Test Bank for Fundamental Orthopedic Management for the Physical Therapist Assistant 4th Edition by

Fundamental Orthopedic Management for the Physical Therapist Assistant 4th Edition Manske Test Bank Chapter 01: Patient Supervision and Observation During Treatment MULTIPLE CHOICE 1. Who is responsible for carrying out prescribed selected interventions, patient supervision, data

collection, and appropriate supervision of a patient during physical therapy?

Physical therapist (PT) Physical therapist assistant (PTA) Nursing assistant Medical doctor

a. b. c. d.

ANS: B

The PTA is responsible for carrying out prescribed selected interventions, patient supervision, data collection skills, and appropriate problem-solving and clinical decision making.

REF: P. 3 2. Which of the following is NOT a purpose of the clinical patient supervision process? a. To gather relevant information and data b. To establish and enhance rapport, trust, and confidence c. To prescribe interventions the patient requires d. To assist in the management of the patient ANS: C

PTAs do not prescribe interventions for the patient. The PTA observes, documents, and discusses patient observations with the PT. REF: P. 4 3. Select the open-ended question. a. What is your pain level today on a scale of 1-10? b. When did the pain begin? c. Tell me about the time that you injured knee. d. When did you take your last pain medication?

ANS: C

The open-ended question leads the patient to say more than yes or no. Open-ended questions provide much richer details about the incident or experience.

REF: P. 6 4. Which of the following statements is true regarding the working environment of PTAs? a. PTAs work in isolation with their patient assignments. b. PTAs work with a team of experts in all areas of a patient’s care. c. PTAs work only with the PT in providing therapy. d. PTAs are the most important people on the rehabilitation team when providing

therapy.

ANS: B

The PTA must be aware of the key members of the rehabilitation team. Occupational therapists, PTs, nurses, respiratory therapists, psychologists, and audiologists are only a few of the important members of the rehabilitation team. The PTA does not work in isolation.

REF: P. 4 5. Which of the following statements would be used in a discussion with a patient? a. Your blood pressure is 150/90, which indicates hypertension and could lead to a

cerebral vascular accident if you don’t take your medications. b. Your blood pressure is higher than normal today, 150/90. Did you take your blood

pressure medication this morning? c. The doctor prescribed a beta-blocker for you a month ago. Has that been helping

your blood pressure? d. The combination of your calcium-channel blocker and beta-blocker do not seem to

be controlling your blood pressure. Let’s call the doctor.

ANS: B

The PTA should learn to communicate openly, freely, and in a professional manner. The PTA must employ appropriate and professional medical terminology with professional people—but use familiar (lay) terms to describe the same condition to a patient or a family member.

Avoiding the use of medical jargon (hypertension, beta-blocker, calcium-channel blocker) with patients is required by PTAs. REF: P. 4 6. How can a PTA demonstrate accountability in their practice? a. Maintain timely documentation about patient interventions. b. Maintain good rapport with patients. c. Continue their education past their initial degree. d. Report all findings to the supervising PT so that modifications can be made in

response to changes in patient status.

ANS: D

PTAs are responsible for reporting all findings to the supervising PT so that modifications can be made in accordance with changes in patient status.

REF: P. 6 7. Which type of questioning would you use to find facts or obtain specific responses from a

patient about an injury to a limb or joint?

Open-ended questions Closed-ended questions A pause Neutral phrase

a. b. c. d.

ANS: B

Figure 1-1. Closed-ended questions are used to find out specific details, direct the discussion, or elicit specific responses from the patient.

REF: P. 8 8. Which of the following is an example of prompting during a physical therapy session?

a. b. c. d.

“When you walk up the steps, which foot will you move first?”

“All right, now pick up your right foot and put it on the next step.”

Point to the step and touch the patient’s right leg.

Observe the behavior of the patient to see if they will lift up the correct foot while walking up the steps.

ANS: A

Prompting a patient to perform a task can be viewed as the presentation of a question.

Prompting allows patients to decipher information, solve problems, and provide solutions to activities they must overcome during recovery. Cues are directions.

REF: P. 9 9. Who holds the ultimate responsibility for the patient’s physical therapy? a. PTA b. Medical doctor c. Nurse d. PT ANS: D

To minimize the confusing array of treatment protocols, the PTA must effectively and efficiently communicate with the supervising PT to clarify differences in patient care, always remembering that the PT has the ultimate responsibility for the interventions provided.

REF: P. 10 10. Which of the following actions should you take if you have a disagreement with the PT? a. Refuse to provide the treatment or intervention on the PT’s plan of care. b. Change the treatment for the day and then report to the PT what was done at the

end of the day. c. Follow the plan of care no matter what changes are observed in the patient and

document later. d. Discuss your findings and rationale with the PT to learn and provide better care.

ANS: D

A full understanding of the rationale and purpose of PT interventions allows for improved delivery of care and safe and effective care. PTAs cannot change the plan of care by themselves.

REF: P. 10 11. What type of behavior is the PTA using in the following example?

The PTA quickly agrees to the patient’s request to slow down and stop the treatment for the day instead of discussing the purpose and benefits of the treatment. a. Dominance b. Submission c. Hostility d. Warmth ANS: B

Figure 1-2. Submission is defined as being passive. People who show submissive behavior are willing to take a back seat and are quick to comply and reluctant to try to exert influence.

REF: P. 8 12. What type of behavior is the PTA using in the following example?

The PT insists the patient continue treatment for the full time limit even when the tearful patient reports a fear of continuing exercise of a particular joint. a. Dominance b. Submission c. Hostility d. Warmth ANS: C

A dominant PTA would try to sway the patient to think or behave in a certain way. In this example, the PTA ignores the patient’s complaints and feelings and continues with the treatment.

REF: P. 8 13. In the basic dimensional model, which behaviors would be seen in a warm but submissive

person? a. Stubborn, argumentative b. Sincere, open, candid, responsive c. Talks little, doesn’t listen well d. Appeases; compromise leads to lack of focus ANS: D

Figure 1-3, B. The submissive-warm person demonstrates a lack of organization, appeasing behavior, and compromises.

REF: P. 8 14. In the basic dimensional model, which behaviors would be seen in a dominant-hostile person? a. Stubborn and argumentative b. Sincere, open, candid, responsive c. Talks little and doesn’t listen well d. Appeases; compromise leads to lack of focus ANS: A

Figure 1-3, B. The dominant-hostile person would be stubborn and argumentative, taking fixed positions and sticking to them, talking a lot rather than listening, and being pushy and arrogant.

REF: P. 8 15. In the basic dimensional model, which behaviors would be seen in a dominant-warm person? a. Stubborn and argumentative b. Sincere, open, candid, responsive c. Talks little and doesn’t listen well d. Appeases; compromise leads to lack of focus

ANS: B

Figure 1-3, B. The dominant-warm person is sincere, open, and candid; listens; is openminded and flexible.

REF: P. 8 16. In the basic dimensional model, which behaviors would be seen in a submissive-hostile

person?

Talks a lot rather than listens and is belligerent.

Sincere, open, candid, responsive Talks little and doesn’t listen well and avoids issues Appeases; compromise leads to lack of focus

a. b. c. d.

ANS: C

Figure 1-3, B. The submissive-hostile person talks little, doesn’t listen well, avoids or ignores issues, is uninvolved, quiet, and backs down easily.

REF: P. 8 17. When can a PTA adjust or modify a program of treatment? a. When the PTA observes certain signs and symptoms in the patient. b. After seeking input and direction from the supervising PT. c. The PTA cannot ever change the plan of care. d. None of the above.

ANS: B

The PTA, with direction and input from the supervising PT, can adjust or modify the program of treatment.

REF: P. 9 18. The PTA’s clinical decision-making process should begin with a. taking orderly and specific steps to notify the supervising PT. b. recognizing that a problem exists. c. adjusting the program according to the patient’s needs. d. asking the PT to assess the patient.

ANS: B

The clinical decision-making process used by the PTA involves recognizing that a problem exists, then taking orderly and specific steps to notify the supervising PT and adjusting the program accordingly.

REF: P. 9 19. Which of the following behaviors exemplifies a well-adapted PTA? a. Constantly asks about the rationale for treatment b. Establishes themselves as an eager learner c. Is open to innovative ways of managing various pathologic conditions d. All of the above ANS: D

The well-adapted PTA views any apparent roadblocks as learning opportunities. The PTA is advised to take advantage of the broad knowledge and experience of many PTs, constantly inquire about the rationale and scientific basis for a particular program, and establish him- or herself as an eager learning participant who is open to innovative ways of managing various pathologic conditions.

REF: P. 10 20. Why do PTAs and PTs use general scales of measurement? a. To standardize assessment and more accurately measure patient progress b. To shorten the amount of time needed to document the patient’s condition c. To demonstrate knowledge of medical terminology d. None of the above ANS: A

General scales are used to standardize assessment and more accurately measure patient progress.

REF: P. 4

Chapter 02: The Role of the Physical Therapist Assistant in Physical Assessment MULTIPLE CHOICE 1. Which health care provider is defined as “a technically educated health care provider who

assists the physical therapist in the provision of select PT interventions?” a. Physical therapist assistant (PTA) b. Physical therapist (PT) c. Nursing assistant d. Medical doctor ANS: A

This is the definition of the PTA as defined by the Guide to Physical Therapy Practice (2nd Ed.).

REF: P. 14 2. Which of the following is the responsibility of the PT alone? a. Observation b. Assessment c. Examination d. Evaluation ANS: D

Evaluation is the specific process reserved solely for the PT, in which clinical judgments are made from this base of data obtained during the examination.

REF: P. 14 3. Which of the following statements is NOT included in the Clinical Performance Instrument

(CPI) by the American Physical Therapy Association (APTA) related to the PTA’s role? a. Participates in patient status judgments within the clinical environment based on

the plan of care established by the PT. b. Obtains accurate information by performing selected data collection consistent

with the plan of care established by the PT. c. Discusses the need for modifications to the plan of care established by the PT. d. Makes clinical judgments based on the assessment and examination of the patient.

ANS: D

It is the role of the PT to make clinical judgments based on the assessment and examination of the patient.

REF: P. 14 4. In the Normative Model of PTA Education (2007), which of the following is NOT an expected

performance theme?

Interventions Communication Diagnosis Resource management

a. b. c. d.

ANS: C

Diagnosis is not one of the five PT performance expectation themes for PTA education. The five include interventions, communication, education, resource management, and career development.

REF: P. 15 5. Which of the following contains the cardinal signs of inflammation? a. Swelling, pallor, cool skin temperature b. Swelling, pain, redness, heat c. Fever, pain, redness, and warmth d. Pain, fever, cool skin temperature ANS: B

The commonly accepted and normal cardinal signs and symptoms of inflammation are localized heat, redness, swelling, and pain (with a resultant loss of function in the injured area).

REF: P. 15 6. How long does acute inflammation last, assuming the precipitating condition, agent, or event

is removed?

12-24 hours 1-2 days 3-5 days 4-6 days

a. b. c. d.

ANS: D

Under normal circumstances, signs of acute inflammation persist for 4-6 days, assuming the precipitating condition, agent, or event is removed.

REF: P. 16 7. When is pain from acute inflammation felt by the patient during range of motion (ROM)

exercises? a. Before tissue resistance (before “end” ROM) b. At the same time end ROM is reached c. After ROM exercises are over d. Never felt by the patient during ROM ANS: A

Pain before tissue resistance felt before “end” ROM is an indication of acute inflammation.

Pain at the same time end ROM is reached is an indication of a subacute inflammatory state.

Pain reported as a stretching sensation at the limit of ROM is a sign of inflammation in the chronic state.

REF: P. 16 8. Which of the following reports of pain is indicative of chronic inflammation? a. Pain reported before tissue resistance (before “end” ROM) b. Pain reported as a stretching sensation at the limit of ROM c. Pain reported at the same time ROM is reached

d. Pain is not seen with chronic inflammation ANS: B

Pain before tissue resistance felt before “end” ROM is an indication of acute inflammation.

Pain at the same time end ROM is reached is an indication of a subacute inflammatory state.

Pain reported as a “stretching sensation” at the limit of ROM is a sign of inflammation in the chronic state.

REF: P. 16 9. Your patient has an oral temperature of 101.6°F. Which other signs and symptoms will you

look for in your patient assessment?

General malaise and increased pulse Strong appetite and dry skin Decreased pulse and respirations Paleness in the affected joint

a. b. c. d.

ANS: A

The clinical signs and symptoms of fever vary based on the underlying cause and stage; they might include general malaise, headache, increased pulse and respirations, general chills, shivering, piloerection, loss of appetite, pale skin, nausea, irritability, and restlessness.

REF: P. 16 10. Which is the most effective means of controlling the transmission of infectious agents? a. Isolating infected patients b. Hand washing by the caregiver and patient c. Disinfecting treatment areas routinely d. B and C ANS: D

The importance of hand washing by the caregiver and patient cannot be overstated as an effective means of controlling the transmission of infectious agents. In addition, treatment areas should be properly cleaned and disinfected as a routine procedure.

REF: P. 16 11. Which of the following actions would be considered discretionary caution by the PTA when

performing pool ROM exercises with a patient experiencing a fever of 102.8°F? Notify the PT and ask to omit the exercises until the fever resolves.

Continue with the prescribed walking activities.

Omit therapy during times the patient has a fever.

Increase the walking exercises to help break or resolve the fever.

a. b. c. d.

ANS: A

Discretionary caution is applied with any patient with a fever, because of stresses on the cardiopulmonary and immune systems and the possible further complications related to dehydration. The PTA should be familiar with specific exercise techniques contraindicated in the presence of diseases transmitted via water or air.

REF: P. 17

12. Which type of redness indicates acute inflammation caused by a bacterial infection? a. Superficial tenderness or hardness of the area b. Red streaks c. Flushed cheeks d. None of the above ANS: B

Red streaks might indicate an acute inflammation caused by a bacterial infection (strep, staph, or both). Superficial tenderness or hardness in an area may be a sign of superficial thrombophlebitis.

REF: P. 18 13. What technique would you use to assess deep vein thrombosis (DVT)? a. Patient sits in a comfortable position and lifts knee to chest. b. Patient points toes toward the floor and reports any pain in the thigh area. c. Patient points toes upward (dorsiflex) for assessment of pain in the calf. d. Patient holds foot in neutral position and you squeeze the calf.

ANS: C

A commonly used quick assessment technique to rule out the presence of a DVT is the Homan sign. It is performed by gentle passive stretching of the ankle into full dorsiflexion and assessing for pain in the calf.

REF: P. 18 14. What are the risk factors for DVT? a. Prolonged bed rest or prolonged air travel b. Varicose veins, fractures, and age under 60 c. Oral contraceptive use and high cholesterol level d. Obesity and falling ANS: A

Box 2-1. Risk factors for DVT. Prolonged bed rest and air travel are risk factors. Items listed that are not risk factors are age under 60, high cholesterol level, and falling.

REF: P. 18 15. Which term is defined as the excessive pooling of fluid in the spaces between tissues

(interstitial spaces)?

Fracture Infection Edema Hemorrhage

a. b. c. d.

ANS: C

Edema refers to excessive pooling of fluid in the spaces between tissues (interstitial spaces).

The main consideration for the PTA is measurement of the edematous part or extremity.

REF: P. 19 16. Which signs and symptoms would be seen with congestive heart failure (CHF)?

a. b. c. d.

Swelling in one ankle without a change in breathing or muscle strength Swelling in both ankles with fatigue and shortness of breath No swelling in either ankle, but fatigue and normal respirations Weakness without a change in respirations

ANS: B

Bilateral pitting edema in the distal lower extremities is a common manifestation in CHF. Other signs include a decrease in tolerance to exercise (fatigue, shortness of breath, and muscle weakness). These symptoms need prompt consultation with the supervising PT. REF: P. 19 17. Which of the following is the PTA’s best response to a patient reporting new pain since the

last therapy session? a. “Well, some pain is to be expected after our therapy sessions” b. “Really? I didn’t think the last session was that difficult for you” c. “That pain is normal and should be expected. Take your pain medication before

and after our therapy sessions and you should feel better” d. “Tell me about the pain, is it sharp or burning? When do you have the pain?”

ANS: D

The PTA’s role in assessing pain is to gather data that present a clear picture of any change in pain since the last visit, and to elicit responses of the patient in terms of how interventions to date have affected pain, patterns of pain, and the characteristics of pain. All pain is considered “real” by the PTA and should be investigated and reported to the PT. REF: P. 23 18. Which of the following are the signs and symptoms of a heart attack? a. Pain or pressure under the breastbone, neck or jaw with pain in the left arm and

shoulder b. Indigestion and pain in the lower abdomen after exercise c. Pain between the shoulder blades and the inside of the left or right arms d. A and C ANS: D

Figure 2-6. Early warning signs of a heart attack. Indigestion and pain in the lower abdomen are not warning signs of a heart attack.

REF: P. 24 19. What should a PTA do when a patient experiences “red flag” pain symptoms during therapy? a. Call the doctor immediately and report the pain b. Continue the therapy session using caution c. Stop any intervention that could be contraindicated and report the findings to the

PT d. Ask the patient when he had his last pain medication and contact the nurse to

deliver a pain medication ANS: C

The PTA must be keenly aware of pain that sends a “red flag” signal. The PTA should not proceed with any interventions or data collection techniques that are potentially contraindicated and should immediately report the findings to the supervising PT. REF: P. 23 20. Which symptoms are exhibited during intermittent claudication? a. Bilateral pain in the calves or thighs described as cramping that goes away with

rest b. Unilateral pain in one calf described as cramping that goes away after walking c. Bilateral pain in calves or thighs that goes away with walking d. Unilateral pain in buttocks or thighs that worsens when the patient rests ANS: A

It is typically described as aching or cramping that is localized in the region affected by the impaired circulation (calves, thighs, buttocks bilaterally) and is rapidly improved after the aggravating activity is discontinued (such as after resting).

REF: P. 23

Chapter 03: Differential Diagnosis and Emergent Conditions MULTIPLE CHOICE 1. The process of providing a label that correlates specific signs and symptoms to an identifiable

disease or disorder is: a. evaluation. b. diagnosis. c. consideration. d. prognosis.

ANS: B

Multiple sources have used this definition of diagnosis.

REF: P. 38 2. The process of comparing and contrasting patient data points with the goal of appropriate

exclusion and inclusion that terminate with the development of intervention strategies is: examination. prognosis. intervention. differential diagnosis.

a. b. c. d.

ANS: D

Examination is the use of tests and measures to screen the patient. Prognosis is the prediction of outcomes. Intervention is the action taken by the physical therapist (PT) or physical therapist assistant (PTA) to resolve the patient’s problem. Differential diagnosis is the process of using patient data to develop intervention strategies.

REF: P. 39 3. What is the term for a comprehensive screening of the patient that includes specific tests and

measures?

Examination Prognosis Intervention Differential diagnosis

a. b. c. d.

ANS: A

Examination is the use of tests and measures to screen the patient. Prognosis is the prediction of outcomes. Intervention is the action taken by the PT or PTA to resolve the patient’s problem. Differential diagnosis is the process of using patient data to develop intervention strategies.

REF: P. 39 4. What is the term for a prediction of the outcome of the physical therapy episode of care with

the establishment of a plan of care (POC)? a. Examination b. Prognosis

c. Intervention d. Differential diagnosis ANS: B

Examination is the use of tests and measures to screen the patient. Prognosis is the prediction of outcomes. Intervention is the action taken by the PT or PTA to resolve the patient’s problem. Differential diagnosis is the process of using patient data to develop intervention strategies.

REF: P. 41 5. Which of the following is not a minimum skill for a PTA? a. Collect data on patient’s current condition and compare results to previously

collected data b. Communicate to the PT when there are significant changes in patient status c. Develop the POC d. Use clinical problem solving skills to determine if the patient is safe and

comfortable with the intervention ANS: C

The PT is responsible for the development of the POC. The PTA is expected to have all of the other skills listed (see Table 3-1).

REF: P. 42 6. The PTA is expected to have which of the following basic assessment skills? a. Assessment of range of motion b. Ability to do manual muscle testing c. Proficiency in anthropometric measurement d. All of the above ANS: D

The PTA is expected to be competent in all of the above skills.

REF: P. 43 7. Which type of diagnosis emphasizes the influence of a disease or disorder on the patient’s

functional status at the system level and on the interrelationship between the system and the patient as a whole? a. Physical therapy diagnosis b. Medical diagnosis c. Nursing diagnosis d. Functional diagnosis ANS: A

A medical diagnosis labels a disease or disorder on a cellular, tissue, or organ level. A physical therapy diagnosis emphasizes the impact of the disorder on the patient’s functional status.

REF: P. 41 8. Which of the following is not true about vital signs? a. They provide an objective overview of the patient’s cardiopulmonary function

b. They may be influenced by exercise, disease, stress, and age c. Baseline vital signs data should be obtained prior to initiation of a POC d. During an episode of care, vital signs are no longer measured or useful ANS: D

Vital signs should be measured periodically during care. Altered vital signs may indicate an adverse response to care and must be evaluated.

REF: P. 48 9. What percentage of patients undergoing orthopedic surgery develops an infection? a. 1% b. 2-5% c. 10% d. 12-15% ANS: B

Two to five percent of patients undergoing orthopedic surgery develop an infection.

REF: P. 48 10. The signs and symptoms of redness, edema, pain, and increased skin temperature may

indicate: inflammation or infection. infection only. inflammation only. a prognosis.

a. b. c. d.

ANS: A

Both inflammation and infection may be indicated by redness, edema, pain, and increased skin temperature. The health care team needs to evaluate these signs and symptoms to determine if infection is present.

REF: P. 48 11. An abnormal response to musculoskeletal trauma that involves the excessive collection of red

and white blood cells and fibrin resulting in a partial or complete occlusion of a vessel is: inflammation. tumor. venous thrombosis. tachycardia.

a. b. c. d.

ANS: C

Venous thrombosis is caused when an excessive collection of white and red blood cells and fibrin occlude a blood vessel. If a deep vessel is involved, the thrombosis is referred to as a deep vein thrombosis (DVT).

REF: P. 48 12. DVT usually occurs in which location? a. Upper extremities b. Lower extremities

c. Head and neck region d. Lungs ANS: B

Approximately 90% of DVTs occur in the lower extremities.

REF: P. 48 13. What is a chronic swelling of an area that leads to the involvement of an entire extremity? a. Thrombosis b. Myocardial infarction c. Orthostatic hypertension d. Lymphedema ANS: D

A chronic swelling of an area that leads to the involvement of the entire extremity is a lymphedema. A common type of lymphedema is secondary lymphedema, which is a direct result of obstruction or damage to the lymphatic system.

REF: P. 51 14. A fall in blood pressure associated with position changes from lying to sitting or sitting to

standing is: syncope. orthostatic hypotension. orthostatic hypertension. lymphedema.

a. b. c. d.

ANS: B

Orthostatic hypotension is defined as a fall in systolic blood pressure of 20 mm Hg or more and a 10 mm Hg decrease in diastolic blood pressure when the patient moves from a lying position to a sitting or standing position or from sitting to standing.

REF: P. 51 15. What is a dysfunction that is a result of a reduction in the quality or quantity of erythrocytes

and results in oxygen deficiency?

Anemia Syncope Pulmonary embolism Hypertension

a. b. c. d.

ANS: A

Anemia is a dysfunction that is a direct result of a reduction in the quality or quantity of erythrocytes. The resultant oxygen deficiency can lead to multi-tissue and organ disturbances that further impair the individuals healing capacity and overall functional capabilities.

REF: P. 52 16. A common problem, especially among elderly patients, to the pulmonary system that is an

inflammation of lung tissue that creates excessive fluids resulting in difficulty breathing is: a. pulmonary embolism.

b. lymphedema. c. pneumonia. d. lung cancer.

ANS: C

The elderly are particularly susceptible to pulmonary dysfunction or disease, such as pneumonia. Pneumonia is an inflammation of lung tissue that results in excessive fluid accumulation. This then creates breathing difficulties.

REF: P. 52 17. Which of the following statements is not true about asthma? a. Asthma primarily inflames the bronchial blood vessels b. Asthma is associated with response to allergens, infectious agents, or pollution c. Asthma may be triggered by exercise d. Asthma may cause a “panting” breathing pattern with a nonproductive, hacking

cough ANS: A

Asthma affects the bronchial airways, not the bronchial blood vessels. All of the other statements are true about asthma.

REF: P. 52 18. When evaluating a patient with low-back pain, who also has experienced unexplained recent

weight loss, night pain, and inability to obtain a comfortable position, the health care team should investigate for: a. spinal muscle spasm. b. spinal tumor or cancer. c. pulmonary embolism. d. osteomyelitis.

ANS: B

Recent weight loss, night pain, and inability to obtain a comfortable position are possible indications of tumor or cancer. None of the other answers are associated with these three signs or symptoms.

REF: P. 53 19. Spinal compression fractures are not associated with which of the following? a. Trauma b. Osteoporosis c. Steroid use d. Infection ANS: D

Spinal fractures are usually caused by trauma. Both osteoporosis and steroid use can weaken bone and inert tissue that may contribute to spinal fracture. Infection is not normally associated with spinal fracture.

REF: P. 53

20. Obesity, eating red meat, cigarette smoking, and alcohol consumption are risk factors for: a. pulmonary embolism. b. colon cancer. c. spinal fracture. d. asthma.

ANS: B

Risk factors for colon cancer include obesity, eating red mean, cigarette smoking, and alcohol consumption.

REF: P. 54

Chapter 04: Muscle Flexibility and Range of Motion MULTIPLE CHOICE 1. Which of the following is NOT a benefit to having a more flexible body? a. Injury prevention and quicker recoveries after workouts b. Faulty postural alignment that leads to injuries c. Reduced postexercise soreness d. Facilitation of relaxation ANS: B

Muscle imbalance leads to faulty postural alignment, which affects flexibility.

REF: P. 65 2. Which type of collagen is most abundant in the body, is a thick fiber, and has little elongation

when placed under tension?

Type I Type II Type III Tropocollagen

a. b. c. d.

ANS: A

Type I collagen is made of short fibrils (bundles) found in all different types of connective tissues. The majority of the collagen in the body is type I. REF: P. 66 3. Which type of collagen would you expect to find in the arteries, liver, and lungs? a. Type I b. Type II c. Type III d. None of the above ANS: C

Type III collagen serves mainly in a structural support capacity and is found in expansible organs (e.g., arteries, liver, lungs). It also helps out in the early stages of wound repair.

REF: P. 66 4. Which term is defined in force/area (pounds per square inch) and is directly related to the

magnitude of force?

Stress (load) Strain Deformation Viscoelasticity

a. b. c. d.

ANS: A

Stress or load is defined as force/area (i.e., pounds per square inch). It is directly related to the magnitude of force and inversely related to the unit area, but it is independent of the amount of a material. Deformation is a complementary measure related to stress and is also called strain.

REF: P. 66 5. Which of the following terms is defined as a gradual increase in tissue length that occurs when

maintaining a constant stress (force)?

Stress (load) Creep Deformation Viscoelasticity

a. b. c. d.

ANS: B

Creep phenomenon means the gradual increase in tissue length that occurs when maintaining a constant stress or force. The deformation of the tissue will continue until a state of equilibrium is reached when the load is balanced. The longer the duration of the applied force, the greater the deformation or stretching.

REF: P. 68 6. What is increased in ligaments and tendons that experience increasing levels of stress? a. Collagen b. Creep c. Strain d. None of the above ANS: A

The ability of tissues to recover after stress is extremely important in relation to flexibility.

Increasing the levels of stress produces an increase in collagen within ligaments and tendons.

REF: P. 69 7. What effect does heat have on the viscoelastic properties of connective tissue? a. No effect b. Greater elongation with stress before tissue failure c. More microscopic damage under stress d. Thermal damage to the connective tissues below 45°C ANS: B

Viscoelastic and plastic changes occur at higher temperatures with less microscopic damage under stress. A temperature of 45°C is needed to reduce tissue damage during strains.

REF: P. 69 8. What happens to flexibility over time in a damaged or unused muscle? a. The muscle shortens and loses its ability to stretch b. The muscle is unchanged c. The muscle remains flexible but weaker d. The range of motion (ROM) of the joint that the muscle serves remains normal

ANS: A

Flexibility refers to the degree of normal ROM available. If a muscle becomes damaged by trauma or disease or becomes shortened because of immobility, its ability to stretch and allow freedom of joint motion is affected. Flexibility will diminish over time if tissues are not stretched or exercised using regular and proper stretching regimens.

