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Your patients MRI results showed occlusion of her right vertebral artery. Which of the
following is true of her condition?
A. Visual agnosia
B. Vertigo, nausea, vomiting
C. Little or no deficit
D. Diplopia on lateral gaze
Lets recall that in the brain there are two main pairs of arteries. These are
the two internal carotid arteries and the two vertebral arteries. The latter
supply the posterior circulation. Since there are two vertebral arteries, an
occlusion of one vertebral artery would not lead to significant deficit as the
other vertebral artery would continue to send blood to the posterior
circulation. Reference: Clinical Anatomy Made Ridiculously Simple by S.
Goldberg, MD, 12.
A two months post-op CVA patient has lesions in the inferior frontal gyrus just rostral to
where the motor representation of the face is located, as shown by the MRI. His case
shows good prognosis. Based on this area affected, the best treatment strategy to use
is___________.
A. Ask speech pathologist to create communication strategies.
B. Take advantage of verbal cues
C. Demonstrate the task so that the patient can execute it.
D. Allow family members to join the PT session to help interpret the instruction.
Which of the following nerve roots is/are affected by large herniation of the L5-S1 disc?
A. L4 and L5
B. L5 and S1
C. L5
D. L4
You are examining a TBI patient in the ICU. You notice his eyes dont open when spoken
to but do so when you pinch his cheek. While he is able to localize the pain, he talks
gibberish. What is the patients score on the Glasgow coma scale?
A. 7
B. 12
C. 6
D. 9
motion exercise and ADLs. The possible reason for this exercise
prescription is because____________.
A. the patients hemoglobin is only 7 g/dL.
B. the patients hemoglobin is only 12 g/dL.
C. the patients platelet count is 19,000 cells/mm3.
D. the patients hematocrit is 19% of RBC of the whole blood.
5. Which of the following SaO2 values requires supplemental O2?
A. 89%
B. 91%
C. 93%
D. 92%
6. The partial thromboplastin time (PTT) would increase its duration if
the patient had the following deficiencies, except:
A. factor X
B. factor IX
C. factor IV
D. factor VIII
7. What is the normal prothrombin time (PT)
A. 11-15 sec
B. 5-10 sec
C. 15-20 sec
D. 6-10 sec
8. what is the normal partial thromboplastin time (PTT)?
A. 15-30 sec
B. 1-2 mins
C. 25-40 sec
D. 11-15 sec
excessive weight gain. She says she has difficulty breathing. You also
notice she is agitated and restless. Her BP reading yields 170/100
mmHg and her pulse rate 115 bpm. Based on these findings, your
impression is that she is hypernatremic. Which of the following is the
cause of her condition?
A. water intoxication
B. excess salt intake
C. excess ADH
D. water deficits
1. Your patient is on the cardiac unit with telemetry ECG monitoring
following congestive heart failure. The figure below indicates that the
patient is_______.
C. early tetany
D. dyspnea
3. if your patient had the following values in the arterial blood gas
analysis: pH = 7.47; PaCO2 = 40 mm Hg; HCO3 = 32 mEq/L, your
patient would be in a state of a/an_______.
A. Uncompensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory alkalosis
D. Uncompensated metabolic alkalosis
4. While treating your patient, you notice her jugular vein distended
and her extremities edematous. You then suspect your patient
has_________.
A. Right-sided heart failure
B. Prinzmetal angina
C. Left-sided heart failure
D. Transmural MI
5. You are at the nurses station reading your patients medical chart. A
report of arterial blood gas analysis is included in
the chart.The following values are: pH= 7.42; paCO2 = 50 mmHg;
HCO3 = 31 mEq/L. Which of the following best reflects the above
values?
A. Fully compensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Partially compensated metabolic alkalosis
D. Fully compensated respiratory acidosis
the answer is fully compensated metabolic alkalosis. But it was not in the
choices. It was a typo error. Sorry.
its FULLY COMPENSATED METABOLIC ALKALOSIS. Why? first of all, we
need to determine where the pH belongs. in this case, the pH is 7.42. that
means the pH is within normal range. PaCO2 is 50 which signifies ACIDOSIS.
While HCO3 is 31 which is ALKALOSIS. Looks confusing, right? how do we
know its ALKALOSIS or ACIDOSIS when you have your pH within normal
range? the key to knowing this is to know where the pH value is
leaning..remember the pH normal range is 7.35-7.45. and 7.40 is our reference
point as this is the perfectly normal pH value, so to speak. So, our patients pH
is 7.42, meaning its leaning toward where? toward ALKALOSIS. And since
our pts HCO3 is 31 (which is alkalosis), the answer then is FULLY
COMPENSATED METABOLIC ALKALOSIS.
pathology is___?
A. Stage 1 external primary impingement
B. Rotator cuff tears (full thickness)
C. Stage 3 external primary impingement
D. Idiopathic frozen shoulder
4. You notice the patient is unable to abduct his arm beyond 90
degrees with pain. The following nerves are not involved, except:
A. Axillary (circumflex) nerve
B. Spinal accessory nerve
C. Long thoracic nerve
D. Suprascapular nerve
5. In Salter Harris Classification, which of the following has a high
complication rate?
A. Types I and II
B. Types III and IV
C. Types II and V
D. Type V
6. The patient just had a total hip arthroplasty. The following is the
position he should not be allowed to do except:
A. Hip flexion at 95 degrees with adduction and medial rotation.
B. Hip flexion at 100 degrees with adduction and medial rotation.
C. Hip flexion at 80 degrees with abduction and lateral
rotation.
D. Hip flexion at 95 degrees with abduction and lateral rotation.
7. You are doing physical examination on your clients thoracic region.
She rotates to her left side. What is the natural consequence of that
movement?
A. The left ribs become convex anteriorly.
4. You assess your clients thoracic region flexibility. You ask him to
rotate to the left side. Which of the following is the normal position of
the rib cage during left rotation?
A. Anterior portion of the rib becomes flattened on the right side.
B. Posterior portion of the rib becomes more convex on the right side.
C. Anterior portion of the rib becomes more convex on the left side.
D. Posterior portion of the rib becomes more convex on the
left side.
5. You are watching a championship boxing match. A 45-year-old
challenger pits against the reigning middleweight champion. It is an
action-packed contest. But in the fifth round, the challenger falls to the
canvas on an outstretched hand when the champion shoves him. The
challenger is grimacing in pain. He manages to stand up and resumes
his attack. But every time he throws a right cross, he grimaces in pain
especially if his arm goes past the midline. Then his face looks even
more apprehensive whenever he brings his right arm too far away to
gain leverage in launching a right cross. Which of the following joint
would be most likely injured?
A. Acromioclavicular joint
B. Sternoclavicular joint
C. Elbow joint
D. Glenohumeral joint
C. Trochanteric bursitis
D. Legg-Calve-Perthes disease
8. A client is referred to PT clinic for peripheral joint mobilization
treatment on her right knee. Which of the following does not warrant
deferral of treatment?
A. Chronic venous insufficiency
B. Trisomy 21
C. Rheumatoid Arthritis
D. Active inflammatory process
9. There are two types of muscle fibers in our body: slow-twitch and
fast-twitch. Which of the following has a higher preponderance of
slow-twitch muscle fiber?
A. Biceps brachii
B. Supraspinatus
C. Gastrocnemius
D. Biceps Femoris
10. Your patient has an acute subacromial bursitis. She is in severe
pain and exhibits muscle guarding as you move her shoulder. Which of
the following end feel is reflective of her condition?
A. Springy
B. Mushy
C. Soft capsular
D. Empty
11. A PT is observing his patient diagnosed with RA ambulating
independently on an even terrain at her residence. He notices her right
knee flexes slight;y and rotates her tibia laterally at heel strike. What is
the best intervention for his patient?
A. Joint mobilization sustained grade III with anteriorly directed glide.
C.Stretching
D.Swimming
Explanation
Answer: B
High-impact exercises like running should be avoided due to the increased stress it puts
on joints. The best exercises for patients with RA are low-impact activities.
You read in a TBI patients chart that they are at Level III of the
Rancho Los Amigos Levels of Cognitive Function Scale. Which
of the following is NOT an appropriate intervention for a patient
at this level of cognition?
A.Simple ADL to promote automatic responses
B.Sensory stimulation such as tactile, visual, auditory, temperature, and
proprioception
C.ROM to prevent contracture/tone and spasticity management
D.Multi-step command following
Explanation
Rationale: A patient at Rancho Level III has a localized response to stimuli and their
response is directly related to the type of stimuli they are receiving. At this point you
want to stimulate them as much as possible to get consistent and automatic responses
(choice A and B). You also want to keep them positioned and provide ROM since they
do not have a lot of active movement (choice C). Choice D is beyond their ability at this
point, because they are not even able to follow one-step commands at this level. They
are simply responding to stimuli.
Source: Occupational Therapy for Physical Dysfunction, Sixth Edition, Radomski and
Latham, p. 1048
Since De Quervains affects the first dorsal compartment ( Abductor pollicis longus and
extensor pollicis brevis are there), swelling and pain in that area (think: snuffbox, radial
styloid area) are indicators. Finkelsteins is the test where they grab their thumb with
their fingers, then move hand toward ulnar deviation- pain in the radial styloid/ radial
wrist/thumb area is a positive test. Cozens test is a test of the elbow, which is not
directly involved in De Quervains
B.helping the child develop one strong sense that will overpower their other
senses
C.helping the child learn to accept that they are different
D.helping the child learn specific skills
Explanation
Specific skill attainment wont aid in integrating ones skills. You want the childs senses
to be in balance. A sensory integration disorder most certainly doesnt ostracize a child
from their peers.
Source: Sensory Integration and the Child by A.Jean Ayers, PhD
Willard and Spackman page 749. a attention involves several components, for instance
the ability to detect/react, the ability to sustain attention for a period of time, the ability to
exhibit selective attention or shift attention, and keep track of stimuli during ongoing
activity. Willard and Spackman page 755. c motor planning is the ability to execute
learned and purposeful activity. Willard and Spackman page 761. And d, problem
solving involves planning and concept. Screening adult neurologic populations page 22.
A is the correct answer. Prone positioning allows gravity and body weight to be used for
a gentle sustained stretch. Supine would be best for an infant with newly repaired
abdominal defect, and side-lying would be best for agitated infant and to promote
midline orientation. Source: Occupational Therapy for Children
You are working with Mr. Brown, who recently suffered a CVA
and is now a left sided hemiplegic. While trying to complete
ADLs sitting EOB you notice that he is pushing away from his Rside(strong side) and he resists attempts to correct his posture.
What should you do to help Mr. Brown maintain a more upright
position?
A.keep trying to physically assist Mr. Brown to maintain midline
B.do nothing, Mr. Brown will correct his posture by himself
C.have Mr. Brown reach for objects toward his R side
D.have a family member sit on his L side to brace him
Explanation
Rationale: Mr. Brown has what is known as pusher behavior and because these patients
tend to resist hands on attempts to correct their posture, you need to select treatments
that manipulate the environment. So reaching for objects toward his R side encourages
a weight shift to his stronger side which will bring him more towards midline. It will also
be important to use verbal cues.
Source: Occupational Therapy for Physical Dysfunction pg. 1025
You are treating a patient 2 weeks s/p left sided CVA for R sided
hemiparesis with Therapeutic electrical stimulation (TES). All of
the following are claimed to be benefits from using TES
EXCEPT:
A.Sensory re-education
B.Improvement of muscle strength
C.Increased ROM
D.Reduction of spasticity
Explanation
Answer A: According to research, the primary benefits of TES do not include anything
about resolving sensory deficits that may be secondary to a CVA
Kroon, J., Van der lee, J., IJzerman, M., & Lankhorst, G. (2002) Therapeutic electrical
stimulation to improve motor control and functional abilities of the upper extremity after
stroke. Clinical Rehab, issue 16: 350-360.
FES treatment for individuals with a SCI can benefit from all of
the following, except:
A.To facilitate bladder and bowel control to provide a reliable method for
emptying the bladder, reduce urinary tract infections, reduce bowel/bladder
accidents and reduce constipation.
B.To provide coughing assistance to provide independent ability to cough and
clear lung secretions.
C.To repair or regenerate the spinal cord for target muscles that have become
denervated.
D.To improve circulation for the purposes of reducing formation of blood clots
(deep venous thrombosis), reducing swelling of limbs and reducing chance of
pressure sores.
Explanation
Answer: C
FES is not able to repair or regenerate a damaged spinal cord, it can promote limited
functional recovery in the areas discussed above.
OMalley-Teeter, J., Kantor, C., Brown, D. (1995). Functional electrical stimulation (FES)
resource guide for persons with spinal cord injury or multiple sclerosis. Cleveland, OH:
FES Information Center.
E.C4
ADLs using D1 flexion patterns because many functional activities can be performed
using diagnol patterns, A and C can facilitate rotation, however, they do not incorporate
FUNCTIONAL activities. And D does not address the effects of poor rotation on the
person's performance of ADLs.
Reference - Fleming-Castaldy, R.P. National Occupational Therapy Certification Exam
Review and Study Guide; pg 521
Umphred, Darcy A., Neurological Rehabilitation, 5th Ed; pg 674
Answer: (c) FES against resistance has shown to put the most force on the muscles
causing the muscles to experience less atrophy than FES against no resistance and
other treatments without electrical stimulation to the muscle fibers.
With the patients eyes closed, you place your patients arm with
shoulder abducted, elbow flexed at 90 degrees, and palm facing
out. The patient is asked to indicate if the elbow is flexed or
extended and states it is extended. What sensory deficit is your
patient experiencing?
A.Kinesthesia
B.Stereognosis
C.Proprioception
D.Tactile Localization
Explanation
Pendleton, H. M., & Schu
Answer: C.
A patient who exhibits . . .
Eye opening to pain = 2 points on the coma scale.
No motor response = 1 point
No verbal response = 1 point
Total = 4 points
A score of 8 or less is indicative of a severe brain injury.
Neurological Rehabilitation 5th edition. Umphred, 2007. pg. 536
B: PROM will not prevent muscle atrophy, increase strength or endurance since there is
not active muscle contraction
Rybski, Melinda (2004). Kinesiology for occupational therapy. Thorofare, NJ: SLACK
Incorporated (p.190).
A.you, as the student are allowed to treat the patient if your CI is there telling
you what to do step by step
B.you are not allowed to treat the patient
C.you, as the student are allowed to treat the patient if on line of sight of CI
D.you are not allowed to treat the patient but can document on the treatment
session
Explanation
c. students are not allowed to treat or document on Medicare B patients.
Explanation
Gutman, S.A., & Schonfeld, A.B.(2009) Screening Adult Neurological Populations, 2nd
edition. The American Occupational Therapy Association, Inc. (p 4-7)