the presentation of Scheuermann disease, which typically affects the T7–T10 region. 4. Spondylolisthesis may be present in the lumbar spine, but it is rare in the thoracic spine.

Answer 21

1. Stage 1 pressure injuries are characterized by nonblanchable erythema of intact skin. In this scenario, the skin is not intact. 2. Stage 2 pressure injuries are characterized by partial-thickness skin loss involving the epidermis, dermis, or both (e.g., abrasion, blister, or shallow crater). 3. Stage 3 pressure injuries are characterized by full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia (deep crater with or without undermining). 4. Stage 4 pressure injuries are characterized by full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon or joint capsule).

Answer 22

1. Blood pressure of 140/83 mm Hg is an incorrect answer because the total change in systolic pressure from baseline is less than 15 mm Hg and the change in diastolic pressure is less than 10, which are both acceptable changes (Hillegass, pp. 546-547). 2. Mean arterial pressure (MAP) of 60 mm Hg is the correct answer because a patient with a MAP this low will be unable to perfuse vital organs. This finding would be MOST concerning (Malone, p. 95). 3. Blood glucose of 95 mg/dL is an incorrect answer because blood glucose of 95 mg/dL is a normal finding and would not be concerning (Malone, p. 79). 4. Presence of a S2 heart sound is an incorrect answer because an S2 heart sound is a normal finding and would not be concerning (Malone, p. 203).

Answer 23

1. Wall sits are performed in an upright position and would not exacerbate a hiatal hernia. 2. An overhead press is typically performed in seated, semireclined, or standing position and would not exacerbate a hiatal hernia. 3. Individuals who have a hiatal hernia should avoid supine position and avoid the Valsalva maneuver. Bilateral leg lifts must be performed in supine position and require strong contractions of the stomach muscles, encouraging the Valsalva maneuver, which would worsen the hiatal hernia. 4. Hamstring stretching can be modified to be done in a position other than supine to avoid exacerbating a hiatal hernia.

Answer 24

1. There is no evidence of a change in ventilation-perfusion ratio with pursed-lip breathing. 2. There is no evidence of a change in partial pressure of arterial oxygen (PaO2) with pursed-lip breathing. 3. The increase in exhalation time creates a decrease in respiratory rate. 4. There is no evidence of a change in strength of the ventilatory muscles with pursed-lip breathing.

Answer 25

1. Excursion is decreased in patients who have chronic obstructive pulmonary disease due to hyperinflation of the chest and a resultant flattened diaphragm. Normal excursion of the diaphragm is 1.2 to 2 inches (3 to 5 cm); therefore, 0.4 to 0.8 inch (1 to 2 cm) would be below the normal excursion value. 2. Excursion is decreased in patients who have chronic obstructive pulmonary disease due to hyperinflation of the chest and a resultant flattened diaphragm. 3. Normal excursion of the diaphragm is 1.2 to 2 inches (3 to 5 cm). 4. Excursion is decreased in patients who have chronic obstructive pulmonary disease due to hyperinflation of the chest and a resultant flattened diaphragm.

Answer 26

1. Face validity is based on the validation of a test without comparison to an already validated test. 2. Construct validity is based on abstract concepts and is not observable or measurable. 3. Content validity of a test is measured to determine the extent of coverage of a concept. It is not determined by comparison with a reliable/valid (gold) standard. 4. Criterion-related validity of a new tool is tested by using practical and objective comparisons to a reliable/valid (gold) standard measure already in use.

Answer 27

1. Weakness in the gastrocnemius-soleus muscle results in excessive knee flexion during stance phase (Dutton, pp. 977-978). 2. Excessive ankle eversion during stance is most frequently associated with marked weakness of inverters such as the tibialis anterior and tibialis posterior (Dutton, p. 309), which may result from a malalignment such as a forefoot or rearfoot varus/valgus (Magee). Other causes of excessive eversion include plantar flexion contracture, fibular (peroneal) hypertonicity, and valgus deformity (Dutton, p. 314). A manual muscle test of the tibialis anterior and tibialis posterior muscles would best determine if these muscles are weak and in need of strengthening (Dutton, pp. 1136-1137). 3. The Modified Ashworth Test is used to examine spasticity (Umphred). However, excessive activation of the tibialis posterior muscle during walking (as would occur with spasticity) results in excessive inversion. The case describes excessive foot eversion. 4. The Modified Ashworth Test is used to examine spasticity (Umphred). Excessive activation of the tibialis anterior muscle during walking (as would occur with spasticity) results in excessive inversion. The case describes excessive foot eversion.

Answer 28

1. Mixed red-white coloring is evident with deep partial-thickness burns because the dermis is almost completely destroyed. 2. Marked edema is present with deep partial-thickness burns because of broken blisters and leakage of plasma fluid. Capillary destruction is marked. 3. Intact blisters are the most common sign of superficial partial-thickness burns. Damage is through the epidermis and into the papillary layer of the dermis. 4. Eschar is evident with full-thickness burns. It is a hard, devitalized tissue consisting of coagulated plasma and necrotic cells. Full-thickness burns destroy all of the epidermal and dermal layers and possibly the subcutaneous fat layer.

Answer 29

1. Spinal cord lesions at the level of S2 and below lead to bladder areflexia and dysfunction of the external sphincter. Surgical interventions for neurogenic bladder exist; sacral nerve modulation is used for incomplete lesions. (Goodman, pp. 991-992) The patient has a complete lesion. 2. Spinal cord lesions at the level of S2 and below lead to bladder areflexia and dysfunction of the external sphincter (Goodman, p. 991). S2–S4 innervate muscles in the perineum and external sphincter; therefore, complete loss of innervation would lead to paralysis of the respective musculature (Moore). Biofeedback is for muscle identification would be an inappropriate intervention for this patient. 3. Spinal cord lesions at the level of S3 and below lead to bladder areflexia and dysfunction of the external sphincter (Goodman, p. 991). S2–S4 innervate muscles in the perineum and external sphincter; therefore, complete loss of innervation would lead to paralysis of the respective musculature (Moore). Strengthening exercises would be an inappropriate intervention for this patient. 4. Spinal cord lesions at the level of S2 and below lead to bladder areflexia and dysfunction of the external sphincter. Bladder tone is preserved, but bladder compliance decreases with time. Catheterization is a commonly employed intervention to avoid excessive bladder distention. (Goodman, p. 991)

Answer 30

1. Water displacement has been regarded as the most sensitive and accurate standard for volume measurement. 2. Circumference measurements taken at various points of a body part are used most frequently to quantify lymphedema, but several problems exist, including limitations for acceptable differences between repeated circumferential measurement of the normal adult and control of intra- and interrater reliability. Circumferential measurement, although used clinically, is not considered a reliable/valid (gold) standard. 3. Single frequency bioelectrical impedance has become more frequently used in the clinical setting to measure limb fluid, but it is not considered the reliable/valid (gold) standard. 4. Optoelectronic volumetry calculates limb volume by using infrared light and has been conceptualized as a continuous variable, supporting a more robust test of the severity of lymphedema, but it is not considered a reliable/valid (gold) standard.

Answer 31

1. Use of tuning forks and vibrators would facilitate reeducation of vibratory sense. This sensory function is related to the dorsal column/medical lemniscus system and may not be affected in this patient. 2. Active movement with visual feedback would facilitate reeducation of proprioceptive sense. This sensory function is related to the dorsal column/medical lemniscus system and may not be affected in this patient. 3. Sensory reeducation focuses on all sensory modalities, but these techniques would emphasize reeducation of discriminative touch functions. These sensory functions are related to the dorsal column/medical lemniscus system and may not be affected in this patient. 4. With lesions to the anterolateral system, a patient may exhibit sensory deficits in both light touch and hot/cold discrimination. Failure to distinguish extremes in temperature could result in the patient sustaining thermal injuries. Instruction in techniques to protect against these injuries would be of primary importance.

Answer 32

1. Culturally and linguistically appropriate services require professional translators with knowledge of the patient's language and knowledge of medical terms. The patient's grandson should not be assumed to be an appropriate translator due to the sensitive topics to be covered. 2. Culturally and linguistically appropriate services require professional translators with knowledge of the patient's language and knowledge of medical terms. 3. Culturally and linguistically appropriate services require professional translators with knowledge of the patient's language and knowledge of medical terms. Although the person is a member of the hospital staff, the person may not have adequate knowledge of the medical terms involved in the patient's care. 4. Use of gestures, pictures, and simple terms by the physical therapist may help avoid confidentiality issues but does not provide satisfactory communication between the therapist and the patient.

Answer 33

1. This is the incorrect answer because this measure is designed to assess lower extremity power of the lower extremities. The patient has had repeated falls and would benefit from an appropriate falls outcome measure. The patient does not necessarily need power in the lower extremities to cross a street safely (Avers, p. 148). 2. This is the incorrect answer because the six minute walk test is a submaximal measure of aerobic capacity. The patient is having the most difficulty with balance and gait. The patient is a household ambulator and will likely not be able to complete the Six Minute Walk Test and will not provide valuable information to help the patient cross the street safely (Avers, p. 149). 3. This is the incorrect answer because the Fullerton is a balance test for higher-functioning older adults and would likely be too challenging for this patient as the patient is a household ambulator who uses a cane for mobility (Avers, p. 155). 4. This is the correct answer because a score of 12 on the DGI indicates a fall risk in older adults. The patient also has a history of recurrent falls. A self-report specific balance measure would be beneficial to gain a better understanding of when and why falls are occurring. (Avers, p. 144).

Answer 34

1. This is the incorrect answer because stridor indicates an upper airway obstruction (food particle in airway or acute airway inflammation). The patient is showing signs of possible acute congestive heart failure (Malone, p. 278). 2. This is the incorrect answer because diminished or absent breath sounds are consistent with an infection such as pneumonia, or a lung pathology such as fibrosis. The patient in this question is experiencing signs consistent with possible congestive heart failure (Frownfelter, pp. 207-208). 3. This is the correct answer because the patient is showing signs consistent with possible acute congestive heart failure (bilateral lower extremity edema, dyspnea, and dyspnea in supine). Patients with heart failure can have a S3 heart sound (Frownfelter, pp, 79-80, 209). 4. This is the incorrect answer because the S4 heart sound signifies rapid ventricular filling after atrial contraction and is consistent with a presentation of systemic hypertension, cardiomyopathy or coarctation of the aorta (Frownfelter, p. 209). The patient in this question is experiencing symptoms most likely related to congestive heart failure due to the bilateral lower extremity edema.

Answer 35

1. This is the incorrect answer because therapists want to recommend the least restrictive assistive device. The patient lives alone and would benefit from continued independence and safe walking to reduce mortality and morbidity (Avers, p. 208). 2. This is the correct answer because the patient has been having frequent falls with the straight cane and needs more stability. The patient also has spinal stenosis which favors spinal flexion. A rolling walker will provide the patient with some degree of spinal flexion (Avers, p. 208, Dutton, Chapter 28). 3. This is the incorrect answer because although the aim is to provide the least restrictive assistive device, the patient is having frequent falls and has a low DGI score. Continued use of the straight cane could result in more falls (Avers, p. 208). 4. This is the incorrect answer because the patient is having frequent falls and scored low on the DGI. The patient most likely needs a more supportive assistive device to lower fall risk and maintain independence (Avers p. 208).

Answer 36

1. Step aerobics is a high-risk activity for patients who have lower extremity edema. The patient is also at high risk for falls, and, therefore, this is not the best choice. (Zuther, p. 270) 2. This is not the best answer because the patient is a household ambulator and has a risk of falls (based on history and DGI) and will likely tire quickly on the treadmill (Avers). 3. Use of a recumbent bike encourages a flexed posture, which is beneficial for individuals with spinal stenosis. A recumbent bike also encourages higher positioning of the legs, which is better for lower extremity edema. Biking will stimulate diaphragmatic breathing, which promotes the return of lymph and venous fluid to the blood circulation. Biking is likely to be able to be performed by the patient. (Zuther, pp. 269-270) 4. This is a plausible answer as the hydrostatic pressure from the pool can provide compression and unweight heavy legs. However, the patient has spinal stenosis and would likely not tolerate the prone position as this increases spinal extension, which can exacerbate symptoms. (Dutton)

Answer 37

1. Unilateral gaze preference is associated with unilateral neglect and results from the lesion itself, not patient positioning. A patient with visual unilateral neglect often avoids crossing the midline visually (p. 1198). This condition is much more common in patients who have left hemiplegia than in patients who have right hemiplegia (p. 1198). 2. Hemiplegic shoulder pain is a common complication after stroke. Poor positioning of the more affected upper extremity has been implicated in producing joint microtrauma and pain. Prolonged soft tissue injury can result in complex regional pain syndrome. (pp. 646-647) 3. Sidelying on the right side should produce elongation of the trunk on the right, not shortening of the trunk. 4. Risk factors for skin breakdown include decreased sensation and abnormal patterns of movement, neither of which should be present on the less involved (left) side in this case (pp. 622-623).

Answer 38

1. A patient who has a C6 spinal cord injury retains full use of the diaphragm but lacks innervation to abdominal and intercostal musculature. The patient will display outward, not inward, motion of the abdomen and inward motion of the upper chest. 2. A patient who has a C6 spinal cord injury retains full use of the diaphragm but lacks innervation to abdominal and intercostal musculature. The patient will display outward, not inward, motion of the abdomen and inward, not outward, motion of the upper chest. 3. A patient who has a C6 spinal cord injury retains full use of the diaphragm but lacks innervation to abdominal and intercostal musculature. The patient will display outward motion of the abdomen and inward motion of the upper chest. The outward motion of the abdominal area is caused by the diaphragm contracting and pushing abdominal contents forward and outward, and the inward motion of the upper chest is due to the lack of structural support from paralyzed thoracic musculature. 4. A patient who has a C6 spinal cord injury retains full use of the diaphragm but lacks innervation to abdominal and intercostal musculature. The patient will display outward motion of the abdomen and inward, not outward, motion of the upper chest.

