CVA patient shoulder shrugging

Practice Questions 1
1. A patient who sustained a right cerebrovascular accident presents with a flaccid left arm. During muscle testing, the patient is
able to shrug the left shoulder. The MOST accurate explanation for shoulder movement is that the right cerebrovascular
accident:
1. has affected the right shoulder and not the left shoulder.
2. did not affect the vagus nerve (X), which innervates the upper trapezius muscle.
3. did not affect spinal accessory nerve (XI), which innervates the upper trapezius muscle.
4. has affected the left biceps and triceps muscles but not the deltoid muscles.
2. Manual muscle test grades are an example of which of the following levels of measurement?
1. Nominal
2. Ratio
3. Interval
4. Ordinal
3. A physical therapist should anticipate that an abnormal lymph node will feel:
1. soft and nonmobile and have an increased skin temperature.
2. firm and nontender and have an increased skin temperature.
3. firm, mobile, and tender or nontender.
4. soft, mobile, and tender or nontender.
4. A patient comes to physical therapy with the diagnosis of a medial meniscus tear of the right knee. Which of the following
signs and symptoms is MOST indicative of this diagnosis?
1. Mechanical locking
2. Decreased pain with weight bearing
3. Posterior knee swelling
4. Atrophy of hamstrings
5. A client who is participating in a weight-loss program has been walking 3 days/week for 15 minutes for the past 3 weeks. To
progress the exercise program, which of the following modifications will MOST likely accomplish the weight-loss goal?
1. Maintain the current walking speed and increase the duration to 30 minutes.
2. Increase the walking speed and keep the duration at 15 minutes.
3. Walk 4 days/week and decrease the duration to 10 minutes.
4. Change from walking 3 days/week to jogging 1 day/week for 20 minutes.
6. A 78-year-old patient who is being treated for osteoarthritis of the knees reports centralized lower thoracic pain and epigastric
pain. The pain is relieved by eating. Which of the following steps would be MOST important in screening for the cause of the
new symptoms?
1. Resist the iliopsoas muscle to screen for a psoas abscess.
2. Ask if the patient has been constipated or has had diarrhea.
3. Perform an abdominal examination to screen for an abdominal aortic aneurysm.
4. Ask if the patient is taking a high dose of nonsteroidal anti-inflammatory drugs.
7. A patient who is re-learning the task of moving from sit to stand following traumatic brain injury is frustrated because of
repeated failed attempts. To facilitate the patient’s success, a physical therapist should FIRST:
1. permit the patient to rest until the next physical therapy session and re-attempt the activity.
2. encourage the patient to visualize success with the task before resuming attempts.
3. provide incentive by holding a desired object for the patient to reach toward.
4. decrease the challenge of the task, so that the patient experiences success.
8. A postural correction program for a patient with forward head, kyphosis, and increased lumbar lordosis should include all of
the following EXCEPT:
1. strengthening the scapular protractors.
2. strengthening the thoracic erector spinae muscles.
3. lengthening the short suboccipital muscles.
4. lengthening the lumbar erector spinae muscles.
9. A physical therapist is applying electrical stimulation to a patient with a neurapraxia. To minimize accommodation, the
therapist should:
1. decrease the size of the stimulating electrode.
2. increase the pulse duration.
3. utilize a rapid rate of rise.
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2 Practice Questions
4. select a biphasic waveform.
10. During examination of a patient, a physical therapist notes hypoventilation, muscular twitching, and increased deep tendon
reflexes. Which of the following conditions is the MOST likely cause of the signs and symptoms?
1. Metabolic alkalosis
2. Metabolic acidosis
3. Respiratory alkalosis
4. Respiratory acidosis
11. A patient is referred to physical therapy with a diagnosis of herniated nucleus pulposus. In addition to low back pain,
examination findings include hypoesthesia, weakness, and diminished deep tendon reflexes in bilateral lower extremities.
Which of the following types of incontinence is MOST likely to be associated with this presentation?
1. Urge
2. Overflow
3. Stress
4. Functional
12. A physical therapist is working with a patient who had a total knee arthroplasty 2 days ago. The patient’s resting
electrocardiogram is shown in strip A. While gait training, the patient’s electrocardiogram changes, as shown in strip B. Based
on this finding, what is the BEST action for the therapist to take at this time?
1. Stop gait training and notify the nurse.
2. Continue gait training as the heart rate is less than 100 bpm.
3. Stop gait training and allow the patient to sit down and rest.
4. Continue gait training, but allow the patient standing rest breaks.
13. A physical therapist is performing sit-to-stand transfer training with a patient in a hospital room. The patient is currently
admitted for acute renal failure and has electrocardiogram monitoring in place. During the transfer training, the therapist notes
new onset of one unsustained, unifocal premature ventricular contraction. Which of the following actions is MOST
appropriate for the therapist to take at this time?
1. Discontinue transfer training and call the nurse immediately.
2. Discontinue transfer training and switch to passive range-of-motion exercises.
3. Allow the patient to rest and continue with transfer training, while monitoring the electrocardiogram.
4. Allow the patient to rest and measure the patient’s blood pressure.
14. When held in supported standing, a 14-month-old child with spastic diplegia is up on tiptoes with the toes curled. This
position is characteristic of a:
1. proprioceptive placing reaction.
2. Moro reflex.
3. plantar grasp reflex.
4. traction response.
15. A patient with multiple sclerosis is referred for physical therapy at home. The patient requires training in bathing, dressing,
and eating, and use of adaptive devices may be needed to accomplish the training. The physical therapist should recommend
that the patient be seen by a/an:
1. social worker.
2. orthotist.
3. occupational therapist.
4. home health nurse.
16. As a patient progresses with physical therapy, which of the following changes in a home exercise program is MOST likely to
increase the patient’s adherence to the program?
1. Add additional exercises to the home program.
2. Increase the intensity of the home exercises.
3. Increase the frequency of home exercise program execution.
4. Choose exercises that can be incorporated into daily activities.
17. A home health patient who recently had a three-vessel coronary artery bypass graft describes experiencing bilateral lower
extremity swelling, leg pain, and shortness of breath, especially when lying down. The patient MOST likely has which of the
following diagnoses?
1. Deep vein thrombosis
2. Myocardial infarction
3. Pulmonary embolism
4. Congestive heart failure
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18. Which of the following techniques is MOST appropriate for a patient with low postural tone?
1. Slow regular rocking while sitting on a treatment bolster
2. Continuous pressure to the skin overlying the back muscles
3. Low-frequency vibration to the back muscles
4. Joint approximation applied through the shoulders to the trunk
19. Which of the following descriptions BEST represents the physical examination technique used to assess tissue hydration in
the hand?
1. Pinch and lift the skin and determine the time for the skin to return to normal.
2. Push into the skin and determine the time for the skin to return to normal.
3. Measure the surface temperature over the volar aspect of the wrist.
4. Obtain volumetric measurements on each arm and compare displacement measures.
20. A physical therapist is issuing a home exercise program to a patient. Which of the following strategies MOST ensures the
patient’s proper adherence with the program?
1. Provide written instructions for the program.
2. Involve a family member in supervising the exercises.
3. Demonstrate the program to the patient while providing verbal instructions.
4. Have the patient perform the exercises under the guidance of the therapist.
21. When training a patient to increase muscle activity with the use of electromyographic biofeedback, the physical therapist
should adjust the unit so that sensitivity:
1. starts low and increases as the patient shows an increase in muscle activity.
2. starts high and decreases as the patient shows an increase in muscle activity.
3. remains at approximately mid-range during the entire treatment period.
4. is not set, since this adjustment is not necessary for this form of biofeedback.
22. In a research study, the independent t-test was used as the statistical tool. How would statistically significant results be
presented if alpha was set at .05?
1. p < .05
2. p > .05
3. r2 > .05
4. r2 < .05
23. To manually assess a patient’s lower extremity circulation, a physical therapist should palpate the patient’s peripheral pulse at
which of the following locations?
1. Dorsal foot, near the base of the first metatarsal
2. Lateral lower leg, just posterior to the fibular head
3. Lateral ankle, just inferior to the lateral malleolus
4. Plantar foot, just medial to the medial calcaneal tuberosity
24. In which of the following conditions is a nerve conduction velocity test MOST appropriate?
1. Carpal tunnel syndrome
2. Cerebrovascular accident
3. Myotonia
4. Duchenne muscular dystrophy
25. A positive finding in which of the following examinations is MOST consistent with a diagnosis of a herniated nucleus
pulposus at L4– L5?
1. Straight leg raise at 25°
4. Prone knee flexion at 90°
26. A patient with lower extremity claudication is exercising to the point of symptom production. Observation of the distal aspect
of the patient’s skin is MOST likely to result in which of the following findings?
1. Edema
2. Hyperhydrosis
3. Hyperemia
4. Pallor
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27. Which of the following exercises should increase a patient’s shoulder lateral (external) rotation range of motion by contraction
of the tight muscle?
1. Isotonic contraction of medial (internal) rotation followed by passive motion into medial (internal) rotation
2. Isometric hold resisting medial (internal) rotation followed by passive motion into medial (internal) rotation
3. Isometric hold resisting lateral (external) rotation followed by passive motion into medial (internal) rotation
4. Isometric hold resisting medial (internal) rotation followed by passive motion into lateral (external) rotation
28. Which of the following community-based sport activities would LEAST likely be CONTRAINDICATED for a patient with
osteoporosis?
1. Tai-chi
2. Golfing
3. Bicycling
4. Swimming
29. Which of the following joints is indicated by the arrow in the radiograph?
1. Tibiofibular
2. Subtalar
3. Talocrural
4. Midtarsal
30. A physical therapist wants to use ultrasound for pain reduction. Ultrasound is CONTRAINDICATED for which of the
following conditions?
1. Dermal ulcer
2. Herpes zoster
3. Thrombophlebitis
4. Surgical incision
31. During gait evaluation, a physical therapist notes that a patient demonstrates a shorter left step length and excessive left knee
flexion during the left midstance phase. Which of the following problems is the MOST likely the cause of the gait
dysfunction?
1. Left hamstrings contracture
2. Right iliopsoas weakness
3. Left hip flexion contracture
4. Right quadriceps weakness
32. A physical therapist is performing a bladder retraining program with a patient who initially needed to urinate hourly. The
patient has been progressed to voiding every 2 hours and now reports accomplishment of this goal with only a slight amount
of incontinence between voiding. Which of the following recommendations is MOST appropriate?
1. Increase the voiding interval by 30 minutes.
2. Increase the voiding interval by 1 hour.
3. Maintain the voiding interval at 2 hours.
4. Decrease the voiding interval to 1.5 hours.
33. A physical therapist notes that a patient has patches of dry, erythematous skin over the extensor surfaces of the elbows and
knees, as well as bony enlargement of the distal interphalangeal joints. These findings are MOST associated with which of the
following diagnoses?
1. Reiter syndrome
2. Psoriatic arthritis
3. Rheumatoid arthritis
4. Systemic lupus erythematosus
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34. For adequate documentation of physical therapy services for neurological patients, changes in which of the following factors
are MOST important to record?
1. Muscle tone
2. Functional abilities
3. Cognitive status
4. Quality of movement
35. A physical therapist, who is newly graduated, is initiating inpatient rehabilitation with a patient who is comatose. A relative of
the patient asks the physical therapist to find a more experienced therapist to work with the patient. Which of the following
responses is MOST appropriate for the physical therapist to provide to the patient’s relative?
1. Do you believe that I am not competent to help with the rehabilitation?
2. Are you concerned that I won’t be able to help your loved one recover?
3. I passed my licensure examination, which indicates that I can be effective.
4. Please allow me to work with this patient, and if you are still concerned, we can discuss changes.
36. A physical therapist is reviewing peer-reviewed articles to find evidence to support a physical therapy intervention. Which of
the following collections of studies would provide the BEST evidence?
1. Two randomized controlled trials
2. Three single-case controlled trials
3. One group-controlled trial and three case studies
4. One randomized controlled trial and three case studies
37. A physical therapist evaluates a patient with back pain and determines that the patient’s pes planus is contributing to this pain.
Which of the following orthotic interventions is MOST appropriate for the patient?
1. Metatarsal pad
2. Solid ankle-foot orthosis
3. Hinged ankle-foot orthosis
4. Longitudinal arch support
38. During the gait evaluation of a patient who has a transfemoral prosthesis, a physical therapist notices that the patient laterally
bends excessively toward the prosthetic side during midstance phase. Which of the following factors is MOST likely to cause
this gait deviation?
1. A prosthesis that is too short
2. A prosthetic socket that is too small
3. Inadequate prosthesis suspension
4. A locked knee unit
39. A physical therapist examines a patient with multiple sclerosis who is in a period of exacerbation. The patient is independent
with bed mobility, can sit unassisted at the edge of the bed, and requires physical assistance to stand with a walker. Which of
the following interventions would have the HIGHEST priority?
1. Wheelchair propulsion up a 10-ft (3-m) ramp
2. Wheelchair transfers
3. Walking with an assistive device
4. Tub transfers
40. A patient with a hiatal hernia is receiving physical therapy. Which of the following exercises would MOST likely worsen the
symptoms related to the hernia?
1. Wall sits
2. Overhead press
3. Bilateral leg lifts
4. Hamstring stretch
41. A physical therapist is designing a rehabilitation program for a patient with a recent diagnosis of ankylosing spondylitis. The
therapist should anticipate that as the disease progresses, the patient is MOST likely to require:
1. special precautions for osteoporosis.
2. a wheelchair for community mobility.
3. assisted ventilation.
4. bilateral ankle-foot orthoses.
42. A physical therapist is working with a patient who has multiple medical issues and has just finished chemotherapy. Which of
the following tests is MOST appropriate to measure changes in this patient’s endurance over time?
1. 10-meter walk for time
2. 6-minute walk
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3. Timed Up and Go
4. Maximum VO2 assessment
43. A patient with idiopathic pulmonary fibrosis completed a 6-minute walk test and demonstrates the following results: total
walking distance of 1200 ft (366 m) in 6 minutes, heart rate of 82 to 110 bpm (pretest to posttest), blood pressure of 125/80 to
145/85 mm Hg (pretest to posttest), respiratory rate of 18 to 40 breaths/minute (pretest to posttest), and oxygen saturation of
98% to 92% (pretest to posttest); an electrocardiogram showed normal sinus rhythm throughout the test. Based on these
results, the physical therapist should determine that the patient has impaired:
1. aerobic capacity and endurance associated with cardiovascular pump dysfunction.
2. ventilation, respiration, and aerobic capacity associated with airway clearance dysfunction.
3. ventilation, respiration, aerobic capacity, and gas exchange associated with ventilatory pump dysfunction.
4. aerobic capacity and endurance associated with cardiovascular pump failure.
44. During gait evaluation, a physical therapist notes that a patient demonstrates a shorter step length with the right lower
extremity. Which of the following problems is the MOST likely the cause of the gait dysfunction?
1. Right iliopsoas contracture
2. Painful left knee
3. Decreased ankle pronation on the right
4. Left gluteus medius weakness
45. Tibial rotation during knee motion is possible when the knee is positioned in 90° or more of flexion because in this position
the:
1. condyles of the femur glide posteriorly on the condyles of the tibia.
2. hamstrings act as a rotating force.
3. patella deviates inferiorly.
4. tension on the ligaments is decreased.
46. While a patient is walking in the parallel bars, the physical therapist observes that the pelvis drops down on the side opposite
the stance extremity. This gait deviation is an indication of weakness of the hip:
1. abductors of the swing extremity.
2. adductors of the swing extremity.
3. abductors of the stance extremity.
4. adductors of the stance extremity.
47. A physical therapist is educating a patient on the use of a moist hot pack for home treatment. For the patient to prevent burns
and still receive the benefits of superficial heat, which of the following heat application time frames is MOST appropriate?
1. 5 to 10 minutes
2. 20 to 30 minutes
3. 45 to 60 minutes
4. 61 to 90 minutes
48. A physical therapist observes a patient from behind during bilateral shoulder abduction and notes that the patient’s right
scapula is more abducted than the left scapula at the end range of movement. Which of the following conditions is the MOST
likely cause of the altered scapula position on the right?
1. Tightness of the rhomboid major and minor
2. Weakness of the serratus anterior
3. Restricted motion of the glenohumeral joint
4. Weakness of the upper trapezius
49. A physical therapist is evaluating a patient who had a right lower lobe resection due to lung cancer 1 day ago. During
auscultation of the patient’s lungs, the therapist notes decreased low-pitched crackles bilaterally. The patient’s vital signs are
heart rate – 99 bpm; blood pressure - 115/75 mm Hg; and pulse oximetry - 92% while receiving 2 liters of oxygen in sitting at
the edge of the bed. Which of the following actions should the therapist take NEXT?
1. Begin walking activities, with the patient receiving 4 liters of oxygen.
2. Contact the physician.
3. Perform active range-of-motion exercises with the patient at bedside.
4. Initiate bronchopulmonary hygiene.
50. A physical therapist plans to use a tilt table for a patient who is having difficulty tolerating upright sitting. The therapist
should stop inclining the tilt table when the patient experiences which of the following signs and symptoms?
