Chapter 2 obtained from heating.

When using
Physical Therapy Modalities hyperemia as the index of the
therapeutic response, the range of
Directions: Each of the questions or incomplete duration of temperature elevation
statements below is followed by five suggested that should be maintained to
answer or completions. Selects the BEST answer in achieve maximal effectiveness is D
each case. A. 1
B. 1 to 3 min
1. the physiological effect of local C. 5 to 120 min
heating include: E D. 3 to 30 min
A. increased local metabolic rate E. none of the above.
B. increased local vasodilation 6. Which of the techniques listed
C. increased local capillary hydrostatic below is most effective in
pressure producing permanently improved
D. local analgesic flexibility? A
E. all of the above A. prolonged stretching during heating
with release from stretching after
2. Which of the following is not a the tissue has cooled to normal
therapeutic effect of vigorous local temperature.
heating?B B. Short duration stretching whole the
A. increased blood flow due to tissue is at maximum temperature
arteriolar and capillary dilation C. prolonged stretching during
B. steady increase in enzyme activity heating, with released from
as the temperature is elevated. stretching before the tissue cools to
C. Increase in the rate of diffusion normal tissue temperature
across biologic membranes D. heating the tissue to maximum
D. Increase in the extensibility of temperature, then prolonged
fibrous connective tissue. stretching then cooling to the
E. Decreased viscoeleastic resistance normal tissue temperature without
to joint stretching
E. heating actually does not improve
3. hyperemia is the most easily the results permanently when used
measured effect of local heating. It with stretching to gain tissue
is often used in research studies as flexibility.
an indication of the response of
tissue to heating. Hyperemia first 7. Which of the following offers the
occurs at what temperature? C quickest response to actual blood
A. 1C above the normal core temperature? A
temperature A. oral temperature
B. 37C (98.6F) B. rectal temperature
C. 43C (109.4F) C. axillary temperature
D. 45C (113F) D. skin temperature over the trunk
E. none of the above E. skin temperature over the
extremities
4. Using hyperemia as the indicator of
therapeutic effect, the therapeutic 8. Which of the following would be
temperature range isC the most likely to elevate core
A. 43C to 49C temperature? (assume that the
B. 37C to 43C patient has normal circulatory
C. 43C to 45C mechanisms) A
D. 45C to 50C A. trunk and extremities in Hubbard
E. 0C to 100C tank or pool at 38.8C
B. hot air bath (saturated with water
5. the Duration of the elevated tissue vapor) at 45C
temperature is an important factor C. paraffin dip-wrap of one hand and
in the degree of biologic response wrist at 52C
 D. ultrasound at 1.5 w/cm2 to the 1. counter irritation theory (attributed to
lateral epicondyle 1 or 7 mm hippocrates)
E. short wave diathermy to the lumbar 2. gate theory
spine for 20 min 3. thermal gradient equalization theory of
wells
9. The maximum safe exposure of the 4. reduction in peripheral nerve integrity
skin to heated water is 45C for 30 theory
min. paraffin dipwrap coats the skin
with a mixture of mineral oil (one 13. Heat can be transferred by :A
part) and paraffin (seven parts) at a 1. conduction
temperature of 52C. why does the 2. convection
skin not get burned.D 3. radiation
A. protective subcutaneous fat layer 4. kinetic energy
B. rapid skin vasodilation
C. paraffin changes rapidly from a 14. The significant factors in
liquid to a solid on contact with determining the quantity of
skin radiation a patient receives are A
D. paraffin has a lower thermal 1. distance between the source and the
conductivity than water patient
E. none of the above. 2. wavelength of the radiation
3. angle of incidence of the radiation to the
Directions: for each incomplete statement below. skin surface
ONE or MORE of the numbered completions is 4. color of the skin
correct. In each case select:
A. if only 1,2 and 3 are correct 15. Converse hearing refers to :D
B. if only 1 and 3 are correct 1. heating that involves conduction
C. if only 2 and 4 are correct 2. healing that involves changing from
D. if only 4 correct potential energy to thermal energy
E. if all are correct 3. heating by direct application
4. the use of heating modality that passes
10. The correct formula(s) for through superficial tissue and is then
converting Fahrenheit degrees to changes to heat in the deeper tissues
centigrade (Celsius) degrees (are):
C 16. The heat transition is: B
1. Fahrenheit degrees plus 273 1. the head gained or lost when a
2. C = 5/9 (F – 32) substance to conduct heat
3. C = F + 32 2. the natural tendency of a substance to
4. F = 9/ 5C + 32 conduct heat
3. more than the amount of heat needed to
11. Local heating is contraindicating raise a substance one degree without a
(or at least must be used with change in physical state.
extreme caution) in patients with 4. The term used to describe the
1. vascular insufficiency relationship of the temperature of a
2. impaired pain and temperature sensation substance to the radiation it emits.
3. edema
4. senility, disorientation or any other 17. Wien’s Law is: D
condition reducing the patient’s ability 1. that some patients react negatively to
to rationally cooperate with the the use of modalities
treatment 2. a mathematical statement of the ability
of a substances to conduct heat
12. Heat has an analgesic effect (which 3. a statement of the relationship of the
explains why it hurts less to catch a temperature of a body and the quantity
ball with bare hands on a warm day of radiation in emits
than on a cold day) The current 4. a statement of the relationship of the
theories explaining this analgesic temperature of a body and the
effect include the :A wavelength of radiation it