Answer 39

1. Jaundice, darkened urine, and ascites are all clinical signs of liver disease. Asterixis, or liver flap, is also likely to be present as a result of ammonia imbalance, which causes this neurologic symptom. (Goodman, p. 341) 2. Pronator drift is more likely to be observed in the presence of an upper motor neuron disorder. Upper motor neuron signs/symptoms are associated with central nervous system conditions, such as cerebrovascular accident, spinal cord injury, and multiple sclerosis. (Fruth, pp. 397, 400) 3. A positive result on the Hoffman Test, or Hoffman sign, is associated with corticospinal tract disorders. A positive result may be found contralateral to the area of a brain lesion or bilaterally in the presence of injury or compression of the spinal cord. (Fruth, p. 402) 4. Jaundice, ascites, and darkened urine are common clinical signs of liver disease. Rebound tenderness is most likely to be associated with appendicitis and peritonitis. (Goodman, pp. 319-320)

Answer 40

1. Also known as thyrotoxicosis, thyroid hypersecretion is associated with an enlarged thyroid gland, also known as a goiter. Patients exhibit hypermetabolism and sympathetic overactivity. Patients report fatigue, tremor, heat intolerance, increased sweating with warm moist skin, weight loss, palpitation with tachycardia, diarrhea, and muscle weakness and atrophy. They do not display an abnormal vital sign response to exercise, nor do they have acetone breath. (pp. 484-486) 2. Giantism and acromegaly can result from excessive secretion of growth hormone. This can result from a pituitary tumor or from a hypothalamic abnormality that leads to increased growth hormone release (pp. 479-480). Pituitary hyperactivity does not result in an abnormal vital sign response to exercise and does not cause the acetone breath associated with ketoacidosis. 3. Patients who have diabetes potentially have a lack of insulin secretion or effectiveness, leading to disruption of glucose metabolism. Results of acute metabolic changes related to glucose metabolism include hyperglycemia (high blood glucose), electrolyte disturbances that are manifested by acidosis that triggers an increased respiration rate, irregular heart rate, and increased fatty acid metabolism resulting in acetone breath. (p. 522) 4. People who have hyposecretion of adrenal hormones have Addison disease. Addison disease is characterized by the inability to withstand food deprivation, hyperpigmentation, dehydration, and postural hypotension (p. 498). A patient who has adrenal insufficiency should not exhibit any of the signs or symptoms described in the stem.

Answer 41

1. For best biofeedback results, electrode placement should be as close to the muscle as possible (Prentice). Hook grasp requires finger flexion (Lippert, p. 215). The finger flexors are located proximal to the anterior forearm (Lippert, pp. 201-202). 2. The proximal posterolateral forearm is the location of the finger extensors (Lippert, pp. 204-205). 3. No muscles originate from the distal anterior, medial forearm area (Lippert, pp. 201-206). 4. The distal posterolateral forearm is the location of thumb and index finger (1st and 2nd digit) extensors (Lippert, pp. 203-205).

Answer 42

1. Lateral (external) rotation and abduction with flexion is not the most likely position to dislocate the reverse total shoulder arthroplasty. Combined medial (internal) rotation and adduction with extension is more likely to cause dislocation. 2. Abduction and flexion are not most likely to cause dislocation. Combined medial (internal) rotation and adduction with extension is more likely to cause dislocation. 3. Lateral (external) rotation is not most likely to cause dislocation. Combined medial (internal) rotation and adduction with extension is more likely to cause dislocation. 4. Patients are most likely to dislocate a reverse total shoulder arthroplasty by performing medial (internal) rotation and adduction in conjunction with extension. This position allows the prosthesis to escape anteriorly and inferiorly.

Answer 43

1. Wearing the harness during rest only is inadequate. It should be worn 18–23 hours/day. 2. Wearing the harness during activity only is inadequate. It should be worn 18–23 hours/day. 3. Wearing the harness for 2–4 hours per day is inadequate. It should be worn 18–23 hours/day. 4. The harness must be worn 18–23 hours/day.

Answer 44

1. Having a patient find an object among similarly shaped objects is a better test for form discrimination rather than figure-ground discrimination as it assesses whether subtle differences in shape can be perceived (p. 1208). Finding a toothbrush amongst an array of utensils of various shapes and sizes would be a better test for figure-ground discrimination (p. 1208). 2. An impairment in figure-ground discrimination is the inability to visually distinguish a figure from the background in which it is embedded. A functional test that can be given to the patient to assess figure-ground discrimination is to ask a patient to point out a white button on a white shirt. Compensatory techniques to be used with patients who lack figure-ground perception are placing red tape over the Velcro strap of the shoe to aid the patient in locating it or using bright red tape to mark the edges on stairs. (pp. 1207-1208) 3. Tactile agnosia is the inability to recognize forms by handling them, although tactile sensation may be intact. If a patient is handed an object while the patient's vision is occluded, the patient will fail to recognize the object. This would not be the best test for an impairment of figure-ground discrimination. (p. 1213) 4. A patient who has depth and distance perception problems may have difficulty grasping an object. The impaired patient will overshoot or undershoot the object. This would not be the best test for an impairment of figure-ground discrimination. (pp. 1210-1211)

Answer 45

1. The purpose of humeroulnar distraction is to increase flexion (or extension) of the elbow joint. 2. The purpose of humeroradial posterior glide is to increase extension, not flexion, of the elbow joint. 3. The purpose of radioulnar anterior glide is to increase supination of the forearm, not elbow joint flexion. 4. The purpose of radioulnar posterior glide is to increase pronation of the forearm, not elbow joint flexion.

Answer 46

1. Direct current is indicated with a maximum safe amplitude of 4 milliamperes. 2. Direct current is indicated, but an amplitude of 8–10 milliamperes is too high. 3. Pulsed current is not the correct type of electrical current to use with iontophoresis. Direct current should be used. 4. Pulsed current is not the correct type of electrical current to use with iontophoresis. Direct current should be used. The amplitude of 8–10 milliamperes is too high.

Answer 47

1. Vancomycin-resistant Enterococcus (VRE) requires contact precautions. Contact precautions require a gown. A mask is not needed unless droplet precautions are necessary. 2. Contact precautions are followed for vancomycin-resistant Enterococcus (VRE). A gown is needed for contact precautions. 3. Vancomycin-resistant Enterococcus (VRE) requires contact precautions. A gown is needed for contact precautions. 4. A gown is appropriate; however, the therapist should follow contact precautions, not droplet precautions.

Answer 48

1. The first step in dealing with an angry patient who is not disruptive or a security risk is to validate the patient's feelings by listening and by acknowledging the patient's anger over the situation. This may diffuse the anger, allowing the therapist to carry on with the examination. 2. Attempting to change the direction of the questions is better used for a patient who is emotionally labile or excessively talkative. It does not acknowledge the patient's anger and thus may not diffuse the patient's anger. 3. Leaving the area would be appropriate if a patient is disruptive and appears to have violent intent. Stepping out of the area does not acknowledge the patient's anger. 4. Explaining the importance of collecting the same information may be an appropriate second step, but it does not acknowledge the patient's anger and thus may not diffuse the situation.

Answer 49

1. Most activities of daily living are performed at 50° of pronation and supination. Pronation and supination limited to 65° on the right would not delay return to work. (Magee, pp. 451-452) 2. One of the complications after an upper extremity trauma is the advent of complex regional pain syndrome. This complication often presents with burning pain with any movement of the body part, excessive sensitivity to light touch or minor stimulation, temperature changes, localized sweating, localized changes of the skin, or trophic changes of the skin, hair, and nails. Of the four options, this complication would result in longest delay in recovery and return to work. (Dutton) 3. The functional position of the wrist is between 20° and 35° of wrist extension, which this patient has (Magee, p. 445). The patient's pain is at end-range of wrist motion, and the patient should not have to push the wrist to end-range for most functional activities. 4. The grip strength on the right is 90% of the grip strength on the left. Although the right hand remains 10% weaker, this is an adequate strength for activities of daily living. (Magee, p. 455)

Answer 50

1. Trendelenburg gait is attributed to weakness in the gluteus medius muscle or L5 nerve root involvement (Magee, pp. 585, 1009). 2. The L4 nerve root is the main segmental innervation to the tibialis anterior. The L4 nerve root is also the myotome for ankle dorsiflexion. Impingement of the L4 nerve root would result in foot slap. (Magee, p. 585; O'Sullivan, p. 239) 3. Backward trunk lean reduces demands on a weakened stance limb gluteus maximus (O'Sullivan, p. 242). The gluteus maximus is innervated by the inferior gluteal nerve (L5–S2) (Magee, pp. 585, 1008-1009). 4. Causes of toe walking include a tight Achilles tendon, clubfoot, cerebral palsy, or limb length discrepancies (Magee, p. 1009; O'Sullivan, p. 239). It is not associated with L4 impingement.

Answer 51

1. Uveitis is commonly found in patients who have ankylosing spondylitis (p. 1134). 2. Urethritis is commonly found in patients who have Reiter syndrome (p. 1344). 3. Skin rashes, fever, fatigue, malaise, photosensitivity, dyspnea, cough, and peripheral neuropathies are all common findings in patients who have systemic lupus erythematosus (pp. 307-308). 4. Psoriasis is commonly seen in patients who have psoriatic arthritis (pp. 1341-1342).

Answer 52

1. This is the correct choice for the following reasons. The most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 20 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Additionally, there is tenderness to palpation with the elbow between 30°–60° of flexion, which is the correct position to palpate the ulnar collateral ligament (Dutton, p. 691). The Milking Maneuver Test is a special test for the medial collateral ligament of the elbow. The patient sits with the elbow flexed to 90° or more and the forearm supinated. The examiner grasps the patient’s thumb under the forearm and pulls it, imparting a valgus stress to the elbow. Reproduction of symptoms (apprehension, medial joint pain, gaping, and/or instability) indicates a positive test and a partial tear of the medial collateral ligament. Thus, the milking maneuver is likely to be positive in this case. 2. This is an incorrect test for the following reasons: While medial elbow tendinopathy (Golfer’s Elbow) is similar in presentation. This is an unlikely diagnosis in this case for the following reasons. While medial elbow tendinopathy may present with tenderness to palpation at the medial elbow, symptoms are typically exacerbated by either resisted wrist flexion and or pronation and passive wrist extension and/or supination (Dutton, p. 724). Both findings are not present in this case making medial elbow tendinopathy an unlikely diagnosis. The Golfer’s Elbow Test is typically performed for medial epicondylitis by passively extending the elbow and wrist (Magee, p. 453). In this case, the wrist and elbow active and passive range of motion are pain-free. Thus, this is the incorrect choice. 3. This is an incorrect test for the following reasons. The Varus Stress Test assess the lateral collateral ligaments of the elbow (Dutton, p. 691), not the medial collateral ligaments of the elbow. The most common mechanism of injury for the lateral collateral ligament is from a fall on outstretched hand (FOOSH) injury or from an elbow dislocation. Also, the patient may report painful catching, clicking or a feeling of instability during elbow flexion/extension particularly around 40° of elbow flexion with forearm supination (Dutton, p. 717). None of these features are present in this case and thus should not be considered a potential diagnosis to test for making this an incorrect choice. 4. This is an incorrect test for the following reasons: This test helps to determine if cubital tunnel syndrome is present (Magee, p. 456). Symptoms of cubital tunnel include paresthesia involving the fourth and fifth digits, accompanied by pain that may extend proximally or distally on the medial aspect of the elbow, pain or paresthesia worse at night; decreased sensation in the ulnar distribution of the hand; progressive inability to separate the fingers; loss of grip power and dexterity; and atrophy or weakness of the ulnar intrinsic muscles of the hand (late sign) are signs of cubital tunnel (Dutton, p. 725). Since none of these findings are present, this diagnosis of cubital tunnel, and a subsequent positive Elbow Flexion Test are unlike making this an incorrect choice.

Answer 53

1. This is an incorrect choice for the following reasons: First, the following structures are typically viewed on a lateral radiograph of the elbow: Olecranon, radius, distal humerus, and anterior fat pad (McKinnis, p. 568). Radiographs remain the initial imaging choice following traumatic elbow injuries to establish the initial injury, any associated fractures or displacement (Dutton, p. 705) which is an unlikely diagnosis in this case. Most fractures and dislocations at the elbow result from falls on an outstretched hand with or without an abduction or adduction component, or a force applied through a flexed elbow. Fractures of the radial and ulnar shafts are more often caused by direct trauma, often associated with violent blows, motor vehicle accidents, or falls from heights (McKinnis, p. 584). None of these mechanisms of injury are present in this case. While radiographs may reveal intra-articular loose bodies in the joint (McKinnis, p. 574), joint locking and twinges that typically indicate a loose body is moving within the joint are not present (Dutton, p. 170). Magnetic resonance imaging (MRI) is the most likely test reveal injuries to the ligament (McKinnis, p. 574). 2. This is an incorrect choice for the following reasons: Computed tomography (CT scan) may be indicated to identify occult fractures, osteochondral lesions, or the specific location of loose bodies or heterotopic ossification. Most fractures and dislocations at the elbow result from falls on an outstretched hand with or without an abduction or adduction component, or a force applied through a flexed elbow. Fractures of the radial and ulnar shafts are more often caused by direct trauma, often associated with violent blows, motor vehicle accidents, or falls from heights (McKinnis, p. 584). This mechanism of injury is not present in this case, and the MRI has been shown to be the most specific tool for diagnosing an ulnar collateral ligament injury (Dutton, p. 705) makings this an incorrect choice. 3. This is the correct choice for the following reasons. The most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 22 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Additionally, there is tenderness to palpation with the elbow between 30°–60° of flexion, which is the correct position to palpate the ulnar collateral ligament (Dutton, p. 691). Magnetic resonance imaging (MRI) has been reported to be highly specific (100% specificity, 57% sensitivity) for detecting ulnar collateral ligament tears (Dutton, p. 705). Indications for MRI of the elbow include suspected ligament injuries (McKinnis, p. 578). 4. This is an incorrect answer. A density dual-energy X-ray absorptiometry (DEXA) scan is used to detect osteopenia or osteoporosis (Goodman, p. 825). While Osteoporosis is a common condition in post menopausal females and half of women older than 50 years of age with osteoporosis will experience fractures due to loss of bone density, this individual does not appear to have signs of a fracture and is not of the most common gender and/or age range for suspected bone mineral density loss. Thus, the most pressing and overwhelming concern is the ulnar collateral ligament which is best visualized with an MRI (McKinnis, p. 578).