1. Decrease in diastolic blood pressure of 15 mm Hg
2. Increase in systolic blood pressure of 10 mm Hg
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3. Increase in heart rate of 15 bpm
4. Decrease in oxygen saturation to 93%
51. A physical therapist is prescribing therapeutic exercises for a patient to perform in the physical therapy gym. The patient had a
left cerebrovascular accident 2 weeks ago with resultant right lower extremity paresis. The patient also has a history of
gastroesophageal reflux disease. The physical therapist should AVOID placing the patient in which of the following positions
during the exercises?
1. Sitting upright at 90°
2. Standing
3. Supine
4. Sitting semi-upright at 45°
52. An important change in gastrointestinal function that occurs with aging is a(n):
1. increase in gastric motility.
2. increase in salivary secretion.
3. decrease in tooth decay.
4. decrease in nutrient absorption.
53. An older adult patient has a sacral pressure ulcer measuring 15 cm × 15 cm. The wound has moderate serous fluid drainage
and is loosely covered with necrotic and fibrotic tissue, although no indications of infection are present. The BEST method of
debridement is:
1. daily vigorous scrubbing of the wound.
2. wet-to-dry dressings with normal saline 2 times/day.
3. daily wet-to-dry dressings with 1:1 diluted povidone-iodine (Betadine).
4. whirlpool jet agitation 2 times/day.
54. When examining a patient with right facial weakness, a physical therapist notes the presence of a right Bell phenomenon.
Which of the following additional findings is MOST likely to be present?
1. Decreased taste sensation on the tongue
2. Abnormal tone of the right limbs
3. Ptosis of the right eyelid
4. Loss of pain and temperature sensation across the lower right jaw
55. A patient is doing active and resistive exercises on a mat table in the physical therapy department. After 15 minutes, the
patient becomes short of breath, begins coughing, and expectorates pink, frothy sputum. At this point, the physical therapist
should first stop the treatment, then NEXT:
1. assess vital signs, let the patient rest a few minutes with the feet elevated, and then resume with a less vigorous
program.
2. sit the patient up, assess vital signs, and call a nurse or physician for further instructions.
3. lay the patient supine, transfer the patient to a stretcher, and return the patient to the nursing unit.
4. lay the patient down flat, call for assistance, and begin cardiopulmonary resuscitation.
56. Instruction in energy conservation and joint protection should be provided to a patient with rheumatoid arthritis, because:
1. the joints may be predisposed to damage by overuse.
2. fatigue often masks joint pain.
3. phagocytes remove more pannus in a resting joint.
4. activity of the antigen-antibody complex is diminished with rest.
57. A manual muscle test of a patient who sustained a gunshot wound immediately superior to the elbow joint reveals specific
muscle weakness from a partial median nerve injury. The physical therapy intervention for the patient should include
strengthening activities for wrist flexion, forearm:
1. pronation, finger flexion, and thumb adduction.
2. pronation, finger flexion, and thumb opposition.
3. supination, finger abduction, and thumb opposition.
4. supination, finger flexion, and thumb extension.
58. For a patient with a bilateral transfemoral amputation to maximize balance in a wheelchair, the rear wheels should be
positioned more:
1. laterally.
2. posteriorly.
3. anteriorly.
4. inferiorly.
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59. A physical therapist is taking the history of a patient with low back pain. If the therapist suspects the pain is caused by an
inflammatory reaction, which of the following questions is BEST for the therapist to ask?
1. Is your pain constant or intermittent?
2. What activity bothers you the most?
3. Is it difficult to stand up straight after you’ve been sitting?
4. Does your pain radiate down into the leg?
60. Which of the following locations corresponds to the sensory function of the nerve root exiting below the fifth lumbar
vertebra?
1. Plantar aspect of the heel
2. Central anterior distal thigh
3. Medial aspect of the knee joint
4. Dorsal web space between the first and second toes
61. A patient had a brainstem stroke 2 months ago and is currently able to independently walk 65 ft (20 m) over level surfaces
with a straight cane and ascend stairs with minimum assistance. Which of the following activities would MOST appropriately
challenge this patient’s balance during a physical therapy session?
1. Ascending stairs using a single handrail
2. Standing on one leg with eyes closed
3. Walking over uneven terrain
4. Walking 130 ft (40 m) with a straight cane
62. When evaluating wheelchair positioning of a child with cerebral palsy, a physical therapist should FIRST examine the
position of the child’s:
1. pelvis.
2. lower extremities.
3. head.
4. spine.
63. A physical therapist is using transcutaneous electrical nerve stimulation to treat a patient with back pain. Biphasic pulsed
current and conventional transcutaneous electrical nerve stimulation parameters are being used. The patient reports a painful
response during the initial treatment. Which of the following treatment modifications is MOST appropriate in this situation?
1. Decrease the electrode size
2. Decrease the pulse width
3. Increase the pulse rate
4. Switch to a monophasic current
64. A physical therapist is conducting a study in which the disability index scores for two groups of patients with subacromial
impingement are compared. One group receives ultrasound and exercise; the other group receives exercise only. Both groups
receive treatment at 2 visits/week for 4 weeks. What is the independent variable in the study?
1. Disability index score
2. Frequency of visits
3. Subacromial impingement
4. Intervention
65. A physical therapist is interviewing a female patient who reports mid-thoracic pain that is limiting her ability to work. Which
of the following additional symptoms should prompt the therapist to refer the patient to a physician?
1. Increased pain with prolonged computer work
2. Nausea, excessive fatigue, and sleep disturbance
3. Intermittent numbness and tingling in the right hand
4. Decreased pain with exercise and increased pain in the mid-morning
66. Which of the following elements of motor learning contributes MOST to retention of a motor skill?
1. Performance under variable conditions
2. Manual contact to guide the patient
3. Summary knowledge of results
4. Practice of the motor skill
67. A physical therapist is working with a patient who has a complete T6 spinal cord injury. The therapist has the patient perform
seated push-ups on a mat by having the patient push down on the mat with both upper extremities while attempting to lift the
buttocks off the mat. This activity is aimed at strengthening which muscle group?
1. Quadratus lumborum
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2. Internal obliques
3. Latissimus dorsi
4. External obliques
68. Following a cerebrovascular accident, a patient is evaluated for cognitive and perceptual dysfunctions. The patient is asked to
stack several wooden blocks. After picking up a block, the patient is unable to determine how the block should be used. This
dysfunction is MOST likely due to:
1. homonymous hemianopsia.
2. astereognosis.
3. unilateral neglect.
4. apraxia.
69. A patient with peripheral vascular disease comes to physical therapy for evaluation of leg pain that gets worse when walking.
The patient will MOST likely also have:
1. relief of pain with the legs elevated.
2. purple or brown pigmentation of the skin on the legs.
3. relief of pain with the legs in the dependent position.
4. a positive Homans sign.
70. A new special test used to evaluate shoulder instability is reported to have a specificity of 0.88. This means that the test has a
high percentage of:
1. true positives.
2. false positives.
3. true negatives.
4. false negatives.
71. Which of the following clinical features is assessed by pressing into the patient’s skin and observing for persistent
indentation?
1. Turgor
2. Pitting edema
3. Dependent edema
72. Which of the following properties describes hyaline cartilage?

1. Hydrophilic
2. Highly innervated
3. Well vascularized
4. Easily damaged under compression
73. On the first day following a patient’s total knee arthroplasty, a physical therapist begins treating the patient with a continuous
passive motion device with a setting of 0° to 40° of motion. Which of the following reasons for using a continuous passive
motion device is MOST appropriate for this patient?
1. To decrease length of the patient’s hospital stay
2. To decrease incidence of deep vein thrombosis
3. To help the patient regain knee flexion
4. To prevent knee flexion contracture
74. A physical therapist is examining a patient for possible lower extremity weakness. Passive range of motion is within normal
limits. The patient is seated. When the patient tries to dorsiflex and invert the right foot, the patient is unable to move it
through the full range of motion and is unable to take any resistance applied by the therapist. During the subsequent gait
examination, the therapist should expect the patient to display which of the following gait patterns?
1. Normal gait with no deviations
2. Increased right hip flexion during the midswing phase
3. Throwing the trunk backward on the right side shortly after heel strike (initial contact)
4. Laterally bending toward the right side during midstance
75. In treating a patient who has had recurrent anterior shoulder dislocation, a physical therapist should AVOID which of the
following extreme shoulder motions?
1. Adduction and lateral (external) rotation
2. Abduction and lateral (external) rotation
3. Hyperextension and medial (internal) rotation
4. Abduction and medial (internal) rotation
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76. A physical therapist is testing the deep tendon reflex of a patient as shown in the photograph. The patient has a partial nerve
injury of the tested nerve root. Which of the following reflex grades is the therapist MOST likely to find in the patient?
1. 0
2. 1 +
3. 2 +
4. 3 +
77. A patient with early symptomatic human immunodeficiency virus infection is MOST likely to report which of the following
symptoms?
1. Fatigue
2. Blurred vision
3. Easy bruising
4. Poor wound healing
78. A physical therapist receives a telephone call from a woman who identifies herself as a friend of one of the therapist’s
patients. She wants to know how the patient is doing and whether the patient will be able to go up and down stairs, because
she wants to take the patient home for a weekend visit. Which of the following actions is MOST appropriate for the therapist
to take?
1. Discuss the patient’s program and functional status with the caller.
2. Invite the caller to observe the patient’s next therapy session.
3. Refuse to discuss the patient, unless the patient’s permission is obtained.
4. Refer the caller to the patient’s social worker.
79. In splinting or immobilization, the functional position of the hand includes wrist extension, phalangeal:
1. flexion, and abduction of the thumb (1st digit).
2. extension, and abduction of the thumb (1st digit).
3. flexion, and adduction of the thumb (1st digit).
4. flexion, and adduction of the thumb (1st digit).
80. A patient with cervical radiculopathy reports numbness of the right little finger (5th digit). A physical therapist will MOST
likely find a diminished tendon reflex in the:
1. biceps brachii.
2. deltoid.
3. triceps brachii.
4. brachioradialis.
81. A patient with Parkinson disease demonstrates shortness of breath with activity. Which of the following tests is MOST
appropriate for a physical therapist to perform to help delineate a cause for the patient’s shortness of breath?
1. Deep tendon reflex testing
2. Sensory examination
3. Muscle strength testing
4. Posture examination
82. A balance test correctly identifies three persons as frequent fallers in a group of 10 persons who fall frequently. The same test
correctly identifies eight persons as non-fallers in a group of 10 persons with no history of falling. This test has which of the
following characteristics?
1. High reliability and low validity
2. High sensitivity and low reliability
3. High predictability and low validity
4. Low sensitivity and high specificity
83. A patient with type 2 diabetes is evaluated by a physical therapist and found to be alert and oriented to person, place, and time.
When continuing the evaluation, the therapist should give the HIGHEST priority to which of the following systems?
1. Cognitive
2. Sensory
3. Genitourinary
4. Musculoskeletal
84. A physical therapist is examining a 70-year-old patient who reports left knee pain. The therapist notes mild edema, brownish
discoloration, and skin contraction in the ankle region bilaterally. The patient’s skin is flaky, dry, and scaling. The patient
MOST likely has which of the following conditions?
1. Cellulitis
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2. Venous insufficiency
3. Age-related trophic changes
4. Arterial disease
85. A patient who is currently participating in an outpatient cardiac rehabilitation program asks the physical therapist about
intervention options for an apparent athlete’s foot fungal infection on both of the patient’s feet. The patient has been using an
over-the-counter analgesic ointment for 5 days, but the condition does not seem to be improving. Which of the following
responses is MOST appropriate for the therapist to make?
1. Refer the patient back to the cardiologist.
2. Recommend an over-the-counter antifungal ointment.
3. Tell the patient to continue using the ointment for another 5 days and then reassess.
4. Instruct the patient to discuss the situation with a pharmacist.
86. A 70-year-old female patient reports the onset of mid back pain after working in a garden for several hours. The patient
reports constant pain, which increases with deep breathing, and demonstrates limited thoracic spine active range of motion in
all planes. The patient has a 40-year history of smoking and long-term use of prednisone (Deltasone). Based on this history,
which of the following pathologies is MOST likely the cause of the patient’s back pain?
1. Thoracic compression fracture
2. Lung cancer
3. Coronary artery disease
4. Abdominal aortic aneurysm
87. Which of the following descriptions BEST characterizes stable angina?

1. Episodes of nonradiating chest pain each lasting 5-15 minutes
2. Episodes of severe chest pain each lasting longer than 15 minutes
3. Chest pain occurring at rest and unaffected by exertion
4. Chest pain accompanied by dysrythmias
88. A patient is referred to a physical therapist for treatment of left shoulder pain. During examination of the patient’s left
acromion, the therapist notes an area of skin discoloration that is 1.3 cm in diameter and lopsided in shape with irregular,
poorly defined edges. The center is deep red with some shades of brown. The patient reports first noticing the discoloration
about 2 months ago. The therapist should recognize these signs as characteristic of:
1. a mole.
2. a blister.
3. dermatitis.
4. melanoma.
89. Which of the following endocrine glands regulates sexual development?

1. Parathyroid
2. Thyroid
3. Adrenal
4. Pituitary
90. A physical therapist is analyzing data regarding functional loss in patients with fibromyalgia. The functional loss scale utilized
has a normal distribution. The therapist finds that a score of 33 is two standard deviations below the mean, and a score of 55 is
two standard deviations above the mean. Which of the following interpretations of these findings is MOST appropriate?
1. 50% of subjects scored 33 and 55.
2. 15% of subjects scored between below 33.
3. 95% of subjects scored between 33 and 55.
4. 6.67% of subjects scored above 55.
91. In the early management of a patient with a partial peripheral nerve injury, the goal of the physical therapy intervention will
MOST likely be to prevent:
1. nerve degeneration.
2. spasticity and increased muscle tone.
3. muscle atrophy.
4. contractures and adhesions.
92. A patient reports weakness and tingling in the lower extremities in the past 2 weeks. The physical therapist suspects that the
patient may have Guillain-Barré syndrome. Which of the following examination findings would MOST likely occur with this
diagnosis?
1. Hypertonicity in the affected muscles
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2. Presence of clonus with rapid passive foot dorsiflexion
3. Diminished tendon reflexes
4. Ataxic gait pattern
93. The physical therapy intervention for a patient with dark skin pigmentation includes superficial heat. After 5 minutes of this
intervention, the physical therapist removes the heat and observes that the skin over the region being treated is blotchy with
both darker and lighter areas. What is the MOST appropriate action for the therapist to take?
1. Discontinue superficial heat and initiate ultrasound.
2. Continue with the use of superficial heat, as this is a normal response.
3. Discontinue superficial heat and initiate diathermy.
4. Continue with the use of superficial heat, but add more towel layers.
94. A physical therapist evaluates a 65-year-old patient with psoriasis for treatment with ultraviolet radiation. The patient’s history
includes the following information: total hip arthroplasty 1 year ago, penicillin allergy, calcium supplements since menopause,
and daily tetracycline (Achromycin) use for the past 2 weeks for a urinary tract infection. Which of these factors should alert
the therapist to use extra caution when applying ultraviolet light?
1. Arthroplasty with a metal implant
2. Daily tetracycline (Achromycin) use
3. Penicillin allergy
4. Long-standing calcium supplement use
95. Which of the following terms describes the intense redness of the skin observed after icing?
1. Pallor
2. Hyperemia
3. Cyanosis
4. Vasospasm
96. Which of the following techniques is MOST effective in teaching a patient with insulin-dependent diabetes about foot care?
1. Reassure the patient that no infections will occur if the directions are followed, then demonstrate procedures.
2. Tell the patient how foot care is performed, then watch the patient’s performance.
3. Watch the patient perform a foot inspection, and caution the patient that amputations result from untended skin
problems.
4. Have the patient demonstrate a foot inspection, then give feedback on the patient’s performance.
97. A patient demonstrates a right thoracolumbar scoliosis in standing but no scoliosis in sitting. Which of the following
dysfunctions is MOST likely the cause of the patient’s scoliosis?
1. Lumbar facet dysfunction
2. Unilaterally weak gluteus medius
3. Short iliopsoas muscle
4. Leg-length discrepancy
98. A patient’s chronic use of which of the following medications should be of MOST concern to a physical therapist when
deciding whether to provide thrust manipulation for the patient?
1. Hormone replacement therapy
2. Nonsteroidal anti-inflammatory medication
3. Antidepressants
4. Corticosteroids
99. A patient fell from a ladder landing on the left side of the trunk with immediate onset of pain over the left lower ribs. The
following day, the patient reports mild light-headedness along with severe pain over the left shoulder and left upper abdomen
that increases with inhalation. Shoulder movement is mildly limited with reports of rib pain at end range. Which of the
following conditions is MOST likely?
