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you are giving home exercise instruction to your Bell's palsy patient.

Which of the following doesn't


help in regaining facial muscle strength?
A. Chewing gum
B. Blowing up a balloon
C. Sipping water through a straw
D. Whistling

A patient has developed trochanteric bursitis


that has gone untreated for 5 weeks. The
patient is 34 years old. Which of the following
Ultrasound settings is most appropriate?
A: Pulsed US at 3MHz
B: Pulsed US at 1MHz
C: Continuous US at 3MHz
D: Continuous US at 1MHz

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

#3 Answer. Please refer to Orthopedic Assessment by D. Magee, pg 527 (5th


edition). It includes an illustration of a disc between L5 and S1.
It is usually presumed that when a disc herniates, its always the lower nerve
root that is affected. So, if a lumbar disc herniates between L4 and L5, the root
that is vulnerable is the 5th lumbar root. But if it is a LARGE disc herniation
between L5 and S1, its not only the S1 nerve root that is affected. L5 nerve
root is also affected.
Let me quote David Magee.
Large herniation of the L5-S1 disc compromises not only the nerve crossing it
(first sacral nerve root) but also the nerve root emerging through the same
foramen (fifth lumbar nerve root) (pg 527).
A 26-year-old soccer player presents at your clinic complaining of pain behind right
lateral malleolus. He says he suffered lateral malleolus fracture weeks before. Which
nerve is mostly likely responsible for his symptom?
A. Sural nerve
B. Lateral plantar nerve
C. Saphenous nerve
D. Superficial peroneal nerve
Your patient has frontal lobe depression and diencephalic dysfunction. Which of the
following is associated with his condition?
A. Apneustic breathing
B. Cheyne-Stokes respiration
C. Hyperventilation
D. Hypoventilation

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

1. A physiotherapist is reading his patients medical record. He notices


his patients hematocrit has increased by 62%. He suspects she is
suffering from the following, except______.
A. severe anemias
B. shock
C. dehydration
D. erythrocytosis
2. A patients hematocrit is 24.5% of RBC of the whole blood. As a PT,
what is the most appropriate management for this patient?
A. postpone the exercise
B. swimming for 30 minutes
C. let your patient do light exercise for 20 minutes
D. De Lorme regimen
3. If a male patient had an acute hemorrhage, one would expect the
patient would have a hematocrit of_____________.
A. 46%
B. 36%
C. 55%
D. 45%
4. A physiotherapist is observing his colleague attending to his female
patient. His colleague only allows his patient to do active range of

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

9. A physiotherapist is reviewing the medical chart of her patient with


RA. Which of the following lab values would be significantly affected?
A. PT
B. ESR
C. RBC
D. Hct
10. You are treating a patient with GERD. Which of the following is the
most appropriate position?
A. recumbent
B. right side lying
C. trendelenburg
D. left side lying
recumbency will induce symptoms . . . left sidelying preferred since right
sidelying may promote acid flowing into the esophagus (Giles, pg 348).

11. A 44-year-old female client comes to you with a chief complaint of


midback pain of one week duration. You then instruct her to extend
her upper/mid back. This movement neither decrease nor increase the
pain. Resisted movement doesnt aggravate the pain either. As an
experienced PT, you conclude that your clients pain is not of
musculoskeletal origin. You then advise her to consult her physician
because you suspect her midback pain is caused
by______________.
A. colon disease
B. cirrhosis (liver)
C. esophageal disorder
D. pericarditis
12. Upon doing your examination on your 59-year-old female patient,
you notice circulatory congestion as evidenced by pitting edema and

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_______.

A. on maintainance doses of digitalis


B. hyperkalemic
C. on maintainance doses of quinidine
D. hypothermic
2. In your patients medical chart, the arterial blood gas analysis has
the following values: pH =7.50; paCO2 = 34; HCO3 = 24. Based on
this ABG analysis, which of the following symptoms your patient
would not exhibit?
A. dizziness
B. tingling

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.

6. You are scheduled to treat a patient with heart disease. Upon


checking the ECG monitor, you notice absence of P waves and
undulations or waviness of the baseline between QRS for 15 minutes
as depicted in the figure below. The patient appears calm but his
resting hear rate is 110 bpm. Which of the following is the most
appropriate action to take?

