WEEK 3

1. A patient with a cerebellar stroke has received functional balance training for 4 weeks. Which
of the following tests is MOST appropriate to measure the effectiveness of the physical therapy
intervention?
a. Romberg Test
b. Berg Balance Scale
c. Fugl-Meyer Assessment
d. Barthel Index
Correct Answer
Berg Balance Scale

Feedback
Although the Romberg Test is a measure of the role of vision in balance, it alone would not be
the most appropriate measure for functional balance. The Berg Balance Scale is an objective
measure
of static and dynamic balance abilities and consists of 14 commonly performed functional tasks;
therefore, it is the most appropriate tool to use as a measure of intervention effectiveness. The
Fugl-Meyer Assessment is appropriate for cortical strokes and would not be the most
appropriate for a cerebellar stroke. It is not as comprehensive in balance tasks as the Berg
Balance Scale. The Barthel Index is a more global instrument and is not as focused on
functional balance as the Berg.

 
2. During the gait evaluation of a patient, a physical therapist notices that the patient
laterally bends excessively toward the right side during the midstance phase on the right. For the
therapist to test the suspected muscle for Normal strength (5/5), the patient should FIRST be
positioned:
a. prone with the knee straight.
b. supine with the knee bent.
c. seated with the hip flexed to 110°.
d. sidelying on the left side.
Correct Answer
sidelying on the left side.
Feedback
Prone with the knee straight would be used to test for a Poor (2/5) grade. Supine with knee bent
is used to isolate the gluteus maximus. Seated hip flexion is used to test the hip flexor muscle
strength. The most likely cause of laterally bending toward the stance limb is abductor weakness
on the stance side. The lateral bending helps compensate for weak abductors. The right
abductors would be tested from a left sidelying position for Fair (3/5) or greater strength.
 
3. A patient is asked to grip a white card between the thumb (1st digit) and index finger (2nd
digit) with both hands. The physical therapist pulls on the card in the direction of the arrow
shown. As the therapist pulls on the card the patient’s right thumb flexes at the interphalangeal
joint. The results indicate weakness in which of the following muscles?

a. Flexor pollicislongus
b. Abductor pollicisbrevis
c. Adductor pollicis
d. Extensor pollicislongus
Correct answer
Adductor pollicis
Feedback
The test shown in the photograph is the Froment test. Both thumbs (1st digits) should stay
extended during the test. If the thumb (1st digit) flexes, it is indicative of weakness of the
adductor pollicis with substitution by the flexor pollicislongus, which is usually due to a lesion of
the ulnar nerve.
 
4. A patient had knee surgery 4 weeks ago. Which of the following neuromuscular electrical
stimulation parameters would be MOST appropriate to use for strengthening the
patient’s quadriceps muscle?
a. 1 to 4 pps, 100 microseconds
b. 1 to 4 pps, 350 microseconds
c. 40 to 50 pps, 350 microseconds
d. 100 pps, 100 microseconds
Correct Answer
40 to 50 pps, 350 microseconds
Feedback
The pulse width of 100 microseconds makes it difficult to achieve a strong enough motor
response. A 1 to 4 pps frequency may lead to a twitch motor response, but not tetany, which is
needed for strengthening. The correct answer requires a frequency that will lead to tetany
(something above about 30 Hz) and a long enough pulse width to recruit motor fibers (usually
something greater than
200 microseconds). Therefore, of the options, 40 to 50 pps with a pulse width of 350
microseconds is the best. Option 4 describes the typical parameter for conventional
transcutaneous electrical nerve stimulation for acute pain management. However, the pulse
width of 100 microseconds makes it difficult to achieve a motor response, and the higher
frequency of 100 pps leads to rapid fatigue.
 
5. During the shoulder examination of a patient, a physical therapist notes the presence of a
capsular pattern without radicular pain. To help establish the cause of the capsular pattern, the
therapist should NEXT:
a. perform axial compression on the cervical spine to check for nerve root compression.
b. ask the patient if there has been any prior trauma to the shoulder joint.
c. check for a painful arc during active range of motion.
d. examine the shoulder for a rotator cuff tear.
Correct answer
ask the patient if there has been any prior trauma to the shoulder joint.
Feedback
A nerve root impingement commonly gives radicular pain. One of the most common causes of a
capsular pattern in the shoulder is traumatic arthritis following injury to the shoulder. The
capsular pattern may gradually develop over time. A painful arc is often associated with a
noncapsular pattern such as seen with bursitis or tendonitis at the shoulder. A torn rotator cuff
is associated with weakness and loss of active shoulder elevation.
 
6. To help students apply a newly learned skill to clinical practice, the MOST effective action
for the clinical instructor to take is to:
a. point out possible clinical situations and discuss how the skill would apply to them.
b. have the students research reference materials and compile a list of the steps required to
acquire the skill.
c. prepare a list of indications and contraindications for the skill.
d. have the students provide examples of clinical situations where the skill would be
appropriately applied
Correct answer
have the students provide examples of clinical situations where the skill would be appropriately
applied
Feedback
Behavioral objectives should be learner centered, outcome oriented, specific, and measurable.
Option 4 is the only one that is learner (student) centered and specific to a situation. Options 1
and 3 require action by the clinical instructor, not the student.
 
7. Which of the following postural drainage positions is MOST appropriate for a patient who has
aspiration pneumonia in the right middle lobe and who had a craniotomy 2 days ago?
a. Right sidelying with one-quarter turn toward supine
b. Left sidelying with one-quarter turn toward supine with head of bed down approximately 20°
c. Right sidelying with one-quarter turn toward supine with head of bed down approximately 20°
d. Left sidelying with one-quarter turn toward supine
Correct answer
Left sidelying with one-quarter turn toward supine
Feedback
Option 1 is incorrect because the traditional position to drain the right middle lobe is left
sidelying, not right sidelying. Option 2 is the traditional drainage position for right middle lobe,
but does not take into account the intracranial pressure issues. Option 3 is the traditional
drainage position for right middle lobe but does not take into account the intracranial pressure
issues. The traditional position to drain the right middle lobe is left sidelying with one-quarter
turn toward supine, head of bed down approximately 20°. However, because of the recent
craniotomy, the patient’s increased intracranial pressure is a major issue to monitor and keep
stable. Therefore, this traditional position should be modified to flat sidelying, as described in
option 4.
 
8. While a physical therapist is performing transfer training from bed to chair with a patient who
had a total knee arthroplasty 2 days ago, the electrocardiograph monitor alarms and the therapist
notes that premature ventricular contractions have developed. What is the
therapist’s BEST course of action at this time?
a. Position the patient on a stable surface and discontinue physical therapy for the day.
b. Continue the transfer to the chair and monitor the patient’s oxygen saturation levels.
c. Continue the transfer to the chair and immediately notify the nurse about the premature
ventricular contractions.
d. Position the patient on a stable surface and determine the stability of the premature ventricular
contractions
Correct answer
Position the patient on a stable surface and determine the stability of the premature ventricular
contractions
Feedback
Option 1 would apply only after the therapist has done further analysis of the situation.
Monitoring oxygen saturation is useful but not the most immediate thing to monitor. The
therapist should monitor the electrocardiogram and blood pressure of the patient. Although
notifying the nurse is something the therapist should do, this should be done after an initial
evaluation of the stability of premature ventricular contractions. Onset of premature ventricular
contractions can be benign or stable. Less than six contractions/minute is generally stable, while
greater than six contractions/minute is considered less stable. A physical therapist should be
able to determine this stability.
 
9. A patient presents with weakness throughout the right lower extremity with normal
strength on the left side. Sensory testing shows a loss of pressure sensation over the right thigh
and leg and a loss of pain and temperature sensation over the left thigh and leg. The patient has a
positive Babinski sign on the right. Which of the following associated findings is MOST likely
to be found during further examination of this patient?
a. The presence of clonus in the left ankle
b. Marked atrophy in the right lower extremity muscles
c. Spasticity in the left lower extremity
d. Increased deep tendon reflexes on the right side
Correct answer
Increased deep tendon reflexes on the right side
Feedback
The presence of clonus would be on the right side, not the left side. Spasticity would be on the
right side, not the left side. This is a case of hemisection of the spinal cord, Brown-Séquard
syndrome. The lesion is on the right side of the spinal cord, and it is an upper motor neuron
lesion (positive Babinski sign) with damage to the corticospinal tract, posterior columns, and
lateral spinothalamic tract. Upper motor neuron spinal cord lesions present with hyperactive
tendon reflexes (in this case on the right side), clonus, and spasticity ipsilateral to the side of the
lesion. Pressure sensation is lost on the ipsilateral side, and pain and temperature are lost
contralateral to the side of the lesion due to the crossing of those fibers in the spinal cord.
 
10. Which of the following descriptions accurately reports a NORMAL patient response to deep
tendon reflex testing?
a. 2 or plus (+)
b. 3 or plus (++)
c. 0 or minus (-)
d. 1 or minus (-)
Correct answer
2 or plus (+)
Feedback
A normal response is 2 or plus (+). Minus (-) or 0 indicates an absent reflex, and minus (-) or 1
indicates a diminished response. Plus (++) or 3 indicates an exaggerated response, and plus (+
++) or 4 indicates clonus.
 
