Vignette for questions 1-5

You are currently treating an 18 year old woman who is a high school volley ball player. She is receiving
physiotherapy to address her reoccurring right shoulder pain. She originally developed right shoulder
pain after returning to volley-ball after dislocating her shoulder while skiing 3 years ago. She reports
pain is worst directly following a game but is flared at various times during the day. She has had
physiotherapy in the past and the pain has settled allowing pain free return to volley-ball. Upon
assessment you note elevated left compared to right shoulder with anteriorly rotated right scapula with
the medial border raised from the posterior chest wall. She complains of pain at approx 130 degrees of
shoulder elevation through abduction. Right shoulder external rotation and abduction strength is 4/5
manual muscle testing grade with abduction limited somewhat by pain.

1. Which special test will offer the physiotherapist the most pertinent information to differential
diagnosis:

a) Impingement test
b) Anterior drawer test
c) Speeds test
d) Apprehension test

2. Which of the following tests would be the least effective to assess for shoulder instability with
this clients presentation:

a) Posterior glide of the humeral head in the glenoid fossa

b) The apprehension test
c) Inferior glide of the humeral head in the glenoid fossa
d) Traction of the humeral head

3. Which condition is most likely to complicate this clients course of treatment:

a) Previous shoulder dislocation

b) Early onset osteoarthritis
c) Long thoracic nerve palsy
d) Inflammation of the long head of biceps

4. An anteriorly shifted humeral head in the glenoid fossa is most likely due to which of the
following for this client:

a) Strain of biceps brachii

b) Deltoid weakness
c) Shortening of pectoralis major
 d) Guarding due to pain

5. Which of the following statements does not describe a painful arc in the shoulder:

a) The individual will attempt to elevate through flexion to avoid pain

b) Abduction is painless in the range of 130-180 degress
c) Often pain is greater going up (against gravity) than down
d) The pain is replicated with passive movement

6. When assessing strength in a `”gravity eliminated” position:

a) The client is required to move the limb through the vertical plane
b) The client can only achieve a maximum grade 3
c) The client is required to the limb through the horizontal plane
d) The client is required to move the limb through the coronal plane

7. During an examination of a client who has recently injured their shoulder, the physiotherapist
notices that they have numbness near the insertion of their deltoid. This is common to:

a) A strain of the deltoid tendon

b) Deltoid bursitis
c) Damage to the circumflex nerve
d) Damage to C7 nerve root

8. Assessment of a clients knee reveals restricted range of motion and a springy end feel
extension. The most likely problem is:

a) An ACL tear
b) Subluxation of their patella
c) A medial meniscus tear
d) A strain of their medial gastrocnemious

Vignette for questions 9-11

A 75 year old female comes to your clinic complaining of back and bilateral leg pain. When you assess
her, you find that the clients ankle jerk reflexes are absent bilaterally and that she has an increasing pain
with lumbar extension and walking. Her pain subsides when sitting.

9. The clients most likely diagnosis is:

a) Intermittent claudication
b) Spinal stenosis
c) Spondylolisthesis
 d) Posterior disc herniation

10. When assessing the clients function the most useful outcome measure is the:

a) WOMAC
b) Visual analogue scale for pain
c) Oswestry back pain scale
d) Patient specific function scale

11. Your client returns complaining of worseneing pain and difficulty urinating. The most
appropriate course of action at this time would be to:

a) Contact her physician

b) Encourage her to continue with her exercises because initially they helped
c) Reassess her reflexes
d) Change her exercises to extension because flexion exercises were making it worse.

12. When testing accessory movements for the first time it is important to have the client in a:

a) Close packed position

b) Loose packed position
c) A position that relates to the pain they are complaining
d) Any position that both the therapist and the client are comfortable in.

13. A client complains of anterior shoulder pain after sleeping soundly on her side. The initial
physiotherapy assessment reveals that the client has pain with passive horizontal adduction at
the end of range of all movements. The physiotherapist should:

a) Assess the stability of her acromioclavicular joint

b) Reassess her reflexes
c) Assess the stability of her anterior glenohumeral joint
d) Assess the position of her first rib.

14. Arthrokinematic movement is:

a) Typically examined with accessory movement testing

b) Described as movement along a mechanical axis
c) Can be performed actively
d) Relative to two bones and not their joint surfaces

15. The concave-convex rule:

 a) States the convex surface rolls and slides in the same direction as the movement
b) Is applied differently to different types of joints
c) Can only be used if there is restriction of movement
d) States that the concave surface rolls and slides in the same direction as the movement

16. A grade 3 mobilization:

a) Is the movement that occurs in the first half of the accessory glide range
b) Is the movement that is most useful to settle acute pain
c) Can be used to achieve an increase in range in a client that is not acute
d) Is performed using a thrusting technique

Vignette for questions 17-19:

A 58 year old very thin female comes to a clinic with a diagnosis of osteoarthritis of her right shoulder.
Her doctor has prescribed her NSAIDS and she states that this helps.

17. After taking her history and examining her the physiotherapist finds her range of motion limited
in a capsular pattern. The capsular pattern of the shoulder is:

a) Internal rotation most limited; abduction less limited and lateral rotation least limited
b) Lateral rotation most limited; internal rotation less limited and abduction least limited
c) Lateral rotation most limited; abduction less limited; internal rotation least limited
d) Abduction most limited; equal limitation of lateral rotation and internal rotation

18. She is complaining of pain that goes down her arm to her waist. She is also unable to support
her right side. After any activity that involves her shoulder she has pain for up to 6 hours and
she is having great difficulty sleeping. Her physiotherapist rates her joint irritability as being:

a) Severe
b) Mild
c) Moderate
d) You wont be sure until her therapist sees her x rays

19. Her physiotherapist decides to try glenohumeral distraction as the first treatment to see how
the client reacts to the treatment. Her physiotherapist decides the following grade and position:

a) Grade 1 or 2 in the resting position

b) Grade 1 or 2 at end range flexion because she is so stiff
c) Grade 2 or 3 in the resting position because she is so stiff
 d) Grade 2 or 3 in end of range lateral rotation because that is her stiffest movement

20. Which of the following is not a physiological response to application of laser:

a) epidermal hyperplasia
b) cutaneous melanogenesis
c) cutaneous erythma
d) cutaneous mastocytosis

21. Which of the following properties of laser light is or are believed to be the therapeutic effects of
LASER in living tissue

a) Monochromaticity
b) Coherence
c) Collimation
d) All of the above

22. A physiotherapist is treating an acute ankle sprain that happened three days ago is applying
ultrasound to the ankle the therapist will choose:

a) a 3MHz transducer head because you don’t need deep penetration

b) pulsed ultrasound because you don’t want heating of the tissues
c) to move the sound head continuously to prevent hot spots
d) all of the above

23. The physiotherapist notes that a clients TENS stimulator is a constant current dosage, which of
the following situations is most likely to cause an increase in current density under the
application electrodes

a) Electrodes drying on the skin

b) Electrodes pushed against the skin
c) Electrode lifting off the skin
d) Increased sweating under electrode.

Vignette for questions 24-29

Your client is a 30 year old male, heavily muscled, who sustained a quadriceps tear 4 days ago. Your
client walks in with a limp and decreased hip extension in late stance phase. Bruising is observing
decreased distal muscle contour visible. He has been using ice and immobilisation throughout to
manage his symptoms. His goal is to return to regular workouts by the following week and is into the
progressive approach to rehabilitation to optimise his healing. The physiotherapist has elected to use
ultrasound in the management of this client.
24. Which statement best describes this clients stage of healing?

a) Muscle guarding stage

b) The inflammatory phase is an essential factor of tissue repair and stimulates the phase of
healing
c) The mature collagen is remodelling in line with local tissue stresses
d) Pitting edema is often associated with this clients stage of healing

25. Healing of soft tissue is affected by:

a) Client cardiovascular fitness

b) Adequate intake of calcium
c) Allowing the client to full weight bear
d) Adequate vascular flow

26. The proliferation phase of wound healing:

a) Typically involves fibroblasts to form scar tissue

b) Takes up to 6 months to complete
c) Is associated with scar remodelling
d) None of the above

27. Which of the following statements would guide the physiotherapist in the choice of ultrasound
frequency?

a) Lower frequency ultrasound penetrates tissue more deeply that higher frequency
ultrasound
b) Shorter wavelength ultrasound penetrates tissue more deeply that longer wave ultrasound
c) Ultrasound frequency is dependent on the diameter of the crystal which generates
ultrasound
d) Depth of tissue penetration is not dependent on ultrasound frequency

28. The physiotherapist has decided to use pulsed ultrasound. Which of the following statements is
true?

a) Pulsed ultrasound delivers the same energy as continuous if applied for the same duration
b) Pulsed ultrasound delivers less energy than continuous ultrasound because the amplitude of
the pulsed waves is lower than that of a continuous wave
c) For a given power setting, the total energy of a treatment with pulsed ultrasound is
dependent on the mark:space ratio (or duty cycle)
d) All ultrasound is “pulsed” because of the nature of the sound waves used.
29. In a clinical application of non thermal ultrasound, which of the following is believed to produce
the most plausible explanation for the therapeutic effect?

a) Cavitation
b) Standing waves
c) Acoustic streaming
d) Micromassage

30. Grade 3 muscle strength indicates:

a) The muscle can move through full available range of motion with some resistance
b) The muscle can move part way through the available range with some resistance at the start
of the movement and the rest of the way with no assistance
c) The muscle is able to contract eccentrically as well as concentrically
d) The muscle is able to contract through the full available range of motion without resistance

31. Descriptions of abnormal end feel do not include:

a) Springy
b) Soft tissue approximation
c) Spasm
d) Capsular

32. End feel can be assessed by testing:

a) Active range of motion at the end of range

b) Resisted muscle contraction at the end of range
c) Eccentric muscle contraction at end of range
d) Passive range of motion at the end of range

33. A disc herniation through the end plate into the vertebral body is referred to as:

a) Sequestration
b) Schmorl’s node
c) Comminuted fracture
d) Compound fracture

34. Joint lubrication is:

a) Described by the hydrodynamic, elastrohyrodynamic and boundary models

b) Impaired with immobilization
c) Helped by restoration of full range of motion
 d) All of the able

35. Which of the following is associated with cauda equine syndrome?

a) Urinary retention
b) Hyper-reflexia
c) Positive babinski
d) Hypertonia

36. A 30 year old office worker attends a physiotherapy clinic because of neck and left arm pain. The
physiotherapy assessment reveals restriction of his cervical range of motion, a decreased
briskness of his left triceps reflex and a reduction in left wrist flexion strength. Sensory loss that
would fit this presentation will be located over:

a) His thumb
b) The medial aspect of his forearm
c) His little finger
d) His middle fingers

37. Rotator cuff injuries are:

a) Detected using a drop arm test

b) Usually seen in clients aged 17-25 years of age
c) Detected with an apprehension test
d) Often associated with excessive computer use

38. A bankart lesion:

a) Occurs in the femoral condyle with a torn with a torn meniscus

b) Occurs in the anteroinferior labrum of the glenohumeral joint
c) Is associated with posterior dislocation of the glenohumeral joint
d) Is ruled out by testing the joint stability

39. Damage to the ulnar nerve presents as:

a) Weakness of flexor carpi radialis

b) Decreased sensation of the medial dorsum of the hand
c) Inability to abduct/adduct fingers
d) Weakness of pronator teres

40. Tinels sign is:

 a) Used only to test nerve function of the upper extremeity
b) Positive when tingling is produced
c) An indicator for poor prognosis in re3covery of function
d) Often seen with repeated dislocation of the glenohumeral joint

41. Pregnancy is associated with:

a) A decrease risk of carpal tunnel syndrome

b) Increased laxity at the elbow causing tennis elbow to occur more frequently
c) Laxity of only the pelvic ligaments to facilitate birth
d) General ligament laxity because of changing hormone levels

42. A 60 year old female comes to a physiotherapy clinic after the removal of a cast for a fractured
wrist. She is unsure of what type of fracture she has. She fell backwards on her outstretched
wrist and was placed in a cast in full supination. She most likely sustained:

a) A colle’s fracture
b) A smiths fracture
c) A dinner fork fracture
d) A scaphoid fracture

43. A swan neck deformity of the fingers is:

a) Associated with severe osteoarthritis

b) Described as flexion of the metocarpophalangeal joints with extension of the proximal
interphalangeal joints
c) Helped by strengthening the intrinsic muscles of the hand
d) All of the above

44. Which of the following indicates normal range of motion at the wrist?

a) Wrist extension 70-90 degrees

b) Wrist flexion 60 degrees
c) Wrist adduction 60 degrees
d) Wrist abduction 30 degrees

45. A 20 year old male soccer player has arrived at a physiotherapy clinic after sustaining a fracture
of his left lateral malleolus. He has just had his cast removed. The physiotherapist has been
asked to assess his balance. Balance impairments in this case are most likely caused by:

a) A decrease in strength and range of motion

b) Sensorimotor integration
 c) A deficit related to medication
d) All of the above

46. Hydrotherapy is a very useful adjunct to therapy. Some of the properties of hydrotherapy
include:
a) The deeper the body part is immersed the greater the hydrostatic pressure
b) Buoyancy decreases the effect of gravity
c) By changing the velocity of movement you can increase or decrease the resistance because
of the property of viscosity
d) All of the above.