REF: P. 69 9. What is the name of the instrument that looks like a protractor with degree measurements and

is used to measure ROM for almost all joints in the body?

Scale Flexibility test Goniometer ROM meter

a. b. c. d.

ANS: C

Measuring joint ROM is accomplished by using standard goniometric instruments. The measuring device most commonly used is a goniometer, which looks like a protractor with degree measurements.

REF: P. 70 10. What are the benefits of a warm-up before strenuous activities? a. Blood flow to working muscles is increased b. Temperature in working muscles is increased c. Cardiovascular response to sudden; dynamic exercise is improved d. All of the above ANS: D

Warm-up is necessary to help prepare the tissue for activity. Stretching alone is not enough.

All of the listed items are benefits of a warm-up before strenuous activities.

REF: P. 73 11. Which term is defined as a common form of stretching that allows one to sustain a controlled

stretch by placing a muscle in a fully elongated position and holding that position for a period of time? a. Static stretching b. Ballistic stretching c. Dynamic stretching d. Proprioceptive neuromuscular facilitation (PNF) ANS: A

Static stretching is the most common form and allows one to sustain a controlled stretch by placing a muscle in a fully elongated position and holding that position for a period of time (Fig. 4-11).

REF: P. 74 12. Which term is defined as using a muscle contraction to stretch a muscle to increase or

decrease the joint angle thereby elongating the musculotendinous unit at the end of ROM exercise?

a. b. c. d.

Static stretching Ballistic stretching Dynamic stretching PNF

ANS: C

Dynamic stretching is defined as using a muscle contraction to stretch it to increase or decrease the joint angle thereby elongating the musculotendinous unit at the end of ROM exercise.

REF: P. 75 13. Which stretching technique is completed by performing the following steps?

The patient is instructed to relax the affected muscle as the therapist passively moves the limb to the limit of motion.

Then the patient actively contracts the restricted muscle against manual resistance for 5-8 seconds.

Then the patient relaxes while the therapist passively moves the limb to the new limits of motion and holds the stretch for 10 seconds. a. Static stretching b. Ballistic stretching c. Dynamic stretching d. PNF ANS: D

PNF has several techniques. The one described in this question is the contract-relax with agonist contraction technique (Fig. 4-18).

REF: P. 77 14. What is the generally recommended length of time (in seconds) that a static stretch should be

held?

0-10 15-30 60-120 120-240

a. b. c. d.

ANS: B

Generally, most research recommends stretches be held between 15 and 30 seconds. Current American College of Sports Medicine guidelines recommend 2-5 repetitions for each stretching exercise.

REF: P. 78 15. How many weeks of stretching are needed to demonstrate significant increases in muscular

flexibility? a. 0-2 b. 2-3 c. 4-5 d. 6 ANS: D

Approximately 6 weeks of stretching are necessary to demonstrate significant increases in muscular flexibility. A person must stretch at least three times per week to improve flexibility and at least 1 day per week to maintain the flexibility gained during the program.

REF: P. 78 16. Based on the research evidence presented in the text about when to perform stretching

exercises, which of the following best describes the state of research?

It is best to stretch before exercise It is best to stretch during exercise It is best to stretch after exercise The research supports stretching before, during, and after exercise

a. b. c. d.

ANS: D

The evidence presented in the text section “When to Stretch” supports all three times for stretching—before, during, and after exercise.

REF: P. 81 17. How long does it take for an immature adaptable scar to mature and reach its maximum

strength?

5 days 40 days 60 days 12 months

a. b. c. d.

ANS: D

At 12 months, a new scar is approximately 100% of its maximum strength.

REF: P. 82 18. Which stretching exercises are effective in stretching joint contractures in combination with

thermal agents such as moist heat?

Static stretching Ballistic stretching Low-load, long-duration stretching PNF

a. b. c. d.

ANS: C

Low-load, long-duration (20-60 minutes) stretching of joint contractures in combination with thermal agents to preheat extensible connective tissue has proved effective in the treatment of soft tissue contracture.

REF: P. 83 19. Which of the following terms is defined as a process that alters the structure of connective

tissue in response to stress? a. Stretching b. Deformation c. Viscoelasticity d. Remodeling

ANS: D

Remodeling is defined as a process that alters the structure of connective tissue in response to stress.

REF: P. 81 20. Which term is defined as a limitation of function that results from the formation of scar

tissue?

Adhesion Contracture Strain Sprain

a. b. c. d.

ANS: A

An adhesion is a limitation of function that results from the formation of scar tissue. A contracture is a permanent or transient limitation of movement or shortening of muscle or other soft tissue.

REF: P. 81

Chapter 05: Muscle Strength MULTIPLE CHOICE 1. A muscle’s strength or tension generating capacity is determined by a number of diverse but

interrelated factors. Select the best explanation of how muscle length affects strength. a. The rate at which the motor neurons fire affects strength b. Muscle produces the greatest strength when it is at or near the physiologic resting position at the time of contraction c. The type of fibers (type I, type IIA, and type IIB) in the muscle determines strength d. How the muscle fibers are aligned in relation to an imaginary line between the muscle’s origin and insertion affects strength ANS: B

The best description of how muscle length affects strength is the length tension ratio; muscle produces the greatest strength when it is at or near the physiologic resting position at the time of contraction.

REF: P. 92 2. What is the noncontractile connective tissue that surrounds the muscle? a. Epimysium b. Fasciculi c. Perimysium d. Endomysium ANS: A

The body of an individual muscle is surrounded by noncontractile connective tissue called the epimysium.

REF: P. 92 3. Actin and myosin are the two predominant proteins in which part of the muscle? a. Perimysium b. Fasciculi c. Myofilaments d. Epimysium ANS: C

The structural components of the myofibrils are called myofilaments and they comprise two predominant proteins, actin and myosin. Myosin is a thick protein and actin is a thin protein.

Both are actively involved with the mechanics of muscle contraction.

REF: P. 92 4. What are the primary differences between the slow twitch (ST) muscle fibers and the fast

twitch (FT) muscle fibers? a. ST fibers are designed for endurance; FT fibers are designed for speed, strength,

and power

b. ST fibers are small and have few mitochondria; FT fibers are vascular and contract

at lower speeds c. ST fibers allow for anaerobic work; FT fibers allow for aerobic work d. ST fibers have high levels of myosin adenosine triphosphatase (ATPase); FT fibers

have low levels of myosin ATPase ANS: A

ST fibers possess large and numerous mitochondria, allow for aerobic work, and have low levels of myosin ATPase. ST fibers are fatigue resistant and contract slowly. FT fibers are anaerobic and not as vascular as ST fibers. FT fibers contract at a higher speed and are used in activities that require speed, strength, and power.

REF: P. 93 5. Which type of muscle contraction is sometimes called the lengthening contraction? a. Concentric b. Eccentric c. Isometric d. Isotonic ANS: B

Eccentric muscle contraction is sometimes referred to as a lengthening contraction. Tension is produced, lengthening occurs, and the net action is the opposite of a concentric contraction.

The origin and insertion of the contracting muscle moves farther apart during the contraction.

(Example: moving from a standing to a sitting position in a chair by descending slowly.) The quadriceps muscles must eccentrically contract to control the descent, or a fall would result.

REF: P. 94 6. Which type of muscle contraction occurs by shortening the muscle in order to overcome an

external force such as a weight?

Isotonic Eccentric Isometric Concentric

a. b. c. d.

ANS: D

In a concentric contraction, tension is produced and shortening of the muscle takes place to overcome an external force such as a weight.

REF: P. 94 7. Which term describes the produced tension in a muscle with no joint movement or action

taking place?

Isometric Isotonic Isokinetic Eccentric

a. b. c. d.

ANS: A

In an isometric contraction, tension is produced but no joint movement or action takes place (Fig. 5-4, C). In isotonic contractions, the resistance, force, load, or tension created in a muscle changes as the joint angle changes. For isokinetic contractions, the speed or velocity of the movement is held constant regardless of the magnitude of force applied to the resistance.

REF: P. 94 8. Which term is defined as a contraction when the resistance, force, load, or tension created in a

muscle changes as the joint angle changes and is illustrated by lifting free weights?

Isometric Isotonic Isokinetic Eccentric

a. b. c. d.

ANS: B

In an isotonic muscle contraction, the resistance, force, load, or tension created in a muscle changes as the joint angle changes and is illustrated by lifting free weights.

REF: P. 95 9. How does the American Physical Therapy Association (APTA) define muscle strength? a. The muscle force exerted by a muscle or group of muscles to overcome resistance

under a specific set of circumstances b. The capacity of a muscle or group of muscles to generate force c. The work produced per unit of time d. The ability to sustain force repeatedly or to generate force over a period of time ANS: A

The muscle force exerted by a muscle or group of muscles to overcome resistance under a specific set of circumstances is the APTA definition for muscle strength. All other options are APTA definitions for other terms.

REF: P. 95 10. How does the APTA define muscle power? a. The muscle force exerted by a muscle or group of muscles to overcome resistance

under a specific set of circumstances b. The capacity of a muscle or group of muscles to generate force c. The work produced per unit of time d. The ability to sustain force repeatedly or to generate force over a period of time ANS: C

The work produced per unit of time or the product of strength and speed is the definition of muscle power.

REF: P. 96 11. How does the APTA define muscle endurance? a. The muscle force exerted by a muscle or group of muscles to overcome resistance

under a specific set of circumstances b. The capacity of a muscle or group of muscles to generate force c. The work produced per unit of time

d. The ability to sustain force repeatedly or to generate force over a period of time ANS: D

The definition for muscle endurance is the ability to sustain force repeatedly or to generate force over a period of time.

REF: P. 96 12. Which of the following equations represents the definition of work? a. Force  distance b. Force  velocity c. Force  perpendicular distance from the axis of rotation d. Mass  acceleration ANS: A

Work is used to describe the result or product of a force exerted on an object and the distance the object moves. Work = force  distance.

REF: P. 96 13. Which of the following equations represents the definition of force? a. Force  distance/time b. Force  velocity c. Force  perpendicular distance from the axis of rotation d. Mass  acceleration ANS: D

Force can be described as either linear or rotary. Force = mass  acceleration.

REF: P. 96 14. Using the manual muscle testing grading scale, how would you record the muscle strength of

a patient who was unable to provide resistance against gravity?

5/5 4/5 3/5 2/5

a. b. c. d.

ANS: C

A person unable to provide resistance against gravity would be rated 3/5 (Table 5-1). Normal strength with full resistance against gravity is rated 5/5.

REF: P. 96 15. Which of the following methods for testing strength requires exercise equipment or barbells

and dumbbells?

Cable tensiometry Dynamometry Isotonic one-repetition maximum lift Isokinetics

a. b. c. d.

ANS: C

Isotonic one-repetition maximum lift is used to test strength using commercially available exercise equipment or barbells and dumbbells. The patient performs a single, full range of motion (ROM) lift such as a bench press for a particular muscle group.

REF: P. 97 16. Select the most widely used and clinically relevant method of objective, reproducible strength

testing.

Cable tensiometry Dynamometry Isotonic one-repetition maximum lift Isokinetics

a. b. c. d.

ANS: D

The most widely used and clinically relevant method of objective, reproducible strength testing is through isokinetics. Isokinetic testing documents strength, torque, power, and work.

REF: P. 97 17. Which test would a physical therapy assistant use to measure functional ability by having the

patient hop on a trampoline a maximum number of times in a 30-second period?

One-leg hop Single-leg triple hop Timed single-leg hop Vertical jump

a. b. c. d.

ANS: C

In the timed single-leg hop (on a minitrampoline) the patient hops a maximum number of times in a 30-second period.

REF: P. 98 18. In the Davies Model of Exercise Progression (1985), which exercises come first? a. Full ROM eccentric isokinetics (maximum effort) b. Isometric/eccentric contractions, multiple angles c. Full ROM concentric isokinetics (submaximum effort) d. Full ROM eccentric isokinetics (submaximum effort) ANS: B

Isometric exercises come first in the progression (Box 5-1). Full ROM exercises are all later in the progression.

REF: P. 99 19. Select the guiding principle of exercise prescription that is demonstrated by applying a load to

a muscle that exceeds the metabolic capacity of the muscle.

Specificity Specific adaptations to imposed demands (SAID) Overload Reversibility

a. b. c. d.

ANS: C

The overload principle is the guiding principle of exercise prescription. If muscle performance is to improve, a load that exceeds the metabolic capacity of the muscle must be applied. A muscle must be challenged to perform at a level greater than that to which it is accustomed.

REF: P. 100 20. Select the term that is defined by training a patient in a specific manner in order to produce a

specific adaptation or training outcome.

Specificity SAID principle Overload Reversibility

a. b. c. d.

ANS: A

Specificity is the training of a patient in a specific manner in order to produce a specific adaptation or training outcome.

REF: P. 100

Chapter 06: Endurance MULTIPLE CHOICE 1. Which body systems are involved in endurance training? a. Endocrine b. Cardiovascular c. Muscular d. B and C ANS: D

Endurance training (exercise) involves the muscular and cardiovascular systems.

REF: P. 116 2. What are the benefits of participating in an aerobic fitness program? a. Reduced risk of developing a chronic disease b. Reduced obesity and diabetes c. Decreased severity of symptoms associated with some diseases d. All of the above ANS: D

All of the above are correct.

REF: P. 117 3. What are the cardiovascular changes associated with regular endurance training? a. Decrease in adipose (fat) tissue b. Increased heart weight and size c. Increased myoglobin content d. Improved oxygen extraction rates from the blood ANS: B

Of all the listed items, increased heart weight and size is the only one that pertains to the cardiovascular system.

REF: P. 117 4. What is the minimum Centers for Disease Control and Prevention (CDC)-recommended

moderate-intensity aerobic exercise for adults, older adults, and pregnant women?

1 hour, 3 times a week 2 hours, 3 times a week 2 hours and 30 minutes a week, spread out across the 7-day period 3 hours and 30 minutes a week, spread out across the 7-day period

a. b. c. d.

ANS: C

See Table 6-1 for minimum weekly aerobic exercise guidelines for adults.

REF: P. 117 5. Which of the following is an example of a moderate-intensity aerobic activity?

a. b. c. d.

Walking briskly, water aerobics, doubles tennis Singles tennis, running, swimming laps Rowing, cycling at a rate of 10 mph None of the above

ANS: A

Examples of moderate-intensity exercises include walking briskly, water aerobics, and doubles tennis.

REF: P. 118 6. What is the CDC-recommended moderate-intensity daily exercise for children? a. 30 minutes b. 45 minutes c. 60 minutes d. 180 minutes ANS: C

CDC recommends that children perform at least 60 minutes of moderate-intensity exercise each day in addition to vigorous-intensity exercises at least three times per week.

REF: P. 118 7. Calculate the maximum heart rate (MHR) in moderate-intensity exercise for a 180-pound man

who is 60 years old.

120 160 180 220

a. b. c. d.

ANS: B

220 minus 60 = 160 (MHR) REF: P. 118 8. Calculate the MHR in moderate-intensity exercise for a 180-pound man who is 60 years old

using a desired intensity of 70%.

102 112 125 160

a. b. c. d.

ANS: B

Target heart rate = MHR  Desired intensity: 160  0.70 = 112 beats per minute REF: P. 118 9. A patient is walking on the treadmill in the therapy department. The patient points to the

number 6 on the Borg scale. What does a rating of 6 mean? a. The patient is at maximum exertion on the treadmill b. The patient is midway toward achieving maximum exertion on the treadmill c. The patient is experiencing no exertion at all

d. The patient is almost at maximum exertion ANS: C

A 6 on the Borg scale means that the patient is experiencing no exertion at all. The scores on the Borg scale range from 6 to 20.

REF: P. 119 10. Which aerobic conditioning program would most likely be prescribed for patients with limited

exercise tolerance?

Continuous Discontinuous None required Slow, walking program that progresses over an 8-week period

a. b. c. d.

ANS: B

Discontinuous aerobic activities are also called interval training activities.

REF: P. 119 11. Which of the following aerobic exercises could be used by a patient whose back cannot

tolerate land-based aerobic exercises?

Stationary bicycle Recumbent bicycle Underwater treadmill Walking on a treadmill

a. b. c. d.

ANS: C

Immersion in water can provide enough buoyancy during walking, unloading the spine, allowing the patient to exercise without exacerbating symptoms.

REF: P. 119 12. While recovering from a total knee replacement 1 week ago, the patient is engaged in aerobic

activities for his upper body. Which of the following pieces of equipment would a PTA use?

Upper body ergometer (UBE) Underwater treadmill Recumbent bicycle Stationary bicycle

a. b. c. d.

ANS: A

Sitting on bicycles and walking underwater are contraindicated for patients in the immediate postoperative period. However, the UBE is ideal for an individual who cannot bear weight or perform full range of motion on an involved lower extremity and therefore can facilitate initial aerobic training.

REF: P. 119 13. Which person would be a candidate for using a stair climber exercise machine? a. A patient who experienced a stroke 6 weeks ago and has right-sided weakness b. A patient who had a total knee replacement 3 weeks ago c. A 70-year-old who had a total hip replacement 2 weeks ago

d. A 65-year-old who had a total hip replacement 12 weeks ago ANS: D

Patients who should not use stair climbers are those in the acute stage of immediate postorthopedic surgery period and those with unstable balance. The patient who should use the stair climber is the 65-year-old who had a total hip replacement 12 weeks (3 months) ago and is ready for increased aerobic activity at this point in the recovery and healing process.

REF: P. 120 14. What would you recommend to increase muscular endurance? a. 10 repetitions per set with a 3-minute rest period between each set b. 25 repetitions per set with a 5-minute rest period between each set c. 15 repetitions per set with a 1- to 2-minute rest period between each set d. 5 repetitions per set with no rest period between each set ANS: C

The key variables that define how a muscle is being trained are (1) the number of repetitions during a set, (2) the amount of weight lifted during the set, and (3) the period of rest between sets. To increase muscular endurance, sets of high repetitions should be performed—at least 15 per set with a period of 1-2 minutes allowed for rest between each set.

REF: P. 121 15. Which type of endurance requires training to maintain or improve capacity, reduces the risk of

developing acute or chronic conditions, and helps restore function after injury? a. Muscular endurance b. Cardiovascular endurance c. Both A and B d. Neither A nor B ANS: C

Both muscular and cardiovascular endurance require training, improve one’s fitness level, reduce the risk of acute and chronic conditions, and help restore function after injury.

REF: P. 116 16. What is the main energy source for muscular function? a. Oxygen (O2) b. Adenosine triphosphate (ATP) c. Fat d. Vitamins and minerals ANS: B

Micronutrients such as carbohydrates, proteins, and fats are converted into adenosine triphosphate, which is the main energy source for muscular function.

REF: P. 116 17. What percentage of adults in the United States are considered overweight or obese? a. 10% b. 25%

c. 50% d. 60% or higher ANS: D

Over 60% of adults in the United States are considered overweight or obese.

REF: P. 117 18. Running, swimming laps, singles tennis, and intense cycling are examples of what level of

exercise?

Minimal-intensity Moderate-intensity Vigorous-intensity Extreme-intensity

a. b. c. d.

ANS: C

Running, swimming laps, singles tennis, and intense cycling are examples of vigorousintensity exercise.

REF: P. 118 19. If a client shows an ability to talk during exercise, the exercise would be considered as what

level of intensity?

Moderate Vigorous Extreme Ability to talk has no relevance to exercise intensity

a. b. c. d.

ANS: A

The talk test is an effective method to assess clinically the relative intensity of an exercise.

The ability to talk during exercise suggests that the exercise is of moderate intensity, whereas the inability to talk without having to pause for breath suggests that the exercise is of vigorous intensity.

REF: P. 117 20. An exercise intensity rating system that uses the client’s perception of exertion is the: a. Karvonen Rating Scale b. Borg Rating of Perceived Exertion Scale c. APTA Exercise Rating Scale d. THR/MHR Perception Rating Scale ANS: B

The Borg Rating of Perceived Exertion Scale may be used to assess exercise intensity based on a client’s perception of exertion. It uses a 6-20 point scale, 6 meaning no exertion and 20 corresponding to maximal exertion.

REF: P. 119

Chapter 07: Balance and Coordination MULTIPLE CHOICE 1. Select the term that is defined as the ability to maintain the center of mass over the base of

support. a. Coordination b. Neuromuscular control c. Proprioception d. Balance ANS: D

Balance is often defined as the ability to maintain the center of mass over the base of support.

REF: P. 125 2. Select the term that is defined as the ability to produce patterns of body and limb motions in

the context of environmental objects and events.

Coordination Neuromuscular control Proprioception Balance

a. b. c. d.

ANS: A

Coordination is the ability to produce patterns of body and limb motions in the context of environmental objects and events.

REF: P. 126 3. What term is defined as the perception of knowing joint position, movement, and movement

resistance?

Coordination Neuromuscular control Proprioception Balance

a. b. c. d.

ANS: C

Essential to joint positions is sufficient sensory (afferent) information regarding joint position, movement (kinesthesia), and movement resistance, or tension. The afferent information contributing to these three elements is called proprioception. Proprioception is vital for neuromuscular control.

REF: P. 126 4. Where are mechanoreceptors located? a. Muscle b. Tendon c. Ligament d. All of the above ANS: D

Mechanoreceptors are the sensory receptors that are responsible for converting mechanical events (movement or tension) into neural signals that can be conveyed to the central nervous system.

REF: P. 127 5. Muscle spindles convey information regarding: a. nutrients delivered to the muscle. b. muscle length and rate of length change. c. muscle tension. d. the balance of the body.

ANS: B

Muscle spindles are responsible for conveying information regarding muscle length and rate of length changes.

REF: P. 127 6. Which of the following mechanoreceptors is responsible for conveying information regarding

muscle tension? a. Golgi tendon organs b. Ruffini receptors c. Pacinian corpuscles d. Free nerve endings ANS: A

Golgi tendon organs, located across a musculotendinous junction, are responsible for conveying information regarding muscle tension.

REF: P. 127 7. Balance tests and balance treatment activities use the same movements. How does the

physical therapist assistant challenge the patient and test different aspects of the postural control system? a. By counting the number of repetitions within a given time frame b. By counting the time the patient can maintain a certain balance activity c. By manipulating the conditions in which the balance tasks are conducted d. There is no way to change balance tests; they are designed to measure all aspects of the postural control system ANS: C

Different aspects of the postural control system may be more selectively challenged by manipulating the conditions in which balance tasks are conducted. For example, having a patient stand with the eyes closed heightens his or her reliance on somatosensory and vestibular information.

REF: P. 127 8. Which of the following are included in a comprehensive balance assessment and training? a. Progressive tasks of incremental difficulty b. Static stance with varying bases of support c. Progressive tasks with unexpected perturbations

d. All of the above ANS: D

Comprehensive balance assessment and training frequently call for a progressive battery of specific tasks of incremental difficulty and should include not only static stances with varying bases of support and support-surface characteristics, but also tasks that involve voluntary movement and unexpected perturbations with task completion.

REF: P. 128 9. Which of the following descriptions of coordination tests applies to the finger-to-nose test? a. A static position test in which the arms are held horizontal or the knees extended b. A reciprocal motion test in which the patient is asked to receive and deliver a ball c. A reciprocal motion test in which the patient alternately touches the tip of each

finger with the tip of the thumb d. A reciprocal motion test in which the patient touches the tip of the index finger to

the tip of the nose ANS: D

The finger-to-nose coordination test involves having the patient touch the tip of the index finger to the tip of the nose.

REF: P. 127 10. Which of the following is involved in coordination? a. Sensory organs b. Muscle function c. Central nervous system centers d. All of the above ANS: D

Coordination involves multiple elements, including sensory organs, muscle function, and central nervous system centers.

REF: P. 127 11. When planning a progressive balance training plan for your postoperative patient, where

would you begin with activities? a. The tasks and drills begin and progress according to the abilities of the patient b. The tasks and drills are established two levels above what the patient can perform

to challenge his balance and coordination c. The tasks and drills are initiated a level below what the patient can perform and

progress as the patient progresses d. The tasks and drills are established based on the diagnosis and followed on a set

time schedule ANS: A

Tasks and drills are initiated and progress according to the abilities and desired goals of the patient.

REF: P. 128

12. Which of the following exercises is NOT a closed kinetic chain (CKC) exercise? a. Double- and single-leg squats on stable and unstable surfaces b. Forward and backward gait c. Sidestepping and heel-to-toe walking d. Reaching for an object placed outside of the patient’s reach ANS: D

Progressively challenging tasks and CKC exercises stimulate a patient’s ability to safely and accurately negotiate obstacles. Such exercises include the double- and single-leg squats, forward and backward gait, sidestepping, and heel-to-toe walking.

REF: P. 131 13. For which training tasks would a wobble board be used? a. Balance training for the lower extremities b. Coordination training for the upper extremities c. Proprioceptive training for the upper extremities d. Flexibility training for the lower extremities ANS: A

The wobble board, or balance board, is a portable and affordable device. It is used in balance training for lower extremities.

REF: P. 131 14. Which training exercise would be most appropriate for the glenohumeral joint of a gymnast? a. Double- and single-leg squats on stable and unstable surfaces b. Forward and backward gait walking c. Medicine balls and physioballs d. Stretching exercises that emphasize the spine and hips ANS: C

Global stability of the glenohumeral joint can be enhanced effectively with the use of medicine balls and physioballs (Fig. 7-10, B1 and B2).

REF: P. 132 15. A critical safety component in all balance and proprioception activities is the patient’s ability

to demonstrate which of the following?

Increased range of motion (ROM) Improved strength Steady gait Protective reactions

a. b. c. d.

ANS: D

Close observation of the patient’s protective reactions during loss of balance is a critical component of all balance tests and training activities.

REF: P. 128 16. Which of the following factors does NOT contribute to balance dysfunction? a. ROM

b. Coordination c. Perception d. CKC exercises ANS: D

Duncan identified several factors that may significantly contribute to balance dysfunction: perception, behavior, ROM, biomechanical alignment, weakness, synergistic organization strategy, coordination, and adaptability.

REF: P. 130 17. Which of the following is not a sensory source that a patient relies on for balance? a. Vision b. Proprioceptive c. Somatosensory d. Vestibular ANS: B

A patient relies on visual, somatosensory, and vestibular senses. By observing changes in the amount of sway or using a forceplate to quantify sway, the clinician can determine which of these sensory sources a patient relies on for balance as well as the degree to which the patient can adapt reliance on the remaining senses during situations of intersensory conflict.

REF: P. 129 18. Why is balance training and proprioceptive training needed for upper extremities? a. Many household chores involve the repetitive use of arms and shoulders to lift,

pull, and carry b. Surgery, injury, and immobilization lead to significant alterations in proprioception c. Many workers use their arms and shoulders in their jobs with vigorous weight

bearing d. All of the above ANS: D

All of the listed items are reasons why balance training and proprioceptive training are needed for the upper extremities.

REF: P. 132 19. In progressive balancing exercises, which of the following exercises would come first? a. Seated: eyes open, then eyes closed b. Single-leg standing: eyes open, then eyes closed c. Minitrampoline: double-leg standing d. Balance board ANS: A

Progressive balancing exercises are in Box 7-2. Seated: eyes open, then eyes closed comes first.

REF: P. 128 20. In progressive balancing exercises, which of the following exercises would come last?

a. b. c. d.

Seated: eyes open, then eyes closed Single-leg standing: eyes open, then eyes closed Minitrampoline: double-leg standing Balance board

ANS: D

Progressive balancing exercises are in Box 7-2. The balance board activities would come last in this list.

REF: P. 128

Chapter 08: Composition and Function of Connective Tissue MULTIPLE CHOICE 1. What are the two classic functions of connective tissues? a. Mechanical support for bone and soft tissues b. Balance and coordination c. Intercellular exchange of oxygen, blood, water, gases, cells, and wastes d. A and C ANS: D

Two classic functions of connective tissues are mechanical support for bone and soft tissues and intercellular exchange of oxygen, blood, water, gases, cells, and wastes.

REF: P. 143 2. Which term is defined as a noncollagenous glycoprotein found in varying amounts in tissues

requiring motion (elasticity), with a unique ability to deform under stress and then return to its original shape and orientation? a. Elastin b. Collagen c. Proteoglycans d. Tendons e. Lipids ANS: A

Elastin is described as a noncollagenous glycoprotein found in varying amounts in tissues requiring motion (elasticity). It has a unique ability to deform under stress and then return to its original shape and orientation.