11. Which of the following structures is indicated by the arrow in the radiograph?
 a. Intertubercular groove
b. Greater tubercle
c. Lesser tubercle
d. Coracoid process
Correct answer
Greater tubercle
Feedback
The structure indicated by the arrow is the greater tubercle. The arm is medially (internally)
rotated in this radiograph.
 
12. During which of the following scenarios would gloves be required to comply with standard
precautions?
a. During all patient care in the hospital setting
b. Performing range of motion on a patient with acquired immunodeficiency syndrome
c. Massaging the neck of a patient with hepatitis C
d. Changing an infant’s diaper in a pediatric setting
Correct answer
Changing an infant’s diaper in a pediatric setting
Feedback
Gloves are required only during contact with blood or body fluids, not during patient care that
does not involve coming in contact with blood or body fluids. Gloves are required whenever
changing an infant’s diapers, because this activity involves coming into contact with body fluids.
 
13. A physical therapist is initiating intervention with a postoperative patient who is taking 20
mg of oral oxycodone (Oxycontin) for pain relief. In planning an intervention for this patient, the
physical therapist should anticipate that:
a. the patient may be hypertensive.
b. the medication may trigger cardiac arrhythmias in the patient.
c. the patient will have an increased likelihood for developing diarrhea.
d. the patient may demonstrate respiratory depression.
 
No correct answers
 
14. A patient is referred for recommendations regarding purchase of a wheelchair. The
measurements of the patient while sitting are 16 in (40.6 cm) across the widest point of the hips
and 18 in (45.7 cm) from the rear of the buttocks to the popliteal crease. Which of the following
wheelchair dimensions would be BEST suited for this patient’s needs?
a. Seat width and seat depth of 18 in (45.7 cm)
b. Seat width of 18 in (45.7 cm) and seat depth of 16 in (40.6 cm)
c. Seat width and seat depth of 16 in (40.6 cm)
d. Seat width of 16 in (40.6 cm) and seat depth of 18 in (45.7 cm)
Correct answer
Seat width of 18 in (45.7 cm) and seat depth of 16 in (40.6 cm)
Feedback
The seat width should be slightly wider than the width of the widest body part, and the depth
should come to within 1 inch of the popliteal fossa.
 
15. A patient has low back and leg pain, with symptoms extending to the bottom of the foot.
During the physical therapy examination, the patient does not report leg pain in the first test
position (photograph #1) but reports a severe increase in symptoms in the second test position
(photograph #2). Which of the following conclusions is MOST likely?
BONUS QUESTION (Please read the rationale)
Correct answer
Feedback
Because sitting knee extension and the straight-leg raise culminate in essentially identical
positions, symptomatic responses to the two types of maneuvers should be similar. If the patient
had a symptomatic herniated disc, both positions would result in a similar symptom increase. If
the patient had an irritated sciatic nerve, both positions would result in a similar symptom
increase. If the patient had a facilitated hamstring, both positions would result in a similar
symptom response.
 
16. A physical therapist is teaching a motor skill to a patient with chronic hemiplegia. Which
of the following teaching approaches should be MOST emphasized?
a. Habituation
b. Sensitization
c. Compensatory strategy
d. Recovery of normal movement
Correct answer
Compensatory strategy
Feedback
A patient with chronic hemiplegia is unlikely to recover normal function. Compensatory
strategies are used when there is a permanent loss of function which prevents reacquiring
normal movement patterns. Habituation is a decrease in responsiveness that occurs as a result
of repeated exposure to a nonpainful stimulus. In the acute patient, the emphasis is on recovery
of normal function, but this patient has a chronic condition. Sensitization is an increased
responsiveness following a threatening or noxious stimulus.
 
17. Which of the following assignments is MOST appropriate for a physical therapist to delegate
to a volunteer?
a. Restocking treatment booths with linens, ultrasound gel, and massage lotion
b. Attending a patient who is on a tilt table while the therapist takes a phone call
c. Transporting a patient who reports dizziness back to the patient's room
d. Transferring a patient from the mat table to a wheelchair
Correct answer
Restocking treatment booths with linens, ultrasound gel, and massage lotion
Feedback
The restocking of treatment booths with supplies is the only option that does not involve direct
patient contact or care and thus is the MOST appropriate activity to delegate to a volunteer.
Although volunteers may at times be involved with patient care activities (i.e., transporting
patients), the patients in the situations described in options 2, 3, and 4 are at potential risk and
would require supervision by someone other than a volunteer.
 
18. A patient is limited in shoulder abduction, as shown in the displayed radiograph. Which of
the following mobilization techniques is MOST likely to assist the patient in achieving increased
shoulder abduction?

a. Posterior glide
b. Anterior glide
c. Inferior glide
d. Superior glide
Correct answer
Inferior glide
Feedback
Neither posterior glide, anterior glide, nor superior glide, would improve abduction. The
radiograph shows limitation of glenohumeral motion causing the reduction in shoulder
abduction. Inferior glide assists with improving abduction.
 
19. A patient suspected of having hypoglycemia is MOST likely to show which of the following
signs?
a. Fruity smelling breath
b. Thirst, nausea, and vomiting
c. Dry, crusty mucous membranes
d. Difficulty speaking and concentrating
Correct answer
Difficulty speaking and concentrating
Feedback
A common mental state manifestation of hypoglycemia is difficulty speaking and concentrating,
whereas in hyperglycemia there is outright confusion. The other options are all signs of
hyperglycemia and not signs of hypoglycemia.
 
20. A patient has a history of neck pain that is aggravated by long periods of sitting and becomes
progressively worse by evening. Range of motion and strength of the neck and shoulders are
within normal limits. Sensation and reflexes are intact in both upper extremities. The patient has
a forward head and excessive thoracic kyphosis. The MOST appropriate exercise program
should focus on:
a. stretching of the neck flexors and pectoral strengthening.
b. upper trapezius strengthening and pectoral stretching.
c. pectoral strengthening and rhomboid stretching.
d. rhomboid strengthening and axial neck retraction.
Correct answer
rhomboid strengthening and axial neck retraction.
Feedback
The history suggests that prolonged improper positioning of the cervical spine resulted in neck
pain. A chronic forward head and kyphosis results in hyperextension in the upper cervical spine
and excessive flexion in the upper thoracic spine. Further muscle length adaptation occurs with
tight anterior muscles and stretched posterior muscles. Treatment should include correction of
muscle weakness or imbalance. Rhomboid strengthening and axial neck extension are the only
options that are both correct.
 
21. A patient with which of the following diagnoses would MOST likely benefit from pursed-lip
breathing during exercise?
a. Peripheral vascular disease
b. Congestive heart failure
c. Emphysema
d. Sarcoidosis
Correct answer
Emphysema
Feedback
Peripheral vascular disease is a vascular problem, not a pulmonary problem. Congestive heart
failure may lead to pulmonary problems, but not obstructive problems. Emphysema is an
obstructive lung disease, for which pursed-lip breathing may be beneficial. Sarcoidosis is a
restrictive lung disease for which pursed-lip breathing is not beneficial.
 
22. Sensory-level electrical stimulation is MOST appropriate for a patient with which of the
following conditions?
a. Chronic low back pain of somatic origin
b. Acute ankle sprain with edema
c. Supraspinatus tendonitis
d. Active Raynaud syndrome
Correct answer
Active Raynaud syndrome
Feedback
Regarding chronic low back pain of somatic origin, the patient has a chronic problem, so will
most likely require motor-level stimulation, because it provides a longer-lasting analgesia.
There is no evidence to indicate that sensory-level stimulation is effective in the treatment of
edema. For edema reduction, rhythmic muscle contraction is preferred. Iontophoresis is more
appropriate than sensory-level electrical stimulation for treatment of a tendonitis, because it
involves the delivery of anti-inflammatory medications. Raynaud syndrome is a condition in
which the smallest arteries that bring blood to the fingers or toes constrict when exposed to cold
or from an emotional upset. Sensory-level stimulation over nerve roots and trunks can increase
peripheral vasodilatation.
 
23. In a research study, a physical therapist performs the same goniometric measurement on the
same group of control subjects during two consecutive testing sessions. This process is used to
demonstrate which of the following measurement properties?
a. External validity
b. Instrument reliability
c. Intrarater reliability
d. Interrater reliability
Correct answer
Intrarater reliability
Feedback
Intrarater reliability describes the repeatability of measurements made by one person
(repeatability within that person).
 
24. A patient who sustained a mild cerebrovascular accident 3 weeks ago is being prepared by a
physical therapist for discharge to home and an adult day program. To facilitate the discharge
plan, the MOST appropriate health professional for the therapist to consult with is the:
a. skilled nursing coordinator.
b. occupational therapist
c. medical social worker
d. primary physician. 
Correct answer
medical social worker
Feedback
Medical social service staff deal with home situations and financial supports and act as a
resource director on behalf of the patient. Social services would be the most appropriate choice
to help arrange and coordinate rehabilitative services for the patient while the patient is at
home. Although nurses, occupational therapists, physical therapists, and physicians may all be
involved with direct patient care, they would not be the most appropriate for this level of
discharge planning.
 
