Sample Test

1. In splinting or immobilization, the functional position of the hand includes wrist:

a. extension, phalangeal flexion, and thumb abduction
b. extension, phalangeal extension and thumb abduction
c. extension, phalangeal flexion and thumb adduction
d. flexion, phalangeal flexion and thumb adduction

2. During pregnancy, which of the ff is contraindicated?

a. curl-ups
b. bridging
c. double leg lifts
d. deep breathing with forced expiration

3. A target heart rate is determined for individual entering a training program in order to:
a. regulate exercise intensity
b. estimate energy expenditure
c. control blood pressure and specific heart rate
d. ensure participants exercise at maximal capacity

4. A herniated nucleus pulposus at the L3-L4 disc produces which of the ff clinical findings?
a. numbness in the back of the calf & dorsiflexor weakness
b. numbness in the anteromedial thigh & knee & quadriceps weakness
c. numbness & weakness in the thigh, legs, feet &/or perineum
d. numbness in the back of the calf & atrophy of gastroc & soleus

5. The intervention for a patient with limitation of shoulder flexion and medial rotation includes mobilization. Which
glide is the most appropriate for
mobilizing this shoulder to specifically increase the restricted motion?
a. Posterior
b. Anterior
c. Medial
d. Lateral

6. Which of the following techniques is MOST appropriate for patient with low postural tone?
a. Slow regular rocking while sitting on the treatment bolster
b. Continuous pressure to the skin overlying the back muscle
c. Low frequency vibration to the back muscle
d. Joint approximation applied through the shoulder to the trunk

7. Which skin change is associated with aging has the GREATEST effect on wound healing?
a. reduction in sensation
b. decrease elasticity of the skin
c. decrease epidermal proliferation
d. change in pigmentation

8. Which of the ff technique is MOST effective in teaching an IDDM patient about foot care?
a. Reassure that the pt that no infection will occur if the directions are followed, then demonstrate procedure
b. Tell patient how foot care is performed, then watch patients performance
c. Watch pt perform foot inspection & caution him that amputation results from unattended skin problems
d. Have pt demonstrate a foot inspection, then give feedback on pt’s performance

9. For a child with DMD, the MOST appropriate PT goal would be:
a. prevention of contractures & determine method of mobility
b. preservation of strength & muscle tone
c. inhibition of abnormal tone & facilitation of normal movement & position reaction
 d. facilitation of normal movement & improvement of strength

10. A patient with complete long thoracic nerve injury would have difficulty in:
c. putting hand in the back pocket
d. bending toward involved side
e. taking a deep breath
f. reaching forward above head

11. Outcomes of prenatal exercise program would not include:

a. improved body mechanics
b. application of relaxation technique
c. improve ligament flexibility
d. strengthen pelvic floor musculature

12. Utilization review & peer review are activities that are part of a comprehensive
a. policy & procedure manual
b. quality improvement program
c. audit cycle
d. performance evaluation

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

a. the PT will reduce pt’s hip flexion contracture to neutral
b. the pt will ambulate 75 feet independently in 3 weeks
c. the PT will reduce pt’s pain from 7/10 to 3/10
d. the pt will understand how to increase ADL in 4 weeks

14. Patient has a limited ankle dorsiflexion ff ORIF of distal tibia. Radiographs reveal that the fracture is well healed.
Treatment with passive
mobilization should include:
a. posterior glide of talus on tibia
b. lateral glide of calcaneus on tibia
c. posterior glide of tibia on talus
d. anterior glide of talus on tibia

15. A pt who has recently & successfully completed a 12 week program of phase III cardiac rehab will MOST likely
demonstrate a decrease in
a. CO2 elimination in maximal work
b. cardiac output in maximal work
c. stroke volume at a given level of sub maximal work
d. heart rate at a given level of sub maximal work

16. The demographic information on the subject in a research study list a mean age of 32 & median of 35. The
difference between the median & mean
indicates
a. the value of standard deviation score
b. the value of the Z-score
c. that the distribution is skewed
d. that the two measures should be average

17. Rocking in a quadruped position could be included in PT intervention for a 40-year old pt to increase ROM at
the:
a. hip joint, 1 month total hip replacement
b. distal radioulnar joint, 2 weeks post fracture of the distal radius
c. glenohumeral joint, 2 months post rotator cuff tear
d. hip joint, 1 week post subcapital fracture of the femoral neck
18. A therapist is treating a young athlete with gastrocnemius muscle strength of fair plus (3+/5). In the prone
position, which of the ff exercises is the
MOST appropriate, to maximize strengthening?
a. resistive exercises with the knee bent
b. resistive exercises with the knee straight
c. active exercises with the knee bent
d. active exercises with the knee straight

19. Redness on the inferior aspect of the patella upon removal of a patellar-tendon bearing prosthesis indicates that
the residual limb:
a. is not far enough into the prosthesis & fewer socks should be worn
b. is not far enough into the prosthesis & additional socks should be worn
c. has slipped too far into the prosthesis & fewer socks should be worn
d. has slipped too far into the prosthesis & add’nl socks should be worn

20. A PT is evaluating a pt with an acute lumbar disc protrusion & a right lateral shift of the thoracic spine. Which of
the ff findings would be the BEST
indicator that the sx will respond positively to PT intervention?
a. The pain is referred only in the buttock & not the thigh
b. The patient prefers standing & walking than sitting
c. There is a decrease in lumbar lordosis
d. Repeated backward bending centralizes the pain

21. A therapist evaluates a pt who has lateral epicondylitis. The pt reports a subjective pain of 8/10. The pt also
reports pain & shows weakness with
resisted wrist extension. The therapist decides to use ice massage as an intervention. The MOST appropriate
length of time for the ice massage is:
a. ten minutes
b. until the area turns red & pt reports burning sensation
c. until the pt reports that the area feels numb
d. no longer than five minutes

22. Ff spinal jt mobilization procedure, a pt calls the therapist & reports a minor dull ache in the treated area of the
back that lasted for 2-3 hrs. Based on
this sx, the therapist should:
a. consider a possible neurological lesion in the area
b. refer the pt back to the physician
c. inform the pt that the response is common
d. add strengthening ex to the home program

23. In order to conduct an experimental study on pain in postsurgical orthopedic pts, a therapist randomly assigns pt
into two groups. One group is treated
with TENS, heat & ex; the second receives heat & ex only. In this experimental design, TENS is the:
a. continuous variable
b. dependent variable
c. discrete variable
d. independent variable

24. A 90-yr-old pt with chronic CHF has been non-ambulatory & a nursing home resident in the past yr. The pt was
recently admitted to the hospital ff an
episode of dehydration. Which of the ff plans for prophylactic respiratory care is MOST appropriate?
a. turning , coughing & deep breathing q 1-2 waking hrs
b. vigorous percussion & vibration 4 times / day
c. gentle vibration, with the foot of the bed elevated once a day
d. segmental postural drainage using standard positions throughout the day

25. Which diagnostic procedure is LEAST likely to confirm suspected disc herniation in a pt with low back pain?
 a. MRI scan
b. CAT scan
c. Radiograph
d. Myelogram

26. To help the students apply newly learned skill to clinical practice, the MOST effective action for the clinical
instructor to take is to:
a. point out possible pt situations & discuss how the skill would apply to them
b. have the students research reference materials & compile a list of the steps required in the acquisition of
the skill
c. prepare a list if indications & contraindications for the skill
d. have the students provide eg. of pt situations where the skill would be appropriately applied

27. It is important to perform cool-down ex’s immed ff a general aerobic program PRIMARILY in order to prevent:
a. venous pooling
b. cardiac arrhythmia
c. decrease body temperature
d. muscle tightening

28. The intervention for a pt who has right sciatic pain caused by piriformis compression would NOT include:
a. instruction in mild self-stretching in sitting with the right hip & knee flexed & pressure applied in the
medial direction to the distal thigh with the left arm
b. contract-relax ex to the hip ext-rotators performed with the pt sidelying & the right hip & knee pos’ned in
90 deg of flexion
c. active resistive strengthening ex to the piriformis with the pt prone & the knee flexed
d. applic of cold to the area of sciatic nerve irritability

29. A PT is assigned in the planning & implementation of services for all members of the community. The therapist
FIRST step would be:
a. develop a brochure for distribution to the community
b. organize a health fair to provide screening for the community
c. evaluate existing services & community resources
d. initiate contacts in the medical community to establish prescriptive relationships

30. To prevent contractures in a pt with an AKA (transfemoral), emphasis should be placed on designing a
positioning program that maintains ROM in
the hip:
a. flexion & abduction
b. extention & adduction
c. adduction & lateral rotation
d. flexion & medial rotation

31. After a long-term history of bilateral LE vascular insufficiency an otherwise healthy pt had a right AKA. For this
pt, which of the ff is the MOST
impt factor in establishing long-term goals for fxn’l walking?
a. Status of the wound at the amputation site
b. ROM of the right hip
c. Condition of the left lower extremity
d. Ability to maintain upright posture

32. A pt is referred to PT complaining of severe pain in the right hip & groin area, which increases during walking.
The pt complains of tenderness when
the therapist palpates the area over the right greater trochanter. The MOST likely cause of the pt’s s/sx is:
a. sacroiliac joint derangement
b. a hip fx
c. a strain of the add longus muscle
 d. hip bursitis

33. A PT is conducting a 12-min walk test with a pt who has COPD & uses 2L/min of O2 by nasal cannula. The pt’s
resting O2 saturation is 91% & the
resting heart rate is 110 bpm. The O2 flow should be increased if the
a. pt’s CO2 level starts to increase
b. pt starts to complain of SOB
c. pt’s O2 saturation falls below 87%
d. pt’s heart rate is greater than 150 bpm

34. When working with a neurological pt to ensure that PT services are adequately documented, it is MOST impt to
record changes in:
a. muscle tone
b. functional abilities
c. cognitive status
d. quality of movt

35. A pt has R hemiparesis resulting from TBI. When assessing motor control in the R LE with the pt standing, the
PT finds that the pt cannot extend the
hip while flexing the knee or flex the hip while extending the knee. In which of the ff fxn’l activities will this
problem be MOST apparent?
a. Shifting weight while standing
b. Walking sideways
c. Walking backward
d. Moving from sitting pos’n to standing pos’n

36. A pt was injured in a motor vehicle accident two days ago, resulting in quadriplegia at C6 level. When providing
PROM to the UE, which of the ff is
MOST critical in order to optimize long-term hand fxn?
a. Passive wrist & finger extension ex to gain maximum stretch of the finger flexors
b. Passive wrist & finger flexion ex to gain maximum stretch of the finger extensors
c. Holding the wrist in flexion when passively extending the fingers
d. Holding the wrist in extension when passively extending the fingers

37. An athlete sustained a severe inversion sprain of the R ankle while playing basketball. To provide strapping
support for the ankle, pressure & support
should be applied over the tendons of the:
a. flexor digitorum longus & tibialis posterior
b. gastrocnemius & FHL
c. peroneus longus & brevis
d. tibialis ant & tibialis post

38. In which of the ff conditions would a nerve conduction velocity test be MOST important?
a. Carpal tunnel syndrome
b. Cerebrovascular accident
c. Myotonia
d. DMD

39. When training a pt to increase muscle activity with the use of EMG biofeedback, the therapist should adjust the
unit so that sensitivity:
a. starts low & increases as the pt shows an increase in muscle activity
b. starts high & decreases as the pt shows an increase in muscle activity
c. remains at approximately mid-range during the entire tx period
 d. is not set, since this is not necessary for this form of biofeedback

40. A pt with leukemia has developed thrombocytopenia ff a bone-marrow transplant. Which of the ff measures are
indicative of the status of the
thrombocytopenia?
a. T4 lymphocyte count
b. Red blood cell count
c. Platelet count
d. White blood cell count

41. During a postural examination, the PT notes that the pt’s patella both point inward when viewed from the front of
the pt. The MOST likely cause of
this problem is excessive:
a. femoral anteversion
b. weakness of the vastus medialis
c. genu varum
d. medial tibial tortion

42. A PT is evaluating a pt who has a vascular lesion in the brainstem affecting the oculomotor nerve. During the
cranial nerve examination, which of the
ff would be the MOST significant sign?
a. Inability to close the eyelid
b. Medial strabismus
c. Ptosis of the eyelid
d. Constricted pupil

43. For a pt with IDDM who is completing a cardiovascular fitness program, what change in diabetic management is
MOST likely to be instituted as
fitness increase?
a. Switching to oral rather than injected medication
b. Decreasing caloric intake for 2-3 hrs ff ex sessions
c. Decreasing the amount of insulin taken daily
d. Increasing the amount of insulin taken daily

44. An elderly pt presents with a sacral pressure ulcer measuring 6 in x 6 in. The wound has moderate serous fluid
drainage & is loosely covered with
necrotic & fibrotic tissue, although there are no indications of infection present. The BEST method of
debridement would be:
a. daily vigorous scrubbing of the wound
b. wet-to-dry dressings with normal saline 2 times a day
c. daily wet-to-dry dressings with 1:1 diluted povidone-iodine (Betadine)
d. whirlpool jet agitation 2 times a day

45. A pt is referred to PT for tx of tenosynovitis. The pt complains of “pins & needles” sensation on the palmar
surface of the first three fingers. The
PTs examination reveals a (+) Tinel’s sign at the wrist & good (4/5) grade thumb opposition. Based on these
findings, the therapist should suspect:
a. median nerve compression at the wrist
b. ulnar nerve compression distal to the elbow
c. tenosynovitis of APL
d. Thoracic outlet syndrome

46. A pt has disuse atrophy of the anterior compartment muscle ff cast removal after a fx of the tibia. The pt has poor
(2/5) strength in the ankle
dorsiflexors. ES is to be used to enhance DF strength in conjunction with ex. Initially, which of the ff waveform
characteristics are MOST
appropriate to stimulate the muscles?
 a. Monophasic pulse with a freq of 110 pps & on/off cycle ratio of 3:1
b. Biphasic pulse with a freq of 30 pps & an on/off cycle ratio of 1:5
c. Direct current waveform with an on/off ratio of 1:1
d. Interferential waveform with a beat freq of 1 pps

47. A pt is referred to PT with a 20 deg knee flexion contracture ff arthroscopic knee surgery a month ago. All of the
ff interventions are approp
EXCEPT
a. stretching of the semimembranosus muscle
b. strengthening of vastus medialis
c. inferior gliding of the patella
d. mobility of the posterior capsule of the knee joint

48. A pt with a complete SCI is sitting in a wheelchair on a custom made cushion. Pressure relief activities should be
performed:
a. when the pt shows signs of pressure sores
b. every 15 to 20 min
c. every 1-2 hrs
d. if the pt does not have an approp cushion

49. During an _eval, a pt lacks 10 deg of passive ankle dorsiflexion. The same deg of limitation is present whether
the knee is flexed or extended. The
muscle MOST likely contributing to this restriction is the:
a. gastrocnemius
b. tibialis anterior
c. plantaris
d. soleus

50. Which of the ff assignments is MOST approp for the PT to delegate to a volunteer?
a. Restocking tx booths with linens, US gel, massage lotion
b. Attending a pt who is on a tilt table while the therapist takes a phone call
c. Transporting a pt who complains of dizziness back to his room
d. Transferring a pt from the mat to a wheelchair

51. A pt sustained a severe brain stem injury one week ago & has demonstrated minimal change since the incident.
The pt’s cognitive status is MOST
likely to include:
a. a decrease level of arousal
b. a decrease level of intelligence
c. an increase level of agitation
d. an increase level of impulsivity

52. The hospital administrator asks members of the rehabilitation department to develop a comprehensive program to
help reduce the risk of low back
injuries. Which of the ff would be the FIRST step necessary to develop this program?
a. Include all employees in a lumbar extension ex class
b. Design a program that meets each dept’s fxn’l needs
c. Perform an ergonomic analysis on each workstation
d. Provide pamphlets on proper body mechanics

53. To maximize continuity of pt care, the PT should begin discharge planning when the:
a. physician refers the pt for discharge
b. therapist makes the discharge _eval of the pt
c. discharge planner request info pertinent to the pt’s discharge status
d. therapist performs initial _eval of the pt
54. The PT is positioning a pt for postural drainage. In order to BEST drain the posterior segment of both lower
lobes, the pt should be placed in which
of the ff positions?
a. Prone, head down at 45 deg angle
b. Supine, flat surface
c. Side lying, head elevated 30 deg angle
d. Sitting, leaning forward

55. A MMT of a pt who sustained a gunshot wound just superior to the elbow joint reveals specific muscle weakness
from a partial median nerve injury.
The PT intervention for this pt would MOST likely include strengthening activities for wrist flexion & forearm:
a. pronation, finger flexion, thumb adduction
b. pronation, finger flexion, thumb opposition
c. supination, finger abduction, thumb opposition
d. supination, finger abduction, thumb extension

56. A pt who has a piriformis syndrome is referred to PT for _eval & intervention. The pt’s history includes THR on
the R side 2 yrs ago. Because of the
THR, which of the ff should only be used with precaution?
a. TENS
b. Continuous US
c. Hot packs
d. Massage to the R hip