1. Shoulder fracture
2. Ruptured spleen
3. Acute cholecystitis
4. Pulmonary embolism
100. A hospital administrator asks members of the rehabilitation department to develop a comprehensive program to help reduce
the risk of low back injuries. Which of the following steps is the FIRST step necessary to develop this program?
1. Include all employees in a lumbar extension exercise class.
2. Design a program that meets each department’s functional needs.
3. Perform an ergonomic analysis on each workstation.
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4. Provide pamphlets on proper body mechanics.
101. A patient who is a waiter has hand pain when carrying trays overhead. Which of the following nerve tension tests is MOST
likely to have a positive result?
1. Ulnar
2. Median
3. Radial
4. Musculocutaneous
102. A physical therapist is interviewing a patient who awoke that day with a slight loss of taste sensation, inability to close the
right eye, and dryness of the right eye. The patient has had a slight headache the last few days and some mild pain around the
right ear. Which of the following questions that is consistent with these signs and symptoms should the therapist ask the
patient?
1. Are you able to smile?
2. Do you have pain over your right jaw?
3. Are you able to chew food?
4. Do you have difficulty swallowing?
103. A physical therapist is using the waveform shown in the diagram to apply electrical stimulation to a patient. Which of the
following rationales for selecting this waveform is MOST accurate?
1. The waveform enhances a contraction in denervated muscle.
2. The waveform enhances patient comfort.
3. The waveform offers a change in frequency that promotes motor unit recruitment.
4. The waveform offers pulse width variability that enhances motor unit recruitment.
104. Utilization review and peer review are activities that are a part of a comprehensive:
1. policy and procedure manual.
2. quality improvement program.
3. audit cycle.
4. performance evaluation.
105. After spinal joint mobilization procedures, a patient calls the physical therapist and reports a minor dull ache in the treated
area of the back that lasted for 2 to 3 hours. Based on this symptom, the therapist should:
1. consider a possible neurological lesion in the area.
2. refer the patient back to the physician.
3. inform the patient that this response is common.
4. add strengthening exercises to the home program.
106. A patient reports pain in the lateral aspect of the proximal forearm. The pain is reproduced with shoulder girdle depression,
elbow extension, shoulder medial (internal) rotation, and wrist flexion. The patient’s symptoms are relieved when the physical
therapist removes the shoulder girdle depression component. Which of the following syndromes is the MOST appropriate
clinical interpretation of these findings?
1. Cubital tunnel
2. Pronator teres
3. Radial tunnel
4. Anterior interosseous
107. A physical therapist is monitoring the exercise of a patient with type 1 diabetes. The patient’s blood glucose level would be
BEST for safe exercise at which of the following values?
1. 90 ml/dL
2. 175 ml/dL
3. 0 ml/dL
4. 345 ml/dL
108. A patient with a mild closed head injury and bilateral femur fractures requires instruction in a lower extremity exercise
program. To plan the most effective teaching methods for this patient, what is MOST critical to assess at the initial visit?
1. Comprehension of written, verbal, and demonstrated instructions
2. Short-term memory capacity
3. Auditory and visual status
4. Any personality changes compared to the patient’s premorbid status
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109. The physical therapy plan for for a patient who underwent medial menisectomy includes exercising the quadriceps femoris
against accommodating resistance. Which of the following exercises should be recommended?
1. Knee bends through half of the range
2. Knee extension with a sandbag at the ankle
3. Knee extension on an isokinetic exercise device
4. Straight-leg raising with a sling suspension
110. To stretch the neck muscles in a patient with an acute, right-sided torticollis, the MOST appropriate therapeutic exercise is:
1. right rotation and right lateral flexion.
2. left rotation and right lateral flexion.
3. left rotation and left lateral flexion.
4. right rotation and left lateral flexion.
111. Which of the following signs or symptoms is MOST likely to be present in a patient with symptomatic hyperthyroidism?
1. Steppage gait
2. Frequent calf cramping
3. Tendonitis of the shoulder
4. Atrophy of foot and hand intrinsics
112. A physical therapist is conducting a 12-minute walk test with a patient who has chronic obstructive pulmonary disease and
uses 2 L/min of oxygen by nasal cannula. The patient’s resting oxygen saturation is 91% and resting heart rate, 110 bpm. The
oxygen flow should be increased if the:
1. patient’s carbon dioxide level increases.
2. patient reports shortness of breath.
3. patient’s oxygen saturation falls below 87%.
4. patient’s heart rate rises to greater than 150 bpm.
113. A physical therapist is developing a new device for measuring range of back extension. To establish reliability for the device,
the therapist gathers a large sample of healthy individuals all with 20° to 25° of back extension. Although the therapist applied
consistent measurement techniques over successive trials, the reliability of the measurement device was low. Which of the
modifications to the follow-up study is MOST likely to increase reliability?
1. Reduce the proportion of variation attributed to error.
2. Reduce total variance in the data.
3. Include subjects with a wider range of back extension measure.
4. Increase the number of trials that include the same subjects.
114. If a transtibial prosthesis has an excessively firm heel wedge, the patient is MOST likely to walk with:
1. excessive knee flexion in foot flat (loading response).
2. premature knee flexion in heel off (terminal stance).
3. insufficient knee flexion in foot flat (loading response).
4. excessive knee flexion in heel off (terminal stance).
115. Elevating a patient’s lower extremity for less than 1 minute produces a noticeable pallor of the foot, followed by delayed
reactive hyperemia in a dependent position. These signs are indicative of:
1. an intact circulatory system.
2. arterial insufficiency.
3. venous insufficiency.
4. acute arterial occlusion.
116. A physical therapist is assessing the lifting technique of a patient who has a history of back pain. The patient performs a lift by
picking up a light weight from the floor, without bending the knees and with excessive lumbar flexion. Limitation of which of
the following measures is the MOST likely contributor to this finding?
1. Hamstring flexibility
2. Gluteal muscle strength
3. Abdominal muscle strength
4. Hip flexor flexibility
117. During the initial evaluation of a patient with right upper extremity pain, the physical therapist notes that the patient’s right
scapula is significantly lower than the left scapula. Shortness in which of the following muscles on the right is MOST likely
to lead to this patient’s postural presentation?
1. Latissimus dorsi
2. Upper trapezius
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3. Levator scapulae
4. Teres major
118. A physical therapist is developing a gait training program for a patient following a total hip arthroplasty of the right hip
performed via an anterolateral approach 2 weeks ago. The proper instructions and rationale for crutch training utilizing one
crutch include holding the crutch in the:
1. right hand to decrease activity in the right hip abductors.
2. right hand to facilitate activity in the right hip abductors.
3. left hand to decrease activity in the right hip abductors.
4. left hand to facilitate activity in the right hip abductors.
119. A patient with functional urinary incontinence should MOST benefit from which of the following exercise interventions?
1. Core stabilization
2. Cardiovascular training
3. Fine motor skill development
4. Pelvic floor muscle strengthening
120. A physical therapist is examining a patient who sustained a right tibial fracture 1 year ago and is now fully healed. The
physical therapist’s measure of the length of the patient’s right tibia is 14 in (36 cm) and of the left tibia, 15 in (38 cm). As a
result of the tibial shortening, which of the following muscles would MOST likely become progressively tight?
1. Left tensor fasciae latae
2. Left piriformis
3. Right gluteus medius
4. Right adductor magnus
121. During examination of a patient, a physical therapist notes a red, swollen foot that is significantly warmer to the touch than the
contralateral foot. The patient denies any pain or trauma. The patient has a history of diabetes, peripheral vascular disease, and
congestive heart failure. The findings are MOST consistent with which of the following conditions?
1. Grade III sprain of the talocrural ligament
2. Fractured distal tibia
3. Bone cancer
4. Charcot disease
122. A physical therapist is observing the gait of a patient with a transtibial prosthesis. The therapist observes that at heel strike
(initial contact) the patient’s knee is hyperextended. What is the MOST likely cause of the patient’s gait deviation?
1. The heel cushion is too soft.
2. The socket is placed too far anterior to the foot.
3. The prosthesis is too long.
4. There is inadequate suspension of the prosthesis.
123. A physical therapist is trying to determine if a relationship exists between a patient’s initial walking speed and length of stay
in a skilled nursing facility. Which of the following statistical analyses should the therapist choose to examine the degree of
this relationship?
1. Chi-square test
2. Independent t-test
3. Analysis of variance
4. Pearson product-moment correlation coefficient
124. A patient comes to physical therapy via direct access for evaluation of insidious shoulder pain. During examination, the
physical therapist notes a yellowish color of the patient’s sclera and skin. The therapist should refer the patient to a physician
for probable primary dysfunction of the:
1. liver.
2. eye.
3. duodenum.
4. heart.
125. Which of the following conditions or clinical features is assessed by lifting the patient’s skin and observing the time it takes to
return to the original position?
1. Turgor
2. Pitting edema
4. Collagen degradation
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126. An attorney calls the physical therapy department seeking information on the status of the attorney’s client, a patient who is
undergoing rehabilitation following total knee arthroplasty. The patient’s physical therapist should:
1. refer the attorney to the patient’s insurance carrier.
2. describe the patient’s current status.
3. require written authorization from the patient to release information.
4. obtain verbal permission from the patient to release information.
127. Prior to starting an exercise training program, a patient with cardiac problems who is receiving beta-blocking medication
should receive an explanation of the:
1. greater benefits from cardiovascular exercise to be achieved at lower rather than at higher metabolic levels.
2. need to use measures other than heart rate to determine intensity of exercise.
3. need for exercise training sessions to be more frequent but of shorter duration.
4. need for longer warm-up periods and cool-down periods during exercise sessions.
128. Which of the following subjective reports from a patient with rheumatoid arthritis indicates the need for further medical
examination by a physician?
1. Morning pain in both lower extremities
2. Numbness in both lower extremities
3. Increased pain during activities of daily living
4. Inability to sleep at night
129. A physical therapist is assigned the planning and implementation of physical therapy services for all members of a
community. The therapist’s FIRST step should be to:
1. develop a brochure for distribution to the community.
2. organize a health fair to provide screening for the community.
3. evaluate existing services and community resources.
4. initiate contacts in the medical community to establish prescriptive relationships.
130. A patient has a history of diabetes, hypertension, and chronic heart failure. The patient’s venous filling time is less than 15
seconds, Homans sign is negative, and rubor of dependency test is not slowed. These findings support which of the following
diagnoses?
1. Lymphedema
2. Arterial insufficiency
3. Intermittent claudication
4. Chronic venous insufficiency
131. The demographic information for the participants in a research study includes a mean age of 32 years and a median age of 35
years. The difference between the median and mean indicates:
1. the value of the standard deviation score.
2. the value of the Z-score.
3. that the distribution is skewed.
4. that the two measures should be averaged.
132. The joint indicated by the arrow contains what soft tissue structure?
1. Glenoid labrum
2. Middle deltoid muscle
3. Subacromial bursa
4. Pectoralis minor muscle
133. A researcher who studied the effects of exercise training on balance test scores obtained balance scores pre-exercise and post-
exercise. Both the exercise group and the control group were randomly selected from a group of older adults residing in an
assisted living facility. A t-test was used to compare the pretest and posttest results. The balance scores were significantly
improved in the group that performed regular exercises but were unchanged in the control group. In deciding whether or not to
incorporate these results into practice, a physical therapist who works in an adult outpatient clinic should be MOST concerned
about which type of validity?
1. External
2. Internal
3. Construct
4. Statistical conclusion
134. A physical therapist wants to utilize a heating modality for the hands of a patient with rheumatoid arthritis. The patient reports
slight edema when performing warm soaks at home. Which of the following modalities is BEST for this patient?
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1. Hot packs
2. Paraffin
3. Ultrasound
4. Fluidotherapy
135. Which of the following types of neurons transmit afferent information regarding proprioception and vibration?
1. Large myelinated fibers
2. Small myelinated fibers
3. Large unmyelinated fibers
4. Small unmyelinated fibers
136. Which of the following methods is MOST appropriate for handling a 1-year-old child with cerebral palsy who exhibits strong
extensor tone in the trunk and extremities?
1. Carrying the child in a sitting position
2. Carrying the child over one’s shoulder
3. Keeping contact with the back of the child’s head
4. Picking the child up under the upper extremities
137. Which of the following outcomes would NOT be appropriate for a prenatal exercise program?
1. Improved body mechanics
2. Application of relaxation techniques
3. Improved ligamentous flexibility
4. Strengthened pelvic-floor musculature
138. Which of the following joint mobilization techniques is MOST appropriate for increasing shoulder abduction?
1. Distraction with inferior glide
2. Anterior glide with medial (internal) rotation
3. Superior glide with approximation
4. Distraction with posterior glide
139. During evaluation of a patient’s gait, a physical therapist observes that the patient leans forward shortly after heel strike
(initial contact). The patient’s forward bending is MOST likely a compensation for weakness in the:
1. quadriceps.
2. hamstrings.
3. gluteus maximus.
4. tibialis anterior.
140. During an examination, a physical therapist strokes the lateral plantar aspect of a patient’s foot. Which of the following
responses indicates an upper motor neuron dysfunction?
1. Absence of sensation
2. Extension of the great toe
3. Flexion of the first through fifth toes
4. Four beats of repeated plantar flexion
141. A physical therapist is teaching a patient to walk with a prosthesis on stairs and uneven surfaces. Which of the following
methods should MOST promote long-term retention of these motor skills?
1. Ensure mastering of use of stairs before practicing walking on uneven surfaces.
2. Practice walking on stairs and uneven surfaces in random order several times during a session.
3. Focus the training session on the movement components the patient finds most difficult.
4. Provide immediate feedback on the patient’s performance when walking on the stairs or on uneven surfaces.
142. Which of the following outcomes is the highest expected functional outcome for a patient with a complete C 7 spinal cord
injury?
1. Minimal assistance with transferring from floor to wheelchair
2. Independent with wheelchair mobility on smooth surfaces
3. Minimal assistance with transferring from supine to sitting
4. Independent with ascending a curb in a wheelchair
143. A patient involved in a motor vehicle accident 1 week ago has multiple fractures of the lower extremities and has bilateral
non-weight-bearing status. The patient lives with an elderly parent and is scheduled for discharge soon. Which of the
following transfers is MOST appropriate in this situation?
1. Standing pivot
2. One-person lift
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3. Sliding board
4. Two-person lift
144. During an initial evaluation, which of the following tests is MOST appropriate to perform with a patient who has acute right-
sided congestive heart failure?
1. Sensory testing of upper extremities
2. Pitting edema measurements in the lower extremities
3. Resisted manual muscle testing of all extremities
4. Reflex testing of lower extremities
145. Cool-down exercises are performed immediately after a general aerobic exercise program PRIMARILY to prevent:
1. venous pooling.
2. cardiac arrhythmia.
3. decreased body temperature.
4. muscle tightening.
146. A physical therapist is examining a patient who has a history of congestive heart failure and peripheral vascular disease.
Bilateral peripheral edema with grade 1+ pitting along with varicose veins is also present. The patient reports a sedentary
lifestyle. The patient is at high risk for developing which of the following types of ulcer?
1. Arterial
2. Pressure
3. Neuropathic
4. Venous stasis
147. What is the close-packed position of the hip?

1. Medial (internal) rotation with extension and abduction
2. Extension with adduction and lateral (external) rotation
3. Lateral (external) rotation with flexion and abduction
4. Flexion with adduction and lateral (external) rotation
148. A physical therapist is evaluating a patient who has a vascular lesion in the brainstem affecting the oculomotor nerve (III).
During the cranial nerve examination, which of the following signs would be the MOST significant?
1. Inability to close the eyelid
2. Medial strabismus
3. Ptosis of the eyelid
4. Constricted pupil
149. A patient receiving physical therapy reports frequent urination, weight loss, and feeling constantly thirsty. The physical
therapist should contact the physician regarding the patient’s symptoms because they are MOST likely consistent with which
of the following pathological conditions?
1. Cancer
2. Cystitis
3. Renal calculi
4. Diabetes mellitus
150. For an individual with a T12 spinal cord injury to be able to walk, achievement of which of the following ranges of motion is
MOST important?
1. Neutral dorsiflexion
2. Full hip extension
3. Normal knee flexion
4. 110° straight-leg raise
151. A 55-year-old patient is referred to physical therapy from the emergency room after casting following a right femur fracture
caused by a motor vehicle accident. The patient is nauseous but has good balance during initial attempts at non-weight-bearing
gait training on the right lower extremity. The patient lives alone on the second floor of an apartment building with no
elevator. Which of the following assistive devices is MOST appropriate for the patient?
1. Standard walker
2. Axillary crutches
3. Quad cane
4. Two straight canes
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152. A physical therapist is treating a patient with moderately controlled type 1 diabetes. One of the goals is to help the patient
regulate insulin dosage through exercise. In establishing an exercise program, the therapist should be aware that regular
exercise will generally:
1. lower blood glucose levels and decrease the amount of insulin required.
2. lower blood glucose levels and increase the amount of insulin required.
3. raise blood glucose levels and decrease the amount of insulin required.
4. raise blood glucose levels and increase the amount of insulin required.