47. The term tendosis is associated with:

a) Inflammation of the tendon

b) Calcium deposits
c) Thickening of the tendon sheath
d) Degeneration of the tendon related to micro trauma

48. Which of the following statements are correct about the acute stage of a soft tissue injury?

a) The client will complain of pain only with movement

b) Usually lasts for 2 weeks
c) There may be swelling and redness
d) There is the formation of granulation tissue

49. A hyperlordotic lumbar spine is UNLIKELY to be due to:

a) Tight psoas muscles

b) Obesity
c) Tight rectus femoris muscles
d) Posterior rotation of the ilia

50. When progressing exercises for a patient it is important to:

a) Consider the clients age

b) Increase strength even when there is a decrease in range of motion
c) Move from unidirectional to complex patterns of movement
d) All of the above

51. A capsular pattern:

a) Is always caused by osteophytes

 b) Is identified as a characteristic pattern of proportional limitation of movement
c) Is determined by assessing active range of motion
d) Was a term first by Dr. Lister

52. A client with rheumatoid arthritis presents at a physiotherapy clinic with complaints of
increasing pain, swelling and fatigue. She attributes this to an increased demand at work (she is
an office worker). Education of this patient could include:

a) Breaking up her day with short rest periods

b) Increasing awareness of potential deforming forces to her joints during a flare up of her
disease
c) Adherence to a home exercise program even if fatigued
d) All of the above

53. A client comes to see you 3 weeks after an excision arthroplasty of her hip. She is complaining of
weaknessof her thigh muscle. When assessed, she has grade 2 quadriceps strength with
numbness of her anterior thigh. She most likely has:

a) A femoral nerve injury

b) A fracture of her femur
c) Loosening of the surgical components
d) None of the above

54. Yergasons test is used to:

a) Detect instability of the anterior shoulder capsule

b) Detect a torn meniscus of the knee
c) Is one of many tests used to assess stability of the knee
d) Detect instability of the biceps tendon in the bicipital groove

55. Hip abduction is produced by the following muscles:

a) Gluteus medius and minimus

b) Gluteus maximus and minimus
c) Piriformis and gluteus medius
d) Piriformis and gluteus maximus

56. A mother has brought her baby in for an assessment after the family pediatrician noticed some
asymmetry in the baby’s face. The diagnosis is “right torticollis”. This means that babys
head\neck posture should present as:

a) Right rotation and right side bending of the neck; tightness of the right SCM
 b) Left rotation and right side bending of the neck; tightness of right SCM
c) Left rotation and right side bending of the neck; tightness of the left SCM
d) None of the above

57. A 13 year old girl arrives at a physiotherapy clinic with complaints of back pain and right leg
pain. The pain worsens with standing and eases with sitting. When an assessing her posture is
completed it is noted that she is underweight and has a marked lordosis. She has stopped
participating in figure skating because of the pain. X rays have revealed a grade 3 slippage of L5
on S1. Her expected lumbar range of motion is:

a) Limitation of both forward flexion and extension; normal straight leg raise
b) Limitation of extension only; limited straight leg raise only
c) Limitation of both forward flexion and extension; limited straight leg raise
d) Limitation of right bending

58. Meniere’s disease is characterized by all of the following except:

a) A history of ‘attacks’
b) Preogressive hearing loss
c) Tinnitus
d) Migraines

59. A client presents with brief vertigo when he looks up and when rolling to one side in bed. What
is the most likely vestibular diagnosis?

a) Vertebrobasilar artery insufficiency (VBI)

b) Benign paroxysmal positional vertigo (BPPV)
c) Meniere’s disease
d) Inner ear infection

60. A disorder of the vestibular system may affect:

a) Hearing only
b) Postural stability and gaze stability
c) Postural stability, gaze stability and hearing
d) None of the above

61. Symptoms of multiple sclerosis may include all of the following except:

a) Blurring or loss of vision

b) Weakness and/or loss of coordination in the extremities
c) Resting tremor
 d) Fatigue

62. Medication management for multiple sclerosis may include:

a) Levidopa
b) Carbidopa
c) Interferon beta 1a
d) Atenolol

63. Which statement is NOT correct about multiple sclerosis?

a) Relapsing-remitting MS is the most common type of MS.

b) Primary-progressive MS accounts for 10% of cases of MS.
c) If someone starts out with the relapsing remitting type of MS they will not switch to more
progressive type of MS.
d) The expanded Disability Status Scale is used as a measure of disability and disease
progression in patients with MS

Vignette for questions 64-66:

Mr. Monroe sustained a right middle cerebral artery stroke 3 weeks ago. He is now on a medical ward
waiting to be transferred to rehabilitation.

64. Mr. Monroe demonstrated poor sitting balance, which is most likely due to:

a) Sensory impairment
b) Cerebellar dysfunction
c) Abnormal motor control
d) A and C

65. You work with a physiotherapist assistant. Which of the following could be assigned by a
physiotherapist to the physiotherapist assistant?

a) Implementation of PROM exercises previously prescribed by the physiotherapist

b) Discussion of prognosis with Mr. Monroe’s family
c) Progression of Mr. Monroe’s exercises
d) Assessment of Mr. Monroe

66. During the assessment, you notice that Mr. Monroe tends to bump his wheelchair into objects
on his left side. Which of the following may be responsible for this deficit?

a) Hemispatial neglect
b) Somatosensory deficit
 c) Homonymous hemianopsia
d) All of above

67. A stroke patient has unilateral neglect on the left side. Your short term goal is to correct this
neglect. Which treatment technique would NOT be effective in improving his left neglect?

a) Inclusion of bilateral tasks to increase total body awareness

b) Use of a mirror while dressing
c) Directing the patient to observe himself massaging his left upper extremity
d) Food placement on the right side of the tray so he can eat independently

68. Your patient is unable to communicate through verbal or written means. This describes:

a) Apraxia
b) Aphonia
c) Aplasia
d) Aphasia

69. Your post stroke patient presents with Wernicke’s aphasia. To enhance learning with sit to stand
transfers, you should avoid which of the following:

a) Demonstration of sit to stand

b) Use of a mirror as visual feedback
c) Provision of detailed verbal instructions
d) Practice of components of sit to stand separately

70. A patient is unable to whistle on command, but you have heard him whistle while listening to
music. In the gym, you notice your patient is unable to walk, but you have seen him walk to the
room and go to the toilet. This is known as:

a) Constructional apraxia
b) Ideational apraxia
c) Ideomotor apraxia
d) Intention apraxia

Vignette for questions 71-72.

Sam is a 2 year old boy with cerebral palsy. He presents with increased tone in lower extremities,
hypotonic trunk and underdeveloped protective reactions.

71. Sam is able to maintain his head in a vertical position when his body position is changed by the
therapist. Which reaction is Sam demonstrating?
 a) An equilibrium reaction
b) A righting reaction
c) A protective reaction
d) A tonic reflex

72. For a child such as Sam, periods of standing using a standing frame are encouraged for all the
following purposes EXCEPT:

a) Improve gastro-intestinal function

b) Perceptual development
c) Elongation of gastrocnemius
d) Decrease activation in the antigravity muscles

73. Mr. Williams is 45 years old and has Guillain Barre Syndrome. You need to determine his safety
for home discharge. He works as an accountant and lives with his wife in a 2 story home
(bedroom on 2nd floor) and uses a cane for ambulation. Which standardised outcome measure
would be the most beneficial to provide an assessment of safety with home mobility?

a) Fugl-meyer assessment
b) Functional independence measure
c) Berg balance scale
d) Community balance and mobility scale

74. Decerbrate posture presents with:

a) Flexion in the upper extremities and extension in the lower extremities

b) Flexion in both the upper and lower extremities
c) Extension in both the upper and lower extremities
d) Extension in the upper extremities and flexion in the lower extremities

75. A client had a traumatic injury 5 days ago, and is currently in the acute care unit with a Glasgow
coma scale (GCS) score of 10. She has a basal skull fracture and has activity as tolerated mobility
in orders. You receive a referral for chest physiotherapy. When treating this client, which one of
the following is contraindicated?

a) High fowlers sitting in bed

b) Deep breathing exercises
c) Nasopharyngeal suction
d) Side lying in bed

76. What is true about Trisomy 21 (Down Syndrome)?

 a) It is the result of an inherited genetic disorder
b) It is associated with hypotonia
c) It is associated with athetoid movements
d) Children with this disorder can have insatiable appetites

77. Mr. Chan underwent neurosurgery for a brain tumour two weeks ago. You are asked if he is
appropriate for referral to a rehabilitation program. Which of the following would be most likely
to prohibit him from being appropriate for rehabilitation?

a) Inability to sit unsupported for over 30 minutes

b) No carry over from one treatment session to the next
c) Endurance of only 60 minutes of continuous therapy time
d) Having no identifiable speech deficits

78. Mrs. Smith is 4 days post traumatic brain injury and is demonstrating increased tone in her right
upper and lower extremity. The most appropriate outcome measure to monitor muscle tone in
Mrs. Smith is:
a) Motor assessment scale
b) Modified ashworth scale
c) Barthel index
d) Wolf motor function test

79. Which of the following neurological conditions presents with both upper and lower motor
neuron signs?

a) Parkinsons disease
b) Amyotrophic lateral sclerosis
c) Guillain barre syndrome
d) Post polio syndrome

80. Your client is four weeks post traumatic brain injury and has now been referred to a
rehabilitation hospital. He gets easily distracted during your physical therapy session and
therefore can only tolerate 20 minutes of physical therapy at a time. Which of the following
would be the least appropriate to include in your physiotherapy session?

a) Repetition of instruction
b) Redirection of tasks
c) Ambulation in busy environments
d) Treatment session in a private room

81. Which of the following positions would you recommend to a client with who has had a
pneumoectomy 2 days ago and who is complaining of shortness of breath?
 a) Left side lying, bed flat
b) Right side lying, bed flat
c) Left side lying, head of bed tipped down
d) High sitting, head of bed elevated

Vignettes for questions 82-83

You are a physiotherapist on the acute medical ward, and have been asked to analyze Mrs. Lee’s arterial
blood gases.

82. Which of the following would describe an acute respiratory acidosis?

a) pH 7.5 with decreased pCO2

b) pH 7.3 with increased pCO2
c) pH 7.3 with decreased p CO2
d) pH 7.5 with increased pCO2

83. Which of the following pathologies will most likely lead to respiratory acidosis?

a) Myasthenia gravis
b) Hyperventilation secondary to an acute episode of severe pain
c) Renal failure
d) Potassium depletion secondary to severe vomiting

84. Following esophagectomy, which of the following is the LEAST important on post op orders?

a) Position the patient with the head of the bed at 30 degrees

b) Mobilising the patient as tolerated
c) Taking care not to dislodge the nasogastric (NG) tube
d) Encouraging the patient to do arm exercises to prevent shoulder stiffness

85. Which of the following is not true?

a) Pulmonary oedema caused by congestive heart failure responds well to physiotherapy

intervention
b) Pain is often a big problem with fractured ribs
c) Patients with cystic fibrosis often have large amounts of secretions
d) Following cardiac surgery, patients often complain of back or shoulder pain.

86. You are a physiotherapist reviewing a respiratory exam for a healthy 25 year old male. You
detect normal breath sounds throughout their thorax. Normal breath sounds are:
 a) Described as bronchial in nature
b) Louder over the right chest wall than over the left
c) Accompanied by adventitious sounds
d) Heard during inspiration and the beginning of expiration

87. A cough mechanism involves:

a) Contraction of the abdominal muscles

b) Secretion clearance predominantly from the smaller airways
c) Negative intra-thoracic pressures
d) A reflex controlled by the afferent stimulation of the sympathetic receptors

88. You know that when comparing lung function in a 22 year old with a 72 year old, the 72 year old
will have:

a) Decreased residual lung volume

b) Increased alveolar surface area
c) Decreased thoracic wall compliance
d) Increased elastic recoil of lung tissue

Vignette for questions 89-93

Mr. Reid is admitted to a medical ward for exacerbation of his chronic bronchitis. He lives in a small
town in a two level house. He is a 67 year old married man with a 10 year history of chronic bronchitis
and congestive heart failure. On admission he reported that he was not able to go up and down stairs
anymore to use his bathroom.