57. A pt presents with adhesive capsulitis of the shoulder jt. The ROM examination reveals restricted ext rot & abd
of the shoulder. The FIRST
mobilization procedure that should be done for this pt is:
a. posterior glide c. anterior glide
b. distraction d. external rotation

58. A pt sustained a severe TBI 3 mos ago. During the exam of passive ROM, the therapist notices decrease passive
knee extension & mod hams
spasticity. Palpation reveals a firm mass on the lateral aspect of the jt. The therapist should refer the pt to a
physician for an _eval of probable:
a. Osteogenic sarcoma
b. Patellar fracture
c. Osteomyelitis
d. Heterotopic ossification

59. A pt complains of anterolat shoulder pain with insidious onset. Examination shows full passive ROM, pain on
passive lateral rot, & pain on resistive
int rot. These signs are consistent with a diagnosis of:
a. bicipital tendonitis
b. supraspinatus tendonitis
c. subscapularis tendonitis
d. infraspinatus tendonitis

60. A measurable objective for a community education program ex techniques would be for participants to:
a. Understand the importance of a sufficient warm-up period
b. List five stretching techniques that can be use when warming up
c. Overcome LE problems & adhere to a regular ex program
d. Appreciate the effects of increasing intensity of ex on heart rate

61. During MMT of the hip flexors in the sitting position, a pt exhibits lateral rotation & abduction of the thigh as
resistance is applied. The PT should
suspect substitution by:
a. sartorius
 b. tensor fascia latae
c. adductor longus
d. semimembranosus

62. A PT is treating a pt who has lymphedema in the R LE. The therapist decides to use mechanical, intermittent
pneumatic compression as an
intervention, using a sleeve that covers the foot, leg & thigh. The therapist measures BP at 135/85 mm Hg. At
first tx session the MOST approp
inflation pressure for the sleeve is:
a. 20 mm Hg
b. 60 mm Hg
c. 100 mm Hg
d. 140 mm Hg

63. A pt is entering a cardiac rehab program. The PT should FIRST asks the pt to:
a. describe the correct aspect of ex demonstrated by the therapist
b. list problems assoc with poor nutritional habits
c. identify the harmful effects of smoking with regards to cardiac disease
d. describe the type of angina that the pt experience

64. A PT receives a tel phone call from a woman who identifies herself as a friend of one of the therapist’s patients.
She wants to know how the pt is
doing & if he will be able to up & down the stairs, bec she wants to take him home for a weekend visit. What
should the therapist do?
a. Discuss the pt’s program & fxnl status with the caller
b. Invite the caller to observe the pt’s next therapy session
c. Refuse to discuss the pt’s status unless the pt’s permission is obtained
d. Refer the caller to the pt’s social worker

65. The parents of a 1-mos-old child with myelomeningocele report that the child has been increasingly irritable &
has changed sleeping patterns over the
past three days. The child has also been vomiting. Which of the ff is the MOST approp action for the therapist to
take?

a. Refer to immed medical follow-up

b. Instruct the parents to monitor head circumference daily
c. Advise the parents to watch the child for worsening sx
d. Take the head circumference measurements to compare at subsequent visits

66. A therapist is setting up a home program of ES for a pt who has bell’s palsy. Which of the ff muscles be
stimulated as part of the home program?
a. Sternocleidomastoid
b. Masseter
c. Temporalis
d. Frontalis

67. A pt is lying supine with his hips & knees extended & hands behind his head. The pt is able to raise his head,
shoulder & thorax from the tx table, but
is unable to to come to a complete long-sitting posn. The PT should target which muscle for strengthening
program?
a. Iliopsoas
b. External abdominal oblique
c. Quadratus lumborum
d. Upper rectus abdominus
68. A 14-month-old child with spastic diplegia is up on his tiptoes with his toes curled when held in supported
standing. This posn is characteristic of a:
a. proprioceptive placing rxn
b. moro reflex
c. plantar grasp reflex
d. traction response

69. A therapist is developing a gait training prog for a pt ff a THA of the R hip. The proper instructions & rationale
for crutch training utilizing one crutch
include holding the crutch in:
a. R hand to decrease activity in the R hip abductors
b. R hand to facilitate act in the R hip abd
c. L hand to decrease act in the R hip abd
d. L hand to facilitate act in the R hip abd

70. Following trauma at C5 spinal cord level, a pt was admitted to the hospital. 24 hrs later the pt shows no reflexes,
sensation, or voluntary motor
activity below level of injury. These findings indicate:
a. the presence of spasticity
b. decerebrate rigidity
c. spinal shock
d. a lower motor neuron lesion

71. A R handed woman is being examined by the PT for R sided weakness in her UE & LE. Her muscle tone is
hypotonic & she is ataxic during walking.
She has a hx of hpn & alcoholism. Passive ROM with DTR showing hyporeflexia. She has an intention tremor
when she tries to pick up an object
from a table, & exhibits difficulty performing the finger to nose test. Where is the MOST probable area of the
lesion?
a. R side, cervical spinal cord
b. L side, cerebral hemisphere
c. L side, substantia nigra
d. R side, cerebellar hemisphere

72. A pt received a gunshot wound to the distal post thigh that resulted in complete severance of the common
peroneal nerve. Which of the ff ex is
necessary in the early rehab period to prevent contracture formation?
a. Active plantarflexion, inversion & toe extension
b. Passive dorsiflexion, eversion & toe extension
c. Active dorsiflexion, eversion & toe flexion
d. Passive plantarflexion, eversion & toe flexion

73. A pt with mild closed head injury & bil femur fx requires instruction in a LE ex program. In order to plan the
most effective teaching methods for this
pt, what would be the MOST critical to assess at the initial visit?
a. Comprehension of written, verbal & demonstrated instructions
b. Short term memory capacity
c. Any personality changes compared to the pt’s pre-morbid status
d. Any personality changes compared to the pt’s pre-morbid status

74. A pt with R above-knee prosthesis will be able to maintain the knee in extension while weight bearing if the
center of gravity of the body is shifted so
that the gravitational line falls:
a. post to the axis of the R knee jt
b. lat to the axis of the R knee jt
c. ant to the axis of the R knee jt
 d. med to the axis of the R knee jt.

75. In order for a pt with bilateral BKA to maximize balance in a wheelchair, the rear wheels should be positioned
more:
a. laterally
b. posteriorly
c. anteriorly
d. inferiorly

76. An initial PT evaluation is performed on an elderly patient who is 1-day post total left hip arthroplasty (non-
cemented) using a posterior-lateral
approach. The patient has no complicating medical history and was active and independent preoperatively.
Which of the following activities is NOT
an appropriate goal for the first week of therapy?
a. Active-assistive positioning of the (L) hip to 60 degrees of flexion
b. Active, (L) hip abduction in ® sidelying
c. Independent bed mobility with use of a trapeze
d. Walking with moderate assistance with a standard walker, to 25 feet (7.6 meters)

77. A patient with frequent tension headaches has been referred to physical therapy for instruction in a program of
progressive relaxation exercises.
Which of the following is MOST essential in a program of progressive relaxation to reduce muscle tension?
a. Release of tension by suggestion and persuasion
b. Passive exercise in quite surrounding to relieve tension
c. General massage using deep stroking and kneading of tense muscle
d. Recognition of the sensations of tension and release

78. On the 4th day of PT tx, a pt who has had an ORIF for a hip fx develops a large ecchymosis over the unaffected
hip. The pt MOST likely developed.
a. A hemangioma
b. A complication of anti-coagulant therapy
c. A hematocele
d. Deep vein thrombophlebitis

79. A patient who is exercising on a bicycle ergometer in the cardiac rehabilitation unit is being monitored with
electrocardiogram leads. During the
exercise, the S-T segment becomes depressed by 2 mm. If the cardiologist has given no specific guidelines, the
PT should:
a. Terminate the session immediately
b. Reduce the resistance load
c. Instruct the patient to slow down
d. Direct the patient to continue as before

80. A patient slips, falls, and cuts her arm in the clinic. The cut is bleeding and the patient is alert and well oriented.
In performing first aid for the patient,
the FIRST action that the PT should take is to:
a. Don a pair of gloves
b. Clean the cut with an antiseptic
c. Check the patient’s B.P.
d. Cover the cut with sterile dressing

81. A physical therapist is working with a patient who is aware that he is terminally ill. What is the MOST
appropriate intervention when the patient
wants to talk about his prognosis?
a. Discourage discussion of death or dying
b. Refer the patient for pastoral counseling
c. Relate the therapist’s experiences with other patients
 d. Encourage the patient’s _expression of feelings

82. Prior to starting an exercise training program, a patient with cardiac problems who is receiving beta-blocking
medication should receive an
explanation of the:
a. Greater benefits from cardiovascular exercise to be achieved at lower rather than at higher metabolic level
b. Need to use measures other than heart rate to determine intensity of exercise
c. Need for exercise training sessions to be more frequent but of shorter duration
d. Need for longer warm-up periods and cool-down periods during an exercise sessions

83. A clean, well granulating stage II pressure ulcer with minimal serous drainage is MOST appropriately dressed
with:
a. A non-adherent dressing
b. A packed dressing
c. Topical medication only
d. Dry-to-dry gauze

84. A physical therapist examines a patient who complains of foot pain while jogging. The examination shows that
the patient has excessive foot
pronation and forefoot varus. The therapist decides to try a temporary orthotic insert in the patient’s running
shoe. Which of the following would be
the MOST appropriate orthotic insert?
a. A lateral forefoot post under the fifth metatarsal head
b. A lateral rearfoot post under the calcaneus placing it in everted position
c. A wedge placed under the instead of the medial foot just beneath the head of the talus
d. A medial post just proximal to the first metatarsal head

85. A patient with chronic adhesive capsulitis of the shoulder is to be treated with joint mobilization to increase joint
range of motion. Which of the
following would be the MOST appropriate to increase shoulder abduction?
a. Distraction with inferior glide
b. Anterior glide with internal rotation
c. Superior glide with approximation
d. Distraction with posterior glide

86. An 8-year-old child who has juvenile RA is developing (B) knee flexion contracture. Which of the following
would be the LEAST appropriate?
a. Exercises to increase joint mobility
b. Ultrasound to the hamstring insertions to increase tissue extensibility
c. Progressive weight bearing by walking in a therapeutic pool to increase endurance
d. Exercise to increase quadriceps strength

87. Although knee motion occurs primarily in one plane, tibial rotation is possible when the knee is positioned in 90
degrees or more of flexion because
in this position the:
a. Condyles of the femur glide posteriorly on the condyles of the tibia
b. Hamstrings act as rotating force
c. Patella deviates inferiorly
d. Tension on the ligaments is decreased

88. A PT is screening a young adult patient for a possible ® thoracic, (L) lumbar structural scoliosis. The postural
deviation commonly seen with this
diagnosis would be:
a. Spinous processes of the thoracic spine rotated to the right
b. High (L) shoulder
c. Posteriorly protruding scapula to the ®
 d. Prominent ® posterior rib cage

89. A postural correction program for a patient with forward head, kyphosis, and increase lumbar lordosis would
include all of the following EXCEPT:
a. Strengthening the scapular protractors
b. Strengthening the thoracic erector spinae muscles
c. Lengthening the short sub occipital muscles
d. Lengthening the lumbar erector spinae muscles
90. A patient in the eight-month of pregnancy presents with numbness and tingling of the (L) hand except the fifth
digit. She demonstrates edema of the
hand and fingers, a positive Tinel’s sign at the wrist, and a Good (4/5) muscle test grade of the wrist and finger
flexors. The MOST appropriate
intervention would be:
a. A wrist splint to position the wrist in full extension
b. A hot pack followed by tendon gliding exercises
c. Resistive exercises for the wrist and finger flexors
d. Frequent rest and elevation of the (L) upper extremity

91. An exercise program for a patient with Parkinson’s disease would MOST likely include exercise to:
a. Decrease movement of the upper extremities and trunk
b. Increase trunk flexor strength
c. Improve balance reactions and reciprocation
d. Stretch back extensor muscle

92. If a BK prosthesis has an excessively firm heel wedge, the pt is MOST likely to walk with:
a. excessive knee flexion in early stance
b. premature knee flexion in late stance
c. Insufficient knee flexion in early stance
d. Excessive knee flexion in late stance

93. A pt who has COPD is being treated with a regimen that includes pursed lipped breathing ex. The PRIMARY
purpose of the pursed lipped breathing
is to:
a. help prevent collapse of pulmonary airways during exhalation thereby reducing air trapping
b. decrease the removal of CO2 during ventilation
c. increase the residual volume of respiration so that more O2 is available for body metabolism
d. stimulate further mobilization of mucous secretions to higher air passages where they can be expectorated

94. A pt with a dx of cervical radiculopathy reports numbness of the ® little finger. The therapist would MOST
likely find a diminished DTR in the:
a. biceps brachii
b. deltoid
c. triceps brachii
d. brachioradialis

95. A therapist is planning a pt education program for a grp of pts with chronic LBP. To increase the likelihood that
the pts will utilize the proper
mechanics at the work site, the therapist should:
a. asks the pts to demonstrate use of proper body mechanics
b. provide a reference list of articles describing body mechanics
c. asks pts to describe actions they do that increases their back pain
d. provide information on the frequency of low back injuries due to improper body mechanics

96. A pt presents with hemiparesis & demonstrate a foot drop during swing phase of gait. It would be MOST approp
to administer FES to the tibialis ant
& the:
 a. gastrocnemius
b. Tibialis posterior
c. Extensor digitorum longus
d. peroneus longus

97. A PT is treating a pt with iontophoresis. If the current is set at 4mA, the duration at 15 minutes, & the
dexamethasone solution at .04%, with an
electrode area of 4 cm2, how would the therapist record the current dosage?
a. 0.16 mA-mg
b. 16 mA/cm
c. 0.60 mg/min
d. 60 mA-min

98. An elderly pt has diabetic neuropathy. Upon examination he shows marked medio-lateral instability of the L
ankle while walking. The pt also has
fluctuating edema & glove-and-stocking sensory loss in both legs. The MOST approp orthotic aid would be:
a. a double-upright ankle foot orthosis
b. hip to toe shoes
c. a prefabricated plastic, solid ankle-foot orthosis
d. a spiral ankle foot orthosis

99. A 25-yr old pt with cystic fibrosis has been experiencing successful mobilization of thickened secretions by
standard percussion & postural drainage.
During the current tx session, the pt coughs up sputum that has small, brownish streak of blood. The PT should:
a. percuss more vigorously in an attempt to clear out any other blood that is present in the airways
b. perform postural drainage in upright positions for this type of pt only
c. continue tx with little modification unless more blood is noted
d. stop the tx & send the pt to the emergency room

100. Which of the ff should be recommended for a pt ff a medial meniscectomy if the PT plans is to ex the
quadriceps femoris against accommodating
resistance?
a. Knee bends through half of the range
b. Knee extension with the sandbag in the ankle
c. Knee extension on an isokinetic ex device
d. Straight leg raising with a sling suspension

101. In a suction-socket prosthesis, the primary fxn of the valve in the lower & medial part of the socket is to permit
air to:
a. remain during the stance phase of gait
b. remain during the swing phase of gait
c. escape during the swing phase of gait
d. escape during the stance phase of gait

102. A pt with chronic venous insufficiency of the LE would MOST likely exhibit:
a. normal superficial veins, no edema, ulceration & patches of gangrene around the toes
b. dilation of superficial veins, edema, stasis ulceration
c. no edema, cold, hairless LE, faint dorsalis pedis pulse
d. dilation of superficial veins, edema made worse during sitting or leg elevation

103. FF removal of a long-leg cast, a pt has limited knee flexion. The MOST approp direction of patellar
mobilization would be:
a. distal
b. lateral
c. proximal
d. medial
104. Which LE PNF pattern is MOST approp for a pt who needs strengthening of the tibialis posterior?
a. Hip extension, abduction & medial rotation with ankle plantarflexion &eversion
b. Hip flexion, adduction, & lateral rotation with ankle dorsifllexion & inversion
c. Hip extension, adduction & lateral rotation with ankle plantarflexion & inversion
d. Hip flexion, abduction & medial rotation with ankle dorsiflexion & eversion

105. A pt is referred to PT with a dx of LBP. Radiographic studies, including MRI, have ruled out presence of disc
pathology. The pt c/o continuous back pain that radiates towards the thorax & anteriorly into the abdominal region.
The therapist should consider which of the ff areas as a potential source of discomfort?
a. Dura mater
b. Diaphragm
c. Kidney
d. Urinary bladder

106. An adult pt who was involved in a motor vehicle accident has sustained multiple traumas, including fx ribs on
the right side. The pt is unconscious,
intubated, & on a mechanical ventilator in ICU. Chest radiographs show the development of an infiltrate in the
® lower lobe during the past two
days. Rales & ronchi are heard over the ® lower lung fields. Which chest program is MOST appropriate ?
a. Manual hyperventilation & suctioning while posn on the L side
b. Positioning supine for suctioning, ff by manual hyperventilation while posn on the L side
c. Suctioning, percussion & vibration while posn on the ® side
d. Positioning on the L side for deep breathing exercises only