25. A physical therapist is evaluating a patient who has shoulder pain. The patient notices the
shoulder pain at work when stocking shelves that are overhead. The pain is not apparent when
stocking shelves at waist or chest level. The patient MOST likely has weakness in which of the
following muscles?
a. Pectoralis minor
b. Upper trapezius
c. Deltoid
d. Rhomboid major
Correct answer
Upper trapezius
Feedback
Weakness in the pectoralis minor would not cause restriction of the scapula but would likely
cause scapular hypermobility. Weakness in the upper trapezius would decrease upward rotation
of the scapula during shoulder flexion and abduction. The more the shoulder is elevated, the
more noticeable this would be. The decreased scapular movement would increase the
predisposition toward impingement. Weakness in the deltoid would cause the humerus to move
downward, not upward, during shoulder elevation. Weakness in the rhomboid major would not
cause restriction of the scapula but would likely cause scapular hypermobility.

1. A physical therapist is considering the use of phonophoresis as part of an intervention plan.

Which of the following steps is the correct FIRST step in the decision-making process to use
phonophoresis?
*
a. Outline the therapeutic goals and outcomes.
b. Select the appropriate coupling agent and medication.
c. Decide on the dosimetry by choosing the appropriate mode and frequency.
d. Determine if there are any contraindications.
Correct Answer:
Determine if there are any contraindications. 
Feedback
Although all of options are involved in the decision-making process, the determination of
contraindications is the first thing to consider, because all other options are unnecessary if the
patient has other pathologies that could be a contraindication.
 
2. A physical therapist places a patient on a strength training program for the lower extremities.
The mode of exercise is a double-leg press unit using free weights. After 1 week, the patient
shows a 10-lb (4.5-kg) increase in the amount of weight the patient is able to lift. What is
the MOST likely cause of the patient’s increase in strength?
a. Muscle fiber hypertrophy
b. Neurological adaptation
c. Hyperplasia of the muscle fibers
d. Increase in the amount of actin and myosin
Correct answer
Neurological adaptation
Feedback
Strength increase in muscle is due to a number of factors, including neurological adaptation and
muscle fiber hypertrophy with an increase in actin and myosin. Hyperplasia in humans is still
controversial. Long-term changes in muscle strength are due to all of the factors listed.
However, short-term changes, such as changes in 1 week, are most likely to due to neurological
factors such as more efficient motor unit recruitment, autogenic inhibition, and more efficient
co-activation of muscle groups
 
3. 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:
a. pronation, finger flexion, and thumb adduction.
b. pronation, finger flexion, and thumb opposition.
c. supination, finger abduction, and thumb opposition.
d. supination, finger flexion, and thumb extension
 
Correct answer
pronation, finger flexion, and thumb opposition.
Feedback
The median nerve innervates the following muscles in the forearm: (1) pronator teres and
quadratus, (2) flexor digitorumsuperficialis, (3) flexor digitorumprofundus (index and middle
fingers), (4) thenar muscles (abductor pollicisbrevis, opponenspollicis, flexorpollicisbrevis).
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).
 
4. Which of the following conditions is the MOST likely cause of a reduced vital capacity in a
patient who has quadriplegia at the C5–C6 level?
a. Decreased anterolateral chest expansion resulting from paralysis of the external intercostal
muscles
b. Inability of the patient to generate a negative intrapleural pressure secondary to a denervated
diaphragm
c. A relatively high resting position of the diaphragm resulting from paralysis of the abdominal
muscles
d. Reduced rib-cage elevation due to paralysis of the anterior scalene and sternocleidomastoid
Muscles
 
Correct answer
Decreased anterolateral chest expansion resulting from paralysis of the external intercostal
muscles
Feedback
The rib cage would not be able to expand normally during inspiration due to weakness of the
external intercostal muscles, which are innervated by thoracic nerve segments. With a spinal
cord lesion at the C5–C6 level, the diaphragm would still receive innervation from the phrenic
nerve (C4). The anterior scalene (C4–C6) would be partially innervated and the
sternocleidomastoid (C2–C3) would be fully innervated. The abdominal muscles would not be
innervated since they receive their innervation from thoracic nerve segments. Paralysis of the
abdominal muscles would cause the diaphragm to assume a low resting position.
 
5. In a research study, a correlation coefficient of .30 was found for the relationship between two
variables. Which of the following interpretations of this finding is MOST appropriate?
a. The variables have a low correlation.
b. Thirty percent of the variability in one variable can be accounted for by the other variable.
c. There are no significant differences between the variables.
d. There is low positive predictive value between the variables.
Correct Answer:
The variables have a low correlation.
Feedback
A correlation coefficient of .26 to .49 is considered low.
 
6. A physical therapist wants to examine the relationship between lower extremity manual
muscle test grades and five ranked categories of functional ambulation ability in a group of older
adults. Which of the following statistics is MOST appropriate for testing this relationship?
a. Paired t-test
b. Pearson product-moment correlation (r)
c. Mann-Whitney U test
d. Spearman rho (rs)
Correct answer
Spearman rho (rs)
Feedback
The research question is one of relationship or correlation between measures, not comparison of
group means, so the t test and the Mann-Whitney U test are not appropriate. Because the data
for both variables are ranked (ordinal), Spearman rho (Spearman rank correlation coefficient)
should be used. This is the nonparametric analog of the Pearson correlation coefficient (r). The
Pearson r requires continuous, not ordinal, data.
 
7. A physical therapist is working on transfers with a patient who had a brainstem
cerebrovascular accident. The patient has ataxia in all four extremities and a high level of
extensor tone in the lower extremities. The patient has fair to good trunk control. Which of the
following transfers is BEST for this patient?
a. Squat pivot
b. Sliding board
c. Standing pivot
d. Dependent tuck
Correct answer
Squat pivot
Feedback
A squat-pivot transfer avoids full lower extremity extension, thus minimizing lower extremity
extensor tone. A sliding-board transfer is not appropriate with a high level of ataxia in the upper
extremities. A standing-pivot transfer is not appropriate because it may increase the extensor
tone in the lower extremities. A dependent tuck transfer does not encourage active patient
participation or promote independence.
 
8. Which of the following diagnoses is MOST associated with urinary incontinence?
a. Orchitis
b. Testicular cancer
c. Testicular torsion
d. Benign prostatic hyperplasia
Correct answer
Benign prostatic hyperplasia
Feedback
The nodular hyperplasia that occurs with benign prostatic hyperplasia causes obstruction of the
urethra, resulting in urinary frequency and urge incontinence. Testicular torsion, orchitis, and
testicular cancer are not associated with urinary dysfunction.
 
9. Excessive upward rotation of the right scapula is noted when a patient attempts to perform
shoulder flexion. Which of the following exercises is MOST appropriate to help correct the
excessive scapular rotation?
a. Right scapular protraction against resistance with the right arm at 90° of flexion
b. Bilateral scapular elevation with the upper extremities at 180° of flexion
c. Wall push-ups with an isometric hold at end range with the elbows flexed
d. Wall push-ups with an isometric hold at end range with the elbows extended
Correct answer
Wall push-ups with an isometric hold at end range with the elbows extended
Feedback
Excessive upward rotation of the scapula can result from weakness of the rhomboids and
latissimus dorsi (downward rotators). The scapular adduction with medial (internal) rotation
and adduction of the arm would require action by those muscles. Option 1 would help strengthen
the serratus anterior, an upward rotator of the scapula. Option 2 would activate the upper
trapezius as well as the rhomboids, and, since the upper trapezius is also an upward rotator of
the scapula, this would not be the best exercise to use. Option 3 would also help strengthen the
serratus anterior, which would tend to aggravate the problem.
 
10. A patient with low back pain also reports constipation, occasional nausea and vomiting, and
unexplained weight loss. The pain worsens when the patient is supine and decreases when the
patient leans forward when sitting. The sclerae are yellow. The signs and symptoms
are MOST consistent with which of the following disorders?
a. Appendicitis
b. Cholecystitis
c. Pancreatic carcinoma
d. Irritable bowel syndrome
Correct answer
Appendicitis
Feedback
Pancreatic cancer is characterized by nonspecific and vague symptoms, which can include
nausea, weight loss, pain radiating to the back or back pain alone, and jaundice. Sitting up and
leaning forward may provide some relief by taking pressure off the pancreas. Irritable bowel
syndrome is characterized by abdominal pain with constipation and diarrhea, nausea and
vomiting, but not referred back pain or jaundice. Cholecystitis is an inflammation of the
gallbladder and typically produces right upper quadrant abdominal pain. There may be nausea
and vomiting, weight loss, and jaundice. However, the pain is referred to the upper back or right
shoulder, not the low back. There is also anorexia, nausea and vomiting with appendicitis, but
the pain is present generally over the right lower quadrant. Bending forward may worsen the
symptoms because of the resultant increase in intraabdominal pressure.
 
11. A physical therapist is teaching a patient who has recently undergone knee surgery to use a
cane while descending stairs without a railing. The patient has partial weight-bearing status on
the right. Which of the following instructional methods should the therapist use to teach the
patient this activity?
a. The therapist stands behind the patient, and the patient descends with the cane and left leg
first.
b. The therapist stands beside the patient, and the patient descends with the right leg first and
then the cane.
c. The therapist stands below the patient, and the patient descends with the cane and right leg
first.
d. The therapist stands behind the patient, and the patient descends with the left leg first
Correct Answer:
The therapist stands below the patient, and the patient descends with the cane and right leg first.
Feedback
Options 1, 2, and 4 are neither safe nor appropriate. When descending stairs, it is generally best
for the therapist to be positioned below the patient as protection from falling. However, the
patient should always descend stairs leading with the involved leg, the right leg in this case, and
the cane.
 
