Question#1

During a motor examination, the therapist asks a patient to drink from a cup. The patient has difficulty
reaching for the cup and misses it several times. When moving the cup toward the mouth, the patient misses
completely and bangs it into his shoulder, spilling its contents. After several trials, he is still unable to drink
from the cup. The therapist documents these findings as:

1) patient is exhibiting severe impairment in dysmetria.

2) patient is exhibiting moderate impairment in dysdiadochokinesia.
3) patient is exhibiting moderate impairment in dystonia.
4) patient is exhibiting severe impairment in dyssynergia.

Correct Ans. 1 Ques. Identifiers: III / C / Analysis Reasoning

Rationale: The patient is exhibiting severe impairment in dysmetria (impaired ability to judge the distance
or range of movement). Dysdiadochokinesia is an impaired ability to perform rapid alternating movements
while dyssynergia is an impaired ability to associate muscles together for complex movement. Dystonia is a
hyperkinetic movement disorder characterized by disordered tone and involuntary movements.

Question#2
A patient is transferred to a burn clinic with deep partial-thickness burns over 30% of the body. Healing of
this type of burn is often characterized by:

1) blisters and minimal edema with spontaneous healing.

2) depressed skin area that heals with grafting and scarring.
3) moderate edema with spontaneous healing and minimal grafting.
4) marked edema with slow healing and extensive hypertrophic scarring.

Correct Ans. 4 Ques. Identifiers: IV / A / Deductive Reasoning

Rationale: Deep partial thickness burns involve destruction of the epidermis with damage of the dermis
down into the reticular area. Appearance is mixed red/white color with sluggish capillary refill. Superficial
sensation is decreased while sense of deep pressure is retained. The burn will heal spontaneously in 3 to 5
weeks if no infection develops (infection can convert the burn to full-thickness). There is marked edema with
excessive scarring (hypertrophic). Superficial burns heal with minimal edema while superficial partial-
thickness burns heal spontaneously with moderate edema and minimal scarring. No grafting is required. Full-
thickness burns require skin grafting; appearance is depressed with significant scarring.

Question#3
A therapist works for a home health agency and is treating a patient, covered by Medicare, at home. The
patient has reached ambulatory independence and is no longer homebound, but will continue to need therapy
twice per week for several weeks to reach full functional status. The patient has a good relationship with the
therapist and would like to continue to be seen at home. There is a hospital physical therapy out-patient
department accessible to the patient. Under Medicare guidelines, the therapist should:
1) continue to see the patient at home because of patient preference.
2) continue to see the patient at home and document the patient as homebound.
3) refer the patient to the out-patient department.
4) discharge the patient as no further benefits are available under Medicare.

Correct Ans. 3 Ques. Identifiers: VI / F / Deductive Reasoning

Rationale: Patients must meet the definition of homebound in order to receive home care Medicare benefits
under part B guidelines. Once a patient is no longer homebound, if, as a practical matter the patient can access
an outpatient facility, the patient should be transferred to care in that setting. It is an ethical violation to
intentionally withhold information from a record.

Question#4
A patient is status post coronary artery bypass graft via sternotomy and is observing sternal precautions.
Which of the following activities should be avoided while observing sternal precautions?
1) huffing.
2) pulling up from supine to sitting with hand rails.
3) coughing.
4) rolling from supine to sidelying.

Correct Ans. 2 Ques. Identifiers: I / D / Inference Reasoning

Rationale: Coughing and huffing cannot be avoided due to the risk for pulmonary complications. Rolling from
supine to sidelying is not contraindicated; however pulling up from the hand rails should be avoided.

Question#5
A patient is referred to physical therapy for evaluation of balance instability. The patient has a history of
several falls within the last month. The therapist administers the Clinical Test for Sensory Interaction in
Balance (CTSIB) using a posturography system. The patient is stable during the first 4 conditions of the test
with only minimal increases of sway. During condition 5 (eyes closed and platform moving) and 6 (visual
surround moving and platform moving) the patient becomes very unstable and requires the overhead
harness to prevent a fall event. The therapist correctly interprets the results of this test as evidence of:

1) problems with sensory selection.

2) somatosensory dependency.
3) vestibular deficiency.
4) visual dependency.

Correct Ans. 3 Ques. Identifiers: III / C / Inference Reasoning

Rationale: The clinical test for sensory integration in balance using dynamic posturography testing is
positive for vestibular deficiency with loss of balance on conditions 5 and 6. Patients who are surface
dependent (somatosensory) have difficulties with conditions 4, 5, and 6. Patients who are visually dependent
have difficulties with conditions 2, 3, and 6. Sensory selection problems are evident with loss of balance on
conditions 3 - 6.

Question#6
The primary reason for performing posteroanterior unilateral vertebral pressure (PACVP) in the cervical
spine would be to assess:

1) arthrokinematic motion.
2) osteokinematic motion.
3) cervical PROM.
4) muscle tone within the cervical region.

Correct Ans. 1 Ques. Identifiers: II / B / Deductive Reasoning

Rationale: PACVP tests are manual procedures that assess the glide of one vertebral segment as compared
to an adjacent vertebral segment. The movement of one segment gliding with respect to another segment is
considered an arthrokinematic movement so the PACVP test is assessing the arthrokinematic glide of each
vertebral segment.

Question#7
A physical therapist has just begun working in a skilled nursing facility. A task that a therapist in this setting
may be asked to perform that is NOT considered skilled care under the Medicare guidelines is:

1) taking blood pressure.

2) using a stethoscope to determine breath sounds.
3) providing patient education about a disease/illness.
4) helping a patient to the toilet.

Correct Ans. 4 Ques. Identifiers: VI / F / Analysis Reasoning

Rationale: Medicare considers helping a patient to the toilet unskilled unless it is part of a treatment plan to
improve the patient's physical function. Take note that in this scenario, it was asked which task may not be
considered skilled care.
Question#8
A physical therapist has chosen to use a hydrocolloid paste covered by a hydrocolloid dressing. This
combination of dressings is most appropriate for:

1) arterial insufficiency wounds. Dry siya, need ng moisture, so hydrogel mas ok

2) grade III pressure ulcer. May baon so need i-fill (h paste) + h dressing dahil sa (+)exudate
3) grade I pressure ulcer. No need for dressing kasi sarado pa ito
4) venous insufficiency wounds. Pwede hydrocolloid dressing pero dapat c compression warp

Correct Ans. 2 Ques. Identifiers: IV / D / Inference Reasoning

Rationale: The use of a hydrocolloid paste signifies that a "filler" is needed, meaning that this wound has
some depth to it. The use of a hydrocolloid also means that there is significant exudate production that must
be controlled. A hydrocolloid would not be appropriate for arterial ulcers. Arterial ulcers usually require
hydration and a hydrogel would most likely be chosen. A Grade I pressure ulcer typically does not require a
dressing since the skin is intact. A transparent film could be justified to decrease shearing forces. A
hydrocolloid could be used with a venous insufficiency if used in combination with a compression wrap (e.g.,
four-layer bandaging system or Unna boot), but not in isolation .
Question#9
A patient is referred to physical therapy for weakness of the right foot following a bicycle accident 3 weeks
ago. The patient is unable to plantarflex, adduct, and invert the foot. Walking is fatiguing and painful. The
therapist examines the leg and finds evidence of muscle wasting (girth measurements of calf are one-half inch
less than the opposite extremity) and fasciculations. Ankle DTR testing reveals a response of 1+ while MMT of
the gastrocnemius-soleus muscle reveals a 2-/5. The therapist concludes this patient is exhibiting signs/
symptoms of:

1) tibial nerve injury.

2) obturator nerve injury.
3) sciatic nerve injury.
4) femoral nerve injury.

Correct Ans. 1 Ques. Identifiers: III / A / Analysis Reasoning

Rationale: This patient is exhibiting signs/symptoms of a peripheral nerve injury (lower motor neuron
lesion) as evidenced by weakness, hyporeflexia, fasciculations, and neurogenic atrophy. The tibial nerve
passes through the popliteal fossa and down the back of the leg. It innervates the gastrocnemius-soleus,
plantaris, popliteus, and tibialis posterior muscles as well as the flexor digitorum longus and flexor hallucis
longus muscles. The obturator nerve innervates the hip adductors and gracilis; the sciatic nerve innervates
the hamstring muscles; and femoral nerve innervates the quadriceps.

Question#10
A frail 90 year-old woman was referred for home-care physical therapy with multiple medical comorbidities
and functional decline following a short hospitalization for fall-related injuries. A comprehensive systems
screen revealed the patient had urinary incontinence, generalized pallor, confusion, apathy, nighttime
agitation, and extreme fatigue. The patient was disoriented to person, place, and time and inconsistently
followed 1 step instructions. Score on Mini Mental State Examination was 5 as compared to 25 prior to the
hospitalization (max score = 30). The therapist's BEST course of action is to:

1) discontinue treatment as patient is not a suitable candidate for physical therapy at this time.
2) encourage the family to seek immediate medical attention.
3) encourage the family to institute restraints to protect the patient from further falls.
4) encourage the family to institutionalize the patient to minimize the fall risk.

Correct Ans. 2 Ques. Identifiers: V / C / Analysis Reasoning

Rationale: This patient is exhibiting signs and symptoms of delirium, defined as an acute, reversible state of
agitated confusion. Additional symptoms include disorientation without drowsiness, disorganized thinking,
hallucinations or delusions, difficulty focusing attention, and disturbed sleep-wake cycles. Onset is rapid
(within hours). Common causes include drug or alcohol withdrawal, medication side-effects, infections,
sensory deprivation, and dehydration. Delirium is treatable and is often mistaken for dementia and goes
unrecognized or is inappropriately managed (all other choices).
Question#11
A patient presents with a tendonopathy of the right biceps (long head). Which of the following circumstances
would worsen the prognosis?

1) vegetarian diet.
2) long-standing Type I diabetes mellitus. For tendonopathy to heal kailang ok ung blood supply
3) consistently drinking a glass of red wine with dinner each evening.
4) 35 pounds overweight.

Correct Ans. 2 Ques. Identifiers: II / C / Inference Reasoning

Rationale: In order to heal a tendonopathy, the individual must have a good vascular supply to the tendon.
The one condition that will have a significant negative impact on circulation to the tissues is diabetes. None of
the other conditions will have a significant negative impact on the ability of the patient's circulatory system
to supply the tendon with blood.
Question#12
In the performance of provocation tests with patients, the proper way to phrase a question to receive the
most informative response is:

1) does that increase your pain?

2) does that alter your pain?
3) does that mimic your pain?
4) does that decrease your pain?

Correct Ans. 2 Ques. Identifiers: II / B / Evaluation Reasoning

Rationale: It is critical not to lead the patient into answering how they think they should answer. To ensure
that the patient is providing an accurate response, the question should be open-ended so that they do not
know if the procedure was supposed to make the pain increase, decrease, etc.

Question#13
A physical therapist has been treating a person with post-op cesarean infection. There is no necrotic tissue,
but the therapist is packing a 3 cm tunnel in the subcutaneous tissues with hydrogel impregnated gauze.
Pulsed-lavage with suction for irrigation at a 15 PSI is also being used. The wound exudate has changed from
serosanguineous to a light green drainage with a foul smell. Infection is suspected. After consultation with the
physician, the BEST action the therapist should take is to:

1) begin whirlpool irrigation with an antiseptic agent.

2) increase the force of pulsed-lavage irrigation.
3) use acetic acid.
4) use hydrogen peroxide.

Correct Ans. 3 Ques. Identifiers: VI / F / Evaluation Reasoning

Rationale: This wound is most likely infected with Pseudomonas aeruginosa. This bacterium often causes
the exudate to have a light green appearance and has a distinctive odor. Acetic acid (vinegar) is the primary
topical agent used to treat this bacterium. There is no reason to increase the force of the irrigation . Eight to
fifteen PSI is commonly recommended because this is sufficient to remove contaminates while preventing
damage to fibroblasts. Hydrogen peroxide is contraindicated in tunneling, non-infected, or granulating
wounds and it is a poor antimicrobial agent. The whirlpool offers no advantage and is riskier than pulsed-
lavage. The whirlpool has a greater risk of cross-contamination and potential systemic effects when
compared to the pulsed-lavage. A whirlpool, if used, should be discontinued when the wound is clean.
Question#14
A college athlete you are treating for shin splints arrives for therapy complaining of pain in the right lower
abdomen. There is some distention on inspection. The patient has been nauseous since the previous night
and vomited once this morning. Pain is made worse by movement, especially hip flexion. During the
examination the therapist should palpate for:

1) tenderness at the level of the umbilicus.

