Neuromuscular and Nervous System 2010

1.Your patient with quadriplegia is exhibiting signs of autonomic dysreflexia. Your

supervisor tells you to that this is an emergency, you need to call the nurse immediately.
Which of the following are signs of this condition?

a) Severe pounding headache/ blurred vision

b) Diarrhea and vomiting
c) Increased heart rate
d) Decreased appetite

2.A male patient with a history of back injury complains of pain in legs. The patient
wears short leg braces. You read his chart and it states "lumbar plexus involvement",
what area of the spinal column is indicated?

a) L1- L2
b) L4 -L5 & S1
c) L5-S2
d) S1-S2

3.Your patient is recovering from a motor vehicle accident. You assess the patient's
independence by evaluating how he performs his activities of daily living. He has good
upper arm strength which allows feeding, some dressing and propelling a wheel chair.
Which area of the spinal cord is affected?

a) C6- C7
b) T1- T3
c) T4- T9
d) T10- L1

4.Your patient states that someon stabbed him with a knife on his back. You perform
your assessement and you note that he has no ability to extend his leg over the
“anteromedial aspect “of his thigh. He also has a loss of sensation in his legs. Which is
the affected nerve ?

a) Lumbar nerve
b) Femoral nerve
c) Obturator nerve
d) Sciatic nerve
5.A female-82-years old was referred for rehabilitation after fall at home injuring her
shoulder. The physician has diagnosed trauma to the “brachial nerve”. Which nerve
roots are affected?

a) C6-C8
b) C5-C6
c) C5-C7
d) C5-C8&T1

6.A female athlete sustained an injury to her arm. On your evaluation, you note
numbness, tingling and pain in the palm and fingers. There is also weakness in
pronation of the forearm and flexion of the proximal interphalangeal joints of the second
and third digits. Which nerve is affected?

a) Radial nerve
b) Median nerve
c) Ulna nerve
d) Long thoracic nerve

7.Your patient has burns on the dorsal surface of the arm. The wound area is mottled
red with a number of blisters. The physician informs the patient that healing should take
place in less than three weeks. This description is indicative of ?

a) superficial burn
b) superficial partial - thickness burn
c) deep partial - thickness burn
d) full -thickness burn

8.A patient is recovering from a complete spinal cord injury, at the level of L3. The
expected outcome would be :

a) greater loss of arm function than leg function

b) loss of motor function
c) a spastic bladder
d) some recovery of function

9.A patient is admitted with complete spinal cord transection. Which of the following
would best describe the diagnosis?

a) Entire severing of the spinal cord

b) Entire control of the arm and chest muscles
c) Entire control of trunk above the umbilicus
 d) Entire control of leg muscles, which allows walking

10.A 22-year-old male waiting for scheduled therapy session in the gym suddenly
begins to scream. The patient sustained a traumatic brain injury in a motor vehicle
accident and is currently functioning at the confused appropriate stage . The Most
appropriate therapist action is:

a) Ask the patient if he needs assistance

b) Seek assistance from other health care professionals
c) Request that the patient is transported back to his room
d) Contact a physician and request that the patient’s medication dosage is
increased.

11.A patient with Parkinson's disease exhibits the following symptoms: facial grimacing
with twitching of the lips, tongue protrusion, restless, with constant dancing and
athetoid-like movements of his legs. He states that he has been taking Levadopa for the
past 7 years. What should you do?

a) ask the patient if he is taking any drugs with hallucinogenic effects

b) complete the treatment session
c) refer the patient back to the physician for levodopa toxicity
d) examine for additional signs of chronic levodopa therapy

12.Brian is a 47 -years-old patient involved in motor vehicle accident. He sustained a

brain stem injury to the medulla oblongata. Which vital function will be affected by this
injury?

a) Blood pressure
b) Sight
c) Hearing
d) Moving

13.A patient came to you with a profound deficit of homonymous hemi-anopsia. The
initial strategy to assist the patient in compensating for this deficit is to:

a) place items, eating utensils on the affected side

b) provide constant reminders, printed notes on the affected side
c) teach the patient to turn the head to the affected side
d) Bed on the affected side should be facing the doorway
14.John Walsh, 4 year-old boy, presents with progressive weakness and falling. The
physician diagnosed him to have Duchene Muscular Dystrophy. What do you expect to
find?

a) Disinterest in communicating or speaking

b) Disinterest in any form of learning
c) Disinterest in running, toe walking
d) Disinterest in any form of activities

15.Your patient with Duchene Muscular dystrophy is scheduled for surgery. The
physical therapy student stated that he studied that most children with DMD die at the
age of 25. What is the main cause of the death for these patients?

a) Congestive heart disease

b) Peripheral vascular disease
c) Cardiopulmonary failure
d) Pneumonia

16.Your patient (5 days old) with hydrocephalus is being admitted for a shunt insertion.
What are the problems associated with having a shunt inserted ?

a) Fixed staring
b) Muscle spasms
c) Involuntary movements
d) Retention of urine

17.Denise, a 38-year-old male, presents with facial weakness and twitching. She was
diagnosed with Bell's Palsy. What other signs do you expect?

