Chapter 4
Nonsystem Topics
Questions
1. A patient presents to physical therapy requiring bracing secondary to scoliosis. What are some of the common precautions given to patients using this type of orthotic?
a. Wear a thick protective layer under the brace.
b. Monitor the skin under the brace for redness.
c. Direct heat improves the integrity of brace materials.
2. All prosthetic feet do which of the following?
3. The distal end of the heel in a solid ankle cushion heel (SACH) foot does which of the following?
4. A resilient socket liner makes it easier for the client to do which of the following?
5. Compared with a cuff, supracondylar brim suspension provides more of which of the following?
6. Compared with a transfemoral exoskeletal shank, an endoskeletal shank is more of which of the following?
7. Which of the following is TRUE about hydraulic swing phase control knee units?
a. Are unsuitable for polycentric axis systems
b. Increase resistance when the client walks faster
c. Decrease stance stability when the client walks faster
8. A transfemoral prosthesis has a knee unit with a manual lock. Which of the following is TRUE about this prosthesis?
a. Provides stability during early stance
b. Requires the client to remain sitting with an extended knee
c. Should be slightly longer than the contralateral intact extremity
d. Is more difficult to don than a prosthetic without a manual lock
9. Compared with a totally rigid socket, a transfemoral socket, which includes flexible plastic, is more of which of the following?
10. What is a common gait deviation after a transmetatarsal amputation?
11. Which of the following is more commonly known as Chopart’s disarticulation?
12. What portion of the foot remains after a Syme’s amputation?
13. A patient has recently undergone a transtibial amputation. The PTA is beginning to teach the patient about proper positioning after the surgery. Which of the following is correct advice for this patient?
a. Place pillows under the knee at all times.
b. Maintain knee extension and hip extension by lying prone.
c. Place pillows under the lumbar spine.
14. Which of the following areas on the residual lower limb after a transtibial amputation tolerates pressure best from the prosthetic socket?
15. What is a disadvantage of the pelvic band suspension system in a transfemoral prosthesis?
a. Better control of hip abduction
b. Better control of hip adduction
c. Better control of hip rotation
16. A patient is beginning rehabilitation after receiving a preparatory prosthesis for a transtibial amputation. How long should the prosthesis be worn before the patient removes it to check the skin for breakdown?
17. The patient is just beginning ambulation after receiving a transtibial prosthesis. The patient shows excessive knee flexion or “buckling” of the knee at early stance. Which of the following are possible causes of this gait deviation?
18. What is the lightest terminal device for a prosthesis for the upper extremity after a transhumeral amputation?
19. Which of the following would be an advantage of an ankle-foot orthosis used by a patient with polyneuropathy?
20. Paul is trying to learn to go up a curb in his wheelchair. To perform this skill successfully, it is critical that he do which of the following?
a. Have good timing and good command of the wheelie skill
b. Have exceptional upper extremity strength and normal upper extremity motor control
c. Be able to use his preserved lower extremity function enough to at least assist during the technique with pelvic and lower extremity control
d. Have a specially modified wheelchair designed to assist with this type of mobility
21. In a clinical setting, which are the most common types of exercise equipment used during assessment of aerobic capacity?
a. Treadmill and stationary bicycle
b. Stationary bicycle and rowing ergometer
c. Treadmill and self-paced walking
22. Which of the following is NOT recommended for compression intervention in patients with a venous ulcer?
23. Which of the following is incorrect for the assessment of proper shoe fit of a patient with diabetes?
a. The widest part of the shoe should be at the first metatarsophalangeal joint
b. There should be approximately ½ inch of space between the end of the longest toe and the end of the shoe with the patient standing
c. The collar or back portion of the shoe should slide up and down on the heel
d. There should be no areas of stitching over the forefoot of the shoe
24. Which of the following is NOT true regarding the use of total contact casting for treatment of neuropathic ulcers?
a. Cast should be replaced every 5 days in ulcers with a Wagner grade 4
b. Fragile skin is a relative contraindication and should be monitored closely
c. Cast should usually be used with a Wagner grade 2 plantar ulcer with loss of protective sensation
