A 35 year old patient with a complete T5 spinal cord injury is working on supine to sit transfers on the mat table when he suddenly appears flushed and complains of his heart pounding.  Upon examination, his blood pressure is 180/100 mmHg and he has a pounding headache.  What is the most appropriate INITIAL course of action?

1. Lay the patient supine and notify the patient’s physician.
2. Sit the patient up and notify the patient’s physician.
3. Allow the patient to rest longer between sets of activity.
4. Initiate core strengthening exercises to maintain intraabdominal pressure.

The correct answer is:

1. This is not correct because putting the patient in supine will exacerbate the autonomic dysreflexia.
2. This is the correct answer.  By sitting the patient up, you decrease the blood pressure in the head and mitigate the effects of the dysreflexia.
3. This is incorrect considering that autonomic dysreflexia is a life-threatening condition.
4. This is incorrect considering that autonomic dysreflexia is a life-threatening condition and intra-abdominal pressure drop is not going to address this condition

12.

A 21 year old female patient presents with neck pain and stiffness that has gradually worsened over the last two weeks.  Upon examination, the patient is noted to have left-sided pain with left side bending with left rotation, and reports pain at the left C5-6 junction.  Hypomobility is also noted with right side-gliding of C6.  Which of the following techniques will be most appropriate to decrease pain?

1. Closing technique for the mid-thoracic spine.
2. Closing manipulation in extension for C5-C6
3. Gapping manipulation in flexion for C5-C6.
4. Flexion/opening manipulation for mid-thoracic spine

The answer is:

1. The cervical spine “closes” with side-bending and ipsilateral rotation (i.e. “closed” with left SB and left rot.).  Manipulating the thoracic spine for neck pain is a common treatment strategy, however the specific issues noted in the question require more than just a nonspecific t-spine manip.
2. This is the correct answer.  The hypomobility is noted at C6 with right side-gliding and pain with left SB and rotation.
3. This would be the treatment if the pain were on the right with the left SB and rotation.  (Difficulty “opening” the right C5-6 facet joint.
4. Refer to #1.  Not the MOST appropriate manipulation, however this could be used as an adjunct to #2.

13.

A 22 year old female presents to the clinic with a chief complaint of knee pain following a twisting injury while playing soccer 5 days ago.  The patient’s knee is swollen significantly and she is unable to jump or run.  What special test would be the MOST appropriate to diagnose the injury?

1. Lachman’s test
2. Posterior drawer test
3. Active Lachman’s test
4. Reverse Lachman’s test

The correct answer is:

1. This is the most correct answer.  The overwhelming majority of injuries to female soccer players is to the ACL, especially with a running/twisting injury and swelling.  In addition, the Lachman’s test is validated well by multiple studies.
2. PCL’s are an issue with twisting injuries, but not to the extent that ACL’s are.
3. Active Lachman’s test has not had near the validation that the plain-vanilla Lachman’s test has.
4. This assesses for a PCL tear, not ACL tear.

14.

A geriatric patient with a history of recent falls is receiving physical therapy for general conditioning. He was recently released from the hospital for pneumonia, and although he was cleared for exercise, he is still having some dyspnea with activity. Based on his presentation, which of the following interventions would be the MOST appropriate to start with in order to improve his cardiovascular fitness? 

1. Avoid exercise 
2. Focus on light intensity exercise before progressing to moderate intensities 
3. Focus on moderate intensity, long duration activities
4. Focus on high intensity interval training

The correct answer is:

1. The patient was cleared for exercise, and it would be OK to start with light activity to the patient’s tolerance.
2. This is the correct answer. It would be safe to start with gentle activity, but avoid moderate activities until some level of baseline fitness is achieved.
3. This would be appropriate to build towards, but is not likely going to be tolerated early on. The patient should start with light exercise.
4. This patient should avoid HIIT until his fitness is significantly improved and he is no longer having symptoms of pneumonia.

15.

