PEAT EXAM 3 QUESTIONS AND 100% CORRECT ANSWERS
LATEST UPDATE
A patient presents with a 2-day history of a hot swollen first metatarsophalangeal joint.
The complaint described in the question is MOST common in:
1. osteoarthritis.
2. polymyositis.
3. gout.
4. rheumatoid arthritis. ANSWER 1. Osteoarthritis is classically characterized by dull
achy pain in weight bearing joints eg hips, knees etc. pp 1304-1306.
2. Polymyositis is a symmetric proximal muscle weakness with malaise and weight loss.
There is no joint involvement. p 1247
3. Gout classically presents with severe joint pain at night classically in the first
metatarsophalangeal joint. Other signs and symptoms include erythema, warmth, and
extreme tenderness and hypersensitivity of the affected joint. (p. 1345)
4. Rheumatoid arthritis presents with symmetrical joint inflammation and with pain and
subluxations (pp. 1319-1322).
A patient who sustained an avulsion of the right C5 and C6spinal nerve roots will show
functional loss of right:
1. flexion of the distal thumb.
2. ulnar wrist deviation.
3. extension of the elbow.
4. shoulder abduction. - ANSWER 1. The flexor pollicis longus muscle receives
innervation via the anterior interosseus branch of the median nerve, which is derived
from the C8-T1 nerve roots. A patient with an avulsion of the C5 and C6 spinal nerve
roots will be able to perform distal thumb flexion (1st digit). (Dutton, p. 83; O'Sullivan, p.
154)
2. The ulnar nerve and radial nerve (posterior interosseus) are derived from the C7-C8
nerve roots, supplying the flexor and extensor carpi ulnaris. Therefore, the patient with
an avulsion of the C5 and C6 spinal nerve roots will have the ability to ulnar deviate their
,wrist. (Dutton, pp. 83, 86; O'Sullivan, p. 154)
3. The radial nerve is comprised of the C5-C8 and T1 nerve roots, supplying the triceps
brachii. Avulsion of the C5 and C6 nerve roots will result in weakness but not functional
loss of elbow extension. (Dutton, pp. 81-82; O'Sullivan, p. 154)
4. The axillary nerve is comprised of the C5-C6 nerve roots, supplying the deltoid and
teres minor muscles. These avulsed nerve roots will result in reduced right shoulder
abduction. Dutton, p. 80; O'Sullivan, p. 154
Post renal transplant, the patient acutely develops a Stage 3 pressure ulcer over the
sacrum and is referred to physical therapy for wound care management. The following
list includes which would be the MOST appropriate agent to apply initially to this open
wound?
1. Povidone-iodine solution
2. Sterile normal saline
3. Silver sulfadiazine (Silvadene) cream
4. Zinc oxide cream - ANSWER 1. Povidone-iodine usage is generally restricted to skin
preparations to prevent surgical site infection. It can be used on an acute traumatic
wound. A Stage 3 pressure injury is a chronic wound. (Sussman, p. 518)
2. Sterile normal saline is the recommended initial agent utilized to clean a wound
(Sussman, p. 518).
3. Silver sulfadiazine can be utilized if the infection is present, but this is not an
indication within the initial treatment. Sussman, p. 513
4. Zinc oxide is used with dental fillings and in local surface applications for skin
conditions other than chronic pressure ulcers. Mosby's, p. 1913).
During cardiac rehabilitation patient education, which of the following signs and
symptoms should the physical therapist emphasize as an indication of exertional
intolerance?
1. Anginal pain, insomnia, sudden weight gain, leg stiffness
2. Dyspnea that persists, dizziness, anginal pain, weight gain that occurs suddenly
3. Dyspnea that persists, anginal pain, insomnia, weight loss
4. Anginal pain, confusion, leg numbness, weight loss-ANSWER 1. Leg stiffness is not a
sign/symptom related to exercise intolerance among cardiac rehabilitation patients
,2. The signs and symptoms outlined in this option are related to exercise intolerance
among cardiac rehabilitation patients.
3. Weight loss is not a sign related to exercise intolerance among cardiac rehabilitation
patients. However angina and dyspnea are important signs of exercise intolerance.
4. Exercise intolerance, leg numbness, confusion, and weight loss are not associated in
this case. Angina is significant to note in a patient with cardiac dysfunction.
A patient with no history of trauma complains of nonradiating low back pain. Forward
flexion of the lumbar spine does not reverse the lordosis and is pain-free; extension of
the lumbar spine increases the symptom. A step-off in the lower lumbar region is
palpable. The MOST appropriate treatment for this patient would be:
1. abdominal strengthening.
