NPTE MODALITIES PRACTICE QUESTIONS

Which situation would warrant the coolest water temperature?
a. pain management
b. general exercise
c. treatment of burns
d. chronic osteoarthritis
Answer: b
Rationale: The temperature of water for general exercise should be between 79-92 degrees Fahrenheit. Water temperature would need to be significantly higher for the remaining options: pain management 99-104 degrees Fahrenheit; treatment of burns 96-98 degrees Fahrenheit; chronic osteoarthritis 104-110 degrees Fahrenheit

A therapist plans to administer cryotherapy to a patient for a period of seven minutes. What type of cryotherapeutic agent would be most likely based on the planned duration of the treatment?
a. cold bath
b. ice massage
c. cold pack
d. vapocoolant spray
Answer: b
Rationale: Ice massage is typically performed by freezing water in paper cups and applying the ice directly to the treatment area. Since the ice is applied directly, the magnitude of the tissue cooling requires a treatment duration of only five to ten minutes. Ice massage is ideal for small or contoured areas, allows for direct observation of the skin, and is inexpensive to use.

What ratio of on:off time is most common when using mechanical compression?
a. 1:3
b. 3:1
c. 1:6
d. 6:1
Answer: b
Rationale: A 3:1 ratio is generally used for on:off time with inflation between 40 to 100 seconds and deflation between 10 to 35 seconds

Which massage technique would not require the use of a lubricant?
a. effleurage
b. petrissage
c. vibration
d. friction
Answer: d
Rationale: Friction is a deep massage technique that penetrates into the depth of a muscle. As a result, a lubricant would make it extremely difficult for the therapist to administer the stroke with the necessary intensity

Which of the following would be considered a potential indication for electrotherapy?
a. cardiac arrhythmia
b. osteomyelitis
c. stress incontinence
d. seizure disorders
Answer: c
Rationale: Stress incontinence refers to the unintentional loss of urine and is often prompted by a physical movement or activity such as coughing or sneezing. Pelvic floor muscle weakness is often the cause of this condition. Electrotherapy can be used effectively to increase the strength and coordination of the pelvic floor muscles. Cardiac arrhythmia, osteomyelitis, and seizure disorders are considered contraindications for electrotherapy

A therapist uses neuromuscular electrical stimulation with a patient rehabilitating from a knee injury. During the treatment session the therapist adjusts the on:off time ratio to 1:5. Which of the following is consistent with the described ratio?
a. 8 seconds on and 40 seconds off
b. 10 seconds on and 30 seconds off
c. 30 seconds on and 10 seconds off
d. 40 seconds on and 8 seconds off
Answer: a
Rationale: An on:off ratio of 1:5 means that for each second of on time there would be five seconds of off time. Eight seconds of on time and 40 seconds of off time maintains the 1:5 ratio.

What electrode configuration includes two electrodes from two different stimulating circuits that are positioned so that the individual currents intersect?
a. unipolar
b. monopolar
c. bipolar
d. quadripolar
Answer: d
Rationale: Quadripolar technique refers to two electrodes from two separate stimulating circuits that are positioned so that the individual currents intersect with each other. This technique is utilized with interferential current.

A therapist treats a patient rehabilitating from an ankle sprain using a cold bath. Which value would be most appropriate for the temperature of the cold bath?
a. 35 degrees Fahrenheit
b. 48 degrees Fahrenheit
c. 60 degrees Fahrenheit
d. 74 degrees Fahrenheit
Answer: c
Rationale: A cold bath requires water temperature ranging from 55 to 64 degrees Fahrenheit. Cold baths are commonly used for the immersion of distal extremities.

Which term describes the transfer of heat that occurs as a liquid absorbs energy and changes form to a vapor?
a. conduction
b. convection
c. conversion
d. evaporation
Answer: d
Rationale: Evaporation refers to the transfer of heat as a liquid absorbs energy and changes form to a vapor. Vapocoolant sprays are an example of a modality that relies on evaporation for heat transfer.

The temperature of the water in a hot pack machine should be:
a. 137 degrees Fahrenheit
b. 148 degrees Fahrenheit
c. 161 degrees Fahrenheit
d. 174 degrees Fahrenheit
Answer: c
Rationale: The water in a hot pack unit should be between 158-167 degrees Fahrenheit

A therapist attempts to determine the amount of time necessary to treat an area approximately two times the size of the ultrasound transducer. The most appropriate treatment time is:
a. 3 minutes
b. 5 minutes
c. 7 minutes
d. 12 minutes
Answer: b
Rationale: A therapist can cover an area two to three times the size of the transducer in a five minute period. Five minutes would be a sufficient amount of time given the size of the area in relation to the size of the transducer.

Which condition would be considered an indication for cryotherapy?
a. chronic pain
b. circulatory impairment
c. cold urticaria
d. ischemic tissue
Answer: a
Rationale: Chronic pain is an indication for cryotherapy. Other indications include pain control, myofascial pain syndrome, muscle spasm, bursitis, tendonitis, acute or subacute inflammation, and musculoskeletal trauma. Circulatory impairment, cold urticarial, and ischemic tissue are all considered contraindications for cryotherapy.

A patient poorly tolerates the sudden increase in force that occurs when transitioning from off time to on time during neuromuscular electrical stimulation. Which action would minimize the impact of this transition?
a. decrease the treatment duration
b. modify the waveform
c. utilize a ramp
d. increase the phase duration
Answer: c
Rationale: Ramp refers to the number of seconds it takes for the amplitude to gradually increase or decrease to the maximum value set by the amplitude control. By adding a ramp the onset of the electrical force will be gradual and, therefore, better tolerated by the patient.

Which property of water increases in proportion to the depth of immersion?
a. buoyancy
b. hydrostatic pressure
c. specific gravity
d. total drag force
Answer: b
Rationale: Hydrostatic pressure is the pressure exerted by a fluid at equilibrium due to the force of gravity. Water exerts pressure that is perpendicular to the body and increases in proportion to the depth of immersion.

A therapist uses compression to treat a patient with edema. How much inflation pressure is necessary when treating the upper extremities?
a. 20 mmHg
b. 45 mmHg
c. 70 mmHg
d. 90 mmHg
Answer: b
Rationale: Treatment for the upper extremities requires between 30 and 60 mmHg of inflation pressure

Which type of hydrotherapy tank would allow the patient to extend their legs, however, would not allow for full body immersion?
a. extremity tank
b. lowboy tank
c. highboy tank
d. Hubbard tank
Answer: b
Rationale: A lowboy tank is used for larger parts of the extremities and permits long sitting with water to the midthoracic level. Approximate dimensions for the lowboy tank are a depth of 18 inches, a length of 52-65 inches, and a width of 24 inches.

A therapist elects to use a small set of electrodes when applying electrical stimulation to the anterior forearm of a patient rehabilitating from an upper extremity injury. Which of the following is most accurate when comparing smaller electrodes to larger electrodes?
a. Smaller electrodes result in increased current density and increased impedance
b. Smaller electrodes result in decreased current density and increased impedance
c. Smaller electrodes result in increased current density and decreased impedance
d. Smaller electrodes result in decreased current density and decreased impedance
Answer: a
Rationale: The smaller surface area of small electrodes increases current density and impedance. Current density is a measure of the density of an electrical current. Impedance refers to the property of a substance that provides resistance to the flow of current by offering an alternate current

Which ultrasound parameters would produce the lowest total amount of heat delivered to the target area?
a. 20% duty cycle at 1.2 W/cm2
b. 50% duty cycle at 1.1 W/cm2
c. 75% duty cycle at 1.3 W/cm2
d. continuous ultrasound at 1.2 W/cm2
Answer: a
Rationale: Pulsed ultrasound at a 20% duty cycle produces sound energy only 20% of the time. A 50% duty cycle produces sound energy 50% of the time. Although the intensity is slightly lower at the 50% duty cycle compared to the corresponding intensity for the 20% duty cycle, the relatively small decrease would still generate additional heat due to the significantly increased duty cycle.

Which of the following would be considered a contraindication for mechanical lumbar traction?
a. muscle spasm
b. joint instability
c. nerve impingement
d. protruding disc
Answer: b
Rationale: Joint instability is considered a contraindication to mechanical lumbar traction. Muscle spasm, nerve impingement, and protruding disc are indications for traction.

What is the most likely treatment objective when administering petrissage?
a. loosen adhesions and improve lymphatic return
b. enhance circulation and stimulate peripheral nerve endings
c. reduce edema and promote relaxation
d. diminish trigger points and muscle spasms
Answer: a
Rationale: Petrissage is a massage technique described as kneading where the muscle is squeezed and rolled under the therapist’s hands. The treatment objective of petrissage is to loosen adhesions, improve lymphatic return, and facilitate the removal of metabolic waste from the treatment area.

What type of electrical current is used with iontophoresis?
a. alternating current
b. direct current
c. pulsatile current
d. interferential current
Answer: b
Rationale: Direct current refers to a continuous unidirectional flow of charged particles. Direct current is used for iontophoresis and for stimulating contraction of denervated muscle.

A therapist applies a hot pack to the lower back of a patient positioned in prone. How long after administering the hot pack should the therapist examine the patient’s skin?
a. 1 minute
b. 5 minute
c. 10 minutes
d. 20 minutes
Answer: b
Rationale: A therapist should check a patient’s skin for redness or signs of a burn shortly after applying the hot pack. Five minutes would be an ideal time to check the patient’s skin since there would be ample time for thermal effects; however, there would be insufficient time for a serious reaction given the number of towel layers required.

What is the maximum depth of tissue heating when using ultrasound with a frequency of 1 MHz?
a. one centimeter
b. two centimeters
c. five centimeters
d. ten centimeters
Answer: c
Rationale: Ultrasound with a frequency of 1 MHz can be used to heat tissues up to five centimeters deep, while ultrasound with a frequency of 3 MHz is used to heat tissue one to two centimeters deep.

A therapist positions a patient in supine prior to initiating mechanical cervical traction. How much neck flexion should be present?
a. 5-10 degrees
b. 10-15 degrees
c. 25-35 degrees
d. 45-55 degrees
Answer: c
Rationale: When administering mechanical traction to the cervical spine with the patient in a supine position, the neck should be flexed 25-35 degrees. Traction to the cervical spine can also occur with the patient in a sitting position.

What parameter is primarily responsible for determining the depth of ultrasound?
a. intensity
b. duty cycle
c. frequency
d. effective radiating area
Answer: c
Rationale: The selected frequency of ultrasound determines the depth of penetration. Frequency is most often 1 MHz or 3 MHz. Increasing the frequency of ultrasound causes a decrease in the depth of penetration and decreasing the frequency causes an increase in the depth of penetration.