A patient complains of weakness in the right hip while she is ambulating.  Upon examination, you notice that the patient has a significant drop of the left hip while in midstance on the right leg.  What is the MOST appropriate treatment for this impairment?

1. Standing hip abduction of the left leg.
2. Standing hip abduction of the right leg.
3. Standing flexion of the left leg.
4. Standing flexion of the right leg.

The correct answer is:

1. This is the most correct answer.  The patient is demonstrating a Trendeleburg gait with the weakness on the right hip abductors.  The trick (and this is very true in the clincal world) is that while standing on the involved hip and abducting the opposite, you are loading the right hip (closed-chain) more than the left hip (open chain).  Thus you are MORE effective at strengthening the right hip abductors by using the closed chain exercise.
2. Good, but this open chain activity for the right hip abductors is not as appropriate as a closed-chain activity.
3. Not directly related to the impairment.
4. Same as (3).

16.

A patient presents to the clinic with signs of lethargy and mild dizziness.  The patient’s resting blood pressure is 100/70 mmHg.  Which of the following is MOST likely to cause this decrease in blood pressure?

1. Lisinopril
2. Prednisone
3. Sertraline
4. Metformin

The correct answer is:

1. This is the correct answer.  Lisinopril is an ACE inhibitor and is used primarily for the treatment of hypertension. 
2. This is used to treat inflammatory diseases and is typically not associated with decreases in blood pressure.
3. Sertraline treats depression and is typically not associated with decreases in blood pressure.
4. Metformin controls blood sugar in Type II Diabetes and is not typically associated with decreases in blood pressure.

17.

A patient presents to the clinic with right shoulder pain and complains of difficulty reaching overhead, with pain especially from 60-120 degrees of shoulder flexion.  Which special test would be MOST informative for this set of symptoms?

1. Neer test
2. Empty can test
3. Crossover test
4. Push off test

The correct answer is:

1. This is the correct answer.    The Neer test is a test for subacromial impingement and is typically associated with the painful arc.
2. The empty can test assesses supraspinatus pathology.
3. The crossover test checks for AC Joint pathology
4. The push off test assesses strength and integrity of the subscapularis, one of the rotator cuff muscles.

18.

A patient is in the inpatient rehabilitation unit for a total knee replacement.  While reviewing the case, the physical therapist notes that the patient has been diagnosed with an infection of Methicillin-resistant Staphylococcus aureus (MRSA) and is in an isolation room.  What is the MOST appropriate action to take to prevent contamination?

1. Don gown, mask, gloves, and respirator before entering the room, wash hands after.
2. Limit therapy sessions to less than 15 minutes and limit contact during treatment.
3. Don gloves when in contact with the patient and wash hands after.
4. Wash hands before and after contact with the patient, but do not touch the patient.

The correct answer is:

1. This is the most conservative of precautions that is used for droplet precautions, especially the mask.  MRSA requires contact precautions.
2. This is not appropriate and is not consistent with contact precautions.
3. Handwashing and gloves are the MOST appropriate.  If the PT anticipates extensive contact, donning a gown would also be appropriate for contact precautions.
4. While handwashing is appropriate, it is OK to touch the patient as long as the provider is wearing the appropriate personal protective equipment.

19.

A 52-year-old female presents to the clinic complaining of left shoulder pain.  The pain started 1 year ago, and while it initially worsened over that time, her symptoms have been unchanged for the last 3 months. The patient has pain with most arm movements and has limited motion in all planes, with external rotation being the most affected.   What would be the MOST effective initial treatment?

1. Refer the patient to an orthopedic surgeon.
2. Begin gentle progressive stretching exercises with the focus on increased active range of motion.
3. Initiate rotator cuff strengthening exercises, focusing on external rotation.
4. Instruct the patient on Codman pendulum exercises and apply a moist heat pack.

