PPTE Review & Study Guide PDF

‫ﻣﺮﳷ و ﺤﺻﺼﺎح‬ ‫ﻣﻠﺰﻣﺔ‬ Dr. Mohammed Marei Ibrahim, BPT MUST Health insurance Manager - Fowa Dr. Sayed Mohammed sahsah, BPT Cairo University 2004 Consultant Physiotherapy  One of requirements to be licensed step has been established by m...

‫ﻣﺮﳷ و ﺤﺻﺼﺎح‬ ‫ﻣﻠﺰﻣﺔ‬ Dr. Mohammed Marei Ibrahim, BPT MUST Health insurance Manager - Fowa Dr. Sayed Mohammed sahsah, BPT Cairo University 2004 Consultant Physiotherapy  One of requirements to be licensed step has been established by managing to practice physiotherapy in the states of this humble book to be a trusty source for Gulf Cooperation Council is to pass the any PT to completely depend on it. The prometric physical therapy examination title of our book “PPTE” an acronym for which is not an easy as this exam often “Prometric Physical Therapy Exam- requires candidates to combine basic ination” from its mission that we wish to physical therapy knowledge with clinical do to the fullest. experience in order to interpret, evalu- Our book consists of two parts one as brief ate, or solve problems that may occur in study guide, which is selectively collect- clinical situations. In order to protect the ed from trusty sources in physiotherapy public, Prometric use examination results in orthopedics, neurology, cardiovascu- as the main resource to determine wheth- lar, pulmonary, pediatric, therapeutic ex- er a candidate has demonstrated minimal ercises and therapeutic modalities, etc.. standards necessary for safe and effective the other part is the quiz bank which con- practice. sists of prometric exams questions parted So, it was our mission and it was a great in pattern that follow the first part topics, mission to make an inclusive,wide and almost all questions are answered, some accurate source to help anyone who seek of them have rationale for the true ques- to work at these states or to be licensed to tions by an elite of professors and teach- pass this exam easily. ing staff in notable universities in ARE. Since fifteen years we had started col- lecting all exams for most of states in humble book, updating them every year until 2022 and the idea to make a great Pre-Exam Guidelines General Rules What are Licensure Examinations? The Licensure Examinations are assessments to ensure that the public will not be harmed by the incompetence of healthcare practitioners. It assesses the abil- ity to apply knowledge, concepts, and principles that constitute the basis of safe and effective health care. What is the Physical Therapy Specialist Licensure Examination? The Physical Therapy Specialist Licensure Examination is an exam that assess- es your readiness to practice. It is a three-hour MCQ examination. It consists of 150 MCQs which may include up to 10 pilot questions. These questions have four options from which the candidate will choose one answer. The examination shall contain recall questions that test knowledge and ques- tions with scenarios that test other skills (interpretation, analysis, decision mak- ing, reasoning and problem solving). What is a test blueprint, and what is its purpose? A test blueprint is a document that reflects the content of your specialty licensure examination. The blueprint is the plan used for “building” the exam. The purpose of the blueprint is to ensure including questions related to what you are expected to know. Note: to know more about Physical Therapy Specialist Licensure Exam Blue- print and References, (See Appendix A & B). Application and Eligibility Eligibility for the Classification Examination? To apply for the Classification Examination, Please follow the most updated in- formation available on SCFHS website. Exam Day Instructions for examination day: You will be continuously monitored by video, physical walk-throughs and the observation window during your test. All testing sessions are video and audio recorded. You must bring valid (unexpired) and acceptable ID(s) (Saudi ID, Resident ID, or Passport) and exam schedule printed out to the examination hall, and present it at the registration desk. Any clothing or jewelry items allowed to be worn in the test room must remain on your person at all times. Removed clothing or jewelry items must be stored in your locker. You may not leave the examination hall before thirty minutes have elapsed and always accompanied by an invigilator if you wish to return. You must conduct yourself in a civil manner at all times when on the premis- es of the testing center. Exhibiting abusive behavior towards the Test Center Administrator (TCA), or any other staff member of the test center, may result in legal prosecution. To protect the privacy of all testers, the TCA can neither confirm nor deny if any particular individual is present or scheduled at the test center. Repeated or lengthy departures from the test room for unscheduled breaks will be reported by the TCA. You must return all materials issued to you by the TCA at the end of your test. You are required to sign out on the test center roster each time you leave the test room. You must also sign back in and show your ID to the TCA in order to be re-admitted to the test room. Prohibitions Before the examination: Seeking, providing, and/or obtaining unauthorized access to examination mate- rials, providing false information or making false statements on or in connection with application forms, scheduling permits, or other exam-related documents. Applying for an examination for which you are not eligible. Communicating or attempting to communicate about specific test items, cases, answers, and/or exam results with an examiner, potential examiner, or formal or informal test developers at any time before, during, or after an examination. During the examination: Taking an examination for which you are not eligible Taking an examination for someone or engaging someone to take an exam- ination for you giving, receiving, or obtaining unauthorized assistance during the examination or attempting to do so Making notes of any kind while in the secure areas of the test center, except on the writing materials provided at the test center for this purpose Failing to adhere to any exam policy, procedure, or rule, including instructions of TCA. Verbal or physical harassment of test center staff or other examination staff, or other disruptive or unprofessional behavior during the registration, scheduling, or examination process Possessing any unauthorized materials, including photographic equipment, communication or recording devices, and cell phones, in the secure testing ar- eas Any