Integumentary
A physical therapist is treating a 72-year-old patient with a non-healing pressure ulcer over the sacrum. The patient has a history of poor nutritional intake, type 2 diabetes, and limited mobility due to a recent stroke. Which of the following interventions would be the MOST important to address first in order to promote wound healing?
A) Increase mobility and reposition the patient every two hours and administer a foam pad
B) Apply a dry gauze dressing to prevent moisture buildup in the wound
C) Encourage a low-protein diet to minimize metabolic stress on the body
D) Initiate the use of a hydrocolloid dressing to create a moist healing environment
A) Increase mobility and reposition the patient every two hours
Repositioning every two hours and increasing mobility reduces pressure, improves blood flow, and prevents further tissue breakdown.
Wrong:
b- will dry out the wound bed and delay healing
c- protein is essential for wound healing, you would want a protein rich diet
d- while an important part of wound healing is a moist wound bed, first it is important reposition and relieve the pressure
What of the following are not one of the three types of hormones:
A) peptide,
B) amino
C) hydrophillic
D) steroid
C) hydrophillic
that is a characteristic of peptide hormones
A 45-year-old patient reports burning pain in the chest that worsens when lying down after meals. The patient also experiences frequent belching and regurgitation of acidic fluid. Which of the following conditions is the MOST likely cause of these symptoms?
A) Peptic ulcer disease
B) Chrohn's disease
C) Gastroesophageal reflux disease (GERD)
C) Gastroesophageal reflux disease (GERD): acid reflux into esophagus, causing heartburn, regurgitation, and woresened symptoms when lying down post meals
Why not:
a- peptic ulcer disease: epigastric pain, pain relieved by eating, does not typically cause regurgitation or worsen with laying down
b- Chrohn's disease: diarrhea, abdominal pain, and weight loss
A 55-year-old male presents to physical therapy with frequent urination, urgency, and difficulty initiating urination. He has a history of benign prostatic hyperplasia (BPH). Which of the following symptoms would MOST likely be present in this condition?
A) Painful urination and hematuria
B) Nocturia and weak urinary stream
C) Fever and chills
D) Incontinence and vaginal discharge
Correct: B) Nocturnia and weak urinary stream
a) signs or UTI or kidney stones not BPH
c) fever and chills are more indicitive of infection
d) female reproductive issues, BPH is a condition affecting males
A 55-year-old female presents to physical therapy with swelling in her left leg after a lymph node dissection. She reports that the swelling worsens throughout the day. Which of the following is the MOST appropriate intervention to address her condition?
A) Compression garments and elevation
B) Deep tissue massage to improve lymphatic drainage
C) Strengthening exercises for the left leg
D) Ice therapy to reduce inflammation
Correct: A) Compression garments and elevation
Deep tissue massage could cause further tissue damage and worsen the edema.
Strengthening the leg is a part of the rehab program, but first compression and elevation are the primary ways for management.
Ice: is not effective for managing chronic swelling and lymphedema
A physical therapist is evaluating a partial-thickness wound on a patient’s lower extremity. The wound involves damage to the epidermis and part of the dermis, with mild drainage. Based on this presentation, which of the following BEST describes this wound?
A) Stage 1 pressure injury
B) Stage 2 pressure injury
C) Stage 3 pressure injury
D) Unstageable pressure injury
Correct: B) Stage 2 pressure injury
Stage 1: non-blanchable erythema
Stage 2: partial thickness skin loss with exposed dermis. Red or pink wound without slough or granulation tissue. Usually moist
Stage 3: full thickness skin loss: adipose visible, slough and eschar may be present, possible undermining, tracts, and epibole
Stage 4: full thickness skin and tissue loss, exsposed fascia, muscle, tendon, ligament, cartilage, or bone
Unstageable:obscured full thickness skin and tissue loss, base covered by slough/eschar, depth can't be determined
A 45-year-old male presents with fatigue, weight gain, cold intolerance, and bradycardia. Laboratory tests reveal elevated thyroid-stimulating hormone (TSH) and low free T4 levels. Which of the following conditions is the most likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing’s syndrome
D) Addison’s disease
B) Hypothyroidism
Hypothyroidism is characterized by elevated TSH and low free T4, along with clinical symptoms such as fatigue, weight gain, cold intolerance, and dry skin.
A 50-year-old male presents to physical therapy with complaints of low back pain that has not improved with treatment. The patient also reports unintentional weight loss, blood in the stool, and changes in bowel habits over the past few months. Which of the following conditions is the MOST likely cause of the patient’s symptoms?
A) Appendicitis
B) Irritable bowel syndrome (IBS)
C) Colorectal cancer
D) Peptic ulcer disease
Correct: C) Colorectal cancer
Why not:
Appendicitis: RLQ pain, nausea, fever, rebound tenderness
IBS: bloating, diarrhea, constipation and not blood in stool or unresponsive to treatment
Peptic Ulcer Disease: epigastric pain that can worsen or improve with eating and no LBP or blood in stool.
A 28-year-old female presents to physical therapy with complaints of lower back pain and flank pain. She also reports fever, chills, and dysuria. She has a history of urinary tract infections. Which of the following physical therapy interventions would be MOST appropriate for this patient?