89. What clinical manifestations would you expect to find on assessment?

a) Dyspnea, cough, fine and coarse crackles at the bases, ankle edema
b) Dry cough, dyspnea, adventitious sounds, edema lower extremitites
c) Pursed lip breathing, cyaniosis, prolonged inspiration, fine crackles
d) Cough, prolonged inspiration, no adventitious sounds

90. Mr. Reid had bronchial breath sounds, this would indicate:

a) Normal lung tissue

b) Consolidation
c) Pneumothorax
d) Hyperinflated lung tissue
 91. You are planning the physiotherapy intervention for Mr. Reid. Which of the following will you
include in your treatment plan?

a) Trendenlenburg positioning for facilitating lower lobes drainage

b) Deep breathing exercises to stimulate surfactant production
c) Positioning for dyspnea relief
d) All of the above

92. You decide to treat Mr. Reid with percussion. Contraindications to this intervention include:

a) Pneumothorax
b) Hemoptysis
c) Pulmonary embolism
d) All of the above

93. You are supervising my Reid while he is performing the exercise program you prescribed. Which
of the following would be an abnormal response to exercise?

a) An increase of 20 beats/minute above his resting heart rate

b) An increase of more that 20-30 beats/minute above his resting heart rate
c) A decrease in oxygen saturation to 92%
d) A rate of perceived exertion of 9/20

94. Which of the following statements is true?

a) Open heart surgery patients should generally avoid coughing to stress a sterna incision
b) The use of mechanical lifts and transfer devices (medilift, medimaid) is contraindicated
following abdominal surgery
c) Alveoli in the bases of the normal upright lung are more compliant that alveoli at the apices
d) Closing volume occurs at lower volumes as age increases

95. Which of the following is not a contraindication to using a tipped (head down) posture drainage
position with a patient?

a) Low blood pressure

b) High intracranial pressure
c) Abdominal distension
d) Lung cancer with gross hemoptysis

Vignette for questions 96-99

Mrs. Walsh is a 69 year old woman who underwent an upper abdominal surgery and has a right sided
costal incision. You see her first day post surgery on the surgical unit.
 96. Mrs. Walsh is spending most of her time in bed, in supine. You advise her on the benefits of
changing positions. What position would you recommend, and for what rationale?

a) Right side lying, to improve perfusion

b) Left side lying, to maximise ventilation/perfusion matching
c) Left side lying to improve ventilation
d) Supine, to maximise ventilation/perfusion matching

97. Which of the following interventions would be the most beneficial for Mrs. Walsh?

a) Deep breathing exercises every hour

b) Positioning for dyspnea relief
c) Deep breathing exercises twice a day
d) Trendelenburg position to improve drainage

98. On the second day post surgery you are planning on taling Mrs Walsh for a short walk. Which of
the following would be a contraindication for this mobilisation?

a. Exhibition of shallow breathing pattern

b. Observable signs of deep vein thrombosis
c. Intravenous perfusion
d. A foley catherter in situ

99. Mrs Walsh develops significant right lower lobe atelectasis post operatively. You will discontinue
treatment when

a. Her oxygen saturation is greater that 85%

b. She is able to take deep breaths and cough effectively
c. She no longer has crackles on auscultation
d. She is able to walk 500 metres unaided

Vignette for questions 100-101

Ms Jones is a 64 year old woman who underwent a right modified mastectomy 1 year ago. She comes to
see you at your private clinic but is unsure whether she is over reacting. She has concerns about the
surgery. Upon taking a subjective history, you believe that she is at risk of developing either
lymphedema or DVT

100. Which of the following signs and symptoms would be most characteristic of a DVT?
 a. Pain, tightness and heaviness in the arm
b. Sharp pain, skin erythema, dependent edema
c. Pain on palpation and passive stretch, significantly warmer on palpation
d. Pale skin, cold at palpation

101. The percentage of cases of breast cancer related lymphedema that occur within 1-2
years after completing adjunct treatments is approximately:

a. 5-10%
b. 40%
c. 60%
d. 80%
102. What is the most common cause of amputations?

a. Congenital deformity
b. Trauma
c. Diabetes
d. Tumours

103. A symes amputation is:

a. A knee disarticulation
b. An amputation through the transmetatarsals
c. An amputation of part of the pelvis
d. An ankle disarticulation

Vignette for questions 104-108

Ms Brooks is a 77 year old woman with a right transtibial amputation secondary to trauma. Her incision
has completely healed and she was fitted with her prosthesis 3 weeks ago. Youve progressed her from
parallel bars to walking with a 2 wheeled walker. During todays physiotherapy session you notice that
when she walks she experiences pain in the residual limb.

104. How will you address the cause of Ms Brooks pain?

a. Ask her to remove her prosthesis and perform a skin inspection,

looking for reddened areas.
b. Check the fit of where the patella is in relation to patellar bar and
anterior rim of the socket
c. Add or remove socks as appropriate
d. All of the above

105. What would be a sign that Ms Brooks needs less socks?

a. Unable to don prosthesis

 b. Bell clapping
c. Redness on anterior and distal end of tibia
d. None of the above

106. Which one of the following is the ideal shape for the residual limb?

a. Cylindrical
b. Bulbous
c. Dog eared
d. Conical

107. Which of the following is a pressure tolerant/weight bearing area in a transtibial

amputee?

a. Head of fibula
b. Distal end of residual limb
c. Femoral condyles
d. Patellar tendon

108. Which of the following is not a type of suspension used with a transtibial prosthesis?

a. Supracondylar
b. Quadrilateral
c. Suction
d. Pin

109. Which of the following is not a principle of bandaging?

a. Wrap circumferentially
b. The pressure gradient should be distal to proximal
c. Rewrap every 4 hours
d. Enclose all skin, especially the distal end

110. You are working in a neurological rehabilitation unit. One of your clients is about to be
discharged home and you know they will require on going treatment in the community. Under
which of the following circumstances could you provide post discharge physiotherapy?
 a. You let the client know that you are available to continue his/her
treatment at home after discharge and that you think it would be
beneficial for him/her to continue treatment with you as this would
provide better continuity of care.
b. If you thought you could provide more specialised and appropriate
treatment that the other therapists in the local area.
c. Only if the client were a close personal friend or a family member.
d. The client has independently approached you to provide the care
you have already provided information about other physical
therapists in the area who could provide appropriate treatment

111. You are a locum working in a private practice clinic where most of the physical
therapists are highly skilled in manual therapy. As you are a new graduate your skills are limited
in this area. One of the clients on your list comes in and demands that you treat him with the
manual therapy techniques that he usually receives, as these work very well for him. You are
aware of these techniques but have not had a lot of practice in them and have never been fully
taught their use. What should you?

a. make use of this situation as an opportunity to practice these skills and

provide the treatment he is asking for
b. explain to the client that you are not qualified to use these techniques and
offer him alternative treatment or the opportunity to see another therapist
at the clinic who does provide this type of treatment.
c. Tell the client that the technique he is asking for are not evidence based and
probably don’t work so you refuse to use them, but that the chiropractor in
the clinic next door may be able to help you.
d. Send the client home as there is nothing you can do for him and tell him to
re book the appointment with his regular therapist.

112. Which of the following may be delegated to a physiotherapy assistant?

a. Application of electrical modalities such as laser when the physiotherapist

has prescribed the dose and the treatment duration
b. Interpretation of the berg balance test results
c. Increasing resistance on an exercise bike accordingly to previously
established limits for the client
d. A and C
 113. Which of the following is not true:

a. Consent to treatment can be implied from the clients words or actions

b. Informed consent to treatment must be obtained each time the treatment is
altered
c. An informed consent includes client awareness of risks of the procedure
d. Obtaining consent through a translator is not valid consent

114 . When treating a client, it is important to:

a. Refrain from developing a close personal relationship with the client whilst
they are in the physiotherapist’s care
b. Respect the clients wishes not to remove clothing even when it minimizes
the treatment that can be offered
c. Avoid taking gifts from clients whilst they are under the physiotherapist’s
care.
d. All of the above.

Vignette for questions 115-119

Your client is a 60 year old woman who was diagnosed with Parkinsons Disease (PD) one year ago. Her
neurologist has referred her to outpatient physical therapy for an assessment and treatment.

115. Which of the following are cardinal signs of PD that you might expect to observe in this client?

a. bradykinesia, rigidity and intention tremor

b. Shuffling gait, rigitdity and dysmetria
c. Bradykinesia, rigidity and resting tremor
d. Chorea, rigidity and resting tremor.

116. Which of the following assessments would you likely NOT conduct with this client?
 a. Timed walking test
b. Modified Ashworth scale
c. Rapid alternating movements
d. Balance

117. Your client states she has started medications for PD. Which of the following medications is
specifically used in the treatment of PD?

a. cortisone
b. Interferon beta therapy
c. Sinemet
d. Plasmaphoresis

118. Your client reports that she often has problems when she initiates a movement, such as walking.
She says she “cant move forward”. Her difficulty with movement inititation is called:

a. Festination
b. Ataxia
c. Freezing
d. Spasticity

119. An important focus of your clients home exercise program is activities and exercises to:

a. keep movements small and safe

b. Improve balance and prevent falls
c. Increase her anaerobic threshold
d. Decrease her resting tremor

Vignette: questions 120-124

Your client is a 23 year old man who was recently diagnosed with primary progressive Multiple Scerlosis
(MS). He was previously a recreational triathlete who has not been able to maintain a regular exercise
program. Currently, his main symptoms include fatigue, increased extensor tone in his legs, which is
worse at the end of the day; and altered sensation in his feet.

120. To monitor your clients functional progression of MS, which of the following outcome measures is
most commonly used?

a. Fugl-Meyer assessment of Physical Performance

b. Expanded Disability Status Scale (EDSS)
c. Community Mobility and Balance Scale (CMBS)
d. Functional Independence Measure (FIM)

121. Your client asks how primary progressive MS differs from other types of MS. Which of the following
statements would be included in your explanation?
 a. primary progressive MS goes through periods of exacerbation and remission.
b. Primary progressive MS occurs in approximately 50% of individuals diagnosed with MS; and
that this type of MS should not get worse over the next 5 years.
c. Primary progressive MS has a continuous progression and you will assist him adapt to the
changes in mobility.
d. Primary progressive MS has a wide variety of signs and symptoms but the medication his
physician prescribed will halt the progression of the disease.

122. How would you assess your clients reported sensory changes in his feet?

a. Time him tapping his feet as quickly as possible

b. Have him stand with his feet together for 10 seconds
c. Hold the sides of his big toe and move it up and down
d. Have him stand and reach forward as far as possible

123. You noted that your client complains of increased extensor tone in his legs at the end of the day.
You explain that increased muscle tone throughout the day is:

a. Common for all individuals who have primary progressive MS

b. Related to a change in the normal excitatory/inhibitory neuronal balance responsible for
normal movement.
c. An indication that he needs to remember to regularly stretch his legs during the day.

d. A result of not doing enough aerobic exercise

124. Your client is keen to start an exercise program again, but is concernced about the frequent periods
of fatigue that he experiences. You start by explaining that his fatigue is probably NOT due to:

a. Lack of sleep due to pain or spasms at night

b. Active inflammatory response
c. Depression
d. Muscle weakness

125. An appropriate exercise program for this client could include:

a. Swimming in a 34 degree heated pool.

b. Starting a restorative balance, stretch and strength class at the recreation centre
c. Walking around his local school running track
d. Restarting a spin stationary bicycle class at the recreation centre

Vignette: Questions 126-128

Your patient is a 20 year old man who sustained a gun shot injury to his head 3 weeks ago. His
cerebellum was affected and he remains extremely ataxic.

126. Which of the following tests might you omit from your assessment?
 a. Rapid Alternating Movements (RAM)
b. Finger to nose
c. Babinski
d. Romberg

127. As part of your neurological assessment, you may perform visual field testing. What cranial nerve is
being assessed with this test?

a. Trochlear nerve
b. Occulomotor nerve
c. Optic nerve
d. Trigeminal nerve

128. To aid in his functional performance, you teach your client to control his movements when reaching
for an object by:

a. Fixating his body

b. Using small range, fast movements to reach quickly
c. Sliding his hand along a support when reaching for objects
d. Applying weights to his ankles, then reaching

129. Which of the following neurological conditions may present with both upper and lower motor
neuron signs?

a. Multiple Sclerosis
b. Guillain Barre Syndrome
c. Amyotrophic Lateral Scerlosis
d. Parkinsons disease

130. Your patient has a unilateral Grade 0 ankle (achillies tendon) reflex. This may indicate:

a. A contralateral diabetic L3 neuropathy

b. A cerebellar lesion
c. An ipsilateral S1/2 lesion
d. A contralateral S1/2 lesion

131. The ear, nose and throat (ENT) specialist has referred a patient to you for the Epley manoeuvre.
Which condition is this treatment used for?

a. Meniere’s disease
b. Tinnitus
c. Benign Paroxysmal Positional Vertigo (BPPV)
d. A central vestibular lesion
132. Your patient had a left motor cortex lacunar stroke 3 days ago. Based on the diagnosis, you might
expect to see facial weakness to which area?

a. The upper and lower part of the right side of the face
b. The lower part only of the right side of the face
c. The upper part only of the right side of the face
d. The lower part of the left side of the face

133. Your patient has a spinal cord injury, which has caused greater loss of their upper limb function
compared to their lower limb. This is described as:

a. Brown Sequard Syndrome

b. Anterior Cord Syndrome
c. Central Cord Syndrome
d. Tabes Dorsalis

Vignette: Questions 134-139

Joan is a 25 year old woman who sustained a severe closed head injury with a basal skull fracture in an
ice hockey game three days ago. Her intracranial pressure is stable, but is being monitored. Her Glasgow
Coma Scale (GCS) has improved from 4 to 8 and she has an activity as tolerated (ATT) mobility order. She
demonstrates decorticate rigidity and is non verbal.

134. Decorticate rigidity presents as:

a. Upper limbs flexed and lower limbs flexed

b. Upper limbs flexed and lower limbs extended
c. Upper limbs extended and lower limbs flexed
d. Upper limbs extended and lower limbs extended

135. Joan is on supplemental oxygen and requires suctioning to clear her secretions. What type of
suctioning is contraindicated?

a. Oral suctioning secondary to her diagnosis of a severe closed head injury

b. Nasopharyngeal suctioning secondary to her ICP being monitored
c. Oral suctioning secondary to her GCS being below 9
d. Nasopharyngeal suctioning secondary to her basal skull fracture

136. Joan has decreased dorsiflexion bilaterally with tight plantar flexors. Your treatment to prevent
contractures and improve dorsiflexion may include:

a. Botulinum toxin injections to the dorsiflexors

b. A foot board at the end of the bed
c. Serial casting in consultation with an occupational therapist
d. Static stretch held for 30 seconds, repeated once a week
137. You attempt to engage Joan in your therapy sessions by:

a. Breaking down activites into multiple components

b. Giving loud but clear instructions
c. Using tactile or verbal commands
d. Using different environmental stimuli each time

3 months post injury, Joan is transferred to the rehabilitation ward, and you continue to see this client for
ongoing physiotherapy treatment.

