A patient has a left thoracolumbar scoliosis. Pelvic landmarks are symmetrical.
Which of the following muscles will MOST likely be tight?
1. Right hip abductors
2. Left latissimus dorsi
3. Right quadratus lumborum
4. Left iliocostalis lumborum - ANSWER 3. Right quadratus lumborum
Rationale:
1. The right hip abductors will be normal length since the pelvis is level.
2. The left latissimus dorsi will be normal or lengthened dependent on the severity
of the curve.
3. With a left thoracolumbar scoliosis, the C curve is concave on the right, resulting
in shortened trunk musculature on the right, i.e., quadratus lumborum.
4. The left iliocostalis lumborum will be of normal length or lengthened,
depending on the severity of the curve.
Which of the following is the MOST appropriate technique to improve the
flexibility of the hip flexors?
1. Active hip extension to end range, followed by isometric hip flexion
2. Resisted hip extension using cuff weights, followed by active hip flexion
3. Placing the patient in prone with pillows positioned under the abdomen
4. Gentle, sustained passive hip extension - ANSWER 4. Gentle, sustained passive
hip extension
Rationale:
1. This exercise requires the addition of active relaxation of the hip flexors and
active or passive movement into hip extension to be effective (pp. 103-104).
2. This exercise is a strengthening exercise for the hip extensors; active movement
of tight muscles does not activate a relaxation response; an isometric contraction
,is required (p. 757).
3. Tight muscles need to be taken to their most lengthened position before
maintaining the position; lying prone on pillows is not the most lengthened
position of the hip flexors (p. 118).
4. Gentle, sustained passive hip extension is an appropriate method of stretching
tight tissues (p. 98).
A physical therapist uses underwater ultrasound as part of the intervention to
treat a patient with an ankle injury. The MOST appropriate mode of application is
to immerse the patient's ankle in a:
1. whirlpool filled with degassed water and hold the transducer underwater
directly on the skin.
2. metal basin filled with mineral oil and hold the transducer underwater
approximately 1 in (2.54 cm) away from the body surface.
3. ceramic basin filled with glycerin and move transducer underwater directly on
the skin.
4. plastic basin filled with tap water and move the transducer approximately 0.25
in (0.64 cm) away from the body surface. - ANSWER 4. plastic basin filled with tap
water and move the transducer approximately 0.25 in (0.64 cm) away from the
body surface.
Rationale:
1. While degassed water is an acceptable coupling medium, the whirlpool surface
will reflect the ultrasound waves thereby increasing the intensity of treatment and
risk of overheating the injured tissue.
2. A metal basin which will reflect the ultrasound waves along with mineral oil as
an immersion medium will both increase the intensity of the treatment and risk
overheating the injured tissue.
3. While a ceramic basin is acceptable, glycerin as a coupling medium will more
likely produce surface overheating of the injured tissue than tap water. It is also
not recommended to place the transducer directly onto the skin during
ultrasound treatment.
4. This option has the correct basin (with reduced reflection), coupling medium,
and application (parallel to and the correct distance from the body surface).
,Which of the following activities should be the PRIMARY emphasis of a physical
therapy treatment program for a child who has athetoid cerebral palsy?
1. Facilitating co-contraction patterns and encouraging control in voluntary
movement gradation
2. Increasing muscle strength using progressive resistive exercises
3. Facilitating use of primitive reflexes to perform gross motor tasks
4. Preventing development of contractures and ensuring full voluntary range of
motion - ANSWER 1. Facilitating co-contraction patterns and encouraging
control in voluntary movement gradation
Rationale:
1. Athetoid cerebral palsy is characterized by involuntary movements that are slow
and writhing. In therapy, the emphasis should be on facilitating cocontraction and
encouraging control in voluntary movement.
2. Although strength training is indicated in children with cerebral palsy, a child
with athetoid cerebral palsy lacks the control to consistently produce a maximal
effort in a controlled movement. Therefore, the focus must first be on gaining
control, then on traditional strength training.
3. A goal of therapy would not be to reinforce primitive reflexes. The primary need
for this child is to gain controlled movement.
4. Children with athetoid cerebral palsy are less likely to have contractures,
compared with children with other forms of cerebral palsy, because of the
constant movement of limbs. This would not be the primary emphasis of therapy.
A patient is referred to physical therapy with a history of ulnar nerve entrapment
at the level of the hamate. Which of the following would be the MOST specific
exercise to improve this patient's strength deficits?
1. Practice pinching between thumb (1st digit) and the tip of the index finger (2nd
digit).
2. Squeeze hand grip with elastic-band resistance.
3. Oppose thumb (1st digit) to the metacarpal phalangeal joint of each finger (2nd
through 5th digits).
4. Squeeze therapy putty between the sides of the fingers. - ANSWER 4. Squeeze
, therapy putty between the sides of the fingers.
Rationale:
1. The muscles that are active during this movement are supplied by the median
nerve, and impingement occurs in the carpal tunnel, not at the hamate (pp. 386,
405).
2. Doing this exercise would not isolate muscles supplied by the ulnar nerve, as
only the 4th and 5th digits would be involved. This exercise would be appropriate
if the ulnar nerve was entrapped at the level of the cubital tunnel and not in the
tunnel of Guyon (at the level of the hamate) (pp. 386-387).
3. This exercise would strengthen muscles supplied by the median nerve at the
wrist. Deficits here would be loss of thumb (1st digit) abduction and opposition (p.
386).
4. This movement isolates the lumbricals and interossei, which are innervated by
the ulnar nerve and are affected when entrapment occurs at the tunnel of Guyon
(at the level of the hamate) (pp. 386-387, 409).
A physical therapist is evaluating a 55-year-old male patient with low back pain.
The therapist asks the patient if he has noticed any changes in bowel or bladder
function. The patient reports he is having difficulty initiating urination. This
symptom is MOST often a result of which of the following conditions?
1. Bladder cancer
2. Stress incontinence
3. Prostate enlargement
4. Renal failure - ANSWER 3. Prostate enlargement
Rationale:
1. Difficulty initiating a urine stream is not consistent with bladder cancer (p. 982).
2. Stress incontinence is characterized by loss of urine with coughing or sneezing
(pp. 985-986).
3. The most common presentation for enlargement of the prostate is difficulty
initiating the urine stream (pp. 998-999).
4. Difficulty initiating a urine stream is not consistent with renal failure (pp.
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