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After an uncomplicated acute myocardial infarction (MI), under what circumstances should a patient be administered a graded exercise test (GXT) before hospital discharge? A. Symptom-limited GXT at 10 days post MI. B. Low level GXT at 4 to 6 days post MI. C. GXT to 85% age predicted maximum HR 3 to 5...

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After an uncomplicated acute myocardial infarction (MI), under what circumstances should a patient be administered a graded exercise test (GXT) before hospital discharge? A. Symptom-limited GXT at 10 days post MI. B. Low level GXT at 4 to 6 days post MI. C. GXT to 85% age predicted maximum HR 3 to 5 days post MI. D. GXT to 75% age predicted maximum HR 4 to 6 days post MI. Correct Answer: B Submaximal GXT can be administered before hospital discharge at 4 to 6 days post acute MI. Low-level exercise testing provides data for recommendations for ADL and early ambulatory exercise therapy. This amount of activity doesn’t place too much demand on the healing myocardium (ACSM guidelines for Exercise Testing and Prescription, 8th ed.). Inconrrect Choices: An intensity higher that 70% can extend the zone of necrosis into the zone of injury and/or zone of ischemia. This will delay healing or, in the worst case, extend the MI. Using symptoms alone may allow the patient to exercise at too low an intensity. 2.

A newborn is examined at birth using the APGAR test. Which of the following APGAR results is a likely indicator of potential neurological complications? A. 3 at 10 minutes B. 9 at 1 minute. C. 8 at 1 minute. D. 8 at 5 minutes. Correct Answer: A The APGAR score is based on heart rate (HR), respiration, muscle tone, reflex irritability (grimace), and color (appearance). APGAR scores are routinely assigned at 1 and 5 minutes and occasionally at 10 minutes postbirth. Incorrect Choices: Scores between 0 and 3 at 1 and 5 minutes are extremely low and indicative of the need for resuscitation. Neurological complications are likely with extremely low APGAR scores, particularly at 10 minutes. 3.

A PT requested that a physical therapy assistant (PTA) perform ultrasound (US) to the shoulder of a patient. During the treatment session, the patient experienced an electrical shock. In which situation would the PT be responsible for any injury the patient might receive? A. Faulty circuitry. B. The PTA failing to use a ground fault interrupter (GFI). C. The patient touching the US device during treatment. D. The PT having instructed the PTA to use a device that had malfunctioned on the previous day. Correct Answer: D The PT in this case correctly delegated the US treatment to the PTA. Every individual (PT, PTA) is liable for their own negligence; however, supervisors may assume liability of workers if they provide faulty supervision or inappropriate delegation of responsibilities (not evident in this case). PTs are liable for use of defective equipment if they contributed to its malfunction or continued to have it used in treatment without having it checked. Incorrect Choices: The institution may assume liability if the patient was harmed as a result of an environmental problem such as faulty circuitry or leakage current that would cause the patient to be shocked if they touched the US unit. The standard of practice is such that a GFI is used during administration of US, which would make the PTA primarily liable if a GFI was not used. The patient assumes no liability in this scenario. 4.

A patient with coronary artery disease received inpatient cardiac rehabilitation after a mild myocardial infarction (MI). The patient is now enrolled in an outpatient exercise class that utilizes intermittent training. What is the BEST initial spacing of exercise/rest intervals to safely stress the aerobic system? A. 5:1 B. 1:1 C. 10:1 D. 2:1 Correct Answer: D Presuming that the exercise goals for inpatient cardiac rehabilitation are met, an exercise/rest ration of 2:1 can be used with this patient to begin exercise in an outpatient setting in a safe manner. Incorrect Choices: An exercise/rest ratio of 1:1 is appropriate for an initial prescription for inpatient rehabilitation programs with a goal of achieving a 2:1 ratio. Ratios of 5:1 or 10:1 are too stressful to begin outpatient rehabilitation . A 5:1 ratio may be a goal for later exercise programming. 5.

What is the BEST initial intervention to improve functional mobility in an individual with a stable humeral neck fracture? A. Isometrics for all shoulder musculature. B. Heat modalities C. Active resistive range of motion (ROM) D. Pendulum exercises. Correct Answer: D This individual will typically be immobilized with a sling for a period of 6 weeks. After 1 week, the sling should be removed to have the patient perform pendulum exercises to prevent shoulder stiffness. Incorrect Choices: Resistive exercises including isometric are not indicated during this early period. Heat modalities may be effective in reducing pain but do not improve mobility.