25. The most common assistive device for mobility is which of the following?
26. Which part of the home interferes least with use of assistive devices for mobility?
27. Which of the following is NOT a purpose of assistive devices for ambulation?
28. A long cane is most useful to the person with visual impairment because of which of the following?
a. Alerts passersby not to impede the patient
b. Increases load on the lower extremities
c. Increases the user’s comfort
29. The underarm crutch should terminate proximally at which of the following?
30. A properly fitted cane places the elbow at approximately what angle?
31. Wheelchair use can improve all of the following EXCEPT which?
32. Which muscles are most important for propelling a manual wheelchair?
33. The most common way to control a powered wheelchair is with which of the following?
34. A wheelchair intended for a patient with lower extremity amputation should have which of the following?
35. The patient who has edematous legs should have a wheelchair that includes which of the following?
36. A wheelchair seat that is too narrow is most likely to do which of the following?
a. Facilitate transfer into and out of the wheelchair
b. Irritate the skin over the greater trochanters
37. A wheelchair with a high backrest will do which of the following?
a. Increase the stability of the wheelchair
b. Protect the patient from tipping forward
c. Make the patient vulnerable to kyphosis
38. Which of the following would make a manual wheelchair easier to propel with the upper extremities?
39. Which of the following is the best way to determine whether a wheelchair cushion is performing adequately?
a. Asking for the patient’s subjective complaints of ischial tuberosity pain
b. Contacting the wheelchair manufacturer for their specific specifications
c. Placing the PTA’s hand between the cushion and seat of the wheelchair for palpable bony prominences
d. Observing the ischial tuberosities after 5 minutes of sitting in the wheelchair
40. If a patient’s walker is adjusted too high, which of the following would the PTA likely observe?
a. Limited front wheel rotation of the walker
b. Patient ambulating with the walker too far forward from the trunk
c. Forward bending of the trunk
41. Which of the following is considered the proper fit for triceps crutches?
a. Upper cuff middle third of the upper arm, lower cuff 6 cm below the olecranon process
b. Upper cuff distal third of the upper arm, lower cuff 1 to 4 cm below the olecranon process
c. Upper cuff proximal third of the upper arm, lower cuff 6 cm below the olecranon process
d. Upper cuff proximal third of the upper arm, lower cuff 1 to 4 cm below the olecranon process
42. Which of the following is a purpose for tennis balls or other glide mechanisms on the rear uprights of rolling walkers?
43. A 65-year-old man has recently suffered a motor vehicle collision. The orders from the physician are to begin gait training immediately. The orders also state that the patient is to be non–weight bearing on the left lower extremity and right wrist. Which of the following would be the best assistive device choice for this patient?
44. Assuming the patient is in normal erect stance, where should the tip of a cane be located on the ground in relation to the foot?
a. 8 inches out from the toes at a 90-degree angle
b. 2 inches out from the toes at a 45-degree angle
c. 6 inches out from the toes at a 90-degree angle
45. A 19-year-old woman has recently suffered a motor vehicle collision. She has sustained multiple fractures to the bilateral lower extremities, and will remain non–weight bearing for several months. She will continue to attend college while she rehabilitates her injuries. What is the most appropriate assistive device for this patient?
46. Which of the following would the PTA observe if a patient’s wheelchair was built so that the seat was too deep within the wheelchair frame?
a. Increased pressure on the ischial tuberosities
b. Excessive hip abduction during sitting
c. Excessive hip external rotation during sitting
47. An ankle-foot orthosis (AFO) worn with a shoe that has a heel higher than that for which the orthosis was made will cause the wearer to have which of the following?
a. Experience laterally directed force at the knee at midstance
b. Maintain the knee extended during stance phase
c. Experience medially directed force at the ankle at midstance
48. Which of the following cervical orthosis most restricts neck motion?
49. The orthosis that is secured directly to the skeleton is which of the following?
50. The best candidate for a scoliosis orthosis has which of the following?
a. Immature spine with a moderate curve
b. Immature spine with a severe curve
c. Mature spine with a severe curve
51. Orthotics are NOT used for which of the following purposes?
52. Orthoses are often helpful for which of the following dysfunctions?
53. What is the difference between a splint and an orthosis?
a. A splint is a temporary orthosis.
b. Splints and orthoses are used on different parts of the body.
c. A splint is made of flexible material, and an orthosis is always made of hard material.
d. An orthosis should be worn 23 hours per day, and a splint can be removed several times per day.