A. Call the nurse and give the patient atenolol


B. Proceed with your PT interventions
C. Call for prompt medical treatment
D. Contact the patients cardiologist immediately
7. In critical care setting, using the mean arterial pressure (MAP) is
preferred over the systolic and diastolic reading of the patients BP. If

the patients blood pressure is 110/70 mmHg, his mean arterial


pressure (MAP) is______.
A. 75 mmHg
B. 85 mmHg
C. 68 mmHg
D. 83 mmHg
8. Which of the following arterial blood gas readings indicates
alkalemia?
A. 7.5
B. 7.3
C. 7.44
D. 7.35
1. A 47-year-old woman presents to you with restricted shoulder ROM
both passive and active. She hikes her shoulder every time she moves
it. Keeping her arm by her side, the woman never complains of pain
and weakness as she attempts to move her shoulder against resistance
applied proximal to her elbow joint. The most likely diagnosis is___?
A. Atraumatic instability
B. Rotator cuff lesions
C. Frozen shoulder
D. Cervical spondylosis
2. In tennis elbow, the tendon affected is_______.
A. ECRB
B. ECRL
C. EDC
D. ECU
3. A 37-year-old man comes to you complaining of intermittent mild
pain while doing overhead activities. The most likely diagnosis of this

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.

B. The right ribs become convex anteriorly.


C. The left ribs flatten posteriorly.
D. The right ribs flatten anteriorly.
8. You suspect a complete rupture of your patients achilles tendon.
The following are not special tests for achilles tendon injury,except:
A. Homans Test.
B. Simmonds Test.
C. Dejour Test.
D. Boyes Test.
9. A 29-year-old male patient was diagnosed to have achilles tendon
complete rupture. A few days after surgery, the compression dressing
was removed. Then the surgeon suggested that below knee cast be
applied. In applying the cast, the ankle should be
positioned___________.
A. 15-30 plantarflexion.
B. Neutral position
C. 5-10 dorsiflexion
D. 10-15 dorsiflexion.
10. A high intensity, anaerobic strength training is prescribed for your
client. The following muscle fiber types do not respond well to such
training, except:
A. Type IIa
B. Type Ia
C. Type IIb
D. Type I
1. A PT is observing his patient diagnosed with RA ambulating
independently on an even terrain at her residence. He notices her right
knee flexes slightly 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.
B. Grade III mobilization with posterior glide.
C. No intervention needed as her right knee angle and tibial rotation
are normal during heel strike.
D. The information is insufficient to come up with the most
appropriate intervention.
1. An obese woman patient has difficulty walking specially during
push-off. She complains of pain on her medial calcaneus which is so
intense when she first steps in the morning upon waking. Upon
examination, her foot reveals weak posterior tibial tendon (PTT) and
plantarflexor muscles. She also has a stretched spring ligament. Which
of the following her condition is usually associated with?
A. Subtalar excessive supination
B. Forefoot valgus
C. Pes varus
D. Forefoot varus
2. Glenda, 45 y/o, suffers MI. Which of the following is true of MI?
A. Antacids may relieve her symptoms
B. Diaphoresis (heavy perspiration)
C. Prolonged or severe substernal chest pain or squeezing pressure
D. Nausea
3. A 45-year-old man comes to you complaining of bilateral leg pain.
He says walking, prolonged standing, and walking downhill trigger the
pain. Your impression is that the man has a lumbar stenosis. His MRI
results confirm your impression. Lumbar traction is one of the
therapeutic modalities included in the PT management. What is the
best patients position during lumbar traction?

A. Prone with rolled towel under his ankle.


B. Prone with pillow under his abdomen.
C. Supine with small bench under lower leg.
D. Supine with rolled towel under his ankle.
lumbar stenosiss symptoms are relieved in supine position with flexd hip