2. sustained prone positioning on elbows.
3. exaggerated lumbar lordosis in sitting.
4. grade III posteroanterior glide to L5. - ANSWER 1. The patient's signs and symptoms
presented are those of spondylolisthesis. Strengthening of the abdominal muscles and
stabilization is conservative management.
2. Extension activities are not appropriate for a patient with spondylolisthesis.
3. Extension activities are not appropriate for a patient with spondylolisthesis.
4. Extension activities are not appropriate for a patient with spondylolisthesis.
A patient positioned in prone has difficulty initiating hip extension with the knee bent.
Which of the following muscles will MOST likely need strengthening?
1. Hamstrings
2. Gluteus maximus
3. Lumbar erector spinae
4. Gluteus medius - ANSWER 1. Hamstrings are primarily knee flexors. They can be
secondary hip extensors but would be tested with the knee extended, not flexed. (p. 242)
2. Gluteus maximus is the major hip extensor muscle tested in this position. (p. 216).
3. Lumbar erector spinae extend the trunk on the thighs. They do not originate on the
femur and, therefore, have no action extending the hip. (pp. 43-44)
, 4. Gluteus medius weakness would be tested by examining hip abduction in sidelying
position. (p. 223).
A patient presents with moderate pain in the elbow after a fall. The radiograph is
negative for a fracture. Which of the following mobilizations is MOST appropriate for
decreasing the pain?
1. Small-amplitude oscillations before the onset of tissue resistance
2. Small-amplitude oscillations into tissue resistance
3. Large-amplitude oscillations into tissue resistance
4. Large-amplitude oscillations into the end of tissue resistance - ANSWER 1. Low
amplitude oscillations before the onset of tissue resistance are indicated for pain
modulation.
2. Low amplitude oscillations into tissue resistance are indicated more for joint stiffness,
not pain.
3. Large-amplitude oscillations into tissue resistance are indicated more for joint
stiffness.
4. Large-amplitude oscillations at the end of tissue resistance are for end range joint
restrictions and are too aggressive for patients who have pain.
During patellar reflex testing, the patient demonstrates hyperreflexia. What is the MOST
likely cause of this finding?
1. A spinal cord tumor at L1
2. A herniated nucleus pulposus at L4
3. Femoral nerve impingement
LATEST UPDATE
A patient presents with a 2-day history of a hot swollen first metatarsophalangeal joint.
The complaint described in the question is MOST common in:
1. osteoarthritis.
2. polymyositis.
3. gout.
4. rheumatoid arthritis. ANSWER 1. Osteoarthritis is classically characterized by dull
achy pain in weight bearing joints eg hips, knees etc. pp 1304-1306.
2. Polymyositis is a symmetric proximal muscle weakness with malaise and weight loss.
There is no joint involvement. p 1247
3. Gout classically presents with severe joint pain at night classically in the first
metatarsophalangeal joint. Other signs and symptoms include erythema, warmth, and
extreme tenderness and hypersensitivity of the affected joint. (p. 1345)
4. Rheumatoid arthritis presents with symmetrical joint inflammation and with pain and
subluxations (pp. 1319-1322).
A patient who sustained an avulsion of the right C5 and C6spinal nerve roots will show
functional loss of right:
1. flexion of the distal thumb.
2. ulnar wrist deviation.
3. extension of the elbow.
4. shoulder abduction. - ANSWER 1. The flexor pollicis longus muscle receives
innervation via the anterior interosseus branch of the median nerve, which is derived
from the C8-T1 nerve roots. A patient with an avulsion of the C5 and C6 spinal nerve
roots will be able to perform distal thumb flexion (1st digit). (Dutton, p. 83; O'Sullivan, p.
154)
2. The ulnar nerve and radial nerve (posterior interosseus) are derived from the C7-C8
nerve roots, supplying the flexor and extensor carpi ulnaris. Therefore, the patient with
an avulsion of the C5 and C6 spinal nerve roots will have the ability to ulnar deviate their
,wrist. (Dutton, pp. 83, 86; O'Sullivan, p. 154)
3. The radial nerve is comprised of the C5-C8 and T1 nerve roots, supplying the triceps
brachii. Avulsion of the C5 and C6 nerve roots will result in weakness but not functional
loss of elbow extension. (Dutton, pp. 81-82; O'Sullivan, p. 154)
4. The axillary nerve is comprised of the C5-C6 nerve roots, supplying the deltoid and
teres minor muscles. These avulsed nerve roots will result in reduced right shoulder
abduction. Dutton, p. 80; O'Sullivan, p. 154
Post renal transplant, the patient acutely develops a Stage 3 pressure ulcer over the
sacrum and is referred to physical therapy for wound care management. The following
list includes which would be the MOST appropriate agent to apply initially to this open
wound?