18. Specific heat is the : C
1. tendency of a substance to conduct heat
2. amount of heat a substance actually
contains at a given temperature
3. type of heat being given (for example,
ultrasound or diathermy)
4. reason why some substance take more
heat than others to raise their
temperature one degree centigrade.
19. The Stefan-Boltzman law states
that :D
1. higher temperatures of a substance
cause shorter wavelength of radiation
emission
2. patients with pacemakers should not be
exposed to microwave radiation
3. thermal conductivity is higher for water
than for paraffin –mineral oil
4. the quantity of radiation emitted by an
object is proportion to the fourth power
of the temperature.
20. Thermal conductivity: A
1. determine how hot or cold an object feel
when placed against the skin
2. is the natural tendency of a substance to
conduct heat (or cold)
3. is lower for wood than for metal such as
copper and iron
4. determines the quality of heat a
substance actually contains at a given
temperature per unit mass.
21. A daily hand program for the
patient with rheumatoid arthritis
often includes a paraffin dip wrap
followed by prescribed exercise of
the wrist and hands. The most
convenient technique(s) for paraffin
dip-wrap in the home is (are): D
1. melting of the paraffin mineral oil
mixture each day in a deep pan
2. melting of the paraffin mineral oil
mixture each day in a double boiler
3. keeping the paraffin mineral oil mixture
at the appropriate temperature at all
times a double boiler
4. keeping the paraffin mineral oil mixture
melted and at the correct temperature in
a specially designed thermostatically
controlled home unit.
22. Local cooling is indicated for: A
1. reduction of posttraumatic edema
2. temporary reduction of spasticity
3. retarding the development of gangrene
in an ischemic limb
4. improving the blood supply to an
ischemic limb
23. Spasticity in some patient can be
temporarily reduced by the local
cooling of the affected muscles.
The most likely reason(s) for this
effect is (are): A
1. muscle spindle afferent impulse firing
decrease
2. cooling reduces the membrane
excitability of axons
3. gamma motor fibers are more easily
blocked by cold than alpha motor fibers
4. small and unmyelinated nerve fibers are
more resistant to blockage by cold than
other nerve fiber types.
24. Superficial local cold penetrates
deeper through human tissue than
superficial local heat because: B
1. arteriolar vasoconstriction occurs with
cold
2. arteriolar vasodilation occurs with cold
3. the countercurrent heat exchange
system keeps blood in a cooled
extremity
4. nerve conduction decreases with cooler
temperatures
25. The important consideration(s) in
treating patients in the Hubbard
tank is (are) : E
1. patients will overheat is emerged in
water above 38.8C
2. patients with extensive burns should be
treated in a physiological saline solution
rather than in water
3. great care must be exercised to prevent
cross infection of patients receiving
tank therapy
4. patients with congestive heart failure
may not be able to tolerate generalized
body heating
26. The major advantage of the Hubbard tank
for hydrotherapy is (are): C
1. it is easily sterilized in a few
minutes between patients
2. it allows full range of motion of the
extremities under water
3. it is large enough to allow the
therapist to get into the tank with
 the patient for range of motion
therapy
4. it has a figure-eight shape that
allows the therapist to reach the
patient adequately without having
to get into the tank
27. The beneficial effects of hydrotherapy
include : E
1. buoyancy effect on body parts
2. mechanical cleansing of the skin due to
the agitation of the water
3. analgesic effect of warm water
4. the posttraumatic antiedema effect of
cold water
28. Hydrocollator packs heated at 60C to 70C
are used instead of the towels or hot water
bottle in most physical therapy departments
because: C
1. are less expensive to use
2. maintain heat longer than hot
towels made of cotton or wool
3. can be heated to a higher
temperature than hot towels
4. are convenient and sanitary as
compared to hot towels
Directions: For each of the incomplete statements
below, ONE or MORE of the numbered completion is
correct. Each case select:
A. if only 1,2 and 3 are correct
B. if only 1 and 3 are correct
C. if only 2 and 4 are correct
D. if only 4 is correct
E. if all are correct
37. Diathermy literally means “heat through” The
clinically used heat modalities generally
referred to as diathermy include:A
1. short wave
2. ultrasound
3. microwave
4. ultraviolet
38. The frequencies granted by the Federal: A
1. 13.66 MHz (wave length 22mm)
2. 27.33 MHz ( wave length 11mm)
3. 40.98 MHz ( wave length 7.5 m)
4. 2450 MHz (wave length 12.2 cm)
39. Which of the following statements regarding
diathermy and cardiac pacemakers is (are)
true?): A
1. a nociceptive pacemaker presents no
significant hazard or diathermy use
2. a competitive pacemaker is the type most
likely to be affected by short-wave
diathermy
3. microwave diathermy affects pacemakers,
but short wave diathermy does not
4. microwave and short wave diathermy
pose a serious danger for patients using
any type of implanted cardiac pacemaker
40. In selecting the dosage of diathermy given to
the patient, the therapist monitors the: D
1. skin temperature of the area being treated
2. power meter of the diathermy machine
3. careful selection of a resonance frequency
between the oscillating circuit of the
machine and the patient circuit
4. patient’s sensation of warmth in the area
being treated
41. The federal Communication Commission
granted the use of the 2,459 MHz band of the
microwave spectrum to medical use because:
D
1. this frequency is capable of producing
deeper heating of tissues than other
frequencies
2. it is more expensive to produce machines
with higher or lower frequencies
3. lower frequencies interfere more with
military radar
4. generators producing this frequency were
available when microwave therapy was
introduced into practice after World War II
42. The apparatus which produces microwaves for
clinical purpose:E
1. generated the microwaves by application
of voltage to a multicavity magnetron tube
2. is similar to microwave ovens and radar
apparatus except in the frequency of the
microwaves generated
3. has a frequency of 2,450 mega Hertz
assigned by the Federal Communications
Commission
4. uses a director or antenna to apply the
microwave to the patient
43. The tissues that best absorb microwaves are :D
1. bone
2. cartilage
3. hair
4. tissue containing the highest percentage of
water such as muscle fat, and eye humors
44. Which of the following are important in
administering microwave therapy? E
 1. preventing sweat droplets from forming
by placing towels on the area to be treated
2. placing the microwave director no closer
than 2cm from the skin surface
3. not exposing the eyes to vigorous
treatment with microwaves
4. using multiple sites to heat a joint
45. Which of the following are indications for
microwave therapy? B
1. superficial inflammatory reactions such as
furuncles and abscesses
2. the need for vigorous heating of the
internal structures of the hip joint
3. the need for heating of the finger joints
4. protruded intervertebral disc syndrome
46. Microwave intensities commonly used in
clinical physical therapy are D
1. not of sufficient intensity to produce any
lens cataracts
2. safe for use over fluid collections
including effusions and edematous tissues
3. safe for use over metallic implants
4. usually 0.1 to 1.0 w/cm2 when measured
with special equipment
47. The most serious problem(s) affecting the eye
with the use of microwave is (are): C
1. selective heating of the vitreous humor
2. selective heating of the aqueous humor
3. the formation of lens cataracts
4. the development of glaucoma
Directions: For each of the incomplete statements
below, ONE or MORE of the numbered
completions is correct. In each case select.
A. if only 1,2 and 3 are correct
B. if only 1 and 3 are correct
C. if only 2 and 4 are correct
D. if only 4 is correct
E. if all are correct
64. Ultrasound is generated for clinical purposes:
B 1. watts of sound centimeters per square
1. by a reversal of the piezoelectric
effect
2. by a small paper cone speaker
3. by a radio frequency generator
which produces an oscillating
circuit to drive the transducer
4. by a standard electrical vibrator
65. The most appropriate transducer applicator
for clinical use is one that :C
1. produces a pencil thin beam emanating
from the center of the applicator
2. produces a beam with a broad based
intensity distribution curve across the
full diameter of the applicator
3. has large applicator surface (greater
than 15cm2)
4. has an applicator surface large enough
to have a low angle of divergence of the
sound beam, but small enough to
maintain contact with uneven body
surfaces
66. Ultrasound machines for clinical therapy have a
frequency of : D
1. 17,000 Hz
2. 5,000 Hz
3. 500,000 Hz
4. 100,000 Hz
67. Ultrasound produces heat in tissues by particle
movement within the field of the sound beam. The
acceleration of these particles with the standard
clinical ultrasound machine is about :D
1. 1 to 4 atmospheres of pressure
2. 1.5 g
3. 3.0 g
4. 100,000 g
68. Ultrasound beams used for clinical therapy do not
have a uniform field of sound intensity. The specific
characteristic of the sound beam include the : E
1. “near field” being the are between the
translucent and the most distant
intensity maximum of sound.
2. “near field” having much greater
variation sites than does the “far field”
3. ‘near field” extending for many
centimeters in clinical machines
4. “far field” having a fairly uniform
intensity of sound
69. Ultrasound intensity is measured in W cm2. this
refers to the:D
centimeter of skin surface
2. watts of electricity used to generate the
sound per square centimeter of skin that
is treated
3. total watts of electricity used to generate
the sound beam per centimeter of depth
of penetration in the tissues
4. total output of tye applicator in watts
divided by the total surface area of the
applicator
70. The wavelength of ultrasound is : C
1 such that some humans can hear it
2. much shorter in tissue than the wave
length of sound produced by the human
voice
3 the same in the air as it is in tissue
4. such that a layer of maternal tends to
reflect or absorb it if the thickness of the
layer is equal to or greater than the
wavelength of ultrasound
71. The wavelength of ultrasound: B
1. is about 1 mm in tissue
2. is shorter in tissue than in air
3. changes in tissue because sound travels
faster in tissue than in air
4. is greater in vaccum
72. The pattern of relative heating in ultrasound is
such that: B
1. a large joint must be heated from all
with
2. ultrasound penetrated bone better than
soft tissue
3. ultrasound heats the deep tissues with
relatively little hearing of skin and
subcutaneous tissue
4. ultrasound heats tissue no deeper than
the depth achieved with short wave
diathermy
73. Reflection of ultrasound: E
1. occurs mainly at interfaces of tissues
with different acoustic impedances
2. is great at the interface of soft tissue and
bone
3. is great at the interface of soft tissue and
metallic implants
4. is minimal at interfaces of layers of soft
tissue
74. Absorption of ultrasound: E
1. is greater in soft tissues with high
proteins content
2. occurs to some extent at interfaces of
different soft tissue layers
3. is very high in bone
4. can be calculated for each tissue type
(often called the ultrasound tissue
absorption) coefficient)
75. The order of deepest penetrates of these heat
modalities is : D
1. short wave diathermy, ultrasound
infrared
2. infrared, short wave, ultrasound
3. ultrasound, infrared, short wave
diathermy
4. ultrasound, short wave diathermy,
infrared.
Directions: For each of the incomplete statements
below, ONE or MORE of the numbered completion is
correct. Each case select:
A. if only 1,2 and 3 are correct
B. if only 1 and 3 are correct
C. if only 2 and 4 are correct
D. if only 4 is correct
E. if all are correct
152. Ultraviolet effects include :C
1. tanning of the skin, which then helps
protect from further ultraviolet injury
2. thickening of the stratum comeum, which
protects from further ultraviolet injury
3. tanning that occurs as a result of a broad
band of wavelength from 2,000 A to 4,000
A.
4. injury of the prickle cell layers of skin,
resulting in the release of vasodilators that
subsequently produce the erythematous
changes
153. Excessive exposure to ultraviolet light may
cause:B
1. squamous cell and basal cell skin
carcinoma
2. severe erythema if the ultraviolet is
transmitted through glass plates
3. marked thickening and loss of skin
pliability
4. permanent tanning in Caucasians
154. Excessive exposure to ultraviolet produces eye
complications such as :E
1. conjunctivitis
2. corneal keratotic changes
3. lenticular opacities and cataracts
4. pain
155. infrared radiation in the far infrared range
(14,000-400,00 A) penetrated to about 0.1 mm while
near infrared radiation (7,700 – 14,000A) penetrates
to 3 mm. patients usually have a greater feeling of
warmth from the far infrared because.: D
1. the near infrared is partially in the visible
spectrum
2. the near infrared is closet to ultraviolet the
electromagnetic spectrum
3. far infrared healers give a more uniform
radiation pattern
 5. far infrared more effectively heats the
nerve ending in the skin
156. The best source of infrared radiation is:B
1. an ordinary frosted incandescent light
bulb
2. a red-filtered incandescent spotlight
3. an incandescent light bulb (nonfrosted)
4. an electric stove burner element
157. The purpose(s) of stimulating denervated muscle
is (are): B
1. help lymphatic venous drainage from the
muscle
2. help retard atrophy to some extent
3. help retard loss of muscle elasticity and
the shortening of tendons
4. help the patient psychologically, in that
stimulation makes patient feel that
“something is being done”
158. Some experimental evidence indicates that
stimulation of denervated muscles is useful in
preventing atrophy under which of the following
conditions:C
1. the patient believes in the treatment
2. the stimulation is done several times per
day
3. the stimulation is done in the physical
therapy department of a hospital rather
than at home
4. the contractions of the muscle from
stimulation are done against external
resistance.
159. When using alternating current stimulation :B
1. the optimum frequency 1 or treating
denervated muscles
2. the optimum frequency for treating
denervated muscle is 2,000 Hz
3. the optimum frequency for treating
normally innervated muscle is 1,000 to 2,00 Hz
4. interrupted galvanic and faradic currents
have been shown to retard atrophy of denervated
muscle to greater degree than alternating currents.
160. Lumbar traction:B
1. requires at least 200 to 300 pounds of
weight to produce any actual skeletal distraction
2. used continuously at 10 pounds for 30
minutes does distract the lumbar spine
3. distract the vertebrae of the lumbar spine
approximately 1-3 mm when at least 300 pounds are
used.
4. doe not distract the spine at any weight
used up to 1,000 pounds
161. Patients with painful back conditions often
improve when lumbar traction is used continuously
for many hours with distractions weights of 50
pounds or less. This is because :B
1. the bed rest the patient gets while in the
traction apparatus is probably the actual treatment
benefit.
2. this technique actually does produce
lumbar distraction
3. the pull of the traction is usually adjusted
such that it helps eliminate the lumbar lordosis.
4. the benefit from the traction is strictly
psychological.
162. Lumbar traction requires:A
1. a distraction force of approximately one
half the body weight just to overcome the friction
between the patient and the table (patient supine on
fixed surface table)
2. a split table in which the upper half of the
table is fixed and the tower half is on rollers to
minimize friction between the patient and the table.
3. a cooperative, patient who will allow the
trunk muscles to relax as the distraction force is
applied
4. a force of least 700 pounds to get actual
distraction
163. the Intervertebral foramina are greatest in size
when.C
1. the neck is full extension
2. the neck is in full flexion
3. traction is given with the neck in
extension
4. traction is given with the neck in flexion
164. Which of the following are important guidelines
to the use of cervical traction?:B
1. intermittent traction of 60 pounds an
distract the cervical spine from 3 to 14 mm
2. the amount of distraction force needed for
cervical traction is about the same as that
needed for lumbar traction.
3. distraction of the spine widens the disc
space and spreads the facet joints
4. the increased length of the cervical spine
during traction is actually only an apparent
lengthening and is really due to straightening of the
normal cervical curve
165. Cervical traction :C
1. should be used such that the pull exerted
by the traction halter pulls the neck into
hyperextension
 2. should be used such that the pull exerted
by the traction halter pulls the neck into flexion
3. has few or no contraindications
4. should be used with caution in patients
with arterial disease and connective tissue disorders.

