Sample/practice exam 2018, questions PDF

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A physical therapist is treating a child with spastic cerebral palsy who is 3 years old cognitively but at a 6-month-old gross developmental level. What is an appropriate treatment activity for this child? A. Reaching for a multicolored object while in an unsupported standing position B. Reaching fo...

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A physical therapist is treating a child with spastic cerebral palsy who is 3 years old cognitively but at a 6-month-old gross developmental level. What is an appropriate treatment activity for this child? A. Reaching for a multicolored object while in an unsupported standing position B. Reaching for a multicolored object while in an unsupported, guarded sitting position C. Visually tracking a black and white object held 9 inches from his/her face D. Reaching for a black and white object while in the supine position Correct Answer: B The appropriate task would include the 6-month-old gross developmental level activity of working on unsupported sitting. A multicolored object is appropriate for a 3-year-old cognitive level. Incorrect Choices: Standing and supine are not appropriate choices (too advanced or not advanced enough). The use of multicolored object is more appropriate than a black and while object for a 3-year-old cognitive level. 2.

A patient is receiving mobilizations to regain normal mid thoracic extension. After three sessions, the patient complains of localized pain that persists for greater that 24 hours. What is the therapist’s best option? A. Change mobilizations to gentle, low-amplitude oscillations to reduce the joint and soft tissue irritation B. Continue with current mobilizations, followed by a cold pack to the thoracic spine C. Place the physical therapy on hold and resume in 1 week D. Change to self-stretching activities, because the patient does not tolerate mobilization Correct Answer: A Changing to low-amplitude oscillations will promote a decrease in the pain and tissue irritation. If pain persists for more than 24 hours, the soft tissue and joint irritation may progress. Incorrect Choices: Pain beyond 24 hours indicates possible tissue damage, so modification would be indicated. Placing the patient on hold would not be indicated or appropriate based on the patient’s response. Self-stretching will improve the osteokinematic motion but not the arthrokinematic motion, so this would not be an appropriate modification. It is not specific to the joint and may increase the irritation. It certainly would not decrease the pain and irritation. 3.

A therapist wishes to use behavior modification techniques as part of a plan of care to help shape the behavioural responses of a patient recovering from traumatic brain injury (TBI). What intervention is the BEST to use? A. Use frequent reinforcements for all desired behaviors B. Encourage the staff to tell the patient which behaviors are correct and which are not C. Reprimand the patient every time an undesirable behavior occurs D. Allow the patient enough time for self-correction of the behavior Correct Answer: A Behavioral modification is best achieved through use of positive reinforcements for all desired behaviors. Incorrect Choices: Negative behaviors should be ignored, not reprimanded. Self-correction is not a form of behavior modification. 4.

A patient with multiple sclerosis (MS) presents with dysmetria in both upper extremities. Which of the following interventions is the BEST choice to deal with this problem? A. 3-lb weight cuffs to wrists during activities of daily living (ADL) training B. Isokinetic training using low resistance and fast movement speeds C. Pool exercises using water temperatures greater than 85oF D. Proprioceptive neuromuscular facilitation (PNF) patterns using dynamic reversals with carefully graded resistance Correct Answer: D Dysmetria is a coordination problem in which the patient is unable to judge the distance or range of movement (overshoots or undershoots a target). Adding manual resistance with PNF can assist the patient in slowing down the movement and achieving better control. Incorrect Choices: The patient lacks speed control. Low-resistance, fast-speed isokinetic training is contraindicated. The resistance of water (pool therapy) could help control the speed of movements, but the temperature is too warm (patients with MS demonstrate heat intolerance). Weight cuffs could also help slow the movements down but would unnecessarily fatigue the patient (patients with MS demonstrate problems with excessive fatigue). 5.

