Book Review 2-1.pdf

 PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW 1. Which one of the following structures does C. Greater thoracic splanchnic nerve NOT pass through the foramen magnum of the D....

 PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW 1. Which one of the following structures does C. Greater thoracic splanchnic nerve NOT pass through the foramen magnum of the D. Tenth intercostal nerve occipital bone? ANSWER: B. A. Spinal cord The phrenic nerve arises from ventral rami of C3, C4, B. Meninges and C5 spinal nerves. The sensory neurons of the C. Cranial nerve XII dorsal root ganglia of C3, C4, and C5 supply axons for D. Vertebral artery somatic pain from the named area of parietal serous ANSWER: C membranes. C3, C4, and C5 also supply the shoulder The structures that pass through the foramen magnum with the cutaneous innervation by the supraclavicular include the spinal cord, the meninges, the spinal nerves. This is why pericardial or diaphragmatic pain components of cranial nerve XI, and the vertebral will refer to the shoulder. arteries. Cranial nerve XII exits the skull through the hypoglossal canals. 5. Ascending tracts in the white matter of the spinal cord carry ___________ information. 2. A therapist is testing key muscles on a patient A. Sensory who recently suffered a spinal cord injury. The current B. Motor test assesses the strength of the long toe extensors. C. Both sensory and motor Which nerve segment primarily innervates this key D. Autonomic muscle group? ANSWER:A A. L2 The white matter of the spinal cord carries ascending B. L3 (sensory) tracts and descending (motor) tracts. C. L4 D. L5 6. Which of the following cranial nerves does ANSWER:D NOT contain parasympathetic fibers? The long toe extensors represent the spinal cord A. Oculomotor segment L5. The iliopsoas represents L2. The B. Facial quadriceps are innervated by L3 and the tibialis C. Trigeminal anterior is innervated by L4. D. Vagus ANSWER:C. 3. A physical therapist is conducting a screen for The four cranial nerves that contain parasympathetic visual field deficits by having the client look straight fibers are oculomotor, facial, glossopharyngeal, and ahead and presenting a stimulus at the outer margins vagus nerves. of the person's visual fields. The examination technique checks cranial nerve(s) __________ 7. Which is an inhibitory neurotransmitter in the function. central nervous system? A. II A. GABA B. III, IV, VI B. Epinephrine C. V C. Glutamate D. VIII D. Norepinephrine ANSWER:A ANSWER:A Of the choices listed, cranial nerve II or the optic nerve Generally, GABA (gamma-aminobutyric acid) is an functions to constrict the pupil and vision. Ischemia, inhibitory neurotransmitter in the CNS, whereas resulting from stroke or head injury, or pressure from epinephrine, glutamate, and norepinephrine are tumors can adversely affect the function of the nerve. excitatory. Visual field loss depends on the location of the lesion. A lesion occurring before the optic chiasm results in 8. On examination of a cross-section of the loss of vision in the fields on the same side. After the spinal cord of a cadaver, the examiner notes plaques. optic chiasm, a lesion will cause loss of vision in both This finding is most characteristic of fields. The visual field affected will be opposite to the A. Parkinson's disease side of the lesion and is also known as homonymous B. Myasthenia gravis hemianopsia. C. Multiple sclerosis D. Dementia 4. Which named peripheral nerve is responsible ANSWER: C for pain sensation from the pericardium, mediastinal Parkinson's disease and dementia are disorders pleura, diaphragmatic pleura, and diaphragmatic involving the brain. Myasthenia gravis is a problem with peritoneum? acetylcholine receptors at the neuromuscular junction. A. Vagus nerve B. Phrenic nerve 2 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW 9. The therapist is ordered to evaluate a patient D. C7 in the intensive care unit. The patient appears to be in ANSWER:D a coma and is totally unresponsive to noxious, visual, and auditory stimuli. What rating on the Rancho Los 13. The spastic type of cerebral palsy usually Amigos Cognitive Functioning Scale is most results from involvement of the appropriate? A. Corpus callosum A. I B. Basal ganglia B. III C. Motor cortex C. IV D. Cerebellum D. VIV ANSWER:C ANSWER:A Involvement of the basal ganglia results in dyskinesia I; No response. II; Generalized response. III; Localized or athetosis. Cerebellar lesions produce ataxia, or responses. IV; Confused agitated. V; Confused unstable movement. The corpus callosum is not inappropriate. VI; Confused appropriate. VII; Automatic involved appropriate. VIII; Purposeful and appropriate 14. A complete rupture of a cord of the brachial 10. Which of the following is not an acceptable plexus is best described using the term long-term goal for a patient with a complete C7 spinal A. Neurotmesis cord injury? B. Neuropraxia A. Independence with dressing C. Axonotmesis B. Driving an automobile D. Axonopraxia C. Balance a wheelchair for 30 seconds using a ANSWER:A "wheelie" Axonotmesis involves disruption of axons while the D. Independence with performing a manual neural sheath remains intact. Neuropraxia is a cough temporary nerve conduction block with intact axons. ANSWER:C The term axonopraxia does not exist. Choice A is incorrect because the patient should be able to learn how to be independent with activities of 15. Which of the following statements is true daily living. Choice B is incorrect because the patient regarding myelodysplasia? can learn to drive an automobile independently with the A. Myelodysplasia is defined as defective assistance of hand controls. Choice C is correct development limited to the anterior horn cells of the because total balance of a wheelchair using a wheelie spinal cord. is an unrealistic goal. After proper rehabilitation, this B. Embryologically, myelodysplastic lesions can patient should be independent with a manual cough. be related to either abnormal nervous system neurolation or canalization. 11. A therapist is examining a patient in the C. Myelodysplasia is often associated with intensive care unit. The therapist notes no eye opening, genetic abnormalities; however, there is no association no verbal response, and no motor response. On the with teratogens. Glasgow coma scale, what is the patient's score? D. Myelodysplasia refers to defects in the lower A. 0 spinal cord only. B. 3 ANSWER:B C. 5 Myelodysplasia can involve the entire spinal cord, not D. 9 just the anterior cord. Teratogens are any agents that ANSWER:B cause a structural abnormality during pregnancy. The responses of the patient represent the lowest Excessive alcohol and drug intake have been shown to possible score on the Glasgow Coma Scale. One point cause myelodysplasia. Although the lower spinal is given for each of the listed responses (or lack region is more likely to be effected in myelodysplasia, thereof). it can refer to defects in any part of the spinal column 12. While examining a patient who suffered a 16. Which of the following statements is true complete spinal cord lesion, the therapist notes the regarding progressive neurologic dysfunction? following strength grades with manual muscle testing: A. Progressive neurologic dysfunction is wrist extensors = 3+/5, elbow extensors = 2+/5, and common during periods of rapid growth but does not intrinsic muscles of the hand = 0/5. What is the highest occur once skeletal maturity is reached. possible level of this lesion? B. Deterioration of the gait pattern is one of the A. C3 last symptoms to be detected. B. C4 C. Symptoms include loss of sensation and/or C. C5 strength, pain along a dermatome or incision, spasticity 3 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW onset or worsens, and changes in bowel or bladder deep tendon reflexes, confusion and later seizures are sphincter control. indications of lithium overdose D. Development of scoliosis will always be rapid. ANSWER:C 21. Your patient is on antipsychotic drug therapy. Exteriorization of neuralgic function can occur During your therapy sessions you might notice a throughout life, and gait abnormalities are often the first number of movement abnormalities. The most severe complaint. Scoliosis can be slow in developing and one is should be monitored by the