What form of heat transfer is used by hot packs?
a. conduction
b. convection
c. conversion
d. evaporation
Answer: a
Rationale: Hot packs transfer heat through conduction. This type of heat transfer occurs as a result of direct contact between two materials at different temperatures.

How much force should be used initially when performing mechanical traction to the cervical spine?
a. 5 pounds
b. 10 pounds
c. 25 pounds
d. 50 pounds
Answer: b
Rationale: A force between 10 and 15 pounds is often used to initiate mechanical cervical traction. Seven percent of the patient’s body weight may be necessary for separation of the vertebrae.

A therapist uses iontophoresis to treat a patient with a fungal infection. Which substance would be the most beneficial to utilize?
a. copper sulfate
b. calcium chloride
c. lidocaine
d. zinc oxide
Answer: a
Rationale: Copper sulfate can be used with iontophoresis to treat fungal infections. The medication has a positive polarity.

Which therapeutic modality transfers heat through convection?
a. hot pack
b. whirlpool
c. paraffin
d. ice massage
Answer: b
Rationale: Whirlpool transfers heat to the body through convection. Convection refers to the gain or loss of heat as a result of air or water moving in a constant motion across the body.

Which of the following would not be considered a nonthermal effect of ultrasound?
a. increased soft tissue repair
b. increased macrophage responsiveness
c. increased extensibility of collagen structures
d. increased cell membrane permeability
Answer: c
Rationale: Increased extensibility of collagen structures would be considered a thermal effect of ultrasound. The increase in tissue temperature generated by ultrasound is necessary to increase the extensibility of collagen structures. An increase in tissue temperature does not occur with nonthermal effects.

Which of the following substances administered with iontophoresis can be used to treat myositis ossificans?
a. acetic acid
b. dexamethasone
c. magnesium sulfate
d. zinc oxide
Answer: a
Rationale: Myositis ossificans is a condition that causes abnormal bone formation within deep muscle tissue. Several studies suggest that acetic acid can be useful to treat patients with myositis ossificans.

Which massage technique utilizes small circular motions over a trigger point or muscle spasm?
a. effleurage
b. friction
c. petrissage
d. tapotement
Answer: b
Rationale: Friction is a deep massage technique that utilizes small circular motions over a trigger point or muscle spasm. Friction requires penetration into the depth of a muscle.

Which of the following is an indication for hydrotherapy?
a. impaired circulation
b. desensitization of a residual limb
c. incontinence
d. diminished sensation
Answer: b
Rationale: Desensitization of a residual limb can occur using a contrast bath. Impaired circulation, incontinence, and diminished sensation are considered contraindications to hydrotherapy.

What massage technique uses rapid, alternating movements such as tapping and cupping?
a. effleurage
b. tapotement
c. petrissage
d. friction
Answer: b
Rationale: Tapotement is a massage technique that provides stimulation though rapid, alternating movements such as tapping, hacking, cupping, and slapping. The primary purpose of tapotement is to enhance circulation and stimulate peripheral nerve endings.

What percentage of body weight is necessary for mechanical separation of the lumbar spine when using spinal traction?
a. 10 percent
b. 25 percent
c. 40 percent
d. 50 percent
Answer: d
Rationale: A force of 25-50 pounds is recommended when initiating mechanical lumbar traction, however, 50 percent of body weight is necessary for actual separation of the vertebrae.

Which type of electrical current is characterized as twin-peak, monophasic pulsed current?
a. direct current
b. alternating current
c. interferential current
d. high-voltage pulsed current
Answer: d
Rationale: High-voltage pulsed current is a twin-peak monophasic pulsed current. High-voltage pulsed current is commonly used in wound healing and pain management.

How many towel layers are generally recommended when using a hot pack?
a. 2-4
b. 4-6
c. 6-8
d. 8-10
Answer: c
Rationale: A therapist should use 6-8 towel layers around a hot pack before applying a hot pack to a patient. If a therapist uses hot pack covers, each cover counts as two towel layers.

A therapist uses iontophoresis to treat a patient diagnosed with lateral epicondylitis. Which of the following would be the most necessary to monitor during the session?
a. blood pressure
b. respiration rate
c. heart rate
d. skin
Answer: d
Rationale: The therapist must monitor the patient during treatment to ensure that the skin is not burned under the electrode. The skin should be thoroughly clean before and after treatment to minimize irritation. Vital signs are not typically affected by iontophoresis.

Which ultrasound parameters are most likely to produce purely nonthermal effects?
a. low intensity, low duty cycle
b. low intensity, high duty cycle
c. high intensity, low duty cycle
d. high intensity, high duty cycle
Answer: a
Rationale: Ultrasound using nonthermal effects is characterized by no measurable net increase in temperature. This occurs by using a relatively low intensity and low duty cycle. In this manner the heat generated during the on time of the cycle is dispersed during the off time.

Which unit is considered a measure of frequency when using electrical stimulation?
a. microseconds
b. Hertz
c. amperes
d. volts
Answer: b
Rationale: Frequency describes the number of cycles (Hertz) or pulses per second (pps) for pulsatile current.

Which term is responsible for the upward force on the body when immersed in water?
a. buoyancy
b. hydrostatic pressure
c. specific gravity
d. total drag force
Answer: a
Rationale: Buoyancy is the upward force caused by fluid pressure that keeps objects afloat. According to Archimedes’ principle of buoyancy there is an upward force on the body when immersed in water equal to the amount of water that has been displaced by the body.

Which type of hydrotherapy tank would hold the largest volume of water?
a. extremity tank
b. lowboy tank
c. highboy tank
d. Hubbard tank
Answer: d
Rationale: A Hubbard tank is used for full body immersion and can hold up to 425 gallons. Approximate dimensions for the Hubbard tank are a depth of four feet, a length of eight feet, and a width of six feet.

A therapist treats a patient with the objective of muscle relaxation using biofeedback. Assuming the patient makes progress during several sessions, the therapist should:
a. move the electrodes further apart and increase the sensitivity setting
b. move the electrodes further apart and decrease the sensitivity setting
c. move the electrodes closer together and increase the sensitivity setting
d. move the electrodes closer together and decrease the sensitivity setting
Answer: a
Rationale: Moving the electrodes further apart and increasing the sensitivity setting will make the activity more challenging for the patient. A higher sensitivity level will require the muscles to be in a more relaxed state.

How much inflation pressure is necessary when treating the lower extremities with compression?
a. 20 mmHg
b. 35 mmHg
c. 60 mmHg
d. 85 mmHg
Answer: c
Rationale: Treatment for the lower extremities requires between 40 and 80 mmHg of inflation pressure. The inflation pressure should not exceed the patient’s diastolic blood pressure.

A therapist would like to increase the lower extremity resistance a patient experiences while exercising in a therapeutic pool. The most appropriate therapist action is:
a. increase the depth of water
b. decrease the level of body immersion
c. increase the speed of movement
d. decrease the duration of the exercise
Answer: c
Rationale: Resistance in water increases in proportion to the speed of the motion. The amount of resistance is also influenced by the shape and size of the object (i.e., lower extremity).

Which formula is the most appropriate for determining duty cycle when using electrical stimulation?
a. on time divided by off time
b. on time divided by total time (on time plus off time)
c. off time divided by on time
d. off time divided by total time (on time plus off time)
Answer: b
Rationale: Duty cycle refers to the percentage of time that electrical current is on in relation to the entire treatment time. Duty cycle equals on time divided by total time (on time and off time).

A therapist treats a patient with a cold pack for 30 minutes. Which condition would most warrant the stated treatment period?
a. acute pain
b. spasticity
c. bursitis
d. subacute inflammation
Answer: b
Rationale: Cryotherapy used to reduce spasticity may extend to period of 30 minutes. Use of a cold pack for traditional therapeutic benefits (e.g., decrease inflammation, promote analgesia, decrease metabolism) typically requires a duration of 15 minutes.

Which substance used with iontophoresis has a positive polarity?
a. lidocaine
b. salicylates
c. dexamethasone
d. calcium chloride
Answer: a
Rationale: Lidocaine has a positive polarity and is used with iontophoresis to provide analgesia and treat inflammation. Salicylates, dexamethasone, and calcium chloride have a negative polarity.

Which massage technique is performed at the beginning and end of a massage to allow the patient to relax?
a. vibration
b. petrissage
c. effleurage
d. tapotement
Answer: c
Rationale: Effleurage is a massage technique performed at the beginning and end of a massage to help the patient to relax. The technique uses a light stroke and produces a reflexive response.

A patient becomes extremely fatigued during a treatment session that includes neuromuscular electrical stimulation to improve muscle strength. Which action would be the most desirable to limit fatigue?
a. decrease the phase duration
b. increase the off time
c. increase the frequency
d. decrease the amplitude
Answer: b
Rationale: Increasing the off time provides the patient with more rest between contractions and therefore serves to limit fatigue during neuromuscular electrical stimulation.

A physical therapist reviews the parameters of several pain modulation theories using transcutaneous electrical nerve stimulation (TENS). When comparing sensory stimulation to motor stimulation, sensory stimulation requires:
a. greater phase duration
b. greater frequency
c. stronger amplitude
d. shorter treatment time
Answer: b
Rationale: Frequency is significantly greater with sensory level stimulation compared to motor level stimulation. Motor stimulation requires sufficient phase charge to elicit a muscle contraction. This is accomplished by using a low frequency and long phase duration. Sensory stimulation, also called conventional TENS, requires a sufficient phase charge to achieve a sensory response, but is below the motor threshold. This is accomplished by using a high frequency and short phase duration.

A physical therapist administers iontophoresis to a patient with a lower extremity ulceration in an attempt to promote tissue healing. Which ion would BEST meet the stated objective?
a. acetate
b. magnesium
c. lidocaine
d. zinc
Answer: d
Rationale: Zinc, from zinc oxide, is a positively charged ion used to promote healing, most often with open lesions and ulcerations. Iontophoresis refers to the transcutaneous delivery of ions into the body for therapeutic purposes using an electrical current. Physical therapists must possess an in-depth awareness of the most appropriate ions to treat specific conditions.