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A patient with unilateral spondylolysis at L4 is preferred for physical therapy. The patient complains of generalized lower back pain when standing longer than 1 hour. Which strengthening exercise is BEST fot the subacute phase of this patient’ rehabilitation? A. Multifidi working from neutral to full extension B. Abdominals working from neutral to full flexion. C. Multifidi working from full flexion back to neutral. D. Abdominals working from full extension to full flexion. Correct Answer: C Performing strengthening exercise to the multifidi from flexion to neutral will not stress the pars defect. Incorrect Choices: Abdominal strengthening will not provide the segmental stability needed with this condition. Lumbar extension beyond neutral and rotation will tend to aggravate the condition in the early stages of trahabilitation. 7.

A patient has fixed forefoot varus malalignment. What possible compensatory motion or posture might occur? A. Excessive subtalar pronation. B. Ipsilateral pelvic external rotation. C. Hallux varus. D. Genu recurvatum. Correct Answer: A Possible compensatory motions or postures for forefoot varus malalignment include excessive midtarsal or subtalar pronation or prolonged pronation; plantarflexed first ray; hallux valgus; or excessive tibial; tibial and femoral; tibial, femoral and pelvic internal rotation; and/or with contralateral lumbar spine rotation. Incorrect Choices: The other compensatory motions or deformities are NOT typical of this problem. 8.

A patient presents with fingertips that are rounded and bulbous. The nail plate is more convex than normal. These changes are the likely result of which condition? A. Psoriasis. B. Chronic hypoxia from heart diease. C. Inflammation of the proximal and lateral nail folds. D. Trauma to the nail bed. Correct Answer: B Chronic hypoxia from heart disease or lung cancer and hepatic cirrhosis leads to clubbing of the fingers, characterized by fingertips that are rounded and bulbous and a nail plate that is more convex than normal. Incorrect Choices: Inflammation to the proximal and lateral nail folds (paronychia) is characterized by red, swollen, and tender folds. Trauma to the nail bed commonly results in white spots that grow out slowly with the nail. Psoriasis can result in small pits in the nails along with a circumscribed yellowish tan discoloration (oil spot lesion). 9.

The PT is examining a patient for right neck pain and spasms. Several inflamed submandibular nodes are noted. The nodes are approximately 1.0 cm in size, tender, and erythematous. The patient has no known history of cancer or metabolic diseases. What is the FIRST action the therapist should take? A. Question the patient regarding impact of neck pain and emotional distress. B. Question the patient regarding any recent dental or throat infections. C. Have another therapist confirm the findings before implementing treatment. D. Apply superficial heat and begin manual lymphatic drainage. Correct Answer: B Typically, lymph nodes are not palpable, but they can become palpable in the presence of infection or metastases. Past medical history is instrumental to identifying when follow-up is required by the physician. Recent infections (especially dental or pharyngeal) can make the lymph nodes swollen, tender, erythematous, and/or firm. Medical referral is necessary. Incorrect Choices: Treatment (manual lymph draining/superficial heat) should not be instituted. While questioning the patient regarding impact of neck pain and emotional distress is an important part of the examination, it will not influence the decision-making regarding enlarged lymph nodes. Having another therapist confirm the findings should not be necessary unless the therapist is inexperienced. In any case, treatment should not be implemented. 10. A PT is reviewing a medical record prior to examining a patient for the first time. The suspected diagnosis is multiple sclerosis. On the neurologist’s note, the therapist finds the following: deep tendon reflex (DTR); right quadriceps is 2+, left quadriceps is 4+. What is the correct interpretation of these findings? A. The right DTR is normal, the left is abnormal. B. Both DTRs are abnormal and indicative of hyporeflexia. C. The right DTR is exaggerated, the left is clearly abnormal. D. Both DTRs are abnormal and indicative of upper motor neuron (UMN) syndrome. Correct Answer: A DTRs are graded on a 1-4 scale. Scores include 0 (no response); 1+ (present but depressed; 2+ (normal); 3+ (increased, brisker than average; possibly but not necessarily); and 4+ (very brisk, hyperactive, with clonus, abnormal). In this case, the right DTR is normal; the left is abnormal and consistent with strong hypertonicity. Incorrect Choices: The other choices do not correctly interpret these findings.

