Techniques for Decreasing Pain and Improving Mobility, Exams of Laboratory Practices and Management

Download Techniques for Decreasing Pain and Improving Mobility and more Exams Laboratory Practices and Management in PDF only on Docsity! PTFE Practice Exam 1 Questions with Correct Answers. A 21-year-old female patient presents with neck pain and stiffness that has gradually worsened over the last two weeks. Upon examination, the patient is noted to have pain with left side bending with left rotation and reports pain on the left at the C5-6 junction. Hypomobility is also noted with right side-gliding of C6. Which of the following techniques will be most appropriate to decrease pain 1) Closing technique for the mid-thoracic spine. 2) Closing manipulation in extension for C5-C6 3) Gapping manipulation in flexion for C5-C6. 4) Flexion/opening manipulation for mid-thoracic spine - Correct Answers 2 The hypomobility is noted at C6 with right side-gliding and pain with left SB and rotation, indicating a closing restriction at the left C5-6 facet joint. Thus, interventions would require assistance with closing (approximation). A patient presents to the clinic with right shoulder pain and complains of difficulty reaching overhead, with pain especially from 60-120 degrees of shoulder flexion. Which special test would be MOST informative for this set of symptoms? 1) Neer Test 2) Empty Can Test 3) Crossover Test 4) Push Off Test - Correct Answers 1 The Neer Test is a test for subacromial impingement and is typically associated with the painful arc. A physical therapist is evaluating a patient with back pain. The patient reports having pain that has increased steadily over the last 2 months and is constant and unremitting. The pain radiates into both lower extremities. The patient also feels marked weakness throughout the right lower extremity. What is the MOST appropriate initial treatment? 1) Discontinue treatment and refer patient to primary care physician for further testing. 2) Begin a program of core strengthening, focusing on transversus abdominis training and progressing toward a long term stabilization program. 3) Instruct the patient in appropriate lower extremity exercises to improve leg strength, focusing on the right leg. 4) Initiate piriformis stretching as tolerated and instruct the patient in self mobilization techniques to improve mobility throughout the lumbar spine. - Correct Answers 1 Constant pain without any relation to position is a key indicator of spinal cancer. While examining a patient's lumbar x-ray films, a physical therapist notices that the L5 vertebra is displaced anteriorly on sacrum by approximately 50% of the vertebral body. How will this MOST affect physical therapy if the patient is being treated for low back pain? 1) Emphasize core strengthening, especially in spine neutral 2) Begin progressive gluteal and quad strengthening to assist the lumbopelvic fascia 3) Avoid extension activities, especially in standing 4) Add progressive external oblique training as tolerated to assist proper spinal alignment - Correct Answers 3 Extension activities will exacerbate any pain from this spondylolisthesis. Hertling D. Lumbar Spine. A physical therapist is treating a patient with cervical pain. The patient reports that the pain occurs with most movements and feels "stiff" with active range of motion. What is the MOST appropriate course of action? 1) Refer to the primary care physician for further testing. 2) Initiate thoracic spine mobilization. 3) Instruct the patient on cervical spine stabilization exercises and issue a home exercise program. 4) Initiate an upper extremity exercise routine to improve shoulder internal rotation range of motion and progress as tolerated. - Correct Answers 2 Increasing amounts of the literature suggest that for hypomobility of the neck, thrust manipulation of the thoracic spine can provide short-term improvements in patients with mechanical neck pain. A physical therapist is treating an individual recovering from a total knee replacement. The therapist desires to make an objective measure regarding the functional ambulation status of this individual. Which of the following devices would be MOST useful? 