MCQs – Flashcard

which of the following should be incorporated in conservative tx for nTOS? a- manual release techniques b-stretching of the scalene, pec minor, and low trap c- strengthening of the SCM, upper trap, elevator scan d-postural corrections and environmental mod e- all the above

which of the following is NOT a recommendation piece of post THR protocol? a. PT treatment 2x/day, 5 days a week b. Bedside exercises & transfers day 1 post op c. Gait training 1 day post op for every patient d. Ankles pumps to prevent DVTs

Patient presents with numbness and tingling radiating down his R arm from his shoulder to his wrist. Symptoms are aggravated with shoulder ER, overhead activities and prolonged sitting at his desk for 2 hours. Symptoms also appear to be intermittent. Which of the following should be assessed to rule in or out thoracic outlet syndrome? a. 1st rib mobility b. Thorough patient history c. Posture d. Scalene muscle length e. B, C, D only f. All the above

What is the best physical therapy treatment plan for a patient undergoing a THR? a. Preoperative rehabilitation (prehabilitation) as well as post-op rehab b. Post-op rehab implementing a progressive resistance training program c. Early home-based progressive resistance training program d. Open chain strengthening of the hip

Physical therapy treatment of neurogenic thoracic outlet syndrome should consist of a. Modalities. The biggest symptom is pain. b. Manual therapy, postural training, and electrical stimulation c. Modalities, manual therapy, postural stability, and postural re-training d. Stretching, strengthening, and stabilization

What are the three spaces of the thoracic outlet where impingement of the neurovascular bundle can happen? a. Supraclavicular space, trans-axillary space, and inter-scalene triangle b. Costoclavicular space, axillary space, and subpectoral triangle c. Inter-scalene triangle, subpectoral triangle, and mid-scalene space d. Subpectoral tunnel, inter-scalene triangle, and costoclavicular space

What are the common precautions to follow post posterior total hip arthroplasty? a) Avoid extension, abduction, and external rotation b) Avoid extension, adduction, and external rotation c) Avoid flexion, abduction, and internal rotation d) Avoid flexion, adduction, and internal rotation

What patient is most likely have the best recovery post THR ? a. Sally, a 76 year old patient who is highly compliant to HEP and received early mobilization post THR b. Duke, a 76 year old patient who did not receive a HEP but had early mobilization post THR c. James, a 76 year old patient whose insurance does not cover HHC and did not receive early mobilization d. Roberta, a 76 year old patient who has a great HEP but was not mobilized until 24 hours after surgery.

A patient walks into your clinic with symptoms of radiating pain down their right arm. Upon evaluation you discover that her scalenes are in spasm, however she is a retired school teacher and states she spends most of her day playing poker with her friends. She states that she has the most pain when sleeping, but she attributes that to her carpal tunnel in the past. How would you rule out the pain at night being caused by carpal tunnel?

How long should a patient undergo conservative treatment for TOS before consulting a surgeon? a. immediately, surgery is the best option for TOS b. 3 months c. 4 years d. 1 month

All of the following are reasonable goals when treating a patient in the hospital following a total hip replacement except A. Decrease pain B. Return to prior level of function C. Prevent ROM loss D. Increase activity and participation E. Increase hip strength

A patient presents with difficulty combing her hair with her right arm due to pain and numbness and tingling in the ipsilateral forearm and hand. She also states that she has neck pain when turning to look in her left side mirror while driving. You suspect neurogenic thoracic outlet syndrome, which other findings would you need to confirm your diagnosis? A. Positive ULTT B. Weak grip strength C. Positive Adson's D. Both A and B E. A, B, and C

When treating a patient with neurological thoracic outlet syndrome, all of the following are important to consider, EXCEPT A. Increasing thoracic spine flexion in sitting B. Stretching of the pectoralis minor muscle C. Strengthening of the deep cervical flexors D. Stretching of the scalene muscles E. Strengthening of inferior shoulder stabilizers

*Which joint mobilization is least likely to benefit a patient with neurogenic TOS? A. Acromioclavicular B. Glenohumeral C. Radioulnar D. Sternoclavicular E. 1st Rib

Which of the following activities is appropriate for your patient who has just undergone a posterior approach total hip replacement? A. Sitting to a low toilet B. Sitting with legs crossed C. Performing quick pivot turns for mobility improvement D. Lying flat in supine

*While assessing your patient you discover sensory impairment in the distal UE. With further testing you determine the symptoms follow the ulnar nerve distribution. Which of the following is not a potential area of ulnar nerve entrapment? (Pick 3) A. Pronator teres B. Guyon's canal C. Axillary space D. Arcade of Struthers E. Cubital tunnel F. Arcade of Froshe

Which of the following exercises would be most important to educate your patient about 1 day s/p THR (posterior lateral approach)? a. SLR past 90 degrees of hip flexion b. Ankle pumps c. Hip Adduction d. Hip ABDuction

Which of the following treatment components would be least appropriate to include with this patient in therapy? a. Scapular retractions b. Paraffin c. Cervical Retractions d. Putty Squeezes

