Practice Questions
A1 C1 3
1. A forty-eight year-old female sustained a fracture to her left
shoulder. Treatment is proceeding well except that with left
shoulder flexion you notice the scapula protract and
elevate early and it continues to move excessively.
Physical therapy intervention should emphasize:
A. glenohumeral mobilization and strengthening of
scapular stabilizers to regain normal scapulohumeral
movement.
B. glenohumeral mobilization, and strengthening of the
rotator cuff muscles to regain muscle balance.
C. scapulothoracic mobilization and strengthening of the
pectoralis major and minor muscles to regain normal
scapulohumeral rhythm.
D. stretching of scapular stabilizers and strengthening of
the pectoralis major and minor muscles to regain
muscle balance.
A2 C8 1
2. A 59 year-old ex-machinist demonstrates significant age-
related hearing loss, presbycusis. When trying to
communicate with this patient you would NOT suspect:
A. bilateral hearing loss, at all frequencies since he has
had this problem for a number of years.
B. decreased language comprehension.
C. poor auditory discrimination.
D. unilateral hearing loss.
A3 C3 3
3. You are supervising the exercise of cardiac rehabilitation
outpatient class on a very hot day, with temperatures
expected to be above 90 degrees F. Your class is
scheduled for 2 p.m. and the facility is not air conditioned.
The strategy that is unacceptable is to:
A. change the time of the exercise class to early
morning or evening.
B. decrease the exercise intensity by slowing the pace
of exercise.
C. increase the warm-up and cool-down periods to equal
the total aerobic interval in time.
D. make the exercise intermittent by adding rest cycles.
A4 C6 1
4. A patient has a transtibial amputation and has recently
been fitted with a PTB socket. During your initial prosthetic
checkout, you instruct the patient to walk several times in
the parallel bars. You then have him sit down and take the
prosthesis off. You inspect the skin. You would expect no
redness in the area of the:
A. anterior tibia, tibial crest, and fibular head.
B. patellar tendon and tibial tuberosity.
C. medial tibial and fibular plateaus.
D. distal end of the residual limb.
A5 C4 2
5. A patient who is terminally ill with cancer is in tears, unable
to cope with the changes in her life and with her current
hospitalization. You have a referral for gait training so she
can be discharged to home under hospice care. The BEST
approach for you to take is:
A. ask the patient questions so you can gain a detailed
history.
B. encourage denial so she can cope better with her
life’s challenges.
C. ignore her tears and focus on her therapy but in a
compassionate manner.
’05 Sullivan A
1
D. take time now to allow the patient to express her
fears and frustrations.
A6 C5 3
6. Your examination reveals muscle spasms of the deep hip
rotators, which are compressing the sciatic nerve and
producing pain in the posterior hip region. The MOST
effective setting of ultrasound in this case is:
A. 1 MHz continuous at 1.0 W/cm2.
B. 1 MHz pulsed at 1.0 W/cm2.
C. 3 MHz continuous at 1.0 W/cm2.
D. 3 MHz pulsed at 1.0 W/cm2.
A7 C2 2
7. A 17 year-old patient is recovering from a complete spinal
cord injury, at the level of L2. The expected outcome in this
case would MOST likely include:
A. a spastic or reflex bladder.
B. greater loss of arm function than leg function with
early loss of pain & temperature sensation.
C. loss of motor function, pain & temperature sensation
below the level of the lesion with light touch,
proprioception and position sense preserved.
D. some recovery of function since damage is to
peripheral nerve roots.
A8 C7 3
8. A physical therapist is gait training a patient with left
hemiplegia. The patient’s new AFO arrives, but the
therapist is overwhelmed with too many patients and asks
the physical therapy student to take over. This is the
student’s first affiliation (second day) and she has never
performed an orthotic checkout for a patient with an AFO.
The supervising therapist will be in the same vicinity
treating other patients. This task should:
A. be considered an advanced task, but allowable for
the student to perform as a good learning experience.
B. be designated as a more advanced task and more
appropriately delegated to another physical therapist.
C. be designated as a routine task and appropriate for
the student who could call out to the supervisor if
problems arose.
D. not be completed now and the patient sent back to
his room.
A9 C1 2
9. A patient has been diagnosed with acute synovitis of the
temporomandibular joint. Early intervention should focus
on:
A. application of an intraoral appliance and
phonophoresis.
B. instruction to eat a soft food diet and phonophoresis.
C. joint mobilization and postural awareness.
D. temporalis stretching and joint mobilization.
A10 C1 3
10. During a cervical spine examination you observe restricted
left rotation of the C7-T1 spinal level. After stabilizing the
thoracic spine, your hand placement for mobilization to
improve left rotation should be at the:
A. posterior left C6 articular pillar.
B. posterior left C7 articular pillar.
C. posterior right C7 articular pillar.
D. T1 spinous process.
A11 C8 1
 2 Practice Questions
11. An appropriate fine motor behavior that should be
established by 9 months of age would be the ability to:
A. build a tower of 4 blocks.
B. hold a cup by the handle while drinking.
C. pick up a raisin with a fine pincer grasp. A17 C5 3
D. transfer objects from one hand to another. 17.
A12 C2 1
12. A patient with a 10 year history of Parkinson’s disease has
been taking L-dopa for the last 5 years. He presents in your
clinic with deteriorating function. He is not longer able to
transfer or walk independently. During the oral interview,
you observe facial grimacing with twitching of the lips and
tongue protrusion. He appears restless, with constant
dancing, athetoid-like movements of his legs. Your BEST
course of action is to:
A. complete your evaluation focusing specifically on his A18 C8 2
main problems of rigidity and bradykinesia. 18.
B. document your observations and refer him back to his
physician for evaluation of possible dopamine toxicity.
C. talk to his wife to see if he is taking any drugs with
hallucinogenic effects.
D. use isokinetic dynamometry to assess his inability to
generate torque output during fast movements.
A13 C7 3
13. A patient who is to undergo surgery for a chronic shoulder
dislocation asks you to explain the rehabilitation following a A19 C1 1
surgical reconstructive procedure he is scheduled to 19.
undergo. Your BEST response is to:
A. explain how patients typically respond to the surgery
and outline the progression of exercises.
B. explain in detail about the surgical procedure.
C. refer the patient to a physical therapy clinical
specialist who is an expert of shoulder reconstructive
rehabilitation.
D. tell the patient to ask his surgeon for this information.
A20 C7 2
A14 C3 2 20.
14. Which of the following is NOT an appropriate reason to
terminate a maximum exercise tolerance test for a patient
with pulmonary dysfunction?
A. ECG monitoring reveals diagnostic ischemia.
B. PaO2 decreases 20 mmHg.
C. patient reaches age-predicted maximal heart rate.
D. patient states he is maximally short of breath.
A15 C6 3
15. A patient with a complete T10 paraplegia is receiving his A21 C7 1
initial ambulation training. He has received bilateral Craig- 21.
Scott knee-ankle-foot orthoses and is being trained with
axillary crutches. Since a reciprocal gait pattern is
problematic for him, the BEST initial gait pattern to teach
him is:
A. four-point.
B. swing-through.
C. swing-to.
D. two-point.
A22 C2 1
A16 C4 2 22.
16. After mastectomy, a patient cannot accept the loss of her
breast. She reports being weepy all the time with loss of
sleep. She is constantly tired and has no energy to do
anything. The BEST action you can take is:
A. observe her closely for possible suicide.
B. request her primary physician to refer her for
psychological evaluation.
’05 Sullivan A
C. tell her she’s over-reacting, she has to get on with her
therapy.
D. tell the nurse case manager to monitor her behavior.
A 23 year-old college volleyball player complains of
moderate pain resulting from a left hamstring strain four
weeks ago. The focal point of pain and tightness is noted
where a hematoma developed initially. The specific
massage technique that would be MOST beneficial in this
case is:
A. friction.
B. kneading.
C. stroking.
D. tapotement.
A six year-old boy born with myelomeningocele at the L2
level is referred for physical therapy treatment at home. In
determining the physical therapy plan of care, it would NOT
be appropriate to emphasize:
A. gait training with a reciprocating gait orthosis.
B. transfer training from floor to wheelchair.
C. upper extremity strengthening with weights.
D. vigorous range of motion of the lower extremities.
During your examination of a patient who complains of
back pain you found pain with end range AROM into hip
flexion, abduction and external/lateral rotation. The
structure most likely causing the patient’s pain is the:
A. hamstring muscle.
B. hip joint.
C. piriformis muscle.
D. SI joint.
A therapist wants to compare frequencies of carpal tunnel
syndrome occurring in different groups of individuals:
assembly line workers and computer programmers. The
MOST appropriate statistical tool to use for analysis of the
data is:
A. chi square test.
B. normal distribution curve.
C. simple one-way ANOVA.
D. t test.
In a research study in which there is a skewed distribution
with extreme scores on a balance measure that deviate
from the performance of the total group, the MOST
accurate representation of central tendency is:
A. mean.
B. median.
C. mode.
D. standard deviation
A 54 year-old factory worker injured his right arm in a
factory press with damage to the ulnar nerve at the elbow.
A diagnostic EMG was performed with evidence of
spontaneous fibrillation potentials. In this case, the physical
therapy plan of care should consider that:
A. axonotmesis is occurring.
B. denervation atrophy has occurred.
 Practice Questions 3

C. reinnervation is complete. first floor apartment. You have determined her ambulation
D. reinnervation is in process. endurance to be only up to 15 feet, not enough to allow her
to get from her bed to the bathroom (a distance of 20 feet).
A23 C6 3 You recommend:
23. A 67 year-old patient is recovering from a left CVA resulting A. a live-in nurse (24 hour coverage) until her condition
in severe right hemiplegia. Additionally, he has a large improves.
diabetic ulcer on his left foot with pitting edema, requiring B. a skilled nursing facility placement until her
elevation of that extremity. The MOST appropriate endurance increases.
wheelchair prescription for this patient would be a: C. environmental changes, a bedside commode, and
A. hemiplegic chair. referral for home health services.
B. lightweight active duty wheelchair. D. postponing her discharge until she can complete the
C. one-arm drive chair. needed 20 feet.
D. powered wheelchair with joystick.
A29 C2 3
A24 C3 1 29. You have determined a patient with a right CVA that you
24. A 14 year-old boy with advanced Duchenne muscular are currently treating has a profound deficit of
dystrophy is administered a pulmonary function test. The homonymous hemianopsia. The BEST initial strategy to
value that is UNLIKELY to show any deviation from normal assist the patient in compensating for this deficit is to:
is: A. make the patient aware of his deficit and teach him to
A. FEV1. turn his head to the affected left side.
B. functional residual capacity. B. place items, eating utensils on his left side.
C. total lung capacity. C. provide constant reminders, printed notes on his left
D. vital capacity. side, telling him to look to the left.
D. rearrange his room so while in his bed his left side is
A25 C6 3 facing the doorway.
25. A 29 year-old woman fractured her right midtibia in a skiing
accident three months ago. After cast removal, a severe A30 C2 2
foot drop was noted. The patient desires to try electrical 30. A patient with multiple sclerosis is agitated, irritated, and
stimulation orthotic substitution. You would set up the tired during treatment. Your BEST response as the P.T. is
functional electrical stimulation to contract the appropriate to:
muscles during: A. begin pool therapy to promote relaxation.
A. foot flat. B. ignore these behaviors and continue treating.
B. push off. C. reduce the exercise intensity and provide relaxation
C. swing phase. strategies.
D. toe off. D. treat the patient in a cool environment.

A26 C4 2
26. You have a small area of dermatitis on the back of your
hand with moderate exudate. You are scheduled to treat a
patient with HIV for management of an open wound. You
should:
A. continue with treatment as scheduled but wash your
hands thoroughly before and after.
B. double glove and treat as scheduled.
C. refuse to treat that patient.
D. use sterile precautions with mask and gloves.
A27 C1 2
27. You are a home therapist treating a patient who underwent
a total hip replacement four weeks ago. You notice that the
patient arches his lumbar spine in supine. He states that it
is uncomfortable and doesn’t remember having the
problem before. The patient is unable to maintain a
comfortable supine position due to:
A. poor abdominal strength.
B. tight hamstrings muscles.
C. tight iliopsoas muscle.
D. tight piriformis muscle.
A28 C8 3
28. Your 102 year-old patient has been hospitalized for the
past three days with an undisclosed ailment. After running
numerous tests and finding nothing to explain her
increasing weakness and fatigue, the physicians are being
pressured to discharge her tomorrow. She lives alone in a
A31 C7 3
31. A 72 year-old medically stable individual requires custodial
care in the home. She is severely disabled with rheumatoid
arthritis and is in a great deal of pain. She presents with
significant deformities which limit her functional abilities
and is dependent in all basic activities of daily living. A
recent exacerbation of her disease has left her bed-bound
for the past 2 weeks. Appropriate physical therapy services
would be covered by:
A. Medicaid.
B. Medicare.
C. Medigap policies.
D. only by HMO or private insurance policies.
A32 C3 2
32. A patient with a purulent venous insufficiency ulcer near the
left medial malleolus is seen at home by a physical
therapist. The MOST important goal/intervention for the
therapist to try to achieve with this patient is:
A. daily changes of elastic wraps to reduce fluid buildup.
B. daily warm water baths to improve circulation.
C. increase ambulation endurance to hasten wound
healing.
D. instruct in proper dressing changes and wound care.
A33 C6 1
33. Your patient is having difficulty bearing weight on the left
leg. She is unable to advance the tibia forward and
abbreviates the end of the stance phase on the left going
directly into swing phase. The MOST likely cause of her
problem is:

‘05 Sullivan A
 4 Practice Questions

A. hip extensor weakness. B. equipment maintenance.

B. spasticity of the anterior tibialis muscle. C. housekeeping supplies.
C. spasticity or contracture of the plantarflexors. D. long distance telephone calls.
D. weakness or contracture of the dorsiflexors. A39 C4 1
39. You are treating a patient with active hepatitis B infection.
A34 C1 1 Transmission of the disease is best minimized if you:
34. With a traction injury to the anterior division of the brachial A. avoid direct contact with any part of the patient.
plexus you would expect to see weakness of the elbow B. have the patient wear a gown and mask every time
flexors, wrist flexors and forearm pronators. You would also your are in the room.
expect to find additional weakness in: C. have the patient wear gloves to prevent him from
A. forearm supination. touching you.
B. lateral rotation of the shoulder. D. wear gloves if there is direct contact with blood or
C. thumb abduction. body fluids.
D. wrist extension.
A40 C5 3
A35 C8 3 40. A wrestler complains of pain (7/10) and limited range of
35. A 95 year-old has recently been admitted to your skilled motion of the right shoulder as a result of chronic overuse.
nursing facility following a fall-related injury (fractured hip You elect to use procaine hydrochloride iontophoresis as
with open reduction, internal fixation). Since she lived alone part of your intervention for this patient’s problems. To
on the second floor, she was unable to return home. She is administer this substance, it would be appropriate to use:
extremely agitated over her placement here and A. continuous biphasic current with the medication under
demonstrates early signs of dementia. She tells you “leave the anode.
me alone, I just want to get out of here!” An important B. continuous monophasic current with the medication
approach to take while working with this client is to: under the anode.
A. be calm and supportive, using only one or two level C. continuous monophasic current with the medication
commands. under the cathode.
B. establish the rules: tell her exactly what she is to do D. interrupted monophasic current with the medication
while you are with her. under the cathode.
C. use gesture or sign language to communicate with
her. A41 C1 2
D. promise her anything as long as she gets up and 41. A contraindication to initiating joint mobilization on a patient
walks for you. with chronic pulmonary disease may include:
A. concurrent inhalation therapy.
A36 C8 1 B. functional chest wall immobility.
36. A 72 year-old woman is being treated for depression C. long term corticosteroid therapy.
following the death of her husband. She is currently taking D. reflex muscle guarding.
antidepressant medication (tricyclics) and has a recent
history of a fall. You suspect the precipitating cause of the A42 C8 3
fall can be attributed to side effects of her medication 42. Long term care for institutionalized elderly who have
resulting in: reduced their financial resources or qualify for low-income
A. cardiac arrhythmias status is typically funded by:
B. dyspnea. A. Health Maintenance Organizations.
C. hyperalertness. B. Medicaid.
D. postural hypotension. C. Medicare.
D. Social Security Administration.
A37 C3 1
37. An 82 year-old patient and his caregivers should A43 C3 1
understand the common side effects of the medication that 43. A 45 year-old computer programmer, with no significant
he is taking. He is continually in and out of congestive heart past medical history, presents to the emergency room with
failure and has been taking digitalis (Digoxin) to improve complaints of fever, shaking chills and a worsening
his heart function. You will know he and his caregivers productive cough. He has chest pain over the posterior
understand the adverse side effects of this medication if base of his left thorax which is made worse on inspiration.
they tell you they will contact the patient’s physician if he An anterior-posterior X-ray shows an infiltrate on the lower
demonstrates: left thorax at the posterior base. This patient’s chest pain is
A. confusion and memory loss. MOST likely caused by:
B. involuntary movements and shaking. A. angina.
C. slowed heart rate. B. infected pleura.
D. weakness and palpitations. C. inflamed tracheobronchial tree.
D. trauma to the chest.
A38 C7 3
38. The Director of Physical Therapy from a large teaching A44 C7 3
hospital is asked to develop an operating budget for the 44. Equipment safety is essential in all physical therapy clinics.
upcoming fiscal year. The item that would NOT be included Regularly scheduling equipment maintenance programs to
in an operating budget is: ensure that all equipment is calibrated, lubricated, and
A. a treadmill purchase. adjusted according to manufacturer’s guidelines is an