153. A patient sustained a severe brainstem injury 1 week ago and has demonstrated minimal change since the incident. The
patient’s cognitive status is MOST likely to include which of the following characteristics?
1. Decreased level of arousal
2. Decreased level of intelligence
3. Increased level of agitation
4. Increased level of impulsivity
154. When treating a patient who has ankylosing spondylitis, which of the following muscles require the MOST emphasis in
strengthening exercises?
1. Pectorals
2. Hip flexors
3. Back extensors
4. Abdominals
155. To obtain informed consent for an intervention, a physical therapist must disclose to the patient all of the following types of
information EXCEPT the:
1. cost of the intervention.
2. goals of the intervention.
3. possible risks of the intervention.
4. alternative interventions available.
156. During steady rate exercise, the blood pressure in a healthy person MOST typically responds with:
1. systolic pressure increase and no change in diastolic pressure.
2. no change in systolic pressure and marked decrease in diastolic pressure.
3. systolic pressure decrease and diastolic pressure increase.
4. no change in systolic pressure until the end point of the exercise session.
157. A patient’s symptoms include muscle atrophy, tachycardia, heat intolerance, brittle hair, and increased appetite with weight
loss. The patient is MOST likely to have which of the following disorders?
1. Hyperthyroidism
2. Hypothyroidism
3. Cushing syndrome
4. Hypoparathyroidism
158. A physical therapist is examining a patient who has a tentative diagnosis of fibromyalgia syndrome. Which of the following
symptoms from the patient’s history would help rule out this diagnosis?
1. Fatigue
2. Recent weight loss
3. Sleep disturbances
4. Paresthesias
159. Following trauma at the C5 spinal cord level, a patient was admitted to the hospital. Twenty-four hours later, the patient shows
no reflexes, sensation, or voluntary motor activity below the level of injury. These findings indicate:
1. the presence of spasticity.
2. decerebrate rigidity.
3. spinal shock.
4. a lower motor neuron lesion.
160. An initial physical therapy evaluation is conducted for an older adult patient 1 day after the patient had a total left hip
arthroplasty (noncemented) using a posterolateral approach. The patient has no complicating medical history and was active
and independent preoperatively. Which of the following activities is LEAST appropriate for the first week of therapy?
1. Active-assistive positioning of the left hip to 60° of flexion
2. Active left hip abduction in right sidelying
3. Independent bed mobility with use of a trapeze
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4. Walking with moderate assistance with a standard walker to 25 ft (7.6 m)
161. A patient with a recent onset of upper extremity lymphedema is MOST likely to have which of the following findings?
1. Pallor
2. Shiny skin
3. Dorsal hand swelling
4. Nonpitting edema in the forearm
162. A patient is referred to physical therapy for treatment of tenosynovitis. The patient reports a “pins and needles” sensation on
the palmar surface of the thumb (1st digit), index (2nd digit), and middle (3rd digit) fingers. The physical therapist’s examination
reveals a positive Tinel sign at the wrist and Good (4/5) opposition of the thumb (1st digit). Based on these findings, the
therapist should suspect:
1. median nerve compression at the wrist.
2. ulnar nerve compression distal to the elbow.
3. tenosynovitis of the abductor pollicis longus.
4. thoracic outlet syndrome.
163. A clean, well-granulating Stage II pressure ulcer with minimal serous drainage is MOST appropriately dressed with:
1. a nonadherent dressing.
2. a packed dressing.
3. topical medication only.
4. dry-to-dry gauze.
164. The brother of a patient who was recently discharged from a hospital’s outpatient physical therapy department telephones on
the patient’s behalf to request a copy of the patient’s medical record. The physical therapist should explain to the patient’s
brother that the medical record is the property of the:
1. patient’s family and can be released to the brother upon written request.
2. patient’s insurer and the request for a copy must be made in writing to the insurer.
3. hospital and the patient and can be released only with written authorization from the patient.
4. hospital and can be released only with written authorization from the patient’s physician.
165. A physical therapist has been treating a female patient with low back pain for 6 weeks. The patient reports that the pain
seemed to lessen earlier in the course of treatment but has intensified again in the past week. To help identify a systemic cause
for the pain, the therapist should ask the patient whether the pain:
1. decreases when she lies down.
2. corresponds with her menstrual cycle.
3. increases when she is driving to work.
4. increases when she has a bowel movement.
166. A patient, who has fallen three times while walking on uneven surfaces, comes to physical therapy for intervention.
Examination reveals that the patient does not have difficulty maintaining balance with the eyes closed or with the introduction
of visual conflict. Which of the following interventions is MOST appropriate for this patient?
1. Instruct the patient to walk a straight line while glancing left and right.
2. Instruct the patient in exercises to strengthen the gastroc-soleus muscle group.
3. Refer the patient to an orthotist for a custom ankle-foot orthoses fitting.
4. Provide the patient with a cane for walking.
167. An 8-year-old child with juvenile rheumatoid arthritis is developing bilateral knee flexion contractures. Which of the
following interventions is LEAST appropriate?
1. Exercises to increase joint mobility
2. Ultrasound to the hamstring insertions to increase tissue extensibility
3. Progressive weight bearing by walking in a therapeutic pool to increase endurance
4. Exercise to increase quadriceps strength
168. A physical therapist recognizes that departmental patient education materials are written at a reading level that is too difficult
for some of the patients. The therapist can help the patients to better understand the materials by:
1. including illustrations with captions in large print.
2. including illustrations and a simpler sentence structure.
3. reducing the number of syllables and lengthening the sentences.
4. using a large-print format to present specific medical terminology.
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169. A physical therapist is gait training a patient who suddenly becomes weak and falls to the floor. The patient is now
unresponsive. The therapist should FIRST:
1. open the patient’s airway.
2. activate the emergency response system.
3. quickly start breathing assistance.
4. begin chest compressions.
170. Which of the following nerves innervates the muscles that control micturition?
1. Genitofemoral
2. Superior gluteal
3. Obturator
4. Pudendal
171. A patient spilled boiling water on the right arm when reaching for a pan on the stove. The forearm, elbow, and lower half of
the upper arm appear blistered and red, with some subcutaneous swelling and pain on touch. To facilitate optimal function,
which of the following interventions should a physical therapist PRIMARILY emphasize?
1. Range of motion exercises to the right hand, wrist, and elbow
2. Application of compression dressings
3. Sterile whirlpool to the right upper extremity
4. Splinting of the right upper extremity in full elbow extension
172. A physical therapist is treating a patient who has lymphedema in the right lower extremity. The therapist decides to use
mechanical, intermittent pneumatic compression as an intervention, using a sleeve that covers the foot, leg, and thigh. The
therapist measures the patient’s blood pressure at 135/85 mm Hg. Which of the following inflation pressures for the sleeve is
MOST appropriate for the first treatment session?
1. 20 mm Hg
2. 60 mm Hg
3. 100 mm Hg
4. 140 mm Hg
173. A physical therapist examines a patient lying supine with the hip and both lower extremities extended. The therapist notes that
both of the patient’s medial malleoli are aligned with each other. The therapist asks the patient to assume the long-sitting
position and notes the position of the malleoli as shown in the photograph. What is the MOST likely cause of this patient’s
test results?
1. Excessive femoral anteversion
2. Anterior rotation of the innominate on the right
3. Functional leg-length discrepancy due to left lateral pelvic tilt
4. Posterior rotation of the innominate on the right
174. Which dermatome is associated with the area including the umbilicus?
1. T3
2. T10
3. L1
4. L3
175. A physical therapist is treating a 12-year-old athlete who has had lateral epicondylitis for 3 weeks. Which of the following
modalities presents the GREATEST concern for possible harm to this patient?
1. Ice massage
2. Iontophoresis
3. Moist heat packs
4. Continuous ultrasound
176. A 22-year-old patient is hospitalized awaiting a lung transplant due to cystic fibrosis. The patient’s physician is interested in
an objective measure of the patient’s preoperative endurance. Which of the following tests is MOST appropriate for the
physical therapist to administer to this patient?
1. VO2 max treadmill test
2. Two-step exercise test
3. Submaximal exercise test on a cycle ergometer
4. 6-minute walk test
177. A patient has difficulty palpating the carotid pulse during exercise. The patient should be instructed in alternate methods of
self-monitoring, because repeated palpation is likely to result in:
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1. an increase in the heart rate.
2. a decrease in the heart rate.
3. an irregular heart rhythm.
4. an increase in systolic blood pressure.
178. A patient with the diagnosis of astrocytoma malignancy is receiving physical therapy in her home. While sitting in a chair at
her dining room table, the patient begins to have a grand mal seizure. The physical therapist lowers her to the floor. The
MOST appropriate next step for the therapist is to:
1. activate the emergency response system.
2. protect the patient from biting her tongue by inserting a tongue blade.
3. roll the patient on her side.
4. extend the patient’s neck for airway clearance.
179. The MOST appropriate position in which to mobilize the radial nerve is:
1. abduction, elbow extension, and wrist extension.
2. flexion, elbow flexion, and wrist extension.
3. abduction, elbow flexion, and wrist flexion.
4. extension, elbow extension, and wrist flexion
180. A physical therapist is measuring ankle range of motion in a patient. The measurement shown in photograph A is greater than
the measurement shown in photograph B. The MOST likely cause of the difference in measurement is:
1. talocrural joint capsule restriction.
2. weakness of the ankle dorsiflexors.
3. tightness in the hamstrings.
4. tightness in the gastrocnemius.
181. Which of the following considerations is MOST reasonable when deciding to use a nonparametric test of difference in data
analysis?
1. Nonparametric tests are more powerful than parametric tests.
2. Nonparametric tests are based on stringent statistical assumptions.
3. Comparison of mean differences between two treatment groups is the main focus of the study.
4. The underlying distribution of the data in the research population is unknown.
182. A physical therapist is planning to use functional electrical stimulation to decrease shoulder subluxation in a patient post
stroke. Which of the following techniques is MOST appropriate?
1. Use direct current.
2. Limit on times to less than 10 seconds.
3. Adjust electrode placement to achieve upper trapezius muscle contraction.
4. Place electrodes over the posterior deltoid and supraspinatus muscles.
183. A physical therapist is setting up a home program of electrical stimulation for a patient who has Bell palsy. Which of the
following muscles should be stimulated as part of the home program?
1. Sternocleidomastoid
2. Masseter
3. Temporalis
4. Frontalis
184. The PRIMARY purpose of pursed-lip breathing is to:

1. help prevent the collapse of pulmonary airways during exhalation.
2. decrease the removal of carbon dioxide during ventilation.
3. increase the residual volume of respiration so that more oxygen is available for body metabolism.
4. stimulate further mobilization of mucous secretions to higher air passages where they can be expectorated.
185. A patient reports numbness and tingling on the lateral side of the right lower leg that sometimes extends into the top of the
foot. Which of the following structures is MOST likely involved?
1. Lateral sural cutaneous nerve
2. L3 nerve root
3. Superficial fibular (peroneal) nerve
4. S1 nerve root
186. While examining a patient who had a baby 3 days ago by vaginal delivery, a physical therapist notices that the patient has a 2-
cm diastasis of the rectus abdominis. To address this problem, the patient should:
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1. perform partial sit-ups supporting her abdominal muscles with her hands, while lifting her head in the supine position.
2. not perform exercises until the diastasis heals spontaneously.
3. perform sit-ups with the knees bent and arms behind the head.
4. perform partial sit-ups with legs straight and arms in front.
187. A patient who is transported to the physical therapy department in a wheelchair reports severe, bilateral lower extremity pain.
A purple discoloration of both feet is observed. The pain is relieved when the patient’s feet are raised just above the horizontal
plane. These signs are MOST indicative of:
1. arterial insufficiency.
2. intermittent claudication.
3. venous insufficiency.
4. a psychosomatic episode.
188. A physical therapist is treating a patient who had knee surgery after a car accident. The patient is suing the driver of the other
car and has hired an attorney. The patient is coming into physical therapy as an outpatient 3 times/week. After the third
session, the patient’s niece calls and wants to know how much weight her aunt can bear on the leg. The therapist should:
1. have the aunt’s attorney call the niece.
2. describe the weight-bearing limits in general terms.
3. have the niece call the medical records office.
4. ask the niece to visit directly with her aunt.
189. A physical therapist reviews the chart of an inpatient and finds that the patient’s angiogram shows a complete blockage of the
left middle cerebral artery. Which of the following is the therapist MOST likely to note upon performing an evaluation?
1. Hemiparesis in the left upper extremity
2. Presence of hemineglect syndrome
3. Left homonymous hemianopsia
4. Presence of expressive aphasia
190. A physical therapist is developing an educational program for individuals with lower extremity peripheral neuropathies due to
diabetes. Information about which of the following topics is MOST important for the therapist to provide to help prevent
injury to the feet?
1. Orthoses to support the extremity
2. Use of proper footwear
3. Moisturizing the skin to prevent dryness
4. Exercise parameters
191. A patient with complete C4 quadriplegia is working on a program to increase tolerance to the upright position. While on the
tilt table, the patient begins to have a pounding headache with flushing and profuse sweating. The physical therapist should
FIRST:
1. lower the tilt table to a flat position
2. remove the patient from the tilt table and return to room.
3. check the patient’s urine catheter.
4. check the patient’s blood pressure.
192. A patient slips, falls, and cuts her arm in the clinic. The cut is bleeding. The patient is alert and well oriented. In performing
first aid for the patient, the FIRST action that a physical therapist should take is to:
1. don a pair of gloves.
2. clean the cut with an antiseptic.
3. check the patient’s blood pressure.
4. cover the cut with a sterile dressing.
193. Which of the following examination findings is indicative of developing nerve root signs?
1. Upgoing Babinski sign
2. Absence of sharp sensation
3. Cogwheel weakness with strength testing
4. Fading deep tendon reflex with repetitive tapping
194. To conduct an experimental study on pain in postsurgical orthopedic patients, a physical therapist randomly assigns patients
into two groups. One group is treated with transcutaneous electrical nerve stimulation, heat, and exercise; the second receives
heat and exercise only. In this experimental design, transcutaneous electrical nerve stimulation is the:
1. continuous variable.
2. dependent variable.
3. discrete variable.
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4. independent variable.
195. A physical therapist is examining hip range of motion in a patient as shown in the photograph. Passive range of motion is
applied to the patient’s legs in the direction of the arrows. The photograph shows the end points of the range of motion. The
MOST likely cause of the hip dysfunction occurring in the patient is:
1. hypomobility of the hip medial (internal) rotators on the left.
2. weakness of the left hip medial (internal) rotators.
3. laxity of the left hip capsule.
4. tightness of the hip lateral (external) rotators on the left.
196. After a long-term history of bilateral lower extremity vascular insufficiency, an otherwise healthy patient had a right
transfemoral amputation. For this patient, which of the following factors is MOST important in establishing long-term goals
for functional walking?
1. Status of the wound at the amputation site
2. Range of motion of the right hip
3. Condition of the left lower extremity
4. Ability to maintain upright posture
197. A physical therapist notes that a patient is taking 180 mg of codeine orally every 3 to 4 hours. Which of the following signs
and symptoms is MOST likely to occur as a side effect of the medication?
1. Urinary frequency
2. Hypertension
3. Constipation
4. Diaphoresis
198. A patient comes to physical therapy with a wound on the plantar aspect of the heel. The patient reports that the wound
developed after the patient stepped on a tack without realizing it. The wound is now round, measures 2 cm in diameter, and
displays no signs of infection. Which of the following initial interventions is MOST appropriate?
1. Bed rest
2. Custom molded shoe
3. Crutches with toe-touch weight-bearing
4. Total-contact casting
199. A patient comes to physical therapy with a 4-month history of low back pain. The patient had previously received therapy
from other health care practitioners for this same pain, without resolution. During examination by the physical therapist, the
patient reports a history of difficulty sleeping, concern that the pain will never improve, and irritability. The physical therapist
should refer the patient to a:
1. social worker.
2. psychiatrist.
3. nutritionist.
4. physiatrist.
200. A patient with a traumatic brain injury is receiving outpatient physical therapy. The physical therapist notices that the patient
becomes agitated during therapy sessions. To which of the following professionals should the patient be referred for
assessment and diagnosis?
1. Occupational therapist
2. Neuropsychologist
3. Vocational counselor
4. Speech-language pathologist
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1. 3 A right cerebrovascular accident affects the left shoulder, not the right shoulder. The upper trapezius is
controlled by spinal accessory nerve (XI ), not the vagus nerve (X). The spinal accessory nerve (XI) (supplied by
the corticobulbar tract) was apparently not affected by the stroke and accounts for the patient’s ability to shrug a
flaccid arm. The deltoid does not shrug the shoulder.
2. 4 Measurement of muscle strength by manual muscle testing uses an ordinal scale. MMT grades are ranked
(and are therefore not nominal) but do not have consistent intervals between ranks as would be required for
interval and ordinal levels of measurement.