Knee capsular tightness has limited a patient’s ability to attain full flexion. An INITIAL intervention a physical therapist can employ to restore joint motion should emphasize sustained mobilization in the loose-packed position. Which of the following is the BEST choice to use? A. Anterior glide and external rotation of the tibia B. Posterior glide and external rotation of the tibia C. Posterior glide and internal rotation of the tibia D. Anterior glide and internal rotation of the tibia Correct Answer: C Posterior glide and internal rotation are accessory motions necessary to increase knee flexion. Initial treatment should not result in pain, soreness, or diminished range of motion. Incorrect Choices: Anterior glide and external rotation are motions necessary for knee extension

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A patient recovering from cardiac transplantation for end-stage heart failure is referred for exercise training. The patient is receiving immunosuppressive drug therapy (cyclosporine and prednisone). What guidelines should the therapist follow when implementing an exercise program for this patient? A. Require longer periods of warm-up and cool-down B. Require short bouts of exercise C. Eliminate all resistance training D. Require a frequency of 2-3 times/week Correct Answer: A A patient recovering from cardiac transplantation will require longer periods of warm-up and cool-down because physiological responses to exercise and recovery take longer. Incorrect Choices: Low-to moderate-intensity resistance training can be performed. Aerobic exercise should be performed 4-6 times/week, while progressively increasing the duration of training from 15-60 minutes per session. 7.

A patient presents with weakness and atrophy of the biceps brachii resulting from an open fracture of the humerus. The therapist reads a report of needle electromyography (EMG) of the biceps. What is the anticipated muscle response after the needle is inserted and prior to active contraction? A. Polyphasic potentials B. Interference patterns C. Electrical silence D. Fibrillation potentials Correct Answer: C Inserting an EMG needle into a normal muscle cause a burst of electrical activity (insertional activity) after which the muscle produces no sound (electrical silence). Incorrect Choices: Fibrillation potentials are spontaneous activity seen in relaxed denervated muscle, and polyphasic potentials are produced in the contracted muscle undergoing reorganization. 8.

A new staff physical therapist (PT) on the oncology unit of a large medical center receives a referral for strengthening and ambulation for a woman with ovarian cancer. She is undergoing radiation therapy after surgical hysterectomy. Her current platelet count is 17,000. What intervention is indicated for this patient at this time? A. Active range-of-motion (AROM) exercises and activities of daily living (ADLs) exercises B. Aerobic exercise 3-5 days/week at 40-60%, one repetition maximum C. Resistance training at 60%, one repetition maximum D. Progressive stair climbing using a weighted waist belt Correct Answer: A AROM and ADL exercises are beneficial and safe for this patient. Incorrect Choices: Exercise testing and training is contraindicated in patients with cancer whose platelets are 140 C. Appearance of a PVC on the electrocardiogram (ECG) D. Systolic BP > 140 mm Hg or diastolic BP > 80 mm Hg Correct Answer: A The upper limit for exercise intensity prescribed for patients post-MI is based on signs and symptoms. Of the choices, only ST segment depression (>1.0 mm of horizontal or downsloping depression) is a significant finding, representative of myocardial ischemia. Incorrect Choices: Both HR and BP are expected to rise (the levels of 140 and 140/80 are not significant for most patients). The appearance of a single PVC is also not significant because single PVCs can occur in individuals without a cardiac history. 63. An infant who was 39 weeks gestational age at birth and is now 3 weeks chronological age demonstrates colic. In this case, what is the BEST intervention the PT should teach the mother? A. Stroking and tapping B. Neutral warmth C. Visual stimulation with a colored object D. Fast vestibular stimulation