’05 Sullivan A
 Practice Questions 5

important element for patient and staff safety. All of the etiology. An initial intervention for this patient would NOT
following procedures should be followed to ensure safety include:
EXCEPT: A. limits of stability re-education including postural sway
A. conducting educational sessions for staff regarding training.
the indications and contraindications for all B. practice in maintenance of a wide base of support
equipment. during gait and turns.
B. documenting all preventive maintenance and keeping C. sit-to-stand and stand-to-sit activity training.
this information on file. D. tandem walking and single limb stance.
C. supervising new staff and students in the use of all
newly purchased equipment. A51 C6 3
D. training all staff to do simple repairs on all electrical 51. A 38 year-old patient with spinal cord injury is being
equipment if a breakdown should occur. discharged home after a 2 month course of rehabilitation.
In preparation for discharge, you and your team visit the
A45 C4 1 home and find he has 3 standard height steps going into
45. A 92 year-old woman presents with hot, red, and his home. A ramp will have to be constructed for his
edematous skin over the shins of both lower extremities. wheelchair. The recommended length of his ramp should
She also has a mild fever. The MOST likely cause of her be:
symptoms is: A. 120 inches (10 feet).
A. cellulitis. B. 192 inches (16 feet).
B. dermatitis. C. 252 inches (21 feet).
C. herpes simplex infection. D. 60 inches (5 feet).
D. scleroderma.
A52 C3 1
A46 C5 2 52. Following pneumonectomy, an expected change in a
46. A 10 year-old presents with pain and limited ROM following patient’s status would NOT include:
surgical repair of the medial collateral ligament and anterior A. asymmetrical breathing.
cruciate ligaments. The modality that would be B. decreased breath sounds.
CONTRAINDICATED in this case is: C. deviated trachea.
A. interferential current. D. increased tidal volume.
B. shortwave diathermy. A53 C3 1
C. transcutaneous electrical stimulation. 53. An older person with diagnosis of congestive heart failure
D. ultrasound. (CHF) should recognize the symptoms of exertional
intolerance. You will know this client is properly informed if
A47 C6 3 she can tell you these symptoms are:
47. Hypertrophy is the muscular response to strength training. A. dizziness, visual blurring especially with turns and
This can be expected to occur following at least: quick movements.
A. 1-2 weeks of training. B. overwhelming weakness with difficulty in standing up
B. 2-3 weeks of training. and walking.
C. 3-4 weeks of training. C. severe, uncomfortable chest pain with shortness of
D. 6-8 weeks of training. breath.
D. shortness of breath at rest and with limited activity,
A48 C1 3 and sudden weight gain
48. A diagnosis of bicipital tendinitis has been made following
an evaluation of a patient with shoulder pain. The BEST A54 C6 3
shoulder position to expose the tendon of the long head of 54. You are instructing a physical therapy student in proper
the biceps for application of phonophoresis would be: positioning to prevent the typical contractures in the patient
A. abduction. with a transtibial amputation. You stress:
B. external/lateral rotation and extension. A. maximize out-of-bed time with sitting in a chair.
C. horizontal adduction. B. position in prone lying and sitting with full knee
D. internal/medial rotation and abduction. extension.
C. position in prone-lying with slight knee flexion.
A49 C7 3 D. position in supine with a small pillow under the knee.
49. A patient is unable to bring her foot up on the next step
during a training session on stair climbing. Your BEST A55 C4 2
course of action to promote active learning is to have the 55. You receive a referral to ambulate a patient who is insulin
patient: dependent. In a review of her medical record, you notice
A. balance on the stairs while you passively bring the her blood glucose level for that day is 310 mg/dL. Your
foot up. BEST course of action is to:
B. practice marching in place in the parallel bars. A. ambulate the patient as planned but monitor closely.
C. practice standing-up from half-kneeling. B. postpone therapy and coordinate with the nurse
D. step up onto a low step while in the parallel bars. regarding insulin management and exercise.
C. refrain from ambulating the patient, reschedule for
A50 C2 3 tomorrow.
50. A 76 year-old patient exhibits impaired balance. A D. talk to the nurse about seeing the patient later on that
diagnostic work-up has failed to reveal any specific day.

‘05 Sullivan A
 6 Practice Questions
A56 C8 3
56. A physical therapy plan of care for a newborn with Erb-
Klumpke Palsy would NOT include:
A. age appropriate movements of the upper extremity.
B. gentle ROM after immobilization.
C. partial immobilization of limb across abdomen.
D. splinting the shoulder in abduction and internal
rotation.
A57 C1 3
57. A six month-old child was referred to physical therapy for
right torticollis. The MOST effective method to stretch the
muscle is by positioning the head and neck into:
A. extension, left side-bending, and right rotation.
B. extension, right side-bending, and left rotation.
C. flexion, left side-bending, and left rotation.
D. flexion, right side-bending, and left rotation.
A58 C7 3
58. A student you are supervising is on final affiliation following
completion of academic training. He is overheard
discussing a patient’s history in the elevator. When you
later point this out to the student, he tells you he was
unaware of any hospital policy regarding confidentiality.
Your BEST analysis of this situation is that:
A. compliance was not a realistic expectation since he
just arrived at this facility.
B. he should be expected to value patient confidentiality.
C. now that he is aware of confidentiality restrictions he
should do better the next time.
D. since this is not strictly part of the professional code
of ethics you should not reasonably expect him to
demonstrate adherence to this concept.
A59 C7 2
59. A therapist is performing clinical research in which a
specific myofascial technique is applied to a patient with
chronic back pain. She is using a single case experimental
design with an A-B-A-B format. Her research hypothesis
states that pain rating scores will decrease with the
treatment intervention. Acceptance of this hypothesis would
be indicated if:
A. B is equal to A.
B. B is greater than A, at the .05 level.
C. B is greater than A, at the 1.0 level.
D. B is less than A.
A60 C2 3
60. Isokinetic training can best be used in the rehabilitation of
patients with stroke during the late stages of recovery to:
A. improve initiation of movement.
B. improve rate control at faster movement speeds.
C. improve rate control at slower movement speeds.
D. increase strength of synergy components.
A61 C6 3
61. A 72 year-old patient with a transfemoral amputation is
unable to wrap his residual limb. Your BEST course of
action is to:
A. apply a temporary prosthesis immediately.
B. consult with the vascular surgeon about the
application of an Unna’s paste dressing.
C. redouble efforts to teach proper wrapping.
D. use a shrinker.
’05 Sullivan A
A62 C3 2
62. A 75 year-old patient with peripheral vascular disease has
been referred for conditioning exercise. He demonstrates
moderate claudication pain in both legs following a 12
minute walking test. The MOST appropriate exercise
frequency and duration for this patient is:
A. 2 times/week, BID 20 minutes/session.
B. 3 times/week, 30 minutes/session.
C. 3 times/week, 60 minutes/session.
D. 5 times/week, BID 10 minutes/session.
A63 C1 1
63. The radiographic view shown in the diagram that
demonstrates the observed spinal defect is: Twomey L,
Taylor J (2000) Physical Therapy of the Low Back, 3rd ed.
Philadelphia, Churchill Livingstone, Figure 7-1, page 204,
with permission.
A. frontal.
B. lateral.
C. oblique.
D. posterolateral.
A64 C4 2
64. A physical therapist is working with a patient with
metastatic breast cancer who has been told that she has
only months to live. She is quite angry and disruptive
during therapy. What is the MOST appropriate intervention
for this patient?
A. allow the patient to express her anger while
refocusing her on effective coping strategies.
B. forbid all expressions of anger as she is only hurting
herself.
C. provide honest, accurate information about her illness
and rehab plan of care.
D. provide opportunities for the patient to question her
impending death but limit all expressions of anger.
A65 C1 1
65. A forty year-old female cafeteria worker sustained a right-
sided injury to her back while playing golf. She was driving
the ball when she felt an immediate sharp pain in her right
low back. She states that in the morning she is stiff and her
pain eases after taking a shower. Based on the above
information, the structure MOST likely involved is:
A. a disc.
B. a facet joint.
C. a nerve root.
D. the arterioles which supply circulation to the spinal
cord.
A66 C7 3
66. At 10 a.m. a physical therapist working on a spinal cord
unit is treating a patient with paraplegia at the T3 level. The
therapist smells alcohol on his breath and the patient is
having difficulty accomplishing a bed-to-chair transfer that
was previously done without assistance. In this case the
physical therapist should:
A. confront the patient and ask if he has been drinking.
B. document and report suspicions of alcoholism to the
rehabilitation team at the weekly meeting.
C. document the findings and immediately inform the
patient’s physician about the situation.
D. immediately inform the nurse in charge.
A67 C2 3
67. A patient with right hemiparesis has difficulty clearing the
affected foot during the swing phase of gait. An appropriate

physical therapy intervention for the right lower extremity
might include:
A. bridging.
B. forward step-ups in standing using graduated height
steps.
C. pushing backward while sitting on a rolling stool.
D. sitting on a Swiss ball, alternating lateral side steps
and back to neutral.
A68 C6 2
68. A 19 year-old patient has a complete spinal cord injury at
the level of L1. His primary goal is to walk again. You
decide it would be MOST appropriate to recommend that
this patient use:
A. a reciprocating gait orthosis and walker.
B. a wheelchair, because ambulation is unrealistic.
C. bilateral AFOs and Lofstrand crutches.
D. bilateral KAFOs with thoracolumbosacral extension
control.
A69 C3 2
69. A patient is four weeks post myocardial infarction. Resistive
exercises using weights are:
A. always contraindicated during acute and post-acute
phases of cardiac rehabilitation due to expected
elevations of BP.
B. appropriate if intensities are kept below 40% maximal
voluntary contraction.
C. appropriate if intensities are kept below 85% maximal
voluntary contraction.
D. safe during all phases of rehabilitation if judicious
monitoring of HR is used.
A70 C5 3
70. A patient diagnosed with cervical radiculitis has been
referred to you for mechanical traction. You are applying
the traction using the cervical halter for 5 minutes at 20°
neck flexion using 10 pounds. The patient complains of
pain in the area of the TMJ. You should:
A. change the angle of pull.
B. decrease the traction poundage.
C. decrease the treatment time.
D. discontinue the treatment.
A71 C4 3
71. On the first day following a cesarean delivery, the physical
therapist’s initial intervention would consist of teaching the
new mother:
A. ankle exercises to prevent thrombophlebitis.
B. assisted ambulation.
C. assisted breathing and coughing and pelvic floor
exercises.
D. partial sit-ups and pelvic floor exercises.
A72 C1 2
72. It is important to note the status of the pars interarticularis
on the X-ray report. A problem with this part of the vertebra
could possibly lead to:
A. spondylolisthesis with discal herniation.
B. spondylolisthesis with possible anterior slippage of
the vertebral body.
C. spondylolysis resulting in early nerve root
compression.
D. spondylolysis with early degeneration of the vertebra.
‘05 Sullivan A
Practice Questions 7
A73 C8 3
73. The most appropriate school physical therapy intervention
to use during class for a child with decreased sitting
balance, but normal tone would be to:
A. adapt a desk and wheelchair to provide adequate
sitting balance.
B. use a prone-stander.
C. use a sidelyer.
D. use a therapeutic ball to promote sitting balance.
A74 C2 2
74. A patient with Parkinson’s disease demonstrates a highly
stereotyped gait pattern characterized by impoverished
movement. The intervention that would be LEAST
appropriate to use with this patient is:
A. a rolling walker to compensate for impaired balance.
B. postural exercises to promote trunk and head
extension in sitting and standing.
C. range of motion exercises to reduce hip and knee
flexion contractures.
D. sidelying, upper and lower trunk rotation segmental
patterns using the technique of rhythmic initiation.
A75 C2 1
75. Your patient is 72 and recovering from a right CVA. She
tells you she is thirsty and asks you for a can of soda.
When you give her the can and instruct her to open it, she
is unable to complete the task. Later after the treatment
session when she is alone you observe her drinking from
the can. You suspect she may have a primary deficit in:
A. anosognosia.
B. ideational apraxia.
C. ideomotor apraxia.
D. unilateral neglect.
A76 C7 3
76. Peer review is an important professional activity. Recently,
physical therapists have been the focus of vigorous peer
review due to increasing financial pressure imposed by
third party payers. An inappropriate use of peer review is to
determine whether care:
A. should be paid for by a third party payer.
B. was appropriate and required the skill of a physical
therapist.
C. was cost effective.
D. was provided by the appropriate personnel.
A77 C3 1
77. A 62 year-old patient has chronic obstructive pulmonary
disease. The MOST likely pulmonary test result would be:
A. decreased functional residual capacity.
B. decreased residual volume.
C. increased total lung capacity.
D. increased vital capacity.
A78 C6 1
78. A patient with a transfemoral amputation is being fitted with
a quadrilateral socket. Areas of pressure tolerance would
be expected over the:
A. distolateral end of femur and ischial seat.
B. gluteals and adductor magnus.
C. ischial tuberosity, gluteals, and lateral sides of
residual limb.
D. perineal area and medial side of femur.
 8 Practice Questions
A79 C4 2
79. A patient recently diagnosed with fibromyalgia and chronic
fatigue immune system dysfunction demonstrates a loss of
interest in all activities and outlets. She is not eating well
and is having problems sleeping. Recently she has talked
about suicide as her only hope. Your BEST course of
action is to:
A. call her physician, saying that you cannot do anything
for this patient until her psychological outlook is
better.
B. discuss her need for medications with her husband.
C. immediately contact her primary physician.
D. present a positive attitude and tell her she will feel
better soon.
A80 C6 3
80. A 77 year-old patient has been confined to bed for a period
of 2 months and now demonstrates limited ROM in both
lower extremities. Range in hip flexion is 5º to 115º and
knee flexion is 10º to 120º. The MOST appropriate
intervention to improve flexibility and ready this patient for
standing is:
A. dynamic lower extremity splints, applied for 2 hours
daily.
B. hold-relax techniques followed by passive ROM 3
times a week.
C. manual passive stretching, 5 repetitions each joint, 2
times a day.
D. mechanical stretching using traction and 5 lb.
weights, 2 hours, twice daily.
A81 C1 2
81. A seventy year-old male retired carpenter who has had
long term lumbar pain with a previous diagnosis of
degenerative joint disease (DJD) of his lumbar facet joints.
He complains of numbness, paresthesias and weakness of
his bilateral lower extremities which increase with extended
positions or walking greater than 100 feet. His pain persists
for hours after assuming a resting position. He reports he
can ride his stationary bike for 30 minutes without any
problems. Primary physical therapy intervention should
include:
A. abdominal and back extension strengthening as the
result of spondylolysis.
B. increasing cardiovascular endurance as the result of
degenerative arthritis.
C. stretching and limiting extended spinal positions as
the result of spinal stenosis.
D. traction and limitation of weight bearing positions as
the result of discal dysfunction.
A82 C7 3
82. A physical therapist is instructing a kindergarten teacher in
a behavior management program for a child with
developmental disabilities who has been mainstreamed
into the regular classroom. The therapist requests that the
teacher encourage the child to maintain a head retracted
sitting position in the class. The strategy that would be
MOST helpful in this situation is to:
A. have the teacher encourage the classmates to tell the
child to sit up in the chair.
B. have the teacher give a smile sticker when the child
sits with head retracted for five minutes.
C. have the teacher issue a verbal reprimand when the
child slumps in the chair.
’05 Sullivan A
D. train the teacher in manual handling techniques to
assist the child in head retraction.
A83 C7 3
83. You have recently attended a professional conference on
myofascial release. You wish to share this information with
your colleagues during an inservice session. You BEST
initial activity is to:
A. ask your colleagues about their current level of
knowledge using a brief questionnaire.
B. determine the best sequence for the learning units
within your presentation.
C. provide a comprehensive packet of handouts when
you begin the first inservice session.
D. select a suitable time and place for your lecture.
A84 C2 2
84. Following an episode of adhesive capsulitis of the right
shoulder, a 52 year-old with a history of left CVA now
exhibits reflex sympathetic dystrophy affecting the right
upper extremity. The intervention that should be AVOIDED
in this case is:
A. graduated active exercises.
B. massage to reduce edema.
C. passive manipulation to the shoulder.
D. passive ROM exercises.
A85 C6 3
85. To prepare a patient with an incomplete T12 paraplegia for
ambulation with crutches, the upper quadrant muscles that
would be MOST important to strengthen include the:
A. deltoid, coracobrachialis, and brachialis.
B. lower trapezius, latissimus dorsi, and triceps.
C. middle trapezius, latissimus, dorsi and triceps.
D. upper trapezius, rhomboids, and levator scapulae.
A86 C3 2
86. A 72 year-old is recovering at home from a myocardial
infarction and percutaneous transluminal coronary
angioplasty. As his home care physical therapist, you
decide to use pulse oximetry to monitor his responses to
exercise. An acceptable oxygen saturation rate (SaO2) to
maintain throughout the exercise period is:
A. 50%.
B. 82%.
C. 85%.
D. 92%.
A87 C5 2
87. A 42 year-old homemaker presents with acute lateral
epicondylitis following participation in a local tennis
tournament. Pain is 9/10. The MOST appropriate initial
intervention for this problem is:
A. cold intermittent compression three times per week.
B. cold whirlpool daily until the pain subsides.
C. fluidotherapy three times per week.
D. ice massage B.I.D. until the pain subsides.
A88 C1 1
88. A patient was referred to physical therapy complaining of
loss of cervical AROM. His X-rays showed DJD at the
uncinate processes in the cervical spine. The motion that
would be MOST restricted would be:
A. extension.
B. flexion.
C. rotation.