3. 3 An abnormal lymph node may feel firm and nontender, but an elevated skin temperature is not an
expected accompanying feature of an abnormal lymph node. An abnormal lymph node can range in feeling from
firm to hard, be mobile or nonmobile, and be tender or nontender. An abnormal lymph node would not feel soft.
4. 1 A history of mechanical locking is a common symptom of knee medial meniscus tear. Pain is commonly
increased with weight bearing, not with decreased weight bearing. Swelling would more likely be evident
anteriorly, not posteriorly. Quadriceps atrophy is more likely, not hamstrings atrophy.
5. 1 The optimal exercise duration for achieving weight loss with a walking program is 40 to 60 minutes of
continuous aerobic activity. Therefore once a patient is safely tolerating 15 minutes, the best progression is to
increase the duration while maintaining the same intensity or walking speed. Increasing walking speed should only
be performed once the patient can consistently tolerate 20 to 30 minutes of exercise. Decreasing the duration while
increasing the frequency of exercise would not accomplish the goal of 40 to 60 minutes of continuous exercise. A
patient who has been walking for only 15 minutes 3 times/week would not be ready to begin jogging, and jogging
1 time/week would be too low of an exercise frequency in general to achieve any training benefit.
6. 4 A high percentage of hospitalizations of the aging population with gastrointestinal complaints are due to
the effects of nonsteroidal anti-inflammatory drugs. This patient may be taking this class of drugs for the pain and
inflammation in the knees. Because the pain changes with food intake, the gastric region as a source is implicated.
An abdominal aortic aneurysm would likely cause severe low back pain and would not change with eating nor
cause epigastric pain. A psoas abscess would be painful in the right or left lower quadrant and refer pain to the low
back. Constipation and diarrhea are symptoms related to the colon, which, when painful, relates to mid abdomen
pain and refers pain to the sacral area.
7. 4 It is most important for the patient to experience some form of success in order to provide motivation.
Stopping the session upon failure may further frustrate the patient. Visualization, although useful, is a higher level
task that should not be the first strategy used. Poor body mechanics and stimulation of tone may occur if the
patient reaches forward while moving from sit to stand. Necessary to learning are motivation to try the unknown
and, simultaneously, success in learning, to retain the learner’s motivation.
8. 1 With this particular posture, the patient’s scapula would be in a protracted (abducted) position; therefore
the scapular protractors are already overactive and would require stretching, not strengthening. The kyphosis
suggests that the thoracic erector spinae muscles are weak and need strengthening. The lumbar lordosis indicates
shortened lumbar erector spinae muscles. The forward head posture suggests that the cervical spine is flexed and
the occiput is extended, therefore stretching of the suboccipital muscles would be indicated. A TEST-TAKING
HINT: Although EXCEPT questions are rarely used on the NPTE, be alert for this type of question and read the
responses so that you select the unrelated response.
9. 3 A decrease in size of the electrode will intensify the current density and is not a measure to minimize
accommodation. An increase in the width of the stimulus increases the amount of time that the electrical
stimulation is applied but should not affect accommodation. Too slow a rise time results in changes in the tissue
membrane known as accommodation, which gradually elevates the threshold required for the nerve to fire.
Therefore, the rise time must be rapid enough to avoid accommodation. A biphasic waveform does not minimize
accommodation.
10. 1 Metabolic alkalosis would result in hypoventilation and increased deep tendon reflexes. Metabolic and
respiratory acidosis result in decreased deep tendon reflexes. Respiratory alkalosis results in tachypnea.
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11. 2 The patient description is one of cauda equine syndrome, which may result from a large central disc
protrusion. In addition to the lower extremity signs and symptoms, an interruption of the micturition reflex occurs,
leading to an inability of the internal urethral sphincter to relax in response to a stretching detrusor muscle. As the
bladder pressure increases above the resistance provided by the internal urethral sphincter, urine is released,
resulting in an overflow dribble.
12. 1 The electrocardiogram change shows 3-mm ST depression, which is indicative of cardiac ischemia and an
indication to stop exercise and notify medical staff. Continuing gait training would endanger the patient. Stopping
and resting is a plausible option. However, the medical staff should be alerted to this situation first. Continuing
gait training, despite some standing rests, could allow the ischemia to progress and endanger the patient.
13. 3 The plantar grasp reflex is characterized by curling of the toes when a child is held supported in standing.
The reflex is normal up to 9 months of age. Delayed integration of this reflex can result in delayed, independent
ambulation.
14. 3 An unsustained unifocal premature ventricular contraction is a stable electrocardiograph change
associated with activity and therefore modification of the current intervention is not necessary. Because this type
of premature ventricular contraction is stable and there is no report of dizziness in the stem, taking blood pressure
is not necessary at this time.
15. 3 The occupational therapist would be the most appropriate members of the health care team to teach the
patient the needed self-care skills. The occupational therapist would also be able to provide the patient with
information regarding modifications to the home environment that would increase the patient’s independence. The
occupational therapist could teach the patient how to use adaptive devices and help with the fabrication of splints
or self care aides.
16. 4 The top reason for noncompliance with a home program is that the exercises required too much time and
did not fit into the patient’s daily life routine.
17. 4 A deep vein thrombosis corresponds to the leg pain and possibly swelling but not shortness of breath. A
myocardial infarction corresponds to shortness of breath but typically does not result in swelling acutely. A
myocardial infarction could result in the development of congestive heart failure, which would result in these
symptoms, but this is a secondary result, not a primary result. A pulmonary embolism would result in shortness of
breath, usually not changed by position, and typically cardiac arrest. Typical signs of congestive heart failure
include dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and peripheral edema.
18. 4 Options 1, 2, and 3 are techniques used to decrease postural tone, which is not indicated for this patient.
Option 4 is the most appropriate technique for improving low postural tone.
19. 1 Tissue hydration is determined by pinching and lifting the skin and timing the return to normal. Option 2
describes the measurement technique for pitting edema. Temperature is not directly related to tissue hydration.
Measurement of girth/size is not related to tissue hydration.
20. 4 The best way to ensure proper exercise performance and adherence is to have the patient demonstrate the
program. Involving a family member is a good idea, but a better option is to directly involve the patient in the
program and provide an opportunity for the patient to demonstrate the program.
21. 2 Increasing the sensitivity makes the biofeedback unit more sensitive to electrical potentials from muscles.
As the sensitivity is decreased, it takes more electrical activity to trigger the biofeedback unit (i.e., provide an
audio or visual cue to the patient). For use in muscle re-education, the unit should be most sensitive during the
initial treatment so the patient is able to recruit enough motor units to trigger the unit. As the patient is able to
recruit more motor units, the sensitivity is decreased, which would require the patient to activate more motor units.
22. 1 A p value is the probability value. With the pre-study alpha set at .05, p values <.05 are considered
statistically significant. The r value is the Pearson product-moment correlation coefficient, and r 2 is the coefficient
of determination (the percentage of variance that is shared by the two variables that are correlated).
23. 1 The therapist should palpate the dorsal pedal pulse, which is found on the dorsal aspect of the foot near
the base of the first metatarsal. The anatomical locations in options 2, 3, and 4 are not appropriate to palpate the
dorsal pedal pulse.
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24. 1 Nerve conduction velocity testing is most useful in the evaluation of peripheral nerve or lower motor
neuron status. Carpal tunnel syndrome is the only one of the conditions listed that directly involves a peripheral
nerve. A cerebrovascular accident is an upper motor neuron disorder. Both myotonia and Duchenne muscular
dystrophy are primary muscle disorders.
25. 3 A lower lumbar herniated nucleus pulposus (involving nerve roots L5 and S1) is consistent with a positive
finding with straight leg raise from 30° to 60°. Prone knee flexion tests the upper lumbar nerve roots. A straight
leg raise over 70° no longer tenses the lower lumbar roots. With a straight leg raise of less than 30°, there is not
enough tension provided on the nerve roots to cause a positive response with a herniated nucleus pulposus.
26. 4 Pallor is caused by shunting of blood to the exercising muscle, away from the distal aspect of the
extremity.
27. 4 According to neurophysiological principles, contraction of the involved muscle should cause a reflex
relaxation of that muscle. The internal rotator muscle(s) limit lateral (external) rotation range of motion.
28. 4 Trunk motions with flexion, lateral flexion, and rotation, such as tai-chi, golfing, and bicycling, are
contraindicated for patients with osteoporosis.
29. 3 The joint indicated in the radiograph is the talocrural (ankle) joint.
30. 3 Ultrasound is contraindicated for thrombophlebitis. The other conditions may be treated with ultrasound.
31. 1 Left hamstrings contracture is a fixed, mechanical limitation. It is the most likely cause of the gait
impairment, as it directly affects both the knee joint during the midstance phase and the step length. It is the only
option that can contribute to both of the gait impairments. Right iliopsoas weakness, left hip flexion contracture
weakness, and right quadriceps weakness do not contribute to both gait impairments.
32. 4 Bladder retraining attempts to reestablish cortical inhibition of sacral reflexes. The goal is to lengthen the
period between voiding episodes while avoiding incontinence. Once the patient is able to void at the instructed
interval without urgency or urge incontinence in between, the voiding interval is increased by 30 minutes. Because
this patient still has some incontinence with 2-hour voiding intervals, the voiding interval should be reduced.
33. 2 Skin lesions described in the stem are characteristic of psoriasis. Psoriatic arthritis occurs in about one-
third of persons with psoriasis. When psoriatic arthritis is present, the distal interphalangeal joints are commonly
affected. The skin lesions described in the stem and involvement of the distal interphalangeal joints are not
characteristic of the other three diagnoses.
34. 2 All documentation about physical therapy services should readily translate the physical findings
(impairments) into functional abilities/limitations.
35. 2 Option 1 may create a barrier to communication, because the response is defensive. Option 2 indicates
that the therapist is concerned with the relative’s feelings and provides the relative with the opportunity to express
any concerns. Passage of the licensure examination may not convince the relative of competency and does not
promote communication between the therapist and the relative. The approach of option 4 does not encourage the
patient’s relative to express concerns.
36. 1 Randomized group controlled (placebo) trials (RCTs) are the most rigorous of study designs for
accurately determining the effects of an intervention. Two RCTs would provide stronger evidence than any of the
other options.
37. 4 A metatarsal pad, a solid ankle-foot orthosis, and a hinged ankle-foot orthosis will not correct a
longitudinal arch. The longitudinal arch support is the only orthotic given that will address pes planus.
38. 1 A prosthesis that is too short causes a patient to laterally bend towards the prosthetic side during stance
phase. Each of the conditions given in options 2, 3, and 4 would make the prosthesis seem too long, and none
would cause the problem described.
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39. 2 Physical therapy intervention should focus on helping the patient obtain maximal functional
independence. Wheelchair transfers are the means to enable the patient to be independently mobile and will be a
requirement before more difficult tasks are performed such as ascending a 10-foot ramp. The patient is presumably
too weak to walk at this point in time. Tub transfers are important, but the wheelchair will be the best means to get
the patient to the tub. Therefore, for the initial intervention session, wheelchair transfers would be the most
important.
40. 3 Individuals with a hiatal hernia should avoid the supine position and avoid the Valsalva maneuver.
Bilateral leg lifts must be done supine and require a strong contractions of the stomach muscles, encouraging the
Valsalva maneuver and thus worsening the hiatal hernia. The other exercises could be modified to be done in a
position other than supine.
41. 1 Osteoporosis is a skeletal complication associated with long-standing ankylosing spondylitis. Regarding
requiring a wheelchair, the patient should still be able to walk, even with advanced stages of ankylosing
spondylitis. Although lung expansion is generally decreased, assisted ventilation would not be required, because
the muscles of respiration remain functional. Peripheral neuropathies are not characteristic of ankylosing
spondylitis.
42. 2 The 10-m walk for time test addresses speed more than endurance. By definition, the 6-minute walk test
is the only option that addresses endurance. The timed up and go test does not measure endurance. A maximum
VO2 assessment does not directly measure functional endurance.
43. 3 Based on the walk test results, the heart rate and blood pressure have normal physiologic rise in response
to exercise and would not indicate cardiovascular pump dysfunction. Although the walk test results do indicate
impaired ventilation and respiration, there is no indication of airway clearance issues in the question. In general a
patient with pulmonary fibrosis will have an impaired ventilatory pump. This is further evidenced by the
exaggerated respiratory rate response and desaturation in the 6-minute walk test results.
44. 2 Right iliopsoas contracture may cause a shorter step length with the left lower extremity, but the not the
right lower extremity. Left knee pain will cause the patient to spend less time in left-sided stance, as the patient
will try to minimize the time spent in stance (weight bearing on the knee) to minimize the pain. Therefore, the
patient will take a shorter step with the right lower extremity. Decreased ankle pronation would not have an effect
on right-sided step length. Gluteus medius weakness would be seen as an increase in lateral pelvic tilt, not step
length.
45. 4 When the knee is extended the medial and lateral collateral ligaments are taut. During knee flexion the
ligaments slacken. Therefore there is very little tibial rotation when the knee is extended (close-packed position)
and approximately 40° of axial rotation with the knee flexed. Although the femoral condyles may glide posteriorly
(depending on the direction of rotation) on the tibia and the hamstrings may rotate the tibia, the reason the motion
is available is due to laxity in the collateral ligaments. Other ligaments such as the cruciates and the joint capsule
may add to the stability in the closed packed position.
46. 3 The abductors are particularly active during the midstance phase (single limb support) of gait to prevent
the contralateral pelvis from excessive lateral tilting. Weakness of the hip abductors, particularly the gluteus
medius, causes the hip to drop down on the side opposite the weakness. For example, weakness in the right gluteus
medius would show up during stance phase on the right by excessive downward movement (lateral tilt) of the left
pelvis. The hip adductors are active during terminal stance and through mid-swing and would not play a role in
controlling the lateral rotation of the pelvis. The hip abductors show little activity during swing phase.
47. 2 Five to 10 minutes is an insufficient amount of time for therapeutic heating effects. The ideal amount of
time for therapeutic heating effects with minimal risk of burns is 20 to 30 minutes. Forty-five to 60 minutes is too
long a period of time, as there is an increased risk of burn. Sixty-one to 90 minutes is also too long and presents a
significantly increased risk of burn.
48. 3 Tightness of the rhomboid major and minor would promote downward rotation of the scapula. Weakness
of the serratus anterior would limit the upward rotation of the scapula. The most likely reason for the increase in
scapular motion is restriction of the glenohumeral joint. To fully abduct the shoulder, the scapula and
glenohumeral joint both have to contribute to the motion. If the glenohumeral joint is restricted, the scapula has to
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increase its motion to accomplish the task. Weakness of the upper trapezius would demonstrate a scapular lag in
upward rotation.
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49. 4 The crackles and low pulse oximetry indicate that the patient needs better ventilation and secretion
clearance, probably secondary to the recent surgery. Bronchopulmonary hygiene, including postural drainage,
percussion, vibration, suctioning, and incentive spirometry, are beneficial in treating and preventing postoperative
atelectasis. Although walking usually helps to clear the lungs, the pulse oximetry measure is too low to initiate
walking before the patient’s lungs are cleared. The therapist should clear the lungs first, not contact the physician.
If the therapist is completely unsuccessful with clearing the lungs and the pulse oximetry remains low, then
contacting the physician may be appropriate. Range of motion exercises are important post-thoracotomy, but
again, the patient’s breathing should be addressed first.
50. 1 Excessive drop in blood pressure is indicative of patient intolerance to upright posture. Systolic blood
pressure may increase slightly, and heart rate may increase slightly. Oxygen saturation of 93% is within the
acceptable range.
51. 3 Neither the standing, sitting upright, nor semi-upright position promotes reflux. Supine position could
facilitate relaxation of the lower esophageal sphincter and promote reflux from the stomach into the esophagus.
52. 4 Changes associated with aging include a decrease in nutrient absorption. Gastric motility and salivary
secretion also decrease with aging. Tooth decay increases (because of tooth enamel and dentin wear and decreased
saliva).
53. 2 Wet-to-dry dressings are indicated for necrotic tissue needing debridement. The moderate amount of
drainage would require more frequent (i.e., 2 times/day) dressing changes. Vigorous scrubbing of the wound could
damage viable tissue. Betadine can be cytotoxic. Whirlpool, by itself, would not be effective in removing necrotic
and fibrotic tissue, which ususally requires the addition of other methodes of debridement.
54. 1 The facial nerve, while primarily motor, does carry some sensations, particularly taste sensation from the
anterior two-thirds of the tongue. Abnormal tone is associated with a supranuclear (central) lesion. Supranuclear
lesions produce contralateral voluntary lower facial paralysis, so weakness would be on the other side. A Bell
phenomenon is not present with central lesions. Ptosis or sagging of the eyelid occurs with weakness of the levator
palpebrae muscle. The levator palpebrae muscle is innervated by the oculomotor nerve (III). Pain and temperature
sensation from the face (jaw) is carried by the trigeminal nerve (V).