A) Referral to a physician for further evaluation and temporary discontinuation of therapy
B) Gentle stretching of the hip flexors to alleviate pain
C) Monitor patient throughout treatment and proceed with a lower-intensity session
D) Strengthening exercises for the core to improve posture and stability
Correct: A) Referral to a physician for further evaluation and temporary discontinuation of therapy
The LBP, flank pain, fever, chills, and dysuria are suggestive of a UTI and/or pyelonephritis, the flank pain suggests UTI spread to kidneys. Immediate referral is needed for proper treatment of infection with antibiotics and it is a systemic issue that could be worsened with physical activity if not allowed to first resolve.
A 66 year old patient is in the clinic with edema in her R lower extremity after spraining her ankle playing softball with her grandkids. Her ABI is 0.7, cleared for DVT, and is claustrophobic. Which of the following is contraindicated?
A) elevation
B) manual lymphatic drainage massage
C) compression
D) ankle pumps
C) compression
A 65-year-old diabetic patient with a non-healing stage 3 pressure ulcer on the sacrum is being evaluated for negative pressure wound therapy (NPWT). Upon examination, the wound bed has granulation tissue with moderate exudate, and the periwound skin appears intact. However, the patient has a fever of 101°F (38.3°C), erythema surrounding the wound, and increasing pain at the site. Which of the following actions is the MOST appropriate for the physical therapist?
A) Initiate NPWT at a low pressure setting to promote wound healing
B) Proceed with NPWT while closely monitoring the wound for changes
C) Hold NPWT and immediately refer the patient to a physician for further evaluation
D) Apply a hydrogel dressing and reassess the wound in 24-48 hours before considering NPWT
C) Hold NPWT and immediately refer the patient to a physician for further evaluation
The presence of fever, erythema around the wound, and increased pain are red flags for a possible wound infection or osteomyelitis.
A physical therapist is evaluating a patient with Cushing’s syndrome. Which of the following clinical signs would most likely be present?
A) Hyperpigmentation, weight loss, and hypotension
B) Buffalo hump, moon face, and striae cutis
C) Heat intolerance, exophthalmos, and tremors
D) Muscle cramps, tetany, and Chvostek’s sign
B) Buffalo hump, moon face, and striae cutis
Why:
a- these are characteristics of Addison's disease
c- grave's
d- more so hypocalcemia associated with hypoparathyroidism
A 2-week-old infant is referred to physical therapy with a history of severe constipation, abdominal distension, and failure to pass meconium within the first 48 hours after birth. The infant’s mother reports episodes of bilious vomiting and irritability. Which of the following is the MOST likely cause of the infant’s symptoms?
A) Ulcerative Colitis
B) Congenital Hirschsprung's disease
C) Celiac
D) Chrohn's disease
Correct: B) Congenital Hirschsprung's disease
absence of ganglion cells in the distal colon, which leads to impaired peristalsis and inability to pass stool with hallmark symptoms of failure to pass meconium within the first 48 hours of birth and severe constipation and abdominal distension
Wrong:
Ulcerative Colitis: bloody diarrhea, weight loss, and abdominal pain typically presents in childhood or adulthood rather than newborn
Celiac Disease: autoimmune reaction to gluten that leads to malabsorption and diarrhea and doesn't cause meconium retention or constipation in newborns
Chrohn's Disease: a chronic inflammatory bowel disease (IBD) that affects the small and large intestines, but it rarely presents in newborns with symptoms such as diarrhea, weight loss, and abdominal pain
A 40-year-old female presents to physical therapy with complaints of pelvic pain, low back pain, and vaginal bleeding between menstrual periods. She also reports unexplained weight loss and fatigue. She has a history of irregular Pap smears but is unsure about her most recent screening. Which of the following is a red flag that would require immediate referral to a physician for further evaluation of potential cervical carcinoma?
A) Dull, localized pelvic pain that is relieved with rest
B) Low back pain that improves with physical therapy interventions
C) Mild fatigue and general discomfort
D) Persistent vaginal bleeding between menstrual periods
D) Persistent vaginal bleeding between menstrual periods
Common signs: bleeding post coitus, discharge bloody / purulent, fowl smell
It is typically asymptomatic and painless, until it spreads and reaches the pelvis so unlikely it is A or B due to it's ability to be relieved and leaning more MSK in nature.
It is not C because the more hallmark symptoms of such a carcinoma are vaginal bleeding and unexplained weight loss.
A patient presents with chronic pitting edema of 4mm with a 10 second rebound. Elevation has a minimal effect on reduction of swelling. Which of the following answers BEST describes this patient's case?
A) Stage 2 with 4 + stemmer sign
B) Stage 3 with 3+ stemmer sign
C) Stage 2 with 3+ stemmer sign
D) Stage 1 with 4+ stemmer sign
C) Stage 2 with 3+ stemmer sign
The lymphedema being chronic and minimally effected by elevation are characteristics of stage 2.
Stage 1: accumulation of fluid subsides with elevation
Stage 3: Such accumulation of fluid that pitting is absent
2+ : 2-4mm, few second rebound
3+ : 4-6 mm, 10-12 second rebound
4+ 6-8mm, >20 second rebound