REF: P. 143 3. Which term is described as an abundant component of the connective tissue matrix that

contributes to the stability and strength of the extracellular matrix?

Elastin Collagen Proteoglycans Ground substance Lipids

a. b. c. d. e.

ANS: B

Collagen is the most abundant component of the connective tissue matrix. It contributes to the stability and strength of the extracellular matrix and its proline amino acids are generally responsible for resisting tensile forces in collagen.

REF: P. 144 4. What is ground substance? a. An amorphous, nonfibrous, aqueous-gel substance that is responsible for

facilitating the exchange of water, oxygen, cells, and gases and also provides

mechanical support between various tissues b. A minor constituent in the extracellular matrix of connective tissue that helps with orientation and maintenance of matrix structure c. A substance that regulates the spread of cells and attracts and binds various connective tissue cells together d. A multifunctional glycoprotein found in the extracellular matrix, important in establishing epithelial tissue in wound healing ANS: A

Ground substance is an amorphous, nonfibrous, aqueous-gel component of the connective tissue matrix. Generally, this substance is responsible for facilitating intercellular exchange of water, oxygen, cells, and gases, as well as providing mechanical support between various tissues.

REF: P. 144 5. Select the best description of laminin. a. An amorphous, nonfibrous, aqueous-gel substance that is responsible for

facilitating the exchange of water, oxygen, cells, and gases, and also provides mechanical support between various tissues b. A minor constituent in the extracellular matrix of connective tissue that helps with orientation and maintenance of matrix structure c. A substance that regulates the spread of cells and attracts and binds various connective tissue cells together d. A multifunctional glycoprotein found in the extracellular matrix that is important in establishing epithelial tissue in wound healing ANS: D

Laminin is a multifunctional glycoprotein found in the extracellular matrix; it is important in establishing epithelial tissue and basement membrane during wound healing.

REF: P. 144 6. What is the name of the connective tissue membrane surrounding the entire muscle? a. Fascicle b. Epimysium c. Perimysium d. Glycosaminoglycan ANS: B

The epimysium surrounds the entire muscle.

REF: P. 144 7. What triggers the inflammatory response? a. An injury b. Release of histamine from mast cells surrounding the tissue c. Platelets and fibroblasts d. Angiogenesis ANS: B

Initially triggered by the release of histamine from mast cells in the surrounding tissue, the inflammatory response is amplified by cytokines that were activated by leukocytes (white blood cells).

REF: P. 146 8. How many days does the acute inflammation phase last? a. 1-2 b. 3-5 c. 5-7 d. 7-9 ANS: C

Acute inflammation is a transient initial phase of injury repair lasting approximately 5-7 days.

REF: P. 146 9. Which phase of the healing process is characterized by a degradation of excess collagen and

the maturation of collagen?

Acute inflammation Fibroplasia Remodeling None of the above

a. b. c. d.

ANS: C

The remodeling phase of injury repair is essentially a balance between enzymatic degradation of excess collagen and the depot/organization/modification/maturation of collagen.

REF: P. 146 10. Of the cell types involved in an injury repair, which cell is described as the powerhouse of the

cells and produces adenosine triphosphate (ATP) and protein synthesis?

Organelle Golgi apparatus Lysosomes Mitochondria

a. b. c. d.

ANS: D

Mitochondria, the powerhouses of the cell, are actively involved with ATP production and protein synthesis.

REF: P. 146 11. Of the cell types involved in an injury repair, which cell is described as the most abundant

granulocyte that migrates to damaged tissue after mediation and function in the initial phagocytosis of foreign matter, bacteria, and cellular debris? a. Mitochondria b. Macrophages c. Neutrophils d. Fibroblasts ANS: C

Neutrophils, the most abundant granulocytes, are leukocytes that migrate to damaged tissue after mediation and activation of cytokines, platelet factor 4. The primary function of neutrophils includes initial phagocytosis of foreign matter, bacteria, and cellular debris from the damaged tissue site.

REF: P. 149 12. Which cells are the scavenger cells that function in phagocytosis, antigen presentation, and

production of cytokine growth factors during the inflammatory process?

Mitochondria Macrophages Neutrophils Fibroblasts

a. b. c. d.

ANS: B

Macrophages are the scavenger cells that function in phagocytosis, antigen presentation, and production of cytokine growth factors during the inflammatory process.

REF: P. 149 13. Which cells stimulate cell proliferation, differentiation, and regulation of normal growth? a. Mitochondria b. Prostaglandins c. Cytokines d. Neutrophils ANS: C

Cytokines are used for cellular communication and stimulate cell proliferation, differentiation, and regulation of normal growth, homeostasis, injury, disease, and repair (Table 8-1).

REF: P. 149 14. Which cytokine stimulates cell proliferation of cartilage matrix and bone tissue? a. Transforming growth factor- b. Platelet-derived growth factor c. Fibroblast growth factor (FGF) d. Tumor necrosis factor (TNF-) ANS: C

FGF stimulates cell proliferation of cartilage matrix and bone tissue. FGF is also an effective angiogenic stimulant for revascularization after injury.

REF: P. 152 15. Which cells are responsible for autolysis leading to tissue necrosis? a. Neutrophils b. Mitochondria c. Cytokines d. Lysosomes ANS: D

When cells are damaged, specific organelles (lysosomes) are involved with autolysis or selfkilling, leading to tissue necrosis.

REF: P. 152 16. Which type of cell is continuously regenerating and proliferating? a. Labile b. Stable c. Cytokines d. Lysosomes ANS: A

Labile cells are proliferative and capable of regeneration after injury. For example, epithelial cells are labile, requiring continued proliferation and regeneration throughout life.

REF: P. 153 17. Which term is defined as programmed cell death? a. Cell necrosis b. Apoptosis c. Regeneration d. Hypoxia ANS: B

Apoptosis is programmed cell death.

REF: P. 152 18. Which selection is the correct sequence of wound healing? a. Reaction, hemostasis, remodeling, regeneration b. Reaction, hemostasis, regeneration, remodeling c. Hemostasis, remodeling, regeneration, reaction d. Hemostasis, reaction, regeneration, remodeling ANS: D

Figure 8-2 shows the orderly sequence of wound healing as hemostasis, reaction, regeneration, remodeling.

REF: P. 147 19. Which cell is responsible for stopping bleeding after an injury? a. Neutrophil b. Macrophage c. Platelet d. Red blood cell ANS: C

Platelet activation stimulates the synthesis of thrombin, fibrin, and the random organization of clot formation.

REF: P. 144

20. Which cytokines are activated by T cells, are potent activators of neutrophils, and are

important regulators of acute inflammatory reactions? These are sometimes involved in different forms of arthritis. a. TNF- b. Granulocytes c. Interleukin-1 d. Interleukin-3 ANS: A

TNF- (lymphotoxin) is activated by T cells and is an important regulator of acute inflammatory reactions (Table 8-1).

REF: P. 151

Chapter 09: Ligament Healing MULTIPLE CHOICE 1. Which of the following influences the characteristic behavior of ligament substance? a. Collagen composition b. Proteoglycans and actions between the extracellular matrix and ground substance c. Orientation of fibers d. All of the above ANS: D

Characteristic behavior of ligament substance is directly influenced by collagen composition, proteoglycans, glycosaminoglycans (GAGs), orientation of fibers, and actions between extracellular matrix and ground substance.

REF: P. 156 2. Which is the correct order in which ligaments heal? a. Remodeling, proliferation, inflammation, hemostasis b. Hemostasis, inflammation, proliferation, remodeling c. Inflammation, hemostasis, proliferation, remodeling d. Hemostasis, inflammation, remodeling, proliferation ANS: B

Ligaments heal in a highly structured, organized, and predictable fashion. The sequential events overlap in four stages of repair: hemostasis and degeneration, inflammation, proliferation and migration, and remodeling and degeneration.

REF: P. 156 3. In which phase of the repair process do the ends of the ligament retract and a hematoma forms

between the damaged ends of the tissues?

Phase I Phase II Phase III Phase IV

a. b. c. d.

ANS: A

The inflammatory reaction to trauma represents phase I of the injury and repair cascade.

Initially the injured ends of ligament retract and usually demonstrate a highly disorganized appearance. A hematoma forms between the damaged ends of the tissue.

REF: P. 156 4. In which phase of the ligament repair process does type III collagen transform to type I

collagen, improving the stiffness of the ligament and increased tensile strength of the repair tissue? a. Phase I b. Phase II c. Phase III

d. Phase IV ANS: D

In phase IV of the tissue repair process, type III collagen transitions to type I, improving stiffness. The hallmark of phase IV remodeling is collagen organization and increases in tensile strength of the repair tissue.

REF: P. 156 5. Which condition is NOT required for a ligament to properly remodel or heal? a. Torn ligament ends being in contact with each other b. Progressive, controlled stress applied to the healing tissues to orient scar tissue

formation c. Complete immobilization during the healing process d. Protection against excessive forces during the remodeling processes ANS: C

Rest is required to various extents depending on the injury, but complete immobilization has negative effects on ligament healing.

REF: P. 157 6. Your patient has a grade III injury to a ligament. Which of the following actions will most

likely be taken for this patient? a. The ligament sprain will be treated with protective bracing and progressive

rehabilitation b. The ligament will be treated with protective bracing and appropriate strengthening to provide dynamic muscular strength c. The patient will require surgical repair of the ligament d. The patient will be treated with a knee support and physical therapy during the healing process ANS: C

Surgical repair of grade II sprain frequently involves repair of associated tissues as well. A grade III injury is a complete rupture of the ligament with profound instability and laxity.

REF: P. 157 7. If a patient has an isolated grade III medial collateral ligament (MCL) tear, which of the

following actions would most likely be taken?

Surgery to repair the ligament Protective bracing and comprehensive and progressive rehabilitation Light brace support of the joint and crutch walking None of the above

a. b. c. d.

ANS: B

Because the MCL has a greater periarticular vascular response and ability to protect the ligament from unwanted forces—and the appropriate environment to stimulate healing—all three grades of injury can heal uneventfully without surgical repair.

REF: P. 157

8. If a patient has a grade III anterior cruciate ligament (ACL) tear, which of the following

actions would most likely be taken?

Surgery to repair the ligament Protective bracing and comprehensive and progressive rehabilitation Light brace support of the joint and crutch walking None of the above

a. b. c. d.

ANS: A

The ACL is not conducive to intrinsic repair. It is difficult to protect the ACL from unwanted deforming forces; using a brace would create a high-stress force environment, which would limit healing. Therefore surgical repair is the best option for healing.

REF: P. 157 9. Adhesion formation, active shortening of ligaments, deterioration in ligament strength, loss of

bone, and weakening of cartilage and tendons can result from which physical therapy intervention? a. Immobilization after injury b. Active strengthening exercises c. Isometric exercises in the initial healing period d. Weight-bearing exercises in the initial healing period ANS: A

Stress deprivation of the ligament and ligament-bone complexes that results from prolonged immobilization after injury or surgery can have significant and profound negative effects (Box 9-1). Joint stiffness after immobilization is related to adhesion formation, active shortening of dense connective tissue (ligament), and decreases in water content. Studies show a gradual deterioration in ligament strength, loss of bone, weakening of cartilage and tendons, significant muscle atrophy, and negative effects on joint mechanics after periods of immobilization.

REF: P. 158 10. How many weeks of immobilization does it take to produce thickening in the joint capsule,

ligaments, and cartilage and decreased compliance resulting in stiffness? a. 1 b. 2 c. 4 d. 6 ANS: D

After 6 weeks of immobilization, joint mobility becomes significantly limited with thickening noted in the joint capsule, ligaments, and cartilage and decreased ligamentous compliance.

Thus, joint immobilization causes a progression of dense connective tissue remodeling, resulting in joint stiffness.

REF: P. 158 11. What happens to the ligament-bone complex during immobilization? a. It remains unchanged during immobilization b. It has some reduction in strength, which quickly returns after therapy begins

c. The ligament-bone insertion site becomes osteoporotic with bone resorption and

reduced strength d. The bone remains strong while the ligament repairs itself ANS: C

Generally, the area of bone directly beneath the ligament-bone insertion site becomes osteoporotic with osteoclastic activity, resulting in pronounced bone resorption, loss of cortex, and reduced strength of the entire ligament-bone insertion complex.

REF: P. 159 12. Which heals faster with remobilization and exercise? a. Ligament b. Ligament-bone insertion complexes c. Both at the same pace over time d. Neither after injury ANS: A

Ligament substance once injured may regain only 50-70% of normal tensile strength after 1 year or more of remodeling. Ligament-bone insertion complexes tend to remodel and regain tensile strength more slowly than ligament tissue after immobilization and therapeutically directed reconditioning.

REF: P. 159 13. What is the effect of continuous passive motion (CPM) on the joint versus immobilization? a. Immobilized joints produce adhesions and scar tissue b. Both are excellent methods of healing ligaments c. Joints that have CPM applied show no adhesions and well-organized longitudinally

oriented collagen fibers d. A and C ANS: C

Joints moved passively have well-organized, longitudinally oriented collagen fibers in which no adhesions are present. Conversely, joints that were immobilized demonstrated scar tissue and adhesions.

REF: P. 159 14. What is the remodeling and maturation time for a ligament? a. 4 weeks b. 3 months c. 6 months d. 1 year ANS: D

As the outward clinical signs point to healing, the ligament, being a dynamic tissue, continues to remodel and mature for up to 1 year.

REF: P. 160

15. When beginning progressive resistance exercises after ACL surgery, where would you place

resistance (a weight) during straight leg raises?

At the ankle Below the knee Above the knee Higher on the thigh

a. b. c. d.

ANS: C

Placing the resistance (weight) above the joint line during straight leg raises after ACL surgery can be the first phase of progressive resistance while protecting the healing ligament and retraining quadriceps activation (Fig. 9-3).

REF: P. 160 16. When beginning progressive resistance exercises after MCL sprain, where would you place

resistance (a weight) during adduction exercises? a. At the ankle b. Below the knee c. Above the knee d. Higher on the thigh ANS: C

To strengthen hip adduction with an MCL sprain, resistance initially is applied above the knee joint line so as not to overstress the healing MCL (Fig. 9-4). As the time constraints of healing allow, progressive strengthening of the adductors can involve loading the joint more distally, if joint protection is applied.

REF: P. 160 17. Which of the following are measures taken for the patient during the acute and subacute

phases of rehabilitation after ligament injury or repair?

Pain management Swelling reduction Muscle reeducation Active range of motion (ROM) All of the above

a. b. c. d. e.

ANS: E

The acute and postacute phases of rehabilitation after ligament injury or repair usually involve pain management techniques, swelling reduction, muscle reeducation (isometric muscle contraction and functional muscle stimulation), CPM, active ROM, ligament protection devices via range-adjustable bracing, and weight-bearing gait maneuvers with crutches as needed.

REF: P. 161 18.

What does the acronym RICE stand for?

Repetition, incline, compress, energy Rest, ice, compression, elevation Raises, increase, core, elevation None of the above

a. b. c. d.

ANS: B

Rest, ice, compression, and elevation (Table 9-1).

REF: P. 162 19. In the therapeutic considerations during stages of ligament healing, what is the treatment for

days 3-14?

RICE, pain management, and weight bearing as tolerated RICE, active progressive motion, and protected active resistance exercise RICE, low-load static stretches, full-weight bearing, isokinetic exercise Prolonged low-load static stretching, and isokinetic and isotonic exercise

a. b. c. d.

ANS: B

For days 3 through 14 of ligament healing, the treatment is RICE, active progressive motion, and protected active resisted exercise (Table 9-1).

REF: P. 162 20. In the therapeutic considerations during stages of ligament healing, what is the treatment for

days 60-360?

RICE, pain management, and weight bearing as tolerated RICE, active progressive motion, and protected active resistance exercise RICE, low-load static stretches, full-weight bearing, isokinetic exercise Prolonged low-load static stretching, and isokinetic and isotonic exercise

a. b. c. d.

ANS: D

For days 60 through 360 of ligament healing, the treatment is prolonged low-load static stretching, and isokinetic and isotonic exercise (Table 9-1).

REF: P. 162

Chapter 10: Bone Healing MULTIPLE CHOICE 1. Which bone cell is found on a bony surface and synthesizes type I collagen? a. Osteoblast b. Osteocyte c. Osteoclast d. All of the above ANS: A

Osteoblasts are functionally distinct cells that form bone matrix (osteoid) and synthesize type I collagen, and are commonly found on a bony surface.

REF: P. 166 2. Which bone cell represents 90% of mature skeletal tissue and functions to control

extracellular concentrations of calcium and phosphorus?

Osteoblast Osteocyte Osteoclast All of the above

a. b. c. d.

ANS: B

Osteocytes represent approximately 90% of mature skeletal tissue and metabolically function to control extracellular concentrations of calcium and phosphorus.

REF: P. 166 3. Which bone cell synthesizes acid phosphatase enzyme and hydrogen ions that allow other

bone cells to bind to bone?

Osteoblast Osteocyte Osteoclast All of the above

a. b. c. d.

ANS: C

Osteoclasts are giant-cell multinucleated bone resorption cells. Osteoclasts synthesize a specific acid phosphatase enzyme and also produce hydrogen ions, which in turn lower the pH environment.

REF: P. 166 4. At what age is the skeleton mostly mature bone? a. 1 month b. 2 years c. 4 years d. 12 years ANS: C

Lamellar bone refers to mature remodeled woven bone. Mature bone begins formation at about 1 month after birth and comprises most of the skeleton by age 4.

REF: P. 168 5. Which type of bone is tube shaped with widenings at each end with intermedullary canals

where blood cells are formed?

Irregular Flat Short Long

a. b. c. d.

ANS: D

Long bones are tube shaped with widenings at each end. Long bones have diaphysis, the tubular shaped midportion that houses cancellous bone and the intermedullary canal where blood cells are formed (Fig. 10-8).

REF: P. 168 6. Which type of bone protects internal organs, is compact with a layer of spongy bone, and is

often curved?

Irregular Flat Short Long

a. b. c. d.

ANS: B

Flat bones are typically larger and appear to serve a purpose protecting organs. These bones consist of two layers of compact bone with a portion of spongy bone between. Bones like the ribs, sternum, scapula, and skull form the majority of flat bones.

REF: P. 168 7. What is the arrangement of bone around the vascular channel that is irregular and branching? a. Lamellar bone b. Osteon c. Cancellous bone d. Cortical bone ANS: B

The osteon is an irregular, branching, and anastomosing cylinder composed of a more or less centrally placed neurovascular canal surrounded by cell permeated layers of bone matrix.

REF: P. 169 8. Which type of bone is less dense and has the highest metabolic activity? a. Cancellous b. Cortical c. Compact d. Long ANS: A

Trabecular or cancellous bone is uniformly less dense with a large surface area and is significantly metabolically more active than cortical bone. In fact, even though cortical bone (compact bone) has four times the mass of trabecular bone, the metabolic activity of trabecular bone is eight times greater than that of cortical bone. Because bone turnover is a surface-oriented event, the profound surface area of trabecular bone explains the greater cellular exchange of cancellous bone.

REF: P. 169 9. When does bone remodeling occur? a. Only after an injury or fracture b. Up to age 4 c. Continually over life d. Up to age 50 ANS: C

The phenomenon of cellular turnover or remodeling of bone is a process that occurs on the surface of various portions of bone (periosteal, endosteal, trabecular, and haversian canal).

Generally, bone remodeling is a lifelong activity.

REF: P. 170 10. What is Wolff’s law? a. Intermittent physiologic loads stimulate bone production; lack of mechanical

forces on bone reduces bone mass b. Compression forces limit bone growth, whereas tensile stress stimulates growth c. Constant physiologic loads inhibit bone production; a lack of mechanical forces on

bone enhances bone mass d. All of the above ANS: A

In simplified terms, Wolff’s law states that intermittent physiologic loads applied to bone stimulate adaptive responses. Removal of mechanical forces on the bone has the opposite effect. That is, when bone does not receive appropriate physiologic stress, osteoclastic activity overwhelms osteoblast production, which in turn reduces bone mass.

REF: P. 170 11. What percent of cardiac output does the adult skeletal system receive? a. 1-2 b. 2-4 c. 5-10 d. 15-25 ANS: C

The adult skeletal system receives between 5% and 10% of the body’s total cardiac output.

Bone receives blood supply from three distinct but interconnected systems: (1) the nutrient artery, (2) metaphyseal-epiphyseal system, and (3) periosteal systems.

REF: P. 170 12. What happens when the osteoclast activity is greater than the osteoblast activity?

a. b. c. d.

Bone formation is enhanced Bones weaken and are subject to greater rates of fracture Nothing; this is normal None of the above

ANS: B

Osteoporosis occurs when osteoblast (bone formation) activity is surpassed by osteoclast (bone resorption) activity (Fig. 10-14). This creates weaker bones that are subjected to greater rates of fracture.

REF: P. 172 13. Which of the following is NOT a risk factor for osteoporosis? a. Age (>40) b. Gender (female) c. Postmenopausal d. Obesity ANS: D

All are risk factors except obesity.

REF: P. 172 14. Which type of fracture is described as a fracture where a portion of the bone is pulled away as

a part of a musculotendinous attachment or ligament-bone attachment?

Avulsion Compound Epiphyseal Transverse

a. b. c. d.

ANS: A

An avulsion fracture occurs when a portion of bone is pulled away as part of a musculotendinous attachment or ligament-bone attachment.

REF: P. 173 15. Which type of fracture occurs only in children? a. Avulsion b. Compound c. Epiphyseal d. Transverse ANS: C

Pediatric fractures have a special classification of injuries involving the epiphysis. Depending on the type of epiphyseal fracture, the eventual growth of the bone can be profoundly affected.

REF: P. 173 16. Which type of fracture might be seen spontaneously in an older person with osteoporosis? a. Avulsion b. Compound c. Pathologic

d. Transverse ANS: C

Pathologic fractures are caused by tumors (malignant or primary bone disease), osteoporosis (most common), microtrauma from repetitive overload (stress fractures), or metastatic bone disease (second most common). These usually occur in the elderly person secondary to osteoporosis and can happen spontaneously or with very minor trauma.

REF: P. 174 17. What happens in primary fracture healing? a. External periosteal soft tissue callus bridges between fracture fragments b. The new bone grows across the bone ends to unite the fracture site c. A callus forms that is larger (wider) than the two opposing bones d. All of the above ANS: A

In primary fracture healing, the new bone grows directly across the bone ends to unite the fracture site. This form of bone healing is very slow and cannot bridge a fracture gap; thus, the two fractured ends appose each other. Secondary or indirect fracture repair is noted for external periosteal soft tissue callus bridging between fracture fragments.

REF: P. 175 18. Which occurs first in the process of bone healing? a. Bleeding occurs, and a hematoma results b. Soft callus forms c. Osteoblasts produce new bone d. Callus is reabsorbed ANS: A

Bleeding occurs, and a hematoma results, followed by soft callus formation, then osteoblasts produce new bone, and callus is gradually reabsorbed.

REF: P. 176 19. Which of the following complications of bone healing is described as bone healing in a

nonanatomic position?

Pathologic Malunion Nonunion Delayed union

a. b. c. d.

ANS: B

Malunion is the incomplete or poor union of a healed fracture that is not in the correct anatomic position.

REF: P. 177 20. Which of the following affects bone healing? a. Cigarette smoking b. Malnutrition

c. Calorie deprivation d. Infection e. All of the above ANS: E

All of the factors listed can affect bone healing.

REF: P. 180

Chapter 11: Cartilage Healing MULTIPLE CHOICE 1. Which of the following terms is defined as the intrinsic cartilage repair? a. Chondromalacia b. Chondrogenesis c. Hydrophilic d. Angiogenesis ANS: B

Proper rehabilitation techniques are based on the foundation of intrinsic cartilage repair (chondrogenesis), time necessary for healing, and extrinsic reparative interventions.

REF: P. 185 2. Which of the following terms is defined as softening of hyaline cartilage? a. Chondromalacia b. Chondrogenesis c. Hydrophilic d. Angiogenesis ANS: A

Osteoarthritis, chondromalacia (softening of hyaline cartilage), meniscal lesions, labral tears, and many other cartilage pathologies are common problems the physical therapist assistant sees clinically.

REF: P. 185 3. Which cartilage zone is composed of calcified cartilage made up mainly of cells, cartilage,

matrix, and inorganic salts?

Superficial Middle/transitional Deep Deepest

a. b. c. d.

ANS: D

The zone of calcified cartilage is the deepest zone that separates cartilage tissue from subchondral bone. This small distinct layer is composed mainly of cells, cartilage, matrix, and inorganic salts.

REF: P. 186 4. Which cartilage zone is composed of water and parallel, highly organized collagen fibrils? a. Superficial b. Middle/transitional c. Deep d. Deepest ANS: A

The superficial zone of articular cartilage is composed of water and parallel, highly organized collagen fibrils with very limited concentration of proteoglycans.

REF: P. 185 5. Which type of collagen is the majority of articular cartilage composed of? a. Type I b. Type II c. Type V d. Type VI ANS: B

Collagen represents more than 50% of the entire dry weight of articular cartilage. The vast majority of collagen in articular cartilage is type II; however, the extracellular matrix also contains types V, VI, IV, X, and XL. REF: P. 186 6. Why is it difficult to impossible for articular cartilage to heal itself? a. Articular cartilage has the wrong type of collagen to stimulate its own healing b. Articular cartilage is an avascular cartilage that produces a limited vascular

inflammatory response c. The vascular inflammatory response overwhelms the articular cartilage and prevents intrinsic healing d. None of the above ANS: B

Articular cartilage is a nonhomogeneous and avascular structure that lacks the ability to stimulate, regulate, or organize intrinsic repair. Without an intense vascular response to injury, articular cartilage cannot form a fibrin scaffold or mobilize cells in order to repair the defect.

REF: P. 186 7. How does cartilage receive its nutrients? a. Through normal joint motion causing fluid movement and through diffusion or

convection b. Through the normal blood supply to the knee c. From the blood supply to the synovial fluid d. Through the cartilage artery ANS: A

Articular cartilage is permeable and the synovial fluid provides the necessary nutrients through diffusion and convection. Normal joint motion is needed to maintain the cartilage integrity and nutrition of hyaline cartilage.

REF: P. 187 8. What is the effect of immobilization on cartilage? a. There is no effect of immobilization on cartilage b. Immobilization encourages cartilage to heal and repair itself c. Immobilization has profound negative effects on cartilage healing d. None of the above

ANS: C

The removal of normal physiologic loading, unloading, and joint motion have profoundly negative effects on the biochemical and mechanical characteristics of articular cartilage. The significance of articular cartilage atrophy and degeneration is related to the magnitude and duration of immobilization.

REF: P. 187 9. Which of the following is NOT a cause of cartilage erosion? a. Trauma b. Infection c. Shearing loads d. Immobilization e. Continuous passive motion (CPM) ANS: E

All of the items listed can cause cartilage erosion except CPM. REF: P. 188 10. Why do superficial articular cartilage defects not heal as well as deeper cartilage injuries? a. They lack the blood vessels needed to deliver the cells in the inflammatory

response b. Superficial defects are not as serious and therefore do not have the strong

inflammatory response deeper injuries receive c. Superficial defects do heal as well as deeper cartilage injuries d. Chondrocytes adhere to the superficial defects better than the deeper injuries ANS: A

Superficial articular cartilage defects do not heal as well as deeper injuries because they injuries do not stimulate the inflammatory response. These superficial injuries lack vascularization.

REF: P. 188 11. Which of the following treatments does NOT stimulate cartilage repair? a. Reduced stair climbing, squats, walking b. Isometric exercises c. Limited weight-bearing activities d. CPM e. Ice and heat ANS: E

All of the items except ice and heat (used for pain and swelling) stimulate cartilage repair.

REF: P. 188 12. Which of the following is the first stage of articular cartilage degeneration? a. Blistering of articular surface b. Fissuring of articular surface c. Fibrillation

d. Splitting ANS: C

Fibrillation, or fraying of articular cartilage, is the first stage of articular cartilage degeneration.

REF: P. 189 13. Which of the following is the last stage of articular cartilage degeneration? a. Blistering of articular surface b. Fraying of articular cartilage c. Splitting d. Fibrillation ANS: C

Splitting, clefting, or fissuring of articular surface, is the last stage of articular cartilage degeneration.

