Practice Exam #1
A college student is seen by a physical therapist 3 weeks after having an open
reduction and internal fixation (ORIF) for a talus fracture. There was no known nerve
damage associated with the original injury or surgery. After several treatment sessions
the therapist notices that the patient's pain is out of proportion to what is expected at
this stage of recovery. The therapist observes that the patient's ankle and foot are still
markedly swollen, and the skin appears mottled (red and white). The injured foot feels
sweaty compared to the unaffected side. What condition should the therapist suspect?
Choices:
1. Infection in the ankle joint.
2. Complex regional pain syndrome (Type I).
3. Complex regional pain syndrome (Type II).
4. Post-traumatic arthritis. - answer Correct Answer: 2 Complex regional pain syndrome
(CRPS) Type I was formerly known as Reflexive Sympathetic Dystrophy. This question
describes classic symptoms of CRPS, which include unexplained and hypersensitive
pain, temperature changes, skin changes, and swelling of the affected area. In CRPS
Type I, there is no known nerve damage, whereas in CRPS Type II (formerly causalgia)
there is a known nerve injury, such as a crush injury to a peripheral nerve.
**An infection of the ankle joint would have presented differently than what is described
in the question stem. Signs of infection include fever and chills, palpable warmth in the
infected area, and pain, redness, and possible purulent drainage at the surgical incision
site. Post-traumatic arthritis may develop in the ankle or subtalar joints following a
surgical repair of the talus, but it would typically take months to develop. Additionally,
the clinical presentation described in this scenario is not consistent with the pain and
stiffness patients describe in an arthritic joint.
An elderly patient with hypothyroidism is recovering from a fall and is referred to
physical therapy to increase exercise tolerance and safety. The patient denies
numbness but reports significant muscle pain in both lower extremities. What additional
musculoskeletal effects should the therapist examine for?
Choices:
1. Distal muscle weakness.
2. Proximal muscle weakness.
3. Joint laxity.
4. Increased deep tendon reflexes. - answerCorrect Answer: 2 Hypothyroidism can
have numerous musculoskeletal effects, including myalgia (muscle pain) and proximal
muscle weakness.
,**Additional musculoskeletal effects include stiffness (not joint laxity) and delayed
relaxation (decreased) deep tendon reflexes
A patient with coronary artery disease has been doing regular aerobic exercise on a
treadmill. If the patient fails to comply in taking prescribed beta-blocker medication and
continues to exercise, what potential rebound effects could result?
Choices:
1. Increase in blood pressure and decrease in heart rate during exercise.
2. Decrease in blood pressure and heart rate during exercise.
3. Increase in blood pressure and heart rate during exercise.
4. Decrease in blood pressure and increase in heart rate during exercise. -
answerCorrect Answer: 3 Beta-blockers affect the beta-1 adrenergic receptors. Blocking
these inhibits the sympathetic response. However, when abruptly terminated, they
cause a reflexive opposite response. This patient will demonstrate increased
contractility, blood pressure (BP), and heart rate (HR) as a result.
A patient is referred to physical therapy with a 10-year history of rheumatoid arthritis
(RA). What are possible extra-articular complications?
Choices:
1. Disc degeneration.
2. Psoriatic skin and nail changes. 3. Vasculitis.
4. Conjunctivitis and iritis. - answerCorrect Answer: 3 Rheumatoid arthritis is a
progressive autoimmune disease affecting primarily joints and synovial tissue. Extra-
articular complications of the disease can include vasculitis (inflammation of blood
vessels).
**The other choices are not expected extra-articular complications in patients with RA.
Disc degeneration is seen in degenerative disc disease. Psoriatic skin and nail changes
and conjunctivitis and iritis can be seen in psoriatic arthritis
A physical therapist is instructing an elderly patient how to perform bed mobility
following a total hip replacement. The therapist should carefully consider the effects of
aging that relate to skin. What is one such effect?
Choices:
1. Increased perception of pain. 2. Impaired sensory integrity.
3. Increased skin elasticity.
4. Increased acute inflammatory response - answerCorrect Answer: 2 Changes in skin
composition associated with aging include decreased sensitivity to touch, decreased
perception of pain and temperature, and increased risk of injury
**Perception of pain is decreased (not increased). The dermis thins, and elasticity is
decreased (not increased). The elderly often exhibit low-grade inflammation; acute
inflammatory responses are commonly caused by tissue injury or infections.