Answer 54

1. This choice is incorrect for the following reasons. First, there are no impairments in supination noted in the case. Second, the supinator has not been documented to have a stabilizing role at the medial elbow. Supination with a dowel or hammer strengthens the supinator (Kisner, p. 649), which does not provide an essential role in the rehabilitation of UCL injuries. Emphasis is placed on the forearm flexors, ulnar deviators, and pronators, in order to enhance their role as secondary stabilizers of the medial joint. Strengthening exercises for the following groups may be included: wrist curls and pronation (Dutton, p. 716). Thus this is not an efficacious choice for this case. 2. This choice is incorrect for the following reasons. First, there are no impairments in elbow flexion strength noted in the case. Second, the elbow flexor has not been documented to have a stabilizing role at the medial elbow. Elbow flexion with a dumbbell strengthens the elbow flexors (Kisner, p. 614), which does not provide an essential role in the rehabilitation of UCL injuries. Emphasis is placed on the forearm flexors, ulnar deviators, and pronators, in order to enhance their role as secondary stabilizers of the medial joint. Strengthening exercises for the following groups may be included: wrist curls and pronation (Dutton, p. 716). The most common clinical utility for resisted elbow flexion is for weakness of the elbow flexors (Kisner, p. 614). Thus this is not the most efficacious choice for this case. 3. This is the correct answer for the following reasons. First, the most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 20 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Additionally, there is tenderness to palpation with the elbow between 30°-60° of flexion, which is the correct position to palpate the ulnar collateral ligament (Dutton, p. 691). The most likely differential diagnosis for this case is medial elbow tendinopathy (Golfer’s elbow). This is an unlikely diagnosis in this case for the following reasons: While medial elbow tendinopathy may present with tenderness to palpation at the medial elbow, symptoms are typically exacerbated by either resisted wrist flexion and or pronation and passive wrist extension and/or supination (Dutton, p. 724). Both findings are not present in this case making medial elbow tendinopathy an unlikely diagnosis. Physical therapy treatment for UCL injuries includes the following: Rest and activity modification for about 2–4 weeks, range-of-motion exercises, modalities. Strengthening and stretching of the flexor carpi ulnaris, pronator teres, and flexor digitorum profundus are initiated once the acute inflammatory stage has subsided. Emphasis is placed on the forearm flexors, ulnar deviators, and pronators, in order to enhance their role as secondary stabilizers of the medial joint. Strengthening exercises for the following groups may be included: wrist curls and pronation (Dutton, p. 716). Thus, wrist curls is a prioritized intervention. 4. This choice is incorrect for the following reasons. First, there are no impairments in extension strength noted in the case. Second, the wrist extensor has not been documented to have a stabilizing role at the medial elbow. Eccentric wrist extension with a dumbbell strengthens the wrist extensors (Kisner, p. 650), which does not provide an essential role in the rehabilitation of UCL injuries. Emphasis is placed on the forearm flexors, ulnar deviators, and pronators, in order to enhance their role as secondary stabilizers of the medial joint. Strengthening exercises for the following groups may be included: wrist curls and pronation (Dutton, p. 716). The most common clinical utility for eccentric wrist extension is for lateral epicondylalgia. There is emerging evidence and moderate research support that suggests eccentric resistance training is effective in the treatment of lateral epicondylalgia (Kisner, p. 644). Thus this is not the most efficacious choice for this case.

Answer 55

1. This is an incorrect choice for the following reasons: The most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 20 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Additionally, there is tenderness to palpation with the elbow between 30°–60° of flexion, which is the correct position to palpate the ulnar collateral ligament (Dutton, p. 691). A wrist cock-up splint is indicated for a number of conditions including Posterior Interosseous Nerve Syndrome (Dutton, p. 728) and extensor tendon repairs (Magee, p. 399), but has no reported functional benefit in an injury to the ulnar collateral ligament making this an incorrect choice. 2. This is the correct choice for the following reasons. The most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 20 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Additionally, there is tenderness to palpation with the elbow between 30°–60° of flexion, which is the correct position to palpate the ulnar collateral ligament (Dutton, p. 691). The most effective brace to prescribe for this condition is a hinged elbow brace. During the inflammatory phase, the intervention includes immobilization of the elbow positioned at 90° of flexion in a well-padded posterior splint for 3–4 days followed by a hinged elbow brace initially set at 15°–90° (Dutton, p. 717). Thus, the hinged elbow brace is the correct choice for a patient with an ulnar collateral ligament injury. 3. This is an incorrect choice for the following reasons: While medial elbow tendinopathy (Golfer’s elbow) is similar in presentation. This is an unlikely diagnosis in this case for the following reasons. While medial elbow tendinopathy may present with tenderness to palpation at the medial elbow, symptoms are typically exacerbated by either resisted wrist flexion and or pronation and passive wrist extension and/or supination (Dutton, p. 724). Both findings are not present in this case making medial elbow tendinopathy an unlikely diagnosis. The Golfer’s elbow test is typically performed for medial epicondylitis by passively extending the elbow and wrist (Magee, p. 453). In this case, the wrist and elbow active and passive range of motion are pain-free. Thus, this is an unlikely diagnosis. The most likely brace prescribed for medial epicondylitis is a counterforce brace. A counterforce brace may be beneficial in patients who are rehabilitating but still involved in activities that may aggravate the symptoms (Magee, p. 307). The use of a counterforce brace is not indicated for an ulnar collateral ligament tear as there is no mechanism in which this brace could have a positive impact making this an incorrect choice. 4. This is an incorrect choice for the following reasons: A forearm-based wrist immobilization orthosis is fabricated with a to obtain a rigid support to be used during the proliferative stage of healing of an open reduction internal fixation. All forearm and wrist motions are significantly limited with this device (Chui, p. 386). The most likely diagnosis in this case is an injury to the ulnar collateral ligament for the following reasons: This patient is 20 years old and plays baseball which is a common population for ulnar collateral ligament injuries. Pain is located at the medial (ulnar) side of the elbow anatomically where the UCL is located (Dutton, p. 705). Immobilization of the wrist and forearm will not aid in this patient's recovery, thus this is an incorrect choice.

Answer 56

1. Hypotension is abnormally low arterial blood pressure or a fall in arterial blood pressure with an increase in exertion or heart rate. It results from many causes, including dehydration and lack of blood ejected from the left ventricle. (p. 66) 2. Hypertension, increased systolic blood pressure, results in increased myocardial work (p. 66). 3. Left ventricular failure results in backup of blood into the pulmonary system and decreased cardiac output. Clinical manifestations include dry cough or wheezing, tachycardia, light-headedness, pallor, or cyanosis. (p. 143t) *4. Right ventricular failure results in backup of blood into the systemic venous circulation, manifested by edema systemically, including jugular venous distention, ascites, and bilateral pedal edema (p. 143t).*CORRECT ANSWER

Answer 57

1. Taking the patient's dietary history would overlook the important opportunity to inquire whether the patient may be a victim of physical abuse. *2. Multiple lesions in various stages of healing in a broad number of areas is a sign of possible abuse. In the interest of patient protection, the issue should be pursued, because the patient may not be forthcoming with an admission that abuse has taken place.*CORRECT ANSWER 3. Instructing the patient in safe movement patterns would overlook the important opportunity to inquire whether the patient may be a victim of physical abuse. 4. Reporting abuse to the appropriate authorities may ultimately be required, but it is not the first step.

Answer 58

*1. The presence of clonus is indicative of an upper motor neuron lesion (p. 377).*CORRECT ANSWER 2. The presence of paresis is indicative of a lower motor neuron lesion (p. 378). 3. The presence of areflexia is indicative of a lower motor neuron lesion (p. 378). 4. The presence of hypotonia is indicative of a lower motor neuron lesion (p. 378).

Answer 59

1. Palpation is not likely to reproduce symptoms for a capsular dysfunction. Palpation is more likely to identify a muscle or soft tissue condition or bursitis. (p. 901) 2. The case presentation indicates hip dysfunction, specifically slipped capital femoral epiphysis. Special tests of the knee are not likely to provoke symptoms. (p. 1002) *3. The stem describes a case of suspected slipped capital femoral epiphysis. Signs and symptoms are typically found in adolescent patients (10-16 years old) and include leg shortness, knee pain, and pain when the hip is medially (internally) rotated. Groin pain will be triggered with the anterior impingement test (hips flexed to 80° to 90° and medially [internally] rotated with adduction) if slipped capital femoral epiphysis exists. (pp. 1580-1581)*CORRECT ANSWER 4. The stem describes a case of suspected slipped capital femoral epiphysis. The flexion, abduction, external rotation test (FABER) described in this option is used to indicate lumbar, sacroiliac joint, or posterior hip dysfunction associated with the hip capsule. Although it is a femoroacetabular impingement test, it is a better indicator of posterior hip dysfunction than anterior hip dysfunction. (pp. 1549-1550)

Answer 60

1. Buoyancy is the upward force equal to the volume of water displacement. Buoyancy provides the patient with relative weightlessness and joint unloading by reducing the force of gravity on the body. It does not affect blood flow. (p. 297) 2. Buoyancy is the upward force equal to the volume of water displacement. Buoyancy provides the patient with relative weightlessness and joint unloading by reducing the force of gravity on the body. It does not affect blood flow. (p. 297) *3. Increased hydrostatic pressure centralizes peripheral blood flow and increases venous return (p. 298).*CORRECT ANSWER 4. Increasing, not decreasing, hydrostatic pressure increases blood pressure via centralizing blood flow and increasing venous return. Decreasing hydrostatic pressure does not increase the blood pressure. (p. 298)

Answer 61

1. Increased stance phase would be associated with increased time weight-bearing on the sole of the shoe (p. 231). 2. Increased/excessive toe off (preswing) would be associated with increased time weight-bearing on the front portion of the sole of the shoe (p. 231). *3. Decreased dorsiflexion would cause increased wear to the anterior portion of the toe box secondary to poor clearance and toe drag (p. 233).*CORRECT ANSWER 4. Circumduction would not cause scuffing and wear to the outside of the toe box because the limb is lifted off the floor to clear the foot/toe box during circumduction (p. 233)

Answer 62

1. Active range of motion exercises should not be started until 6 to 8 weeks after surgery for a large rotator cuff tear. 2. Supine, active-assisted range of motion exercises of the involved shoulder are appropriate. Seated, active-assisted range of motion exercises would put too much stress on the patient's shoulder because a 5-centimeter tear is considered massive and requires a more conservative approach. *3. Passive range of motion exercises are initiated immediately in rehabilitation. A 5-centimeter tear is considered a massive rotator cuff tear that requires a conservative approach to rehabilitation, but passive range of motion exercises should occur immediately.*CORRECT ANSWER 4. Isotonic strengthening exercises should not be started until 6 to 8 weeks after surgery for a large rotator cuff tear

Answer 63

1. An increase in the secretion of adrenocorticotropic hormone causes Cushing disease, associated with hypertension, mental changes, weight gain, and increased hair growth, not the symptoms listed (p. 500). *2. A hyperactive thyroid will elevate the body's metabolism, causing an elevated heart rate, fatigue, weight loss, heat intolerance, and muscle atrophy, among other symptoms (p. 484).*CORRECT ANSWER 3. An increase in insulin will cause a decrease in blood glucose levels, resulting in a hypoglycemic reaction, which includes pallor, increased perspiration, tachycardia, weakness, shakiness, and blurred vision. Fatigue and weight loss are not symptoms of hyperglycemia. (p. 510) 4. Elevation of epinephrine can cause an increase in blood pressure, tachycardia, and hyperglycemia. It causes an increase in the sympathetic response ("fight or flight"). Heat intolerance, fatigue, and weight loss are not consequences of an increase in epinephrine. (p. 473)

Answer 64

1. As gait develops, velocity increases, not decreases, and cadence decreases, not increases. *2. Velocity increases and cadence decreases as gait develops.*CORRECT ANSWER 3. Single-limb stance time increases as gait develops. 4. Step length increases as gait develops.

Answer 65

1. Prone with the lower extremities raised 18 inches (45.7 cm) is the preferred position for postural drainage of the lower lobes. 2. Supine position with the lower extremities raised 12 inches (30.5 cm) is the preferred position for postural drainage of right middle lobe secretions. 3. Supine with the lower extremities raised 18 inches (45.7 cm) is the preferred position for postural drainage of anterior segment secretions. *4. The correct patient position for postural drainage of the right lateral segment is left sidelying with the legs raised 18 inches (45.7 cm)*CORRECT ANSWER

Answer 66

1. Dependent edema is one of the early signs of right-sided heart failure. The edema is usually symmetric and occurs in the feet and ankles (Goodman, Differential Diagnosis; Goodman, Pathology, pp. 591-592). 2. Edema associated with chronic venous insufficiency usually presents in a gaiter distribution creating the appearance of an inverted bottle at the calf. Acute onset of swelling at the dorsum of the foot, as described in the stem, is not typical of chronic venous changes. (Goodman, Pathology, pp. 655-656) *3. Lymphedema is usually unilateral with typical presentation distally on the extremity (dorsum of the foot or hand) (Goodman, Differential Diagnosis; Goodman, Pathology, pp. 680-682).*CORRECT ANSWER 4. Lipedema is a symmetrical swelling of both legs, extending from hips to ankles. Lipedema onset is primarily proximal to distal. (Goodman, Pathology, pp. 702-704).