138. You suspect that Joan has developed heterotopic ossification in her left elbow. The following
clinical indicator led you to this conclusion:

a. Suddent dramatic loss of range of motion

b. Cool clammy skin
c. No pain on range of motion
d. Flaccid paralysis

139. Heterotopic ossification of Joans left elbow is confirmed. What treatment contraindications must
be observed?

a. No range of motion
b. No serial casting
c. No cardiovascular exercise
d. No functional activites

Vignette: Questions 140-143

You have just started working with a 65 year old man who sustained a left middle cerebral artery infarct
2 days ago. He is currently in the acute stroke unit. He has a history of hypertension, bradycardia and a
pacemaker. Today he presents with low tone on his right side and requires a two person assist with bed
mobility.

140. His physician has ordered activity as tolerated (ATT). What informationdo you need before you can
mobilise this client out of bed to standing?

a. Chedoke leg >Stage 5

b. Stable blood pressure and heart rate
c. Glasgow Coma Scale >12
d. Independent sitting balance

141. Your client is unable to verbalise but is able to consistently answer your questions by using his left
hand. He probably has:

a. Global aphasia
b. Expressive aphasia
 c. Apraxia
d. Receptive aphasia

142. Your client remains dependent for all mobility and has significant movement impairment. Your
treatment objectives would include interventions to minimize secondary complications. For example:

a. Use of a tens machine to prevent shoulder subluxation

b. Standing with a rigid ankle brace and quad cane to promote equal weight bearing
c. Using reciprocal pulleys to maintain shoulder range of motion
d. Two person assisted standing to prevent fear of falling.

Your patient is now 3 weeks post stroke and demonstrates a Chedoke stage 3 right hand and arm.

143. His family brings him a soft ball for him to squeeze. You advise them that he should avoid which of
the following:

a. Holding the ball with both hands and sliding it across his bedside table
b. Assisted opening of his hand to reach for the ball in different directions
c. Squeezing the ball 3 times a day to strengthen his muscles
d. Clasping both hands around the ball and lowering/raising from a stool

144. A 25 year old man sustained a T3 complete spinal cord injury 7 days ago while snowboarding. In the
middle of your treatment session, he asks you if he will ever walk again. As his physical therapist, you
respond by saying, based on individuals who have had a similar injury:

a. That he will be able to ambulate with bilateral knee/ankle/foot orthoses (KAFO)

b. That he will be able to ambulate with bilateral ankle/foot orthoses (AFO)
c. That he will likely be using an electric wheelchair at all times for his mobility
d. That he will likely be using a manual wheelchair at all times

145. Which complete spinal cord injury level is the highest level where an individual can still maintain
independence for bed mobility with or without assistive devices:

a. C3 complete spinal cord

b. C5 complete spinal cord
c. C6 complete spinal cord
d. T2 complete cord

146. A medical student asks you what “clonus is”. You describe it as:

a. “a series of involuntary muscle contractions, associate with motor neuron disease, when
the muscle is stretched slowly.
b. “a muscle contraction, associated with an upper motor neuron disease, when the muscle
is stretched rapidly”
c. “a series of involuntary muscle contractions, associated with an upper motor neuron disease,
 when the muscle is stretched rapidly”
d. “a series of voluntary muscle contractions, associated with an upper motor neuron disease,
when the muscle is stretched rapidly”

147. An individual with a complete spinal cord injury at C6 level will”

a. Need to allow a tenodesis to develop

b. Have full strength triceps
c. Always transfer with assistance
d. Use only a electric wheelchair

148. Possible complications for individuals with a SCI include:

a. Autonomic dysreflexia, pressure sores, ptosis

b. Dysdiadochokinesia, osteoporosis, syringomyelia
c. Spasticity, deep vein thrombosis, cardiovascular disease
d. Deep vein thrombosis, autonomic dysreflexia, dysarthria

Vignete: Questions 149 to 151

A new client comes to your clinic for advice regarding an exercise program. He remembers doing
physiotherapy exercises when he was a child with poliomyelitis, at age 7. He now reports the onset of
new weakness in his legs. He is confused as to how his symptoms resolved when he was young, and
what is happening now.

149. You explain to him that recovery from polio when he was a child is related to the following:

a. After initial infection, new anterior horn cells develop and sprout nerve endings to the
affected muscles
b. After the initial infection, motor neurons that survived sprout new nerve endings to the
affected muscles
c. After initial infection, the unaffected muscles sprout new connections to the affected muscles
d. After the initial infection, the surviving motor neurons became smaller.

150. You describe to him some of the symptoms of post polio syndrome are:

a. Rapid onset of pain and weakness in muscles previously not affected by polio
b. Intermittent but progressive weakness of muscles previously affected by polio.
c. No fatigue but weakness which will likely require him to use mobility aids
d. Rapid progression of weakness in muscles previously affected by polio

151. Following your education session, you work with your client to develop a home exercise program
which includes:

a. Specific weight training exercises to target the affected muscles, 3 sets of 10 reps at 60%
maxweight, 5x a week
 b. A general exercise program of durations 2-3 minutes, followed by 1-2 min rest, 3x per week,
intensity level 40-50% heart rate reserve (HRR)
c. Daily muscle stretches, 30 seconds for each lower extremity muscle group
d. A general reserve exercise program 5 days a week with 30 minutes of aerobic training at
70% heart rate.

Vignette: Questions 152-155

You are asked to see an 80 year old woman POD 1 left total hip replacement. There is a large lateral
incision covered by a bulky dressing. She is drowsy and reluctant to move. The orthopaedic surgeons
post op orders are mobilization, weight bearing as tolerated.

152. With your initial introduction to the patient, she informs you she does not want to get out of bed
and is scared to move. You check with her RN regarding pain medication timing and find she has had
pain medication approximately one hour ago. You proceed by:

a. Explain that it is surgeons orders and not her choice.

b. Review the post operative course of treatment with her to address her concerns
c. Respect her fear and chart patient does not want to get out of bed yet
d. None of the above

153. The patient is now agreeable to try and mobilise. You review the THA precautions with her before
she starts moving. The precautions are:

a. No hip flexion beyond 90 degrees, no hip adduction or abduction, no hip internal rotation
b. No hip flexion beyond 90 degrees, no hip rotation, no crossing your legs when sitting
c. No hip flexion, no hip external rotation, no hip adduction
d. No hip flexion beyond 90 degrees, no hip adduction past midline, no hip internal rotation past
neutral

154. It is now POD 10 and you are seeing the patient at the rehabilitation hospital. She is doing very well
and is up and walking with a walker independently. Planning is now taking place for discharge home. She
mentions that her lower leg today is suddenly a bit sore and as you assess you find her calf is tender and
swollen. The most appropriate action is to:

a. Discuss the findings with the physician following your assessment

b. Decrease her exercises in the exercise class
c. Treat her leg with rest, ice and elevation
d. Instruct the patient to follow up with her physician in the community if this persists post
discharge home.

155. The patient is now being assessed in outpatient physiotherapy. When assessing the patients gait
you notice that she is leaning towards her left side at heel strike. She is now 10 weeks post left total hip
replacement and her left abduction strength is grade 4. When writing in her chart you describe your
findings as:
 a. a left Trendelenburg
b. a right Trendelenburg
c. A left compensated Trendelenburg
d. A right compensated Trendelenburg

Vignette: Questions 156-159

You are a physiotherapist in a busy private clinic. Your new patient is a 42 year old woman who is a
lawyer and mother of 3. She reports working long hours at a desk, and maintains a busy schedule with
her kids. She has come to you regarding her mid scapular pain. She states it is made worse by holding
her 2 year old, sitting at her desk working on her computer but really seems to never go away
completely. She reports not sleeping through the night. She states she saw her family physician and was
given medication but is frustrated because it actually feels worse and she is exhausted.

156. Concerning signs and symptoms considered red flags are present within this history for:

a. Depression
b. Mulitple sclerosis
c. Cancer
d. There are no red flags of concern as she has been seen by her physician.

157. The patient is now clear of any concerns. You decide to treat with manual therapy using Grade 3
extension mobilisations through the mid thoracic spine. Upon return 3 days post treatment she reports
feeling pain for approximately a day post treatment. Treatment today will:

a. Continue with the same treatment with heat added prior to mobilization
b. Will progress more quickly to grade 4 to treat the joint restriction more directly
c. Adjust the treatment to grade 2 mobilisations to reduce joint irritation
d. Not include manual therapy

158. Accessory movements at joint are not:

a. performed actively
b. related to restriction of range of motion
c. Part of a detailed joint assessment
d. Indicators of joint dysfunction

159. Treatment for hypomobility of the thoracic spine with the presence of a mild non fixed kyphosis
would be best addressed for this patient with:

a. Improved cardio-vascular training

b. Postural retraining
c. A new chair at work
d. Use of a cervicothoracic orthosis
Vignette: Questions 160-161

You are working in an acute care hospital. You are treating a 60 year old man who is now POD 3 right
transtibial amputation. The diagnosis leading to amputation was peripheral vascular disease, related to
diabetes.

160. Treatment at this stage would not include:

a. wrapping with an elastic wrap

b. positioning of the residual limb in knee flexion on a pillow while in bed
c. Teaching the patient how use crutches on level and on stairs
d. Range of motion as tolerated at the knee

161. The patient is now ready to learn how to wrap his residual limb himself. You are quite busy and ask
the new physiotherapy assistant (PTA) to teach the patient. The PTA has not done this before but is
happy to do it and understands the theory. The most appropriate next step is to:

a. provide the PTA with a handout with images and written description to follow
b. teach the patient and the PTA when you have time later in the day
c. Check the result of wrapping once the PTA has taught the patient
d. None of the above

Vignette: 162-164

A 10 year old girl has been seen by you in fracture clinic. She fell off her bike and was diagnosed in the
emergency department with a distal radial fracture. The fracture is reduced and immobilised in a cast
for an anticipated 6 weeks.

162. You call her in to provide instruction regarding the time while her cast is on, however, her mther
has gone down to the cafeteria. You proceed by:

a. Providing the information to the patient and a book for her mother
b. review the range of motion exercises only
c. Wait for her mother to return before continuing
d. Informing her mother that she has missed her appointment and provide her with the follow
up book.

163. The following day her mother calls to say that her hand is slightly blue and she is complaining of
tingling. Your directions to her mother is:

a. The patient should perform hand pumping

b. To take the patient to the emergency room as the cast may need to be removed
c. Put ice over her hand and the cast
d. None of the above

164. The primary concern regarding this facture in children is:

 a. Proximity of the fracture to the epiphyseal growth
b. Involvement of circulatory system avascular necrosis
c. Neural impingement
d. Ligamentous disruption

165. Your patient is a 21 year old man two weeks post anterior dislocation of his right shoulder. He is
now referred to you for gentle exercise, avoiding external rotation past 30 degrees when shoulder is
abducted. The arm is to remain in the sling when he is not doing his exercise. Which exercise do you
include in your treatment plan:

a. elbow flexion and extension full AROM exercises

b. pendulum exercises
c. Deltoid muscle isometric exercises with shoulder held at 0 degree flexion.
d. All of the above

166. A positive Hawkins Kennedy Test is most likely an indication of:

a. Suprainspinatus impingement
b. Long head of the biceps rupture
c. Sternoclavicular joint separation
d. Fracture of the humeral head

167. An 80 year old woman complains of low back pain with a sudden onset following moving a heavy
box of books in her home. The pain occurred immediately following and has not decreased since, it has
now been two weeks. She is quite slim and is walking with a forward flexed posture which she states is
not her normal posture. Her PMHx includes MI 2 years ago, osteoporosis and migraine headaches. From
the history you are now considering:

a. Lumbar stenosis
b. Vertebral compression fracture
c. L4-L5 lateral stenosis
d. Cancer

168. Fibroplastic stage of healing:

a. is also known as the proliferation phase

b. creates scar tissue
c. Is expected to take place during 3-20 days post injury.
d. All of the above

169. A 65 year old man is non weight bearing post right patellar fracture. His right leg is immobilised in a
knee brace locked in extension. You are training him to use the stairs. The most appropriate walking aid
is:
 a. a cane and the use of the railing
b. crutches and the rail when available
c. A hemi walker
d. He should not to use the stairs

170. A 34 year old man was playing soccer 2 days ago sustained a quadriceps contusion resulting from a
blunt trauma. He is experiencing loss of function and the area is swollen. The most appropriate initial
treatment is:

a. Progressive squats and lunges with weights as tolerated

b. Acupuncture
c. Deep soft tissue massage
d. Gentle AROM with in pain tolerance

171. A 30 year old client has been admitted through emergency with a fractured femer. They have
undergone internal fixation with flexible nailing. You have been asked to teach the client crutch walking
non weight bearing. During your session the client becomes very pale and short of breath. Which is the
most likely to have occurred?

a. The patient has had a fat embolism

b. the patient has become faint because of poor pain control
c. The patient has developed a deep vein thrombosis
d. The patient has developed pneumonia post operatively

172. A client presents with medial knee pain after being hit on the outside of the knee during a soccer
game. The knee was forced into a valgus position. They most likely have:

a. A medial ligament sprain the severity is to be determined

b. an ACL tear
c. A medial meniscus tear
d. A strain of the medial head of the gastrocnemius

173. A client presents with L shoulder pain after painting their house over the weekend. Your exam
reveals that isometric abduction is the only test that provokes pain. They report that lying on the
shoulder is not painful. They most likely have:

a. a biceps tendonitis
b. a deltoid bursitis
c. A supraspinatus
d. A pec major strain

174. A 23 year old client arrives with a history of shoulder pain. You need to choose an outcome
measure that is appropriate. You choose to use a:
 a. WOMAC
b. SF 36
c. Upper extremeity function scale
d. TUG

175. Therapists should be most concerned if:

a. the patient has an empty end feel of their knee

b. the patients pain is 10/10 on a VAS scale
c. The patient is complaining of feeling light headed with changes of position
d. The patient has sensory changes

176. When assessing a patients knee you find that they do not have full range of motion. When
assessing passive range of motion you notice that they have a springy end feel in extension. The most
likely problem is:

a. an ACL tear
b. a subluxation of their patella
c. A medial meniscus tear
d. A strain of their medial head of gastrocnemius

177. Rehabilitation of proprioception can be progressed by:

a. increasing the size of base of support

b. increasing the external perturbations
c. Keeping the clients eyes open
d. All of the above

178. Joint lubrication is:

a. described by the hydrodynamic, elastrohydrodynamic and boundary models

b. impaired with immobilisation
c. Helped with restoration of full range of motion
d. All of the above

179. An isometric muscle test that results in a ‘weak and painless’ finding means:

a. complete rupture of tendon or muscle

b. the client should be tested on an isokinetic dynamometer
c. This client should be given strengthening exercises
d. All of the above

180. Capsulitis of the of the shoulder or ‘frozen shoulder’ often

a. presents with restriction of medial rotation>abduction>lateral rotation

b. is common in women 30 years of age and older
 c. Happens with or without trauma
d. Is always helped with physiotherapy

181. A patient is complaining of pain at the base of their thumb after falling off their bike. You have
located their anatomical snuff box.

a. it is bordered by the thumb and finger extensors

b. tenderness can indicate a fracture of the scaphoid
c. Is best found by asking the patient to form a fist with their hand
d. Listers tubercle is found within the snuff box.