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

6. Sachin Tendulkar, a famous cricket player, presents to you with


pain and paresthesia of two weeks duration in his right anterior thigh.
You suspect a femoral nerve involvement. Which of the following best
test the femoral nerve?
A. Patient is in prone position, then you passively flex his right knee at
90 degrees of flexion while the patient actively plantarflexes his ankle.
Keeping his ankle plantarflexed, you extend his knee and slowly lower
it.
B. Have the patient lie on his left side and put his lower hip
and knee in 80 degrees and 90 degrees of flexion,
respectively. Keeping the patients upper knee at 90 degrees
of flexion, you passively abduct and extend his upper hip
and then you slowly lower it.
C. Patient is in supine position. He places his hips at 90 degrees of
flexion while his right knee in flexed position. He then extends his
right knee simultaneous with left knee full flexion. At this point, you
plantarflex his right ankle, then you slowly lower it.
D. Have the patient lie on his left side. Place his lower hip and knee at
90 degrees and 80 degrees of flexion, respectively. You then extend
and abduct his upper leg while keeping his upper knee straight. After
doing so, you slowly lower it.
7. You notice in your patient a psoatic limp. When asked to move his
hip, he favors adduction, external rotation, and flexion. You then
suspect the patient is suffering from___________.
A. Avascular necrosis (AVN) of the hip
B. Slipped capital femoral epiphysis

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.

B. Grade III mobilization with posterior glide.


C. No intervention needed as her right knee angle and tibial rotation
are normal during heel strike.
D. The information is insufficient to come up with the most
appropriate intervention

A child has been referred to you with arthrogryposis multiplex


congenita. Which of the following areas would be least
important to evaluate and treat?
A.Trunk Stability
B.ROM
C.Hand Functions
D.PROM
Explanation
Kids with arthrogryposis are at risk for contractures. Their joints are not always mobile
and it is important to keep the ROM that they have in order to increase their
independence. These kids do not typically have difficulty with trunk stability.

Neurological: You are assessing a traumatic brain injury patient


and note that the patient is very agitated, moving around in his
bed almost non-stop (requiring restraints at times). The patient
is also very confused and follows very few one-step
commands. According to the Rancho Los Amigos Levels of
Cognitive Function Scale, your patient is at:
A.Level II
B.Level III
C.Level IV
D.Level V
Explanation
Rationale: C is the correct answer because according to the Rancho Scale Level IV is
confused, agitated. Agitation is the key in this answer. Level II and III are less
responsive and only responding to certain stimuli. By Level V the agitation has
subsided, but the confusion remain

Pediatrics: An occupational therapist is evaluating a 12 month


old child due to concerns with self-feeding. What skills should
the therapist be looking for to determine if the childs current
performance is developmentally appropriate?
A.Utilizes raking grasp to finger feed
B.Spoon feeds with some inversion and spilling
C.Scoops food with spoon and brings it to mouth
D.Holds table food but sucks on it rather than biting
Explanation

Case-Smith, O'Brien; Occupational Therapy for Children, 2010 pg 453

Pediatrics: What type of developmental pre-writing grasp would


you expect to see in a 2-3 year old?
A.Dynamic Tripod Posture
B.Static Tripod Posture
C.Palmar Supinate Grasp
D.Digital Pronate Grasp

A mental health facility provides in-patient and outpatient


services for a catchment area that encompasses five counties.
The Continuous Quality Improvement Team would most likely
focus on:
A.The follow up process after discharge from the hospital
B.Cost reduction in specific service areas
C.Methods to educate staff on new wellness services
D.Keeping services that are rated positively on a satisfaction survey
Explanation

Fleming-Castaldy, National Occupational Therapy Certification Exam Review and Study


Guide Pg 636

hich of the following exercises would be a contraindication for a


patient with rheumatoid arthritis?
A.Running
B.Yoga

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.

Which of the following is a contraindication for electrical


stimulation usage?
A.Pacemaker
B.Hip replacement
C.COPD
D.Knee replacement
Explanation

Pacemakers are a contraindication for any electrical stimulation or diathermy usage.


Source- http://www.biomedofla.com/images/contraindications.htm

When working with a patient 1 day post a total shoulder


arthroplasty it is appropriate to do:
A.AROM exercises hitting full ROM in all planes
B.Resistive strengthening exercises
C.Codmans pendulum exercises
Explanation

Rationale: It is not appropriate to do resistive exercises or full range of motion exercises


one day post surgery due to the risk of dislocation, however to keep the shoulder from
freezing Codmans pendulum exercises are the most appropriate.
Source: National Occupational Therapy Certification Exam: Review and Study Guide by
Rita P. Fleming-Castaldy

All of these are indications for physical agent modalities except:


A.After acute inflammation to increase tissue healing
B.Before traction and soft tissue mobilization