107. A pt who has RA comes to PT with signs of muscle atrophy, ecchymosis, puffy cheeks & a dx of osteoporosis.
This pt is MOST likely receiving a
high dosage of:
a. penicillin
b. prednisone
c. aspirin
d. gold salts

108. A PT is examining a pt who has difficulty making a fist. The muscle test show the ff: flexors of the 2nd to 5th
digits at the PIP are normal (5/5);
flexors of the 2nd & 3rd digits at the DIP are normal (5/5); flexors of the 4th & 5th digits at the DIP are poor
(2/5). These findings are consistent with
a lesion of the:
a. median nerve C8-T1
b. median nerve C5-C6
c. ulnar nerve C5-C6
d. ulnar nerve C8-T1

109. An elderly man who lives alone fell in his home, sustaining a hip fx, which necessitated a THR. The pt was
previously able to perform all ADL’s
independently. He has been admitted to a SNF for rehabilitation. The pt’s goal is to return home. His family
believes he should be admitted to a
long-term care facility for his own safety once acute rehab is completed. The PT’s MOST approp action is to:
a. advise the family that the pt should determine his own discharge environment
b. recommend a team conference with the pt & his family to discuss discharge plans
c. schedule a home visit to determine if home modifications are needed before discharge
d. implement a tx plan with a long-term goal of discharge to home

110. During LE ex, a pt with incomplete C6 quadriparesis reports a new onset of tingling & numbness in both hands.
MMT reveals that overall strength
has decreased by one grade. In this situation, the PT’s MOST approp course of action is:
a. modify the ex program to accommodate change in strength
b. apply an ice massage prior to ex
 c. continue LE therapeutic ex & use facilitation techniques to stimulate more activity
d. discontinue all exercises & notify the physician

111. In early management of a pt with a partial PNI, the goal of the PT intervention will MOST likely be to prevent:
a. nerve degeneration
b. spasticity & increase muscle tone
c. muscle atrophy
d. contractures & adhesions

112. A PT is developing an educational program for individuals with LE peripheral neuropathies due to diabetes.
Which of the ff is the MOST impt
information for the PT to recommend for the prevention of injury to the foot?
a. Orthosis to support the extremity
b. use of proper footwear
c. Moisturizing the skin to prevent dryness
d. Exercise parameter

113. Elevating a pt’s LE for less than 1 minute produces a noticeable pallor of the foot, followed by delayed reactive
hyperemia in a dependent posn.
These signs are indicative of:
a. an intact circulatory system
b. arterial insufficiency
c. venous insufficiency
d. acute arterial occlusion

114. While ascending stairs, an elderly pt leans forward with increase hip flexion. Which of the ff muscles are being
used to the BEST advantage with
this forward posture?
a. Rectus femoris
b. Tensor fascia latae
c. Gluteus maximus
d. Lumbar paraspinal

115. A PT is treating a pt with moderately well controlled type I diabetes. One of the goals is to help regulate her
insulin dosage through the ex. In
establishing an ex program, the therapist should be aware that regular ex will generally:
a. lower blood glucose levels & decrease amt of insulin required
b. lower blood glucose levels & increase amt of insulin required
c. raise blood glucose levels & decrease amt of insulin required
d. raise blood glucose levels & increase amt of insulin required

116. A PT recognizes that departmental education materials are written on a reading level that is too difficult for
some of the pts. The PT can help the pts
to better understand the materials by:
a. including illustrations & a larger print
b. including illustrations & a simpler sentence structure
c. reducing the # of syllables & lengthening the sentences
d. using a larger print format to present specific medical terminology

117. An inpatient PT dept has only one PT & one PTA on duty due to staff illness. A pt with which of the ff is
MOST approp for the PT to delegate
to the assistant?
a. Ataxia, who is undergoing a trial to determine an approp assistive device
b. Hemiparesis, whose initial _eval has not been completed
c. MS, who is receiving gait training with a rolling walker
 d. Alzheimer’s disease, who is easily agitated during the initial gait training

118. During inspiration, a pt demonstrates increased upper chest expansion with retraction of the epigastric area. The
PT should suspect weakness of the:
a. scalene muscle
b. diaphragm
c. rectus abdominis
d. intercostals muscles

119. The brother of a pt who was recently discharged from the hospital’s outpatient PT dept telephones on the pt’s
behalf to request a copy of the pt’s
medical record. The therapist should explain to the pt’s brother that the medical record is the property of the:
a. pt’s family & can be released to the brother upon request
b. pt’s insurer now & that the request for a copy must be made in writing to the insurer
c. hospital & the pt & can be released only with written authorization from the patient
d. hospital & can be released only with written authorization from the pt’s physician

120. A PT is examining a pt for a possible LE weakness. PROM is within normal limits. The pt is seated. When the
pt tries to dorsiflex & invert his R
foot, he is unable to move it through the full ROM & is unable to take any resistance applied by the therapist.
During the subsequent gait
examination, the therapist would MOST likely expect the pt to display which of the ff?
a. Normal gait, with no deviations
b. Increased R hip flexion during swing phase
c. Throwing the trunk backward, on the R side, shortly after initial contact
d. Lateral bending toward the R side during midstance

121. A pt is referred for PT with a dx of chondromalacia patella. The PT decides to include quad setting & SLR as
part of the home ex program because:
a. the vastus medialis muscle is primarily responsible for terminal knee extension
b. quad setting & SLR help improve patellar tracking
c. petello-femoral compression forces are increased when the knee is extended
d. the vastus medialis muscle is preferentially activated during SLR

122. A pt with LBP has been undergoing tx for two sessions. The pt tells the therapist that today the pain is
centralizing with the extension ex, but is as
intense as it was at the fist tx session. The pt is frustrated by this rxn. The therapist most approp response would
be:
a. continue with the present program
b. eliminate the extension ex
c. consult the pt’s physician about the situation
d. progress to trunk flexion exercises

123. Which of the ff statements does NOT document pt outcome?

a. The pt propelled his wheelchair independently after 4 weeks
b. The pt demonstrated independent performance of home program after 2 weeks
c. The pt walks 100 feet with minimal assistance after one week
d. The pt attended PT sessions 3x a week for 2 weeks

124. Which of the ff is the MOST likely caused of reduced vital capacity in a pt who has quadriplegia at C5-6 level?
a. Decreased antero-lateral chest expansion resulting from paralysis of the external intercostals muscle
b. Inability of the pt to generate a negative intrapleural pressure secondary to a denervated diaphragm
c. A relatively high resting posn of the diaphragm resulting from paralysis of abdominal muscles
 d. Reduced rib cage elevation due to paralysis of the ant scalene & SCM muscles

125. An attorney calls the PT dept seeking information on the status of his client, a pt who is undergoing rehab ff
total knee surgery. The pt’s PT should:
a. refer the attorney to the pt’s insurance carrier
b. describe the pt’s current status
c. require written authorization from the pt to release information
d. obtain verbal permission from the pt to release information

126. Involving interdisciplinary team members in making decisions about continuity of patient care has all of the
following benefits EXCEPT:
a. promoting each individual’s commitment to, & responsibility for, the decisions that have been made by
the group
b. discouraging one or two members from being in control & having all the authority
c. enabling decisions regarding quality of care to be made quickly
d. promoting quality of care by including several aspects of the patient’s care

127. Instruction in energy conservation & joint protection should be provided to the patient with rheumatoid arthritis
because:
a. the joints may be predisposed to damage by overuse
b. fatigue often masks joint pain
c. phagocytes remove more pannus in resting joint
d. activity of the antigen-antibody complex is diminished with rest

128. In which of the following is independence the MOST realistic long-term goal for a patient with a complete
spinal cord lesion at C8?
a. Effective cough technique
b. Rolling from side to side
c. Transfer from bed to wheelchair
d. Ambulation with forearm crutches

129. A PT examines a pt with MS who is in a period of exacerbation. The pt is independent with bed mobility, can
sit unassisted at the edge of the bed, &
requires physical assistance to stand with a walker. Which of the following ADL activities is the MOST
important for the initial intervention?
a. Wheelchair propulsion up to 10 foot ramp
b. Wheelchair transfers
c. Walking with an assistive device
d. Tub transfers

130. When examining a pt who had a baby 3 days ago by vaginal delivery, the PT notices that the pt has a 2-cm
diastasis of the rectus abdominis. To
address this problem, the pt should:
a. perform partial sit-ups, supporting her abdominal muscles with her hands while lifting her head in the
supine position
b. not perform exercises until the diastasis heals spontaneously
c. perform sit-ups with the knees bent & arms behind the head
d. perform partial sit-ups, with the legs straight & arms in front

131. To minimize skin irritation during functional electrical nerve stimulation, the PT should use:
a. lower intensity, larger inter-electrode distance & larger electrodes
b. lower intensity, larger inter-electrode distance & smaller electrodes
c. higher intensity, smaller inter-electrode distance & smaller electrodes
d. lower intensity, smaller inter-electrode distance & larger electrodes

132. A pt is doing active & resistive exercises on a mat table in the PT dept. After 15 minutes, the pt becomes short
of breath, begins coughing &
 expectorates pink, frothy sputum. At this point, the PT should first stop the tx, then:
a. assess vital signs, let the pt rest a few minutes with the feet elevated, & then resume with a less vigorous
program
b. sit the pt up, assess vital signs & call a nurse or physician for further instructions
c. lay the pt supine, transfer the pt to stretcher & return the pt to the nursing unit
d. lay the pt down flat, call for assistance & begin cardiopulmonary resuscitation

133. When evaluating a wheelchair positioning of a child with CP, the PT should FIRST examine the position of the
child’s:
a. pelvis
b. legs
c. head
d. spine
134. A pt who sustained a mild CVA 3 weeks ago is being prepared by the PT for discharge to home & an adult day
program. To facilitate the discharge
plan, the MOST appropriate health professional for the therapist to consult with is the:
a. skilled nursing coordinator
b. occupational therapist
c. medical social worker
d. primary physician

135. For a pt with a R middle lobe pneumonia, the proper bronchial drainage position is supine with the body:
a. one-quarter turned to the L & the foot of the bed raised 14 inches
b. one-quarter turned to the R & bed flat
c. three-quarters turned to the L & head of the bed raised 14 inches
d. three-quarters turned to the R & foot of the bed raised 14 inches

136. To avoid the appearance of increased motion, which movement must be prevented during goniometric
measurement of shoulder abduction?
a. Upward rotation of the scapula
b. Medial rotation of the shoulder
c. Lateral rotation of the shoulder
d. Lateral flexion of the trunk to the opposite side

137. A pt who received organ transplantation 4 yrs ago demonstrates progressive weakness & is referred to PT for
strengthening exercises. In reviewing
the medical history, the therapist learns the the pt takes a prednisone & immunosuppressive drugs. Which of the
following would the therapist
MOST likely need to consider?
a. Isokinetic strengthening will be preferable for this pt
b. The pt may have limited ROM from increased bone mass
c. The pt will need to be treated in an isolation room
d. Muscle strengthening may be limited in this pt

138. A PT examines a high school athlete in the training room. After removing the adhesive strapping from the
athlete’s ankle, the therapist discovers
that the athlete has developed an open weepy rash on the instep of the foot. The therapist should FIRST:
a. apply moist heat to the foot
b. send the pt to the hospital emergency room
c. use more pre-wrap with the next joint taping
d. refer the pt to the team physician

139. A pt who sustained a L BKA 2 yrs ago & a R BKA 3 weeks ago is being evaluated for possible ambulation with
prosthesis. Which of the following
factors is MOST relevant?
a. Size of the R residual limb scar
b. Length of the R residual limb
 c. Proficiency in previous prosthetic use
d. Severity of phantom pain

140. The results of a developmental screening of a 4-month-old infant indicate a possible R hip dislocation. The
presence of which of the following are
the MOST consistent with this diagnosis?
a. Pelvic obliquity, apparent pain on movt of the R hip, & decreased hip abduction on the L side
b. Asymmetrical gluteal folds, femoral telescoping, & limited hip abduction on the ride side
c. Decreased active movt of the R hip, increased femoral neck retroversion, & atrophy of the gluteus
maximus on the R side
d. Hip flexion contracture on the R side, apparent leg length discrepancy, & inability to tolerate supported
sitting

141. A 14-month-old child with brachial nerve palsy has motor & sensory loss in the R upper extremity in the areas
innervated by C5 & C6. Which of the
following activities is MOST difficult to accomplish with the affected UE?
a. Pushing a wagon
b. Carrying a teddy bear in the crook of the arm
c. Holding a raisin in the palm of the hand
d. Grasping a cup

142. A PT is treating a pt who has been diagnosed with a nerve root impingement on his R side due to narrowing of
the intervertebral foramen between
L4 & L5. The therapist decides to use mechanical, lumbar traction as an intervention. Which of the following
positions, on a traction table, would be
the MOST appropriate to relieve pressure on the nerve root?
a. Supine, hips & knees flexed
b. Supine, with hips & knees straight & laterally shifted to the R
c. Prone, hips & knees straight
d. Sidelying on the R, with a bolster between the table & pt

143. A prone standing board has been recommended for a 5 y/o child with severe hypotonia. The PRIMARY
purpose for the use of a prone stander is to:
a. promote weight bearing
b. reinforce an exaggerated positive support reflex
c. prevent hip dislocation
d. increase hip & knee ROM

144. A pt who is transported to the PT dept in a wheelchair complains of severe, bilateral LE pain. A purple
discoloration of both feet observed. The pain is relieved when the pt’s feet are raised just above the horizontal plane.
These signs are MOST indicative of:
a. arterial insufficiency
b. intermittent claudication
c. venous insufficiency
d. a psychosomatic episode
145. A pt who completes a Phase I cardiac rehabilitation program should be expected to achieve:
a. independence in self-monitored walking
b. increased aerobic capacity to physical activity
c. modification of risk factors
d. increased blood pressure at a given workload

146. A PT has been working with a pt who has a spinal cord injury. To document that the pt has been educated about
skin care, the therapist should
record that the pt:
a. is unable to tolerate more than 1 ht in a wheelchair
b. has good strength of the scapular depressors & elbow extensors
c. is able to state 3 causes of skin breakdown
 d. is able to perform 10 push-ups in the wheelchair

147. A pt has difficulty palpating the carotid pulse during exercise. The pt should be instructed in alternate methods
of self-monitoring, because repeated
palpation is likely to result in:
a. increasing the heart rate
b. decreasing the heart rate
c. an irregular heart rhythm
d. increasing systolic BP

148. A pt complains of pain lateral to the coracoid process. When palpating the shoulder to assess the possible cause
of the pain, starting at the coracoid
process & moving laterally, the PT would expect to find the following sequence of structures:
a. lesser tuberosity, biceps tendon, greater tuberosity
b. greater tuberosity, biceps tendon, lesser tuberosity
c. lesser tuberosity, coracobrachialis tendon, greater tuberosity
d. greater tuberosity, coracobrachialis tendon, lesser tuberosity

149. A factor that MUST be considered in designing an exercise program for a pt with angina pectoris is that, when
the arms are exercised:
a. angina occurs at a lower heart rate than when exercising the legs
b. heart rate & BP rise more steeply in relation to workload than when exercising the legs
c. pulmonary ventilation increases less rapidly than when exercising the legs
d. angina occurs at higher workloads than when exercising the legs

150. A pt spilled boiling water on the R arm when reaching for a pan on the stove. The forearm, elbow, & lower half
of the upper arm appear blistered &
red, with some subcutaneous swelling & pain on touch. To facilitate optimal function, the PT should
PRIMARILY emphasize:
a. ROM exercises to the R hand, wrist & elbow
b. application of compression dressings
c. sterile whirlpool to the R UE
d. splinting of the R arm in full elbow extension

151. A PT wishes to study the effect of cold compression on PROM in a group of 10 patients. The plan is to apply
this compress to the hamstring muscles
once a day for 5 days. Which of the following experimental designs is the MOST appropriate for this type of
study?
a. For both the experimental & control groups, gather data from pt record
b. For both the experimental & control groups, measure ROM of both groups on day 5
c. For both the experimental & control groups, measure ROM on days 1 and 5
d. For the experimental groups, measure ROM everyday. For the control group, measure ROM on days 1
and 5

152. During an examination of elbow strength using MMT, the pt supinates the forearm when attempting elbow
flexion. Which of the following muscles
is MOST likely doing the major part of the work?
a. biceps brachii
b. brachialis
c. supinator
d. brachioradialis

153. A PT is treating a pt for LOM ff knee surgery several weeks ago. The pt’s passive knee extension is lacking 15
deg from full extension, & knee
flexion is limited to 95 deg. Both movts have capsular end-feel. Which of the ff mobilization techniques is the
MOST appropriate for increasing
knee flexion?
 a. Anterior glide of tibia on femur
b. Posterior glide of tibia on femur
c. Superior glide of patella
d. Posterior glide of femur on tibia