A physical therapist incorporates electrical stimulation as part of the plan of care for a patient rehabilitating from a lower extremity injury. Which of the following recommendations would be LEAST effective to minimize electrode resistance?
a. keep the sponge interface well moistened
b. use small electrodes
c. maintain even, firm contact with the skin
d. remove hair from the skin
Answer: b
Rationale: Small electrodes increase electrode resistance, while large electrodes decrease electrode resistance. Resistance refers to the opposition to electron flow in a conducting material

A physical therapist would like to minimize the likelihood of a burn when using iontophoresis. Which action would be the MOST consistent with the therapist’s objective?
a. increase the size of the cathode relative to the anode
b. decrease the space between the electrodes
c. increase the current intensity
d. decrease the moisture of the electrodes
Answer: a
Rationale: Current density (mA/cm2) is calculated by taking the current amplitude (mA) and dividing by the surface area (cm2). Greater current density will result in an increased risk of an electrochemical burn. Increasing the size of the cathode relative to the anode serves to decrease current density and therefore reduces the probability of a burn when using iontophoresis. The cathode refers to the negatively charged electrode in a direct current system and the anode refers to the positively charged electrode. The accumulation of positively charged ions in a small area creates an alkaline reaction that is more likely to create tissue damage. As a result, it is desirable to increase the size of the cathode.

A physical therapist prepares to administer iontophoresis over the anterior surface of a patient’s knee. The therapist would like to keep the current density low in order to avoid skin irritation. Which of the listed parameters would BEST accomplish the therapist’s objective?
a. current amplitude of 4 mA; electrode with an area of 12 cm2
b. current amplitude of 4 mA; electrode with an area of 4 cm2
c. current amplitude of 3 mA; electrode with an area of 6 cm2
d. current amplitude of 3 mA; electrode with an area of 4 cm2
Answer: a
Rationale: The current density may be altered either by increasing or decreasing current intensity or by changing the size of the electrode. Current density with iontophoresis equals current amplitude (mA) divided by electrode size (cm2). Failure to select appropriate treatment or failure to monitor the patient’s response to treatment creates and unnecessary safety risk. Current density= 4mA/12cm2= .33mA/cm2

A physical therapist adjusts the on:off time on an electrical stimulation unit prior to beginning treatment. When using the unit for muscle re-education the MOST appropriate on:off ratio is:
a. 5:1
b. 15:1
c. 1:5
d. 1:15
Answer: c
Rationale: The on:off ratio should be determined based on the established therapeutic objectives. The on:off ratio for muscle strengthening is most often expressed as 1:5 while a ratio of 1:1 may be more appropriate for a therapeutic objective such as relieving muscles spasm. The initial on:off ratio should be 1:5 in order to minimize muscle fatigue. As the patient gets stronger, the on:off ratio may be altered to 1:4 or 1:3

A patient complains of pain (7/10) and limited ROM of the right shoulder as a result of chronic overuse. The PT elects to use procaine hydrochloride iontophoresis as a part of the intervention for this patient’s problems. To administer this substance, it would be appropriate to use:
a. Continuous biphasic current with the medication under the anode
b. Continuous monophasic current with the medication under the anode
c. Continuous monophasic current with medication under the cathode
d. Interrupted biphasic current with the medication under the cathode
Answer: b
Rationale: Continuous monophasic current, with the medication under the anode
Because like charges are repelled, the positively charged medication would be forced into the skin under the (+) electrode (anode). A continuous unidirectional current flow is very effective in repelling ions into the skin. Procaine is a (+) medicinal ion and will be repelled from the anode (positive pole)

A 10 year old presents with pain (4/10) and limited knee ROM (5,-95) following surgical repair of the medial collateral ligament and ACLs. In this case the modality that can used with PRECAUTION is:
a. Pre-mod IFC
b. Continuous shortwave diathermy
c. High rate TENS
d. Low-dose US
Answer: d
Rationale: Because the epiphyseal plates do not close until the end of puberty, US energy should be applied with caution around the epiphyseal area due to its potential to cause bone growth disturbances. However there is no documented evidence that US creates any direct untoward effects on the growth plates, especially of applied at low dosage

A patient is referred for physical therapy following a fx of the femur 6 months ago. The cast has been removed, but the patient is unable to volitionally contract the quadriceps. The PT decides to apply electrical stimulation to the quadriceps muscle. The BEST choice of electrode size and placement is:
a. Large electrodes, closely spaced
b. Small electrodes, closely spaced
c. Large electrodes, widely spaced
d. Small electrodes, widely spaced
Answer: c
Large electrodes are used on large muscles in order to disperse the current (minimize current density under the electrode), enabling a more comfortable delivery of current. Widely spaced electrodes permit the current to travel deeper into the muscle to stimulate a greater number of deep muscle fibers

A patient was instructed to apply conventional (high-rate) TENS to the low back to modulate a chronic pain condition. The patient now states the TENS unit is no longer effective in reducing the pain in spite of increasing the intensity to maximum. The PT should now advise the patient to:
a. Switch to low-rate TENS
b. Increase the treatment frequency
c. Switch to modulation-mode TENS
d. Decrease the pulse duration
Answer: c
Rationale: Because of the long-term, continuous use of TENS, the sensory receptors accommodated to the continuous current, and longer responded to the stimuli. Changing to modulation mode (i.e., burst modulation), which periodically interrupts the current flow, does not allow accommodation to occur

A patient with spastic hemiplegia is referred to physical therapy for ambulation training. The patient is having difficulty in rising to a standing position due to co-contraction of the hamstrings and quadriceps. The therapist elects to use biofeedback as an adjunct to help break up this pattern. For knee extension, the biofeedback protocol should consist of:
a. High-detection sensitivity, with electrodes place close together
b. Low-detection sensitivity, with electrodes placed far apart
c. High-detection sensitivity, with electrodes placed far apart
d. Low-detection sensitivity, with electrodes placed close together
Answer: d
Rationale: When the electrodes are close together, the likelihood of detecting undesired motor unit activity from adjacent muscles (crosstalk) decreases. By setting the sensitivity (gain) low, the amplitude of signals generated by the hypertonic muscles would decrease and keep the EMG output from exceeding a visual or auditory range

A patient strained the lower back muscles 3 weeks ago, and now complains of pain (6/10). Upon examination the therapist identifies bilateral muscle spasm form T10-L4. The therapist elects to apply IFC to reduce pain and spasm. The BEST electrode configuration to choose in this case would be:
a. Two electrodes, with current flow parallel to the spinal column
b. Two electrodes, with current flow perpendicular to the spinal column
c. Four electrodes, with the current flow diagonal to the spinal column
d. Four electrodes, with the current flow perpendicular to the spinal column
Answer: c
Rationale: The crisscrossed electrode configuration allow: (1) a greater area to be treated and (2) current interference to occur between the frequencies of the two circuits because of the diagonal pattern

A patient with a 2 inch stage II decubitus ulcer over the left lateral malleolus is referred for physical therapy. The therapist notes a greenish pungent exudate at the wound site. The therapist decides to use ES. The BEST choice of polarity and electrode placement is:
a. Anode placed in the wound
b. Cathode paced in the wound
c. Anode placed proximal to wound
d. Cathode placed proximal to wound
Answer: b
Rationale: It is purported that the bactericidal effect produced by negative current is a result of substrate depletion or alteration of the internal processes of the microorganisms. Neutrophils are also attracted to the wound area by chemotaxis to purge the bacteria. The cathode should be placed directly in contact with the wound to cover as much treatment area as possible

A patient complains of pain (7/10) in the shoulder region secondary to acute subdeltoid bursitis. As part of the plan of care during the acute phase, the therapist elects to use conventional TENS, which will modulate the pain primarily through:
a. Ascending inhibition
b. Descending inhibition
c. Stimulation of endorphins
d. Gate control mechanisms
Answer: d
Rationale: The gate control mechanism is activated by the application of conventional (high rate) TENS at the spinal cord level

A patient is referred for outpatient care after a tendon transfer of the extensor carpi radialis longus. The muscle strength tests poor (2/5) in spite of previous intensive therapy. The therapist elects to apply biofeedback to assist in progressively increasing active motor recruitment. Initially the EMG biofeedback protocol should consist of:
a. High-detection sensitivity with recording electrodes placed close together
b. High-detection sensitivity with recording electrodes placed far apart
c. Low-detection sensitivity with recording electrodes placed close together
d. Low-detection sensitivity with recording electrodes placed far apart
Answer: a
Rationale: High-detection sensitivity is needed to detect low-amplitude signals generated by a small number of motor units such as in a weak extensor carpi radialis longus

A patient present with partial and full thickness burns on the chest and neck regions. The therapist decides to apply TENS before debridement to modulate pain. Which TENS mode should provide the BEST relief?
a. Conventional (high-rate) TENS
b. Acupuncture-like (low-rate) TENS
c. Modulated TENS
d. Brief intense TENS
Answer: d
Rationale: Brief intense TENS is used to provide rapid onset, short term relief during painful procedures. The pulse rate and pulse duration are similar to conventional TENS; However the current intensity is increased to patient’s tolerance

An elderly patient presents with stage III decubitus ulcer on the plantar surface of the right foot. After a series of conservative interventions with limited success, the therapist chooses to apply electrical stimulation for tissue repair. The BEST choice of electrical current in this case is:
a. Low-volt biphasic pulsed current
b. High-volt monophasic pulsed current.
c. Medium-frequency burst current
d. Medium-frequency beat current
Answer: b
Rationale: Because high volt pulsed current is a monophasic, unidirectional current, the unidirectional current could produce a therapeutic effect at the active (treatment) electrode. A negative charge (polarity) should be applied for a bactericidal effect or a positive charge given to promote would healing

A therapist is applying a symmetrical biphasic pulsed current to the vastus medialis to improve patellar tracking during knee extension. The patient complains that the current is uncomfortable. To make the current more tolerable to the patient, yet maintain a good therapeutic effect, the therapist should consider adjusting the:
a. Pulse rate
b. Current intensity
c. Pulse duration
d. Current polarity
Answer: c
Rationale: Decreasing the pulse duration reduces the electrical charge at each pulse, making the current more comfortable by decreasing the total current applied while maintaining full therapeutic effect

A patient with spastic hemiplegia is referred to the therapist for ambulation training. The patient is having difficulty with standing up from a seated position as the result of co-contraction of the quadriceps and hamstrings during the k knee and hip extension phase. The therapist wishes to use biofeedback beginning with simple knee extension exercise in the seated position. The plan is to progress to sit-to-stand training. The initial biofeedback protocol should consist of:
a. High detection sensitivity with recording electrodes placed closely together
b. Low detection sensitivity with recording electrodes place closely together
c. Low detection sensitivity with recording electrodes placed far apart
d. High detection sensitivity with recording electrodes placed far apart
Answer: b
Rationale: By initially placing the electrodes close together, the therapist decreases the likelihood of detecting undesired motor units from adjacent active muscles (crosstalk). By setting the biofeedback sensitivity (gain) low, the therapist would decrease the amplitude of the signals generated by the hypertonic muscles and keep the EMG output from exceeding a visual and/or auditory range scale