2) pain with contraction of the lower obliques.
3) rebound tenderness at McBurney's point.
4) epigastric pain radiating to the back.

Correct Ans. 3 Ques. Identifiers: V / A / Analysis Reasoning

Rationale: This patient is presenting with signs and symptoms of appendicitis (inflammation of the
vermiform appendix): epigastric pain; right lower quadrant or thigh/groin pain; abdominal muscular rigidity;
rebound tenderness; nausea and vomiting; anorexia; dysuria; and/or low-grade fever. Palpation at
McBurney's point (in supine, a point halfway between the right ASIS and umbilicus) may reveal rebound
tenderness or pain. Epigastric pain radiating to the back is common with acute pancreatitis. Prompt medical
referral is indicated; surgery is typically required to prevent rupture and peritonitis.
Question#15
An older adult with a 10-year history of rheumatoid arthritis is referred to physical therapy for development
of an exercise program. Following 2 weeks of exercise intervention (strength training using weights and a
walking program), the patient complains of increased pain in the left knee lasting more than 2 hours post-
exercise, mild swelling, increased fatigue, and weakness. The therapist's BEST course of action is to:

1) stop all exercise for a minimum of two weeks.

2) switch to gentle PROM exercises to the left knee and decrease walking duration.
3) continue with resistance exercises but decrease the weight by half.
4) discontinue resistance exercises and increase walking duration.

Correct Ans. 2 Ques. Identifiers: II / D / Evaluation Reasoning

Rationale: This patient is exhibiting symptoms of an acute joint flare. Exercise modification is required to
decrease the risk of injury during the flare. Exercises to the left knee should be decreased to gentle PROM
activities until the flare subsides. Walking duration should be decreased to comfortable, pain-free levels.
Question#16
A 74 year-old retired professor had a total hip replacement 2 days ago and remains hospitalized with
complications related to congestive heart failure. Medications include intravenous furosemide (Lasix),
digoxin, and potassium replacement. During the initial physical therapy session, the patient was assisted out-
of-bed, moving from supine to standing. Blood pressure initially was 100/76; systolic pressure dropped to 90
mm Hg. Pulse rate was initially 56 bpm and did not change with postural change. These findings can be
explained by the action of:

1) furosemide, which can produce postural hypertension.

2) digoxin, which acts to increase cardiac output and lower heart rate.
3) digoxin, which can produce hyperactivity.
4) furosemide, which acts to stabilize hypovolemia and dehydration.

Correct Ans. 2 Ques. Identifiers: V / A / Inductive Reasoning

Rationale: In patients with congestive heart failure (CHF), vital signs must be monitored carefully during
activity. Under normal circumstances, moving from supine to standing will result in an increase in heart rate.
When digoxin is used, this increase cannot occur as heart rate is suppressed. Adverse effects of digoxin
include fatigue, muscle weakness, and headache, Furosemide is a rapid-acting diuretic used in the treatment
of edema with CHF. Adverse effects include postural hypotension and dizziness, hypovolemia, and
dehydration.

Question#17
Which of the following is true with respect to a ground fault interrupter (GFI)?

1) It is incorporated into most electrical stimulator units.

2) It is a circuit breaker, often located in the basement, that opens and closes the current in a circuit.
It is the ground port in a three-pronged wall receptacle that conducts current away from the
3)
patient.
It is a safety device that monitors current flow and automatically shuts off current to reduce
4)
electrical shock.

Correct Ans. 4 Ques. Identifiers: VI / F / Analysis Reasoning

Rationale: The GFI protects from electrical shock by interrupting a circuit when there is a small difference
current (5mA) between the "hot" and "neutral" wires. The current is diverted into the ground. All electrical
equipment should be connected to a GFI, especially modalities that come in contact with water.

Question#18
A therapist wishes to strengthen the vastus medialis and the vastus lateralis muscles and selects a high volt
pulsatile current. The type of electrode configuration [figure] that the physical therapist used is:
1) monopolar.
2) bipolar.
3) tripolar.
4) quadripolar.

Correct Ans. 1 Ques. Identifiers: VI / E / Analysis Reasoning

Rationale: A monopolar technique consists of an active electrode placed in the target area and usually a
larger dispersive electrode placed out of the target area. This setup consists of a single lead with two
bifurcated active electrodes, to stimulate the vastus medialis and vastus lateralis, and a single dispersive
electrode is placed near the femoral triangle.
Question#19
An 86 year-old patient with a history of congestive heart failure (CHF) is now medically compensated and
admitted to a rehabilitation facility following a long acute care hospital stay. The etiology of CHF in this
patient is left ventricular hypertrophy (LVH). Which test / measure provides the best indication of this
patient's cardiac impairment?

1) cardiac index.
2) left ventricular ejection fraction.
3) maximal oxygen consumption.
4) pulmonary artery pressure.

Correct Ans. 1 Ques. Identifiers: I / B / Inference Reasoning

Rationale: Cardiac index expresses cardiac output in relationship to body surface area and provides the most
complete determination of the adequacy of an individual's left ventricular function. Left ventricular ejection
fraction is not a good measure for impairment in diastolic etiologies of congestive heart failure (left
ventricular hypertrophy). Maximal oxygen consumption is dependent not only on cardiac function, but
pulmonary and muscle function. It is an excellent indication of the patient's overall aerobic condition, but is
not specific to the cardiac impairment and can be greatly influenced by the presence of peripheral
deconditioning, the prevalence of which increases with age. Pulmonary artery pressure is an excellent
measure for assessment of the presence of decompensated CHF, however, the actual value is not specific to
cardiac impairment, and in patients who are medically compensated their values will be close to normal,
therefore poorly representative of the existing underlying cardiac impairment.

Question#20
The physical therapist intervention which is part of the plan of care for a 6 month-old infant includes parental
education and stretching of the right sternocleidomastoid muscle to increase right lateral flexion and left
neck rotation. What is the MOST appropriate medical diagnosis based on this intervention?
1) left congenital muscular torticollis.
2) right congenital muscular torticollis.
3) right plagiocephaly.
4) right cervical scoliosis.

Correct Ans. 2 Ques. Identifiers: II / C / Analysis Reasoning

Rationale: Congenital muscular torticollis involves a shortened sternocleidomastoid muscle (SCMM) with a
weakened contralateral SCMM with a resulting posture of lateral flexion of the head to the tight SCMM side
and rotation to the opposite side. Plagiocephaly, misshapen head, can develop in response to untreated
torticollis. Appropriate interventions for plagiocephaly may require a referral and potentially the use of a
custom fitted helmet. A compensatory cervical scoliosis may develop in the child who is persistently
attempting to bring the eyes to a horizontal position when cervical motion is limited. Appropriate
intervention for cervical scoliosis would include strengthening of the neck extensors.

Question#21
The spinal cord injury (SCI) service of a large rehabilitation hospital had a significant rate of recidivism
(30%) of patients returning for treatment of skin ulcers following discharge from active rehabilitation. The
aim of the staff was to reduce the frequency of skin ulceration and shorten length of stays. The plan was to
use a group education class. The MOST important focus of initial planning for this class is:

1) chart review and identification of outcomes achieved during initial rehab.

2) financial support of potential SCI patients and ease of transportation.
3) strategies to engage community dwelling SCI survivors.
4) use of a depression scale to identify and rule out potential participants with depression.

Correct Ans. 3 Ques. Identifiers: VI / F / Inductive Reasoning

Rationale: A thorough needs assessment is the most important initial task for the planners to engage in.
Developing effective recruitment strategies to motivate community dwelling participants to come to class is
also important. Chart review will reveal retrospective information but will not adequately identify where the
participants are now (which may be very different than at discharge). Financial support and ease of
transportation may be important for some individuals; this information will be revealed in a thorough needs
assessment. Excluding individuals with depression is not appropriate; they may need the group support the
most.

Question#22
A 36 year-old with a long history of alcohol abuse and homelessness presents with a cough, CXR findings of
upper lobe infiltrate and history of night sweats. Given the history, the most likely diagnosis for this patient
would be:

1) tuberculosis.
2) bacterial pneumonia.
3) lung contusion.
4) lung cancer.

Correct Ans. 1 Ques. Identifiers: I / C / Analysis Reasoning

Rationale: This patient has both the signs and symptoms of TB, upper zone infiltrates, cough and night
sweats as well as a social and living history that puts the patient at risk for the development of TB. Since TB
can take days to diagnose (3 sputum samples on three consecutive days to rule out TB), it is important to
protect the health care workers and the other patients in the rooms/wards from this contagious disease.
Proper environmental precautions should be instituted until the diagnosis is proven negative or positive.
Question#23
A new diagnostic test was evaluated in terms of its ability to accurately assess the presence or absence of a
target condition. Following the test, 7 infants out of 20 were identified as having a condition called patent
ductus arteriosus. Later extensive testing of the infants indicated this was not the case. They were reclassified
as within normal limits. The results of the first test should be viewed as a:

1) false negative with poor sensitivity.

2) false positive with poor specificity.
3) true positive with poor specificity.
4) true negative with poor sensitivity.

Correct Ans. 2 Ques. Identifiers: VI / F / Inference Reasoning

Rationale: A true positive test correctly classifies individuals as having the target condition. A true negative
test correctly classifies individuals as not having the target condition. A false positive incorrectly identifies
individuals as having the condition while a false negative incorrectly identifies individuals as not having the
condition. The specificity of the test was poor as it did not have the ability to obtain a negative test when the
condition was really absent (true negative). Sensitivity refers to a test's ability to obtain a positive test when
the condition is really present (true positive). Patent ductus arteriosus is an abnormal communication
between the main pulmonary artery and the aorta that persists after birth.

Question#24

An eight year-old with a medical diagnosis of Down Syndrome is being seen for physical therapy. During
treatment, the child begins to complain of pain behind the ear and the back of the neck. Upon examination,
there is limited neck motion. The child's mother notes that the child is also having increasing difficulty with
walking and clumsiness at home. What is the MOST appropriate response by the physical therapist based on
the signs and symptoms?

1) carefully monitor what happens to the child in the next week.

attribute the behaviors to limited development maturation associated with Down syndrome and
2)
continue intervention.
3) activate Emergency Medical Services by calling 911.
4) refer immediately to an appropriate specialist.

Correct Ans. 4 Ques. Identifiers: III / D / Evaluation Reasoning

Rationale: The prevalence of atlantoaxial instability in children with Down syndrome has been estimated to
be between 10 and 40 percent. Atlantoaxial instability is an abnormally large space and excessive motion
between the first and 2nd cervical vertebrae thought to be due to lax transverse atlantal ligaments. The
enlarged space, which, at extremes of flexion or extension of the neck, can permit compression of the spinal
cord. Any child with symptoms should be immediately referred to a neurologist. Though the child's medical
status may be in jeopardy, activation of EMS is not warranted in the situation described.

Question#25
A patient with a recent history of cerebrovascular accident (CVA) currently resides in a skilled nursing
facility. At 9 AM the patient is found to be hypoxemic and unresponsive. A nursing co-worker remarked that
the patient had been fine an hour and a half earlier during breakfast. The patient is examined and noted to be
afebrile with crackles at the right posterior base of the lung. The oxygen saturations are 88% on room air.
The most likely pathology for the hypoxemia and unresponsiveness would be:

1) viral pneumonia.
2) bacterial pneumonia.
3) Legionella pneumonia.
4) aspiration pneumonia.

Correct Ans. 4 Ques. Identifiers: V / C / Analysis Reasoning

Rationale: This patient, with a recent history of a stroke, is a likely to have swallowing impairments
(dysphagia), making the patient a possible host for an aspiration event. The speed with which the patient
went from "fine" to hypoxemic and unresponsive, however, is key. Viral, Legionella and bacterial pneumonias
would demonstrate a slower onset. Finally, viral, Legionella and bacterial pneumonias would likely present
with an initial fever.
Question#26
When applying a pulsed-wave ultrasound, which of the following settings represents a 20% duty cycle?