a) Hearing
b) Facial rash
c) Paralysis
d) Difficulty swallowing

18.A CVA patient is unable to advance the tibia forward. He shortens the end of the
stance phase going directly into swing phase. The MOST likely cause of her problem is:

a) contracture of the plantar flexors

b) contracture of hip extensors
c) spasticity of dorsiflexors
d) weakness of the dorsiflexors
19.Mr Carson, a 50-year-old below the knee amputatee, complains of pain on the
affected leg. His pain was classified as neuropathic pain. On your assessment, what do
you expect to find?

a) Altered sensation of affected area to pinprick

b) Swelling of affected leg
c) Altered sensation in the hip
d) Increased motor strength

20.A patient is prescribed an opioid analgesic for neuropathic pain associated with her
diagnosis of shingles. What are the known side effects of opioids ?

a) Fatigue
b) Urinary retention
c) Blurred vision
d) Insomnia

21.The patient is unable to climb the stairs. How do you train the patient to perform this
task?

a) high marches
b) hip and knee flexion in supine and sitting
c) step on a 2 inch or 4 inch step ups
d) weight shifting between the parallel bars

22.Your patient complains of pain in an area of absent sensation due to lesion in the
central or peripheral system. What is the first line medication for this type of pain?

a) Meperidine
b) Morphine
c) Gabapentin
d) Pethidine

23.A 52-year-old female sustained an injury to the forehead due to motor vehicle
accident. The physician told you that she suffered a brain injury. Based on the location
of her injury, what do you expect?

a) loss of spontaneity in interacting with others

b) Increase in sleeping pattern
c) Inability to control bowel / bladder
d) loss of hearing
24.You are performing a manual muscle test on a patient. Your findings are-- paralysis
of the adductor muscles of the leg and loss of sensation over the medial aspect of the
thigh. Which nerve is affected with this presentation?

a) Femoral nerve
b) lumbar plexus nerve
c) Sacral plexus nerve
d) Obturator nerve

25.Jane 34 year old, with adductor muscle paralysis and loss of sensation over the
medial aspect of the thigh. What would be indicative of this neurological problem?

a) Back injury due to a fall

b) Congenital defect
c) Medical problem
d) Child birth

26.What should be avoided in C5-C6 nerve palsy?

a) gentle ROM
b) partial immobilization
c) age specific exercises
d) abduction

27.Your patient with a lengthy history of cardiac problems, appears to be confused and
dizzy. She complains of inability to move one limb. You think that your patient is
suffering from:

a) Transient Ischemic Attack

b) Myocardial Infarction
c) Congestive Heart Failure
d) Low Blood Sugar

28.Isokinetic training is used for patients with neuromuscular problems for:

a) rate control at fast movement speeds

b) rate control at slow movement speeds
c) rate control at varying movement speeds
d) does not improve rate control
29.Your patient presents with an involuntary and rhythmic movement or oscillation of
the eye. The physician diagnoses nystagmus. What other signs do you expect?

a) Dilated pupils
b) Poor vision
c) Eyelid closing
d) Inflammation of the eye

30.Your patient is diagnosed with congenital nystagmus. What would be the most
appropriate intervention for this diagnosis ?

a) Contact lenses
b) Glasses
c) Wearing an eye patch
d) No devices

31.A patient with complete C6 tetraplegia should be instructed to initially transfer with a
sliding board. Which muscles can the patient use?

a) shoulder extensors, external rotators, and anterior deltoid

b) shoulder depressors and triceps
c) pectoral muscles and scapular depressors
d) serratus anterior with elbow extensors

32.You are performing an evaluation on a patient. Your findings are: pain and sensory
loss in the posterior thigh, lateral calf, and dorsal foot; Extension of the hallux is poor,
however the Achilles reflex is normal. Which spinal level is affected?

a) L4
b) L5
c) S1
d) S2

33.Which muscles should be strengthened for an incomplete T12 paraplegia for

ambulation with crutches?

a) middle trapezius, latissimus dorsi, and triceps.

b) deltoid, triceps, and wrist flexors.
c) upper trapezius, rhomboids, and levator scapulae
d) lower trapezius, latissimus dorsi, and triceps
34.A physical therapist examines the forefoot position of a 36 year old male referred to
physical therapy with ankle pain of unknown etiology. The therapist determines that the
patient has a forefoot varus. What compensatory finding would the therapist most likely
find?

a) Subtalar eversion
b) Subtalar inversion
c) Talocrural dorsiflexion
d) Talocrural plantar flexion

35.A 66 year old female, is referred to physical therapy with rheumatoid arthritis . During
the initial examination, the physical therapist notes that the fingers exhibit increased
flexion at the proximal interphalangeal joints and hyperextension at the
metacarpophalageal and distal interphalangeal joints. This deformity is most
representative of:

a) Boutonniere deformity
b) Mallet finger
c) Swan neck deformity
d) Ulnar drift

36.A patient diagnosed with piriformis syndrome is referred to physical therapy for one
visit for instruction in a home exercise program. After examining the patient, the physical
therapist feels the patients rehabilitation potential is excellent , but is concerned that one
visit will not be sufficient to meet the patient's needs . The appropriate action is to:

a) Schedule the patient for treatment sessions,as warranted by the results of the
examination
b) Explain to the patient that recent health care reforms have drastically reduced the
frequency of the physical therapy visits covered by third party payers
c) Explain to the patient that she can continue with physical therapy beyond the
initial session, but will be liable for all expenses not covered by her insurance.
d) Contact the referring physician and request approval for additional therapy visits .