A patient with TBI presents with hemiparesis. The examination reveals slight cutaneous and proprioceptive impairment, fair (3/5) strength of the shoulder muscles and triceps and slight spasticity of the biceps. Voluntary control of the patient’s left arm and has not progressed since admission. The therapist decides to use FES and place the active electrode on the triceps to facilitate active extension of the elbow. The timing sequence BEST to apply is:
a. 2 sec ramp up, 5 sec stimulation, 2 sec ramp down
b. 5 sec ramp up, 5 sec stimulation, 5 sec ramp down
c. 2 sec ramp up, 10 sec stimulation, 2 sec ramp down
d. No ramp up, 10 sec stimulation, 2 sec ramp down
Answer: b
Rationale: A relatively long ramp-up time over a 5 second period is used to minimize stimulating the muscle too quickly and increasing the spasticity. The ramp-down time has no effect on spasticity

A physical therapist administers ultrasound over a patient’s anterior thigh. After one minute of treatment, the patient reports feeling a slight burning sensation under the sound head. The therapist’s MOST appropriate action is to:

a. explain to the patient that what she feels is not out of the ordinary when using ultrasound
b. temporarily discontinue treatment and examine the amount of coupling agent utilized
c. discontinue treatment and contact the referring physician
d. continue with treatment utilizing the current parameters

Answer: b
Rationale: The complaint of a slight burning sensation may indicate improper coupling. By temporarily discontinuing the treatment and examining the amount of coupling agent used, the physical therapist may be able to continue with treatment. If the physical therapist adds coupling agent and the patient reports a similar sensation, the intervention should be discontinued and the ultrasound unit should be formally inspected by a qualified technician.

A physical therapist prepares to administer ultrasound to a patient with lateral epicondylitis. When applying ultrasound the amount of heat absorbed is LEAST dependent upon:

a. the intensity
b. the duration of exposure
c. the choice of the coupling agent
d. the size of the area sonated

Answer: c
Rationale: A coupling agent is used to transmit ultrasound energy between the transducer and the target area since ultrasound waves do not travel well through air. Examples of coupling agents include gels, lotions, bladders or water. The choice of coupling agent has a relatively small impact when compared to the other presented options.

A physical therapist elects to use mechanical lumbar traction for a patient rehabilitating from a back injury. The therapeutic goals of the session include decreasing the patient’s muscle spasm. The MOST appropriate force based on the stated objective would be:

a. 10% of body weight
b. 15% of body weight
c. 25% of body weight
d. 50% of body weight

Answer: c
Rationale: Twenty-five percent of the patient’s body weight is generally recommended when the goal of treatment is to decrease muscle spasm or stretch soft tissue in the lumbar spine.

A patient diagnosed with infrapatellar tendonitis completes a series of functional activities. After completing the activities the physical therapist instructs the patient to use ice massage over the anterior surface of the knee. The MOST appropriate treatment time is:

a. 3-5 minutes
b. 5-10 minutes
c. 10-15 minutes
d. 15-20 minutes

Answer: b
Rationale: Ice massage requires a treatment time of 5-10 minutes due to the intensity of the cooling

A physical therapist reviews a patient coverage form that lists the parameters used during a recent ultrasound treatment to the right anterior shoulder: 1.5 W/cm2, pulsed 20%, 1 MHz, 6 minutes. Assuming the objective of the ultrasound was to increase tissue temperature, which parameter would be the MOST critical for the therapist to alter?

a. time
b. duty cycle
c. frequency
d. intensity

Answer: b
Rationale: Duty cycle is defined as the ratio of the on time to the total time. When ultrasound is used in a pulsed mode with a 20% or lower duty cycle, the heat produced during the on time of the cycle is dispersed during the off time and as a result there is no measurable net increase in temperature. To increase tissue temperature it would be necessary to significantly increase the duty cycle or use a continuous mode.

A physical therapist elects to begin a trial of mechanical lumbar traction on a 165 pound male diagnosed with suspected nerve root impingement. The MOST appropriate amount of force to initiate the session is:

a. 15 lbs.
b. 30 lbs.
c. 60 lbs.
d. 80 lbs.

Answer: b
Rationale: A traction force of 30-45 lbs. is recommended when initiating mechanical lumbar traction. The amount of force is low enough to reduce the risk of protective muscle guarding and spasm, but is sufficient to determine if traction is likely to aggravate the patient’s symptoms.

A physical therapist sets up a patient for mechanical traction to the lumbar spine. The therapist’s objective is to provide soft tissue stretch to surrounding muscles. Assuming the therapist uses a force equivalent to 25% of the patient’s body weight and the patient has tolerated treatment without difficulty on several other occasions, the MOST appropriate duration of treatment is:

a. 5 minutes
b. 10 minutes
c. 25 minutes
d. 40 minutes

Answer: c
Rationale: A duration of 25 minutes would be appropriate when attempting to stretch soft tissue in a patient who has previously tolerated traction without difficulty. A duration of 20-30 minutes is most often recommended for stretching soft tissue or reducing muscle spasm. This amount of time allows for a prolonged stretch without compromising the integrity of other structures.

A physical therapist uses a 3.0 MHz ultrasound beam at 1.5 W/cm2 to treat a patient diagnosed with carpal tunnel syndrome. The majority of ultrasound energy will be absorbed within a depth of:

a. 1-2 cenitmeters
b. 2-3 centimeters
c. 4-5 centimeters
d. 5-6 centimeters

Answer: a
Rationale: Tissues 1-2 centimeters in depth can be effectively treated with ultrasound using a frequency of 3.0 MHz.

A physical therapist positions a patient in prone on a treatment plinth in preparation for a hot pack. When preparing the hot pack for the low back, the therapist should use:

a. 2-4 towel layers
b. 4-6 towel layers
c. 6-8 towel layers
d. 8-10 towel layers

Answer: c
Rationale: Six to eight towel layers placed between a hot pack and the treatment surface is generally adequate to allow for the necessary transmission of heat without jeopardizing patient safety.

A physical therapist prepares to treat a patient with continuous ultrasound. Which general rule BEST determines the length of treatment when using ultrasound?

a. two minutes for an area that is two times the size of the transducer face
b. five minutes for an area that is two times the size of the transducer face
c. five minutes is the maximum treatment time regardless of the treatment area
d. ten minutes is the maximum treatment time regardless of the treatment area

Answer: b
Rationale: An accepted recommendation is that ultrasound can be administered to an area two to three times the size of the effective radiating area of the transducer face in a five minute period. This recommendation equates to roughly twice the size of the transducer face.

A physical therapist prepares to use phonophoresis as a component of a patient’s plan of care, but is concerned about the potential of the ultrasound to exacerbate the patient’s current inflammation. The MOST effective method to address the therapist’s concern is:

a. utilize ultrasound with a frequency of 1 MHz
b. limit treatment time to five minutes
c. incorporate a pulsed 20% duty cycle
d. select an ultrasound intensity less than 1.5 W/cm2

Answer: c
Rationale: When ultrasound is used in a pulsed mode with a 20% or lower duty cycle, the heat produced during the on time of the cycle is dispersed during the off time and as a result there is no measurable net increase in temperature. Ultrasound using a 20% or lower duty cycle would typically be used for nonthermal effects.

A physical therapist treats a patient diagnosed with spinal stenosis. As part of the treatment program the patient lies prone on a treatment plinth with a hot pack draped over the low back. The MOST effective method to monitor the patient while using the hot pack is:

a. check on the patient at least every 10 minutes
b. supply the patient with a bell to ring if the hot pack becomes too hot
c. instruct the patient to remove the hot pack if it becomes too hot
d. select an alternate superficial heating modality

Answer: b
Rationale: Supplying the patient with a bell to ring if the hot pack becomes too intense provides a form of instant communication with the therapist. The use of a bell does not negate the need for the physical therapist to formally check on the patient frequently.

Prior to initiating an ultrasound treatment a physical therapist formally measures the target area as 12 cm2. Based on the therapist’s measurements the MOST appropriate size soundhead to utilize during the treatment is:

a. 1 cm2
b. 3 cm2
c. 5 cm2
d. 8 cm2

Answer: c
Rationale: A soundhead 5 cm2 is slightly less than half the size of the target area. This size soundhead would allow the therapist to achieve the desired therapeutic effects within a reasonable amount of time.

A physical therapist uses intermittent compression to treat a patient with an acute ankle sprain. The patient is positioned in supine with the leg elevated on a 40 degree wedge. The therapist uses an inflation pressure of 50 mm Hg with an on:off time of 40 seconds on and 20 seconds off. The treatment time is scheduled for 20 minutes. After five minutes of treatment the patient reports some discomfort in the ankle. The MOST appropriate modification to the current treatment parameters would be:

a. increase the inflation pressure
b. increase the off time
c. increase the total treatment time
d. increase the elevation of the leg

Answer: b
Rationale: Increasing the off time greater than the current 20 second interval would provide the patient with a greater rest period and may therefore decrease the patient’s discomfort.

A physical therapist selects a therapeutic ultrasound generator with a frequency of 3.0 MHz. Which condition would MOST warrant the use of this frequency?

a. lumbar paravertebral
b. hip flexion contracture
c. quadriceps strain
d. anterior talofibular ligament sprain

Answer: d
Rationale: The anterior talofibular ligament is a thickening of the anterior joint capsule that extends from the anterior surface of the lateral malleolus to the lateral facet of the talus and the lateral surface of the talar neck. The relatively superficial ligament is only two to five millimeters thick and therefore a frequency of 3.0 MHz would be adequate.

A physical therapist employed in a busy outpatient orthopedic clinic attempts to determine a schedule for calibration and maintenance of an ultrasound unit. The MOST important factor for the therapist to consider when determining an appropriate schedule is:

a. beam nonuniformity ratio
b. frequency of use
c. cost associated with calibration and maintenance
d. availability of qualified personnel to inspect the unit

Answer: b
Rationale: The frequency of use of an ultrasound device is extremely important when determining a schedule for calibration and maintenance. Ultrasound units used frequently may be calibrated several times a year, while a unit used sparingly would likely warrant a longer interval.