other electronic communication device, not herein mentioned, are prohib- ited in the examination hall irrespective if they are turned off, and no provision will be made to store them  Communicating or attempting to communicate about specific test items, cases, and/or answers with another examinee, or formal or informal test preparation group at any time before, during, or after an examination. After the examination: Altering or misrepresenting examination scores. Any reproduction by any means, including, but not limited to, reconstruction through memorization, and/or dissemination of copyrighted examination materi- als by any means, including the internet. Communicating or attempting to communicate about specific test items, cases, and/or answers with another examinee, potential examinee, or formal or infor- mal test preparation group at any time before, during, or after an examination. Failure to cooperate fully in any investigation of a violation of the SCFHS rules. Post-Exam Guidelines General Rules When and Where Can I Find My Score? A detailed report will be provided upon completing your test. After Getting Your Passing Score: Congratulations. Passing the licensing test is one of the requirements for regis- tration. Now you may complete your registration at SCFHS by fulfilling all the requirements. After Getting Your Failing Score: We regret that you have not pass. We recognize that you have spent much time and exerted efforts to prepare for the exam. Thus, you must not lose hope and start over. Consider your failure as a beneficial experience that enables you to know more about your weakness and strength points and how so strengthen them and be determined to make it on the next chance, if Allah will. Be sure that you are not the first one who fail in this world as many other people have experienced the same and they have made their failure a strong motivation to succeed. If you would like to request a rescoring: Read carefully the SCFHS rescoring Process. Then , fill the Rescoring Request Form and submit it to Tawasul During two weeks from announcing the result. If you would like to request a formal review: Read carefully the Policy and Procedures for the Formal Review of SCFHS Examinations. Types of Requests may include: disruption during examination, faulty examination equipment, or other similar issues related to examination process. Then , fill the Formal Review Request and submit it to Tawasul. Please make sure your Request is submitted during two weeks from exam date. Appendix A: Physical Therapy Specialist Licensure Examination Blueprint Note: 1. Blueprint distributions of the examination may differ up to ±3% in each cate- gory. 2. See the SCFHS website for the most up-to-date information. Appendix B: References 1. Muscle: Testing and Function with Posture and Pain. 5th Edition, Florence Peterson, 2005. 2. Clayton`s Electro Therapy, Theory and Practice, Angela Forster, 9th Edition 1999. 3. Tidy`s Physiotherapy, 13th Edition. 4. Physical Rehabilitation, Assessment and Treatment, 3rd Edition, Susan B.Q., Sullivan, 1994. 5. Tide`s Physical Therapy, Ann Thomason, 12th Edition. Note: This list is intended for use as a study aid only. SCFHS does not in- tend the list to imply endorsement of these specific references, nor are the exam questions necessarily taken from these sources. Muscloskeletal Systems - Biomechanics Question 1 Chapter 1 Question 2 Question 3 Question 4 23  PPTE Review & Study Guide Question 5 Question 6 Question 7 24 Muscloskeletal Systems - Biomechanics Question 8 Chapter 1 Question 9 Question 10 Question 11 25  PPTE Review & Study Guide Question 12 Question 13 Question 14 26 Muscloskeletal Systems - Biomechanics Chapter 1 Question 15 Question 16 Question 17 27  PPTE Review & Study Guide Question 18 Question 9 Question 19 Question 20 Question 21 28 Muscloskeletal Systems - Biomechanics Question 22 Chapter 1 Question 23 Question 24 Question 25 29  PPTE Review & Study Guide Question 26 Question 27 Question 28 30 Muscloskeletal Systems - Biomechanics Question 29 Chapter 1 Question 30 Question 31 Question 32 31  PPTE Review & Study Guide Question 33 Question 34 Question 35 32 Muscloskeletal Systems - Biomechanics Question 36 Chapter 1 Question 37 Question 38 33  PPTE Review & Study Guide Question 39 Question 40 Question 41 Question 42 34 Muscloskeletal Systems - Biomechanics Chapter 1 Question 43 Question 44 Question 45 35  PPTE Review & Study Guide Question 46 Question 47 Question 48 36 Muscloskeletal Systems - Biomechanics Question 49 Chapter 1 Question 50 Question 51 Question 52 37  PPTE Review & Study Guide Question 53 Question 54 38 Muscloskeletal Systems - Biomechanics Question 55 Chapter 1 Question 56 Question 57 39  PPTE Review & Study Guide Question 58 Question 59 Question 60 40 Muscloskeletal Systems - Biomechanics Chapter 1 Question 61 Question 62 Question 63 41  PPTE Review & Study Guide Question 64 Question 65 Question 66 Question 67 42 Muscloskeletal Systems - Biomechanics Question 68 Chapter 1 Question 69 Question 70 Question 71 43  PPTE Review & Study Guide Question 72 Question 73 Question 74 Question 75 44 Muscloskeletal Systems - Biomechanics Question 76 Chapter 1 Question 77 Question 78 Question 79 45  PPTE Review & Study Guide Question 80 Question 81 Question 82 Question 83 46 Muscloskeletal Systems - Biomechanics Question 84 Chapter 1 Question 85 Question 86 Question 87 47  PPTE Review & Study Guide Question 88 Question 89 Question 90 Question 91 48 Muscloskeletal Systems - Biomechanics Question 92 Chapter 1 Question 93 Question 94 Question 95 49  PPTE Review & Study Guide Question 96 Question 97 Question 98 50 Muscloskeletal Systems - Biomechanics Question 99 Chapter 1 Question 100 Question 101 Question 102 51  PPTE Review & Study Guide Question 103 Question 104 Question 105 Question 106 52 Muscloskeletal Systems - Biomechanics Question 107 Chapter 1 Question 108 Question 109 Question 110 53  PPTE Review & Study Guide Question 111 Question 112 Question 113 Question 114 54 Muscloskeletal Systems - Biomechanics Question 115 Chapter 1 Question 116 55  PPTE Review & Study Guide Question 1 Patient walking on slippery surface we teach him to do: 1- COG keeping close to the body 2- Wide base of support 3- Walking fast Correct Answer: 1 rationale: The closer the body’s center of gravity is to its base of support, the more stable it is. Question 2 The therapist is treating a 52-year-old woman after right total hip replacement. The patient complains of being self-conscious about a limp. She carries a heavy briefcase to and from work every day. The therapist notes a Trendelenburg gait during ambulation on level surfac- es. What advice can the therapist give the patient to minimize gait deviation? 