MSK
A PT is informed that a patient was diagnosed with a Lisfranc injury after returning from a physician visit. The patient was originally diagnosed with a minor lateral ankle sprain however returned to the physician after failing to make progress, Which bone would be the LEAST likely to be impacted with this type of injury?
A. Calcaneus
B. Cuboid
C. Second cuneiform
D. Navicular
A. Calcaneus
Rationale: this bone is considered part of the hindfoot, a Lisfranc injury is a disruption of the joint between the metatarsal bones (bones in the middle of the foot) and the tarsal bones (bones in the back of the foot)
pg 1118 Scorebuilders
A patient is diagnosed with end stae kidney disease. Which comorbidity is likely to have caused this condition?
A. Chronic hypotension
B. Diabetes
C. Peripheral arterial disease
D. CHF
B. Diabetes
Rationale: high glucose overwork the kidneys causing them to filter excessive volumes of blood
pg. 1077 in Scorebuilders
After completing a wheelchair seating and mobility assessment, a PT determine the wheelchair has excessive seat width, which of the following adverse effects would most likely result from excessive seat width?
A. difficulty changing position within the wheelchair
B. insufficient trunk support
C. difficulty propelling the wheelchair
D. increased pressure to the distal posterior thighs
C. difficulty propelling the wheelchair*
we were told in class B was the answer, see rationale on page 1043 of scorebuilders
A 45-year-old male patient with a lumbar disc disorder is referred for physical therapy. Which of the following interventions is most appropriate when treating this patient?
A) Maximize flexed postures and positions and minimize lordotic positions
B) Maximize extension and minimize flexion
C) Minimize flexed postures and positions and emphasize lordotic positions
D) Maximize flexion and promote lumbar hyperextension
C) Minimize flexed postures and positions and emphasize lordotic positions
Explanation:
a PT treats a child with CP classified level V using the Gross Motor Functoin Classification System. Wghich recommendation is the MOST likely?
A. orthoses and AD for community ambulation
B. orthoses and AD for home ambulation
C. standing frame and orthoses and/or assistive devices for household ambulation
D. standing frame and wheelchair for community ambulation
D. standing frame and wheelchair for community ambulation
Rationale: most appropriate to assume upright position for weight bearing thru LE, also serve as prolong stretch to hip flexors and hamstrings. Kevel 5 child with CP would likely use a wheelchair for both home and community
pg. 1038 Scorebuilders
A. Tarsal Tunnel Syndrome
B. Peroneal tenosynovitis
C. Plantar fasciitis
D. posterior tibial tenosynovitis
B. Peroneal tenosynovitis
Rationale: inflammation of fibularis/peroneal tendons, usually associated with repetitive ankle motions from over use, supinated gait places additional stress on peroneal tendons
pg. 994 scorebuilders
A physical therapist is reviewing the results of a patient's DEXA scan to assess bone density. The report shows the following T-scores: -3.0, -2.0, 2.0, and 3.0. Which of the following T-scores is MOST indicative of osteopenia?
a. -3.0
b. -2.0
c. 2.0
d. 3.0
B. -2.0
T-score Interpretation:
Normal bone density: T-score above -1.0.
Osteopenia: T-score between -1.0 and -2.5.
Osteoporosis: T-score -2.5 or lower.
Above-average bone density: T-score above 0.
The T-score of -2.0 falls within the range of -1.0 to -2.5, indicating osteopenia. This suggests lower-than-normal bone mass but not low enough to be classified as osteoporosis
A patient sustained a C7 spinal cord injury (ASIA Impairment Scale A). Which of the following descriptions BEST represents the highest potential of function for this patient?
A. Level transfers with total assistance, bed mobility with total assistance, power wheelchair mobility with head controls.
B. Level transfers with modified independence, bed mobility with modified independence, manual wheelchair mobility over level surfaces with modified independence.
C. Unlevel transfers with minimal assistance, bed mobility with moderate assistance, power wheelchair mobility with joystick control.
D. Unlevel transfers with total assistance, bed mobility with maximum assistance, manual wheelchair mobility with moderate assistance.
B. Level transfers with modified independence, bed mobility with modified independence, manual wheelchair mobility over level surfaces with modified independence.
C7 Spinal Cord Injury (ASIA Impairment Scale A):
Injury at C7 allows for control of the triceps, wrist extensors, and finger extensors (partial).
Patients can extend their elbows, which is critical for independent transfers, bed mobility, and manual wheelchair use.
Grip strength is limited but present, allowing some level of functional independence with adaptive equipment.