The correct answer is:

1. Adhesive capsulitis is not typically a surgical condition-conservative measures are tried first before surgery. Common surgeries for a frozen shoulder include hydrodilation, capsular release, and a manipulation under anesthesia.
2. This is the most correct answer.  An effective treatment program for adhesive capsulitis should use gentle progressive stretching as the primary treatment.
3. The patient may not be able to perform isotonic external rotation due to their limitations in ROM. Depending on the patient’s pain levels, isometrics may be appropriate at this time.
4. While this would not be harmful to the patient, this patient is likely in the middle stage or “frozen” stage of adhesive capsulitis. In this phase, stiffness is more limiting than pain, so these exercises are likely not necessary.

20.

While treating a patient for cardiac rehab, a physical therapist relies on the Borg rating of perceived exertion (RPE) scale.  The Borg RPE scale is MOST representative of which type of data scale?

1. Nominal
2. Ordinal
3. Cardinal
4. Marginal

The correct answer is:

1. Nominal scales are used to indicate categories that are not higher or lower (example: race, gender, etc.)
2. Ordinal scales are used to represent data that is comparatively higher or lower that other data.  This is the most correct answer.
3. Cardinal scales are used when there is an absolute zero and are quantitative.  Age and weight are good examples of these.
4. Not related.

21.

A physical therapist is trying to determine which special test to use for an examination by looking at statistical attributes of each test.  What is the MOST important statistical attribute a special test must have to effectively limit Type I errors?

1. Sensitivity
2. Specificity
3. Positive likelihood ratio
4. Negative likelihood ratio

The correct answer is:

1. High sensitivity effectively limits type II errors (False negatives).  In essence, high sensitivity indicates that if the test is negative, you can effectively rule out the condition, with very few false negatives.
2. This is the correct answer – High specificity effectively limits type I errors (False Positives).  High specificity indicates that if the test is positive, you can effectively rule IN the condition with very few false positives.
3. Positive likelihood ratios indicate a likelihood that a positive test is accurate.  This does relate to Type I errors, however the calculation to create the LR+ uses the raw sensitivity and specificity and is used to compare one test to another in the likelihood of accurate positives.
4. Negative likelihood ratios indicate a likelihood that a negative test is accurate.  This relates to Type II errors, and is calculated in a similar way to positive likelihood ratios.

22.

A physical therapist is evaluating a 50 year old patient with a generally swollen right leg.  The patient does not report any trauma to the leg and describes the swelling as increasing gradually over the last 12 months.  The swelling is non-pitting, primarily below the knee.  The leg is not red or hot, and the patient indicates that his leg just feels “heavy.”  What is the MOST likely origin of the swelling?

1. Systemic infection
2. Chronic inflammation
3. Congestive heart failure
4. Lymphedema

The correct answer is:

1. Swelling from an systemic infection would not be insidious over 12 months (thus acute) and would be associated with redness and hotness.
2. Swelling from chronic inflammation would likely be associated with some type of trauma or pain, and is not the MOST appropriate response.
3. Congestive heart failure can cause swelling, but is more likely to be pitting and more generalized.
4. This is the correct answer.  This condition is typically associated with a “heaviness” that appears gradually and usually involves non-pitting edema.

23.

A physical therapist is evaluating a patient with pain that radiates throughout his left lower extremity.  The patient has significant foot drop while ambulating and complains of numbness and tingling extending from the great toe up to the knee along the anterior leg.  What is the MOST likely pathology underlying these symptoms?

1. Sciatic nerve entrapment at the glute
2. Deep peroneal nerve inflammation
3. Tibial nerve entrapment at the knee
4. L5 nerve root entrapment

The answer is:

1. Sciatic nerve entrapment can occur and cause symptoms radiating down the posterior leg.  Foot drop is not common with this condition.
2. Deep peroneal nerve inflammation can lead to drop foot, however the deep peroneal nerve only innervates a small portion of the dorsum of the foot, thus eliminating this choice.
3. Tibial nerve entrapment would affect the posterior leg, extending to the heel.  Motor loss would be present in the plantarflexors.
4. This is the correct answer.  Tibialis anterior weakness and sensory loss along the anterior leg below the knee are the most common signs of L5 nerve root entrapment.

