Question 1
A physical therapist is conducting a reflex test by stroking the lateral aspect of the sole of the foot.
The arrow in the photograph indicates the path of the stimulus. If the test is positive, the great toe
will extend and the other toes will fan out. A positive result from this test MOST likely indicates:
A) A peripheral nerve injury.
B) A lesion of the anterior horn cells.
C) A normal response in an adult.
D) An upper motor neuron lesion, such as a spinal cord injury.
Correct Answer: D) An upper motor neuron lesion, such as a spinal cord injury.
Rationale: The test being performed is the Babinski reflex. A positive sign (extension of the
great toe) is an abnormal finding in adults and is indicative of damage to the central nervous
system, specifically an upper motor neuron lesion. A normal response in an adult is flexion of
the toes. Peripheral nerve injuries and anterior horn cell lesions are lower motor neuron
lesions and would not cause a positive Babinski sign.
Question 2
A 3-month-old infant presents with poor midline head control. The physical therapist notes facial
asymmetry, limitation of cervical rotation to the left, and limitation of cervical lateral flexion to the
right. This presentation is MOST consistent with:
A) Right congenital muscular torticollis.
B) Left congenital muscular torticollis.
C) Right cervical facet hypomobility.
D) Left cervical facet hypomobility.
Correct Answer: A) Right congenital muscular torticollis.
Rationale: Congenital muscular torticollis is a condition involving the tightening of one
sternocleidomastoid (SCM) muscle. The right SCM muscle is responsible for left rotation and
right lateral flexion. The infant's limitations (limited left rotation and right lateral flexion) are
consistent with a tight right SCM. The condition is named for the side of the involved muscle.
Question 3
A physical therapist evaluates a patient with back pain and determines that the patient's pes planus
(flat feet) is a contributing factor. Which of the following orthotic interventions is MOST appropriate
for this patient?
A) Metatarsal pad
B) Solid ankle-foot orthosis (AFO)
C) Hinged ankle-foot orthosis (AFO)
D) Longitudinal arch support
Correct Answer: D) Longitudinal arch support
Rationale: Pes planus is characterized by a loss or collapse of the medial longitudinal arch of
the foot. A longitudinal arch support is an orthotic specifically designed to support this arch,
,which can help to correct the foot's alignment and reduce the biomechanical stresses that
may be contributing to the patient's back pain.
Question 4
According to standard precautions, in which of the following scenarios are gloves required?
A) During all patient care activities in a hospital setting.
B) When performing passive range of motion on a patient with AIDS.
C) While massaging the neck of a patient with hepatitis C.
D) When changing an infant's diaper in a pediatric setting.
Correct Answer: D) When changing an infant's diaper in a pediatric setting.
Rationale: Standard precautions require the use of gloves whenever there is a potential for
contact with blood, body fluids, non-intact skin, or mucous membranes. Changing a diaper
involves direct contact with feces and urine, which are body fluids. The other scenarios do
not involve anticipated contact with body fluids, so gloves are not required.
Question 5
A physical therapist is educating a patient on the home use of a moist hot pack. To achieve
therapeutic heating effects while minimizing the risk of burns, which application time frame is MOST
appropriate?
A) 5 to 10 minutes
B) 20 to 30 minutes
C) 45 to 60 minutes
D) 61 to 90 minutes
Correct Answer: B) 20 to 30 minutes
Rationale: Superficial heating modalities like moist hot packs typically require 15 to 20
minutes to reach maximum therapeutic temperature in the target tissues. A time frame of 20
to 30 minutes is considered ideal for achieving these benefits. Shorter durations are
insufficient, and longer durations do not add significant therapeutic benefit and substantially
increase the risk of skin burns.
Question 6
A patient presents to physical therapy via direct access for insidious shoulder pain. During the initial
inspection, the therapist notes a yellowish discoloration of the patient's sclera (the whites of the
eyes) and skin. The therapist should recognize this as a sign of potential dysfunction and refer the
patient to a physician. This finding is MOST indicative of a problem with which organ system?
A) Liver.
B) Eye.
C) Duodenum.
D) Heart.
,Correct Answer: A) Liver.