154. A pt has pain, swelling & tenderness in the medial border of the hand. The pt also shows changes in the color &
temperature of the skin,
hyperhydrosis & progressive joint stiffness in the wrist & hand. The MOST likely cause of the pt’s s/sx is:
a. Cervical disc disease
b. Raynaud’s phenomenon
c. Reflex sympathetic dystrophy
d. Carpal tunnel syndrome

155. When considering a special test for orthopedic assessment of a client, the validity of the test is important
because the:
a. Results of the test can be standardized
b. Test measures what it is supposed to measure
c. Results of the test are reproducible
d. Test can be accurately performed by someone else

156. A pt sustained a Colle’s fracture 8 wks ago & has been in a cast since that time. Immediately after cast removal,
the PT intervention for the wrist
hand should MOST appropriately include:
a. Passive & active assistive ROM exercises
b. Progressive resistive exercises
c. Grade 4 mobilization techniques
d. Return to pre-fracture level of activity

157. A pt with TBI is receiving outpatient PT. The therapist notices that the pt becomes agitated during therapy
sessions. To which of the ff professionals
should the pt be referred for assessment & dx?
a. Occupational therapist
b. Neuropsychologist
c. Vocational counselor
d. Speech-language pathologist

158. While a pt is walking in the parallel bars, the PT observes that the pelvis drops down on the side opposite the
stance extremity. This gait deviation is
an indication of weakness of the hip:
a. abductors of the swing extremity
b. adductors of the swing extremity
c. abductors of the swing extremity
d. adductors of the stance extremity

159. A client on a weight loss program has been walking 3days/wk for 15 mins for the past 3 wks. To progress the ex
program, which of the ff will
MOST likely accomplish the weight loss goal?
a. Maintain the current walking speed & increase the duration to 30 mins
b. Increase the walking speed & keep the duration to 15 mins
c. Walk 4 days/wk & decrease the duration to 10 mins
d. Changing from walking 3 days to jogging 1 day/wk for 20 mins

160. When treating a pt with AS, the muscle requiring the MOST emphasis for strengthening exercises are the:
a. Pectorals
b. Hip flexors
c. Back extensors
 d. Abdominals

161. A 3-month-old child has motor & sensory loss in the R UE in the areas innervated by the C5 & C6 spinal
nerves. The cause of this birth injury
MOST likely is:
a. Hemiplegia
b. Erb-Duchenne paralysis
c. SCI
d. Klumpke’s paralysis

162. During examination of the jaw-opening pattern of the pt with TMJ problem, the PT notes early protrusion of the
mandible. Which of the ff
mandibular movts MOST likely cause the protrusion?
a. Condylar translation
b. Mandibular depression
c. Condylar rotation
d. Lateral glide
163. A pt with MS is referred for PT at home. Before going home, the pt requires training in bathing, dressing &
eating. Adaptive devices maybe needed
to accomplish this. The PT should recommend that the pt be seen by:
a. a social worker
b. an orthotist
c. an occupational therapist
d. a home health nurse

164. A CP child who has been receiving PT once a wk for the past month. During the 4th visit, the PT instructs the
parents in a daily exercise program for
the child, including stretching techniques. The BEST method to ensure correct implementation & carry-over of
the program is for the therapist to:
a. reassess the pt’s ROM one month after instructing the parents
b. review the parent’s written notes on the child’s progress
c. demonstrate the exercises for the parents & ask them to return for a program check in one week
d. ask the parents to demonstrate the exercises & to return for a program check in one week

165. An otherwise healthy in-patient is referred to PT ff THA (?). The pt reports persistent low energy levels. What
medical record information will
provide the GREATEST clarification of the complaint?
a. CO2 value
b. Hematocrit value
c. Creatinine level
d. Blood urea nitrogen (BUN) level

166. Excessive upward rotation of the R scapula is noted when the pt attempts to perform shoulder flexion. Which of
the ff exercises is MOST approp to
help correct the excessive scapular rotation?
a. ® scapular protraction against resistance with the ® arm at 90 deg of flexion
b. Bilateral scapular elevation with the UE at 180 deg of flexion
c. Wall push-ups with an isometric hold at the end range with the elbows extended
d. Bilateral scapular adduction with the arms medially rotated & adducted across the back

167. A pt with PD has just been admitted to the rehabilitation unit. The pt is dependent in all transfers & requires
moderate assistance of one person to
walk 30 feet with standard walker. In order to facilitate good carry-over for activities, instruction of the family
in transfers should occur:
a. during a home visit after the pt is discharge
b. just prior to discharging the pt
c. early in the rehab program
 d. when the family feels ready to take the pt home

168. A pt had final approval & checkout of a permanent prosthesis 2 wks ago. The pt now complains to the PT that
the prosthesis is too heavy. The pt
will benefit MOST from:
a. an evaluation of socket fit by the prosthetist
b. a prescription from the physician for a lighter weight prosthesis
c. reevaluation of hip strength by the PT
d. adding a fork strap attachment to the prosthesis

169. A pt with L hemiparesis is being discharged from the rehab center. The PT has been unsuccessful in getting the
family’s cooperation to instruct them
in transfers, bed mobility, & safety precautions. The MOST approp action for the PT to take is to:
a. educate the pt so he can tell others how to assist her
b. contact social services & arrange for a team & family meeting
c. refer the pt for home care & document approp interventions
d. write a home program & give it to the family

170. A pt has a history of neck pain that is aggravated by long periods of sitting. The pain becomes progressively
worse by evening. ROM & strength of
the neck & shoulder are within normal limits. Sensation & reflexes are intact in both UE. The pt has a forward
head & excessive thoracic kyphosis.
The MOST approp ex program would include:
a. stretching of the neck flexors & pectoral strengthening
b. upper traps strengthening & pectoral stretching
c. pectoral strengthening & rhomboid stretching
d. rhomboid strengthening & axial neck extension

171. A pt is being examined for medial epicondylitis. With this dx, the therapist would MOST likely expect to find
pain over the:
a. origin of flexor digitorum profundus with resisted finger flexion
b. origin of pronator teres muscle with active pronation
c. medial epicondyle with passive wrist flexion
d. insertion of the triceps brachii with passive elbow extension

172. In treating a pt who has had recurrent anterior shoulder dislocation, the therapist should AVOID which of the ff
extreme shoulder motions?
a. Adduction & external rotation
b. Abduction & external rotation
c. Hyperextension & internal rotation
d. Abduction & internal rotation

173. During the examination of a pt with carpal tunnel syndrome, the PT will MOST likely find:
a. paresthesia of the medial palmar surface of the hand
b. weakness of finger extension of the lateral three digits
c. paresthesia of the lateral three digits
d. weakness in wrist flexion & ulnar deviation

174. Upon removal of a wet-to-dry dressing from a draining wound, the PT observes that the skin immediately
surrounding the wound is macerated.
What should the therapist recommend for future wound care?
a. Continue using current dressing type
b. Make the dressing more absorbent
c. Leave the dressing on longer between dressing changes
d. Change to a pressure type dressing
175. A pt’s severe knee sprain resulted from medial rotation of the femur on the tibia with simultaneous application
of a valgus force while the foot was
placed on the ground. Which structures are MOST likely to be involved?
a. MCL, medial meniscus, ACL
b. MCL, LCL, PCL
c. LCL, medial meniscus, ACL
d. MCL, lateral meniscus, PCL

176. A pt with GBS experiencing progressive paralysis is admitted to the ICU. As a member of the interdisciplinary
team managing this pt’s care, the
MOST approp PT intervention would be to:
a. alter pt’s mechanical ventilation settings
b. develop pt’s medication schedule
c. perform airway clearance techniques
d. discuss the pt’s medical prognosis with the family

177. A pt is performing a phase I cardiac rehab ex session. The PT should terminate low-level activity in which of
the ff value changes from resting
level?
a. the diastolic BP increases to 120 mm Hg
b. the respiratory rate increases to 20 breaths per minute
c. the systolic BP increases by 20 mm Hg
d. the HR increases by 20 bpm

178. A PT is preparing to teach a pt who has GBS to transfer from wheelchair to a mat table. The pt weighs 150 lbs,
she has Poor (2/5) grade in both of
her LE, & Fair (4/5) grade in her L UE. Her ® UE has Normal (5/5) strength. Which of the ff would be the
MOST approp, assisted transfer for the
initial session this pt?
a. Two person lift on her ® side
b. Sliding board transfer on her ® side
c. A hydraulic lift from her wheelchair to the mat
d. Full, standing pivot transfer to her ® side

179. A pt with complete C4 quadriplegia is working on a program to increase tolerance to the upright position. While
on the tilt table, the pt begins to
complain of a pounding headache, with flushing & profuse sweating. The therapist should FIRST:
a. lower the tilt table to a flat position
b. remove pt from tilt table & return to room
c. check the pt’s catheter
d. check the pt’s BP

180. In PT program planning for geriatric patients, an important age-related change that should be taken into
consideration is:
a. the inability to learn new motor tasks
b. decrease pain sensation
c. decrease motivation
d. the inability to select alternative movt strategies

181. To achieve maximum reaction of lymphedema following a mastectomy in the UE by means of massage, it is
MOST important that:
a. local heat be applied before the massage
b. the upper arm be massage before the forearm
c. the hand be massaged before the forearm
d. the massage strokes occur in a centrifugal direction
182. A 6-year-old child with spastic diplegia is walking in the parallel bars with increased trunk & hip flexion. What
would be the MOST appropriate
assistive device
a. Standard walker
b. Forearm crutches
c. Posterior rolling walker
d. Bilateral quad canes

183. A PT is teaching a pt with T12 paraplegia to fall. The pt walks with bilateral KAFO & bilateral forearm
crutches using swing-to gait. The MOST
appropriate method to use to prevent injury would be:
a. have the pt wear a helmet & practice on a soft padded surface
b. give the pt written instructions & illustrations on falling
c. demonstrate & guide the pt through the correct process of falling
d. demonstrate the correct method of falling

184. A pt with dx of complete SCI at C4-C5 demonstrate a weak cough mechanism. Which of the techniques would
be MOST effectively augment
coughing?
a. Manual pushing against the upper abdomen
b. Positioning the pt in prone
c. Pursed-lipped breathing
d. Interrupting the expiratory air stream

185. A pt is referred for recommendation regarding purchase of a W/C. The measurements of the pt while sitting are
16 inches across the widest point of
the hips & 18 inches from the rear of the buttocks to the popliteal crease. Which of the ff W/C dimensions are
BEST suited for this pt’s neds?
a. Seat width & seat depth of 18 inches
b. Seat width of 18 inches & seat depth of 16 inches
c. Seat width & seat depth of 16 inches
d. Seat width of 16 inches & seat depth of 18 inches

186. A PT is designing an exercise program for a healthy, elderly individual. Which of the following types of
exercise is MOST stressful to the
cardiovascular system?
a. Upper-limb ergometry
b. Spinal ROM exercise
c. Quadriceps setting exercise
d. Lower-limb diagonal PNF patterns

187. Which of the following techniques is MOST important prior to discharge for a pt who has had MI?
a. Ascend a flight of stairs before discharge
b. Perform prescribed exercises without angina
c. Return to normal daily activity level
d. Take a radial pulse reliably before discharge

188. A PT is evaluating a pt for a wheelchair prescription. The pt, who lives alone in a small apartment, has bilateral
LE weakness & is unable to stand to
transfer. Trunk strength & UE strength are normal & the pt can transfer independently with a sliding board.
The MOST appropriate prescription for
this pt is a wheelchair with:
a. fixed, adjustable-height arm rests & detachable foot rests
b. removable arm rests & detachable swing-away leg rests
c. fixed arm rests & removable leg rests
d. desk-style removable arm rests & fixed elevating leg rests
189. A pt is undergoing a treadmill stress test. The appearance of abnormally wide, irregularly spaced QRS
complexes on the ECG represents:
a. ventricular depolarization
b. premature ventricular contractions
c. atrial fibrillation
d. atrial repolarization

190. A pt who is on bed rest exhibits orthostatic hypotension upon standing will MOST likely experience:
a. increase venous tone in the LE
b. inadequate ventricular filling during diastole
c. decrease hydrostatic pressure in the capillary beds
d. parasympathetic stimulation of the heart

191. Treatment of a pt with hemophilia who has a subacute hemarthrosis of the knee will initially include:
a. active assistive ROM exercise to the knee
b. instruction of the pt for weight bearing to tolerance
c. gentle resistive ROM exercise to the knee
d. continuous immobilization of the knee in an extension splint

192. Which of the following is the MOST appropriate intervention for a pt with juvenile RA who is experiencing
painful swelling of both knees?
a. Resistive exercises
b. Stretching to prevent contractures
c. Gentle, active exercises
d. Walking program

193. Which of the following is the MOST appropriate home program for a pt with chronic lateral epicondylitis?
a. Using a forearm cuff to increase loading on the extensor tendons
b. Performing exercises for wrist strength & stretching
c. Administering iontophoresis with dexamethasone & xylocaine
d. Doing friction massage of the brachioradialis tendon

194. A PT who works in a home health agency is treating a pt with DM. He tells the PT that he no longer takes his
insulin. The PT should:
a. instruct the pt in proper technique for injecting insulin
b. contact the pt’s home health insurance
c. tell the pt’s family to report this information to the physician
d. have the pt perform a urine glucose test while the therapist is in the home

195. Which of the following methods is appropriate for handling a 1-year-old child with CP who exhibits strong
extensor tone in the trunk & extremities?
a. Carrying the child in a sitting position
b. Carrying the child over one’s shoulder
c. Keeping contact with the back of the child’s head
d. Picking the child up under the arms

196. A pt with L hemiparesis exhibits shoulder subluxation on the affected side. The pt has a demand-type cardiac
pacemaker. Which of the following
interventions should be used only with extreme caution?
a. Manual resistive exercise on the non-affected side
b. Active exercise on the affected UE
c. FES to the affected
d. Biofeedback to the affected side

197. A 5-year-old pt with a closed head injury is exhibiting behavior consistent with the confused/agitated level of
cognitive function. During PT
 intervention, the pt becomes combative. Which of the following techniques would be MOST effective in
calming the pt?
a. Providing brief moving touch to the face & turning on the pt’s favorite musical tape
b. Maintaining touch to the shoulders & brightening the room by opening curtains
c. Removing the pt from the current tx environment & placing the pt in a quiet setting
d. Wrapping the pt in a blanket & rocking the pt rapidly

198. The MOST appropriate therapeutic exercise to stretch the neck muscles for the pt with an acute, ® sided
torticollis is:
a. R rotation & R lateral flexion
b. L rotation & R lateral flexion
c. L rotation & L lateral flexion
d. R rotation & L lateral flexion

199. A PT evaluates a 65-year-old pt with psoriasis for tx with ultraviolet radiation. The pt’s history includes the
following: THA 1 year ago; penicillin
allergy; calcium supplements since menopause; daily tetracycline use for the past 2 weeks for a urinary tract
infection. Which of these factors should
alert the therapist to use extra caution when applying ultraviolet light?
a. Arthroplasty with a metal implant
b. Daily tetracycline use
c. Penicillin allergy
d. Long-standing calcium supplement use