37.A male patient with limited shoulder range of motion, explains that he has difficulty
wiping himself after going to the bathroom. How much shoulder range of motion is
required to successfully complete toileting activities using a posterior approach ?

a) 50 degrees, horizontal abduction, 30 degrees abduction 45 degrees medial

rotation
b) 30 degrees horizontal abduction, 45 degrees adduction, 65 degrees medial
rotation.
c) 80 degrees horizontal, 40 degrees abduction, 70 degrees medial rotation
 d) 90 degrees horizontal adduction, 75 degrees abduction, 60 degrees medial
rotation

38.A female patient recovering from ankle surgery has consistent difficulty with
functional activities that emphasize the frontal plane. Which of the following would be
most difficult for the patient?

a) Anterior lunge
b) six inch lateral step down
c) six inch posterior step up
d) eight inch posterior step down

39.A physical therapist, employed in an acute care hospital, conducts an initial interview
with a patient referred to physical therapy. During the interview, the therapist asks the
patient if he feels dependent on coffee, tea, or soft drinks. Which clinical scenario would
most appropriately warrant this type question ?

a) A 27 year old female status post arthroscopic medial menisectomy

b) A 42 year old male with premature ventricular contractions
c) A 37 year old female with restrictive pulmonary disease
d) A 57 year old male with respiratory alkalosis

40.A patient with a lengthy history of substance abuse, is referred to physical therapy
after sustaining multiple injuries in a motor vehicle accident. Which of the following
controlled substances would not typically foster physical dependence?

a) Depressants
b) Hallucinogens
c) Narcotics
d) Stimulants

41.A physical therapist examines a patient diagnosed with post polio syndrome. Which
of the following areas is least likely to be affected based on the patient's diagnosis?

a) Strength
b) Sensation
c) Endurance
d) Functional mobility
42.During gait analysis, the physical therapist notes that the patient's gait has the
following characteristics; narrow base of support, short step length , and decreased
trunk rotation. This gait pattern is often observed in patients with a diagnosis of :

a) CVA
b) Parkinson’s disease
c) Post polio syndrome
d) Multiple sclerosis

43.A patient who is 2 months post CVA complains of symptoms including burning pain
in the right upper extremity that is increased by the dependent position along with
lowered pain threshold and heightened sensitivity to light touch. The right hand is mildly
edematous and the skin is dry and warm to touch. Which stage of Complex Regional
Pain Syndrome is the patient in?

a) Stage III (atrophic stage)

b) Stage II (dystrophic stage)
c) Stage I (early) changes
d) None of the above

44.A patient complains of numbness, paresthesias and weakness of his bilateral lower
extremities which increase with extended positions or walking greater than 100 feet. His
pain persists for hours after assuming a resting position. Other activities does not affect
his pain. What do you think that patient has?

a) discal dysfunction
b) spondylolysis
c) degenerative arthritis
d) Spinal Stenosis

45.An 8 year-old child with decreased sitting balance, but normal tone would need:

a) standard chair with lateral supports

b) prone stander
c) Sitting on a therapy ball
d) adaptive wheelchair

46.A patient with a complete spinal cord injury with C5 tetraplegia complains of sudden
pounding headache and double vision. He is sweating excessively and his BP is
240/95. All are interventions you should perform except for?

a) sit the patient up

 b) lie the patient down
c) check/empty catheter bag
d) call for emergency medical assistance

47.A patient demonstrates beginning recovery Stage 4 movements following a left CVA.
The PNF pattern that represents the BEST choice to promote continued recovery of the
right upper extremity through the use of out-of-synergy movements is:

a) chop, reverse chop with right arm leading.

b) bilateral symmetrical Dl thrust and reverse thrust.
c) lift, reverse lift with right arm leading.
d) bilateral symmetrical D2F and D2E, elbows straight.

48.What is contraindicated for a patient with Parkinson's who demonstrates festinating

gait?

a) side stepping
b) rolling walker
c) stepping on treadmill
d) rhythmic stepping

49.Your patient cannot perform a task upon command but can do the task when on their
own, for example, when you ask her to put on her socks, she cannot do it, but you
observe that she can do it on her own later in the day. This patient may have:

a) ideational apraxia
b) anosognosia
c) ideomotor apraxia
d) unilateral neglect

50.Your patient suffered a traction injury to the anterior division of the brachial plexus
the therapist would expect to see weakness of all the muscles listed below except for:

a) forearm pronators
b) thumb abductors
c) elbow flexors
d) wrist extensors