55. 2 The presence of dyspnea and the pink, frothy sputum would suggest the presence of congestive heart
failure and resultant pulmonary edema. Congestive heart failure can occur from poor cardiac muscle function as a
result of myocardial infarction. Pulmonary edema occurs from the backflow of blood from the heart into the
pulmonary vessels, increasing pulmonary capillary pressure. The increase in pulmonary capillary pressure
increases fluid movement into the alveoli, which are normally dry. This leads to the presence of pink, frothy
sputum that can be expectorated along with shortness of breath (dyspnea). Positions that increase blood flow to the
heart, such as lying flat, will increase the signs and symptoms. Therefore, the patient should be positioned with the
head up or should be placed in a sitting position to help alleviate the symptoms. Laying the patient down flat,
supine, or with the legs elevated would exacerbate the patient’s problems.
56. 1 Rheumatoid arthritis is a chronic inflammatory disease that affects many body systems, including the
joint spaces. Destruction and subluxation of joints can occur over time secondary to the inflammation that occurs
in the synovium. Fatigue is a common symptom that accompanies rheumatoid arthritis. Patients must get enough
rest to avoid excessive fatigue and to protect the joints from overuse damage. Therefore, education on energy
conservation and joint protection is essential to minimize joint deformity. However, patients must realize that
some activity is recommended, to prevent contractures and to maintain strength and endurance. Fatigue and joint
pain can and often do coexist in patients with rheumatoid arthritis. The pannus in the joints is actually increased
with rest. Rest does not appear to change the activity of the antigen-antibody complex.
57. 2 The median nerve innervates the following muscles in the forearm: (1) pronator teres and quadratus, (2)
flexor digitorum superficialis, (3) flexor digitorum profundus (index and middle fingers), (4) thenar muscles
(abductor pollicis brevis, opponens pollicis, flexor pollicis brevis). Therefore, a lesion of the median nerve would
affect those muscles and their accompanying actions: forearm pronation, finger flexion, and thumb opposition.
Thumb adduction is accomplished by the adductor pollicis (ulnar nerve). Finger abduction is performed by the
dorsal interossei (ulnar nerve). Forearm supination is the action of the supinator (radial nerve) and biceps brachii
(musculocutaneous nerve).
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58. 2 The center of gravity of a person with bilateral transfemoral amputations is more posterior than the center
of gravity of a person with lower extremities intact. Setting the back wheels more posteriorly will make the patient
more stable in the chair. This adjustment prevents the wheelchair from tipping backward.
59. 1 All of the questions are important in history taking. However, constant pain is usually a hallmark of an
inflammatory reaction. Mechanical pain generally changes with positions or activities. “What bothers you the
most” is a good question to ask to find out what makes the pain better or worse and often helps determine the best
course of intervention. Difficulty standing up from a sitting position is usually indicative of mechanical (disc)
pain. Radiating pain could occur with mechanical or inflammatory disorders, so is not as discriminating as “Is your
pain constant or intermittent?”
60. 4 The L5 nerve root exits below the fifth lumbar vertebra and supplies sensory information from the dorsal
aspect of the web space between the first and second toes.
61. 3 Option 1 is not a more difficult activity than the one the patient is currently able to perform. It is not
challenging the patient. Option 2 addresses balance, but is not a functional activity. Option 3 is correct, as it
challenges the patient, addresses endurance, and is safe for this patient. Option 4 progresses endurance, not
balance.
62. 1 The assessment of posture in a wheelchair begins with the pelvis and its relationship to its adjacent
segments. The orientation and range of mobility of the pelvis in all three planes will in turn determine the
alignment and support needed at the trunk, head, and extremities.
63. 2 Decreasing the electrode size will increase current density and make the treatment more intense and
uncomfortable. Decreasing the pulse width will make the treatment more comfortable, still affecting large fibers
(A beta) without stimulating the A delta and C fibers (pain). Increasing the pulse rate while using pulsed current
will not make the treatment any more comfortable. It has been proposed that a higher frequency is more
comfortable with alternating current, but this is not true with pulsed current. Switching to a monophasic current
without any other changes will not affect this patient’s comfort.
64. 4 The independent variable is the factor (intervention) that causes a change in the dependent variable
(disability index score).
65. 2 Mid-thoracic pain may be a pattern of cardiac ischemia, especially in women. Additional symptoms
would include fatigue, nausea, shortness of breath, and sleep changes. Pain not induced by activity or static sitting
posture would suggest a possible cardiac source.
66. 4 Generally, the more practice a patient has, the more the patient learns. Therefore for optimal retention,
ample practice sessions should be available while avoiding fatigue. The other options are components of learning
and are certainly important, but actual practice of the motor skill remains the most salient aspect.
67. 3 The quadratus lumborun, internal obliques, and external obliques are all innervated below the level of the
lesion. Sitting push-ups are often used as preparation for gait training and transfers. The push-ups are done to
strengthen the muscles that “hike the pelvis” or lift the buttocks from the mat in a seated position. In a patient with
a complete spinal cord injury at the T6 level, the only muscle group that is still capable of lifting the pelvis is the
latissimus dorsi, which is innervated by the cervical roots C6–C8. The therapist is attempting to strengthen these
muscles because they are capable of lifting the pelvis in the absence of the erector spinae and abdominal
musculature, which are innervated below the level of the lesion.
68. 4 Homonymous hemianopsia describes a visual impairment. There is no evidence of visual limitations in
the stem. Astereognosis is the inability to recognize an object by handling the object without looking at the object.
Unilateral neglect describes the inability to register and integrate stimuli from one side of the body. Constructional
apraxia describes a cognitive dysfunction in which a patient does not know what to do with the blocks.
69. 3 Elevating the legs in the presence of arterial insufficiency decreases blood flow, which increases pain.
Purple or brown pigmentation of the skin on the legs is associated with venous insufficiency, not arterial
insufficiency. The patient most likely has intermittent claudication caused by arterial insufficiency. Placing the
patient’s legs in the dependent position facilitates blood flow and reduces pain. Pain with exercise is indicative of
intermittent claudication, not deep vein thrombosis, which is associated with a positive Homans sign.
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70. 3 A high percentage of true positives would indicate high sensitivity. A high percentage of false positives
would indicate low sensitivity. A high percentage of true negatives indicates high specificity. A specificity of 0.88
is considered high. A high percentage of false negatives indicates low specificity.
71. 2 The definition of pitting edema is described in the stem.
72. 1 Hyaline cartilage is avascular, aneural, hydrophilic (70%-80% water), and can deform under compressive
loading.
73. 3 There is no clear evidence that a continuous passive motion device reduces hospital stay or prevents deep
vein thrombosis. Evidence suggests that a continuous passive motion device can help the patient to regain knee
flexion. If the knee is not placed in full extension outside the continuous passive motion device unit, a knee flexion
contracture may result.
74. 2 The anterior tibialis showed Poor (2/5) grade strength during the examination. Because this muscle is
active during swing phase of gait and shortly after initial contact, one would expect to see gait deviations showing
up at those times. Specifically, the anterior tibialis maintains dorsiflexion of the foot during swing phase and
controls plantar flexion after initial contact. During the swing phase, weakness of the anterior tibialis would cause
the patient to increase the amount of hip and knee flexion to prevent toe drag. With weak hip abductors, the patient
would be expected to have excessive pelvic rotation. To compensate, the patient would laterally bend toward the
weak (right) side during midstance to help prevent the excessive hip drop. Throwing the trunk backward after
initial contact may be due to weakness of the hip extensors (gluteus maximus).
75. 2 The mechanism that creates an anterior dislocation of the shoulder is forced abduction and lateral
(external) rotation of the shoulder. This frequently results in a tear of the anterior portion of the capsule. Abduction
and lateral (external) rotation may subject the patient to recurrent subluxations and/or dislocations and should
therefore be avoided.
76. 2 A grade of 0 indicates complete severance of the nerve. A partial nerve injury causes a diminished reflex
grade, which is graded as 1+. A 2+ grading is normal. A 3+ grade indicates an upper motor neuron lesion, not a
peripheral nerve injury.
77. 1 Fatigue is an early symptom of HIV infection. Blurred vision is not associated with early HIV infection.
Easy bruising and poor wound healing are found at more advanced stages of the disease.
78. 3 Information relating to the physical therapist/patient relationship is confidential. It may not be
communicated to a third party not involved in the patient’s care without the patient’s prior written consent. Option
3 is the only one that fits these criteria.
79. 1 The functional position of the wrist and hand describes the position from which the optimal function is
most likely to occur. This position is described as: (1) slight wrist extension, (2) slight ulnar deviation, (3) fingers
flexed at the MCP, PIP and DIP joints and (4) thumb slightly abducted.
80. 3 The dermatome providing sensation to the little finger is innervated by the C8 nerve root. The triceps
brachii is the only one of the muscles listed that is also innervated by the C8 nerve root. The biceps brachii, deltoid,
and brachioradialis are innervated by the C5, C6, and sometimes C7 nerve roots.
81. 4 Changes in reflexes would hinder balance and equilibrium more than ventilation. In Parkinson disease,
changes in sensation are less pronounced than motor changes. Depending on a patient’s level of tone, muscle
strength is difficult to accurately examine in patients with Parkinson disease and also would be less likely to
directly contribute to shortness of breath. With regard to posture examination, as bradykinesia and rigidity evolve
in Parkinson disease; concomitant kyphosis also develops. Thoracic kyphosis contributes to a restriction in
ventilation and subsequent shortness of breath.
82. 4 A screening tool with high sensitivity can correctly identify the presence of a target condition.
Identification of only 3 of 10 is a low sensitivity. Specificity is the ability of a tool to identify the absence of a
target condition. In this case, 8 of 10 is high, so there is a high specificity. Reliability refers to measurement error,
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and validity deals with an instrument’s ability to measure what it is intended to measure. Reliability and validity
are not addressed in the stem.
83. 2 Type 2 diabetes can result in dysfunctions in all of the systems listed, but deficits in the sensory system
pose significant risk to the patient’s skin integrity. Given that the patient is oriented to person, place, and time, the
therapist can assume that the patient would inform someone in the case of developing pain over a bony
prominence (a common site of decubitus ulcers), given an intact sensory system. Establishing the integrity of the
sensory system is of highest priority, because an unchecked and unrecognized ulcer can quickly become life-
threatening.
84. 2 Edema, brownish discoloration (hemosiderin deposits), and skin contraction in the ankle region are
characteristics of venous insufficiency. Trophic changes that can occur with aging and with arterial disease include
absence of hair and shiny, pale skin. With cellulitis, the skin is erythematous.
85. 4 The cardiologist is not the best referral, as this appears to be an integumentary problem unrelated to the
cardiac condition. A physical therapist should not recommend any over-the-counter medications, as it is outside
the scope of practice of a physical therapist. Any pharmaceutical education or advice, except “as prescribed by
your physician,” is outside the physical therapist’s scope of practice. A pharmacist is the most appropriate heath
care professional of those given to assist this patient.
86. 1 The data in the question are risk factors for osteoporosis and possible compression fracture. This patient
could have weak bones due to long-term steroid use, smoking, or being postmenopausal. Although lung cancer
may be likely with a history of smoking, lung cancer is unlikely because of symptom onset occurred after
prolonged flexion and lung cancer should not cause limited active range of motion. Coronary artery disease and an
abdominal aortic aneurysm would not cause limited active range of motion or pain with deep breathing. The
patient’s history does not increase her likelihood for having an abdominal aortic aneurysm.
87. 1 Stable angina generally occurs during physical effort and is characterized by substernal, usually
nonradiating pain lasting between 5 and 15 minutes. In unstable angina, the episodes occur during physical
exertion or psychological stress and are more frequent, the pain may be severe, and the duration of each event is
usually greater than 15 minutes. Variant angina occurs while the individual is at rest, usually during waking and at
the same hour of the day. Dysrhythmias occur more commonly in individuals who have variant angina than in
those with exertional angina (either stable or unstable).
88. 4 Classic signs of early melanoma are skin discolorations characterized by asymmetry; irregularity; black,
brown, red, white, or blue coloring that is not uniform; and area larger than a pencil eraser.
89. 4 The anterior pituitary glands regulate sexual development via gonadotropins. Gonadotropins regulate
secretion of male and female hormones.
90. 3 In a normal distribution, the area between +/- 2 standard deviation units represents about 95% of the
population. Greater than 50% of the scores fell between 33 and 55. Approximately 2.5% of the scores fell below
33 and approximately 2.5% of the scores fell above 55.
91. 4 The primary physical therapy goal in this case would be joint protection and the prevention of
contractures and adhesions, usually through splinting. There is no evidence to suggest that physical therapy can
prevent nerve degeneration and muscle atrophy, as they are the normal effects of a peripheral nerve lesion.
Spasticity would not be present in a lower motor neuron injury.
92. 3 Guillian-Barré is a lower motor neuron disorder. Diminished reflexes are expected with lower motor
neuron disease. Options 1 & 2 are found with upper motor lesions. Ataxia would be much more common with
cerebellar disorders.
93. 4 There is no reason to suspect that the modality must be changed. The first logical step is to increase
toweling. The patient’s response is not a normal response. Uneven blotchy red and white skin in a light-skinned
patient or darker and lighter areas in a darker-skinned patient could be a sign of overheating. Five minutes after
initiating heating, the physical therapist should remove the pack and check the patient’s skin for any blotching-
mottled erythema. If it is found, the heat is too intense, and adding more towel layers would be the most
appropriate action.
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94. 2 Caution should be used in patients who are taking tetracycline, because the drug will enhance the effects
of the ultraviolet radiation. Ultraviolet is not contraindicated in these patients; however, the dosage of the
ultraviolet would probably have to be adjusted to some lower level. The penicillin allergy, calcium supplements,
and metal implants would not be affected by the ultraviolet light. It should be noted that although ultraviolet
radiation therapy is not common in today’s practice of physical therapy, therapists should nonetheless be aware of
the precautions and be able to advise patients who may be using ultraviolet radiation at home.
95. 2 By definition, hyperemia is the intense redness or rubor caused by increased blood flow
96. 4 Learning the process of foot care is a psychomotor skill. Effective strategies to teach psychomotor skills
include repeat demonstration by the patient of the skill followed by feedback from the therapist to highlight what
was performed correctly and what areas need improvement, if any. Reassurance about prevention of infection with
proper foot care would primarily be a cognitive skill and does not ensure that the patient can effectively perform
proper foot care. Options 2 and 3 do not include feedback that informs the patient about performance of foot care.
97. 4 A facet dysfunction would remain in sitting and in standing. A weak gluteus medius would result in more
problems during gait or movement. Although the iliopsoas is passively shortened in sitting, a short iliopsoas is not
a common cause of scoliosis, especially not thoracolumbar scoliosis. Leg length discrepancy is correct because
when the patient is sitting, the leg length does not affect the spinal posture, however a leg length discrepancy could
affect posture and standing.
98. 4 Manipulation should not be applied to areas of the body directly affected by osteoporosis due to risk of
fracture. Chronic use of corticosteroids can lead to calcium loss and osteoporosis. Estrogen therapy alone or in
combination with another hormone, progestin, has been shown to decrease the risk of osteoporosis and
osteoporotic fractures in women. Osteoporisis is not a side-effect of NSAIDS or antidepressants.
99. 2 The spleen is positioned above the stomach and under the left ribs. The spleen can rupture with trauma,
but the symptoms may occur gradually from slow hemorrhage. The symptoms of a ruptured spleen include pain in
the upper left abdomen and radiating to the top of the left shoulder. The pain gets worse with breathing in and
then spreads quickly over the entire abdomen. If the leak of blood is gradual, symptoms may not occur until the
blood supply to the body is diminished. This will result in light-headedness, low blood pressure, blurred vision,
confusion, and loss of consciousness, as the oxygen supply to the heart and brain is affected. Symptoms of a
pulmonary embolus are variable but do not include referred pain to the shoulder. The presence of pain with
shoulder movement at the initial injury site, the ribs, rather than the shoulder, decreases the likelihood that the
shoulder itself has pathology. Also, inhalation shouldn’t aggravate a shoulder fracture. Acute cholecystitis is
associated with fever, chills, nausea and vomiting, tenderness on the tip of the 10th rib, and pain in the right upper
quadrant and radiating into the right shoulder and between the scapulae.
100. 3 The first step in preparing any education experience is to determine what the needs of the audience are.
Since prevention of low back injury is the ultimate goal, assessment of the employee’s workstations is an
important first step in planning the educational program. Simply instructing all employees in lumbar extension
exercises is inappropriate without a thorough evaluation of their physical needs. Option 2 cannot be done unless an
assessment of the functional needs has been performed. Providing pamphlets is a useful teaching adjunct but
would not be the first step to prevent low back pain effectively in this population.
101. 1 The overhead positioning of carrying food trays is similar to the end position of the ulnar nerve tension
test. The test for the ulnar nerve includes shoulder depression, abduction, and lateral (external) rotation; elbow
flexion; forearm pronation or supination; and wrist and finger extension. The median nerve tension test employs
elbow extension, but the position of the waiter is more consistent with elbow flexion. The radial nerve test is low
by the side, not reaching overhead. The musculocutaneous nerve does not innervate the hand.