A patient is treated using pulsed wave ultrasound at 1.2 W/cm2 for seven minutes. The specific parameters of the pulsed wave are 2 msec on time and 8 msec off time for one pulse period. The duty cycle should be recorded as:

a. 10%
b. 20%
c. 25%
d. 50%

Answer: b
Rationale: The question indicates that the parameters of the pulsed wave are 2 msec on time and 8 msec off time for one pulse period. As a result, duty cycle=2 msec/(2 msec + 8 msec) = .20 (100)= 20%

A patient reports significant discomfort in the lower leg during ultrasound treatment. The therapist believes the discomfort is caused by periosteal pain from the ultrasound. Which scenario is MOST likely associated with the patient’s subjective report of discomfort?

a. an ultrasound unit with a high beam nonuniformity ratio
b. an ultrasound unit with a low beam nonuniformity ratio
c. a transducer with a large effective radiating area
d. a transducer with a small effective radiating area

Answer: a
Rationale: A high beam nonuniformity ratio produces a less uniform beam and therefore places the patient at greater risk for undesirable side effects such as periosteal pain or hot spots.

A patient has a transtibial amputation and has recently been fitted with a patellar tendon-bearing (PTB) socket. During initial prosthetic checkout the PT instructs the patient to walk several times in the parallel bars, and then sit down and take off the prosthesis. Upon inspection of the skin, the therapist would expect no rednesss in the area of the:
a. Anterior Tibia and tibial crest
b. Patellar tendon and tibial tuberosity
c. Medial tibial and fibular plateaus
d. Medial and lateral distal ends of the residual limb
A

A patient is recovering from a right cerebrovascular accident (CVA), resulting in severe left hemiplegia and visuospatial deficits. In addition, there is a large diabetic ulcer on the left foot with pitting edema. The BEST choice for wheelchair prescription for this patient is:
a. Hemiplegic chair with elevating leg rest on the left.
b. Powered wheelchair with joystick and elevating leg rests
c. Lightweight active duty wheelchair with elevating leg rests
d. One-arm drive chair with elevating leg rest on the left
A

A patient fractured the right mid tibia in a skiing accident 3 months ago. After cast removal, a severe foot drop was noted. The patient wants to try electrical stimulation orthotic substitution. The PT would set up the functional electrical stimulation to contract the appropriate muscles during:
a. Late stance at push-off
b. Mid swing
c. Early stance at foot-flat
d. Late stance at toe-off
B

A patient complains of pain (7/10) and limited range of motion (ROM) of the right shoulder as a result of chronic overuse. The PT elects to use procaine hydrochloride Iontophoresis as part of the intervention for this patient’s problems. To administer this substance, it would be appropriate to use:
a. Continuous biphasic current, with the medication under the anode.
b. Continuous monophasic current, with the medication under the anode
c. Continuous monophasic current, with the medication under the cathode
d. Interrupted biphasic current, with the medication under the cathode.
B

A 10-year-old presents with pain (4/10) and limited knee ROM (5-95) following surgical repair of the medial collateral ligament and ACLs. In this case, the modality that can be used with PRECAUTION is:
a. Premodulated interferential current
b. Continuous shortwave diathermy
c. High-rate transcutaneous electrical stimulation
d. Low-dose ultrasound (US)
D

A patient with a complete spinal cord injury (SCI) at the T6 level is being discharged home after 2 months of rehabilitation. In preparation for discharge, the rehabilitation team visits the home and finds three standard-height steps going into his home, A ramp will have to be constructed for wheelchair access. The recommended length of this ramp should be:
a. 60 inches (5 feet)
b. 192 inches (16 feet)
c. 252 inches (21 feet)
d. 120 inches (10 feet)
C

A patient diagnosed with lumbar spinal root impingement due to narrowing of the intervertebral foramen has been referred to physical therapy for mechanical traction. What is the lowest percentage of body weight that should be considered for the initial traction force when using a split table?
a. 15%
b. 25%
c. 55%
d. 85%
B

A patient is referred for physical therapy following a fracture of the femur 6 months ago. The cast has been removed, but the patient is unable to volitionally contract the quadriceps. The PT decides to apply electrical stimulation to the quadriceps muscle. The BEST choice of electrode size and placement is:
a. Large electrodes, closely spaced
b. Small electrodes, closely spaced
c. Large electrodes, widely spaced
d. Small electrodes, widely spaced
C

A patient was instructed to apply conventional (high-rate) transcutaneous electrical nerve stimulation (TENS) to the low back to modulate a chronic pain condition. The patient now states that the TENS unit is no longer effective in reducing the pain in spite of increasing the intensity to maximum. The PT should now advise the patient to:
a. Switch to low rate TENS
b. Increase the treatment frequency
c. Switch to modulation-mode TENS
d. Decrease the pulse duration
C

A patient with spastic hemiplegia is referred to physical therapy for ambulation training. The patient is having difficulty in rising to a standing position due to cocontraction of the hamstrings and quadriceps. The therapist elects to use biofeedback as an adjunct to help break up this pattern. For knee extension, the biofeedback protocol should consist of:
a. High detection sensitivity, with electrodes placed close together
b. Low-detection sensitivity, with electrodes placed far apart
c. High-detection sensitivity, with electrodes placed far apart
d. Low-detection sensitivity, with electrodes placed close together
D

A patient has extensive full-thickness burns to the dorsum, of the right hand and forearm, and is being fitted with a resting splint to support the wrists and hands in a functional position. The splint should position the wrist and hand in:
a. Neutral wrist position, with slight finger flexion and thumb flexion
b. Slight wrist extension, with fingers supported and thumb in partial opposition and abduction
c. Slight wrist flexion, with interphalangeal extension and thumb opposition
d. Neutral wrist position, with interphalangeal extension and thumb flexion
B

The use of ultrasound in the area of a joint arthroplasty is permissible, even if the surrounding area contains:
a. Plastic implants
b. Infected tissue
c. Metal implants
d. Neoplastic lesions
C

A patient with a T4 spinal cord injury (SCI) is being measured for a wheelchair. In determining the correct seat height, the PT can use as a measure:
a. Clearance between the floor and the foot plate of at least 2 inches
b. Clearance between the floor and the foot plate of at least 4 inches
c. The patients leg length measurement plus 4 inches
d. The distance from the bottom of the shoe to just under the thigh at the popliteal fossa.
A

A patient has been diagnosed with acute synovitis of the temporomandibular joint. Early intervention should focus on:
a. Application of an intraoral appliance and phonophoresis
b. Joint mobilization and postural awareness
c. Instruction to eat a soft food diet and phonophoresis
d. Temporalis stretching and joint mobilization
C

A factory worker injured the right arm in a factory press with damage to the ulnar nerve at the elbow. A diagnostic EMG was performed 3 weeks after the injury, with evidence of spontaneous fibrillation potentials. In this case, the PT recognizes that:
a. Denervation has occurred
b. Reinnervation is complete
c. Neurapraxia has occurred
d. Reinnervation is in process
A

A Contraindication to initiating extremity joint mobilization on a patient with chronic pulmonary disease may include:
a. Reflex muscle guarding
b. Long-term corticosteroid therapy
c. Concurrent inhalation therapy
d. Functional chest wall immobility
B

A diagnosis of bicipital tendinitis has been made following an evaluation of a patient with shoulder pain. The BEST shoulder position to expose the tendon of the long head of the biceps for application of phonophoresis would be:
a. Lateral rotation and extension
b. Medial rotation and abduction
c. Horizontal adduction
d. Abduction
A

Following major surgery of the right hip, a patient ambulates with a Trendelenburg gait. Examination of the right hip reveals abductor weakness (gluteus medius 3/5) and ROM limitations in flexion and external rotation. As part of the intervention, the PT opts to include functional electrical stimulation to help improve the gait pattern. Stimulation should be initiated for the:
a. Right abductors during swing on the right
b. Right abductors during stance on the right
c. Left abductors during stance on the right
d. Left abductors during swing on the right
B

A computer programmer in her second trimester of pregnancy was referred to physical therapy with complaints of tingling and loss of strength in both her hands. Her symptoms are exacerbated if she is required to use her keyboard at work for longer than 20 minutes. The MOST beneficial physical therapy intervention is:
a. Dexamethasome phonophoresis to the carpal tunnel
b. Ice packs to the carpal tunnel
c. Hydrocortisone Iontophoresis to the volar surfaces of both wrists
d. Placing wrists in resting splints
D

A 12 yr old has been referred to a physical therapy clinic for treatment of patellar tendinitis. The examination reveals that the patient is unable to hop on the affected lower extremity because of pain. The PT decides to refer the patient back to pediatrician for an x-ray of the knee. The patient returns for therapy with the x-ray shown in the figure. Ther therapist’s initial intervention should focus on:
a. Aggressive plyometric exercises with focus on endurance training
b. Iontophoresis using dexamethasome and patient education regarding avoidance of squatting and jumping
c. Fitting the patient with crutches for non-weight bearing ambulation and initiation of hydrocortisone phonophoresis
d. Patient education regarding avoiding falls onto the affected knee, and open chain knee, extension exercises to improve quadriceps strength
B

Following a total knee replacement (TKR), continuous passive motion (CPM) is initiated. One of the main objectives in using CPM in this case is to facilitate:
a. Active knee extension
b. Active knee flexion
c. Passive knee flexion
d. Passive knee extension
B

A patient is being treated for secondary lymphedema of the right arm as a result of a radical mastectomy and radiation therapy. The resulting edema (stage 1) can best be managed in physical therapy by:
a. Isokinetics, extremity positioning in elevation and massage
b. AROM and extremity positioning in a functional arm/hand position
c. Isometric exercises, extremity positioning in elevation and compression bandaging
d. Intermittent pneumatic compression, extremity elevation and massage
D

A retired bus driver has experienced increasing frequency of low back pain over the past 10 years. The patient states that nonsteroidal anti-imflamatory drugs( NSAIDs) help to relieve the symptoms, but there is always a nagging-type pain. The patient reports significant stiffness in the morning that dissipates by noon after exercising and walking. Pain is exacerbated with frequent lifting and bending activities, as well as sitting for long periods. Physical therapy intervention should emphasize:
a. modalities to reduce pain, joint mobilization and lumbar extension exercises.
b. joint mobilization, soft tissue mobilization and dynamic stabilization
c. Postural reeducation, soft tissue mobilization and dynamic stabilization
d. Modalities to reduce pain , postural reeducation and dynamic stabilization exercises.
C