1) Goniometer 2) Treadmill 3) Stopwatch 4) Stairs - Correct Answers 3 A stopwatch for the TUG or 6 MWT would be MOST useful. These are excellent tests in determining function in a community ambulator. A patient is being treated for difficulty with overhead activities and subacromial bursitis. Which of the following strengthening activities will be MOST helpful? A physical therapist is mobilizing a patient's glenohumeral joint to improve passive range of motion. The therapist provides a large amplitude oscillation to the limits of available motion. Which of the following grades of mobilization is being provided? 1) Grade II 2) Grade III 3) Grade IV 4) Grade V - Correct Answers 2 Grade III is correct. II is large amplitude oscillations, but not to end of range. IV is small amplitude oscillations at the end of range. V is high velocity, low amplitude thrust past the end of range. Which of the following would align with a plumb line in proper postural alignment (lateral view)? 1) Anterior to the coronal suture 2) Posterior to the lateral malleolus 3) Center of the iliofemoral joint 4) Vertebral bodies of the lumbar spine - Correct Answers 4 4 is correct. 1 is posterior to the coronal suture. 2 is anterior of the lateral malleolus. 3 is posterior to the iliofemoral joint. Dutton p. 293 A patient is struggling to regain full motion in the thoracic spine following a motor vehicle accident and appears to have a capsular restriction. Which of the following BEST represents the capsular pattern for the thoracic spine (listed in order of most limited to least limited)? 1) Equal lateral flexion and rotation, extension 2) Equal flexion and extension, side flexion 3) Equal flexion and rotation, extension 4) Equal extension and side flexion, rotation - Correct Answers 1 Capsular patterns in the thoracic spine affect the zygapophyseal joints as they articulate on both sides of the vertebrae. A patient is having difficulty achieving full knee extension after arthroscopic surgery. The patient appears to have difficulty with the "screw-home" mechanism. Which of the following BEST describes the action of the screw-home mechanism? 1) The tibial plateau rotates medially during the final 10 degrees of extension. 2) The tibial plateau rotates medially during the final 20 degrees of extension. 3) The tibial plateau rotates laterally during the final 10 degrees of extension. 4) The tibial plateau rotates laterally during the final 20 degrees of extension. - Correct Answers 4 When using the parallel bars for gait training, what is the appropriate adjustment of the height of the parallel bars that will optimize stability and security for the patient? 1) A height that allows for elbow flexion of approximately 0 degrees. 2) A height that allows for elbow flexion of approximately 10 degrees. 3) A height that allows for elbow flexion of approximately 15 degrees. 4) A height that allows for elbow flexion of approximately 20 degrees. - Correct Answers 4 Having elbow flexion of approximately 20 degrees will allow optimal stability while ambulating. Which of the following BEST describes a Chopart amputation? 1) A transtibial amputation. 2) Removal of the ankle joint just proximal the malleoli. 3) Amputation of the metatarsals. 4) Disarticulation at the midtarsal joint. - Correct Answers 4 The calcaneus and talus are left intact, but the midtarsals are removed. During ambulation, what is the normal range of motion required for ankle plantar flexion? 1) 5 degrees 2) 10 degrees 3) 15 degrees 4) 20 degrees - Correct Answers 4 20 degrees of plantarflexion is required for gait during the preswing phase. According to the Rancho Los Amigos gait terminology, when does terminal swing phase begin? 1) At the point of toe off of the reference foot. 2) When the contralateral tibia is perpendicular to the ground. 3) When the reference tibia is perpendicular to the ground. 4) At the point of toe off of the contralateral foot. - Correct Answers 3 1 is the beginning of initial swing. 2 is the beginning of terminal stance. 4 is the beginning of midstance. A patient is being evaluated after a knee injury, and the examiner chooses to use the Reverse Pivot-Shift Test? Which of the following structures is BEST tested with this special test? 1) Anterior Cruciate Ligament 2) Posterior Cruciate Ligament 3) Medial Collateral Ligament 4) Lateral Collateral Ligament - Correct Answers 2 The plain vanilla pivot shift test uses medial rotation of the leg, and the Reverse uses lateral rotation A patient presents to the inpatient rehabilitation unit who has suffered a vertebro- basilar CVA and has difficulty depressing the eye from an adducted position. Which cranial nerve is the MOST likely cause of this impairment? 