1- Carry the briefcase in the right hand. 2- Carry the briefcase in the left hand. 3- The patient should not carry a briefcase at all. 4- It does not matter in which hand the briefcase is carried. Correct Answer: 1 rationale: Trendelenburg gait is also seen after hip replacement surgery and femoral fixation with intra- medullary nail. In patients with hip replacement, trendelenburg gait ensues due to the surgical dissection of the gluteus medius muscle during surgery to expose the hip joint; thus the dys- function in the abductor muscles. at patient with a positive Trendelenburg sign the pelvis drops on one side “ contralateral “ , the trunk lurches to the other sides “ ipsilateral “, in an effort to maintain balance so she can Carry the briefcase in the right hand to help in maintaining balance and decrease deviation. Question 3 patient ask to go upstairs with crutch 1- Sound limb go up 1 2- Affected limb go up 1 Correct Answer: 1 rationale: same answer as we described above in Q ( 23 ) Question 4 A 36-year-old woman comes to the Physical Therapy Clinic with right heel pain for more than 3 months. The physical therapist decides to do a gait analysis to this patient. Which of the following is the most appropriate step length? 1- Distance between 2 consecutive foot flat. 2- Distance between 2 consecutive heel strikes. 3- Distance between 2 consecutive foot flat by the same leg. 4- Distance between 2 consecutive heel strikes by the same leg. 58 Muscloskeletal Systems - Biomechanics Chapter 1 Correct Answer: 2 rationale: The most basic spatial descriptors of gait include the length of a stride and the length of a step. Stride length is the distance between two successive heel contacts of the same foot and Step length, in contrast, is the distance between successive heel contacts of the two different feet. Comparing right with left step lengths can help to evaluate the symmetry of gait between the lower extremities. Question 5 A 23 - year - old man presents to the clinic with pain in his right knee before 10 days ago. During treatment, the physical therapist observed a difficult knee joint flexion during motion at heel strike. What is the degree of knee flexion during normal gait? 1- 10 2- 20 3- 30 4- 40 Correct Answer: 2 rationale: At heel contact the knee is flexed approximately 5 degrees, and it continues to flex an additional 10 to 15 degrees during the initial 15% of the gait cycle. This slight knee flexion, controlled by eccentric action of the quadriceps, serves the purpose of shock absorption and weight accep- tance as body weight is progressively transferred to this lower extremity. Question 6 A 30 - year - old man presents to the clinic with right foot pain 2 weeks ago and starts treat- ment. The physical therapist conducts a gait analysis to detect any gait abnormalities. What is the percentage of the swing phase in the normal gait cycle? 1- 20 2- 40 3- 60 4- 80 Correct Answer: 2 rationale: At normal walking speed, the stance phase occupies approximately 60% of the gait cycle, and the swing phase occupies the remaining 40%. Question 7 elderly person 65 year of age during his gait: 1- swing phase more than 40% 2- swing phase less than 40% 3- swing phase 59  PPTE Review & Study Guide Correct Answer: 2 rationale: Ageing is marked with cognitive decline, reduction in joint motion with reduction in acuity for auditory, vestibular, visual and somatosensory system results in increase in prevalence of gait disorders among older adults such as ( the stance and gait base is widened, the swing phase will be limited or reduced ) Because of the need for more stability due to weakness in muscles. Question 8 What motion takes place in the lumbar spine with right lower extremity single limb support during the gait cycle? 1- Left lateral flexion 2- Right lateral flexion 3- Extension 4- Flexion Correct Answer: 2 rationale: Activation of both erector spinae ( be- fore heel contact to about 20% and from 45% to 70% of the gait cycle ) and rec- tus abdominis ( between 20% and 40% and again at between 70% and 90% of the gait cycle ) and both muscles share function of ipsilateral lateral flexion as shown in fig below : Question 9 While examining a patient’s gait, the physical therapist observes muscle weakness in right side hip abductors and also shows lateral deviation of trunk as compensatory reaction. What is the compensatory gait the patient used? 1- Vaulting 2- Crouched 3- Scissoring 4- Trendelenburg Correct Answer: 4 rationale: Trendelenburg gait as we described above in Q2 60 Muscloskeletal Systems - Biomechanics Chapter 1 Question 10 A physical therapist is ordered to provide gait training for an 18-year-old girl who received a partial medial meniscectomy of the right knee one day earlier. The patient was independent in ambulation without an assistive device before surgery and has no cognitive deficits. The patient’s weight bearing status is currently partial weight bearing on the involved lower ex- tremity. Which of the following is the most appropriate assistive device and gait pattern? 1- Crutches, three-point gait pattern. 2- Standard walker, three-point gait pattern. 3- Standard walker, four-point gait pattern. 4- Crutches, swing-to gait pattern. Correct Answer: 1 rationale: Partial meniscectomy patients usually need to use two crutches for only a few days. You should remember to put the involved foot flat on the ground, even when lightly weight bearing. Increase the weight on the foot as tolerated. You can advance to one crutch for the next few days and then a cane if needed. Most patients can be full weight bearing by the end of the first week. Note that two crutches with uninvolved limb considered 3 point gait. Question 11 A physical therapist is evaluating a patient with muscular dystrophy. The patient seems to “waddle” when she walks. She rolls the right hip forward when advancing the right lower ex- tremity and the left hip forward wheadvancing the left lower extremity. Which of the following gait patterns is the patient demonstrating? 