1. Povidone-iodine solution
2. Sterile normal saline
3. Silver sulfadiazine (Silvadene) cream
4. Zinc oxide cream - ANSWER 1. Povidone-iodine usage is generally restricted to skin
preparations to prevent surgical site infection. It can be used on an acute traumatic
wound. A Stage 3 pressure injury is a chronic wound. (Sussman, p. 518)
2. Sterile normal saline is the recommended initial agent utilized to clean a wound
(Sussman, p. 518).
3. Silver sulfadiazine can be utilized if the infection is present, but this is not an
indication within the initial treatment. Sussman, p. 513
4. Zinc oxide is used with dental fillings and in local surface applications for skin
conditions other than chronic pressure ulcers. Mosby's, p. 1913).
During cardiac rehabilitation patient education, which of the following signs and
symptoms should the physical therapist emphasize as an indication of exertional
intolerance?
1. Anginal pain, insomnia, sudden weight gain, leg stiffness
2. Dyspnea that persists, dizziness, anginal pain, weight gain that occurs suddenly
3. Dyspnea that persists, anginal pain, insomnia, weight loss
4. Anginal pain, confusion, leg numbness, weight loss-ANSWER 1. Leg stiffness is not a
sign/symptom related to exercise intolerance among cardiac rehabilitation patients
,2. The signs and symptoms outlined in this option are related to exercise intolerance
among cardiac rehabilitation patients.
3. Weight loss is not a sign related to exercise intolerance among cardiac rehabilitation
patients. However angina and dyspnea are important signs of exercise intolerance.
4. Exercise intolerance, leg numbness, confusion, and weight loss are not associated in
this case. Angina is significant to note in a patient with cardiac dysfunction.
A patient with no history of trauma complains of nonradiating low back pain. Forward
flexion of the lumbar spine does not reverse the lordosis and is pain-free; extension of
the lumbar spine increases the symptom. A step-off in the lower lumbar region is
palpable. The MOST appropriate treatment for this patient would be:
1. abdominal strengthening.
2. sustained prone positioning on elbows.
3. exaggerated lumbar lordosis in sitting.
4. grade III posteroanterior glide to L5. - ANSWER 1. The patient's signs and symptoms
presented are those of spondylolisthesis. Strengthening of the abdominal muscles and
stabilization is conservative management.
2. Extension activities are not appropriate for a patient with spondylolisthesis.
3. Extension activities are not appropriate for a patient with spondylolisthesis.
4. Extension activities are not appropriate for a patient with spondylolisthesis.
A patient positioned in prone has difficulty initiating hip extension with the knee bent.
Which of the following muscles will MOST likely need strengthening?
1. Hamstrings
2. Gluteus maximus
3. Lumbar erector spinae
4. Gluteus medius - ANSWER 1. Hamstrings are primarily knee flexors. They can be
secondary hip extensors but would be tested with the knee extended, not flexed. (p. 242)
2. Gluteus maximus is the major hip extensor muscle tested in this position. (p. 216).
3. Lumbar erector spinae extend the trunk on the thighs. They do not originate on the
femur and, therefore, have no action extending the hip. (pp. 43-44)
, 4. Gluteus medius weakness would be tested by examining hip abduction in sidelying
position. (p. 223).
A patient presents with moderate pain in the elbow after a fall. The radiograph is
negative for a fracture. Which of the following mobilizations is MOST appropriate for
decreasing the pain?
1. Small-amplitude oscillations before the onset of tissue resistance
2. Small-amplitude oscillations into tissue resistance
3. Large-amplitude oscillations into tissue resistance
4. Large-amplitude oscillations into the end of tissue resistance - ANSWER 1. Low
amplitude oscillations before the onset of tissue resistance are indicated for pain
modulation.
2. Low amplitude oscillations into tissue resistance are indicated more for joint stiffness,
not pain.
3. Large-amplitude oscillations into tissue resistance are indicated more for joint
stiffness.
4. Large-amplitude oscillations at the end of tissue resistance are for end range joint
restrictions and are too aggressive for patients who have pain.
During patellar reflex testing, the patient demonstrates hyperreflexia. What is the MOST
likely cause of this finding?
1. A spinal cord tumor at L1
2. A herniated nucleus pulposus at L4
3. Femoral nerve impingement