physical therapist. A. Tardive dyskinesia B. Tremor 17. Ballistic movements of arms and legs are C. Akathisia characterized by D. Dystonia A. Reciprocal activation of antagonist muscles. ANSWER:A. B. Coactivation of antagonist muscles. All of these movement disorders can occur but tardive C. Need for proprioceptive feedback during dyskinesia is irreversible and might possibly require an movement. immediate change in the drug prescribed. D. Visual guidance during movement. ANSWER:A 22. Among other reasons, mental activity and Ballistic movements are high velocity motor control is the result of excitatory and inhibitory neurotransmitter actions in the CNS. The most 18. A patient with Parkinson's disease on important inhibitory neurotransmitter is levodopa/carbidopa therapy might experience during A. Glutamate therapy all of the following except B. GABA A. The "off" phase C. Norepinephrine B. Dizziness D. Acetylcholine C. Involuntary movements ANSWER:B D. Marked bradycardia GABA is one of the main inhibitory neurotransmitters in ANSWER:D the CNS. Some sedatives, anxiolytics, skeletal muscle Levodopa/carbidopa can cause all of the listed effects relaxants, and anticonvulsants cause their therapeutic except bradycardia. Due to the off-effect, the patient effects by increasing its actions. might have to be scheduled at times when he or she is in the on-phase. 23. A patient has a tumor in the parietal lobe. The physical therapist anticipates problems with 19. A patient whose seizures are controlled with A. Muscle strength an anticonvulsant should be treated in a room or an B. Perception of spatial relationships area that C. Sensation and motor function A. Is devoid of bright flickering lights and D. Vision repetitive, loud noises ANSWER:B B. Has no electronic equipment near the patient Choice B, perception of spatial relationships, is the C. Is warm and somewhat humid correct answer. The parietal lobes function to integrate D. Is not frequented by many people sensory information for perception of spatial relations. ANSWER:A It is known that flickering lights or repetitive noises can 24. What are the components of upper motor trigger epileptic episodes. Although anticonvulsants neuron syndrome? are quite effective, it is recommended to avoid such A. Fasciculations, spasticity, hyperreflexia aversive stimuli in these patients. B. Spasticity, rigidity, hyporeflexia C. Spasticity, positive Babinski sign, rigidity 20. You might want to inform a patient on lithium D. Spasticity, hyperreflexia, positive Babinski therapy to contact the physician or call the physician sign directly if this patient shows ANSWER:D A. Ataxia and a fine tremor Choice D, spasticity, hyperreflexia, positive Babinski B. Increased blood pressure and dyspnea sign, is the correct answer. Fasciculations are also a C. Excessive salivation and tearing sign of lower motor neuron disorders as they represent D. Constipation and trouble voiding denervation hypersensitivity of the lower motor neuron. ANSWER:A UMN syndrome does not produce rigidity. Rigidity is a Lithium has a very small margin of safety and can be sign of basal ganglia disease. Hyporeflexia is a sign of quickly under- or overdosed requiring frequent drug lower motor neuron lesions. blood level determinations. Ataxia, tremors, increased 4 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW 25. Nerve regeneration occurs at a pace of 30. A patient cannot find his dentures when they ________ per month are on his crowded bedside table. His visual acuity A. 5 mm tests at 20/20 with the Snellen eye chart. The physical B. 1 inch therapist suspects problems with C. 1 cm A. Figure-ground discrimination D. 2.5 inches B. Body scheme awareness ANSWER:B C. Agraphia A nerve regenerates at an approximate rate of 1 inch D. Vertical orientation per month. ANSWER:A Figure-ground discrimination. The patient has difficulty 26. A physical therapist working in an early finding an item within a crowded visual field. This is intervention program is providing intervention to an figure-ground discrimination. Agraphia is the inability to infant diagnosed with Erb's palsy. This condition most write. Vertical orientation and body scheme awareness often involves what nerve roots? relate to the patient's self-awarene A. C2-C3 B. C3-C4 31. During therapy, a patient with Parkinson's C. C5-C6 disease on levodopa/carbidopa therapy might D. C8-T1 experience all of the following except ANSWER:C A. The "off" phase The most common injury of the brachial plexus is to the B. Dizziness upper roots, C5-C6, resulting in an Erb's palsy. C. Involuntary movements D. Marked bradycardia 27. A patient with an Erb's palsy will have ANSWER:D paralysis of all of the following muscles except the LevoDOPA/carbidopa can cause all of the listed effects A. Flexor carpi ulnaris except bradycardia. Due to the off-effect the patient B. Rhomboids might have to be scheduled at times when he or she is C. Brachialis in the on-phase of the drug. D. Teres minor ANSWER:A. 32. What is the difference in testing motor An injury to the C5-C6 nerve roots results in an Erb's function when examining for a nerve root deficit versus palsy. The flexor carpi ulnaris is innervated by C8-T1. a peripheral nerve deficit? A. In peripheral nerve deficit, the motor 28. Which of the following muscles of the pharynx weakness is evident more rapidly when applying is supplied by the glossopharyngeal nerve (CN IX)? resistance compared with nerve root deficit. A. Palatopharyngeus B. In nerve root deficit, the motor weakness is B. Stylopharyngeus evident more rapidly when applying resistance C. Superior constrictor compared with peripheral nerve deficit. D. Middle constrictor C. In peripheral nerve deficit, the motor ANSWER:B weakness is only evident when applying resistance All the pharyngeal muscles are supplied by the vagus without gravity. nerve (CN X) except the stylopharyngeus muscle, D. In nerve root deficit, the motor weakness is which is supplied by the glossopharyngeal nerve (CN only evident when applying resistance without gravity. IX). ANSWER: A A lesion of a peripheral nerve produces a complete 29. The patient has a dysfunction of the tenth rib; paralysis of the muscles innervated by this nerve. however, he complains of nausea and fullness. This is Weakness is immediately apparent when testing the an example of motor function. A lesion of a unique nerve root A. Viscero-viscero reflex produces paresis of the myotome (group of muscles B. Viscero-somatic reflex innervated by a single nerve root) innervated by this C. Somatic-viscero reflex nerve root. Some time is necessary for the weakness D. Somatic-somatic reflex to become apparent when testing for motor function. ANSWER:C The isometric contraction must be held for a minimum It is possible to get these reflexes because the somatic of 5 seconds and visceral afferents enter the spinal cord at the same level. Somatic sources that create visceral symptoms 33. Which impairment occurs in carpal tunnel are known as somatic-visceral reflexes. syndrome? A. Atrophy of the hypothenar eminence 5 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW B. Paresthesias over the dorsal aspect of the hand 37. A physical therapist performs the following C. Decreased resisted thumb abduction test during an examination: With the patient lying in D. Decreased resisted forearm pronation supine position, the therapist traces a diamond shape ANSWER:C around the patient's umbilicus with a sharp object. Atrophy of the hypothenar eminence is a sign of ulnar What reflex is being assessed, and what is the nerve lesion, while paresthesias over the dorsal aspect significance if the patient's umbilicus does not move in of the hand are symptoms of radial nerve lesion. response to the stimulus provided by the therapist? Decreased resisted thumb abduction and forearm A. Cremaster reflex, suggests upper motor pronation are signs of median nerve lesion, but the neuron involvement motor branches of pronator teres and pronator B. Superficial abdominal reflex, suggests upper quadratus arise before the median nerve enters the motor neuron involvement carpal tunnel. C. Cremaster reflex, suggests lower motor neuron involvement 34. The L4 deep tendon reflex is elicited at the D. Superficial abdominal reflex, suggests lower A. Achilles tendon motor neuron involvement B. Femoral tendon ANSWER:B