1) CN I 2) CN II 3) CN III 4) CN IV - Correct Answers 4 Cranial nerve testing for ocular movements is performed using the "H" pattern to assess tracking movements. Difficulty adducting and depressing the eye is indicative of Trochlear nerve involvement. A patient reports feeling dizzy and lightheaded upon standing. The patient reports that the condition has been worsening over time and that he commonly sees dark spots when changing positions. Which of the following conditions is MOST likely present? 1) Benign paroxysmal positional vertigo 2) Meniere's disease 3) Orthostatic hypotension 4) Transient ischemic attack - Correct Answers 3 A sudden drop in blood pressure upon standing is the most common effect of this condition. The question is very brief and does not describe any complicated symptoms. BPPV is characterized by dizziness lasting about 1 minute following head position changes, such as stooping or turning. Meniere's disease is a fluid imbalance in the inner ear. This can cause persistent dizziness and lightheadedness. A TIA causes stroke-like symptoms and is not related to position changes. A patient is experiencing numbness and paresthesia on the scalp, forehead, upper eyelids, and nose. Which of the following disorders is the MOST likely origin of the sensory disturbance? 1) C2 spinal nerve root impingement 2) Bell's Palsy of the facial nerve 3) Trigeminal nerve lesion A patient is experiencing numbness and tingling along the S1 nerve root dermatome. Which of the following BEST describes the innervation area of this dermatome? 1) Lateral aspect of the calcaneus 2) Anterior and medial thigh 3) Dorsum of the foot 4) Medial malleolus - Correct Answers 1 Lateral aspect of the calcaneus is correct. 2 is the dermatome for L2. 3 is is the dermatome for L5. 4 is the dermatome for L4. Which of the following structures will lead to ipsilateral impairments when damaged? 1) Anterior corticospinal tract 2) Parietal lobe 3) Cerebellar lobe 4) Spinothalamic tract - Correct Answers 3 Damage to one cerebellar lobe will produce ipsilateral impairments. The anterior corticospinal tract decussates at the spinal level where it exits the spinal cord. Damage to the anterior corticospinal tract would result in contralateral impairments. Information from the parietal lobe decussates and travels down the contralateral side. The spinothalamic tract decussates and courses up the contralateral side. A physical therapist is evaluating a 65 year old patient who complains of progressive weakness that first began 1 year ago. The patient reports increasing fatigue, diminished muscle mass, and generalized muscle pain. MRI and lab tests are negative for irregularities. Which of the following conditions is MOST likely present? 1) Multiple Sclerosis 2) Post-polio syndrome 3) Acute inflammatory demyelinating polyneuropathy 4) Charcot-Marie-Tooth disease - Correct Answers 2 Post-polio syndrome is a progressive weakness and fatigue that affects people who had poliomyelitis approximately 15-30 years earlier. There are no lab tests or imaging to confirm this diagnosis. A 12 year old boy with spina bifida occulta is receiving physical therapy for bilateral leg weakness and difficulty walking. Which of the following will be the MOST important consideration when developing a plan of care for this patient? 1) Train the patient in the use of appropriate adaptive equipment. 2) Provide training to upper body muscles to promote independence. 3) Provide exercises to increase tone in the legs and become as independent as possible. 4) Train the patient to use crutches to allow for more active participation in socially appropriate activities. - Correct Answers 3 Increasing tone in flaccid legs and promoting independence is the MOST important consideration. A patient with cystic fibrosis is receiving postural drainage and percussion for the right lower lobe's superior segments. What is the MOST appropriate patient position? 1) Supine on a wedge with the left shoulder elevated and the head lower than the pelvis. 2) Supine on a wedge with the right shoulder elevated and the head lower than the pelvis. 3) Prone with the two pillows under the hips and treatment table flat 4) Supine with the two pillows under the knees and treatment table flat - Correct Answers 3 Prone with the two pillows under the hips and treatment table flat is the most appropriate position for the lower lobe's superior segments bilaterally. A physical therapist is performing a treadmill exercise stress test using the Bruce protocol. During stage 3 of the test, the P wave increases in height, and the S-T segment begins to become significantly upsloping. What is the MOST appropriate course of action? 