12. Which of the following lower extremity findings is MOST likely to be the FIRST sign of
vascular occlusive disease?
a. Edema of the legs and ankles
b. Brown discoloration at the ankles
c. Increased cyanosis when legs are dependent
d. Lack of hair on the toes
Correct answer
Lack of hair on the toes
Feedback
Poor hair growth is characteristic for arterial disease due to inadequate cellular nutrition. The
first sign of arterial disease is often loss of hair on the toes. Edema may be present with
advanced cases of arterial disease. Increased cyanosis with legs in the dependent position is
present in advanced disease. Brownish discoloration at the ankles is characteristic of chronic
venous disorders.
 
13. A patient with a complete thoracic spinal cord injury is sitting in a wheelchair on a custom
made cushion. Pressure relief activities should be performed:
a. when the patient shows signs of pressure sores.
b. every 15 to 20 minutes.
c. every 1 to 2 hours.
d. if the patient does not have an appropriate cushion
Correct Answer
every 15 to 20 minutes.
Feedback
A patient with a thoracic spinal cord level injury is able to perform independent pressure relief
strategies and should complete pressure relief every 15 to 20 minutes.
 
14. A physical therapist is examining muscle strength in a patient. The patient is asked to move
the leg along the path indicated by the arrow shown in the photograph and to hold the leg in
place while the therapist applies resistance to the leg. The patient moves through the range of
motion shown and is able to take maximal resistance. Intervention should address which of the
following problems?
 a. Tightness of the hip medial (internal) rotators
b. Weakness of the gluteus minimus and medius
c. Correction of the right lateral trunk shift
d. Piriformis weakness
Correct answer
Tightness of the hip medial (internal) rotators
Feedback
The fact that the patient has normal muscle strength of the hip lateral (external) rotators along
with limitation of range of motion indicates either tightness of the medial (internal) rotators or
hip capsule tightness. The gluteus medius and minimus are medial (internal) rotators of the hip.
The trunk shift is a normal substitution pattern found in individuals who lack hip range of
motion. The problem is related to the hip, not the trunk. The patient’s piriformis shows normal
strength, so it is not weak.
 
15. Which of the following joint mobilizations would be MOST effective for improving a
patient’s ability to progress into terminal stance?
a. Anterior glide of the talus on the tibia
b. Posterior glide of the calcaneus on the talus
c. Plantar glide of the 1st proximal phalanx on the metatarsal
d. Dorsal glide of the 1st proximal phalanx on the metatarsal
Correct answer
Dorsal glide of the 1st proximal phalanx on the metatarsal
Feedback
Extension of the 1st metatarsophalangeal joint is needed in terminal stance. The distal
metatarsal is convex. The proximal portion of the articulating phalanx is concave. According to
the convexconcave rule, when a therapist moves a concave joint surface on a convex joint
surface, the concave joint surface is moved in the same direction as the range-of-motion
limitation. Therefore, the appropriate accessory glide is a dorsal glide of the proximal phalanx
on the metatarsal. Anterior glide of the talus on the tibia and plantar glide of the 1st proximal
phalanx on the metatarsal promote plantar flexion. Posterior glide of the calcaneus on the talus
is not as relevant for terminal stance, which involves the 1st MTP joint.
 
16. A 90-year-old patient with chronic congestive heart failure has been non-ambulatory and has
resided in a nursing home for the past year. The patient was recently admitted to the hospital
after an episode of dehydration. Which of the following plans for prophylactic respiratory care
is MOST appropriate?
a. Turning, coughing, and deep breathing every 1 to 2 waking hours
b. Vigorous percussion and vibration 4 times/day
c. Gentle vibration with the foot of the bed elevated 1 time/day
d. Segmental postural drainage using standard positions throughout the day
Correct answer
Turning, coughing, and deep breathing every 1 to 2 waking hours
Feedback
A patient who is immobile and restricted to bed is at risk for developing atelectasis (partial
collapse of lung tissue), which can then lead to pneumonia. Frequent position changes with deep
breathing and coughing will help prevent development of atelectasis. Given that this patient is
elderly and does not have a diagnosis of secretion retention, vigorous percussion and vibration
is not indicated. Vibration with the head down or standard postural drainage positions will not
be tolerated in this elderly patient with chronic congestive heart failure.
 
17. A patient has medication-induced Cushing syndrome. Which of the following physiological
problems is a common manifestation of this disorder?
a. Hypotension
b. Hypercalemia
c. Muscle catabolism
d. Decreased protein metabolism
 
Correct answer
Hypercalemia
Feedback
Corticosteroid-induced myopathies are common after prolonged use of the drug, and they are
common in the proximal musculature of the extremities. The other options are the opposite of
symptoms commonly found with steroid-induced conditions. Usually there are problems with
hypertension, hypocalemia, and increased protein metabolism.
 
18. A patient is lying supine with hips and knees extended and hands behind the head. The
patient is able to raise the head, shoulders, and thorax from the treatment table but is unable to
come to a complete long sitting position. What muscle should the physical therapist target for a
strengthening program?
a. Iliopsoas
b. External abdominal oblique
c. Quadratus lumborum
d. Upper rectus abdominis
Correct answer
Iliopsoas
Feedback
The abdominal muscles are active during a sit-up (with the knees extended) up until the spine is
completely flexed (head, shoulders, thorax lifted from surface). In order to come to a long-sitting
position, however, the hips must be flexed, and the abdominals cannot perform this action
because they do not cross the hip joint. Therefore, the hip flexors (iliopsoas among others)
would have to complete this motion. The inability to achieve a long-sitting position would
suggest weakness in the iliopsoas muscle.
 
19. During an intervention session with a patient with a recent onset of hemiplegia, a physical
therapist plans to focus on transfers to and from a wheelchair, a bathtub, and an automobile.
Which of the following methods should be MOST effective for long-term retention of these
skills?
a. Practice the activities in random order.
b. Sequence the activities from easiest to most difficult
c. Allow the patient to determine the sequence of activities
d. Establish a predictable but variable practice sequence.
Correct answer
Practice the activities in random order.
Feedback
It has been determined that a critical factor in improving learning is that the subject must do
something different on consecutive trials. Therefore the traditional approach for retraining by
practicing one skill repeatedly is not the most effective. It is believed that having a patient
practice a number of tasks in random order would probably be more successful for long-term
retention. The other options do not provide for randomization of the activities and are therefore
less likely to provide for long-term retention.
 
20. A long-distance runner comes to physical therapy with insidious onset of lower leg pain. The
patient’s examination results reveal weakness of toe flexion and ankle inversion. The physical
therapist suspects vascular compromise associated with this presentation. Palpation at which of
the following locations is MOST likely to reveal diminished arterial pulses in the patient?
a. Dorsal aspect of the foot
b. Posterior to the lateral malleolus
c. Posterior to the medial malleolus
d. Lateral aspect of the popliteal fossa
Correct answer
Posterior to the medial malleolus
Feedback
The posterior tibial artery is most likely to be involved in chronic posterior compartment
syndrome, which is described in the question. This artery should be palpated posterior to the
medial malleolus. The dorsal aspect of the foot is the site for palpation of the dorsalispedis
pulse. The dorsalispedis artery is not involved in posterior compartment syndrome. The
palpation site posterior to the lateral malleolus is used to access the fibular (peroneal) artery.
The fibular (peroneal) artery is not involved in posterior compartment syndrome. Palpation in
the popliteal fossa is a poor choice of palpation location in association with posterior
compartment syndrome. The popliteal artery may be palpated here, but the compartment
syndrome manifestations are distal to this site.
 
21. The work modification (standing) shown in the photograph is MOST appropriate for a
patient with which of the following pathologies?

a. Central lumbar stenosis

b. Deep vein thrombosis
c. Thoracolumbar scoliosis
d. Posterolateral lumbar disc bulge
Correct answer
Posterolateral lumbar disc bulge
Feedback
The photograph shows a standing desk/work station. A patient with stenosis will do better in
sitting, not standing. A patient with a deep vein thrombosis will need to move, not be stationary.
A scoliosis alone does not warrant a standing work station. Sitting increases intradiscal
pressure, so standing is often preferred to sitting.
 
22. A physical therapist is conducting a reflex text as shown in the photographs. The arrow
indicates the path of the applied stimulus. The results of the test are MOST likely to indicate:

a. a peripheral nerve injury

b. a lesion of the anterior horn cells
c. a normal response.
d. an injury to the spinal cord
Correct answer
an injury to the spinal cord
Feedback
The therapist is testing for a positive Babinski sign. When the Babinski sign is positive, the toes
flare at the end of the test. The presence of a positive Babinski sign indicates an upper motor
neuron lesion such as a spinal cord injury. If no upper motor neuron lesion is present, the toes
will flex. The only upper motor neuron lesion is injury to the spinal cord. Peripheral nerve
injuries and lesions of the anterior horn cells are lower motor neuron lesions.
 