C. Medial hamstring tendon When the test is performed on a patient with no motor D. Patella tendon neuron lesion, the umbilicus should move toward the ANSWER:D stimulus. Unilateral movement suggests lower motor According to Hoppenfeld, the patella deep tendon neuron involvement. A cremaster reflex is performed reflex muscles (the quadriceps muscle group) are by stroking the medial thigh of a male with a sharp innervated by the L4 nerve root via the femoral nerve. object. A normal response consists of superior movement of the scrotum on the ipsilateral side. An 35. A physical therapist is asked by a coworker to abnormal response is absence of scrotal movement on finish examining a patient because an emergency one side, which indicates possible lower motor neuron requires the therapist to leave. The coworker agrees involvement. Bilateral absence of movement indicates and resumes the examination. The first therapist left upper motor neuron involvement. notes titled, "sensory assessment." Two wooden blocks identical in appearance but 1 pound different in 38. Which of the following muscles would you not weight are on the table in front of the patient. What test expect to be affected by a C6-C7 lesion? was the prior therapist most likely performing? A. Biceps brachii A. Barognosis test B. Anterior deltoid B. Stereognosis test C. Infraspinatus C. Graphesthesia test D. Triceps brachii D. Texture recognition ANSWER:D ANSWER:A Choices A, B, and C all receive innervation from that Barognosis is the ability to differentiate between branch of the brachial plexus. The triceps brachii is different weights. Stereognosis is the ability to innervated by C7-C8. differentiate between different sizes and shapes. Graphesthesia is the ability to identify letters, numbers, 39. What is the BEST order of these tests during or designs traced on the skin. Texture recognition is the neurologic patient examination? ability to differentiate between textures such as cotton, A. Cognition, sensation, range of motion (ROM), wool, and silk. reflexes, spasticity testing, manual muscle testing (MMT) 36. A physical therapist is reviewing the chart of a B. Reflexes, MMT, cognition, sensation, ROM, 24-year-old woman with a diagnosis of L2 incomplete spasticity testing paraplegia. The physician noted that the left quadricep C. Cognition, sensation, spasticity testing, ROM, tendon reflex is 2. What does this information relay to MMT, reflexes the therapist? D. ROM, reflexes, sensation, MMT, spasticity A. No active quadricep tendon reflex testing, cognition B. Slight quadricep contraction with reflex testing ANSWER:A C. Normal quadricep tendon reflex Cognition, sensation, ROM, reflexes, spasticity testing, D. Exaggerated quadricep tendon reflex MMT is the best order. Sensory testing results can only ANSWER:C be considered accurate if a patient's cognitive status is C. No activity = 0. Slight contraction = 1; Normal known. Spasticity and manual muscle testing results response = 2; Exaggerated response = 3; Severely are based on range of motion, so ROM must come first. exaggerated = 4 6 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW 40. The patient has dysdiadochokinesia. What is American Spinal Injury Association (ASIA) sensory the best measure of patient function? level of injury a clinician tests A. Drawing figure eight A. Proprioception B. Alternating pronation/supination B. Kinesthesia C. Rebound test C. Pain D. Static balance D. Reflexes ANSWER:B ANSWER:C Alternating pronation/supination is the correct answer. Pain as measured by pinprick and light touch are used Dysdiadochokinesia is difficulty with rapid alternating to determine sensory level for ASIA guidelines. motions such as pronation and supination. A drawing does not capture the rapid motion. The rebound test 44. During your cranial nerve examination of measures graded muscle response to stimulus. Static extraocular muscle function, you note that your patient balance does not involve rapid alternating motion has vertical nystagmus during smooth pursuits. You patterns. suspect A. Lesion of optic nerve (cranial nerve II) 41. Upon observation, the patient has unilateral B. Posterior canal BPPV LEFT facial weakness. He is unable to smile or show C. Acoustic neuroma his teeth on the left side. However, he is able to raise D. Central nervous system lesion his left eyebrow. The physical therapist suspects ANSWER:D A. Peripheral cranial nerve 5 lesion Central nervous system lesion. Central nervous system B. Central cranial nerve 5 lesion nystagmus has a more vertical component. C. Peripheral cranial nerve 7 lesion Peripherally generated nystagmus is typically D. Central cranial nerve 7 lesion horizontal and rotary in nature. A lesion of optic (cranial ANSWER:D nerve II) would cause only sensory changes. It has no The therapist suspects central cranial nerve 7 lesion motor component. BPPV would not be triggered with because the facial nerve 7 innervates the motions testing because no head motions are occurring. An described. A peripheral lesion results in complete loss acoustic neuroma would also not cause nystagmus to one side of the face. Sparing of the frontalis is a sign during smooth pursuit, as no head motion is occurring of a central lesion due to bilateral corticobulbar innervation of that muscle. 45. Your patient presents with a nerve injury that causes the thenar eminence to be flattened because of 42. During physical therapy examination, the muscle atrophy. The thumb is adducted and extended. patient has full ROM bilaterally. Muscle tone at rest You would want to test the muscles supplied by the appears normal bilaterally. Reflexes on the right side A. Ulnar nerve are 2+. On the left they are 1+. What is the next thing B. Antebrachial nerve you should test for? C. Median nerve A. Repeat reflex testing with Jendrassik D. Radial nerve maneuver to enhance deep tendon reflex on the left ANSWER:C B. Spasticity testing on the left due to increased The ape or simian hand described is indicative of a reflexes median nerve palsy C. Assess for associated reactions as patient has upper motor neuron syndrome findings on the left. 46. Your patient is a framer on a construction D. Cognition, as the patient may have been project. He has been wearing a heavy carpenter's belt confused with reflex testing so results could be for the last month. He now complains of painful unreliable hyperthesias on the proximal anterior lateral thigh. He ANSWER:A gets relief with sitting, and walking seems to aggravate Repeat reflex testing with Jendrassik maneuver to his symptoms. The structure most likely producing enhance DTR on the left. This answer is correct these symptoms is the because you have no reason to suspect abnormal A. Lateral femoral cutaneous nerve reflexes (normal muscle tone), so tester error is the B. Motor branch of the femoral nerve most likely first hypothesis. Reflexes of 2+ are normal, C. Medial femoral cutaneous nerve and 1+ is hyporeflexia, not increased or a sign of upper D. Inguinal nerve motor neuron syndrome. Cognition will not change ANSWER:A findings with reflex testing, as it is a test of an This case represents a classic presentation of meralgia unconscious spinal reflex arc. parasthetica, which involves the lateral femoral cutaneous nerve. The other choices are not in the area. 43. When performing an examination on a patient after traumatic spinal cord injury to determine the 7 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW 47. Your patient complains of neck pain and D. Cauda Equina peripheral symptoms. Radiographs revealed narrowing ANSWER:B of the C4-C5 intervertebral foramen. The nerve root Damage to the anterior cord results in loss of motor most likely involved would be the function and pain/temperature sensation. There will be A. C5 nerve root preservation of light touch, proprioception, and B. C4 nerve root vibratory sense. C. C6 nerve root D. Sensory branch of C4 51. A 5-year-old male had an undiagnosed ANSWER:A arteriovenous malformation and is recently It is well known that the C5 nerve root exits the C4-C5 hospitalized because of an acute brain bleed. The intervertebral space. The other choices exit above and patient is not acknowledging individuals who stand on below this level. the left side of his bed, he does not respond to sensory stimuli that is applied to the left side of his body, and