C.Prior to active exercise, passive stretching, and joint mobilization Prior to


active exercise, passive stretching, and joint mobilization Prior to active
exercise, passive stretching, and joint mobilization
D.To increase circulation
Explanation

It is a contraindication/precaution if someone has decreased circulation, sensibility,


altered cardio respiratory status, open wound, recently healed burns, areas of edema,
or over tissue during acute inflammation
Crepeau, E.S., Cohn, E.S., & Boyt-Shell, B.A. (2009). Williard and Spackmans
Occupational Therapy Eleventh Edition. Baltimore, MD: Lippincott Williams & Wilkins

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

After experiencing a TBI your patient is found lying on the


ground demonstrating decorticate rigidity as a result of damage

to the cerebral hemispheres causing interruption in the


corticospinal tracts that transmit voluntary motor messages to
all extremities. How would the UE and LE present in this
situation?
A.UEs = Extended, internally rotated, and adducted LEs = extended,
internally rotated, and adducted.
B.UEs = Flexed, externally rotated, and adducted. LEs = extended, internally
rotated, and adducted.
C.UEs = Flexed, internally rotated, and adducted. LEs = extended, internally
rotated, and adducted.
D.UEs = Extended, internally rotated, and abducted. LEs = extended,
internally rotated, and adducted.
Explanation
Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2006). Pedrettis occupational threapy:
Practice skills for phyisical dysfunction. St. Louis, MO: Mosby Elsevier. (845-847).

Which provocative test would not be used when evaluating De


Quervains tenosynovitis?
A.Look for pain with resisted thumb extension or abduction
B.Finkelsteins test
C.Cozens test
D.Thickening/swelling over first dorsal compartment
Explanation

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

he primary role of an Occupational Therapist in sensory


integration is...
A.helping the child learn to reorganize their brain

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

Which area of cognition can be described as an impaired


association with neurological dysfunction including the lack of
knowledge about own physical/cognitive-perceptual
impairments and/or their functional implications as well as the
inability to anticipate difficulties, recognize error, or monitor
performance within the context of an activity?
A.Motor planning
B.Self awareness
C.Problem solving
D.Attention
Explanation

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.

OT's commonly assess peripheral nerve function with screening


tests. The best way to test for radial nerve function would be to
have the patient perform:
A.Wrist Extension
B.Thumb Opposition
C.Gross grasp with Dynomometer

D.Pincer grasp with index and thumb

After a Total Hip Replacement (posterolateral approach), a


patient is permitted to do which of the following:
A.Rotate the operated leg outward.
B.Cross the operated leg past the midline of the body.
C.Bend at the waist/hips more than 90 degrees.
D.Rotate the operated leg inward.
Explanation
B is the correct answer. Positions of instability include adduction, internal rotation, and
flexion. While external rotation is allowed for the posterolateral approach, it is not
permitted for patients who have had an anterolateral approach.
Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2006). Pedrettis occupational threapy:
Practice skills for phyisical dysfunction. St. Louis, MO: Mosby Elsevier. (pp. 1024).

Which of the following is not true about subluxation following a


CVA?

A.A common symptom of subluxation is pain at the glenohumeral joint.


B.Subluxation is caused by instability of the glenohumeral joint which may be
malaligned inferior, anterior, or superior.
C.Treatment of subluxation should focus on achieving trunk alignment and
scapular stability in a position of upward rotation.
D.A subluxed shoulder should be supported in bed, wheelchair, or an upright
position through the use of positioning with pillows, lap boards, and/or taping.
Explanation
A common misunderstanding about subluxation is that it is associated with pain. The
literature does not support this relationship.

Pedretti, L. W., Pendleton, H. M. H., & Schultz-Krohn, W. (2006). Pedretti's occupational


therapy: Practice skills for physical dysfunction. St. Louis, Mo: Mosby/Elsevier

What is NOT a sternal precaution for patients following heart


surgery?
A.No pulling or pushing up with arms when transferring
B.No driving for 4 weeks post-operative
C.No pushing, pulling, lifting more than 4 lbs for 6 weeks following surgery

D.No shoulder elevation above 90 degrees


Explanation
A is correct answer because the proper precaution is no pushing, pulling, or lifting more
than 10 lbs for 6 weeks following surgery.
All of the other answers are proper sterna precautions