182. An 80 year old woman has been sent to your clinic because she keeps falling. You have been asked
to treat this woman.

a. home assessment isn’t necessary

b. this client should come off all her medication because this increases the risk of all
c. Falls are often related to multiple risk factors
d. Vertebral artery testing is not included in this type of assessment

183. Your hospital sees many patients with total knee replacements and you have been asked to design
an exercise/education program for a total knee class. You decide that you will need:

a. equipment the patients can use at home

b. some outcome measures so you can objectively measure how the groups are doing
c. Break the groups into stages of healing rather than age and type of replacement
d. All of the above

184. Your patient arrives for their initial assessment with you. When they are walking into the treatment
area you notice that they have a high stepping gait on their R lower extremity and an audible foot slap.
Their history is of low back pain and R leg pain. They state that their pain is much improved now.

a. they most likely have an L4 nerve palsy

b. they most likely have a bucket handle tear of the meniscus
c. They most likely have peroneal nerve palsy
d. They most likely have a disc herniation of L5/S1

185. Which one of the following statements is true about postural drainage.

a. postural drainage is an evidence based treatment for pulmonary embolus

b. postural drainage is an evidence based treatment for pneumothorax
c. Prone is the optimal position to drain the superior segments of the right and left posterior
lobes.
d. Supine with the head of the bed raised 35 degrees is the optimal position to drain the
right middle lobe.
186. Jane Doe has right lower lobe atelectasis following abdominal surgery. Assuming there are no
contraindications to positioning the patient, which of the following would be best to optimise
perfusion/ventilation matching?

a. left side lying

b. right side lying
c. Supine
d. Prone

187. When analysing a chest x ray a silhouette sign over the left dome and left heart border indicates
pathology in the following:

a. right lower lobe and right middle lobe

b. left lower lobe and lingula
c. Left upper lobe and lingual
d. Lingual and right middle lobe

188. Which of the following is not the function of a chest tube?

a. removal of fluid from pleural space

b. removal of fluid from the alveoli
c. Removal of air from the chest cavity
d. Removal of fluid from the mediastinal cavity

189. When working with a patient who has a chest tube, which of the following is true?

a. collection chamber must be below the level of the insertion point at all time
b. the patient must be on bed rest at all times
c. Suction (negative pressure) must be applied at all times
d. Chest tube must be removed after 7 days

190. Patients under going cardio thoracic surgery have increased risk factors if they are:

a. 70 years old or older

b. undergoing their first cardio thoracic surgery
c. Non smokers
d. Female

191. Which one of the following statements is true about postural drainage (PD)

a. to drain the superior of both lower lobes, the optimal position is prone
b. to drain the right middle lobe the optimal position is supine with the head of the bed raised
to 35 degrees.
c. PD is a recommended treatment for a patient who may have a pulmonary embolis
d. PD is a recommended treatment for a patient with increased cranial pressure.
192. You are treating a patient following a mild myocardial infarction using a prescribed exercise
protocol. The protocol states that the patient should not exceed 5 metabolic equivalents (METS) with
any activity at this stage of recovery. Which of the following activities would not be appropriate for the
patient:

a. cycling 18km
b. walking 6.5km
c. Driving a car for 30 mins
d. Weeding a garden for 1 hour

193. Patients with COPD who experience breathlessness from exertion find the following position
helpful:

a. standing upright with arms extended over their head

b. sitting in a forward lean position with forearms resting on their knees
c. Supine
d. Sitting in upright position

194. Diaphramatic innervations is from:

a. the phrenic nerve and cervical nerves C4, C5 and C6

b. cervical nerves C3, C4 and C6
c. The phrenic nerve and cervical nerves C3, C4 and C5
d. Cervical nerves C3, C4 and C5

195. Signs and symptoms of cardiac insufficiency in a baby are most likely to include which of the
following:

a. central cyanosis and increased urine output

b. upper airway obstruction and stridor
c. Poor peripheral perfusion and feeding
d. Hyper activity and liver failure

196. A patient has the following arterial blood gas (ABG) values: PH 7.2, PaCO2 49, HCO3 24. These
ABG’s indicate:

a. respiratory acidosis uncompensated

b. respiratory alkalosis partially compensated
c. Metabolic acidosis partially compensated
d. Metabolic alkalosis uncompensated

197. A patient has the following ABG’s; PH 7.5, PaCO2 29, HCO3 25. These ABG’s indicate:

a. respiratory acidosis, uncompensated

b. respiratory alkalosis, uncompensated
 c. Metabolic alkalosis, partially compensated
d. Metabolic alkalosis uncompensated

198. Inspiratory crackles heard on auscultation are most likely to indicate which of the following:

a. Pneumothorax
b. consolidation
c. Atelectasis
d. Pleural effusion

199. You are working in a cardiac rehabilitation setting. Which of the following types of exercise pose
the highest risk of harm to a 64 year old man with a history of myocardial infarction?

a. concentric
b. eccentric
. Aerobic
d. Isometric

200. Restrictive lung disease usually causes:

a. decreased tidal volume

b. decreased V\Q matching
c. Increased inspiratory capacity
d. Increased total lung volume

201. During an exercise session a patient is asked to assess level of exertion using the Borg
Rating of perceived exertion Scale (RPE). The patient rates the level of exertion as 9 on the 6 -20
scale. A rating of 9 corresponds to which of the following:

a. Very, very light

b. Very light
c. Somewhat hard
d. Hard

202. A therapist is evaluating a patient in the intensive care unit. The therapist notes no eye
opening, no verbal response and no motor response. On the Glasgow coma scale, what is the
patient’s score?

a. 0
b. 3
c. 5
d. 9

203. A physiotherapist is teaching a family how to care for a family member who is totally bed
bound (restricted to bed). To prevent pressure ulcers most effectively, what should be the
maximal amount of time between position changes?

a. One hour
b. Two hours
c. Six hours
d. Eight hours

204. What is the best definition of the term “low expiratory reserve volume”?

a. The volume of air remaining in the lungs after a full expiration is low
b. The volume of air taken in during a normal breath is low
c. The volume of air forcefully expired after a forceful inspiration is low
d. The amount of air forcefully expired after a normal resting expiration is low

205. A patient who has previously suffered a myocardial infarction is participating in an exercise
test. The therapist notes ST-segment depression of 1.7mm on the patient’s current rhythm strip.
What is the most appropriate course of action?

a. Stop the exercise session immediately and send the patient to the emergency room
b. Continue with the exercise session
c. Contact the patient’s cardiologist for advice about continuing exercise
d. Stop the exercise session and tell the patient to return to their family doctor for
advice about
continuing exercise.
Vignette. Questions 206 – 209

Joe Puffer, a 72 year old with a 10 – year history of COPD (emphysema) has been admitted to
hospital with a complete right middle lobe consolidation secondary to pneumonia. He is also
suffering from diarrhoea and has been put on antibiotic therapy and oxygen therapy, at 4 –
litres/per minute via nasal prongs.

206. What breath sounds and/or added sounds would you expect to hear over the right middle
lobe?

a. An asthmatic inspiratory wheeze

b. Decreased breath sounds
c. Bronchial breathing
d. Expiratory crackles or B or C

207. ABG results: pH 7.8 PaCO2 30 HCO3 24 What is the primary acid – base disorder?
 a. Respiratory acidosis with compensation
b. Matabolic acidosis with compensation
c. Respiratory and metabolic acidosis
d. Respiratory alkalosis

208. Which silhouette sign will be affected by the consolidation on the chest X – ray?

a. Right mediastinum silhouette

b. Right heart border silhouette
c. Right diaphragm (dome) silhouette
d. Left heart border and diaphragm (dome) silhouette

209. What is the maximum flow rate comfortably tolerated with nasal prongs?

a. 2L/min
b. 4L/min
c. 6L/min
d. 8L/min

Vignette:

Joe fumer is 72 years old and has a 15 year history of COPD. He has been admitted to hospital
with an acute on chronic respiratory exacerbation. He as moderate to severe disease and is a
chronic CO2 retainer. He presents with increased shortness of breath and is temporarily
receiving oxygen therapy at 3l O2 via nasal prongs.

210. On admission, which ABG results belong to Joe?

a. pH 7.22 PaCO2 50 HCO3 20

b. pH 7.50 PaCO2 32 HCO3 24
c. pH 7.39 PaCO2 42 HCO3 24
d. pH 7.32 PaCO2 60 HCO3 31

211. If Joe develops paradoxical/asynchronus rib cage and abdominal movement in his
breathing pattern, it is a sign of:

a) a developing pleural effusion

b) a tension pneumothorax
c) a fatiguing diaphragm
d) fatiguing abdominal muscles

212. During an acute exacerbation, why is it beneficial to teach Joe to sit in a forward lean
position with his forearms resting on his knees?
 a. to decrease dyspnea
b. To isolate diaphragmatic breathing
c. To alter the rib cage angle to maximize inspiration
d. To decrease the work of accessory muscles

213. Which breathing control technique should the Physical Therapist teach Joe to use his acute
exacerbation?

a. quick inspiration followed by long expiration

b. Breath stacking
c. deep breathing with an inspiratory hold of 3 seconds
d. Gentle expiration through pursed lips

214. What signs and symptoms indicate a long standing, chronic respiratory disease?

a. increased respiratory rate

b. Fever
c. Prominent trapezius and SCM muscles
d. Infected sputum

End of Vignette

215. Which of the following statements best describes the autogenic technique for secretion
clearance?

a. it opens up the collateral airways to allow air to move behind the mucus plug.
b. It creates a vibratory effect within the airways to loosen secretions for easier
clearance
c. It involves breathing at different lung volumes to move secretions from the distal to
proximal airways
d. It utilizes the equal pressure point in the airways to mobilise secretions

216. A newborn is primarily reliant on which muscle(s) for respiration?

a. the intercostals muscles

b. The diaphragm only
c. The accessory muscles
d. The diaphragm and accessory muscles equally

217. A 30 year old female, who is non smoking and does not have any co-morbitites, had a small
bowel resection. What would the physical therapist’s main treatment be on day 1 post op?

a. teach the patient lower extremity exercises

b. Assist the patient to sit on the edge of the bed
 c. Teach the patient breathing exercises
d. Assist the patient to take short walks

218. When treating a morbidly obese patient after abdominal surgery, a physical therapist
should be aware of an increased risk of which post operative complication?

a. chest infection
b. Atelectasis
c. Pleural effusion
d. Pneumothorax

219. In a post operative patient who smokes one pack per day, how are Functional Residual
Capacity and Closing Volume (CV) different from a non smoking patient?

a. both FRC and CV are increased to a greater

b. Both FRC and CV are decreased to a greater extent
c. FRC remains unchanged and CV is increased
d. FRC is decreased and CV is increased

220. When treating a patient with painful fractured ribs, which of the following breathing
exercises would the physical therapist first teach?

a. breath stacking
b. Purse lip breathing
c. Deep breathing exercises
d. Deep breathing exercises with a maximum inspiratory hold

221. What structures does a pleurovac chest tube pierce?

a. skin, intercostals muscles and visceral membrane

b. Skin and intercostals muscle only
c. Skin, intercostals muscles and parietal membrane
d. Skin, intercostals muscles, visceral and parietal membranes

222. Which of the following is not a sign or symptom of a Pulmonary Embolus (PE)?

a. sudden onset of dysnea

b. Bloody sputum
c. Sudden spike in temperature
d. Tachycardia

223. The Physical therapist is assessing the pulmonary function of a patient by looking at the
Functional Residual Capacity. What is true about FRC?

a. it decreases in person over 65 years of age

b. It is the volume at which alveoli start to close
 c. It is the volume of air in the lungs at the end of active expiration
d. Balanced point between outward recoil of the chest and inward recoil of the alveoli.