23. While working in a private practice clinic, a physical therapist observes a patient fall in the
parking lot outside the office. The patient sustains a severe laceration to the forearm. The
therapist secures a pressure dressing to the wound site but notes that blood is soaking through the
dressing and the bandage. Which of the following actions should the therapist perform NEXT?
a. Elevate the limb and apply pressure to the wound.
 
b. Remove the dressing and bandage and start over with a tighter bandage.
c. Apply additional dressings and bandages and apply pressure to the brachial artery.
d. Call the patient’s physician and arrange transportation for medical care
Correct Answer
Elevate the limb and apply pressure to the wound.
Feedback
Elevation and pressure is the correct next step in controlling bleeding. Removal of the dressing
and bandage would potentially irritate the wound and increase the hemorrhage. Elevation and
pressure should be applied first, before additional dressings, bandages, and pressure to the
brachial artery. While calling the patient’s physician to arrange transportation for medical care
may be necessary, it does not immediately control the bleeding.
 
24. A patient is undergoing a treadmill stress test. The appearance of abnormally wide,
irregularly spaced QRS complexes on the electrocardiogram represents:
a. ventricular depolarization.
b. premature ventricular contractions.
c. atrial fibrillation.
d. atrial repolarization.
Correct answer
premature ventricular contractions.
Feedback
The QRS complex represents ventricular contraction. Atrial contraction is represented by the P
wave. When an area of the ventricle becomes irritable and develops an ectopic foci, the ventricle
will depolarize prematurely before the normal conduction sequence (e.g., prior to SA node firing
in the atria) and presents as a wide, irregularly spaced QRS complex. In normal ventricular
depolarization, the QRS would be narrow and regularly spaced and atrial fibrillation would
appear as the P wave changes. Atrial repolarization occurs within the QRS complex and is not
normally visible on EKG.
 
25. As a patient progresses in learning a new motor skill, there should be a resultant increase in
which of the following types of feedback?
a. Tactile
b. Visual
c. Intrinsic
d. Verbal
Correct Answer
Intrinsic
Feedback
As learning progresses, feedback should progress from extrinsic (which included tactile, visual,
verbal) to intrinsic feedback from the muscle spindle and joint receptors.

1. The authors of a research article describe a favorable study outcome as insignificant because
the study results were not statistically significant. The insignificant finding would MOST likely
be due to poor research methods if which of the following study characteristics was present?
a. Small sample size
b. Small within-group variance
c. 85% analysis power
d. Controlled alpha level
Correct Answer:
Small sample size
Feedback
small sample size can be linked to errors in statistical conclusions because there may not be
enough participants to allow application of the findings to all patients in the population of
interest. The within-group variance being smaller enables less overlapping of sample
distributions. Greater than 80% analysis power is linked with a higher probability that study
conclusions are accurate. An inflated alpha level (i.e., noncontrolled) results in a higher level of
statistical significance and greater probability of a type 1 error.
 
2. While ascending stairs, an older adult patient leans forward with increased hip flexion. Which
of the following muscles is being used to BEST advantage with this forward posture?
a. Rectus femoris
b. Tensor fasciae latae
c. Semitendinosus
d. Lumbar paraspinal
Correct answer
Semitendinosus
Feedback
The hamstrings are hip extensors that are more active when the hip is in flexion, especially in
functional activities such as stair climbing. In this case, the patient flexes the hip, placing the
semitendinosus on stretch and increasing its moment arm and increasing its ability to produce
hip extension. Therefore, the patient is leaning forward to maximize the ability of the hamstrings
to extend the hip during the stair climbing activity. The other muscles listed would not benefit as
much from the increased hip flexion.
 
3. A measurable objective for a community education program on proper exercise techniques
would be for participants to:
a. understand the importance of a sufficient warm-up period.
b. list five stretching techniques that can be used when warming up
c. overcome lower extremity problems and adhere to a regular exercise program.
d. appreciate the effects of increasing intensity of exercise on heart rate.
Correct answer
list five stretching techniques that can be used when warming up
Feedback
Objectives must be measurable, and the specific behavior expected should be stated.
Understanding, overcoming, and appreciating elude tangible measurement, while listing five
techniques is an activity that can be documented and is therefore measurable.
 
4. A physical therapist who works in a home health agency is treating a patient with diabetes
mellitus. The patient reports that he is no longer taking insulin. The therapist’s FIRST course of
action should be to:
a. instruct the patient in the proper technique for injection of insulin.
b. contact the patient’s home health nurse.
c. tell the patient’s family to report this information to the physician.
d. have the patient perform a urine glucose test while the therapist is in the home.
Correct answer
contact the patient’s home health nurse.
Feedback
Contacting the patients home health nurse is the appropriate first course of action because of
the possible safety risk associated with the patient&8217s not taking insulin. Injections and
glucose testing would go beyond the scope of practice for physical therapy. Placing the
responsibility on the family would not be appropriate because of the gravity of the situation.
 
5. A patient is entering a cardiac rehabilitation program. The physical therapist
should FIRST ask the patient to:
a. describe the correct aspects of exercise demonstrated by the therapist.
b. list problems associated with poor nutritional habits.
c. identify the harmful effects of smoking with regard to cardiac disease.
d. describe the type of angina that the patient experiences.
Correct Answer
describe the type of angina that the patient experiences
 
Feedback
In order to best intervene with a patient who has had cardiac dysfunction, a full examination
and evaluation are necessary to properly form a treatment plan. An important aspect of the
examination is ascertaining the type of angina that the patient experiences so that the therapist
will know how to prevent angina with exercise or recognize it if it does occur during the
treatment session. The other options provided are all outcomes that would occur after the
patient has completed a cardiac rehabilitation program.
 
6. 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?
a. Sensory testing of upper extremities
b. Pitting edema measurements in the lower extremities
c. Resisted manual muscle testing of all extremities
d. Reflex testing of lower extremities
Correct Answer:
Pitting edema measurements in the lower extremities
Feedback
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.
 
7. Which of the following trunk strengthening exercises is BEST for a patient to help minimize
the complications associated with osteoporosis?
a. Flexion
b. Rotation
c. Extension
d. Lateral flexion
Correct answer
Extension
Feedback
Trunk extension is the safest exercise for patients with osteoporosis and is necessary, given the
high risk for kyphosis with vertebral fractures. The other trunk motions are contraindicated for
patients with osteoporosis.
 
8. Which of the following modalities is MOST appropriate for decreasing pain and increasing
tissue extensibility prior to active hand exercises in a patient with rheumatoid arthritis?
a. Cold gel pack
b. Direct contact ultrasound
c. Continuous short-wave diathermy
d. Paraffin wax bath
Correct Answer:
Paraffin wax bath
Feedback
Paraffin wax baths are used in the nonflare phases to decrease pain and increase tissue
extensibility in patients with rheumatoid arthritis. The increase in collagen extensibility
associated with heating may decrease pain perception and increase tolerance for and
participation in active exercise. Option 1 is incorrect because cyrotherapy (cold gel pack)
decreases tissue extensibility. Options 2 and 3 are incorrect because these modalities are not
easily applied over areas with thin soft tissue (hands and fingers). Paraffin allows for even
distribution of heat to fingers (all joints).
 
9. A physical therapist is evaluating a 70-year-old female patient who reports the onset of
midthoracic pain after working in a garden for several hours. The presence of which of the
following history items should increase the therapist’s suspicion of a thoracic compression
fracture in the patient?
a. Bowel and bladder dysfunction
b. Smoking and prolonged steroid use
c. Hypertension and diabetes
d. Emphysema and hormone replacement therapy
Correct answer
Smoking and prolonged steroid use
Feedback
Bowel and bladder dysfunction are related to spinal cord/upper motor neuron dysfunction.
Smoking and steroids can weaken bone and increase the likelihood for a compression fracture.
Hypertension and diabetes are not risk factors for a compression fracture. By themselves,
neither emphysema nor hormone replacement therapy increases the likelihood of a compression
fracture.
 
10. A physical therapist is completing an examination of an inpatient with multiple comorbidities
who had a total knee arthroplasty 2 days ago. The therapist observes a bluish discoloration of the
toes on the operative extremity. This finding should be documented as:
a. cyanosis
b. deep vein thrombosis
c. Raynaud disease
d. cardiac pathology
Correct Answer:
cyanosis
Feedback
Cyanosis is described in the stem. Although this finding often accompanies cardiac / pulmonary
pathology or may occur with hematological or central nervous system disorders, the objective
description is cyanosis.
 
11. Which of the following recommendations is MOST appropriate for a patient with
gastroesophageal reflux disease?
a. Sit upright for at least 10 minutes after a meal.
b. Lie on the right side before performing exercises.
c. Head-lifting exercises should be performed in the upright position.
d. Activities that require the supine position should be performed before a meal
Correct answer
Activities that require the supine position should be performed before a meal
Feedback
Exercises that require a supine position should be performed before eating so tha?t the stomach
is relatively empty. The recommended time to remain upright after a meal is 3 hours. Head
lifting in supine is the recommended exercise to strengthen the upper esophageal sphincter
muscle. If performed in upright, the head falls into gravity and the exercise is no longer resistive.
A patient should lie on the left side to reduce reflux, because lying on the right side makes it
easier for acid flow into the esophagus, since the lower esophagus bends to the left and this
straightens out with right sidelying
 
12. 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?
a. Ice massage
b. Iontophoresis
c. Moist heat packs
d. Continuous ultrasound
Correct Answer
Continuous ultrasound
Feedback
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.
 