1- Gluteus maximus gait 2- Dystrophic gait 3- Arthrogenic gait 4- Antalgic gait Correct Answer: 2 rationale: Waddling Gait occurs when there is extreme muscular weakness in the thigh and hip muscles as commonly found in pseudohypertrophic muscular paralysis and muscular atrophy or dystrophy. In this gait, the shoulders are thrown back, the lower section of the spine is lordotic, the pelvis is tilted greatly, and when walking, the subject swings from side and his hip drops with each step. Question 12 A physical therapist is treating a 24-year-old woman with lumbar muscle spasm. Part of the patient’s treatment involves receiving instruction on correct sleeping positions. Which of the following would be most comfortable? 1- Supine with no pillows under the head or extremities. 2- Prone with a pillow under the head only. 3- Sidelying with a pillow between flexed knees. 61  PPTE Review & Study Guide Correct Answer: 3 rationale: Lower back pain makes it hard to get comfortable enough to fall asleep or may provoke night- time awakenings when pain surges. The best sleeping position for lower back pain ( lumbar muscle spasm) is on your side with partial bending in knees , Keeping the knees bent helps balance the body and reduces pressure on the lumbar spine. and it sometimes helpful to put a small pillow between knees to make this position more comfortable. Question 13 While gait training a patient following a cerebral vascular accident, you observe the knee on the affected side going into recurvatum during stance phase. The most likely cause of this deviation can be attributed to: 1- Severe spasticity of the hamstrings or weakness of the gastrocnemius- soleus. 2- weakness or severe spasticity of the quadriceps. 3- Weakness of the gastrocnemius-soleus or spasticity of the pretibial muscles. 4- Weakness of both the gastrocnemius-soleus and pretibial muscles. Correct Answer: 2 rationale: Genu recurvatum (GR), a gait pattern commonly seen in hemiplegic patients, is defined as full extension or hyperextension of the knee in the stance phase , Knee hyperextension can be caused by several causes. These include muscle weakness, especially of the muscles in the top of the thigh (quadriceps). Question 14 Max Knee flexion occur in any phase from this: 1- mid stance 2- toe off 3- mid swing 4- heel strike Correct Answer: 3 rationale: Maximum knee flexion of approximately 60 degrees is assumed by the beginning of mid swing (75% of the gait cycle). NOTE 5° flexion -> initial contact 20° flexion -> 15% of gait knee approches near full extension -> (30% to 40%) of gait cycle 35° flexion -> toe off ( 60% of gait ) max flexion ( 60° ) -> mid swing ( 75% of gait ) 62 Muscloskeletal Systems - Biomechanics Chapter 1 Question 15 A 43-year-old woman with walking dysfunction and inability to clear her foot from the ground during swing phase. The physical therapist assessed her gait and found the following in mid-swing: 25-degree hip flexion, 25-degree knee flexion, and 25-degree ankle planterflexion. Where is the expected dysfunctional site that needs intervention? 1- Hip 2- Knee 3- Ankle 4- Spine and pelvic Correct Answer: 3 rationale: 25 hip flexion -> normal in mid swing ( Maximum flexion to 30 degrees is reached by con- tinued iliacus action ) 25 knee flexion -> normal in end of mid swing ( Relaxation of the flexor muscles allows the knee to extend passively and By the end of mid swing, knee flexion (30 degrees) equals that of the hip, and the tibia is vertical ) 25 ankle plantarflexion -> abnormal in mid swing ( During the swing phase the ankle is again dorsi- flexed to a neutral position to allow the toes to clear the ground ). Question 16 C.O.G during locomotion observation can change the gait due to: 1- c.o.g go upward and oblique to stance phase. 2- downward during double limb support. 3- side to side oscillation. 4- move forward and backward. Correct Answer: 4 rationale: the most notable displacement of the body during gait is in the forward direction. Superimposed on this forward displacement, however, are two sinusoidal patterns of movement that correspond to the movement of the CoM in the vertical ( upward during stance and downward during double limb support) and side-to-side directions. 63  PPTE Review & Study Guide Question 17 During evaluation of a patient, the therapist observes significant posterior trunk lean at initial contact (heel strike). Which of the following is the most likely muscle that the therapist needs to focus on during the exercise session in order to minimize this gait deviation? 1- Gluteus medius 2- Gluteus Maximus 3- Quadriceps 4- Hamstrings Correct Answer: 2 rationale: Posterior trunk lean is done to compensate for inef- fective (weak) hip extensors. The line of the ground reaction force early in the stance phase normally passes in front of the hip joint. This produces an external moment which attempts to flex the trunk forward on the thigh and is opposed by contraction of the hip extensors, particularly the gluteus maxi- mus. Should these muscles be weak or paralysed, the subject may compensate by moving the trunk backwards at this time, bringing the line of action of the external force behind the axis of the hip joint Question 18 A 53-year-old patient complains of difficulty in walking. Manual muscle testing reveals weak (grade 3) abductors of the left hip joint. Which of the following findings will be observed during the stance phase of the affected leg when the patient is asked to walk? 1- Lifting of the pelvis on the left side. 2- Lifting of the pelvis on the right side. 3- Dropping of the pelvis on the left side. 4- Dropping of the pelvis on the right side. Correct Answer: 4 rationale: The gluteus medius and minimus, the two primary hip abductors, are most active during the first 40% of the gait cycle, especially during single-limb support. The primary function of the abduc- tors is to control the slight lowering of the contralateral pelvis on the side of the swing limb. 64 Muscloskeletal Systems - Biomechanics Chapter 1 Question Question19 9 Patient uses crutches and move the crutches forward and move his body to the crutches the gait is: OR patient move crutches first then move legs to them: 1- swing through 2- swing to c- 2 gait point. Correct Answer: 2 rationale: the swing to gait is where the patient will move both crutches forward then they will hint swing or move both legs forward and place them at the placement of where the crutches are located. Question 20 Which is not correct about hip during gait? 1- max hip flexion occur in terminal swing. 2- Slight hip extension before ic. 3- Hip extension occur during double limb support. Correct Answer: 1 rationale: Maximum flexion (slightly more than 30 de- grees) is achieved by mid swing and main- tained in terminal swing just before heel con- tact. Note that at heel contact the hip has already started to extend in preparation for weight acceptance. Question 21 When evaluating knee in gait cycle it maximum flexion is during? 