D. side-bending.
A89 C1 2
89. A 55 year-old male electrician is unable to pull wire
overhead due to a painless inability to reach past 80
degrees of right shoulder abduction. He has had numerous
previous episodes of right shoulder pain over the last ten
years which were diagnosed as shoulder tendinitis. Early
subacute physical therapy intervention should focus on:
A. active assistive pulley exercises.
B. gentle grade III translatory glenohumeral
mobilizations.
C. modalities to reduce pain and inflammation.
D. resistance exercises for the affected supraspinatus
muscle.
A90 C7 2
90. Two therapists are asked to perform a test on the same
group of patients using the Functional Independence
Measure (FIM). The results of both sets of measurements
reveal differences in therapists’ scores but not in the repeat
measurements. This is indicative of a problem in:
A. concurrent validity.
B. construct validity.
C. interrater reliability.
D. intrarater reliability.
A91 C2 3
91. Your patient is a 16 year-old recovering from a complete
spinal cord injury with C5 quadriplegia. You are performing
PROM exercises on the mat when he complains of a
sudden pounding headache and double vision. You notice
he is sweating excessively, and when you take his BP it is
240/95. Your BEST course of action is to:
A. immediately contact the patient’s physician.
B. lie the patient down immediately, elevate his legs,
then call for a nurse.
C. place him in sitting position and continue to monitor
BP.
D. sit the patient up, check/empty catheter, and then call
for emergency medical assistance.
A92 C6 3
92. A 46 year-old patient presents with a flatfoot deformity with
abduction of the forefoot in relation to the weight bearing
line. The forefoot is inverted to the varus position when
inspected from the frontal plane. Corrections for this foot
deformity would NOT include a:
A. metatarsal bar.
B. scaphoid pad.
C. Thomas heel.
D. UCBL insert.
A93 C4 3
93. A 10-year old with full thickness burns to both arms is
developing hypertrophic scars The BEST intervention to
manage these scars is:
A. custom made pressure garments.
B. occlusive dressings.
C. primary excision followed by autografts.
D. surgical resection (Z-plasty).
A94 C3 1
94. A patient with COPD has developed respiratory acidosis.
You instruct the physical therapy student who is
participating in her care to monitor the patient closely for:
‘05 Sullivan A
Practice Questions 9
A. dizziness or syncope.
B. dyspnea, anxiety, or disorientation.
C. muscle twitching or tetany.
D. tingling or numbness.
A95 C1 2
95. A 34 year-old female in her second trimester of pregnancy
was sent to physical therapy with complaints of tingling and
loss of strength in both of her hands. Her symptoms are
exacerbated if she is required to use her keyboard at work
for longer than 20 minutes. The MOST appropriate physical
therapy intervention would include:
A. dexamethasone phonophoresis to the carpal tunnel.
B. hydrocortisone iontophoresis to the volar surfaces of
both wrists.
C. ice packs to the carpal tunnel.
D. placing the wrists in resting splints.
A96 C8 3
96. A child you are working with in the elementary school
system has moderate to severe extensor spasticity and
limited head control. The MOST appropriate positioning
device would be a:
A. prone stander with abduction wedge.
B. supine stander with abduction wedge.
C. wheelchair with a back wedge and head supports.
D. wheelchair with adductor pommel.
A97 C2 3
97. A patient with complete C6 quadriplegia should be
instructed to initially transfer with a sliding board using:
A. pectoral muscles to stabilize elbows, scapular
depressors to lift trunk.
B. serratus anterior to elevate trunk with shoulder
extensors stabilizing.
C. shoulder extensors, external rotators, and anterior
deltoid to position and lock the elbow.
D. triceps, keeping the hands flexed to protect tenodesis
grasp.
A98 C7 3
98. You have volunteered to teach a stroke education class on
positioning techniques for family members and caregivers.
There will be 12 individuals attending this class, ranging in
age from 42 to 82. Your BEST choice of teaching methods
is to utilize:
A. demonstration, practice, and follow-up discussion.
B. lecture with some time for questions at the end of the
30 minute session.
C. multimedia (slides and overheads) to accompany
your oral presentation.
D. one on one practice with adequate critiquing of
performance.
A99 C3 2
99. A patient with active tuberculosis is referred for physical
therapy. Which of the following is NOT an appropriate
precaution?
A. have the patient wear a tight fitting mask while being
treated in his room.
B. insure that the patient is in a private, negative
pressurized room.
C. wash hands upon entering and leaving the patient’s
room.
D. wear a tight fitting mask while treating the patient.
 10 Practice Questions
A100 C1 2
100. A twelve-year old female figure skater has been referred to
your clinic for treatment for patellar tendinitis. The
examination reveals that she is unable to hop on the
affected lower extremity due to pain. You decide to refer
her back to her pediatrician suggesting that the patient
receive an x-ray of her knee. The patient returns for
therapy with the x-ray shown in the figure. Your initial
intervention should focus on: Magee D (2002). Orthopedic
Physical Assessment, 4th ed. Philadelphia, W. B.
Saunders, Figure 12-149, page 746, with permission.
A. aggressive plyometric exercises with focus on
endurance training.
B. fitting patient with crutches for non weight-bearing
ambulation and initiation of phonophoresis at 3mHz
continuous wave using hydrocortisone.
C. patient education regarding avoidance of squatting
and jumping activities as well as initiation of
iontophoresis using dexamethasone.
D. patient education regarding avoiding falls onto her
affected knee and open chain knee extension
exercises to improve quadriceps strength.
A101 C6 2
101. A 40 year-old male with a history of low back pain has been
receiving physical therapy for 12 weeks. The patient is
employed as a loading dockworker. He performs repetitive
lifting and carrying of boxes weighing between 15 and 30
pounds. An appropriate engineering control to reduce the
stresses of lifting and carrying would be to:
A. issue the employee a back support belt.
B. provide a two-wheel handcart for use in moving the
boxes.
C. require the worker to attend a class in using correct
body mechanics while performing the job.
D. use job rotation.
A102 C1 1
102. Common compensatory postures you would expect for a
patient diagnosed with fixed severe forefoot varus are:
A. excessive ankle dorsiflexion and medial rotation of
the femur.
B. excessive midtarsal supination and lateral rotation of
the tibia.
C. subtalar pronation and medial rotation of the tibia.
D. toeing-in and lateral rotation of the femur.
A103 C1 2
103. A patient has undergone surgery and subsequent
immobilization to stabilize the olecranon process. The
patient now exhibits an elbow flexion contracture. In this
case, an absolute CONTRAINDICATION for joint
mobilization would be:
A. empty end-feel.
B. firm end-feel.
C. soft end-feel.
D. springy end-feel.
A104 C6 3
104. You observe a physical therapist assistant ambulate a
patient for the first time after a left total hip replacement.
The patient is using crutches and is practicing on a level
surface. The PTA should guard the patient by standing
slightly:
A. behind and to the intact side, one hand on the gait
belt.
’05 Sullivan A
B. behind and to the left side, one hand on the gait belt.
C. behind the patient with both hands on the gait belt.
D. in front of the patient, walking backward, with one
hand on the gait belt and one hand on the shoulder.
E. A105 C5 1
105. A 13 year-old severed the median nerve three days ago
when his hand went through a glass window. To determine
the motor function of the nerve you perform a chronaxie
test. At this time you would expect the chronaxie of the
nerve to be:
A. absent.
B. decreased.
C. increased.
D. unaffected.
A106 C1 3
106. A patient has lumbar spinal stenosis encroaching on the
spinal cord. The physical therapist should educate the
patient to AVOID:
A. bicycling.
B. rowing.
C. swimming using a crawl stroke.
D. Tai Chi.
A107 C6 2
107. A patient with post-polio syndrome presents in your clinic
with symptoms of myalgia and increasing fatigue. He is
wearing a KAFO which he has had for 10 years. When
walking, you observe that he rises up over the sound limb
to advance the orthotic limb forward. Your BEST
intervention is to provide:
A. a manual wheelchair with reclining back and elevating
legrests.
B. a shoe lift on the orthotic side.
C. a shoe lift on the sound side.
D. an electric wheelchair with joystick.
A108 C5 2
108. Your patient has moderate spasticity of the biceps brachii
on the left as a result of a CVA. You choose to use
electrical stimulation to temporarily decrease the effects of
hypertonicity in order to work on ADL activities. Your
objective in applying the current is to:
A. fatigue the ipsilateral biceps brachii.
B. stimulate the contralateral biceps brachii.
C. stimulate the contralateral triceps.
D. stimulate the ipsilateral triceps.
A109 C8 2
109. You are working with a four year-old child who has
myelodysplasia at the L5 level. At this level the most
appropriate orthosis to recommend for ambulation would
be a (an):
A. ankle-foot orthosis.
B. knee-ankle-foot orthosis.
C. parapodium.
D. reciprocating gait orthosis.
A110 C1 2
110. An eleven-year-old male was referred to physical therapy
with complaints of vague pain at his right hip and thigh
which radiates to his knee. His AROM is restricted in
abduction, flexion, and internal rotation. A gluteus medius
gait was observed with ambulation for 100 feet. Appropriate
PT intervention would include:

A. closed-chain partial weight-bearing lower extremity
exercises for slipped capital femoral epiphysis.
B. hip joint mobilization to improve the restriction in
motion as the result of Legg-Calvé Perthe’s disease.
C. open-chain strengthening of his right hip abductors
and internal rotators for avascular necrosis of the hip.
D. orthoses to control lower extremity position as the
result of femoral anteversion.
A111 C7 2
111. A researcher states that he expects that there will be no
significant difference between 20 and 30 year-olds after a
12 week exercise training program using exercise heart
rates and myocardial oxygen consumption as measures of
performance. The kind of hypothesis that is being used in
this study is a (an):
A. directional hypothesis.
B. experimental hypothesis.
C. null hypothesis.
D. research hypothesis.
A112 C7 3
112. A physical therapist was treating a patient and the patient
in the next bed was uncomfortable and asked the therapist
to move his leg. The therapist placed the leg on 2 pillows
as requested by the patient. Unknown to the therapist this
patient had a femoral artery graft 2 days previously. As a
result the graft became occluded and the patient was
rushed to surgery for a replacement. The patient claimed
the therapist placed his leg too high on the pillows causing
the occlusion of the original graft and sued for malpractice.
The hospital administrator decided:
A. it was the patient’s fault for requesting the position
change and therefore supported the action of the
physical therapist.
B. that the physical therapist was functioning according
to common protocols of the institution and thus
supported the actions of the therapist.
C. that the therapist was functioning outside the
common protocols of the hospital, and therefore did
not support the actions of the physical therapist.
D. to counter-sue the patient because he was
responsible for requesting the position change.
A113 C2 3
113. A 26 year-old female has a 3 year history of multiple
sclerosis. One of her disabling symptoms is a persistent
and severe diplopia which leaves her frequently nauseated
and immobile. An appropriate intervention strategy to assist
her in successfully participating in rehabilitation would be
to:
A. give her a soft neck collar to limit head and neck
movements.
B. give her special glasses which magnify images.
C. have her close her eyes and practice movements
without visual guidance.
D. patch one eye.
A114 C2 3
114. The MOST appropriate positioning strategy for a patient
recovering from acute stroke who is in bed and
demonstrates a flaccid upper extremity is:
A. sidelying on the affected side with the affected upper
extremity flexed overhead.
B. sidelying on the sound side with the affected upper
extremity supported on a pillow with the shoulder
protracted and elbow extended.
‘05 Sullivan A
Practice Questions 11
C. supine with the affected hand positioned on stomach.
D. supine with the affected upper extremity positioned
close to the side of the trunk.
A115 C3 2
115. A patient presents with a large plantar ulcer that will be
debrided in the whirlpool. The foot is cold, pale, and
painless. The condition that would most likely result in this
clinical presentation is:
A. acute arterial insufficiency.
B. chronic arterial insufficiency.
C. chronic venous insufficiency.
D. deep venous thrombosis.
A116 C5 3
116. A patient has been referred to you following a fracture of
the femur six months ago. The cast was removed, but the
patient was unable to volitionally contract the quadriceps.
You decide to apply electrical stimulation to the quadriceps
muscle. Your choice of electrode placement and electrical
stimulation duty cycle (on:off ratio) would consist of:
A. large electrodes, closely spaced; 10:30.
B. large electrodes, widely spaced; 10:30.
C. small electrodes, closely spaced; 10:30.
D. small electrodes, widely spaced; 10:10.
A117 C4 2
117. While setting a patient up for cervical traction, you notice a
purplish mole with rough edges on the patient’s neck. You:
A. call the physician immediately and report your
findings.
B. document the skin condition and keep a watchful eye
on it.
C. tell the patient if it bleeds at all to report it to his
physician.
D. treat the patient but cover the mole with a gauze pad.
A118 C2 1
118. A 15 year-old male suffered traumatic brain injury and
multiple fractures following a motor vehicle accident. He is
recovering in the intensive care unit. Your referral states
PROM and positioning. On day 1 he is semi-alert and drifts
in and out while you are working with him. On day 2 you
become concerned because you observe signs suggestive
of increasing intracranial pressure. You promptly report
these symptoms to his physician. The signs that would be
cause for immediate action in this case would be:
A. decreasing consciousness with slowing of pulse and
Cheyne-Stokes respirations.
B. decreasing function of cranial nerves IV, VI, and VII.
C. developing irritability with increasing symptoms of
photophobia, disorientation and restlessness.
D. positive Kernig’s sign with developing nuchal rigidity.
A119 C2 1
119. You have received a referral for a 42 year-old patient who
has a neurapraxia involving the ulnar nerve secondary to
an elbow fracture. Based on your knowledge of this
condition, you expect that:
A. regeneration is unlikely because surgical
approximation of the nerve ends was not performed.
B. nerve dysfunction will be rapidly reversed, generally
in 2-3 weeks.
C. regeneration is likely after 2-21/2 years.
D. regeneration is likely in 6-8 months.
 12 Practice Questions
A120 C7 3
120. After three weeks of teaching a patient how to ambulate
with bilateral crutches and a touch down gait, you
determine the most appropriate kind of feedback to give to
the patient is:
A. continuous feedback in which you provide ongoing
verbal cuing during gait.
B. immediate feedback given after each practice trial.
C. intermittent feedback given at scheduled intervals,
every other practice trial.
D. occasional feedback given when consistent errors
appear.
A121 C8 2
121. You are a home health physical therapist. During one of
your regularly scheduled visits with a 72 year-old male
patient, you find him to be confused with shortness of
breath and significant generalized weakness. Assessing
these symptoms and given his history of hypertension and
hyperlipidemia, you suspect:
A. he forgot to take his hypertension medication.
B. he may be experiencing unstable angina.
C. he may be presenting with early signs of myocardial
infarction.
D. his mental changes are indicative of early Alzheimer’s
disease.
A122 C1 2
122. Physical therapy intervention for a sixty-five year-old male
patient with a recent diagnosis of supraspinatus tendinitis
with possible impingement syndrome of the right shoulder
should emphasize:
A. joint mobilization, use of ice, and rotator cuff
strengthening.
B. modalities to reduce inflammation, active assistive
range of motion exercises using pulleys, and postural
realignment.
C. reducing stresses to abnormal tissues by placing the
right upper extremity in a sling, use of ice, and rotator
cuff strengthening.
D. rest to reduce pain, iontophoresis, and strengthening
of the rotator cuff muscles.
A123 C3 3
123. The recommended time duration for endotracheal
suctioning is:
A. 1 to 5 seconds.
B. 10 to 15 seconds.
C. 15 to 20 seconds.
D. 5 to 10 seconds.
A124 C3 3
124. A 76 year-old frail older adult is confined to bed in a nursing
facility. He has developed a small superficial wound over
the sacral area. Since only small amounts of necrotic tissue
are present, the physician has decided to use autolytic
wound debridement. This is BEST achieved with:
A. forceful irrigations.
B. hydrotherapy.
C. occlusive dressings.
D. wet-to-dry dressings.
A125 C5 3
125. Three weeks ago, you instructed your patient in applying
conventional (high rate) TENS to the low back to modulate
a chronic pain condition. The patient now states that the
TENS unit is no longer effective in reducing the pain in
’05 Sullivan A
spite of increasing the intensity to maximum . You should
now advise the patient to:
A. decrease the pulse duration.
B. increase the treatment frequency.
C. switch to low rate TENS.
D. switch to modulation mode TENS.
A126 C2 1
126. During initial standing a patient is pushing backward
displacing the center-of-mass at or near the posterior limits
of stability. The most likely cause of this is contraction of
the:
A. gastrocnemius-soleus.
B. hamstrings.
C. hip extensors.
D. tibialis anterior/peroneals.
A127 C7 2
127. A patient has been screened using a new test for the
presence of a gene (ALG-2) linked to Alzheimer’s disease.
His physician reports he lacks the gene and should not be
at increased risk to develop the disease. Some years later
he develops Alzheimer’s and a repeat test reveals the
presence of the gene. The results of the initial test can be
interpreted as:
A. false negative.
B. false positive.
C. high degree of sensitivity.
D. high degree of specificity.
A128 C8 1
128. A 62 year-old lives at home with his wife and adult
daughter. He has recently been diagnosed with multi-infarct
dementia and is recovering from a fractured hip following a
fall injury. In your initial interview with his wife you would
expect to find:
A. agitation and sundowning.
B. history of steady progression of loss of judgment and
poor safety awareness.
C. history of sudden onset of new cognitive problems
and patchy distribution of deficits.
D. perseveration on a thought or activity.
A129 C1 2
129. A fourteen-year-old girl complains of subpatellar pain after
participation in an aerobic exercise program for two weeks.
Your examination shows a large Q angle, pain with
palpation at the inferior pole of the patella, and mild
swelling at both knees. Physical therapy intervention
should promote:
A. hamstring strengthening.
B. lateral patellar tracking.
C. vastus lateralis strengthening.
D. vastus medialis muscle strengthening.
A130 C2 3
130. You receive a referral from an acute care physical therapist
to treat a patient with right hemiparesis in the home. The
referral indicates that the patient demonstrates good
recovery: both involved limbs are categorized as stage 4
(Brunnstrom recovery stages). He is ambulatory with an
small-based quad cane. The activity that would be MOST
appropriate for a patient at this stage of recovery is:
A. sitting, marching in place (alternate hip flexion
movements).
B. standing, picking the foot up behind and slowly
lowering it.