Answer 67

1. The symmetrical biphasic waveform is not a polar current and thus cannot be used in wound healing per the theory of galvanotaxis (pp. 271-272). For symmetrical biphasic waveforms, the polarity is irrelevant since polar effects are not demonstrated. A frequency of 35 pps is more relevant for a nonfatiguing muscle stimulation. The symmetrical biphasic waveform is primarily used in neuromuscular stimulation for functional support or muscle strengthening. (p. 263) 2. Interferential current is not a polar current and thus cannot be used in wound healing per the theory of galvanotaxis (pp. 271-272). For interferential current, the polarity is irrelevant since polar effects are not demonstrated. Interferential current is thought to be more comfortable and is used primarily for pain control. (pp. 222-223) 3. High-voltage pulsed current is a polar current that is used for wound healing. However, the positive electrode is used when the wound is clean and not when it is infected. The low pulse frequency has not been demonstrated to cause healing and would not be comfortable to the patient. (pp. 272, 278) *4. The principle behind wound healing with electrical stimulation is galvanotaxis. The current's polarity introduced into the wound attracts cells that promote healing. Thus, a generator that has polarity must be used. High-voltage pulsed currents are polar currents. The other stimulators are not polar because they have a counter-pulse in the opposite direction that cancels out any polar effects. The negative electrode will attract neutrophils and is used in infected wounds. The positive electrode attracts macrophages and epidermal cells and is used in treating noninfected wound states. The frequency of 100 pps provides a continuous, comfortable current and has been demonstrated to promote healing. (pp. 271-272, 278)*CORRECT ANSWER

Answer 68

1. Changes in a patient's skin and nail beds may be the first sign of an inflammatory, infectious, or immunological disorder. Significant changes warrant further questioning and a report to the patient's physician. It would not be appropriate to ignore the findings. (p. 163) 2. Changes in a patient's skin and nail beds might be a sign of systemic disease. It would not be necessary to stop physical therapy, but a referral to the patient's physician would be appropriate. (p. 163) *3. Any changes in the integumentary system maybe the precursor to infection, inflammation, and systemic disease. Since the patient declines any follow-up, changes should be reported to the physician. (pp. 163, 169)*CORRECT ANSWER 4. It would not be necessary to alarm the patient by a referral to an emergency department. Questioning the patient about changes is appropriate, as is informing the physician. (p. 169)

Answer 69

*1. Midline retraining in both sitting and standing positions with the use of visual cues or a visual aide is an appropriate intervention for a patient who exhibits pusher syndrome (ipsilateral pushing).*CORRECT ANSWER 2. Weight-bearing should be encouraged on the involved lower extremity. The left lower extremity is involved, since the cerebrovascular accident affected the right side of the brain. 3. Fixed resistance on the uninvolved side should be used. The right lower extremity is uninvolved, since the cerebrovascular accident affected the right side of the brain. 4. Lowering the height of the assistive device will encourage weight-bearing on the uninvolved side.

Answer 70

*1. Herpes zoster (shingles) is a painful, blistering skin rash caused by the varicella-zoster virus. The first symptom is usually one-sided pain, tingling, or burning followed by development of a rash that usually involves a narrow area from the spine around to the front of the chest or abdomen. A typical location for occurrence of shingles rash is the T11–T12 dermatome along the iliac crest. The location of the rash, postsurgical onset, and symptoms of pain all suggest herpes zoster. (Goodman, p. 177)*CORRECT ANSWER 2. The surgical incision for a lumbar laminectomy is located along the lumbar spine. An infected surgical incision would be associated with pain, erythema, edema, and increased temperature over the wound site. (Bryant) 3. The area of rash described in the stem includes the area where the pelvic (lower) strap of the thoracolumbosacral orthosis is placed. However, contact dermatitis would not present with the dermatomal pattern described and would be more itchy than painful. (Goodman, p. 171) 4. An allergic response to medication would not be localized to a specific dermatome but would most likely be a generalized response. Also a rash due to medication is generally not painful. (Goodman, pp. 171, 435

Answer 71

1. With left brain injuries, common impairments include speech and language problems, difficulty planning and sequencing movements, and a cautious behavioral style. Spatial impairments are more likely to be associated with right brain injuries. 2. With left brain injuries, common impairments include speech and language problems, difficulty planning and sequencing movements, and a cautious behavioral style. Spatial impairments, difficulty sustaining movements, and an impulsive behavioral style are more likely to be associated with right brain injuries. *3. Certain sensory, motor, and behavioral impairments are associated with hemispheric brain injuries. With left brain injuries, common impairments include speech and language problems, difficulty planning and sequencing movements, and a cautious behavioral style.*CORRECT ANSWER 4. With left brain injuries, common impairments include speech and language problems, difficulty planning and sequencing movements, and a cautious behavioral style. Difficulty sustaining movements and impulsive behavior are more likely to be associated with right brain injuries

Answer 72

1. Pain performing the Homan Sign Test would be indicative of a possible deep vein thrombosis. It would not indicate any ligamentous or tendon tears. *2. According to the magnetic resonance imaging results, there was a complete disruption of the Achilles tendon. The Thompson Test is used to assess for an Achilles tendon rupture.*CORRECT ANSWER 3. Findings of the magnetic resonance imaging indicate a split tear of the fibularis (peroneus) brevis tendon. This muscle would test weak and painful if the tendon was torn. 4. According to the magnetic resonance imaging results, there was a complete disruption of the Achilles tendon and a complete tear of the anterior talofibular ligament. The Prone Ankle Anterior Drawer Test indicates anterior talofibular ligament instability, and this test would have a positive result in this patient.

Answer 73

1. As described in the scenario, the patient used to run 3-5 miles a day. The patient also works on a naval ship, which can be quite physically demanding and require good ankle stability. The patient at this point is only 6 weeks after surgery and demonstrates limited range of motion and an antalgic gait. Recommendations are for dynamic proprioceptive exercises and jogging not to begin until at least 12 weeks after surgery. The patient should demonstrate pain-free normal gait with normal dorsiflexion range of motion. 2. As described in the scenario, the patient used to run 3-5 miles a day. The patient also works on a naval ship, which can be quite physically demanding and require good ankle stability. The patient at this point is only 6 weeks after surgery and demonstrates limited range of motion and an antalgic gait. Recommendations are for dynamic proprioceptive exercises and jogging not to begin until at least 12 weeks after surgery. The patient should demonstrate pain-free normal gait with normal dorsiflexion range of motion before advancing to higher-level activities. *3. As described in the scenario, the patient used to run 3-5 miles a day. The patient also works on a naval ship, which can be quite physically demanding and require good ankle stability. The patient at this point is only 6 weeks after surgery and demonstrates limited range of motion and an antalgic gait. Recommendations are for dynamic proprioceptive exercises and jogging not to begin until at least 12 weeks after surgery. The patient should demonstrate pain-free normal gait with normal dorsiflexion range of motion before advancing to higher-level activities. Individuals are gradually permitted to return to sporting activities 4-6 months after surgery. Clinical criteria for return to sport activity include range of motion and strength within normal limits. Emphasis on this phase of rehabilitation is eccentric loading of the gastrocnemius-soleus complex, transitioning to independent maintenance, and directing rehabilitation toward returning to preinjury level of function.*CORRECT ANSWER 4. As described in the scenario, the patient used to run 3-5 miles a day. The patient also works on a naval ship, which can be quite physically demanding and require good ankle stability. The patient at this point is only 6 weeks after surgery and demonstrates limited range of motion and an antalgic gait. Recommendations are for dynamic proprioceptive exercises and jogging not to begin until at least 12 weeks after surgery. The patient should demonstrate pain-free normal gait with normal dorsiflexion range of motion before advancing to higher-level activities. Individuals are gradually permitted to return to sporting activities 4-6 months after surgery. Clinical criteria for return to sport activity include range of motion and strength within normal limits.

Answer 74

1. This exercise should not be performed until at least 10 weeks post-operatively. This is an advanced exercise that requires good plantar flexor strength which the patient does not have at this point. For these reasons this answer is incorrect. 2. Unilateral weight-bearing stretches should not occur until at least 10 weeks post-operatively. Since this patient is only 6 weeks post op this exercise would not be appropriate and therefore incorrect. 3. Plyometric activity is an advanced activity that may occur 12 weeks post operatively. Prior to beginning plyometric training the patient should be able to ambulate pain free without device, complete 5 unilateral heel raises at greater than 90% of the limb's maximum heel-rise height, and demonstrate normal ankle dorsiflexion. The patient in this scenario is only 6 weeks post-op and still has limited DF ROM and pain during gait. For these reasons, this answer is incorrect. *4. This exercise is a good way to restore balance reactions in standing and are appropriate for this patient in the scenario who is 6 weeks post-operative, therefore this answer is correct.*CORRECT ANSWER

Answer 75

1. Cross-sectional research involves studying a group at one point in time and generalizing the results to a population (p. 280). This is not the method described in the stem. 2. Correlational research is conducted for the purpose of determining the interrelationships among variables (pp. 281-282). This is not consistent with the stem. *3. Meta-analytical research is a process by which the results of several studies are synthesized in a quantitative way (pp. 357-358). This is consistent with the stem.*CORRECT ANSWER 4. Methodological research is conducted to determine the reliability and validity of clinical and research measurements (p. 290). This is not consistent with the stem.

Answer 76

*1. A white blood cell count of 16,000/mm3 exceeds the normal range of 4,500 to 11,000/mm3 (Hillegass, p. 268). This elevated count suggests infection, which may compromise exercise tolerances (Goodman).*CORRECT ANSWER 2. Normal response is for the oxygen saturation level to remain in the normal range of 98% to 100%. If the oxygen saturation level falls below 90% with activity, the exercise intensity should be decreased and caution used. (Hillegass, p. 558) 3. A hemoglobin level of 15 g/dL is within the normal range for males and females (Hillegass, p. 268). 4. Partial pressure of arterial oxygen (PaO2) of 80 mm Hg and partial pressure of arterial carbon dioxide (PaCO2) of 40 mm Hg are within the normal ranges (Hillegass, p. 354).

Answer 77

1. Children who have spasticity are prone to poor flexibility and would benefit from exercises to improve flexibility (p. 468). 2. Children who have juvenile rheumatoid arthritis lose a substantial amount of flexibility. A stretching program to improve flexibility is important for children who have juvenile rheumatoid arthritis. (p. 146) *3. Children who have Down syndrome are extremely flexible (p. 433).*CORRECT ANSWER 4. Children who have muscular dystrophy are prone to poor flexibility. A daily stretching program to improve flexibility is recommended for children who have muscular dystrophy. (p. 246)

Answer 78

1. Stretching of hip flexors is important for patients who exhibit limited hip extension. This patient has full passive range of motion. *2. Strength training has been shown to improve gait and muscle performance in patients who have cerebral palsy. The physical therapist should seek to create a balance of muscle activity across a joint. In this case, addressing quadriceps and gluteal muscles will be beneficial for improving knee and hip extension by counteracting the forces potentiating flexion.*CORRECT ANSWER 3. Stretching exercises should be followed by active movement to maximize gains; therefore, stretching of the hamstrings and gastrocnemius muscles without strengthening muscle groups to promote improved extension would not optimize long-term gains. 4. Although strengthening is beneficial, strengthening of the hamstrings would not counteract the forces contributing to hip flexion.

Answer 79

1. Supramalleolar orthoses would not provide enough support for an individual who has a history of S1 myelomeningocele, given the poor strength of the gastrocnemius. 2. Knee-ankle-foot orthoses provide too much support for an individual who has a history of S1 myelomeningocele, because the muscles of the knee are not weak. 3. Reciprocating gait orthoses provide too much support for an individual who has a history of S1 myelomeningocele, because the muscles of the knee and hip are not weak. *4. S1 myelomeningocele would cause weakness in the muscles of the posterior lower leg and tibia, without affecting muscle strength in the hips and knees. Solid ankle-foot orthoses would provide the appropriate support at the foot and ankle.*CORRECT ANSWER

Answer 80

*1. Chorea is a type of dyskinesia that is often observed as a side effect of antiparkinsonian medication and that typically emerges with prolonged use of such medications. Chorea is characterized by involuntary, rapid, irregular, and jerky movements.*CORRECT ANSWER 2. Dysmetria is defined as problems in judging the distance or range of movement and is associated with cerebellar dysfunction. 3. Dystonia is characterized by co-contraction of the agonist and antagonist muscles and is associated with basal ganglia dysfunction. Segmental dystonia involves two or more adjoining body regions dominated by sustained muscle contractions, causing twisting and repetitive movements and abnormal postures. 4. The presence of abnormal synergies is closely associated with lesions in the corticospinal centers that result in the emergence of mass movement patterns. Abnormal synergies are associated with motor cortex deficits.

Answer 81

1. The physical therapist should conduct further measures to rule in or out signs and symptoms that may show if the patient's problem can be addressed within the scope of practice. Results of further measures can also provide the physician with additional clinical information. (p. 3) *2. In view of the symptoms presented in the case, the therapist should screen for appendicitis by checking for the presence of a low fever as well as palpating the abdomen for tenderness (pp. 319-320).*CORRECT ANSWER 3. Frequently, appendicitis pain is aggravated by movement. The patient tends to lie down, drawing legs up to relieve the pain. Strength testing the abdominal and hip muscles may exacerbate pain unnecessarily. (p. 319) 4. Early detection of a medical problem is key to preventing further medical complications. In this case, it would be more important for the therapist to screen for an acute condition than to provide nutrition education. (p. 3)

Answer 82

*1. Excessive foot pronation during midstance to toe off is the result of a compensated rearfoot (or forefoot) varus deformity.*CORRECT ANSWER 2. A compensated forefoot valgus deformity would result in excessive foot supination. 3. Uncompensated lateral (external) rotation of the tibia would result in excessive foot supination. 4. Uncompensated pes cavus would result in excessive foot supination.

Answer 83

*1. Marked ulnar drift is a hallmark sign of rheumatoid arthritis (O'Sullivan, p. 1000). Because cervical spine ligaments can be affected in this population, cervical stabilization exercises in neutral are appropriate for managing neck pain in patients who have rheumatoid arthritis (Brody).*CORRECT ANSWER 2. Cervical spine ligaments can be affected in patients who have rheumatoid arthritis, placing the patient at high risk for subluxation and significant complications from cervical mobilization (O'Sullivan, p. 998). 3. Cervical traction is contraindicated in patients who have rheumatoid arthritis (Belanger, p. 334). 4. Although thermal agents can provide some local pain relief, application of heating modalities to an area with potential ligamentous laxity or acute inflammation is not recommended for patients who have rheumatoid arthritis (Belanger, p. 82; O'Sullivan, p. 1024).

Answer 84

*1. Sever disease is a calcaneal apophysitis and will benefit from stretching to improve flexibility of the gastrocnemius and soleus and use of a heel wedge to decrease the stress and traction of the Achilles insertion.*CORRECT ANSWER 2. Sever disease affects the Achilles area, not the plantar fascia. 3. Sever disease affects the Achilles area, not the quadriceps tendon. 4. Sever disease affects the Achilles area, not the tibialis posterior muscle.

Answer 85

*1. The pes anserine is medial and just distal to knee joint line. The semitendinosus and sartorius attach here, would be stretched with extension and valgus, and are involved in knee flexion. (p. 858)*CORRECT ANSWER 2. The patellar tendon is located on the anterior knee and would not be painful with passive knee extension (p. 857). 3. Medial meniscus injury would be painful with palpation on the joint line (p. 858). 4. The popliteus tendon is located in the posterior knee (p. 858).