1- initial contact 2- feet flat 3- mid swing 4- terminal swing Correct Answer: 3 rationale: Maximum knee flexion of approximately 60 de- grees is assumed by the beginning of mid swing (75% of the gait cycle). 65  PPTE Review & Study Guide Question 22 what is not a part of stance phase? 1-deceleration 2-midstance 3-intial contact 4-preswing Correct Answer: 1 rationale: subdivision of stance phase -> “ 1) Initial Con- tact – 2) Loading Response – 3) Midstance – 4) Terminal Stance – 5) Pre swing “ Question 23 which statement correct during training with cane up and down stairs 1- unaffected leg put first during upstairs. 2- unaffected leg put down during up stairs. 3- affected leg put first in down stairs. Correct Answer: 1 rationale: in ascending stairs , Going up the stairs lead with your uninvolved leg and followed by involved leg and in descending stairs , Going down the stairs lead with your involved leg and followed by uninvolved leg. For example, if right lower extremity affected , during ascending Patient leads with left leg on step and Right leg and cane follows and during descending patient Lead with cane and right leg on step below and Left leg follows. Question 24 Patient walk using crutches , patient first make two elbow crutches move forward then , make two lower limbs advance? 1- swing two 2- swing through 3- 2 point gate 4- 4 point gate Correct Answer: 2 rationale: the swing through gait is where th patient will move both crutches forward then the will move both legs forward and they will swing it pass the crutches placement. 66  Muscloskeletal Systems - Biomechanics Chapter 1 Question 25 Which of the following is the most appropriate position of the ankle during the first phase of the gait cycle? 1- Neutral position 2- 5-degree dorsiflexion 3- 5-degree plantarflexion 4-10-degree plantarflexion Correct Answer: 3 rationale: At the ankle, heel contact ( first phase of gait ) occurs with the talocrural joint in a slightly plan- tar flexed position (between 0 and 5 degrees) Question 26 All of the following in the gait cycle except: 1- Swing phase 2- Mid swing 3- Initial contact 4- Heal flat Correct Answer: 4 rationale: Phases of the Gait Cycle -> “ 1) Initial Contact – 2) Loading Response – 3) Midstance – 4) Terminal Stance – 5) Pre swing – 6) Initial Swing – 7) Mid Swing – 8) Late Swing “ Question 27 In the terminal swing phase of gait, what muscles of the foot and ankle are active? 1- Extensor digitorum longus 2- Gastrocnemius 3- Tibialis posterior 4- B and C Correct Answer: 1 rationale: During the swing phase the ankle is again dorsiflexed to a neutral position to allow the toes to clear the ground Answer (a) -> ankle dorsiflexor Answer (b and c) -> ankle plantar flexors 67  PPTE Review & Study Guide Question 28 Which of the following types of gait training are most likely described as both crutches moved forward together, both lower limbs then move towards the crutches? 1- 2-point 2- 4-point 3- Swing to 4- Swing through Correct Answer: 3 rationale: the swing to gait is where the patient will move both crutches forward then they will hint swing or move both legs forward and place them at the placement of where the crutches are located. Question 29 Evaluating the gait of a patient with left hemiplegia, you note toe drag during mid swing on the left. The least likely cause of this deviation would be: 1- inadequate concentric activity of the ankle dorsiflexors. 2- excessive extensor synergy. 3- knee and ankle joint pain. 4- decreased proprioception. Correct Answer: 3 rationale: Hemiplegic gait, This gait pattern is described as unilateral weakness on the affected side with weakness in flexion (excessive extensor synergy) and dorsiflexion (inadequate concentric ac- tivity of ankle dorsiflexors). This causes the person to swing the paraplegic leg outwards and in a circular motion in order to bring the leg forward. Question 30 Which muscle bilateral weakness patient use bilateral crutches 1- Gluteus medius 2- Gluteus maximus 3- Quadriceps 4- Hamstrings Correct Answer: 2 rationale: The Gluteus Maximus (GM) muscle is the largest and most powerful in the human body. It plays an important role in optimal functioning of the human movement system as well as athletic performance , It is an important muscle for activities of daily living and allow us to be able to maintain an upright erect posture. so bilateral weakness of gluteus maximus will need bilateral crutches because it will affect greatly the normal mechanics of gait cycle. 68 Muscloskeletal Systems - Biomechanics Chapter 1 Question 31 If there is weakness of right gluteus medius dropping pelvis of occurs at 1- right pelvic drop at stance phase. 2- left pelvic drop at stance phase. 3- right pelvic drop at swing phase. 4- left pelvic drop at swing phase. Correct Answer: 4 rationale: The gluteus medius and minimus, the two primary hip abductors, are most active during the first 40% of the gait cycle, especially during single-limb support. The primary function of the abduc- tors is to control the slight lowering of the contralateral pelvis on the side of the swing limb. Question 32 Quadriceps function in swing phase: 1- accelerated knee flexion. 2- prevent excessive knee flexion. Correct Answer: 2 rationale: the quadriceps is active in the very late stage of the swing phase in preparation for heel contact. The major burst of activity, however, occurs shortly after heel contact. The function of the quad- riceps at this time is to control the knee flexion that takes place in the first 10% of the gait cycle. Eccentric activation serves to cushion the rate of weight acceptance on the lower extremity (i.e., shock absorption) and to prevent excessive knee flexion. Question 33 When comparing the gait cycle of young adults to the gait cycle of older adults, what would a therapist expect to find? 1- The younger population has a shorter step length. 2- The younger population has a shorter stride length. 3-The younger population has a shorter period of double support. 4- The younger population has a decrease in speed of ambulation. Correct Answer: 3 rationale: Ageing is marked with cognitive decline, reduction in joint motion with reduction in acuity for auditory, vestibular, visual and somatosensory system results in increase in prevalence of gait disorders among older adults such as ( the stance and gait base is widened, bipedal floor con- tact is prolonged “ increase time spent in double stance phase “ , step length becomes shorter, the feet are lifted less high during the swing phase, walking becomes slower “ decrease the speed of ambulation “ and the posture becomes stooped. 