C. standing, small range knee extension to gain
quadriceps control.
D. supine, bending the hip and knee up to the chest with
some hip abduction.
A131 C4 2
131. During a physical therapy session for low back pain, a 67
year-old patient tells you that she has had urinary
incontinence for the last year. It is particularly problematic
when she has a cold and coughs a lot. She has not told her
doctor about this problem because she is too embarrassed.
Your BEST course of action is to:
A. examine the patient and proceed with her back
treatment.
B. examine the patient, document and discuss your
findings with the doctor.
C. examine the patient, document the problems, then
send her back to her doctor.
D. refer the patient back to her doctor.
A132 C2 1
132. During a sensory exam you determine that a patient
complains of a dull, aching pain but is not able to
discriminate a stimulus as sharp or dull. Two-point
discrimination is absent. Based on these findings, the
pathway that is intact is the:
A. anterior spinothalamic tract.
B. dorsal columns/neospinothalamic systems.
C. fasciculus gracilis/medial lemniscus.
D. lateral spinothalamic tract.
A133 C3 2
133. A patient is five days post-MI and is receiving cardiac
rehabilitation. At this time a goal that would be
INAPPROPRIATE is to:
A. counteract deconditioning associated with bed rest.
B. educate the patient and family regarding risk factor
reduction.
C. increase the patient’s maximal oxygen consumption
by discharge.
D. initiate early return to independence in activities of
daily living.
A134 C6 3
134. A 73 year-old man has bilateral short transfemoral (AK)
amputations and will require a wheelchair for functional
mobility in the home and community. An appropriate
prescription for his wheelchair includes:
A. increasing the seat depth by 2 inches to
accommodate the length of the residual limbs.
B. lowering the seat height by 3 inches.
C. placement of the drive wheels 2 inches anterior to the
vertical back supports.
D. placement of the drive wheels 2 inches posterior to
the vertical back supports.
A135 C7 2
135. A multicenter study was done on the reliability of passive
wrist flexion and extension goniometric measurements
using volar/dorsal alignment, ulnar alignment and radial
alignment. Significant differences were revealed between
the three techniques. An appropriate level for determining
significant difference is a P value of:
A. P=0.015
B. P=0.05
C. P=0.1
D. P=0.5
‘05 Sullivan A
Practice Questions 13
A136 C1 3
136. In treating a patient with a diagnosis of right shoulder
impingement syndrome, the therapist should not allow the
patient to perform assisted repetitive overhead exercises
without FIRST:
A. controlling all pain.
B. having complete AROM at the shoulder.
C. instruction in proper postural alignment.
D. stretching the shoulder girdle muscles.
A137 C8 3
137. An older person with a diagnosis of degenerative joint
disease should understand his disease, its progression,
and its management. You will know your patient education
has been effective if he can tell you:
A. aerobic conditioning is not appropriate when pain is
present and medications must be used.
B. joint protection strategies are important but cannot
reduce the expected loss of function.
C. loss of ROM and immobility are expected and
irreversible.
D. pain and stiffness are worse in the early morning and
should decrease with moderate activity.
A138 C2 1
138. A 34 year-old patient is recently admitted to your facility
with a diagnosis of Guillain-Barré syndrome. In your initial
examination, you expect to find:
A. asymmetrical weakness with hyperreflexia, bulbar
palsy.
B. glossopharyngeal and vagal paralysis with
hyperactive jaw and snout reflexes.
C. sensory loss (stocking and glove distribution) with
minor loss of motor function.
D. symmetrical distribution of weakness, ascending with
possible involvement of lower cranial nerves.
A139 C5 3
139. A 31 year-old patient presents with patellar tendinitis as a
result of a mountain climbing accident three weeks ago.
The patient complains of pain on resisted knee extension,
stair climbing, and sit-to-standing movements. You choose
to apply iontophoresis using a pain medication with a
positive charge. The correct current type, polarity and
active electrode placement is:
A. biphasic current with the cathode placed proximal on
the tendon.
B. low volt continuous current with the anode placed
distal on the tendon.
C. monophasic current with the anode placed on the
tendon.
D. monophasic current with the cathode placed on the
tendon.
A140 C6 3
140. A 52 year-old patient sustained a T10 spinal cord injury
four years ago. During initial examination you observe
redness over the ischial seat that persists for 10 minutes
when not sitting. The BEST intervention in this case would
be to:
A. change to a low density wheelchair cushion.
B. have the patient do sitting push-ups at least every 10
minutes.
C. increase the arm rest height.
D. order a tilt-in-space wheelchair.
 14 Practice Questions
A141 C1 1
141. A 16 year-old adolescent female was sent to physical
therapy with a diagnosis of anterior knee pain. Positive
findings include pes planus, lateral tibial torsion and genu
valgum. The position the femur will be in is excessive:
A. abduction.
B. lateral rotation.
C. medial rotation.
D. retroversion.
A142 C2 3
142. A 24 year-old patient in a coma recovering from traumatic
brain injury is receiving PROM exercises. The family is
confused because the occupational therapist has told them
to do range of motion exercises in a different way than the
physical therapist had instructed. As the physical therapist
it would be BEST to deal with this situation by telling the
family:
A. the PT and OT supervisors will review and correct
any discrepancies in the exercise program.
B. there is no need for them to worry and note the
problem in the patient’s record.
C. to exercise the way you instructed until any
differences can be worked out with the occupational
therapist.
D. you will meet with the occupational therapist to
discuss the exercise approaches and you will let them
know the outcome of the meeting as soon as
possible.
A143 C7 3
143. You are working with a 10 year-old girl with cerebral palsy.
Part of the exercises in her plan of care involve using the
Swiss ball. The choice of educational media that is BEST to
use when instructing her in use of this device is:
A. a oral presentation that uses transparencies of Swiss
ball positions.
B. a slide presentation of exercises using the Swiss ball.
C. a videotape of another child with cerebral palsy on a
Swiss ball.
D. printed handouts with stick figure drawings and
instructions.
A144 C3 3
144. As a physical therapist you are the health professional in
charge during a high school football game. During the
game, a player is tackled violently by two opponents. You
determine that the player is unresponsive. Your immediate
course of action should be to:
A. ask for help to log roll the player on his back while
stabilizing his neck.
B. open the airway by using the chin-lift method.
C. stabilize the neck and flip back the helmet face mask.
D. summon emergency medical services.
A145 C8 2
145. During a home visit, the mother of an 18 month-old child
with developmental delay and an atrio-ventricular shunt for
hydrocephalus tells you that her daughter vomited several
times, was irritable and is now lethargic. Your BEST course
of action is to:
A. call the girl’s pediatrician immediately.
B. give the child a cold bath to try and rouse her.
C. give the child clear liquids since she vomited.
D. place the child in a sidelying position and monitor vital
signs.
’05 Sullivan A
A146 C4 2
146. A 24 year-old woman recently delivered twins on the
obstetrical service of your hospital. After delivery she has
developed a 4 centimeter diastasis recti abdominis. The
BEST initial intervention for this problem is to teach:
A. gentle stretching of hamstrings and hip flexors.
B. pelvic floor exercises and sit-ups.
C. pelvic tilts and bilateral straight leg raising.
D. protection and splinting of the abdominal
musculature.
A147 C3 3
147. The optimal position for ventilation of a patient with a C5
complete spinal cord injury is:
A. semi Fowler’s.
B. sidelying, head of bed elevated 45 degrees.
C. sidelying, head of bed flat.
D. supine, head of bed flat.
A148 C7 2
148. A 16 year-old patient with osteosarcoma is being seen in
physical therapy for crutch training. Her parents have
decided not to tell her about her diagnosis. She is quite
perceptive and asks you directly if she has cancer and
about her future. Your BEST course of action is to:
A. change the subject and discuss the plans for that
day’s treatment.
B. discuss her condition gently indicating her parent’s
fears about not telling her the diagnosis.
C. schedule a conference with the doctor and family
about her condition and your discussions with the
patient.
D. tell the patient that you don’t know the specifics of her
condition or prognosis, and she should speak with her
doctor.
A149 C2 2
149. Your patient has had amyotrophic lateral sclerosis for the
past two years with mild functional deficits. He is still
ambulatory with bilateral canes but is limited in his
endurance. An important goal for his physical therapy plan
of care should be to prevent:
A. further gait deterioration as a result of ataxia.
B. myalgia.
C. overwork damage in weakened, denervated muscle.
D. radicular pain and paresthesias.
A150 C6 3
150. A 28 year-old patient has extensive full thickness burns to
the dorsum of the hand and forearm. He is to be fitted with
a resting splint to support his wrists and hands in a
functional position. An appropriately constructed splint
positions the wrist and hand in:
A. neutral wrist position with IP extension and thumb
flexion.
B. neutral wrist position with slight finger flexion and
thumb flexion.
C. slight wrist extension with fingers supported and
thumb in partial opposition and abduction.
D. slight wrist flexion with IP extension and thumb
opposition.
A151 C3 1
151. Your patient is 82 years-old with a long history of
congestive heart failure. You are alert to the signs of left-
sided heart failure associated with activity. The MOST
important indicators include:
 Practice Questions 15

A. bilateral ankle swelling within 2-3 hours post exercise. 157. A 24 year-old pregnant woman who is 12 weeks pregnant
B. complaints of fatigue with increasing dyspnea and asks you if it is safe to continue with her aerobic exercise.
cough. Currently she jogs 3 miles, 3 times a week. Your BEST
C. nausea and anorexia. answer is:
D. sudden weight gain within 24 hours following A. continue jogging only until the 5th month of
exercise. pregnancy.
B. during the last trimester do not jog but switch to
A152 C3 2 exercising in the supine position only.
152. A patient using an incentive spirometer complains of feeling C. jogging is safe but you might want to switch to
lightheaded. Your instructions to the patient should be to: swimming during later months.
A. lie down while using the spirometer. D. jogging is safe but your target HR should not exceed
B. take a deeper breath on the following attempt. 140 beats/min.
C. take a rest period and only use the device 10 times
per hour. A158 C6 3
D. try to use the spirometer more frequently to get used 158. Your patient returns to P.T. after his first exercise session
to it. complaining of muscle soreness that developed later in the
A153 C8 3 evening after his first session and continued into the next
153. An eighteen month-old child with Down Syndrome and day. He is unsure he wants to continue with exercise. You
moderate developmental delay is being treated at an Early can minimize the possibility of this happening again by
Intervention Program. The schedule that would best using:
facilitate motor learning of this child is physical therapy A. concentric exercises, 3 sets of 10, at 80% of maximal
intervention given: intensity.
A. 30 minutes each day. B. concentric exercises, 3 sets of 10, with gradually
B. once a week for two hours. increasing intensity.
C. one hour each week with a portion of that time used C. eccentric exercises, 1 set of 10, lifting body weight
to teach the caretaker a home program to be done 3 (sit-to-stand).
times a week. D. eccentric exercises, 3 sets of 10, with gradually
D. three times a week for fifteen minutes. increasing intensity.
159 C1 1
A154 C1 1 159. Upon examining a patient with vague hip pain which
154. A patient has been referred to you for acute shoulder pain radiates to the lateral knee, you have found a negative
after shoveling snow in a driveway for two hours. Positive FABERE test, negative grind test, and a positive Noble
findings include pain and weakness with flexion of an compression test. The dysfunction is most likely due to:
extended upper extremity as well as scapular winging with A. a possible fracture of the femoral neck.
greater than 90 degrees of abduction. The patient’s B. an iliotibial band friction disorder.
problem is MOST LIKELY the result of: C. degenerative joint disease of the hip.
A. compression of the long thoracic nerve. D. sacroiliac joint dysfunction.
B. compression of the suprascapular nerve.
C. subdeltoid bursitis. A160 C2 1
D. supraspinatus tendinitis. 160. A 22 year-old male suffered carbon monoxide poisoning
from a work-related factory accident. He is left with
A155 C2 1 permanent damage to his nervous system, affecting the
155. A patient with multiple sclerosis demonstrates strong basal ganglia. You logically expect his symptoms to
bilateral lower extremity extensor spasticity in the typical include:
distribution of antigravity muscles. You would expect this A. impaired sensory organization of balance.
patient to demonstrate: B. motor paralysis.
A. sacral sitting. C. muscular spasms and hyperreflexia.
B. sitting with both legs abducted and externally rotated. D. problems with motor planning and scaling of
C. sitting with the pelvis tilted, weight bearing on ischial movements.
tuberosities.
D. skin breakdown on the ischial tuberosities and lateral A161 C2 1
malleoli. 161. A patient presents with problems with swallowing. When
you test for phonation by having the patient say “AH” with
A156 C4 1 his mouth open, you notice there is deviation of the uvula
156. A 58 year-old woman with osteopenia has been on to one side. You then test for function of the gag reflex and
Premarin for the past 4 years. Based on your knowledge of notice loss of response to stimulation. These findings
estrogen replacement therapy, you recognize this patient is suggest involvement of the:
more susceptible to: A. facial nerve.
A. fractures. B. hypoglossal nerve.
B. osteoporosis. C. trigeminal nerve.
C. peripheral edema. D. vagus nerve.
D. vasomotor symptoms (hot flashes).
A162 C3 1
A157 C4 2 162. A patient with COPD is sitting in a bedside chair. The
apices of the lungs in this position compared with other
areas of the lungs in this position would demonstrate:

‘05 Sullivan A
 16 Practice Questions
A. increased perfusion.
B. increased volume of air at resting end expiratory
pressure (REEP).
C. the highest changes in ventilation during the
respiratory cycle.
D. the lowest oxygenation and highest CO2 in blood
exiting this zone.
A163 C6 1
163. Checkout for a lower limb orthosis includes inspection of
the alignment of anatomic and orthotic joints. During a
sagittal plane check-out you determine that the orthotic hip
joint is malaligned. The correct position is:
A. 3 inches below the anterior superior iliac spine.
B. just anterior and superior to the greater trochanter.
C. just posterior and inferior to the greater trochanter.
D. lateral to the greater trochanter.
A164 C7 3
164. A physical therapist assistant you supervise treated a
patient in the home care setting. The patient is status post
CVA. Part of the plan of care includes “progressive gait
training on level surfaces”. The patient falls and sustains a
fractured hip during a visit done by the PTA. The fall
occurred when the PTA took the patient on the stairs for the
first time. The responsible party in this case is:
A. both the PT and the PTA because the PT gave
inadequate supervision, and the PTA used poor
judgment.
B. neither the PT nor the PTA because patients who
have sustained a CVA are always at high risk for
falling, and thus it is a regrettable occurrence only.
C. the PT who is negligent for failing to provide adequate
supervision of the PTA.
D. the PTA who is completely liable because the plan of
care was altered without communicating with the
supervising PT.
A165 C1 3
165. As the result of blunt trauma to the quadriceps femoris
muscle, a patient experiences loss of knee function. Early
PT interventions should stress:
A. aggressive open-chain strengthening of the
quadriceps femoris to regain normal lower extremity
strength.
B. aggressive soft tissue stretching to remove blood
which has accumulated in soft tissues.
C. gentle AROM exercises in weight bearing.
D. gentle PROM exercises in nonweightbearing to
regain normal knee motion.
A166 C8 3
166. An important adjunct to physical therapy management of a
child with moderate spastic hemiplegia would be use of:
A. a KAFO on the affected side.
B. a posterior walker.
C. a tone inhibiting ankle-foot orthosis (AFO).
D. an anterior rollator walker.
A167 C2 1
167. While evaluating the gait of a patient with right hemiplegia,
you note foot drop during midswing on the right. The MOST
LIKELY cause of this deviation is:
A. decreased proprioception.
’05 Sullivan A
B. excessive extensor synergy.
C. excessive flexor synergy.
D. inadequate contraction of the ankle dorsiflexors.
A168 C7 3
168. A patient’s daughter wants to look at her father’s medical
record. He has recently been admitted for an insidious
onset of low back pain. You, as the physical therapist,
should:
A. give her the chart and let her read it.
B. tell her she cannot see the chart because she could
misinterpret the information.
C. tell her that she must have the permission of her
father before she can look at the chart.
D. tell her to ask the physician for permission
A169 C5 2
169. A 48 year-old female has had a total knee replacement.
Following surgery, you place her on a regimen of
continuous passive motion. The primary purpose for
applying CPM for the first few hours is to:
A. decrease edema.
B. decrease pain.
C. increase range of motion.
D. increase tissue tensile strength.
A170 C5 2
170. A 37 year-old male developed acute bicipital tendinitis two
days after water skiing. He is unable to work as a result of
the pain he rates as 8/10. He is referred to physical therapy
for iontophoresis treatment to help relieve the pain. For the
first two weeks this patient should optimally be seen:
A. five times per week
B. once a week.
C. three times per week.
D. two times per week
A171 C6 1
171. You observe genu recurvatum as a patient with hemiplegia
ambulates using his posterior leaf spring (PLS) orthosis. A
factor that is NOT a possible cause of this gait deviation is:
A. extensor spasticity.
B. hip flexion contracture.
C. pes equinus.
D. quadriceps weakness.
A172 C3 2
172. During a home visit you are providing postural drainage in
the Trendelenburg position to a 15 year-old male with
cystic fibrosis. The patient suddenly complains of right-
sided chest pain and shortness of breath. On auscultation,
there are no breath sounds on the right. The physical
therapist should:
A. call emergency medical technicians as it may be a
pneumothorax.
B. continue treating as it is possibly a mucous plug.
C. place the right lung in a gravity dependent position to
improve perfusion.
D. reposition patient in the head of bed flat position as
Trendelenburg is causing shortness of breath.
A173 C2 3
173. A 65 year-old patient with multiple sclerosis is being treated
at home. The patient is bedridden for most of the day with
only short periods up in a bedside chair. Medicare is
funding the patient’s home care program which has as its