Chapter 3
Therapeutic Exercise

Directions: For each of the incomplete statements

below, ONE or MORE of the numbered completion is
correct. Each case select:
A. if only 1,2 and 3 are correct
B. if only 1 and 3 are correct
C. if only 2 and 4 are correct
 D. if only 4 is correct
E. if all are correct
61. The maximum strength of a muscle is:B
1. the maximum tension developed per unit
of cross-sectional area
2. occurs mainly when the muscle is used in
an isometric manner
3. most likely to occur when the muscle is at
resting length
4. possible only during an eccentric
contraction
62. Maximum strength can be obtained with:E
1. low weight (40% maximal) repetitions if
done to the point of fatigue
2. high weight (85 to 100% maximal)
repetitions if done to the point of fatigue
3. isometric muscle strengthening technique
if the final measurement of strength is done
isometrically
4. isotonic muscle strengthening technique if
the final measurement of strength is done isotonically
63. Progressive resistive exercise:E
1. was first described by Delorme
2. is based on weekly increases in the 10
repetitive maximum (RM)
3. can be used even if the muscle is not anti
gravity in strength
4. begins with 10 repetitions of one-half 10
RM and ends with 10 RM
64. Exercise to improve strength in muscles is the
greatest that can be moved: :E
1. should be done with caution and careful
monitoring of strength
2. can be done by placing the joint moved in
a gravity eliminated position
3. can be done with an assistive devise
moved such as a powder board
4. can be done with a cable and pulley
assistive system such as that used in the Elgin
exercise table.
65. The Oxford Technique:B
1. is essentially like the PRE program of
Delome except that the exercise is arranged from the
heaviest to the lightest weight
2. is an isometric exercise technique
3. was designed to allow the use of lower
resistance as muscle fatigue ensued
4. has definitely been shown to provide a
faster improvement in strength than the PRE
technique of De Lome
66. Body building techniques that commonly used for
producing muscle hypertrophy: C
1. provide an adequate stimulus for
generalized aerobic conditioning
2. usually involve the used of multiple ( 3 7)
sets of 9 16 repetitions on alternate days
3. often consist of a program of decreasing
numbers of repetition with increasing resistance.
4. use maximum resistance (10 RM)
constantly rather than incremental increases or
decreases in resistance load
67. A power program for weight lifter:A
1. is designed to produce muscle bulk or
endurance
2. is a program of decreasing numbers of
repetitions with increasing weight until the last
weight is the greatest that can be moved once.
3. is usually done on five to seven days each
week.
4. is good stimulus for aerobic physical
68. Isometric exercise: E
1. is often clinically in a form called BRIME
2. improves muscle strength without muscle
hyperthropy
3. does not significantly improve joint range
of motion
4. is often difficult to measure in terms of
the muscle tension being exerted
69. Synchronization refers to: D
1. maximal isometric tension
2. minimal isometric tension
3. the pattern of agonist cooperation units to
increase strength
4. the coordinated firing of motor units to
increase strength
70. Biofeedback training:E
1. involves the use of equipment that reveals
to the patient some internal parameter or event that
would otherwise have not been consciously known
to the patient
2. requires that the patient receiving the feed
back volitionally use it to accomplish a desired goal
3. using electromyographic equipment often
improves the results of an exercise program
especially if the desired goals include muscle
relaxation or specific muscle firing
4. is probably the most useful clinically
71. Some of the most important parameters in
evaluating the patient who is going to receive
neuromuscular facilitation exercise include. E
1. the distribution of abnormal tone and spastiolty in
the trunk and extremities.
2. voluntary movements and the effect of abnormal
tone on them
3. coordination of voluntary movements
4. motivation of the patient for the treatment and for
improvement.
72. the peripheral influences on motoneuron
excitability usually used in propreceptive
neuromuscular facilitation exercise techniques are. C
1. cerebellar and corticospinal input to the alpha
motor neurons
2. muscle receptors such as the intrafusal muscle
system
3. psychological influences such as a emotion
4. different input to the alpha motor neurons from the
skin and tendon receptors.
73. An acceptable facilitatory stimulus should be
minimally capable of causing.: D
1. motorneuron discharge
2. motorneuron inhibition
3. clonus
4. at least sub threshold affect toward discharging a
motoneuron
74. The main difference between the therapeutic
effects of quick and slow passive stretch of a muscle
is. D
1. there is actually no significant therapeutic
difference
2. the pain experienced by the patient is less with
slow stretch
3. the slow stretch is used only when muscle exhibit
clonus
4. a muscle inhibitory or relaxing effect is obtained
by slow stretch, while fast stretch is excitatory and
facilitaties muscle activity
75. In classical proprioceptive neuromuscular
facilitation (PNF) techniques, a therapist might
stretch a muscle spindle: E
1. facilitate voluntary activity in the muscle
2. increase the firing rate of the afferents from the
muscle spindle
3. inhibit voluntary activity in the antagonistic
muscle
4. focus the patient’s attention on the movement of
the muscles
76. Proprioceptive neuromuscular facilitation (PNF)
programs typically include. : A
1. deep cooling of muscle
2. muscle stretching
3. withdrawal reflexes
4. superficial
77. Noxious stimuli. E
1. produce a generalized flexion synergy withdrawal
2. produce the some general effect as tickling
3. relax extensor tone by inhibition flexor anatagonist
4. are often used as part of a PNF program
78. Rood’s technique of superficial cooling of the
skin over a muscle or brushing the skin over a muscle
is. A
1. useful in increasing the activity level of a muscle
2. based on the observation that skin stimulation over
a muscle increases the gamma efferent activity to the
muscle spindle system.
3. due to a multisynaptic reflex connecting skin
receptor and muscles underlying the skin and which
in an evolutionary sense may have been useful in
avoiding capture
4. not explainable with current neurophysiological
information
79. Central facilitation techniques. B
1. utilize synergies associated reactions and radiation
to get facilitator or inhibition of a muscle
2. utilize stroking or icing techniques
3. include the common practice of having a
hemiplegia patient maximally activate the muscle on
the normal side while to voluntarily use the desired
muscle on the affected side.
4. should not be simultaneously with PNF techniques
Directions: For each of the incomplete statements
below, ONE or MORE of the numbered completion is
correct. Each case select:
A. if only 1,2 and 3 are correct
B. if only 1 and 3 are correct
C. if only 2 and 4 are correct
D. if only 4 is correct
E. if all are correct
106. Exercise programs for the hand in patients with
inflammatory arthritis are controversial because. :A
1. many authorities feel that any exercise increase the
loss of joint stability
2. exercise takes too much of the patient’s time and
has been proven to be definitely effective
3. hand exercise programs are very complicated and
must be designed for each patient and even for each
finger joint
4. they are clinically proven to be useful following
hand surgery in patients with inflammatory
107. The prescription of exercise for the patient with
simple recurrent low back pain should achieve at
least the following. E
1. improved low back flexibility
2. improved posture with minimized lumbar lordosis
3. improved body mechanism in all activities and
exercise
4. improved strength of abdominal and hip extensor
muscles
108. Probably the most useful technique for treating
simple recurrent low back pain is D
1. traction
2. pelvic tilt exercise
3. knee-chest exercise
4. bed rest
109. Prescribing leg lifts in patients with simple
recurrent low back pain may E
1. exacerbate the [ain as the iliopsoas muscle pulls
the lumbar spine into lordosis
2. strengthen the iliopsoas muscle and to some extent
the abdominal muscles
3. be less helpful than prescribing book-line sit-ups
4. increase intradiscal pressure in the lumbar spine.
110. knee-chest exercise are used in patients with low
back pain to E
1. strengthen the hip flexors
2. stretch the hamstring muscle
3. strengthen the hamstring muscles
4. stretch the soft tissue structures of the low back
111. hamstring muscle stretching is often done in
patient with low back pain :A
1. with the patient sitting, knees extended, bouncing
the trunk forward to attempt to touch the toes.
2. with the patient standing, trying to touch the toes.
3. with the patient sitting with one knee extended and
one flexed, with truncal bouncing to touch the touch
the toes of the extended side.
4. patient with low back pain should be stretching the
hamstring muscles since these exercises increase the
lumbar lordosis
112. Pelvic tilt exercise is often prescribed for patient
with low back pain because : A
1. abdominal muscle strengthening
2. reflex inhibition of back musculature
3. stretching of the low back structures to present
fixed with truncal bouncing to touch the toes of the
extended side.
4. patients with low back pain should not be
stretching the hamstring muscles since these exercise
increase the lumbar lordosis
112. Pelvic tilt exercise is often prescribed for
patients with low back pain because A
1. abdominal muscle strengthening
2. reflex inhibition of back musculature
3. stretching of the low back structures to present
fixed excessive lumbar lordosis
4. permanent reduction of the lumbar lordosis.
113. Stretching the hip flexors is often useful in
patients with hip, flexion contractures and low back
pain. In this type of exercise. B
1. there is active use of the Thomas test for hip
flexion contracture
2. the patient lies supine with both hips in full
extension
3. the patient kneels on one knee and rocks back and
forth
4. the patient lies prone
114. A hook-lying (or hook-line) sit-up is B
1. done in the supine position with the knees flexed
2. used to strengthen the hip flexors
3. used to strengthen the abdominal muscles and to
some extent the hip flexors
4. particularly useful during episodes of acute back
pain
5. particularly useful during episodes of acute back
pain
115. Bridging is a useful exercise in patients with low
back pain if it can be done without exacerbating the
pain because it strengthens the D
1. abdominal muscles
2. hip flexor muscles
3. neck flexor muscles
4. back and hip extensor muscles
116. postural exercise in scoliosis: E
1. are used while in the Miwaukee brace since this
brace forces the patient to extend the spine to prevent
painful pressure on the chin or neck
2. are used to elongate the spine low back are used to
elongate the spine
3. are used to reduce the lumbar lordosis and dorsal
kyphosis
4. can be done with weight on the head to improve
the strength of the muscle that distract the spine
117. exercise in patients with scoliosis has been
shown to C
1. control and even improve the scoliotic curve
2. increase the flexibility of the concave side of the
spine curvature
3. worsen the curvature when used without adequate
bracing
4. improve respiration
118. Cotrel’s exercises for scoliosis include E
1. elongation of the spine
2. derolation of the spine
3. lateral flexion of the spine
4. self powered cervical traction (the lower
extremities push on a bar to provide the power for
cervical traction through a double pulley system)
119. Buerger’s exercises for treatment of peripheral
vascular disease E
1. have not been shown to be effective in controlled
2. do not increase muscle blood flow
3. are based on the theory that alternately distending
and emptying blood vessels would make them
capable of handling greater quantities of blood
4. originally included the use of an electric heating
pad or hot water bottle on the limbs.
120. Buerger-Allen exercise A
1. Combine the postural program of Buerger with
active plantar flexion and dorsiflexion of the ankle at
rate of 30 min
2. are less effective in increasing blood flow to
muscles than resistive exercise of the lower
extremities
3. increase the quantity of blood flowing to lower
extremity muscles
4. include walking to the point of claudictory pain
121. Achieve muscle contraction; B
1. reduces the quantity of blood flowing in a muscle
during the contraction
2. are less effective in increasing blood flow to
muscles than resistive exercise of the lower
extremities
3. increase the quantity of blood flowing in a muscle
between contractions
4. decreases the quantity of blood flowing in a muscle
between contractions.
122. The most effective treatment (nonsurgical) of the
following treatment programs for peripheral vascular
disease is:D
1. Buerger’s exercise
2. vasodilators
3. Buerger-Allen exercise
4. brisk walking to the point of claudicatory pain (for
at least one hour per day)
123. The main advantages of immediate
postoperative fitting of a lower extremity prosthesis
are E
1. psychological benefits to the patient of early
ambulation
2. early re establishment of prioprioceptive feedback
by contact with floor
3. pain relief by prevention of stump edema
4. prevention of complications of prolonged bed rest
124. Ambulation exercise with immediate
postoperative fit prosthesis should C
1. involve no weigh bearing on the prosthetic side of
six weeks
2. involve only touchdown weight bearing the first
day after amputation
3. achieve full weight bearing by the fourth
postoperative week
4. involve progressively more weight bearing on the
temporary prosthesis until it is bearing a maximum of
15 pounds (6 kg)
125. The most appropriate exercise regimen for a
patient with below-knee amputation and immediate
postoperative fitting is to B
1. begin with touchdown weight bearing on the
prosthesis and progress to a three-point gait using
parallel bars, crutches, or a walker
2. begin with three-point gait using axillary crutches
3. after fitting the permanent prosthesis, focus on
obtaining equal stride length and elimination of
prosthesis gait deficiencies
4. begin with a four-point gait using axillary crutches.
126. The exercise program for a lower extremity
amputee not fitted with an immediate post operative
prosthesis is aimed at: E
1. preventing contractures of the hip and knee
2. preventing loss of strength of the hip extensors,
flexors, and abductors as well as the knee extensors
and flexors
3. rapid shrinkage of the stump (elimination of post
operative edema)
4. preservation of the strength and range of motion of
joints in the remaining extremities
127. The treatment program for an infant with
acquired flat feet who is not old enough to walk
should include E
1. passive external rotation of the hips by the parents
2. passive internal rotation of the hips by the parents
3. massaging of the feet at least four times per day
5. passive foot stretching
by the parents in which
the forefoot is adducted
while the heel is
inverted
128. Treatment program for an infant with acquired
flatfeet who is not old enough to walk should
include:C
1 passive external rotation of the hips by the parents
2. passive internal rotation of the hips by the parents
3.massaging of the feet at least four times per day
4.passive foot stretching by the parents in which the
forefoot is adducted while the heel is inverted
129. Treatment of acquired flat feet in a child old
enough to walk might include: E
1. shoes having an adducted forefoot pattern
2. a lift under the medial side of the heel
3. attaching a bar to the sole of the shoes at night to
hold the hip in internal rotation
4. stretching the Achilles tendons
130. The treatment of the older child with flat feet
usually includes: B
1. stretching the Achilles tendons
2. stretching the foot evertors
3. strengthening the foot inventors
4. encouraging the child to walk with feet pointing
outward
131. Treatment for foot strain in the adult might
include: A
1. toe pick-up exercises
2. standing with the feet in slight inversion
3. weight loss down to ideal weight
4. one-eight inch wedge in the lateral border of the
heel of the shoe
132. Treatment program for a child with pigeon toes
must be based on the type of lower extremity
pathology producing it, such as A
1. medial hip rotation, usually associated with
2. a history of “W” sitting
3. metatarsus varus
4. external hip rotation, usually associated with a
history of lying prone with lower extremities in the
frog leg position
133. The typical exercise program for pigeon toeing
due to internal tibial torsion includes. B
1. passive rotation of the tibia and fibula into external
rotation
2. passive external rotation of the femur
3. “strengthening” the leg by grasping the medial
aspect of the knee and ankle and using the thumbs to
push against the fibula
4. a shoe bar can be used to keep the femur on each
side in internal rotation during the night
134. Pigeon-toed due to metatarsus varus is best
treated by D
1. casting of the foot in every case
2. encouraging “w” sitting
3. using cable “twister”
4. passively stretching the forefoot toward normal
alignment
135. In treating gait dysfunction it is important to
bear in mind that gait is affected by E.
1. a person’s body image
2. neurological muscle control competency
3. conscious and unconscious sensory feedback
4. perceptual orientation competence
136. The technical difference between walking and
running exercise is that the D
1. stance phase of gait is decreased in running
2. swing phase of gait is increased in running
3. period of double stance (double support) is longer
in walking
4. period of double stance (double support) occurs
only in walking
137. Gait speed is :A
1. unconsciously chosen by each individual at the
speed giving the lowest energy
2. about 3 mph for adult males
3. unconsciously chosen by each individual such that
the pendulum periodicity of the lower extremities fits
the cadance
4. only 3mph for adult males because the slower you
walk the less energy required for ambulating any unit
distance
138. Gait speed is unconsciously chosen by each
individual to allow maximum use of: C
1. large rather than small muscles
2. gravity and inertia rather muscles
3. concentric rather than eccentric contractions of
muscles
4. eccentric or lengthening contraction of muscles
139. Loss of motion at which joint produces the least
increases in the energy required for ambulation D
1. knee
2. hip
3. both hips
4. ankle
140. A gait characterized by reduction of stance phase
on one side with sudden movements downward of the
head, arms and trunk at stance phase on the same side
is D
1. due to gluteus medius weakness
2. due to anterior tibial muscle weakness
3. hysterical
4. antalgic
141. Some of the gait characterized of normal aging
include E
1. slower walking speed
2. shorter stride length
3. wider base of gait
4. relatively more time is spent in distance phase