Prone is often the position of choice for which of following:


A.to promote midline orientation
B.agitated, arching infant
C.infant with newly repaired abdominal defect
D.infant with contractures
Explanation

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

ll of the following are examples of Psychosocial approaches to


working with clients diagnosed with Parkinsons Disease except:
A.Educate the family to understand how the social interaction is affected by
PD, such as facial masking and oral rigidity.
B.Encourage the client to increase voice volume through speaking and singing
activities.
C.Encourage continuation of productive activities and leisure with suitable
challenges.
D.Group approach promoting exercise and teaching groups to improve mood
and socialization.
Explanation
Willard and Spackmans Occupational Therapy 11th ed.

Which of the following is a contraindication for ultrasound use?


A.Wound healing
B.Tendon injuries
C.Scar/incision management
D.CNS tissue
E.Fracture healing
Explanation

Rationale: Contraindications for US are: malignant tumors, joint cement,


thrombophlebitis, pregnancy, plastic components, eyes, CNS tissue, pacemakers,
reproductive organs
Therapeutic application is for: pain control, fracture healing (must be very low pulsed
rate and intensity), wound healing, soft tissue extensibility, tendon injuries, scar/incision
management, phonophoresis
*Information obtained from an inservice given at my fieldwork site as part of a continuing
ed course.

ou are completing an evaluation of a patient, Ms.


Allthatandthensome, who is complaining of intermittent bilateral
hand numbness and tingling that happens on a daily basis. She
explains that she has been feeling very clumsy lately because
she is constantly dropping small objects at work. She also

reports experiencing nocturnal hand pain and paresthesia which


wakes her up at night, but feels better after shaking or
massaging her hands. During your observation, you notice
thenar eminence atrophy of both of her hands. You suspect
that Ms. Allthatandthensomes symptoms are consistent with
Carpal Tunnel Syndrome (CTS). Which of the following would
assist you in further screening the patient for CTS?
A.Tinels sign of median nerve distribution
B.Phalens Test
C.Froments sign
D.Both A & C
Explanation
Carpal Tunnel Syndrome is the result of median nerve compression in the carpal tunnel
of the hand. For answer A, Phalens Test (a.k.a. the Wrist Flexion Test) involves placing
the wrist in a position of full flexion for 1 minute and asking the patient to describe any
changes in sensation during or after this posture. A positive response involves patient
report of numbness and tingling in the median nerve distribution of the hand. For
answer B, Froments sign is observed when there is flexion of the IP joint of the thumb
as the flexor pollicis longus attempts to compensate for the paralyzed or weak adductor
pollicis and flexor pollicis brevis and is indicative of an ulnar nerve lesion. For answer C,
Tinels sign occurs when there is gentle percussion along the course of the median
nerve and tingling persists for several seconds along the median nerve distribution of
the hand. Since both the Phalens Test and the Tinels sign indicate median nerve
compression, answer D is the correct choice.

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.

A patient with left-sided hemiplegic stroke has a non-functional


right hand with a mildly increased muscle tone in the flexor
muscle groups. The patient has been using a hand splint to
prevent joint deformities. The hand splint should maintain the
hand in a position of:
A.Slight flexion of the wrist, IPs and flexion of MCPs
B.Slight extension of the wrist, MCPs and flexion of IPs

C.Slight extension of the wrist, IPs, and flexion of MCPs


D.Slight flexion of the wrist, MCPs and IPs joints
E.Slight extension of the wrist, MCPs and IPs joints
Explanation
Source: Fundamentals of Hand Therapy

Which of the following is the least important thing to do before


seeing a patient in acute care?
A.Check to see if the patient is awake
B.Check all of the orders and verify that there is an activity order from the
doctor. If not, page the doctor and ask them to put one in.
C.Tell the nurse that you are from OT and are checking to see if you can see
the patient and if there is anything you should know before going in.
D.Do a thorough chart review.
Explanation
Answer: B, It is not very important to see if the patient is awake or not. In most cases
you will wake the patient up to participate in therapy anyway.