REF: P. 189 14. Which joint disease seems to respond to injections of hyaluronic acid to reduce inflammation? a. Degenerative disk disease b. Psoriatic arthritis c. Osteoarthritis d. Knee replacements ANS: C

Osteoarthritis creates a deficit in volume and molecular mass of hyaluronic acid. Injecting hyaluronic acid proposes to benefit the osteoarthritic knee by reducing pain and inflammation, replenishing decreased volume of hyaluronic acid, and stimulating intrinsic synovial synthesis of hyaluronic acid.

REF: P. 189 15. What is articular cartilage repair using microfracture? a. The surgeon deeply fractures the cartilage to stimulate the inflammatory response b. The surgeon aggrades or fractures multiple small holes in the cartilage layers down

to the bone to stimulate bleeding and initiate the healing process c. This is a nonsurgical procedure that delivers saline lavage to the irritated joint d. None of the above ANS: B

With some cartilage defects, surgically abrading or fracturing multiple small holes through the cartilage layers down to bone stimulates bleeding and initiates the healing process.

REF: P. 189 16. What procedure involves a two-step procedure to harvest articular cartilage, culture the

material in the laboratory, and then patch the cartilage? a. Débridement b. Microfracture c. Arthroscopic osteochondral autografts

d. Autologous chondrocyte implantation (ACI) ANS: D

The ACI procedure calls for two separate surgical interventions. First, the surgeon harvests articular cartilage from the superomedial edge of the trochlea or the lateral edge of the intercondylar notch. This harvested tissue is sent to a specific laboratory, where the chondrocytes are enzymatically separated from the extracellular matrix, cultured, and multiplied. The second procedure typically occurs 6-18 weeks after harvesting. At this time, a periosteal patch may be harvested from the proximal medial tibia.

REF: P. 191 17. Which of the following synovial joints contain fibrocartilage? a. Shoulder and knee b. Elbow and wrist c. Hip d. A and C only ANS: D

Fibrocartilage is found within the synovial joints of the shoulder, hip, and knee. A large percentage of fibrocartilage is water. The collagen in fibrocartilage is made up almost entirely of type I collagen. Proteoglycans and elastin (0.6%) complete the components of fibrocartilage.

REF: P. 192 18. Which of the following meniscus tears typically occurs with the older population? a. Intraarticular fibrocartilage tears b. Degenerative meniscal tears c. Glenoid labrum detachment d. All of the above ANS: B

Degenerative meniscal tears typically occur in people over 40. These injuries do not present with a history of sudden trauma, but rather with a minor event that precipitates complaints of pain and dysfunction.

REF: P. 192 19. What is the zone category for a meniscus tear where one portion is torn within the

vascularized area and the other portion is in a nonvascularized area?

Zone I Zone II Zone III Zone IV

a. b. c. d.

ANS: B

Zone II: One portion of the meniscus is torn within the vascularized periphery, and the other portion is in the avascular region (red-on-white).

REF: P. 192

20. What is the repair required for a meniscus injury that is called white-on-white? a. Surgical repair b. Partial or total meniscectomy c. Immobilization d. Débridement and microfracture ANS: B

When injuries occur in an avascular portion of the meniscus, the surgeon must perform either a partial or total meniscectomy.

REF: P. 192

Chapter 12: Muscle and Tendon Healing MULTIPLE CHOICE 1. What is the area between the muscle and the tendon? a. Joint b. Muscle-tendon connector c. Musculotendinous junction d. Musculotendinous area ANS: C

The transition zone between the muscle and tendon is called the musculotendinous junction.

REF: P. 197 2. Select the term that is defined as the outermost layer of connective tissue that surrounds the

muscle.

Endomysium Perimysium Epimysium Fasciculus

a. b. c. d.

ANS: C

The epimysium surrounds the muscle and (along with the perimysium and the endomysium) is continuous with the muscle’s tendons.

REF: P. 197 3. Which of the following surrounds each individual muscle fiber? a. Endomysium b. Perimysium c. Epimysium d. Fasciculus ANS: A

Within each fasciculus, each individual muscle fiber is surrounded by the endomysium.

REF: P. 197 4. What is the basic functional unit of the myofibril composed of? a. Contractile proteins myosin and actin grouped together as a sarcomere b. Tendons and muscles c. Skeletal muscle d. Type I muscle fibers ANS: A

The myofibrils are bundles of contractile proteins myosin and actin grouped together as sarcomere (the basic functional unit of the myofibril).

REF: P. 197

5. What does the term twitch refer to in muscle fibers? a. The ability to cause a contraction b. The time it takes the muscle fiber to contract and relax c. The shape and function of the fiber d. The consistency of resistance to fatigue ANS: B

Twitch relates to the time it takes muscle fiber (and its associated nerve) to contract and relax.

REF: P. 197 6. Why is it important for the physical therapist assistant (PTA) to understand the types of fibers

comprising muscle? Select the best answer. a. The exercise prescription during different phases of the healing process takes into

account the fiber composition of the injured skeletal muscle b. The physical therapist expects the PTA to understand the different types of muscle

fibers and their corresponding exercises c. The muscles require the same exercises for all types of muscle fibers d. The outcomes of physical therapy depend on the types of muscle fibers involved in

the treatment exercises ANS: A

The exercise prescription strategy used during different phases of the healing process should take into account the primary fiber composition of the injured skeletal muscle. The three most common types are I, IIA, and IIX (Table 12-1).

REF: P. 198 7. What is the basic functional unit of the tendon? a. Subfascicles b. Collagen fibrils c. Collagen fiber d. Partenon ANS: C

Collagen fibrils are grouped together into the tendon’s basic functional unit—the collagen fiber. Groups of collagen fibers form a subfascicle. Several subfascicles group together to form a fascicle. Several fascicles form a tertiary bundle.

REF: P. 198 8. What is the function of the paratenon? a. It surrounds the fiber bundles of the tendon in a protective mechanism b. It allows gliding over adjacent structures c. It prohibits fibrocartilage from converting to mineralized fibrocartilage d. It stores elastic energy created during plyometric exercises ANS: B

The function of the paratenon (a loose areolar connective tissue attaching to the outer portion of the epitenon) is to allow gliding over adjacent structures.

REF: P. 199

9.

Select the cause of a direct muscle injury. a. Violent or excessive muscular stretch b. Excessive muscular stretch combined with an eccentric muscular contraction c. A severe compressive applied load d. Blunt trauma or a deep laceration ANS: D

A direct (external) mechanism is blunt trauma or a deep laceration. The other options are all internal (indirect) mechanisms.

REF: P. 199 10. Select the best characteristic of a second-degree muscle strain. a. A muscle tear of a few fibers, minor weakness, no loss of function, minor pain b. Tear of the whole muscles, major weakness, loss of function c. Noticeable degree of swelling, moderate weakness, and loss of function d. Significant degree of swelling and no pain ANS: C

Table 12-2 lists the characteristics of first-, second-, and third-degree muscle strains.

REF: P. 200 11. Which term is defined as an acute injury to the tendon with an associated inflammatory

response?

Tenosynovitis Peritenonitis Tendinosis Tendinitis

a. b. c. d.

ANS: D

Tendinitis is the acute injury to the tendon with associated inflammatory response (Table 123).

REF: P. 200 12. Which term is defined as degeneration to the tendon not associated with an inflammatory

process? a. Tenosynovitis b. Peritenonitis c. Tendinosis d. Tendinitis ANS: C

Tendinosis is the degeneration of the tendon not associated with the inflammatory process and due to one or more factors such as microtrauma or age-related changes (Table 12-3).

REF: P. 200 13. Which skeletal muscle fiber type is characterized by high resistance to fatigue, slow twitch,

high aerobic capacity, and high myoglobin content?

a. b. c. d.

Type I Type IIA Type IIX (IIB) Type X

ANS: A

Type I skeletal muscle fibers have few muscle fibers, slow twitch, high resistance to fatigue, and high myoglobin content.

REF: P. 198 14. An injured patient complains of pain, functional loss, and warmth and swelling at the site of

an injury for the past week. What diagnosis would you suspect?

Tendinopathy Tendon rupture Tendonitis Tenovaginitis

a. b. c. d.

ANS: C

Tendinitis is characterized by a recent injury, pain, functional loss, and signs and symptoms of inflammation (redness, swelling, warmth).

REF: P. 200 15. Which tendon is frequently ruptured and surgically repaired? a. Quadriceps b. Achilles c. Supraspinatus (rotator cuff) d. All of the above ANS: D

The Achilles tendon, supraspinatus, extensor carpi radialis brevis, and quadriceps tendon are surgically repaired.

REF: P. 200 16. Which of the following changes occurs in an aging tendon? a. There is an increase in collagen fibers b. The ability to turn over collagen increases c. The ability to add new collagen fibers decreases d. The size of the tendon is larger ANS: C

The aging tendon is smaller in size, has fewer collagen fibers, loses its ability to turn over collagen and has a decreased ability to add new collagen fibers—all leading to weakened tendons in older adults.

REF: P. 201 17. In which stage of the inflammatory process do capillaries begin growth and fibroblast cells

enter the injured area to begin synthesizing new collagen? a. Acute

b. Inflammatory c. Subacute d. Chronic ANS: C

In the subacute phase (repair and healing), the growth of capillaries into the injured region and fibroblastic activity are initiated early in the phase.

REF: P. 202 18. Which of the following muscle changes is characterized by loss of muscle weight, loss of

force and tension, and decreased muscle fiber size?

Muscle atrophy Muscle strain Muscle tendinopathy None of the above

a. b. c. d.

ANS: A

Muscle atrophy results in lower muscle weight, lost ability to generate force and tension, and a decreased fiber size.

REF: P. 202 19. Select the physical therapy interventions implemented immediately following an acute injury

to a muscle. a. Protection, rest, ice, compression, and elevation (PRICE) b. Nonsteroidal antiinflammatory drugs (NSAIDs), passive range of motion (ROM),

and active assisted ROM c. Active ROM and NSAIDs, massage, mobilization d. NSAIDs, progressive strengthening and functional exercise ANS: A

At the time of an injury PRICE is implemented: protection, rest, ice, compression, and elevation.

REF: P. 203 20. Select the interventions implemented in the physical therapy department for the chronic stage

of healing.

Protection, rest, ice, compression and elevation NSAIDs, passive ROM, and active assisted ROM Active ROM and NSAIDs, massage, mobilization NSAIDs, progressive strengthening and functional exercises

a. b. c. d.

ANS: D

In the chronic stage, increasing endurance capacity of the muscle is indicated, as tolerated.

Functional exercises are prescribed.

REF: P. 204

Chapter 13: Neurovascular Healing and Thromboembolic Disease MULTIPLE CHOICE 1. Which of the following is true about the vascular supply to nerves? a. The peripheral nerves do not have an extensive blood supply b. Nerves require an ongoing nutritive energy supply for nerve conduction c. Peripheral nerves do not require much vascularization d. All of the above ANS: B

A mechanical insult to nerves stimulates an intense inflammatory reaction. Peripheral nerves have a complex and extensive blood supply. The peripheral nervous system (PNS) requires an ongoing nutritive energy supply for maintenance of nerve conduction.

REF: P. 207 2. How far can you stretch (elongate) a peripheral nerve before you tear it? a. 1% b. 5% c. 20% d. 70% ANS: C

Peripheral nerve tissue may tear when the nerve is elongated to approximately 20% more than its resting length. However, ischemic changes, which profoundly affect nerve function, may occur when a nerve is stretched up to 15% of its resting length.

REF: P. 208 3. Which is the best definition of the term axonotmesis? a. Nerve conduction at the site of injury is reduced, usually due to compression b. The nerve epineurium remains intact while the perineurium and endoneurium incur

damage in varying degrees c. The entire nerve trunk is transected or ruptured d. The peripheral nerve is compressed, causing ischemia ANS: B

In axonotmesis, the epineurium remains intact, while damage to the perineurium and endoneurium occurs to varying degrees. Functional recovery without surgery may occur.

REF: P. 209 4. Which is the best definition of the term neurotmesis? a. Reduction in nerve conduction at the site of injury, usually due to compression b. The nerve epineurium remains intact while the perineurium and endoneurium incur

damage in varying degrees c. The entire nerve trunk is transected or ruptured d. The peripheral nerve is compressed, causing ischemia ANS: C

Neurotmesis is diagnosed when the entire nerve trunk is transected or ruptured. The total loss of nerve continuity requires surgical adaptation and coaptation. Prognosis depends on the nature of the injury and other factors.

REF: P. 209 5. Select the best rationale for the double crush syndrome a. The syndrome occurs in major motor vehicle accidents with multiple injuries b. The syndrome is not frequently seen but involves compression on two different

nerves c. The compression on one area of a nerve reduces conduction and blood supply,

which puts the rest of the nerve at risk for injury d. None of the above ANS: C

The most common example is carpal tunnel medial nerve compression neuropathy and cervical nerve root injury. A compression lesion at one level of the nerve makes the same nerve more susceptible to injury at another site.

REF: P. 210 6. What is the name of the surgical procedure that reconnects nerve stumps or fascicles? a. Neuropathy b. Neurorrhaphy c. Zenografting d. Direct coaptation e. B and D ANS: E

The term neurorrhaphy is synonymous with direct coaptation or surgical apposition of corresponding nerve stumps or fascicles.

REF: P. 210 7. Which of the following is critical for the physical therapist assistant to avoid in the immediate

postoperative period after nerve coaptation or autograft?

Overzealous range of motion (ROM) exercise Superficial heat application Sensory reeducation exercise Stimulation of distal target sites

a. b. c. d.

ANS: A

Repair site protection is the most important factor after peripheral nerve coaptation or autograft. Overzealous ROM exercise during early recovery can easily disrupt fragile healing of fascicle sutures and axonal regeneration.

REF: P. 211 8. When assessing the motor and sensory nerve recovery of your physical therapy patient, you

note that the patient has good motor (M) and fair sensory (S) recovery. How would you chart this finding? a. M5, S5

b. M5, S4 c. M4, S3 d. M4, S4 ANS: C

Motor (M) recovery ranges from 1 (none) to 5 (normal). Sensory (S) recovery ranges from 0 (none) to 4 (full recovery). Good motor = 4 and Fair sensory = 3.

REF: P. 212 9. When assessing the motor and sensory nerve recovery of your outpatient therapy patient, you

chart M5, S4. What does this mean?

The patient has no motor or sensory recovery The patient has fair motor and fair sensory recovery The patient has normal motor and normal sensory recovery The patient has poor motor and poor sensory recovery

a. b. c. d.

ANS: C

Motor (M) recovery ranges from 1 (none) to 5 (normal). Sensory(S) recovery ranges from 0 (none) to 4 (full recovery).

REF: P. 212 10. What is the innermost lining of a blood vessel called? a. Tunica adventitia b. Tunica media c. Tunica intima d. Tunica inner ANS: C

The innermost layer is the tunica intima (interna) consisting of connective tissue, endothelial cells, and a basement membrane.

REF: P. 212 11. Which of the following is the outermost layer of a blood vessel? a. Tunica adventitia b. Tunica media c. Tunica intima d. Tunica inner ANS: A

The outermost layer is the tunica adventitia (externa) made up of fibrous connective tissue that blends with loose surrounding connective tissue.

REF: P. 212 12. Which of the following is the correct order for the organized and predictable inflammatory

response in blood vessels? a. Remodeling and maturation, coagulation, fibroplasia, inflammation b. Coagulation, fibroplasia, inflammation, remodeling, and maturation c. Fibroplasia, coagulation, inflammation, remodeling, and maturation

d. Coagulation, inflammation, fibroplasia, remodeling, and maturation ANS: D

Injuries to vessels incite an organized, predictable inflammatory response with distinct overlapping sequential events: coagulation, inflammation, fibroplasia, and remodeling and maturation.

REF: P. 212 13. Which of the following is a “hard” sign of peripheral artery injury? a. Hematoma over a peripheral artery b. Neurologic deficit originating in a nerve adjacent to the injured artery c. Absent or diminished peripheral pulse distal to the injury d. Pulselessness, pallor, and paralysis ANS: D

The “hard” signs are pulselessness, pallor, paresthesias, pain, paralysis, overt bleeding, and rapidly spreading hematoma.

REF: P. 212 14. What test is considered the gold standard for diagnosis of a suspected arterial injury? a. Physical assessment of the hard signs b. Physical assessment of the soft signs c. Doppler or duplex ultrasonography d. Percutaneous arteriography ANS: D

Percutaneous arteriography is the gold standard and most commonly used invasive technique for diagnosis of suspected arterial injury.

REF: P. 213 15. Which of the following is the most common cause of mortality and morbidity in hospitalized

patients—particularly in hip and knee arthroplasties?

Deep vein thrombosis (DVT) Pulmonary embolism (PE) Hematoma B and C A and B

a. b. c. d. e.

ANS: E

DVT and PE are the most common causes of mortality and morbidity in hospitalized patients.

Hip and knee arthroplasties place patients at increased risk of developing thromboembolic disease.

REF: P. 213 16. What factors are included in Virchow’s triad? a. Hypercoagulability, venous stasis, venous injury b. DVT, PE, postoperative status c. Total knee or hip replacement and venous stasis

d. None of the above ANS: A

Three factors generally lead to DVT development: hypercoagulability, venous stasis (caused by immobilization, obesity, heart disease), and venous injury (surgery, trauma, and prior DVTs).

REF: P. 214 17. Which noninvasive test is used to diagnosis DVT? a. Homans test b. Peripheral pulse assessment test c. Duplex ultrasonography d. Chest X-ray ANS: C

Duplex ultrasonography is a common noninvasive diagnostic technique for suspected DVT. REF: P. 214 18. What are the common complications of a dislocated deep vein thrombus? a. Loss of pulses in the distal extremity b. Pulmonary infarction, shock, death c. Hard signs of arterial hemorrhage d. Difficulty walking long distances ANS: B

A dislocated deep vein thrombus might travel to the pulmonary artery or obstruct pulmonary blood supply. The result is hypoxia from constriction of the bronchioles. The effect is pulmonary infarction, shock, right heart failure, and occasionally death.

REF: P. 214 19. What is the postoperative treatment of total joint arthroscopy patients to prevent DVT? a. Low-molecular-weight heparin b. Heparin c. Coumadin d. All of the above ANS: D

All three are postoperative prophylactic medications to prevent DVT. REF: P. 214 20. Which nonpharmacologic actions are taken to prevent DVT? a. Antiembolism stockings b. Intermittent pneumatic compression c. Ambulation as soon as possible postoperatively d. All of the above ANS: D

All of the options are employed postoperatively to prevent DVT.

REF: P. 215

Chapter 14: Fundamentals of Normal and Abnormal Gait MULTIPLE CHOICE 1. Which of the following definitions applies to the term stance phase? a. The portion of the gait cycle where the foot is off the ground b. Contact on one foot until contact with the other foot c. Contact with one foot until contact with the same foot d. The portion of the gait cycle where the foot is in contact with the ground ANS: D

The stance phase is defined as the portion of the gait cycle where the foot is in contact with the ground.

REF: P. 221 2. Which of the following definitions applies to the term stride? a. The portion of the gait cycle where the foot is off the ground b. Contact on one foot until contact with the other foot c. Contact with one foot until contact with the same foot d. The portion of the gait cycle where the foot is in contact with the ground ANS: C

Stride is defined as contact with one foot until contact with the same foot in the gait cycle.

REF: P. 221 3. Which of the following is correct about stride? a. Length ranges from 2 to 3 meters in healthy individuals b. Men have longer strides than women c. It is contact of one foot until contact with the other foot d. All of the above ANS: B

Normal strides are 1.33-1.63 meters in healthy individuals. Because stride is defined as ground contact with one foot until contact with the same foot, it is true that men have longer strides than women.

REF: P. 223 4. What determines average walking speed? a. Cadence b. Step width c. Foot progression angle d. Step length e. A and D ANS: E

Walking speed is based on cadence (number of steps per minute) and step length. To increase walking speed, one can increase either or both.

REF: P. 223 5. In the foot, which joint is instrumental to a stable gait? a. Ankle b. First metatarsophalangeal joint c. A and B d. None of the above ANS: B

The first metatarsophalangeal joint hyperextends 45-55° as the ankle actively plantar flexes.

The joint then returns to 0° during the remainder of the gait cycle. A limitation in this passive hyperextension may cause compensations in other joints in the chain.

REF: P. 224 6. Which action in the ankle during normal gait occurs first? a. Ankle dorsiflexion b. Ankle plantar flexion c. Ankle remains in neutral position d. None of the above ANS: B

After contact, the ankle plantar flexes about 5° so that the foot becomes flat on the ground.

Next the tibia rotates over the foot in the stance phase.

REF: P. 224 7. At ground contact, what position is the knee in? a. It is flexed b. It is in full extension c. It is slightly extended d. None of the above ANS: B

The knee is close to full extension at ground contact.

REF: P. 224 8. What is the maximum amount of hip flexion during normal gait? a. 10° b. 20° c. 30° d. 50° ANS: C

The hip is flexed to about 30° at ground contact. This is typically the maximum amount of hip flexion observed during normal gait.

REF: P. 225 9. What happens to a person’s center of mass (COM) during normal gait? a. It stays at the same point throughout normal gait

b. It moves up and down and side to side with normal gait c. It moves up and down with normal gait d. It moves side to side with normal gait ANS: B

Movement of the COM oscillates up and down and from side to side during normal gait (Fig. 14-5).

REF: P. 225 10. During which phase of normal gait does the quadriceps muscle group become activated in

preparation to accept weight during stance?

Preswing Swing Terminal swing Stance

a. b. c. d.

ANS: C

During terminal swing, the quadriceps muscle group begins to become activated in preparation for weight acceptance during stance.

REF: P. 226 11. When is the gluteus maximus active during normal gait? a. The first 20% of the gait cycle b. The first 30% of the gait cycle c. For half of the gait cycle d. For 80% of the gait cycle ANS: B

The gluteus maximus is active during terminal swing to slow the rate of hip flexion and prepare for weight acceptance during stance. The gluteus maximus remains active during the first 30% of the gait cycle.

REF: P. 227 12. Which of the following statements is FALSE about abnormal gaits? a. They increase energy expenditure b. They negatively affect functional independence c. They decrease safety d. They contribute to different gait abnormalities over time e. None of the above ANS: E

All of the items are true about abnormal gaits.

REF: P. 228 13. Which of the following abnormal gaits is characterized by a gait pattern accompanied by pain

when the person leans the trunk toward (hip pain) or away (knee or ankle pain) from the side of painful lower extremity during the stance phase? a. Lateral trunk bending

b. Antalgic gait c. Contralateral pelvis drop d. Anterior trunk lean ANS: B

Antalgic gait is a general term used to describe a gait pattern accompanied by pain. There is an observable reduction in motion at the painful joint as well as asymmetry in gait parameters —typically accomplished by leaning the trunk toward (hip pain) or away (knee or ankle pain) from the side of the painful lower extremity during the stance phase.

REF: P. 229 14. Which of the following abnormal gaits is a compensation for weakness of the hip abductors,

when patients lean toward the stance leg of the weak abductors in order to minimize the force required of the weak muscles to prevent downward movement of the pelvis? a. Lateral trunk bending b. Antalgic gait c. Contralateral pelvis drop d. Anterior trunk lean ANS: A

Lateral trunk bending may be observed among patients attempting to minimize joint compression loads and pain during ambulation. It is observed as a compensation for weakness of the hip abductors.

REF: P. 229 15. Which of the following abnormal gaits is characterized by excessive downward movement of

the pelvis by the swing leg? It occurs as a consequence of a musculoskeletal impairment such as hip abductor weakness or a neuromuscular disease affecting the gluteus medius recruitment. a. Lateral trunk bending b. Antalgic gait c. Contralateral pelvis drop d. Anterior trunk lean ANS: C

Contralateral pelvis drop is most frequently observed as a consequence of a musculoskeletal impairment such as hip abductor weakness or a neuromuscular disease. The hip abductors do not produce enough force to resist the torque created by the weight of the trunk acting medially to the hip joint during the single-leg stance phases of the gait cycle—also known as the Trendelenburg sign.

REF: P. 229 16. Which of the following terms is described as an abnormal gait seen in the stance phase when

the trunk lean is often a compensation for quadriceps weakness. It is commonly seen in poliomyelitis patients. a. Lateral trunk bending b. Antalgic gait c. Contralateral pelvis drop

d. Anterior trunk lean ANS: D

Anterior trunk lean is described as an abnormal gait seen in the stance phase when the trunk lean is often a compensation for quadriceps weakness. It is commonly seen in poliomyelitis patients.

REF: P. 229 17. Which of the following abnormal gaits is described as an indication of decreased ankle range

of motion, with heel rise very shortly after contralateral toe off? It can be a compensatory mechanism for the swing leg or due to decreased leg dorsiflexion range of motion and appears as a bouncy appearance. a. Excessive ankle plantar flexion b. Antalgic gait c. Excessive ankle dorsiflexion d. Increased knee flexion ANS: A

Increased ankle plantar flexion is frequently observed in both the stance and swing phases of the gait cycle—also called vaulting and appears as a bouncing gait.

REF: P. 230 18. Which of the following abnormal gaits is characterized by a person who advances the swing

leg in a lateral semicircular pattern rather than in a straight plane? a. Increased knee flexion b. Hip circumduction c. Antalgic gait d. Excessive ankle plantar flexion ANS: B

Hip circumduction is characterized by a person who advances the swing leg in a lateral semicircular pattern rather than in a straight plane.

REF: P. 231 19. For a patient with an injured left leg using four-point crutch walking, which movement is

made first?

Left crutch, right foot, right crutch, left foot Right crutch, left foot, left crutch, right foot Left foot, left crutch, right crutch, right foot Right crutch, right foot, left crutch, left foot

a. b. c. d.

ANS: B

Right crutch, left foot, left crutch, right foot.

REF: P. 231 20. Which weight-bearing status would be used for a person who is unable to support any weight

on the affected limb? a. Partial weight bearing

b. Touchdown weight bearing c. Toe touch weight bearing d. Non–weight bearing ANS: D

If an injured limb is unable to support any weight, non–weight bearing status is assigned until sufficient healing has taken place to allow the limb to safely accept some degree of weight.

REF: P. 232

Chapter 15: Concepts of Joint and Soft Tissue Mobilization MULTIPLE CHOICE 1. What are the consequences of immobilization on a joint? a. Fatty infiltration b. Articular adhesions c. Loss of strength and tolerance in ligaments d. All of the above ANS: D

Immobilization causes a host of negative consequences such as fatty infiltration, articular adhesions, and physiologic changes to the strength and tolerance of ligaments, tendons, and capsular tissue.

REF: P. 236 2. Which of the following is the definition of range of motion (ROM)? a. Motions that occur in the cardinal planes of movement such as frontal, sagittal, and

transverse b. Motions that are not under voluntary control and are known as glide/slide, spin and

roll c. The active or passive motions of a given joint through one of the traditional

cardinal planes of flexion, extension, abduction, adduction, or internal/external rotation d. None of the above ANS: C

ROM involves physiologic movements that are active/passive motions of a given joint through one of the traditional cardinal planes of flexion, extension, abduction, adduction, or internal/external rotation.

REF: P. 236 3. Where do gliding and sliding occur? a. Where one portion of the articular surface comes into contact with a series of

locations on the corresponding joint surface b. Where a portion of the ligament comes into contact with a muscle in the corresponding location c. Where the joints are totally congruent in close-packed positions d. None of the above ANS: A

Gliding and sliding occur as a specific point on one portion of the articular surface comes into contact with a series of locations on the corresponding joint surface.

REF: P. 237 4. What is joint play? a. The movement of a joint through its normal ROM

b. Motion within the joint as a response to an outside force c. A voluntary movement of the joint through spin, glide, and slide d. Osteokinematic motions in the cardinal planes of movement ANS: B

Joint play is the motion that occurs within the joint as a response to an outside force but not as a result of voluntary movement.

REF: P. 237 5. Which of the following is a close-packed position? a. Elbow bent at a 45°angle b. Knee fully extended. c. Mouth slightly open d. Knee at 45° flexion ANS: B

Table 15-1 describes the close-packed and loose-packed positions. The knee in full extension is a close-packed position.

REF: P. 238 6. Which of the following is a loose-packed position? a. Spine in extension b. Elbow fully extended c. Supination of the midtarsal or tarsometatarsal d. Arm resting by the side in normal physiologic position ANS: D

Table 15-1 describes the close-packed and loose-packed positions. The arm resting by the side in normal physiologic position is a loose-packed position.

REF: P. 238 7. Which joint is ready for mobilization and testing of joint play? a. Spine in extension b. Elbow fully extended c. Arm resting by the side in normal physiologic position d. Knee at 25° flexion e. C and D ANS: E

Mobilization is done with the joint in loose-packed, resting position when the capsule and ligaments are most relaxed and allow the maximum amount of joint play.