Answer 86

*1. New symptoms of redness, swelling, and increasing warmth following a surgical procedure are indicators of a possible infection. The surgeon should be notified. (O'Sullivan)*CORRECT ANSWER 2. Redness, swelling, and increasing warmth are indicators of possible acute inflammation, which is a contraindication for superficial moist heat (Cameron, p. 155). 3. Ice is not the modality of choice to prepare a patient for exercise and gait training (Cameron, pp. 134-135). 4. Because the patient is demonstrating signs of a possible infection at the surgical site, the most appropriate action is to notify the surgeon. Inaction could cause potential harm to the patient. (O'Sullivan)

Answer 87

1. Although rare, a tumor could cause symptoms of radicular pain. However, plain radiographs are not considered sensitive to early changes associated with tumors, infection, soft tissue structures, and some fractures. (Dutton, p. 345) 2. Disc herniation is a common cause of cervical radiculopathy. However, plain radiographs are not considered sensitive to early changes associated with tumors, infection, soft tissue structures, and some fractures. (Dutton, pp. 1312-1313) *3. Bone spurs are a common cause of lateral stenosis, which can cause radicular pain. Osteophytes is the correct answer because radiographs provide an excellent view of cortical bone and are more sensitive than magnetic resonance imaging in detecting calcification. (Dutton, pp. 345, 1317)*CORRECT ANSWER 4. Although rare, a fracture could give some signs of cervical radiculopathy. However, plain radiographs are not considered sensitive to early and small changes associated with acute stress fractures and can result in false-negative findings. (Magee)

Answer 88

1. The results given in the stem are describing egophony. Egophony is a voice sounds test and is the transmission of an "A" sound when the patient says "E." Voice sounds will increase in patients who have consolidation, whereas in a patient who has atelectasis, voice sounds will decrease since the lung tissue is deflated and will not transmit sounds. *2. When a patient has consolidated lung tissue or increased secretions, egophony will be present. Egophony is a voice sounds test and is the transmission of an "A" sound when the patient says "E." Voice sounds will increase in patients who have consolidation.*CORRECT ANSWER 3. The results given in the stem are describing egophony. Egophony is a voice sounds test and is the transmission of an "A" sound when the patient says "E." Voice sounds will increase in patients who have consolidation, whereas in a patient who has pleural effusion, voice sounds will not be present over the effusion since the lung tissue is deflated. Voice sounds may be increased immediately above the line of the fluid of the effusion, but pleural effusion is not the most likely diagnosis since the stem describes a condition present in an entire lobe. 4. The results given in the stem are describing egophony. Egophony is a voice sounds test and is the transmission of an "A" sound when the patient says "E." Voice sounds will increase in patients who have consolidation, whereas in a patient who has a pneumothorax, voice sounds will decrease since the lung is collapsed and will not allow transmission of sounds

Answer 89

1. Manual lymph drainage is useful to stimulate circulation to the extremities and is an appropriate treatment for chronic edema (pp. 248-249). *2. Manual lymph drainage facilitates the removal of fluid from the extremities back into the circulatory system. If the patient has heart failure, the heart will not be able to handle the additional fluid and the heart failure will worsen. (p. 253)*CORRECT ANSWER 3. Manual lymph drainage is indicated for venous insufficiency. Excess fluid in the extremities can be managed by this technique. (pp. 248-249) 4. Effects of manual lymph drainage include pain relief and relaxation. It is, therefore, a useful treatment for complex regional pain syndrome (also called reflex sympathetic dystrophy). (pp. 248-249).

Answer 90

1. Posterior pelvic tilts performed in supine position would not be contraindicated for a patient who has irritable bowel syndrome (pp. 890-891). 2. Posterior pelvic tilts performed in supine position would not be contraindicated for a patient who has a duodenal ulcer (pp. 878-879). *3. When a client has a known hiatal hernia, the supine position and any exercise (such as posterior pelvic tilts) for which the patient might use the Valsalva maneuver should be avoided (pp. 901-902).*CORRECT ANSWER 4. Diverticulosis presents with diverticula in the wall of the colon or small intestine, but no infection or inflammation. Posterior pelvic tilts performed in supine position would not be contraindicated for a patient who has diverticulosis, although the patient should not hold his or her breath (perform Valsalva maneuver) when exercising. (pp. 893-894)

Answer 91

1. Although pain and swelling occur about the medial ankle in a patient who has an eversion ankle sprain, the patient would demonstrate pain with eversion stress. Also, the patient would relate this pain to a specific traumatic event (Dutton, pp. 1151-1154). The patient would also not necessarily have rearfoot pronation and forefoot abduction. 2. In retrocalcaneal bursitis, the pain is behind the ankle posterior to the talus, but there is no pain with resistive testing (Dutton, pp. 1165-1166). 3. Although pain occurs in the medial aspect of the ankle with tarsal tunnel syndrome, this condition is associated with paresthesias, which are not reported by the patient in the stem (Dutton, p. 1137). *4. The main function of the tibialis posterior is to plantar flex and invert the foot as well as support the medial arch. The tendon courses under the medial malleolus, causing pain and inflammation in this area when the tendon is dysfunctional. With a heel raise, the tendon becomes stressed due to its actions of plantar flexion and inversion. Finally, a finding of the "too many toes sign," which is the hallmark sign of this diagnosis, is due to forefoot abduction and hindfoot valgus. (Neumann)*CORRECT ANSWER

Answer 92

1. Restriction from all sports is not necessary. The patient may participate in low-intensity sports. 2. Full activity without restrictions for a patient who has pulmonary hypertension may put the patient at risk for developing cyanosis, heart failure, or pulmonary hemorrhage. *3. Although exercise tolerance for this patient is likely to be normal or only mildly impaired, intense exertion accompanied by pulmonary hypertension may result in cyanosis, heart failure, or pulmonary hemorrhage. The patient may participate in low-intensity sports.*CORRECT ANSWER 4. The patient should be encouraged to participate in low-intensity sports. Limiting the patient to only basic activities of daily living is too restrictive.

Answer 93

1. Placing the patient in prone position would take a good deal of planning, would be very staff dependent, and may position the C2–C4 fusion in an undesired position. Cervical fusion requires that the patient avoid bending and twisting the neck, which may occur when placing the patient in prone position. *2. Sidelying is the best position to relieve pressure to the affected areas and will afford the patient a safe position that will not affect the cervical spine fusion or ventilator management.*CORRECT ANSWER 3. Sitting position is not acceptable because areas of the pelvis and trunk would still be affected by pressure. 4. Supine position causes increased pressure on the sacrum.

Answer 94

*1. Blood pressure should not be taken on the ipsilateral side. This is a precaution for patients who have a peripherally inserted central line, as well as for patients who have some other lines. (pp. 450, 458)*CORRECT ANSWER 2. Although weight-bearing through the hand is a precaution for patients who have an arteriovenous graft (p. 454), it is not a precaution for patients who have a peripherally inserted central catheter inserted through the cephalic vein. 3. Although active upper extremity range of motion is a precaution for patients who have a central line and possibly for patients who have a pulmonary artery catheter, active range of motion is encouraged for patients who have a peripherally inserted line (pp. 450, 458). 4. Although maintaining elevation is a precaution for 24 hours following arteriovenous graft placement (p. 454), it is not a precaution for patients who have a peripherally inserted central catheter.

Answer 95

1. This is not the best answer as this does not assess exertional symptoms and is not a graded assessment. 2. This is not the best answer as this does not assess exertional symptoms and is not a graded assessment. 3. This is not the best answer as this is a sideline measurement for concussion. *4. This is the best choice. This is a standardized, progressive exercise test that can diagnose physiological dysfunction after concussion and differentiate between factors other than exercise tolerance that may be impacting post-concussion symptoms*CORRECT ANSWER

Answer 96

*1. This is the correct answer. The patient had a positive Head Thrust Test along with a positive Dynamic Visual Acuity Test. This imbalance of vestibular function would be the most likely reason for the dizziness experienced.*CORRECT ANSWER 2. This is not the best answer. Although this patient does exhibit convergence insufficiency, it would not be directly linked to the dizziness this patient is experiencing. 3. This is not the correct answer as both the Dix Hallpike and the Roll Test were negative. 4. This is not the best answer. Although this may play a role with higher level activities related to cervicogenic dizziness, this would not be the best answer given the positive results for a vestibular hypofunction.

Answer 97

1. This is not the best answer as this would be better added once the patent's pain and headache frequency was better managed. 2. This is not the best choice as a combination approach of manual therapy, stretching, and postural re-education has been found to be most effective. These interventions have not been found to be an effective stand along treatment strategy. *3. This is the best choice as this combination has been found to be effective in treating headaches associated with concussions.*CORRECT ANSWER 4. This is not the best choice as there have been several studies demonstrating the benefits of physical therapy in the management of cervical related headaches. Given this question is asking about what the best initial intervention would primarily be physical therapy. If headache symptoms continue past the acute phase then this would be an appropriate referral to incorporate medication as a treatment tool for headache management.

Answer 98

1. Arthrogryposis comprises nonprogressive conditions characterized by multiple joint contractures found throughout the body at birth. Fatty deposits in the skin and tufts of hair are not characteristic of this disorder. (pp. 1209-1210) 2. A spondylolisthesis is a visible or palpable step-off suggesting forward slippage of one vertebra over another. Fatty deposits in the skin and tufts of hair are not characteristic of this disorder. (pp. 1313-1314) *3. An unusual patch of hair on the back may be evidence of a bony defect of the spine. Fatty masses appearing as lumps in the area of the low back may be a sign of spina bifida. (p. 1171)*CORRECT ANSWER 4. Paget disease is a chronic bone condition characterized by disorder of the normal bone remodeling process. The bone that is formed is abnormal, enlarged, brittle, and prone to breakage. Fatty deposits in the skin and tufts of hair are not characteristic of this disorder. (pp. 1229-1230)

Answer 99

1. T-scores of -2.5 and lower indicate osteoporosis. *2. T-scores falling in the range -1.0 to -2.5 indicate low bone mass, which is osteopenia.*CORRECT ANSWER 3. T-scores of -1.0 and higher indicate normal bone mass. 4. T-scores of -1.0 and higher indicate normal bone mass.

Answer 100

1. This pattern describes bradypnea. Bradypnea is associated with impairment of the respiratory control center and may occur with an increased intracranial pressure, drug intake, or metabolic disorder. (p. 57) 2. This pattern describes tachypnea. Tachypnea is associated with respiratory insufficiency and fever as the body attempts to rid itself of excess heat. (p. 57) 3. This pattern is characteristic of Biot respirations (p. 58). *4. This is a typical Cheyne-Strokes respiratory pattern, which is an irregular respiration pattern characterized by a period of apnea followed by gradually increasing depth and frequency of respirations (pp. 57-58). This breathing pattern is often observed with depression of the cerebral hemisphere (e.g., coma), in basal ganglia disease, and occasionally with congestive heart failure.*CORRECT ANSWER

Answer 101

1. The recommended ramp length is 12 inches (30 cm) for each inch (2.5 cm) of rise (p. 324). 2. Wheelchairs can cross thresholds of up to 0.5 inch (1.3 cm) (p. 326). *3. Wheelchairs require a minimum of 32 to 34 inches (81 to 86 cm) in doorway width and would be unable to go through a door 28 inches (71 cm) in width (p. 326).*CORRECT ANSWER 4. A door opening space of 5 feet by 5 feet (1.5 m x 1.5 m) is sufficient for a door opening that swings toward the patient (p. 325).

Answer 102

*1. The cognitive stage is the beginning of the learning process. Cues, instructions, and guidance are provided by the therapist, and demonstration is used.*CORRECT ANSWER 2. Performing a task with little cognitive attention at variable speeds is characteristic of the autonomous stage of learning. 3. Problem-solving independent from the therapist's feedback is characteristic of the associative stage of learning. 4. Exploration of different strategies with little or no input from the therapist is characteristic of the associative stage of learning.

Answer 103

1. Although family involvement in the patient's care is important, there is no evidence that family involvement improves outcomes specifically in upper extremity functional tasks. 2. There is no evidence to support the use of blocked practice specifically to improve outcomes in upper extremity functional tasks. 3. Although the patient's cognitive understanding of the impairments and the intervention program is important, there is no evidence that the patient's understanding improves outcomes specifically in upper extremity functional tasks. *4. Research evidence supports that patients who possess active wrist and finger extension have improved upper extremity functional outcomes after a cerebrovascular accident.*CORRECT ANSWER

Answer 104

1. Foam dressings are highly absorbent and are appropriate for a granular wound that is draining (p. 191). 2. Collagen dressings are highly absorbent and are appropriate for a granular wound that is draining (p. 193). 3. Calcium alginate dressings are highly absorbent and are appropriate for a granular wound that is draining (p. 192). *4. Hydrogel dressings provide hydration to dry wound beds and are appropriate for a granular wound that is not draining (p. 190).*CORRECT ANSWER

Answer 105

*1. Patients who have sustained a C1–C4 spinal cord injury are dependent in bed mobility and transfers and use a power wheelchair independently as the primary means of mobility (p. 470).*CORRECT ANSWER 2. Patients who have sustained a complete C5 spinal cord injury should be able to achieve transfers and bed mobility with assistance, or at maximum are dependent for transfers and bed mobility. Power wheelchair mobility is the recommended mode of mobility, with modified independence as the highest level. (p. 471) 3. Patients who have sustained a complete C6 spinal cord injury should be able to perform transfers with some assistance and are likely to be able to perform bed mobility independently with assistance needed only for leg management at times. Manual wheelchair mobility will be possible over level surfaces, but assistance will be required over unlevel surfaces such as rough terrain and curbs. (p. 472) 4. Patients who have sustained a complete C7–C8 spinal cord injury should be able to perform transfers with modified independence and may not need a transfer board. They will be able to perform bed mobility without assistance and wheelchair mobility over most surfaces, including ramps and rough terrain. (pp. 473, 474)

Answer 106

1. Leaving this message would violate Health Insurance Portability and Accountability Act (HIPAA) regulations. Messages should be limited to clinic name and call-back number without any information specific to the patient's therapy program. (p. 363) 2. The physical therapist must give the patient advanced notice of the intent to discharge (p. 248). *3. Termination of the provider-patient relationship is justified when the patient makes a knowing voluntary election to end the relationship. This is the only option that seeks to determine the patient's wishes. (p. 467)*CORRECT ANSWER 4. The cancellations may have nothing to do with nonadherence. The therapist should notify the physician about nonadherence or when the need to terminate the patient-therapist relationship has been confirmed with the patient. (p. 467)

Answer 107

1. Although pain inhibition causes some cervicothoracic muscles to adaptively shorten after a whiplash injury, stretching them will not eliminate the cause of the hypertonicity. Stretching may give temporary relief, but the patient needs to change movement patterns and improve proprioception for long-term gains. *2. For patients in the subacute phase of healing after a whiplash injury, cervical proprioception exercises along with deep neck flexor strengthening are recommended.*CORRECT ANSWER 3. At 10 weeks after injury, the patient should be performing an active exercise program. Use of modalities for pain relief should be limited to the acute phase of healing. 4. Following a whiplash injury, there is a change in muscle fiber type from type I slow-twitch to type II fast-twitch in the deep cervical flexors. As the slow-twitch muscles function in the stabilization of the cervical spine, exercises to increase the endurance of the type I muscle fibers should be emphasized.