Rationale: The yellowish discoloration, known as jaundice, is caused by an accumulation of
bilirubin in the blood. Bilirubin is a waste product that is normally processed by the liver. The
presence of jaundice is a classic sign of liver or gallbladder dysfunction and requires
immediate medical referral.
Question 7
A 22-year-old patient with cystic fibrosis is hospitalized awaiting a lung transplant. The physician
requests an objective measure of the patient's preoperative endurance. Which test is MOST
appropriate for the physical therapist to administer?
A) VO2 max treadmill test
B) 2-step test
C) Submaximal exercise test on a cycle ergometer
D) 6-minute walk test
Correct Answer: D) 6-minute walk test
Rationale: The 6-minute walk test is a submaximal exercise test specifically designed to
assess functional exercise capacity in patients with moderate to severe heart or lung
disease. It is safe, well-tolerated, and provides a reliable and valid measure of endurance for
this patient population. The other tests would likely be too strenuous for a patient this ill.
Question 8
A physical therapist is preparing for the first gait training session with a young adult patient who has
paraplegia. Which of the following options is the MOST appropriate and safest choice for this initial
session?
A) Swing-through gait pattern with a walker.
B) Swing-through gait pattern with forearm crutches.
C) Swing-to gait pattern with axillary crutches.
D) Swing-to gait pattern in the parallel bars.
Correct Answer: D) Swing-to gait pattern in the parallel bars.
Rationale: The parallel bars provide the maximum amount of stability and safety for an initial
gait training session with a patient who has significant weakness or paralysis. The swing-to
gait pattern is less demanding and easier to learn initially than the swing-through pattern.
This option represents the safest and most realistic starting point.
Question 9
A patient with peripheral arterial disease (PAD) reports leg pain with walking that is relieved by rest.
This patient will MOST likely also experience:
A) Relief of pain when the legs are elevated.
B) Purple or brown pigmentation of the skin on the legs.
C) Relief of pain when the legs are in a dependent position.
D) A positive Homan's sign.
, Correct Answer: C) Relief of pain when the legs are in a dependent position.
Rationale: The patient is describing intermittent claudication, a hallmark of arterial
insufficiency. The pain is caused by a lack of blood flow to the muscles. Placing the legs in a
dependent (hanging down) position uses gravity to assist blood flow to the feet and can help
to relieve ischemic pain. Elevating the legs would worsen the pain.
Question 10
A patient presents to physical therapy with an ulcer on the right medial malleolus. The therapist
notes brownish pigmentation of the skin and normal skin temperature. These findings are consistent
with chronic venous insufficiency. The patient MOST likely also has:
A) Edema.
B) A diminished pedal pulse.
C) Lower extremity pain that increases with exercise.
D) Hypersensitivity to cold.
Correct Answer: A) Edema.
Rationale: The signs described (medial ulcer, brownish discoloration from hemosiderin
staining, normal temperature) are all classic indicators of chronic venous insufficiency. This
condition is caused by incompetent valves in the veins, which leads to the pooling of blood
and fluid in the lower extremities, resulting in chronic edema.
Question 11
The parent of a 4-year-old child with a myelomeningocele at the L1 neurological level is interested in
orthoses for gait training. Which orthosis is the MOST appropriate selection for the physical therapist
to discuss?
A) Hip-knee-ankle-foot orthosis (HKAFO) with locked hips
B) Reciprocating-gait orthosis (RGO)
C) Knee-ankle-foot orthosis (KAFO) with a pelvic band
D) Ankle-foot orthosis (AFO)
Correct Answer: B) Reciprocating-gait orthosis (RGO)
Rationale: A child with an L1 lesion lacks active hip flexion and has paralysis of the muscles
of the lower extremities. To achieve a functional walking pattern, they require an orthosis that
can provide support to the trunk, hips, knees, and ankles, and that can assist with limb
advancement. The RGO uses a cable system to couple hip extension on one side with hip
flexion on the other, allowing for a reciprocal gait pattern.
Question 12
A patient who sustained a right cerebrovascular accident (CVA) presents with a flaccid left arm.
During muscle testing, the patient is able to shrug the left shoulder. The MOST accurate explanation
for this is that the right CVA:
A) Has affected the right shoulder and not the left shoulder.
B) Did not affect the vagus nerve (cranial nerve X).