he 48. A physical therapist is conducting a screening displays visual spatial deficits. What lobe of the brain examination on a patient with a suspected upper motor has been affected by the stroke? neuron lesion. In the presence of an upper motor A. Right parietal neuron lesion, deep tendon reflexes will be B. Left temporal A. Hypoactive C. Frontal B. Absent D. Occipital C. Diminished ANSWER:A D. Hyperactive A lesion to the parietal lobe results in loss of ANSWER:D contralateral stimulus location and intensity, Upper motor neuron lesions involve damage to neural impairment of two-point discrimination, tactile and pathways above the level of the motor neuron. Such visual agnosia, visual disorientation, and neglect of lesions typically result in a constellation of symptoms contralateral self and surroundings. that include increased or hyperactive deep tendon reflexes, the appearance of pathologic reflexes, tonal 52. A patient with an upper motor neuron spinal increases, and weakness. Muscle wasting is not cord lesion at C6 began receiving occupational therapy common. Increased deep tendon reflexes can be one 2 weeks after the injury. During the third week, the finding in determining the need for referral or therapist notices an increase in spasticity. The differential diagnosis. therapist should A. Conclude that symptoms are typical after 49. You are performing an examination on a 2- spinal shock month-old infant diagnosed with Klumpke's palsy. The B. Conclude that the patient maybe in classic physical findings of a Klumpke's palsy are respiratory distress A. Lack of forearm supination, elbow extension, C. Suspect that a contracture is developing and wrist flexion D. Look for signs of autonomic dysreflexia B. Lack of forearm supination, elbow flexion, and ANSWER: A. wrist extension An initial spinal cord lesion results in spinal shock, C. Lack of shoulder external rotation, elbow which lasts for 1 week to 3 months. During spinal flexion, and wrist extension shock, the spinal cord may function as though it is alive D. Lack of elbow extension, forearm pronation, both above and below the level. The problem is one of and wrist flexion communication; the brain cannot receive sensory ANSWER:D information beyond the lesion site and cannot A Klumpke's palsy involves injury to the lower roots, volitionally control motor function below that point. C8-T1 (occasionally C7 is also involved) and results in Eventually, this subsides, and in upper motor neuron weakness of the triceps, forearm pronators, and wrist lesion, spasticity normally increases. flexors. 53. At the caudal level of the medulla, what 50. A 16-year-old male is diagnosed with a spinal percentage of the fibers of the corticospinal tract cross tumor and has undergone surgery to resect the mass. at the pyramidal decussation? After the procedure, the patient presents with variable A. 90to 100 motor paralysis and loss of pain and temperature B. 80 to 90 sensation below the level of the injury. The patient C. 70 to 80 would be diagnosed with what spinal cord syndrome? D. 60 to 70 A. Brown-Sequard ANSWER: B. B. Anterior Cord Most anatomists agree that 80 to 90 of the fibers of the C. Posterior Cord corticospinal tract cross over. 8 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW B. Bell's palsy 54. This descending tract, the C. Lyme disease ________________, originates in the superior D. Stroke colliculus and is involved with the orientation toward a ANSWER: B. stimulus in the environment by reflex turning of the Bell's palsy is a disease process affecting the seventh head. cranial nerve leading to abrupt facial A. Rubrospinal paralysis/weakness and the symptoms presented in B. Reticulospinal the case study; it is usually unilateral and self-remitting C. Tectospinal within a few months to a year. Several possible causes D. Vestibulospinal have been linked to the onset or recurrence of the ANSWER: C. disease process, one of which is a recent viral The rubrospinal tract originates in the red nucleus; the infection. Obvious physical examination findings reticulospinal tract originates in the medullary and involve those structures innervated by the seventh pontine reticular formation; and the vestibulospinal cranial nerve. Other areas of the body are not affected tract originates in the lateral vestibular nucleus. with Bell's palsy, as would be evident with Lyme disease, Guillain-Barre syndrome, and stroke. In 55. Which is the LEAST likely cause of dementia stroke, the patient is able to wrinkle the forehead. in the elderly? A. Stroke 58. A 50-year-old man presents to your office with B. Alzheimer's disease the following presentation: +2 muscle strength with left C. Depression shoulder abduction and elbow flexion; +5 muscle D. Cerebrovascular accident strength of left elbow extension and the intrinsic ANSWER: C. muscles of the hand; bicipital reflex absent on the left Alzheimer's and stroke (cerebrovascular accident) are and hypotonia of the biceps and deltoid muscles; the two most common causes of dementia in the triceps reflex +2 with normal triceps muscle tone; elderly. Depression may coincide with dementia but is spasticity and hyperreflexia in the left lower extremity. not a cause. Based upon this presentation, where is the MOST likely site of the lesion? 56. Postinfectious ascending paralysis and A. Left side of the spinal cord at C5 radiculoneuropathy are characteristics of what B. Left side of the spinal cord at C7 condition? C. Right side of the spinal cord at T1 A. Guillain-Barre syndrome D. Right side of the spinal cord at C5 B. Myasthenia gravis ANSWER: A. C. Amyotrophic lateral sclerosis Spinal cord lesions usually present with upper motor D. Multiple sclerosis neuron signs below the level of the lesion; however, if ANSWER: A. the lesion involves the anterior horn cells, there will About two thirds of the cases of Guillain-Barré also be lower motor neuron signs at the site of the syndrome are preceded by an acute influenza-like lesion. Therefore, based on the information provided in illness. It is also characterized by weakness beginning the question, the lesion must be located at C5 on the in the distal limb and advancing to affect the proximal left side of the spinal cord and involving the anterior muscles and inflammation and demyelination of spinal horn cells. nerve roots and peripheral nerves 59. A patient recently diagnosed with multiple 57. A 41-year-old woman presents with sudden sclerosis presents to a physical therapy clinic. The onset of numbness and drooping of the left side of her patient asks the therapist what she needs to avoid with face and pain directly behind her left ear. Further this condition. Which of the following should the patient questioning and a general assessment of the patient avoid? revealed asymmetric facial expression lateralizing to A. Hot tubs the right side, mild slurring of speech, dysgeusia, B. Slightly increased intake of fluids hyperacusis, and difficulty drinking noted as the C. Application of ice packs "dribbling" of a beverage. She was recently diagnosed D. Strength training with a viral upper respiratory infection 3 days ago and ANSWER: A. treatment consisted of rest and fluids. Ms. Ryan denies The danger in using a hot tub for a person with multiple a traumatic episode, headache, vertigo, sclerosis is that it may cause extreme fatigue. There is lightheadedness, tinnitus, use of oral contraceptives, no need to avoid the other activities listed. and smoking of cigarettes. What is the most likely diagnosis? 60. The therapist is examining a patient with a A. Guillain-Barre syndrome diagnosis of cerebral palsy. The therapist notes that all 9 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW of the extremities and the trunk are involved. Further This scenario describes a central cord lesion. It is assessment also reveals that the lower extremities are common in the geriatric population after cervical more involved than the upper extremities and that the extension injuries (such as whiplash). right side is more involved than the left. This patient most likely has which classification of cerebral palsy? 