Answer 108

*1. The levator ani muscles consist of the pubococcygeus, iliococcygeus, and puborectalis, which actively compress the urethra, vagina, and rectum, thus maintaining continence.*CORRECT ANSWER 2. The levator ani muscles consist of the pubococcygeus, iliococcygeus, and puborectalis, which actively compress the urethra, vagina, and rectum, thus maintaining continence. The obturator internus is a lateral (external) hip rotator. 3. The levator ani muscles consist of the pubococcygeus, iliococcygeus, and puborectalis, which actively compress the urethra, vagina, and rectum, thus maintaining continence. The pubovesical ligament provides passive support. 4. The levator ani muscles consist of the pubococcygeus, iliococcygeus, and puborectalis, which actively compress the urethra, vagina, and rectum, thus maintaining continence. The anococcygeus ligament provides passive support

Answer 109

1. A pulse oximeter is used to determine oxygen saturation and is an indicator of oxygenation/perfusion in the lungs (p. 52). It is not the best method for determining exercise intensity. 2. The Karvonen formula uses a patient's resting heart rate and should not be used to determine exercise intensity because a patient who is taking metoprolol will have a blunted heart rate response. Metoprolol is a beta-blocker that lowers the maximum heart rate and, therefore, lowers the target heart rate zone. (p. 47) 3. Heart rate should not be used to determine exercise intensity because a patient who is taking metoprolol will have a blunted heart rate response. Metoprolol is a beta-blocker that lowers the maximum heart rate and, therefore, lowers the target heart rate zone. (p. 48) *4. Metoprolol is a beta-blocker that lowers the maximum heart rate and, therefore, lowers the target heart rate zone. The rating of perceived exertion is the most appropriate method to determine exercise intensity since it is not affected by metoprolol. Rating of perceived exertion is a subjective rating of intensity of exertion used to quantify effort during exercise. (p. 48)*CORRECT ANSWER

Answer 110

1. Normal diastolic pulmonary arterial pressure ranges from 5 to 15 mm Hg (Hillegass, p. 423). A measure of 3 mm Hg is pathologically low and may indicate unstable hemodynamic status, which is a relative contraindication for percussion (Hillegass, p. 544). 2. The normal range of intracranial pressure is 0 to 10 mm Hg for adults and 0 to 5 mm Hg for children younger than age 6 years. High intracranial pressure correlates with low cerebral perfusion pressure. Percussion would be likely to further increase this value. (Hillegass, p. 427) 3. Coagulopathy is a precaution for percussion (Hillegass, p. 544). Percussion, like mechanical compression or soft tissue mobilization, increases the risk of injury for patients who have a low platelet count and should not be performed without the approval of the physician (Paz, p. 188). Although a platelet count of 30,000/mm3 is a precaution, a platelet count below 20,000/mm3 is a relative contraindication (Hillegass, p. 544). *4. Normal partial pressure of arterial oxygen is greater than 80 mm Hg (Hillegass, p. 354). As this value drops, the patient may become tachypneic and tachycardic (Paz, p. 64). Airway clearance techniques, such as percussion, can help to optimize ventilation and perfusion matching, increase gas exchange, and increase alveolar ventilation by mobilizing secretions (Hillegass, p. 541).*CORRECT ANSWER

Answer 111

*1. Chest wall motion can be assessed using a tape measure with the patient in supine position. The therapist should measure the chest's circumference at the levels of the axillae and the xiphoid process to assess motions of the upper and middle chest, respectively. (O'Sullivan; DeTurk)*CORRECT ANSWER 2. Lower chest wall excursion measurements should be taken circumferentially at the midpoint between the xiphoid process and the umbilicus, not at the level of the umbilicus (DeTurk). 3. Measuring the distance between the xiphoid and umbilicus during inhalation would be done to gain some understanding of the diaphragm's functioning in this patient, but not as a measure of chest excursion (O'Sullivan). 4. The recommended method to measure chest wall excursion is circumferentially around the thorax, not by using the vertical distance between two anatomical points (DeTurk).

Answer 112

1. The myotome associated with L4 is ankle dorsiflexion. The dermatome associated with L4 is along the medial leg and foot. The stem describes involvement of the L5 nerve root. *2. The myotome associated with L5 is toe extension/dorsiflexion. The dermatome associated with L5 is the lateral leg and dorsum of the foot.*CORRECT ANSWER 3. The myotome associated with S1 is ankle plantar flexion. The dermatome associated with S1 is along the posterior thigh and lateral foot. The stem describes involvement of the L5 nerve root. 4. The myotome associated with S2 is knee flexion, and the dermatome associated with S2 is the posterior thigh and medial ankle. The stem describes involvement of the L5 nerve root.

Answer 113

1. A transfer is initially easier and safer to the strong side (Fairchild). Rotating or twisting the upper body toward the surgical side with the lower extremity fixed should be avoided after total hip arthroplasty (Cheatham). 2. The patient's left side is unaffected and able to bear weight without difficulty. The patient's ability to bear weight on the left would warrant a standing pivot transfer rather than use of a hydraulic lift. (Fairchild) *3. The femoral nerve is vulnerable to injury, which would result in quadriceps weakness. Quadriceps injury leads to knee buckling and possible injury during the transfer. Stabilizing the right knee will allow the transfer to take place with the physical therapist in control of the weak extremity. (Fairchild)*CORRECT ANSWER 4. Although an abduction pillow would help with hip precautions [avoiding hip medial (internal) rotation and adduction] (Paz), the pillow is bulky and could potentially increase problems because it does not limit hip flexion beyond 90°, which is a potential cause of hip dislocation following a posterolateral approach total hip arthroplasty (Cheatham).

Answer 114

1. When measuring forearm supination, lateral (external) rotation of the shoulder or adduction past 0° should be avoided (p. 92). Shoulder medial (internal) rotation and abduction should be avoided when measuring forearm pronation (p. 94). 2. When measuring forearm supination, lateral (external) rotation of the shoulder or adduction past 0° should be avoided (p. 92), not shoulder medial (internal) rotation. 3. When measuring forearm supination, lateral (external) rotation of the shoulder or adduction past 0° should be avoided (p. 92), not shoulder abduction. *4. When measuring forearm supination, lateral (external) rotation of the shoulder or adduction past 0° should be avoided (p. 92).*CORRECT ANSWER

Answer 115

1. The stem indicates the patient may have a venous thromboembolism. According to the Wells criteria, a history of active breast cancer with treatment, swelling, and tenderness at the posterior lower leg would warrant further testing to rule out a venous thromboembolism. Statin use is not a component of the Wells criteria and would not be taken into consideration to warrant further testing prior to mobilizing this patient. (Malone; Hillegass) 2. The stem indicates the patient may have a venous thromboembolism. According to the Wells criteria, a history of active breast cancer with treatment, swelling, and tenderness at the posterior lower leg would warrant further testing to rule out a venous thromboembolism. The patient's sex is not a component of the Wells criteria and would not be taken into consideration to warrant further testing. (Malone; Hillegass) *3. History of breast cancer is the correct answer because the stem indicates the patient may have a venous thromboembolism. According to the Wells criteria, a history of active breast cancer with treatment, swelling, and tenderness at the posterior lower leg would warrant further testing, according to the Wells criteria, to rule out a venous thromboembolism. (Malone; Hillegass)*CORRECT ANSWER 4. The stem indicates the patient may have a venous thromboembolism. According to the Wells criteria, a history of active breast cancer with treatment, swelling, and tenderness at the posterior lower leg would warrant further testing to rule out a venous thromboembolism. A history of type 2 diabetes is not a component of the Wells criteria and would not be taken into consideration to warrant further testing prior to mobilizing this patient. (Malone; Hillegass)

Answer 116

*1. Apply an abdominal binder is a correct answer because the patient is demonstrating orthostatic hypotension (drop in systolic/diastolic blood pressure with a subsequent spike in heart rate). Application of an abdominal binder will assist with venous return and help stabilize blood pressure during position changes (Fairchild, p. 217).*CORRECT ANSWER 2. Initiate active cycle of breathing exercises is an incorrect answer because this technique is used for secretion clearance. The stem/scenario does not indicate the patient requires secretion management (Frownfelter, pp. 326-327). 3. Administer oxygen via nasal cannula at 2L per minute is an incorrect answer because there is no indication the patient has a physician order for oxygen administration. Oxygen is a medication and cannot be administered without an order (Frownfelter, p. 707). 4. Discontinue therapy session and notify nursing is an incorrect answer because the vital sign findings do not warrant discontinuation of the therapy session (Hillegass, pp. 470; 473-474).

Answer 117

1. Symptoms of ulcerative colitis include mild to moderate anorexia and weight loss, abdominal pain, and skin rashes (p. 884). 2. Celiac disease is an intolerance for gluten. Initially, the condition is characterized by weight loss, abdominal bloating, weakness, and diarrhea. (p. 882) *3. The signs exhibited by the patient described in the stem are indicative of anorexia nervosa, which can occur frequently in this population (p. 93).*CORRECT ANSWER 4. Symptoms of irritable bowel syndrome include abdominal pain and bloating. Although there may be some anorexia, the evidence of long-term nutritional deficits is not as evident as in anorexia nervosa. (p. 890)

Answer 118

1. Stridor is a continuous monophonic high-pitched crowing sound heard during inspiration. It is usually caused by upper airway obstruction. (O'Sullivan, p. 57) *2. High-pitched wheezes are continuous musical sounds of variable pitch and duration that are heard on inspiration, expiration (most common), or both and are usually caused by narrow airways or stenosis (Main; O'Sullivan, p. 449).*CORRECT ANSWER 3. A pleural rub is inspiratory and expiratory grating, creaking sound like sandpaper or leather being rubbed together, usually due to pleural inflammation (Main). 4. Crackles (rales) are discontinuous, nonmusical, crackling sounds similar in sound to several hairs being rubbed together. It is most often heard on inspiration and usually caused by sudden opening of closed airways or movement of secretions. (O'Sullivan, p. 449)

Answer 119

1. Cervical flexion at 10° does not achieve the greatest opening at the intervertebral foramina, although cervical flexion in supine position allows for more patient comfort and muscle relaxation than cervical flexion in sitting position. *2. Flexion at 30° results in greater separation of the posterior structures, which include the facet joints and the intervertebral foramina. Cervical flexion in supine position allows for more patient comfort and muscle relaxation than cervical flexion in sitting position.*CORRECT ANSWER 3. Cervical flexion in sitting position does not allow for as much muscle relaxation, since the head is still in a weight-bearing position. Cervical flexion in supine position allows for more patient comfort and muscle relaxation than cervical flexion in sitting position. Facing the door does allow for more flexion of the cervical region. 4. Cervical flexion in sitting position does not allow for as much muscle relaxation, since the head is still in a weight-bearing position. Cervical flexion in supine position allows for more patient comfort and muscle relaxation than cervical flexion in sitting position. Facing away from the door gives more extension of the cervical region, but this would not open the cervical foramina, which would be necessary for treatment of cervical stenosis.

Answer 120

1. Chorea-type movements are related to a pathological condition of the basal ganglia, not the cerebellum. 2. Chorea-type movements are related to a pathological condition of the basal ganglia, not the thalamus. *3. Hyperkinetic disorders such as chorea arise from a pathological condition of the basal ganglia.*CORRECT ANSWER 4. Chorea-type movements are related to a pathological condition of the basal ganglia, not the limbic system.

Answer 121

*1. Muscle setting isometric exercises are begun immediately to prevent adhesions of the tendon to the sheath or surrounding tissues and to promote alignment of healing tissue.*CORRECT ANSWER 2. Weight-bearing is most likely restricted for as long as 6-8 weeks after a lower extremity repair. 3. Passive end-range stretching is not performed until about 8 weeks after surgery and can only be done initially within protected ranges. 4. Concentric exercises with gentle resistance are not performed until the repair has had several weeks to heal. Typically these exercises are not initiated until 8 weeks after the repair.

Answer 122

1. When mobilizing a patient who has a temporary pacemaker, the therapist should be aware of the location of the pacemaker and the wires and should monitor the patient continuously during mobilization. Although mobilization is not contraindicated in the presence of a temporary pacemaker, restrictions may be associated with the underlying condition, and the therapist should check with the nurse or physician regarding these types of restrictions. (Hillegass, p. 438) *2. When mobilizing patients who have an intra-aortic balloon pump, no hip flexion is allowed in the leg where the catheter is inserted, therefore, sitting at the edge of the bed or moving from sitting to standing position would be restricted. Patients are restricted to strict bed rest but can participate in therapeutic activities. Out-of-bed activities are contraindicated until the intra-aortic balloon pump is removed. (Hillegass, p. 440)*CORRECT ANSWER 3. The presence of a chest tube is not a contraindication to mobilization (Hillegass, p. 437). 4. Mechanical ventilation is typically not a contraindication for physical therapy (Paz). Although not a weaning mode of ventilation, assist/control mode allows the patient to generate as many breaths as needed. Patients usually tolerate increased demands during physical therapy if medically stable (Hillegass, p. 435). After cardiovascular surgery, the individual will still have good respiratory drive.