24.

A patient has sudden onset of right leg pain, and displays redness and swelling throughout the foot and ankle. The patient reports no trauma and complains of a deep ache in the calf musculature.  What is the MOST appropriate initial treatment?

1. Refer to physician to further examination.
2. Elevate the lower extremity and apply an ice modality.
3. Instruct the patient in range of motion exercises and begin a home exercise program.
4. Perform instrument assisted manual soft tissue mobilization to decrease the swelling.

The correct answer is:

1. This is the correct answer.  Symptoms of a DVT include redness and swelling combined with a deep ache.  Suspected DVT’s should be ruled out before beginning treatment.
2. While this may help alleviate some of the symptoms, applying an ice pack in elevation is not the MOST appropriate initial treatment.
3. Again, this may help with swelling, but is not the MOST appropriate treatment.
4. This could dislodge the DVT which could travel and create a pulmonary embolism.  This is contraindicated until diagnostic ultrasound can rule out any DVT’s.

25.

A patient with cystic fibrosis is receiving postural drainage and percussion for the middle lobe of the right lung.  What is the MOST appropriate patient position for this technique?

1. Supine on a wedge with the left shoulder elevated on pillows; head lower than the pelvis.
2. Supine on a wedge with the right shoulder elevated on pillows; head lower than the pelvis.
3. Prone with the right shoulder elevated on pillows; head on the same plane as the pelvis.
4. Prone with the left shoulder elevated on pillows; head on the same plane as the pelvis.

The correct answer is:

1. This is the drainage position for the left lingular lobe.
2. This is the correct position and is most appropriate for the right middle lobe.
3. This is the drainage position for the right posterior lower lobe.
4. This is the drainage position for the left posterior lower lobe.

26.

A patient is being evaluated by a physical therapist for a diabetic ulcer that penetrates the subcutaneous tissue, extending into the subcutaneous fat and fascia but without any gangrene or osteomyelitis present.  The physical therapist documents the severity of the ulcer.  Which of the following classifications would BEST describe the wound using the Wagner Ulcer Grade Classification System? 

1. Grade 2 
2. Grade 3 
3. Grade 4 
4. Grade 5

The correct answer is:

1. This is the correct answer.  As a physical therapist, you should always document depth and shape of the ulcer.  Grade 2 on the Wagner Scale is defined as a deep ulcer penetrating into the subcutaneous tissue, but without gangrene.  The Wagner scale is commonly used to classify diabetic ulceration.
2. Grade 3 is defined as a wound extending into the bone and tendon with osteomyelitis present.
3. Grade 4 is defined as a wound with a small (size of 1 digit) amount of gangrene.
4. Grade 5 is defined as a wound with a large amount of gangrene, indicating the need for amputation of the involved limb.

27.

A physical therapist is evaluating a patient with ulceration on the lower extremity.  The leg is swollen and red upon examination.  Which of the following grouping of symptoms is MOST consistent with this type of ulceration?

1. Ulceration is on the lateral leg, pulseless, cool, and painful.
2. Ulceration is medial leg, shows permanent blanching, and is painless.
3. Ulceration is upon bony prominences, shows non-blanchable redness at the perimeter of the wound, and has a pink appearance.
4. Ulceration is upon the bony prominence, began as a small scrape or blister several months ago, with a concomitant diagnosis of diabetic neuropathy.

The correct answer is:

1. These are the most common symptoms of arterial insufficiency ulcers.
2. This is the correct answer.  Venous insufficiency ulcers are typically less painful than arterial ulcers.
3. These are symptoms common to pressure ulcers.
4. These are symptoms consistent with diabetic ulceration.

28.

A physical therapist is performing a treadmill exercise stress test using the Bruce protocol.  During stage 3 of the test, the P wave increases in height and the S-T segment begins to become significantly upsloping.  What is the MOST appropriate course of action?