Which of the following standardized tests would be the LEAST


helpful when performing an evaluation of an individual who has
undergone a recent carpal tunnel release?
A.Having the patient dip his/her hand in a volumeter to analyze amount of
edema
B.Using the Semmes Winestein monofilaments to measure sensation
C.Having the patient perform Phalens test to check for positive
symptoms(Missed)
D.Using a dynamometer to measure grip strength
E.Using a goniometer to measure AROM

At what level of spinal cord injury is the important skill of


tenodesis grasp maintained?
A.T2
B.L1
C.C6
D.C5

E.C4

An individual with Parkinson's disease presents with poor trunk


rotation during ambulation and while performing acitvities of
daily living. The therapeutic intervention that would be most
appropriate to use with this person is:
A.Slow rolling with the person supine with knees and hips flexed
B.Activities of daily living using D1 flexion patterns
C.Facilitation of rotation through NDT handling techniques
D.Provision of a rolling walker to compensate for limited rotation and to
enchance mobility
Explanation

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

A patient just experienced a L ACA infarct CVA, what is the best


statement concerning the patients question about rehabilitation
potential?
A.You will be able to regain the full function you experienced before your
stroke.
B.You will be a able to perform the tasks that you performed before the stroke,
however you may need to use different methods and adapt your lifestyle.

Which of the following would produce the least amount of


muscle atrophy in a patient with a spinal cord injury?
A.Loaded (against resistance) functional electric stimulation
B.Do nothing, let the body heal itself
C.PROM
D.Non-loaded (against no resistance) functional electrical stimulation
Explanation

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.

How can a therapist differentiate between visual field cuts and


unilateral neglect?
A.Convergence
B.Patterns during scanning task
C.A&C
D.Peripheral vision tests
Explanation

Laurie Lundy-Ekman (2007). Neuroscience Fundamental for Rehabilitation 3rd Edition.


St. Louis, MO: Saunders-Elsvier. (230).

Splints are commonly used to prevent contractures. What is the


term used for the safe position (wrist in 20-30 degrees
extension, MCPs in 40-60 degrees flexion, IPs in extension and
thumb in abduction ) when positioning a hand into a splint?
A.Extrinsic Plus Position
B.Intrinsic Plus Position
C.Neutral Hand Position
D.Deformity Prevention Position
Explanation

Cooper, C. Fundamentals of Hand Therapy Clinical Reasoning and Treatment


Guidelines for Common Diagnoses of the Upper Extremity. Page 441.

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

A person who suffered a TBI exhibits eye opening to pain, no


motor response, and no verbal response. What is their
Glascow Coma Scale?
A.2
B.6
C.4
D.0
Explanation

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

A child with a brachial plexus injury at your outpatient facility


has begun to develop contractures in the left elbow. Using your
clinical judgment based on current research trends, you decide
to treat the patient with the following:
A.Serial casting to regain the full ROM, then maintenance ROM stretching.
B.Nighttime splints to maintain the current ROM the patient has.
C.A combination of serial casting and nighttime splinting to initially regain full
ROM and then maintain it in the future.
D.PROM once a day at therapy and school.
Explanation
Source: Sheffler, L. C., Lattanza, L., Hagar, Y., Bagley, A., James, M. A. (2012). The
prevalence, rate of progression, and treatment of elbow flexion contracture in children
with brachial plexus birth palsy. Journal of Bone and Joint Surgery, 94(5), 403-409

Your patient JW is a 76 year old female who has recently had a


stroke. Upon examining her you find that she does not display
any numbness or weakness in her extremities. When examining
her vision you find that she is not able to see on her right side.
She does, however, attempt to turn her head to the right to help
locate you in her line of sight. She also displays visuospatial
impairment and has impaired left-right discrimination. Upon
looking at your chart, you find that the CVA occured in the
right_______:
A.Internal Carotid Artery
B.Posterior Cerebral Artery
C.Middle Cerebral Artery
D.Anterior Cerebral Artery
Explanation
Pendleton, H. M., & Schultz-Krohn, W. (Eds.). (2006). Pedrettis occupational threapy:
Practice skills for phyisical dysfunction. St. Louis, MO: Mosby Elsevier. (805-807).