A physical therapist is conducting a reflex test by stroking the lateral aspect of the sole of the foot.
The arrow in the photograph indicates the path of the stimulus. If the test is positive, the great toe
will extend and the other toes will fan out. A positive result from this test MOST likely indicates:
A) A peripheral nerve injury.
B) A lesion of the anterior horn cells.
C) A normal response in an adult.
D) An upper motor neuron lesion, such as a spinal cord injury.
Correct Answer: D) An upper motor neuron lesion, such as a spinal cord injury.
Rationale: The test being performed is the Babinski reflex. A positive sign (extension of the
great toe) is an abnormal finding in adults and is indicative of damage to the central nervous
system, specifically an upper motor neuron lesion. A normal response in an adult is flexion of
the toes. Peripheral nerve injuries and anterior horn cell lesions are lower motor neuron
lesions and would not cause a positive Babinski sign.
Question 2
A 3-month-old infant presents with poor midline head control. The physical therapist notes facial
asymmetry, limitation of cervical rotation to the left, and limitation of cervical lateral flexion to the
right. This presentation is MOST consistent with:
A) Right congenital muscular torticollis.
B) Left congenital muscular torticollis.
C) Right cervical facet hypomobility.
D) Left cervical facet hypomobility.
Correct Answer: A) Right congenital muscular torticollis.
Rationale: Congenital muscular torticollis is a condition involving the tightening of one
sternocleidomastoid (SCM) muscle. The right SCM muscle is responsible for left rotation and
right lateral flexion. The infant's limitations (limited left rotation and right lateral flexion) are
consistent with a tight right SCM. The condition is named for the side of the involved muscle.
Question 3
A physical therapist evaluates a patient with back pain and determines that the patient's pes planus
(flat feet) is a contributing factor. Which of the following orthotic interventions is MOST appropriate
for this patient?
A) Metatarsal pad
B) Solid ankle-foot orthosis (AFO)
C) Hinged ankle-foot orthosis (AFO)
D) Longitudinal arch support
Correct Answer: D) Longitudinal arch support
Rationale: Pes planus is characterized by a loss or collapse of the medial longitudinal arch of
the foot. A longitudinal arch support is an orthotic specifically designed to support this arch,
,which can help to correct the foot's alignment and reduce the biomechanical stresses that
may be contributing to the patient's back pain.
Question 4
According to standard precautions, in which of the following scenarios are gloves required?
A) During all patient care activities in a hospital setting.
B) When performing passive range of motion on a patient with AIDS.
C) While massaging the neck of a patient with hepatitis C.
D) When changing an infant's diaper in a pediatric setting.
Correct Answer: D) When changing an infant's diaper in a pediatric setting.
Rationale: Standard precautions require the use of gloves whenever there is a potential for
contact with blood, body fluids, non-intact skin, or mucous membranes. Changing a diaper
involves direct contact with feces and urine, which are body fluids. The other scenarios do
not involve anticipated contact with body fluids, so gloves are not required.
Question 5
A physical therapist is educating a patient on the home use of a moist hot pack. To achieve
therapeutic heating effects while minimizing the risk of burns, which application time frame is MOST
appropriate?
A) 5 to 10 minutes
B) 20 to 30 minutes
C) 45 to 60 minutes
D) 61 to 90 minutes
Correct Answer: B) 20 to 30 minutes
Rationale: Superficial heating modalities like moist hot packs typically require 15 to 20
minutes to reach maximum therapeutic temperature in the target tissues. A time frame of 20
to 30 minutes is considered ideal for achieving these benefits. Shorter durations are
insufficient, and longer durations do not add significant therapeutic benefit and substantially
increase the risk of skin burns.
Question 6
A patient presents to physical therapy via direct access for insidious shoulder pain. During the initial
inspection, the therapist notes a yellowish discoloration of the patient's sclera (the whites of the
eyes) and skin. The therapist should recognize this as a sign of potential dysfunction and refer the
patient to a physician. This finding is MOST indicative of a problem with which organ system?
A) Liver.
B) Eye.
C) Duodenum.
D) Heart.
,Correct Answer: A) Liver.