1. Stop the test and refer patient to a physician.
2. Lower the stage back to stage 2 and monitor for improved electrocardiographic indicators.
3. Continue with the test without any modification, monitoring for symptoms of cardiac distress.
4. Discontinue the test, and monitor the patient’s vital signs for 10 minutes.

The correct answer is:

1. The Bruce Protocol for an exercise stress test involves using a 12-lead ECG monitor to evaluate the amount of stress placed on the heart.  The test would stop if there was S-T elevation or depression.  P wave increases and S-T upsloping are normal responses to a stress test.
2. This is not appropriate for the Bruce Protocol.
3. This is the correct answer.  Both of these signs are normal responses to the stress test.
4. If the patient requested to stop, this would be the appropriate action.  Because it is not mentioned in the question, this is NOT the most appropriate course of action.

29.

A patient is receiving cardiac rehab and has a heart rate of 110 during moderate intensity exercise.  The patient reports a 16 on the Borg rate of perceived exertion scale.  Which class of heart medications is MOST likely present?

1. Beta blockers
2. Angiotensin-converting enzyme (ACE) Inhibitors
3. Calcium channel blockers
4. Angiotensin II receptor blockers

The correct answer is:

1. This is the correct answer.  Beta blockers work on the beta-adrenergic receptors to decrease sympathetic responses to stress, primarily the heart rate.  The Borg Scale should represent heart rate divided by 10.  Thus there is a disparity in heart rate and exertion, indicating a blunted heart rate.
2. ACE inhibitors block the angiotensin-converting enzyme to prevent vessel constriction during sympathetic responses to stress, primarily blood pressure.
3. Calcium channel blockers work on the heart musculature to decrease the force of contraction, as well as decreasing the vasoconstrictive smooth muscle in the arteries.  The primary response is decreased blood pressure.
4. Angiotensin II receptor blockers do not prevent the angiotensin I to angiotensin II conversion; rather, they block the receptors of angiotensin II and have an effect similar to the ACE inhibitors.

30.

A 12 year old male athlete is being evaluated by a physical therapist.  The patient reports pain with running and has a sharp pain over the patellar tendon, particularly on the tibial tubercle.  Which of the following disorders is MOST likely present?

1. Legg-Calvé-Perthes’ disease
2. Chondromalacia patellae
3. Osgood-Schlatter disease
4. Pes anserine bursitis

The correct answer is:

1. Legg-Calvé-Perthes’ disease is characterized by loss of blood supply to the head of the femur and subsequent bone death.  The cause is often unknown and typically occurs in boys from 4-10 years old.
2. Chondromalacia patellae is characterized by cartilage loss or disturbance underneath the patella.  This is evinced by pain with knee motion, but not a painful tibial tubercle.
3. This is the correct answer.  Osgood-Schlatter disease is characterized by a painful bump over the tibial tubercle and pain with sporting activities.  This is most common in young children who are very active in sports, particularly males.
4. Pes anserine bursitis is characterized by pain at the insertion of the sartorius, gracilis, and semitendinosus, which is medial to the tibial tubercle by 3-4 cm.

31.

A patient is recovering from a broken tibia and has just been instructed to discontinue use of a walking boot.  The patient demonstrates excessive pronation and complains of pain and instability in the ankle while ambulating.  Which of the following is the MOST appropriate treatment?

1. Begin a single leg standing program and advance to eccentric calf strengthening as tolerated.
2. Begin with open-chain exercises and progress to closed-chain strengthening of the ankle as tolerated.
3. Begin with closed-chain exercises and progress to open-chain strengthening of the ankle as tolerated.
4. Begin a strengthening program involving primarily ankle evertors, progressing as tolerated.