142. Gait in Women is B

1. slower than in men (mainly due to shorter stride
length rather to slower cadenced
2. not related to the rule of choosing gait speed based
on the least energy expenditure per unit distance
3. slower than normal in high heels
4. faster than men in a crowded area

143. The normal aging process produces an

involuntional gait involving a flexed attitude, dorsal
kyphosis, mild proximal muscle rigidity, decreased
automatic movements, and a decrease in the
amplitude of associated movements, tending to
indicate involutional changes D
1. pyramidal system
2. skeletal muscle
3. autonomic nervous system
4. extrapyramidal system

144. A prescription of progressive ambulation might

include E
1. tilt table therapy
2. pool walking
3. walking in the parallel bars
4. walking with asistive devices such as crutches,
cane, walker, etc.

145. In very severe gait, problems the wheelchair

may :E.
1. be a liberating rather than confining device
2. be better form of ambulation because of the much
lower level of energy required to travel per unit of
distance
3. be safer for some patients than attempts at walking
4. have to be self-powdered (usually electric) if the
upper extremities are also impaired.

Chapter 4
Neurophysiology
Directions: For each of the incomplete statements
below, ONE or MORE of the numbered completion is
correct. Each case select:
A. if only 1,2 and 3 are correct
B. if only 1 and 3 are correct
C. if only 2 and 4 are correct
 D. if only 4 is correct 6. During voluntary muscle contraction (light to
E. if all are correct maximal effort) the discharge rates of single
motoneurons varies between D
1. What is the resting transmembrane potential in A. one to five impulses per second
muscle? C B. one to 20 impulses per second
A. – 70 mV C. five to 20 impulses per second
B. + 70 mV D. five to 50 impulses per second
C. – 90 mV E. one to 60 impulses per second
D. + 90 mV
E. there’s none 7. What is the most conspicuous sign of spinal shock
in man and other primates? E
2. What is the “resting transmembrane potential in A. loss of motor strength
nerve? A B. loss of sensation
A. –70 mV C. presence of autonomic hypereflexia
B. +70 mV D. hypereflexia below the level of cord transection
C. –90 mV E. areflexia or hypereflexia below the level of cord
D. +90 mV transection
E. there is none
8. What are the first reflexes to emerge from the
3. Which of the following is the correct sequence period of areflexia following spinal cord transection? C
when considering the production of an action potential A. tendon jerks
D B. anal reflexes
A. increase in sodium permeability; increase in C. withdrawal movements in response to plantar
potassium permeability; decrease in sodium and stimulation
potassium permeabilities simultaneously; active D. genital reflexes
transport of sodium out of nerve fiber E. none of the above
B. increase in sodium permeability; increase in
potassium permeability; decrease in potassium 9. The higher centers of the nervous system control a
permeability while sodium permeability remains spinal reflex by exerting their influence on which of the
constant; decrease in sodium permeability; diffusion following? D
of sodium out of the nerve and potassium into the A. motoneurons
nerve B. intemuncial neurons of the reflex arc
C. simultaneous increase of sodium and potassium C. gamma motoneurons, which set the sensitivity of
permeabilities; simultaneous decrease of sodium and the stretch afferent organs
potassium permeabilities; simultaneous diffusion of D. all of the above
sodium out of and potassium into the cell E. none of the above
D. increase of sodium permeability; increase of
potassium permeability with simultaneous decrease of 10. Body temperature is regulated to what part of the
sodium permeability, decrease of potassium central nervous system? E
permeability, active transport of sodium out of nerve A. right parietal lobe
fiber, with concurrent active transport and diffusion of B. pons
potassium into nerve above. C. limbic system
E. none of the above D. thalamus
E. hypothalmus
4. Saltatory conduction in nerves is a result of which
one of the following? C 11. What are the efferent cells of the cerebellar
A. myelination of only large diameter axons cortex? B
B. myelination of only small diameter axons A. Betz’z cells
C. myelination of any size nerve B. Purkinje’s cells
D. loss of myelination of very large diameter nerve C. Cuboid cells
E. changing the potassium ion concentration in the D. Schwann’s cells
intestinal fluid about a nerve E. none of the above