1) On time: 2 ms, Off time: 10 ms.

2) On time: 10 ms, Off time: 2 ms.
3) On time: 2 ms, Off time: 8 ms.
4) On time: 8 ms, Off time: 2 ms.

Correct Ans. 3 Ques. Identifiers: VI / E / Deductive Reasoning

Rationale: Duty cycle is a ratio of the pulse duration (on-time) to the pulse period (the sum of on-time + off-
time). It also represents the percentage of the on-time to the off-time. In our illustration, the on-time is 2 ms
and the off-time is 8 ms. Therefore, the sound energy is being emitted during 20% of the pulse period (10
ms).
Question#27
The integumentary examination of an 87 year-old nursing home resident with end stage renal disease reveals
decreased turgor bilaterally and skin that is rough and dry. The most important action for the therapist to
take is:

1) recommend having the volume of water intake increased.

2) speak with the patient's primary care physician ASAP.
3) inform the nursing supervisor that a humidifier is needed.
4) recommend laboratory tests that include a BUN:creatinine ratio test be performed.

Correct Ans. 2 Ques. Identifiers: V / C / Evaluation Reasoning

Rationale: Although decreased turgor is a sign of dehydration, it occurs normally with aging. It should be
checked regularly in vulnerable age groups. The BUN:creatinine ratio can indicate kidney and/or liver
disease, but most therapists do not order laboratory tests . Hydration levels need to be carefully monitored
especially in patients with end stage renal disease. Their water intake volume should not be changed without
consultation from their physician. A humidifier may be important but consulting with the physician about
potential dehydration is the most important step a therapist can take for the patient's safety. (Boissonnault,
1995)

Question#28
An 8 year-old student has been tested and the school system is developing an individualized education plan
(IEP). According to the Individuals with Disabilities Education Act (IDEA) the person that is not required to
but may attend this IEP meeting is:

1) the student's regular school teachers.

2) the student's parent/guardian.
3) a school administration representative.
4) the student.

Correct Ans. 4 Ques. Identifiers: VI / F / Deductive Reasoning

Rationale: Under the Individuals with Disabilities Education Act (IDEA) guidelines, a student may, but is not
required to, attend the IEP meeting. This allows for students who might be uncomfortable in a group setting
where he/she is being discussed to forgo the meeting and receive a summary of the meeting at a later time.
All others are required to attend. The student's age in this case (8 years-old), might also be a factor in
determining attendance at an IEP meeting.
Question#29
A patient is recovering from a L2 spinal cord injury, level C on the ASIA Impairment Scale. Functional
expectations for this patient include locomotion using:

1) bilateral AFOs and canes.

2) bilateral KAFOs and a reciprocating walker.
3) bilateral KAFOs, Loftstrand crutches, and a four point gait.
4) an active duty light weight wheelchair.

Correct Ans. 1 Ques. Identifiers: III / C / Inductive Reasoning

Rationale: A spinal cord lesion at the level of L2 is considered a lower motor neuron injury (cauda equina
injury). Intact movements include hip flexion, hip adduction, and knee extension. Level C on the ASIA Scale
(American Spinal Injury Association) is an incomplete lesion with motor function preserved below the level of
the lesion. More than half the muscles have a muscle grade less than 3 out of 5. This patient can be expected
to be a functional ambulator using bilateral ankle-foot orthoses and crutches or canes. For some community
activities, the patient may elect to use a wheelchair for convenience and energy conservation but is not
expected to be a full-time wheelchair user. Orthotic bracing of the knees (KAFO) is not appropriate.
Question#30
A 93 year-old patient is in the intensive care unit with influenza. The patient is showing signs of dehydration
and vomiting. The patient is lethargic with a respiratory rate of 8. The arterial blood gas is reported as PaO 2-
86, PaCO2- 45, pH- 7.48, HCO3- 28. Physical therapy is ordered to try and increase breathing rate and improve
the breathing pattern. The arterial blood gas is interpreted correctly by the physical therapist as:

1) compensating respiratory alkalosis. pH and PaCO2 same; PaCO2 (35-45)

2) significant hypoxemia.
3) primary metabolic alkalosis. pH & HCO3 same; pH inc = alka, HCO3 inc (22-26) = alka
4) respiratory failure.

Correct Ans. 3 Ques. Identifiers: I / C / Analysis Reasoning

Rationale: The arterial blood gas reveals an alkalemia as the pH of the blood is above the range of normal
(7.35 to 7.45). It is imperative to determine the cause of the alkalemia so that the primary problem is
corrected. The metabolic HCO3 is elevated, likely due to the patient's vomiting (losing acid becoming more
alkalotic). The pulmonary system is compensating for this by creating an acidosis to compensate for the
metabolic alkalosis. The treatment therefore should not include changing the respiratory pattern or rate as it
is the system providing the compensation. If the patient's respiratory system was "normalized", the alkalosis
would worsen, not improve.

Question#31
A patient presents with rotator cuff impingement involving primarily the supraspinatus tendon secondary to
a restriction of inferior glide of the glenohumeral capsule. Which activity would be advisable prior to the
restriction being eliminated?

1) finger climbing on the wall.

2) shoulder internal/external rotation exercises.
3) passive elevation using overhead pulleys and the opposite upper extremity.
4) Codman's pendulum exercises with weight in hand.

Correct Ans. 2 Ques. Identifiers: II / D / Inference Reasoning

Rationale: Shoulder internal/external rotation exercises will not irritate the impinged tendon while they do
assist with healing secondary to revascularization. Both wall climbing exercises and passive exercises with
the pulleys may cause further irritation of the tendon. Since the restriction is still present every time the arm
is elevated the tendon becomes impinged, so those two exercises are counterproductive to healing. The
Codman's exercise may also take the shoulder too far into the elevated range since the patient has minimal
control of the swing secondary to the use of momentum to create the motion.

Question#32
A 16 year-old fell during a rock climbing expedition. The individual is complaining of pain over the left lateral
chest wall. The chest wall has no noticeable paradoxical motion of the rib cage. Palpation reveals crepitation
over the right lateral lower thoracic wall. Which of the following signs or symptoms would be expected in this
scenario?

1) increased thoracic excursion.

2) asymmetrical breathing pattern.
3) use of accessory muscles of inspiration.
4) increased abdominal muscle contraction during exhalation.

Correct Ans. 2 Ques. Identifiers: I / B / Inference Reasoning

Rationale: Given the tactile crepitus, it is likely the rock climber has fractured one or more ribs. Since there is
no observable paradoxical motion of the thorax, it is unlikely to be a flail chest. Unilateral pain will cause an
asymmetrical breathing pattern and a shallow breathing pattern which could be measured as a decreased
excursion of the thorax. Since there is no need to increase either volume of the breath or rapidity of
exhalation, there is no need for any accessory muscle use.

Question#33
A physical therapist is treating an 83 year-old out-patient who has metastatic prostate cancer. The therapist
receives a phone call from the patient's son who is trying to help determine whether his father needs help
from an aide in order to cope at home. Under HIPAA guidelines, the therapist can provide information and
advice to the son:

1) without consulting the father since the son is a family member.

2) only with the father's written permission.
3) as long as the father does not verbally object.
4) only with the father and son together to discuss the concerns.

Correct Ans. 3 Ques. Identifiers: VI / F / Deductive Reasoning

Rationale: The HIPAA Privacy Rule allows physicians, hospitals, and other providers to disclose information,
when needed, to a family member or other person responsible for the care of the patient about the patient's
condition with the patient's consent. If a patient is incapacitated, providers can share appropriate information
with the family member or involved person if it is determined that doing so is in the patient's best interest. In
this case, verbal consent from the father is adequate. There was nothing in this case that indicated that the
father was cognitively impaired.
Question#34
An 83 year-old patient is hospitalized for an exacerbation of COPD. The patient is afebrile, in no distress, with
oxygen saturations at 93% on 2 liters of supplemental oxygen. The patient states that coughing is currently
not clearing secretions as well as usual. The therapist should:

1) teach the patient to huff instead of cough to improve cough effectiveness.

assist the patient's cough by pushing in on the abdomen in time with the patient's own
2)
cough effort.
3) endotracheally suction the patient to clear retained secretions.
4) use tracheal stimulation in order to improve the cough effectiveness.
Correct Ans. 1 Ques. Identifiers: I / D / Inference Reasoning

Rationale: The huff is an effective alternative to coughing in a patient with diseased airways such as with
COPD. The assisted cough is used only for patients who do not have intact sensation in their abdomen, such as
a patient s/p spinal cord injury. Suctioning this patient is only indicated when unable to clear secretions
independently and the secretions are interfering with gas exchange. As this patient has adequate saturations
and is in no distress, there is no need for suctioning at this time. Finally, tracheal stimulation is used to initiate
a cough. This patient has no problems initiating a cough. It is the effectiveness of the cough that is in question.
Question#35
The most important outcome of the patient history/interview is to:

1) develop a rapport with the patient.

2) determine if the patient has any "red flags".
3) identify the patient's current medications.
4) determine the patient's diagnosis.

Correct Ans. 2 Ques. Identifiers: II / B / Inductive Reasoning

Rationale: The determination of "red flags" is the most important component of the patient
history/interview. Identifying "red flags" will guide the physical therapist as to whether the patient requires a
referral to another healthcare provider and it will also dictate the flow of the tests and measures component
of the examination. The other items are valuable and typically components of the history/interview, but they
are not critical in terms of determining if it is safe to proceed with the remainder of the examination.
Question#36
A patient is referred for physical therapy with chronic pain and postural abnormalities. The patient describes
diffuse aching in the spine and legs as well as frequent disabling headaches. Examination reveals increased
thoracic kyphosis and bowing of both the femora and tibiae. A radiograph of the spine shows loss of height
with widening and thickening of the vertebra. A radiograph of the skull shows marked patchy sclerosis of the
bone with significant thickening. The therapist recognizes these findings are consistent with:

1) osteoporosis.
2) Paget's disease. Osteitis Deformans
3) osteopenia.
4) degenerative joint disease.

Correct Ans. 2 Ques. Identifiers: V / C / Analysis Reasoning

Rationale: Paget's disease (osteitis deformans) is a progressive metabolic bone disease that affects older
adults. It is characterized by excessive bone thickening and hypertrophy. Symptoms includ pain (muscular
and skeletal), deformities (kyphoscoliosis, bowing, coxa varus and waddling gait, vertebral compression or
collapse), and fractures. Additional symptoms may evolve with bone thickening of the skull including
headache, mental confusion, sensorineural hearing loss, tinnitus, and lightheadness/dizziness/vertigo.
Osteoporosis results in bone loss and osteopenia results in bone thinning on x-ray. Osteoarthritis (DJD) is
characterized by marked cartilage deterioration in synovial joints and vertebral deterioration.

Question#37
Following examination and evaluation, a therapist determines that a patient would benefit from distraction of
the right temporomandibular (TM) joint. This maneuver is accomplished by moving the mandible in which
direction?

1) inferior glide.
2) posterior glide.
3) medial glide.
4) anterior glide.
Correct Ans. 1 Ques. Identifiers: II / D / Inference Reasoning

Rationale: By definition, joint distraction describes moving one joint surface perpendicular to the other joint
surface. Since the maxillary surface of the TM joint faces caudally a perpendicular movement from this
surface would entail an inferior glide of the TM joints condylar surface.
Question#38
A patient recovering from traumatic brain injury demonstrates behaviors consistent with Level IV of the
Rancho Los Amigos Levels of Cognitive Functioning Scale. Appropriate training activities during the physical
therapy session include:

1) assisted walking in a quiet hall.

2) PNF lower extremity patterns while in sitting.
3) assisted walking in the clinic gym.
4) ball bouncing while walking.