A patient is seen in physical therapy 2 days after a motor vehicle accident. The chief complaints are headaches, dizziness, neck pain with guarding and a “sensation of a lump in the throat. “plain film x-rays were read as negative. The therapist should refer this patient for a :
a. second series of plain film x-rays.
b. myelogram
c. T2 magnetic resonance imaging (MRI).
d. Computed tomography (CT) scan
D

A patient recovering from an incomplete spinal cord injury at the L3 level ( Asia scale D) ambulates with bilateral lofstrand crutches. The patient reports great difficulty going down ramps with unsteady , wobbly knees. An appropriate intervention for this problem would be:
a. Prolonged icing to reduce hamstring pain
b. Biofeedback training to reduce knee extensor spasticity.
c. Progressive resistance training for the quadriceps.
d. stretching using a posterior resting splint for tight plantar flexors.
C

A patient presents with multiple fractures of both hands and wrists as a result of a mountain bike accident. Now, 5 weeks later, the patient has vertigo, limited wrist and finger motion and dry , scaly skin over the involved areas. The physical agent of Greatest Benefit to select in this case would be:
a. Paraffin
b. Hot packs
c. Functional electrical stimulation
d. Contact ultrasound
A

A patient presents with pain and paresthesia over the first two metatarsal heads of her right foot. Pain is worse after prolonged periods of weight bearing. she typically wears shoes with 3 inch heels and pointed toes. The Best intervention is a:
a. pad placed distal to the metatarsal heads
b. scaphoid pad to support the medial longitudinal arch
c. thomas heel to support the medial longitudinal arch
d. pad placed proximal to the metatarsal heads.
D

A patient developed right throbbing shoulder pain after painting the kitchen. Passive and active glenohumeral motions increase pain. The Best Initial intervention for this acute shoulder condition is :
a. Manual therapy techniques and modalities to reduce pain as the result of subdeltoid bursitis
b. correction of muscle imbalances to allow healing of right shoulder supraspinatus tendinitis
c. Stretching of the pectoralis minor muscle after acromioclavicular joint inflammation
d. Rotator cuff strengthening exercises to allow ADL function after biceps tendinitis
A

A patient demonstrates postpartum sacral pain. the patient complains that pain is increased with prolonged walking, ascending or descending stairs and rising from sit-to-stand. The intervention that is Most beneficial for this problem is:
a. cryotherapy and TENS to promote normal healing
b. performing mobilization followed by cryotherapy to restore normal motion to the SI joint.
c. Increasing non-weight bearing with ambulation training and stabilization using a lumbosacral orthosis.
d. Manual therapy techniques of the SI joint to provide relief of symptoms, and therapeutic exercise to restore normal function of the pelvic girdle
D

A patient sprained the left ankle 4 days ago. The patient complains of pain (4/10), and there is moderate swelling that is getting worse. At this time, which intervention would be Best to use?
a. Intermittent compression followed by elevation.
b. Contrast baths followed by limb elevation
c. Cold whirlpool followed by massage.
d. Cold/intermittent compression combination with the limb elevated.
D

A patient with a 2 inch stage II decubitus ulcer over the left lateral malleolus is referred for physcial therapy . The therapist notes a greenish, pungent exudate at the wound site. The therapist decides to use electrical stimulation. The Best choice of polarity and electrode placement is:
a. Anode place in the wound
b. Cathode placed in the wound.
c. Anode placed proximal to wound.
d. Cathode placed proximal to wound.
B

During an ultrasound treatment, the patient flinches and states that a strong ache was felt in the treatment area. To address this patient’s concern, it would be Best to:
a. increase the size of the treatment area
b. add more transmission medium
c. decrease the US intensity
d. decrease the US frequency
C

A patient complains of pain (7/10) in the shoulder region secondary to acute subdeltoid bursitis. As part of the plan of care during the acute phase, the therapist elects to use conventional TENS, which will modulate the pain primarily through :
a. ascending inhibition
b. descending inhibition
c. stimulation of endorphins
d. Gate control mechanisms
D

A patient is referred for outpatient care after a tendon transfer of the extensor carpi radialis longus. The muscle strength tests poor (⅖) in spite of previous intensive therapy. The therapist elects to apply biofeedback to assist in progressively increasing active motor recruitment. Initially, the EMG biofeedback protocol.
a. high-detection sensitivity with recording electrodes placed close together.
b. high-detection sensitivity with recording electrodes placed far apart
c. low-detection sensitivity with recording electrodes placed close together
d. low-detection sensitivity with recording electrodes placed far apart.
A

A PT requested that a physical therapy assistant (PTA) perform ultrasound (US) to the shoulder of a patient. During the treatment session, the patient experienced an electrical shock. The PT would be responsible for any injury to the patient if it was the result of:
a. the patient touching the US device during treatment
b. The PTA failing to use a ground fault interrupter (GFI)
c. The PT having instructed the PTA to use a device that had a malfunctioned on the previous day
d. faulty circuitry
C

2. A patient presents with partial- and full-thickness burns on the chest and neck regions. The therapist decides to apply transcutaneous electrical nerve stimulation (TENS) before debridement to modulate pain. Which TENS mode should provide the BEST relief?
a. conventional (high rate ) TENS
b. Acupuncture-like (low rate) TENS
c. Modulated TENS
d. Brief Intense TENS
D

3. Electromyogram (EMG) activity in the lower extremities during quiet standing is fairly continuous in the:
a. Anterior tibialis and peroneals
b. posterior tibialis and instrinsic foot muscles
c. quadriceps femoris and anterior tibialis
d. soleus and gastrocnemius
D

4. An elderly patient presents with a stage III decubitus ulcer on the plantar surface of the right foot. After a series of conservative interventions with limited success, ther threapist chooses to apply electrical stimulation for tissue repair. The BEST choice for electrical current in this case is:
a. low-volt biphasic pulsed current
b. High-volt monophasic pulsed current
c. medium frequency burst current
d. medium frequency beat current
B

5. A patient presents with pain radiating down the posterior thip and thigh as a result of a herniated disc in the lumbar spine. The therapist decides to apply mechanical traction. If the patient can tolerate it, the PREFERRED patient position is:
a. supine with one knee flexed
b. supine with both knees flexed
c. prone with no pillow
d. prone with pillow under the abdomen
C

6. A patient presents with supraspinatus tendinitis. After the initial cryotherapy, the therapist decides to apply US. To effectively treat the supraspinatus tendon, the therapist should place the shoulder joint in:
a. slight abduction and external rotation
b. slight abduction and internal rotation
c. adduction and internal rotation
d. adduction and external rotation
B

7. A therapist is applying a symmetrical biphasic pulsed current to the vastus medialis to improve patellar tracking during knee extension. The patient complains that the current is uncomfortable. To make the current more tolerable to the patient, yet maintain a good therapeutic effect, the therapist should consider adjusting the:
a. pulse rate
b. current intensity
c. pulse duration
d. current polarity
C

8. An elderly patient with a left transfemoral amputation complains that when sitting, the left foot feel cramped and twisted. Th therapist’s BEST choice of intervention is:
a. hot packs and continuous US to the residual limb
b. iontophoresis to the distal limb using hyaluronidase
c. appropriate bed positioning with the residual limb in extension
d. icing and massage to the residual limb
D

9. A patient with spastic hemiplegia is referred to the therapist for ambulation training. The patient is having difficulty with standing up from a seated position as the result of co-contraction of the quadriceps and hamstrings during the knee and hip extension phase. The therapist wishes to use biofeedback beginning with simple knee extension exercise in the seated position. The plan is to progress to sit-to-stand training. The initial biofeedback protocol should consist of:
a. high detection sensitivity with recording electrodes placed close together
b. low detection sensitivity with recording electrodes placed closely together
c. low detection sensitivity with recording electrodes placed far apart
d. high detection sensitivity with recording electrodes placed far apart
B

10. A patient presents with pain and muscle spasm of the upper back (C7-T8) extending to the lateral border of the scapula. This encompasses a 10 x 10-cm area on both sides of the spine. If the US only has a 5-cm^2 sound head, the therapist should treat:
a. the entire area in 5 minutes
b. the entire area in 10 minutes
c. each side, allotting 2.5 minutes for each section
d. each side, allotting 5 minutes for each section.
D

11. A patient with a traumatic brain injury presents with hemiparesis. The examination reveals slight cutaneous and proprioceptive impairment, fair (3/5) strength of the shoulder muscles and triceps and slight spasticity of the biceps. Voluntary control of the patients left arm has not pregressed since admission. The therapist decides to use FES and place the active electrode on the triceps to facilitate active extension of the elbow. The timing sequence BEST to apply is:
a. 2-second ramp up, 5-second stimulation, 2-second ramp down
b. 5-second ramp up, 5-second stimulation, 5-second ramp down
c. 2-second ramp up, 10-second stimulation, no ramp down
d. no ramp up, 10 second stimulation, 2-second ramp down
B

1. A patient presents with pain radiating down the posterior hip and thigh as a result of a herniated disc in the lumbar spine. The therapist decides to apply mechanical traction. If the patient can tolerate it, the preferred patient position is:
a. Supine with one knee flexed
b. Prone with pillow under the abdomen
c. Supine with both knees flexed
d. Prone with no pillow
B

2. A patient with a traumatic brain injury presents with hemiparesis. The examination reveals slight cutaneous and proprioceptive impairment, fair (3/5 strength) of the shoulder muscles and triceps, and slight spasticity of the biceps. Voluntary control of the patient’s left arm has not progressed since admission. The therapist decides to use FES and place the active electrode on the triceps to facilitate active extension of the elbow. The timing sequence BEST to apply is:
a. No ramp up, 10 second stimulation, 2 second ramp down
b. 2 second ramp up, 10 second stimulation, no ramp down
c. 2 second ramp up, 5 second stimulation, 2 second ramp down
d. 5 second ramp up, 5 second stimulation, 5 second ramp down
D

3. A therapist is applying a symmetrical biphasic pulsed current to the vastus medialis to improve patellar tracking during knee extension. The patient complains that the current is uncomfortable. To make the current more tolerable to the patient, yet maintain a good therapeutic effect, the therapist should consider adjusting the:
a. Current polarity
b. Pulse duration
c. Current intensity
d. Pulse rate
B

4. A patient complains of pain (7/10) and limited range of motion (ROM) of the right shoulder as a result of chronic overuse. The PT elects to use procaine hydrochloride iontophoresis as part of the intervention for this patient’s problems. To administer this substance, it would be appropriate to use:
a. Continuous monophasic current, with the medication under the anode
b. Continuous biphasic current, with the medication under the anode
c. Interrupted biphasic current, with the medication under the cathode
d. Continuous monophasic current, with the medication under the cathode
A