Answer 123

1. The purpose of postural drainage is to drain secretions for airway clearance. Postural drainage for the lung bases would require prone positioning, which is not likely to be tolerated by a patient who just had abdominal surgery. Splinted coughing is more appropriate for airway clearance for patients who have undergone surgery. (pp. 541, 545) 2. The oxygen saturation is within normal limits, so supplemental oxygen appears unnecessary (p. 420). 3. Deep coughing may be too painful 1 day after surgery. Splinted coughing is more appropriate for airway clearance for patients who have undergone surgery. (pp. 544-545) *4. Atelectasis is present in up to 95% of patient who undergo abdominal surgery (p. 180). Deep breathing (diaphragmatic breathing) is used to resolve atelectasis and increase oxygenation (pp. 550-551, 553).*CORRECT ANSWER

Answer 124

1. A Stage 1 pressure injury is characterized by intact skin with nonblanchable redness of a localized area, usually over a bony prominence. A pink, shiny, shallow wound without slough on the heel associated with bed rest is consistent with a Stage 2 pressure injury. *2. A pink, shiny, shallow wound without slough on the heel associated with bed rest is consistent with a Stage 2 pressure injury.*CORRECT ANSWER 3. A Stage 3 pressure injury is characterized by full-thickness skin loss. Subcutaneous fat may be visible, but bone, tendon, and muscle are not exposed. A pink, shiny, shallow wound without slough on the heel associated with bed rest is consistent with a Stage 2 pressure injury. 4. A Stage 4 pressure injury is characterized by full-thickness skin loss with exposed bone, tendon, or muscle. A pink, shiny, shallow wound without slough on the heel associated with bed rest is consistent with a Stage 2 pressure injury.

Answer 125

1. Although increasing the resistance may improve strength in the short term, in the absence of increasing the speed at which the exercise is performed, power may actually be reduced. Increasing the repetitions per set beyond 15 would be more likely to improve endurance. The combination would not be as likely to increase power. *2. Power requires a combination of strength and speed. Strength is improved by training at a greater percentage of the one-repetition maximum, at least 60% for untrained individuals and 80% to 100% for an advanced training program. Speed is an essential component of power. Strength training in the absence of increasing speed may actually reduce power. In the example described in the stem, the individual is training below 60%, so increasing the weight at which the exercise is performed, in combination with increasing the speed at which the exercise is performed, would be most likely to increase power.*CORRECT ANSWER 3. Decreasing the sets, while increasing the number of repetitions per set, may keep the training volume the same. However, without an increase in resistance and an increase in speed, this modification would be unlikely to generate an increase in power. 4. Although increasing the resistance may lead to an increase in strength, reducing the speed at which the exercise is performed would not be likely to improve power.

Answer 126

*1. Myofascial tightness in the posterior structures is a common occurrence with chronic whiplash injuries (Dutton, p. 1320).*CORRECT ANSWER 2. Although cervical facet joint pain is common after a motor vehicular collision, the exact cause, whether because of osteophytic spurring or another mechanism, remains unknown (Dutton, pp. 1320-1321). 3. Muscles that are short and tight are typically overactive, not weak. Weakness typically occurs in the deep posterior cervicothoracic musculature. (Giangarra, p. 482). 4. Patients who sustain a whiplash injury typically exhibit decreased cervical proprioception and sensorimotor deficits (Giangarra, p. 483).

Answer 127

1. Left thoracic rotation would create a rib hump on the left. In the example described in the stem, the rib hump is on the right. A structural scoliosis creates a rib hump that is present when the patient is in standing position and in full forward flexion. The rib hump in the example is not present with full forward flexion. 2. Although it is correct that this scoliosis would involve right rotation and left side bending, a structural scoliosis creates a rib hump that is present when the patient is in standing position and in full forward flexion. The rib hump in the example is not present with full forward flexion. 3. The patient exhibits a functional scoliosis since the curve disappears upon forward bending. However, left thoracic rotation and right side bending would be seen as a rib hump on the left, not the right. *4. A right thoracic rib hump is associated with a right thoracic rotoscoliosis. Scoliosis is an abnormal lateral curve that can be structural or functional. Structural scoliosis is a fixed deformity that persists during forward bending. Functional scoliosis is a changeable adaptation that is not present when fully forward flexed. The abnormal lateral curve is associated with rotation to the convex side of the curve. The rotation causes the transverse processes of the vertebrae to move posteriorly on the ipsilateral side, and the attached ribs follow to create a rib hump. In this example, the rib hump is on the right, so the rotation is to the right. The rotational component of scoliosis most frequently occurs to the convex side of the curve, so this example most likely involves left side bending.*CORRECT ANSWER

Answer 128

1. The key areas to examine to determine if returning to the workplace is appropriate include the patient's ability to access the environment, to perform the job with or without assistive technology, and to perform the job safely. It is not appropriate or within the scope of physical therapy practice to address issues of workplace satisfaction. 2. The current level of function as related to the job tasks, not the previous level of function, is key in this context. *3. A job analysis as a component of a workplace assessment is the identification of the specific components of job tasks and the work environment.*CORRECT ANSWER 4. The key areas to examine to determine if returning to the workplace is appropriate include the patient's ability to access the environment, to perform the job with or without assistive technology, and to perform the job safely. It is the employer's role to establish salary and benefit levels.

Answer 129

1. The use of superficial cooling over superficial nerves is a precaution (p. 134). 2. Hypertension is listed as a precaution for use of superficial cooling (p. 134). *3. Raynaud syndrome is listed as a contraindication for use of superficial cooling (p. 133).*CORRECT ANSWER 4. Poor cognition is listed as a precaution for use of superficial cooling (p. 134).

Answer 130

1. The biceps brachii is innervated by the musculocutaneous nerve and would be nonfunctional (p. 170). The supinator would not influence elbow flexion (p. 174). *2. If the biceps brachii and the brachialis are paralyzed, weak elbow flexion is achieved through function of the brachioradialis, which is innervated by the radial nerve (p. 170), with assistance from the pronator teres, which is innervated by the median nerve (p. 173).*CORRECT ANSWER 3. The action of the extensor digitorum is primarily at the wrist and hand (p. 204). The anconeus would assist with extension at the elbow (p. 172). 4. The brachialis is innervated by the musculocutaneous nerve and would be paralyzed (p. 169). The extensor carpi radialis longus does not have a primary action at the elbow (p. 187).

Answer 131

1. Carpal tunnel syndrome is compression of the median nerve as it enters the hand. A positive result on the Phalen Test might be present, and compression would be associated with weakness of the lumbricals. The flexor carpi radialis is innervated above the wrist and would not be weakened. (p. 483) 2. The cubital tunnel in the elbow region is a common site of entrapment neuropathy, but compression of the ulnar nerve would occur with entrapment at the cubital tunnel (p. 421). The weak muscles listed in the stem are innervated by the median nerve. *3. The flexor carpi radialis, flexor digitorum superficialis, and flexor pollicis longus and brevis are innervated by the median nerve (p. 413). The pronator teres can compress the median nerve as it passes through this muscle. Repetitive movements may be one cause of enlargement and entrapment. Symptoms would include weakness in the distribution of the median nerve distal to the pronator teres, affecting the wrist and hand (p. 413). However, because the entrapment is superior to the wrist rather than at the wrist, the result of the Phalen Test would not likely be positive.*CORRECT ANSWER 4. Compression of the median nerve that occurs with thoracic outlet syndrome is more proximal than with compression by the pronator teres and thereby affects the entire nerve distribution. However, symptoms are usually exacerbated with head movements, and weakness would be identified in all of the muscles and sensory distributions. (p. 261)

Answer 132

1. Graves disease is a hyperthyroid condition causing proximal muscle weakness and a generalized elevation of body metabolism. It has been linked to periarthritis and calcific tendinitis in the shoulder, and sometimes the wrist, but not the knee. It does not cause local joint inflammation. (Goodman, Differential Diagnosis, pp. 395, 417) 2. Complications of diabetes include atherosclerosis, delayed wound healing, and neuropathy, but not a sudden onset of monoarticular arthritis (Goodman, Differential Diagnosis, p. 403). 3. Clinical signs of sepsis include fever, tachycardia, and tachypnea (Goodman, Pathology). *4. The typical symptom of gout is acute monoarticular arthritis with redness and swelling. The knee is one of the commonly affected joints. The peak incidence is in the 40-50-year age group, and it predominantly affects men. (Goodman, Differential Diagnosis, p. 413)*CORRECT ANSWER

Answer 133

1. An individual with hypoglycemia would exhibit pallor, not a flushed appearance. 2. An individual with hyperglycemia would potentially display deep respirations, while an individual with hypoglycemia would likely experience shallow respirations. 3. An individual with hyperglycemia would experience a diminished pulse response, while an individual with hypoglycemia would experience tachycardia. *4. With the onset of hypoglycemia, an individual will experience a sudden change in appearance from normal coloration to pallor.*CORRECT ANSWER

Answer 134

1. The pectoralis major does not have attachments to the lumbar spine. 2. The pectoralis minor does not have attachments to the lumbar spine. *3. The latissimus dorsi is the only muscle listed that has an attachment to the lumbar spine (through the thoracolumbar fascia). Therefore, this is the only muscle listed that could be affected by the position of the lumbar spine. If the latissimus dorsi is short, the lumbar spine is not allowed to extend and shoulder flexion/elevation will be limited.*CORRECT ANSWER 4. The serratus anterior does not have attachments to the lumbar spine.

Answer 135

1. There are no hormonal changes that will compromise circulation while a pregnant woman is in supine position. Hormonal changes affect pulmonary secretions and rib cage position. 2. Blood volume increases 35% to 50% during pregnancy. 3. Oxygen consumption increases by 15% to 20% during pregnancy. *4. After the 20th week of gestation, the weight of the fetus can impair blood flow through the inferior vena cava when the woman is in supine position.*CORRECT ANSWER

Answer 136

1. Since there is no remaining devitalized tissue, an enzymatic agent, which is used for debridement, would no longer be needed. More appropriate and less expensive dressings should be used instead. (p. 297) 2. Alginate dressings are highly absorbent, so they are more appropriate for a wound that is producing moderate to high amounts of exudate (pp. 309-310). *3. Hydrocolloids are indicated for wounds that have low to moderate amounts of drainage and that need protection from bacteria or other contaminants (pp. 312, 314).*CORRECT ANSWER 4. Nonwoven gauze dressing would not be an appropriate choice because it would possibly adhere to the wound surface and disrupt healing (pp. 316-317).

Answer 137

*1. Initial paresis grade is an important predictor of motor recovery. Of patients admitted with complete paralysis, less than 15% experience complete motor recovery.*CORRECT ANSWER 2. Paresis status upon hospital admission has not been found to be a predictor for proprioception. 3. Paresis grade has not been found to be a predictor of executive functions. 4. The risk of seizures is more related to the location of the occlusion or infarct than to the degree of hemiparesis.

Answer 138

1. A second-degree prolapse is marked by the cervix as part of the uterus having descended through the introitus, or vaginal opening. Pelvic floor rehabilitation has become the recommended first course of treatment and should include a discussion of alternative positions for sexual intercourse. Additional functional questions should include those related to bladder and bowel habits. Questions about usual sitting patterns would not be most important to ask. 2. A second-degree prolapse is marked by the cervix as part of the uterus having descended through the introitus, or vaginal opening. Pelvic floor rehabilitation has become the recommended first course of treatment and should include a discussion of alternative positions for sexual intercourse. Additional functional questions should include those related to bladder and bowel habits. Questions about usual sleeping patterns would not be most important to ask. *3. A second-degree prolapse is marked by the cervix as part of the uterus having descended through the introitus, or vaginal opening. Pelvic floor rehabilitation has become the recommended first course of treatment and should include a discussion of alternative positions for sexual intercourse. Symptoms may be exacerbated by prolonged standing, walking, coughing, or straining (i.e., for a bowel movement). Urinary incontinence is also a common problem as a result of uterine prolapse. Additional functional questions should include those related to bladder and bowel habits.*CORRECT ANSWER 4. A second-degree prolapse is marked by the cervix as part of the uterus having descended through the introitus, or vaginal opening. Pelvic floor rehabilitation has become the recommended first course of treatment and should include a discussion of alternative positions for sexual intercourse. Additional functional questions should include those related to bladder and bowel habits. Personal hygiene is a broad category and does not relate exclusively to the presence of a prolapse. Questions related to bowel and bladder habits would be more comprehensive but are not included as options.

Answer 139

1. Common moles and other normal skin changes usually have smooth, even borders or edges. Malignant melanomas have uneven, notched borders. *2. A single lesion with more than one shade of black, brown, or blue may be a sign of malignant melanoma.*CORRECT ANSWER 3. Round, symmetric skin lesions, such as common moles, freckles, and birthmarks, are considered normal. 4. The average mole is less than 0.25 inch (6.3 mm) in diameter. Anything larger than this should be inspected carefully.

Answer 140

1. High Fowler position is defined as a position in which the head of the patient's bed is raised 80° to 90° with knees flexed (p. 173). Over time this position increases the risk of development of a knee flexion contracture (p. 190). *2. The residual limb supported by pillows and the knee resting in full extension is the preferred position, because it decreases the risk for knee flexion contracture (p. 190).*CORRECT ANSWER 3. In this position the residual limb is supported, but the knee is still flexed, creating pressure on the distal end of the residual limb that could lead to pressure injuries (p. 190). 4. In this position the residual limb is in a dependent position, which promotes swelling, and the knee is flexed, which promotes knee flexion contracture (p. 190).

Answer 141

1. Supine position is best to drain the upper lobes, anterior segments. *2. Leaning forward over a pillow is the best position to allow for drainage of the upper lobes, posterior segments.*CORRECT ANSWER 3. Long sitting, leaning back is best used to drain the upper lobes, apical segments. 4. Prone position with the bed flat is best to drain the lower lobes, superior segments.

Answer 142

1. In the management of chronic low back pain, stretching, strengthening, and mobility should be promoted (p. 1480). *2. Aerobic exercise combined with specific strengthening may decrease the frequency of low back pain recurrence (p. 1480).*CORRECT ANSWER 3. Traction is utilized in the acute phase for patients who have signs of nerve root impingement and for whom symptoms are not centralized with any lumbar movement (p. 1204). 4. Bracing is used for temporary pain relief during the acute phase of nerve root impingement (p. 1479).

Answer 143

1. A center coordinator for clinical education may be a physical therapist or physical therapist assistant however it may be another professional besides a physical therapy practitioner (p. 91). 2. Reviewing daily student documentation is not part of the role of the center coordinator for clinical education but is rather the role of the clinical instructor (pp. 91-92). *3. Serving as a liaison between clinical education sites and the academic institution is the primary role of the center coordinator for clinical education (p. 91).*CORRECT ANSWER 4. Acting as a clinical instructor for physical therapy students is a role that is separate and distinct from the role of the center coordinator for clinical education, although a center coordinator for clinical education may also be a clinical instructor (p. 92).

