Giles Exam 2009 PDF

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A nine-year-old child with cerebral palsy is referred to physical therapy for an adaptive equipment evaluation. The PRIMARY purpose for the use of adaptive equipment with this child is: a. normalization of tone b. remediation of strength c. remediation of postural control d. participation in activit...

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1. A nine-year-old child with cerebral palsy is referred to physical therapy for an adaptive equipment evaluation. The PRIMARY purpose for the use of adaptive equipment with this child is: a. b. c. d.

normalization of tone remediation of strength remediation of postural control participation in activities

D - Adaptive equipment should be used to assist children with cerebral palsy to participate in activities. Adaptive equipment cannot normalize tone, remediate strength, or remediate postural control. The term remediation implies that adaptive equipment can "fix" or "make normal." Assistive technology is more appropriately viewed as a compensatory strategy to assist children to participate in activities. (Campbell p. 63)

2. A physical therapist employed in a large acute care hospital notices that many of his colleagues consistently bill using individual current procedural terminology (CPT) codes, despite the fact that patients are participating in group activities. The therapist is troubled by this since insurance companies and many patients incur unjustified fees. The MOST appropriate therapist action is: a. confront the involved therapists and remind them of the need to follow established billing procedures b. inform the director of rehabilitation about the billing irregularities c. contact the involved insurance providers and patients about the noted events d. report the information to the state licensing agency B - The physical therapist is obligated to discuss the situation with the director of rehabilitation services. The problem appears to be widespread enough that to attempt to deal with the situation on an individual physical therapist level is not practical. If there was sufficient evidence to indicate that the director of rehabilitation was aware of the billing irregularities and did not take action, it would be appropriate to take more formal action. (Guide for Professional Conduct)

3. A 53-year-old patient status post cerebral vascular accident is referred to physical therapy. During the examination the physical therapist determines that the patient is unable to sense sharp pain on the right side of the body. Which testing procedure would typically be used to obtain this information? a. b. c. d.

bilateral simultaneous touch drawing a line (using a dull point) on the patient's skin gently poking with a pin interspersed with light touches using the blunt end of the pin Semmes-Weinstein monofilament testing

C - Gently poking the skin with a pin and intermittently touching the skin with the pin's blunt end tests the ability to differentiate between sharp and dull stimuli. The inability to distinguish sharp stimuli is typically a result of damage to the anterolateral tracts or thalamocortical radiations. (Lundy-Ekman p. 127)

4. A patient two days status post coronary bypass graft surgery is having electrocardiograph monitoring by telemetry in the hospital's step down unit. While assisting the patient to transfer from a bed to a chair, the therapist observes a heart rhythm on the electrocardiograph monitor that causes the therapist to activate the emergency medical system. Which heart rhythm did the therapist MOST likely observe? a. b. c. d.

ventricular fibrillation complete heart block sinus arrhythmia atrial fibrillation

A - Ventricular fibrillation is defined as an erratic quivering of the ventricle muscle resulting in no cardiac output. Treatment requires defibrillation as quickly as possible followed by cardiopulmonary resuscitation, supplemental O2, and injection of medications. (Hillegass p. 410)

5. A physical therapist completes an examination on a patient recently referred to an outpatient clinic. A note from the referring physician indicates that magnetic resonance imaging confirmed the presence of a small tear in the biceps tendon. Which of the following results would be MOST consistent with the patient's diagnosis when performing resistive isometrics to the elbow flexors? a. b. c. d.

strong and painful strong and pain free weak and painful weak and pain free

A - A patient with a small tear in the biceps tendon is usually able to generate a significant amount of force during resistive isometrics. However, the patient often experiences pain due to the disruption of the integrity of the biceps tendon. (Magee p. 31)