Correct Ans. 1 Ques. Identifiers: III / D / Inference Reasoning

Rationale: The patient is confused and agitated based on the Level IV designation. Behaviors are bizarre and
non-purposeful relative to the immediate environment. Gross attention is very brief while selective attention
is often nonexistent. The patient lacks both short and long-term recall. Consistency and structure are
essential as is modeling calm behavior. The patient cannot be expected to do well with new or unfamiliar
tasks (PNF patterns) or working in an open and variable environment (PT gym). Dual tasking (ball bouncing
while walking) also exceeds this patient's cognitive abilities.
Question#39
Company records were examined to identify all individuals complaining of low back pain (LBP) within the
past 5 years. Records were also examined to identify a second group of individuals without LBP. Both groups
were matched for age, sex, weight, and job status. The researchers then compared the frequency of LBP in
both groups relative to job status. This study is an example of a:

1) case control, type 3 study design.

2) before-after, type 3 study design.
3) descriptive, type 4 study design.
4) randomized control, type 1 study design.

Correct Ans. 1 Ques. Identifiers: VI / F / Deductive Reasoning

Rationale: This is an example of a type 3, case control design. A group of interest (LBP) was compared to a
matched group without LBP. A determination of the influence of job status based on the frequency of LBP was
made. This is a retrospective (backward-in-time) study. It has a low level of confidence in that co-intervention
and contamination may have occurred in the 5 year study period. Before-after, type 3 study design is a
prospective (forward-in-time) study of a single group of patients assessing an outcome. There is no control
group as in a randomized control, type 1 design. Descriptive, type 4 study design involves describing a group
of individuals with similar characteristics (LBP). There is no control group or scientific rigor.
Question#40
A patient recovering from a lower extremity chronic quadriceps strain is practicing squat jumps. The patient
is instructed to drop into a partial squat position and then jump vertically into a fully extended position. The
patient absorbs the shock of landing by returning to the squat position and then repeats the activity. This
exercise is an example of:

1) plyometric drills.
2) open-kinetic chain exercise.
3) core stabilization training.
4) isokinetic exercise.
Correct Ans. 1 Ques. Identifiers: II / D / Inference Reasoning

Rationale: Plyometric training involves activating muscles eccentrically (partial squat) followed by
concentric action (jump). They are used in advanced rehabilitation and sports specific training to promote
quick, powerful movements. The initial eccentric activity provides stretch to the muscle while the concentric
phase uses the elastic recoil of muscle and neuromuscular (muscle spindle) support of contraction. Open-
kinetic chain resistance exercise (isotonic, isokinetic, isometric) uses resistance applied to the distal segment
of the limb. Core stabilization training refers to strengthening of proximal limb segments and the trunk.
Isokinetic exercise uses dynamometers to provide maximum resistance throughout the entire range.
Question#41
A patient is receiving treatment in an out-patient physical therapy facility. During the treatment session, the
patient walks across the room to the treatment table and slips, but catches himself from falling by reaching
out and grabbing onto a nearby table. The patient apologizes for his clumsiness and says he has not hurt
himself. The therapist knows that an incident report should be completed whenever:

1) there is an injury to a patient.

2) something unusual occurs.
3) the facility may be at fault.
4) the patient may be at fault.

Correct Ans. 2 Ques. Identifiers: VI / F / Deductive Reasoning

Rationale: Staff should complete an incident report for any unusual occurrence to minimize and manage the
facility's risk. Completing the report does not assign blame. It allows the facility to monitor all unusual
occurrences and identify potential problem areas. An accident report is required if a patient is injured or
harmed in any way.

Question#42
With aging, the peak force generated during a single maximal contraction against a constant force can be
expected to:

1) increase with greater muscle fatigue.

2) decrease with slower onset of muscle fatigue.
3) increase with decreased muscle fatigue.
4) decrease with quicker onset of muscle fatigue.

Correct Ans. 4 Ques. Identifiers: II / A / Inductive Reasoning

Rationale: Changes with aging in response to open-chain resistance training include: (1) decreased peak
force generated during a single maximal contraction against a constant force (isometric work), and (2)
decreased peak force generated as the muscle is shortened (concentric work). For both types of exercise, the
muscle fatigues more quickly. Speed of response (both reaction time and movement time) is slower.
Question#43
A patient presents with complaint of shooting pain in the left lateral thigh and leg as well as muscle weakness
in the left gluteus medius and peroneal (fibular) muscles. These findings are most consistent with a
neurologic radiculopathy at the dermatomal level of:

1) L3.
2) L5.
3) L4.
4) S1.

Correct Ans. 2 Ques. Identifiers: II / A / Analysis Reasoning

Rationale: The L5 dermatome travels down the lateral thigh and leg so any pain related to a neurologic
condition involving the L5 spinal nerve will follow that path. Both the gluteus medius and peroneal muscles
receive significant contributions from the L5 spinal nerve, so if there was abnormal function of L5, both of
those muscles would demonstrate weakness.
Question#44
The primary outcome of continuous passive motion (CPM) in the early treatment phase following a total knee
replacement is increased:

1) passive knee extension.

2) active knee flexion.
3) passive hip flexion.
4) active hip flexion.

Correct Ans. 2 Ques. Identifiers: VI / E / Inductive Reasoning

Rationale: Studies have indicated that active knee flexion is the most significant finding during early
rehabilitation. The other motions are affected by CPM, but not to the same degree as active knee flexion.
Question#45
An acute care hospital is developing primary prevention health promotion programs. An example of a
primary health prevention program would be one that focuses on:

1) a support group for people with Parkinson's disease.

2) exercises for people with multiple sclerosis.
3) screening elders at risk for falls.
4) reducing cigarette use in chronic smokers.

Correct Ans. 3 Ques. Identifiers: VI / F / Inductive Reasoning

Rationale: The goal of primary prevention is to prevent a first occurrence, or episode of a health problem.
Screening elders at risk for falls will identify elders at risk before those falls occur. The other three choices
focus on people that already have a health problem and those efforts would be secondary, not primary
prevention.

Question#46
A patient with a T10 incomplete spinal cord lesion (C on the ASIA Impairment Scale) is receiving locomotor
training using partial body weight support (BWS) on a motorized treadmill. The BEST initial prescription for
this patient to begin training is:

1) 10% BWS, treadmill speed at 3.0 mph.

2) 30% BWS, treadmill speed at 0.25 mph.
3) 30% BWS, treadmill speed at 3.5 mph.
4) 50% BWS, treadmill speed at 1.0 mph.

Correct Ans. 2 Ques. Identifiers: III / D / Analysis Reasoning

Rationale: Spinal cord injury, ASIA C, signifies an incomplete lesion with motor function preserved below the
level of the lesion;. At least half of key muscles below the neurological level have a muscle grade less than 3.
This patient will require manual assistance to move the limbs initially, necessitating a slow treadmill speed
and partial BWS to start. Partial BWS is typically 30%;. A 10% BWS is a goal to progress toward during
training while 50% doesn't allow enough active participation by the patient. Speeds are very slow to start
(e.g. 0.25 mph) and gradually increased.
Question#47
The design of the quadrilateral socket for the transfemoral prosthesis incorporates:
1) high anterior and medial walls.
2) high anterior and lateral walls.
3) wide medial brim and posterior shelf.
4) convex lateral wall to provide pressure on the femoral triangle.

Correct Ans. 2 Ques. Identifiers: VI / E / Deductive Reasoning

Rationale: The quadrilateral socket is designed with a horizontal shelf for the ischial tuberosity and gluteal
musculature, a medial brim at the same level as the posterior shelf, and anterior wall 2.5 to 3 in. higher to
apply a posteriorly directed force to retain the ischial tuberosity on the shelf. The high lateral wall aides in
medial-lateral stabilization. The anterior wall has a convexity, Scarpa's bulge, to maximize pressure
distribution in the area of the femoral triangle.
Question#48
A frail, elderly patient has been admitted to a nursing home. The patient has multiple flexion contractures and
has not been ambulatory for the last year. The MOST important aspect of the initial physical examination is:

1) manual muscle testing.

2) functional testing using the Functional Independence Measure (FIM).
3) pressure sore risk using the Norton Risk Assessment scale.
4) sitting balance assessment using Multidirectional Reach.

Correct Ans. 3 Ques. Identifiers: IV / B / Analysis Reasoning

Rationale: Patient safety is the primary concern for a therapist. This person was admitted to a nursing home,
they are in a frail, and non-ambulatory state. The patient is at risk for pressure ulcers. The Norton Risk
Assessment scale or Braden Scale for Predicting Pressure Sore Risk are important measures to assess the
client's pressure ulcer risk. They incorporate a variety of measurements including sensation, mobility,
nutrition, mental alertness, and incontinence/moisture. Once risk is assessed, appropriate prevention and
treatment can be implemented. Manual muscle testing, sitting balance, and functional abilities are important,
but the Norton Risk Assessment scale incorporates multiple measures to determine the client's risk for
pressure ulcers. It includes five subscales: physical condition, mental state, activity, mobility, and
incontinence.

Question#49
Physical therapy intervention is being provided to an individual with a lateral epicondylosis of the left elbow.
The patient is compliant with attendance and activities during the clinic visits, but there is concern that the
patient is not performing their home exercise program. The most likely mechanism to identify if the patient is
performing their home exercise program is to:

1) ask the patient if they are performing the home exercise program.
2) have the patient complete an outcome measure survey to determine their progression.
perform a reassessment to determine if there are significant changes in the patient's
3)
functional status.
4) ask the patient to demonstrate the components of the home exercise program.

Correct Ans. 4 Ques. Identifiers: II / D / Inductive Reasoning

Rationale: If the patient is performing the exercises at home they should be able to easily perform them in
the clinic with no cueing. Patients may not always be reliable so asking them about performance may not help
answer the concerns. Measured improvements via the outcome measure or by functional assessment may be
related to many factors such as normal healing, the benefits of the clinical intervention, etc. Changes in those
measures will not provide specific information regarding performance of home exercise programs.

Question#50
The father accidentally spilled a cup of tea on his child resulting in a 10 percent total body surface area
(TBSA) burn. The father is quite upset and is concerned that his child is in pain from the burn. Based on this
information and the accompanying figure, the child's burn is most likely:

1) superficial partial thickness.

2) deep partial thickness.
3) full thickness.
4) superficial.

Correct Ans. 1 Ques. Identifiers: IV / A / Inference Reasoning

Rationale: Superficial partial thickness burns usually present as pink or red, and wet. Sensation is intact, but
the integument is not. These injuries involve the dermis and usually heal within a couple weeks primarily
through epithelialization which helps to minimize scarring. A superficial burn presents as pink or red, the
surface is dry, sensation intact, and the integument is intact. These injuries involve primarily the epidermis,
although a small portion of the dermis may be damaged. These burns heal without scarring in a few days to
two weeks. Deep partial thickness burns are waxy white with red patches, wet, sensation to pressure is intact
while sensation to light touch or pin prick is usually absent. Healing is slow, scarring is excessive, and grafting
may be needed. A full thickness burn appears like a charred structure that is white, leathery, dry, and
anesthetic. This requires grafting for healing. The burn pictured in this question is very typical of a spill burn
(most common for toddlers). Less than a cup of coffee (or in this case a tea) can easily cause a burn of 10%
TBSA (total body surface area). Fortunately in this case, the therapist can tell the father that his child's
injuries will heal rapidly with little chance of scarring although some minor discoloration may be present.
Question#51
A patient is referred to physical therapy for cervical pain following a whiplash injury from a motor vehicle
accident. The therapist positions the patient to administer a hot pack and notices a dark, irregular black-blue
nevus with irregular borders on the upper back. The patient relates that the mole had always been there and
it has been somewhat itchy lately. The therapist's BEST course of action is:

1) refer the patient to or call her primary physician immediately.

2) suggest the patient follow it weekly and document any changes.
3) continue with her scheduled treatments and monitor it closely.
4) talk to the patient and spouse about the seriousness of the findings.

Correct Ans. 1 Ques. Identifiers: IV / C / Evaluation Reasoning

Rationale: The nevus or mole findings are suggestive of malignant melanoma. The therapist should examine
the lesion looking for warning signs (ABCDE): Asymmetrical shape; Border is irregular or jagged; Color is
mixed; Diameter is equal to or greater than 7mm; and lesion is Evolving. Itching and bleeding occurs in
advanced stages. Immediate referral to the primary physician is indicated; surgical excision is indicated with
no evidence of metastatic spread.
Question#52
A high school cross-country runner is seen in physical therapy for shin splints. The patient presents with
localized pain and tenderness over the anterior tibialis as well as generalized muscle aches and joint pains.
During the initial examination the therapist notices a solid red central spot with rings on the posterior calf.
The patient tells the therapist he doesn't know how he injured his calf and almost didn't keep his
appointment today because he thinks he is coming down with the flu. He has a slight fever and headache. The
therapist's BEST course of action is to:

1) refer him to his primary physician immediately.