Correct Answer: B Neutral warmth achieved through wrapping or bundling the infant is a calming stimulus. Incorrect Choices: All of the other choices would likely increase arousal of the infant. The infant is still too developementally immature for any of the stimuli other than neutral warmth. 64. A therapist is treating a patient with Brown-Sequard syndrome that resulted from a gunshot wound. The therapist’s examination should reveal: A. Sparing of tracts to sacral segments with preservation of perianal sensation and active toe flexion B. Loss of motor function and pain and temperature sensation, with preservation of light touch and proprioception below the level of the lesion C. Loss of motor function below the level of the lesion, primarily in the upper extremities D. Ipsilateral loss of motor function, ipsilateral loss of light touch and proprioception, and contralateral loss of pain and temperature Correct Answer: D Brown-Sequard syndrome is a hemisection o f the spinal cord characterized by ipsilateral loss of dorsal columns with loss of touch, pressure, vibration and proprioception; ipsilateral loss of corticospinal tracts with loss of motor function below level of lesion; contralateral loss of spinothalamic tract with loss of pain and temperature below level of lesion; at lesion level bilateral loss of pain and temperature. Incorrect Choices: Anterior cord syndrome: loss of lateral corticospinal tracts with bilateral loss of motor function; loss of spinothalamic tracts with bilateral loss of pain and temperature; preservation of dorsal columns (proprioception, vibratory sense). Central cord syndrome: loss of spinothalamic tracts with bilateral loss of pain and temperature; loss of ventral horn with bilateral loss of motor function (primarily the upper extremities); preservation of proprioception and discriminatory sensation. Sacral sparing: sparing of tracts to sacral segments with preservation of perianal sensation, rectal sphincter tone, active toe flexion. 65. A patient is recovering from stroke and presents with moderate impairments of the left upper and lower extremities. The PT’s goal today is to instruct the patient in a stand-pivot transfer to the more affected side so the patient can go home on a weekend pass. The spouse is attending today’s session and will be assisting the patient on the weekend. What is the BEST choices for teaching this task? A. Practice the task first with the patient then with the caregiver B. Demonstrate the task, then have the caregiver practice with the patient C. Practice the task first with the caregiver, then with the patient D. Demonstrate the task, and then practice with the patient Correct Answer: D To ensure optimal motor learning, first demonstrate the task at ideal performance speeds. This provides the patient with an appropriate reference of correction (cognitive map) of the task. Then use guided practice with the patient to ensure safety and successful performance. Incorrect Choices: Caregivers should become involved only after initial practice of the task with the patient and after the safety of the patient can be assured. 66. A patient presents with low back pain of insidious onset. Based on the history and subjective complaints, the patient appears to have a dysfunction of a lumbar facet joint. What clinical test should be utilized to confirm this diagnosis? A. McKenzie’s side glide test B. Stork standing test C. Slump test D. Lumbar quadrant test Correct Answer: D The motion of the lumbar quadrant test places the lumbar facet joint in its maximally closed and therefore most provocative position, so if positive it is typically indicative of a lumbar facet dysfunction. Incorrect Choices: The slump test is utilized to assess the neurodynamics of the spinal and peripheral nerves. The stork standing test is utilized to identify a spondylolisthesis. McKenzie’s side glide test is utilized to determine if a disc dysfunction with nerve root involvement is present versus a postural disorder. 67. When using a patellar tendon-bearing (PTB) prosthesis, a patient will experience excessive knee flexion in early stance if the: A. Socket is aligned too far back or tilted posteriorly B. Foot position is inset too much C. Socket is aligned too far forward or tilted anteriorly D. Foot position is outset too much Correct Answer: C In a PTB prosthesis, the socket is normally aligned in slight flexion to enhance loading on the patellar tendon, prevent genu recurvatum and resist the tendency of the amputated limb to slide too deeply into the socket. If it is aligned incorrectly (too far anterior or excessively flexed), it will result in excessive knee flexion. Incorrect Choices: A socket aligned too posterior results in insufficient knee flexion. Excessive foot inset results in lateral thrust at midstance. Excessive foot outset results in medial thrust at midstance. 68. A patient presents with Bluish discoloration of the skin and nail beds of fingers and toes. Palms are also cold and moist. What is the MOST likely cause of these changes? A. Carotenemia B. Hypothyroidism C. Cyanosis D. Liver disease

Correct Answer: C Bluish discoloration of the skin and nailbeds of fingers and toes, along with palms that are cold and moist, is indicative of cyanosis. It is caused by an excess of deoxygenated haemoglobin in the blood. It may be central (due to advanced lung disease, congenital heart disease, abnormal haemoglobin) or peripheral (decreased blood flow, venous obstruction). Incorrect Choices: Liver disease produces jaundice (diffusely yellow skin and sclerae). Carotenemia produces a yellow color, especially in the palms, soles, and face (does not affect the sclerae). Hypothyroidism produces dry and cool skin. 69. An outpatient physical therapist is examining a patient who underwent a total knee arthroplasty 2 weeks ago. The patient reports that the entire leg has started swelling in the past 2 days. On examination there is pitting edema throughout the lower leg and foot with tenderness throughout the mid calf. Girth measurements reveal a 3.5 cm increase in the size of the mid calf in the symptomatic leg. What recommendation should the physical therapist make to the patient? A. Rest, ice, and elevate the affected lower extremity B. Go home and monitor symptoms. Phone the physician if there is no improvement in 24 hours C. Go immediately to the emergency department D. Go to the physician’s office after the therapy session for further assessment Correct Answer: C The patient scores a 3 on Well’s criteria for deep vein thrombosis, placing him/herin the high probability category. The most appropriate response for the physical therapist would be to send the patient to the emergency department for further assessment. Incorrect Choices: Any choice except sending the patient to the emergency department would place the patient at an unnecessary risk for developing a pulmonary embolism. 70. A patient complains of persistent wrist pain after painting a house 3 weeks ago. The patient demonstrates signs and symptoms consistent with de Quervain’s tenosynovitis. An appropriate special test to confirm the diagnosis is: A. Finkelstein’s test B. Phalen’s test C. Froment’s sign D. Craig’s test Correct Answer: A Finkelstein’s test is specific for reproducing the pain associated with de Quervain’s tenosynovitis of the abductor pollicis longus and extensor pollicis brevis. Incorrect Choices: Froment’s sign is used to identify ulnar nerve dysfunction. Phalen’s test identifies median nerve compression in the carpal tunnel. Craig’s test identifies an abnormal femoral antetorsion angle, which you hopefully eliminated first. 71. As part of the chart review, the physical therapist views the patient’s most current chest film.

