PEAT 4 EXAM
1) A physical therapist is examining a patient who was unaware of a circular
ulcer on the plantar surface of the second metatarsal head. The patient is noted
to have hammer toes. Which additional findings are MOST likely?
1. Normal arterial pulses
2. Increased sweating over the foot
3. Increased pain with elevation of the foot
4. Altered biomechanics when weight-bearing - ANSWERS-4
The location of the painless ulcer is characteristic of a neuropathic (diabetic)
ulcer. Loss of sensation renders the patient unaware of the repetitive trauma
from altered biomechanics due to weakness of the intrinsics, which leads to
hammer toes, and abnormal pressure on the plantar foot when weight-bearing.
Increased pain with foot elevation is characteristic of arterial ulcers, which are
painful. Normal arterial pulses may be present with a venous ulcer, but arteries
are often calcified with advanced diabetes. A neuropathic foot is warm and dry.
1) A physical therapist examining wrist-joint play finds restriction in the
direction indicated by the arrow. To address the restriction, the therapist should
include an intervention to increase which motion of the index finger (2nd digit)?
1. Flexion
2. Extension
3. Abduction
4. Rotation - ANSWERS-1
,The therapist is shown performing a volar glide, which is the same joint motion
used for finger flexion. Limited motion in this direction indicates limited ability
to perform finger flexion.
1) A physical therapist is treating a patient who has diabetes mellitus. Which of
the following information is MOST important to include when educating the
patient about the benefits of exercise?
1. Blood glucose levels increase during exercise.
2. Weight training is preferred to aerobic exercise for patients with diabetes.
3. Exercise can reduce the amount of insulin the patient must administer.
4. Exercising before meals is recommended for patients with diabetes. -
ANSWERS-3
One of the benefits of exercise is improved insulin sensitivity, which reduces the
amount of insulin needed. Blood glucose levels decrease during exercise.
Patients with diabetes should not exercise before meals because this timing
increases the risk of hypoglycemia. Aerobic exercise is just as important for
people who have diabetes as for healthy people, so weight training is not
preferable.
1) A patient has pain, edema, and tenderness over the medial border of the hand.
The patient also shows changes in the color and temperature of the skin,
hyperhidrosis, and progressive joint stiffness in the wrist and hand. The MOST
likely cause of the patient's signs and symptoms is:
1. cervical disc disease.
2. Raynaud phenomenon.
3. complex regional pain syndrome.
4. carpal tunnel syndrome. - ANSWERS-3
,All of these symptoms are indicative of complex regional pain syndrome.
Cervical disc disease does not produce swelling in the hand, color and
temperature changes, or hyperhidrosis. Raynaud phenomenon results in pain,
pallor, and coolness, but no hyperhidrosis. Although carpal tunnel syndrome can
also show sympathetic nervous system abnormalities, compression of the
median nerve would refer symptoms to the lateral border of the hand (thumb
area). With carpal tunnel syndrome, the patient may also display thenar muscle
weakness.
1) A physical therapist is planning a patient education program for a group of
patients with chronic low back pain. The therapist should use which of the
following strategies to MOST increase the likelihood that the patients will
utilize the proper body mechanics they learn?
1. Ask the patients to demonstrate use of proper body mechanics.
2. Provide a reference list of articles describing body mechanics.
3. Ask the patients to describe actions they do that increase their back pain.
4. Provide information on the frequency of low back injuries due to improper
body mechanics. - ANSWERS-1
Evaluation of the patients' retention of the information presented in the program
can be enhanced by asking the patients questions about the program
information, having the patients ask questions about the program, having the
patients demonstrate what they have learned, and testing the patients about the
program material. Option 1 is the only option that includes one of these
techniques. The other options do not require active participation by the patients
and do not address specific interventions.
1) A physical therapist should expect a patient to describe pain associated with a
5-year history of rheumatoid arthritis as:
, 1. morning pain with stiffness that improves with activity.
2. pain that is worse at the beginning of an activity.
3. constant pain that lasts throughout the day.
4. pain that increases throughout the day. - ANSWERS-1
Chronic inflammatory disorders such as rheumatoid arthritis are often
associated with morning pain and stiffness that decrease throughout the day
with activity. Pain that is worse at the beginning of an activity implies acute
inflammation. Constant pain suggests tumors or a visceral cause. Pain that
increases throughout the day indicates increased congestion in a joint.
1) Use of ice massage to affected area(s) is MOST appropriate for a patient who
has which of the following problems?
1. Trigger point in the upper trapezius muscle
2. Spasticity of the plantar flexor muscles after stroke
3. Exercise-induced soreness of abdominal muscles
4. Decreased extensibility of bilateral hamstrings muscles - ANSWERS-1
Ice massage is used to treat a small area, such as a trigger point in a muscle. Ice
is applied to produce analgesia and allow for deep pressure massage over the
trigger point and stretching of the muscle. Treating large areas, such as the
lower leg (as in option 2), is done more efficiently with cold baths or cold packs
than with ice massage. Cryotherapy increases stiffness and decreases tissue
extensibility (p 76) and so would not be indicated for stretching hamstrings.
1) A patient presents with sudden onset of weakness of the facial muscles on the
right side. The patient is unable to wrinkle the forehead, smile, pucker the lips,
or wrinkle the nose. There is an absence of tearing in the patient's right eye,
1) A physical therapist is examining a patient who was unaware of a circular
ulcer on the plantar surface of the second metatarsal head. The patient is noted
to have hammer toes. Which additional findings are MOST likely?