6. A patient with peripheral neuropathy demonstrates decreased tibialis anterior strength (3-/5) and resultant foot slap during gait. The patient has decreased sensation in the foot and reports occasional falling due to tripping. Muscle testing of the hip and knee reveals grossly 4/5 strength. Range of motion at the hip, knee, and ankle is within functional limits. Which of the following orthotic prescriptions is MOST appropriate for the patient? a. custom posterior leaf spring orthosis b. prefabricated ankle-foot orthosis

c. custom tone reducing ankle-foot orthosis d. custom solid (i.e., non-articulating) ankle-foot orthosis A - A custom posterior leaf spring orthosis will provide the patient with adequate support for the foot during swing phase. Due to the patient's loss of sensation, a custom ankle-foot orthosis is preferable as compared to a pre-fabricated ankle-foot orthosis. A tone-reducing ankle-foot orthosis is not warranted since there is no indication of the presence of tone and spasticity rarely accompanies a peripheral neuropathy. (Seymour p. 383)

7. A physical therapist prepares to transfer a patient from a mat table to a wheelchair using a stand pivot transfer. The patient has generalized weakness with greater deficits in the right lower extremity compared to the left. The therapist recognizes that the patient will likely require a considerable amount of assistance during the transfer in order to limit the possibility of a fall. The MOST appropriate technique for the therapist to utilize is: a. stand in front of the patient with hands on the gait belt and knees blocking the patient's knees b. stand in front of the patient with hands on the patient's shoulders; position the patient's feet close together c. stand on the patient's affected side with both hands on the gait belt d. stand on the patient's affected side with one hand on the shoulder and one hand under the buttocks A - When a patient needs significant assistance the therapist must be aware of the possibility that the patient may be extremely unstable. Standing in front of the patient and blocking the knees will greatly reduce the probability of a safety incident. (Pierson p. 129)

8. A physical therapist monitors the electrocardiogram of a 43-year-old female exercising on a treadmill as part of a cardiac rehabilitation program. While monitoring the patient the therapist identifies atrial fibrillation. The MOST appropriate therapist action is: a. use the patient's pulse rate as a means of monitoring the intensity of exercise while she is in atrial fibrillation b. use the rate of perceived exertion as a means of monitoring the intensity of exercise while she is in atrial fibrillation c. stop the exercise immediately and begin cardiopulmonary resuscitation d. activate the emergency medical response system B - The rating of perceived exertion when used in conjunction with other markers of ischemia and arrhythmias is a valuable tool, especially for individuals who have difficulty accurately measuring their pulse, such as in the presence of atrial fibrillation. (Hillegass p. 696)

9. A physical therapist has been asked to determine whether a ramp to enter a local shopping mall meets the minimum accessibility standards required by law. The MAXIMUM grade for wheelchair ramps is BEST identified as:

a. b. c. d.

for every inch of rise, there should be twelve inches of length for every inch of rise, there should be nine inches of length for every inch of rise, there should be six inches of length for every inch of rise, there should be three inches of length

A - The maximum grade for a wheelchair ramp is best defined as for every inch of threshold height there is a corresponding twelve inches of ramp length. (Minor p. 482)

10. A physical therapist participates in a research study examining the optimal frequency for performing a lower extremity strengthening exercise. The study utilizes a sample of convenience drawn from a local high school. The PRIMARY shortcoming of this type of sample is: a. b. c. d.

lack of generalizability of results expensive to obtain subjects inability to obtain informed consent requires additional time and resources

A - A sample of convenience is a form of non-probability sampling where subjects are chosen based on availability. The most significant limitation of this type of sampling is the potential bias of self selection which may result in the sample being quite different from the target population in terms of specific attributes such as age, motivation, or activity level. (Portney p. 147)

11. A patient with patellar tendonitis is referred to physical therapy with a referral to "evaluate and treat." The physical therapist decides to utilize a physical agent that utilizes direct current to deliver charged ions of medication. This description is MOST consistent with: a. b. c. d.

interferential current iontophoresis phonophoresis ultrasound

B - Iontophoresis utilizes direct current to deliver medication. Phonophoresis utilizes sound waves to deliver medication. An interferential device is a form of electrical stimulation that utilizes two biphasic currents that are slightly out of phase with each other. (Cameron p. 235)

12. A physical therapist administers ultrasound to a patient using cushion contact. This method on ultrasound application would be MOST useful over: a. b. c. d.