224. Where will optimal gas exchange occur in the healthy, upright adult lung?

a. in the mid zones, because the V/Q ratio is 1:1 in this area
b. In the bases, because ventilation and perfusion are both at their greatest in this area.
c. Equally throughout all the lung areas
d. In the apex, because intrapleural pressure is most negative in this area

225. Which statement is true about pulmonary edema caused by congestive heart failure?

a. it causes dyspnea which is relieved by sitting up.

b. It causes mucoid and contains clots of blood
c. It results in decreased breath sounds on auscultation
d. It responds well to secretion clearance techniques

226. What would the physical therapist observe on an echocardiogram (EKG) tracing
immediately following an acute myocardial infarction?

a. increased R amplitude
b. Changes in ST segment
c. Flat QRS complex
d. Absent T wave.

227. At what age does rib angle change to better position the diaphragm for greater mechanical
advantage?
a. 9 months
b. 6 months
c. 3 months
d. 12 months

228. At what embryonic age does surfactant production begin?

a. 20 weeks with a surge about week 22

b. 14 weeks with a surge about week 18
c. 23 weeks with a surge about week 30
d. 32 weeks with a surge about week 34

229. The physical therapist has been asked to see a patient who had surgery 2 days ago for
Coronary Artery Bypass Grafts x3. Upon initial assessment, the physical therapist observes
jugular vein distension, hypotension and muffled heart sounds. These symptoms may be
indicative of:
 a. a pleural effusion
b. A pulmonary embolism
c. A pneumothorax
d. A cardiac effusion/tamponade

Vignette: Questions 230-233

Ms Ford is a 39 year old woman who was diagnosed with relapse remitting multiple sclerosis 3
years ago. It is 2 weeks after Ms Fords most recent exacerbation and she is attending an
outpatient physical therapy clinic. Prior to her exacerbation, ms Ford was walking 3km, 3x a
week. Since her exacerbation, she has returned to walking but reports that her legs feel weak
and she has intermittent numbness around her right foot/ankle. She also complains of
generalised gatigue.

230. Ms Ford is concerned that her walking routine caused her most recent exacerbation. An
appropriate response from the Physical therapist is:

a. No, there is not evidence that exercise causes exacerbations in MS. If you notice a
change in your symptoms with exercise, this is usually a temporal phenomenon and
does not require medication.
b. Yes, when you have relapse remitting MS, you must make changes to your exercise
regime gradually (usually over 3 months) or an exacerbation will occur.
c. Yes, when you have relapse remitting MS, you should only increase your walking
distance by 0.5km/month, and therefore the rapid increase likely resulted in the
exacerbation.
d. No, it is highly unlikely that your exercise increase caused your exacerbation as the
primary cause of exacerbations in relapsing remitting MS is die to changes in diet.

231. What is an appropriate outcome measure for the Physical therapist to monitor the strength
in Ms Fords lower extremities?

a. Motor Activity scale

b. Fugl-Meyer Motor strength test
c. Manual muscle testing
d. Expanded disability status scale (EDSS)

232. A comprehensive physical therapy program for Ms Ford at this time may address all of the
following except:

a. resistance training, balance training, anaerobic capacity

b. Balance training, aerobic training, functional strength training
c. Resistance training, balance training, aerobic capacity
d. Patient education, resistance training, balance training
233. Ms Ford asks about the best way to manage her symptoms of fatigue. An appropriate
response from the physical therapist is:

a. to tell her to talk to her neurologist as they are medications that can significantly
decrease her symptoms
b. To educate her that fatigue related to multiple sclerosis tends to be worse in the
morning, so to postpone her exercise and daily routines until the afternoon.
c. That exercise can be beneficial in managing her symptoms of fatigue, but it needs to
be incorporated appropriately into her daily routine.
d. All of the above.

Vignette: questions 234-238

Mr. Jones is a 67 year old man diagnosed with idiopathic Parkinsons Disease (PD) 4 years ago.
He has been referred to an outpatient physical therapy clinic by his neurologist for an
assessment and treatment program. He is currently independent with all activities of daily living,
and ambulates independently without the use of assistive aids.

234. From Mr. Jones’ subjective history, the physical therapist that he is on multiple medications
to manage his PD. Medications to manage PD may include all of the following except:

a. Monoamine oxidase (MAO) inhibitors

b. Prednisone
c. Sinemet
d. Levodopa

235. During the physical assessment of Mr Jones, the physical therapist should find which
hallmark features of PD?

a. resting tremor, rigidity, bradykinesia and postural imbalance

b. Intentional tremor, rigidity, bradykinesia and postural imbalance
c. Rigidity, bradykinesia, postural imbalance and chorea
d. Resting tremor, bradykinesia, rigidity and dementia

236. During the assessment, the physical therapist observes that Mr Jones develops a shuffling
gait pattern when he turns corners, Mr Jones reports that he often gets “stuck” when walking in
a busy environment. Which of the following is the most appropriate for the physical therapist to
choose to address the issue?

a. counting
b. Visualisation
c. Using a 4 point cane
d. Balance training
237. The physical therapist implements a training program to address Mr Jones gait deficits
described in Q 236. Which of the following outcome measures is the most appropriate to
monitor Mr Jones walking improvement?

a. 3 min walk test

b. 6 min walk test
c. 10 metre walk test
d. Timed up and go

238. Mr Jones states that one of his goals of coming to physical therapy is to adopt a general
exercise program to combat the deleterious effects of PD. The physical therapist advises him
that a comprehensive exercise program will include:

a. postural exercises, aerobic conditioning, and exercises to decrease his resting tremor
b. Balance exercises, aerobic conditioning and exercises to prevent rigidity
c. Postural exercises, balance exercises and anaerobic conditioning
d. Aerobic conditioning, balance exercises and safety/falls education

Vignette: Questions 239- 243

Mrs Lee is a 52 year old woman who sustained a right middle cerebral artery infarct 1 day ago
and is currently in the acute stroke unit. She is following three stage verbal commands and is
able to move her left upper and lower extremity against gravity. Mrs Lee is on supplemental
oxygen by face mask (FiO2 = 28%) and has mobility orders for ‘activity as tolerated’

239. On auscultation, Mrs Lee has decreased breath sounds to her right lower lobe. What
physical therapy intervention would improve air entry to Mrs Lee’s right lower lobe?

a. perform percussion techniques on her right lower lobe and teach her deep
breathing exercises
b. Re-position her into left side lying and teach her deep breathing exercises
c. Re position her into semi prone and teach her deep breathing exercises
d. Mobilize her into sitting on the edge of the bed and teach her deep breathing
exercises

240. What should the physical therapist ensure prior to mobilising Mrs Lee?

a. that she has independent sitting balance

b. That she has normal sensation in both lower extremities
c. That she is able to weight bear symmetrically through both lower extremities
d. That she has stable vital signs

241. Which outcome measure should the physical therapist use to provide a comprehensive
evaluation of Mrs Lee’s current balance?
 a. the Functional independence measure
b. The berg balance scale
c. The Dynamic gait index
d. The Community Balance and Mobility scale

It is 2 weeks post stroke and Mrs Lee can perform her transfers independently and is ambulating
with a 4 point cane.

242. Which outcome measure should the physical therapist select to monitor Mrs Lees walking
endurance?

a. 10 metre walk test

b. 6 minute walk test
c. Dynamic gait index
d. Timed up and go

243. Mrs Lee reports that she feels she is walking slowly. From a 10 metre walk test, the physical
therapist assesses Mrs Lee’s walking velocity to be 1.0 m/s. What is normal walking velocity?

a. 1.0 m/s
b. 1.4 m/s
c. 1.8 m/s
d 2.2 m/s

244. Which questionnaire is suitable when assessing a patient, who had a stroke 1 year ago and
wishes to return running, in order to rule out significant risk factors to exercise?

a. Stroke Physical Exercise Questionnaire (SPEQ)

b. Stroke impact scale
c. Functional independence measure (FIM)
d. Physical activity readiness Questionnaire (PAR-Q)

245. When taking the subjective history of a patient who had a previous stroke, the physical
therapist learns that she is taking the medication atenolol. During exercise, which of the
following should be used to assess the patients response to exercise?

a. maximal oxygen consumption (VO2 max)

b. Respiration rate
c. Heart rate
d. Rating of perceived exertion (RPE)

Vignette: Questions 246-250

Jason is 22 years old and was admitted to the intensive are unit yesterday with the diagnosis of
T5 complete spinal cord injury sustained from a mountain biking accident.
246. Based on Jasons diagnosis, the physical therapist would expect to find which of the
following symptoms?

a. no preservation of motor or sensory function below T5

b. No preservation of motor or sensory function above T5
c. Sensory function preserved below T5, but no motor function preserved below T5
d. Motor function preserved below T5, but no sensory function preserved below T5

247. Physical therapy management of Jason in the intensive care setting should include all of the
following except:

a. assessing his sensation

b. Assessing his extremity strength
c. Monitoring his respiratory status
d. Preventing heterotrophic ossification

7 days after admission, Jason is transferred to the acute spinal cord injury unit. His physician
requests that Jason begin mobilising.

248. Since admission, Jason has been on physician orders of ‘bedrest with head of bed flat’. The
most appropriate physical therapy treatment to commence jasons initial mobilisation is:

a. to sit him on the edge of the bed and monitor his vitals
b. To increase the head of his bed gradually and monitor his vitals
c. To transfer him from his bed to a wheelchair using a ceiling lift to monitor his vitals
d. To practice rolling from side to supine to side

249. Jason asks if he will be able to walk again. The physical therapist should explain that people
with a T5 complete spinal cord injury:

a. are usually able to ambulate at least 20 feet with bilateral hip-knee-ankle orthoses
b. Usually use an electric wheelchair at all times for their mobility and don’t ambulate
with assistive devices
c. Are usually able to ambulate at least 20 feet with bilateral knee-ankle-foot orthoses
d. Usually use a manual wheelchair at all times for their mobility and don’t ambulate
with assistive devices.

250. A comprehensive rehabilitation program for Jason should include all of the following
except:

a. transfer training
b. Education regarding pressure relief
c. Education regarding bladder and bowel management
d. Assistive devices for feeding
Vignette: Questions 251-256

Susie is a 45 year old woman who sustained a traumatic brain injury two days ago in a motor
vehicle accident. She is currently in the neurological intensive are unit, and is being closely
monitored as she is not neurologically stable. Susie is intubated and ventilated, and is currently
on bedrest with the head of the bed (HOB) flat.

251. The nurse reports that Susie’s intracranial pressure increases to 45mmHg with any
stimulation. What is the normal range of ICP values for an adult lying supine that the physical
therapist should be aware of?

a. 0-5mmHg
b. 7-15mmHg
c. 17-25mmHg
d. 25-35mmHg

252. Physical therapy management for Susie at this current time will include:

a. completing a motor and sensory assessment

b. Closely monitoring her respiratory status and assisting the nurse with susie’s
positioning in bed
c. Performing passive range of motion on upper and lower extremity joints
d. Positioning her in high fowlers at least once a day to optimise her respiratory
compromise.

253. On review of Susie’s chart, the physical therapist notes that her Glasgow coma scale at
admission was 6. What is the lowest possible score an individual can receive on the Glasgow
coma scale?

a. 0
b. 1
c. 2
d. 3

It is now 3 weeks post admission, and Susie has been transferred to the acute neurological unit.
She is breathing on room air and has mobility orders ‘activity as tolerated’.

254. Susie is a risk for aspiration when eating orally so is receiving all her nutrients through a
nasogastric tube. Due to aspiration risk, it is important that Susie:

a. delay mobilisation to a wheelchair until her nasogastric tube is removed.

b. Only participate in occupational therapy and speech therapy at this time and
commence physical therapy once her nasogastric tube is removed
c. Keep her head of bed at a minimum of 30 degrees when the nasogastric tube feeds
 are running.
d. None of the above

255. On assessment, the physical therapist suspects that Susie has heterotrophic ossification in
her left elbow. Which of the following clinical indicators can indicate the presence of HO?

a. discolouration of the skin over her left elbow

b. Increased hair growth on the skin over her left elbow
c. Sudden dramatic loss of elbow range of motion
d. Hyporeflexia

256. After numerous diagnostic and clinical tests, it has been confirmed that Susie has HO in her
left elbow. Which of the following physical therapy treatments is contraindicated?

a. isometric strength training of her left upper extremity

b. Weight bearing through her left upper extremity
c. Forced passive range of motion of her left elbow
d. Active range of motion of her left elbow

257. The physical therapist is treating a client who sustained a gunshot wound to the head. The
client has no gag reflex, suggesting which of the following cranial nerves has been damaged?

a. abducens
b. Trigeminal nerve
c. Facial nerve
d. Vagus nerve

258. A client presents to an outpatient physical therapy clinic with a diagnosis of Bells Palsy. The
physical therapist would expect the client to demonstrate which of the following clinical signs?

a. facial weakness on the lower part of one side of her face

b. Facial weakness on the upper part only of one side of her face
c. Facial weakness on the upper and lower part of one side of her face only
d. Facial weakness on both the upper and lower part of both sides of her face

259. Ralph sustained a lacunar stroke 2 days ago and is currently in the acute stroke unit. He
presents with left sided weakness. The Physical Therapist would expect the client to demonstrate which
of the following patterns of facial weakness?

a. Isolated to the lower part only of the left side of his face
b. Isolate to the upper part only of the right side of his face
c. Isolated to the upper part only of the left side of his face
d. Isolated to the lower part only of the right side of his face
260. During the observation of an asymmetric tonic neck reflex (ATNR) in a healthy child, a Physical
Therapist will observe which of the following when the child’s head is turned to the right?