1. Normal arterial pulses
2. Increased sweating over the foot
3. Increased pain with elevation of the foot
4. Altered biomechanics when weight-bearing - ANSWERS-4
The location of the painless ulcer is characteristic of a neuropathic (diabetic)
ulcer. Loss of sensation renders the patient unaware of the repetitive trauma
from altered biomechanics due to weakness of the intrinsics, which leads to
hammer toes, and abnormal pressure on the plantar foot when weight-bearing.
Increased pain with foot elevation is characteristic of arterial ulcers, which are
painful. Normal arterial pulses may be present with a venous ulcer, but arteries
are often calcified with advanced diabetes. A neuropathic foot is warm and dry.
1) A physical therapist examining wrist-joint play finds restriction in the
direction indicated by the arrow. To address the restriction, the therapist should
include an intervention to increase which motion of the index finger (2nd digit)?
1. Flexion
2. Extension
3. Abduction
4. Rotation - ANSWERS-1
,The therapist is shown performing a volar glide, which is the same joint motion
used for finger flexion. Limited motion in this direction indicates limited ability
to perform finger flexion.
1) A physical therapist is treating a patient who has diabetes mellitus. Which of
the following information is MOST important to include when educating the
patient about the benefits of exercise?
1. Blood glucose levels increase during exercise.
2. Weight training is preferred to aerobic exercise for patients with diabetes.
3. Exercise can reduce the amount of insulin the patient must administer.
4. Exercising before meals is recommended for patients with diabetes. -
ANSWERS-3
One of the benefits of exercise is improved insulin sensitivity, which reduces the
amount of insulin needed. Blood glucose levels decrease during exercise.
Patients with diabetes should not exercise before meals because this timing
increases the risk of hypoglycemia. Aerobic exercise is just as important for
people who have diabetes as for healthy people, so weight training is not
preferable.
1) A patient has pain, edema, and tenderness over the medial border of the hand.
The patient also shows changes in the color and temperature of the skin,
hyperhidrosis, and progressive joint stiffness in the wrist and hand. The MOST
likely cause of the patient's signs and symptoms is:
1. cervical disc disease.
2. Raynaud phenomenon.
3. complex regional pain syndrome.
4. carpal tunnel syndrome. - ANSWERS-3
,All of these symptoms are indicative of complex regional pain syndrome.
Cervical disc disease does not produce swelling in the hand, color and
temperature changes, or hyperhidrosis. Raynaud phenomenon results in pain,
pallor, and coolness, but no hyperhidrosis. Although carpal tunnel syndrome can
also show sympathetic nervous system abnormalities, compression of the
median nerve would refer symptoms to the lateral border of the hand (thumb
area). With carpal tunnel syndrome, the patient may also display thenar muscle
weakness.
1) A physical therapist is planning a patient education program for a group of
patients with chronic low back pain. The therapist should use which of the
following strategies to MOST increase the likelihood that the patients will
utilize the proper body mechanics they learn?
1. Ask the patients to demonstrate use of proper body mechanics.
2. Provide a reference list of articles describing body mechanics.
3. Ask the patients to describe actions they do that increase their back pain.
4. Provide information on the frequency of low back injuries due to improper
body mechanics. - ANSWERS-1
Evaluation of the patients' retention of the information presented in the program
can be enhanced by asking the patients questions about the program
information, having the patients ask questions about the program, having the
patients demonstrate what they have learned, and testing the patients about the
program material. Option 1 is the only option that includes one of these
techniques. The other options do not require active participation by the patients
and do not address specific interventions.
1) A physical therapist should expect a patient to describe pain associated with a
5-year history of rheumatoid arthritis as:
, 1. morning pain with stiffness that improves with activity.
2. pain that is worse at the beginning of an activity.
3. constant pain that lasts throughout the day.
4. pain that increases throughout the day. - ANSWERS-1
Chronic inflammatory disorders such as rheumatoid arthritis are often
associated with morning pain and stiffness that decrease throughout the day
with activity. Pain that is worse at the beginning of an activity implies acute
inflammation. Constant pain suggests tumors or a visceral cause. Pain that
increases throughout the day indicates increased congestion in a joint.
1) Use of ice massage to affected area(s) is MOST appropriate for a patient who
has which of the following problems?
1. Trigger point in the upper trapezius muscle
2. Spasticity of the plantar flexor muscles after stroke
3. Exercise-induced soreness of abdominal muscles
4. Decreased extensibility of bilateral hamstrings muscles - ANSWERS-1
Ice massage is used to treat a small area, such as a trigger point in a muscle. Ice
is applied to produce analgesia and allow for deep pressure massage over the
trigger point and stretching of the muscle. Treating large areas, such as the
lower leg (as in option 2), is done more efficiently with cold baths or cold packs
than with ice massage. Cryotherapy increases stiffness and decreases tissue
extensibility (p 76) and so would not be indicated for stretching hamstrings.
1) A patient presents with sudden onset of weakness of the facial muscles on the
right side. The patient is unable to wrinkle the forehead, smile, pucker the lips,
or wrinkle the nose. There is an absence of tearing in the patient's right eye,