primary goals maintaining PROM and positioning to
prevent deformity. Your role as the physical therapist is to
provide:
A. a limited cardiovascular conditioning (sitting) program
aimed at improving respiratory capacity.
B. a restorative exercise program aimed at improving
upright sitting control and improved functional
independence.
C. PROM exercises 2 times a day with additional family
instruction to ensure weekend coverage.
D. supervision of home health aides for completion of a
daily home exercise program.
A174 C2 3
174. Your patient is a 72 year-old man with an 8 year history of
Parkinson’s disease. He demonstrates significant rigidity,
decreased PROM in both upper extremities in the typical
distribution, and frequent episodes of akinesia. The
exercise that BEST deals with these problems would be:
A. modified plantigrade, isometric holding, stressing
upper extremity shoulder flexion.
B. PNF bilateral symmetrical upper extremity D2 flexion
patterns, rhythmic initiation.
C. quadruped position, upper extremity PNF D2 flexion
and extension.
D. resistance training, free weights for shoulder flexors
at 80% of 1 repetition max.
A175 C7 3
175. A 72 year-old patient with diabetes is recovering from
recent surgery to graft a large decubitus ulcer over the heel
of her left foot. You are concerned that her loss of range at
the ankle (-5° to neutral) will limit her ambulation and
independent status. One afternoon you are very busy and
request that one of the physical therapy aides do her range
of motion exercises. The aide is new to your department
but tells you she is willing to take this challenge on if you
show her how to do it. Your BEST course of action is to:
A. modify the treatment session to eliminate the ROM
exercises and have the aide walk the patient in the
parallel bars.
B. perform the ROM exercises yourself.
C. reschedule the patient for tomorrow when you have
more time.
D. take 5 minutes to instruct the aide in ROM exercises,
then have her do them.
A176 C8 2
176. The MOST appropriate type of adaptive equipment for a
teenager with severe athetosis and severe extensor
spasms of the lower extremities would be:
A. posterior rollator walker.
B. scooter board.
C. supine stander with head support.
D. wheelchair with head and trunk support with abductor
wedge.
A177 C1 2
177. The symptoms of ankylosing spondylitis in its early stages
can best be managed in physical therapy by:
A. back extension, costal expansion exercises, and
maintenance of proper posture to prevent deformity.
B. cardiovascular conditioning, weight bearing
exercises, and joint protection education.
C. pain management, abdominal strengthening, and
breathing exercises.
‘05 Sullivan A
Practice Questions 17
D. strengthening of anterior chest muscles, costal
expansion, and stretching of scapular stabilizers.
A178 C2 1
178. A 72 year-old male was referred for rehabilitation following
a middle cerebral artery stroke. Based on this diagnosis
you suspect he will present with:
A. aphasia since his right hemisphere is involved and he
is right hand dominant.
B. contralateral hemiparesis and sensory deficits with
greater involvement in the arm than the leg.
C. contralateral hemiparesis and sensory deficits with
greater involvement of leg than the arm.
D. homonymous hemianopsia, contralateral hemiplegia
with thalamic sensory syndrome.
A179 C3 1
179. The cardiac rehabilitation team is conducting education
classes for a group of patients. The focus is on risk factor
reduction and successful life style modification. A
participant asks you which is the bad cholesterol that
increases atherosclerosis and risk of heart disease. Your
answer is:
A. all cholesterol is bad and total levels should be below
200 mg/dl.
B. cholesterol is not the important factor; the
triglycerides should be kept low.
C. elevated levels of high-density lipoprotein or HDL.
D. elevated levels of low-density lipoprotein or LDL.
A180 C7 3
180. An attractive physical therapist is treating a young and
handsome football player with an ACL sprain. She is very
fond of this patient and enjoys treating him. After a few
visits, the football player asks her out to dinner. The
physical therapist’s response should be to:
A. thank him very much, and accept his offer for dinner.
B. thank him very much, and invite him for dinner at her
apartment with other guests.
C. thank him very much, but refuse his invitation while
he is receiving treatment.
D. transfer the patient care to one of her colleagues and
then go out to dinner with him.
A181 C1 2
181. After running one mile, an athlete complains of deep
cramping at the anterior aspects of the legs which does not
ease and prevents continued running. Management of this
problem should include:
A. orthotic fabrication to enable continued running on all
surfaces
B. referral to a physician to evaluate anterior
compartment pressures during activity.
C. referral to a physician to rule out spinal stenosis.
D. stretching of the tibialis anterior muscles to help
resolve shin splints.
A182 C2 2
182. A 62 year-old woman developed polio at the age of 6 with
significant lower extremity paralysis. She wore bilateral
long leg braces for a period of 2 years. She then recovered
enough to stop using her braces but still required bilateral
Lofstrand crutches, then bilateral canes to ambulate.
Recently she has been complaining of new difficulties (she
has had to start using her crutches again). You suspect
post-polio syndrome. The BEST goal/intervention for this
patient based on her current findings is to:
 18 Practice Questions
A. prescribe an aquatic therapy program consisting of
daily 1 hour aerobics.
B. put her on a lower extremity resistance training
program utilizing 80% one repetition max.
C. teach her activity pacing and energy conservation
techniques.
D. utilize a moderate conditioning program consisting of
cycle ergometry 3 times a week of 60 minutes at 60%
maximal heart rate.
A183 C1 1
183. A patient diagnosed with lumbar spondylosis without discal
herniation or bulging has a left L5 neural compression. The
most likely structure compressing the nerve root is:
A. anterior longitudinal ligament.
B. ligamentum flavum.
C. posterior longitudinal ligament.
D. supraspinous ligament.
A184 C3 2
184. During an exercise tolerance test (ETT) a patient
demonstrates poor reaction to increasing exercise intensity.
According to the American College of Sports Medicine, an
absolute indication for terminating this test is:
A. 1.5 mm of downsloping ST-segment depression.
B. fatigue and shortness of breath.
C. onset of moderate to severe angina.
D. supraventricular tachycardia.
A185 C2 3
185. A patient with T10 paraplegia is receiving daily ROM
exercises. On this day you notice swelling, pain, local
warmth and erythema in the thigh near the hip joint with
some limitation in motion. Your BEST course of action is:
A. apply ice before his ROM exercises to ease his pain
and discomfort and inflammation.
B. document the findings in his record and double his
daily sessions of ROM exercises.
C. instruct his aides to be more vigorous in positioning
and ROM exercises.
D. notify the physician immediately, you suspect
heterotopic ossifications may be developing.
A186 C6 1
186. A patient with a T4 spinal cord injury is being measured for
a wheelchair. In determining the correct seat height you
can use as a measure:
A. clearance between the floor and the foot plate of at
least 2 inches.
B. clearance between the floor and the foot plate of at
least 4 inches.
C. the distance from the bottom of the shoe to just under
the thigh at the popliteal fossa.
D. the patient’s leg length measurement plus four
inches.
A187 C8 2
187. A 6 year-old boy has a diagnosis of Duchenne muscular
dystrophy and is still ambulatory. The MOST appropriate
activity to include in his plan of care would be:
A. circuit training program.
B. progressive resistance strength training.
C. recreational activities such as swimming or biking.
D. wheelchair sports.
A188 C7 3
’05 Sullivan A
188. A 72-year old patient is receiving outpatient physical
therapy at your private clinic. The clinic is an approved
Medicare outpatient provider. Your patient is concerned
that she will not be able to pay for her continuing care and
worries that her Medicare benefits will run out soon. You
tell her:
A. coverage is limited only for hospital-based outpatient
PT services.
B. currently there is no limit to her Medicare coverage
for outpatient PT services.
C. there is currently a limit of $1000.00 for coverage of
outpatient PT services.
D. there is currently a limit of $1590.00 for coverage of
outpatient PT services.
A189 C2 3
189. Your patient is a 42 year-old woman who suffered a stroke
and demonstrates a locked-in state characterized by
spastic quadriplegia and bulbar palsy. To facilitate
communication with this patient you should instruct the
family to:
A. give her a chance to mouth her responses even
though she can’t vocalize well.
B. look closely at her facial expression to detect signs of
what she is trying to communicate.
C. use a communication board with minimal movements
of her hand.
D. use an alternate eyelid taping schedule which will
allow her to use eye movements to communicate.
A190 C6 2
190. After performing an ergonomic examination of a worker
and workstation the most appropriate recommendation for
achieving ideal wrist and elbow positioning would be to:
A. add armrests.
B. elevate the keyboard to increase wrist flexion.
C. lower the keyboard to increase wrist extension.
D. maintain the keyboard in a position allowing a neutral
wrist position.
A191 C3 1
191. A 43 year-old patient with a post myocardial infarction is on
digitalis to improve cardiac contractility. He is a new
participant in your Phase 2 outpatient cardiac rehabilitation
program. He is being continuously monitored by ECG via
radio telemetry. On his ECG, the medication induced
changes that could be expected are:
A. decreased heart rate with prolonged QRS and QT
intervals.
B. depressed ST segment with a flat T wave and
shortened QT interval.
C. elevated ST segment with T wave inversion.
D. widened QRS complex with a flattened P wave.
A192 C3 2
192. Your patient has lymphatic disease of the right arm
secondary to radical mastectomy and radiation. The
resulting edema can BEST be managed in physical therapy
by:
A. AROM and extremity positioning.
B. intermittent pneumatic compression, extremity
elevation, and massage.
C. isometric resistive exercises and extremity positioning
in elevation.
D. PROM and extremity elevation.
 Practice Questions 19

A193 C7 2 important aspect of physical therapy intervention

193. You have been treating a patient for chronic subluxation of
the patella in the outpatient clinic. He is now scheduled for
a lateral release and is worried about any complications of
the surgical procedure. He asks you to describe any
potential complications. Your BEST response is to:
A. do a search on the internet and get back to the
patient with the desired information.
B. explain how patients you have treated responded to
the surgery. A199 C6 1
C. refer the patient to a physical therapy colleague who 199.
specializes in knee problems.
D. suggest that the patient speak with his surgeon.
A194 C1 3
194. A 46 year-old female was referred for physical therapy
following a right breast lumpectomy with axillary lymph
node dissection. Scapular control is poor when upper
extremity flexion or abduction is attempted. PT intervention
should focus on:
A. active assistive pulley exercises to assist rotator cuff
muscles as a result of damage to the suprascapular
nerve.
B. gravity assisted right upper extremity exercises to A200 C3 3
promote scapular control following damage to the 200.
long thoracic nerve.
C. rhomboid strengthening as a result of disuse of the
scapular stabilizers.
D. strengthening of the right deltoids to help stabilize the
shoulder to compensate for damage to the dorsal
scapular nerve.
A195 C3 3
195. A post surgical patient is receiving a regimen of postural
drainage three times a day. You could reduce the
frequency of treatment if the:
A. amount of productive secretions decreases.
B. consistency of the sputum changes.
C. patient becomes febrile.
D. patient experiences decreased postoperative pain.
emphasizes:
A. lumbar extension exercises.
B. modalities to decrease pain.
C. postural reeducation to prevent positions that
increase symptoms.
D. strengthening exercises for the abdominals and back
muscles.
A patient with spastic left hemiplegia experiences severe
genu recurvatum during stance phase. If the patient is
using an ankle-foot orthosis, the cause of the problem
might be attributed to:
A. the anterior stop setting the foot in too much
dorsiflexion.
B. the anterior stop setting the foot in too much plantar
flexion.
C. the posterior stop setting the foot in too much
dorsiflexion.
D. the posterior stop setting the foot in too much
plantarflexion.
A patient has arterial peripheral vascular disease with
symptoms of intermittent claudication in both lower
extremities. Which of the following is NOT an appropriate
guideline for exercise training?
A. daily walking through pain in order to attain
predetermined distances.
B. daily walking, 2 to 3 times a day.
C. interval training protocol with frequent rests.
D. stopping exercise and resting once the pain threshold
is reached

A196 C2 1
196. The distinguishing feature of Mèniére’s disease which sets
it apart from other peripheral conditions affecting the
vestibular system is:
A. chronic, episodic bouts of dysfunction.
B. postural instability.
C. significant dysfunction with severe attacks of vertigo
and nausea.
D. time-limited, usually lasting only 24-48 hours.
A197 C7 3
197. A physical therapist arriving at work one hour before she
was due to start work, began moving treatment tables and
rearranging the physical therapy clinic. This operation
could have been done during regular hours. The therapist
sustained a low back injury as a result of moving the
equipment. Payment for the therapist’s care relating to this
incident would be covered primarily by:
A. employee’s health insurance.
B. the hospital’s insurance company.
C. the therapist’s own resources.
D. Workers’ Compensation.

A198 C1 2
198. Patients diagnosed with Paget’s disease typically have
similar symptomatology to spinal stenosis. The most

‘05 Sullivan A
 20 Practice Questions
1. glenohumeral mobilization and strengthening of scapular
stabilizers to regain normal scapulohumeral movement.
Compensation of glenohumeral restrictions if often
exhibited as excessive scapular movement. Therefore,
mobilization of the glenohumeral joint and strengthening of
scapular stabilizers is needed to regain normal
scapulohumeral motion.
2. unilateral hearing loss. Presbycusis is a sensorineural
hearing loss associated with aging. It is characterized by
bilateral hearing loss with deficits noted in auditory
discrimination and comprehension.
3. increase the warm-up and cool-down periods to equal the
total aerobic interval in time. Clinical decisions should focus
on reducing the environmental costs of exercising (change
the time of the day of the exercise class to reduce the heat
stress) or reducing the overall metabolic costs of the
activity (decrease the pace of the exercise, add more rest
periods). Altering the warm-up and cool-down periods does
not lower the overall cost of the aerobic exercise period.
4. anterior tibia, tibial crest, and fibular head. In the PTB
socket, reliefs are provided for pressure sensitive areas:
the anterior tibia and tibial crest, fibular head, and peroneal
nerve. All the other choices are considered pressure
tolerant areas.
5. take time now to allow the patient to express her fears and
frustrations. It is important to be supportive of a patient who
is experiencing losses and resentment. Allow the patient to
fully verbalize her feelings and frustrations.
6. 1 MHz continuous at 1.0 W/cm2. 1 MHz of continuous
ultrasound provides deep heating to a depth of 3-5 cm. At
this frequency, attenuation (absorption) is les in superficial
tissues. His allows more energy to be absorbed, thus more
heat production in deeper tissue layers. Continuous US is
applied to achieve thermal effects (i.e., chronic pain) and
pulsed US is used when nonthermal effects are desired
(i.e., acute soft tissue injuries).
7. some recovery of function since damage is to peripheral
nerve roots. A spinal cord lesion below L1 is a cauda
equina lesion (injury to the peripheral roots and nerves).
Since some regeneration is possible, some recovery in
function can be expected. A spastic or reflex bladder is
associated with upper motor neuron injury. Other choices
describe the deficits associated with anterior cord
syndrome or central cord syndrome.
8. be designated as a more advanced task and more
appropriately delegated to another physical therapist.
Physical therapy students should not perform advanced
tasks for the first time without any instruction or direct
supervision. This might be unsafe for the patient. The task
of orthotic checkout is most appropriately performed by
another physical therapist.
9. instruction to eat a soft food diet and phonophoresis.
Phonophoresis and education regarding consumption of
only soft food with help resolve the acute inflammatory
process in the temporomandibular joint. Application of an
’05 Sullivan A
intraoral appliance occurs only when the acute
inflammation is not resolved or bruxism continues. Joint
mobilization should not be attempted with an acute
inflammation.
10. posterior right C7 articular pillar. The most effective hand
placement for mobilization into great left rotation is at the
posterior aspect of the right C7 articular pillar because it
rotates the C7 vertebra to the left.
11. transfer objects from one hand to another. Transferring
objects from one hand to another is a task developmentally
appropriate for an 8-9 month-old. Using a fine pincer grasp
and building a tower of 4 blocks are skills which develop
later. Holding a cup by the handle while drinking usually
occurs by 12 months of age.
12. document your observations and refer him back to his
physician for evaluation of possible dopamine toxicity.
Dyskinesias (involuntary movements) are a common side
effect of dopamine toxicity as are gastrointestinal
disturbances (nausea, vomiting) and mental disturbances
(restlessness, general overactivity, anxiety or depression).
While the symptoms described in the other choices may
also occur with Parkinson’s disease, they do not
adequately explain the presence of adventitious or
involuntary movements.
13. explain how patients typically respond to the surgery and
outline the progression of exercises. Assess the needs of
the patient and provide appropriate information based on
the expected rehabilitation process. Do not “pass the buck”
unless the information is outside of the scope of your
expertise.
14. patient reaches age-predicted maximal heart rate. A
maximum exercise tolerance test is a sign or symptom
limited test. Achieving age adjusted predicted maximum
heart rate is not a sign or symptom and therefore does not
stop the test.
15. swing-to. A swing-to gait pattern is indicated to individuals
with limited use of both lower extremities and trunk
instability. It is slower and more stable than a swing-
through gait pattern (a gait pattern this patient can be
progressed to after his initial training). This patient is
unable to perform a reciprocal gait.
16. request her primary physician to refer her for psychological
evaluation. The patient is experiencing grief over her loss.
Significant persistent symptoms are an indication for a
referral to a qualified professional (psychologist) to help her
deal with her loss.
17. friction. Friction massage is effective when applied across
(perpendicular) muscle fibers to stretch scars and loosen
adhesions in the tissue due to the inflammatory process.
Stroking is a relaxation technique and usually initiates and
ends massage treatment. Some passive muscle stretching
is performed with deep stroking. Kneading aids in
loosening adhesions and increasing venous return.