5. A patient fractured the right mid tibia in a skiing accident 3 months ago. After cast removal, a severe foot drop was noted. The patient wants to try electrical stimulation orthotic substitution. The PT would set up the functional electrical stimulation to contract the appropriate muscles during:
a. Mid swing
b. Late stance at push off
c. Early stance at foot flat
d. Late stance at toe off
A

6. A patient is referred for outpatient care after a tendon transfer of the extensor carpi radialis longus. The muscle strength tests poor (2/5) in spite of previous intensive therapy. The therapist elects to apply biofeedback to assist in progressively increasing active motor recruitment. Initially, the EMG biofeedback protocol should consist of:
a. High-detection sensitivity with recording electrodes placed far apart.
b. Low-detection sensitivity with recording electrodes placed close together.
c. High-detection sensitivity with recording electrodes placed close together
d. Low-detection sensitivity with recording electrodes placed far apart
C

7. A patient is referred for PT following a fracture of the femur 6 months ago. The cast has been removed, but the patient is unable to volitionaly contract the quadriceps. The PT decides to apply electrical stimulation to the quadriceps muscle. The BEST choice of electrode size and placement is:
a. small electrodes, closely spaced
b. large electrodes, widely spaced
c. small electrodes, widely spaced
d. large electrodes, closely spaced
B

8. The use of ultrasound in the area of a joint arthroplasty is permissible, even if the surrounding area contains: (A-193)
a. metal implants
b. infected tissue
c. plastic implants
d. neoplastic lesions
A

9. A patient presents with weakness and atrophy of the biceps brachii resulting from an open fracture of the humerus. The therapist’s examination includes needle electromyography (EMG) of the biceps. The muscle response anticipated after the needle is inserted and prior to asking the patient to contract the muscle is:
a. polyphasic potentials
b. interference patterns
c. electrical silence
d. fibrillation potentials
C

10. A therapist has elected to use continuous inductive coil short wave diathermy (SWD) as one of the interventions in managing hip pain. Use of other thermal or electrical modalities were either ineffective or contraindicated. Which patient would be a candidate for use of short wave diathermy?
a. A morbidly obese patient
b. A patient with Type 1 diabetes who use an insulin pump.
c. An 11 year-old boy with a slipped capital femoral epiphysis
d. A patient with ankylosing spondylitis on high doses of NSAIDS and DMARDS.
D

11. A patient strained the lower back muscle 3 weeks ago, and now complains of pain (6/10). Upon examination the therapist identifies bilateral muscles spasm from T10-L4. The therapist elects to apply interferential current to help reduce pain and spasm. The BEST electrode configuration to choose in this case would be:
a. four electrodes, with the current flow perpendicular to the spinal column.
b. two electrodes, with current flow perpendicular to the spinal column.
c. four electrodes, with current flow diagonal to the spinal column
d. two electrodes, with the current parallel to the spinal column.
C

12. A patient presents with multiple fractures of both hands and wrists as a result of a mountain bike accident. Now, 5 weeks later, the patient has limited wrist and finger motion and dry, scaly skin over the involved areas. What is the physical agent that would provide the GREATEST benefit? (B-88)
a. contact ultrasound
b. hot packs
c. paraffin
d. functional electrical stimulation
C

A patient employed in a machine shop is referred to physical therapy with a diagnosis of carpal tunnel syndrome, the patient indicates that he is scheduled for a diagnositic test that may help to confirm the diagnosis. Which of the following electrodiagnostic tests would be the MOST appropriate?
a. Electroencephalography
b. Evoked potentials
c. Nerve conduction velocity
d. Electromyography
C

A physical therapist uses Iontophoresis over the anterior knee of a patient with patellar tendonitis. Assuming the therapist’s goal is to reduce the patient’s present level of pain, the MOST appropriate solution to ultilize is:
a. Acetic acid
b. Lidocaine
c. Sodium chloride
d. Zinc oxide
B

. A physical therapist elects to use mechanical lumbar traction for a patient rehabilitating from a back injury. The therapeutic goals of the session include decreasing the patient’s muscle spasm. The MOST appropriate force based on the stated objective would be:
a. 10% of body weight
b. 15% of body weight
c. 25% of body weight
d. 50% of body weight
C

A physical therapist inspects a burn obtained as a result of Iontophoresis. The therapist describes the burn as an acidic reaction. If the therapist is correct, the pH of the skin would MOST likely be:
a. 2
b. 4
c. 6
d. 8
A

A physical therapist adjusts the on:off time on an electrical stimulation unit prior to beginning treatment. When using the unit for muscle re-education the MOST appropriate on:off ratio is:
a. 5:1
b. 15:1
c. 1:5
d. 1:15
C

A physical therapist is scheduled to administer a whirlpool treatment to a patient that is HIV positive. The therapist is concerned about her ability to complete the treatment since she sustained a small paper cut on her fourth digit approximately three hours ago. The MOST appropriate therapist action is:
a. Refuse to treat the patient and document the rationale in the medical record
b. Treat the patient using appropriate medical asepsis
c. Ask the patient to reschedule their appointment
d. Select another appropriate treatment procedure
B

A patient is treated using pulsed wave ultrasound at 1.2 W/cm^2 for seven minutes. The specific parameters of pulsed wave are 2 msec on time and 8 msec off time for one pulse period. The duty cycle should be recorded as:
a. 10%
b. 20%
c. 25%
d. 50%
B

A physical therapist uses functional electrical stimulation as part of a treatment regimen designed to improve quadriceps strength. which on:off time ratio would result in the MOST rapid onset of muscle fatigue?
a. 3:1
b. 1:4
c. 5:1
d. 1:6
C

9. A physical therapist employed by a home health agency visits a patient status post total knee arthropllasty. The patient was discharged from the hospital yesterday and according to the medical record had an unremarkable recovery. the physician orders include the use of a continuous passive motion machine. The MOST appropriate rate of motion would be:
a. 2 cycles per minute
b. 4 cycles per minute
c. 6 cycles per minute
d. 8 cycles per minute
A

10. A physical therapist reviews the parameters of several pain modulation theories using transcutaneous electrical nerve stimulation (TENS). when comparing sensoryu stimulation to motor stimulation, sensory stimulation requires:
a. greater phase duration
b. greater frequency
c. stronger amplitude
d. shorter treatment time
B

11. A physical therapist prepares to applu a hot pack to the low back of a patient diagnosed with degenerative disk disease. when examining the patient the therapist identifies several blisters on the patient’s right side. the patient indicates they were caused by heat from a hot pack applied during the previous treatment session. The patient indicates he was hesitant to tell the therapist that the heat was too intense. The MOST appropriate therapist action is to:
a. complete an incident report
b. contact the referring physician
c. modify the documentation from the previous treatment session
d. avoid documenting the event since it occurred during the previous treatment session.
A

12. A physical therapist prepares to administer ultrasound to a patient with lateral epicondylitis. When applying ultrasound the amount of heat absorbed is LEAST dependent upon:
a. the intensity
b. the duration of exposure
c. the choice of the coupling agent
d. the size of the area sonated
C

1. A physical therapist using an electrical stimulation device attempts to quantify several characteristics of a monophasic waveform. When measuring phase change, the standard unit of measure is the:
a. coulomb
b. ampere
c. ohm
d. second
A

2. A patient rehabilitating from a lower extremity injury is referred to physical therapy for hydrotherapy treatments. the physical therapist would like the patient to fully extend the involved lower extremity while sitting in the hydrotherapy tank. Which type of whirlpool would NOT allow the patient to extend the involved lower extremity?
a. hubbard tank
b. highboy tank
c. lowboy tank
d. walk tank
B

3. A physical therapist prepares a whirlpool treatment for a scheduled patient. which treatment area would place the patient at the GREATEST risk for hypothermia?
a. wrist and hand
b. thigh
c. elbow
d. foot and ankle
B

4. A physical therapist checks the water temperature of the hot pack machine after several patient report the heat being very strong. Which of the following temperatures would be acceptable?
a. 64 degrees celsius (147 degrees F)
b. 71 degrees C (160 degrees F)
c. 83 degrees C (181 degree F)
d. 94 degrees C (201 degrees F)
B

5. A 28 yr old male referred to physical therapy by his primary physician complains of recurrent ankle pain. As part of the treatment program, the therapist uses ultrasound over the peroneus longus and brevis tendons. The MOST appropriate location for the ultrasound application is:
a. inferior to the sustentaculum tali
b. over the sinus tarsi
c. posterior to the lateral malleollus
d. anterior to the lateral malleolus
C

6. A physical therapist treats a patient rehabilitating from an achilles tendon repair using cryotherapy. Which cryotherapeutic agent would provide the GREATEST magnitude of tissue cooling?
a. frozen gel packs
b. ice massage
c. flouri-methane spray
d. cold water bath
B

7. A physical therapist uses a 3.0 MHz ultrasound beam at 1.5 W/cm^2 to treat a patient diagnosed with carpal tunnel syndrome. The MAJORITY of ultrasound energy will be absorbed within a depth of:
a. 1-2 cm
b. 2-3 cm
c. 4-5 cm
d. 5-6 cm
A

8. A physical therapist positions a patient in prone on a treatment plinth in preparation for a hot pack. When preparing the hot pack for the low back, the therapist should ultilize:
a. 2-4 towel layers
b. 4-6 towel layers
c. 6-8 towel layers
d. 8-10 towel layers
C

9. A physical therapist records the parameters of an electrical stimulation treatment in a patients medical record. the standard unit of measure when recording alternating current frequency is:
a. volt
b. hertz
c. coulumb
d. pulses per second
B

10. A physical therapist utilizes continuous ultrasound to supply thermal effects to a patient rehabilitating from a lower extremity injury. During the treatment session, the patient suddenly becomes startled and reports feeling an electrical shock from the ultrasound machine. The MOST appropriate therapist action is to:
a. decrease the intensity of the ultrasound
b. modify the duty cycle
c. discontinue ultrasound treatment
d. unplug the machine and label – “defective, do not use”
D

11. A physical therapist treats a patient who sustained a right lateral ankle sprain less than six hours ago. The therapist contemplates the use of cold water immersion as a crytherapeutic agent. what would be the primary limitation of this type of intervention?
a. decreased cell metabolism
b. excessive vasoconstriction of blood vessels
c. the involved extremity cannot be elevated
d. decreased nerve conduction velocity
C