102. 1 All of the questions are important in history taking; however the suspected diagnosis is Bell palsy caused
by a lesion of the facial nerve. The patient would most likely have weakness in the muscles of facial expression,
including smiling. Asking the patient to smile would most likely show an asymmetrical smile with weakness on
the right side. Jaw pain and inability to chew food would be more likely due to a lesion of the trigeminal nerve.
Inability to swallow may be caused by damage to cranial nerves IX, X, or XII.
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103. 2 Regarding effective pain modulation, ramps are used to obtain a more gradual activation of muscle, rather
than as a method of pain modulation. The waveform shown is monophasic with a ramp-up and ramp-down surge
of the amplitude. The gradual rise and fall in the stimulus pulse amplitude allows the gradual recruitment of nerve
fibers, creating a more comfortable initiation of contraction for the patient. The declining ramp at the end of the
contraction allows a smooth gradual drop in the force produced by the muscle, also enhancing comfort. The
gradual onset of muscle stimulation produces contractions that more closely mimic those produced in functional
activities during voluntary muscle activation. Regarding frequency and motor unit recruitment, the waveform
shown has a change in amplitude, not frequency. Regarding pulse width and motor unitrecruitment, the waveform
has a change in amplitude, not pulse width. A monophasic pulse is not appropriate for denervated muscle, which
requires direct current.
104. 2 According to the Standards of Practice for Physical Therapy, there should be a written plan for
continuous improvement of quality of care. This includes ongoing review and evaluation of the physical therapy
services provided. Utilization review and peer review are two types of review processes.
105. 3 Joint mobilization procedures may cause some soreness. The therapist should inform the patient of this
response to treatment. The therapist should re-evaluate the patient and could alter the treatment by waiting an extra
day before the next treatment or by decreasing the dosage. There would not be a need to refer to the physician. The
addition of exercises would not alter the response, and there would be no indication of neurological involvement
with the reported symptoms.
106. 3 Cubital tunnel syndrome is ulnar nerve entrapment. The test as described is for the radial nerve. Tingling
and paresthesias in the medial forearm and hand are typical findings with cubital tunnel syndrome. Pronator teres
syndrome is compression of the median nerve. Although the patient may have pain on the radial side of the hand
with pronator syndrome, it usually extends from the little finger (5th digit) to the index finger (2nd digit) and does
not result in lateral elbow pain. The test described is for the radial nerve. Radial tunnel syndrome involves
compression of the deep branch of the radial nerve and presents with symptoms similar to lateral epicondylitis, i.e.,
poorly localized pain over the radial aspect of the proximal forearm. Symptoms are reproduced in the test position
described. Anterior interosseous syndrome is compression of the anterior interosseous nerve, which is a branch of
the median nerve. The median, not the radial, nerve tension test will provoke symptoms of anterior interosseous
nerve syndrome.
107. 4 Patients with type 1 diabetes use insulin. Blood glucose levels should be between 100 and 250 ml/dL for
patient safety.
108. 1 Option 1 is the best answer. In Option 2, if the patient does not initially understand the information, then
having short-term memory is irrelevant. For Option 3, hearing and vision are obviously important, but the most
critical component is comprehension. Option 4 is irrelevant to the scenario.
109. 3 Isokinetic exercise devices utilize accommodating resistance throughout the range of motion. The other
exercises do not include forms of accommodating resistance.
110. 4 Isolated contraction of the right sternocleidomastoid muscle would cause the head to rotate to the left and
side bend (lateral flexion) to the right. To stretch the muscle, the opposite actions would be performed on the
patient by the therapist: rotation of the head to the right and lateral flexion to the left.
111. 3 Hyperthyroidism is an excessive secretion of thyroid hormone. Chronic periarthritis can occur, often with
calcification. This occurs most often in the shoulder. Atrophy of intrinsics and steppage gait would not be likely,
because proximal muscles are affected, rather than distal muscles. Calf cramping is not a symptom of
hyperthyroidism.
112. 3 A fall in oxygen saturation below 87% is equivalent to a partial pressure of 55 mm Hg of oxygen in the
blood, which is considered to be moderately hypoxemic (low oxygen levels). This situation would require
increased oxygen levels in order to be rectified. A rise is carbon dioxide level would not be alleviated by increased
oxygen levels. Complaints of shortness of breath can come from a variety of causes and would not necessarily be
alleviated by increased oxygen levels. An increase in hear rate to 150 bpm may be a normal response to this
activity and would not necessarily require increased oxygen levels.
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113. 3 This therapist is minimizing the proportion of the total observed variance that is attributable to error by
being consistent across successive trials. It is unlikely that much more can be done in the follow-up study to
further reduce the systematic error. For a given amount of error variance, the reliability will improve as the total
variance increases; that is, as the total variance gets larger, the error component will account for a smaller
proportion of it. The original study included subjects with a very narrow range of mobility, which would result in
small variance in the data. Including subjects with a wider range of mobility in the follow-up study will likely
boost variance and ultimately reliability.
114. 1 Upon heel contact, the heel section compresses, partially absorbing the ground impact and thus permitting
a controlled plantar flexion. If the heel is too stiff, the knee flexes too soon and excessively on initial contact. An
excessively firm heel wedge would not be a factor in late stance.
115. 2 An intact circulatory system can sustain adequate blood flow to an elevated limb. A limb with arterial
insufficiency may not be able to sustain adequate blood flow with the leg elevated. The vasodilation, caused by
local mechanisms, occurs in response to ischemia. An acute arterial occlusion creates a pallor, but because blood
flow is blocked, the reactive hyperemia is impaired.
116. 1 Tightness of the hamstrings causes excessive lumbar flexion, because tight hamstrings restrict the amount
of hip flexion. Weak gluteals allow more hip flexion. Weak abdominals show up in antigravity flexion of the
trunk, not passive forward bending. Hip flexor flexibility is not a factor in forward bending.
117. 1 The latissimus dorsi depresses the shoulder girdle and can be short in patients with depressed scapulae.
The upper trapezius, if short, would elevate the scapula. The levator, if short, would elevate the scapula. The teres
major, if short, would adduct the arm.
118. 3 With an anterolateral approach, the gluteus medius is reflected or the trochanter is taken down.
Postoperatively, these structures need time to heal and will not be healed only 2 weeks after surgery. The
abductors should not be aggressively strengthened with exercise.
119. 3 Functional urinary incontinence occurs in patients with a normal functioning bladder who have difficulty
in reaching the toilet or preparing to urinate, often as a result of decreased fine motor skills and resulting inability
to manage the zippers, buttons, and drawstrings on garments.
120. 3 The left tensor fasciae latae would be chronically stretched, rather than shortened. The piriformis is an
extensor and lateral (external) rotator of the hip and would not be as likely to be affected. The right leg is shorter,
so in standing, the patient’s right hip should be lower than the left. This relatively places the right lower extremity
in abduction and the left lower extremity in adduction. This chronic posturing would most likely cause tightness in
the right hip abductors and the left hip adductors. Of all the options, the right gluteus medius muscle is the most
likely to be tight, because it is a right hip abductor. The right adductors would be in a chronically lengthened
position and would not be as likely to be affected.
121. 4 The signs and symptoms, along with a history of diabetes, are most consistent with Charcot foot. A
patient with any of the other options would have referred pain or local pain. A patient with a sprain or fracture
would have a history of trauma.
122. 1 A heel cushion that is too soft allows too rapid plantar flexion after heel strike (initial contact), which
causes the knee to go into extension and stay there longer than normal. A socket that is placed too far anterior on
the foot causes knee flexion, not extension. A prosthesis that is too long causes vaulting in midstance. Inadequate
suspension causes the socket to slip during midswing phase, resulting in the toe of the prosthesis catching on the
floor.
123. 4 The Pearson product-moment correlation coefficient is the only option that can be used to determine the
degree of relationship between two continuous variables in the same group of subjects. All the other options relate
to statistical testing between groups of subjects with differing characteristics using the same measure, such as
determining the difference between the mean walking speed of a group of young people and a group of elders.
124. 1 The patient is exhibiting jaundice consistent with liver or gallbladder disorder. Eye involvement (sclera)
is a symptom, not the primary disorder. There are no indications of duodenal involvement or cardiac involvement
in this patient.
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125. 1 Skin turgor is tested by lifting the patient’s skin between the fingers and observing for return to the
original position. If this process is delayed, it is a sign of poor skin turgor.
126. 3 Information relating to the physical therapist/patient relationship is confidential and may not be
communicated to a third party not involved in that patient’s care without the prior written consent of the patient.
Option 3 is the only one that fits these criteria.
127. 2 The patient taking beta-blocking medication will experience a lower heart rate and blood pressure
response during exercise, compared to a patient who is not taking this type of medication. Heart rate is lower than
anticipated in patients taking beta-blockers, and using heart rate to monitor exercise intensity may not give an
accurate indication of intensity. Another measure, such as the Borg Scale (rating of perceived exertion), would be
more beneficial. However, even though heart rate and blood pressure would be lower, the patient actually achieves
the same metabolic levels during exercise, and therefore altering the frequency or duration of exercise is
unnecessary. The time for warm-up and cool-down exercises does not need to be altered.
128. 2 Morning pain is a typical finding in rheumatoid arthritis. Symmetrical numbness could be indicative of
myelopathy from either infectious or neoplastic causes. Increased pain during activities of daily living is also a
typical finding in rheumatoid arthritis. Inability to sleep at night alone is too vague of a report to cause suspicion of
more medical problems.
129. 3 The most appropriate first step (pre-planning) would be to evaluate existing services within the
community and work out a budget for the project. Options 1 and 2, although important, are things that would most
likely be done after the practice is up and running. Option 4 may be done early on in the planning process, but
would follow Option 3.
130. 4 Unresolved edema is not indicated and would be more prevalent in lymphedema. A venous filling time of
more than 15 seconds is suggestive of arterial insufficiency. Intermittent claudication is related to activity, not to
dependency tests. A venous filling time of less than 15 seconds is suggestive of venous insufficiency.
131. 3 A normally distributed sample has a median and a mean that are equal in value. In that type of
distribution, the median and mean would be at the halfway point. One-half of the scores (50 %) would be
distributed above the median and one-half below. If the median and mean are not of equal value, the distribution is
skewed. If the median is of a higher value than the mean, the distribution is skewed to the left; if lower, it is
skewed to the right. The standard deviation is a measure of the variability of the mean. The Z-score is a standard
score with a mean of zero and a standard deviation of one. Averaging the two measures would not be appropriate
or meaningful.
132. 3 The joint indicated (subacromial) in the radiograph contains several soft tissue structures, including the
biceps brachii tendon, supraspinatus tendon, and subacromial bursa. The other structures listed are not located in
this area.
133. 1 Threats to external validity limit the generalizability of the results. Since the research parrticipants differ
from the therapist’s patient population, applying the results to a different group of people would not be appropriate
due to limitation on validity. Internal validity means that internal factors other than the independent variables
could be related to changes in the dependent variable(s). Construct validity is challenged when constructs are
poorly defined or an inconsistent use of constructs occurs. Statistical conclusion validity is challenged with
irregularities in the use of statistical tools or the use of incorrect statistical tools.
134. 2 Although all of the listed modalities would provide heat, paraffin is the best choice, since the limb can be
elevated during the application of heat. Elevation of the limb may reduce likelihood of edema.
135. 1 Afferent sensory information regarding proprioception and vibration is transmitted on large myelinated A
alpha fibers. A delta fibers are small unmyelinated fibers, and C fibers are unymelinated; both provide pain
sensation.
136. 1 The sitting position promotes visual attending, use of the upper extremities, and social interaction. A
child who exhibits extensor posturing should be carried in a symmetric position that does not allow axial
hyperextension and keeps the hips and knees flexed.
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137. 3 During pregnancy, the ligaments soften due to hormonal influences and allow some degree of separation
between the joint surfaces. Additional stretching of the ligaments could result in joint instability or injury and
would not be a goal of treatment. The remaining options are all appropriate interventions.
138. 1 Because most of the joint contracture/adhesion forms in the anterior-inferior portion of the capsule,
treatment to mobilize that portion of the capsule is of primary concern. Inferior glide would stretch the inferior
portion of the capsule.
139. 1 The quadriceps are active shortly after heel strike (initial contact) to prevent excessive knee bending
during the loading phase of initial stance. Weakness of the quadriceps causes the patient to compensate by leaning
forward at heel strike (initial contact) and to use the body weight to help keep the knee extended. Weakness of the
hamstrings causes excessive knee extension (recurvatum) prior to heel strike (initial contact). Weakness of the
gluteus maximus would be observed shortly after heel strike (initial contact). However, the patient would lean
backward to compensate. Weakness of the anterior tibialis causes a “foot slap” just after heel strike (initial
contact).
140. 2 A positive Babinski reflex is characterized by great toe dorsiflexion and fanning or splaying of the other
toes. A positive Babinski reflex indicates upper motor neuron or central nervous system involvement.
141. 2 Greater retention of motor skills is achieved when tasks are practiced randomly and are practiced in a
distributed fashion rather than massed. Mastering use of stairs before attempting walking on uneven surfaces
would eliminate use of randomization. Practice of a movement in its entirety, rather than focusing on smaller
components, leads to better retention. Immediate knowledge of results can be detrimental to learning because it
provides too much information and can result in the person relying too much on the external feedback rather than
internalizing the information.
142. 2 Patients with a complete C7 spinal cord injury require maximal assistance for floor-to-wheelchair
transfers because they typically do not have the trunk control required to perform this task. Typically with C 7
spinal cord injury, patients are able to perform wheelchair mobility on smooth surfaces independently. They may
require an upright wheelchair to assist with trunk control. These patients usually are independent with supine-to-sit
transfers; by rolling from side to side and getting their arms behind them, they are able to come to long sitting.
They do not have the trunk control to perform a wheelie, which is required for ascending a curb in a wheelchair.
143. 3 Since the patient is non-weight-bearing bilaterally, the standing-pivot transfer is contraindicated. Since
the caregiver is elderly, neither a one-person nor a two-person lift is a safe choice. Since the caregiver is elderly
and the patient is non-weight-bearing bilaterally, the sliding-board transfer is the best choice of the options given.
144. 2 Although sensory testing is important in an initial examination, impaired sensation is less likely to occur
in a patient with congestive heart failure only. Right-sided congestive heart failure results in dependent edema;
measurements of pitting edema are appropriate to determine the severity of congestive heart failure and aid the
therapist in treatment planning. Manual muscle testing is also appropriate for an initial exam. However, with acute
congestive heart failure, resisted manual muscle testing is generally avoided until the congestive heart failure is
more stable. Reflex testing is also important in an initial examination, but because the patient has congestive heart
failure only, reflexes are less likely to be impaired.
145. 1 During aerobic exercise, vascular dilation occurs in order to optimize blood flow, and the venous system
relies on muscular pumping in order to return blood back to the heart. Without a cool-down period, there would be
no muscular pumping and therefore blood would pool in the venous system. Cardiac arrhythmia may occur as well
but is less likely in someone without cardiac disease. Cessation of activity by itself would result in a gradual
decrease in body temperature, and specific exercises are not necessary. Muscle tightening may occur as a result of
metabolites accumulating in the circulatory system, but this would occur as a result of the venous pooling.
146. 4 This patient has a history that would lead to a venous stasis ulcer.
147. 1 The close-packed position for the hip is medial (internal) rotation with extension and abduction. An
alternative position is 90° of hip flexion with abduction and slight lateral (external) rotation.
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148. 3 The oculomotor nerve innervates the levator palpebrae superioris muscle that elevates the upper eyelid
and the pupillary constrictor muscle. Therefore, a lesion of the oculomotor nerve would make it difficult, if not
impossible, for the patient to fully raise the lid (open the eye) and would cause a condition termed ptosis. In
addition, the eye may not react to light and therefore would not show pupillary constriction when light is directed
into the eye. Inability to fully close the eye would be seen with a lesion of the facial nerve (Bell palsy). Medial
strabismus would be caused by damage to the abducens nerve, innervating the lateral rectus, causing a medial
strabismus.
149. 4 These symptoms are consistent with diabetes mellitus. Cancer would not likely include the feeling of
thirst and frequent urination. Cystitis would not include symptoms of weight loss and thirst. Renal calculi are
characterized primarily by pain and not thirst, frequent urination, or weight loss.
150. 2 Ten degrees of dorsiflexion is required for normal walking. Full hip extension is required for walking for
a person with a T12 level injury. Normal knee flexion is not required for normal walking. While option 4 is
important for long sitting and floor-to-wheelchair transfers, this is not required for gait.
151. 2 A standard walker on stairs is not as safe as crutches. As the patient was previously active, has stairs at
home, and must be non-weight-bearing on one lower extremity, axillary crutches would provide the greatest safety
margin and independence. A quad cane would not be sufficient, since the patient is non-weight-bearing on one
lower extremity. The patient would not be able to be non-weight-bearing on one lower extremity with two straight
canes.