13. A patient has been receiving physical therapy for a large wound on the lower leg. After 3
weeks of treatment, the wound is free of necrotic tissue, but a copious amount of exudate is
present. Which of the following dressings is MOST appropriate for the wound at this time?
a. Saline-saturated gauze
b. Semipermeable film
c. Gauze impregnated with zinc oxide
d. Hydrocolloid paste
Correct Answer
Hydrocolloid paste 
Feedback
Saline-saturated gauze is not advised to control copious amounts of drainage. Semipermeable
film cannot absorb copious amounts of exudate. Gauze impregnated with zinc oxide has not been
shown to be beneficial. Hydrocolloid paste is the only option given that would be appropriate for
managing wounds with high levels of exudate.
 
14. Regular aerobic exercise lasting at least 30 minutes should be MOST beneficial in
decreasing the pathology associated with which of the following conditions?
A. Type 1 diabetes
b. Type 2 diabetes
c. Multiple sclerosis
d. Amyotrophic lateral sclerosis
Correct Answer
Type 2 diabetes
Feedback
Exercise is a major contributor in controlling hyperglycemia in type 2 diabetes by improving
skeletal muscle glucose transport and whole-body glucose homeostasis. Regular exercise can
help the body respond to insulin and is known to be effective in managing blood glucose.
Exercise can lower blood glucose and possibly reduce the amount of medication needed to treat
diabetes, or even eliminate the need for medication. Exercise has not been shown to improve
glycemic control for the person with type 1 diabetes. Patients with degenerative neuromuscular
diseases such as multiple sclerosis should use caution when exercising to avoid excessive
fatigue, which can result in permanent losses in strength. Respiratory system impairment in
individuals with multiple sclerosis and amyotrophic lateral sclerosis may lead to poor tolerance
of intense aerobic exercise.
 
15. A patient who has rheumatoid arthritis comes to physical therapy with signs of muscle
atrophy, ecchymosis, puffy cheeks, and a diagnosis of osteoporosis. Which of the following
medications is the patient MOST likely receiving?
a.Penicillin (Ampicillin)
b. Prednisone (Deltasone)
c. Acetylsalicylic acid (aspirin)
d. Gold salts
Correct answer
Prednisone (Deltasone)
Feedback
Prednisone is a glucocorticoid that exhibits the side effects described in the stem. The primary
side effect of penicillin is an allergic reaction, such as skin rashes and difficulty breathing. The
primary side effect of aspirin is gastritis. The primary side effect of gold therapy is diarrhea,
irritation of oral mucosa, and skin rashes
 
16. The parent of a 4-year-old child who has myelomeningocele is interested in obtaining
orthoses for the child’s gait training. The child has an L1 neurological level lesion. Which of the
following orthoses is the MOST appropriate selection for the physical therapist to discuss with
the parent?
a. Hip-knee-ankle-foot with locked hips
b. Reciprocating-gait
c. Knee-ankle-foot with a pelvic band
d. Ankle-foot
Correct answer
Reciprocating-gait
Feedback
Options 1, 3, and 4 would provide insufficient orthotic support for the child to walk. A child with
an L1 lesion can walk only with support of reciprocating gait orthoses or thoracic lumbar sacral
orthosis.
 
17. Which of the following motions are MOST restricted with a hip capsular pattern?
a. Medial (internal) rotation and abduction
b. Lateral (external) rotation and abduction
c. Extension and adduction
d. Flexion and lateral (external) rotation
Correct Answer:
Medial (internal) rotation and abduction
Feedback
The capsular pattern of restriction at the hip is loss of medial (internal) rotation and abduction,
followed by a loss of flexion and extension; loss of lateral (external) rotation is insignificant.
 
18. A physical therapist is preparing to evaluate a patient who had a closed reduction with cast
fixation for an ankle fracture 1 day ago and currently has non-weight-bearing status. The patient
reports foot pain in the injured extremity. Based on the patient’s report, which of the following
procedures should the physical therapist perform?
a. Gait examination
b. Transfer abilities
c. Capillary refill in toes
Correct answer
Capillary refill in toes
Feedback
Since the patient is non-weight-bearing, transfer abilities and gait examination are less likely to
yield information regarding the cause of foot pain. With regard to capillary refill in toes,
complications of cast fixation may include swelling and, if severe, compartment syndrome.
Improperly fitted casts and/or patients leaving limbs in a dependent position can result in
painful swelling that creates occlusion to distal blood flow. Testing capillary refill is an easy test
to examine distal extremity perfusion. Blood pressure changes could cause changes in perfusion
to distal extremities, but it would be very difficult to measure lower extremity blood pressure
with the cast on.
 
19. A 50-year-old patient had an uncomplicated open repair of a rotator cuff tear 2 weeks ago.
The patient asks the physical therapist when the shoulder will be normal again. Which of the
following expected outcome time frames MOST accurately addresses this patient’s question?
a. 3 weeks to lift a 5-lb (2.3-kg) object
b. 3 weeks to sleep on the involved side
c. 3 months to lift the upper extremity overhead to reach into a cabinet
d. 3 months to play golf
Correct answer
3 months to lift the upper extremity overhead to reach into a cabinet
Feedback
Three weeks is too early to lift 5-lb (2.3-kg) objects. Three weeks is too early to sleep on the
involved side. Usually by 8 to 12 weeks, a patient who has had an uncomplicated open repair of
a rotator cuff 2 weeks ago is able to actively elevate the arm to functional heights. Three months
is too early to play golf.
 
20. Upon removal of a wet-to-dry dressing from a patient’s draining wound, a physical therapist
observes that the skin immediately surrounding the wound is macerated. What should the
therapist recommend for future wound care?
a. Continue using the current dressing type.
b. Make the dressing more absorbent.
c. Leave the dressing on longer between dressing changes.
d. Change to a pressure-type dressing.
Correct Answer
Make the dressing more absorbent
Feedback
Macerated tissue results from excessive moisture. A more absorbent dressing would soak up the
excessive moisture and prevent the maceration.
 
21. Which of the following reasons is the PRIMARY purpose for applying statistical analyses to
single-subject research?
a. To substantiate visual analysis of graphically displayed data
b. To determine whether observed changes are real or chance occurrences
c. To advocate changes in intervention methods
d. To establish credibility for the intervention technique
Correct Answer
To determine whether observed changes are real or chance occurrences
Feedback
Data analysis in single-subject research is based on evaluation of measurements within and
across design phases, to determine if behaviors are changing and if observed changes during
intervention are associated with the onset of treatment. While visual analysis of graphic display
of data is the most commonly used data analyses method in single-subject design, statistical
analysis provides a more quantitative approach to determine whether observed changes are real
or chance occurrences.
 
22. An older adult patient had a total hip arthroplasty following a hip fracture from a fall in his
home. The patient lived alone and was previously able to perform all activities of daily living
independently. He has been admitted to a skilled nursing facility for rehabilitation. The patient’s
goal is to return home. His family believes he should be admitted to a long-term care facility for
his own safety after acute rehabilitation is completed. The physical
therapist’s MOST appropriate action is to:
a. Advise the family that the patient should determine his own discharge environment.
b. recommend a team conference with the patient and his family to discuss discharge plans.
c. schedule a home visit to determine if home modifications are needed before discharge.
d. implement a treatment plan with a long-term goal of discharge to home.
Correct answer
recommend a team conference with the patient and his family to discuss discharge plans.
Feedback
The best answer would be for the therapist to recommend a team conference. That conference
would bring together members of the health care team, as well as the patient and family
members, to arrive at joint decision for placement of the patient. The best time for such a
meeting would be prior to discharge, because such meetings are difficult to arrange after
discharge. Allowing the patient to determine his own discharge environment may be fine if there
are no safety concerns; however, a decision whether or not the patient is competent to make that
decision must be made first. Scheduling a home visit or the implementation of a treatment plan
for home care would be premature until a decision on placement has been made.
 
23. A patient with muscular dystrophy was removed from mechanical ventilation 1 day ago. The
patient is currently unable to independently clear secretions, despite receiving instruction in the
bronchopulmonary hygiene techniques of positioning, percussion, shaking, and vibration. Which
of the following interventions is MOST appropriate to help this patient clear the secretions?
a. Nasotracheal suctioning
b. Manual costophrenic assist
c. Supplemental oxygen
d. Inspiratory muscle training
 Correct answer
Manual costophrenic assist
Feedback
While nasotracheal suctioning is a viable option to clear a patient’s secretions, it is usually the
last resort when a patient does not have an artificial airway. So if a manual costophrenic assist
doesn’t work, then suctioning may be needed. Any patient who has been receiving mechanical
ventilation will likely have some respiratory muscle deconditioning. However, with
superimposed neuromuscular disease, the respiratory muscle weakness will be further
exacerbated. Therefore, providing manual assist at the lower ribs during cough will assist the
patient in successfully clearing secretions. Supplemental oxygen can help a patient’s ventilatory
muscle endurance but does not ensure that the patient will be able to generate enough force
during the cough. Inspiratory muscle training would be beneficial for this patient, but not at this
acute stage just after removal of ventilation. Once secretions are under control, then muscle
training can begin.
 