Tapotement is used when nerve stimulation or lung
decongestion is the desired treatment effect.
18. vigorous range of motion of the lower extremities.
Vigorous range of motion is contraindicated due to
osteoporosis and risk of fracture. All of the other choices
are appropriate to promote functional independence.
19. SI joint. Pain at end range of flexion, abduction, and
external/lateral rotation (FABERE Test) is diagnostic for SI
joint dysfunction because it both gaps and compresses the
joint. Pain at the midrange into hip flexion, abduction and
external/lateral rotation suggests hip joint pathology.
20. chi square test. Chi square is nonparametric statistical test
used to compare data in the form of frequency counts (in
this example frequencies of carpal tunnel syndrome)
occurring in two different groups of workers.
21. median. The mean is a measure of central tendency that is
calculated by adding up all the scores and dividing the total
by the number of scores. The median is a middle score
while the mode is the most frequently occurring score. The
most accurate measure of performance is skewed
distribution with extreme scores in the median.
22. denervation atrophy has occurred. Spontaneous fibrillation
potentials present on EMG are evidence of denervation
atrophy. Polyphasic motor units of low amplitude and short
duration are evidence of reinnervation.
23. one-arm drive chair. A one-arm drive wheelchair has both
drive mechanisms located on one wheel. The patient can
propel the wheelchair by using one hand(in this case his
sound left hand). It is contraindicated in patients with
cognitive or perceptual deficits. A hemiplegic chair (low
seat height) allows use of both the sound hand and leg to
propel the chair. The electric wheelchair with joystick might
also work but is significantly more expensive, less
transportable, and would require increased maintenance.
An elevating legrest is needed to complete the wheelchair
prescription.
24. functional residual capacity. Muscular dystrophy will alter
the muscles’ ability to pull in air and blow out air; therefore,
vital capacity, total lung capacity, and forced expiratory
volume in one second will be decreased. Since muscular
dystrophy does not change the lung parenchyma, REEP
will occur at same point of equilibrium between lung recoil
and thoracic outward pull. Therefore, functional residual
volume will not change.
25. swing phase. Foot drop is a swing phase deficit.
Stimulation of the dorsiflexor muscles during the swing
phase places the foot in a more neutral position and
prevents the toes from contacting the ground and
interfering with the gait pattern.
26. refuse to treat that patient. Blood and Body Fluid
Precautionary Guidelines from the Centers of Disease
Control (CDC) state that a healthcare worker with
exudative lesions or weeping dermatitis should refrain from
all direct patient care and from handling patient-care
equipment until the condition resolves.
‘05 Sullivan A
Practice Questions 21
27. tight iliopsoas muscle. Tight iliopsoas muscles are
common after THR surgery because the patient typically
spends more time in a sitting position. The iliopsoas
attaches to the transverse processes of the lumbar spine
and the lesser trochanter of the femur. Therefore, when the
iliopsoas is tight, the lumbar spine will extend if the femur is
fixed. In supine, the hamstrings and piriformis muscles are
on slack and would not cause alteration in spinal position.
28. environmental changes, a bedside commode, and referral
for home health services. Clinical decision making in this
case should focus on the patient’s ability to manage in the
home. Environmental modifications (the addition of a
commode) and assistance of a home care aide should
allow her to safely return home. The referral for home
physical therapy should focus on improving her endurance
to regain independence in the home. Treatment at home is
the most cost effective in this case.
29. make the patient aware of his deficit and teach him to turn
his head to the affected left side. A patient with
homonymous hemianopsia needs to be made aware of his
deficit and instructed to turn his head to the affected left
side (a compensatory training strategy). Initial strategies
include placing items or doorway on his right (unaffected
side) so he can successfully interact with his environment.
Later, as he demonstrates the ability to compensate, items
can be moved to midline and finally to his affected left side.
30. reduce the exercise intensity and provide relaxation
strategies. Common problems in multiple sclerosis include
fatigue and heat tolerance. The agitation and irritation are
most likely a result of frustration and fatigue. Exercise
intensity should be reduced and relaxation strategies
utilized. A cool environment is important to reduce fatigue
but would not address the problems of agitation and
irritation. A warm pool is contraindicated.
31. Medicare. Custodial care of a medically stable individual
(over 65) who needs assistance with basic activities of
daily living such as eating, dressing, toileting and bathing in
the home is covered by Medicare only when skilled care
(the services of a professional nurse or therapist under a
physician-authorized plan of home care) is required.
32. instruct in proper dressing changes and wound care.
Proper dressing changes and wound care to prevent
secondary wound infection are the hallmarks of
conservative management of venous ulcers. Pliable,
nonstretchable dressing wraps (e.g., Unna boot) or
custom-fitted support stockings can be used to assist in
venous circulation while elastic wraps do little to assist
circulation. Prolonged hydrotherapy is contraindicated for
venous ulcers.
33. spasticity or contracture of the plantarflexors. Forward
advancement of the tibia from midstance to heel-off is
controlled by eccentric contraction of the plantarflexors;
from heel-off to toe-off the plantarflexors contract
concentrically. Either spasticity or contracture of the
plantarflexors would limit this forward progression. Patients
compensate by going right into swing, typically with
circumducted gait, or with increased hip and knee flexion
since there is no push off.
 22 Practice Questions
34. thumb abduction. Thumb abductors are innervated by the
median nerve, primarily by the C6 nerve root. The anterior
divisions contribute to nerves that primarily serve flexors,
and in this case, the thumb.
35. be calm and supportive, using only one or two level
commands. An agitated patient with dementia does not
process information easily. A calm and supportive approach
with low level commands (one or two actions) provides the
best approach to take with this patient.
36. postural hypotension. Fall risk is significantly increased
with certain medications. Tricyclic antidepressants (e.g.,
Elavil) can be effective in relieving depression but may
cause postural hypotension, fainting or confusion, thus
increasing fall risk. The elderly are particularly susceptible
to adverse drug effects due to multitude of factors.
37. weakness and palpitations. Digitalis (Digoxin) is frequently
used to treat congestive heart failure (it slows heart rate
and increases force of myocardial contraction). Adverse
side effects of digitalis can include muscle weakness and
supraventricular or ventricular arrhythmias including
ventricular fibrillation without premonitory signs.
38. a treadmill purchase. Any purchases of $300 or more
would be considered a capital expense and listed as an
expense in the capital budget, not an operating budget.
39. wear gloves if there is direct contact with blood or body
fluids. Standard Precautions specify health care workers
wear gloves when they come into direct contact with blood or
body fluids. Health care workers should wear moisture-
resistant gowns and masks for protection from the
splashing of blood, other body fluids or respiratory
droplets.
40. continuous monophasic current with the medication under
the anode. Continuous unidirectional current flow is more
effective in repelling ions into skin than pulsed or
bidirectional current. Procaine is a positive medicinal ion
and will be repelled from the anode (positive pole).
41. long term corticosteroid therapy. Very often patients with
chronic pulmonary disease have been managed using
corticosteroid therapy. Long term steroid use affects
ligamentous integrity, which often produces joint
hypermobility.
42. Medicaid Long term care for institutionalized elderly is
funded by Medicaid, a state-federal partnership of funding.
Patients must first spend down their assets to qualify for low
income stains before they are eligible for Medicaid. Individual
slates determine eligibility requirements.
43. infected pleura. The case is supportive of a pulmonary process
as evidenced by radiography and history. Since the radiographic
findings and the pain are in the same vicinity, the likelihood is this
pain is pleuritic in origin. Angina is not the most likely cause since
the cardiac system is not involved. There is no history of trauma
to the chest and no trauma was found radiographically, making
it unlikely as the source of pain. An inflamed tracheobronchial
tree would not usually reflect pain in the posterior base of the
left thorax.
’05 Sullivan A
44. training all staff to do simple repairs on all electrical
equipment if a breakdown should occur. Electrical
equipment is repaired by the manufacturer or local vendor,
or in some cases, the maintenance department, not by
physical therapy staff.
45. cellulitis. Cellulitis is an inflammation of the cellular or
connective tissue in or close to the skin. It is characterized
by skin that is hot red, and edematous. Fever is a common
finding. Dermatitis produces red, weeping, crusted skin
lesions, but is not commonly accompanied by fever.
Location on shins makes herpes an unlikely choice and
there are no skin eruptions, or vesicles. Scleroderma is a
collagen disease producing tight, drawn skin.
46. ultrasound. Ultrasound energy may affect the epiphyseal
areas causing bone growth disturbances. The epiphyseal
plates close at the end of puberty.
47. 6-8 weeks of training. Hypertrophy is the increase in muscle
size as a result of resistance training and can be observed
following at least 6-8 weeks of training. Individual muscle
fibers are enlarged, contain more actin and myosin, and
have more, larger myofibrils.
48. external/lateral rotation and extension. The long head of
the biceps is best exposed in shoulder lateral rotation and
extension due to its attachment at the supraglenoid
tubercle of the scapula which is at the medial aspect of the
shoulder joint. Medial rotation and abduction places the
long head of the biceps deep to the anterior deltoid and
pectoralis major muscles. The anterior surface of the
shoulder, including the long head of the biceps, loses
exposure with horizontal adduction.
49. step up onto a low step while in the parallel bars. Active
practice of stepping using a low step represents the best
choice to ensure motor learning. Passively bringing the loot
up does not promote active learning. Choices A and C are
appropriate lead-up skills to stair climbing.
50. tandem walking and single limb stance. A patient with
balance instability would benefit from all of the
interventions except tandem walking and single limb
stance. These activities are too difficult (high level) to be
included in an initial training program. A significant
percentage of healthy elderly are unable to stand on one
leg.
51. 252 inches (21 feet). The architectural standard for rise of a
step is 7 inches (steps may vary from 7-9 inches). The
recommended ratio of slope to rise is 1:12 (an 8% grade).
For every inch of vertical rise, 12 inches of ramp will be
required. A straight ramp will have to be 252 inches or
21 feet long.
52. increased tidal volume. Asymmetrical breathing, deviated
trachea towards the side to the pneumonectomy, and
decreased breath sounds would be likely changes. An
increased tidal volume due to incisional pain and sedation
would not be likely.
53. shortness of breath at rest and with limited activity, and
sudden weight gain. Elderly patients with moderate to
severe congestive heart failure demonstrate diminished
cardiac reserve and intolerance to strenuous physical

activity. Symptoms of exertional intolerance include
shortness of breath and sudden weight gain, the result of
circulatory backflow and peripheral edema.
54. position in prone lying and sitting with full knee extension.
The typical contractures with a transtibial amputation are
knee flexion and hip flexion (typically from too much sitting).
When in bed, hip and knee extension should be emphasized
(e.g. prone-lying). When sitting in the wheelchair, knee
extension should be emphasized (e.g. using a posterior
splint or knee board).
55. postpone therapy and coordinate with the nurse regarding
insulin management and exercise. Normal lasting plasma
glucose is less than I 15 mg/dL while a fasting plasma
glucose level greater than 126 mg/dL on more than one
occasion is indicative of diabetes. This patient is
hyperglycemic with high glucose levels (equal to or
greater than 250 mg/dL). Clinical signs that may accompany
this condition include ketoacidosis (acetone breath) with
dehydration, weak and rapid pulse, nausea/vomiting, deep and
rapid respirations (Kussmaul’s respirations), weakness, dimin-
ished reflexes, and paresthesias. The patient may lie
lethargic and confused and may progress lo diabolic coma
and death if not treated promptly with insulin. Physical
therapy intervention is contraindicated; exercise can lead to
further impaired glucose uptake.
56. splinting the shoulder in abduction and internal rotation.
Splinting the shoulder in abduction leads to formation of
abduction contractures and later hypermobility of the
shoulder.
57. extension, left side-bending, and right rotation. The right
sternocleidomastoid produces left lateral rotation and flexion of
the cervical spine. The right sternocleidomastoid is in
lengthened position with the head turned to the right and the
cervical spine extended.
58. he should be expected to value patient confidentiality.
Valuing and upholding patient confidentiality is an expected
behavior for all physical therapists and physical therapy
students specified by the American Physical Therapy
Association Code of Ethics. Since this a final affiliation, the
student should adhere fully to the APTA's Code of Ethics.
59. B is less than A. In an A-B-A-B single subject design, the As
represent multiple baseline-measurements while the Bs
represent multiple post-treatment measurements. If the
hypothesis is accepted, the pain rating scores will he lower
following the treatment when compared to the baseline
measurements.
60. improve rate control at faster movement speeds. Patients
during the later stages of recovery from stroke frequently
exhibit problems with rate control. They are able to move
at slow speeds but as speed of movement increases, control
decreases. An isokinetic device can be an effective training
modality to remediate this problem.
61. use a shrinker. A shrinker is a suitable alternative to
elastic wraps. It is important to select the right size
shrinker to limit edema and accelerate healing. An Unna's
paste dressing is applied at the time of initial surgery. Use of
a temporary prosthesis should be a prosthetic team
‘05 Sullivan A
Practice Questions 23
decision and is based on additional factors such as age,
balance, strength, cognition and so forth.
62. 5 times/week, BID 10 minutes/session. Patients with
vascular insufficiency and claudication pain should be
encouraged to walk daily, 2-3 x/day. Duration should be short.
The patient should walk to the point of maximum tolerable
pain, and allowed to rest.
63. oblique. The spinal defect is spondylolisthesis and the
radiographic view that demonstrates the scotty dog neck
fracture is the oblique view. A lateral radiographic view will
show the degree of anterior or posterior slippage of one
vertebra on another allowing the radiologist to grade the
spondylolisthesis.
64. allow the patient to express her anger while refocusing her
on effective coping strategies. Anger is a recognized stage
in the psychological adaptation to death and dying (Kubler-
Ross). Patients should be allowed to express anger,
frustration, and resentment. A helpful strategy is to redirect the
patient to achieve effective coping strategies (anger
management techniques). While honest, accurate
information is important it is not the most useful strategy for
this patient at this time.
65. a facet joint. Facet joint dysfunction is exacerbated with
sustained positions and eases with movement.
66. document the findings and immediately inform the patient’s
physician about the situation. It is most appropriate to
discuss a patient problem with the person who is ultimately
responsible for the patient. The physician as team leader
can affect a change in behavior or seek additional help
for the patient.
67. forward step-ups in standing using graduated height steps.
Decreased foot clearance during swing may result from
weak hip and knee flexors or may be the result of a drop
foot (weak dorsiflexors or spastic plantarflexors). Step-ups
represents the best choice to functionally strengthen the
hip and knee flexors. Bridging promotes knee flexion with
hip extension. The sitting activities promote hip abduction
(A) and knee extension (B).
68. a reciprocating gait orthosis and walker. A patient with a
SCI at the level of L1 or above has lost all functioning
lower extremity muscles needed for gait. A
reciprocating gait orthosis is the best choice for this
patient. Because of the high energy expenditure, patients
with injuries at this level typically depend upon the
wheelchair as their primary means of mobility. However,
the physiological and psychological benefits make it is
appropriate to train this patient in ambulation.
69. appropriate if intensities are kept below 40% maximal
voluntary contraction. Resistance training is typically
initiated after patients have completed 4 to 6 weeks of
supervised cardiorespiratory endurance exercise. Lower
intensities are prescribed. Careful monitoring of BP is
necessary as BP will be higher and HR lower than for
aerobic exercise.
70. change the angle of pull. Changing the angle of pull will
reduce the traction pressure on the mandible and at the
 24 Practice Questions
TMJ. The greatest traction force should be felt on the
occiput.
71. assisted breathing and coughing and pelvic floor exercises.
It is important to teach the patient to provide incision support
for breathing and coughing. Pelvic floor exercises are also
important since hours of labor and pushing arc typically
present before surgery. Assisted ambulation and ankle
exercises would routinely be carried by nursing personnel
and would not necessarily require a P.T. referral.
72. spondylolisthesis with possible anterior slippage of the
vertebral body. Spondylolisthesis is a bilateral fracture of the
pars interarticularis with anterior slippage. Spondylolysis is a
unilateral or bilateral fracture without anterior slippage.
73. adapt a desk and wheelchair to provide adequate sitting
balance. The goal of school physical therapy is to directly
facilitate the educational process, for example, interacting in
class viewing the blackboard, etc.
74. a rolling walker to compensate for impaired balance. The
patient with Parkinson's disease typically presents with
postural deficits of forward head and trunk with hip and knee
flexion contractures. Gait is narrow-based and shuffling. A
festinating gait may result from persistent forward posturing
of the body near the forward limits of stability. A rolling
walker is contraindicated because it would increase
forward postural deformities and festinating gait.
75. ideomotor apraxia. With ideomotor apraxia, a patient
cannot perform a task upon command but can do the task
when on their own. With ideational apraxia, a patient
cannot perform the task at all.
76. should be paid for by a third party payer. Determination
about whether care is paid for by a third party payer is
determined by the payer based on contract terms and
condition. Ideally those terms include same or similar clinical
factors and rationale that are part of appropriate peer review
but they need not be.
77. increased total lung capacity. An obstructive pattern on
pulmonary function tests includes increased total lung capacity
caused by destruction of alveolar walls. This same destruction
causes an increased residual volume with a resulting increased
functional residual capacity and decreased vital capacity.
78. ischial tuberosity, gluteals, and lateral sides of residual
limb. A quadrilateral socket in a transfemoral amputation is
designed to selectively load tissues that are pressure tolerant:
the ischial tuberosity, gluteals, and lateral sides of the residual
limb.
79. immediately contact her primary physician. This patient is
presenting with signs of clinical depression. Her primary physician
should be contacted immediately (especially if suicide is
mentioned).
80. mechanical stretching using traction and 5 lb. weights, 2
hours, twice daily. Prolonged mechanical stretching involves
a low-intensity force (generally 5 to 15 Ibs.) applied over a
prolonged period (30 minutes to several hours). It is generally
the most effective way to manage long-standing flexion
contractures. Manual passive stretching is a short duration stretch
that is not likely to be effective in this case. Lower extremity splints
’05 Sullivan A
and hold-relax techniques can be used to improve flexibility but are
also not likely to be effective in this case because of the short
duration.
81. stretching and limiting extended spinal positions as the
result of spinal stenosis. Spinal stenosis presents with
bilateral dysesthesias and pain in extended positions
and/or during walking for distances greater than 100 feet.
Physical therapy intervention should emphasize stretching
of tight structures and dynamic control of the trunk to limit
long-term extended spinal positions.
82. have the teacher give a smile sticker when the child sits
with head retracted for five minutes. Positive reinforcement
(use of the smile sticker) is an effective way to shape
behavior by operant conditioning. Negative behaviors are
ignored (slumping in the chair) while positive behaviors are
encouraged (hold head in a retracted position for 5
minutes.
83. ask your colleagues about their current level of knowledge
using a brief questionnaire. In order to better share the
information you have learned, you need to assess what
information and skills your colleagues currently have. A
brief questionnaire can be an effective means to achieve
this. Choices A, B, C, demonstrate planning of the learning
experience without benefit of a needs assessments.
84. passive manipulation to the shoulder. All of the treatments
may lie used for RSD (Complex Regional Pain
Syndrome, CRPS) except passive manipulation which
may aggravate sympathetically maintained pain.
85. lower trapezius, latissimus dorsi, and triceps. The upper
quadrant muscles that arc most important to strengthen
for crutch gaits include the lower trapezius, latissimus
dorsi, and triceps. Shoulder depression and elbow
extension strength is crucial.
86. 92%. A 92% SaO2 is low but acceptable.
Unacceptable oxygen saturation rates during exercise
are < 88%. Normal SaO2 is >95% - 98%.
87. ice massage B.I.D. until the pain subsides. Pain and
inflammation can be effectively treated with a cold modality.
Ice massage can rapidly reduce pain and tissue
temperature in a small area without affecting the bony
structure. Treatment frequency should increase if pain is
severe. Fluidotherapy three times a week is not
appropriate.
88. side-bending. The uncinate processes (joints of Luschka)
are located-at the inferior lateral aspect of the lower
cervical vertebrae. Side-bending is lost with
degenerative changes at the joint the uncinate process
makes with the vertebra below. Other motion is
restricted but to a lesser degree.
89. active assistive pulley exercises. The patient is most likely
suffering from a rotator cuff tear. Acute physical therapy
intervention should focus on reduction of pain and
inflammation. During the early subacute phase, active
assistive pulley exercises would be indicated lo promote
healing of the supraspinatus muscle and maintain active
range of motion of the glenohumeral joint.