152. 1 In patients with moderate hyperglycemia, exercise can lead to hypoglycemia for periods of 24 to 48 hours
after exercise. Exercise has been shown to increase sensitivity of the insulin receptors, leading to a decrease in the
amount of insulin required.
153. 1 A state of alertness to the internal and external environment must be maintained for motor or mental
activity to occur. The brainstem reticular activating system brings about this state of general arousal. To proceed
from a state of general arousal to one of selective attention requires the communication of information to and from
the cortex, the thalamus, and the limbic system and its modulation over the brainstem and spinal pattern
generators.
154. 3 Trunk ROM exercises and strengthening to minimize thoracic kyphosis are essential. Persons with
ankylosing spondylitis tend to assume flexed postures. Disproportionately strong pectorals, hip flexors, or
abdominals could worsen the kyphosis.
155. 1 Option 1 is not among the information that must be disclosed to a patient to obtain informed consent. The
goals of the intervention, the possible risks of the intervention, and any alternative interventions available must be
disclosed to the patient to obtain the patient’s informed consent.
156. 1 Steady rate exercise such as jogging or cycling causes a relatively rapid increase in systolic pressure, with
diastolic pressure remaining the same or decreasing only slightly. Systolic pressure may level off somewhat during
the exercise, if exercise intensity remains the same.
157. 1 Normal function of thyroid hormone generally regulates metabolism. Excessive thyroid hormone creates
a generalized elevation of body metabolism that manifests in most systems of the body. The patient described in
the stem has these manifest symptoms of increased metabolism. Hypothyroidism would have nearly the opposite
manifestations, such as bradycardia and cold intolerance. Cushing syndrome is a problem of hypercortisolism and
has a very different set of manifestations. Hypoparathyroidism leads to problems of calcium regulation and also
has a different set of manifestations.
158. 2 Weight gain is common with this disorder, not weight loss. All other options are seen in patients with
fibromyalgia.
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159. 3 Spinal shock occurs as a reaction to spinal cord injury and is characterized by an absence of all reflex
activity below the level of the lesion. Depending on the extent of the lesion, the patient may lose all or some
sensation and motor activity below the level of the lesion. Spasticity is associated with hyperreflexia and increased
muscle tone. Spasticity would be expected to develop following the spinal shock stage. Decerebrate rigidity
involves a sustained contraction of the upper and lower extremities in extension. With a lower motor neuron
lesion, the loss of sensation and motor activity would be confined to a much smaller region (depending on the
exact lesion) and would not affect all levels below the lesion.
160. 2 Although protocols depend on the surgeon and the approach, it is generally recommended that anti-
gravity hip abduction exercises not begin until 5 to 6 weeks post surgery. Patients are taught to avoid excessive hip
flexion, usually beyond 80°. Bed mobility and ambulation would be started 1 or 2 days postoperatively.
161. 3 In the early stages of lymphedema (Stage I), reversible swelling is common, especially in the dorsum of
the hand. Signs of lymphedema development include slow progression of swelling, which is typically distal to
proximal progression. Nonpitting edema is present with Stage II lymphedema. Pallor and shiny skin are changes
associated with conditions resulting in arteriospasm.
162. 1 The median nerve supplies sensory innervation to the palmar surface of the thumb, index, and middle
fingers (1st, 2nd, and 3rd digits). A positive Tinel sign (eliciting a paresthesia while tapping over the carpal tunnel at
the wrist) and weakness of the opponens pollicis muscle are indicative of carpal tunnel syndrome. Ulnar nerve
compression would cause sensory and motor changes in the little and ring fingers (4 th and 5th digits), not the thumb
(1st digit). Tenosynovitis of the abductor pollicis longus muscle would most likely reveal a positive Finkelstein test
(stretching of the abductor muscle) with pain over the dorsum of the thumb (1st digit). Thoracic outlet syndrome
would most likely be revealed with special tests that cause alteration of the radial pulse.
163. 1 A nonadherent dressing is best choice because any adherence of the dressing to the fragile granulating
tissue could cause additional trauma. This is a superficial wound, so there would be no need to pack the wound.
Because there is some drainage, a covering is preferred to topical medication only.
164. 3 The medical record is owned by the hospital subject to the patient’s interest in the information it contains.
Unless restricted by state or federal law or regulation, a hospital shall furnish to a patient, or a patient’s
representative, parts of the hospital record upon request in writing by the patient or the representative. Option 3 is
the only correct answer in this case, because it specifies that the patient must authorize the release of information.
165. 2 Pain from endometriosis often is cyclic in nature and corresponds with the menstrual cycle. The other
options are more likely to indicate mechanical causes of pain.
166. 4 Instructing the patient to walk a straight line while glancing left and right would address a vestibular
problem, specifically oscillospsia, but would not help a patient with a primarily somatosensory deficit, as
described in the question. Instructing the patient in exercises to strengthen the gastroc-soleus muscle group would
not provide protection against falling, although it may be an appropriate adjunct in a comprehensive therapy
program. Referring the patient to an orthotist for a custom ankle-foot orthoses fitting may be included at some
point in the intervention scheme, but the most important factor is immediate protection from falling, which is best
addressed with a cane. This patient has a somatosensory deficit, and while introducing somatosensory challenges
is appropriate, the most important thing to do is provide the patient with a cane for balance and upper extremity
proprioceptive input.
167. 2 Options 1, 3, and 4 are acceptable interventions for this patient. The epiphyseal areas (growth areas of
bones) in children should not be exposed to ultrasound. The application of ultrasound over the knee joint
(hamstring insertion) could expose epiphyseal areas to the ultrasound.
168. 2 Larger print will not simplify the meaning, nor will lengthening the sentences. Only Option 2, the choice
of illustrations and a simpler sentence structure, is likely to improve patients’ understanding of the materials.
169. 2 Although all of the options are steps in the cardiopulmonary resuscitation guidelines, based on the
presented signs and symptoms, activation of the emergency response system is the first thing the therapist should
do, as the patient is located within a hospital setting.
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170. 4 Micturition is the physiologic process of urination. The pelvic floor muscles control urination by stopping
the flow of urine. The pelvic floor muscles are innervated by the pudendal nerve. The superior gluteal muscle
innervates the gluteus minimus, gluteus medius, and tensor fasciae latae. The genitofemoral nerve provides
sensory innervation, but not motor innervation. The obturator nerve innervates the adductor muscle, gracilis, and
obturator externus.
171. 1 The patient will be reluctant to move the limb because it is painful. ROM is essential to regain and
maintain a functional ROM. In this case, the physical therapist’s primary goal is to restore function with ROM
exercises. Compression dressings, whirlpool, and splinting are all acceptable aspects of care that help in the
restoration of ROM. However, functional ROM would be the primary goal.
172. 2 The recommended dosage for mechanical, intermittent pneumatic compression pressure is between 30
and 80 mm Hg (higher for the lower extremities than upper extremities). It is also recommended that the pressure
be below the diastolic pressure. Pressures below 30 mm Hg are not considered to be effective. Pressures above the
diastolic pressure can be used with caution. For the first treatment, it would be most appropriate to use a pressure
that is considered effective, yet not so high as to cause potential problems for the patient. If the patient responds
positively to the intervention, a higher pressure could be instituted.
173. 4 Excessive femoral anteversion could cause toeing in during standing. Anterior rotation of the innominate
would cause shortening of the extremity. Pelvic tilt may cause a leg-length discrepancy with the longer leg being
on the side of the tilt. When the malleoli are aligned in supine and then change with long sitting, it is indicative of
innominate rotation. In this case the right malleolus shifted inferiorly (got longer), indicating a posterior rotation of
the pelvis on the side of the longer leg.
174. 2 The T10 dermatome includes the umbilicus. T5 is closer to the nipple line, and L1 includes the region over
the inguinal ligament. L3 covers the anterior thigh.
175. 4 Use of therapeutic ultrasound over epiphyseal plates of growing bones is contraindicated. There is
potential for damage to the growth plate with intense thermal ultrasound and for increased stimulation of bone
formation even with very minimal ultrasound exposure. There are no contraindications or unusual precautions for
use of ice massage, moist heat, or iontophoresis in the elbow region in healthy adolescents.
176. 4 The patient is too ill for either the VO2 max treadmill test or the two-step test. The submaximal exercise
test is not as sensitive or specific a test as the 6-minute walk test. The 6-minute walk test is designed for acutely ill
cardiopulmonary patients.
177. 2 Pressure receptors (baroreceptors) are present in the carotid sinus, and these receptors respond to changes
in blood pressure. An increase in blood pressure that is sensed by these receptors will stimulate the
parasympathetic system to decrease the rate and force of contraction of the heart in order to help lower the
pressure. Repeated palpation in the carotid sinus area may simulate an increase in blood pressure and cause this
reaction. Therefore increased heart rate and blood pressure are incorrect. Irregular heart rhythms generally result
from electrolyte imbalance and/or ischemia to the conduction system of the heart.
178. 3 Activating the emergency response system is not the first step and may not be indicated until further
assessment is completed after the seizure. There is no need to try and keep the patient from biting her tongue or to
insert an object into the mouth, which could cause damage to the patient’s teeth. During a seizure, injury should be
prevented. Rolling the patient on her side will help prevent aspiration. Option 4 is not an appropriate response to
the patient having a seizure.
179. 4 The shoulder abduction, elbow extension, wrist extension position is for the median nerve. The shoulder
flexion, elbow flexion, wrist extension position is for the ulnar nerve. Option 3 is incorrect because the radial
nerve stretch requires elbow extension, not flexion. Option 4 is the correct position for end-range gliding of the
radial nerve.
180. 4 Capsular restriction would show up in both measurements. Dorsiflexor weakness would show up in both
measurements. Hamstring tightness would affect knee range of motion, not ankle range of motion. In photograph
A, there is more dorsiflexion present with the knee bent. In this position, the gastrocnemius is on slack across the
knee joint, which allows greater range of dorsiflexion. In photograph B, the gastrocnemius is stretched over the
knee joint, so the ankle joint and tightness in the gastrocnemius would restrict ankle dorsiflexion.
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181. 4 Nonparametric tests are not based on specific assumptions about the distribution of data within a
population. They are used with rank or frequency information to draw conclusions about differences between
populations. While versatile, they are generally considered less powerful than parametric tests.
182. 4 Recommended electrode placement for reducing shoulder subluxation is over the posterior deltoid and
supraspinatus muscles. The goal is to increase on time and decrease off time as muscle endurance improves. On
times up to 30 seconds can be used if tolerated by muscles or if pulsed current is used. Direct current is not well
suited for this type of application. A pulsed current (symmetrical or asymmetrical biphasic PC) is recommended
for treatment of shoulder subluxation. Activation of the trapezius muscle should be avoided.
183. 4 Bell palsy involves the facial nerve. The frontalis is the only muscle listed that is innervated by the facial
nerve. The sternocleidomastoid is innervated by the spinal accessory nerve, and the masseter and temporalis are
innervated by the trigeminal nerve.
184. 1 A patient with COPD has premature collapse of the airways upon exhalation, which leads to air trapping
and ultimately poor gas exchange. Breathing out through pursed lips slows the airflow and creates a back pressure,
which helps to prevent the airways from collapsing while exhaling. By exhaling more fully through pursed lips,
more carbon dioxide is removed. By preventing airway collapse and air trapping in the lungs, the residual volume
is actually decreased. Pursed-lip breathing helps with ventilation but does not necessarily assist with secretion
mobilization.
185. 3 The sensory distribution for the lateral sural cutaneous nerve includes the upper portion of the lateral
lower leg but does not extend into the foot. The L3 nerve root usually covers the medial knee. The information
given in the question includes the sensory distribution of the superficial fibular (peroneal) nerve. The S 1 nerve root
extends into the lateral portion of the foot, not the top portion of the foot.
186. 1 Raising just the head activates only the recti muscles, and supporting the abdominal muscles with the
hands provides external support to the stretched abdominal muscles. This is the optimal position to initiate
abdominal strengthening following delivery for a patient with diastasis rectus abdominis. Doing no exercise would
not be appropriate. With no support of the abdominal muscles, Options 3 and 4 would be too aggressive at this
time.
187. 3 With arterial insufficiency, elevation increases ischemia and therefore pain. Intermittent claudication is a
phenomenon associated with metabolic demands exceeding the capability of the vascular system to supply
adequate blood flow. Placing the limb in a dependent position increases swelling and therefore possibly pain with
venous insufficiency. An objective sign such as purple discoloration rules out a psychosomatic episode.
188. 4 A patient must give informed consent regarding information about the treatment. The best alternative for
the therapist is to have the niece visit directly with the aunt or have the niece attend a treatment session with the
aunt’s permission. Informed consent can only be given by the patient, unless the patient is incapable of doing so.
In this case, there is nothing to suggest that the patient is unable to give her own consent.
189. 4 Left hemiparesis occurs with a blockage of the right middle cerebral artery. Hemineglect syndrome is
much more common in right cerebral hemisphere lesions. Left homonymous hemianopsia occurs with a blockage
of the right middle cerebral artery. Complete blockage of the left middle cerebral artery would most likely cause a
problem with expressive speech (Broca aphasia), especially in a right-handed individual.
190. 2 While all of the options would help prevent injury to a diabetic foot, information about proper footwear is
the most important information to provide. Properly fitting footwear would alleviate risk of skin breakdown as
well as provide appropriate cushioning to the articular cartilage of the foot joints that are prone to injury from
repetitive trauma and compression. Orthoses may not be necessary for all patients. Despite moisturizing the skin, if
there is improper protection, skin breakdown can still occur. Exercising within appropriate parameters will not be
beneficial if the patient’s footwear is not supportive or properly fitting.
191. 3 These are signs of autonomic dysreflexia. Among the most common cause is a distended or irritated
bladder. The FIRST step is to remove the noxious stimulus.
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192. 1 Infection control requires that the wound not be contaminated further and that the health care workers
protect themselves from disease by avoiding contact with body fluids. In this case the patient does not appear to be
in life-threatening danger and so the wound should be attended to. Therefore, checking blood pressure would not
be the first thing to do. Once the gloves are donned, cleaning the wound and covering it with a sterile dressing
would be appropriate.
193. 4 A fading deep tendon reflex with repetitive tapping indicates developing nerve root signs. The Babinski
sign and cogwheel rigidity are signs of a central nervous system dysfunction. An absence of sensation does not
indicate developing root signs, as paresthesia or diminished sensation would.
194. 4 The independent variable can be thought of as the cause or treatment and the dependent variable can be
thought of as the effect or response. In this case the TENS is the treatment or independent variable. Continuous
and discrete variables are methods of quantifying variables.
195. 4 Medial (internal) rotation of the left hip is limited. This could be caused by hypomobility of the left hip
capsule or tightness of the left lateral (external) rotators, especially the piriformis. Hypomobility of the medial
(internal) rotators would cause limited lateral (external) rotation.
196. 3 The left limb must function as the main support limb. Any treatment strategy for ambulation must ensure
that the remaining limb is optimally functioning and that the limb is healthy. While the other factors are relevant,
the integrity of the remaining limb is the greatest concern for this patient in establishing long term, functional
goals.
197. 3 Urinary frequency is not a side effect of opioids. Hypertension is a potential side effect of stronger
opioids such as morphine. Constipation is a frequent side effect of opioid analgesics, because they decrease
gastrointestinal motility. Diaphoresis is a symptom of narcotic withdrawal, but is not expected in a patient who is
still taking the medication.
198. 4 Although bed rest would decrease pressures on the foot and may allow healing, it would also lead to
deconditioning and other avoidable side effects. A custom molded shoe would not be sufficient as an initial
treatment option, as the wound is still open. Crutches with toe-touch weight-bearing would help to decrease the
pressure on the heel if the patient were able to appropriately follow instructions. However, as the patient most
likely cannot feel the foot, there is a high probability of noncompliance. Also, it would not protect the foot from
further injury as does the total-contact casting. The patient’s report of stepping on a tack without realizing it
indicates that this patient has a neuropathy. The best way to treat a neuropathic foot ulcer is with total-contact
casting.
199. 2 Neither a social worker nor a nutritionist can adequately treat the patient’s depression. A patient
exhibiting symptoms of chronic pain and depression warrants a referral to a psychiatrist or psychologist. A
physiatrist can address the patient’s chronic pain, but is not as well equipped as a psychiatrist to address the
patient’s depression.
200. 2 Because the problem is a behavioral disorder, the most appropriate person to assess this patient would be
a neuropsychologist. The neuropsychologist is trained to assess intellectual, emotional, and coping functions of the
patient as well as levels of depression and anxiety. A neuropsychologist could also provide consultation to help the
rehabilitation team members deal with the problem.
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Practice Questions 1

72. Which of the following properties describes hyaline cartilage?

87. Which of the following descriptions BEST characterizes stable angina?

89. Which of the following endocrine glands regulates sexual development?

147. What is the close-packed position of the hip?

184. The PRIMARY purpose of pursed-lip breathing is to:

71. 2 The definition of pitting edema is described in the stem.

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