24. A patient with chronic venous insufficiency of the lower extremities is MOST likely to
exhibit:
a. normal superficial veins, no edema, ulceration, and patches of gangrene around the toes.
b. dilation of superficial veins, edema, and stasis ulceration
c. no edema, faint dorsalis pedis pulse, and cold, hairless extremities.
d. dilation of superficial veins and edema made worse during sitting or elevation of the lower
extremities
Correct Answer
dilation of superficial veins, edema, and stasis ulceration
Feedback
With venous insufficiency, the limbs would be edematous and the superficial veins would be
dilated. If the venous insufficiency is not corrected, ulceration could develop. Options 1 and 3
are ruled out because they indicate no edema. Option 4 is not correct because the condition is
relieved by sitting or leg elevation.
 
25. Which of the following teaching strategies is MOST appropriate for an older adult patient
with mild dementia?
a. Use auditory or visual input separately.
b. Use metaphors to reinforce new concepts.
c. Establish a consistent pace for teaching.
d. Present one piece of new information at a time.
Correct answer
Present one piece of new information at a time.
Feedback
To minimize confusion, the patient should be presented with one new item at a time. The pace of
learning should be set by the patient. Visual and auditory input together can promote learning.
Concrete examples are easier to understand than metaphors.

1. A physical therapist researcher is developing a study to compare differences in range of

motion outcomes in two groups of patients who have had a total knee arthroplasty. Over an 8-
week period, one group of patients receives outpatient physical therapy 1 time/week and the
other group receives outpatient physical therapy 3 times/week. In this study, what is the
dependent variable?
a. Range of motion
b. Frequency of visits
c. Total knee arthroplasty
d. 8 weeks
Correct Answer
a. Range of motion
Feedback
The dependent variable (ROM) is the factor that is caused by the independent variable
(frequency of visits).
 
2. A physical therapist reads that the interrater reliability of a new hand-held dynamometer is .93.
What is the MOST appropriate interpretation of this value?
a. Similar scores were obtained for a group of subjects when different therapists measured the
subjects
b. Similar scores were obtained for a group of subjects when the same therapist repeated the
measures.
c. Dissimilar scores were obtained for a group of subjects when different therapists measured the
subjects.
d. Dissimilar scores were obtained for a group of subjects when the same therapist repeated the
measures.
Correct answer
Similar scores were obtained for a group of subjects when different therapists measured the
subjects
Feedback
Interrater reliability concerns variation between two or more raters who measure the same
group of subjects. The reliability coefficient has values from 0.00 to 1.00. A reliability of 1.00
means there was total agreement. Thus a value of .93 means there was a high degree of
agreement on the scores from the dynamometer among several therapists. Agreement of
measures by the same therapist would be intrarater reliability.
 
3. During manual muscle testing of the hip flexors in the sitting position, a patient exhibits lateral
(external) rotation with abduction of the thigh as resistance is applied. The physical therapist
should suspect muscle substitution by the:
a. sartorius.
b. tensor fasciae latae.
c. adductor longus.
d. semimembranosus.
Correct answer
sartorius.
Feedback
The sartorius flexes, laterally (externally) rotates, and abducts the hip joint. With resisted hip
flexion, the sartorius will be recruited to perform all three actions, giving the observed
substitution pattern. The tensor fasciae latae is a medial (internal) rotator and flexor of the hip,
so substitution by it would involve medial (internal) rotation and abduction. The adductor
longus would adduct the hip. Substitution by the semimembranosus would cause hip extension.
 
4. If a transtibial prosthesis has an excessively firm heel wedge, the patient is MOST likely to
walk with:
a. excessive knee flexion in foot flat (loading response).
b. premature knee flexion in heel off (terminal stance).
c. insufficient knee flexion in foot flat (loading response).
d. excessive knee flexion in heel off (terminal stance).
 Correct answer
excessive knee flexion in foot flat (loading response).
Feedback
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.
 
5. A patient with Parkinson disease has just been admitted to a rehabilitation unit. The patient is
dependent in all transfers and requires moderate assistance of one person to walk 30 ft (9.1 m)
with a standard walker. To facilitate good carryover for activities, instruction of the family in
transfers should occur:
a. during a home visit after the patient is discharged.
b. just prior to discharging the patient.
c. early in the rehabilitation program
d. when the family feels ready to take the patient home.
Correct Answer:
early in the rehabilitation program

Feedback
The family should be involved in all stages of planning and treatment. Family involvement can
shorten the rehabilitation process and facilitate the patient’s return to the community. It is
important to have the family involved early in the rehabilitation process rather than wait until
the patient is ready to be discharged.
 
6. A patient who is 8 months pregnant has an abdominal diastasis-recti with a separation of 1.5 in
(4 cm). Which of the following exercises would be the MOST appropriate initial exercise for
abdominal strengthening in a supine position?
a. trunk curls
b. Hooklying head lifts
c. Pelvic-tilt leg sliding
d. Bilateral leg lowering
Correct Answer
Hooklying head lifts
Feedback
Trunk curls are contraindicated for a patient with diastasis recti. Supine hooklying head lifts
emphasize the rectus abdominis muscle and are least likely to increase the separation of the
diastasis recti. Pelvic-tilt leg sliding is more advanced than head lifts. Bilateral leg-lowering is
an advanced abdominal strengthening exercise that causes excessive low back strain and should
not be performed during pregnancy.
 
7. Clubbing of the fingers is MOST associated with which of the following pathologies?
a. Lymphedema
b. Pulmonary disease
c. Chronic venous insufficiency
d. Complex regional pain syndrome
Correct answer
Pulmonary Disease
Feedback
Conditions that chronically interfere with tissue perfusion and nutrition may cause clubbing.
Pulmonary disease is the most predominant cause of digital clubbing, present 75% to 85% of the
time clubbing is noted. Since the other conditions also affect tissue perfusion, they could
contribute to the condition, but are not listed as common findings.
 
8. The physical therapist is positioning a patient for postural drainage. To BEST drain the
posterior segment of both lower lobes, the patient should be placed in which of the following
positions?
a. Prone, head down at a 45° angle

b. Supine, flat surface

c. Sidelying, head elevated at a 30° angle
d. Sitting, leaning forward
Correct Answer

Prone, head down at a 45° angle

Feedback
The best position for draining the posterior segment of both lower lobes would be prone lying
with the head down and the lower extremities and hips elevated to about 45°.
 
9. In addition to standard precautions, what other precaution should a physical therapist observe
when working with a patient infected with methicillin-resistant Staphylococcus aureus?
a. Airborne

b. Sterile
c. Droplet
d. Contact
Correct answer
Contact
Feedback
Since methicillin-resistant Staphylococcus aureus is spread by contact, wearing a face shield or
mask is not necessary. Sterile precautions or techniques are not necessary for the physical
therapist to use with a patient infected with methicillin-resistant Staphylococcus aureus.
 
10. A patient who reports double vision has ptosis, lateral strabismus, and a dilated pupil in the
left eye. Which of the following cranial nerve test results is MOST likely to be abnormal?
a. Pupillary light reflex
b. Facial muscle strength
c. Jaw-jerk reflex
d. Pain sensation on the face
Correct Answer:
Pupillary light reflex
Feedback
The cranial nerve involved is the oculomotor nerve. This nerve innervates the medial rectus,
which, if weak, would cause a lateral strabismus. The oculomotor nerve is also responsible for
mediating papillary constriction and a lesion would cause papillary dilation. The ptosis is
caused by loss of innervation to the levator palpabrae superioris muscle, which elevates the
eyelid. The double vision would be caused by the inability to move the eyeball normally, because
four of the six ocular muscles are controlled by the oculomotor nerve. The oculomotor nerve is
also important in mediating the pupillary light reflex. The facial nerve innervates the muscles of
facial expression. The trigeminal nerve mediates the jaw-jerk reflex and pain sensation from the
face.
 
11. A patient has a spinal cord injury that resulted in damage to the sacral segments and
disruption of the sacral reflex arc. The patient is MOST likely to have which of the following
characteristics?
a. Voluntary control of defecation
b. Tonic contraction of the external anal sphincter
c. Flaccidity of pelvic floor musculature
d. Permanent absence of the gastrocolic reflex
 
Correct answer
Flaccidity of pelvic floor musculature
Feedback
The external anal sphincter and pelvic floor muscles are composed of striated muscle fibers.
They receive somatic innervation from sacral cord segments 2 through 4. With damage to these
segments, the sphincter and the pelvic floor muscles remain flaccid. The individual loses
voluntary control of defecation. The gastrocolic reflex, mediated by the intrinsic nervous system
of the GI tract, returns after resolution of spinal shock.
 
12. Which of the following instructions is MOST appropriate for teaching a patient with C6
quadriplegia to transfer from a wheelchair to a mat?
a. Keep fingers flexed to give a broader base of support.
b. Keep fingers extended to give a broader base of support.
c. Rotate head and shoulders in the direction opposite to the desired hip motion.
d. Keep both hands next to the knees to lock the elbows.
Correct Answer
Rotate head and shoulders in the direction opposite to the desired hip motion.