thickened or callused skin irregular shaped or bony areas tissue with relatively high fat content areas of absent or diminished sensation

B - Cushion contact involves the use of a balloon filled with water positioned between the soundhead and the area to be treated. The technique is often employed as a substitute for water immersion usually in order to provide a more uniform surface for ultrasound application. (Prentice - Techniques p. 292)

13. A physical therapist reviews the medical record of a patient entering a cardiac rehabilitation program. The patient is status post myocardial infarction and was recently placed on Propanol (a beta-blocker) by his physician. The therapist would expect the medication to: a. b. c. d.

lower the patient's heart rate response to exercise increase the patient's oxygen saturation during exercise increase the patient's heart rate response to exercise lower the patient's level of dyspnea during submaximal levels of exercise

A - The therapist needs to be aware of the patient's medications and their effect on exercise response. A beta adrenergic blocker suppresses the heart rate increase with exercise. (American College of Sports Medicine p. 277)

14. A home visit is conducted for a patient status post total hip replacement. The patient is scheduled to be discharged to a two-story home using a walker. Which of the following recommendations would be the LEAST appropriate? a. b. c. d.

use area rugs smaller than 5 feet by 7 feet use non-skid rubber cups under bed posts use a tub bench and hand held shower place frequently used items on the kitchen counter top

A - The use of area rugs is contraindicated for safe home return secondary to the rug's ability to bunch up and cause falls due to unexpected movement. It is best to have floor coverings that are glued or tacked down to prevent this potential hazard. (O'Sullivan p. 338)

15. An outpatient physical therapy clinic divides the staff into three teams each consisting of a physical therapist, physical therapist assistant, and physical therapy aide. Which health care provider(s) are able to independently delegate physical therapy interventions? a. b. c. d.

physical therapist physical therapist assistant physical therapist and physical therapist assistant physical therapist, physical therapist assistant, and physical therapy aide

A - The Guide to Physical Therapist Practice indicates that regardless of practice setting the physical therapist is the sole individual responsible for making a determination relating to the use of support personnel in providing physical therapy interventions. (Guide to Physical Therapist Practice p. 42)

16. A physical therapist reviews the results of a gait analysis summary for a patient with a lower extremity injury. The summary reveals that the patient's stance phase represents 45 percent of the patient's gait cycle. How does this compare to the values typically expected with normal gait? a. b. c. d.

the patient demonstrates slightly less than average time in stance phase the patient demonstrates significantly less than average time in stance phase the patient demonstrates an average amount of time in stance phase the patient demonstrates slightly more than average time in stance phase

B - Stance phase typically accounts for 60 percent of the gait cycle. (Levangie p. 438)

17. A physical therapist collects data from a patient participating in a study that attempts to quantify quadriceps muscle atrophy following anterior cruciate ligament reconstruction. The MOST likely test and measure to utilize is: a. b. c. d.

Body-Mass Index volumetric measurements hydrostatic measurements circumferential measurements

D - Circumferential measurements using a flexible tape measure allows a therapist to obtain a gross estimate of muscle atrophy or edema. Measurements are usually obtained at fixed intervals from an established anatomical landmark on the anterior surface of the knee. The collected data would then be compared to the data obtained from the contralateral limb. (Magee p. 726)

18. When a patient enters an exercise-based cardiac rehabilitation program without a preliminary exercise test or when the patient's clinical medical status changes, the physical therapist should: a. b. c. d.

make sure the patient warms up sufficiently before every exercise session establish the optimum exercise target heart rate zone from the heart rate reserve refer the patient to their primary care physician before undertaking an exercise program use the rate of perceived exertion scale as an intensity guide for exercise

D - The rate of perceived exertion provides a useful and important adjunct to heart rate as a guide for exercise intensity. It is particularly valuable when patients enter a rehabilitation program without a preliminary exercise test or when their clinical medical status changes. (American College of Sports Medicine p. 171)

19. A physical therapist performs massage using his index finger over a patient's patellar tendon. The therapist applies pressure perpendicular to the direction of the patellar tendon's fibers. This type of massage technique is BEST described as:

a. b. c. d.