Based on this film, what is the MOST likely examination finding? A. Increased lateral costal expansion B. Increased subcostal angle C. Decreased inspiration:expiration (I:E) ratio D. Decreased mediate percussion Correct Answer: B This film demonstrates a patient with hyperinflated lungs as evidenced by the flattened diaphragm, blunted costophrenic angle, and increased amount of air. This will cause the subcostal angle to increase significantly. Incorrect Choices: Hyperinflated lungs are indicative of obstructive disease. The I:E ratio will increase in this case as the patient has difficulty getting air out. There is no evidence 72. An elderly patient with persistent balance difficulty and a history of recent falls (two in the past 3 months) is referred for physical therapy examination and evaluation. During the initial examination, what should the therapist examine first? A. Level of dyspnea during functional transfers B. Cardiovascular endurance during a 6-minute walking test C. Sensory losses and sensory organization of balance D. Spinal musculoskeletal changes secondary to degenerative joint disease (DJD) Correct Answer: C A critical component of balance control is sensory input from somatosensory, visual and vestibular receptors, and overall sensory organization of inputs. Initial examination should address these elements before moving on to assess the motor components of balance (e.g., postural synergies). The Clinical Test for Sensory Integration in Balance (CTSIB) or modified CTSIB (Shumway-Cook, Horak) are appropriate instruments.

Incorrect Choices: Cardiovascular endurance and level of dyspnea during functional transfers are appropriate elements to examine but should occur after key elements of balance are examined (sensory components and integration; motor and synergistic elements). In this case, DJD changes would not be crucial to examine initially. 73. To reduce an elderly individual’s chronic forward head posturing in standing and sitting the therapist should consider stretching exercises to: A. Middle trapezius and rhomboid muscles B. Rectus capitis anterior muscles C. Longus capitis and longus colli muscles D. Rectus capitis posterior minor and rectus capitis posterior major muscles Correct Answer: D Forward head posturing or forward translation of the occiput in relation to the neck and trunk is associated with extension of the occipital axial joint and flexion of the lower and mid cervical spines. Chronic extension of the occipital axial joint will lead to shortening of the suboccipital extensor muscles (rectus capitis posterior major and minor), and localized stretching of these muscles would be indicated as part of a therapeutic intervention to reduce forward head posturing. Incorrect Choices: Muscles anterior to the axis for mid and lower cervical flexion and extension will be chronically overlengthened, and therefore further stretching of these would not be indicated. Forward head posturing is also associated with forward scapular posturing, and therefore further stretching of scapular adductors (middle trapezius and rhomboid muscles) would not be indicated. 74. What are the major benefits of using the 6-Minute Walking Test as an outcome measure? A. Accurately documents maximal exercise capacity B. Provides good correlation with functional abilitites C. Allows determination of severity of lung disease D. Provides determination of peak oxygen uptake Correct Answer: B The 6-Minute Walk Test (6MWT) shows a good correlation with function, as the 6MWT is a submax test, and function is performed at a submax work level. Incorrect Choices: The 6MWT does not correlate to lung disease severity. The 6MWT has only about a 73% correlation with VO 2max. The 10-Meter Shuttle Walk Test would be a better test to use if correlation with VO2 is desired. As the 6MWT doesn’t correlate with VO2max, it cannot document maximal exercise capacity. 75. During a postural screen for a patient complaining of low back pain, the therapist notices that the knees are in genu recurvatum. What are the common contributory problems for which the therapist should examine? A. Ankle...