Rationale: The yellowish discoloration, known as jaundice, is caused by an accumulation of
bilirubin in the blood. Bilirubin is a waste product that is normally processed by the liver. The
presence of jaundice is a classic sign of liver or gallbladder dysfunction and requires
immediate medical referral.
Question 7
A 22-year-old patient with cystic fibrosis is hospitalized awaiting a lung transplant. The physician
requests an objective measure of the patient's preoperative endurance. Which test is MOST
appropriate for the physical therapist to administer?
A) VO2 max treadmill test
B) 2-step test
C) Submaximal exercise test on a cycle ergometer
D) 6-minute walk test
Correct Answer: D) 6-minute walk test
Rationale: The 6-minute walk test is a submaximal exercise test specifically designed to
assess functional exercise capacity in patients with moderate to severe heart or lung
disease. It is safe, well-tolerated, and provides a reliable and valid measure of endurance for
this patient population. The other tests would likely be too strenuous for a patient this ill.
Question 8
A physical therapist is preparing for the first gait training session with a young adult patient who has
paraplegia. Which of the following options is the MOST appropriate and safest choice for this initial
session?
A) Swing-through gait pattern with a walker.
B) Swing-through gait pattern with forearm crutches.
C) Swing-to gait pattern with axillary crutches.
D) Swing-to gait pattern in the parallel bars.
Correct Answer: D) Swing-to gait pattern in the parallel bars.
Rationale: The parallel bars provide the maximum amount of stability and safety for an initial
gait training session with a patient who has significant weakness or paralysis. The swing-to
gait pattern is less demanding and easier to learn initially than the swing-through pattern.
This option represents the safest and most realistic starting point.
Question 9
A patient with peripheral arterial disease (PAD) reports leg pain with walking that is relieved by rest.
This patient will MOST likely also experience:
A) Relief of pain when the legs are elevated.
B) Purple or brown pigmentation of the skin on the legs.
C) Relief of pain when the legs are in a dependent position.
D) A positive Homan's sign.
, Correct Answer: C) Relief of pain when the legs are in a dependent position.
Rationale: The patient is describing intermittent claudication, a hallmark of arterial
insufficiency. The pain is caused by a lack of blood flow to the muscles. Placing the legs in a
dependent (hanging down) position uses gravity to assist blood flow to the feet and can help
to relieve ischemic pain. Elevating the legs would worsen the pain.
Question 10
A patient presents to physical therapy with an ulcer on the right medial malleolus. The therapist
notes brownish pigmentation of the skin and normal skin temperature. These findings are consistent
with chronic venous insufficiency. The patient MOST likely also has:
A) Edema.
B) A diminished pedal pulse.
C) Lower extremity pain that increases with exercise.
D) Hypersensitivity to cold.
Correct Answer: A) Edema.
Rationale: The signs described (medial ulcer, brownish discoloration from hemosiderin
staining, normal temperature) are all classic indicators of chronic venous insufficiency. This
condition is caused by incompetent valves in the veins, which leads to the pooling of blood
and fluid in the lower extremities, resulting in chronic edema.
Question 11
The parent of a 4-year-old child with a myelomeningocele at the L1 neurological level is interested in
orthoses for gait training. Which orthosis is the MOST appropriate selection for the physical therapist
to discuss?
A) Hip-knee-ankle-foot orthosis (HKAFO) with locked hips
B) Reciprocating-gait orthosis (RGO)
C) Knee-ankle-foot orthosis (KAFO) with a pelvic band
D) Ankle-foot orthosis (AFO)
Correct Answer: B) Reciprocating-gait orthosis (RGO)
Rationale: A child with an L1 lesion lacks active hip flexion and has paralysis of the muscles
of the lower extremities. To achieve a functional walking pattern, they require an orthosis that
can provide support to the trunk, hips, knees, and ankles, and that can assist with limb
advancement. The RGO uses a cable system to couple hip extension on one side with hip
flexion on the other, allowing for a reciprocal gait pattern.
Question 12
A patient who sustained a right cerebrovascular accident (CVA) presents with a flaccid left arm.
During muscle testing, the patient is able to shrug the left shoulder. The MOST accurate explanation
for this is that the right CVA:
A) Has affected the right shoulder and not the left shoulder.
B) Did not affect the vagus nerve (cranial nerve X).