90. interrater reliability. Interrater reliability is the degree to
which two or more independent raters can obtain the same
rating for a given variable. In this case, two therapists
obtained different HIM scores for the same group of
patients, indicating a problem in interrater reliability.
91. sit the patient up, check/empty catheter, and then call for
emergency medical assistance. The patient is exhibiting
autonomic dysreflexia (an emergency situation). You
should first sit the patient up and check for irritating or
precipitating stimuli (e.g., a blocked catheter). Then call for
emergency medical assistance.
92. metatarsal bar. Correction for a pes planus deformity
(support of the longitudinal arch) can be provided by a
UCBL insert, scaphoid pad or Thomas heel. A metatarsal
bar is indicated to take pressure off the metatarsal heads
and improve push off.
93. custom made pressure garments. Following burns, edema
and hypertrophic scarring can be effectively controlled with
elastic or pressure garments. Surgery is an option of last
resort.
94. dyspnea, anxiety, or disorientation. A patient with
respiratory acidosis may present with symptoms of
dyspnea, anxiety, restlessness, or headache. Significant
acidosis may lead to disorientation, stupor, or coma.
Answers A, B, C are signs and symptoms of respiratory
alkalosis.
95. placing the wrists in resting splints. Modalities which use
steroids are contraindicated for pregnant women. The most
effective intervention would be to place the wrists in a neutral
position in splints. The carpal tunnel is, therefore, not
compromised by poor hand positioning while at work.
96. wheelchair with a back wedge and head supports. A
wheelchair wedge and head supports holding the trunk and
head in slight flexion will help decrease the extensor tone
and is the most appropriate positioning in the educational
setting. An abduction pommel controls scissoring of the
legs but does not control head and upper trunk necessary
for functioning in the school environment.
97. shoulder extensors, external rotators, and anterior deltoid
to position and lock the elbow. The patient with complete
C^, quadriplegia will lack triceps. He can be taught to lock
the elbow for push-up transfers by using shoulder external
rotators, extensors to position the arm; the anterior deltoid
locks the elbow by reverse actions (all of these muscles are
functional).
98. demonstration, practice, and follow-up discussion. A
variety of teaching methods including demonstration,
practice, and discussion has the best chance of reinforcing
the learning in a diverse group. One teaching method is not
likely to be as successful in meeting the needs of all group
members.
99. have the patient wear a tight fitting mask while being
treated in his room. The therapist should wash his/her
hands upon entering and leaving every patient’s room.
When the patient is suspected of having tuberculosis, the
patient should be in a private, negative pressurized room.
The room is considered a potentially infective environment
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Practice Questions 25
and the therapist should don a tight fitting mask prior to
entering the room. The patient only needs to wear a mask
if he needs to leave his room (for a medical test, etc.). See
Transmission-Based Precautions, Table 5-3.
100. patient education regarding avoidance of squatting and
jumping activities as well as initiation of iontophoresis
using dexamethasone. The dysfunction observed on the
x-ray is Osgood-Schlatter's Disease. The radiograph
depicts epiphysitis of the tibia at the attachment of the
patellar tendon seen in adolescents. It occurs as the result
of activities that require continued explosive contractions
of the quadriceps muscle complex during pubescent
growth spurts. Patient education should locus on control-
ling knee loading activities such as squatting and
jumping. Explosive contractions of the quadriceps
complex should be avoided. Ambulation and AROM
activities maintain mobility while the structure heals,
Phonophoresis would be contraindicated because it may
be painful to move the sound head over the affected
area. Additionally, ultrasound should not be used over
open epiphyses. Open chain knee extension exercise
may aggravate symptoms due to the increased load at
the attachment of the patellar tendon to the tibial
tuberosity.
101. provide a two-wheel handcart for use in moving the boxes.
Implementation of an engineering control technique
can be accomplished by designing or modifying the
workstation, work methods, and tools to
eliminate/reduce exposure to excessive exertion,
awkward postures and repetitive motions.
102. subtalar pronation and medial rotation of the tibia. In order
to maintain the center of gravity over the base of support,
the subtalar joint must pronate and the entire lower quarter
must medially rotate.
103. empty end-feel. An empty end-feel (no real end-feel) may
be indicative of severe pain and muscle guarding associated
with pathological conditions. Springy and firm end-feels may
be expected after elbow surgery. Soft end-feel is an indication
of range limited because of tissue compression (e.g. in
knee flexion there is contact between the posterior leg and
the posterior thigh).
104. behind and to the left side, one hand on the gait belt. The
correct guarding technique to protect a patient from failing
is to stand slightly behind and to one side (the involved or
left side).
105. unaffected. The chronaxie is the duration of the current at
twice the rheobase (minimal intensity at a given long
duration). The chronaxie of an innervated nerve is less than
then 1 ms. When a motor nerve is severed it undergoes a
process called Wallerian degeneration in which the axons
distal to the lesion degenerate. The chronaxie of the
denervated nerve is greater than I ms. During the first 7 to
10 days much of the nerve constituents are st i l l present,
thus no change in the chronaxie is observed.
106. swimming using a crawl stroke. Positioning in spinal
extension increases symptoms in patients with spinal
stenosis. Activities such as swimming using a crawl stroke
place the spine in a constant extended position. All other
 26 Practice Questions
activities described do not require the patient to maintain
an extended spinal position.
107. a shoe lift on the sound side. This patient is vaulting (rising
up on the sound limb to advance the orthotic limb forward).
This gait deficit increases the energy demands of gait and is
most likely contributing to his fatigue. The myalgia and
fatigue arc also direct impairments of post-polio syndrome.
An appropriate intervention plan would be to reduce the
energy demands of gait. The use of a shoe lift on the sound
side would help accomplish this. A wheeled mobility device
(motorized cart) would also assist in reducing energy
demands of functional mobility. The wheelchair choices
presented are poor ones.
108. stimulate the ipsilateral triceps. Stimulation of the
ipsilateral triceps will reduce the muscle tone of the
biceps through reciprocal inhibition.
109. ankle-foot orthosis. Individuals with an L5 lesion need an
orthosis to correct foot alignment and for push-off. There is
partial innervation of the hamstrings and gluteus minimus
and medius, posterior tibialis and peroneus tertius muscles.
The other orthoses would he indicated for higher level
lesions.
110. closed-chain partial weight-bearing lower extremity
exercises for slipped capital femoral epiphysis. Slipped
capital femoral epiphysis is characterized by a glutens
medius gait. Closed-chain exercises with weight-bearing to
tolerance will help regain or maintain functional muscular
strength and normal motion.
111. null hypothesis. The null hypothesis is a statistical
hypothesis that states that there is no relationship (or
difference) between variables. Any relationship found will
be a chance relationship, not a true one.
112. that the therapist was functioning outside the common
protocols of the hospital, and therefore did not support the
actions of the physical therapist. The physical therapist
was acting outside of her area of responsibility and did
something that caused the patient harm.
113. patch one eye. Double vision (diplopia) can be managed by
patching of one eye. Patients are typically on an eye
patching schedule which alternates the eye that is patched.
Loss of depth perception can be expected with eye patching
but is not as disabling as diplopia.
114. sidelying on the sound side with the affected upper
extremity supported on a pillow with the shoulder
protracted and elbow extended. Most patients with stroke
recover from the flaccid stage and develop spasticity.
Positioning for the patient with early stroke stresses (I)
protection against ligamentous strain and the development of a
painful subluxed shoulder and (2) positions counter to the
typical spastic posture of flexion and adduction with pronation.
Sidelying with the affected upper extremity supported on a
pillow with the shoulder protracted and elbow extended
accomplishes both of these goals. The other positions do not.
115. chronic venous insufficiency. Venous ulcers are often
painless, or present with minimal pain when compared to
arterial ulcers which are painful (claudication and rest pain).
Chronic venous insufficiency is also characterized by
’05 Sullivan A
thickening, coarsening, and brownish pigmentation of the
skin around the ankles. The skin is usually thin, shiny, and
cyanotic. DVT may be asymptomatic initially. When
symptoms occur, patients typically report a dull ache,
tightness, or pain in the calf.
116. large electrodes, widely spaced; 10:30. Large electrodes
are used on large muscles in order to disperse the current
(minimize current density under the electrode) enabling a
more comfortable delivery of current. Widely spaced
electrodes permit the current to travel deeper into the
muscle to stimulate a greater number of deeper muscle
fibers. A duty cycle of 1:3 will allow a sufficient rest period
between contractions to minimize the fatiguing effect of
repetitive muscle contractions.
117. call the physician immediately and report your findings. A
mole with irregular edges and multiple colors (black or
blue) is characteristic of a melanoma. It is associated with
sun-damaged skin but can appear anywhere on the body.
Early recognition before tumor invasion and metastatic
spread is critical in improving survival rates. The physician
should be informed immediately. Medical management
consists of biopsy and surgical removal.
118. decreasing consciousness with slowing of pulse and
Cheyne-Stokes respirations. Signs of increased intracranial
pressure secondary to cerebral edema and brain herniation
include decreasing consciousness with slowing of pulse and
Cheyne-Stokes respirations. Cranial nerve dysfunction is
typically noted in C.N. II (papilledema) and C.N.III (dilation
of pupils). Choices A and C are signs of meningeal
irritation and CNS infection.
119. nerve dysfunction will be rapidly reversed, generally in 2-3
weeks. Neurapraxia is a mild peripheral nerve injury
(conduction block ischemia) that causes transient loss of
function. Nerve dysfunction is rapidly reversed, generally
within 2 - 3 weeks. An example is a compression injury
to the radial nerve from falling asleep with the arm over
the back of a chair (Saturday night palsy).
120. occasional feedback given when consistent errors appear.
In learning a psychomotor skill, the patient needs to be able
to actively process information and self-correct responses.
Occasional feedback provides the best means of allowing for
introspection and is appropriate for later in practice
(associated and autonomous phases of motor learning).
121. he may be presenting with early signs of myocardial
infarction. An elderly patient with a cardiac history may
present with initial symptoms of mental confusion, the result
of oxygen deprivation to the brain. The SOB and
generalized weakness may also be due to generalized
circulatory insufficiencies coexisting with the developing
myocardial infarction.
122. modalities to reduce inflammation, active assistive range of
motion exercises using pulleys, and postural realignment.
Initial physical therapy intervention of tendinitis with possible
impingement should emphasize active assistive exercises,
modalities to reduce inflammation, and postural
realignment to reduce impingement of the rotator cuff at the
acromion.

123. 10 to 15 seconds. The recommended time duration for
endotracheal suctioning is 10 to 15 seconds. Any longer
risks serious any shorter and the risk is ineffective
secretion removal.
124. occlusive dressings. Autolytic wound debridement allows
the body's natural enzymes to promote healing by trapping
them under a synthetic, occlusive dressing. The dressings
arc applied for short durations (less than 2 weeks ) and arc
contraindicated in infection. The other answer are
appropriate wound management techniques; however, they
are not autolytic.
125. switch to modulation mode TENS. Because of the long-
term continuous use of TENS, the sensory receptors
accommodated to the continuous current and no longer
responded to the stimuli. Changing to modulation mode (i.e.
burst modulation), which periodically interrupts the current
flow docs riot allow accommodation to occur.
126. gastrocnemius-soleus. The muscles of the foot and ankle
move the long lever of the body forward and backward
using ankle synergies. The gastrocnemius-soleus moves
the body backward while the anterior tibialis moves the
body forward. Action of the hip extensors would result in a
backward lean with the center of motion occurring at the
hip.
127. false negative. Sensitivity refers to the ability of a test to
correctly identify individuals who truly have a disease or
condition (a true positive). In this example, the individual
was found not to have the Alzheimer's gene, when years
later he tested positive for the gene and the disease. The
original test produced a false negative result.
128. history of sudden onset of new cognitive problems and
patchy distribution of deficits. Multi-infarct dementia differs
from primary degenerative dementia, Alzheimer's type, in
(1) onset: sudden rather than slowly progressive
(characteristic of small focal infarcts) and (2) the nature of
symptoms: areas of deficits coexist with areas of intact
cerebral function. Agitation and sundowning (late afternoon
wandering) are characteristics of Alzheimer's disease.
129. vastus medialis muscle strengthening. Q angles greater
than 15 degrees could be indicative of abnormal lateral
patellar tracking. Vastus medialis muscle strengthening can
reduce the tendency for the patella to track laterally. Vastus
lateralis (VL) strengthening can promote greater lateral
patellar tracking and further irritation of the patellofemoral
joint. VL strengthening may promote an outward pull or
dislocation of the patella. Hamstring strengthening does not
directly affect tracking of the patella.
130. standing, picking the foot up behind and slowly lowering it.
Stage 4 recovery is characterized by some movement
combinations that do not follow that paths of either flexion or
extension synergies. Knee flexion in standing is an out-of-
synergy movement. All other choices represent synergistic
movements: choices A and B are flexion synergy
movements while choice C focuses on knee extensor
movement within an extended position.
131. examine the patient, document and discuss your findings
with the doctor. The physical therapist should complete the
examination of the patient, adequately document the
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Practice Questions 27
findings, and determine the physical therapy diagnosis.
While many states have direct access laws which permit
physical therapy intervention without referral, most
insurance companies including Medicare (affecting the
patient in this example) require a physician referral in order
for services to be reimbursed. Thus the therapist needs to
consult with the physician to get a referral before initiating any
intervention for this problem. This patient demonstrates
stress incontinence, a problem that could be successfully
treated with physical therapy (e.g., Kegel exercises and
other interventions).
132. anterior spinothalamic tract. Sensations interpreted as dull,
aching pain travel in the anterior (paleo) spinothalamic
tract. Discriminative fast pain is carried in I he lateral (neo)
spinothalamic tract. Discriminative touch is carried in the
proprioceptive pathways (fasciculus gracilis/cuneatus, medial
lemniscus).
133. increase the patient’s maximal oxygen consumption by
discharge. All of the choices are important goals for Phase
I, acute or inpatient cardiac rehabilitation except for altering
maximal oxygen consumption. Patients generally are
expected to reach a functional capacity of 3-5 METs by
discharge from a Phase I program.
134. placement of the drive wheels 2 inches posterior to the
vertical back supports. Placement of the drive wheels 2
inches posterior to the vertical back supports is an
appropriate modification for a patient, with bilateral
transfemoral amputations. This increases the length of the
base of support and provides increased posterior stability.
Lowering the seat height by 3 inches is an appropriate
modification for a patient with stroke who will use his sound
limbs for wheelchair propulsion. Increasing the seat depth
is not an appropriate modification.
135. P=0.05. A preselected probability level of 0.05 indicates
that the results (in this example differences in
measurements) would be the result of chance only 5 times
out of every 100 studies. This level of confidence helps us
reject the null hypothesis (there is no difference in
goniometric measurement techniques) and is common in
most experimental studies (0.01 is the other, more stringent
level of significance commonly applied).
136. instruction in proper postural alignment. Without regaining
normal postural alignment and scapular-humeral rhythm,
the patient will continue to impinge the supraspinatus
and/or biceps tendon at the acromion and never regain
normal function of the shoulder. It is unlikely that all pain
would be controlled.
137. pain and stiffness are worse in the early morning and
should decrease with moderate activity. Degenerative joint
disease (osteoarthritis) is a noninflammatory progressive
disorder affecting primarily the carpometacarpal, knee, and hip
joints. Stiffness is common following inactivity and is
relieved with movement. Exercise can be helpful in reducing
pain and immobility and is not contraindicated. Joint projection
strategies are effective intervention for maintaining function.
138. symmetrical distribution of weakness, ascending with
possible involvement of lower cranial nerves. Guillain-
Barre syndrome is an acute polyneuritis characterized by
rapid development of progressive muscle weakness. The
 28 Practice Questions
weakness is typically symmetrical and ascends the body
(starting first in the lower extremities, progressing to trunk,
upper extremities, and finally cranial nerves). Stocking and
glove sensory loss could also be found but not with minor
loss of motor function.
139. monophasic current with the anode placed on the tendon.
The anode (positive) electrode would effectively repel the
positively charged ion into the tendon. Because of its
unidirectional flow, monophasic currents are best suited
for iontophoresis.
140. have the patient do sitting push-ups at least every 10
minutes. Excessive ischial pressure and redness from
prolonged sitting requires an aggressive approach. Arm
push-ups, at least every 10 minutes, is indicated if redness
is present. A high-density gel cushion might help as would
a tilt-in-space chair but neither of these would address the
immediate problems.
141. medial rotation. Common abnormal postural findings
consistent with anterior knee pain in an adolescent female
include pes planus, lateral tibial torsion and genu valgum
with compensation at the femur of excessive medial rotation.
Lateral femoral rotation is commonly observed with genu
varum. Retroversion of the hip is an abnormally small angle
between the femoral neck and condyles and is not affected
by posture.
142. you will meet with the occupational therapist to discuss the
exercise approaches and you will let them know the
outcome of the meeting as soon as possible. Any
discrepancies in educational approaches used with the
patient's family should be handled by the learn members,
not the family or rehabilitation supervisors. A team meeting is
a good place to iron out approaches to patient care and
ensure consistency.
143. a videotape of another child with cerebral palsy on a Swiss
ball. A videotape of another child with CP on the ball
represents the best choice to engage this child: The other
choices, while important educational media, are not likely to
adequately present the three-dimensional qualities of
performance needed for exercising on the Swiss ball.
144. summon emergency medical services. If the victim is
unresponsive, Emergency Medical Services must be
activated immediately by calling 911 or calling a "code" if in
a health care institution. If the victim is a young child or
infant, try one minute of rescue breathing before
summoning help.
145. call the girl’s pediatrician immediately. These signs could
be the result of increased cerebral edema due to a clogged
or infected shunt. Medical attention should he obtained
immediately to avoid damage to the brain.
146. protection and splinting of the abdominal musculature.
Diastasis recti abdominis is a condition in which there is a
lateral separation or split of the rectus abdominis. It is
important to teach protection (splinting) of the abdominal
musculature. Patients should be instructed to avoid full sit-
ups or bilateral straight leg raising. Pelvic floor exercises
should be done but are not remediation for diastasis
recti.
’05 Sullivan A
147. supine, head of bed flat. A patient with a C5 spinal cord
injury will not have the abdominal musculature necessary
to return the diaphragm to a high domed position during
exhalation. Inspiration will be affected by the change in the
diaphragm's resting position. In supine, gravity will take the
place of abdominals, holding the abdominal contents
under the diaphragm, improving the zone of apposition,
the height of the diaphragm dome and therefore, the
ability to ventilate. The other positions listed negate the
positive effects of gravity on the abdomen.
148. schedule a conference with the doctor and family about her
condition and your discussions with the patient. The most
appropriate strategy is to hold a conference with the doctor
and family about her condition and your discussions with the
patient. Everyone interacting with this patient should be
answering her questions in the same way. A direct and
honest approach is best but must be consistent with the
parent’s wishes since she is a minor child.
149. overwork damage in weakened, denervated muscle.
Amyotrophic lateral sclerosis is a progressive
degenerative disease that affects both upper and lower
motor neurons. An important early goal of physical
therapy is to maintain the patient's level of conditioning
while preventing overwork damage in denervated muscle
(lower motor neuron injury). Myalgia is common in I,MN
lesions. It can be ameliorated " but not prevented. Ataxia
and radicular pain are not associated with ALS.
150. slight wrist extension with fingers supported and thumb in
partial opposition and abduction. A resting splint that
positions the wrist and hand in a functional position includes
10-20 degrees of wrist extension, fingers supported, and
thumb in partial opposition and abduction.
151. complaints of fatigue with increasing dyspnea and cough.
Left heart failure is a condition in which blood is not
adequately pumped out of the heart by the left ventricle. The
blood; therefore, backs up creating pulmonary signs and
symptoms (increased pulmonary artery pressures, cough,
dyspnea, orthopnea), weakness, and fatigue. All other
choices are signs associated with right-sided heart failure.
152. take a rest period and only use the device 10 times per
hour. If a patient feels lightheaded with an incentive spirometer,
it may be that they are blowing off too much CO2 by
hyperventilating. An incentive spirometer should always be
used in the most upright position possible to attain the highest
values possible.
153. 30 minutes each day. Motor learning is enhanced by daily
practice of moderate duration.
154. compression of the long thoracic nerve. Vigorous upper
limb activities can cause inflammation of soft tissues
surrounding the shoulder resulting in compression of the long
thoracic nerve and weakness of the serratus anterior. The
serratus anterior stabilizes the scapula with greater than 90
degrees of abduction. Supraspinatus tendinitis or weakness
does not result in scapular winging. The supraspinatus muscle in
concert with the deltoids initiates abduction in the upper
extremity. Subdeltoid bursitis causes pain with all active range
of motion arid does not result in scapular winging.