2) skip therapy that day and send him home to recover from the flu.
3) treat his anterior tibialis pain and tenderness and instruct him to go home to rest.
4) tell his mother to enforce bed rest and ice to his lower leg until he feels better.

Correct Ans. 1 Ques. Identifiers: V / C / Evaluation Reasoning

Rationale: Along with the symptoms of shin splints (a localized problem), he is exhibiting the classic signs
and symptoms of Lyme disease: the bull's-eye rash with expanding rings, fever, malaise, headache and muscle
aches and joint pains. He should be referred to his primary physician immediately for a Lyme disease workup
(blood work confirms the presence of the tick spirochete disease). Early diagnosis and treatment is the key to
successful management.
Question#53
A patient presents with lymphedema of the left upper extremity following a radical mastectomy. The patient
weighs 160 pounds, is 5'5'', and has a resting BP of 115/80, a resting HR of 90 and a respiratory rate of
12/minute. Initial pressure setting for compression therapy that would be appropriate in this case is:

1) 45 psi.
2) 60 psi.
3) 80 psi.
4) 115 psi.

Correct Ans. 3 Ques. Identifiers: VI / E / Inference Reasoning

Rationale: Typically, the external pressure is set at or slightly below the diastolic pressure when using
compression therapy. The pressure should be high enough to move the blood through the venous system.
External pressures significantly less are ineffective in moving fluids and external pressures significantly
greater will retard or stop the flow of blood. Some suggest that compression can be slightly greater than
diastolic pressure applied due to the relatively short intermittent nature of the technique.
Question#54
A patient recovering from stroke is able to generate a contraction in the elbow flexors of the affected right
upper extremity but the contraction fades out quickly. He is unable to generate significant active tension from
mid range to the maximally shortened position. The therapist documents this finding as:

1) passive insufficiency.
2) muscle inhibition.
3) active insufficiency.
4) overload.

Correct Ans. 3 Ques. Identifiers: III / A / Deductive Reasoning

Rationale: Active insufficiency refers to the inability of a muscle to generate significant active tension when it
is maximally shortened. Muscles that that cross more than one joint are more likely to exhibit active
insufficiency. Passive insufficiency refers to the inability of the muscle-tendon unit to allow the joints to move
through the full available range of motion due to restrictions in length (e.g., contracture). Muscle inhibition
results from spinal reflex circuits (autogenic inhibition results from activation of the Golgi tendon organ in
the agonist muscle; reciprocal inhibition results from activation of the muscle spindle afferents, IA, of the
antagonist muscle). Overload refers to the minimum threshold for the intensity and duration of stress for a
muscle to become stronger.

Question#55
The therapist is examining the skin of a patient of color who has a diagnosis of anemia. In this situation, it
would be BEST if the therapist first examines the:

1) lips and mucous membranes of the mouth.

2) palms and soles of the feet.
3) backs of the hands.
4) dorsum of the feet and lower legs.

Correct Ans. 2 Ques. Identifiers: IV / B / Evaluation Reasoning

Rationale: Pallor (decreased redness) is seen in anemia and in arterial insufficiency (decreased blood flow).
In dark-skinned persons, inspecting the palms and soles will reveal pallor. The lips are unreliable as melanin
in the lips can simulate cyanosis.

Question#56
A patient is referred for vestibular rehabilitation following a motor vehicle accident two weeks ago. The
patient reports mild neck pain from whiplash injury and mild vertigo and nausea with change in head
position. She also reports loss of balance with mild gait instability and the need for use of a cane. The
physician indicates on the referral suspected benign paroxysmal positional vertigo [BPPV] in the posterior
semicircular canal. The MOST appropriate intervention is:

1) canalith repositioning treatment.

2) balance exercises.
3) habituation training.
4) Brandt-Daroff repositioning movements.

Correct Ans. 4 Ques. Identifiers: III / D / Inference Reasoning

Rationale: Benign paroxysmal positional vertigo (BPPV) is characterized by acute onset of vertigo and is
positional, related to the provoking stimulus of head movement. It can be effectively treated by canalith
repositioning treatment (CRT) which involves a series of head rotations by the therapist. CRT is
contraindicated in this case however due to the acute whiplash injury. Brandt-Daroff treatment involves
active repositioning movements by the patient (e.g., sit to sidelying to sit) with the head rotated 45. It is the
better choice as it produces less stress on the neck while still working to return the dislodged otoconia into
the vestibule (the primary goal of BPPV intervention). Balance exercises are indicated for safety but will not
serve to move the otoconia. Habituation training is indicated for patients with unilateral vestibular
hypofunction who demonstrate continued complaints of dizziness.
Question#57
A patient presents with pain of the cervical region. During the history it is noted that the patient is taking the
medication Fosamax. Which intervention would be contraindicated based on the use of this medication?

1) joint mobilization.
2) aerobic exercise.
3) soft tissue techniques.
4) aquatic exercise.

Correct Ans. 1 Ques. Identifiers: II / A / Inference Reasoning

Rationale:Fosamax is a medication for patients with osteoporosis. Therefore joint mobilization would be
contraindicated for a patient with osteoporosis. The other interventions would not be considered
contraindications for a patient with osteoporosis.
Question#58
The Gross Motor Function Measure is used to evaluate change in gross motor function and not quality of
movement. This test is used primarily with children who have a diagnosis of:

1) spina bifida.
2) developmental delay.
3) sensory processing disorder.
4) cerebral palsy.

Correct Ans. 4 Ques. Identifiers: III / B / Analysis Reasoning

Rationale: The Gross Motor Function Measure (GMFM) is an assessment to determine quantity of movement
in children with cerebral palsy. The assessment was developed and validated for measuring change over time
in gross motor function for children with cerebral palsy. Assessments must be used for the purpose for which
they were developed. The Sensory Integration and Praxis Test assesses sensory integration. WeeFim, School
Function Assessment and the Pediatric Evaluation of Disability Inventory (PEDI) are functional tests and
measures considered indicators for health-related outcomes.

Question#59
A therapist is examining a Spanish-speaking patient. The patient speaks no English and the therapist speaks
no Spanish; no one else is available for translation. The therapist uses the referral information and gestures in
order to best communicate with the patient. After having the patient sign a consent form, written in English,
the therapist initiates the examination. In doing so, the therapist does not meet the ethical principle of:

1) beneficence.
2) non-maleficence.
3) veracity.
4) autonomy.

Correct Ans. 4 Ques. Identifiers: VI / F / Deductive Reasoning

Rationale: Ethical standards require that a patient understand the procedure that is recommended and
agrees to it. The patient either must have a translator or have the consent form translated into Spanish to
fulfill this standard. The principle of patient autonomy, i.e., involvement and agreement with the procedures
has not been met in this situation. The therapist has met the principle of beneficence, i.e., the obligation to
help people in need. There is no indication that the therapist has harmed the patient, thus non-maleficence is
not a concern. Lastly, the situation does not raise of question of veracity or truth telling.

Question#60
A patient is 2 days post left CVA and has just been moved from the intensive care unit to a stroke unit. During
the initial interview and history, the therapist finds the patient's speech is of normal rate and melody.
Auditory comprehension appears impaired and use of word substitutions make no sense. These difficulties
are consistent with:

1) global aphasia.
2) dysarthria.
3) Wernicke's aphasia.
4) Broca's aphasia.

Correct Ans. 3 Ques. Identifiers: III / C / Deductive Reasoning

Rationale: This patient is demonstrating classic signs of Wernicke's aphasia (a type of fluent, aphasia). It is
the result of a lesion involving the posterior portion of the first temporal gyrus of the left hemisphere.
Wernicke's aphasia is characterized by impaired auditory comprehension with fluently articulated speech
marked by word substitutions. Frequent neologisms (nonsense words) are present. Broca's aphasia is
characterized by slow and hesitant speech with limited vocabulary and labored articulation. There is relative
preservation of auditory comprehension. Global aphasia is a severe aphasia with marked dysfunction across
all language modalities. Dysarthria is an impairment in the motor production of speech.

Question#61
In order to conceptualize outcomes, the World Health Organization adopted a classification for understanding
functioning and disability, the International Classification of Functioning (ICF) model (or ICIDH-2) in 2001.
Target outcomes at the activity level for an 8 year-old boy referred to therapy with a diagnosis of
developmental coordination disorder would include:

1) improved walking skills and ability to ride a bike.

2) increased range of motion and muscle strength.
3) improved patterns of normal movement.
4) inclusion in playground game activities with peers.

Correct Ans. 1 Ques. Identifiers: VI / F / Inference Reasoning

Rationale: The activity level defines performance of a task or action by an individual (e.g. walking, riding a
bike). The body function and structure ICF level defines functioning at the physiological and anatomical
levels. Thus impairments that specify problems in body function or structure are defined (e.g. range of
motion, balance, memory, sensory abilities, praxis, and so forth). The final dimension of the ICF model is at
the participation level, defined as an individual's involvement in life situations (e.g. playground activities with
peers).

Question#62
A patient has a 4 year history of multiple sclerosis and is referred for physical therapy. The physical therapist
suspects trigeminal nerve impairment. Appropriate motor tests for the trigeminal nerve include asking the
patient to:

1) look up and away while touching the cornea with a piece of cotton.
2) put out the tongue and check for deviation to one side.
3) clench the teeth followed by pushing the mouth open against resistance.
follow the therapist's finger movements with both eyes and observe for oscillations of the
4)
eyes.

Correct Ans. 3 Ques. Identifiers: III / B / Inference Reasoning

Rationale: The trigeminal nerve (CN V) innervates the muscles of mastication (masseter and temporalis
muscles). Motor function can be examined by asking the patient to clench the teeth while palpating the
masseter and temporalis muscles. The patient can also be asked to open the mouth against resistance. The
jaw jerk is also an appropriate motor test for this cranial nerve. The corneal reflex test investigates the
afferent (ophthalmic branch) of CN V This is NOT a motor test for CN V. The tongue (tongue protrusion) is
supplied by the hypoglossal nerve (CN XII). Oscillations of the eyes, termed nystagmus, is a function of CN
VIII.
Question#63
A therapist has been managing a patient for 3 previous visits with a diagnosis of patellofemoral pain of the
right knee. Upon presentation today the patient states that his physician had prescribed some DMARDS for
him to take to control his pain better. What would be the primary concern regarding this medication as to the
physical therapy intervention?

1) potential exists that the patient will become addicted to the medication.
2) the patient may become lightheaded and predisposed to falling while performing exercise.
3) the patient may choose to discontinue physical therapy as the pain diminishes.
4) pain may be masked during the physical therapy intervention as the patient is progressed.
Correct Ans. 4 Ques. Identifiers: II / A / Evaluation Reasoning

Rationale: Patient progression through interventions is challenging and is typically based on the patient's
ability to report accurate changes in symptoms. If a patient's ability to judge pain is altered by taking
DMARDS (disease-modifying, anti-rheumatic drugs), then the ability to provide accurate feedback during
physical therapy interventions may become impaired. Patients who are taking pain medications very seldom
become addicted. It is important to monitor patients on medications. Patients on pain medications should
recognize that the pain is gone as a result of the medication; however, physical therapy intervention still
remains a priority.

Question#64
During an electromyography examination, a therapist observes fibrillation potentials. These are indicative of:

1) myotonic dystrophy.
2) myopathy.
3) lower motor neuron injury.
4) artifacts.

Correct Ans. 3 Ques. Identifiers: III / B / Analysis Reasoning

Rationale: Fibrillation potentials (biphasic spikes) result from spontaneous depolarization of a single muscle
fiber. They are indicative of lower motor neuron disorders, such as peripheral nerve injury, anterior horn cell
disease, radiculopathies, and polyneuropathies with axonal degeneration. Myotonic dystrophy results in
complex repetitive discharges that increase and decrease in amplitude, creating a "dive-bomber" sound.
Myopathy produces polyphasic potentials that occur with voluntary contraction, not at rest. An artifact is any
unwanted electrical signal recorded by the EMG (e.g., 60 cycle interference in the room).