5. What is the name applied to what happens to the 12. Increasing degrees of heat first stimulate warmth
distal portion of an axon when the axon is severed? D endings and then commence to stimulate pain
A. neuropraxia endings. At what temperature are pain endings first
B. axonotmesis stimulated? D
C. neurotmesis A. 16.4 C
D. wallerian degeneration B. 23.7 C
E. none of the above C. 25.2 C
D. 44.9 C
E. 59.9 C
 1. III
13. The Weber and Rinne diagnostic test are used to 2. VII
test which sense? D 3. IX
A. vision 4. XI
B. taste
C. touch 20. The autonomic nervous system innervates:A
D. hearing 1. smooth muscle
E. smell 2. cardiac muscle
3. glands
14. Broca’s area is typically associated with which 4. skeletal muscle
term? A
A. expressive aphasia 21. damage to the basal ganglia can result in which
B. receptive aphasia disorders?: E
C. apraxia 1. athetosis
D. auditory agnosia 2. chorea
E. visual agnosia 3. ballismus
4. Parkinson’s disease
15. Which hormone is concerned with water
regulation? C 22. Dysmetria is a deficiency ion which of the
A. prolactin following?C
B. oxytocin 1. force
C. ADH (antidiuretic hormone) 2. rate
D. Epinephrine 3. steadiness
E. nonrepinephrine 4. direction

Directions: For each of the incomplete statements
below, ONE or MORE of the numbered
completions is correct. In each case select.
A. if only 1,2 and 3 are correct
B. if only 1 and 3 are correct
C. if only 2 and 4 are correct
D. if only 4 is correct
E. if all are correct
16. When considering muscle contraction calcium
ions. E
1. stimulate the Atpase of aytomyosin
2. are concerned mainly with control of muscle
contraction
3. stimulate the ATPase of myosin
4. play a more important physiologic role than
magnesium ions
17. The sympathetic division of the autonomic
nervous system originates from pregganglionic
neurons in C
1. certain cranila nerve nuclei
2. the thoracic spinal segments
3. the second third, and fourth sacral segments of the
spinal cord
4. the upper lumbar spinal segment
18. The stellate ganglion: c
1.is formed by the fusion of the superior and middle
cervical ganglia
2.is formed by the fusion of the inferior and first
thoracic ganglia
3. is part of the parasympathetic nervous system
4. is part of the sympathetic nervous system
19. Which cranial nerves are involved in the
parasympathetic nervous system?: A
23. With reference to sensory pathways of the spinal
cord, the anterolateral tracts exclusively conduct
impulses concerning which kind(s) of sensation?:E
1. pain from skin, muscles, tendons joints and viscera
2. warmth
3.cold
sexual sensations
24. With reference to sensory pathways of the spinal
cord, the posterior white colums conduct impulses
concerning which kind(s) of sensation?: E
1. proprioception
2. touch-pressure
3. kinesthesia
4. those related to perceptual functions
25. Irritaion of tyeh viscera by a pathologic process is
manifested by: E
1. pain
2. somatic reflexes, muscular rigidity
3. autonomic reflexes – sweating, piloerection, or
vasomotor changes
4. hyperalgesia, hyperesthesia, or tenderness
26. Which cranial nerves are concerned with
sensation of the tongue? A
1. VII
2. V
3. IX
4. X
27. Which of the following are forms of agnosia : A
1. failure to recognize common objects by palpating
them
2. inability to appreciate the meaning of objects seen
of colors or of visual space in the absence of a
primary visual defects.
3. failure to recognize the parts of the body, to
differentiate right and left or in general to recognize
the relationship of objects to the body.
4. inability to perform voluntary movements in the
absence of motor paralysis.

28. Water deprivation is the usual physiologic

situation that elicit drinking behavior. Which of the
following are neural mechanism responsible for this
drinking behavior? C
1. thalamic osmoreceptors
2. hypothalamic osmoreceptors
3. osmoreceptors in the limbic system
4. cells of the lateral hypothalmus

29. Which of the following are properties of axonal

transmission of impulses:B
1. conduction in both directions
2. greater susceptibility to asphylaxia, ischemia, and Chapter 5
depressant drugs than synaptic transmission of Eletromyography
impulses
3. evovation of one action potential by each stimulus Direction: Each of the question or incomplete
(disregarding refractory period) statements below is followed by five suggested
4. unidirectional conduction
answer or completion. Select the single BEST answer
30. The gamma efferent system is excited primarily by in each case.
the D
1. cerebellum 1. Electrodiagnosis is useful in detecting
2. cerebral cortex abnormalities of E
3. basal ganglia A. muscle fibers
4. bulboreticular facilitatory region of the brain stem. B. peripheral nerves
C. myneural junctions
D. anterior horn cell
E. all of the above

2. The “motor unit” consists of all of the following

except the A
A. cerebral cortical motor strip
B. anterior horn cells
C. axon
D. myoneural junction
E. muscle

3. What is the proper definition of term “motor

point”? D
A. the point along a peripheral nerve where motor
fiber only are found
B. the ventral root of spinal nerve consists only of
motor nerve fiber and is referred to as the motor
point.
C. the anterior horn cell is the “motor point” of the
motor unit, and the term refers to the location of
anterior horn cells in the spinal cord.
D. the “motor point” refers to the point where the
motor nerve enters the muscle
E. none of the above

4. The term “innervation ratio” refers to the C

A. number of individual nerve root which innervate a
specific muscle
B. number of muscle fiber peripheral nerves which
innervate a specific muscle
C. number of muscle fiber per motor nerve fiber
D. number of nerve contained in the peripheral nerve
E. none of the above
5. Nerve conduction velocity is most dependent upon.
C
A. length of entire nerve
B. size of the muscle
C. diameter of the nerve fiber
D. intensity of the stimulus
E. none of the above
6. In Lloyd’s Roman numeral classification system of
sensory nerve fibers. Group of fiber will have the
highest conduction velocities? A
A. group I
B. group II
C. group III
D. group VI
E. none of the above, since Lloyd system does not
categories fiber either by their size or conduction
speed
7. The term “volume conduction” refers to the D
A. absolute frequency range of the electromyography
(EMG) machine speakers
B. ability of EMG machine amplifier to handle large
amplitude electrical discharges
C. conduction along a peripheral nerve involving
both sensory and motor fibers
D. spread of current through a conducting medium
from its source
E. none of the above.
8. In normal muscle at rest which following potential
is common fibers? E
A. fibrillation
B. positive wave
C. “myopathic” motor unit action potential
D. myotonic discharge
E. none of the above
9. Following insertion of the needle recording
electrode into a muscle, a patient complain of pain
the EMG scope shows low amplitude and short
duration potentials which have an initial negative
deflection. These potentials most likely represent E
A. positive waves
B. fibrillation
C. myotonic discharges
D. bizarre high frequency potentials
E. end-plate potentials
10. When a muscle is voluntarily contracted, the
motor units will begin to fire. What is the usual initial
rate of firing of motor unit during a week contraction.
A. 1 to 3/min
B. 5 to 15/min
C. 5 to 15/sec
D. 75 to 100/sec
E. none of the above
11. In a patient complaining of weakness, the
electromyogram reveals polyphasic motor unit action
potentials. These polyphasic potentials account for
about 10% of motor unit action potentials studied.
The remainder of the study is normal. How should
these findings be interpreted? E
A. suggestive of myopathy
B. diagnostic of myopathy
C. suggestive of a neuropathic process
D. diagnostic of neuropathic process
E. none of the above
12. In routine nerve conduction studies what would
be the approximately normal value obtained for the
velocity of nerve conduction? D
A. 0.5 m/sec
B. 5m/sec
C. 15 m/sec
D. 50 m/sec
E. 100 m/sec
13. A patient presents with the following nerve
conduction values:
ulnar nerve motor latency = 3.2 m/sec
ulnar nerve sensory latency = 3.0 m/sec
median nerve motor latency = 4.0 m/sec
median nerve sensory latency = 4.2 m.sec
median nerve motor conduction velocity = 57 m/sec
what is a likely diagnosis in this case? C
A. ulnar neuropathy at the elbow
B. ulnar nerve entrapment at the wrist
C. carpal tunnel syndrome
D. peripheral polyneuropathy
E. these are the normal findings
14. A patient presents with what appears to be a
pronator syndrome. Which nerve is compressed in
this syndrome? E
A. tibial
B. peroneal
C. ulnar
D. radia;
E. median
15. The most common site ulnar nerve compression is
D tibialis anterior
A. in the palm
B. in the palm
C. at the wrist
D. in the forearm
E. at the elbow
F. at the thoracic outlet
16. A patient complains of hyperthesia in the ulnar
nerve distribution. Nerve conduction studies are
performed and reveal the following results:
median nerve motor distal latency =3.6m/sec
median nerve motor conduction velocity in the
forearm==55 m/sec.
Ulnar nerve motor distal latency = 3.2 m/sec
Ulnar nerve motor conduction velocity across in the
forearm = 52 m/sec
Ulnar nerve motor conduction velocity in the arm =
62 m/sec
What is the likely diagnosis? D
A. carpal tunnel syndrome
B. pronator syndrome
C. thoracic outlet syndrome
D. ulnar nerve compression at the elbow
E. insufficient data are given for any conclusions
17. Femoral nerve are performed on a patient the
following results are obtained:
latency from above the inguinal ligament to the
vastus medials muscle = 9.7 m/sec
latency from below the inguinal ligament to the
vastus from below medialis muscle = 5.8 m/sec
distance between the two sites of stimulation = 12cm
what would be likely diagnosis?D
A. the studies are normal
B. diabetic amyotrophy
C. peripheral neuropathy
D. femoral nerve compression at the inguinal
ligament
E. femoral nerve injury at level of the psoas muscle
18. After a prolonged period of sitting with the legs
crossed, a patient complain of dragging the right foot.
The patient is able to walk on her toes but cannot
walk on the heel of her right foot due to weakness.
An EMG examination is planned.
Which muscle would be expected to show EMG
abnormalities? E
A. extensor digitorum brevis, tibialis posterior and
extensor hallucis longus
B. tibialis anterior, tibialis posterior, and peroneus
brevis
C. extensors hallucis longus, abductor hallucis and
peroneus tertius
D. Flexor hallucis longus, abductor hallucis and
E. extensor digitorum brevis, peroneus longus and
tibialis anterior
19. A patient was stabbed with a knife and the ulnar
nerve was severed at the elbow. Nerve conduction
studies are performed with the following results:
1. no response in the abductor digiti quinti when the
ulnar nerve is stimulated
2. an evoked response with a latency of 3.8 m/sec is
obtained from the abductor digiti quinti when the
ulnar nerve is stimulated at the wrist.
What is a likely explanation for these results? D
A. the ulnar was not totally severed but is still
partially functioning
B. the response recorded from the stimulation at the
wrist is a volume conducted response from the
median innervated hand muscles
C. there is spread of the stimulus to the median nerve
when the nerve is stimulated at the wrist.
D. there is median-ulnar crossover
E. the studies are definitely in error and should be
repeated
20. A patient has the following EMG findings:
1. positive waves and fibrillations in the proximal
girdles muscles
2. low amplitude, short duration motor unit action
potentials
3. normal nerve conduction and respecyive
stimulation studies
what would be the most likely diagnosis? C
A. myasthemia gravis
B. myotonic dystrophy
C. polymyositis
D. amytrophic lateral sclerosis
E. G ilain-Barre syndrome
21. An EMG performed during the period of flaccid
paralysis in the disease known as hypokalemic
periodic paralysis reveals. E
A. normal findings
B. positive waves and fibrillations
C. bizarre high frequency potentials
D. long duration motor unit action potentials
E. electrical silence
22. A patient presents with symptoms typical of an
acute radiculopathy. The EMG examination is normal
but the H reflex response is absent on the affected
side. A normal H reflex response is obtained on the
uninvolved side. Which nerve root is probably
compressed? E
A. C6
B. C7
C.C8
D. L5
E. S1