54. Orthotics are NOT designed to provide which of the following functions?
a. Support musculoskeletal deviations
b. Correct musculoskeletal deviations
c. Improve the function of moveable parts of the body
55. Which of the following is TRUE regarding the comfort of an orthosis?
a. The area covered by the orthosis should be minimized to decrease pressure.
b. An orthosis could be lengthened to provide comfort.
c. A functional orthosis would be used by the patient even if it is uncomfortable.
d. The straps that attach the orthosis should be as tight as possible.
56. A PTA has decided to use a knee-ankle-foot orthosis to control genu valgum of the knee. Where must the force be applied to control this deformity?
a. Superior force medially, knee force medially, ankle force medially
b. Superior force laterally, knee force laterally, ankle force laterally
c. Superior force laterally, knee force medially, ankle force laterally
d. Superior force medially, knee force laterally, ankle force medially
57. A child with an ankle-foot orthosis breaks his orthosis about every 2 to 3 months. What material property is the most likely cause of this orthosis failure?
58. Which of the following orthosis materials is most easily adapted to fit a patient’s limb?
59. What portion of a shoe should be modified if the shoe is to be used with an ankle-foot orthosis that has an insert at its distal attachment?
60. Which of the following types of orthosis is molded into the sole of a shoe to transfer force posteriorly from metatarsal heads?
61. Which of the following types of ankle-foot orthosis (AFO) contributes least to frontal and transverse plane control?
62. Which of the following is FALSE regarding wearing an ankle-foot orthosis after a stroke?
63. What is the most common type of knee control used in a knee-ankle-foot orthosis?
64. What is the primary effect of a lumbar corset?
a. Decrease abdominal musculature activity
b. Decrease erector spinae muscle activity
c. Compress the abdomen to increase intraabdominal pressure
65. What type of upper extremity splint is most commonly prescribed for repetitive motion injuries such as carpal tunnel syndrome?
66. What is the purpose of most shoulder orthoses?
a. To decrease rotator cuff involvement
c. To prevent shoulder subluxation
d. To reduce anterior deltoid involvement in shoulder flexion
67. Which of the following is an example of an assistive device?
68. The PTA is treating a patient who received an above-elbow amputation 2 years ago. The prosthesis has a split cable that controls the elbow and the terminal device. With this type of prosthesis, the patient must first lock the elbow to allow the cable to activate the terminal device. This is accomplished with what movements?
69. The PTA is crutch-training a 26-year-old man who underwent right knee arthroscopy 10 hours ago. The patient’s weight-bearing status is toe-touch weight bearing on the right lower extremity. If the patient is going up steps, which of the following is the correct sequence of verbal instructions?
a. Have someone stand below you while going up, bring the left leg up first, then the crutches and the right leg.
b. Have someone stand above you while going up, bring the left leg up first, then the crutches and the right leg.
c. Have someone stand below you while going up, bring the right leg up first, then the crutches and the left leg.
d. Have someone stand above you while going up, bring the right leg up first, then the crutches and the right leg.
70. A patient is receiving crutch training 1 day after a right knee arthroscopic surgery. The patient’s weight-bearing status is toe-touch weight bearing on the right lower extremity. The PTA first chooses to instruct the patient how to perform a correct sit to stand transfer. Which of the following is the most correct set of instructions?
a. (1) Slide forward to the edge of the chair; (2) put both the crutches in front of you and hold both grips together with the right hand; (3) press on the left armrest with the left hand and the grips with the right hand; (4) lean forward; (5) stand up, placing your weight on the left lower extremity; (6) place one crutch slowly under the left arm, then under the right arm.
b. (1) Slide forward; (2) put one crutch in each hand, holding the grips; (3) place crutches in a vertical position; (4) press down on the grips; (5) stand up, placing more weight on the left lower extremity.
c. (1) Slide forward to the edge of the chair; (2) put both the crutches in front of you and hold both grips together with the left hand; (3) press on the right arm rest with the right hand and the grips with the left hand; (4) lean forward; (5) stand up, placing your weight on the left lower extremity; (6) place one crutch slowly under the right arm, then under the left arm.
d. (1) Place crutches in close proximity; (2) slide forward; (3) place hands on the armrests; (4) press down and stand up; (5) place weight on the left lower extremity; (6) reach slowly for the crutches and place under the axilla.