155. sacral sitting. Spasticity is typically strong in antigravity
muscles. In the lower extremities this is usually the hip and knee
extensors, adductors, and plantar flexors. Strong extensor
tone results in sacral sitting with the pelvis tilted posteriorly.
156. peripheral edema. Peripheral edema is a symptom of
overdosage/toxicity for patients on Premarin. The risk of
osteoporosis and fracture is reduced for individuals on estrogen
replacement therapy. Control of hot flashes is a major indication
for its use.
157. jogging is safe but you might want to switch to swimming
during later months. According to the American College
of Sports Medicine, women can continue to exercise
regularly (3 times a week) throughout pregnancy if no
additional risk factors are present. After the first trimester
women should avoid exercise in the supine position since
this position is associated with decreased cardiac output.
Non-weightbearing exercise (swimming) is an appropriate
alternative to decrease the risk of injury and facilitate
continuation of exercise throughout pregnancy.
158. concentric exercises, 3 sets of 10, with gradually
increasing intensity. This patient is experiencing
delayed-onset muscle soreness (DOMS) as a result
of vigorous exercise or muscular overexertion. It
typically begins 12 to 24 hours after exercise, peaks in
24 to 48 hours, and can last up to 5 to 7 days. DOMS
is usually greater after muscle lengthening or eccentric
exercise and can be lessened by gradually increasing
intensity and duration of exercise.
159. an iliotibial band friction disorder. A positive Noble
compression test is an indication of an i l i o t i b i a l band
friction disorder. A FABERE test can distinguish between h i p
joint pathology and sacroiliac joint dysfunction.
160. problems with motor planning and scaling of movements.
The basal ganglia functions to convert general motor activity
into specific, goal-directed action plans. Dysfunction results
in problems with motor planning and scaling of movements
and postures (e.g., bradykinesia).
161. vagus nerve. These are the tests for the vagus nerve C.N.
X. See chapter 2 for cranial nerve tests.
162. increased volume of air at resting end expiratory pressure
(REEP). The gravity independent area of the lung in the
upright sitting position refers to the apices of I he lungs
which house the most air at REEP. That area has the least
perfusion because of the effects of gravity on blood flow. The
apices also have the smallest change in ventilation during the
respiratory cycle because they are the most full at rest. Finally,
this area of the lung has the highest oxygenation and lowest
carbon dioxide content due to the small volume of blood that
needs to be diffused.
163. just anterior and superior to the greater trochanter. The
orthotic hip joint should coincide with a point just anterior and
superior to the greater trochanter (the anatomic center of the
hip joint).
164. the PTA who is completely liable because the plan of care
was altered without communicating with the supervising
PT. Only the supervising PT may alter the established plan of
care. In this case the treatment plan stipulated progressive
‘05 Sullivan A
Practice Questions 29
ambulation on level surfaces only. Therefore, the PT is not
responsible, the PTA is responsible and negligent.
165. gentle AROM exercises in weight bearing. Aggressive soft
tissue stretching and strengthening can promote myositis
ossificans. Gentle weight bearing AROM exercises to
patient's tolerance will minimize the chance of myositis
ossificans and promote improved function.
166. a tone inhibiting ankle-foot orthosis (AFO). A tone inhibiting
AFO will make ambulation easier and will help maintain ROM
of the affected ankle. The most appropriate assistive device
would be a cane (i. e. straight or SBQC), not a walker.
167. inadequate contraction of the ankle dorsiflexors.
Weakness or delayed contraction of the ankle dorsiflexors
or spasticity in the ankle plantarflexors may cause foot drop
during midswing. Excessive extensor synergy would cause
plantarflexion during stance.
168. tell her that she must have the permission of her father
before she can look at the chart. The only time
confidentiality can be breached is if the patient agrees or he is
in danger. Even the family doesn't have the right to the medical
information without the patient's permission unless the patient
is a minor child or is incompetent to make decisions.
169. decrease edema. The reduction of edema is through the
diffusion of synovial fluid. In addition, increased venous flow and
increased nutrition is occurring in and around the joint
enhancing the healing process. The reduction of pain is a
secondary consequence of decreased inflammation. Range of
motion is usually limited during the first few hours of treatment
and no tension is to be placed on the surrounding tissues.
170. five times per week. The patient with acute tendinitis receiving
iontophoresis should come daily the first two weeks to enable
optimal amounts of medication to affect the inflamed tissue.
The patient needs to return to work as soon as possible.
171. hip flexion contracture. A hyperextended knee can be
caused by extensor spasticity, quadriceps weakness (a
compensatory locking of the knee), or by plantarflexion
contractures or deformity.
172. call emergency medical technicians as it may be a
pneumothorax. The combined signs and symptoms of
absent breath sounds, sudden onset of chest pain and
shortness of breath indicate a pneumothorax, especially in
a 15 year-old male (growth spurt) with pathological changes
of king tissue. This should be considered an emergency
situation.
173. supervision of home health aides for completion of a daily
home exercise program. Medicare funds home health care
under Part A. Teaching of home care aides to ensure
completion of a daily home exercise program is a
reimbursable service while routine provision of an
established maintenance program in which the therapist
performs the exercises would not be covered.
174. PNF bilateral symmetrical upper extremity D2 flexion
patterns, rhythmic initiation. The patient with Parkinson's
disease typically develops elbow flexion, shoulder
adduction contractures of the upper extremities along with
a flexed, stooped posture. Bilateral symmetrical upper
 30 Practice Questions
extremity PNF D2F patterns encourage shoulder flexion
and abduction with elbow extension, and upper trunk
extension (all needed motions). Both quadruped and
modified plantigrade positions encourage postural flexion.
175. perform the ROM exercises yourself. The practice of using
supportive personnel falls under the Guide for Professional
Conduct (Appendix B0 and under the individual practice
acts of the states. Delegated responsibilities should be
commensurate with the qualifications (experience,
education, training) of the individual to whom
responsibilities are being assigned. In this case, it is not
reasonable to assume an aide newly arrived to the P.T.
department has the knowledge or skills to do this
treatment. A brief orientation to ROM exercises is not
adequate to ensure proper treatment. The therapist should
do the ROM exercises herself. In some states, any
treatment by an aide would be inappropriate.
176. wheelchair with head and trunk support with abductor
wedge. The wheelchair would be the most functional
adaptive equipment with postural support and abductor
wedge to help decrease extensor spasms of lower
extremities. This individual is not stable enough to use a
rollator walker or scooter board.
177. back extension, costal expansion exercises, and
maintenance of proper posture to prevent deformity.
Postural reeducation will help to prevent further increase in
thoracic kyphosis and costal expansion exercise will
improve breathing efficiency. Abdominal strengthening and
stretching of scapular stabilizers are not indicated for
ankylosing spondylitis.
178. contralateral hemiparesis and sensory deficits with greater
involvement in the arm than the leg. A CVA affecting the
middle cerebral artery will result in symptoms of
contralateral hemiparesis and hemi sensory deficits with
greater involvement of the arm than the leg. Choice B is
incorrect since involvement would be the left hemisphere
with right hand dominance. Choice C (greater leg
involvement than arm) is characteristic of a CVA affecting the
anterior cerebral artery.
179. elevated levels of low-density lipoprotein or LDL.
Increased blood cholesterol levels with high levels of
low-density lipoproteins (LDLs) increases the risk of
coronary artery disease (CAD); conversely low
concentrations of high-density lipoproteins (HDLs) is
also harmful. The link between CAD and triglycerides
is not as clear.
180. thank him very much, but refuse his invitation while he is
receiving treatment. Physical therapy departments should
have a policy stating it would be unethical to have sexual
contact or dating between staff and patients. The Guide for
Professional Conduct of the American Physical Therapy
Association (Appendix B, Administration Chapter) states in
Principal 2 that physical therapists shall not engage in any
sexual relationship or activity, whether consensual or non-
consensual with any patient while a physical therapist-patient
relationship exists. Some authorities suggest a waiting period
of 6 months after discharge from treatment before
commencing an intimate relationship.
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181. referral to a physician to evaluate anterior compartment
pressures during activity. Deep anterior leg cramping after
running distances- one mile or greater would most likely be
due to a local ischemic condition of the anterior
compartment as a result of excessive pressure. Shin splints
and tendinitis symptoms would occur earlier in running and
be felt as pain. Referral to a physician is indicated if
nontraumatic compartment syndrome is suspected.
Traumatic anterior compartment syndrome requires
immediate attention by a physician. Spinal stenosis usually
manifests itself as posterior leg cramping.
182. teach her activity pacing and energy conservation
techniques. You should teach this patient activity pacing
and energy conservation techniques. It is important she is
able to balance rest with activity in order to not further
weaken muscles affected by progressive post polio
muscular atrophy.
183. ligamentum flavum. The ligamentum flavum becomes
hypertrophied with lumbar spondylosis and may invade the
intervertebral foramen compressing the left L5 spinal nerve
root.
184. onset of moderate to severe angina. According to the
American College of Sports Medicine, an absolute
indication for terminating an exercise bout is onset of
moderate to severe angina. Other absolute indications
include: acute MI, a drop in SBP with increasing workload,
serious arrhythmias (2nd or 3rd degree heart blocks,
sustained ventricular tachycardia or PVCs, atrial
fibrillation with fast ventricular response), unusual or
severe shortness of breath, CNS symptoms (ataxia,
vertigo, confusion), or patient's request. The other choices
are considered relative indications and require close
monitoring.
185. notify the physician immediately, you suspect heterotopic
ossifications may be developing. Early signs of
heterotopic bone formation include swelling, pain,
erythema occurring near a large joint. The physician
should be notified immediately. Vigorous stretching is
contraindicated.
186. clearance between the floor and the foot plate of at least 2
inches. The correct measure for seat height in a
wheelchair is 2 inches clearance between the floor and the
foot plate, measured from the lowest point on the bottom
of the footplate.
187. recreational activities such as swimming or biking.
Recreational exercise will be both fun and helpful in
maintaining functional level as long as possible. At 6 years
of age, wheelchair confinement is not usual.
188. currently there is no limit to her Medicare coverage for
outpatient PT services. From September J, 2003 through
December 7, 2003 there was a limit on the amount
Medicare would pay for outpatient physical therapy
services. The limit of $1590.00 was in effect for outpatient
PT services given at a private clinic but not for hospital
outpatient department services. Effective December 8, 2003
the limit was removed by the recent Medicare Prescript ion
Drug and Modernization Act of 2003. Currently there is no
limit to the amount of medically necessary outpatient PT, OT,
or SLP services.
 Practice Questions 31

from Paget's disease are aggravated by positions where

189. use an alternate eyelid taping schedule which will allow her
to use eye movements to communicate. Pontine lesions
that result in locked-in syndrome leave the patient with an
inability to move or speak but with full cognitive function. By
taping one eye open, the patient's ability to receive sensory
inputs is increased (sensory deprivation is lessened) and eye
movements can be used for communication. They should
not expect any active responses from the patient.
190. maintain the keyboard in a position allowing a neutral wrist
position. Work involving increased wrist deviation from a
neutral posture in either flexion/extension or radial/ulnar
deviation have been associated with increased reports
of carpal tunnel syndrome and other wrist and hand
problems.
191. depressed ST segment with a flat T wave and shortened
QT interval. Digitalis produces characteristic changes on
the ECG: gradual downward sloping of ST segment with a
flat T wave and shortened QT interval.
192. intermittent pneumatic compression, extremity elevation,
and massage. Lymphedema following surgery and radiation
can be effectively managed by external compression and
extremity elevation. Manual lymph drainage (massage and
PROM) are also appropriate interventions. Exercise and
positioning alone would not provide the needed lymph
drainage; isometric exercise is contraindicated.
the lumbar spine is in extension. Because this is a chronic
condition, modalities are not the most effective
management strategy. Lumbar extension exercises decrease
the space within the vertebral foramen thereby increasing
symptoms associated with stenosis and Paget's disease.
199. the posterior stop setting the foot in too much
plantarflexion. An ankle-foot orthosis can be used to assist
in knee control for the patient with hemiplegia. A foot set in
slight plantarflexion (generally about 5 degrees) helps to
create an extension moment at the knee and can thus assist
weak knee extensors in extending the knee. However if the
ankle is set in too much plantarflexion, it can cause genu
recurvatum.
200. daily walking through pain in order to attain predetermined
distances. Patients with peripheral vascular disease with
intermittent claudication can benefit from a walking program
to improve peripheral blood flow and functional capacity.
The program should be of moderate intensity and duration.
Patients should be encouraged to exercise to the point of
pain, not through or beyond.

193. suggest that the patient speak with his surgeon. It is within
the physician's scope of practice to discuss the indications
and problems that could arise from this surgical procedure. It
is not within the physical therapist's scope of practice to be the
expert who discusses problems associated with surgery.

194. gravity assisted right upper extremity exercises to promote

scapular control following damage to the long thoracic
nerve. With axillary dissection the long thoracic nerve
may be damaged. This leads to serratus anterior
weakness and loss of scapular control. Gravity
assisted exercises to promote scapular control should
be emphasized early in rehabilitation to help restore
proper scapular humeral rhythm.

195. amount of productive secretions decreases. The purpose

of postural drainage is to help remove secretions. If the
amount diminishes this might be an indicator that the
treatment has been successful and that the frequency of
treatment can be reduced. The other choices of lever,
sputum consistency and pain do not provide a rationale
to decrease treatment frequency.

196. chronic, episodic bouts of dysfunction. Meniere's disease

is a recurrent and usually progressive vestibular disease
characterized by episodic bouts of dysfunction. As w i t h
most vestibular disorders, varying degrees of vertigo,
nausea, and postural i n s t a b i l i t y will occur.

197. Workers’ Compensation. T h e employee was injured on

the job even though she arrived early. She is therefore
covered by Worker's Compensation for her injury.

198. postural reeducation to prevent positions that increase

symptoms. Patients should be educated to prevent
extended positions for long periods. Symptoms resulting

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