REF: P. 237 8. What is the definition of a grade I mobilization? a. A high-velocity thrust of small amplitude at the end of the available ROM b. A large-amplitude motion that occurs from midrange of motion to the end of

available range c. A larger amplitude motion occurring from the beginning of the ROM to near

midrange d. A small oscillation or small amplitude joint motion that occurs only at the beginning of the available ROM ANS: D

A grade I mobilization is a small oscillation or small amplitude joint motion that occurs only at the beginning of the available ROM. REF: P. 238 9. What is the definition of a grade V mobilization? a. A high-velocity thrust of small amplitude at the end of the available ROM b. A large-amplitude motion that occurs from midrange of motion to the end of

available range c. A larger amplitude motion occurring from the beginning of the ROM to near

midrange d. A small oscillation or small amplitude joint motion that occurs only at the beginning of the available ROM ANS: A

A grade V mobilization is a high-velocity thrust of small amplitude at the end of the available ROM. This grade is not applied to mobilization techniques used by physical therapist assistants (PTAs).

REF: P. 238 10. Select the stage of traction technique used to take up the slack and treat pain. a. Stage I b. Stage II c. Stage III d. Stage IV ANS: B

Stage II traction is defined as being able to take up the slack in the capsule of the joint being stretched; it is commonly used to treat pain.

REF: P. 240 11. Select the stage of traction technique that involves stretching the soft tissues. a. Stage I b. Stage II c. Stage III d. Stage IV ANS: C

Stage III traction is more substantial and actually involves stretching the soft tissues.

REF: P. 240 12. Which type of end-feel is described as a hard stretch, elastic resistance, or rising tension? a. Bone-to-bone end-feel b. Soft tissue approximation

c. Springy tissue stretch d. Normal end-feel ANS: C

The hard or springy tissue stretch has a characteristic feature that is elastic resistance or rising tension. The most common normal feel occurs at the end-range of joints. Terminal knee extension and wrist flexion provide a springy stretch that defines tissue stretch.

REF: P. 240 13. Which type of end-feel is described as yielding compression? a. Bone-to-bone end-feel b. Soft tissue approximation c. Springy tissue stretch d. Normal end-feel ANS: B

Soft tissue approximation is a type of joint end-feel characterized by a yielding compression typically encountered with knee or elbow flexion and resulting from muscular tissue compression during joint flexion.

REF: P. 240 14. Which abnormal end-feel is characterized by pain and a sudden halt of movement that

prevents full ROM? Muscle spasm Springy block Loose end-feel Capsular end-feel

a. b. c. d.

ANS: A

A muscle spasm is characterized by pain with a sudden halt of movement that prevents full ROM. REF: P. 240 15. Which abnormal end-feel is characterized by joint hypermobility with no resistance felt at the

end of ROM? Muscle spasm Springy block Loose end-feel Capsular end-feel

a. b. c. d.

ANS: C

Loose end-feel is characterized by joint hypermobility where no resistance is felt at the end of ROM. REF: P. 240 16. Which abnormal end-feel is characterized by a loss of elastic resistance normally encountered

before the normal ROM? a. Muscle spasm

b. Springy block c. Loose end-feel d. Capsular end-feel ANS: D

A capsular end-feel is analogous to a normal tissue stretch, but the elastic resistance is encountered before the normal ROM. REF: P. 240 17. Which of the following noncapsular patterns is described as a displaced or loose cartilaginous

or bony fragment within the joint?

Ligamentous adhesions Internal derangements Extraarticular lesions Normal capsular pattern

a. b. c. d.

ANS: B

Internal derangements are displaced or loose cartilaginous or bony fragments within the joint.

The limitation of movement depends on the location and size of the fragment.

REF: P. 240 18. Which of the following noncapsular patterns is described as a restriction in one direction that

causes pain and limitation of motion? Other motions remain unaffected and pain-free.

Ligamentous adhesions Internal derangements Extraarticular lesions Normal capsular pattern

a. b. c. d.

ANS: A

Ligamentous adhesions frequently cause pain and limitation of motion. There is restriction in one direction, but other motions remain unaffected and pain-free.

REF: P. 241 19. Which of the following patient considerations would be a contraindication for mobilization or

manipulation?

Currently healing fracture Bleeding disorders Connective tissue instability Anticoagulant therapy All of the above

a. b. c. d. e.

ANS: E

All items are contraindications for joint mobilization or manipulation.

REF: P. 241 20. Which of the following interventions can aid in joint mobilization and manipulation? a. Application of heat and/or ultrasound to the joint b. Placing the patient in a comfortable position

c. Placing the joint in a loose-packed position d. Reducing pain prior to mobilization e. All of the above ANS: E

All of the items are PTA interventions that can be performed before joint mobilization or manipulation to promote safe and effective treatment.

REF: P. 242

Chapter 16: Biomechanics and Kinesiology MULTIPLE CHOICE 1. Biomechanics helps the health professional understand the cause and severity associated with

an injury. Which of the following is NOT a factor when determining this? a. Magnitude b. Location c. Direction d. Duration e. Speed ANS: E

Speed is not one of the factors involved when determining the cause and severity of an injury.

The factors are magnitude, location, direction, duration, frequency, variability, and rate.

REF: P. 248 2. Which basic directional term means toward the feet? a. Anterior b. Posterior c. Superior d. Inferior ANS: D

Inferior means toward the feet (Box 16-1).

REF: P. 249 3. Which basic directional term means away from the midline of the body? a. Superficial b. Proximal c. Lateral d. Medial ANS: C

Lateral means away from the midline of the body (Box 16-1).

REF: P. 249 4. Which basic directional term means toward the surface (skin) of the body? a. Superficial b. Anterior c. Proximal d. Superior ANS: A

Superficial means toward the surface (skin) of the body (Box 16-1).

REF: P. 249

5. Which cardinal plane divides the body into right and left parts? a. Transverse b. Frontal c. Sagittal d. Horizontal ANS: C

The sagittal or anteroposterior plane divides the body into right and left parts.

REF: P. 249 6. Which cardinal plane divides the body into front and back parts? a. Transverse b. Horizontal c. Sagittal d. Coronal ANS: D

The coronal or frontal plane separates the body into front and back parts.

REF: P. 249 7. In the correct anatomic position, which way do the palms of the hand face? a. Front, toward the front of the body b. Back, toward the back of the body c. In, toward the thigh d. None of the above ANS: A

Palms face toward the front of the body when in correct anatomic position (Fig. 16-3, A).

REF: P. 249 8. Select the best definition for the term mass (m). a. The resistance that an object offers to a change in its state of motion b. The push or pull acting on an object c. The amount of matter an object possesses within its physical boundaries d. The point at which the weight and mass of an object are equally distributed or

balanced in all directions ANS: C

Mass (m) is the amount of matter an object possesses within its physical boundaries; generally, the denser the material which comprises the object, the greater the mass.

REF: P. 255 9. Select the best definition of the term force (F). a. The resistance an object offers to a change in its state of motion b. The push or pull acting on an object c. The amount of matter an object possesses within its physical boundaries d. The point at which the weight and mass of an object are equally distributed or

balanced in all directions

ANS: B

Force (F) is a push or pull acting on an object. A force has both direction and magnitude, and is commonly expressed in Newtons (N). If sufficient to overcome their inertia, forces applied to objects cause them to accelerate in direct proportion to the magnitude of the force.

REF: P. 255 10. Select the best definition of the term center of mass (COM). a. The resistance an object offers to a change in its state of motion b. The energy by virtue of an object’s motion c. The product of the force and the perpendicular distance from the line of action to

the axis point d. The point at which the weight and mass of an object are equally distributed or

balanced in all directions ANS: D

COM, or center of gravity (COG), is the point within which the weight and mass of an object are equally distributed or balanced in all directions.

REF: P. 249 11. Select the best definition of kinetic energy (KE). a. Energy generated by virtue of the position or shape of an object b. The product of force and the perpendicular distance from the line of action to the

axis point c. Energy by virtue of an object’s motion d. Distribution of a force over a given area ANS: C

Kinetic energy is energy by virtue of an object’s motion. The units for KE are typically expressed as a joule (J)—also seen in units of Newton-meters (N-m).

REF: P. 255 12. Select the best definition of work (W). a. Force  displacement/time b. Force/area c. Mass  velocity d. Force  distance an object moves ANS: D

Work (W) is the product of force and the distance an object moves. If no displacement of the object occurs, even though force may have been applied to the object, no work is done.

REF: P. 255 13. Select the best definition of pressure (p). a. Force  displacement/time b. Force/area c. Mass  velocity d. Force  distance an object moves

ANS: B

Pressure (p) is a measure of the distribution of a force over a given area (force/area).

REF: P. 255 14. Select the best definition of momentum. a. Force  displacement/time b. Force/area c. Mass  velocity d. Force  distance an object moves ANS: C

Momentum is the product of mass and velocity used to determine the outcome of collisions between two objects of mass as well as to determine the ease with which one can stop or change the direction of travel when velocity is present.

REF: P. 255 15. Which of the following is an example of linear motion? a. Rotation of the forearm about the elbow b. Rotation of the shoulder in the golf swing c. Doing a dumbbell curl with the arm d. Swinging a tennis racket ANS: C

Linear motion is the point-to-point, straight-line movement of the body in space. Angular motion is the measurement of rotation about an axis of a rigid lever.

REF: P. 256 16. What is the definition of kinematics? a. The study of applied human anatomy with that of mechanical physics b. The branch of mechanics concerned with the analysis of loads on physical systems c. The study of a body segment experiencing accelerations d. The description of human motion in terms of position, velocity, and acceleration ANS: D

Kinematics is the description of human motion in terms of position, velocity, and acceleration.

REF: P. 256 17. What is the definition of Newton’s first law of motion? a. To every action there is always an opposite and equal reaction. b. The change in motion is proportional to the force impressed and is made in the

direction of the straight line in which that force is impressed. c. A body remains in a state of rest unless it is compelled to change that state by

forces impressed on it. d. Forces responsible for equilibrium are concerned with a normal joint movement

pattern.

ANS: C

Newton’s first law of motion, the law of inertia, states, “A body remains in a state of rest, or of uniform motion in a straight line, unless it is compelled to change that state by forces impressed on it.”

REF: P. 256 18. Select the definition of Newton’s third law of motion. a. To every action there is always an opposite and equal reaction. b. The change in motion is proportional to the force impressed and is made in the

direction of the straight line in which that force is impressed. c. A body remains in a state of rest unless it is compelled to change that state by

forces impressed on it. d. Forces responsible for equilibrium are concerned with a normal joint movement pattern.

ANS: A

Newton’s third law of motion, the law of reaction, states that to every action there is always an opposite and equal reaction; or, the mutual action of two bodies on each other is always equal and directed to contrary parts.

REF: P. 257 19. Select the definition of Newton’s second law of motion. a. To every action there is always an opposite and equal reaction. b. The change in motion is proportional to the force impressed and is made in the

direction of the straight line in which that force is impressed. c. A body remains in a state of rest unless it is compelled to change that state by

forces impressed on it. d. Forces responsible for equilibrium are concerned with a normal joint movement

pattern.

ANS: B

Newton’s second law of motion, the law of acceleration, states that the change of motion is proportional to the force impressed and is made in the direction of the straight line in which that force is impressed.

REF: P. 257 20. Which of the following injuries is caused by shear? a. Stretching of the calf muscles during warm-up exercises b. Vertebral disk problems occurring when lifting a dumbbell c. Epiphyseal fractures in children d. A and B ANS: C

Shear occurs when there are two parallel forces or loads in opposite directions, causing adjacent points on the surface to slide past each other. Examples of shear are injuries such as vertebral disk problems, femoral condyle fractures, and epiphyseal fractures of the distal femur in children.

REF: P. 261

Chapter 17: Orthopedic Management of the Ankle, Foot, and Toes MULTIPLE CHOICE 1. Which of the following injuries are among the most common sports and orthopedic injuries? a. Fractures of the ankle b. Ankle sprains c. Cartilage tears in the ankle d. Twisted ankles ANS: B

Inversion ankle sprains are among the most common sports and orthopedic injuries.

REF: P. 271 2. Which position is the ankle most likely in just before an injury? a. Full weight bearing b. Partial weight bearing c. Non–weight bearing d. All of the above ANS: C

Most commonly, ankle sprains occur with the foot in an unloaded or non–weight-bearing position before injury.

REF: P. 272 3. Using Leach’s classification model, which of the following would be classified as second-

degree ankle sprain?

A completely torn single ligament Completely torn anterior talofibular and fibulocalcaneal ligaments Torn anterior and posterior talofibular and fibulocalcaneal ligaments None of the above

a. b. c. d.

ANS: B

According to Leach’s classification, a second-degree ankle sprain is a double ligament rupture. Both the anterior talofibular ligament and the fibulocalcaneal ligaments are completely torn.

REF: P. 272 4. Using Leach’s classification model, which of the following would be classified as a first-

degree ankle sprain? a. A completely torn single ligament b. Completely torn anterior talofibular and fibulocalcaneal ligaments c. Torn anterior and posterior talofibular and fibulocalcaneal ligaments d. None of the above ANS: A

According to Leach’s classification, a first-degree sprain is a single ligament rupture.

REF: P. 272 5. Which of the following interventions is used in the initial management phase of an acute

inversion ankle sprain?

No weight bearing Partial weight bearing Weight bearing as tolerated Plyometrics

a. b. c. d.

ANS: C

In the initial phase, rest, ice, compression, and elevation (RICE) is done along with weight bearing as tolerated.

REF: P. 274 6. Which of the following interventions is the most effective means to reducing swelling? a. Elevation and compression b. Application of ice and maximum protection c. Casting and ice applications d. Elevation and casting ANS: A

Elevation and compression are the most effective means to reduce swelling. Elasticized wraps and elevation of the limb are the interventions.

REF: P. 274 7. Which of the following interventions are to be avoided during the maximum protection phase? a. Isometric exercises b. Active range of motion (ROM) exercises—plantar flexion and inversion c. Active ROM exercises—dorsiflexion and eversion d. General fitness exercises ANS: B

Active ROM exercise might cause unwanted stress that would disrupt the normal healing process. Plantar flexion or inversion should not be done in the maximum protection phase.

REF: P. 274 8. When does the moderate protection phase begin? a. When the swelling is gone and the patient is pain-free b. When the patient can run short distances with moderate pain c. When the patient can bear weight without crutches but with some pain d. When the pain level decreases to a moderate amount ANS: C

The moderate protection phase can begin when the patient can bear weight on the injured limb without crutches, perform all ROM and isometric exercises without undue pain, and control the swelling.

REF: P. 274

9. How many weeks should an ankle brace be used for running activities after an injury? a. 6-8 b. 8-12 c. 12-26 d. 26-52 ANS: D

Maturation of the injured ligaments can take as long as 6-12 months. Therefore it is critical to encourage patient compliance with the use of either tape or a semirigid brace during all running activities.

REF: P. 275 10. A skier’s ankle is forced into dorsiflexion and the structures supporting the ankle are injured.

Which injury has likely occurred and which test would be diagnostic for the injury?

Deltoid ligament sprain; X-ray High ankle sprain; squeeze test Inversion ankle sprain; talar tilt test Grade III ankle sprain; talar tilt test

a. b. c. d.

ANS: B

High ankle sprains or ankle syndesmosis injuries occur in skiing, football, soccer, and other sports activities when the ankle is forced into dorsiflexion or rotation with the foot in a weight-bearing position. Diagnostic testing includes external rotation and squeeze tests, as well as diagnostic imaging.

REF: P. 277 11. Select the ankle complication that results in laxity of the ankle ligaments. a. Functional instability b. Mechanical instability c. Lifestyle instability d. General instability ANS: B

Mechanical instability is defined as laxity of the ankle ligaments.

REF: P. 277 12. Select the ankle complication that results in the patient feeling that the ankle joint is giving

way without affecting ligament laxity.

Functional instability Mechanical instability Lifestyle instability General instability

a. b. c. d.

ANS: A

Functional instability refers to a subjective feeling of giving way without affecting ligament laxity.

REF: P. 278

13. A subluxing peroneal tendon injury can be acute or chronic. How does this type of injury

occur?

Plantar flexion, inversion, and adduction of the foot and ankle Fracture in the medial or lateral malleolus Dorsiflexion or rotation with the foot in a weight-bearing position Passive dorsiflexion with the foot slightly everted

a. b. c. d.

ANS: D

Subluxing peroneal tendon injuries occur with passive dorsiflexion with the foot slightly everted.

REF: P. 278 14. Inversion ankle sprains occur frequently. How? a. Plantar flexion, inversion, and adduction of the foot and ankle b. Fracture in the medial or lateral malleolus c. Dorsiflexion or rotation with the foot in a weight-bearing position d. Passive dorsiflexion with the foot slightly everted ANS: A

Inversion ankle sprains occur with plantar flexion, inversion, and adduction of the foot and ankle.

REF: P. 272 15. Surgical repair procedures such as bone block, rerouting, periosteal flaps, groove deepening,

and tendon slings are done for which type of ankle injury?

Acute subluxing peroneal tendons Third-degree sprains Chronic subluxing peroneal tendons Achilles tendinopathy

a. b. c. d.

ANS: C

There are five basic types of surgical repair procedures for correction of chronic subluxing peroneal tendons: bone block, rerouting, periosteal flaps, groove deepening, and tendon slings.

REF: P. 279 16. An athlete enters the emergency room complaining of localized pain at the midportion, distal

third, and insertion on the calcaneus. What do you suspect?

Subluxing peroneal tendon Acute ankle sprain Lateral ligament injury Achilles tendinopathy

a. b. c. d.

ANS: D

The primary feature of Achilles tendinopathy is localized pain at the midportion, distal third, and insertion on the calcaneus.

REF: P. 280

17. Which of the following exercises for Achilles tendinopathy are safe without any evidence of

adverse effects?

Ballistic motions Vigorous exercises that stretch the Achilles Standing cord stretches that bounce the Achilles tendon Daily eccentric training exercises

a. b. c. d.

ANS: D

Daily eccentric training for Achilles tendinopathy is a safe activity without any evidence of adverse effects in either midportion or insertional Achilles tendinopathy.

REF: P. 281 18. Which of the following repairs have better success rates and a significant increase in ultimate

recovery of strength, power, and endurance after an Achilles tendon rupture?

Nonoperative treatment with casting for at least 8 weeks Surgical repair of the tendon Immediate initiation of physical therapy with light casting None of the above

a. b. c. d.

ANS: B

Surgically repaired Achilles tendons have a much lower rate of rerupture and there is a significant increase in the ultimate recovery of muscular strength, power, and endurance.

REF: P. 282 19. Why is acute elevated intracompartmental pressure in the lower leg considered a medical

emergency? a. The fracture has not been realigned and the patient’s pain continues to be extreme until the fracture is aligned. b. Ischemia and reduced neuromuscular function can result in permanent damage if left 12 or more hours. c. Ischemia results in continued swelling. d. None of the above ANS: B

Elevated intracompartmental pressure within the lower leg can result in permanent damage.

The physical therapist assistant should immediately report suspected compartmental syndrome.

REF: P. 284 20. What is the treatment for acute compartment syndrome? a. Rest, ice, compression, and elevation (RICE) b. Elevation and compression c. Fasciotomy d. Rest, heat, and pain relievers ANS: C

Treatment for acute compartmental syndrome is a surgical procedure called fasciotomy. For chronic compartment syndrome, rest, antiinflammatories, stretching, and strengthening of the involved muscles and foot orthotic devices may be ordered.

REF: P. 284

Chapter 18: Orthopedic Management of the Knee MULTIPLE CHOICE 1. Which grade of ligament injury occurs when there is a partial loss of ligament fiber continuity

and increased laxity of the joint? a. Grade 1 b. Grade 2 c. Grade 3 d. Grade 4 ANS: B

Grade 2 (second-degree) ligament injuries are characterized by partial loss of ligament fiber continuity, moderate pain and swelling, and some loss of joint dysfunction. There is no grade IV injury.

REF: P. 314 2. Which grade of ligament injury presents with a firm endpoint with no change in laxity

compared with the contralateral knee?

Grade 1 Grade 2 Grade 3 Grade 4

a. b. c. d.

ANS: A

Grade 1 ligament injuries are characterized by little or no pain or swelling and no loss of function.

REF: P. 314 3. Which grade of ligament injury occurs when the entire collagen ligament fiber bundles are

completely torn?

Grade 1 Grade 2 Grade 3 Grade 4

a. b. c. d.

ANS: C

Grade 3 (rupture) is characterized by completely torn fiber bundles and no continuity within the body of the ligament. This is characterized by profound pain, intense swelling, loss of joint function, and instability.

REF: P. 314 4. Which of the following ligaments is generally torn more often in women is responsible for

preventing hyperextension and extreme varus and rotational movements about the knee? a. Anterior cruciate ligament (ACL) b. Medial collateral ligament (MCL) c. Posterior cruciate ligament (PCL)

d. Meniscus ANS: A

The ACL is responsible for preventing hyperextension and extreme varus of the knee as well as rotational movements about the knee; it is ruptured more frequently in women than men.

REF: P. 301 5. Which of the following are beneficial in treating a patient’s pain and swelling following an

acute ACL injury? a. b. c. d.

Electrical stimulation Cryotherapy Compression

All of the above

ANS: D

Cryotherapy, compression, and electrical stimulation may prove beneficial in treating a patient’s pain and swelling following an acute ACL injury.

REF: P. 301 6. Which type of procedure uses the tissue of the patient to fix the injury? a. Autograft b. Allograft c. Autogenous central-third bone–patellar tendon–bone autograft procedure d. A and C only ANS: D

An autograft uses tissue from the body of the patient to fix the injury. An allograft uses tissue from a cadaver.

REF: P. 302 7. When is an ACL graft substitute at its strongest? a. 2 weeks before reconstruction b. At reconstruction c. 2 weeks after reconstruction d. 1 month after reconstruction ANS: B

The ACL graft substitute is at its strongest at the time of reconstruction. Over time the graft undergoes periods of necrosis, revascularization, and remodeling. Graft strength decreases during the period of necrosis and gradually increases as it revascularizes and remodels.

REF: P. 304 8. Following an advanced ACL fixation, at what point can weight bearing begin? a. Immediately b. After 2 weeks c. After 8 weeks d. After 3 months ANS: A

Advanced fixation techniques allow for immediate postoperative weight bearing.

REF: P. 305 9. In the first phase of rehabilitation after ACL reconstruction, appropriate goals include which

of the following?

Return to sport Control of postoperative effusion and quadriceps reeducation Return to normal activities of daily living (ADL) Unilateral closed kinetic chain (CKC) exercises

a. b. c. d.

ANS: B

Control of postoperative effusion and quadriceps reeducation are primary goals in the first phase of rehabilitation after ACL reconstruction. Return to sport, return to normal ADL, and unilateral CKC exercises are goals in the final phase of rehabilitation.

REF: P. 305 10. Which of the following exercises would you avoid in the immediate postoperative phase of

ACL reconstruction rehabilitation? a. Minisquats b. Calf flexibility exercises c. Prolonged standing or walking d. Upper extremity cardiovasular exercises ANS: C

In the immediate postoperative phase of ACL reconstruction rehabilitation, prolonged standing or walking should be avoided.

REF: P. 305 11. Which of the following is NOT a criterion for advancing from the immediate postoperative

phase to the return-to-function phase of reconstructive rehabilitation?

ROM is 0° extension to 125° of flexion Normal gait pattern Ability to ascend an 8-inch step A minimum of 10 weeks from the day of surgery

a. b. c. d.

ANS: D

There is no minimum length of time needed from the day of surgery before progressing to the return-to-function phase of rehabilitation.

REF: P. 305 12. In the immediate postoperative phase of ACL reconstruction rehabilitation, how often is the

use of a compression cold wrap device recommended?

20-30 minutes, several times per day 10-20 minutes, once a day 30 minutes, twice a day 20 minutes, twice a week

a. b. c. d.

ANS: A

A commercial cold wrap devie is recommended for 20 to 30 minutes several times per day in the early postoperative course.

REF: P. 305 13. Which of the following is required to progress from the return-to-function phase to the return-

to-sport phase following ACL reconstruction?

75% or greater limb symmetry on isokinetic testing Return to preinjury functional activities Hamstring and quadriceps control Full weight bearing with the use of one crutch

a. b. c. d.

ANS: A

The criteria that must be met by the patient before progressing to the return-to-sport phase include 75% or greater limb symmetry.

REF: P. 307 14. Which test is used to assess anteriolateral rotational instability? a. Lachman test b. Anterior drawer test c. Pivot shift test d. B and C ANS: C

The pivot shift test is used to assess anteriolateral rotational instability.

REF: P. 301 15. Which of the following exercises is used after clinical testing of the ACL shows the patient

has achieved a 50% weight-bearing status?

Active and passive ROM Leg press Straight leg raising Rocker board

a. b. c. d.

ANS: D

A rocker board proprioception device or dynamic balance system can be used as soon as the patient achieves 50% weight-bearing status.

REF: P. 306 16. Which ligament functions as a primary restraint to posterior displacement of the tibia relative

to the femur?

ACL PCL MCL Meniscus

a. b. c. d.

ANS: B

The PCL functions as a primary restraint to posterior displacement of the tibia relative to the femur.

REF: P. 310 17. Which injury commonly occurs after a fall on a hyperflexed knee or a dashboard injury from a

motor vehicle accident?

ACL MCL PCL Meniscus

a. b. c. d.

ANS: C

The most frequent mechanism of injury in isolated PCL tears is a direct blow on the anterior tibia with the knee flexed position (e.g., motor vehicle accidents involving the knee hitting the dashboard).

REF: P. 310 18. Which is the most accurate test for the integrity of the PCL? a. Hughston jerk test b. Pivot shift test c. Anterior drawer test d. Posterior drawer test ANS: D

The most common and accurate test for the integrity of the PCL is the posterior drawer test.

REF: P. 310 19. Which of the following ligaments is most frequently injured in the knee? a. ACL b. MCL c. PCL d. Meniscus ANS: B

The MCL is the most injured ligament in the knee.

REF: P. 311 20. Which of the following tests is used to describe the severity of an MCL sprain? a. Valgus stress test b. Pivot shift test c. Anterior drawer test d. Posterior drawer test ANS: A

The grade of MCL injury is ascertained by the amount of laxity demonstrated on valgus stress testing.

REF: P. 314

Chapter 19: Orthopedic Management of the Hip and Pelvis MULTIPLE CHOICE 1. What is the most significant complication after hip fracture? a. Postoperative pain b. Postoperative osteonecrosis and avascular necrosis c. Repeat hip fracture d. None of the above ANS: B

Secondary to the location and severity of hip fracture, the most significant complication is related to osteonecrosis and the loss of blood supply to the femoral head, leading to avascular necrosis.

REF: P. 348 2. Which of the following is NOT a main clinical complication noted with subtrochanteric

fractures?

Malunion Delayed union Nonunion Refracture of the femur

a. b. c. d.

ANS: D

The three main clinical complications noted with subtrochanteric fractures are malunion, nonunion, and delayed union.

REF: P. 349 3. Which of the following patient characteristics are considered when determining the type of

hip fracture repair to be done?

Age, location of the fracture, quality of the bone Severity of the fracture, activity level of the patient before fracture Goals for the patient’s return to activity All of the above

a. b. c. d.

ANS: D

All of these are factors in deciding which type of treatment a patient with a hip fracture will need.

REF: P. 349 4. How would a hip dislocation generally be treated? a. Bed rest, traction, protected limited weight bearing for 12 weeks b. Open reduction with internal fixation (ORIF) with bed rest and protected weight

bearing for 3-4 weeks c. ORIF with limited weight bearing for 2-3 weeks d. Bed rest, casting, and limited exercise for 12 weeks ANS: A

Isolated hip dislocations generally are treated conservatively with bed rest, traction, and protected limited weight bearing for up to 12 weeks.

REF: P. 349 5. Select the risk factors that predict failure to achieve overall postoperative hip surgery success. a. Cardiovascular or pulmonary diseases b. Obesity and osteoporosis c. Dementia and poor upper body strength d. All of the above ANS: D

The patient’s overall preoperative physical and mental condition is a predictor of postoperative success. Patients with cardiovascular or pulmonary diseases, obesity, osteoporosis, dementia, and poor upper body strength are at increased risk for postoperative complications.