11. A patient has an episode of syncope in the physical therapy clinic. The therapist attempts to rule out orthostatic hypotension as the cause of the fainting. What is the BEST test protocol to use? A. Palpate the carotid arteries and take resting HR and BP in the supine position. B. Take resting HR and BP in supine, then in sitting, then in standing after 1 minute. C. Take resting HR and BP in supine after 5 minutes, then in semi-Fowler position. D. Take resting HR and BP in sitting and after 3 and 5 minutes of cycle ergometry exercise. Correct Answer: B Orthostatic hypotension is a fall in BP with elevation of position; thus responses to movements (HR and BP) are tested from supine to sitting or sitting to standing. A small increase or no increase in HR upon standing may suggest baroreflex impairment. An exaggerated increase in HR upon standing may indicate volume depletion. Incorrect Choices: The other choices do not challenge the system with adequate change of position (supine to semi-Fowler or remaining supine or sitting) 12. An inpatient with a grade III diabetic foot ulcer is referred for physical therapy. Panafil has been applied to the necrotic tissue BID. The wound has no foul smell; however, the therapist notes a green tinge on the dressing. What is the BEST action for the therapist to take? A. Fit the patient with a total contact cast. B. Document the finding and contact the physician immediately. C. Begin a trial of acetic acid to the wound. D. Document the finding and continue with treatment. Correct Answer: D In this case, the therapist should document the findings and continue with treatment. Panafil is a keratolytic enzyme used for selective debridement. A greenish or yellowish exudate can be expected. Incorrect Choices: If the exudate was green and had a foul smell, pseudomonal aeruginosa should be suspected. The physician will most likely order a different topical agent. Acetic acid would not be the topical agent of this choice. A total contact cast can be used only after the wound is free of necrotic tissue. 13. A PT receives a referral to examine the fall risk of an elderly patient with Parkinson’s disease who lives alone and has had two recent falls. Which activity is the MOST common reason for falls in the elderly? A. Walking with a roller walker with hand brakes. B. Climbing on a step stool to reach overhead objects C. Turning around and sitting down in a chair. D. Dressing while sitting on the edge of the bed. Correct Answer: C Most falls occur during normal daily activity. Getting up or down from a bed or chair, turning, bending, walking, and climbing/descending stairs are all high-risk activities. Incorrect Choices: Only a small percentage of individuals fall during clearly hazardous activities (e.g. climbing the step stool) proper use of an assistive device reduces the risk of falls. Sitting does not typically present a fall risk. 14. A patient with Addison’s disease is referred for physical therapy following a hip fracture. Which of the following is a cardinal symptom of Addison’s disease? A. Weight gain B. Tremors C. Asthenia D. Diarrhea Correct Answer: C The cardinal symptom of Addison’s disease is asthenia. The weakness is slowly progressive and debilitating. Incorrect Choices: Other symptoms include anorexia, weight loss, nausea and vomiting, abdominal pain, and syncope. Other listed choices are not characteristic of Addison’s disease. 15. A 2-month-old child with bilateral hip dislocations is being discharged from an acute pediatric facility. The PT has developed a home exercise program and now needs to instruct the patients. What is the MOST important item for the therapist to assess before instructing the parents? A. Their degree of anxiety and attention. B. Their knowledge of the etiology of the hip dislocations. C. The home environment. D. The financial reimbursement plan. Correct Answer: A A needs assessment should include a determination of the level of anxiety and ability to attend to the instructions given. If anxiety is high and the parents are unable to attend to the therapist’s instructions, risk of failure to perform the home exercises correctly is high. Incorrect Choices: Although the other factors may also be considered in the development of a home exercise plan, they do not represent immediate priorities for instruction. 16. A PT receives a referral for a young child that had been swung around while being held from the wrists. The referral reads, “functional disuse following nursemaid’s elbow.” Which of the following commonly results from a forceful longitudinal pull of the forearm of a child? A. Superior subluxation of the radial head from the annular ligament. B. Inferior subluxation of the ulna from the annular ligament. C. Superior subluxation of the ulna from the annular ligament D. Inferior subluxation of the radial head from the annular ligament.