a. Extension of the arm and leg on the right and extension of the arm and flexion of the leg on the
left
b. Extension of the arm and leg on the right and flexion of the arm and leg on the left
c. Flexion of the arm and leg on right and extension of the arm and leg on the left
d. Flexion of the arm and extension of the leg on the right and flexion of the arm and leg on the left

261. Physical therapy management of a client with Stage 5 Amyoptrophic Lateral Sclerosis (ALS) will
include:

a. Sensory stimulation of upper and lower extremities

b. Client/family education re: bed positioning and transfers
c. Daily lower extremity strengthening exercises
d. Daily ambulation training with 4 wheeled walker

262. On assessment of a client with a central cord lesion, the Physical Therapist should observe:

a. Ipsilateral motor and sensory loss and contralateral loss of pain and termperature bleow the
level of the lesion
b. Bilateral loss of join position sense and two-point discrimination below the level of the lesion
c. Bilateral motor and sensory loss below the level of the lesion
d. Greater impairment of function in the upper extremities than in the lower extremities

263. On assessment of a client with a cauda equine syndrome, the Physical Therapist should observe:

a. Hyporeflexia in the Achilles tendon

b. An extensor plantar response
c. Increased tone in bilateral lower extremities
d. Numbness in bilateral lower extremities

264. Which of the following is a clinical rating scale that a Physical Therapist can use to assess the
progression of Parkinson’s Disease?

a. Hoehn and Yahr Classification of Disability

b. Oswestry Disability Index
c. Disability Rating Scale (DRS)
d. Kurtske Expanded Disability Scale

265. When assessing the stance phase of gait, the Physical Therapist should observe which of the
following:

a. Hip circumduction
b. Heel strike and toe off
 c. Toe-off and terminal swing
d. Terminal swing and heel strike

266. When performing a manual muscles test of gluteus medius, how should the Physical Therapist first
position the patient?

a. Supine to check for grade 3 prior to progressing the testing

b. Side lying so you can test their abduction strength with maximal resistance
c. Prone so you can test their hip extension strength
d. Side lying so you can test both abduction and extension strength

267. A Physical Therapist is seeing a patient who has “tennis elbow” and reports pain on the lateral
aspect of her elbow. Which structures are likely to be affected?

a. Supinators and radiohumeral joint

b. Lateral thumb and finger extensors
c. Wrist extensor tendons, lateral epicondyle and radiohumaral joint
d. Common flexor/pronator tendon and the tenoperiosteal junction

268. Lucas is a 10 year old boy who is brought into a physical therapy clinic to be treated for Osgoode
Schlatter’s disease. What education should the Physical Therapist provide this child and his parents?

a. He should be shown stretching exercise for his iliotibial band and gastrocnemius as tightness of
these structures contribute to the pathology
b. He should limit his running but continue with other activities and ice his knee if it is sore
c. He should limit his jumping and be shown stretching exercises for his hamstrings and quadriceps
d. He should continue with all the activities since the symptoms of the disease will resolve once
Lucas stops growing

269. Slipped capital femoral epiphysis occurs in children and can be acute of chronic or actue on chronic.
Its classification is dependent on:

a. The degree of necrosis that is associated with the slip

b. The restriction of range of motion at the hip
c. Severity of displacement of the femoral head
d. Where the pain is located (groin or knee)

270. Legg-Calve-Pathes and Slipped capital epiphysis both present with:

a. Pain in the groin, thigh and/or knee

b. Capsular pattern of the hip
c. Trendelenburg or antalgic gait pattern
d. All of the above

Vignette: (271-274)
Anna is 6 year old female who has been referred for Physical Therapy 7 weeks after sustaining and
supracondylar fracture of her elbow. Her fracture has been fixed with two pins which have now been
removed. The doctor has asked for range of motion (ROM) exercises and strengthening.

271. The Physical Therapist has treated Anna twice over the past two weeks and her elbow ROM has
improved. Anna’s father reports that he has been working with his daughter to regain her movement.
The Physical Therapist should check the following:

a. What specifically the father has been doing

b. If Anna has had any pain with treatment
c. Anna’s joint end feel in extension and flexion
d. If Anna’s strength has improved as well as her range of motion

272. The Physical Therapist notices after 4 weeks of treatment that Anna is reporting increasing pain.
Her mother thinks that it is because she is doing more activities during her day. The Physical Therapist’s
assessment should include:

a. Isometric testing of strength

b. Her join end feel in extension and flexion
c. Observation of swelling
d. An objective measures of pain

273. Anna’s mother has stated that Anna is falling behind in her school work and that her teacher has
noticed that she is unable to complete any written work on time. What is an appropriate response from
the Physical Therapist?

a. Arrange for referral to Occupational Therapy for a writing assessment

b. Assess the strength of Anna’s lumbrical muscles
c. Make sure Anna has full range of motion in her hand
d. Ask the school to allow Anna more time to complete written work

274. Which of the following complications does Anna have a higher risk of developing after
sustaining an elbow fracture?

a. Elbow instability
b. Ulnar nerve injury
c. Prolonged elbow stiffness
d. Recurrent fracture

Vignette (275-276)

Liam is a 23 year-old man who attends a physical therapy clinic for radiating pain in his left leg. The pain
began 2 weeks ago after he bent over to put on his socks. The pain does not radiate into Liam’s foot and
seems relieved by standing and walking.
275. Liam reports that sitting at his desk exacerbates his pain. He is a student and must continue with his
studies. The physical therapist’s client education should include:

a. Studying in the morning as that is when his pain is least

b. Adjusting his monitor height so it is at eye level and he isn’t looking down
c. Taking frequent breaks to walk around
d. Adjusting his chair so his knees are flexed to 100 degrees

276. The physical therapist decides that the initial home exercise program should include:

a. Extension exercises, only

b. Rotation exercises
c. Flexion and extension exercises
d. Flexion exercises only

277. A median nerve injury will present with which of the following physical signs:

a. Weakness of the flexor carpi radialis

b. Decreased sensation in the index finger
c. Weakness of the finger extensors
d. Diminished two point discrimination of the tips of the lateral two fingers.

Vignette: (278-282)

Mary is a 55 year old woman who is seeking treatment for her left lateral elbow pain. She has spent the
last 3 days working in her harden and noticed an increase in pain over this time.

278. During the assessment, the Physical Therapist determines that Mary has a repetitive trauma type
injury, which is characterized by which of the following?

a. Inflammation of the epineurium of associated nerves

b. Hyperreflexia of associated muscle tendons
c. Chronic scar formation
d. Excessive use of one muscle group

279. The Physical Therapist educates Mary on the underlying pathology of her elbow injury, and explains
that healing of soft tissue is most affected by which of the following factors?

a. Nutritional intake
b. Neurological impairment
c. Medications
d. Hyper-oxygenation

280. Mary has been coming to the clinic for 2 weeks of treatment and she reports that her pain is
decreasing. On reassessment, the Physical Therapist observes that Mary’s elbow extension has a soft
end feel, and is -10 degrees of full extension. The Physical Therapist decides that treatment should
include:

a. Contrast hot and cold baths

b. Hold-relax at end range extension
c. Stretching of her triceps muscle
d. Mobilization of her radial head with a anterior glide

281. Massage can be used to treat repetitive soft tissue injuries because it can:

a. Numb the area prior to exercise

b. Help to strength the individual muscle fibers
c. Create a mobile scar
d. Regain range of motion by relaxing the patient

282. Mary is planning on working in the garden over the weekend. What should the Physical Therapist
include in Mary’s education?

a. It is not a good idea for Mary to do any gardening at this point

b. Not to wear an elbow support as they impeded elbow range of motion
c. Stop activity as soon as she feels pain
d. Use ice after 10-15 minutes of activity

Vignette: (283-285)

Gladys is an 83 year old woman with dementia who was admitted to the hospital with a fractured left
hip. She has undergone a cemented total hip arthroplasty. In the past year, Gladys had a cardiac
infarction and is on medication. She also has a history of arthritis in her shoulders and hands.

283. The Physical Therapist assist Gladys with her initial mobilization, and observes a Trendelenberg sign
during the stance phase of Gladys’ left leg. Trendelenberg’s sign is an indication of:

a. Nerve pathology
b. Muscle weakness
c. Post operative complication
d. Pain avoidance

284. The Physical Therapis decides to assess the Gladys’ leg lengths. What should be ensured in
order to get an accurate measurement?

a. The patient’s pelvis is posteriorly tilted

b. The patient’s pelvis is anteriorly tilted
c. The measurement is taken from the ASIS to the medial or lateral malleolus
d. The patient is standing with feet should-width apart
285. The Physical Therapist determines that an ambulation aid is necessary for Gladys to mobilize safely.
Which of the following would be the best choice of ambulation aid for Gladys?

a. A cane for mobility

b. Axillary crutches for mobility
c. A walker for stability
d. Forearm crutches for independent activities of daily living

286. When measuring elbow flexion with a goniometer, the Physical Therapist must place the movable
arm of the goniometer parallel to the longitudinal axis of the :

a. Ulna
b. Radius
c. Trunk
d. Humerus

287. The Physical Therapist can assess the function of the dorsal interossei by asking the patient to
perform which action?

a. Flex metacarpalphalangeal joints and extend the interphalangeal joints

b. Extend both metacarpalphalangeal and interphalangeal joints and abduct fingers
c. Squeeze a grip dynamometer
d. Cup his hand and adduct fingers

288. During isometric should external rotation, the integrity of which structures is being assessed?

a. Latismus dorsi and C6 – 8 nerve roots

b. Teres major and C5 and C6 nerve roots
c. Infraspinatus and C5 and C6 nerve roots
d. Supraspinatus and C5-7 nerve roots

289. In order to assess the integrity of a patient’s L5 nerve root, the Physical Therapist should assess
which of the following?

a. Sensation of the great toe; isometric strength of gastrocnemium

b. Sensation of the lateral aspect of the foot; isometric strength of anterior tibialis
c. Sensation of the lateral aspect of the shin; isometric strength of extensor hallucis longus
d. Sensation of the heel; isometric strength of peroneus longus

290. A patient has come into the Physical Therapy department after the removal of an above-knee
cast for a fractured patella. The Physical Therapist’s assessment reveals restriction of inferior glide of
the patella on the femur which could affect which knee movement?

a. Knee flexion
b. Knee external rotation
 c. Knee internal rotation
d. Knee extension

291. In a patient who has sustained a Colle’s fracture, which mobilization should the Physical Therapist
perform to assist with increased wrist extension?

a. Palmer glide of the carpals on the radius

b. Dorsal glide of the proximal carpals on the distal carpals
c. Palmer glide of the radius on the carpals
d. Dorsal glide of carpals on the radius

Vignette: Questions 292-296

Clara is a 19 year old female who is attending a physical therapy clinic for treatment after undergoing a
below knee amputation for cancer. She reports that she was diagnosed with osteosarcoma and has just
completed chemotherapy.

292. The physical therapist notices that Clara is very pale and has facial edema. What tests should be
conducted before physical therapy treatment commences?

a. Absolute neutrophil count

b. Platlet count
c. White cell count
d. Hemoglobin count

293. What common side effects of chemotherapy should the physical therapist monitor?

a. Impairment in hearing
b. Impairment of visual acuity
c. Altered hot/cold sensation
d. Hypertension

294. The physical therapist notices that Clara’s prosthesis makes an unusual noise while she is walking.
This could be related to which of the following?

a. Prosthetic pistoning
b. Stump swelling
c. Poor prosthetic
d. Vincristine neuropathy

295. Clara is complaining of fatigue and has a poor exercise tolerance. Which of the following is the best
approach to address this?

a. Low levels of aerobic activity in a supervised setting

b. More rest breaks when the patient is at home
c. Orders to stop exercising if the patient feels fatigued
 d. Organise additional assistance for activities of daily living

Vignette: Questions 296-298

Lou is a 30 year old man who comes into a physical therapy clinic with complaints of back pain and
stiffness. On assessment, the physical therapist observes that lou has an extremely stiff lumbar spine and
he can barely reach his knees in forward flexion. In addition, Lou reports that he has no pain in forward
flexion.

296. During the subjective assessment, Lou reports that he has tested positive for ankylosing spondylitis.
Which result on a blood test would indicate this?

a. Rheumatoid factor (+)

b. Hyperuricemia
c. (+) IgM, IgG and IgA
d. HLA –B27

297. Lou has been placed on the non steroidal anti-inflammatory drugs (NSAIDS) and the physical
therapist has developed an exercise program. This program should include which of the following:

a. Achillies tendon stretches

b. Deep neck extensor exercises
c. Core muscle strengthening exercises
d. Spinal extension exercises

298. In order to keep Lou’s chest mobile, the physical therapist should include which of the following
interventions?

a. Upper limb exercises

b. Thoracic flexion range of motion exercises
c. Rib springing technique during expiration
d. Deep breathing exercises

Vignette: Questions 299-301

Mr, lee is a 27 year old client who fractured his right femer skiing 3 days ago. He was initially admitted
through the emergency department and underwent an internal fixation with flexible nailing. His doctors
orders are non weight bearing on his right side. Mr Lee has no significant past medical history.