69  PPTE Review & Study Guide Question 34 A physical therapist begins gait training for a patient with bilateral knee flexion contractures at 30o at a long-term care facility. The therapist knows that the patient will have a forward trunk lean during gait because: 1- The patient’s line of gravity is anterior to the hip. 2- The patient’s line of gravity is anterior to the knee. 3- The patient’s line of gravity is anterior to the ankle. 4- A and C. Correct Answer: 2 rationale: Anterior trunk lean is done to compensate for an inadequacy of the knee extensors , the line of action of the ground reaction force vector nor- mally passes behind the axis of the knee joint and generates an external moment which at- tempts to flex it. anterior trunk bending is used to move the centre of gravity of the body for- wards, which results in the line of force passing in front of the axis of the knee, producing an ex- ternal extension (or hyperextension) moment. Question 35 Which of these joints is classified as a biaxial diarthrosis? 1- the metacarpophalangeal joint 2- the elbow joint 3- the hip joint 4- the pubic symphysis Correct Answer: 1 rationale: A freely mobile joint is classified as a diarthrosis. These types of joints include all synovial joints of the body, which provide the majority of body movements. These joints are divided into three categories, based on the number of axes of motion provided by each (uniaxial – biaxial – mul- tiaxial) A biaxial joint allows for motions within two planes. An example of a biaxial joint is a metacar- pophalangeal joint (knuckle joint) of the hand. The joint allows for movement along one axis to produce bending or straightening of the finger, and movement along a second axis, which allows for spreading of the fingers away from each other and bringing them together. 70 Muscloskeletal Systems - Biomechanics Chapter 1 Question 36 At what point in the gait cycle is the center of gravity the lowest? 1- Double support. 2- Terminal swing. 3- Deceleration. 4- Midstance. Correct Answer: 1 rationale: In the vertical direction, the CoM oscillates up and down to describe two full sine waves per gait cycle , Minimum height of the CoM occurs at the midpoint of both periods of double-limb support (5% and 55% of the gait cycle). Question 37 patient during walking raise his hip to clear toes from ground due to: 1- paralysis of dorsiflexors 2- paralysis of planter flexors 3- paralysis of quadriceps Correct Answer: 1 rationale: A person with foot drop is unable to raise their foot at the ankle , the muscles affected are the dorsi flexors ( paralysis of ankle dorsi flexors ). a person suffering from foot drop may have to excessively lift their hip to compensate for the inability to clear the foot and toes from ground. Question 38 An outpatient physical therapist is gait training a patient recently discharged from the hos- pital. The inpatient therapist’s notes describe a decrease in left stride length due to pain with weight bearing on the right lower extremity. The outpatient therapist knows that the patient’s gait deviation is: 1- An abnormally short distance from the left heel strike and the successive right heel strike. 2- An abnormally short amount of time between the left heel strike and the successive right heel strike. 3- An abnormally short amount of time in stance phase on the left lower extremity. 4- An abnormally short distance between the left heel strike and the successive left heel strike. Correct Answer: 4 rationale: A stride (synonymous with a gait cycle) is the sequence of events taking place between succes- sive heel contacts of the same foot. 71  PPTE Review & Study Guide Question 39 use of can in contralateral hand will: 1- not affected gait pattern. 2- reduce energy expenditure in normal person. 3- decrease the floor reaction force on the opposite foot. 4- not affected floor reaction force on the opposite foot. Correct Answer: 3 rationale: A cane held in the contralateral hand reduces joint reactive forces through the affected hip up to 50% by reducing abductor muscle pull with significant reduction in peak vertical ground reaction force on the symptomatic limb ( opposite foot ). Question 40 As a result of a gait analysis, a therapist has determined that the patient ambulates with ex- cessive foot pronation. This deviation would not occur as a result of: 1- compensated forefoot varus 2- internal tibial rotation 3- a weak tibialis posterior 4- excessive ankle dorsiflexion Correct Answer: 4 rationale: commonly accepted compensation for a mild lack of ankle dorsiflexion is increased foot prona- tion. With or without toeing-out, excessive foot pronation can lead to greater stresses applied to the supporting soft-tissue structures of the plantar aspect of the foot. Question 41 joint play R O M which occurs not named with: 1- necessary to completion of joints ROM 2- Passively occur 3- under voluntary control Correct Answer: 3 rationale: By nature, joint play which is essential for the proper functioning of normal, painless active and passive range of movements is an involuntary movement that is inherent to the musculoskeletal system and cannot be introduced by voluntary muscles. It provides roll, glide, distraction, and spin combinations for joint motion and occurs in the shape of the joint surfaces. Question 42 Normal ROM of hip joint: 1- extension 35 --- flexion 125 2- extension 10 ---- flexion 125 3- extension 0 -----flexion 125 72 Muscloskeletal Systems - Biomechanics Chapter 1 Correct Answer: 2 rationale: 1-Hip flexion range of motion (ROM) for adults is 120 degrees according to the American Acad- emy of Orthopedic Surgeons (AAOS). The hip flexion with the knee flexed will permit a range of motion of approximately 115° to 125°. 2- Beyond the midline the normal extension of the hip is of 10° to 15° Question 43 When the knee is at its maximal amount of flexion during the gait cycle, which of the follow- ing muscles are active concentrically? 1- Hamstrings 2- Gluteus maximus 3- Gastrocnemius 4- All of the above. Correct Answer: 1 rationale: Maximum knee flexion mean that knee flexors are the concentric group of muscles and knee extensors are the eccentric group of muscles and main knee flexors are hamstrings. Question 44 Patient complaining of knee pain, the therapist decides to test the available movement in the joint, what is this type of joint play called? 