REF: P. 349 6. What is the overall mortality of hip fracture patients 6 years postoperatively? a. 20% b. 50% c. 60% d. 70% ANS: C

Only 20-35% of patients regain their preinjury level of independence. Overall mortality of 20% at 1 year, 50% at 3 years, 60% at 6 years, and 77% at 10 years has been reported.

REF: P. 350 7. In the maximum protection phase after hip surgery, which of the following treatments are

performed by the physical therapist assistant (PTA)? a. Isometric exercises, gentle protected range of motion (ROM) exercise, limited

weight bearing, isometric quadriceps sets, gluteal sets, and heel slides b. Partial wall squats and step-ups c. Pool walking d. Treadmill and gait exercises ANS: A

In the early maximum protection phase, isometric exercises, gentle protected ROM exercise, limited weight bearing, isometric quadriceps sets, gluteal sets, and heel slides are done.

REF: P. 350 8. Which of the following procedures are done for degenerative joint disease (DJD) when it is

extensive and the patient has pain from subchondral bone erosion, articular cartilage fibrillation, and hip joint incongruity? a. ORIF b. Conservative treatment (bed rest) c. Proximal femoral osteotomy d. Total hip replacement

ANS: C

Proximal femoral osteotomy is done when DJD is extensive and results in hip pain from subchondral bone erosion, articular cartilage fibrillation, and hip joint incongruity.

REF: P. 351 9. What guides the physical therapist (PT) in deciding the type of weight bearing a postoperative

proximal femoral intertrochanteric osteotomy patient should use?

The amount of pain the patient is having The rate and quality of the bone healing The patient’s request to stop using the walker The number of weeks since the patient had surgery

a. b. c. d.

ANS: B

Weight-bearing status is highly individualized; it progresses according to the rate and quality of bone healing.

REF: P. 351 10. What criterion does the PT use to determine bone healing following hip surgery? a. Patient’s statement that the hip feels better b. Strength of the limb in walking exercises c. An X-ray that suggests secure bone healing d. A healed surgical wound and decreased swelling in the hip ANS: C

Once radiographic evidence suggests secure bone healing and the physician approves, more challenging and intense strengthening exercises are added gradually after hip surgery.

REF: P. 352 11. In which of the following types of hip surgeries is the femoral head and the acetabulum

replaced? a. ORIF b. Total hip arthroplasty (THR) c. Hemiarthroplasty d. Femoral osteotomy ANS: B

THR involves replacing both the femoral head and the acetabulum.

REF: P. 355 12. Select the most common serious complication(s) related to THR. a. Postoperative hip dislocation b. Persistent thigh pain c. Deep vein thrombosis (DVT) d. All of the above ANS: D

DVT is a form of thromboembolic disease. This and persistent thigh pain are the common complications of THR, with DVT of more serious nature.

REF: P. 355 13. Your patient had a lateral total hip replacement a week ago. You enter the room and find the

patient on her back with the abduction wedge between her knees. What is your next action?

Remove the wedge and reposition the patient observing universal hip precautions Nothing, the patient is in a good position Place the hip in 90° of flexion Place the affected hip in internal rotation

a. b. c. d.

ANS: B

Using universal hip precautions, this patient is in the proper position. You would not remove the wedge, flex the hip 90°, or rotate the hip internally.

REF: P. 356 14. Your patient had an anterior surgical approach to a total hip replacement. Which of the

following positions in the affected hip are avoided in an anterior approach versus a posterolateral or lateral approach following surgery? a. Hip adduction b. Hip extension and external rotation c. Hip flexion > 90° d. Hip internal rotation ANS: B

If an anterior surgical approach is used, combined hip extension and external rotation should be avoided.

REF: P. 356 15. When can the moderate protection phase begin for hip replacement patients? a. When they show no pain and can ambulate with full weight bearing b. When they demonstrate quadriceps control and active knee flexion c. When they show compliance with all hip precautions d. B and C ANS: D

The moderate protection phase can begin when a patient has demonstrated improved quadriceps control, active knee flexion, reduced pain, compliance with all precautions and exercises, independent bed mobility and transfers, and improved gait.

REF: P. 357 16. When can total hip precautions be stopped? a. When the PTA determines the patient’s strength and flexibility have returned to

normal b. When the patient decides that he has enough strength and control in the quadriceps

muscle to balance appropriately c. When the doctor elects to discontinue the total hip replacement precautions d. When the PT determines the patient has enough quadriceps strength and control ANS: C

THR precautions are stopped by order of the doctor.

REF: P. 358 17. Which disease is characterized by a noninflammatory, self-limiting syndrome where the

femoral head becomes flattened at the weight-bearing surface?

Complete hip fracture Osteoarthritis of the hip Rheumatoid arthritis of the hip Legg-Calvé-Perthes disease

a. b. c. d.

ANS: D

Legg-Calvé-Perthes disease or coxa plana occurs in the growing child and is characterized as a noninflammatory, self-limiting syndrome in which the femoral head becomes flattened at the weight-bearing surface as a result of disruption of the blood supply to the femoral head.

REF: P. 360 18. Which of the following terms is described as chronic pain in the region of the pubic tubercle

and inguinal region resulting from athletic involvement and includes lower abdominal pain as a symptom? a. Arthralgia b. Pubalgia c. Bursitis d. Osteitis pubis ANS: B

Pubalgia is a collective term for all disorders causing chronic pain in the region of the pubic tubercle and inguinal region.

REF: P. 360 19. Which of the following terms describes pain and bony erosion of the symphysis pubis

characterized with pain aggravated by striding, kicking, or pivoting?

Arthralgia Pubalgia Bursitis Osteitis pubis

a. b. c. d.

ANS: D

Osteitis pubis is characterized by pain and bony erosion of the symphysis pubis.

REF: P. 361 20. Which of the following interventions must NOT be done during the maximum protection

phase following a hamstring strain?

Tolerated cardiovascular conditioning exercises Aggressive stretching program for the hamstrings Full knee extension Full leg flexion B, C, and D

a. b. c. d. e.

ANS: E

Aggressive stretching, full knee extension, and full leg flexion should be avoided in the maximum protection period following a hamstring strain. Tolerated cardiovascular conditioning is the exception.

REF: P. 362

Chapter 20: Orthopedic Management of the Lumbar, Thoracic, and Cervical Spine MULTIPLE CHOICE 1. Which part of the spinal column provides the greatest portion of shock absorption? a. Vertebral arch b. Vertebral body c. Annulus d. Nucleus pulposus ANS: B

The greater portion of shock absorption comes from the vertebral body.

REF: P. 375 2. Which of the following motions is normal for the spine? a. Flexion b. Extension c. Lateral flexion d. Rotation e. All of the above ANS: E

Spinal motions include flexion, extension, lateral flexion, and rotation.

REF: P. 375 3. Which region of the spine serves to support the weight of the upper body and dissipate

compressive loads?

Cervical Thoracic Lumbar Sacral

a. b. c. d.

ANS: C

The lumbar spine serves to support the weight of the upper body and dissipate compressive loads with minimal production of muscular torque.

REF: P. 375 4. Select the activity that produces the highest amount of disk pressure. a. Lifting with a flexed torso b. Sitting with knees straight out in front of body c. Isometric abdominal exercises d. A and B e. All of the above ANS: D

Isometric abdominal sets produce 110 kg of pressure; lifting with a flexed torso and knees held straight produces 340 kg of intradiscal pressure.

REF: P. 375 5. Select the injury whose short- and long-range goals for recovery emphasize protecting the

spine from unwanted forces and positions?

Ligament sprains Muscle strains Both A and B Neither A nor B

a. b. c. d.

ANS: C

Ligament sprains and strains both have the short- and long-term goal of protecting the spine from unwanted forces and positions.

REF: P. 377 6. Which one of the following injuries produces the symptoms of pain and paresthesias, strength

loss in a myotomal distribution, and sensory loss in a dermatomal pattern, found during a physical examination by the physical therapist, and caused by inflammation of a nerve root? a. Muscle sprain b. Muscle strain c. Radiculopathy d. Spondylolysis ANS: C

Radiculopathy is defined as mechanical compression or inflammation of a nerve root that causes neurologic symptoms into the lower extremities. This can be caused by encroachment on the spinal nerve root by osteophytes or a large disk herniation.

REF: P. 377 7. Which of the following is an age-related degenerative change within the disk? a. Increased hydration b. Increased water content to 88% by age 30 c. Decrease in collagen d. Biochemical changes in the glycosaminoglycans of the nucleus ANS: D

The disk loses hydration and increases in collagen, and has biochemical changes in the glycosaminoglycans.

REF: P. 377 8. Which diagnosis is described as a stress fracture or fracture in the pars interarticularis? a. Spondylolisthesis b. Spondylolysis c. Muscle strain d. Radiculopathy ANS: B

Spondylolysis is a bony defect (stress fracture or fracture) in the pars interarticularis of the posterior elements of the spine.

REF: P. 378 9. Which classification of spondylolisthesis is defined as degenerative spondylolisthesis, occurs

in older adults, and is characterized by a loss of ligament integrity (or stability) that results in forward slippage of the vertebrae? a. Type I b. Type II c. Type III d. Type IV ANS: C

Type III is degenerative spondylolisthesis, common in the older population and generally associated with the normal aging process.

REF: P. 379 10. Which classification of spondylolisthesis is defined as pathologic and is characterized by bone

tumors that affect the pars interarticularis?

Type II Type III Type IV Type V

a. b. c. d.

ANS: D

Type V is a pathologic spondylolisthesis.

REF: P. 379 11. What is another term for spondylosis? a. Decompression of the spine b. Osteoarthritis of the spine c. Grade V bone tumor of the spine d. Spinal stenosis ANS: B

Spondylosis is defined as osteoarthritis of the spine. Radiographic findings might include bone spurring and osteophytes as well as fusing of the adjacent levels in advancing stages.

REF: P. 379 12. Which spinal diagnosis is described by a narrowing of the spinal canal that constricts nerve

roots and results in radicular ache in the thigh, paresthesias into the leg, and disturbances in motor function? a. Lumbar spondylosis b. Lumbar spine fracture c. Spondylolisthesis d. Spinal stenosis ANS: D

Lumbar spinal stenosis is defined as a narrowing of the spinal canal, which constructs and compresses nerve roots. The symptoms include radicular ache into the thigh, paresthesias into the leg, and disturbances in motor function.

REF: P. 380 13. Your 80-year-old patient complains of pain doing daily activities such as lifting or rising from

a chair. She has a diagnosis of osteoporosis and is in therapy for the back pain. What diagnosis would you consider first? a. Compression fracture b. Spondylolisthesis c. Spinal stenosis d. Muscle sprain ANS: A

Benign activities can produce compression fractures in an elderly population of patients with osteoporosis. Complaints of pain caused by typical daily activities such as bending, lifting, or rising from a chair must be viewed with a high level of suspicion in elderly patients.

Treatment focuses on relief of pain.

REF: P. 380 14. Which subgrouping of the treatment-based classification (TBC) would most likely apply to a

client with chronic or recurring symptoms of low-back pain, an average straight leg raise > 91°, and the presence of aberrant motions? a. Manual therapy and exercise b. Specific exercise for directional preference c. Traction d. Neuromuscular reeducation and stabilization exercise e. Aerobic exercise ANS: D

Patients with more chronic or recurring symptoms of low-back pain are managed with neuromuscular reeducation and stabilization exercise.

REF: P. 381 15. Which subgrouping of the TBC would apply to a client with back pain for a short period of

time, no symptoms distal to the knee, and low fear avoidance?

Manual therapy and exercise Specific exercise for directional preference Traction Neuromuscular reeducation and stabilization exercise Aerobic exercise

a. b. c. d. e.

ANS: A

Some patients with acute or chronic low-back pain benefit from first restoring mobility in the spine; therefore, these patients will initially be placed in the manual therapy and exercise category. These patients have short duration of symptoms (less than 2 or 3 weeks), no symptoms distal to the knee, and low fear avoidance behaviors.

REF: P. 381 16. Following microsurgical diskectomy or automated percutaneous diskectomy, what technique

does the patient use to turn in bed or move from a supine to sitting position?

a. b. c. d.

Total lift by two people Assistance to standing by two people Log roll Independent movement and sitting

ANS: C

After surgery, the patient is taught bed mobility and transfer training using the log roll technique to move from a supine to sitting position.

REF: P. 382 17. Which of the five Ls refers to the amount of weight to be hoisted by an individual? a. Load b. Lever c. Lordosis d. Legs e. Lungs ANS: A

The load to be lifted is central to all concepts of lifting mechanics. The amount of weight to be hoisted should be appropriate to the task and the individual attempting to lift it.

REF: P. 383 18. Which of the following people would be ideal candidates for back training (back school)? a. An 18-year-old high school athlete who works part time at the local hardware store b. A 35-year-old nurse who works on an orthopedic unit c. A 45-year-old employee at an airport who loads and unloads baggage d. All of the above ANS: D

All are ideal candidates for back school because they demonstrate at-risk characteristics such as job responsibilities, repetitive lifting, poor body mechanics, or poor general conditioning.

REF: P. 383 19. Which of the following terms applies to the quantifiable system of job or activity of daily

living (ADL) modification (or redesign) that allows for continued productivity while reducing work-related physical stress? a. Ergonomics b. Physical capacity assessments c. Physical therapy d. None of the above ANS: A

The term ergonomics refers to a quantifiable system of job or ADL modification (or redesign) that allows for continued productivity while reducing work-related physical stress.

REF: P. 384 20. Which of the following terms is defined as an increase in the thoracic posterior convexity that

is manifested by a rounded-back (protracted scapulae) posture?

a. b. c. d.

Kyphosis Lordosis Scoliosis Cervical radiculopathy

ANS: A

Kyphosis is defined as an increase in the thoracic posterior convexity that is manifested by a rounded-back (and protracted scapulae) posture.

REF: P. 387

Chapter 21: Orthopedic Management of the Shoulder MULTIPLE CHOICE 1. Which of the following anatomic parts belongs to the osteology of the shoulder? a. Glenohumeral, acromioclavicular (AC), sternoclavicular articulation b. Labrum, glenohumeral ligament, glenohumeral capsule c. Humerus, clavicle, scapula d. All of the above ANS: C

Osteology (bone) consists of the humerus, the clavicle, and the scapula.

REF: P. 398 2. Which of the following anatomic parts belongs to the “arthrology” structures of the shoulder? a. Glenohumeral, AC, sternoclavicular articulation b. Labrum, glenohumeral ligament, glenohumeral capsule c. Humerus, clavicle, scapula d. All of the above ANS: A

Arthrology (joints) consist of glenohumeral, AC, and sternoclavicular articulation.

REF: P. 398 3. Which of the following anatomic parts are passive stabilizing structures of the shoulder? a. Glenohumeral, AC, sternoclavicular articulation b. Labrum, glenohumeral ligament, glenohumeral capsule c. Humerus, clavicle, scapula d. All of the above ANS: B

Support and stability of the shoulder are provided by the labrum, glenohumeral ligament, and the glenohumeral capsule.

REF: P. 398 4. Your 35-year-old patient has fibrosis and tendinitis of the shoulder with pain predominantly at

night. Select this patient’s stage of rotator cuff impingement.

Stage I Stage II Stage III Stage IV

a. b. c. d.

ANS: B

Stage II is the fibrosis and tendinitis stage, which is irreversible because of long-term repeated stress. Pain is the predominant feature and occurs with daily activities and particularly at night.

REF: P. 400

5. Your 60-year-old patient has tendon degeneration and rotator cuff rupture after playing 18

holes of golf. Which stage of rotator cuff impingement does the patient have?

Stage I Stage II Stage III Stage IV

a. b. c. d.

ANS: C

Stage III affects people over 40 and is characterized by tendon degeneration, rotator cuff tears, and rotator cuff ruptures. It is associated with a long history of repeated shoulder pain and dysfunction, as well as significant muscle weakness and atrophy.

REF: P. 400 6. Which phase of nonoperative treatment of impingement and symptomatic rotator cuff tears

focuses on modifying activities of daily living (ADL), management of pain and swelling, and stretching exercises to increase blood flow? a. Phase I b. Phase II c. Phase III d. Phase IV ANS: A

Phase I, the prefunctional phase, focuses on relief of symptoms and initiating exercises to improve or maintain motion. Modifications in ADL and management of pain and swelling are characteristic of this phase.

REF: P. 401 7. Which phase of nonoperative treatment of impingement and symptomatic rotator cuff tears

focuses on progressive resistive strengthening via increased resistance while using open kinetic chain exercises? a. Phase I b. Phase II c. Phase III d. Phase IV ANS: B

Phase II (return to function) focuses on progressive resistive strengthening via increased resistance while using open kinetic chain exercises.

REF: P. 402 8. Which of the following interventions occur in phase I of rehabilitation after a subacromial

decompression (SAD)? a. Pain control, ice packs, ultrasound, phonophoresis, manual range of motion

(ROM) exercises b. Strengthening with TheraBand, dumbbell isotonic concentric and eccentric exercises c. Progressive resistive exercises

d. Bodyblade® ANS: A

Initially the postoperative patient is treated with pain control, ice, ultrasound, and phonophoresis. The other interventions come later in phase II. REF: P. 403 9. For postoperative SAD patients with massive rotator cuff tears, how many weeks must a

patient wait before performing active motion or active concentric or eccentric strengthening?

2 4 8 24

a. b. c. d.

ANS: C

The prefunctional phases of passive or manual control motion are extensive for rehabilitation after surgical repair of massive rotator cuff tears. Generally, no active motion or active concentric or eccentric strengthening is allowed for 2-3 months after surgery.

REF: P. 404 10. For postoperative SAD patients, how many weeks does the PTA need to wait to introduce

progressive motion, dumbbell isotonic concentric and eccentric exercises, and short-arc painfree ROM exercise? a. 2-4 b. 5-12 c. 14-26 d. Not at all during rehabilitation ANS: B

In phase II (return to function, 5-12 weeks postoperative), progressive motion is used along with resistance band strengthening, dumbbell isotonic exercises, and short-arc pain-free ROM exercise.

REF: P. 404 11. Which of the following exercises are performed only in phase III (return to activity) following

SAD and rotator cuff repair?

Scaption, prone, horizontal abduction, press ups, and seated rows Manual ROM, isometric submaximal muscle sets of the shoulder extenders Shoulder hike, dumbbell isotonic concentric and eccentric exercises All of the above

a. b. c. d.

ANS: A

Phase III begins when the patient can demonstrate normal motion without symptoms and with improved strength. During this phase, the following exercises are introduced: scaption, prone, horizontal abduction, press ups, and seated rows.

REF: P. 404 12. Select the correct definition of a Bankart lesion.

a. An impact fracture of the posterolateral aspect of the humeral head as a result of

anterior shoulder instability b. An avulsion of the capsule and glenoid labrum off of the anterior rim of the

glenoid resulting from traumatic anterior dislocation of the shoulder c. Formation of fibrous synovial adhesions causing the reduction of the joint cavity,

pain, and inflammation d. Partial tearing of the AC ligaments with no resulting joint instability or laxity of

the ligament and minimal loss of function ANS: B

A Bankart lesion is an associated injury from shoulder dislocation and is defined as an avulsion of the capsule and glenoid labrum off of the anterior rim of the glenoid resulting from traumatic anterior dislocation of the shoulder.

REF: P. 405 13. Select the best definition of a Hill-Sachs lesion. a. An impact fracture of the posterolateral aspect of the humeral head as a result of

anterior shoulder instability b. An avulsion of the capsule and glenoid labrum off of the anterior rim of the

glenoid resulting from traumatic anterior dislocation of the shoulder c. Formation of fibrous synovial adhesions causing the reduction of the joint cavity,

pain, and inflammation d. Partial tearing of the AC ligaments with no resulting joint instability or laxity of

the ligament and minimal loss of function ANS: A

A Hill-Sachs lesion is a compression or impaction, fracture of the posterolateral aspect of the humeral head as a result of anterior shoulder instability.

REF: P. 405 14. How many weeks does the nonoperative protection phase last for a 20-year-old with an acute

anterior shoulder dislocation?

2-4 4-6 6-8 8-10

a. b. c. d.

ANS: B

The initial management of acute shoulder dislocations calls for a period of protection lasting up to 4-6 weeks.

REF: P. 405 15. In the prefunctional stage following a shoulder dislocation, what signs does a PTA look for in

a patient to determine whether or not exercises can be progressed? a. Decrease in pain b. Decrease in swelling c. Improved strength d. All of the above

ANS: D

The physical therapist and the physical therapist assistant (PTA) look for decreased swelling, pain, and improved strength to determine how and when to progress the patient’s exercises.

REF: P. 405 16. A patient having postdislocation of the shoulder therapy is having difficulty with isotonic

resistance exercises for the glenohumeral joint. What should the PTA do?

Continue working with the same exercises until the patient builds strength Return to lower level, or earlier exercises, until the patient builds strength Modify the exercises to accommodate limitations of motion and pain All of the above

a. b. c. d.

ANS: C

Isotonic resistance exercises are quite challenging and stressful to the glenohumeral joint.

Consequently, many appropriate exercises must be modified to accommodate limitations of motion, pain, and the provocative positions of abduction and external rotation.

REF: P. 406 17. Which patient would likely receive surgery to repair a shoulder dislocation? a. A 30-year-old with a first-time shoulder dislocation b. A 40-year-old with a repeated anterior shoulder dislocation that does not respond

to therapy c. A 20-year-old with subluxation and recurrent anterior instability d. B and C e. All of the above ANS: D

Repeated episodes of shoulder dislocation or subluxation can result in anterior instability.

Patients failing to respond to an aggressive physical therapy program can have surgical repair to correct the instability.

REF: P. 407 18. In general, how many months are needed to recover from open shoulder stabilization surgery

and finish the return to activity phase?

2-3 3-5 5-7 7-12

a. b. c. d.

ANS: B

Generally, the total length of rehabilitation after surgical stabilization of the glenohumeral joint ranges from 3 to 5 months.

REF: P. 409 19. Which of the following diagnoses is characterized by a decrease in shoulder ROM, pain,

inflammation, fibrous synovial adhesions, and reduction of the joint cavity? a. Rupture of the shoulder tendons b. Dislocation

c. Adhesive capsulitis d. Shoulder fracture ANS: C

Adhesive capsulitis, or frozen shoulder, is characterized by decreased shoulder ROM, pain, inflammation, fibrous synovial adhesions, and reduction of the joint cavity. It occurs in patients 40-60 years of age and in women more often than men.

REF: P. 409 20. Which of the following grades of ligamentous structure in the shoulder is defined by complete

rupture of the AC ligaments with partial tearing of the coracoacromial ligaments?

First degree, grade I Second degree, grade II Third degree, grade II Fourth degree, grade IV

a. b. c. d.

ANS: B

A second-degree, grade II AC sprain is characterized by complete rupture of the AC ligaments with partial tearing of the coracoacromial ligaments.

REF: P. 410

Chapter 22: Orthopedic Management of the Elbow MULTIPLE CHOICE 1. Which of the following injuries occurs from repetitive overuse and affects the common wrist

extensor origin of the extensor carpi radialis longus and brevis, and extensor digitorum and digiti minimi? a. Lateral epicondylitis b. Medial epicondylitis c. Medial valgus stress overload d. Fracture of the distal humerus ANS: A

Lateral epicondylitis (tennis elbow) affects the common wrist extensor origin of the extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, and extensor digiti minimi. Repetitive overuse of this area leads to tendinitis of the origin of the extensor carpi radialis brevis tendon.

REF: P. 418 2. Which of the following injuries occurs from overuse and affects the origin of the pronator

teres, flexor carpi radialis, and the flexor carpi ulnaris?

Lateral epicondylitis Medial epicondylitis Medial valgus stress overload Carpal tunnel syndrome

a. b. c. d.

ANS: B

Medial epicondylitis, an overuse condition, affects the origin of the pronator teres, flexor carpi radialis, flexor digitorum sublimis, and flexor carpi ulnaris at the medial epicondyle of the elbow.

REF: P. 420 3. Why is early protection needed following the diagnosis of lateral epicondylitis? a. The patient is in a high degree of pain and movement worsens the pain b. The elbow is inflamed and movement will cause more inflammation c. Excessive tissue scarring and random collagen fiber alignment would limit normal

motion and function of the elbow and wrist d. Active and passive range of motion (ROM) exercises for the elbow and wrist are

needed from the splinted position ANS: C

Without early protection (splint, not rigid immobilization), excessive tissue scarring and random collagen fiber alignment would severely limit normalized motion and function of the elbow and wrist.

REF: P. 419

4. In the initial healing stage, what actions does the physical therapist assistant (PTA) take to

promote healing in lateral epicondylitis? a. Encourage the patient to use the elbow and wrist normally b. Make short-term modifications in activities of daily living (ADL) and job-related

activities c. Encourage exercises such as holding a hammer at the end of the shaft to promote

greater control, strength, and torque d. Encourage the patient to work through the pain to promote healing ANS: B

During the initial healing stage of lateral epicondylitis, the PTA must encourage the patient to avoid any and all motions that may adversely affect healing. Short-term modification in ADL, sports, and job-related activities must be addressed to provide a pain-free environment for healing.

REF: P. 419 5. How can the PTA enhance the effectiveness of low-load, long-duration static stretching? a. Premedicate the patient with nonsteroidal antiinflammatory drugs (NSAIDs)

before to treatment b. Use moist heat or ultrasound c. Use prestretching exercises that are pain-free d. None of the above ANS: B

The PTA can enhance the effectiveness of low-load, long-duration static stretching by applying moist heat packs or ultrasound to the lateral epicondyle to stimulate local circulation and relieve congestion caused by metabolic waste products and relax soft tissues in preparation for stretching.

REF: P. 419 6. What does the counterforce brace do for the patient with lateral epicondylitis? a. Provides support to the upper arm when performing routine activities b. Dissipates the overload forces on the origin of the wrist extensors c. Provides a reminder to the patient to perform activities and sports carefully to

prevent further injury to the wrist extensors d. Supports the forearm during sports activities ANS: B

With a gradual return to functional activities, some doctors and therapists advocate the use of a counterforce brace (Fig. 22-3, D) to help dissipate the overload forces on the common origin of the wrist extensors.

REF: P. 419 7. What does the PTA do in the case of a patient in the acute phase of the inflammatory overuse

condition known as medial epicondylitis? a. Protect the elbow from further injury with a cast for immobilization and provide

isometric exercises b. Focus on ice to protect the ulnar nerve, phonophoresis, and relative active rest

c. Provide resistance training with submaximal isometrics d. Instruct the client to actively use the shoulders and follow a conditioning program ANS: B

Management in the acute phase of medial epicondylitis (golfer’s elbow) concentrates on the management of pain and swelling. Usually the doctor prescribes NSAIDs, ice, phonophoresis or iontophoresis, relative rest (not immobilization), protection, and gentle active motion exercises.

REF: P. 421 8. What is the normal degree of flexion for the elbow? a. 20-100 b. 0-145 c. 75-85 d. 30-130 ANS: B

The normal elbow ROM is 0-145 of flexion.

REF: P. 421 9. Which of the following injuries are you more likely to see in a baseball pitcher versus a

golfer?

Lateral epicondylitis Medial epicondylitis Medial valgus stress overload Lateral collateral ligament injury

a. b. c. d.

ANS: C

Injuries to the elbow often occur in athletes who practice a repetitive overhead motion involved in throwing, which is responsible for unique and sport-specific patterns of injuries to the elbow. Chronic stress overload or repetitive microtraumatic stress is observed during pitching and results in medial valgus stress overload. It also occurs with javelin throwers and players of racquet ball and tennis.

REF: P. 422 10. What recommendations should a PTA make to a patient experiencing medial valgus stress

overload? a. Return to normal sports activities as soon as the pain and swelling are gone b. Rest and protect the injured elbow by omitting the activities that produce medial valgus stress c. Exercise the wrist, hand, and shoulder of the affected arm regularly d. B and C ANS: D

The wrist, hand, and shoulder of the affected limb must be exercised during each phase of recovery. The athlete should rest and protect the injured elbow by omitting activities that produce medial valgus stress.

REF: P. 422

11. Which of the following measures are taken to regain full elbow extension in patients having

difficulty achieving full extension? a. Flexion/extension ROM exercises more frequently during therapy b. Pretherapy treatment with phonophoresis and active range of motion (AROM)

exercises for the affected elbow c. Low-load, long-duration stretches d. None of the above ANS: C

If a patient continues to have difficulty achieving full extension using ROM and mobilization techniques, a low-load, long-duration stretch may be performed to produce a deformation (creep) of the collagen tissue, resulting in tissue elongation.