1) Stop the test and refer patient to a physician. 2) Lower the stage back to stage 2 and monitor for improved electrocardiographic indicators. 3) Continue with the test without any modification, monitoring for symptoms of cardiac distress. 4) Discontinue the test, and monitor the patient's vital signs for 10 minutes. - Correct Answers 3 Both of these signs are normal responses to the stress test. Which of the following arterial blood gas values is MOST indicative of respiratory alkalosis? 1) PaO2 80 mmHg 2) PaO2 100 mmHg 3) PaCO2 25 mmHg 4) PaCO2 45 mmHg - Correct Answers 3 PaCO2 levels are typically between 35-45 mmHg. With decreased PaCO2, the pH of the blood increases, causing alkalosis. 1 is a normal PaO2 value (bottom end). 2 is a normal PaO2 value (top end). 4 is a normal PaCO2 value (top end). A patient in the intensive care unit has a Swan-Ganz catheter. What is the PRIMARY purpose of this type of catheter? 1) Introduce pharmaceuticals via a portal in a peripheral vein. 2) Introduce pharmaceuticals directly into the inferior vena cava or right atrium. 3) Monitor blood pressure and detect heart failure. 4) Collect urine into a receptacle to be discarded. - Correct Answers 3 A Swan-Ganz catheter is a diagnostic tool used to detect blood pressure in the right side of the heart. A male patient in the intensive care unit is being treated for multiple trauma injuries after a motor vehicle accident. A physical therapist is reviewing the most recent lab results. Which of the following would be the GREATEST indication to postpone therapeutic exercise until consulting with the attending physician? 1) Venous partial pressure O2 40 mmHg 2) Hemoglobin A1C 5.1 % 3) White Blood Cell Count 10,000 cells/mL 4) Hematocrit 22% - Correct Answers 4 A low hematocrit will likely lead to lightheadedness and will interfere with physical therapy intervention. No exercise is permitted with HCT < 25%. The other values are normal or borderline normal. During an exercise stress test, a patient begins to display large, irregular ECG signals that are turbulent and asynchronous. Which of the following conditions is MOST likely present? 1) Premature ventricular contraction 2) Ventricular fibrillation 3) Ventricular tachycardia 4) Ventricular asystole - Correct Answers 2 Ventricular fibrillation is a medical emergency. A patient has just undergone a procedure to remove an air pocket from the lung that has resulted from several years of COPD. What is the term for this type of procedure? 1) Lobectomy 2) Pneumonectomy 1) Instruct the patient on the importance of glucose monitoring and diabetes control. 2) Instruct the patient to offload the pressure point and use bulky dressing to absorb the exudate. 3) Begin whirlpool therapy to assist in nonspecific wound debridement. 4) Begin sharp debridement of wound bed, carefully removing areas of thickened callus and eschar. - Correct Answers 1 Maintaining good diabetic control is critical to improving circulation and decreasing the patient's propensity for further wounds. 2 is a part of the treatment plan, but not the MOST important initial course of action. 3 can aid in eschar debridement, but is not the MOST important of the choices presented. 4 is a very viable treatment option, but not the correct answer. A patient has weakness, low blood pressure, hyperpigmentation of the skin, and decreased amounts of cortisol and aldosterone. Which of the following conditions is MOST likely present? 1) Conn's Syndrome 2) Cushing's Syndrome 3) Addison's Disease 4) Graves Disease - Correct Answers 3 Addison's disease is commonly caused by adrenal destruction, typically by autoimmune pathways. A patient has just received the results of a recent blood test. Which of the following blood chemistry values would be the cause for greatest concern? 1) Triglycerides 110 mg/dL 2) Total cholesterol 120 mg/dL 3) HDL cholesterol 30 mg/dL 4) LDL cholesterol 90 mg/dL - Correct Answers 3 All values are normal except for the HDL cholesterol, which is out of the normal parameters of 40-80 mg/DL. A patient with schizophrenia is receiving physical therapy treatment for a rotator cuff injury sustained from a recent fall. Which of the following will be the MOST important consideration in treating this individual? 1) Begin a structured routine with little variation in a predictable environment. 2) Assure the patient that he is safe in therapy and avoid group settings. 