,What would a therapist who is examining the breathing pattern of a patient with a
complete (ASIA A) C5 spinal cord injury expect to observe?
Choices:
1. Asymmetric lateral costal expansion due to ASIA A injury.
2. An increased subcostal angle due to air trapping from muscle weakness.
3. No diaphragmatic motion since the diaphragm is below the level of the lesion.
4. Rising of the abdomen due to no abdominal muscle tone on the abdominal viscera -
answerCorrect Answer: 4 The abdominal musculature provides external stability to the
abdominal viscera. Without this, the viscera are displaced with respiration.
**With an ASIA A injury, the muscle weakness would be symmetric. The diaphragm is
innervated by C3-5 nerve roots, so it will be functioning in this patient. Muscle weakness
will cause a restrictive disorder (inability to generate negative pressure), not an
obstructive disorder (air trapping).
Men are at risk for development of metabolic syndrome if they exhibit which of the
following symptoms?
Choices:
1. An HDL level lower than 45 mg/dL.
2. A waist size greater than 40 inches.
3. Triglyceride levels greater than 100 mg/dL.
4. Fasting blood glucose less than 100 mg/dL. - answerCorrect Answer: 2 Criteria for
diagnosis of metabolic syndrome include abdominal obesity (waist circumference >40
inches in men or >35 inches in women).
**Other criteria include elevated triglycerides (150 mg/dL or higher); low HDL levels
(<40 mg/dL in men or <50 mg/dL in women); and a fasting plasma glucose level >110
mg/dL.
A patient with a body mass index (BMI) of 37 is referred to physical therapy for exercise
conditioning. What are additional clinical manifestations associated with the BMI that
this patient might exhibit?
Choices:
1. Hyperpnea and hyperpituitarism.
2. Hypertension and hyperinsulinemia.
3. Hormone-related cancer.
4. Hypolipoproteinemia and hypotension. - answerCorrect Answer: 2 Obesity is
associated with hypertension, dyslipidemia, hyperinsulinemia (type 2 diabetes), and
hyperglycemia. The presence of these comorbidities increases risk, resulting in the
need for additional medical screening before exercise testing
, What will a patient with a significant right thoracic structural scoliosis demonstrate on
examination?
Choices:
1. Decreased breath sounds on the right.
2. Decreased thoracic rib elevation on the right.
3. Increased lateral costal expansion on the right.
4. Shortened internal and external intercostals on the right - answerCorrect Answer: 3
With a right thoracic scoliosis, the convex side is on the right. This would allow for
increased aeration and mobility on that side.
**The ribs would elevate normally or more on the right side. The remaining choices
would be true on the contralateral or shortened side of the scoliosis. The left side would
have shortened muscle length and decreased aeration
A therapist has been treating a patient for several weeks for decreased shoulder
elevation and a loss of external rotation. Recovery has been good; however, the patient
still complains of being unable to reach the upper shelves of kitchen cabinets and
closets. To help the patient achieve this goal, what should be the focus of manual
therapy?
Choices:
1. Superior glide.
2. Inferior glide.
3. Anterior glide.
4. Grade II oscillations. - answerCorrect Answer: 3 Anterior glide would help increase
external rotation (ER), which is a component of full elevation. Performing anterior glides
to improve ER and late flexion will help increase overhead reach since ER of humerus
occurs with flexion
A patient recovering from a partial spinal cord injury reports lack of feeling in the more-
affected hand. Monofilament testing reveals lack of ability to tell when the stimulus is
being applied (only 1 correct response out of 5 tests). What additional sensory tests
should the therapist perform?
Choices:
1. Test for sharp sensation.
2. Test for two-point discrimination.
3. Test for vibration.
4. Test for joint proprioception (thumb up/thumb down). - answerCorrect Answer: 1
Testing for perception of sharp sensation can be performed as pain and temperature
are carried in a different pathway (anterolateral spinothalamic pathways) from other
answer options; monofilament, vibration, and joint proprioception are carried in the
dorsal column-lemniscal pathways.