200. Which of the following instructions is MOST appropriate for teaching a pt with C6 quadriplegia to transfer
from a wheelchair to a mat?
a. “Keep your fingers extended, to give a broader base of support”
b. “Rotate your head & shoulders in the same direction to the desired hip motion”
c. “Rotate your head & shoulders in the direction opposite to the desired motion”
d. “Keep both hands next to your knees to lock your elbows”
1. A. The functional position of the wrist and hand describes the position from which the optimal function is most
likely to occur. This position is described
as: (1) slight wrist extension, (2) slight ulnar deviation, (3) fingers flexed at the MCP, PIP & DIP joints & (4)
thumb slightly abducted.
2. C. During pregnancy & postpartum, the stretched abdominal muscles are unable to stabilize the lower back as the
legs are raised. Attempting to perform
double leg lifts can overwork the abdominal muscle & cause damage to spinal joints.
3. A. Exercise intensity can be expressed as O2 uptake during activity. HR & O2 uptake have a relatively linear
relationship. Therefore utilizing a target HR
will ensure that the appropriate exercise intensity being achieved. Estimation of energy expenditure requires
measurement of O2 consumption that is then
calculated into calories metabolized during the activity. BP cannot be controlled at specific HR. Exercising at
maximal capacity does not achieve aerobic
training benefits and is unsafe for the majority of patient populations.
4. B. Pressure on the L3-L4 root causes numbness in the anteromedial thigh & knee & quads weakness. Numbness in
the back of the calf & dorsi flexor
weakness is indicative of L4, L5 & S1 nerve root involvement. Numbness & weakness in the thighs, legs & feet &/
perineum is indicative of L2 through
S1 nerve root involvement. Numbness in the back of the calf & atrophy of the gastrocnemius & soleus.
5. A. The most appropriate mobilization technique for increasing both shoulder flexion & medial rotation would be
posterior (dorsal) glide. Lateral glide
may be used as a general joint distraction technique. Medial glide would not be appropriate to increase flexion &
medial rotation. Anterior glide is used
to increase extension & lateral rotation.
6. D. Options a, b, c are techniques used to decrease postural tone, which is not indicated for this pt. Option d is the
most appropriate technique for improving low postural tone.
7. C. Wounds heal via a complex process involving re-epithelialization. With advance aging, the rate of epidermal
proliferation decreases.
8. D. Learning the process of foot care is a psychomotor skill & effective strategies to teach psychomotor skills include
repeat demonstration by the pt of the
skill followed by feedback from the therapist to highlight what was performed correctly & what areas need
improvement, if any. Reassurance about
prevention of infection with proper foot care would primarily be a cognitive skill & does not ensure that the pt can
effectively perform proper foot care
Options b &c not include feedback that informs the pt about their performance.
9. A. Goals of PT intervention for a child with DMD are to retard the development of contracture & muscle weakness,
which could lead to functional
limitations, and thus, disability. The PT would also play a role in determining the appropriate use of assistive
devices that could help maintain the child’s
mobility such as wheelchairs, walkers & orthoses. Muscle tone changes & declines in strength cannot be prevented
since they are results of the disease
process.
10. D. The long thoracic nerve innervates the serratus anterior muscle. Reaching forward above the head (shoulder
flexion) would require the action of serratus anterior, & long thoracic nerve would affect the motion. The serratus
anterior muscle also works in conjuction with the upper & lower trapezius muscle to upwardly rotate the scapula
(abduct) during shoulder flexion. Putting the hand in the back pocket would require scapular adduction. Side bending
& deep breathing would not require scapular motion.
11. C. During pregnancy, the ligaments soften due to hormonal influences, & allow some degree of separation between
joint surfaces. Additional stretching of the ligaments could result in joint instability or injury, & would not be a goal
of treatment. The remaining options are all appropriate interventions.
12. B. According to the Standards of PT Practice there should be a written plan of continuous improvement of quality of
care. This includes ongoing review & evaluation of the PT services provided. Utilization & peer review are two
types of review processes.
13. B. A goal should include the following elements: (1) Audience: who will exhibit the skill, (2) Behavior: what the
person will do, (3) Condition: under
what circumstances (the position, the equipment that must be available for the pt to perform the behavior), (4)
Degree: how well will the behavior be
done, (5) Time span: set an anticipated specific time span in which the goal will be achieved, & (6) Measurable: the
outcome must be measurable. Option
b meets all the criteria while the other responses do not.
14. A. The trochlea of the talus is convex. Therefore, during dorsiflexion of the ankle, the talus moves posteriorly
relative to the tibia. To facilitate the
movement of dorsiflexion one would need to perform a posterior glide of the talus on the tibia.
15. D. Aerobic conditioning that occurs during the 12 wks of cardiac rehab will result in a decrease HR both at rest &
with exercise. CO2 elimination & CO
would both increase with maximal work. The stroke volume would increase during submaximal work.
16. C. A normally distributed sample has a median & mean that are equal in value. In that type of distribution, the
median & mean would be at the halfway
point. One half of the scores (50 percent) would be distributed above the median & one half below. If the median &
mean are not of equal value, the
distribution is skewed. If the median is of a higher value than the mean, the distribution to the left, if lower it is
skewed to the right. The standard
deviation is a measure of the variability of the mean. The Z score is a standard score with a mean of zero & a
standard deviation of one. Averaging the
two measures would not be appropriate or meaningful.
17. C. Increasing hip flexion is usually contraindicated for THA at 1 month. The quadruped position would not be
allowed for a pt at 2 weeks post distal
radius fracture, as the splint/fixator would likely by used. Increaing hip flexion would be a potential precaution for a
pt one week after post subcapital
femoral neck fracture. There are no precautions for the pt 2 months following a rotator cuff tear as the motions in
quadruped rocking would be snonymous
with the glenohumeral motions that need to be increased & are achieved in a closed chain position.
18. B With a muscle grade of Fair plus, the pt should not need active assistive exercise. Resistive exercise against
gravity would be most appropriate to
strengthen this muscle. Since the gastrocnemius in a shortened position & lessen it’s ability to produce tension.
Therefore, exercising with the knee
straight put the gastrocnemius on a stretch, increasing its ability to produce tension.
19 . D. The residual limb is pistoning up & down because the socket diameter is too large or the suspension system is
inadequate, resulting in skin friction.
The addition of more socks will enhance the fit.
20. D. The fact that backward bending is centralizing the pain is an indicator that the nucleus of the dics is being moved
centrally, & the pressure is being
Taken off of the nerve root. Centralization of the pain is also a good indicator for PT intervention.
21. C. Ice massage is usually applied to control pain, edema or inflammation. In this case, the ice would be used for pain
relief & to reduce inflammation, if
present. The dosage for ice massage is determined by the pt’s response, & usually applied until the pt experiences
analgesia or reported numbness over
the area of the massage. Although 5 to 10 minutes maybe a usual time for the response to occur, the dosage
depends on the pt’s response, not an exact
time. The pt will usually feel the following, sequential sensations during the massage: cold, burning, aching, &
then finally numbness. The desired effect
is numbness, not aching. The skin may turn white; however, the desired effect is numbness or pain reduction & not
skin color.
22. C. Joint mobilization procedures may cause some soreness. The therapist should inform the pt of this response to tx.
The pt should re-evaluate the pt &
could alter the tx by waiting an extra day before the next tx or by decreasing the dosage. There would not a need to
refer to the physician. The additional
exercises would not alter the response & there would be no indication of neurological involvement wit the reported
sx.
23. D. The independent variable can be thought of as the cause or tx & the dependent variable can be thought of as the
effect or response. In this case the
TENS is the tx or independent variable. Continuous & discrete variables are methods of quantifying variables.
24. A. A pt who is bed-bound & immobile will be prone to developing atelectasis (partial collapse of lung tissue), which
can then lead to pneumonia.
Frequent position changes with deep breathing & coughing will help prevent development of atelectasis. Given that
this pt is elderly & does not have dx
of secretion retention, vigorous percussion & vibration is not indicated. Vibration with the head down or standard
postural drainage positions will not be
tolerated in this elderly pt with chronic CHF.
25. C. Radiographs are in orthopedics to detect bony abnormalities. Soft tissue defects such as dics herniations would
not show up on the radiograph. MRI
scans are used to assess degenerative diseases, infarction, tumor, hemorrhage & congenital anomalies.
Myelography is used to assess bone displacement,
disc herniation, cord compression or tumor. Computed tomography (CAT scan) is used to assess the density,
displacement or abnormality of the
ventricular system & gray & white matter.
26. D. Behavioral objectives should be learner centered, outcome oriented, specific, & measurable. Option d is the only
one that is learner (student) &
specific to a situation. Options a & c require action by the clinical instructor, not the student. Option c, which may
be a step in the process, is not as
learner centered or outcome centered as option d.
27. A. During aerobic exercise, there is vascular dilation that occurs in order to optimize blood flow & the venous
system relies on muscular pumping in
order to return blood back to the heart. Without a cool-down period, there would be no muscular pumping &
therefore blood would pool in the venous
system. Cardiac arrhythmia may occur as well, but is less likely in someone without cardiac disease. Cessation of
activity by itself would result in gradual
decrease in body temperature & specific exercises are not necessary. Muscle tightening may occur as a result of
metabolites accumulating in the
 circulatory system, but this would occur as a result of the venous pooling.
28. C. The piriformis muscle functions as an external rotator of the hip, & it is thought that the tight piriformis muscle
may compress the sciatic nerve cause pain. Passive internal rotation & resisted external rotation may be painful.
Intervention would call for stretching of the piriformis muscle, not strengthening it. Modalities such as ice may also
be helpful to decrease the inflammation.
29. C. The most appropriate first step (pre-planning) would be to evaluate existing services within the community &
work out a budget for the project. Options a & b, although important, are things that would most likely be done after
the practice is up & running. Option d maybe done early on in the planning process, but would follow option c.
30. B. Following an AKA (transfemoral), the residual limb has tendency to develop contractures in the hip flexors &
abductors. Therefore, it is particularly important that the pt be positioned so as to maintain full ROM in hip extension
& adduction.
31. C. The L limb must function as the main support limb. Any tx strategy for ambulation must ensure that the
remaining limb is optimally functioning & that the limb is healthy. While the other factors are relevant, the integrity
of the remaining limb is the greatest concern for this pt establishing long term, functional goals.
32. D. S/sx of hip bursitis include the following severe pain over the bursa area, with pain aggravated by active motion
including activities such as walking. S/sx of a sacroiliac joint derangement include pain directly over the region of
the joint & in the low back, in addition to pain with walking. S/sx of hip fracture will include the following: severe
pain in the groin area & tenderness occurs in the area anterior to the femoral neck. An adductor longus muscle strain
would not cause tenderness over the greater trochanter.
33. C. A fall on O2 saturation below 87% is equivalent to a partial pressure of 55 mm Hg of O2 in the blood, which is
considered to be moderately hypoxemic (low O2 levels). This situation would require increased O2 levels in order to
be rectified. A rise is carbon dioxide level would not be alleviated by increased oxygen levels. Complaints of SOB
can come from a variety of causes & would not necessarily be alleviated by increased oxygen levels. An increased
HR to 150 bpm maybe a normal response to this activity & would not necessarily require increased O2 levels.
34. B. All documentation about PT services should readily translate the physical findings (impairments) into functional
abilities/ limitations.
35. C. Of the four options, backward walking is the only one that requires hip extension with concurrent knee flexion &
hip flexion with knee extension.
36. C. This pt needs to have functional benefits of tenodesis by allowing the finger flexors to shorten with the wrist
extended; therefore, PROM of the finger flexors should be performed with the wrist in non-functional position of
flexion. People with C6-7 quadriplegia use the tenodesis grasp. This allows the fingers to flex with wrist extension &
to open with wrist flexion.
37. C. With an inversion injury, the tendons of peroneus longus & brevis can become strained. Swelling with an
inversion strain usually occurs over the anterolateral part of the ankle. Compression & support is most beneficial by
placing tape stirrups on the lateral side of the ankle, over the tendons of the peroneus longus & brevis & pulling the
ankle into slight eversion.
38. A. Nerve conduction velocity testing is most useful in the evaluation of peripheral nerve or lower motor neuron
status. Therefore, since carpal tunnel syndrome is the only one of the conditions that directly involves a peripheral
nerve; it would be the most appropriate choice. A CVA is an upper motor neuron disorder. Both myotonia & DMD
are primary muscle disorders.
39. B. Increasing the sensitivity makes the biofeedback unit more sensitive to electrical potentials from muscles. As the
sensitivity is decreased, it takes more electrical activity to trigger the biofeedback unit (i.e., provide an audio or
visual cue to the pt). For use in muscle re-education, the unit should be most sensitive during the initial tx so the pt is
able to recruit enough motor units to trigger the unit. As the pt is able to recruit more motor units, the sensitivity is
decreased which would require the pt to activate more motor units.
40. C. Thrombocytopenia is an acute or chronic decrease in the number of platelets in the circulation. The T4
lymphocyte count is used to assess immune status in patients with HIV or AIDS. The re blood cell count is utilized
to assess for presence of anemia & the white blood cell count would be examined to determine presence of infection
or degree of immunosuppression.
41. A. The most common cause of inwardly pointing or “squinting patellae” is excessive femoral anteversion. Although
there is normally 8-15 degrees of femoral anteversion, an excessive amount leads to squinting patellae & toeing-in.
The other options would all have a tendency to cause the patella to point outward during standing.
42. C. The occulomotor nerve innervates the levator palpebrae superioris muscle that elevates the upper eyelid & the
papillary constrictor muscle. Therefore, a lesion of the occulomotor nerve would make it difficult, if not impossible,
for the pt to fully raise the lid (open the eye) & would cause a condition termed ptosis. In addition, the eye may not
react to light & therefore may not show papillary constriction when light is directed into the eye. Inability to fully
 close the eye would be seen with a lesion of the facial nerve (Bell’s palsy). Medial strabismus would be caused by
damage to the abducens nerve, innervating the lateral rectus causing a medial strabismus.
43. C. Exercise has been shown to increase sensitivity of insulin receptors therefore leading to a decrease in the amount
required. Administration of medication is dictated by tolerance & efficacy of the medication & would not necessarily
be altered by exercise. In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24
- 48 hrs after exercise, therefore increasing caloric intake, particularly carbohydrates, would be essential.
44. B. Wet-to-dry dressings are indicated for necrotic tissue needing debridement. The moderate amount of drainage
would require more frequent (i.e., bid) dressing changes. Vigorous scrubbing of the wound could damage friable
tissue. Betadine can be cytotoxic. Whirlpool would not be effective in removing necrotic tissue.
45. A. The median nerve supplies sensory innervation to the palmar surface of the thumb, index & middle fingers. A
positive Tine’s sign (eliciting a paresthesia while tapping over the carpal tunnel at the wrist) & weakness of the
opponens pollicis muscle are indicative of carpal tunnel syndrome. Ulnar nerve compression would cause sensory &
motor changes in the little & ring fingers not the thumb. Tenosynovitis of the APL muscle would most likely reveal a
positive Finklestein’s test (stretching of the abductor muscle) with pain over the dorsum of the hand. Thoracic outlet
syndrome would most likely revealed with special tests that cause alteration of radial pulse.
46. B. The most efficient stimulus would be one that causes tetany in the muscle (s) without causing fatigue. The
biphasic waveform at 30 pps best fir this stimulus. The 100 pps stimulus rate may cause fatigue, which would be
undesirable. The interferential waveform at the frequency of 1 pps is too low & the direct current would not be
appropriate because it would not cause tetany. In addition an on/off cycle of 1:5 would allow adequate recovery time
for the muscles between successive contractions.
47. C. A 20 degrees knee flexion contracture means that the knee is unable to complete the last 20 degrees of extension.
This limitation of motion can be caused by several factors including tightness of the hamstrings (semimembranosus),
restriction in the posterior capsule of the knee, & weakness in the quadriceps femoris muscle (vastus medialis).
Restriction of patellar movement may also be a factor, however the proper glide technique to increase knee extension
would be a superior (not inferior) glide of the patella.
48. B. A pt with thoracic spinal cord level injury is able to perform independent pressure relief strategies and should be
completed every 15 to 20 minutes.
49. D. The soleus originates on the tibia & fibula & inserts onto the calcaneus, crossing only the ankle joint. Therefore, it
will have an effect on the ankle whether the knee is flexed or extended. The gastrocnemius & plantaris both have
origins on the femur & insert onto the calcaneus crossing both the knee & ankle joints. Therefore, they will be placed
on stretch with the knee extended & will potentially limit ankle dorsiflexion to a greater extent with the knee
extended. The tibialis anterior is a dorsiflexor of the ankle & while weakness in this muscle may limit active
dorsiflexion, it would not affect passive dorsiflexion.
50. A. The restocking of tx booths with supplies is the only option which does not involve direct pt contact or care, &
thus is the MOST appropriate activity to delegate to a volunteer. Although volunteers may at times be involved with
pt care activities (i.e., transporting patients), the patients in the above situations pose a potential risk & would require
supervision by someone other than a volunteer.
51. A. A state of alertness to the internal & external environment must be maintained for a motor or mental activity to
occur. The brainstem reticular activating system brings about this state of general arousal. To proceed from a state of
general arousal to one of “selective attention” requires the communication of information to & from the cortex, the
thalamus, & the limbic system & it’s modulation over the brainstem & spinal pattern generators.
52. C. The first step in preparing any education experience is to determine what the needs of the audience are. Since
prevention of low back injury is the ultimate goal, assessment of the employee’s workstations is an important first