Question#65
A four year-old boy is observed to move from the floor to standing during the physical therapist's
examination. The child manually assists knee extension by "walking" his hands up his lower extremities.
What pathology is likely to reveal this sign?

1) hip dysplasia.
2) Legg-Calve'-Perthes disease.
3) arthogryposis.
4) Duchenne's muscular dystrophy.

Correct Ans. 4 Ques. Identifiers: II / C / Analysis Reasoning

Rationale: Standing up with the aid of hands pushing on knees is considered a positive Gower's sign. It is
common in boys with Duchenne's muscular dystrophy. It is indicative of children who are compensating for
proximal weakness in the knees, hips and pelvic girdle. Hip abduction, limitation or asymmetry is the most
consistent sign of hip dysplasia in neontates. Ortolani and Barlow signs are the two primary clinical tests used
to assess hip stability in neonates less than 1 month of age. Legg-Calve' Perthes disease is a bone abnormality
that affects a child's hips. Interruption of the blood flow from the medial femoral circumflex artery is
suspected to lead to aseptic avascular necrosis and to Legg-Calve' Perthes disease. The onset of Legg-Calve'
Perthes disease is between the ages of 4 and 8 with boys affected 4 times more often than girls. Children with
the syndrome present with a limp of insidious onset and frequently a positive Trendelenburg sign.
Arthrogryposis is distinguished at birth by the presence of multiple congenital contractures.
Question#66
A patient with incomplete spinal cord injury has been practicing transfers from wheelchair-to-floor. The
patient is 76y order. The patient is still struggling with overall timing, efficiency, and economy of effort. The
BEST motor learning strategy for the therapist to use is to:
1) focus the patient on watching body movements during practice using a large floor mirror.
2) provide constant tactile guidance during practice attempts.
3) provide constant verbal cueing during practice attempts.
4) allow repetitive practice focusing the patient on the "feel" of the movements.

Correct Ans. 4 Ques. Identifiers: VI / F / Inference Reasoning

Rationale: This patient is in the middle or associative stage of motor learning. The patient understands the
idea of the task, i.e. cognitive mapping, achieved during the initial cognitive stage of learning. During the
middle stage of learning, errors are becoming less apparent and some trial and error practice (active
learning) is appropriate. The use of constant tactile guidance and constant verbal cueing are contraindicated
as is an emphasis on visual feedback (all are more appropriate for early cognitive learning). Emphasis on use
of proprioceptive (intrinsic) feedback and active learning is the correct choice.

Question#67
To examine a patient recovering from stroke with a suspected deficit in astereognosis, the therapist would
ask the patient, with eyes shut, to identify:

1) different weighted, identically shaped cylinders placed in the hand.

2) a series of familiar objects placed in the hand and manipulated.
3) the vibrations of a tuning fork when placed on a bony prominence.
4) a series of letters traced on the palm of the hand.

Correct Ans. 2 Ques. Identifiers: III / B / Deductive Reasoning

Rationale: Stereognosis is the ability to recognize different objects placed in the hand and manipulated. A
variety of small and culturally familiar objects of differing size and shape are used (e.g. key, coin, safety pin).
Astereognosis represents complete absence of this ability and parietal lobe impairment (sensory association
areas). Barognosis is the ability to recognize different weights placed in the hand using identically shaped
objects. Pallesthesia is the ability to recognize vibratory stimuli, i.e., a vibrating tuning fork placed on a bony
prominence. Graphesthesia is the ability to recognize letters, or symbols traced on the skin.
Question#68
A morbidly obese individual who weighs 365 pounds is referred for nutritional counseling and exercise
intervention. MOST APPROPRIATE initial physical therapy intervention for this individual would be:

treadmill training at 65% maximal voluntary capacity 3 times per week and a home
1)
walking program.
2) standing, lower extremity leg lifts using light weights and a daily home walking program.
seated cycle ergometry at 50% maximal oxygen consumption and on alternate days pool
3)
calisthenics.
stationary cycle training at 60% maximal voluntary capacity 3 times a week and light
4)
weights for upper extremity resistance training.

Correct Ans. 3 Ques. Identifiers: VI / E / Inference Reasoning

Rationale: Excess body weight will influence overall endurance, level of exertion, and incidence of exercise
induced trauma including back injury, foot/ankle trauma. According to the American College of Sports
Medicine, a safe initial exercise prescription for the obese individual should include: (1) non-weight-bearing
exercise, walking, and resistance training daily or at least 5 days per week, (2) 40-60 minutes per day or 20-
30 min twice daily, and (3) 50-60% of maximal oxygen consumption. Non-weight-bearing exercise reduces
strain on the weight-bearing joints and risk of injury. Examples include seated cycle ergometry, seated
resistance exercises, and pool exercises. Low resistance exercises using distributed practice and circuit
training also reduce the likelihood of injury. This patient will not be able to use a regular stationary
ergometer due to size.
Question#69
A patient arrives for a regularly scheduled cardiac rehab class but does not begin exercising with the rest of
the class. The patient says she doesn't feel very well and has a temperature with chills, nausea, and sweats.
When asked if in any pain, the patient reports an aching pain in the shoulder and back. Palpation reveals
tenderness in the posterior subcostal and costovertebral regions. The therapist's BEST course of action is to:

1) apply a hot pack and allow the patient to rest until feeling better.
2) initiate a referral for medical workup for suspected urinary tract infection.
3) initiate a referral for medical workup for suspected pelvic inflammatory disease.
4) send the patient home and instruct to contact her M.D. if not feeling better in a few days.

Correct Ans. 2 Ques. Identifiers: V / C / Evaluation Reasoning

Rationale: A medical referral is indicated with signs and symptoms of acute infection. Common signs and
symptoms of urinary tract infection (UTI) include: urinary frequency and urgency; pain in the shoulder, back,
lower abdomen or groin; fever and chills; costovertebral tenderness; hematuria (blood cells in urine);
nocturia (urination at night); dysuria (painful urination); and pyuria (pus in urine). Pelvic inflammatory
disease (PID) is an inflammation of the fallopian tubes and produces signs and symptoms of lower abdominal
pain.
Question#70
A patient recovering from traumatic brain injury is sitting on a platform mat and demonstrates sacral sitting
with a kyphotic upper spine and a forward poking head posture. The MOST appropriate initial intervention in
sitting to ensure optimal function is:

1) resisted holding using the PNF technique of rhythmic stabilization.

2) forward-backward weight shifts using resisted movement to the upper trunk.
3) active assisted mobilization of the pelvis to neutral using manual contacts.
4) side to side weight shifts using active reaching movements of the upper extremities.

Correct Ans. 3 Ques. Identifiers: III / D / Inference Reasoning

Rationale: Modification of the pelvic position to a neutral position (reversing the sacral sitting position of a
posterior pelvic tilt) promotes good lumbar and trunk alignment. Many additional postural problems
(kyphosis and forward head) are correctable by aligning the pelvis first and achieving a stable base. Only then
can the therapist focus on stability control in sitting (e.g., using the PNF technique of rhythmic stabilization).
Weight shifts in any direction are contraindicated as the basic requirement for dynamic stability has not been
achieved, i.e., stability control.
Question#71
A patient recovering from a stroke demonstrates poor appetite and weight loss, difficulty sleeping, impaired
concentration, and lack of interest in activities outside the home. The primary physician has prescribed
Amitriptyline Hydrochloride, a tricyclic anti-depressant. During a home physical therapy session, the patient
demonstrates increased balance difficulties. The therapist should examine for:

1) blurred vision, ataxia, and hypertension.

2) tachycardia, palpitations, and hypertension.
3) hypotension, bradycardia, and nausea.
4) drowsiness, dizziness, and postural hypotension.

Correct Ans. 4 Ques. Identifiers: V / A / Inductive Reasoning

Rationale: This patient is exhibiting clinical depression. Pharmacological management with tricyclic anti-
depressants can cause a number of adverse changes affecting balance. Early changes include drowsiness and
dizziness. Continued use can result in orthostatic hypotension, restlessness, fatigue and abnormal
movements. Tachycardia, palpitations, and blurred vision can also occur as adverse effects of this medication
but not hypertension or bradycardia. Fall prevention strategies are an important part of the plan of care.
Question#72
A patient with a T5 complete spinal cord lesion is a recent admission to a SCI rehabilitation unit. On the
second day of therapy the patient complains of a sudden onset of a throbbing headache. The therapist notices
profuse sweating of the face, neck, and shoulders. The patient becomes very apprehensive and reports not
being able to see clearly. The therapist's BEST course of action is to:

1) take the patient's heart rate and lower to supine with head supported.
2) allow the patient to rest and monitor BP and HR closely.
return the patient to the unit, report to the charge nurse and document findings in the
3)
medical record.
4) take the patient's BP and activate the emergency response system.

Correct Ans. 4 Ques. Identifiers: III / C / Evaluation Reasoning

Rationale: This patient is presenting with signs of autonomic dysreflexia (AD). Signs and symptoms include
sudden and significant elevation in BP (>20mmHg), visual field changes, and changes in heart rate
(arrhythmias, fibrillation, PVCs). In SCI, AD is common with lesions above T6 and results from the disruption
of autonomic pathways from the hypothalamus (loss of sympathetic inhibitory output below the level of the
lesion). It is always an emergency situation as AD can quickly result in stroke, renal or retinal hemorrhage,
seizure, or myocardial infarction. Suspected triggers (e.g. full bladder, tight or restrictive clothing) should be
checked immediately and the patient's head should be elevated.
Question#73
A patient with a 10-year history of osteoarthritis is referred to physical therapy following a right knee joint
replacement. The patient is currently using a wheeled walker and walks slowly with a stiff knee and an
antalgic gait. Gait is frequently interrupted by dizziness which the patient describes as disabling. The patient
takes daily ibuprofen and Darvocet for pain. During the history, the therapist's questions should focus on the
presence of drug adverse effects. The one side effect that is NOT expected is:

1) headaches.
2) photosensitivity.
3) ringing in the ears.
4) epigastric pain.

Correct Ans. 2 Ques. Identifiers: V / A / Inference Reasoning

Rationale: Any patient with a prolonged history of NSAIDs use (longer than 3 months) is at risk for
gastropathy (erosive gastritis, ulcers, bleeding). Signs and symptoms include epigastric pain, nausea, loss of
appetite. Occasionally, painless GI hemorrhage can be present. GI bleeding can result in bloody stools, and
dizziness/falls secondary to decreased blood flow to the brain. Additional side effects (among many) include:
fatigue, itching, headache, anxiety, confusion, blurred vision, dry mouth, tinnitus, and impaired hearing.
Photosensitivity is not associated with prolonged NSAID use.
Question#74
A 3 year-old with bronchopulmonary dysplasia had been doing well at home for the last 6 months. The child
has just been diagnosed with pneumonia. The CXR shows an infiltrate at the right base on the AP film and the
infiltrate is anterior on the lateral view. You are teaching the parents how to perform postural drainage on
the child. The proper position would be lying on the:

1) left side, rotated 1/4 turn forward with the feet elevated higher than the head.
2) right side, rotated 1/4 turn backwards with the feet elevated higher than the head.
3) right side, rotated 1/4 turn forward with the feet elevated higher than the head.
4) left side, rotated 1/4 turn backwards with the feet elevated higher than the head.

Correct Ans. 4 Ques. Identifiers: I / D / Deductive Reasoning

Rationale: The infiltrate of right anterior base is most likely the right middle lobe. The standard postural
drainage position for the right middle lobe is lying on the left side, rotated 1/4 turn backwards with the feet
elevated higher than the head.
Question#75
A patient is referred to physical therapy following recent resection of a cerebellar tumor. The patient presents
with symptoms of dysdiadochokinesia, dysmetria, and action tremor. These symptoms indicate a primary
deficit in the functions of the:

1) neocerebellum.
2) spinocerebellum.
3) vermis.
4) vestibulocerebellum.