Functional Expectations:
Transfers: Independent or modified independent for level surfaces using a sliding board or depression transfers.
Bed Mobility: Independent or modified independent with the use of adaptive techniques.
Manual Wheelchair Mobility: Independent on level surfaces with potential difficulty on uneven terrain.
A researcher conducts a hypothesis test to determine if there is a significant difference in recovery times between two groups of patients. The p-value obtained is 0.03. Which of the following conclusions is most appropriate based on this result?
a. There is no statistically significant difference between the groups, and the null hypothesis should not be rejected.
b. There is strong evidence to reject the null hypothesis, and the observed difference is likely due to random chance.
c. The result is statistically significant, so the null hypothesis should be rejected in favor of the alternative hypothesis.
d. The result is not statistically significant, so the alternative hypothesis should be accepted.
Answer: c. The result is statistically significant, so the null hypothesis should be rejected in favor of the alternative hypothesis.
Explanation: A p-value of 0.03 is less than the common alpha level of 0.05, indicating that the observed result is statistically significant. This leads to rejecting the null hypothesis and supporting the alternative hypothesis.
during a session the PT becomes concerned a patient may be contemplating suicide based on verbal statements, which actions would be MOST appropriate initial step by the therapist?
A. remind the patient it normally takers a period of time for this type of medication to become effective
B. discuss the impact suicide would have of the family as a deterrent
C. recommend the patient make an appointment to return to the physician
D. ask questions to determine if the patient is considering suicide
D. ask questions to determine if the patient is considering suicide
Rationale: QPR model for suicide prevention, Q is question the person about suicide, p is persuade to get help, r is refer to help
pg. 1011 in scorebuilders
A PT makes footwear recommendations for a patient with foot pathology, the recommendations include high and wide toe box, small to no heel, medial arch support, and contoured posterior counter. This type of recommendation would be MOST beneficial for a patient diagnosed with which condition?
A. sesamoiditis
B. pes cavus
C. hallux valgus
D. metatarsalgia
C. hallux valgus
reduce friction and pressure on MTP joint, decrease pronation, decreased foot pressure and control subtalar joint.
pg. 928 scorebuilders
A physical therapist is scheduled to treat a patient in an acute care setting who has tested positive for Vancomycin-Resistant Enterococcus (VRE). Which of the following infection control measures is MOST appropriate to follow during treatment?
a. Wearing a surgical mask and gloves, but no gown is necessary.
b. Wearing gloves and a gown upon entering the patient's room, with hand hygiene performed before and after patient contact.
c. Wearing an N95 respirator, gown, and gloves for all patient interactions.
d. Maintaining a distance of at least 6 feet from the patient to prevent droplet transmission.
b. Wearing gloves and a gown upon entering the patient's room, with hand hygiene performed before and after patient contact.
Why?
VRE (Vancomycin-Resistant Enterococcus):
A type of bacteria resistant to vancomycin, commonly transmitted via direct contact with contaminated surfaces or person-to-person contact.
Contact precautions are necessary to prevent the spread of infection.
Recommended Infection Control Measures:
Wear gloves and a gown upon entering the patient’s room.
Perform hand hygiene before and after contact with the patient or their environment.
Use dedicated or disposable equipment whenever possible.
Patient isolation or cohorting may be implemented
A patient sustained a T10 spinal cord injury (ASIA Impairment Scale A). Which of the following descriptions BEST represents the highest potential of function for this patient?
A. Independent transfers, independent bed mobility, manual wheelchair mobility over all surfaces with modified independence.
B. Independent level transfers, independent bed mobility, ambulation with KAFOs and assistive device for household distances.
C. Transfers with moderate assistance, bed mobility with minimal assistance, power wheelchair mobility with joystick control.
D. Transfers with total assistance, bed mobility with maximum assistance, power wheelchair mobility with head controls.
B. Independent level transfers, independent bed mobility, ambulation with KAFOs and assistive device for household distances.
T10 Spinal Cord Injury (ASIA Impairment Scale A):
The injury is below the level of the abdominal muscles (innervated by T7-T12), meaning trunk control is preserved to some extent.
The lower extremities are completely paralyzed, but upper body strength is fully intact.
Functional Expectations:
Transfers: Independent on level surfaces due to intact upper body strength.
Bed Mobility: Independent with the ability to utilize abdominal muscles for rolling and positioning.
Ambulation: Possible with KAFOs (Knee-Ankle-Foot Orthoses) and assistive devices (e.g., walker or forearm crutches) for short household distances. Functional ambulation is usually not realistic for community distances.