step in planning the educational program. Simply instructing all employees in lumbar extension exercises is
inappropriate without a thorough evaluation of their physical needs. Option b cannot be done unless an assessment of
the functional needs has been performed. Providing pamphlets are useful teaching adjunct but would not be the first
step to prevent low back pain effectively in this population.
53. D. The Standards of Practice of PT state that the PT is responsible for establishing a plan of care for the pt based on
the evaluation of the examination data & pt needs. The plan of care includes plans for discharge. The implication is
that the long-term goals for the pt (discharge plans) are determined when the therapist first sees the pt. It is
anticipated that modifications of the plan of care is to be expected depending on the response of the pt to the
intervention.
54. A. The best position for the pt, to drain the posterior segment of both lower lobes would be prone lying with the head
down & the lower extremities & hips elevated to about 45 degrees.
55. B. The median nerve innervates the following muscles in the forearm: (1) pronator teres & quadratus, (2) flexor
digitorum superficialis, (3) flexor digitorum profundus (index & middle fingers), (4) thenar muscles (abductor
pollicis brevis, opponens pollicis, flexor pollicis brevis). Therefore, a lesion of the median nerve would affect those
 muscle & their accompanying actions: forearm pronation, finger flexion & thumb opposition. Thumb adduction is
accomplished by the adductor pollicis (ulnar nerve). Finger abduction is performed by the dorsal interossei (ulnar
nerve). Forearm supination is the action of the supinator (radial nerve) & biceps brachii (musculocutaneous nerve).
56. B. The only one of the above interventions that requires precaution because of THR is continuous US. However that
does not mean that US is contraindicated for this pt. TENS may be used over metal implants. Hotpacks & massage
would not affect the total hip prosthesis.
57. B. For this pt, the first mobilization procedure would be distraction of the glenohumeral joint. The distraction
separates the joint surfaces & is used as a test of joint play. The distraction can also help increase joint play.
Distraction may also be used in conjunction with the other mobilization techniques listed. Later mobilization
techniques would most likely include anterior glide.
58. D. Heterotopic ossification occurs in 10% to 20% of patients with TBI. The abnormal bone formation occurs in the
soft tissue surrounding major joints. Patients with spasticity are at increased risk. Loss of ROM is characteristic for
this problem. Osteogenic sarcoma is less likely. A patellar fracture would not present as a lateral mass.
59. C. Pain with resisted medial (internal) rotation & pain with passive lateral (external) rotation is indicative of
subscapularis tendonitis. Bicipital tendonitis is suspected if resisted supination is painful when the pt’s arm is at the
side & the elbow is flexed to 90 degrees. Painful resisted abduction & resisted lateral (external) rotation is indicative
of supraspinatus tendonitis. Pain on resisted lateral (external) rotation is indicative of infraspinatus tendonitis.
60. B. Objectives must be measurable & the specific behavior expected should be stated. Understanding, overcoming, &
appreciating elude tangible measurement, while listing five techniques is an activity that can be documented & is
therefore measurable.
61. A. The sartorius flexes, externally rotates & abducts the hip joint. With resisted hip flexion, the sartorius will be
recruited to perform all three actions giving the observed substitution pattern. The tensor fascia latae is a medial
(internal) rotator flexor of the hip, so substitution by it would involve medial (internal) rotation & abduction. The
adductor longus would adduct the hip. Substitution by the semimembranosus would cause hip extension.
62. B. The recommended dosage for mechanical, intermittent pneumatic compression pressure is between 30 and 80 m
Hg, (higher for the LE than UE). It is also recommended that the pressure be below the diastolic pressure. Pressures
below 30 mm Hg are not considered to be effective. Pressures above diastolic can be used with caution. For the first
tx, it would be most appropriate to use a pressure that is considered effective, yet not so high as to cause a potential
problem for the pt. If the pt responds positively to the intervention, the higher pressure could be instituted.
63. D. In order to best intervene with a pt who has had cardiac dysfunction, a full examination & evaluation is necessary
to properly form a tx plan. An important aspect of the examination is ascertaining the type of angina that the pt
experience so that the therapist will know how to prevent angina with exercise or recognize it if it does occur during
the tx session. The other options provided are all outcomes that would occur after the pt has completed a cardiac
rahab program.
64. C. According to the Guide to PT Practice, “Information relating to PT/patient relationship is confidential & may not
be communicated to a third party not involved in that pt’s care without the prior written consent of the pt.” Option c
is the only one that fits these criteria.
65. A. Sixty percent of children with myelomenigocele develop hydrocephalus after surgical closure of their lesion.
Early warning signs of hydrocephalus include irritability; changes in sleep patterns, & changes in appetite & weight.
80 - 90% of children who acquire hydrocephalus will require a cerebrospinal fluid shunt. These children require
ongoing follow-up by a physician. Given the seriousness of this child’s sx, the child should immediately be referred
for medical follow-up.
66. D. Bell’s palsy involves the facial nerve. The frontalis is the only muscle listed that is innervated by the facial nerve.
The SCM is innervated by spinal accessory nerve, & the masseter & temporalis are innervated by the trigeminal
nerve.
67. A. The abdominal muscles are active during sit-ups (with knees extended) up until the spine is completely flexed
(head, shoulders, thorax lifted from surface). In order to come to a long-sitting position however, the hips must be
flexed & the abdominals cannot perform this action because they do not cross the hip joint. Therefore, the hip flexors
(iliopsoas among others) would have to complete this motion. The inability to achieve a long-sitting position would
suggest weakness in the iliopsoas muscle.
68. C. The plantar grasp reflex is characterized by curling of the toes when the child is held supported in standing. The
reflex is normal up to 9 months of age. Delayed integration of this reflex can result in delayed, independent
ambulation.
69. C. Placing a crutch in the L hand reduces the magnitude of the ® hip abductor force needed to prevent the pelvis
from dropping on the L side during the stance phase on the ®. Pushing down on the crutch of the ® limb reduces the
amount of ® hip abductor force needed, which in turn reduces the compression force on the ® hip joint. This effect
is desirable in patients who have hip abductor weakness or hip pain.
70. C. Spinal shock occurs as a reaction to SCI & is characterized by an absence of all reflex activity below the level of
the lesion. Depending on the extent of the lesion, the pt may lose all or some of their sensation & motor activity
below the level of the lesion. Spasticity is associated with hyperreflexia & increased muscle tone. Spasticity would
be expected to develop following the spinal shock stage. Decerebrate rigidity involves sustained contraction of the
UE &LE in extension. With a LMNL, the loss of sensation & motor activity would be confined to a much smaller
region (depending on the exact lesion) & would not affect all levels below the lesion.
71. D. The pt’s s/sx are reflective of a ® sided cerebellar hemisphere lesion. That is, cerebellar lesions commonly
produce hypotonia, hyporeflexia, ataxia & an intention tremor. Cerebellar lesions also produced ipsilateral s/sx in the
extremities. A ® sided lesion of the spinal cord (Brown-Sequard syndrome) would produce weakness with spasticity
& hyperreflexia. A L sided cerebral hemisphere lesion would present similar to a ® sided cervical spinal cord lesion.
A lesion of the substantia nigra would produce s/sx like as those seen with PD with rigidity & resting tremor.
72. B. The common peroneal nerve innervates the following muscles: peroneus longus & brevis, tibialis anterior,
extensor digitorum longus & brevis, peroneus tertius & extensor hallucis longus. Because of the complete severance,
all of those muscles would be affected & would not be able to actively contract until regeneration has taken place.
Therefore, the pt would completely lose ankle dorsiflexion, eversion & toe extension. Those motions have to be
performed passively in order to maintain ROM. Option b is the only one that contains all of the correct actions.
73. A. Option a is the best answer. In option b, if the pt does not initially understand the information, then having short-
term memory is irrelevant. For option c, hearing & vision are obviously important but the most critical component is
comprehension.
74. C. Status alignment for knee stability is established by pistoning of the knee so that the lateral reference line falls
anterior to the knee joint.
75. B. The COG of a person with bilateral AKA is more posterior than the COG of a person with their LE intact. Setting
the back wheels more posteriorly will make the pt more stable in the chair. This adjustment prevents the wheelchair
from tipping backward.
76. B. Although protocols depend on the surgeon & the approach, it is generally recommend that anti-gravity hip
abduction exercises not begin until 5 to 6 weeks post surgery. Patients are taught to avoid excessive hip flexion,
usually beyond 80 degrees. Bed mobility & ambulation would be started 1 to 2 days post operatively.
77. D. Posterior muscle tension is implicated in the development of tension headaches. Positive imagery recommended
as a self-tx technique, but the awareness of tension & the appreciation of its absence are foundational. Massage &
passive exercise may be relaxing, but the pt must be aware of the sensations of tension to prolong the benefit.
78. B. Anticoagulation therapy inhibits the synthesis & function of clotting factors can lead to bruising (ecchymosis) or
more severely hemorrhage. A hemangioma is a benign liver tumor. DVT would result in redness, swelling & warmth
in the affected area & most commonly occurs in the calf muscle, not the hip region. A hematocele is a blood cyst.
79. A. An S-T segment depression of greater than 1mm is indicative of MI. Continuing the exercise session could place
the pt at serious risk for continued ischemia, which could ultimately lead to MI. Therefore the best response for the
therapist would be to stop the exercise session immediately & inform the cardiologist of the pt’s response. All of the
other options would continue to place the pt at risk.
80. A. Infection control requires that the wound not be contaminated further, & that the health care workers protect
themselves from dse by avoiding contact with body fluids. In this case the pt does not appear to be in life threatening
danger, & so the wound should be attended to. Therefore, checking the pt’s BP would not be the first thing to do.
Once the gloves are donned, cleaning the wound & covering it with a sterile dressing would be appropriate.
81. D. Patients should be encouraged to express their feelings. Comparisons to other pt who are dying in an effort to
assure the pt he is not alone, takes away from this pt’s feelings. Denial of death would not be good for the pt, since
he must ultimately cope with the inevitable. Pastoral counseling would be an option, but the therapist should be
ready to listen to the pt, encourage _expression of feelings & avoid denial.
82. B. The pt taking beta-blocking medication will experience a lower HR & BP response during exercise as compared
to a pt who is not taking this medication. Since the HR is lower than anticipated, using HR to monitor exercise
intensity may not be as accurate. Another measure, such as the Borg Scale (rating of perceived exertion) would be
more beneficial. However, even though HR & BP would be lower, the pt actually achieves the same metabolic levels
during exercise & therefore altering the frequency or duration of exercise is unnecessary. The time for warm-up &
cool-down exercises does not to be altered.
83. A. A non-adherent dressing is best choice because any adherence of the dressing to the fragile granulating tissue
could cause additional trauma. This is superficial wound, so there wound be no need to pack the wound. Since there
is some drainage, a covering is preferential to topical medication only.
84. D. Pronation of the foot can be cause by a variety of factors including calcaneal eversion & forefoot varus.
Correction of the pronation by an orthosis could include a medial post (wedge) placed just proximal to the metatarsal
heads or a medial post under the calcaneus. This approach involves bringing the ground up to meet the foot. A post
 under the fifth metatarsal head would accentuate the problem, as would a rearfoot post placing the calcaneus in an
everted position. If the pt has excessive forefoot varus, a wedge may be placed in the instep in addition to the medial
wedge proximal to the metatarsal heads to distribute the load; however a wedge in the instep by itself would not be
the best intervention.
85. A. Since most of the joint contracture/adhesion forms in the anterior-inferior portion of the capsule, tx to mobilize
that portion of the capsule is of primary concern. Inferior glide would stretch the inferior portion of the capsule. 8
86. B. Options a, c &d are acceptable interventions for this pt. The epiphyseal areas (growth areas of bones) in children
should not be exposed to ultrasound. The application of US over the knee joint (hamstring insertion) could expose
the epiphyseal areas to the US.
87. D. When the knee is extended the medial & lateral collateral ligaments are taut. During knee flexion the ligaments
slacken. Therefore there is very little tibial rotation when the knee is extended (closed packed position) &
approximately 40deg of axial rotation with the knee flexed. Although the femoral condyles may glide posteriorly
(depending on the direction of rotation) on the tibia & hamstrings may rotate the tibia, the reason the motion is
available is due to laxity in the collateral ligaments. Other ligaments such as the cruciates & the joint capsule may
add to the stability in the closed packed position.
88. D. Scoliosis deformities are named relative to the convexities of the curves, with the apex of the curve defining the
vertebral level. In the ® thoracic, L lumbar scoliosis, there is a convex curve to the ® in the thoracic spine & a
convex curve to the L in the lumbar spine. In the thoracic spine, the body of the vertebrae rotates to the ® (convex
side) & the spinous process rotate toward the L (concave side). Along with this transition, the ribs rotate posteriorly
on the convex side causing the scapula to become more prominent on the convex side & causing the shoulder to be
elevated on the convex side.
89. A. With this particular posture, the pt’s scapula would be in a protracted (abducted) position, therefore the scapular
protractors are already overactive & would require stretching not strengthening. The kyphosis suggests that the
thoracic erector spinae muscles are weak & need strengthening. The lumbar lordosis indicates shortened lumbar
erector spinae muscles. Forward head posture suggest that the cervical spine is flexed & the occiput is extended,
therefore stretching of suboccipital muscles would be indicated. A TEST-TAKING HINT: Although EXCEPT
questions are rarely used on the NPTE, be alert for this type of question & read the responses so that you select the
unrelated response.
90. D. Compression on the median nerve (carpal tunnel syndrome) is occurring, most likely as a result of swelling
associated with the individual being in the eight month of pregnancy. In this case, rest & elevation would do the
most to decrease the edema & relieve the sx. The wrist should not be positioned in full extension. Initial conservative
tx sometimes includes cock-up splinting to hold the wrist in neutral to 10 degrees of extension, but not full extension.
Although tendon gliding exercises may be used, heat would not be indicated since it may increase the edema.
Resistive exercises for the wrist & fingers may aggravate the compression in the carpal tunnel.
91. C. Patients with PD are characterized by rigidity, bradykinesia, tremor, lack of associated movements, impaired
balance reactions & a flexed posture (kyphosis). Therefore intervention should be directed toward full ROM &
correction of kyphotic posture through back extensor strengthening exercises, balance exercises, & exercises that
promote reciprocal movement. Option c is the only one that includes appropriate exercises.
92. A. Upon heel contact, the heel section compresses partially absorbing the ground impact & thus permitting a
controlled plantarflexion. If the heel is too stiff, upon initial contact, the knee flexes too soon & excessively on initial
contact. An excessively firm heel wedge would not be a factor in late stance.
93. A. A pt with COPD has premature collapse of the airways upon exhalation, which leads to air trapping & ultimately
poor gas exchange. Breathing out through pursed-lips slows the airflow & creates a backpressure which helps to
prevent the airways from collapsing while exhaling. By exhaling more fully through pursed-lips, more CO2 is
removed. By preventing airway collapse & air trapping in the lungs, the residual volume is actually decreased.
Pursed-lipped breathing helps with ventilation, but does not necessarily assist with secretion mobilization.
94. C. The dermatome providing sensation to the little finger is innervated by the C8 nerve root. The triceps brachii is
the only one of the muscles listed that is also innervated by the C8 nerve root. The biceps brachii, deltoid, &
brachoiradialis are innervated by the C5, C6 & sometimes C7 nerve roots.
95. A. Evaluation of the pt’s retention of information presented in the program can be enhance by asking the patients
questions about the program information, having the pts ask questions about the program, having the pts demonstrate
what they have learned & testing the pt about the program material. Option a is the only one that utilizes one of these
techniques. The other options do not require active participation by the pts, they do not address specific
interventions.
96. C. During the swing phase of gait, the foot is dorsiflexed to clear the foot. Muscles active during this phase of gait
are the tibialis anterior, extensor hallucis longus & extensor digitorum longus. The gastrocnemius, tibialis posterior
& peroneus longus are active during the stance phase of gait. Therefore, of the muscles listed, the EDL is the best
 choice. If only the tibialis anterior was stimulated the foot would go into inversion & dorsiflexion, which could cause
the pt to land on the lateral side of the foot at initial contact causing them injury. Addition of the EDL would bring
the foot up into more dorsiflexion & avoid excessive inversion.
97. D. The current dosage for iontophoresis is calculated by multiplying the current (4mA) by the duration (15 minutes).
In this case the calculation would yield a value of 60 mA-min. None of the other options use the correct values.
98. A. The double upright metal AFO would provide the best support for the mediolateral instability & would aloe for
changes in leg volume. The plastic, solid AFO would not provide as much mediolateral support & because of its
confirmation to the leg it would not be advisable for pts who are experiencing changes in leg volume due to edema.
High top shoes would not provide enough support. The spiral AFO would nor provide needed stability to the ankle &
the design would not be indicated when a pt has fluctuating edema
99. C. Hemoptysis or the coughing up of blood can be benign or severe & can be a common occurrence in the cystic
fibrosis population secondary to the pathophysiological processes in their pulmonary system. In general, a small
amount of hemoptysis that occurs occasionally or is non-persistent hemoptysis is benign. The brownish color
indicates either venous blood or old blood. In this situation, if the hemoptysis does not persist, then it is appropriate
to continue tx without modification. If the blood was larger in amount & fresher (denoted by a bright red color), then
the tx should be discontinue. The presence of blood in the sputum should not warrant more vigorous chest
percussion, until it is deemed appropriate to continue with the session. Since this situation is benign scenario,
alteration of drainage position is not necessary, & there is no need to send the pt to the emergency room.
100. C. Isokinetic exercise device utilize accommodating resistance throughout the ROM. The other exercises are not
forms of accommodating resistance.
101. D. Air is released during the stance phase of gait, which results in a negative pressure inside the socket to