1- Manipulation 2- Mobilization 3- Arthrokinematics test 4- Osteokinematics fest Correct Answer: 3 rationale: arthrokinematics is the general term for the specific movements of joint surfaces. Normal joint surface movement is necessary to ensure long-term joint integrity and joint surface movement are sometimes called joint play motion or component motions. Question 45 The number of joint and bones in the foot 1- 23 joint and 25 bones 2- 33 joint and 26 bones 3- 23 joints and 17 bones Correct Answer: 2 rationale: The foot is a complex mechanical structure of the human body composed of 33 joints, 26 bones, and more than a hundred muscles, tendons, and ligaments that all work together to bear weight, allow for locomotion, and transmit force. 73  PPTE Review & Study Guide Question 46 Knee joint ROM: 1- flexion 110 – extension 0 2- flexion 130 – extension 0 3- flexion 140 – extension 0 Correct Answer: 3 rationale: The knee is a hinge joint and primarily only moves in one plane of movement, flexion and ex- tension. A straight leg is at 0 degrees. A flexed knee is at about 140 degrees. It is a common misconception that 0-140 degrees is a normal range of motion, but most people have some hyperextension, too, taking their ROM into negative numbers. normal ROM is usually minus 5 to 143 degrees in women normal ROM is usually minus 6 to 140 degrees in men. Question 47 elbow joint: 1- uniaxial 2-biaxial 3- three axial d-multi-axial Correct Answer: 1 rationale: uniaxial joint only allows for a motion in a single plane (around a single axis). The elbow joint, which only allows for bending or straightening, is an example of a uniaxial joint. Question 48 which is synovial joint: 1- TMJ joint 2- Symphysis pubis Correct Answer: 1 rationale: 1-TMJ joints is a synovial joint is formed by the articulation of the mandible and the temporal bone of the cranium. the articular surfaces of the bones never come into contact with each other – they are separated by an articular disk. This disk splits the joint into two synovial joint cavities, each lined by a synovial membrane. The articular surface of the bones are covered by fibrocar- tilage, not hyaline cartilage. 2- symphysis pubis isn`t synovial joint it is a secondary cartilaginous joint. 74 Muscloskeletal Systems - Biomechanics Chapter 1 Question 49 all of the following are synovial joints except: 1- Elbow joint 2- Knee joint 3- Hip joint 4-Symphysis pubis Correct Answer: 4 rationale: The pubic symphysis is a secondary cartilaginous joint (a joint made of hyaline cartilage and fibrocartilage) located between the left and right pubic bones near the midline of the body. Question 50 Spyndolythesis: 1- vertbera above vertebra dislocat posterior. 2- vertbera below vertebra dislocat posterior. 3- vertbera above vertebra dislocat anterior. 4- vertbera belowe vertebra dislocat anterior. Correct Answer: 3 rationale: Spondylolisthesis is where one of the bones in your spine, called a vertebra, slips forward (an- terior). It can be painful, but there are treatments that can help. It may happen anywhere along the spine but is most common in the lower back. Question 51 Brodie abscess in osteomyelitis what stage? 1- Acute 2- Subacute 3- Chronic Correct Answer: 2 rationale: Brodie abscess is referred to as the most common subacute form of osteomyelitis. Question 52 Osteomyelitis abscess spread: 1- Acute stage 2- Sub-acute stage 3- Chronic stage Correct Answer: 2 rationale: Brodies abscess is a suppurative collection of necrosis that is encapsulated by granulation tis- sue in the setting of subacute osteomyelitis. 75  PPTE Review & Study Guide Question 53 The joint between adjacent vertebrae that includes an in vertebral disc is classified as which type of joint? 1- multiaxial 2- synarthrosis 3- amphiarthrosis 4- diarthrosis Correct Answer: 3 rationale: An amphiarthrosis is a joint that has limited mobility. An example of this type of joint is the carti- laginous joint that unites the bodies of adjacent vertebrae. Filling the gap between the vertebrae is a thick pad of fibrocartilage called an intervertebral disc. Each intervertebral disc strongly unites the vertebrae but still allows for a limited amount of movement between them. However, the small movements available between adjacent vertebrae can sum together along the length of the vertebral column to provide for large ranges of body movements. Question 54 Which of these joints is classified as a synarthrosis? 1- the epiphyseal plate 2- the shoulder joint 3 the pubic symphysis 4- an in vertebral disc Correct Answer: 1 rationale: primary cartilaginous joints, also known as synchondroses, only involve hyaline cartilage. These joints may be slightly mobile (amphiarthroses) or immobile (synarthrosis). A temporary form of synarthrosis joint called an epiphyseal (growth) plate, is one where the cartilage is converted into bone before adult life. Such joints are found between the epiphyses and diaphysis of long bones, between the occipital and the sphenoid bones, and during the early years of life, be- tween the petrous portion of the temporal and the jugular process of the occipital bone. The epiphyseal plate is a hyaline cartilage plate in the metaphysis at each end of a long bone. Question 55 Synovial joints ________. 1- are joints where the bones articulate with each other within a fluid filled joint cavity 2- may be functionally classified as amphiarthroses. 3- may be functionally classified as synarthroses. 4- are joints where the bones are anchored to each other by fibrocartilage. Correct Answer: 1 rationale: Answers b, c and d describe cartilaginous joint. 76 Muscloskeletal Systems - Biomechanics Chapter 1 Question 56 Which of the following is not an example of a synarthrodial joint in the body? 1- Coronal suture 2- The fibrous joint between the shaft of the tibia and fibula. 3- Symphysis pubis 4- Metacarpophalangeal Correct Answer: 4 rationale: 1-Metacarpophalangeal joint is a condyloid joint is classified as a biaxial diarthrosis. 2- Synarthrodial joint is a fibrous joint which mean A union of two bones by fibrous tissue such that there is no joint cavity and almost no motion possible; the types of fibrous joints are sutures, syndesmoses, and gomphoses. Synonym(s): immovable joint. Question 57 Myositis ossificans most affected: 1- wrist Joint 2- Elbow Joint 3- Shoulder Joint 4- Knee Joint Correct Answer: 2 rationale: The most common sites affected are the hip, anterior thigh (quadriceps) and anterior arm (bra- chialis). Hip and elbow the common site but if the question mentions the hip chose the hip is the most common. Question 58 Treatment of myositis ossificans? 