23. A patient has a right facial palsy (Bell’s palsy).

Nerve conduction studies are performed and revel a
latency of 3.4 m/sec to the frontalis muscles and 3.3
m/sec to the orbicularis oris muscle. The facial palsy
ahs been present for 24 hours prior to the above
studies. What can be said about the prognosis? E
A. excellent for full and rapid recovery
B. expected full recovered but over a period of about
six weeks
C. expected incomplete recovery
D. poor, with little recovery
E. none of the above
Chapter 6
Orthotics and Ptosthetics

Directions: For each of the incomplete statements

below, ONE or MORE of the numbered
completions is correct. In each case select.
A. if only 1,2 and 3 are correct
B. if only 1 and 3 are correct
C. if only 2 and 4 are correct
D. if only 4 is correct
E. if all are correct
1. A mechanical object that support a body part is
called a (n) E
1. brace
2. othosis
3. orthesis
4. splint

2. Some of the basic reasons of a deformity of a body

device include A
1. support of body part
2. immobilization of a body part
3. prevention or correction of a deformity of a body
part
4. replacement of a body part

3. Some of the characteristic of a successful orthosis

include E
1. durability
2. comfort and cosmetic appearance
3. lightness in weight
4. strength

4. An orthotic prescription should include E

1. the body part to be braces
2. the type of brace
3. the type of material
4. the type of joint and other special considerations
5. The most similar devices from a prosthetic and 1. a long opponens orthosis
orthotic standpoint are D 2. a short oponens orthosis
1. lower extremity prosthetic and orthotics 3. a spring –loaded ankle joint
2. upper extremity orthotics and lower extremity 4. a flexor hinge splint
3. lower extremity orthotics and upper extremity 79. The level of quadriplegia (lowest spared level)
4. upper extremity orthotics and prosthetics most likely to benefit from a flexor hinge splint is D
1. C-4
6. Some of the reasons a patient might reject 2. C-8
anorthosis include E 3. C-7
1. no useful activity in which the patient could use in 4. C-6
device 80. The level(s) of quadriplegia most likely to benefit
2. difficulty in putting the orthosis on and taking it off from long opponents orthosis is fare. C
3. negative attitudes of the prescribing physician and 1. C-6
other rehabilitation team members 2. C-5
4. cosmetic appearance 3. C-7
4. C-4
7. Leather is till in orthotics because it has some Chapter 7
characteristics that are unmatched by any synthetic Spinal Cord Injuries
material, including A
1. water vapor permeability Direction: Each of the questions or incomplete
2. ability to absorb water from moist air surrounding statements below is followed by five suggested
the skin answer or completions. Select the single BEST
3. ability to absorb ,and disperse moisture from points answer in each case.
to heavy sweating
4. ability to retain its shape 1. The approximate number of persons with spinal
cord injury and paraplegia or quadriplegia currently
Directions: For each of the incomplete statements residing in the United States is about D
below, ONE or MORE of the numbered A. 5,000
completions is correct. In each case select. B. 10,000
A. if only 1,2 and 3 are correct C. 100,000
B. if only 1 and 3 are correct D. 200,000
C. if only 2 and 4 are correct E. 800,000
D. if only 4 is correct
E. if all are correct 2. Cervical spine immobilization is desired during
74. The principal use of lower extremity orthotic healing of a cervical fracture. In case where surgical
devices include E stabilization is not planned, how might adequate
1. support of body water immobilization best be achieved? D
2. prevention of lower extremity deformities A. bedrest with the use of sandbags beside the head
3. correction of lower extremity deformities B. use of a body cast extending up over the mandible
4. control of involuntary movements C. soft collar
D. use of traction through skull tongs
75. Pivot or suspension feeders are prescribed to B E. Philadelphia collar
1. support the thumb in abduction to allow opposition
with the fibers 3. The muscle stretch reflexes during the period of
2. hold the interphalangeal spinal shock are A
joints in full A. absent
3. support the metacarpal arch B. diminished
4. prevent ulnar deviation of the fifth digit C. normal
76. A long opponents orthosis is prescribed to A D. increased
1. support the thumb in abduction to allow opposition E. can be quite variable
with the fingers
2. support the metacarpal arch 4. The term spinal shock refers to:
3. stabilize the wrist A. the hypoexcitability of the portion of the spinal
4. allow flexion of the wrist only cord below the level of a spinal cord injury
78. The reciprocal-wrist extension- finger flexion B. the circulatory shock that occurs following spinal
orthosis is also called D cord injury
C. a transient phenomenon
D. all of the above
5. A patient with C6 quadriplegia is examined by
means of electromyography and at the level of the
lesion, abnormalities consistent with lower motor
neuron disorder are found. How would this be
explained.
A. any injury to the spinal cord produces lower motor
neuron findings at below the level of the lesion
B. the electromyogram is probably in error since only
upper motor neuron abnormalities should be present
C. the changes seen on the electromyogram reflect
damage to the anterior horn cells and anterior roots
D. both A and C
E. all of the above.
6. Particular ossification has just developed around a
hip and limits hip joint motion. The most appropriate
treatment B
A. immediate surgical removal of the bone
B. delayed surgical removal of the bone
C. radiation to the bone
D. methotrexate
E. disodium edentate
6. Paraarticular ossification has just developed
around a hip joint and limits hip joint motion. The
most appropriate treatment is B
A. immediate surgical removal of the bone
B. radiation to the bone
C. methotrexatre
D. disodioum edentate
7. A patient with quadriplegia develops swelling in
the upper thigh. An x-ray of this area reveals what
appear to be cloudy, streaky densities in the muscles.
What is the likely diagnosis? A
A. heterotropic ossification
B. cellulites
C. thrombophlebitis
D. acute rupture of the quadriceps mechanism
E. Osteogenic sarcoma
8. The most important way to help combat
osteoporosis in the spinal cord patient is to D
A. administer high doses of vitamin D
B. administer vitamin D and calcium supplement
C. administer calcitonin
D. mobilize the patient as early as possible
E. perform range of motion exercises passively three
times daily
9. A paraplegia patient sustains a fracture of the
femur during stretching exercises. What is the
probable underlying reason for this fracture? A
A. osteoporosis
B. osteomalacia
C. muscle paralysis
D. muscle contracture
E. ligamentous laxity
10. A quadriplegic patient is on respirator. What
guidelines might be used to help indicate that the
patient may be able to be taken off the patient may be
able to be taken off the respirator? C
A. generally patient can be safely weaned from the
respirator at 6 months postonset
B. motor unit action potentials in the stemomastoid
muscle on EMG examination indicate that the patient
can be removed from respirator
C. a vital capcity of 500 to 800 ml is a good
guidelines for the beginning of removal of the patient
from the respirator
D. the patient can be taken off the respirator if he is
afebrile and has a normal ECG
E. the patient should be weaned only following a
laminectomy and fusion
11. The major area of concern is managing the C3
quadriplegic patient is E
A. maintaining proper nutrition
B. preventing pressure ulcers
C. preventing contractures
D. strengthening the tongue and muscles of
mastication
E. maintaining adequate respiration
12. A patient with early flaccid quadriplegia develops
swelling of the leg and low grade fever. What is the
likely diagnosis? D
A. urinary tract infection
B. Undiagnosed fracture of the femur
C. undiagnosed fracture of the tibia
D. thrombophlebitis
E. arterial embolism
13. Immediately following an automobile accident, a
patient is rendered a C7 quadriplegic. Over the next
two days, the patient seems to develop further
weakness, and a through examination reveals the
presence of a C6 quadriplegic. What should be done
in most such cases? A
A. nothing
B. immediately laminectomy to decompress the cord
C. immediately laminectomy with spinal fusion
D. anterior interbody fusion without laminectomy
E. intrathecal administration of factor VIII to obtain
hemostasis
14. Which of the following statements is most
correct? E
A. early laminectomy is indicated in all cases of
spinal cord injury
B. early laminectomy is indicated only in cases of
quadriplegia
C. early laminectomy is indicated only in case of
paraplegia
D. early laminectomy is indicated only in cases of
complete cord lesion
15. At the time of laminectomy is usually not
indicated a spinal cord injury, the cord appears intact
with no apparent has a complete flaccid paraplegic.
What can be said about the prognosis? E
A. the lesion is probably a neuropraxia and the
patient should go on to complete recovery in from
one to two weeks
B. full recovery will occur but will probably occur
over a one year period
C. the patient will probably be permanently left with
a neurologic bladder but the legs will recover fully.
D. the patient will probably have only some
permanent weakness in the muscles around the feet
E. none of the above
16. a patient sustains a sever fracture of the L1
vertebral body and is left with neurological deficit.
What type of deficit would be expected? D
A. spastic paraplegia with spastic
bladder
B. spastic paraplegia with flaccid
bladder
C. flaccid paraplegia with spastic
bladder
D. flaccid paraplegia with flaccid
bladder
E. paraplegia with no bladder
involvement
17. The most frequent type to injury to the spinal cord
is C
A. stretch
B. laceration
C. confusion
D. transection
E. all of the above are about equal in frequency
18. The artery of Adamkiewiez is a major feeder this
artery most commonly found? D
A. C1 and C4
B. C7 and T1
C. T2 and T5
D. T9 and L1
E. L4 and S1
19. Blood supply to the spinal cord is not equal at all
spinal segments, some areas better vascularized than
others. Which segment is most poorly vascularized?