connective tissue petrissage tapotement transverse friction

D - Transverse friction massage is most commonly utilized in chronic overuse problems such as rotator cuff tendonitis, patellar tendonitis, medial epicondylitis, and lateral epicondylitis. The technique requires the therapist to administer force perpendicular to the orientation of the targeted fibers usually with the tendon placed on slight stretch. (Prentice-Therapeutic Modalities p. 518)

20. A physical therapist reviews a physician report on a patient referred to physical therapy. In the report it indicates the patient presents with a Dowager's hump. Which patient description would be MOST likely based on the stated spinal deformity? a. b. c. d.

a 16-year-old female with idiopathic scoliosis a 62-year-old male with ankylosing spondylitis a 66-year-old female with osteoporosis a 57-year-old male with thoracic kyphosis

C - Dowager's hump refers to a condition caused by anterior wedge fractures of vertebrae usually in the upper or middle thoracic spine that combine to create a structural scoliosis. The term Dowager's hump is typically reserved for post menopausal women with the described kyphotic deformity due to osteoporosis. (Magee p. 430)

21. A physical therapist prepares to administer ultrasound to a patient rehabilitating from a shoulder injury sustained in a gymnastics competition. When selecting the effective radiating area of the soundhead, the MOST important factor for the therapist to consider is: a. b. c. d.

the beam nonuniformity ratio the size of the area to be treated the desired depth of penetration the condition of the patient's skin

B - The effective radiating area (ERA) refers to the surface area of the soundhead where radiation of acoustic energy occurs. The ERA is synonymous with the piezoelectric transducer surface area from which the ultrasonic energy is emitted. (Belanger p. 233)

22. A physical therapist is working with a patient with type I diabetes. Due to peripheral neuropathy, the patient has decreased sensation in his fingers. What measure of exercise intensity should the therapist recommend the patient use to monitor the intensity of the activities he performs at home? a. percent of maximum heart rate b. rating of perceived exertion

c. percent of heart rate reserve d. respiratory exchange ratio B - The rating of perceived exertion (RPE) is a valuable measure of exercise intensity for individuals who have difficulty palpating heart rate or where the heart rate response to exercise may be altered by medications (i.e., beta blockers), atrial fibrillation, pacemakers, chronotropic incompetence or other conditions that alter the natural response of the heart rate to exercise. Because the patient has decreased sensation in his fingers any measure of intensity that relies on the patient's accurate measure of heart rate, like the percent of maximum heart rate or percent of heart rate, will be unreliable. The respiratory exchange ratio requires the analysis of expired gases. (American College of Sports Medicine p. 146)

23. A physical therapist prepares to auscultate the lungs as part of an examination. When performing this procedure correctly, the therapist should: a. b. c. d.

listen to at least three breaths in each bronchopulmonary segment ask the patient to breathe deeply through an open mouth hear tubular quality sounds over distal portions of the lung in a person without lung disease hear adventitious breath sounds over portions of the tracheobronchial tree that are clear of secretions

B - Optimal auscultation requires patients to breathe deeply through an open mouth. (Hillegass p. 624)

24. A physical therapist prepares to treat a patient using ice massage. Which objective finding would be considered a contraindication for the proposed intervention? a. b. c. d.

areas of compromised circulation acute pain subacute inflammation muscle spasm

A - Ice massage is typically performed by freezing water in paper cups and applying the ice directly to the treatment area. Contraindications for ice massage include areas of compromised circulation, Raynaud's phenomenon, peripheral vascular disease, cold urticaria, ischemic tissue, cold hypersensitivity, cryoglobinemia, and infection. (Cameron p. 145)

25. A physical therapist employed by a home health agency receives a referral to treat a patient status post total knee replacement. After completing the examination the therapist discusses the recommended plan of care with the patient. The patient indicates that he understands what the therapist is recommending, but insists he is not interested in performing active exercise as part of the program. The MOST appropriate therapist response would be to: a. explain to the patient why active exercise is a critical component of the pl...