Correct Ans. 1 Ques. Identifiers: III / A / Analysis Reasoning

Rationale: The neocerebellum (cerebrocerebellum) controls ipsilateral limb movements, ensuring

coordination (adequate force, direction, extent of movement, ordering and timing). The spinocerebellum and
vermis control synergistic action of axial and girdle muscles (postural stability) while the
vestibulocerebellum controls equilibrium responses and head and eye muscles.
Question#76
A community dwelling elder who has been living alone is referred for fall risk assessment. Upon arrival to the
patient's home, the therapist observes the patient is demonstrating mental confusion. He has a productive
cough with rust-colored sputum with sharp chest pain and SOB. Respirations are rapid. The therapist's BEST
course of action is to:

1) ask the agency to send the nurse practitioner tomorrow to evaluate the patient.
2) document the findings and provide scheduled physical therapy examination.
3) document the findings and cancel the scheduled physical therapy examination.
4) consult with his primary physician immediately.

Correct Ans. 4 Ques. Identifiers: V / C / Evaluation Reasoning

Rationale: This patient is exhibiting signs and symptoms of pneumonia (productive cough, pleuritic chest
pain, shortness of breath). Mental confusion is a common additional symptom in the elderly along with
changes in sleep habits and loss of appetite. His physician should be contacted immediately with symptoms of
inadequate ventilation.
Question#77
A 92 year-old individual who lives alone is referred for home physical therapy to improve functional mobility.
During the initial history, the patient reveals he weighs about 100 lbs and has not been eating well lately. Skin
turgor is poor and he complains of a dry mouth and decreased urination. He demonstrates postural
hypotension when moving from sitting to standing position and dizziness when standing. The therapist
suspects:

1) dehydration.
2) diabetes.
3) peripheral edema.
4) potassium depletion.

Correct Ans. 1 Ques. Identifiers: V / A / Analysis Reasoning

Rationale: This patient is exhibiting classic signs and symptoms of dehydration (fluid loss): weight loss,
excessive thirst, poor skin turgor, dryness of mouth, low urine output, postural hypotension and dizziness.
Additional signs and symptoms include absence of sweat, increased body temperature, increased hematocrit,
and confusion. If the state persists, the patient can progress to unconsciousness. While diabetes can produce
increased thirst and weight loss, increased urination is seen. Peripheral edema produces weight gain and
dependent edema. Potassium depletion produces muscle weakness, fatigue, nausea and vomiting, and cardiac
arrhythmias.
Question#78
Which of the following neuromuscular effects are common in both heat and cold modality applications?

1) increased pain threshold.

2) decreased muscle tone.
3) decreased nerve conduction velocity.
4) increased pain threshold and decreased muscle tone.

Correct Ans. 1 Ques. Identifiers: VI / E / Inference Reasoning

Rationale: Both physical agents can decrease pain (increased pain threshold). Cold will decrease nerve
conduction velocity, one of the mechanisms that decrease pain and reduced muscle tone (spasticity), whereas
heat will increase nerve conduction velocity which has no effect on pain or spasticity.
Question#79
A 72 year-old patient with osteoporosis is referred to physical therapy for management of postural
abnormalities and core strengthening. Examination reveals an increase in dorsal kyphosis with forward
rounded shoulders, forward head position, and posterior pelvic position. Which of the following is NOT an
appropriate choice for intervention with this patient?

1) supine lying, shoulder press toward the floor with mid-back lift.
2) supine lying, abdominal crunches with head and shoulder lifts.
3) bridging lifts with arms extended overhead.
4) standing, wall push-ups.

Correct Ans. 2 Ques. Identifiers: VI / F / Inference Reasoning

Rationale: The postural changes described (dorsal kyphosis with forward rounded shoulders, forward head
position, and posterior pelvic position) are typical abnormal changes associated with osteoporosis. All of the
exercise choices are appropriate to improve postural alignment and strength for this patient except
abdominal crunches which are absolutely contraindicated. All forward-bending (flexion) exercises of the
trunk should be avoided as they can cause increased compression on the vertebral column and could result in
compression fractures. These include abdominal crunches, sit-ups, straight leg raises, toe touches (from a
seated or standing position) and any exercise in which the trunk bends and twists.
Question#80
A patient recovering from stroke is ambulatory in the parallel bars with moderate assistance of one. The
patient demonstrates a consistent problem, on the affected side, of knee hyperextension during forward
progression. The best intervention strategy is:

1) supine, bridging, progressing to holding in the bridge position.

2) sitting, knee slides underneath the patient's seat.
3) standing, weight shifts onto the affected lower extremity in step position.
4) small range squats/wall slides using a small stability ball.

Correct Ans. 4 Ques. Identifiers: III / D / Inductive Reasoning

Rationale: Knee hyperextension on the affected limb during forward progression is a common gait deviation
following stroke and can be the result of (1) a plantarflexion contracture, (2) impaired proprioception, (3)
severe spasticity in the quadriceps, or (4) weak knee extensors with compensatory locking of the knee in
hyperextension. Small-range squats strengthen hip and knee extensors (closed chain exercises) while
improving range in ankle dorsiflexion. The small stability ball assists in maintaining the lumbar curve while
enhancing ease of motion. Spasticity can be counteracted by not allowing the knee to go fully back into
hyperextension. The other functional training tasks do not enhance the required knee control, e.g. bridging
promotes hip extension with knee flexion, knee slides promote knee flexion control. Standing weight shifts do
not counteract knee hyperextension.

Question#81
A hospital human resource manager is interviewing a prospective physical therapist for employment. The
physical therapy department has had a high turnover rate as a result of staff members taking maternity leave
and job-related disability leave. It is illegal for the manager to ask whether this female applicant:

1) can fulfill the hours and days per week that the job requires.
2) is planning to start a family.
3) has the qualifications that the job requires.
4) has a disability that would prevent her from satisfactorily performing the job.

Correct Ans. 2 Ques. Identifiers: VI / F / Deductive Reasoning

Rationale: The Pregnancy Discrimination Act, an amendment to Title VII of the 1964 Civil Rights Act,
prohibits an employer from using pregnancy-related information as a means of determining suitability for
employment. It is not illegal to ask about information that was mentioned in the other choices.
Question#82
A review of the medical record reveals a newly arrived patient suffers from a potassium imbalance
(potassium level is 2.5mEq/L). During the initial examination, the therapist should examine for:

1) muscle wasting with hyperexcitability.

2) leg cramps and myalgia with fasciculations.
3) muscle weakness with fatigue and leg cramps.
4) muscle weakness with hyperreflexia and fasciculations.

Correct Ans. 3 Ques. Identifiers: V / B / Inductive Reasoning

Rationale: Normal serum potassium levels are from 3.5 to 5.5 mEq/L. This patient is suffering from
hypokalemia (low potassium). Possible changes include: muscle weakness and fatigue, leg cramps, and
hyporeflexia. Cardiac symptoms (postural hypotension, dizziness, ECG abnormalities), respiratory distress,
cognitive symptoms (irritability, confusion, depression) and GI symptoms (nausea, diarrhea, abdominal
cramps) can also result from hypokalemia. Myalgia and fasciculations are not characteristic.

Question#8
3
A therapist is providing an electrical stimulation treatment. When the therapist turns on the machine, the
patient jumps and cries out that he has received a shock. The ethical principle that has NOT been met in this
situation is:

1) autonomy.
2) fidelity.
3) non-maleficence.
4) veracity.

Correct Ans. 3 Ques. Identifiers: VI / F / Deductive Reasoning

Rationale: A health provider is obligated not to harm the patient. In this situation, the therapist has caused
harm. Autonomy is the patient's right to make decisions about his care; fidelity is one's faithfulness to his/her
duties; and veracity is telling the truth.
Question#84
A patient with a right middle cerebral artery stroke demonstrates early recovery movements in the left upper
extremity (stage 2), left homonymous hemianopsia and a left unilateral neglect. The exercise intervention
that represents the BEST choice to promote functional recovery is:
1) sitting, left upper extremity extended and weightbearing.
2) PNF chop/reverse chop with right arm leading.
3) sitting, arms cradled position, active holding.
4) PNF lift/reverse lift pattern with right arm leading.

Correct Ans. 4 Ques. Identifiers: III / D / Inductive Reasoning

Rationale: The PNF pattern of lift/reverse lift moves the affected arm in an out-of-synergy pattern.
Obligatory synergies can be expected in early (stage 2) and middle (stage 3) following stroke and should be
discouraged. Allowing the sound arm to move in the chop/reverse chop pattern would move the affected arm
in-synergy and is therefore contraindicated. Sitting, left upper extremity weightbearing is a good out-of-
synergy activity but does little for left unilateral neglect. The arms cradled position places the left upper
extremity in an in-synergy position and is contraindicated for patients who demonstrate obligatory synergies.
Question#85
Two patients are being seen in an out-patient physical therapy department for strengthening exercises
following an internal fixation to repair a hip fracture. Patient A has a managed care health insurance policy
that allows 15 visits per episode of illness. Patient B has a managed care policy that allows unlimited physical
therapy visits as long as progress is being made. Both patients will require at least 25 visits to reach
maximum functional improvement. To best help Patient A reach maximum improvement, the therapist
should:

1) write an appeal to Patient A's insurer justifying more visits.

2) do nothing and advise Patient A that coverage cannot be changed.
3) provide care to Patient A but do not bill for it.
4) work with the APTA to lobby for improved physical therapy benefits for Patient A's policy.

Correct Ans. 1 Ques. Identifiers: VI / F / Evaluation Reasoning

Rationale: Physical therapists should serve as patient advocates and be involved in appealing to insurers for
exceptions that will result in the patient reaching a goal. The insurer will evaluate the appeal based on the
determination that the additional costs associated with the appeal are justified by the anticipated outcome.
Providing care without billing for it could financially harm the facility unless pro bono care is granted in this
case. Working with the APTA to improve physical therapy benefits is a noble cause; however, Patient A will
not benefit as it usually takes a long time to make policy and regulatory changes.
Question#86
A 30 year-old patient is brought into the emergency room by ambulance following a motor vehicle accident
while being an unrestrained passenger. The patient complains of right-sided chest pain and has a consistent
tracheal deviation to the left. What pathology would be the most likely cause of tracheal shift to the left?

1) right lung collapse.

2) right pneumothorax.
3) rib fractures.
4) flail chest.

Correct Ans. 2 Ques. Identifiers: I / C / Analysis Reasoning

Rationale: Given this patient was the passenger and was unrestrained, and complaining of right sided chest
pain, the likely scenario is that the patient was forced into contact with the passenger side door. This could
cause rib fractures on the right, causing the pain in the R chest but this alone wouldn't cause a tracheal shift.
Tracheal shifts are caused by either a pneumothorax (with a tracheal shift away from the cause) or a lung
collapse (with a tracheal shift toward the cause). In this case, the tracheal shift is away from the trauma,
making the best answer a R pneumothorax. If a flail chest was enough to cause a tracheal shift, it would not be
consistently toward one side, but it would alternate with the respiratory cycle.
Question#87
A 72 year-old individual wants to begin an exercise training program that includes weights. The expected
musculoskeletal changes that occur with aging that might influence the patient's response to training include:

1) decreased muscle mass with greater decrease in Type I fibers.

2) decreased motor unit recruitment.
3) decreased muscle mass with greater decrease in Type II fibers.
4) increased speed of movement.

Correct Ans. 3 Ques. Identifiers: II / A / Inductive Reasoning

Rationale: Musculoskeletal changes associated with aging include decreased muscle mass with greater
decreases in Type II (fast twitch) fibers responsible for rapid powerful contractions (power and mobility).
Overall strength and speed of movement are decreased. Type I (slow twitch) fibers responsible for slow
speed contraction and continuous activity (postural control) are less affected. Decreased motor unit
recruitment is a neuromuscular change associated with aging.

Question#88
A developmental examination of a 20 month-old reveals the following: inability to move forward in prone,
inability to move in or out of sitting without support, a "bunny hopping" pattern instead of reciprocal
creeping, and impairments of fine motor control when manipulating a cube. All of these developmental
milestones should have been reached by the age of:

1) 6 months.
2) 9 months.
3) 12 months.
4) 15 months.