C
A. C3
B. C8
C. T4
D. T9
E. L3
20. A quadriplegic patient becomes hypotensive when
raised to the upright position on the tilt table. Why is
this? A
A. blood pools in the abdomen and lower extremities
B. the heart is unable to increase its rate when the
patient is upright
C. pulmonary ventilation is compromised by the
straps on the tilt table restricting chest expansion
D. only A and C
E. all of the above
21. A typical cystometrogram in a patient with a
complete cauda equina injury would look loke D
A. a line with multiple large spikes
B. a line with one large spike
C. a line with multiple small spikes
D. a line that is nearly horizontal
E. a line with a rather large upward slope
22. A potential serious side effect of autonomic
hyperreflexia is E
A. myocardial infraction
B. renal failure
C. Dehydration
D. Gastric ulceration
E. cerebral hemorrhage
23. The apparent mechanism of autonomic
hyperreflexia is A
A. massive release of catecholamines
B. inactivation of acytylcholinesterase
C. potentiation of the effect of acetylcholine by
increasing its duration of release
D. inhibition of the vagal responses
E. central release of dopamine in the striatum
24. In lesions of the cervical spinal cord, bladder
distention may be associated with the development of
E
A. systolic hypertension
B. bradycardia
C. sweating above the level of the lesion
D. cardiac arrhythmia
E. all of the above
 E. all of the above
25. In an autonomic reflex type of bladder that is
being treated with intermittent catheterization what is 31. The major cause of death in the paraplegic is C
the acceptable quality of residual urine in the bladder A. pneumonia
A. 5 to 10% of bladder volume B. myocardial infraction
B. 25 to 30% of bladder volume C. renal disease
C. 45 to 50 of bladder volume D. suicide
D. 65 to 70% of bladder volume E. cancer
E. 85 to 90% of bladder volume
32. A patient with acute paraplegia is seen in the
26. Following cervical spinal cord injury, what is the emergency room one hour after the injury. How
status of the bladder after the patient has passed should his bladder be managed in the first several
through the stage shock? B hours following injury? (no renal damage occurred
A. normal function from the injury.) B
B. spastic uninhibited function A. intermittent catheterization should be started with
C. flaccid and areflexic the initial catheterization being performed as soon as
D. ataxic contractions of the detrussor muscle possible
E. the patient often remains anuric B. intermittent catheterization should be started but
the initial catheterization need not be performed until
27. What is the status of the bladder during the period 12-24 hr postinujury
of spinal shock? C C. a Foley catheter should be inserted and left in
A. normal function place to monitor urine output during the immediate
B. spastic uninhibited function postinjury period. Fluids should be forced.
C. flaccid areflexic D. a Foley catheter should be inserted and left in
D. ataxic contractions of the destrussor muscle place to monitor urine output during the immediate
E. the patient is anuric during spinal shock postinjury period. Fluids should be restricted
E. an immediate suprapubic cystostomy should be
28. The term “neurologic bladder refers to perfomed.
A. dysfunction of the bladder owing to peripheral
nerve disorder 33. The most common suprapubic cyctostomy is D
B. dysfunction of the bladder owing to disorders of A. bladder stones
the bladder musculature B. renal stones
C. dysfunction of the bladder owing to central C. peno-scrotal abscess
nervous systems disorders D. infection
D. only A and C E. bladder rupture
E. all of the above
34. The procedure of management of the
29. Following cervical spinal cord injury, what neurologenic bladder in which the bladder is
happened to the sweating pattern? A alaternatly filled and emptied of irrigating fluid is
A. sweating decreases below the level of the lesion called A
B. sweating increases below the level of the lesion A. tidal drainage
C. sweating decreases over the entire body B. intermittent catheterization
D. sweating increases over the entire body C. bladder reeducation
D. a cutaneous vesicostomy
30. A patient who has been quadriplegic for one E. none of the above
month is noted to have a depressed body temperature
after coming in form the cold. Why is this? B 35. Complication from the use of the indwelling
A. it is normal finding for all humans urethral catheter include E
B. the mechanism controlling heat production and A. urinary infection
loss do not properly function in the quadriplegia B. bladder stones
patient C. hydronephrosis
C. the quadriplegia patient has diminished sensation D. peno-scrotal abscess, diverticulum or fistula
and most likely dressed insufficiently for the cold E. all of the above
D. postural hypotension decreased the blood flow to
such an extent that the temperature could not be 36. The term “cutaneous vesicostomy” refers to B
maintained
A. a procedure in which the bowel is directly
connected to the bladder
B. a procedure in which the bladder is directly so that
they drain into bowel
C. a procedure in which the uterus are diverted so
that they drain into bowel
D. suprapubic cystostomy with the use of a catheter
E. none of the above
37. In a patient requiring the use of an indwelling
urtheral catheter, what can be done to decrease the
incidence of peno-scrotal fistulae? E
A. administer prophylactic antibiotics
B. encourage a high fluid intake
C. restrict oral fluids
D. tape the catheter to the upper medial thigh
E. tape the catheter to the abdomen
38. The procedure of choice for the treatment of
vesico-uretheral reflux is A
A. uretheral catheter drainage
B. transurethreal resection (TUR) of the bladder neck
C. contraction vesicostomy
D. cutaneous vesicostomy
39. A useful trechnique or procedure for
demonstrating vesico-uretheral reflux is the E
A. cystometrogram
B. intravenous pyelogram (IVP)
C. high infusion IVP
D. nephrotomogram
E. cystogram
40. The major cause of vesico- uretheral in the
paraplegic is
A. anatomical anomaly of the vesico-ureteral junction
B. uretheral stones
C. bladder infection
D. ascending infection of the urinary tract
E. peno-scrotal fictula
41. Management of the neurologenic bowel in the
first several days following injury should consist of B
A. digital rectal stimulation
B. digital evacuation of feces
C. use of oral laxatives
D. use of suppositories
E. no therapeutic measures are usually indicated
42. What happens to intestinal function immediately
following spinal cord transection in the upper
thoracic area? A
A. persitalis is lost and fecal retention occurs
B. function is affected
C. persitalsis is increased and severe diarrhea occurs
D. retrograde peristalsis occurs
E. none of the above
43. How soon following cervical cord injury would it
be expected that peristalsic sound might be first
heard? A
A. within two or three days
B. between one and three weeks
C. between three and five weeks
D. between five and nine weeks
E. only after 10 weeks
44. What is generally the best time of day for the
quadriplegia patient to perform his bowel program? B
A. in the morning just after awakening
B. after breakfsat
C. around noontime
D. before the evening meal
E. just before going to bed
45. In patient with a complete spinal cord lesion, the
penis is noted to be enlarged and semi-erected during
the stage of spinal shock. Why? C
A. this a reflex erection owing to the stimulation
provided by the catheter
B. this is probably a psychological erection
C. the corpora cavemosa are passively engorged of
vasodilation
D. this represents priaprism which commonly occurs
with complete cord lesions
E. none of these
46. A patient with paraplegia is noted of have a small
ulcer over the lateral malleolus. The likely cause is D
A. cellulitis
B. arteriosclerosis
C. thrombophlebitis
D. pressure
E. diminished skin touhgness
47. The patient with paraplegia should be instructed
in appropriate therapeutic activities for home use
after discharge from the rehabilitation unit. Which of
the following should not be used by the paraplegia
patient? D
A. strengthening exercises of the upper extremities
B. range of motion exercises of the lower extremities
C. activities of daily living (ADL)
D. heating pads to the legs
E. none of the above
48. During labor in pregnant, spinal cord-injured
patient, what side effect is rather common? D
A. hypertension
B. uterine rupture
C. sweating of the face and neck
D. only A and C
E. all of the above A. a paraplegia patient can often drive standard car
which has no special adaptions
49. A patient with a cauda equina injury develops B. paraplegia patients can move only specially
anemia and is started on oral iron therapy. A possible adapted vans
side effect would be B C. a paraplegia patient can drive a car only if he does
A. urinary infection not need a wheelchair
B. constipation D. a paraplegic patient can often drive a car with
C. hypoglycemia automatic transmission and hand controls
D. thrombophlebitis E. the paraplegia patient should not try to drive
E. none of the above
56. A large ischial pressure ulcer looks as if it will
50. A patient with paraplegia presents with what require surgical correction. What techniques should
appears to be a small diameter but deep ischial probably be used for adequate repairs? D
pressure ulcer. What should be considered in this A. excision of necrotic tissue and approximation of
cases? D the ulcer edge
A. osteomyelitis may be present B. excision of necrotic tissue followed by a split-
B. approximation and suturing of the ulcer edges thickness graft
C. a sinogram may provide useful information about C. rotation of a full-thickness flap
the ulcer D. rotation of full-thickness flap plus excision
D. only A and C E. none of the above
E. all of the above
Directions: For each of the incomplete statements
51. The most common upper extremity contracture in below, ONE or MORE of the numbered
the C6 quadriplegia patient is B completions is correct. In each case select.
A. adduction of the arm A. if only 1,2 and 3 are correct
B. elbow flexion B. if only 1 and 3 are correct
C. supination of the forearm C. if only 2 and 4 are correct
D. extension of the shoulder D. if only 4 is correct
E. finger extension E. if all are correct