REF: P. 423 12. When does nonoperative rehabilitation for a lateral collateral ligament injury begin? a. Immediately b. 2-5 weeks after injury c. 4-8 weeks after injury d. 12 weeks after injury ANS: A

Nonoperative rehabilitation should begin immediately following the traumatic event. The focus of rehabilitation is to restore ROM within the limits of elbow stability.

REF: P. 426 13. Following surgical repair for a lateral collateral ligament injury, after how many weeks can

full passive range of motion (PROM) be expected?

2-4 4-6 6-8 8-10

a. b. c. d.

ANS: D

Full PROM may be expected by 8-10 weeks postoperatively. If full ROM has not been achieved, then the LLLD guidelines can be used to assist in obtaining the remaining ROM. REF: P. 426 14. When can an athlete anticipate returning to an interval sports program following surgery for a

lateral collateral ligament injury?

2 months 4 months 6 months 8 months or longer

a. b. c. d.

ANS: B

Beyond week 16, the patient is reassessed to determine strength levels before progressing to an interval sports program.

REF: P. 427 15. How many weeks is a distal humerus fracture typically immobilized? a. 2 b. 4-6 c. 10 d. 12 or more ANS: B

The most common treatment of distal humerus fractures is closed reduction and immobilization for 4-6 weeks.

REF: P. 427 16. What complication of distal humerus fracture results from arterial and venous obstruction that

might not be noticed until the end of immobilization?

Comminuted fracture with deformity Malunion Nonunion Volkmann ischemic contracture

a. b. c. d.

ANS: D

The most disastrous complication results from vascular compromise. As the fracture fragments are displaced, hemorrhage beneath the deep fascia produces an ischemic injury that creates an arterial and venous obstruction. This leads to Volkmann ischemic contracture (Fig. 22-11).

REF: P. 427 17. Which of the following is NOT a symptom indicating vascular obstruction? a. Severe pain in the forearm muscles b. Limited and extremely painful finger movement c. Purple discoloration of the hand with prominent veins d. Loss of the radial pulse and loss of capillary return e. Complaints of pain in the shoulder ANS: E

The six symptoms of vascular obstruction from a distal humerus fracture are severe pain in the forearm muscles, limited and extremely painful finger movement, purple discoloration of the hand with prominent veins, loss of the radial pulse and capillary refill, and pallor, anesthesia and paralysis of the extremity. This is a medical emergency.

REF: P. 428 18. An 18-year-old patient comes to therapy complaining of painful finger movement and

numbness in her forearm and hand. What would you do first?

Notify the physical therapist (PT).

Explain that this is a normal side effect of having a cast on the arm.

Elevate the extremity and perform gentle ROM exercise on the affected hand.

Continue with the prescribed therapy.

a. b. c. d.

ANS: A

This patient has the signs of vascular obstruction. The PT should be notified immediately to assess and treat the patient.

REF: P. 428 19. Which fracture of the elbow may be commonly seen in someone who fell on an outstretched

arm?

Radial head T or Y Distal humerus Shoulder

a. b. c. d.

ANS: A

Another common fracture that occurs as a result of a fall on an outstretched arm is a radial head fracture.

REF: P. 428 20. For how many weeks is an isolated posterior elbow dislocation placed in a splint? a. 2-4 b. 3-6 c. 4-8 d. 6-10 ANS: B

Isolated posterior elbow dislocations are managed with closed reduction and immobilization.

The elbow is placed in 90 of flexion in a splint for 3-6 weeks.

REF: P. 431

Chapter 23: Orthopedic Management of the Wrist and Hand MULTIPLE CHOICE 1. What is the name of the common distal radius fracture that results from a fall on the palm of

an outstretched hand? a. Smith b. Colles c. Boxer’s d. Bennett ANS: B

The most common distal radius fractures is the Colles fracture, a radial fracture within 2.5 cm of the wrist in which the distal fragment is displaced in a dorsal direction. It results from a fall on the palm of an outstretched hand.

REF: P. 446 2. What is the name of the common distal radius fracture that results from a fall on the dorsum

of the hand?

Smith Colles Boxer’s Bennett

a. b. c. d.

ANS: A

A Smith fracture is also referred to as a reverse Colles fracture. This fracture occurs from a fall on the dorsum of the hand.

REF: P. 446 3. Why must the physical therapist assistant (PTA) monitor the patient’s pain, circulation, and

sensation during each therapy session? a. To prevent complications following fracture such as nonunion and malunion,

tendon adhesions, and ischemic contractures b. To be able to document the progress of the patient in therapy c. To determine when the therapy session should end d. None of the above ANS: A

The patient’s pain, circulation, and sensation should be monitored during each session and the exercises should be adjusted accordingly to prevent the complications of fracture.

REF: P. 446 4. When do strengthening exercises for the wrist muscles begin following a Colles or Smith

fracture? a. When the fracture is clinically healed b. After the cast is removed c. After the patient can move the wrist painlessly

d. While the cast is in place ANS: A

Strengthening is usually started 4-5 weeks after the cast is removed. The doctor orders this only if the fracture site is no longer tender to palpation and evidence of bony union is seen.

REF: P. 447 5. Which anatomic fracture has the highest incidence of nonunion and may take as long as 12-24

weeks of immobilization to heal?

Fractures of the distal third of the scaphoid bone Fractures of the proximal third of the scaphoid bone Fractures of the middle third of the scaphoid bone None of the above

a. b. c. d.

ANS: B

Fractures in the proximal third of the scaphoid bone have a high incidence of nonunion and those that do heal take much longer (12-24 weeks) immobilization compared to 5 or 6 weeks for the distal portion.

REF: P. 448 6. How are fully displaced fractures of the metacarpal bones fixed? a. Splint b. Cast c. Surgery with open fixation or percutaneous techniques d. None of the above ANS: C

Displaced fractures of the metacarpals require surgical intervention and fixation by open or percutaneous techniques. Nondisplaced or minimally displaced fractures are casted or splinted for 3-4 weeks.

REF: P. 448 7. What is the name of the fracture that results from a person striking a hard object with a

clenched fist?

Smith Colles Boxer’s Bennett

a. b. c. d.

ANS: C

Fractures of the neck of the fourth or fifth metacarpal are called boxer’s fractures caused by striking a hard object with a clenched fist.

REF: P. 449 8. Which fracture occurs at the palmar base of the proximal first metacarpal and results in a

fracture dislocation treated with rigid cast immobilization or surgery? a. Smith b. Colles

c. Boxer’s d. Bennett ANS: D

A Bennett fracture is a fracture of the palmar base of the proximal first metacarpal. It results in a fracture dislocation. Treatment is a rigid cast or open reduction with internal fixation, based on the severity of the fracture.

REF: P. 449 9. How would a stable, closed, nondisplaced fracture of a phalanx be treated? a. Full arm cast b. Partial forearm cast c. Buddy taping d. Rigid immobilization ANS: C

Stable, closed, nondisplaced fractures are treated by buddy taping (Fig. 23-18, A) or with simple splints and immediate range of motion (ROM).

REF: P. 449 10. Which intervention comes last in the rehabilitation of a hand ligament injury? a. Elevation, massage, light external compression wraps, and digit active range of

motion (AROM) exercise b. Gentle, active, pain-free motion in all planes c. Submaximal isometric contractions progressing to resistance exercises d. Using a metronome to increase the speed of movement and sustained gripping

exercises to improve wrist strength ANS: D

The last step is to gradually increase the speed of movement. Exercising with a metronome is helpful. Sustained gripping and concentric and eccentric exercises improve wrist strength.

REF: P. 451 11. Which of the following injuries may be seen more in gymnasts than in golfers or baseball

players?

Colles fracture Carpal tunnel syndrome (CTS) Triangular fibrocartilage complex Acute sprain of the ulnar collateral ligament of the thumb

a. b. c. d.

ANS: C

Injury to the triangular fibrocartilage complex (TFCC) can occur from an axial force applied to the ulnar side of the wrist during weight bearing and gripping (as in gymnastics) or a fall on the palm with the forearm pronated.

REF: P. 451

12. A skier experiences a complete rupture of the ulnar collateral ligament of his thumb which

shows a small fracture of the proximal phalanx. What treatment would you expect to see for this patient? a. Nonsurgical treatment with a thumb spica cast or rigid immobilization for 3-4 weeks b. Surgical repair and a short arm thumb spica cast for 4 weeks c. Continuous uninterrupted splinting of the distal interphalangeal (DIP) joint for 6 weeks in hyperextension d. Surgery to correct the nerve entrapment, neuroma, or joint derangement ANS: B

Complete ruptures of the ulnar collateral ligament can be associated with a fracture. A short arm thumb spica cast is applied for approximately 4 weeks.

REF: P. 451 13. Which of the following diseases is characterized by pain on the radial side of the wrist that is

aggravated by use of the thumb? a. Colles fracture b. De Quervain’s disease. c. TFCC d. Skier’s thumb ANS: B

De Quervain’s disease presents as pain on the radial side of the wrist that is aggravated by use of the thumb. Swelling and, in some cases, nodules might be palpable.

REF: P. 452 14. Which extensor tendon injury occurs in zone 1, places the DIP joint in flexion, and over time

can lead to hyperextension of the proximal interphalangeal (PIP) joint?

Mallet finger Boutonniere deformity Dupuytren’s disease Complex regional pain syndrome

a. b. c. d.

ANS: A

In mallet finger, the imbalance that is created by the unopposed force of the flexor digitorum profundus muscle positions the DIP joint in flexion and with time may lead to hyperextension of the PIP joint resulting in swan neck deformity.

REF: P. 453 15. Which extensor tendon injury occurs in zone III and allows the head of the proximal phalanx

to herniate dorsally resulting in deformity? a. Mallet finger b. Boutonnière deformity c. Dupuytren’s disease d. Complex regional pain syndrome ANS: B

In Boutonnière deformity, interruption of the central tendon, and triangular ligament at the PIP joint (zone III) allow the head of the proximal phalanx to herniate dorsally resulting in a boutonniere deformity (Fig. 23-25).

REF: P. 453 16. Who is the best qualified health care provider to perform hand rehabilitation for flexor tendon

injuries?

PTA Physical therapist (PT) Medical doctor Certified hand therapist

a. b. c. d.

ANS: D

Flexor tendon injuries should ideally be managed by a certified hand therapist who is either a PT or occupational therapist with advanced training in hand rehabilitation.

REF: P. 454 17. Which disease is characterized by increased friction and pressure constricting the nerve in the

wrist and producing sensory problems such as decreased sensation, pain and tingling, and motor problems? a. Dupuytren’s disease b. CTS c. Mallet finger d. Complex regional pain syndrome ANS: B

CTS refers to the symptoms that occur when the median nerve is compressed or entrapped at the wrist. Increased friction and pressure constricting the nerve produces sensory problems, pain and tingling, and motor problems.

REF: P. 456 18. Which of the following recommendations can a PTA make to a patient experiencing CTS? a. Remove watchbands and bracelets from the affected wrist b. Wear the splint day and night for the first several weeks c. Avoid simultaneous wrist and finger flexion d. All of the above ANS: D

All of these recommendations may be made by the PTA for a CTS patient.

REF: P. 456 19. Which of the following is NOT a primary characteristic of complex regional pain syndrome

(CRPS)? a. Flexibility of the wrist joint and pain b. Trophic changes c. Autonomic disturbances such as sweating or dryness of the skin d. Functional impairment such as not using the hand due to pain

ANS: A

All of the symptoms are found in CRPS except increased joint flexibility.

REF: P. 457 20. Which of the following surgeries can result in CRPS? a. Carpal tunnel b. De Quervain’s release c. Distal ulnar surgery d. Dupuytren release e. All of the above ANS: E

All of these surgeries can possibly have CRPS as a complication. The PTA must be alert to the signs and symptoms of CRPS. REF: P. 457

Chapter 24: Orthopedic Management of Rheumatic Disorders MULTIPLE CHOICE 1. Which of the following is the most common form of arthritis in adults and is generally the

most painful and disabling joint disorder? a. Rheumatoid arthritis (RA) b. Osteoarthritis (OA) c. Psoriatic arthritis d. Septic arthritis ANS: B

OA is the most common form of arthritis and generally the most painful and disabling joint disorder.

REF: P. 467 2. Which of the following forms of arthritis would you suspect in a 50-year-old woman with

painful knees and hips after activity that is relieved with rest?

RA OA Psoriatic arthritis Septic arthritis

a. b. c. d.

ANS: B

OA is more common in women over 45 and is characterized by pain that occurs after activity and is relieved by rest.

REF: P. 468 3. Which of the following forms of arthritis would you suspect in a 30-year-old woman with

complaints of fatigue, fever, pain in the knees and wrists, and morning stiffness?

RA OA Psoriatic arthritis Septic arthritis

a. b. c. d.

ANS: A

Early signs of RA include fatigue, weight loss, fever, and pain; later symptoms are pain, tenderness, swelling, redness, and stiffness in specific joints. RA morning stiffness can last hours and even all day. Fatigue in patients with RA may cause patients to rest through the day.

It occurs more often in women ages 20-40.

REF: P. 470 4. Which physical changes would you expect to see in the hands of a person with RA arthritis? a. Swelling of the joints b. Hyperflexion and extension of the joints c. Swan neck deformity d. Boutonniere deformity

e. All of the above ANS: E

All of these deformities are seen in patients with RA. REF: P. 470 5. Which of the following exercise recommendations would you give to a patient having an

exacerbation of RA? Avoid vigorous activity Continue muscle conditioning and strength training through the episode Do not use isometric exercises during an exacerbation Dynamic exercises are fine but do not do them if they cause pain

a. b. c. d.

ANS: A

Vigorous activity should be avoided during an exacerbation of RA symptoms.

REF: P. 470 6. Which of the following would you suspect in a young man with conjunctivitis, urethritis, and

oligoarticular arthritis?

OA RA Psoriatic arthritis Reactive arthritis

a. b. c. d.

ANS: D

Reactive arthritis is seen in an abrupt onset in young men with conjunctivitis, urethritis, and oligoarticular arthritis and occurring within days or weeks of a dysenteric or sexually transmitted infection.

REF: P. 471 7. Which of the following is similar to RA but not so severe, seen in those aged 30-50, and

usually affecting joints asymmetrically?

OA RA Psoriatic arthritis Reactive arthritis

a. b. c. d.

ANS: C

Psoriatic arthritis is a seronegative inflammatory joint disease affecting a small percentage of people with psoriasis. Gender does not predispose one to this disease; it usually affects people between ages 30 and 50. It is usually asymmetric and involves the small joints of the hands and feet.

REF: P. 472 8. Which form of juvenile rheumatoid arthritis (JRA) presents with a high fever, rash, malaise,

irritability, anemia, lymphadenopathy, and splenomegaly? a. Pauciarticular b. Polyarticular

c. Systemic d. Septic ANS: C

Systemic JRA presents with a high fever—usually treated as a fever of unknown origin. The rash appears with the fever and is salmon pink, 2-5 mm in diameter. Other symptoms include malaise, irritability, anemia, lymphadenopathy, and splenomegaly.

REF: P. 473 9. What is the first line of drug therapy for pain, stiffness, and swelling for children with JRA? a. Corticosteroids b. Disease-modifying antirheumatic drugs (DMARDs) c. Nonsteroidal antiinflammatory drugs (NSAIDs) d. Immunosuppressive medications ANS: C

Stiffness, pain, and swelling in children with JRA are usually treated with NSAIDs. Other medications can be added later if the symptoms are not controlled.

REF: P. 473 10. Your patient has had noninflammatory joint pain for 1-4 days with skin lesions over the palms

and soles of feet. Which type of arthritis does the patient likely have?

Septic Gonococcal Nongonococcal JRA

a. b. c. d.

ANS: B

Gonococcal arthritis occurs in healthy individuals and begins with wrist, ankle, knee, and elbow inflammatory joint pain with characteristic asymptomatic skin lesions over the palms and soles of feet.

REF: P. 473 11. Which arthritic condition affects the spine as well as all the joint ligaments of the spine,

spreads superiorly up the spine, and has an onset usually in the late teens to early twenties?

Gonococcal Ankylosing spondylitis Gout JRA

a. b. c. d.

ANS: B

Ankylosing spondylitis is a type of inflammation that affects the synovium of the spinal arthrodial joints as well as the joint ligament. It moves upward; age at onset is usually in the late teens to early twenties.

REF: P. 474 12. What does physical therapy focus on for a patient with ankylosing spondylitis? a. Strengthening postural muscles, back and neck extensors, shoulder retractors, and

hip extensors and abductors b. Pain management and antiinflammatory drug treatments c. Aquatic therapy and heat treatments d. Preventing pain by monitoring the level and type of exercises done during

occupational therapy ANS: A

Specifically, therapy should focus on strengthening the postural muscles, back and neck extensors, shoulder retractors, and hip extensors and abductors.

REF: P. 474 13. Your patient with hypertension and psoriasis has a history of taking diuretics. Now he is

showing evidence of an acute onset of inflammatory arthritis in the great toe and ankle of one foot. What do you suspect is occurring with this patient? a. He is experiencing ankylosing spondylitis b. He has gout c. He has an acute form of JRA d. He has RA ANS: B

Gout is characterized by acute onset of inflammatory arthritis that is worse at night and targets one or more joints. It is commonly seen in the great toe, but can also cause other joints to become tender, swollen, warm, and red. People with a history of taking diuretics or having hypertension or psoriasis may be more likely to have this disease.

REF: P. 475 14. In providing patient education to your gout patient, which recommendations would be useful? a. Lose weight and lower intake of alcohol b. Take colchicine as prescribed by the doctor c. Avoid foods that are high in purine d. All of the above ANS: D

All of these are strong recommendations to be given to the patient with gout.

REF: P. 475 15. What description would your fibromyalgia patient use to describe his pain? a. Sharp, stabbing pain over one or more joints b. Burning or aching c. Tenderness, stiffness, or throbbing d. B and C ANS: D

Fibromyalgia pain is often described as burning or aching, tender, stiff, throbbing, and sore.

REF: P. 476 16. When beginning an exercise program with a newly diagnosed fibromyalgia patient, which of

the following would you recommend?

a. b. c. d.

One 30-minute session daily that has some aerobic and some stretching exercises Daily stretches with 5 minutes of aerobic activity Dumbbell weights and a walking regimen for 30 minutes three times a week Water aerobics for 1 hour three times a week

ANS: B

For newly diagnosed patients with fibromyalgia, beginning with 5 minutes daily and working up to 30 minutes slowly will help improve function and fitness level. Begin at a level where the patient can be successful.

REF: P. 477 17. Which disease is characterized by low bone mass and microarchitectural deterioration of bone

tissue leading to fragility and risk of fracture?

RA Synovitis Systemic lupus erythematosus Osteoporosis

a. b. c. d.

ANS: D

Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk.

REF: P. 478 18. Which test is performed to diagnose osteoporosis? a. Vitamin D blood levels b. Calcium blood levels c. Dual energy x-ray absorptiometry d. Exercise stress test ANS: C

The bone mineral density test (dual energy x-ray absorptiometry) is the method used to make a true diagnosis of osteoporosis.

REF: P. 479 19. Which of the following is an example of an analgesic used in treating rheumatic disorders? a. Acetaminophen b. Ibuprofen c. Hydrocortisone d. Methotrexate ANS: A

There are several analgesics available to patients with rheumatic disorders, most notably acetaminophen, oxycodone, propoxyphene, and tramadol.

REF: P. 482 20. Which of the following is an example of a DMARD? a. Acetaminophen b. Ibuprofen

c. Hydrocortisone d. Methotrexate ANS: D

Methotrexate is generally the first option for severe RA because of its long-term efficiency and its antiinflammatory and immunosuppressant effects. It is a DMARD. REF: P. 482

Chapter 25: Orthopedic Management of Pain and Pain Syndromes MULTIPLE CHOICE 1. Which of the following is the correct definition of chronic pain? a. The experience of pain in one area when the actual tissue damage is in another area b. Pain of less than 3 months duration that has an underlying pathology c. Pain that lasts beyond normal healing time, which generally is 3-6 months d. Pain perceived to be in a diseased limb even after that limb has been amputated ANS: C

Chronic pain is the experience of pain that lasts beyond normal healing time, which generally is thought to be 3-6 months.

REF: P. 488 2. In the past 20 years, chronic pain rates in the United States have been: a. increasing steadily. b. decreasing steadily. c. essentially unchanged. d. untracked by epidemiological data.

ANS: A

Epidemiological studies since the 1990s show chronic pain rates steadily increasing in the United States.

REF: P. 488 3. Which of the following is true for treatment of chronic pain? a. Traditional modalities such as transcutaneous electrical neuromuscular stimulation

(TENS) and ultrasound usually are effective b. Traditional modalities such as TENS and ultrasound usually are not effective c. TENS normally is effective, but ultrasound is not d. Ultrasound normally is effective, but TENS is not ANS: B

Traditional treatments such as TENS and ultrasound usually are not effective because in chronic pain, the pain is spread over various body parts.

REF: P. 488 4. Which of the following have been found to be effective in treating chronic pain? a. Aerobic exercise and behavior therapy b. Behavior therapy and ultrasound c. Ultrasound and electrical stimulation d. Aerobic exercise and ultrasound ANS: A

Recent studies have shown that aerobic exercise and behavior therapy are effective in treating chronic pain. The other modalities are effective for treating acute, localized pain, but not for treating chronic pain.

REF: P. 489 5. What is a fast-acting neurotransmitter and hormone that affects many tissues, including the

regulation of heart rate, blood vessels, and air passages?

Estrogen Adrenocorticotropic hormone (ACTH) Cortisol Adrenaline

a. b. c. d.

ANS: D

Adrenaline is a fast-acting neurotransmitter that is effective in immediate stress response. It affects heart rate, blood vessels, and air passages. Cortisol is also produced in reaction to stress, but it is slower acting.

REF: P. 489 6. Another name for the human basic threat response is: a. excitability response. b. fight-or-flight response. c. aggressive/passive response. d. adrenaline/cortisol response.

ANS: B

A common name for the basic threat response is the fight-or-flight response.

REF: P. 489 7. In an acute stress situation, adrenosensitive ion channels (nerve sensors): a. close. b. open. c. do not change. d. produce high levels of cortisol.

ANS: B

In an acute stress situation, ion channels open, allowing for easier firing of the nervous system and pain response.

REF: P. 489 8. Which glucocorticoid steroid hormone increases blood sugar, suppresses the immune system,

and aids in the metabolism of fat, protein, and carbohydrates?

Cortisol Adrenaline ACTH Corticotropin-releasing hormone

a. b. c. d.

ANS: A

Cortisol is a glucocorticoid steroid hormone that increases blood sugar, suppresses the immune system, and aids in fat, protein, and carbohydrate metabolism.

REF: P. 490

9. Which gland produces cortisol? a. Pancreas b. Liver c. Hypothalamus d. Adrenal ANS: D

Cortisol is produced by the adrenal gland.

REF: P. 490 10. What is the correct daily pattern of cortisol production? a. Peak at midnight, low point at noon b. Peak around 8:00 a.m., low point after midnight c. Peak at noon, low point around 8:00 p.m. d. Peak around 8:00 a.m., low point around 8:00 p.m.

ANS: B

Cortisol has a daily pattern, typically peaking around 8:00 a.m. with a low point between midnight and 4:00 a.m.

REF: P. 490 11. Which of the following currently is recommended for patients with lower back pain (LBP)? a. Back school education b. Cognitive behavioral therapy c. Therapeutic neuroscience education (TNE) d. All of the above ANS: D

Current approaches to LBP have turned away from anatomical and biomechanical models and now emphasize patient education, including back school education, cognitive behavioral therapy, and TNE. REF: P. 492 12. A type of patient education that helps patients gain an increased understanding of the

neurological processes underpinning their pain state is: a. cognitive behavioral therapy. b. TNE. c. Back School. d. biomechanical patient education.

ANS: B

TNE differs from traditional patient education programs in that it focuses on neurophysiology, neurobiology, and the processing and representation of pain.

REF: P. 492 13.

Which of the following is a primary goal of TNE? a. Resolve the specific tissue injury causing pain

b. Substitute for therapeutic exercises c. Replace the interventions of a physical therapist (PA) and physical therapist

assistant (PTA) d. Decrease the patient’s fear and perception of pain and improve the patient’s

attitude about pain ANS: D

Ideally, the PA and PTA would implement TNE as part of a holistic approach to treatment.

Studies have shown that TNE can decrease the patient’s fear of and perception of pain and can improve the outcomes of therapeutic exercises.

REF: P. 492 14. Part of a TNE approach to chronic pain is an emphasis on: a. a new language for the description and explanation of pain. b. the patient’s intelligence. c. the patient’s pain tolerance. d. the required discontinuation of traditional treatment modalities.

ANS: A

Part of the TNE approach is the development of a new “pain language” that uses metaphors and examples to explain how pain works and what pain might mean. TNE is used in conjunction with, not instead of, traditional treatment modalities.

REF: P. 492 15. Where is pain produced? a. Injured tissue b. Affected body system c. Brain d. Nerve endings ANS: C

Pain is 100% produced by the brain, in response to information from tissues, the environment, beliefs, memory, etc.

REF: P. 492 16. The theory that pain is produced by the brain’s processing of information from tissues, the

environment, thoughts, beliefs, experiences, memories, and senses is called the: hypothalamus theory. neuromatrix theory. gate control theory. pain reaction theory.

a. b. c. d.

ANS: B

The theory that pain is produced by the brain’s processing of information from tissues, the environment, thoughts, beliefs, experiences, memories, and senses is referred to as the neuromatrix theory.

REF: P. 492

17. Traditionally, which nerve fibers were considered to be “pain conductors?” a. Q fibers b. C fibers c. D fibers d. All of the above ANS: B

Traditionally, in gate control theory, C fibers, along with A-delta fibers, were considered responsible for pain conduction.

REF: P. 493 18. What is the name of the pain theory that proposes pain is conducted from tissue to the brain

by thin pain fibers along with thick fibers that conduct sensations of touch, pressure, and vibration? a. Gate control theory b. Pressure theory c. Pain reaction theory d. Neuromatrix theory ANS: A

According to gate control theory, information is sent to the spinal cord and ultimately the brain from various nerve fibers, including thin “pain” fibers as well as larger diameter fibers dealing with touch, pressure, and vibration.

REF: P. 501 19. Which of the following is a shortcoming of the gate control theory of pain? a. It does not explain phantom limb pain b. It does not account for immune and inflammatory processes, which are

components of pain c. It does not consider patient emotions d. All of the above ANS: D

Gate control theory cannot account for phantom limb pain or pain in quadriplegics, it does not account for the involvement of immune and inflammatory processes in pain, and it does not consider how patient emotions affect pain perception.

REF: P. 502 20. What is another name for an individual pain neuromatrix? a. Gate control b. Pain neurotag c. Individualized emotional state d. No pain, no gain ANS: B

The terms “pain neurotag” and “pain neurosignature” are synonymous with “individual pain neuromatrix.”

REF: P. 494

Chapter 26: Orthopedic Management of Orthotics and Prosthetics MULTIPLE CHOICE 1. Which of the following is a specification for the ideal prosthetic or orthosis? a. Meets the user’s needs, is simple and easily learned b. Looks, smells, sounds normal, cleans easily, is stain resistant c. Affordable, worth the cost of financial investment d. All of the above ANS: D

All of these specifications are required for an ideal prosthetic or orthosis.

REF: P. 512 2. What is the abbreviation for an orthosis for the wrist only? a. HO b. WD c. WHO d. WO ANS: D

The abbreviation for an orthosis for the wrist only is WO. REF: P. 512 3. This prosthesis assists patients in traversing most environmental barriers and allows some

vocational or exercise activity beyond simple locomotion. At what activity level would this prosthesis be ranked? a. K1 b. K2 c. K3 d. K4 ANS: C

A K3 prosthesis offers the ability or potential for ambulation with variable cadence, allowing a person to traverse most environmental barriers. It might allow activity beyond simple locomotion—for vocational, therapeutic, or exercise needs.

REF: P. 530 4. Which component of an upper arm prosthetic must be molded to a patient’s residual limb for a

proper fit that is directly related to the patient’s requirements for use and wear time? a. Socket b. Shoulder joint c. Wrist unit d. Hand ANS: A

The socket is the custom fabricated portion created from a mold of the patient’s residual limb.