A college student is seen by a physical therapist 3 weeks after having an open
reduction and internal fixation (ORIF) for a talus fracture. There was no known nerve
damage associated with the original injury or surgery. After several treatment sessions
the therapist notices that the patient's pain is out of proportion to what is expected at
this stage of recovery. The therapist observes that the patient's ankle and foot are still
markedly swollen, and the skin appears mottled (red and white). The injured foot feels
sweaty compared to the unaffected side. What condition should the therapist suspect?
Choices:
1. Infection in the ankle joint.
2. Complex regional pain syndrome (Type I).
3. Complex regional pain syndrome (Type II).
4. Post-traumatic arthritis. - answer Correct Answer: 2 Complex regional pain syndrome
(CRPS) Type I was formerly known as Reflexive Sympathetic Dystrophy. This question
describes classic symptoms of CRPS, which include unexplained and hypersensitive
pain, temperature changes, skin changes, and swelling of the affected area. In CRPS
Type I, there is no known nerve damage, whereas in CRPS Type II (formerly causalgia)
there is a known nerve injury, such as a crush injury to a peripheral nerve.
**An infection of the ankle joint would have presented differently than what is described
in the question stem. Signs of infection include fever and chills, palpable warmth in the
infected area, and pain, redness, and possible purulent drainage at the surgical incision
site. Post-traumatic arthritis may develop in the ankle or subtalar joints following a
surgical repair of the talus, but it would typically take months to develop. Additionally,
the clinical presentation described in this scenario is not consistent with the pain and
stiffness patients describe in an arthritic joint.
An elderly patient with hypothyroidism is recovering from a fall and is referred to
physical therapy to increase exercise tolerance and safety. The patient denies
numbness but reports significant muscle pain in both lower extremities. What additional
musculoskeletal effects should the therapist examine for?
Choices:
1. Distal muscle weakness.
2. Proximal muscle weakness.
3. Joint laxity.
4. Increased deep tendon reflexes. - answerCorrect Answer: 2 Hypothyroidism can
have numerous musculoskeletal effects, including myalgia (muscle pain) and proximal
muscle weakness.
,**Additional musculoskeletal effects include stiffness (not joint laxity) and delayed
relaxation (decreased) deep tendon reflexes
A patient with coronary artery disease has been doing regular aerobic exercise on a
treadmill. If the patient fails to comply in taking prescribed beta-blocker medication and
continues to exercise, what potential rebound effects could result?
Choices:
1. Increase in blood pressure and decrease in heart rate during exercise.
2. Decrease in blood pressure and heart rate during exercise.
3. Increase in blood pressure and heart rate during exercise.
4. Decrease in blood pressure and increase in heart rate during exercise. -
answerCorrect Answer: 3 Beta-blockers affect the beta-1 adrenergic receptors. Blocking
these inhibits the sympathetic response. However, when abruptly terminated, they
cause a reflexive opposite response. This patient will demonstrate increased
contractility, blood pressure (BP), and heart rate (HR) as a result.
A patient is referred to physical therapy with a 10-year history of rheumatoid arthritis
(RA). What are possible extra-articular complications?
Choices:
1. Disc degeneration.
2. Psoriatic skin and nail changes. 3. Vasculitis.
4. Conjunctivitis and iritis. - answerCorrect Answer: 3 Rheumatoid arthritis is a
progressive autoimmune disease affecting primarily joints and synovial tissue. Extra-
articular complications of the disease can include vasculitis (inflammation of blood
vessels).
**The other choices are not expected extra-articular complications in patients with RA.
Disc degeneration is seen in degenerative disc disease. Psoriatic skin and nail changes
and conjunctivitis and iritis can be seen in psoriatic arthritis
A physical therapist is instructing an elderly patient how to perform bed mobility
following a total hip replacement. The therapist should carefully consider the effects of
aging that relate to skin. What is one such effect?
Choices:
1. Increased perception of pain. 2. Impaired sensory integrity.
3. Increased skin elasticity.
4. Increased acute inflammatory response - answerCorrect Answer: 2 Changes in skin
composition associated with aging include decreased sensitivity to touch, decreased
perception of pain and temperature, and increased risk of injury
**Perception of pain is decreased (not increased). The dermis thins, and elasticity is
decreased (not increased). The elderly often exhibit low-grade inflammation; acute
inflammatory responses are commonly caused by tissue injury or infections.