63. A 31-year-old man has loss of vision in one A. Spastic hemiplegia eye, staggering gait, numbness in bilateral upper B. Spastic triplegia extremities, and decreased bowel and bladder control. C. Spastic quadriplegia The episodes of these symptoms have occurred every D. Spastic diplegia few weeks for the past 6 months. Each episode has ANSWER:D been slightly worse than the last. What is the most likely A child with spastic diplegia most often presents with condition? the lower extremities and trunk more involved than the A. Parkinson's disease upper extremities. Also one side is often more involved B. Guillain-Barre syndrome than the other side. C. Multiple sclerosis D. Amyotrophic lateral sclerosis 61. The therapist receives an order to treat a 42- ANSWER:C year-old man admitted to the hospital 3 days ago with This set of signs and symptoms most likely points to a stab wound to the left lower thoracic spine. The multiple sclerosis. The other conditions listed are patient is unable to move the left lower extremity and progressive, but the best answer is multiple sclerosis cannot feel pain or temperature differences in the right lower extremity. What is the most likely type of lesion? 64. A 35-year-old woman suffered brain injury in A. The patient most likely has an anterior cord a motor vehicle accident and presents with an intention syndrome. tremor, nystagmus, hypotonia, and B. The patient most likely has a Brown-Sequard dysdiadochokinesia. What is the most likely location of syndrome. the lesion? C. The patient most likely has a central cord A. Basal ganglia syndrome. B. Dorsal columns D. The patient is equally as likely to have anterior C. Frontal lobe cord syndrome as he is to have Brown-Sequard D. Cerebellum syndrome. ANSWER:D ANSWER:B These signs and symptoms are most likely associated The question describes a hemisection of the spinal with damage to the cerebellum. Injuries to the basal cord, which is classified as a Brown-Sequard lesion. ganglia can present with: rigidity, resting tremor, Anterior spinal cord injuries present with loss of motor choreiform movements (jerky movements), and function and insensitivity to pain and temperature difficulty with initiating movement. Frontal lobe lesions bilaterally. Central cord injuries are characterized by lead to a change in mood or overall personality. The loss of function in the upper extremities and normal dorsal columns are involved in proprioception and function in the trunk and lower extremities. awareness of movement 62. A therapist receives an order to examine and 65. A 42-year-old construction worker received a treat a 76-year-old woman who was involved in a motor burst fracture in the cervical spine when struck by a vehicle accident 2 days ago. The patient's vehicle was falling cross-beam. Proprioception is intact in bilateral struck in the rear by another vehicle. The patient has lower extremities. The patient has bilateral loss of normal sensation and strength in bilateral lower motor function and sensitivity to pain and temperature extremities but paralysis and loss of sensation in below the level of the lesion. This type of lesion is most bilateral upper extremities. Bowel and bladder function typical of which of the following syndromes? are normal. The patient most likely has what type of A. Central cord syndrome spinal cord injury? B. Brown-Sequard syndrome A. The patient most likely has an anterior cord C. Anterior cord syndrome syndrome. D. Conusmedullaris syndrome B. The patient most likely has a Brown-Sequard ANSWER:C syndrome. A burst fracture causes damage to the spinal cord C. The patient most likely has a central cord because bony fragments are pushed posteriorly into syndrome. the spinal canal. This type of fracture is often D. There is no evidence of an incomplete spinal accompanied with anterior cord syndrome. cord lesion. ANSWER:C 66. A 52-year-old man with sciatica presents to outpatient physical therapy. The patient indicates that 10 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW he is experiencing paresthesia extending to the left neurotmesis the damage is so severe that full function ankle and severe lumbar pain. Straight leg raise test is may not be regained positive with the left lower extremity. Of the following, which is the most likely source of pain? 70. A therapist is assessing a patient in an A. A lumbar disc with a left posterior herniation attempt to discover the source of her pain. She or protrusion positions the patient's cervical spine in different B. A lumbar disc with a right posterior herniation directions in an attempt to elicit the patient's symptoms. or protrusion In one such direction, the patient reports return of C. Piriformis syndrome symptoms, including pain located at the right posterior D. Sacroiliac joint dysfunction scapular region, which extends down the posterior side ANSWER:A of the right upper extremity to the ends of the fingers, The symptoms involving the left lower extremity are an and tingling in the second, third, and fourth digits. The indication that a disc is herniated or protruding onto a patient also indicates that she often has a decrease in nerve root on the left side. A positive straight leg-raise sensation on the dorsal side of the second and third test is also often an indication of a disc herniation or digits. She also has noticeable weakness in the right protrusion. triceps. Which nerve root is most likely involved? A. Fourth cervical root 67. An infant with Erb's palsy presents with the B. Fifth cervical root involved upper extremity in which of the following C. Sixth cervical root positions? D. Seventh cervical root A. Hand supinated and wrist extended ANSWER: D. B. Hand supinated and wrist flexed Dermatome charts in distribution vary from source to C. Hand pronated and wrist extended source, but one common aspect of C7 innervation is D. Hand pronated and wrist flexed the middle finger. The triceps muscles are also ANSWER:D innervated by C7. The involved upper extremity is in this position because of damage to the C5 and C6 spinal roots. 71. A patient informs his therapist that his problem began 3 months after a bout of the flu. The 68. When reviewing a patient's chart, the patient originally experienced tingling in the hands and therapist determines that the patient has a condition in feet. He also reports progressive weakness to the point which the caudaequina is in a fluid-filled sac protruding that he required a ventilator to breathe. He is now from the back. What form of spina bifida does the recovering rapidly and is expected to return to a normal patient most likely have? functional level in 3 more months. From which of the A. Meningocele following conditions is the patient most likely suffering? B. Meningomyelocele A. Parkinson's disease C. Spina bifida occulta B. Guillain-Barre syndrome D. Lipoma C. Multiple sclerosis ANSWER:B D. Amyotrophic lateral sclerosis This form of spina bifida is associated with direct ANSWER: B. involvement with the caudaequina. The muscles that This patient is suffering from Guillain-Barre syndrome. are innervated by the caudaequina usually present with Some permanent damage can result, with loss of flaccid paralysis. sensory or motor function, but most patients make a full recovery in approximately 6 months. The syndrome 69. A 32-year-old construction worker fell off a often starts after a person has had a bout of the flu or ladder. In his effort to prevent the fall, the worker a respiratory infection. reached for a beam with his right arm. This motion stretched the brachial plexus, resulting in decreased 72. A therapist is examining a patient in the function in the right arm. Full function returned after 2 intensive care unit. The therapist notices that the 1/2 weeks. What is the most likely type of injury? patient is moving his hands and fingers in slow, writhing A. Axonotmesis motions. Which of the following terms best describes B. Neurotmesis this type of movement? C. Neurapraxia A. Lead-pipe rigidity D. Nerve root avulsion B. Ballisms ANSWER:C C. Chorea Neurapraxia is not associated with axon degeneration; D. Athetosis it is associated instead with demyelination and ANSWER:D complete recovery. With axonotmesis there is wallerian This type of movement, known as athetosis, also can degeneration below the site of the lesion. In involve the feet, proximal parts of the extremities, and 11 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW face. Chorea is rapid movements of the hands, wrist, likely compromised? What is the most likely area of or face. Ballism refers to forceful and