71. Which of the following is NOT a physiologic benefit associated with the use of continuous passive motion?
72. The PTA makes recommendations to a patient after hip replacement surgery for positioning in a wheelchair. Which set of instructions would adhere to safety precautions?
a. Keep legs abducted with abductor pillow and affected leg in neutral.
b. Keep legs together by using an adductor strap to prevent external rotation of legs.
c. Sit in a regular wheelchair with feet supported on foot rest.
d. Sit in regular wheelchair with affected leg in full extension.
73. The PTA is ambulating a patient with an above-knee amputation. The new prosthesis causes the heel on the involved foot to move laterally at toe-off. Which of the following is the most likely cause of this deviation?
a. Too much internal rotation of the prosthetic knee
b. Too much external rotation of the prosthetic knee
c. Too much outset of prosthetic foot
74. The use of compression stockings on the feet and ankles is contraindicated in which patient population?
75. The PTA is ambulating a 42-year-old man who has just received an above-knee prosthesis for the left leg. The PTA notices pistoning of the prosthesis as the patient ambulates. Which of the following is the most probable cause of this deviation?
76. While examining a patient who has just received a new left below-knee prosthesis, the PTA notes that the toe of the prosthesis stays off the floor after heel strike. Which of the following is an unlikely cause of this deviation?
a. The prosthetic foot is set too far anterior.
b. The prosthetic foot is set in too much dorsiflexion.
c. The heel wedge is too stiff.
77. Which of the following is the most appropriate orthotic for a patient with excessive foot pronation during static standing?
78. A PTA is instructing a patient in the use of a wrist-driven prehension orthotic. What must be done to achieve opening of the involved hand?
79. The PTA has just given the patient a custom wheelchair. The patient has a long-standing history of hamstring contractures resulting in fixation of the knees into 60 degrees of flexion. The patient is also prone to develop decubitus ulcers. Which of the following is incorrect advice for the PTA to give the family and patient?
a. Keep the patient’s buttocks clean and dry.
b. Make sure that the wheelchair cushion is always in the wheelchair seat.
c. Keep the leg rests of the wheelchair fully elevated.
d. Never transfer using a sliding board from one surface to another.
80. A PTA is ordered to provide gait training for an 18-year-old girl who received a partial medial meniscectomy of the right knee 1 day earlier. The patient was independent in ambulation without an assistive device before surgery and has no cognitive deficits. The patient’s weight-bearing status is currently partial weight bearing on the involved lower extremity. Which of the following is the most appropriate assistive device and gait pattern?
a. Crutches, three-point gait pattern
b. Standard walker, three-point gait pattern
c. Standard walker, four-point gait pattern
81. A PTA is ordered to provide gait training to a 78-year-old man who received a right cemented total knee replacement 24 hours earlier. The patient also had a traumatic amputation of the left upper extremity 3 inches above the elbow 40 years ago. If the patient lives at home alone, which of the following is an appropriate assistive device?
82. Which of the following is a FALSE statement about below-knee amputations?
a. Gel socket inserts should be left in the prosthesis overnight.
b. The PTA should puncture any blisters that appear on the stump.
c. Areas of skin irritation on the stump can be covered with a dressing, then a nylon sock before donning the prosthesis.
d. When not in use, the prosthesis should be placed on its side on the floor.
83. A PTA is assisting a patient with pregait activities who has been fitted with a hip disarticulation prosthesis. To ambulate with the most correct gait pattern, what must be mastered first?
a. Forward weight shift on to the prosthesis
b. Swing-through of the prosthesis
c. Maintenance of stability while in single-limb support on the prosthesis
84. A 68-year-old man is being treated by a PTA after a right below-knee amputation. The patient is beginning ambulation with a preparatory prosthesis. In the early stance phase of the involved lower extremity, the PTA notes an increase in knee flexion. Which of the following is a possible cause of this gait deviation?
b. The foot is set too far anterior in relation to the knee.
c. The foot is set in too much plantar flexion.