299. You have been asked to teach Mr Lee non-weight bearing cruth walking. During your session Mr
Lee becomes very pale and short of breath. Which is the most likely to have occurred?

a. The client has a fat embolism

b. The client has developed pneumonia post operatively
c. The client has become faint because of poor pain control
d. The client has developed a deep vein thrombosis
300. Six weeks after his right femer internal fixation, Mr Lee has been referred to a private practice clinic
for range of motion and strengthening exercises. Fracture healing could be affected by:

a. Nutrition
b. Type and location of fracture
c. Type of fixation
d. All of the above

301. It is now 8 weeks post right femur internal fixation. The strength of Mr Lee’s quadriceps and
hamstrings are each graded 4/5. Which answer best describes effective exercises at this stage of
rehabilitation?

a. Passive knee ROM exercises

b. Standing on one leg on an unstable surface
c. Running obstacle courses
d. Lateral jumping over pylons to mimic skiing

302. A client has come into your clinic complaining of neck and left arm pain. During your initial scanning
examination you notice that he has a decrese in his left elbow jerk. Weakness of his left wrist extensors
and a small area of decreased light touch over his thumb and index finger. You decide he most likely has:

a. An incomplete C5 nerve root palsy

b. A complete C5 nerve root palsy
c. An incomplete C6 nerve root palsy
d. A complete C6 nerve root palsy

303. Regarding manual muscle testing, indicate which of the following statements is true:

a. Manual muscle testing is performed at the outer range of joint movement

b. Manual muscle testing is considered a subjective outcome measure
c. Manual muscle testing resistance is held for 8 to 10 seconds
d. Grade 2 manual muscle test means the client can move the muscle against gravity part way
through range of motion

304. When performing the anterior drawer test of the talocrural joint, an excessive straight anterior
translation indicates:

a. Laxity of the ATFL

b. Laxity of the ATFL and anterior tibiotalar ligament
c. Laxity of the calcaneofibular ligament and tibiocalcaneal ligament
d. Laxity of the posterior talofibular ligament and the posterior tibiotalar ligament

305. The normal end feel of subtalar joint inversion is:

a. Firm
 b. Soft tissue approximation
c. Soft tissue stretch
d. Hard

306. The following characteristics are true of deep tendon reflexes except

a. Can be elicited from almost any tendon

b. Hyperreflexia is indicative of a peripheral nerve lesion
c. Are tested with the tendon on some degree of stretch
d. May be assisted by the jendrassik manoeuver

Vignette: Questions 307-309

Mrs Chow is a 60 year old accountant who tripped going up the stairs and broke her right neck of femur.
She underwent an uncemented arthroplasty performedwith a posterior approach two days ago. Mrs
Chow lives alone in a two story house quite close to the local shops. She is a very independent woman
who does not complain during her stay at the hospital.

307. You have been asked to teach Mrs Chow crutch walking but there are no orders regarding her
weight bearing status. You decide to:

a. Teach her weight bearing as tolerated

b. Teach her toe touch weight bearing
c. Teach her partial weight bearing
d. Confirm her weight bearing orders with her surgeon before teaching her crutch walking.

308. Mrs Chow is keen to get back home. When you arrive at her room, you find her sitting in her chair
with her legs crossed. You explain to her that movement restrictions after a posterior approach total hip
arthroplasty include:

a. Avoid flexion greater than 80; adduction past neutral; internal rotation past neutral
b. Avoid flexion greater than 100; adduction past neutral; external rotation past neutral
c. Avoid flexion greater than 60; adduction past 5; and internal rotation greater than 10
d. Avoid flexion greater than 80; adduction past 5; external rotation past neutral

309. The resting position of the hip is:

a. 60 flexion, 30 abduction and slight lateral rotation

b. 30 flexion, 60 abduction and slight lateral rotation
c. 30 flexion, 30 abduction and slight lateral rotation
d. 60 flexion, 30 abduction, and 60 lateral rotation

Vignette: Questions 310-313

Mr Stark is a 34 year old man who sustained a complete tear of his left ACL playing ultimate. His medical
health is good. However, he has a past history of right knee MCL Sprains. He is eager to start
rehabilitating his knee as there is an ultimate tournament that he was hoping to attend in 6 months
time.

310. Mr Stark arrives in your clinic after having ACL reconstruction 4 days prior. Your immediate short
term goals for his left knee are:

a. Relieving pain to improve functioning at home

b. Reducing swelling and regaining knee range of motion
c. Regaining knee range of motion and strengthening quadriceps
d. Regaining knee range of motion and maintaining cardiovascular conditioning

311. During your assessment, you perform a stability test of Mr Stark’s right knee. Ligament testing in
the presence of 1st degree sprain of the MCL of the knee would most likely reveal:

a. Pain, no laxity
b. No pain, no laxity
c. Pain, a lot of laxity
d. No pain, a lot of laxity

312. It is now 3 months post ACL reconstruction and you are re-examining the stability of Mr Starks
knee. The following are true regarding the lachman test, except:

a. The knee is positioned at 20-30 degrees of flexion

b. The proximal tibia is drawn anteriorly on the fixed femur
c. It primarily tests the posterolateral band of the ACL
d. None of the above

313. You determine that Mr stark is ready to begin eccentric muscle work of his quadriceps muscles.
Which of the following statements is true about eccentric work:

a. A tension is developed while the muscle shortens

b. Constant tension is developed as the muscle contracts
c. Tension is developed at a constant speed
d. Tension is developed while the muscle lengthens

314. A client comes to your clinic with complaints of severe right shoulder pain after it ‘popped out’ 14
days ago. It has since been reduced. Your exam should focus on:

a. Checking sensation over the clavicle

b. An anterior apprehension test
c. A postural examination
d. A WOMAC to assess their disability

315. A client presents with an acute lateral ankle sprain that was sustained 2 days ago. Your initial
treatment goals are to:
 a. Increase strength and proprioception of the ankle
b. Decrease pain and swelling of the ankle
c. Decrease bruising and increase proprioception of the ankle
d. Increase range of motion and decrease swelling of the ankle

316. A client presents with complaints of back pain. His present job demands heavy lifting. When you
examine him you notice that he has poor abdominal strength and stands with increased lordosis. Your
short term goals are:

a. Flexibility exercises and bilateral leg strength

b. Increase bilateral leg strength and agility
c. Increase core strength and correct posture
d. Increase core strength and teach proper lifting techniques

317. Three days ago your client sustained a fracture of her right wrist. She has been put into a cast and
has returned to the fracture clinic. When you see her, you observe that her fingers are very swollen and
dusky with a capillary refill time of 6 seconds. You should do the following:

a. Teach the patient about RICE

b. Begin range of motion exercises of her shoulder to help improve circulation
c. Begin finger range of motion exercises because her fingers appear stiff
d. Ask the doctor to assess her immediately because this is an emergency

318. Secondary bone healing occurs when:

a. There has been a compression plate and screw used to fixate the fracture
b. There is some micromotion at the fracture site
c. The client is very osteoporotic
d. The client is less than 18 years of age.

319. The salter fracture system describes injury to growth plates in children. If there is a fracture salter 4
of the growth plate, which is the most likely to occur?

a. No growth arrest

b. Partial closure of the growth plate with possible growth disturbance

c. Cessation of growth at that joint
d. It doesn’t affect growth if there is complete reduction of the fracture

Vignette: Questions 320-324

Mr Smith, a 70 year old man with a 10 year history of chronic bronchitis and congestive heart failure, is
admitted to the medical ward for exacerbation of his chronic bronchitis.

320. What clinical manifestations would you expect to find on Mr. Smiths assessment?
 a. Dyspnea, cough, fine and coarse crackles at the bases, bilateral ankle edema
b. Dry cough, dysnea, adventitious sounds, lower extremity edema
c. Pursed lip breathing, cyanosis, prolonged inspiration, fine crackles
d. Cough, prolonged inspiration, no adventitious sounds

321. Which of the following are common presentations of COPD on chest x ray?

a. Hyperinflated lungs
b. Flattened hemidiaphragms
c. Cardiology
d. All of the above

322. You are supervising Mr Smith while he is performing the exercise program you prescribed. Which of
the following would be an abnormal response to exercise for Mr Smith?

a. An increase of 20 beats/min above his resting heart rate

b. An increase of more than 20-30 beats/min above his resting heart rate
c. A decrease in oxygen saturation to 92%
d. A rate of perceived exertion of 9/20

323. You are reviewing Mr Smiths pulmonary function test. What proportion of vital capacity is normally
expired in the first second of expiration?

a. 65-70%
b. 75-80%
c. 80-85%
d. 90-95%

324. Upon auscultation of Mr Smith, you hear some abnormal breath sounds. How would you describe
normal breath sounds?

a. Bronchial in nature
b. Louder over the right chest wall that over the left
c. Accompanied by adventitious sounds
d. Heard during inspiration and expiration

325. A 45 year old lady had a gastrectomy yesterday. She is supine with the head of the bed at 30
degrees, and is complaining of a lot of pain. She is very reluctant to move and refuses to cough due to
the pain. You hear crackles in her left lower love, and she is taking very shallow breaths. The first thing
you need to do is:

a. Roll her onto her side

b. Ask the nurse if she is due for some analgesia and try and get her pain under control
c. Tell her you will come back later when she is more comfortable
d. Ask the physician to order a chest x ray for her as you think she might have a chest infection
326. Clients older than 70 years of age undergoing upper abdominal surgery are most at risk for
developing which of the following:

a. A post operative chest infection

b. Post operative atelectasis
c. Post operative pneumothorax
d. All of the above

327. Indicate the best answer. Active cycle of breathing :

a. Is a good treatment choice for post operative clients with retained secretions.
b. Is a good treatment choice for COPD clients who experience shortness of breath
c. Is a good treatment choice for clients who are cognitively impaired
d. Is the best technique for clients with pneumonia who do not have retained secretions, but
who have difficulty mobilising.

328. Indicate the best answer. Percussion and vibration:

a. May be a good treatment choice for a client with retained secretions who cannot co-
operate or mobilise.
b. Are contraindicated in post op abdominal surgery clients
c. Have an excellent evidence base for their effectiveness
d. Are often helpful in clients with acute asthma

329. From your knowledge of the effects of normal aging on the cardio respiratory system and its impact
on the oxygen transport system, which of the following statements is not true?

a. Decreased compliance of the chest wall leads to increased work of breathing

b. V/Q mismatching is partly caused by a reduced number of pulmonary capillaries
c. VO2 max is decreased because of a decrease in maximum heart rate and stroke volume
d. When exercising, older people achieve steady state sooner and recover slower than younger
people

330. A patient who sustained damage to her right parietal lobe combs her hair on her right side
but “forgets” to comb her hair on the left side. This behaviour is most likely a result of:

a. Preservation
b. Unilateral neglect
c. Agnosia
d. apraxia
Answer Key

1. a 2. d 3. c 4. c 5. d 6. c
7. c 8. c 9. b 10. c 11. a 12. b
13. a 14. a 15. d 16. c 17. c 18. a
19. a 20. d 21. a 22. d 23. c 24. b
25. d 26. a 27. a 28. c 29. d 30. d
31. b 32. d 33. b 34. d 35. a 36. d
37. a 38. b 39. c 40. b 41. d 42. b
43. b 44. a 45. a 46. d 47. d 48. c
49. d 50. d 51. b 52. d 53. a 54. d
55. a 56. b 57. c 58. d 59. b 60. b
61. c 62. c 63. c 64. d 65. a 66. d
67. d 68. d 69. c 70. c 71. b 72. d
73. c 74. c 75. c 76. b 77. b 78. b
79. b 80. c 81. d 82. b 83. a 84. d
85. a 86. d 87. a 88. c 89. a 90. b
91. c 92. d 93. b 94. c 95. a 96. b
97. a 98. b 99. b 100.c 101.d 102.c
103.d 104.d 105.a 106.d 107.d 108.b
109.a 110.d 111.b 112.a 113.b 114.d
115.c 116.b 117.c 118.c 119.b 120.b
121.c 122.c 123.b 124.b 125.b 126.c
127.c 128.c 129.c 130.c 131.c 132.b
133.c 134.b 135.d 136.c 137.c 138.a
139.b 140.b 141.b 142.d 143.c 144.d
145.c 146.c 147.a 148.c 149.b 150.b
151.b 152.b 153.d 154.a 155.c 156.c
157.c 158.a 159.b 160.b 161.b 162.c
163.b 164.a 165.d 166.a 167.b 168.d
169.b 170.d 171.a 172.a 173.c 174.c
175.a 176.c 177.b 178.d 179.a 180.c
181.b 182.c 183.d 184.a 185.c 186.a
187.b 188.b 189.a 190.a 191.a 192.a
193.b 194.c 195.c 196.a 197.b 198.c
199.d 200.a 201.b 202.b 203.b 204.d
205.b 206.d 207.d 208.b 209.c 210.d
211.c 212.d 213.d 214.c 215.c 216.b
217.d 218.b 219.d 220.a 221.d 222.c
223.d 224.a 225.b 226.b 227.b 228.c
229.d 230.b 231.c 232.a 233.c 234.a
235.a 236.a 237.d 238.d 239.d 240.d
241.b 242.b 243.b 244.d 245.d 246.a
247.b 248.b 249.d 250.d 251.b 252.b
253.d 254.c 255.c 256.c 257.d 258.c
259.a 260.b 261.b 262.d 263.? 264.A
265.b 266.b 267.c 268.c 269.c 270.d
271.a 272.c 273.a 274.b 275.c 276.a
277.a 278.d 279.a 280.b 281.c 282.c
283.b 284.c 285.c 286.b 287.a 288.c
289.c 290.a 291.c 292.b 293.b 294.a
295.a 296.d 297.c 298.b 299.a 300.d
301.b 302.c 303.b 304.b 305.a 306.b
307.d 308.a 309.c 310.b 311.a 312.d
313.d 314.b 315.b 316.d 317.d 318.b
319.b 320.a 321.d 322.b 323.b 324.a
325.b 326.b 327.a 328.a 329.d 330.b