uncontrollable compression? throwing of the extremities outward. Lead-pipe rigidity A. Median nerve, carpal tunnel is increasing resistance of an extremity to passive B. Ulnar nerve, Guyon's canal ranging. All of the aforementioned can result from C. Ulnar nerve, pronator quadratus damage to the basal ganglia. D. Median nerve, pronator teres ANSWER: D. 73. A 29-year-old woman who is 8 months These signs and symptoms are common with median pregnant presents to an outpatient clinic with nerve compression as it travels through the two heads complaints of "pain and tingling" over the lateral thigh. of the pronator teres. Carpal tunnel syndrome usually She also indicates no traumatic injury. The symptoms presents with a positive Tinel's sign, a positive Phalen's increase after she has been sitting for 30 minutes or test, and decreased strength and sensation over the longer, and the overall intensity of the symptoms has median nerve distribution. Ulnar nerve compression at been increasing over the past 2 weeks. The therapist Guyon's canal typically presents with numbness, pain, notes that repeated active lumbar flexion does not and tingling along the ulnar nerve distribution increase pain, and the patient's lumbar range of motion is normal for a pregnant woman. There is also no motor 76. The best predictor of ambulation in young weakness in the hip or pelvis, and the sacroiliac joint is children with cerebral palsy is not abnormally rotated. What is the most probable A. Absence of primitive reflexes at 3 months diagnosis? B. Absence of tonic neck reflexes A. L3 disc dysfunction C. Independent sitting by 24 months of age B. Spondylolisthesis D. Independent standing by 1 year of age C. L4 disc dysfunction ANSWER:C D. Meralgiaparesthetica Cerebral palsy children are slow to reach motor ANSWER: D. milestones. This is the most accurate choice. Studies Meralgiaparesthetica is the compression of the lateral show that his group of children will walk by age 8. femoral cutaneous nerve of the thigh as it passes under the inguinal ligament near the anterior superior iliac 77. Which complication of spinal cord injury is spine. Examples of the source of this problem include more likely to occur in children and teenagers than in periods of obesity, postural changes, and tight clothing. adults? Lumbar disc involvement and spondylolisthesis are A. Hypercalcemia less likely choices because the question indicates B. Autonomic dysreflexia normal range of motion, lack of motor weakness, and C. Spasticity no change with repeated active lumbar flexion. D. Deep venous thrombosis ANSWER: A. 74. A 14-year-old girl placed excessive valgus While all of the choices do occur in children with a stress to the right elbow during a fall from a bicycle. Her spinal cord injury, choice A is the most appropriate. forearm was in supination at the moment the valgus During the first year of spinal cord injury, 40of bone stress was applied. Which of the following is most likely mineral density is lost through calcium excreted in the involved in this type of injury? urine. A. Ulnar nerve B. Extensor carpi radialus 78. Recovery from spinal cord injury occurring C. Brachioradialis over several years is most likely with which syndrome D. Annular ligament A. Brown-Sequard ANSWER: A. B. Anterior cord A valgus stress is most likely to injure any medial elbow C. Posterior cord structures, such as the ulnar nerve. The structures on D. Caudaequina the lateral side are likely to be injured with a varus ANSWER: D. stress. Choice C originates on the lateral Cauda equine syndrome is the most likely of the supracondylar ridge. choices to regrow damaged axons, since it is essentially damage to the peripheral nerves. All other 75. A patient presents to an outpatient clinic with choices are damage to the spinal cord itself. an order to examine and treat the right forearm and wrist secondary to nerve compression. The patient has 79. Which orthopedic complication is not the following signs and symptoms: pain with manual probable in a child with tetraplegic spinal cord injury? muscle testing of pronation, decreased strength of the A. Shoulder subluxation flexor pollicislongus and pronator quadrates, and pain B. Scoliosis with palpation of the pronator teres. What nerve is most C. Heterotopic ossification 12 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW D. Hip dislocation abduction tests the C5 nerve root, while the ANSWER:A tricepbrachii reflex is involves the C7 nerve root The other choices are more probable in a tetraplegic child. 84. Your patient was in a car accident and now has a herniated nucleus pulposis at vertebral level C5- 80. The most common clinical signs of a C6. She reports difficulty removing her shirt overhead. cerebellar brain tumor may include all of the following With nerve root injury at the level of C5-C6, what part except of the motion will most likely be problematic for your A. Hypotonia patient and why? B. Ataxia A. Grasping the shirt due to weakness of all C. Vomiting finger flexors D. Low back pain B. Internally rotating the shoulder due to ANSWER:D weakness of teres minor Low back pain is not an indicator of a brain lesion. C. Shoulder flexion due to weakness of deltoid D. Cervical flexion to remove shirt due to 81. Areas that a physical therapist can address weakness of deep neck flexors with a child with an acquired brain injury in terms of ANSWER:C long-term health and well-being include all of the A herniation at C5-6 results in nerve root compression following except of C5. This corresponds to the axillary nerve supplying A. Neurologic sequelae the deltoid. The teres minor is also innervated by the B. Growth disturbance axillary nerve; however it is an external rotator. Cervical C. Obesity flexion is innervated by the cervical spinal nerves C1- D. Arthritis C4. Finger flexors are innervated by the ulnar nerve ANSWER:B arising from nerve root levels C7, C8 and T1. A physical therapist can provide intervention for all of the other choices listed regardless of the presence of a 85. A 55-year-old man with type I diabetes brain injury. Growth disturbances are out of the control mellitus reports double vision. On examination of his of the therapist. extraocular movements, he has limited adduction, elevation, and depression of his right eye. The pupils 82. Based on recent studies in children with are equal and reactive. The patient most likely has a traumatic brain injury, you would expect to see lesion of the following right side cranial nerve recovery slow down after ______ in a child with a A. Abducens nerve VI severe injury. B. Trochlear nerve IV A. 6 months C. Oculomotor nerve III B. 1 year D. Optic nerve II C. 3 years ANSWER:C D. 5 years Oculomotor nerve III. The occulomotor nerve ANSWER:B innervates muscles that produce eye adduction, Progress will slow to a halt 1 year after a severe injury. elevation, and depression The actual length of recovery varies according to many factors such as area of the brain injured, type of injury, 86. The classification of a nerve injury that would treatment after injury, and so on. produce pain, muscle wasting, complete motor and sympathetic function loss with a recovery time of 83. During examination of a patient with neck pain months, with sensation restored before motor function and left arm pain, the therapist is suspicious of a C6 best describes nerve root irritation. Which of the findings will help A. Neuropraxia confirm that condition? B. Axonotmesis A. Weakness in shoulder abduction of left arm C. Neurotmesis B. Decreased triceps reflex on left compared to D. Axonopraxia right ANSWER:B C. Decreased biceps reflex on left compared to According to Sunderland's and Seddon's classification right of nerve injuries, the description provided best D. Increased tone in left biceps describes axonotmesis. Neurotmesis involves ANSWER:C complete disruption of the nerve while neuropraxia is Examination of root irritation can be conducted by only transient, and there is little or no muscle wasting. myotome, dermatome, or reflexes. The bicep brachii Axonopraxia is a similar term for neuropraxia reflex is indicative of a C6 lesion. Increased tone is associated with upper motor lesions. Shoulder 13 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW 87. When performing resistive testing to Spinal Injury Association (ASIA). A spinal cord injury