The correct answer is:

1. This may be included in the plan of care, but when initiating exercise, this may be too advanced. It would be best to start with tandem balance and concentric double leg strength or open chain strengthening before starting eccentrics.
2. This is the correct answer.  Progressive strengthening of the ankle will be the MOST appropriate treatment, and starting with open chain strengthening is usually well tolerated when beginning a program. 
3. Typically closed chain exercises are introduced after tolerance to open chain exercises can be established. 
4. To address excessive pronation, it would be more appropriate to emphasize the muscles of inversion

32.

A patient reports pain around the anterior aspect of the calcaneus extending toward the 2nd metatarsal head.  The patient has the most pain when first standing up after waking which gradually lessens throughout the day.  The patient has recently begun a walking program.  Which of the following disorders is MOST likely present?

1. Medial deviation of the 1st metatarsal
2. Metatarsalgia
3. Tarsal tunnel syndrome
4. Plantar fasciitis

The correct answer is:

1. A bunion or medical deviation of the 1st metatarsal presents with pain over the medial side of the head of the 1st metatarsal.
2. Metatarsalgia is pain localized under the ball of the foot, typically under the head of the first metatarsal.
3. Tarsal tunnel syndrome presents with numbness and pain throughout the first 3 toes secondary to the tibial nerve being compressed.
4. This is the correct answer. Plantar fasciitis is typically associated with pain at the anterior portion of the calcaneus and increased symptoms with the first steps of the day that gradually decreases.  

33. 

A physical therapist is evaluating a patient with back pain.  The patient reports his pain has increased steadily over the last 2 months and is constant and unremitting.  The pain radiates into both lower extremities.  The patient also feels marked weakness throughout the right lower extremity.  What is the MOST appropriate initial treatment?

1. Discontinue treatment and refer patient to primary care physician for further testing.
2. Begin a program of core strengthening, focusing on transversus abdominis training and progressing toward a long term stabilization program.
3. Instruct the patient in appropriate lower extremity exercises to improve leg strength, focusing on the right leg.
4. Initiate piriformis stretching as tolerated and instruct the patient in self mobilization techniques to improve mobility throughout the lumbar spine.

The correct answer is:

1. This is the correct answer.  Constant pain without any relation to position is a key indicator of spinal cancer.
2. This would be appropriate for individuals with poor core strength and signs of hypermobility in the lumbar spine.
3. This would be appropriate for signs of weakness.
4. This would be appropriate for signs of piriformis syndrome.

34. 

After working for several hours as a mechanic, a patient describes sharp elbow pain over the origin point of the common extensor tendon of the wrist extensors.  The pain is alleviated with rest.  Which of the following disorders is MOST likely present?

1. Medial epicondylitis
2. Lateral epicondylitis
3. Anconeus tendonitis
4. Olecranon bursitis

The correct answer is:

1. Medial epicondylitis presents with pain on the medial elbow over the flexor tendons.
2. This is the correct answer.  Pain is typically over the extensor tendons, especially on the insertion point of the lateral epicondyle.  Repetitive motions involving mechanic work are also among common causes of lateral epicondylitis (tennis elbow).
3. The anconeus assists in extension of the elbow and would present with pain over the olecranon process.
4. Olecranon bursitis would present with pain and swelling over the olecranon process.

35. 

A patient presents with rheumatoid arthritis and finger pain.  The 2nd digit has a flexed metacarpophalangeal joint, hyperextended proximal interphalangeal joint, and a flexed distal interphalangeal joint.  Which of the following is the MOST accurate description of the position?

1. Swan neck deformity
2. Boutonniere deformity
3. Mallet finger deformity
4. De Quervain syndrome

The correct answer is:

1. This is the correct answer. The finger deformity described is consistent with a swan neck deformity.
   
2. Boutonniere deformity is just opposite of the Swan Neck
3. Mallet finger involves just flexion of the DIP joint.
4. De Quervain syndrome is tenosynovitis of the extensor pollicis brevis and abductor pollicis longus as they pass under the fascial sheath that covers the two tendons.

36. 

A physical therapist examines a patient and determines that the patient has a positive active compression test (O’Brien’s Test).  Which of the following pathologies is MOST implicated?