85. A patient begins ambulation with axillary crutches for the first time. The gait required will be non–weight bearing for the right foot. What is the best advice to give the patient in regard to crutch placement during static standing?
a. Stand with the crutches and weight bearing foot in a parallel line.
b. Stand with both crutches under the right arm.
c. Stand with both crutches under the left arm.
d. Stand with both crutches about 4 inches to the front and side of the shoulders.
86. Of the walkers listed below, which is the least stable?
87. The PTA is providing intervention for a patient with a recent stroke. Gait training with a new ankle-foot orthosis (AFO) will begin today. What is the most important aspect of the fit of the AFO?
88. A physician orders gait training for a 16-year-old boy with recent open-reduction internal fixation of the left femur. The patient is non–weight bearing on the affected leg. Which of the following assistive device is most appropriate for this patient?
89. Postoperative knee braces have been associated with all the following complications EXCEPT which?
90. Which of the following is indicated for treatment directly over a tumor?
91. What modality should NOT be used to increase tissue extensibility before a stretching session?
92. A patient presents to outpatient physical therapy today to begin rehabilitation following a grade 1 ankle sprain. Treatment today consists of ankle range of motion (ROM), weight-bearing exercises, resisted ankle exercises, and cryotherapy. When would the cryotherapy be MOST appropriately used for this patient?
93. A PTA wishes to use a superficial heating modality to a patient’s lumbar extensors before today’s treatment. Which of the following modalities would NOT be appropriate to use to produce a superficial heat intervention?
94. Which of the following electrical stimulation parameters are appropriate for reduction of edema?
a. Polyphasic pulsed current with a pulse rate of 120 pulses per second, and the cathode at the site of inflammation
b. Monophasic pulsed current with a pulse rate of 240 pulses per second, and the anode at the site of inflammation
c. Polyphasic pulsed current with a pulse rate of 240 pulses per second, and the cathode at the site of inflammation
d. Monophasic pulsed current with a pulse rate of 120 pulses per second, and the cathode at the site of inflammation
95. Which of the following is the primary modality to relieve pain at a fracture site?
96. Which of the following is NOT a proposed mechanism for the effectiveness of low-intensity pulsed ultrasound on the healing of a delayed or nonunion fracture?
97. Which of the following modalities would be contraindicated over a recent cemented total hip arthroplasty?
98. Which of the following is appropriate to use after surgical repair of the ulnar nerve?
99. Transcutaneous electrical nerve stimulation may help control neuropathic pain by which of the following mechanisms?
100. The PTA decides to use deep heat on a patient’s calf secondary to complaints of pain. The patient has a diagnosis of advanced diabetic neuropathy. Of the choices given, what is the best deep-heating agent to use for this situation?
101. The PTA decides to use pneumatic compression pumping for patient’s edematous lower extremity. How much pressure should the compression pump exert for this particular patient?
102. A stage IV sacral ulcer has a large amount of necrotic tissue and a minimal to moderate amount of exudate on the old dressings. The patient has no fever, chills, or other signs of systemic infection. The most appropriate adjunct modality to facilitate wound healing at this point would be which of the following?
103. Which of the following mechanisms is NOT a way in which vacuum-assisted closure (VAC) facilitates wound healing?
a. Reducing the bacterial load
b. Effectively managing exudates and thereby preventing further periwound skin damage
c. Increasing the amount of granulation tissue in the wound bed
104. Which of the following is a false statement regarding the application of superficial heat to a client’s lumbar area?
105. Short-wave diathermy is an example of what type of physical agent used in physical therapy?
106. What heating agent uses corncobs finely chopped into a sawdust-type substance?
107. Which of the following is NOT a normal clinical indication for the use of electrical stimulation on a client?
108. The terms below refer to properties of water that make hydrotherapy valuable to a variety of patient populations. Match the following terms with the statement that best relates to each term.
A This property can assist in prevention of blood pooling in the lower extremities of a patient in the pool above waist level.
B This property makes it harder to walk faster through water.
C A person with a higher amount of body fat can float more easily than a lean person because of this property.
D This property makes it easier to move a body part to the surface of the water and harder to move a part away from the surface.
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