Proper fit of the socket is crucial, and intimacy of the fit is directly related to the patient’s end result for use and wear time.

REF: P. 513 5. Plastazote, PPT, and pe-lite are examples of which type of commonly used materials in

prosthetics?

Device selection Interface material Carbon fiber composites None of the above

a. b. c. d.

ANS: B

Interface material is used for cushioning an orthosis or prosthetic for comfort and fit.

Examples are Plastazote, PPT, and pe-lite.

REF: P. 514 6. A patient is of normal height, weight, and bone structure. Which type of orthosis is most likely

needed?

Prefabricated orthosis Custom orthosis Both of the above None of the above

a. b. c. d.

ANS: A

A prefabricated orthosis will likely work with a patient who can fit a readily available product.

A large percentage of the general population can be fitted with these new devices.

REF: P. 514 7. What splint is used for flexion contracture and nerve or tendon damage due to accident or

rheumatoid arthritis? It provides dynamic finger extension and allows a patient to use flexors needed for gripping? a. Thomas suspension splint b. Long opponens splint c. Tenodesis splint d. Wrist cock-up splint ANS: B

The long opponens splint is often used for flexion contractures, nerve or tendon damage due to traumatic accidents, or rheumatoid arthritis.

REF: P. 514 8. Which elbow orthosis is used for contractures, strains, sprains, and ligament repairs and offers

flexion/extension stop sets at five-degree increments as the patient progresses?

Lateral epicondylitis splint Static splints Dynamic elbow splint Flex POP Elbow Orthosis

a. b. c. d.

ANS: D

The Flex POP Elbow Orthosis by Restorative Care of America Incorporated provides rehabilitation for joint stiffness and contractures, instabilities, strains, sprains, and ligament repairs. This elbow orthosis offers flexion/extension stop sets at five-degree increments, which allow changes to be made in therapy sessions as the patient progresses.

REF: P. 515 9. Which orthosis is a prefabricated orthosis made of foam, has a cotton cover and hook-and-

loop closure in the back, and is used for neck sprains?

Cervicothoracic orthosis Soft collar Rigid panel support Neck splint

a. b. c. d.

ANS: B

The soft collar is a prefabricated orthosis made of foam with a cotton cover and has a hookand-loop closure in the back (Fig. 26-8).

REF: P. 516 10. Which of the following is the least rigid lumbosacral orthosis available in varying widths and

lengths that provides support and compression to the abdominal muscles, which in turn support the lower back? a. Aspen Quick Draw RAP b. Thoracolumbosacral orthosis (TLSO) c. Hyperextension orthosis TLSO d. Abdominal binder ANS: D

The most flexible (least rigid) lumbosacral orthosis is the abdominal binder.

REF: P. 517 11. Which orthosis is applied to vertebrae L1 through L5, is easy to put on and take off, and has

lightweight and breathable fabric that can house a rigid panel and a hot or cold pack for therapeutic benefit? a. Abdominal binder b. Aspen QuickDraw RAP c. The S.W.A.S.H. d. The ToeOFF ANS: B

The Aspen QuickDraw RAP is an example of a prefabricated orthosis that is easy to put on and take off, fabricated of lightweight and breathable materials, with a back panel pocket for hot or cold packs.

REF: P. 517 12. Select the best orthosis for a child with spastic hemiplegia. a. Abdominal binder

b. Aspen QuickDraw RAP c. The S.W.A.S.H. d. The ToeOFF ANS: C

The S.W.A.S.H. orthosis is designed for children with neuromuscular diagnoses such as spastic hemiplegia, quadriplegia, low trunk tone, or cerebral palsy or who have a risk of hip displacement.

REF: P. 518 13. Which type of knee orthosis would be applicable for a patient with mild osteoarthritis or knee

pain?

The S.W.A.S.H. Knee sleeve Hinged-knee orthotic Combined instability orthosis

a. b. c. d.

ANS: B

To relieve pain in an arthritic joint, a knee sleeve can be used.

REF: P. 519 14. Which orthoses would you select for a patient with anterior cruciate ligament (ACL),

posterior cruciate ligament (PCL), or medial collateral ligament (MCL) tears?

The S.W.A.S.H. Knee sleeve Hinged-knee orthotic Combined instability orthosis

a. b. c. d.

ANS: D

A combined instability orthosis is used for ACL, PCL, and MCL tears.

REF: P. 519 15. Which orthoses would you select for immobilization of an ankle following surgery? a. Boot walker b. Cam walker c. Stirrup splint d. A and B ANS: D

Boot walkers or cam walkers are appropriate selections when treating fractures or severe sprains or for immobilization of a foot or ankle after surgery.

REF: P. 520 16. For which diagnosis would you recommend a shoe that has extra depth to accommodate a

custom arch support, has a hidden rocker bottom to decrease pressure on the metatarsal heads, is covered by insurance, and is seamless? a. Ankle fracture b. Diabetes

c. Plantar fasciitis d. Heel spurs ANS: B

If the patient is diabetic, then insurance companies will cover the shoes and there are numerous options for diabetic shoe brands and styles.

REF: P. 520 17. Which type of ankle-foot orthosis (AFO) would you expect to see used a patient with edema

in a lower extremity that accumulates during the day?

Plastic AFO Metal AFO Charcot Restraint Orthotic Walker The ToeOFF

a. b. c. d.

ANS: B

The plastic AFO is in contact with the skin and not an option for patients with edema in their lower extremities. Therefore, the metal AFO is the correct option for these patients.

REF: P. 522 18. Which client is likely to have the most difficult time adjusting to an amputation and a

prosthetic following the amputation? a. A 20-year-old war veteran with a below-the-knee traumatic amputation b. A 40-year-old victim of a motor vehicle accident with an above-the-knee

amputation c. A 65-year-old uncontrolled diabetic patient who had severe leg ulcers before

amputation d. A 12-year-old child with supportive parents ANS: C

The younger the amputee, the greater the likelihood of a higher level of flexibility, strength, balance, and marked improvements at a faster rate. The younger the amputee, the better the outcome in most cases because of a longer available period of time to learn coping skills and compensation techniques and ways to adapt physically to the environment.

REF: P. 524 19. Which prosthetic suspension method would be described as creating an airtight socket through

the use of an expulsion valve?

Locking pins Suction valves Patella strap Harnesses

a. b. c. d.

ANS: B

Suction is a viable and desirable way to suspend a prosthetic. Suction creates an airtight socket through the use of an expulsion valve.

REF: P. 526

20. Which knee prosthetic is inherently the most stable and safe? a. Locking knee b. Weight-activated knee c. Knee sleeve d. None of the above ANS: A

A locking knee is inherently the most stable and safe knee.

REF: P. 530

Chapter 27: Musculoskeletal-Related Dysfunctions of the Pelvic Floor MULTIPLE CHOICE 1. What is a condition in which there is an inability to coordinate the necessary muscles of the

abdominal wall and the pelvic floor to urinate or defecate? a. Animus b. Abdominal pelvic dyssynergia c. Chronic pelvic pain d. Constipation ANS: B

Abdominal pelvic dyssynergia is a condition in which there is an inability of the patient to coordinate the necessary muscles of the abdominal wall and the pelvic floor to urinate or defecate.

REF: P. 542 2. What is the term for a muscle spasm of the anal sphincter that causes rectal pain that restricts

the anal canal?

Anismus Bladder sphincter dyssynergia Coccydynia Constipation

a. b. c. d.

ANS: A

Anismus is a muscle spasm of the anal sphincter that causes rectal or anal pain that restricts the anal opening.

REF: P. 541 3. What is the term for a prolapse of the bladder? a. Cystocele b. Enterocele c. Piriformis syndrome d. Sciatica ANS: A

Cystocele is a prolapse of the bladder.

REF: P. 541 4. What is the common name for voluntary pelvic floor contractions or exercises? a. Levator ani stretches b. Dyspareunia c. Kegel exercises d. Isometrics ANS: C

Kegel exercises are voluntary pelvic floor contractions or exercises, named after Dr. Arnold Kegel.

REF: P. 543 5. The pelvic floor is bordered by the pubic symphysis and pubic rami anteriorly, the ischial

tuberosities and acetabulum laterally, and the coccyx, levator ani muscle anterior ligament, posterior ligament bladder, vagina sacrum, coccyx

and

posteriorly.

a. b. c. d.

ANS: D

The pelvic floor is bordered by the pubic symphysis and pubic rami anteriorly, the ischial tuberosities and acetabulum laterally, and the sacrum and coccyx posteriorly.

REF: P. 536 6. How many layers of musculature are in the pelvic floor? a. 3 b. 6 c. 10 d. 12 ANS: A

The pelvic floor consists of three layers of musculature, commonly categorized into the urogenital triangle, the deep urogenital triangle, and the anal triangle.

REF: P. 536 7. Which muscle is NOT in the deepest layer of muscles of the pelvic floor? a. Levator ani b. Coccygeus c. Piriformis d. Bulbocavernosus ANS: D

The deepest layer of muscles of the pelvic floor consists of the levator ani muscles (pubococcygeus and illiococcygeus), the coccygeus, and the piriformis and obturator internis muscles.

REF: P. 537 8. How many layers of fascia are in the pelvic floor? a. 1 b. 2 c. 3 d. 5 ANS: B

The pelvic floor consists of two continuous layers of fascia, the parietal pelvic fascia and the visceral pelvic fascia.

REF: P. 537

9. Which of the following is not considered a function of the pelvic floor? a. Maintain urinary and fecal continence b. Support the upper and lower extremities c. Aid in sexual appreciation d. Support the bony pelvis ANS: B

The pelvic floor supports the internal abdominopelvic organs, maintains urinary and fecal continence, aids in sexual appreciation, and supports the bony pelvis. It does not support the upper and lower extremities.

REF: P. 538 10. The levator ani muscle can stretch almost 260% of its resting length. What function relies on

this extremely large stretch ratio?

Vaginal childbirth delivery Defecation Diaphragmatic breathing Ambulation

a. b. c. d.

ANS: A

The levator ani has been shown to stretch up to almost 260% of its resting length to accommodate for vaginal delivery.

REF: P. 538 11. The pelvic floor musculature may become dysfunctional for many reasons, including: a. childbirth. b. surgery. c. skeletal malalignment. d. All of the above ANS: D

The pelvic floor musculature may become dysfunctional due to many causes, including childbirth, surgery, trauma, pain, and skeletal malalignment.

REF: P. 538 12. Urinary continence is maintained when which of the following is true? a. Sphincteric pressure around the anus exceeds that of the contracting detrusor

muscle of the bladder and intraabdominal pressure b. Sphincteric and detrusor muscle pressure around the urethra exceed intraabdominal

pressure c. Sphincteric pressure around the urethra exceeds that of the contracting detrusor

muscle of the bladder and intraabdominal pressure d. Sphincteric pressure around the urethra is less than that of the contracting detrusor

muscle of the bladder and intraabdominal pressure ANS: C

Urinary continence is maintained when sphincteric pressure around the urethra exceeds that of the contracting detrusor muscle of the bladder and intraabdominal pressure.

REF: P. 539 13. An anatomical support deficit of the pelvic viscera that may result from a series of long-term

failures of the supporting and suspension mechanisms of the uterus and vaginal wall is: pelvic organ prolapse (POP). bladder sphincter dyssynergia. abdominal pelvic dyssynergia. all of the above.

a. b. c. d.

ANS: A

POP is defined as an anatomical support deficit of the pelvic viscera. It may result from a series of long-term failures of the supporting and suspension mechanisms of the uterus and vaginal wall.

REF: P. 539 14. Which of the following is true about POP? a. It decreases with age and number of given births b. It increases with age and number of given births c. It increases with number of given births, but age is not a factor d. It increases with age, but number of given births is not a factor ANS: B

POP increases significantly with age and with the number of given births.

REF: P. 539 15. What type of pelvic floor dysfunction is characterized by pelvic floor muscles being in a state

of increased tension or prolonged state of contraction with the inability to relax? a. Supportive b. Incoordination c. Hypertonic d. Visceral ANS: C

A hypertonic pelvic floor dysfunction is characterized by pelvic floor muscles being in a state of increased tension or prolonged state of contraction with the inability to relax.

REF: P. 541 16. What is the term for a muscle spasm of the anal sphincter that causes sharp rectal pain that

lasts from seconds to 30 minutes and frequently occurs in the middle of the night?

Coccydynia Proctalgia fugax Levator ani syndrome Nonrelaxing puborectalis

a. b. c. d.

ANS: B

Proctalgia fugax is the term for a muscle spasm of the anal sphincter that causes sharp rectal pain that lasts from seconds to 30 minutes and frequently occurs in the middle of the night.

REF: P. 541 17. Dysparenunia is the term for pain during or after: a. defecation. b. urination. c. sexual intercourse. d. vaginal childbirth.

ANS: C

Dyspareunia is pain before, during, and after sexual intercourse. The majority of causes of dyspareunia are directly or indirectly related to hypertonus of the pelvic floor.

REF: P. 542 18. What type of pelvic floor dysfunction involves an inability to coordinate the muscles of the

abdominal wall and the pelvic floor necessary to urinate or defecate?

Hypertonic Visceral Supportive Incoordination

a. b. c. d.

ANS: D

Incoordination dysfunction involves an inability to coordinate the muscles of the abdominal wall and the pelvic floor necessary to urinate or defecate. This is described as abdominal pelvic dyssynergia, bladder sphincter dyssynergia, or pelvic floor dyssynergia.

REF: P. 542 19. Another name for interstitial cystitis (IC) is: a. painful bladder syndrome. b. levator ani syndrome. c. dyspareunia. d. vulvodynia.

ANS: A

IC is also known as painful bladder syndrome.

REF: P. 542 20. What is a commonly used scale for assessment of the pelvic floor in order to determine an

appropriate exercise prescription?

Cambridge scale PELVIC Scale PERFECT Scale POWER Scale

a. b. c. d.

ANS: C

The PERFECT Scale is used for assessment of the pelvic floor. PERFECT is an acronym for Power (P), Endurance (E), Repetitions (R), Fast contractions (F), and Every contraction timed (ECT).

REF: P. 543

Chapter 28: Concepts of Orthopedic Pharmacology MULTIPLE CHOICE 1. Which of the following terms is defined as the movement of medication from the bloodstream

into various areas of the body (central nervous system, breast milk, and adipose [fat] tissue)? a. Excretion b. Metabolism c. Distribution d. Absorption ANS: C

Distribution is the movement of medication from the bloodstream into various areas of the body such as the central nervous system, breast milk, and adipose tissue.

REF: P. 562 2. Which of the following terms is defined as the biotransformation or chemical alteration of the

medication?

Excretion Metabolism Distribution Absorption

a. b. c. d.

ANS: B

Metabolism is the biotransformation or chemical alteration of the medication in the body.

REF: P. 562 3. What is the best definition of half-life? a. What the medication does to the body b. How the drug is eliminated from the body c. The rate at which a drug is cleared from the body d. The length of time the drug is active in the body ANS: C

Half-life is the rate at which a drug is cleared from the body. It is the time it takes to reduce the drug’s blood concentration by half. It can take seconds to days.

REF: P. 562 4. Which is the best definition of duration of action? a. What the medication does to the body b. How the drug is eliminated from the body c. The rate at which a drug is cleared from the body d. The length of time the drug is active in the body ANS: D

Duration of action is the length of time the drug is active in the body and is related to the drug’s half-life.

REF: P. 563 5. Which pharmacodynamic principle is defined as the relationship between the amount of drug

in the body and its expected effectiveness and the likelihood and severity of side effects?

Tolerance Adverse drug reaction Therapeutic window Dose-response relationship

a. b. c. d.

ANS: D

The dose-response relationship describes the relationship between the amount of drug in the body and its expected effectiveness and likelihood and severity of side effects (i.e., the higher the dosage, the more side effects seen).

REF: P. 563 6. Which pharmacodynamic principle is defined as the unintended effect of the medication

including an exaggerated medication response?

Tolerance Adverse drug reaction Therapeutic window Dose-response relationship

a. b. c. d.

ANS: B

An adverse drug reaction is the unintended effect of the medication including an exaggerated medication response.

REF: P. 563 7. Which of the following medications can cause psychological dependency? a. Benzodiazepines b. Amphetamines c. Opioid analgesics d. All of the above ANS: D

These (as well as other substances like caffeine, alcohol, cocaine, and nicotine) can cause psychological dependency. Withdrawal symptoms contribute to the development of addiction in that the patient continues to use the substance to avoid the unpleasantness of the withdrawal symptoms.

REF: P. 563 8. Select the role of the physical therapist assistant (PTA) in safe medication use. a. Administer pain medications to the patients b. Prescribe pain or other medications for the patient c. Document the pain medications given to the patient d. Have a general understanding of commonly used medications ANS: D

Although PTAs are not involved in the decision-making process regarding prescriptions and over-the-counter (OTC) medication use, having a general understanding of commonly used medications and knowing where to look for more information can help the PTA identify medically related problems that should be brought to the attention of the prescriber or other health care team members.

REF: P. 563 9. Which of the following instructions should not be provided to any patient by a PTA? a. Take medications as directed b. Ask questions when things are unclear about your medications c. Keep a current list of all medications (OTC, prescription, herbal) d. Do not take your medication if you are feeling drowsy ANS: D

PTAs can give general education to patients but not specific medication information, which is outside the PTA’s scope of practice. Advising patients when to take or not to take their medications is outside the scope of PTA practice.

REF: P. 564 10. Which of the following type of medication is used to treat an infection? a. Antihypertensives b. Antibiotics c. Amphetamines d. Opioid analgesics ANS: B

Antibiotics are used in the treatment and prevention of orthopedic-related infections.

REF: P. 564 11. Which of the following is correct about the education a PTA may provide to a patient? a. Patients can take a little extra opioid pain medication now and then if they are

hurting more than usual b. Patients can take their family members’ medications if they know why the

medication was prescribed c. Patients should not start or stop medications without consulting the doctor who

prescribed them d. Patients can crush or dissolve medications in milk or orange juice to make taking the medication easier ANS: C

Patients should not start or stop medications without consulting the doctor who prescribed them.

REF: P. 564 12. Which physical therapy patient is at highest risk for infection? a. A patient with tendon ligament strain undergoing therapeutic treatment and

exercise b. A total joint replacement patient with implanted hardware

c. An arthritic patient undergoing therapy for swollen joints and fatigue d. An elderly diabetic total hip replacement patient with a history of pneumonia ANS: D

The patient at highest risk for infection is the elder diabetic patient who after total joint replacement with a history of pneumonia. Risk factors include diabetes, joint replacement with implanted hardware, and a history of infection.

REF: P. 565 13. Which statement regarding compliance in treatment of bacterial infections is FALSE? a. All antibiotics should be taken with food to avoid stomach upset b. The medication concentration in the body needs to be maintained throughout the

day in order to kill or inhibit bacterial growth c. Stopping the antibiotic too soon can allow the infection to return or become

resistant to the antibiotic d. Taking the antibiotic exactly as directed will help it work better ANS: A

Taking the antibiotic exactly as directed, without skipping doses, and for the full duration of therapy will help it work better by maintaining good blood levels throughout the day. There is no general rule with regard to food and medications. Some antibiotics work better if taken with food, but others work better if taken on an empty stomach.

REF: P. 564 14. Which statement regarding treatment and prevention of orthopedic infection is FALSE? a. Antibiotics are sometimes given prophylactically to help prevent infections (e.g.,

before surgery) b. Infections are easier to treat in patients with diabetes and peripheral vascular

disease c. It is important to clean rehabilitation equipment between patients to prevent the

spread of infection d. The PTA can help prevent the spread of infection by thorough hand washing ANS: B

Antibiotic compliance is important for all orthopedic patients, but is especially important for patients with poor peripheral blood flow, such as those with peripheral vascular disease and diabetes. The reduced blood flow to the extremities reduces the amount of antibiotic that reaches the site of infection and makes infections harder to treat.

REF: P. 565 15. Which of the following types of medications are the most powerful medications for treatment

of nociceptive pain and some neuropathic pain? a. Nonsteroidal antiinflammatory drugs (NSAIDs) b. Acetaminophen c. Opioids d. Corticosteroids ANS: C

Opioid analgesics are all chemically related to opium. These are the most powerful medications available for treatment of nociceptive pain.

REF: P. 565 16. Which medications are most effective for neuropathic pain? a. NSAIDs b. Antidepressants and anticonvulsants c. Opioids d. Corticosteroids ANS: B

Neuropathic pain results from damage to or dysfunction of nerves. Antidepressants and anticonvulsants work well for neuropathic pain.

REF: P. 565 17. When would you expect patients to be on a once-daily pain medication patch? a. When their intermittent pain that comes and goes throughout the day b. When they have persistent pain that does not goes away c. When they are addicted to pain medications d. When there are no other medications that can handle their pain ANS: B

Persistent chronic pain is best treated with long duration, sustained released products to prevent the need for frequent administration. The pain patch is one example of this. Some patches can be applied every 3 days.

REF: P. 566 18. Which condition can be caused by long-term use of corticosteroids such as prednisone? a. Blunting of exercise-induced tachycardia b. Shortness of air, wheezing c. Osteoporosis, increased risk of fractures d. Addiction ANS: C

One side effect of long-term corticosteroid use is osteoporosis. PTAs can ask their patients to check with their doctor to see if they need calcium and vitamin supplementation.

REF: P. 568 19. Which type of pain is acetaminophen good at relieving? a. Noninflammatory pain b. Chronic inflammatory pain c. Acute inflammatory pain d. Acute pain ANS: A

Acetaminophen is effective for noninflammatory, mild to moderate, acute, and chronic types of pain. It is not useful for inflammatory pain.

REF: P. 566 20. Which statement best describe the type of pain NSAIDs treat? a. Only mild noninflammatory pain (e.g., headaches, osteoarthritis, toothaches) b. Both mild to moderate acute and chronic inflammatory and noninflammatory pain

(e.g., headaches, back pain, arthritis, gout, bursitis) c. Mostly neuropathic pain (e.g., fibromyalgias, spinal cord injuries, diabetic

neuropathy, phantom pain) d. Mostly severe, acute pain in hospitalized patients who need immediate relief (e.g.,

traumatic accidents) ANS: B

NSAIDs are effective for a broad variety of types of pain, both mild to moderate, both acute and chronic, and both inflammatory and noninflammatory.

REF: P. 567

Chapter 29: Musculoskeletal Imaging MULTIPLE CHOICE 1. What is the role of the physical therapist assistant (PTA) regarding the patient and the imaging

process? a. Perform imaging as directed by the physical therapist b. Interpret images for the patient c. Answer basic questions about imaging, but do not interpret images d. Avoid any communication or conversation with the patient about imaging ANS: C

The PTA should be able and willing to answer basic questions from the patient about imaging, but the PTA should not try to interpret images or make recommendations about treatment based on images.

REF: P. 571 2. The imaging technique that uses radiation to penetrate the body to create a two-dimensional

“picture” of a body part is: plain film imaging (radiography). computed tomography (CT). arthrography. venography.

a. b. c. d.

ANS: A

Plain film imaging is the classic technique of creating a two-dimensional picture of a body part using ionizing radiation.

REF: P. 571 3. In what form of imaging are low cost, quick and efficient production, and reasonable

delineation for care benefits in many situations?

Magnetic resonance imaging (MRI) CT Venography Plain film imaging (radiography)

a. b. c. d.

ANS: D

The strengths of radiography include low cost, the ability to be performed quickly and efficiently, and the production of images that frequently are adequate for the determination of care.

REF: P. 572 4. Which of the following is a limitation of radiography? a. Inadequate visualization of soft tissue b. Inadequate visualization of simple bone fracture c. Lengthy time of production d. High cost

ANS: A

Limitations of radiography include inadequate visualization when overlapping layers of bone are present and very incomplete information related to soft tissues.

REF: P. 572 5. Because radiographs use ionizing radiation, there is some concern that radiographs can

contribute to: cell mutation and cancer. heart disease. displaced fractures. ischemia.

a. b. c. d.

ANS: A

Because radiographs are generated through the use of ionizing radiation, it is possible they can contribute to the risk of cell mutation and cancer. Radiologists attempt to minimize risk by obtaining only the radiographs required for clinical decision making and treatment planning.

REF: P. 572 6. What is the name for the adaptation of plain film radiography that links sequential plain films

to enable a computer to create a cross-sectional picture of internal structures?

CT MRI Arthrography Positron emission tomography

a. b. c. d.

ANS: A

CT is an adaptation of plain film radiography that links sequential plain films to enable a computer to develop a cross-sectional picture of internal structures.

REF: P. 574 7. Which type of imaging uses a continuous rotational scanning process that increases speed of

acquisition and decreases radiation exposure? a. MRI b. CT c. Arthrography d. Ultrasound ANS: B

CT has been advanced through the use of a continuous rotational scanning process that increases the speed of acquisition and decreases radiation exposure.

REF: P. 574 8. Which of the following is a disadvantage of CT? a. Provides poor definition of cortical bone b. Provides only two-dimensional models of internal structures c. Requires patient to be injected with dye d. Does not isolate soft tissue well

ANS: D

Most CT scan devices do not isolate soft tissues well and, thus, are most valuable in bony delineation. CT does provide three-dimensional models of structures, and it does not require an injection of dye.

REF: P. 574 9. Which imaging technology does not expose the patient to radiation? a. Plain film imaging b. CT c. Ultrasound d. Mammography ANS: C

Ultrasound does not expose the patient to radiation. Plain film imaging, CT, and mammography all expose the patient to radiation.

REF: P. 576 10. Which imaging technology exposes the patient to the most radiation? a. Chest radiograph b. Mammography c. Abdominal CT scan d. Abdominal ultrasound ANS: C

An abdominal CT scan exposes the patient to more radiation than the other choices. An abdominal ultrasound does not expose the patient to any radiation.

REF: P. 575 11. Which imaging technology uses a magnetic field and computer software manipulations? a. MRI b. CT c. Venography d. Ultrasound ANS: A

MRI uses magnets and computer software to contract both bony tissue and soft tissue.

REF: P. 575 12. Which imaging technology provides that best information about soft tissues? a. Ultrasound b. CT c. Plain film imaging d. MRI ANS: D

MRI provides good visualization of soft tissues along with some aspects of bony tissue.

Ultrasound also provides some visualization of soft tissue but not to the degree that MRI does.

REF: P. 575 13. What is the primary disadvantage of MRI? a. High radiation exposure b. Cost c. Poor soft tissue visualization d. Injection of dye into the patient ANS: B

The main disadvantage of MRI is high cost. MRIs do not expose the patient to radiation and do not require a dye injection.

REF: P. 575 14. Which imaging technology relies on the use of sound waves? a. MRI b. CT c. Ultrasound d. Venography ANS: C

Ultrasound is a modality that passes sound waves into the body and records the rebounded energy.

REF: P. 576 15. Which imaging technology can be used in real time to show muscle activation patterns? a. CT b. Arthrography c. Radiography d. Ultrasound ANS: D

Ultrasound can be used in real time to show muscle activation patterns.

REF: P. 576 16. A radiopaque dye is injected into a joint to enable which imaging technology? a. Arthrography b. Mammogram c. CT scan d. Venography ANS: A

Arthrography can be used to assess internal structures within joints. Frequently a radiopaque dye would be injected to “coat” specific structures that then would be seen in outline on a plain radiograph.

REF: P. 577 17. A radiopaque dye is injected into the bloodstream to enable which imaging technology? a. Arthrography

b. Mammogram c. CT scan d. Venography ANS: D

Venography is a process of radiopaque dye being injected into the bloodstream to allow a plain radiograph to outline blood supply.

REF: P. 577 18. Which imaging technology can be defined as the radiographic technique of obtaining slices or

sections of a body part that are combined in a computer to create an enhanced presentation of that body part? a. MRI b. CT c. Plain film d. Ultrasonography ANS: B

CT uses radiographic slices of a body part that are combined in a computer to create an enhanced presentation of that body part.

REF: P. 574 19. A common term for ionizing radiation is: a. ultrasound. b. tomography. c. x-ray. d. beta radiation.

ANS: C

X-ray is a commonly used term for ionizing radiation, which is electromagnetic waves of energy capable of causing ion formation in the body.

REF: P. 577 20. Which imaging technology uses an injection into the bloodstream of a radioactive tracer to

study metabolic activity levels?

Ultrasound Positron emission tomography MRI Arthrography

a. b. c. d.

ANS: B

Positron emission tomography is an imaging technique that uses a radioactive tracer injected into the patient’s bloodstream to enable the study of metabolic activity levels.

REF: P. 577