Correct Ans. 2 Ques. Identifiers: III / A / Inference Reasoning

Rationale: The behaviors are all typically developed by 9 months of age. Children at six months-old are
typically able to roll segmentally, go from sitting to quadruped or prone, able to reach on one arm in prone
and able to hold a small object in each hand. Children at 12 months are able to creep well, over, around, and
on objects and walk with one arm held. Children at 15 months are able to take independent steps with a wide
base of support, creep backwards down stairs. They have a precise, controlled release grasp of a small
container with wrist extended.
Question#89
A researcher investigated the effect of constraint induced movement (CIM) therapy on motor function of the
upper extremity in chronic stroke. Fifty patients were randomly divided into groups: the CIM intervention
and the conventional physical therapy intervention. The Wolf Motor Action Test was used to measure
function before and after the interventions. After evaluating the results, the researcher accepted the null
hypothesis. This can be interpreted as:

1) there was a statistical difference; conventional PT was more effective than CIM.
2) CIM was superior to conventional PT but did not rise to the level of statistical significance.
3) there was no statistical difference in the two interventions in terms of motor outcomes.
4) there was a statistical difference; CIM was more effective than conventional PT.

Correct Ans. 3 Ques. Identifiers: VI / F / Deductive Reasoning

Rationale: The null hypothesis is a hypothesis of no difference or effect. Inferential statistics are used for
hypothesis testing. A statistically significant statistic (P<.05) leads to a rejection of the null hypothesis and
support for the research hypothesis (CIM is superior to conventional PT in influencing motor outcomes in
patients with chronic stroke). Confounding variables must be controlled in order to advocate support for the
hypothesis (i.e., randomized controlled trial).
Question#90
A 92 year-old man suffered a comminuted subtrochanteric femoral neck fracture with internal fixation of the
femoral head. Appropriate interventions to improve strength and muscular endurance at 6-8 weeks post-
surgery would include:

1) open-chain hip and knee resistance exercises using 10 lb weights.

2) bilateral closed-chain mini-squats.
3) hip abductor exercises using theraband resistance.
4) bilateral closed-chain full squats.

Correct Ans. 2 Ques. Identifiers: II / D / Inductive Reasoning

Rationale: Fracture healing can extend for 10-16 weeks. Early postoperative weight bearing during
ambulation and transfers is important. Exercise during the moderate and minimum protection phases (8-12
weeks) can safely include bilateral closed-chain mini-squats and heel-raises. Open-chain hip and knee
resistance exercises can be used with weights up to 5 lbs. Hip abductor exercises using theraband resistance
and bilateral closed-chain full squats are contraindicated.
Question#91
An elderly patient complains of persistent lightheadedness and loss of balance upon standing up. During the
initial examination the therapist reviews all the medications the patient is currently taking. The medications
MOST likely to cause these problems are:

1) tricyclic antidepressants and antihypertensives.

2) antiarrhythmic drugs.
3) hypoglycemic agents.
4) anticoagulant and antiplatelet agents.

Correct Ans. 1 Ques. Identifiers: V / A / Analysis Reasoning

Rationale: This patient is experiencing orthostatic hypotension, a common problem in the elderly.
Medications that commonly cause problems with orthostatic hypotension include tricyclic antidepressants,
phenothiazine, methyldopa, clonidine and centrally acting psychotropics, and antihypertensives.
Antiarrhythmic, hypoglycemic, anticoagulant, and antiplatelet agents do not typically cause hypotension.

Question#92
A patient recovering from stroke has received an AFO with a plastic shoe insert, double uprights, and
bichannel adjustable ankle locks. Lower-limb orthotic examination reveals that the mechanical ankle joint
coincides with a point at the proximal medial malleolus. There is adequate clearance between the anatomical
ankle and mechanical ankle joints. The orthotic checkout should be reported as:

1) provisional pass.
2) pass.
3) failure.
4) provisional failure.

Correct Ans. 3 Ques. Identifiers: VI / E / Evaluation Reasoning

Rationale: The mechanical ankle joint should coincide with the anatomical ankle joint which is
approximately a horizontal line between the malleoli at the level of the distal tip of the medial malleolus. This
orthosis should be reported as failure, signifying a major defect that would interfere with its use and training.
Pass indicates that the orthosis is completely satisfactory while a provisional pass indicates that minor faults
exist and will not interfere with its use or training (generally reserved for cosmetic defects).
Question#93
An older adult is referred to physical therapy with left shoulder pain and loss of range of motion. Examination
reveals decreased ROM (flexion is 0-110, abduction is 0-95, and external rotation is 0-20). Patient describes
pain as intense (rates pain as 6 out of 10) and progressively worsening over the past 2 months. Pain is often
present at night and interferes with sleep. The exercise intervention that is contraindicated is:

1) passive range of motion.

2) passive grade I small-amplitude joint mobilizations.
3) passive grade III large-amplitude joint mobilizations.
4) pendulum exercises.

Correct Ans. 3 Ques. Identifiers: II / D / Inference Reasoning

Rationale: This patient is exhibiting classic signs and symptoms of adhesive capsulitis (frozen shoulder):
decreased shoulder ROM, intense pain with no other identifiable cause, and pain at night. Vigorous stretching
(grade III large-amplitude joint mobilizations) is contraindicated during the acute period of active
inflammation. Once pain and inflammation subside, grade III mobilizations can be considered. All other
choices are appropriate for the initial inflammatory stage. In addition, gentle muscle setting of shoulder
muscles and modalities (heat, ultrasound, or electrical stimulation) can be considered.

Question#94
In pulmonary rehabilitation, the best reason to perform a six minute walk test is to determine:

1) improvement in a pre and post conditioning program.

2) peak oxygen consumption prior to starting a conditioning program.
3) HR max following a conditioning program.
4) RPE max prior to starting a conditioning program.

Correct Ans. 1 Ques. Identifiers: I / B / Evaluation Reasoning

Rationale: The 6 minute walk test is helpful as a pre and post test to document patient improvement with an
exercise program. Maximal values of VO2, HR and RPE from a 6 minute walk test do not correlate as well with
those values from maximal test measures from a graded exercise test.
Question#95
An elderly resident of a skilled nursing facility is given a wheelchair with a sling seat. The therapist examines
the patient's seated position in the chair and recognizes common seating problems associated with this type
of seat. These include:

1) increased popliteal pressure from the front of the seat.

2) dorsal kyphosis.
3) excessive abduction and external rotation of the thighs.
4) posterior pelvic tilt and adduction/internal rotation of the thighs.

Correct Ans. 4 Ques. Identifiers: VI / E / Inductive Reasoning

Rationale: A fabric or sling seat results in poor pelvic position in which the hips slide forward, creating a
posterior pelvic tilt. Adduction and internal rotation of the thighs also occur. Most wheelchair users benefit
from a firm seating surface (solid insert) to reduce these problems. Increased popliteal pressure results from
an increased seat depth. Dorsal kyphosis commonly results from a soft sling back and poor hip position.
Excessive abduction and external rotation of the thighs occurs with poor lower extremity (hip) alignment and
can be controlled by the addition of lateral knee glides.
Question#96
A patient with bipolar disorder is referred to physical therapy following a mild myocardial infarction. For
control of acute mania, the patient has been taking lithium. Possible adverse effects of this medication that
might accompany exercise include:

1) decreased blood pressure at rest and with exercise.

2) increased heart rate at rest and with exercise along with arrhythmias.
3) increased blood pressure at rest and with exercise.
4) arrhythmias at rest and with exercise along with T wave changes.

Correct Ans. 4 Ques. Identifiers: V / A / Inference Reasoning

Rationale: Adverse cardiovascular effects of lithium include ECG changes (arrhythmias at rest and with
exercise along; T wave changes) hypotension, vasculitis, and peripheral circulatory collapse. Decreased blood
pressure and increased heart rate at rest and with exercise can be caused by some psychotropic medications
(antidepressants, major tranquilizers) while lithium has no effect. Nicotine, thyroid medications, alcohol, and
anorexiants/diet pills can result in increased blood pressure at rest and with exercise. (Source: American
College of Sports Medicine: Guidelines for Exercise Testing and Prescription, 7th ed. Philadelphia: Lippincott
Williams & Wilkins, 2006, p. 265).
Question#97
A patient complains of pain in the low back resulting from moving furniture two weeks ago. The therapist
decides to apply high rate conventional TENS. The patient states that after a few sessions, despite increasing
current intensity, pain relief is now less effective. It would be best if the physical therapist:

1) replace the batteries.

2) discontinue the treatment.
3) switch the unit to the modulation mode.
4) instruct the patient to increase the duration of the treatment.

Correct Ans. 3 Ques. Identifiers: VI / E / Evaluation Reasoning

Rationale: When electrical stimuli are delivered at the same repetitive rate, e.g., 100 pps, the sensory
receptors tend to reduce the excitability of the receptor membrane and thus lessen the response to the
stimulus. This is called adaptation. Modulation is a change of stimulus in either pulse rate, or pulse duration
or current intensity. In this case, by changing the TENS unit to Modulation, adaptation is avoided and the
effect on pain remains constant. The batteries are not likely the problem after just a few treatments.
Increasing the duration of the treatment would have no effect on adaptation. Nothing in the protocol
warrants discontinuing the treatment.
Question#98
A patient with advanced Parkinson's disease exhibits marked balance impairment. The therapist's BEST
choice to examine these deficits is:

1) Clinical Test for Sensory Interaction in Balance [CTSIB].

2) the Berg Balance scale.
3) timed static standing balance using the Romberg quotient.
4) 10 meter walk test with dual task attentive demands.

Correct Ans. 2 Ques. Identifiers: III / B / Inductive Reasoning

Rationale: The Berg Balance Scale examines functional limitations associated with the performance of daily
activities requiring balance. It has 14 items with a total score of 56 points; individuals with scores of 45 and
below are at higher risk for falls. Basic balance items (1-5) are indicated for low level patients and examine
sitting and standing unsupported, sit-to-stand and stand-to-sit, and transfers. The remaining three choices do
not adequately assess functional deficits. The CTSIB examines sensory interaction and the Romberg test
examines sensory ataxia. The 10 meter walk test with dual tasking is a limited item test which will likely
indicate severe impairment; patients with Parkinson's disease demonstrate great difficulty with dual tasking.
Question#99
A 16 year-old patient with complete T10 spinal cord injury was discharged with a home exercise program
(HEP). The patient had not come to grips yet with his new self-image or with the restrictions of the condition
and is experiencing difficulty at home and in school. The patient failed to regularly complete his HEP and is
now back in the hospital after 2 months with developing contractures in both lower extremities and a stage II
pressure ulcer over his sacrum. The therapist's initial teaching efforts failed to achieve success. An
educational objective that BEST supports a successful resolution of this situation is:

1) the patient will closely attend to HEP instructions.

2) the patient will consistently value the worth of his HEP.
3) the patient will demonstrate satisfaction in describing all the components of the HEP.
4) the patient will recognize the family's role in assisting with the HEP.

Correct Ans. 2 Ques. Identifiers: VI / F / Evaluation Reasoning

Rationale: In the affective domain, a behavioral objective that focuses on Level 4.0 Valuing is the most
important. Unless this patient internalizes the worth of the HEP, the commitment to lifelong self-care will be
lacking. Attending to the HEP instructions (Level 1.0 Receiving) and describing the components of the HEP
(Level 2.0 Responding) do little to ensure lasting commitment to a HEP.

Question#10
0
A 6 year-old child with spastic diplegia needs to increase standing time during school hours. The physical
therapist decides to use a parapodium instead of a standing frame. The key reason for ordering this device is:

1) articulated hip joints for easy stand-to-sit.

2) articulated knee joints for easy sit-to-stand.
3) midtorso chest support.
4) wheeled base for easy mobility.

Correct Ans. 2 Ques. Identifiers: VI / E / Inductive Reasoning

Rationale: Both the standing frame and the parapodium allow the wearer to stand without crutch support,
freeing up the hands for activities. The parapodium has knee joints that can be unlocked, allowing the wearer
to assume sit-to-stand and stand-to-sit more easily. A standing frame has nonarticulated uprights. Both have
bands to stabilize the body at key points (midtorso, pelvic and leg bands). Both can have a wheeled base for
easy positioning.