,What would a therapist who is examining the breathing pattern of a patient with a
complete (ASIA A) C5 spinal cord injury expect to observe?
Choices:
1. Asymmetric lateral costal expansion due to ASIA A injury.
2. An increased subcostal angle due to air trapping from muscle weakness.
3. No diaphragmatic motion since the diaphragm is below the level of the lesion.
4. Rising of the abdomen due to no abdominal muscle tone on the abdominal viscera -
answerCorrect Answer: 4 The abdominal musculature provides external stability to the
abdominal viscera. Without this, the viscera are displaced with respiration.
**With an ASIA A injury, the muscle weakness would be symmetric. The diaphragm is
innervated by C3-5 nerve roots, so it will be functioning in this patient. Muscle weakness
will cause a restrictive disorder (inability to generate negative pressure), not an
obstructive disorder (air trapping).
Men are at risk for development of metabolic syndrome if they exhibit which of the
following symptoms?
Choices:
1. An HDL level lower than 45 mg/dL.
2. A waist size greater than 40 inches.
3. Triglyceride levels greater than 100 mg/dL.
4. Fasting blood glucose less than 100 mg/dL. - answerCorrect Answer: 2 Criteria for
diagnosis of metabolic syndrome include abdominal obesity (waist circumference >40
inches in men or >35 inches in women).
**Other criteria include elevated triglycerides (150 mg/dL or higher); low HDL levels
(<40 mg/dL in men or <50 mg/dL in women); and a fasting plasma glucose level >110
mg/dL.
A patient with a body mass index (BMI) of 37 is referred to physical therapy for exercise
conditioning. What are additional clinical manifestations associated with the BMI that
this patient might exhibit?
Choices:
1. Hyperpnea and hyperpituitarism.
2. Hypertension and hyperinsulinemia.
3. Hormone-related cancer.
4. Hypolipoproteinemia and hypotension. - answerCorrect Answer: 2 Obesity is
associated with hypertension, dyslipidemia, hyperinsulinemia (type 2 diabetes), and
hyperglycemia. The presence of these comorbidities increases risk, resulting in the
need for additional medical screening before exercise testing
, What will a patient with a significant right thoracic structural scoliosis demonstrate on
examination?
Choices:
1. Decreased breath sounds on the right.
2. Decreased thoracic rib elevation on the right.
3. Increased lateral costal expansion on the right.
4. Shortened internal and external intercostals on the right - answerCorrect Answer: 3
With a right thoracic scoliosis, the convex side is on the right. This would allow for
increased aeration and mobility on that side.
**The ribs would elevate normally or more on the right side. The remaining choices
would be true on the contralateral or shortened side of the scoliosis. The left side would
have shortened muscle length and decreased aeration
A therapist has been treating a patient for several weeks for decreased shoulder
elevation and a loss of external rotation. Recovery has been good; however, the patient
still complains of being unable to reach the upper shelves of kitchen cabinets and
closets. To help the patient achieve this goal, what should be the focus of manual
therapy?
Choices:
1. Superior glide.
2. Inferior glide.
3. Anterior glide.
4. Grade II oscillations. - answerCorrect Answer: 3 Anterior glide would help increase
external rotation (ER), which is a component of full elevation. Performing anterior glides
to improve ER and late flexion will help increase overhead reach since ER of humerus
occurs with flexion
A patient recovering from a partial spinal cord injury reports lack of feeling in the more-
affected hand. Monofilament testing reveals lack of ability to tell when the stimulus is
being applied (only 1 correct response out of 5 tests). What additional sensory tests
should the therapist perform?
Choices:
1. Test for sharp sensation.
2. Test for two-point discrimination.
3. Test for vibration.
4. Test for joint proprioception (thumb up/thumb down). - answerCorrect Answer: 1
Testing for perception of sharp sensation can be performed as pain and temperature
are carried in a different pathway (anterolateral spinothalamic pathways) from other
answer options; monofilament, vibration, and joint proprioception are carried in the
dorsal column-lemniscal pathways.