at determine the integrity of the C5 myotome, the physical the level of C6. During manual muscle testing of the therapist should examine which of the following upper extremity, the patient should have function in all movements? of the following muscles EXCEPT the A. Wrist radial deviation A. Biceps B. Elbow extension B. Triceps C. Thumb extension C. Deltoid D. Elbow flexion D. Diaphragm ANSWER:D ANSWER:B Myotome testing can be important in localizing central In a complete ASIA, A C6 lesion, muscle function and peripheral lesions. A lesion involving the C5 impairments would be expected below the indicated myotome will affect the client/patient's ability to flex the level of the identified lesion. The triceps is innervated elbow. Key muscles innervated at this level include the by the radial nerve, which arises from spinal levels C7- biceps brachii and the deltoid. C8. Spinal levels C3-C5 give rise to the phrenic nerve, which innervates the diaphragm. The biceps is 88. While performing an upper quarter screen, a innervated by spinal levels C5-C6. The axillary nerve, physical therapist suspects neurologic system which runs to the deltoid, arises from the C5-C6 spinal involvement. In examining the integrity of the C8 levels. dermatome, the therapist should check sensation along the 91. A physical therapist is treating an 18-year-old A. Thumb and index finger male who had an ASIA T1 spinal cord injury (SCI) 6 B. Ulnar border of the hand months ago. Given the level and completeness of the C. Middle three fingers lesion, what would be his EXPECTED functional D. Radial border of the hand capability for transfers? ANSWER: B A. Dependent with all mat mobility Several dermatomes, C6-C8, are responsible for B. Dependent with wheelchair to mat transfers sensory innervation of the hand. The dorsum and C. Independent with wheelchair to mat transfers palmer surfaces of the thumb, first finger and thenar D. Independent with floor to wheelchair transfers eminence receive their sensory component from C6. ANSWER:C Dermatome C7 is responsible for the palmar and dorsal Achieving independence for wheelchair to mat surfaces of the third and fourth fingers and middle transfers is a realistic expected level of function given portion of the palm. The C8 dermatome specifically the lesion. According to Somers (Spinal Cord Injury: provides sensation along the ulnar boarder of the hand, Functional Rehabilitation) and Sisto, Druin and including the fifth finger and is part of the screen for Sliwinski (Spinal Cord Injuries: Management and peripheral or central nervous system impairment. Rehabilitation), achieving independence is a realistic goal for the level and type of lesion. Upper extremity 89. A patient has been referred to physical function is present, which allows independence for therapy for acute shoulder pain after shoveling snow in most transfers; thus, that patient is not likely to be a driveway for 2 hours. Positive findings include pain dependent for mat mobility and wheelchair to mat and weakness with flexion of an extended upper transfers. Transferring from the floor to wheelchair may extremity as well as scapular winging with greater than require assistance. 90 degrees of abduction. The patient's problem is MOST LIKELY the result of 92. Recovery of the upper arm after a brachial A. Supraspinatus tendinitis plexus injury can occur for up to B. Compression of the long thoracic nerve A. 2 years C. Compression of the suprascapular nerve B. 1 year D. Subdeltoid bursitis C. 6 months ANSWER:B D. 9 months Compression of the long thoracic nerve will result in ANSWER:A serratus anterior weakness, which has associated Continued recovery can occur for up to 2 years in the postural and motor disturbances. In terms of posture, upper arm and 4 years in the lower arm. weakness of the serratus anterior will result in scapular winging. Motor disturbances can also occur because of 93. A patient is difficult to arouse and falls asleep the action of the serratus anterior on the scapula during without constant stimulation from the therapist. Even overhead reaching. when the patient is aroused, he has difficulty interacting with the physical therapist. What would be the BEST 90. A physical therapist is conducting a physical description of the patient's level of arousal? examination with a patient diagnosed with an American A. Stupor 14 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW B. Lethargic giving the client enough function to complete the C. Obtunded activities. D. Alert ANSWER:C 97. Which of the following is the most important to Obtunded. This patient requires continual stimulus to assess first during an examination of a patient with a stay awake. The patient in a stupor is not interactive, recent stroke? while a lethargic patient stays interactive with A. Sensory status stimulation during a session. B. Motor control C. Mental status 94. Mrs. Brown is a patient on the acute D. Ambulation potential rehabilitation unit. She is sleepy, but easily roused ANSWER: C. when you enter the room. She knows her name but Mental status is the first item to assess. A therapist thinks she is at home. She is unable to give the year. must first determine whether the patient is able to She tries to get out of bed when you approach, and provide a reliable subjective history. It is also important doesn't seem to realize she has weakness on the left to know whether the patient can follow a 1- or 2-step side. Briefly describe Mrs. Brown's arousal, orientation, command before beginning a formal evaluation. The and cognition. other choices should be assessed later in the A. Alert, oriented x2, confused evaluation. B. Obtunded, oriented x1, confused C. Lethargic, oriented x1, confused 98. A 25-year-old man suffered C4 quadriplegia D. Sleepy, oriented x3, confused in a motor vehicle accident. The injury is acute, and the ANSWER: C patient is beginning to work on increasing upright Lethargic, oriented x1, confused. The patient is best tolerance in the sitting position with an abdominal described in this way. Sleepy is not a proper clinical binder. He is looking to the therapist for description. She is easily roused so obtunded does not encouragement. The therapist is attempting to convey apply. She is oriented to name only realistic long-term goals for self-care ability and overall mobility. Of the listed goals, what can this patient 95. An 18-year-old male was involved in a reasonably expect at his highest level of function in the motorcycle accident and has sustained a traumatic future? brain injury. The patient is starting to squeeze the A. Transfer from wheelchair to bed therapist's hand upon command, beginning to independently with a sliding board recognize his mother, and withdraws to pain. The B. Use of a power wheelchair patient is at what stage on the Rancho Los Amigos C. Independent feeding without an assistive Levels of Cognitive Functioning? device A. II-generalized response D. Donning a shirt independently and pants with B. III-localized response minimal assistance C. IV-confused-agitated Answer: B. D. V-confused-inappropriate, nonagitated A person with C4 quadriplegia can be reasonably ANSWER:B expected to use a power wheelchair for locomotion with A patient functioning at Level III (localized response) mouth, chin, breath, or sip-and-puff controls. A person demonstrates withdrawal to painful stimuli, turns with C5 quadriplegia may be reasonably expected to toward or away from auditory stimuli, begins to be able to transfer independently from wheelchair to recognize family members, follows simple commands bed with a sliding board. A person with C4 quadriplegia such as "Look at me" or "squeeze my hand," reacts may be able to feed independently but will need some slowly and inconsistently, and begins to respond type of assistive device. A person with C5 quadriplegia inconsistently to simple questions. may be able to don a shirt with assistance. Sources vary significantly on this subject. 