Wheelchair Use: Independent with a manual wheelchair for community mobility.
A 42-year-old male recently discharged from the hospital after treatment of fractures to ribs 4-7 on the right suddenly becomes extremely short of breath after a bout of aggressive coughing. The patient appears to be in distress and complains of sharp pain on the right side of their chest. A quick screen of the patient demonstrates tachypnea, tachycardia, and tracheal deviation to the left. What is the MOST likely cause for this patient's signs and symptoms?
A. Pulmonary embolus
B. Aortic dissection
C. Unstable angina
D. Pneumothorax
D. Pneumothorax
A pneumothorax is a condition that occurs when air leaks into the pleural cavity due to a blunt or penetrating chest injury, specific medical procedures, or lung disease. The buildup of air within the mediastinum places pressure on the affected lung rendering it unable to fill with air. The mediastinum will be pushed contralateral to the affected side as the pressure increases, causing a contralateral tracheal deviation. Symptoms of a pneumothorax include pain in the affected area, tachycardia, shallow breathing, shortness of breath accompanied by tachycardia, and a decrease in Spo2.
A pulmonary embolus is a reasonable answer to this question due to the recent trauma; however, tracheal shifts do not occur due to a pulmonary embolus.
An aortic dissection and anginal pain are not appropriate answers since a dissection would cause sharp and intense mid-thoracic pain followed by signs and symptoms of anxiety, and anginal pain would cause pain in the traditional referred pattern (left jaw, left arm, mid-back) and would not cause a tracheal shift either.
A PT examines a patient with a cerbrovascular disorder due ti arterial occlusion, The patient exhibits an ataxic gait, intention tremor and dysmetria. Which of the following arteries is most likely affected?
A. Anterior inferior Cerebellar
B. Anterior spinal
C. Basilar
D. Middle cerebral
A. Anterior inferior Cerebellar
pg 978 scorebuilders
A PT obtains gross measurement of the hamstring length by passively extending the lower extremity of a patient in short sitting. Which of the following substitutions is the most common to attempt to exaggerate hamstring length?
A. weight shift to contralateral side
B. anterior rotation of the pelvis
C. posterior rotation of the pelvis
D. hiking of the contralateral hip
C. posterior rotation of the pelvis
this would make the apparent HS length longer than actual length due to HS origin of tuberosity of the ishium
pg 912 scorebuilders
A physical therapist is evaluating a 17-year-old female soccer player who reports pain and swelling in the forefoot that has progressively worsened over the past few months. The pain is localized to the dorsal aspect of the second metatarsophalangeal (MTP) joint and increases with weight-bearing activities. On examination, the patient exhibits tenderness over the second metatarsal head and pain with passive dorsiflexion of the second MTP joint.
Which of the following interventions is MOST appropriate to address this patient's condition?
a. Achilles tendon stretching and ankle strengthening exercises
b. Non-weight-bearing activities with crutches and metatarsal padding
c. Corticosteroid injection into the MTP joint to reduce inflammation
d. Progressive resistive exercises for the intrinsic muscles of the foot
b. Non-weight-bearing activities with crutches and metatarsal padding.
Why?
The patient’s presentation is consistent with Freiberg Disease, characterized by pain, swelling, and limited ROM at the second MTP joint, commonly due to avascular necrosis of the metatarsal head.
Conservative management is typically the first line of treatment, which includes:
Non-weight-bearing or reduced weight-bearing to offload the affected joint.
Metatarsal padding or cushioned orthotics to reduce pressure on the metatarsal head.
Rest and modification of activity to prevent further injury.
A physical therapist employed by a wheelchair fitting company receives a consult to obtain measurements from a patient with a complete T8 spinal cord injury. The therapist obtains a value of 18 inches when measuring the widest part of the patient’s hips while seated. What should the therapist recognize as the MOST appropriate seat width measurement given the obtained information?
a. 20 inches
b. 18 inches
c. 16 inches
d. 22 inches
A. 20 inches.
Wheelchair Seat Width Measurement:
To determine proper seat width, the therapist measures the widest part of the patient's hips or thighs while seated.
To prevent skin breakdown and provide optimal comfort, 2 inches are added to the measured width to allow space for clothing and ease of movement.
In this case, the measured width is 18 inches. Adding 2 inches results in a final measurement of 20 inches
A physical therapist in a rehabilitation center is treating a patient who underwent knee replacement surgery. After a session, the therapist notices that the surgical wound dressing is slightly moist with a clear, yellowish fluid. Which term BEST characterizes this type of exudate?
a. Sanguineous
b. Serous
c. Serosanguineous
d. Purulent
b. Serous
Explanation:
Serous exudate is a clear, watery fluid that typically occurs in mild inflammation or after surgery. It's often seen in wounds healing by primary intention.