provide a suction suspension during swing phase.
102. B. With venous insufficiency, the limbs would be edematous, the superficial veins would be dilated & if not
corrected ulceration could develop. Options a & c are ruled out because they indicate no edema. Option d is not
correct because the condition is relieved by sitting or leg elevation.
103. A. In order to improve knee flexion, the PT needs to address patellar tightness. During flexion at the knee, the
posterior motion of the tibia causes the ligamentum patellae to pull the patella distally & posteriorly. Patellar
mobilization in the distal direction would assist with increasing knee flexion.
104. C. The tibialis posterior plantar flexes & inverts the foot. This pattern requires the specific action of that muscle.
The other patterns do not.
105. C. Pain that is experienced in the thoracic spine can be caused by a variety of pathologic conditions. LBP can be
either mechanical or non-mechanical in nature. Pathology in the kidney may refer pain to the lumbar spine
(ipsilateral flank), or upper abdomen. Pathology in the urinary bladder refers to the subpubic or thoracolumbar
region. The diaphragm is innervated by C3, C4 &C5 with the pain normally confused to the C4 dermatome. The
negative MRI has ruled out possible involvement of the dura mater.
106. A. In order to optimally clear the congestion that has developed in the ® lower lobe, the pt would need to be
positioned on the L side to allow gravity to help drain the secretions to the proximal airways. This pt is also
unconscious & intubated so in addition to drainage, manual hyperinflation is necessary to provide increase
ventilation which would help mobilize secretions followed by suctioning to clear out secretions. Suctioning first then
hyperventilating while in L sidelying is less effective than the order suggested in option a. Positioning on the ® side
would not drain the ® lower lobe, & since also the pt is laying on the ® side, the only place to percuss & vibrate
would be on the L side, which has no pathology. Finally, positioning on the L side with deep breathing will not be
effective in mobilizing secretions, especially since the pt is unconscious & unable to actively perform deep breathing
exercise.
107. B. Prednisone is a glucocorticoid that exhibits these side effects. The primary side effect of penicillin is an
allergic reaction such as skin rashes & difficulty breathing. The primary side effect of aspirin is gastritis. The
primary side effect of gold therapy is diarrhea, irritation of oral mucosa & skin rashes.
108. D. The weakness in the flexors of the 4th & 5th digits at the DIP joint (2/5). The other fingers show normal
strength (5/5). This weakness would indicate a problem with the flexor digitorum profundus, since the distal joints
are involved. The FDP is innervated by both median & ulnar nerves. The median nerve innervates the FDP muscles
flexing the index & middle fingers. The ulnar nerve innervates the FDP muscles flexing the ring & little fingers.
Therefore, since the ring & little fingers are involved, The lesions would have to be involving the ulnar nerve. The
FDP to the 4th & 5th fingers is innervated by the ulnar nerve roots C8 & T1.
109. B. The best answer would be for the therapist to recommend a team conference. That conference would bring
together members of the health care team as well as the pt & family members, to arrive at joint decision as to the
placement of this pt. The best time for such meeting would be prior to discharge, because after discharge it is
difficult to arrange such meetings. Allowing the pt to determine his own discharge environment may be fine if there
 is no safety concerns, however a decision whether or not the pt is competent to make that decision must be made
first. Scheduling a home visit or the implementation of a tx plan for home care would be premature until a decision
on placement has been made.
110. D. Sudden tingling of the hands & weakness of muscle groups are alarming signs of cord compression. The
concern is that the spinal cord sustaining further injury. The exercise may be exacerbating or causing these signs.
This is considered a medical emergency & the physician should be immediately advised.
111. D. The primary PT goal in this case would be joint protection & the prevention of contractures & adhesions,
usually through splinting. There is no evidence to suggest that PT can prevent nerve degeneration & muscle atrophy,
as they are the normal effects of a peripheral lesion. Spasticity would not be present in lower motor neuron injury.
112. B. While all of the above would help prevent injury to a diabetic foot, the most important information to provide
is about proper footwear. Ensuring properly fitting footwear would alleviate risk of skin breakdown as well as
providing appropriate cushioning to the articular cartilage of the foot joints that are prone to injury from repetitive
trauma & compression. Orthoses may not be necessary for all patients. Despite moisturizing the skin, if there is
improper protection, skin breakdown can still occur. Exercising within appropriate parameters will not be beneficial
if the pt’s footwear is not supportive or properly fitting.
113. B. An intact circulatory system can sustain adequate blood flow to an elevated limb. A limb with arterial
insufficiency may not be able to sustain adequate blood flow against gravity. The vasodilation, caused by local
mechanisms, occurs in response to ischemia. An acute arterial occlusion creates pallor, but because blood flow is
blocked, the reactive hyperemia is impaired.
114. C. The gluteus maximus is a hip extensor that is more active during resisted motions or when the hip is in
flexion, especially in functional activities such as stair climbing. In this case, the pt flexes the hip placing the gluteus
maximus on stretch increasing it’s ability to produce tension. Therefore, the pt is leaning forward to maximize the
ability of the gluteus maximus to extend the hip during the stair climbing activity. The other muscles listed would
not be benefit as much from the increased hip flexion.
115. A In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 to 48 hrs after
exercise. Exercise has been shown to increase sensitivity of the insulin receptors therefore leading to a decrease in
the amount of insulin required.
116. B. A larger print will not simplify the meaning, nor will lengthening the sentences. Only option b, the choice of
illustrations & a simpler sentence structure, is correct.
117. C. A PT would be required to perform the initial evaluation, plan of care, re-evaluations, modifications to the
plan of care, & discharge plans for the pt’ The pt who is stable & on an existing program would be most appropriate
pt to be delegated to the assistant. Therefore, the pt who ha multiple sclerosis 7 who is on an established gait training
program would be the most appropriate. The other three patients are receiving their initial treatments.
118. B. Normally, as the diaphragm descends with inspiration, it places increased pressure on the abdominal contents
with a resultant distension of the epigastric area. Weakness of the diaphragm would decrease the distension & may
result in a compensatory increase in upper chest expansion to improve ventilation. The scalene muscles act to elevate
or stabilized the clavicle during inspiration. The rectus abdominus is a stabilizer during inspiration & assists with
forced expiration. The intercostals muscles act to stabilize the thoracic cage during ventilation.
119. C. The medical record is owned by the hospital subject to the pt’s interest in the information it contains. Unless
restricted by state or federal law or regulation, a hospital shall furnish to a pt, or a pt’s representative parts of the
hospital record upon request in writing by the pt or their representative. Option c is the only correct answer in this
case, since it specifies that the pt must authorize the release of information.
120. B. The anterior tibialis shows poor (2/5) grade strength during the examination. Because this muscle is active
during swing phase of gait & shortly after initial contact, one would expect to see gait deviations showing up at those
times. Specifically, the anterior tibialis maintains dorsiflexion of the foot during swing phase & controls
plantarflexion after initial contact. During swing phase, weakness of the anterior tibialis would cause the pt to
increase the amount of hip & knee flexion to prevent toe drag. With weak hip abductors, the pt would be expected to
have excessive pelvic rotation. To compensate the pt would laterally bend toward the weak (right) side during
midstance to help prevent the excessive hip drop. Throwing the trunk backward after initial contact may be due to
weakness of hip extensors (gluteus maximus).
121. B. The pt’s sx would be aggravated by exercises that cause increases in patellofemoral joint reaction forces. One
of the goals of tx would be to promote proper patellar tracking. Isometric exercises such as quadriceps setting & SLR
are most often used for strengthening with a dx of chondromalacia patella because they produce smaller
patellofemoral joint reaction forces than some other forms of quadriceps exercises, & thus are less painful. The
vastus medialis is one of the muscles active during quad setting. This muscle tends to pull the patella medially during
contraction & thus acts as a dynamic medial stabilizer, which promotes proper patellar tracking. The vastus medialis
is not preferentially recruited during a SLR, nor it is the only muscle responsible for terminal knee extension.
 Patello-femoral compression forces are generally less during SLR than when doing extension exercises with the knee
bent.
122. A. With an extension exercise program, centralization indicate that the pt is improving, even though the pain
may be just as intense as it was. Even though the pt may feel frustrated, he is actually improving; & therefore the
therapist should continue with the extension exercise program. There is no need to call the physician at this point,
since the centralization is perfectly normal. Although trunk flexion may be used later in the intervetion, it would not
be indicated at this point because extension is working.
123. D. An outcome measure documents a desired performance or change in the pt’s condition over time. This may
include a description of the pt’s function before, during & after intervention. Option d does not indicate a change or
function, but is focused on attendance.
124. A. The rib cage would not be able to expand normally during inspiration due to weakness of the intercostals
muscles, which are innervated by thoracic nerve segments. With a spinal cord lesion at the C5-6 level, the diaphragm
would still receive innervation from the phrenic nerve (C4). The anterior scalene (C4-6) would be partially
innervated & the SCM (C2-3) would be fully innervated. The abdominal muscles would not be innervated since they
receive their innervation from thoracic nerve segments. Paralysis of the abdominal muscles would cause the
diaphragm to assume a low resting position.
125. C. “Information relating to the PT/pt relationship is confidential & may not be communicated to a third party not
involved in that pt’s care without the prior written consent of the pt.” Option c is the only one that fits these criteria.
126. C. Inclusion of all members of the health care team into decision-making is important for the pt & provides for
continuity of care for the pt. However, the team approach has some pitfalls such as arranging meetings between team
members, which may be atime consuming process. The team concept would also assume that the team reaches a
consensus that requires more time than relying on individual decisions that can be made quickly. Therefore, Option c
is the best answer to this question. The other three options are advantages of the team concept.
127. A. RA is a chronic inflammatory dse that affects many body systems including the joint space. Destruction &
subluxation of joints can occur over time secondary to the inflammation that occurs in the synovium. Fatigue is a
common sx that accompanies RA. Therefore, the pt must get enough rest to avoid excessive fatigue & to protect the
joints from overuse damage. Therefore education on energy conservation & joint protection is essential to minimize
joint deformity. However, the pt must realize that some activity is good for them to prevent contractures & to
maintain strength & endurance. Fatigue & joint pain can & often do co-exist in pts with RA. The pannus in the joints
is actually increased with rest. Rest does not appear to change the activity of the antigen-antibody complex.
128. C. This pt would have functional use of the triceps & finger flexors & would therefore, be independent for all
wheelchair transfers to all surfaces. Coughing would not be limited & would not be a goal. Rolling would be easily
achievable as a short-term goal. Ambulation with forearm crutches would not be a reasonable expectation for this pt.
129. B. PT intervention should focus on helping the pt obtain maximal functional independence. Wheelchair transfers
are the means to enable the pt to be independently mobile & will be a requirement before more difficult tasks are
performed such as ascending a 10-foot ramp. The pt is presumambly too weak to walk at this point in time. Tub
transfer is important, but the wheelchair will be the best means to get the pt to the tub. Therefore, for the initial
intervention session wheelchair transfers would be the most important.
130. A. Raising just the head activates only the recti muscles, & supporting the abdominal muscle with the hands
provides external support to the stretched abdominal muscles. This is the optimal position to initiate strengthening
following delivery for a pt with diastasis rectus abdominus. Doing exercise would not be appropriate. With no
support of the abdominal muscles, option c & d would be too aggressive at this time.
131. A. Several things can be done to decrease the current density & the possibility of skin irritation. These include
decreasing the intensity of the stimulation, increasing the inter-electrode distance & the use of larger electrodes.
132. B. The presence of dyspnea & the pink, frothy sputum would suggest the presence of CHF & resultant
pulmonary edema. CHF can occur from poor cardiac muscle function as a result of MI. Pulmonary edema occurs
from the backflow of blood from the heart into the pulmonary vessels, increasing pulmonary capillary pressure. The
increase in pulmonary capillary pressure increases fluid movement into the alveoli, which are normally dry. These
leads to the presence of pink, frothy sputum that can be expectorated along the shortness of breath (dyspnea).
Positions that increase blood flow to the heart, such as lying flat, will increase the s/sx. Therefore, the pt should be
positioned with the head up or as in this problem; the pt should be placed in a sitting position to help alleviate the sx.
Laying the pt down flat, supine or with the legs elevated would exacerbate the pt’s problems.
133. A. The assessment of posture in a wheelchair begins with the pelvis & it’s relationship to its adjacent segments.
The orientation & range of mobility of the pelvis in all three planes will in turn determine the alignment & support
needed at the trunk, head & extremities.
134. C. Medical social services deal with home situations, financial supports & acts, as a resource director on behalf
of the pt. Social services would be the most appropriate choice to help arrange & coordinate rehabilitative services
 for this pt while they are at home. Although nurses, occupational therapist, PT & physicians may all be involved
with direct pt care, they would not be the most appropriate for this level of discharge planning.
135. A. In order to place the ® middle lobe in an optimal position to drain secretions, a pt would need to be
positioned as stated in option a. Another way this position may be stated is “left sidelying with a quarter turn towards
supine”. The other positions do not optimally drain this lobe.
136. D. During measurement of shoulder abduction, the spine should be kept straight. If the pt is allowed to laterally
flexion the trunk it will give the appearance of increased shoulder abduction, but the motion would be occurring in
the spine & not in the shoulder. Upward rotation of the scapula & lateral rotation of the shoulder would normally
accompany the motion of shoulder abduction. Medial rotation of the shoulder would decrease the available
abduction.
137. D. An adverse side effect of prolonged prednisone use, in this case for 4 yrs, is muscle degeneration & therefore
achieving increases in muscle strength may be limited. Since muscle strengthening may be limited, then isokinetic
exercise would not necessary be more beneficial. Prednisone may lead to a decrease in bone density, not an increase.
Four yrs after transplantation, the pt will have been out in the community & the need for an isolation room in
unnecessary.
138. D. The open weeping rash may be infected. Skin infections are easily spread in training room environment, & if
not attended to correctly may infect more people. If an infection were suspected, the precise dx would be made by
means of a culture. Therefore the most appropriate action would be to refer the pt to the team physician. Moist heat
increases the infection by increasing blood flow. An emergency room visit would not be indicated at this time.
Occluding the wound with more pre-wrap creates an environment ideal for infection.
139. C. The previously amputated L limb must function as the main support limb. Any tx strategy for ambulation
must ensure that the L limb is functioning optimally. While the other factors are relevant, the previous ability of the
pt to ambulate is the greatest concern.
140. B. Physical findings of congenital hip dislocation include asymmetric skin folds of the buttocks & adductor
region; limitation of passive hip abduction; leg length inequality; & telescoping of the flexed & adducted thigh on
the pelvis.
141. B. The C5 & C6 myotomes include the biceps brachii, brachialis, brachioradialis & deltoid muscles. The elbow
flexors & supinators (C5-6) are used to carry a teddy bear in the crook of the arm. Pushing a wagon requires the use
of the triceps (C7-8). Holding a raisin requires presence of wrist flexors (C6-8). Grasping a cup requires finger,
thumb & wrist muscles (C6-8, T1).
142. A. In order to open up the intervertebral foramen, it would be best to flexion or at least flatten the lumbar spine
prior to applying the traction. Of the above options, positioning the pt supine with the hips & knees flexed would be
the best way to do this. Laterally bending the trunk to the L would also open up the foramen, but this is not one of
the options. Supine with hips & knees straight & then laterally shifted to the ® would tend to close down the
intervertebral foramen. Prone would also close the foramen. Sidelying with a bolster under the ® lumbar spine also
tend to close the foramen.
143. A. Prone standers are used frequently for children who cannot achieve or maintain upright standing. The benefits
from the physiologic changes associated with weight bearing & from the social & perceptual opportunity to see the
environment from an upright position.
144. C. With arterial insufficiency, elevation increases ischemia & therefore pain. Intermittent claudication is a
phenomenon associated with metabolic demands exceeding the capability of the vascular system to supply adequate
blood flow. Placing the limb in a dependent position increases swelling & therefore possibly pain with venous
insufficiency. An objective sign such as purple discoloration rules out a psychosomatic episode.
145. A. The primary PT goal of phase I cardiac rehabilitation is to achieve a safe & independent level of activity that
can be carried out at home. Increasing aerobic capacity cannot happen until phase III, when cardiac tissue has healed
fully. Modification of risk factors is a life-long process & will not be achieve during a short inpatient stay. Systolic
BP, when exercising, during the inpatient stay should only rise approximately 20 mm Hg above resting.
146. C. Option c is the only one stated clearly in educational terms. The other options are objectives based on
observations.
147. B. Pressure receptor (baroreceptors) are present in the carotid sinus & these receptors respond changes in BP. An
increase in blood pressure that is sensed by these receptors will stimulate the parasympathetic system to decrease the
rate & force of contraction of the heart in order to help lower the pressure. An increase in BP that is sensed by these
receptors will stimulate the parasympathetic system to decrease the rate & force of contraction of the heart in order
to help lower the pressure. Repeated palpation in the carotid sinus area may stimulate an increase in BP & cause this
reaction. Therefore increased HR & BP are incorrect. Irregular heart rhythms generally result from electrolyte
imbalance &/or ischemia to the conduction system of the heart.
148. A. Starting at the coracoid process & moving laterally, one would palpate the following structures: (1) lesser