Maintaining ROM may be indicated for those individuals who


are unable to actively move or who are not permitted to move
through full, partial, or any amount of motion. This may include
a client on extended bed rest or may be with a client with the
potential for scar development due to surgery. Below are
benefits of PROM except...
A.Prevent muscle atrophy
B.Maintain joint and soft tissue integrity
C.Help maintain an awareness of movement
D.Assist circulatory and vascular functions
Explanation

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 client has been hospitalized for surgical repair of a right-side


hip injury. Her medical history indicates that she had a remote
stroke affecting her left side. Per her chart, this client has been
advised that she should not drive due to slow reaction times and
homonymous hemianopsia. Upon discharge from the hospital,
she returns to her one-story apartment where she will receive
home health occupational therapy. Which of the following
interventions would you NOT incorporate into therapy sessions
for this client?
A.Providing strategies to the client for entering/exiting vehicles
B.Education of family, caregivers, and home health aide regarding hip
precautions
C.Environmental modifications, activity adaptations, and equipment that
maintain independent functionality
D.Incorporating a home exercise program that encourages hip flexion beyond
90 degrees
Explanation
A should be incorporated into sessions to everyone caring for the client so they can in
turn provide a possibly medicated client of her hip precautions. Since she has returned
to her familiar home environment, she may attempt to return to normal too soon, thus
forgetting her precautions. B is important in home health OT because these items
assist clients with navigating their environment independently, safely, and functionally.
C should be part of a clients treatment since she still needs to attend follow-up
physicians appointments, even though she no longer drives. D is the correct answer
because hip precautions do not allow flexion past 90 degrees.
Source: Fleming-Castaldy, R. (2009). National occupational therapy certification exam:
Review & study guid (5th ed.). Evanston, IL: TherapyEd.

Patient with rotator cuff injury had a repair surgery. At what


week should the patient start isotonic exercises with Theraband
and free weights for strengthening?
A.Week 4
B.Week 12
C.Week 8
D.Week 6
Explanation
At week 4, patient starts PROM/AROM exercises beginning with gravity eliminated
position positions and progress to against gravity movements. Patient start the
strengthening exercises at week 6 with isometric exercises for the rotator cuff and
scapula stabilization exercises. At week 8 after surgery patient progresses to isotonic
exercises using Theraband and free weight. At week 12, patient can begin resistive
occupational tasks (taking off jacket)

As a student, you have been treating patients and had extra


time one day. Your clinical supervisor has a few patients that
he/she has on her caseload to treat that are Medicare B. She
decides to give one to you to fill your day.

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.

Damage to the right hemisphere would result in the following


symptoms except:
A.Left motor praxis
B.Speech
C.Emotion
D.Visual spatial processing

Explanation

Neurological Rehabilitation, 5th edition. Umphred, D. A.. Mosey, 2007.

You are seeing a patient who shows aggressive behavior and


keeps removing his restraints and pulling at his catheter. Pt.
lacks short term recall and seems to be acting out based on
past events. Pt is unable to complete self feeding and dressing
without maximum assistance. What Rancho level is your pt.
functioning at?
A.I no response
B.VII- automatic/appropriate
C.IV-confused/agitated
D.III- localized response
Explanation

Gutman, S.A., & Schonfeld, A.B.(2009) Screening Adult Neurological Populations, 2nd
edition. The American Occupational Therapy Association, Inc. (p 4-7)

A child has sensory processing issues, specifically in body


awareness and modulation affecting attention and ability to
transition throughout the day. Which of the following is NOT an
appropriate intervention for this child?
A.Joint compressions/deep pressure massage
B.Free play/running in the gym class
C.Jumping on a trampoline
D.Single-point platform swinging
Explanation

ANSWER: C. Free play/running with peers in an open gymnasium will be too


overstimulating for a child with these issues. It will be difficult for them to keep their body
under control or focus on what is going on. The child will probably become too
overstimulated or shut down. Swinging, jumping, and joint compressions/massage are
good activities to help provide regulation and body awareness.

A patient with a recent hip fracture wants to have grab bars


installed in her bathtub to prevent future falls. The occupational
therapist recommends the grab bars to be installed:
A.33-36 inches from the floor outside of the bathtub
B.At the patients waist level
C.33-36 inches from the floor of the bathtub
D.24 inches from the floor
Explanation
According to ADA recommendations, grab bars should be 33 to 36 inches above the
bathroom floor (Grab bars at bathtubs, 2002), not from the bottom o

If a patient presents to the clinic with a high level of shoulder


pain what type of interventions should you avoid initially?
A.Posture education
B.Strengthening
C.Modalities
D.ROM