Sanguineous exudate contains a large amount of blood and is typically seen in fresh, traumatic wounds or in the early stages after surgery.
Serosanguineous exudate is a mixture of serum and blood, often seen in the early stages of wound healing.
Purulent exudate is thick, cloudy, and often green or yellow in color, usually indicating infection.
In a clinical trial, patient height is measured in centimeters and weight is measured in kilograms. The PT should recognize that ht and wt are measures on which scale of measurement?
A. ratio
B. ordinal
C. nominal
D. interval
A. ratio
pg. 956 scorebuilders
A patient 4 weeks post ACL reconstruction questions PT as to why they are still partial weight bearing. Which of the following impairments would be the MOST likely rationale for the patients weightbearing status?
A. the patient lacks full active knee extension
B. the patient has good (4/5) quadriceps strength
C. the patient has fair (3/5) hamstring strength
D. the patient has diminished superficial cutaneous sensation
A. the patient lacks full active knee extension
ambulation on a flexed knee can result in excessive irritation of the patellofemoral joint.
pg 1042 scorebuilders
A physical therapist is treating a 55-year-old patient with a history of recurrent urinary tract infections who was recently prescribed Ciprofloxacin (Cipro). The patient reports new-onset pain and swelling in the right Achilles tendon during ambulation. Which of the following actions should the therapist take as the MOST appropriate response?
a. Continue with the treatment session, but recommend icing the Achilles tendon post-treatment.
b. Instruct the patient to perform aggressive stretching of the Achilles tendon to improve flexibility.
c. Discontinue weight-bearing activities and advise the patient to consult their physician.
d. Apply ultrasound to the Achilles tendon to reduce inflammation and improve tissue healing.
c. Discontinue weight-bearing activities and advise the patient to consult their physician.
Why?
Ciprofloxacin (Cipro) is a fluoroquinolone antibiotic commonly prescribed for bacterial infections, including urinary tract infections.
A well-documented adverse effect of ciprofloxacin and other fluoroquinolones is an increased risk of tendinitis and tendon rupture, particularly affecting the Achilles tendon.
This risk is higher in:
Older adults (especially >60 years old)
Those on corticosteroid therapy
Patients with renal disease or other chronic conditions
Discontinuing weight-bearing activities is necessary to prevent further damage, and the patient should consult their physician immediately for evaluation and potential modification of their medication.
A physical therapist is designing a wheelchair ramp for a patient who uses a manual wheelchair and has limited mobility. The ramp will need to be installed at the entrance to the patient's home, and the rise of the step is 12 inches. According to the ADA (Americans with Disabilities Act) guidelines, what is the MINIMUM recommended ramp length to accommodate this rise?
a. 12 feet
b. 8 feet
c. 10 feet
d. 15 feet
a. 12 feet.
Why?
According to the ADA guidelines, the recommended slope ratio for a wheelchair ramp is 1:12, meaning that for every 1 inch of rise, the ramp should be 12 inches (1 foot) long.
In this case, the rise is 12 inches, so the minimum ramp length required would be 12 feet.
This ensures that the ramp is not too steep, which could be dangerous for users of manual wheelchairs.
A 35-year-old woman presents with difficulty extending her finger after an injury to the hand. Upon examination, the therapist notices that the patient has a flexion deformity at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint. Which of the following is the MOST likely diagnosis for this deformity?
a. Mallet finger
b. Swan neck deformity
c. Boutonnière deformity
d. Claw hand
c. Boutonnière deformity
Explanation:
Boutonnière deformity is characterized by flexion at the PIP joint and hyperextension at the DIP joint, often caused by damage to the central slip of the extensor tendon.
Mallet finger involves the inability to extend the DIP joint due to damage to the distal portion of the extensor tendon.
Swan neck deformity presents with hyperextension at the PIP joint and flexion at the DIP joint, often due to rheumatoid arthritis or other connective tissue disorders.
Claw hand is a condition associated with ulnar nerve damage, presenting as flexion at the PIP and DIP joints and hyperextension at the MCP joints.
A PT consults with a teacher regarding a child who has impairments in sensory processung. Which piece of equipment would be MOST useful to address the childs dyspraxia?
A. swing
B. weighted vest
C. sit and spin
D. rocking chair
B. weighted vest
Dyspraxia: A developmental disorder characterized by difficulty in planning and coordinating purposeful movement
pg. 951 scorebuilders