1. Rotator cuff tear
2. Biceps tendonitis
3. Superior labral tear
4. Acromioclavicular joint sprain

The correct answer is:

1. RTC tears are indicated by tests such as the drop arm test, external rotation lag sign, belly press test.
2. This is indicated by tests such as Yergason’s test.
3. This is the correct answer.  The O’Brien’s test is indicative of SLAP tears.
4. AC joint sprains are indicated by tests similar to the cross-over test.

37. 

While examining a patient’s lumbar x-ray films, a physical therapist notices that the L5 vertebra is displaced anteriorly on sacrum by approximately 50% of the vertebral body.  How will this MOST affect physical therapy if the patient is being treated for low back pain?

1. Emphasize core strengthening, especially in spine neutral
2. Begin progressive gluteal and quad strengthening to assist the lumbopelvic fascia
3. Avoid extension activities, especially in standing
4. Add progressive external oblique training as tolerated to assist proper spinal alignment

The correct answer is:

1. This is a great consideration, but not the MOST important of the choices. The x-ray is consistent with spondylolisthesis (grade II). It is important early on to avoid extension activities as this may exacerbate symptoms. 
2. Good consideration, but not the MOST important of the choices.
3. This is the correct answer.  Extension activities will exacerbate any pain from this spondylolisthesis. 
4. Good consideration, but not the MOST important of the choices, very similar to #1.

38. 

A 51-year-old female presents to physical therapy with complaints of generalized muscle pain and fatigue. She reports steady weight gain over the last few months without changing her diet. She reports she has noticed her hair and nails have been more brittle, and she has noticed increased swelling in her hands. Which of the following conditions is MOST likely present? 

1. Hypoparathyroidism
2. Hypothyroidism
3. Hyperparathyroidism
4. Hyperthyroidism

The correct answer is:

1. Hypoparathyroidism-This will result in low blood calcium, which can affect the nervous system and heart. Patients may have muscle tetany, cardiac arrhythmias, spasms of the intercostals, or a positive Chvostek sign (a contraction of ipsilateral facial muscles when performing percussion over the facial nerve).
2. This is the correct answer. This condition is characterized by a slowed metabolism, which causes fatigue and weight gain. Patient’s may present with generalized myalgias and proximal muscle weakness. It can affect the hair and nails and cause myxedema, a boggy non-pitting swelling that commonly affects the hands. 
   
3. Hyperparathyroidism. This will result in high levels of calcium in the blood and decreased calcium in the bone. This leads to low bone density, sensory changes, and can lead to kidney stones. 
4. Hyperthyroidism. Also known as Grave’s disease. This is the opposite of hypothyroidism and is characterized by an accelerated metabolism. Patients may complain of tachycardia, heat intolerance, and bulging eyes (exophthalmos).

39. 

A patient has just undergone a total hip replacement via a posterior surgical approach.  Which of the following combinations of movements of the hip are MOST important to avoid?

1. Extension, medial rotation, and abduction.
2. Extension, external rotation, and adduction.
3. Flexion, medial rotation, and adduction.
4. Flexion, external rotation, and abduction

The correct answer is:

The most correct answer is 3-flexion, medial rotation, and adduction.  These are the standard precautions to avoid dislocation with a THA that used a posterior surgical approach.

40. 

A patient who has suffered a cutting injury to the entire left half of the spinal cord at the T8 level is being examined by a physical therapist.  Which of the following impairments would be MOST apparent on the ipsilateral lower extremity?

1. Loss of pain and temperature sensation
2. Loss of movement and light touch sensation
3. Loss of peripheral smooth muscle control
4. Loss of coordination and accuracy.

The correct answer is:

1. This would be lost on the contralateral lower extremity due to the decussation of these sensory afferent fibers.
2. This is the correct answer.  These pathways decussate in the brain stem.
3. This is not correct at all since arterial smooth muscle relies wholly on adrenergic receptors.
4. This would be caused by an injury at the cerebellar level.