3) Begin the patient with several low intensity exercises that increase heart rate. 4) Remain calm and speak softly throughout the treatment session. - Correct Answers 2 Patients with schizophrenia are commonly apprehensive about group settings and have frequent hallucinations and delusions. It is best to treat these individuals as privately as possible to avoid anxiety/fear. A patient with a body mass index of 34.9 is being treated for generalized weakness and difficulty walking. Which of the following will be MOST important when creating a home exercise program for this patient? 1) Use recumbent and low impact drills to minimize jarring forces. 2) Monitor heart rate and blood pressure throughout treatment. 3) Add both strength and endurance activities to promote weight loss. 4) Instruct the patient to maintain a Borg RPE less than 13 during endurance activities. - Correct Answers 4 The Borg scale was created to correlate fatigue and exertion to approximate heart rate (thus 13 on the scale would be 13x10=130 for the heart rate). For a long term intervention, combined with a home exercise program, instruction on the Borg RPE will be MOST important. A patient with type I diabetes is coming to the physical therapy clinic for treatment after a total knee replacement. Which of the following will be most important when treating this individual with therapeutic exercise? 1) Include activities for large muscle groups to improve glucose absorption. 2) Encourage the patient to eat more than 1/2 hour before the therapy session. 3) Add appropriate exercises as tolerated, focusing on knee extension. 4) Instruct the individual to bring small snacks to eat throughout the session. - Correct Answers 2 If the patient eats 1/2 hour before treatment, the insulin response combined with the exercise-induced glucose absorption will likely cause hypoglycemia. A patient with an adrenal medulla adenoma is being examined by a physical therapist. Which of the following metabolic symptoms would be MOST likely present when assessing the patient's resting vital signs? 1) Decreased respiration rate and decreased heart rate 2) Decreased respiration rate and increased heart rate 3) Increased respiration rate and increased heart rate 4) Increased respiration rate and decreased heart rate - Correct Answers 3 An adenoma would most likely cause hypertrophy of the adrenal medulla and thus an overproduction of epinephrine and norepinephrine, increasing respiration rate and heart rate. A magnetic resonance image (MRI) correctly identifies 95% of patients as positive for anterior cruciate ligament tear. Based on this information, which of the following measures would have the HIGHEST value? 1) Sensitive 2) Specific 3) Significant 4) Stable` - Correct Answers 1 A test that is sensitive will correctly identify the true positives. With high sensitivity, a test that is negative will likely mean that you can rule OUT the condition because positives are so reliable. Specificity is the % of true negatives identified. With high specificity, a test that is positive will rule IN the condition because the negatives are so reliable. Statistically significant would mean the result is likely NOT due to chance. Stable would mean the result does not fluctuate. A physical therapist is trying to determine which special test to use for an examination and is researching the individual statistical values of each. Which of the following statistical attributes must a special test have to BEST limit Type I errors? 1) Sensitivity 2) Specificity 3) Positive likelihood ratio 4) Negative likelihood ratio - Correct Answers 2 High specificity effectively limits Type I errors (False Positives). Specificity is the ratio of true negatives to false positives + true negatives. In other words, specificity is "correctly identifying true negatives." With higher specificity, you have fewer false positives (Type I errors) A 30 year old patient is recovering from an ankle fracture has instructions from the physician to ambulate with partial weight bearing on the involved extremity. Which of the following assistive devices would be MOST appropriate for this patient to facilitate ambulation? 1) Single point cane 2) Four wheeled-walker 3) Lofstrand crutches 4) Knee scooter - Correct Answers 3 Forearm or Lofstrand crutches offer the ability to bear weight through the upper extremities without irritating the axillae. Which of the following BEST represents a handicap on the International Classification of Functioning, Disability, and Health?