96. The highest level of spinal cord injury at which you would expect a client to become independent in all 99. A 17-year-old boy presents to therapy after self-care and driving with equipment would be being involved in a motor vehicle accident resulting in A. C7 C7 quadriplegia. The therapist is setting long-term B. C8 goals for the patient. Which of the following goals C. C5 represents the most reasonable and highest level of D. C6 function that the patient should achieve? Answr:D A. Use of a wheelchair with power hand controls A client with a C6 injury would have control of the head, on even terrain neck, diaphragm, deltoids, biceps, and wrist extensors, B. Negotiation of uneven terrain with a manual wheelchair 15 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW C. Ambulation for short distances on level consciousness but not drop attacks, lip paresthesias, surfaces with knee-ankle-foot orthoses and lower extremity paresthesias D. Use of a power wheelchair with head or chin controls on even surfaces 102. In children with osteogenesisimperfecta, ANSWER: B. fractures heal A person with C7 quadriplegia should be able to use a A. Within the normal healing time wheelchair without power controls. The goals set in B. More quickly than normal Choices A and D do not represent the maximal C. More slowly than normal functional potential for this patient. The goal in Choice D. Only with assistance of medication C is set too high for this patient. ANSWER:A. Healing time is unchanged with this patient population. 100. A therapist is treating a patient with a spinal cord injury. The therapist is discharging the patient 103. The joint most frequently involved in after completion of all physical therapy goals. One of pauciarticular juvenile rheumatoid arthritis is the (1.46) the completed long-term goals involved the ability to A. Cervical spine dress and bathe independently with assistive devices. B. Lumbar spine This would be a most challenging but obtainable goal C. Knee for which of the following? D. Wrist A. C5 quadriplegia ANSWER:C B. C7 quadriplegia The knee is most common with this diagnosis followed C. T1 paraplegia by the ankles and elbows. D. C4 quadriplegia ANSWER:B 104. The most common onset type of juvenile This goal should be most challenging and obtainable rheumatoid arthritis is (1.47) for a patient with C7 quadriplegia. A person with C4 or A. Systemic C5 quadriplegia probably needs assistance from B. Juvenile ankylosing spondylitis another person to dress and bathe. A person with C7 C. Polyarticular quadriplegia would find this goal more challenging than D. Pauciarticular a person with T1 paraplegia. ANSWER:D. Pauciarticular juvenile rheumatoid arthritis (RA) occurs 101. Which is not a typical clinical finding of a in 50% to 60% of the cases, followed by polyarticular patient with a brachial plexus injury? RA and then systemic RA. A. Decreased ROM/contractures B. Decreased muscle strength 105. What is the correct order of the stages of bone C. Spasticity healing after a fracture? (1.50) D. Altered sensation A. Inflammatory phase, hard callous phase, soft ANSWER: C callous phase, remodeling phase A brachial plexus injury is a lower motor neuron injury; B. Inflammatory phase, soft callous phase, hard and therefore, it does not cause spasticity, an upper callous phase, remodeling phase motor neuron sign. C. Remodeling phase, soft callous phase, hard callous phase, inflammatory phase 101. Your patient presents with dizziness, lip D. Remodeling phase, hard callous phase, soft paresthesias, nystagmus, lower extremity callous phase, inflammatory phase paresthesias, and drop attacks. This would be most ANSWER:B indicative of Healing phases of bone after fracture are divided into A. A concussion the following categories: Inflammatory phase B. Vertebral basilar insufficiency (immediately after injury), soft callous phase (1 to 6 C. A labyrinthine syndrome weeks postinjury), hard callous phase (4 to 6 weeks D. Carotid artery tear after injury), and remodeling phase (6 weeks to several ANSWER: B. months postinjury). The cardinal signs described in this question are classic signs of vertebral basilar instability. With a 106. Which type of connective tissue includes the labyrinthine involvement you will mostly get dizziness superficial sheath of body tissue under the skin, but not all of the cardinal signs. With a carotid artery muscle, and nerve sheaths, and the framework of tear you may lose consciousness because it supplies internal organs? the higher centers of the brain. A concussion may A. Dense regular connective tissue cause a variety of symptoms to include loss of B. Dense irregular connective tissue C. Loose irregular connective tissue 16 Copyright. © The Catalyst. Unauthorized reproduction, use or dissemination, uploading or downloading is strictly prohibited and shall be prosecuted to the full extent of the law, including administrative complaints with the Professional Regulatory Board, Philippine Regulation Commission.  PT APPS BOOK REVIEW 2 PLP PT BOARD REVIEW D. Loose regular connective tissue ANSWER:C 111. The most common cause of burn injury in Dense regular connective tissue includes ligaments infants is and tendons, and dense irregular connective tissue A. Accidental flame burn from a smoking adult includes joint capsules, periosteum, and aponeurosis. B. Car accidents with immolation Choice D does not exist. C. Scald injury, either intentional or accidental by neglect 107. You are seeing a patient who has just D. House fires, in which all family members are received a steroid injection into a joint. You should injured A. Treat this joint vigorously ANSWER:C B. Treat this joint gently Choice C is more common than the other choices. C. Not touch this joint at all D. Postpone the session for at least 1 week 112. A physical therapist is treating a patient with ANSWER:B significant burns over the limbs and upper trunk. Which A steroid injection can weaken tendons and ligaments; of the following statements is false about some of the thus, the joint must be moved carefully changes initially experienced after the burn? A. This patient initially experienced an increase 108. A patient with osteoporosis might be treated in the number of white blood cells. with all of the following drugs except B. This patient initially experienced an increase A. Bisphosphonates in the number of red blood cells. B. Calcitonin C. This patient initially experienced an increase C. Calcium with vitamin D in the number of free fatty acids. D. Thyroid hormones D. This patient initially experienced a decrease ANSWER:D in fibrinogen. Thyroid hormone is not used but the parathyroid ANSWER:B hormone is used in cases of certain calcium This patient is likely to experience a decrease in the imbalances. All of the listed agents are used with number of red blood cells. All of the other statements bisphosphonates to be taken on an empty stomach and are correct. Fibrinogen drops initially but then rises sitting or standing for at least 30 min. throughout recovery. 109. The next patient on your schedule is a 69- 113. What are the four stages, in time order, of year-old Asian woman with a diagnosis of "T8 fracture." wound healing after surgery? What condition are you most concerned with for this A. Coagulation, inflammatory phase, granulation patient? phase, and scar formation and maturation A. Neck pain B. Inflammatory phase, coagulation, scar B. Myopathy formation and maturation, and granulation phase C. Dizziness C. Scar formation and maturation, granulation D. Osteoporosis phase, coagulation phase, and inflammatory phase ANSWER:D D. Inflammatory phase, granulation phase, Risk factors for osteoporosis include advanced age, coagulation, and scar formation and maturation being thin, positive family history, exposure to certain ANSWER:A medications, and ancestry (Caucasian or Asian). A. This is the correct order of incision or wound healing after surgery. 110. Which of the following are not appropriate interventions for a patient with osteoporosis and a T8 114. Which of the following layers of the epidermis compressions fracture? is responsible for the constant renewal of epidermal A. Balance exercises cells? B. Postural exercises A. Stratum germinativum C. Proprioceptive training B. Stratum granulosum D. Ultrasound C. Stratum lucidum ANSWER:D D. Stratum corneum Physical therapy intervention for individuals with ANSWER:A osteoporosis has several goals: optimization of bone The stratum germinativum (basale) contains stem cells formation, fall prevention, fracture prevention, characterized by intense mitotic activity indicative of postfracture rehabilitation, and treatment of cellular division since the main function of this layer is musculoskeletal conditio