Answer 144

1. Uncontrolled seizures within the last year are considered a contraindication for aquatic therapy, not a history of seizures in the previous 2 years. 2. Human immunodeficiency virus (HIV) is not a waterborne or airborne transmitted infection. Only waterborne and airborne transmitted infections are contraindications for aquatic therapy. 3. An open wound is not a contraindication as long as it is covered with an occlusive dressing. *4. Aquatic therapy is contraindicated for patients who have a vital capacity of 1 liter or less.*CORRECT ANSWER

Answer 145

*1. Entrapment of the ulnar nerve as it courses through the hook of the hamate and the pisiform can lead to paresthesia along the ulnar side of the hand into the volar (palmar) aspect in the little finger (5th digit) and medial half of the ring finger (4th digit). It will also lead to weakness of the hypothenar muscles, making it difficult to perform gripping activities, such as opening jars or turning doorknobs. Common etiologies include repetitive gripping as occurs with knitting, tying knots, or using pliers and staplers. (p. 409)*CORRECT ANSWER 2. Carpal tunnel syndrome is a disorder affecting the median nerve as it courses through the wrist (p. 405). It is characterized by numbness and tingling in the median nerve distribution of the hand in the volar (palmar) aspect of the lateral three and a half digits (p. 388). It is also marked by atrophy of the first two lumbricals and the thenar muscles. Symptoms tend to get worse at night (p. 406). 3. Thoracic outlet syndrome is characterized by symptoms related to entrapment of the neurovascular bundle in the neck and shoulder region and will have more widespread symptoms that are not just localized to the hand (p. 402). 4. Complex regional pain syndrome typically occurs after trauma or injury to the affected extremity and is characterized by hyperesthesia and pain that is out of proportion to the injury. It is also characterized by edema, vasomotor instability, trophic changes, and, in chronic cases, increased fibrosis and synovial proliferation leading to joint restrictions. (p. 410)

Answer 146

1. With the wrist in neutral, the finger flexors are not lengthened to the optimal length for tenodesis action and, as a result, are not as likely to generate the greatest force. 2. In 15° of flexion, the finger flexors are shortened and, as a result, are not as likely to generate the greatest force. *3. A muscle has maximal ability to generate force (or tension) when the muscle is contracted at its optimal length. Finger flexors involved in grip cross the wrist, so wrist position affects the length of the finger flexors and consequently also affects the ability of the flexors to generate force. The optimal length of the finger flexors is maintained when the wrist is held at approximately 30° of extension.*CORRECT ANSWER 4. In 60° of extension, the wrist flexors are lengthened beyond their optimal length and, as a result, are not as likely to generate the greatest force.

Answer 147

1. A decrease, not increase, in hair growth in the lower extremities is expected in patients who have chronic lower limb ischemia. *2. With chronic ischemia due to arterial insufficiency, a cardinal sign is that the skin in the lower extremities becomes thin, scaly or shiny, and transparent due to inadequate blood flow.*CORRECT ANSWER 3. The lower extremity nail beds are typically thick and brittle, not thin and supple, in patients who have chronic lower limb ischemia. 4. With ischemia, there is decreased blood flow, so the skin feels cooler, not warmer.

Answer 148

*1. When communicating with a person who has difficulty speaking, physical therapists should intensify their listening skills and provide feedback to the individual to indicate understanding.*CORRECT ANSWER 2. A person who is hearing impaired may need to have tactile or visual cues, but this would not be most appropriate for a person who has difficulty speaking. 3. When communicating with a person who has difficulty speaking, the physical therapist should use questions that require brief responses. 4. The physical therapist should speak directly to the patient rather than to a companion or family member.

Answer 149

1. Bilateral touch, also known as sensory extinction, tests a patient's ability to perceive simultaneous stimuli. The patient states "one" or "two" to indicate the number of stimuli felt. (p. 96) *2. The assessment described in the stem tests the sensory modality of touch localization, which is the ability to localize the area tested after a stimulus was provided with vision occluded (p. 95)*CORRECT ANSWER 3. The sensory modality that best fits the stem described is touch localization. If the patient were asked to indicate an affirmative response when the stimulus is felt, then the appropriate sensory modality tested would have been touch awareness. (p. 93) 4. The touch pressure threshold is tested using Semmes-Weinstein monofilaments. The patient indicates when the stimulus from the monofilaments is felt. (p. 548)

Answer 150

*1. A patient who has lower crossed syndrome will have tight erector spinae and iliopsoas muscles and weak abdominal and gluteus maximus muscles. This results in an anterior pelvic tilt, an increased lumbar lordosis, and a slight flexion of the hip.*CORRECT ANSWER 2. A patient who has lower crossed syndrome will have tight erector spinae and iliopsoas muscles and weak abdominal and gluteus maximus muscles. This results in an anterior pelvic tilt, an increased lumbar lordosis, and a slight flexion of the hip, not slight extension of the hip. 3. A patient who has lower crossed syndrome will have tight erector spinae and iliopsoas muscles and weak abdominal and gluteus maximus muscles. This results in an anterior, not posterior pelvic tilt, an increased lumbar lordosis, and slight flexion of the hip. 4. A patient who has lower crossed syndrome will have tight erector spinae and iliopsoas muscles and weak abdominal and gluteus maximus muscles. This results in an anterior, not posterior pelvic tilt, an increased lumbar lordosis, and a slight flexion, not extension, of the hip.

Answer 151

1. Cryotherapy would restrict blood and lymph flow due to the physiological reaction to cold. This is contrary to the effect the therapist is attempting to achieve to relieve lymphedema. (Zuther, p. 505) *2. Manual lymphatic drainage and compression with short-stretch dressings are the cornerstones of lymphedema therapy (Zuther, p. 247).*CORRECT ANSWER 3. Percussive massage, also known at tapotement, is used to stimulate the skin, subcutaneous tissue, and muscle tissue (Andrade). It is applied with considerable pressure and should not be confused with techniques of manual lymph drainage, which are very gentle techniques designed to have an effect on fluid components and lymphatic structures located in the superficial tissues (Zuther, pp. 247-248). 4. Negative pressure therapy is more appropriate for wound treatments (Hamm).

Answer 152

1. Pitting is generally more pronounced in the early stages of lymphedema (p. 73). 2. If lymphedema management starts in Stage 3, reduction of lymphedema can still be expected; it may just take longer (p. 74). 3. There is no specific period of time for each stage (p. 72). *4. There is no cure or permanent remedy for lymphedema (p. 71).*CORRECT ANSWER

Answer 153

1. Clubbing of the digits is associated with conditions that have interfered with tissue oxygenation and perfusion for a long period of time. Pleuritis is most often an acute condition that is managed quickly. Pleuritis is not commonly associated with digital clubbing. (pp. 775-776, 859) 2. Clubbing of the digits is associated with conditions that have interfered with tissue oxygenation and perfusion for a long period of time. Atelectasis is most often an acute condition that is managed quickly. Atelectasis is not commonly associated with digital clubbing. (pp. 775-776, 883) 3. Clubbing of the digits is associated with conditions that have interfered with tissue oxygenation and perfusion for a long period of time. Pleural effusion is most often an acute condition that is managed quickly. Pleural effusions are not commonly associated with digital clubbing. (pp. 775-776, 860-861) *4. Clubbing of the digits is associated with conditions that have interfered with tissue oxygenation and perfusion for a long period of time. A chronic disorder that causes hypoxemia, such as pulmonary fibrosis, can cause digital clubbing. (pp. 775-776, 812)*CORRECT ANSWER

Answer 154

1. Hip dysplasia occurs when the femoral head is subluxed or dislocated from the acetabulum. It is typically diagnosed in infancy and occurs more often in females. This patient is the wrong sex and is beyond the normal age range for this condition to cause an acute onset of pain. (Goodman, pp. 1178, 1181) 2. Femoroacetabular impingement (FAI) typically occurs in young to middle-aged active adults. The pain is typically activity related and intermittent at first. (Cheatham, pp. 114-115) 3. Slipped capital femoral epiphysis (SCFE) is an acute or chronic fracture of the proximal femoral physis. It typically occurs in males in early adolescence. It may occur acutely. This patient is beyond the normal age range for this condition to cause an acute onset of pain. (Cheatham, p. 230) *4. Osteonecrosis typically has a gradual onset of pain, occurs between the 3rd and 5th decades, and is more likely to occur in males than in females. History of corticosteroid use is a risk factor for osteonecrosis. (Goodman, pp. 1364-1365) Symptoms may be nonspecific and clinical findings vary. Pain is likely to be exacerbated with weight bearing activity however is often present even at rest (Dutton, p. 252).*CORRECT ANSWER

Answer 155

*1. The piriformis arises from the anterior aspect of S2–S3 and S4 segments of the sacrum and attaches to the upper border of the greater trochanter of the femur. The piriformis primarily functions to produce lateral (external) rotation and abduction of the femur but is also thought to function as a medial (internal) rotator and abductor of the hip if the hip joint is flexed beyond 90°. The piriformis has been implicated as the source for a number of conditions in this area, including entrapment neuropathies of the sciatic nerve, trigger points, and tender points. (pp. 879, 1533)*CORRECT ANSWER 2. The gluteus minimus is the major medial (internal) rotator of the femur. It also abducts the thigh as well as helps the gluteus medius with pelvic support. The muscle activation described in the scenario is performed by the piriformis muscle. The piriformis primarily functions to produce lateral (external) rotation and abduction of the femur but is also thought to function as a medial (internal) rotator and abductor of the hip if the hip joint is flexed beyond 90°. (pp. 879, 1533) 3. The obturator externus is an adductor and lateral (external) rotator of the hip in neutral (p. 880). The muscle activation described in the scenario is performed by the piriformis muscle. The piriformis primarily functions to produce lateral (external) rotation and abduction of the femur but is also thought to function as a medial (internal) rotator and abductor of the hip if the hip joint is flexed beyond 90° (pp. 879, 1533). 4. The obturator internus is normally a lateral (external) rotator of the hip in neutral and a medial (internal) rotator of the ilium but becomes an abductor of the hip at 90° of hip flexion (p. 879). The muscle activation described in the scenario is performed by the piriformis muscle. The piriformis primarily functions to produce lateral (external) rotation and abduction of the femur but is also thought to function as a medial (internal) rotator and abductor of the hip if the hip joint is flexed beyond 90° (pp. 879, 1533).

Answer 156

*1. Lesions in the skin are often the first sign of an underlying rheumatic disease. Scleroderma is accompanied by many skin changes. (p. 445)*CORRECT ANSWER 2. Thromboangiitis obliterans or Buerger disease is vasculitis affecting the peripheral blood vessels. Clinical manifestations of pain and tenderness in the affected part are caused by occlusion of arteries, reduced blood flood, and subsequent reduced oxygenation. Symptoms of cold sensitivity, rubor (redness from dilated capillaries under the skin), cyanosis, and thin, shiny, hairless skin (trophic changes) occur from chronic ischemia. Thus, integumentary changes occur in the latter part of the disease process, when chronic ischemia and oxygenation may eventually lead to ischemic ulceration and possible development of gangrene. (p. 637) 3. Mild anemia often causes only minimal and usually vague symptoms such as fatigue. As anemia progresses, the general signs and symptoms caused by the inability of anemic blood to supply the body tissues with enough oxygen may include pallor or yellowness of skin, especially of the palms of the hands and fingernails, mucosa, and conjunctiva; leg ulcers; and occasionally koilonychia or spoon-shaped nails. (p. 715) 4. Integumentary clinical manifestations of hypothyroidism include carotenosis, poor wound healing, and dry, flaky skin (pp. 488-489).

Answer 157

1. Variations of tapotement consist of brisk percussive movements with the goal of increasing alertness or stimulating airway clearance, not improving scar mobility (Benjamin, pp. 279-280). 2. Effleurage is a slide or glide over the skin with continuous motion and light to moderate pressure in order to increase relaxation as well as venous and lymphatic drainage, not to improve scar mobility (Dutton, p. 425). 3. Pétrissage involves compression of soft tissue structures by means of kneading, wringing, rolling, and picking up techniques to release areas of muscle fibrosis, not improve scar mobility (Dutton, p. 425). *4. Friction involves direct circular or cross-fiber massage applied to increase mobility of scar tissue (Dutton, p. 422; Benjamin, p. 279).*CORRECT ANSWER

Answer 158

1. Exercise should be avoided during the peak activity time of insulin, because insulin is absorbed much faster with exercise, thus altering its effectiveness. 2. With greater effects of insulin associated with exercise, food intake should occur to avoid hypoglycemia. 3. It is important that the person avoid insulin injections within 1 hour of exercise because insulin is absorbed much more quickly in active extremities. This can cause blood glucose levels to drop. *4. Exercise typically increases insulin sensitivity and enhances the effect of insulin. Therefore, glucose intake should be increased to counter the effects of exercise. Insulin intake could be decreased to counter the effects of exercise. During prolonged activity, a snack is recommended for every 30 minutes of activity.*CORRECT ANSWER

Answer 159

1. Resistance training has been shown to be beneficial for patients who have primary progressive multiple sclerosis (p. 690). 2. Exercising to the point of fatigue is contraindicated and can result in worsening of symptoms, most notably increasing weakness (p. 689). *3. Patients who have primary progressive multiple sclerosis should exercise when the core body temperatures is the lowest and before fatigue sets in. Most commonly, this is in the morning hours. (p. 690)*CORRECT ANSWER 4. Heart rate responses may be attenuated during exercise. A category-ratio rating of perceived exertion scale can be used to estimate central and peripheral exertion. Heart rate may be difficult to monitor due to dysautonomia; sensory loss in the fingers may make self-monitoring difficult. (pp. 690-691).

Answer 160

1. Stretching the gluteus maximus to 90° of hip flexion will not improve long sitting, which involves the hamstrings (Umphred). 2. Patients who have a complete T4 injury do not have control of abdominal or low back muscles (O'Sullivan, p. 886). *3. Stretching of the hamstring muscles prevents overstretching of the back during long sitting. Passive low back muscle tightness is important to develop for passive trunk stability. Straight leg raises less than 100° to 110° in long sitting put a passive pull on the pelvis, resulting in posterior pelvic tilt and stretching of the low back. (O'Sullivan, p. 894)*CORRECT ANSWER 4. Patients who have a complete T4 injury do not have control of abdominal or low back muscles (O'Sullivan, p. 886).

PEAT #1 Flashcards

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