12. A physical therapist observes a patient’s skin shortly after applying moist heat to the low back. The therapist identifies several signs of heat intolerance including uneven blotching and a surface rash. The MOST appropriate action is to:
a. continue with the present treatment
b. select an alternate superficial heating agent
c. limit moist heat exposure to five minutes
d. discontinue the moist heat and document the findings
D

13. A physician orders compression garments for an ambulatory patient who has significant difficulty with lower extremity edema. How much pressure would typically be necessary to control lower extremity edema?
a. 10 mmHg
b. 18 mmHg
c. 25 mmHg
d. 35 mmHg
D

14. A physician orders electromyography for a patient with a brachial plexus injury to objectively determine the extent of the pathology. Which of the following responses is most indicative of a normal muscle at rest?
a. electrical silence
b. spontaneous potentials
c. polyphasic potentials
d. occasional motor unit potentials
A

15. a physical therapist treats a patient diagnosed with lateral epicondylitis using iontophoresis. the therapist uses dexamethasone with a current intensity of 3 mA for 20 minutes. How often during the treatment session should the therapist check the skin?
a. every minute
b. every 3 to 5 minutes
c. every ten minutes
d. at the conclusion of the treatment session
B

16. A physical therapist administers iontophoresis to a patient with a lower extremity ulceration in an attempt to promote tissue healing. which ion would BEST meet the stated objective?
a. acetate
b. magnesium
c. lidocaine
d. zinc
D

17. A patient diagnosed with lateral epicondylitis is referred to physical therapy. the therapist elects to use iontophoresis over the lateral epicondyle. Which type of current would the physical therapist use to administer the treatment?
a. direct
b. alternating
c. pulsative
d. interferential
A

18. A physical therapist sets up a patient for mechanical traction to the lumbar spine. The therapist’s objective is to provide soft tissue stretch to surrounding muscles. Assuming the therapist uses a force equivalent to 25% of the patient’s body weight and the patient has tolerated treatment without difficulty on several other occasions, the MOST appropriate duration of treatment is:
a. 5 minutes
b. 10 minutes
c. 25 minutes
d. 40 minutes
C

19. A physical therapist prepares to treat a patient with continuous ultrasound. Which general rule BEST determines the length of treatment when using ultrasound?
a. two minutes for an area that is two times the size of the transducer.
b. five minutes for an area that is two times the size of the transducer face
c. five minutes is the maximum treatment time regardless of the treatment area
d. ten minutes is the maximum treatment time regardless of the treatment area
B

20. A physical therapist preparing a hot pack notices the water in the hot pack unit is cloudy. The MOST probably explanation is:
a. power failure
b. seepage from a hot pack
c. ineffective heating element
d. thermostat set too low
B

A patient status post knee surgery receives instructions on the use of a continuous passive motion machine. Which of the following would be the MOST essential to ensure patient safety?
a. instructions on progression of range of motion
b. utilization of proximal and distal stabilization straps
c. recommendations for cryotherapy following treatment sessions
d. orientation to remote on/off switch
D

22. A physical therapist prepares to use phonophoresis as a component of a patient’s plan of care, but is concerned about the potential of the ultrasound to exacerbate the patient’s current inflammation. The MOST effective method to address the therapist’s concern is:
a. utilize ultrasound with a frequency of 1 MHz
b. limit treatment time to five minutes
c. incorporate a pulsed 20% duty cycle
d. select an ultrasound intensity less than 1.5 W/cm^2
C

23. A physical therapist prepares to treat a patient diagnosed with impingement syndrome with iontophoresis directly over the insertion of the supraspinatus muscle. What bony landmark BEST corresponds to this site?
a. lesser tubercle of the humerus
b. greater tubercle of the humerus
c. supraspinous fossa of the scapula
d. deltoid tuberosity of the humerus
B

24. A patient status post motor vehicle accident is referred to physical therapy. the patient has multiple injury sites including the hand, wrist, elbow, and knee. As part of the patient care plan, the physical therapist attempts to increase tissue temperature at each of the invloved sites. The MOST appropriate thermal agent is:
a. diathermy
b. ultrasound
c. hydrotherapy
d. hot packs
C

25. A patient appears to be somewhat anxious after learning her treatment will include soft tissue massage. The MOST appropriate massage stroke to being treatment is:
a. effleurage
b. vibration
c. petrissage
d. tapotement
A

26. A physical therapist treats a patient with a decubitus ulcer using whirlpool. After treating the wound for 10 treatment sessions, the wound still shows little evidence of granulation. The MOST appropriate action is:
a. begin aggressive debridement
b. recommend a wound culture
c. apply aseptic ointment to the wound
d. discontinue whirlpool treatments
D

1. A physical therapist would like to minimize the likelihood of a burn when using iontophoresis. What action would be the MOST consistent with the therapist’s objective?
a. increase the size of the cathode relative to the anode
b. decrease the space between the electrodes
c. increase the current density
d. decrease the moisture of the electrodes
A

2. A physical therapist reviews a patient coverage form that lists the parameters used during a recent ultrasound treatment to the right anterior shoulder: 1.5 W/cm^2, pulsed 20%, 1 MHz, 6 minutes. Assuming the objective of the ultrasound was to increase tissue temperature, which parameter would be the most critical for the therapist to alter?
a. time
b. duty cycle
c. frequency
d. intensity
B

3. A physical therapist incorporates electrical stimulation as part of the plan of care for a patient rehabilitating from a lower extremity injury. Which of following recommendations would be LEAST effective to minimize electrode resistance?
a. keep the sponge interface well moistened
b. use small electrodes
c. maintain even, firm contact with the skin
d. remove hair from the skin
B

4. A physical therapist tests a small area of skin for hypersensitivity prior to using a cold immersion bath. The patient begins to demonstrate evidence of cold intolerance within 60 seconds after cold application. The MOST appropriate response is to:
a. limit cold exposure to ten minutes or less
b. select an alternate cryotherapeutic agent
c. continue with the cold immersion bath
d. discontinue cold application and document the findings
D

5. A physical therapist uses intermittent compression to treat a patient with an acute ankle sprain. The patient is positioned in supine with the leg elevated on a 40 degree wedge. The therapist uses an inflation pressure of 50 mmHg with an on:off time of 40 seconds on and 20 seconds off. The treatment time is scheduled for 20 minutes. After five minutes of treatment the patient reports some discomfort in the ankle. The MOST appropriate modification to the current treatment parameters would be:
a. increase the inflation pressure
b. increase the off time
c. increase the total treatment time
d. increase the elevation of the leg
B

6. A physical therapist reviews a patient’s medical history prior to administering intermittent compression. Which of the following conditions would be considered a contraindication to the use of this mechanical device?
a. venous stasis ulcer
b. acute pulmonary edema
c. intermittent claudication
d. lymphedema
B

7. A patient coverage form indicates selective debridement is to be perdormed on a patient rehabilitating from a lower extremity burn. Based on the coverage form, the MOST likely intervention would be:
a. whirlpool
b. wet-to-dry dressings
c. enzymatic debridement
d. wound irrigation
C

8. A patient with acute back pain is given a transcutaneous electrical nerve stimulation unit to use at home. The physical therapist provides detailed instructions on the care and use of the unit. WHich of the following activities is NOT the responsibility of the patient?
a. modulate the current intensity
b. application of new electrodes
c. change the battery
d. alter the pulse rate and width
D

9. A physical therapist prepares to administer iontophoresis over the anterior surface of a patient’s knee. The therapist would like to keep the current density low in order to avoid skin irritation. which of the listed parameters would BEST accomplish the therapist’s objective?
a. current amplitude of 4 mA; electrode with an area of 12 cm^2
b. current amplitude of 4 mA; electrode with an area of 4 cm^2
c. current amplitude of 3 mA; electrode with an area of 6 cm^2
d. current amplitude of 3 mA; electrode with an area of 4 cm^2
A

10. A patient status post open knee meniscectomy is referred to physical therapy for neuromuscular electrical stimulation. The MOST beneficial frequency of treatment to promote strengthening is:
a. two times per day
b. one time per week
c. three times per week
d. once every two weeks
C

11. A physical therapist treats a patient diagnosed with spinal stenosis. As part of the treatment program the patient lies prone on a treatment plinth with a hot pack draped over the low back. The MOST effective method to monitor the patient while using the hot pack is:
a. check on the patient at least every ten minutes
b. supply the patient with a bell to ring if the hot pack becomes too hot.
c. instruct the patient to remove the hot pack if it becomes too hot
d. select an alternate superficial heating modality
B

12. A physical therapist administers ultrasound over a patient’s anterior thigh. After one minute of treatment, the patient reports feeling a slight burning sensation under the soundhead. The therapist’s MOST appropriate action is to:
a. explain to the patient that what she feels is not out of the ordinary when using ultrasound
b. temporarily discontinue treatment and examine the amount of coupling agent utilized
c. discontinue treat and contact the referring physician
d. continue with treatment utilizing the current parameters
B

13. A physical therapist utilizes neuromuscular electrical stimulation by attaching an electrode over the motor point of the peroneus longus. The MOST appropriate location to attach the electrode is:
a. along the lateral border of the popliteal fossa
b. on the anterolateral surface of the lower leg
c. proximal to the first metatarsophalangeal joint
d. immediately inferior to the lateral malleolus
B

14. A physical therapist works with a patient using a flotation device positioned vertically in the deep end of a pool. Which area of the patient’s body would experience the GREATEST amount of hydrostatic pressure?
a. shoulders
b. torso
c. hips
d. feet
D

15. A physical therapist elects to begin a trial of mechanical lumbar traction on a 165 lb male diagnosed with suspected nerve root impingement. The MOST appropriate amount of force to initiate the session is:
a. 15 lbs.
b. 30 lbs.
c. 60 lbs
d. 80 lbs
B

16. A patient elevated on a tilt table to 60 degrees suddenly begins to demonstrate signs and symptoms of orthostatic hypotension. The MOST appropriate physical therapist action is to:
a. lower the tilt table 10 degrees and monitor the patient’s vital signs
b. lower the tilt table 20 degrees and monitor the patient’s vitals signs
c. lower the tilt table 40 degrees and monitor the patient’s vital signs
d. lower the tilt table completely and monitor the patient’s vital signs
D

17. A physical therapist obtains a complete medical history prior to administering cryotherapy. Which condition would NOT be considered a contraindication to cryotherapy?
a. raynaud’s disease
b. cryoglobulinemia
c. cancer
d. cold urticaria
C

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