Correct Answer: D The inferior subluxation of the radial head from the annular ligament typically occurs with a forceful longitudinal pull of the forearm in a child. It is also known as “baby sitter’s elbow.” Incorrect Choices: The ulna is not subluxed from the humerus with this condition, and the subluxation is not superior. 17. Which is typical early clinical manifestation of cystic fibrosis (CF)? A. Increase in secretions of the endocrine system. B. Frequent recurrent urinary tract infections. C. Excessive appetite and weight loss. D. Increased FEV1 (forced expiratory volume in 1 sec) during pulmonary function testing. Correct Answer: C CF is an inherited disorder affecting the exocrine glands of the hepatic, digestive, and respiratory systems. The patient with CF is prone to chronic bacterial airway infections and progressive loss of pulmonary function from progressive obstructive lung disease. Early clinical manifestations include an inability to gain weight despite an excessive appetite and adequate caloric intake. Incorrect Choices: The pulmonary function test results in a patient with CF can have a mixed picture of both obstructive and restrictive disease components. It is typical to have a decrease in the FEV1 value over time, not an increase. There will also be recurrent infections in patient with CF; however, these infections will be in the airways and lung parenchyma. Urinary tract infections, thought quite possible, are no different in frequency than in any patient or nonpatient population. Finally, CF is a disorder of the exocrine glands, meaning those glands that excrete secretions. The endocrine system, including the hypothalamus, pituitary, thyroid, etc., are not particularly involved in the disease of CF. The pancreas is both an exocrine and an endocrine gland. CF does affect the pancreas by decreasing the bicarbonate secretions, reducing the effectiveness of pancreatic enzymes and leading to pancreatic insufficiency. 18. Which of the following activities demonstrates an infant’s integration of the asymmetrical tonic neck reflex? A. Turns head to one side and brings opposite hand to mouth. B. Can turn head to either side with extended arms. C. Turns head to one side and brings hand to mouth on the same side. D. Turns head to one side and looks at the extended arm on that side. Correct Answer: C ATNR causes extension of upper extremity on the side the head is turned toward. Bringing the hand to the mouth would not be possible with an obligatory reflex. Incorrect Choices: The other choices do not correctly define actions that are limited with an obligatory ATNR. The ATNR is a total upper extremity response and not limited to hand opening or simply looking at the hand. 19. A Physical therapy aide is cleaning a mat table with a new product supplied by the housekeeping department. The spray from the cleaning agent contact the skin resulting in irritation, redness, and some swelling. The symptoms were minor and abated within 20 minutes. Later, the aide informed the physical therapy supervisor of this situation. What action should the supervisor take? A. Initiate first aid by rinsing the affected area with a skin cleanser and applying cortisone cream for the inflammation. B. Inform housekeeping to immediately cease using the cleaning agent. C. Fill out an incident/occurrence report and have the aide examined by employee health or their own primary care physician. D. Fill out an incident/occurrence report and review the Material Safety Data Sheet (MSDS) from occupational Safety and Health Administration (OSHA) with the aide on how to properly handle the cleaning agent. Correct Answer: D Material Safety Data Sheets are mandated by OSHA of the U.S Department of Labor. Thses sheets give employees information about potentially hazardous materials in the workplace and how to protect themselves. An incident/occurrence report is used to document situations that involve patients or staff that could have resulted in potential long-lasting or permanent harm and are part of an internal quality improvement program. The use of this cleaning agent may have some specific directions in method of application and precautions needed to be observed by the user. The MSDS would make this clear. Incorrect Choices application of first aid in this case seems unnecessary since the symptoms abated very soon. The aide may have used the cleaning agent inappropriately or not used proper precautions; therefore recommending that housekeeping cease using it immediately is premature. filling out an incident report and having the aide seen by employee health is not a thorough enough response without going over the MSDS to prevent future problems. 20. During surgery an apical lung tumor, the long thoracic nerve was injured. Muscle testing of the serratus anterior demonstrates its strength to be 3+/5. What is the BEST initial exercise for this patient? A. Standing wall push-ups. B. Standing arm overhead lifts using hand weights. C. Supine arm overhead lifts using weights. D. Sitting arm overhead lifts using a pulley. Correct Answer: A The long thoracic nerve supplies serratus anterior muscle. With a muscle grade of 3+/5, the patient can then begin functional strengthening using standing wall push-ups, with resistance provided by the patient’s own body. Incorrect Choices: The other exercises would not be optimal or used INITIALLY for strengthening a fair plus serratus anterior. Performing overhead exercises with resistance (weights or pulleys) will overload the weakened serratus anterior muscle, causing the patient to compensate and potentially develop inappropriate movement patterns.

21. A PT examination reveals posterior supuerior iliac spine (PSIS) is low on the left; anterior superior iliac spine (ASIS) is high on the left; standing flexion test shows that the left PSIS moves first and farthest superiorly; Gillet’s test demonstrates that the left PSIS moves i...