tuberosity, (2) biceps tendon & (3) greater tuberosity. Any other order of structure palpation would be incorrect.
149. B. HR & systolic BP responses are higher for any given workload when performed with the UE as compared to
the LE. Angina is determined by a certain myocardial workload that is represented by the product of HR & systolic
BP. Therefore option a cannot be a conclusive statement. Pulmonary ventilation has less definitive responses but in
general would be similar in that UE exercise would cause a greater ventilatory response than LE exercise would.
Since HR & BP would be higher at any given workload with UE exercise , then angina would most likely occur at a
lower workload.
150. A. The pt will be reluctant to move the limb because it is painful. ROM is essential to regain & maintain a
functional ROM. In this case, The PT’s primary goal is to restore function with ROM exercises. Compression
dressings, whirlpool, & splinting, are all acceptable aspects of care that help in restoration of ROM. However,
functional ROM would be the primary goal.
151. C. The most appropriate design would be a two-group pretest-posttest. Both groups are measured at the same
times, but only the experimental group receives tx. Gathering information from pt records may not provide the same
accuracy as if the researcher had performed all the measurements directly. Measuring ROM only on day 5 would not
account for any pretest differences between groups.
152. A. The biceps brachii is both an elbow flexor & supinator, & it is most effective as a supinator with the elbow
flexed to about 90 degrees (approximately the muscle testing position). The brachialis does not cause supination
(only flexion). The supinator does not flexion the elbow. The brachioradialis would move the forearm to a
midposition rather than fully supinating it. Therefore, when the elbow both flexes & supinates the biceps brachii
would be the most likely muscle causing this action.
153. B. During normal knee extension, the tibia moves posterior relative to the femur. Therefore, posterior gliding of
the tibia would promote knee flexion. Superior glide of the patella could be used to increase knee extension.
Posterior glide of the femur on the tibia would be used to increase knee extension.
154. C. All of these sx are indicative of reflex sympathetic dystrophy syndrome. Cervical disc dse does not produce
swelling in the hand, color & temperature changes, or hyperhydrosis. Raynaud’s phenomenon results in pain, pallor,
& coolness, but no hyperhydrosis. Although carpal tunnel syndrome can also show sympathetic nervous system
abnormalities, compression of the median nerve would refer sx to the lateral border of the hand (thumb area). With
carpal tunnel syndrome, the pt may also display thenar muscle weakness.
155. B. Option b is the definition of validity. Options c & d refer to reliability measures. Results can be standardized
even though they are not valid.
156. A. The primary PT goal at this time is to restore ROM. Therefore, the most appropriate intervention for that goal
is passive & active assistive ROM exercises. Although gentle joint mobilization techniques may be indicated, grade
4 techniques at this time would not be. Progressive resistive exercises would come later in the plan of care. Although
the long-term goal would be to return to normal activities, the short-term goal would not.
157. B. Because the problem is a behavioral disorder, the most appropriate person to assess this pt would be a
neuropsychologist. The neuropsychologist is trained to assess intellectual, emotional & coping functions of the pt as
well as levels of depression & anxiety. They could also provide consultation to the rehab team members as to how to
deal with the problem.
158. C. The abductors are particularly active during the midstance phase (single limb support) of gait to prevent the
contralateral pelvis from excessive lateral tilting. Weakness of the hip abductors, particularly the gluteus medius,
causes the hip to drop down on the side opposite the weakness. For example, weakness in the ® gluteus medius
would show up during stance phase on the ® by excessive downward movement (lateral tilt) of the L pelvis. The hip
adductors are active during terminal stance & through mid-swing & would not play a role in controlling the lateral
rotation of the pelvis. The hip abductors show little activity during swing phase.
159. A. The optimal exercise duration for achieving weight loss with a walking program is 40 to 60 minutes of
continuous aerobic activity. Therefore once a pt is safely tolerating 15 minutes, the best progression is to increase the
duration while maintaining the same intensity or walking speed. Increasing walking speed should only be performed
once the pt can consistently tolerate 20 to 30 minutes of exercise. Decreasing the duration while increasing the
frequency of exercise would not accomplish the goal 40 to 60 minutes of continuous exercise. A pt who has been
walking for only 15 minutes 3 times/wk would not be ready to begin jogging & jogging one time per wk would be
too low of an exercise frequency in general to achieve by training benefit.
160. C. Trunk ROM exercises & strengthening to minimize thoracic kyphosis are essential. Persons with ankylosing
spondylitis tend to assume flexed postures. Disproportionately strong pectorals, hip flexors, or abdominals could
worsen the kyphosis.
161. B. A brachial plexus injury that affects the C5 & C6 nerve root is termed Erb-Duchenne paralysis. A lesion
affecting the C8 & T1 roots is termed Klumpke’s paralysis. Hemiplegia & spinal cord injury would be caused by
trauma to the CNS & would not normally affect just the C5 & C6 nerve roots.
162. A. The protrusion component involves the arthrokinematic movement of anterior condylar translation.
Mandibular depression (jaw opening) involves both condylar rotation and anterior translation. However, this
question is asking only about the protrusion component. Lateral glide involves anterior translation on the
contralateral side and spin on the ipsilateral side.
163. C. The occupational therapist would be the most appropriate members of the health care team to teach the
patient the needed self-care skills. The occupational therapist would also be able to provide the patient with
information regarding modifications to the home environment that would increase the patient’s independence. The
occupational therapist could teach the patient how to use adaptive devices and help with the fabrication of splints or
self care aides.
164. D. The therapist should observe the parents performing the program as instructed to ensure correct
implementation. The parents should return in one week for another demonstration to determine if they can correctly
repeat the program as previously instructed.
165. B. The hematocrit value provides the percentage of red blood cells in plasma. A decrease in the number of red
blood cells (anemia) would lead to a decreased oxygen carrying capacity in the blood and therefore less oxygen to
the tissues would lead to fatique. The CO2 value would be examined to assess a patient’s respiratory status while
creatinine and BUN levels are examined in relation to kidney function.
166. D. Excessive upward rotation of the scapula can result from weakness of the rhomboids and latissimus dorsi
(downwards rotators). The scapular adduction with medial rotation and adduction of the arm would require action by
those muscles. Option 1 would help strengthen the serratus anterior, an upward rotator of the scapula. Option 2
would activate the upper trapezius as well as the rhomboids and since the upper trapezius is also an upward rotator of
the scapula, this would not be the best exercise to use. Option c also help strengthen the serratus anterior, which
would tend to aggravate the problem.
167. C. The family should be involved in all stages of planning and treatment. Family involvement can shorten the
rehabilitation process and the patient’s return to the community. It is important to have the family involved early in
the rehabilitation process rather than wait until the patient is ready to be discharge.
168. C. A complaint of heaviness likely reflects weakness. The complaint is not the fit or comfort of the prosthesis, so
Option 1 is incorrect. The expense of obtaining a lighter prosthesis is not justified without determining if the solution
is strengthening of the muscle groups, which controls the prosthesis. A fork strap attachment will assist with
suspension, but will not reduce the weight of the prosthesis.
169. B. Of the options above, a social worker (social services) would be the most appropriate person to intervene in
this case. The social worker is trained to help resolve family issues that arise and would be the best person to lead a
team of caregivers and family members in deciding the appropriate action in this case. Educating the patient would
only put more burden on them without guaranteeing results. A referral for home care may be appropriate, but the
social worker would be the best person to make such contact. Writing a home program for the family would not
address the need to instruct family members in person.
170. D. The history suggests that prolonged improper positioning of the cervical spine resulted in neck pain. A
chronic forward head and kyphosis results in hyperextension in the upper cervical spine and excessive flexion in the
upper thoracic spine. Further muscle length adaptation occurs with tight anterior muscles and stretched posterior
muscles. Treatment should include correction of muscle weakness or imbalance. Rhomboid strengthening and axial
neck extension are the only options that are both correct.
171. B. The lesion is most likely a tendonitis involving a muscle or muscles that originate from the medial epicondyle
of the humerus (i.e., pronator teres, palmaris longus, flexor carpi radialis and ulnaris, and flexor digitorum
superficialis). Pain would be elicited with active contraction of the involved muscle (or muscles) or when the muscle
(s) is/are passively stretched. Resisted wrist flexion and pronation would cause pain over the origin of the pronator
teres. Option 1,3 and 4 do not meet the criteria for eliciting pain.
172. B. The mechanism that creates an anterior dislocation of the shoulder is forced abduction and lateral (external)
rotation of the shoulder. This frequently results in a tear of the anterior portion of the capsule. Abduction and
external rotation may subject the patient to recurrent subluxations and/or dislocations, and should therefore be
avoided.
173. C. In carpal tunnel syndrome there is pain and paresthesias in the median nerve distribution of the hand, which
includes the lateral three digits. There is weakness of the abductor pollicis brevis, but not of the wrist flexors or
finger extensors.
174. B. Macerated tissue results from excessive moisture. A more absorbent dressing would soak up the excessive
moisture and prevent the maceration
175. A. A combination of valgus, flexion and external rotation forces applied to the knee while the foot is planted on
the ground results in damage to the ACL, MCL and median meniscus.
176. C. The key phrase in this question is “interdisciplinary.” Of all the options provided, only airway clearance is
within the scope of practice for physical therapists. Patients with Guillain-Barre’ syndrome may experience
respiratory muscle fatique or paralysis and are susceptible to pulmonary infection. Pulmonary hygiene is a critical
role in their care.
177. A. During Phase I (inpatient) cardiac rehabilitation, vital sign parameters with activity that warrant termination
are: diastolic blood pressure of 110 mm Hg or greater, systolic blood pressure above 210 mm Hg or an increase
greater than 20 mm Hg from resting and a heart rate that increases beyond 20 beats per minute above resting. The
normal resting respiratory rate can range between 121 to 20 breaths per minute in adults, so an increase to 20 breaths
per minute with low- level activity would not be a reason to terminate the activity.
178. B. Because this patient has significant weakness in (B) lower extremities, a standing pivot transfer would not be
safe. However, since the patient does have fair to normal upper extremity strength, and is not totally dependent, a
hydraulic lift or two person lift would not be appropriate because it would not be enhancing the patient’s functional
skills. The most appropriate transfer method would be for the patient to use a sliding board transfer to her strongest
® side.
179. C. These are signs of autonomic dysreflexia. Among the most common cause is a distended or irritated bladder.
The FIRST step is to remove the noxious stimulus.
180. B. Neurological changes that are age related include decreased pain and vibratory sensation. The other changes
listed do not normally occur with aging in the absence of pathology.
181. B. Massaging the upper arm before the forearm helps reduce the proximal resistance of lymphatic flow, which
will optimize the flow of fluid or edema from the distal areas. This has been referred to as the “uncorking effect”.
Local heat would cause vasodilation & may increase edema. Massaging the forearm would not allow the “uncorking
effect” to occur. The massage strokes should be from distal to proximal (centripetal) direction.
182. C. The use of posterior walker has been found to encourage a more upright posture during gait & to promote
better gait characteristics than does the use of an anterior walker. A standard walker , forearm crutches & bilateral
quad canes all emphasize trunk & hip flexion, which is already increased for this child.
183. C .If patients are skilled in falling, they are less likely to become injured during a fall. The pt demonstrating or
performing the task best understanding of a skill. To accomplish this, the pt should be given a demonstration of
proper falling technique & then the pt should be allowed to practice while being guided & guarded by the therapist>
Without first demonstrating & then allowing the pt to practice, the pt could be placed at risk for injury. Therefore,
options a, b &d are not adequate to ensure pt safety.
184. A. In order to cough effectively, the abdominal muscles must contract to expel air forcefully. This pt does not
have this ability; therefore manual force against the abdomen would mimic the action of the abdominal muscles. The
prone position would not assist the cough mechanism in this pt. Both pursed-lipped breathing & interrupting the
expiratory air stream would decrease the force of exhalation & decrease cough effectiveness.
185. B. The seat width be slightly wider than the width of the widest body part, & the depth should come to within 1
inch of the popliteal fossa.
186. A. HR & systolic BP responses are higher for any given workload when performed with the UE as compared to
the LE. Spinal motion does not create much stress on the cardiovascular system. The quadriceps setting & diagonal
patterns are performed with the LE & would produce less cardiovascular stress.
187. D. There is normal, linear relationship between HR & exercise intensity in patients who are not on beta-blocker
medication or who are on non-rate responsive pacemakers. Therefore, teaching patients to take their pulse reliably
before discharge is important learning objective to ensure safety with exercise upon discharge. Ascending a flight of
stairs before discharge is only appropriate if the patient needs to negotiate stairs at home, but not as important as
pulse monitoring. Performing exercises without angina can be achieve by monitoring HR with exercise; therefore,
taking a pulse is necessary. Returning to normal daily activity immediately after an MI is an unreasonable objective,
as it will take 6 to 8 weeks for the myocardium to heal; therefore, activity levels will need to be tempered in order to
protect the heart while it is healing.
188. B. In order to facilitate transfers utilizing a sliding board, the pt will need both removable arm rests & detachable
swing-away leg rests. Fixed arm rests make sliding board transfers extremely difficult & unsafe. Any other options
would not be optimal for this particular pt’s needs.
189. B. The QRS complex represents ventricular contraction. Atrial contraction is represented by the ‘p’ wave. When
an area of the ventricle becomes irritable & develops an ectopic foci, the ventricle will depolarize prematurely before
the normal conduction sequence (e.g., prior to SA node firing in the atria) & presents a wide, irregularly shaped QRS
complex. In normal ventricular depolarization, the QRS would be narrow & regularly spaced & atrial fibrillation
 would appear as the ‘p’ wave changes. Atrial repolarization occurs within the QRS complex & is not normally
visible on EKG.
190. B. Orthostatic hypotension from bed rest occurs as a result of decreased venous tone, which will lead to a
pooling of blood in the LE upon standing. The pooling of blood in the LE will reduce the amount of blood returning
to the heart decreasing ventricular filling & ultimately decreasing cardiac output. This results in drop in BP with
resultant dizziness. With pooling of blood in the LE, the hydrostatic pressure would increase. To compensate for the
decrease in CO, the sympathetic system (not the parasympathetic) would stimulate the heart.
191. A. The stage of hemarthrosis will mean that there is still some bleeding into the joint space, but not as
extensively, therefore the pt will benefit from ROM exercise to prevent contracture. The pt may need active-assist, as
there may still be pain or edema in the joint that prevents independent performance of ROM. The mechanical trauma
of weight bearing to tolerance at this stage may impinge & damaged the pathologic synovium within the joint.
Resistive ROM is more appropriate when pain & swelling have subsided & no bleeding is occurring. Continuous
immobilization in the extended position will promote contracture in edematous knee.
192. C. All of the options, except for gentle, active exercises, are precautions or contraindications for this patient.
193. B. Lateral epicondylitis is caused by overuse of wrist extensors that originate on the lateral epicondyle of the
humerus, especially the ECRB. If the lateral epicondylitis is at a chronic stage, conditioning of the extensor muscles
& sustained grip activities will be most effective in long term management. A forearm cuff is thought the muscle
loading. Iontophoresis would not be appropriate for a home program. Friction massage of the brachioradialis would
not be appropriate since the ECRB muscle is usually the one affected.
194. B. Contacting the pt’s home nurse is the appropriate first course of action because of the possible safety risk
associated with the pt not taking their insulin. Injections & glucose testing would go beyond the scope of practice of
PT. Placing the responsibility on the family would not be appropriate because of the gravity of the situation.
195. A. The sitting position promotes visual attending, use of the UE, & social interaction. A child who exhibits
extensor posturing should be carried in a symmetric position that does not allow axial hyperextension & keeps the
hips & knees flexed.
196. C. ES for patients with demand-type pacemakers is often listed as contraindication. However, even though it is
often listed as contraindication in textbooks, research studies apparently have not substantiated the suspected risks.
Nonetheless, it should only be applied with caution & close supervision in these patients. Exercise, unless very
strenuous, would be indicated in this pt. Biofeedback introduces no electrical signals into the body & therefore
would not be contraindicated.
197. C. Sensory inputs such as intermittent music & touching the face, rocking the pt rapidly & brightening the room
elicit arousal. When a child becomes agitated & confused, it is appropriate reduce the general amount of
environment stimulation. Decreasing auditory & visual activity in the room may help the child focus.
198. D. Isolated contraction of the ® SCM muscle would cause the head to rotate to the L & side bend (lateral
flexion) to the ®. To stretch the muscle, the opposite actions would be performed on the pt by the therapist: rotation
of the head to the ® & lateral flexion to the L.
199. B. Caution should be used in patients who are taking tetracycline, because the drug will enhance the effects of
ultraviolet radiation. Ultraviolet is not contraindicated in these patients, however the dosage of the ultraviolet would
probably have to be adjusted to some lower level. The penicillin allergy, calcium supplements & metal implants
would not be affected by the ultraviolet light. It should be noted that although UV radiation therapy is not common
in today’s practice of PT, therapist should nonetheless be aware of the precautions; & be able to advise patients who
maybe using UV radiation at home.
200. C. The position described creates the necessary force to move the lower body in this transfer given the level of
SCI. Finger extension against resistance would be difficult for a pt with C6 quadriplegia. The pt’s hands would be
kept near the thigh or hips with one hand on the mat & one on the wheelchair.