1- Active and active assisted movement 2- massage 3- strengthening ex 4- stretching ex Correct Answer: 1 rationale: Rehabilitation of patients with myositis should include restoration of ROM, strength and proprioception by Active and active assisted movement. Heat, continuous ultrasound, massage, stretching, and strengthening exercise should be avoided initially to pre- vent further bleeding in the area that may promote the progression to MO. Protective padding should be worn to prevent further injury to the area. 77  PPTE Review & Study Guide )VIP( Question 59 Sudeck’s atrophy which is not true: 1- sever burning pain 2- sympathetic hyperactivity 3- trophic changes occur 4- more perspiration Correct Answer: 2 rationale: Complex regional pain syndrome (CRPS), also known as Sudeck atrophy, is a condition that can affect the extremities in a wide clinical spectrum. (CRPS) is a broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg. CRPS has acute (recent, short-term) and chronic (lasting greater than six months) forms. CRPS used to be known as reflex sympathetic dystrophy (RSD) and causalgia. People with CRPS have changing combinations of spontaneous pain or excess pain that is much greater than normal following something as mild as a touch. Other symptoms include changes in skin color, temperature, and/ or swelling on the arm or leg below the site of injury. Although CRPS improves over time, even- tually going away in most people, the rare severe or prolonged cases are profoundly disabling. Most CRPS illnesses are caused by improper function of the peripheral C-fiber nerve fibers that carry pain messages to the brain. Their excess firing also triggers inflammation designed to promote healing and rest after injury. Question 60 Osteomyelitis is: 1- infective inflammation of the bone due infective bacteria entered into bone. 2- Decreased bone density and increased porosity. 3- due to repetitive trauma. 4- Vitamin D deficiency. Correct Answer: 1 rationale: Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs. most cases of osteomyelitis are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals. Question 61 A 27-year-old man presents to the Physical Therapy Department with pain, redness and fever on the leg. He has been diagnosed with osteomyelitis (see report). X-ray: Brodies abscess. Which is the following is the most likely form of osteomyelitis? 1- Acute 2- Chronic 3- Subacute 4- Tubercular 78 Muscloskeletal Systems - Biomechanics Chapter 1 Correct Answer: 3 rationale: Brodies abscess is a suppurative collection of necrosis that is encapsulated by granulation tis- sue in the setting of subacute osteomyelitis. Question 62 An 11-year-old patient with post-fracture stiffness of the elbow has been referred to a therapist for mobilizing exercise. Which of the following risks make the physi- cian strongly recommends against forced passive movements? 1- Ulnar nerve injury 2- Myositis ossificans 3- Brachial artery injury 4- Refracturing the bone Correct Answer: 2 rationale: In treatment of MO Contusions and strains are vulnerable to additional trauma during the first couple of weeks.so physician Avoid forced passive movements, heavy activity, massage, and forceful stretching. Question 63 32 - year - old patient requires a physical therapy assessment to start the postoperative re- habilitation program. A surgeon performs partial osteotomy of the right shaft of the femur to correct its alignment. Which of the following describes the procedure of osteotomy? 1- Internal fixation of a bone. 2- removal of the periosteum. 3- Operative sectioning of a bone. 4- Surgical closure of an epiphysis. Correct Answer: 3 rationale: An osteotomy is a surgical procedure that involves cutting bone (and sometimes adding bone tissue) to reshape or realign your bones. Femoral osteotomy This surgery involves cutting and aligning your upper thigh bone (femur) to help restore hip function. Question 64 most common site of estrogenic sarcoma is: 1- Femur, upper end 2- Femur, lower end 3- Tibia, upper end 4- Tibia, lower end 79  PPTE Review & Study Guide Correct Answer: 2 rationale: Osteosarcoma is a bone tumor and can occur in any bone, usually in the extremities of long bones near metaphyseal growth plates. The most common site is Femur (42%, 75% of which are in the distal femur (lower end). Question 65 Infection of microorganism lead to: 1- osteomyelitis 2- Rocket 3- Equinovarus Correct Answer: 1 rationale: Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs. Most cases of osteomyelitis are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals. Question 66 Which of the following scientific terms is most likely used to describe an involuntary move- ment response to the stimulus that serves to maintain normal alignment of the head and body in space? 1- Balance 2- Motor program 3- Postural control 4- Righting reaction Correct Answer: 3 rationale: Postural control is the ability to maintain our body in space achieving both goals of stability and orientation. Question 67 All of the following is clinical features in fracture neck of femur except 1- pain in hip region 2- abduction of leg 3- shortness of the limb 4- lateral rotation of the leg Correct Answer: 2 rationale: the clinical feature of Neck femur fracture is adduction with lateral rotation in the leg. 80 Muscloskeletal Systems - Biomechanics Chapter 1 Question 68 A 27-year-old man presents to the Physical Therapy Department with pain and swelling (see report). X-ray: Burst fracture. Which of the following is the most likely affected area? 1- Talus 2- Scaphoid 3- Vertebral 4- Femoral head Correct Answer: 3 rationale: Burst fractures are a type of compression fracture related to high-energy axial loading spinal trauma that results in disruption of a vertebral body endplate and the posterior vertebral body cortex. Question 69 The angle between Neck of femur and Shaft of femur : 1- 90 Degree 2- 120 Degree 3-150 Degree 4-170 Degree Correct Answer: 2 rationale: The femoral neck-shaft angle (NSA) or caput-collum-diaphyseal (CCD) angle is one of the most frequently applied measurements to assess hip morphology, in particular, the relation of the femoral shaft to the femoral head-neck axis. A known normal range of the caput-collum-diaph- yseal (CCD) angle is generally considered 125°-135° 3, with a global mean of 126.4° and stan- dard deviations are approximately 5.6° measured with a 360° goniometer in anatomical studies.Widely considered cut-off values are the following : coxa Valga: >140 coxa Vara: