1.

A physical therapist is caring for an infant that has recently been diagnosed
with a congenital heart defect. Which of the following clinical signs would most
likely be present?

A: Slow pulse rate

B: Weight gain
C: Decreased systolic pressure
D: Irregular WBC lab values

2. A patient's chart indicates a history of hyperkalemia. Which of the following

would you not expect to see with this patient if this condition were acute?

A: Decreased HR low pr. Tingling. Numbness tingling.fatigue

B: Paresthesias
C: Muscle weakness of the extremities
D: Migranes-mentor answer

3. A physical therapist is evaluating an adult that has recently been diagnosed

with respiratory acidosis. Which of the following clinical signs would most likely
not be present?

A: CO2 Retention
B: Dyspnea
C: Headaches
D: Tachypnea

4. A physical therapist is reviewing a patient's medication list. The drug

Pentoxifylline is present on the list. Which of the following conditions is
commonly treated with this medication?

A: COPD
B: CAD
C: PVD-its primary use in medicine is in treating the symptoms of intermittent
claudication resulting from peripheral artery disease
D: MS

5. A patient's chart indicates the patient is suffering from Digoxin toxicity. Which
of the following clinical signs is not associated with digoxin toxicity?

A: Ventricular bigeminy is a descriptor for a heart arrhythmia in which there is a

continuous alternation of long and short heart beats. Most often this is due to ectopic
heart beats occurring so frequently that there is one after each sinus beat, typically
prematureventricular contractions (PVCs).
B: Anorexia
C: Normal ventricular rhythm
D: Nausea
6. Overload principle is used to enhance physiologic improvement and bring
about a training change. Which is the correct statement regarding overload
principle?

a. The appropriate overload for each person can be achieved by

manipulating combinations of training frequency, intensity, and duration.
( The overload principle is not just specific to strength training; it can be
applied to any physical training from flexibility to cardiovascular
exercise.)= FIT principle also can be applied for cardio flexibility traning
b. Specific exercise elicits specific adaptations creating specific training effects.
c. A cardio respiratory training effect can be achieved at a rating of "somewhat
hard" or "hard" (13 to 16 on the original Borg scale of 6 to 19).
d. Training level or target heart rate (THR) can be established at 70% of
maximum to increase aerobic capacity.

7. FlIT equation includes factors that affect training; frequency, intensity, time
and type. Intensity is interrelated with both duration (time) and frequency. In
this aspect frequency is the number of exercise sessions per week. Which is the
incorrect statement relating to frequency at FIIT?

a. If the intensity is constant, the benefit from 2 versus 4 or 3 versus 5 times per
week is the same.-mentor ans
b. Less than 2 days per week does not produce adequate changes in aerobic
capacity or body composition.
c. For weight loss, 5-7 days per week increases the caloric expenditure more than
2 days per week.
d. The Karvonen formula is used to predict heart rate reserve.
*Target Heart Rate = ((max HR − resting HR) × %Intensity) + resting HR example

8. Progressive Resistance Strength Training results in improvements to muscle

strength and some aspects of functional limitation, such as gait speed, in older
adults. However, based on current data, the effect of PRT on physical disability
remains unclear. Further, due to the poor reporting of adverse events in trials, it
is difficult to evaluate the risks associated with PRT.

8. Which is the false statement among the following?

a. Significant improvements noted in frail, institutional sized 80 and 90 years.

b. Improvements in strength correlate to improved functional abilities.
c. Cervical flexor muscles exercise is not effective in reducing myoelectric
increases manifestations of superficial cervical flexor muscle fatigue in elders.-
mentor ans
d. Increase in strength noted in older adults with isometric and progressive
resistive exercise regimes.

9. The Integrated system of organs involved in the intake and exchange of oxygen
and carbon dioxide between an organism and the environment. In humans, the
diaphragm and, to a lesser extent, the muscles between the ribs generate a
pumping action, moving air in and out of the lungs through a system of pipes
(conducting airways), divided into upper and lower airway systems. Which one
of the following is not a pulmonary system age related disorder?

a. Loss of lung elastic recoil, decreased lung.

b. Changes in blood vessels
c. Forced expiratory volume (air flow) decrease
d. Blunted defense/immune responses.

Respiratory Changes
Alveoli and Lungs of the Respiratory System
image: alveoli and lungs
This image shows a male torso with head turned sideways to reveal the major
anatomic elements of the respiratory system. To the left is a close-up view of the
alveoli, tiny air sacs responsible for the oxygen-carbon dioxide exchange of the
blood in the lungs. Illustration provided by 3DScience.com. Used with
permission.
The lungs bring oxygen from the air into the blood and send carbon dioxide and
water back into the air. The respiratory tract also warms and moistens the
incoming air, regulates air flow, removes airborne particles, and cools the entire
organism.

Alveoli of the Respiratory System

image: alveoli
The respiratory tubes, or bronchioles, end in minute alveoli, each of which is
surrounded by an extensive capillary network. The alveoli are responsible for
gas exchange in the blood. Illustration provided by 3DScience.com. Used with
permission.
Similar to other organ systems, aging of the pulmonary system is associated with
structural changes leading to a progressive decline in function. Decreased
collagen and elastin result in the loss of elastic recoil of the lungs. There is
decreased diameter of small airways and a tendency to early closure, leading to
air trapping and ventilation/perfusion mismatches.

With age, there is a decrease in the number of alveoli (the primary gas exchange
units of the lungs) and lung capillaries, with a corresponding decrease in gas
exchange.

Aging lungs become stiffer and less able to expand and contract. Vital capacity,
muscle strength, and endurance decrease. The chest wall becomes more rigid
and the diaphragm and other muscles of respiration become weaker. A
decreased cough reflex and a reduction in the number of cilia that sweep mucous
up and out of the lungs results in increased likelihood of infection (Medline Plus,
2010b).

10. In the following, which is not a clinical implication of Pulmonary System

Disorder?
a. Cough mechanism is impaired.
b. Gag reflex is decreased, increased risk of aspiration.
c. Provide augmented feedback through appropriate sensory channels.
d. Recovery from respiratory illness.

11. Complete cardiopulmonary examination prior to commencing an exercise

program is essential in older adults due the high incidence of cardiopulmonary
pathologies. Which is the incorrect mode for the Interventions to slow or reverse
changes in cardiopulmonary system?

a. Selection of appropriate exercise tolerance testing protocol (ETT) is important.

b. Individualized exercise prescription essential.
c. Aerobic training programs can significantly improve cardiopulmonary function
in the elderly.
d. Ignore circuit training

12. Aerobic training programs can significantly improve cardiopulmonary

function in the elderly age. Which of the following is not an advantage of aerobic
training?

a. Improves recovery heart rates.

b. Increase maximum ventilatory capacity: vital capacity.
c. Reduces breathlessness lowers perceived exertion.
d. Increase systolic blood pressure. -Increase systolic blood pressure: no way it
can increase BP ... It will improve BP

13. A physical therapist is educating a patient about right-sided heart deficits.

Which of the following clinical signs is not associated with right-sided heart
deficits?

A: Orthopnea
B: Dependent edema
C: Ascites
D: Nocturia

Symptoms=
Shortness of breath
Swelling of feet and ankles
Urinating more frequently at night
Pronounced neck veins
Palpitations (sensation of feeling the heart beat)
Irregular fast heartbeat
Fatigue
Weakness
Fainting

14. SCENARIO: 65 YEAR OLD FEMALE WHO HAD UPPER LEFT LOBE RESECTION
1 DAY AGO. CHEST DRAIN IN SITU.

14. How would you assess this pt?

a. Sitting on side of bed
b. High supported sitting
c. Right side lying
d. Supine

15. How would you modify your assessment for this patient?

a. Avoid palpation and auscultation around drain site-its saying around drain
site. As long as u r not pressing to hard its k. N u do auscultate in these pts. N if
its draining fluid its will be basal drain/lower lobes. N we will get consent from
them n we will do the auscultation s mildly. V dnt avoid palpation n ausc. Some
doc as lavanya said get the patient to even turn on the drain site. So aus/pal is ok.
b. Advise to take shallow breaths on auscultation
c. Do not move patient- no CI mentioned in there. Its only day 1 post op. we do
move patient as they hv post op complication if not moving.
d. Monitor pain on movement-mentor ans-it is painful while moving so we
should monitor.
If we getting a post op pt v r not going to ask then VAS score always. But in
thoracic n abd surgery v will monitor pain.

16. You have mobilised patient 20 meters and have returned her to her chair.
What would you advise?

a. Sit there and wait for nursing staff to return you to bed-unless other
CI(contraindications), this is routinely what v do, half hour or one hour.
Give them a calling bell.nurse also keeps an eye on them.Many ppl think v
dnt leave the patient, but if pt is haemodynamically stable then its ok. Day
1-20m is good. Pt very good can walk on day 1. Progress walking in day 2.
Positiong is a good thing. Sitting puts FRC up(PNP-FRC goes up by 17%).
The patient will ask as soon as he sits in the chair.how long will I sit here?
Who will take me back?
NORMAL- Day 1-Normal sit out of bed.- MENTOR ANS
b. Walk again in 1 hour and double your distance
c. Wait for a few mins and then practice your breathing exercises- NUTAN ASKED
HER PHYSIO WHERE SHE WORKS> THEY SAID THEY DO THIS OPTION.
d. Support cough -ambulation is one the chest clearance techneque, mmoving the
secretion to proximal airways : we will wait for mentor to hav a say. Weather v
would do it directly,no. – LAST YR MENTOR ANSWERED THIS OPTION.

17. SCENARIO: 55 YEAR OLD EX SMOKER 50 PACK YEAR HISTORY OF SMOKING,

HE QUIT 6 MONTHSAGO. HAS HAD RECURRENT PNEUMONIA IN THE PAST 4
YEARS. HE HAS BRONCHIECTASIS. HESHOWS SOB AND OEDEMA IN LEGS. ON
LONG TERM O2 THERAPY. HE SHOULD BE ON CONTINUOUS 2L/MIN.

17. His medical chart says he needs 2l of oxygen via nasal prongs. How much
FiO2 does this correspond to?
a. 24%
b. 28%
c. 32%
d. 35%

18. He needs lasix with K+ supplement. How do you explain the patient how it
works?

a. It reduces your heart beats

b. It reduces the fluids of your body
c. increases myocardial contractility
d. stretches heart walls and increases volume

19. He has to have long term oxygen therapy. How do you explain this to the
patient?

a. You can have also for only few hours during the day
b. You need it for most hours of the day
c. You can leave it at home when you go out
d. You can have oxygen when your symptoms get worse

20. You see the patient coming back from the toilet with the nurse who gave
assistance but the patient is without oxygen. What do you do?

a. Check for desaturation

b. Seek nurse assistance to decide re: reapplying oxygen
c. You tell him to put back the nasal prongs-if its LTOT then he has to wear it
continuouslt. He is expected to wear o2. There wont be oreder is the ward to
take it off. If he is in room n toilet is close by then there may be no portable o2.
His lung will not get better from before as its copd. Doc might review them as out
patient. They r worse than normal. So check for desaturation- tell him to put it
back on.
d. Ask him if he has been wearing it today.

21. The patient has “50 pack year” smoking history what does this mean?
a. 50 pack last year
b. 50 pack per year
c. 2 pack per day in 25 years

22. The cardiovascular system is formed by the heart, arteries, and veins. In
connection to the respiratory system, the cardiovascular system provides oxygen
to cell and collect carbon dioxide (CO2). It also helps on the transportation of
hormones, wastes. It is responsible for the circulation of the blood that carries all
the substances to and from the cell. With the blood circulating the temperature
of the body is also affected. Which of the following is not a correct clinical
implication for cardio logical system?

a. Blunted, decrease in heart rate acceleration, decrease maximal oxygen uptake

and heart rate.
b. Respiratory responses to exercise similar to younger adult at low and
moderate intensities; at higher intensities.
c. Decreased stroke volume due to decreased myocardial contractility.
d. Orthostatic hypotension.

23. SCENARIO: THOROCOSCOPY FOR WEDGE RESECTION RIGHT UPPER LOBE.

UNDERWATER DRAIN IN SITU ON SUCTION. TRANSFERRED FROM ICU TO THE
WARD.

23. What is normal about underwater seal drainage for the normalized air leak.

a. Bubbling intermittently in under water seal drainage

b. Bubbling continuously in under water seal drainage
c. Intermittent bubbling in the suction chamber
d. No bubbling in suction chamber

24. When mobilizing the patient, what would you do manage the drain?

a. Measure the length of tubes and mobilize within the reach

b. Ask a physio assistant to carry intercostal catheter
c. Fix it to the frame
d. Remove the suction

25. After mobilizing him what would you do?

a. Make him sit on the chair and say the nurses will take you to the bed.-mentor
ans
b. Ask him to stay in the chair and after resting for few min practice breathing
exercises
c. Ask to Huff strongly with pillow support.
d. Put him back in bed
Explain that yes we know u will hv pain, it will be looked after. Say this is a
routine we get all patients after surgery to sit out in a chair, that s what ur doc
wants u to do, all patients do that. Patients who r cognitively stable will be out in
a chair. In some conditions it isn’t safe like patients not oriented well, dizzy etc.
Nurses help them. “think abt the standard thing u do after mobilizing the patient.
Sit the patient.”

26. What should ICU physio record in hand over note?

a. Initial PT Ax and Rx
b. Discharge plan and prognosis
c. Respiratory care and mobility requirements-mentor ans
e. Physiotherapy interventions
generally we say their current status, like x ray n if any complication, how they r
walking with 2 assist n all, r they sitting out of bed etc. Like pls progress their
mobility they were sitting at edge of the bed as of now. It has to hv the current
finding, mobility status, chest status.
27. A patient has been on long-term management for CHF. Which of the following
drugs is considered a loop dieuretic that could be used to treat CHF symptoms?

A: Ciprofloxacin ab
B: Lepirudin anti coagulant
C: Naproxen nsaids
D: Bumex for edema renal dz nephritic syndrome

Loop Diuretic Relative Potency

Furosemide 1
Bumetanide 40
Ethacrynic Acid 0.7
Torsemide

28. SCENARIO: PATIENT CARDIO - EMPYEMA

5 YEAR OLD TOBY WAS ADMITTED TO THE ICU AND STAYED THERE FOR 10
WEEKS. THE EMPYEMA IN THE LEFT LOWER LOBE HAS BEEN DRAINED AND
NOW HE HAS BEEN MOVED TO THE WARD. TOBY IS VERY AFRAID AND
RELUCTANT TO SPEAK TO ANY OF THE STAFF MEMBERS, IN PARTICULARLY
TO THE PHYSIOTHERAPIST. HE WON’T SPEAK A WORD DURING
EXAMINATION. TOBY’S PARENTS ARE THER E AND THEY WANT TO ASSIST IN
TOBY’S MANAGEMENT. THE ICCS ARE OUT BUT HE STILL HAS NASAL PRONG
AND IV.

28. In which position would you assess Toby?

a. High supported sitting
b. SOOB in mothers arms
c. SOOB in Physio’s arms

29. Before mobilizing you want to use demand ventilation to improve his lung
function. How would you do this?

a. ask Toby’s mother to hold and raise his arms in the air
b. ask Toby to raise his arms in the air a couple of times quickly
c. ask mother to distract Toby while you raise his arms in air
d. blow bubbles in front of him and ask Toby to burst them

30. How would you make Toby walk?

a. ask the parents to stand at the door and ask him to walk towards them
b. you can help Toby and encourage him to walk to the door
c. stay in front of Toby so he can see you.
d. ask mother to support him at hips & make him walk

31. After you have done your session what position would you leave Toby to be
in?
a. High supported sitting
b. Sitting out of bed
c. Right side lying

32 SCENARIO: 50 YEARS OLD FEMALE WAS ADMITTED WITH ASTHMA. SHE IS

ALLERGIC TO DUST, MITE SAND POLLENS. HER SYMPTOMS WORSENED SINCE
SHE HAD DIFFICULTY TO TAKE RESPIRATORY MEDICATIONS. SALBUTAMOL
AND FLIXIOTIDE WERE GIVEN AND ASTHMA HAS BEEN CONTROLLED SINCE
HER ADMISSION. SHE WAS REFERRED TO A PHYSIOTHERAPIST.

32. What is the primary focus for physiotherapy treatment?

a. Reviewing medication
b. Breathing control

c. Sputum clearance

d. Investigation of allergen

33. Flixiotide was given, what is it?

a. Preventer

b. Combination

c. Reliever
d. Symptom controller

34. What is the rationale for using spacer?

a. Even spread of drug in airways and goes in the airways and not in the stomach
b. Because it is cheap and increases compliance
c. It decreases candidasis infection
d. Easy to use and takes less time

35. How will patient measure her respiratory function?

a. Peak expiratory flow rate

b. Peak inspiratory flow rate
c. Forced vital capacity

d. Forced expiratory rate

36. SCENARIO: THE PATIENT HAS COPD FOR A LONG TIME. HE CAN WALK
500M. HE IS SEDENTARY FOR MOST OF HIS LIFE, AND WE WANT TO INCREASE
HIS ENDURANCE.

36. His physiotherapist wants to check his exercise tolerance. What is the
appropriate measure for it?

a. 6 min walk test

b. Graded exe test

c. Borg dyspnea scale

d. St. George questionnaire

37. After assessing his exercise tolerance his physiotherapist prescribed a

walking program. To be effective how long does he have to walk per day?
a. 10min
b. 40min
c. 20min
d. 30min

38. How many days per week should he walk in order to gain the benefits from
walking?

a. 3-4/ week
b. 4-5/ week
c. 8-12/week
d. 2-3/week

39. Patient completed his pulmonary rehabilitation and increased exercise

tolerance and he wanted to continue it. What would his physiotherapist advise
him?

a. Now you can stop walking since you have gained enough exercise tolerance.
b. Continue to walk for 3-5/week

c. Decrease exercise to 2-3 times/week
d. Join gym

40. SCENARIO: 23 YEAR OLD MALE, MOTOR BIKE ACCIDENT 1 DAY AGO. # RIBS
5 & 6
(so this patient might hv a lot of pain, decreased sputum clearance, ex
tolerance less,might get )

40. What would indicate worsening state?

a. Increase Respiratory Rate
-mentor ans

b. Decrease respiratory rate

c. Productive cough

d. Increase in his pain- rib # is painful. So that will not tell me worsening state. It
tell if pain is up then may be medical team will hv to review for pain control n
give meds.

41. How would you treat?

a. Autogenic Drainage and supported cough with pillow
-

AD-ask u to imagine at diff breathing levels. Like ur on the basement level now.
Generally not AD. Therapist goes for acbt first. That is a first line treatment. AD is
not used now days. Its moving from low-mid-high volumes. (PNP PHYSIO TECH
CHAP)- MENTOR ANS
b. Autogenic Drainage and supported cough

c. Active Cycle of Breathing and suction
- the patient is conscious so we can ask
him to cough on his own. We do not need suction.
d. Active Cycle of Breathing and nasopharyngeal suction

other cases had – the same question but will have diffenent options when-ACBT
with pillow or without pillow. So we will go for acbt first.
42. How would you monitor him during treatment? – monitoring is the key word.
We will monitor saturation also.

a. Breath sounds on auscultation and saturation
- auscultate prior n after

treatment.
b. Temperature
-no we dnt take temp
c. Blood pressure
- if we sat him at the edge of the bed he gets dizzy n gets pale
n all then might see BP.
d. Pain level
- as it is During treatment -pain is important to take care of, as we
have to stop as soon as pain increase. Pain is top priority for rib # n pelvic #. Hv
to monitor. Before touching them at rest-on VAS how much is it. Cought now how
is ur Pain. NOW SIT AT THE EDGE OF THE BED N HOW IS UR PAIN.-MENTOR
ANS

43. How would reassess to know you were effective in your treatment?

a. Breath sounds and auscultation-mentor ans

b. Temperature
c. Pain
d. Blood pressure

44. SCENARIO: POST UPPER COLON CANCER REMOVAL. NO HISTORY OF COPD.

THE PATIENT IS DROWSY. SHE IS ON PCA (MORPHINE) AND VERY DROWSY
BUT RESPONDS TO COMMAND. SPO2 98%.


44. What may cause post operative pulmonary complications?

a. COPD

b. Cancer

c. Opioid use
d. Age

45. What side effect can we expect from oxycodone?

a. Difficulty to be awake

b. Increase respiratory rate

c. Dryness of mouth-
Common side effects may include:

nausea, vomiting, constipation, loss of appetite;

dizziness, headache, tired feeling;
dry mouth;
sweating; or.
itching
d. Urinary urgency

46. A physical therapist is caring for an adult that has recently been diagnosed
with respiratory alkalosis. Which of the following clinical signs would most likely
not be present?
A: Anxiety attacks
B: Dizziness
C: Hyperventilation cyanosis
D: Blurred vision -

http://www.healthline.com/health/respiratory-alkalosis#Hyperventilation2

47. SCENARIO:
A therapist is supervising the exercise of cardiac rehabilitation outpatient class
on a very hot day, with temperatures expected to be above 90 degrees F. The
class is scheduled for 2 p.m. and the facility is not air conditioned. The strategy
that is unacceptable is:

A. Decrease the exercise intensity by slowing the pace of exercise.

B. Increase the warm-up period to equal the total aerobic interval in time.
C. Change the time of the exercise class to early morning or evening.
D. Make the exercise intermittent by adding rest cycles

48. Which of the following is NOT an appropriate reason to terminate a

maximum exercise tolerance test for a patient with pulmonary dysfunction

A. ECG monitoring reveals diagnostic ischemia.

B. Patient states he is maximally short of breath.
C. PaO2 decreases 20 mmHg.
D. Patient reaches age-predicted maximal heart rate.-
even after reaching age predicted HR he can cont without terminating

49. A 14 year-old boy with advanced Duchenne muscular dystrophy is

administered a pulmonary function test. The value that is UNLIKELY to show any
deviation from normal is:

A. Vital capacity.
B. FEV1.
C. Functional residual capacity.
D. Total lung capacity.

50. An elderly patient has been hospitalized for the past three days with
pneumonia. The physician is being pressured to discharge her tomorrow. The
patient lives with her sister in a first floor apartment. The physical therapist has
determined her ambulation endurance to be only up to 15 feet, not enough to
allow her to get from her bed to the bathroom (a distance of 20 feet). The
therapist should recommend:

A. Postponing her discharge until she can walk 20 feet.

B. A skilled nursing facility placement until her endurance increases.
C. A bedside commode, and referral for home health services. – they are forcing
for discharge. So arrangements can be made in the house as she is not walking
the distance to the toilet.
D. Outpatient physical therapy until her condition improves.

51. A patient with multiple sclerosis exhibits moderate fatigue during a 30

minute exercise session. When the patient returns for the next regularly
scheduled session 2 days later, the patient reports that she went home after the
last session and went right to bed. The patient was so exhausted she was unable
to get out of bed until the late afternoon of the next day. The therapist's BEST
strategy is to:

A. Treat the patient in a warm, relaxing environment.

B. Utilize a massed practice schedule.
C. Utilize a distributed practice schedule. -sullaivan
D. Switch the patient to a pool therapy program.

52. A contraindication to initiating joint mobilization on a patient with chronic

pulmonary disease may include:
A. Reflex muscle guarding.
B. Long term corticosteroid therapy.
C. Concurrent inhalation therapy.
D. Functional chest wall immobility.

53. Chronic pulmonary changes following a left pneumonectomy would include

all of the following except:

A. Decreased residual volume.

B. Increased tidal volume.
C. Deviated trachea toward the left.
D. Decreased breath sounds on the left.

54. A patient with diagnosis of left-sided heart failure (CHF), Class II, is referred
for physical therapy. With exercise, this patient can be expected to demonstrate:
A. Severe, uncomfortable chest pain with shortness of breath.
B. Weight gain with dependent edema.
C. Anorexia, nausea with abdominal pain and distention.
D. Dyspnea with fatigue and muscular weakness.

 http://www.heartfoundation.org.au/SiteCollectionDocuments/Chronic_H
eart_Failure_Guidelines_2011.pdf -pg 8 in text,pdf pg 10

 Functional Capacity: How a patient with cardiac disease feels during

physical activity
I Patients with cardiac disease but resulting in no limitation of physical activity.
Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea or
anginal pain.
II Patients with cardiac disease resulting in slight limitation of physical activity.
They are comfortable at rest. Ordinary physical activity results in fatigue,
palpitation, dyspnea or anginal pain.
III Patients with cardiac disease resulting in marked limitation of physical
activity. They are comfortable at rest. Less than ordinary activity causes fatigue,
palpitation, dyspnea or anginal pain.

55. A computer programmer, with no significant past medical history, presents

to the emergency room with complaints of fever, shaking chills and a worsening
productive cough. Complaint of chest pain over the posterior base of the left
thorax is made worse on inspiration. An anterior-posterior X-ray shows an
infiltrate on the lower left thorax at the posterior base. This patient's chest pain
is MOST likely caused by:

A. Inflamed tracheobronchial tree.

B. Angina.
C. Trauma to the chest.
D. Infected pleura.

56. A patient is four weeks post myocardial infarction. Resistive training using
weights to improve muscular strength and endurance is appropriate:

A. If exercise intensities are kept below 85%25 maximal voluntary contraction.

B. If exercise capacity is greater than 5 METs with no anginal symptoms/ST
segment depression.
C. During all phases of rehabilitation if judicious monitoring of HR is used.
D. Only during post-acute phase 3 cardiac rehabilitation.-mentor answer

57. A 62 year-old patient has chronic obstructive pulmonary disease. Pulmonary

test results include all of the following except increased:
A. Total lung capacity.
B. FEV1/FVC ratio
C. Residual volume.
D. Functional residual capacity.

58. A patient is recovering at home from a myocardial infarction and

percutaneous transluminal coronary angioplasty. The physical therapist decides
to use pulse oximetry to monitor his responses to exercise and activity. An
acceptable oxygen saturation rate (SaO2) to maintain throughout the exercise
period is:
A. 82%
B. 75%
C. 92%
D. 85%

59. A patient with COPD has developed respiratory acidosis. The physical
therapist instructs a PT student participating in the care to monitor the patient
closely for:
A. Disorientation.
B. Tingling or numbness of the extremities.
C. Dizziness or lightheadedness.
D. Hyperreflexia.

60. A patient with active tuberculosis is referred for physical therapy. Which of
the following is NOT an appropriate precaution?
A. Have the patient wear a tight fitting mask while being treated in his room.
B. Wash hands upon entering and leaving the patient's room.
C. Wear a tight fitting mask while treating the patient.
D. Ensure that the patient is in a private, negative pressurized room.

61. The optimal position for ventilation of a patient with a C5 complete spinal
cord injury is:
A. Semi Fowler's.- http://www.spinalhub.com.au/what-is-a-spinal-cord-
injury/how-do-i-move/c5-complete
B. Sidelying, head of bed flat.
C. Supine, head of bed flat.
D. Sidelying, head of bed elevated 45 degrees.

62. An 82 year-old patient has a 10-year history of heart disease. He presents

with severely impaired aerobic capacity (less than 4 METS), abnormal heart rate
and pulmonary responses to increased oxygen demand, severely limited ADL,
and hypertensive blood pressure to increased oxygen demand. The preferred
practice pattern that describes the generally accepted elements of patient/client
management by physical therapists is:-
A. Impaired Aerobic Capacity/Endurance Associated with Cardiovascular Pump
Dysfunction or Failure.
B. Impaired Ventilation, Respiration/Gas Exchange, and Aerobic
Capacity/Endurance Associated with Airway Clearance Dysfunction.
C. Impaired Aerobic Capacity/Endurance Associated with Deconditioning.
D. Primary Prevention/Risk Reduction for Cardiovascular/Pulmonary Disorders.

63. The following set of PFTs demonstrate an FVC of 3.2, an FEV1 of 2.6, and an
FEV1/FVC ratio of 81.25%. Which of the following Caucasian female patients
would these PFTs most likely represent:

A. 5'2 healthy 68 year-old with a s/p total knee replacement. - FEV1/FVC ration
changes with age, as we grow old it decreases. Here it is near normal. So this
option is out.
B. 5'4 28 year-old in a mild exacerbation of her asthma. –in asthma the fev1/fvc
ration decreases.so this is out too.
C. 4'8 10 year-old with cystic fibrosis.-CF seen in Caucasian population (PNP
chap on CF),option given to confuse.
D. 5'2 healthy 31 year-old with a casted tibia/fibula fracture. – FEV1/FVC ration
changes with age, as we grow old it decreases. So v r going with this option. –
“That book: COPD: A Guide to Diagnosis and Clinical Management “ -
http://www.nationalasthma.org.au/uploads/content/211-
spirometer_handbook_naca.pdf
64. A 24 year-old pregnant woman who is 12 weeks pregnant asks a therapist if
it is safe to continue with her aerobic exercise. Currently she jogs 3 miles, 3 times
a week and has done so for the past 10 years. The therapist's BEST answer is:

A. Jogging is safe as long as the target HR does not exceed 140 beats/ min
B. Jogging is safe at mild to moderate intensities while vigorous exercise is
contraindicated.
C. Continue jogging only until the 5th month of pregnancy.
D. Swimming is preferred over walking or jogging for all phases of pregnancy.-
take of the weight with the help of boyancy.body feels weightless.

65. A patient returns to physical therapy after his first exercise session
complaining of muscle soreness that developed later in the evening and
continued into the next day. He is unsure he wants to continue with exercise. The
therapist can minimize the possibility of this happening again by using:

A. Eccentric exercises, 1 set of 10, lifting body weight (sit-to-stand).

B. Eccentric exercises, 3 sets of 10, with gradually increasing intensity.
C. Concentric exercises, 3 sets of 10, at 80% 25 of maximal intensity.
D. Concentric exercises, 3 sets of 10, with gradually increasing intensity.
generally the muscle contraction goes from iso-conc-ecc. We generally say the
muscle tears when there is an eccentric muscle contraction.

66. A patient suffered carbon monoxide poisoning from a work-related factory

accident. He is left with permanent damage to his nervous system, affecting the
basal ganglia. Exercise training for this patient will need to address expected
impairments of:

A. Motor paralysis with the use of free weights to increase strength.

B. Muscular spasms and hyperreflexia with the use of ice wraps
C. Impaired sensory organization of balance with the use of standing balance
platform training
D. Motor planning with the use of guided and cued movement-as it said BG lesion
n parkinsond can be related to it. Visual cues are given in parkinsons to improve
gait,rigidity,balance-sullaivan text book.

67. A patient presents with problems with swallowing. When the physical
therapist tests for phonation by having the patient say “AH” with the mouth
open, there is deviation of the uvula to one side. The therapist then tests for
function of the gag reflex and notices decreased response to stimulation. These
findings suggest involvement of the:

A. Vagus nerve-lindsay text book

B. Trigeminal nerve.
C. Facial nerve.
Hypoglossal nerve
68. A patient with COPD is sitting in a bedside chair. The apices of the lungs in
this position compared with other areas of the lungs in this position would
demonstrate:

A. Increased perfusion.-its more in basal

B. Increased volume of air at resting end expiratory pressure (REEP).- upper
most areas get more vol of air- MENTOR ANS
C. The lowest oxygenation and highest CO2 in blood exiting this zone.
D. The highest changes in ventilation during the respiratory cycle

69. The cardiac rehabilitation team is conducting education classes for a group of
patients. The focus is on risk factor reduction and successful life style
modification. A participant asks the physical therapist to help him interpret his
cholesterol findings. His Total cholesterol is 220mg/dL, his HDL cholesterol is 24
mg/dL, and his LDL is 160 mg/dL. Analysis of these values reveals:

A. The levels of HDL, LDL, and total cholesterol are all abnormally
B. LDL and HDL cholesterol levels are within normal limits and total cholesterol
should be below 200 mg/dL.
C. The levels of HDL, LDL, and total cholesterol are all abnormally low.
D. Levels of LDL and total cholesterol are abnormally high and HDL abnormally
low.

70. The recommended time duration for endotracheal suctioning is:

A. 10 to 15 seconds.-chap intensive care for the critically ill adult PNP
B. 1 to 5 seconds.
C. 5 to 10 seconds.
D. 15 to 20 seconds.

71. During an exercise tolerance test (ETT) a patient demonstrates poor reaction
to increasing exercise intensity. An absolute indication for terminating this test ?
A. 1.5 mm of down sloping ST-segment depression.
B. Onset of moderate to severe angina.
C. Fatigue and shortness of breath.
D. Supraventricular tachycardia.

Pg 85n 105PNP

72. A patient recovering from an extensive myocardial infarction is on digitalis to

improve cardiac contractility. He is a new participant in a Phase 2 outpatient
cardiac rehabilitation program. He is being continuously monitored by ECG via
radio telemetry. On his ECG, the medication-induced changes that might be
expected are:

A. Depressed ST segment with a flat T wave and shortened QT interval.-

http://lifeinthefastlane.com/ecg-library/digoxin-effect/
B. Elevated ST segment with T wave inversion.
C. Widened QRS complex with a flattened P wave.
D. Decreased heart rate with prolonged QRS and QT intervals.
73. SCENARIO: MR A IS A 80 YO, ALMOST RETIRED MAN OF A FARM, WHO
HELPS HIS FAMILY WITH THE FAMILY BUSINESS. HE HAS HAD CABG X 2 IN
1994 AND 2007. HE LIVES 300KM FROM THE REHAB CENTRE. OVER THE PAST
4MONTHS HE HAS BEEN FEELING BREATHLESS OVER SMALL ACTIVITIES. HE
CAN WALK 200M ON FLAT GROUND BUT HE IS VERY BREATHLESS ON SLOPE
OR INCLINE AND WHILE CLIMBING STAIRS. HIS WIFE IS CONCERNED THAT HE
MIGHT DO TOO MUCH.

73. What is the best management plan for this patient?

A. Arrange an outpatient service for his cardiac rehab
B. Arrange a 4 weeks inpatient stay and then outpatient rehab twice a week
C.Provide a home program with written exercises and review him on intervals
D.Review every 6 weeks

74. How can his wife be a part of his rehab?

A. Ask her to check he is doing his exercises correctly
B. Ask her to report to the physio his progress regularly
C. She can encourage him to keep his rehab going
D. She can implement emergency treatment

75. Mr A now feels better. He is able to walk 500m and feels much less breathless
on slope. He asks you if he can play golf now, help more with the farm and do
some lifting. What is the most appropriate answer that you would give as his
treating physio?

A. Ask him to call his cardiologist and check with him

B. Tell him to go back to work and play golf and stop his rehab
C. Tell him he’ll be able to go back to work and play golf but later
D. Tell him he won‘t be able to do such activities anymore

76. How can Mr A self-monitor his exercise intensity?

A. Based on pain in his legs
B. Based on level of exertion
C. Measuring his blood pressure
D. Measuring his respiratory rate
(p. 476 Pryor and Prasad 4. ED, "valid and reproducable indicator of the intensity
of steady-state exercises" Patients should aim to exercise on Borg Scale level of
"somewhat hard")Chapter 14, Use of rating of perceived exertion

77. A 55 yo female is admitted with right middle lobe pneumonia with a

background of history of COPD and bronchiectasis. She is an ex-smoker but quit
smoking 8 months ago. She has had 4 episodes of pneumonia over the past year.
Her blood gases upon admission are pH 7.21 PaCO2 65 PaO2 89 HCO3 26, Her
heart rate is 70 beats /min & he blood pressure is stable.

77. What does the ABG results imply?

A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis

78. What do you expect to find on her Chest X ray?

A. Reduced costo phrenic angles
B. Diminished shadow of the right heart border-pg35pnp (see ILP 2007, p. 30
"loss of right heart border such that the margin is not clearly differentiated")
C. Diminished shadow of left heart border and costophrenic angle
D. Elevation of the diaphragm

79. When you visit her on the ward she is very agitated & her condition is
deteriorating. What would you do in this situation?
A. Postpone Physio treatment for the next day
B. Ignore the signs and mobilize her anyway
C. Inform the nursing staff immediately (ILP 2007 p. 48"patient demonstrating
signs of Type 1 Resp. Failure"Signs and symptoms of Type I Respiratory Failure:
· ¯ pO2 < 60 mmHg
· - Vital signs - - RR - PR - BP
· Hypoxaemia
· Restless
· Confused and agitated
· Plucking at sheets
(Patient may need Ventilation)
D. Inform physiotherapy manager immediately

80. The next day her condition is stable. The medical team has requested that she
be mobilized during her Physio session. When you visit her she refuses to
mobilise. What would you do as the next step?
A. You tell her that she has to walk because it is Drs’ order
B. You’ll say OK for not mobilizing today but that she has to walk the next day.
C. You’ll ask her why she doesn’t want to walk.
D. You’ll request her nurse to mobilise her later on.

81. A 64year old female has had an abdominal surgery for removal of her
pancreatic cyst. On observation she is of thin built. She is complaining of
shortness of breath at rest and is in considerable pain besides being on
analgesics. Her chest X ray has revealed minor bilateral infiltrations. Her ABG
findings are: pH 7.48, PaCO2 28mmHg, HCO3 26, PaO2 87mmHg, SaO2 90%. On
her observation charts her vital signs are recorded as follows: SpO2 96%, HR
110bpm, RR 22, Temperature 37 & BP 137/80.

81. What do the ABG findings indicate?

A. Compensated respiratory acidosis
B. Uncompensated respiratory alkalosis
C. Uncompensated metabolic alkalosis
D. Uncompensated respiratory acidosis
82. Her Physio has taught her to do forced expiratory technique. What is the
purpose of this technique?
A. To correct breathing pattern
B. To improve lung volume
C. To clear secretions from peripheral airways –pg139pnp
D. To clear secretions from central airways (Pryor and Prasad, 4. ED, p. 226,
"From the central airways, forced expiratory manouvres such as coughing or
huffing are used to facilitate expectoration)Chapter 6, PT Management

83. How can a Physio train a patient to do an effective huff?

A. Instruct the patient to take a deep breath and blow hard and fast
B. Instruct the patient to take a deep breath and blow until all the air comes out
C. Instruct the patient to take a moderate depth breath and blow as much as
possible (Pryor and Prasad, 4. ED, p. 140, "a huff from mid lung volume is more
efficient and probably more effective",..." medium sized breath should be taken
in...air squeezed out...should be long enough to loosen secretions from
peripheral...)Chapter 5, FET
(lungfoundation.com.au: In most instances a huff uses a medium volume
breath in, followed by a forceful expiration (breath out) that helps to move
sputum towards the mouth so it can be cleared)
D. Instruct the patient to take a moderate breath and blow forcefully but stop
before the lungs are empty-pg140pnp

84. What is risk factor for post op pulmonary complication in this patient’s case?
Bi lateral infil does not mean cancer. Age is less than 65.so she is borderline. If
she had COPD then its copd ans. But she dsnt hv.
A. Age- mentor ans
B. COPD-
C. Metastasis.
D. Opioid use

In VIC PPC is a physio role to see hoe much risk the patient is to develop PPC. See
how many risk factors r there n what is the priority out of them. if pt has PPC
then v dnt hv to teach her br ex n deep br as it wont change their outcome
completely. Just mobilizing n supported cough is good. If pt already has
complication then definitely teach br ex or tech. if chest x ray clear n all.
PPc(IN PNP pg-407)- h/o cancer n all, dec albumi, yes with bronchiectasis n all-
Age->65yrs

85. SCENARIO: TOBY, A 2 YEAR OLD BOY IS DIAGNOSED WITH BASAL

EMPYEMA. HE HAS BEEN IN ICU FOR 10 DAYS AND NOW TRANSFERRED TO
THE WARD. WHEN YOU VISIT HIM HIS PARENTS ARE PRESENT. TOBY IS VERY
FRIGHTENED OF ANYONE FROM THE MEDICAL TEAM AND REFUSES TO TALK
TO YOU OR ENGAGE WITH YOU. HIS CHEST DRAIN HAS NOW BEEN REMOVED.
HE IS STILL ON ANALGESIA. HE IS RECEIVING OXYGEN VIA NASAL PRONGS AND
IS ALSO ON INTRAVENOUS ANTIBIOTICS.

85. During your subjective assessment what would you first ask Toby’s parents?
A. Was Toby comfortable to sleep last night and what does his cough sound like?
B. Has the bed sheets been changed today?
C. Has Toby had a shower today?
D. Has Toby had breakfast already?

86. The doctor has requested you to make him walk. How will you proceed?
A. Instruct the mother to get him up into standing supporting him with her hands
because he’ll be weak from the bed rest. – therapy has to be play. Mom can help
coz first we need to know if he can stand.check his strength as he is only 2 yr
old.-mentor ans
B. Tell his mother to walk with him to the door holding him by the hand
C. Tell his mother that she will need to hold the tubes while you make him walk
D. Ask his mother to stand by the door and ask Toby to come to her- Dnt know
how strong toby is. V r seeing him for the fist time. Coz he will be weak.

87. How can you improve his lung volumes?

A. Ask him to blow bubbles-pg153PNP
B. Ask him to burst the bubbles you make
C. Demonstrate deep breathing exercises
D. Ask him to copy your cough

88. Toby’s mother is asking you if the nasal prongs can be removed, as Toby
doesn’t like them. What would your response be?
A. The nasal prongs can be removed if the child is not happy
B. It is best to wean off oxygen gradually and remove when Toby can maintain
good oxygen levels
C. She can check with the doctors if they can be removed
D. The nasal prongs can be replaced by a face mask.