Select the most appropriate justification for why Ms. Appleguarde's correct diagnosis WOULD NOT be cubital tunnel syndrome a. Because the slump sign special test was negative b. Because the symptoms and objective findings in the hand are not exclusive to the ulnar nerve. c. Because she can still perform her ADL's fine - she's just irritable d. There is no correct justification because it is most likely a diagnosis of cubital tunnel syndrome

What percentage of patients with NTOS that participate in a 6-month therapeutic exercise program show clinical improvement? a. 50 b. 12 c. 94 d. 81

Which of the following have shown to have the shortest length of stay for patients with knee and hip replacements? a. Freestanding SNF b. Hospital-based SNF c. Inpatient rehab facility

Of the following tests for thoracic outlet syndrome, which is the most reliable according to research? a. Adson's b. Wright's c. Upper Limb Tension test d. Roos

A 50 year old female is being treated in your outpatient clinic for neurogenic Thoracic Outlet Syndrome. She complains of pain in her forearm and hand. According to the articles, all of the following are supported in the treatment of Thoracic Outlet Syndrome and would be appropriate for this patient EXCEPT: A. Modifications to home and workplace behaviors B. Restoration of scapula control and positioning C. Taping to either elevate or retract the shoulder girdle D. Stretching of the scalene and pectoralis muscles E. All of the above

Based on the articles all of the following are true regarding Thoracic Outlet Syndrome and its symptoms except: A. TOS most commonly occurs in middle age women B. The Wedge Sickle sign is a fibrous band of muscle that compresses the brachial plexus C. Provocative maneuvers such as neck rotation and head tilting were found to be important in TOS diagnosis D. The Upper Limb Tension Test was not found to be accurate or an important part of a TOS diagnostic exam

A 60 year old female patient is three days post posterior lateral approach Total Hip Replacement at the Skilled Nursing Facility that you are a physical therapist at. According to the articles, all of the following are supported by evidence and true regarding the treatment you would chose for this patient EXCEPT: A. Bed mobility exercises B. Marching exercises with >90 hip flexion C. Gait training with two crutches WBAT D. Unilateral resistance training of the quadricep E. All of the above

Typically, how long should a patient follow hip precautions after surgery? A. 4 weeks B. 6 weeks C. 9 weeks D. 3 weeks

Mrs. Annette is a 55 y/o female that was recently diagnosed with Thoracic outlet syndrome (TOS). She reports frequently waking up in the middle of the night due to increased pain. What is (are) some positioning suggestions a PT could give Mrs. Annette? A. Prone with arms overhead B. Sidelying on effected side C. Supine with her arms by her side D. Prone with her arms by her side

Upper extremity referred pain can sometimes mimic double crush syndrome. What is double crush syndrome? A.Cervical radiculopathy and median nerve impingement B. Cervical radiculopathy and scalene MTrP C. Cervical radiculopathy and cervicogenic headache D.Carpal tunnel syndrome and bicep tendonitis

Given the lack of specific and sensitive tests for neurogenic thoracic outlet syndrome (NTOS) and the difficulty diagnosing it, what is the best course of action for a patient who you suspect has NTOS?

When there are not many high quality studies that support use of a specific treatment technique or protocol for a diagnosis, what is the best way to proceed?

You are a physical therapist at a skilled nursing facility. The patient you are about to see is a 55-year-old female who was just discharged to your facility from an acute care unit. She is POD6 THR. Her prognosis has been negatively affected due to the presence of multiple co-morbidities and a postoperative complication that resulted in acute renal failure. She is eager to return home and get back to her normal routine. Now that you know this, use your best clinical judgment and evidence-based practice to determine what you should do next.) a) Refuse to treat her until her acute renal failure resolves. b) Treat her, but only do supine exercises in bed. c) Get her up and walking, full weight bearing, practice sit to stands and stair climbing. d) Get her up and walking, minimal weight bearing, exercises only at EOB.

Patient presents to physical therapy with diagnosis of neurogenic thoracic outlet syndrome with painful muscle spasm of the anterior scalene. Which of the following exercises would you not include in your treatment plan?a) a)Manual therapy b) Shoulder depression exercises c) Isometric lateral flexion exercises d) Postural re-education

Patient presents to physical therapy with pain and weakness in the right upper extremity, paresthesia that travels down the arm and into the hand, and pallor and coldness in their hand and digits. The therapist suspects thoracic outlet syndrome, but is not sure which type: vascular or neurogenic. Based on best evidence which of the following tests should be used to differentiate between vascular thoracic outlet syndrome and neurogenic thoracic outlet syndrome? a) Nerve conduction velocity test b) Arteriography c) Modifed upper limb tension test of Elvey d) Adson's Maneuver e) X- ray

According to Chi-ngai Christopher Lo and colleagues (2011), PT for neurogenic TOS should be for a minimum of _________ to ensure treatment efficacy. a. 4 weeks b. 2 months c. 6 months d. 1 year

Which of the following reasons serves to justify why the Adson test has been deemed unreliable in the diagnosis of neurogenic TOS? A. During the test, the pulses could be obliterated by turning the head to either the ipsilateral or contralateral side B. It is employing a vascular sign to diagnose a neurologic condition, which is frequently misleading C. This test is thought to stress the scalene triangle but may also stress the contralateral scalene triangle, indirectly bring on symptoms D. All of the above