Feedback
The position described creates the necessary force to move the lower body in this transfer, given
the level of the spinal cord injury. Finger extension against resistance would be difficult? for a
patient with C6 quadriplegia. The patient’s hands would be kept near the thigh or hips with one
hand on the mat and one on the wheelchair.
 
13. Which of the following findings BEST describes normal capillary filling?
a. Rebound vasodilation after icing
b. Blood pressure of 120/76 mm Hg
c. Pulse oximetry measurement of 98%
d. Blanching of the nail bed with color return in <3 seconds
 
Correct Answer
Blanching of the nail bed with color return in <3 seconds
Feedback
By definition, the blanching of nail bed with color return in < 3 seconds is normal capillary
refill.
 
14. During evaluation of a patient’s balance, a physical therapist gently pushes the patient
backward slightly and observes how the patient recovers from the perturbation. What strategy is
the patient MOST likely to use to correct for the perturbation?
a. Knee
b. Hip
c. Ankle
d. Stepping
 
Correct answer
Ankle
Feedback
Regarding options 1 and 2, for larger perturbations, individuals utilize hip and knee muscles to
recover the balance. Regarding option 3, for slight perturbations, most individuals use an ankle
strategy. Ankle musculature is used to control the perturbation and recover the balance.
Regarding option 4, if the perturbation is strong enough to cause the individual’s center of mass
to move outside the base of support, a stepping strategy would be employed by taking a step and
increasing the size of the base of support.
 
15. During an examination of elbow strength using manual muscle testing, a patient supinates the
forearm when attempting elbow flexion. Which of the following muscles is MOST likely doing
the major part of the work?
a. Biceps brachii
b. Brachialis
c. Supinator
d. Brachioradialis
Correct Answer
Biceps brachii
Feedback
The biceps brachii is both an elbow flexor and supinator, and it is most effective as a supinator
with the elbow flexed to about 90° (approximately the muscle testing position). The brachialis
does not cause supination (only flexion). The supinator does not flex the elbow. The
brachioradialis would move the forearm to a midposition rather than fully supinating it.
Therefore, when the elbow both flexes and supinates, the biceps brachii would be the most likely
muscle causing this action.
 
16. Manual muscle testing of a patient’s pelvic floor muscles reveals a grade of Poor (2/5).
Which of the following positions is BEST to begin strengthening?
a. Supine
b. Standing
c. Seated
d. Walking
Correct Answer
Supine
Feedback
A grade of Poor (2/5) is defined as full excursion in a gravity-eliminated position. All of the
other options are against gravity positions, which would be inappropriate, given this grade of
weakness.
 
17. To minimize skin irritation during functional electrical nerve stimulation, a physical therapist
should use:
a. lower intensity, larger interelectrode distance, and larger electrodes.
b. lower intensity, larger interelectrode distance, and smaller electrodes
c. higher intensity, smaller interelectrode distance, and smaller electrodes.
d. lower intensity, smaller interelectrode distance, and larger electrodes.
Correct answer
lower intensity, larger interelectrode distance, and larger electrodes.
Feedback
Several things can be done to decrease the current density and the possibility of skin irritation.
These include decreasing the intensity of the stimulation, increasing the inter-electrode distance,
and using larger electrodes.
 
18. Which of the following modalities BEST addresses the cause of calcific tendinitis in the
bicipital tendon?
a. Sensory level interferential current at 80 Hz to 100 Hz
b. Iontophoresis with acetic acid at 60 mA/minute
c. High-volt pulsed electrical stimulation at 200 pps
d. Diathermy with a parallel treatment set-up
 
Correct answer
Iontophoresis with acetic acid at 60 mA/minute
Feedback
Sensory level interferential current at 80 to 100 Hz does not address the problem itself but may
address any related pain. Iontophoresis with acetic acid can address the cause of calcific
tendinitis, not just the symptoms. High-volt pulsed electrical stimulation at 200 pps does not
address the problem itself but may address any related pain. Diathermy with a parallel
treatment set-up is not the best choice, as deep heat will not address the pathology.
 
19. A patient had a split-thickness skin graft for a partial-thickness burn injury to the upper
extremity. The surgeon has requested range-of-motion exercises for the patient. Currently, the
patient is able to actively move the upper extremity through one-third of the range of motion for
shoulder flexion. Based on this finding, what is the MOST appropriate action for the physical
therapist to take at this time?
a. Defer any range-of-motion exercises until the patient is able to participate more actively.
b. Begin active assistive range-of-motion exercises.
c. Begin bed mobility training to facilitate increased use of the upper extremity
d. Continue with active range-of-motion exercises.
Correct answer
Begin active assistive range-of-motion exercises.
Feedback
Deferring any range-of-motion exercises is not a practical choice, as contracture will develop
postoperatively. Because this patient cannot achieve full range of motion by himself, active
assistive range of motion is indicated to prevent contracture postoperatively. Although bed
mobility training is a creative way to possibly increase upper extremity range of motion, given
the acuity of the patient’s surgical wound, the patient would need more range of motion for this
intervention to be more beneficial. Continuing with only active range of motion would not
facilitate adequate increases in range of motion and would not prevent contractures.
 
20. A 3-month-old infant has poor midline head control. During evaluation, the physical therapist
notes facial asymmetry and observes that the infant holds the head in cervical rotation to the left
and cervical lateral flexion to the right. A radiology report indicates premature fusion of the
infant’s cranial sutures. The infant MOST likely has
a. right congenital muscular torticollis.
b. left congenital muscular torticollis.
c. right cervical facet hypomobility.
d. left cervical facet hypomobility.
Correct answer
right congenital muscular torticollis.
Feedback
The infant exhibits signs of torticollis affecting the right sternocleidomastoid muscle. Torticollis
is named for the side of the affected sternocleidomastoid. Asymmetry and premature closure of
sutures (plagiocephaly) are not typically seen with cervical facet hypomobility in infants.
 
21. Which of the following examination findings would be expected in a patient who also had
sustained ankle clonus?
a. An upgoing great toe when the sole of the foot is stroked
b. Weakness of ankle plantar flexors with one-repetition strength testing
c. Absence of sensation to sharp/dull testing over the posterior lower leg
d. Hyporeflexia when deep tendon reflexes are elicited in the lower leg
Correct answer
An upgoing great toe when the sole of the foot is stroked

Feedback
Sustained ankle clonus indicates a central nervous system dysfunction, as does the presence of a
Babinski sign (that is, an upgoing great toe with stroking of the plantar foot). The other options
are associated with lower motor neuron problems.
 
22. Which of the following sensory testing locations corresponds to the C7 nerve root?
a. Volar aspect of the little finger (5th digit)
b. Dorsal aspect of the middle finger (3rd digit)
c. Lateral aspect of the upper arm
d. Medial aspect of the upper arm
Correct Answer
Dorsal aspect of the middle finger (3rd digit)
Feedback
The C7 nerve root supplies sensation in the dorsal middle finger.
 
23. When examining a patient with a history of alcohol abuse, a physical therapist notes that the
patient demonstrates fine resting tremors and hyperactive reflexes. The patient reports frequent
right upper quadrant pain. Which of the following additional signs is MOST likely?
a. Jaundice
b. Hyperhidrosis
c. Hypotension
d. Nocturnal Cough
Correct Answer
Jaundice
Feedback
With a history of alcohol abuse and the presence of fine resting tremors and right upper
quadrant pain, the patient is presenting a history and signs and symptoms consistent with liver
disease. Jaundice is a skin change associated with disease of the hepatic system. Hyperhidrosis
can be present with endocrine disorders but is not associated with liver disease. Hypotension is
not listed as a sign of liver disorders. A nocturnal cough can be associated with rheumatic fever,
but is not characteristic of liver disease.
 
24. A patient is being evaluated for possible carpal tunnel syndrome, and a nerve conduction
velocity test is performed. Which of the following findings would MOST strongly support the
diagnosis?
a. Decreased latency at the elbow
b. Decreased latency at the carpal tunnel 
c. Increased latency at the carpal tunnel
d. Increased latency at the forearm
Correct answer
Increased latency at the carpal tunnel
Feedback
Nerve conduction above and below the local nerve compression is usually normal. Latency is
typically increased, not decreased, across the carpal tunnel compression site. Nerve conduction
above and below the local nerve compression is usually normal.
 
25. A patient is performing a Phase I (inpatient) cardiac rehabilitation exercise session. The
physical therapist should terminate low-level activity if which of the following changes occurs?
a. The diastolic blood pressure increases to 120 mm Hg.
b. The respiratory rate increases to 20 bpm
c. The SBP increases to 175 mm Hg.
d. The HR increases by 18 bpm.
Correct answer
The diastolic blood pressure increases to 120 mm Hg.
Feedback
During Phase I (inpatient) cardiac rehabilitation, vital sign parameters with activity that
warrant termination are: diastolic blood pressure of 110 mm Hg or greater, systolic blood
pressure above 210 mm Hg or an increase greater than 20 mm Hg from resting, and a heart rate
that increases beyond 20 bpm above resting. The normal resting respiratory rate can range from
12 to 20 breaths per minute in adults, so an increase to 20 breaths per minute with low-level
activity would not be a reason to terminate the activity.