52. Which technique for controlling lower extremity
spasticity is relatively contraindicated in the young
quadriplegia male? E
A. use of diazepam
B. use of baclofen
C. use of dantrolene sodium
D. use of phenol motor point blocks
E. use of intrathecal alcohol block
57. Areas of concern in the definitive management of
spinal injury include E
A. restoration of normal alignment of the spine
B. attainment of complete stability of the injured area
of the spine
C. decompression of neurologic structures that are
being progressively compressed
D. early rehabilitation of the patient

53. For severe spasticity of the hip adductor muscles
the best treatment is often E
A. diazepam
B. baclofen
C. dntrolene sodium
D. surgical crushing of the obtructor nerve
E. surgical sectioning of the obtructor nerve
54. Techniques used to manage spasticity in the
spinal-cord-injured patient include E
A. medication
B. proper bowel and bladder care
C. passive movement
D. prompt treatment of infection
E. all of the above
55. Which of the following is true?
58. With a suspected cervical fracture, which x-rays
should be obtained initially? B
1. anteroposterior films
2. flexion and extension views
3. lateral views
4. fluoroscopy of the cervical spine in motion
59. After the patient with a suspected cervical injury
arrives in the hospital emergency unit, the initial
action should be C
1. a complete neurological examination
2. placement of the head a halter traction with
sandbags put beside the head
3. complete x-ray of the spine
4. immobilization of the head and neck in a cervical
collar
60. A patient is involved in an automobile accident
and sustains an injury to the neck. He complains of
some tingling in the hands. Appropriate initial
therapy at the scene of the accident would include :C
1. maintaining of neck in flexion
2. strapping the back and neck to a rigid board before
moving the patient
3. turning the head slightly to one side to prevent
aspiration
4. maintaining the neck in extension
61. Which of the following is/are true of the
Circolectric bed for the acute treatment of the
spinally injured patient? D
1. the bed should be used because it permits safe
turning of the patient
2. in the head-down position, the weight of the head
provides adequate traction force on the neck, and
artificial traction ca n be
3. the bed is quite portable
4. the bed is generally felt to be contraindicated for
use in the spinal cord-injured patient
62. Findings in a patient at the C2 spinal cord level
could include E
1. paralysis of the arms and legs
2. neurologenic bowel and bladder
3. respiratory insufficiency
4. Horner’s syndrome
63. Following the period of spinal shock there
develops the period of reflex automatism of the
isolated cord. This characterized by A
1. hyperreflexia
2. rigidity
3. spasticity
4. athetosis
64. Which of the follwing is/are true of phantom
sensations in the spinal cord-injured patient? D
1. there may be a burning anf tingling sensation
below the level of the lesion
2. the phantom sensations are usually most
troublesome in the early stages following spinal
injury
3. the phantom sensations may remain on a relatively
permanent basis in cauda equina injurues
4. the injury usually gives the sensation that the leg is
in flexion
65. A quadriplegia patient develops postural
hypotension. How might this be combated? A
1. use of elastic wraps around the legs
2. use of an abdominal binder
3. vigorous exercise
4. forcing oral fluids to increase intravascular
volume
66. Goals in the management of neurogenic bladder
include: E
1. prevention of infection
2. prevention of bladder overdistention
3. prevention of local damage to the urethra
and bladder
4. making the patient catheter-free as soon as
possible
67. Possible difficulties from use of indwelling
catheter with balloon include: E
1. insidious deflation of the balloon
2. occlusion of the catheter lumen by pressure
within the balloon
3. occlusion of the catheter lumen by an
eccentrically inflated balloon
4. failure of the balloon to deflate properly
68. Advantages to use of intermittent catheterization
over an indwelling catheter include: B
1. a lower rate of infection with intermittent
catheterization
2. not having to insert the intermittent catheter
with such aseptic technique as is used for the
indwelling catheter, since the intermittent
catheter is in place for so short a time
3. intermittent catheterization permits the
urethral mucosa to gradually become
accustomed to a foreign body
4. there are actually no major advantages of
intermittent catheterization. An indwelling
catheter should generally be used
69. In a patient with urinary retention owing to
structural resistance of peripheral portions of the
urinary tract, what might be appropriate therapy? B
1. tranurethral resection of an enlarged prostate
2. electrical stimulation of the bladde
3. transurethral resection of the bladder neck
4. cutaneous vesicostomy
70. Major factors in the formation of upper urinary
tract stones in the paraplegic patient include: B
1. infection
2. hyperuricemia
3. hypercalciuria
4. hyperglycemia
71. Causes of the anemia noted with chronic renal
failure usually include: A
1. blood loss
2. hemolysis bone marrow defficiecies
3. vomiting and diarrhea

72. Tests that are useful indetecting diminished renal
function include : E
1. urea clearance
2. creatinine clearance
3. ]careful
4. blood urea level
73. Which of the following might be beneficial in
obtaining evacuation of the bowel during the period
of spinal shock? D
1. oral laxatives
2. digital rectal stimulation
3. rectal suppositories
4. none of the above
74. Complications that are not infrequent in patients
with conus-cauda injuries include: A
1. hemorrhoids
2. chronic constipation
3. anal fissures
4. rectal carcinoma
75. What therapeutic measures can be employed to
help the quadriplegic patient achieve the goal of
bowel evacuation
following spinal shock? A
1. mild laxatives
2. digital rectal stimulation
3. glycerine or bisacodyl suppositories
4. enemas
76. Which of the following are true of te quadriplegic
female? C
1. menstruation ceases permanently
2. orgasm is absent in complete cord lesions
3. pregnancy must be aborted if it occurs
4. the quadriplegic female can continue to be
sexually active
77. Techniques that may help the quadriplegic malew
to establish sexual relations include: E
1. experimenting with alternate methods of
sexual intercourse
2. emptying the bladder prior to intercourse
3. constricting the base of the penis if erctions
are short-lasting
4. taping a catheter back along the shaft of the
penis if an indwelling catheter must be worn
78. Which of the following is/are true/ A
1. reflex penile erctions can occur following
spinal shock in a quadriplegic patient
2. in the spinal cord patient, ejaculation often
occurs into the bladder in a retrograde
fashion
3. excessive flexor and adductor spasms may
be a major obstacle to the penile penetration
4. in the complete paraplegic, the normal
orgasmic sensation occurs with ejaculation
79. Commonsites of pressure ulcers include the :E
1. sacrum
2. femoral trochanters
3. lateral malleoli
4. ischial tuberosities
80. Before attempting surgical correction of a
pressure ulcer, which of the following should be
required? :E
1. control of active infection
2. the ulcer should be in the process of healing
3. correction of anemia
4. the general condition of the patient should
be as good as possible
81. Appropriate treatmenbt of pressure ulcers
includes: A
1. removal of necrotic tissue
2. thorough cleansing of the ulcer
3. use of a heat lamp over the ulcer
4. removing pressure from the ulcer by means
of a circular rubber ring
82. Complications of chronic pressure ulcers can
inclyde: E
1. osteomyelitis
2. amyloidosis
3. sepsis
4. anemia
83. Activities which hould be inclyde in the physical
therapy program of the spinal cord injured patient
are: E
1. strengthening exercises of intact muscle
groups
2. range of motion exercise
3. transfer activities
4. ambulatory activities
84. Which might be appropriate features on the
wheelchair for a C7 quadriplegic patient? B
1. detachable arm rests
2. large drive wheel in the front
3. desk arm type of armrests
4. full reclining heavy duty chair
85. In which of the following might a spinal cord
patient participate? E
1. athletics
2. recreational activities
3. educational activities
4. vocational activities
CHAPTER 8 7. Aspirin in divided doses is the most satisfactory
RHEUMATOLOGY drug for helping suppress JRA. What aspirin dosage
range is most often recommended? C
Directions: Each of the questions or incomplete A. 5-15 mg/kg daily
statements below is followed by five suggested B. 30-60 mg/kg daily
answer or completions. Select the single BEST C. 90-130 mg/kg daily
D. 250-300 mg/kg daily
1. Juvenile rheumatoid arthritis (JRA) differs from the E. 310-340 mg/kg daily
adult form of rheumatoid arthritis in that D. 8. After 10 years of JRA what percentage of patients
A. high fever, rash and uveitis are more have regained an excellent level of function? D
common in JRA A. 10-20%
B. subcutaneous nodules and rheumatoid factor B. 30-40%
are more common in JRA C. 50-60%
C. marked leukocytosis in JRA D. 70-80%
D. only A and C E. 90-100%
E. all of the above
9. What most typifies the subcutaneous nodule found
2. The onset of JRA may E in rheumatoid arthritis? B
A. be polyarticular with four or more joints A. synovial tissue
involved B. chronic inflammatory
B. be acute or fulminating with systemic C. nodular areas of glycogen deposition
manifestations but without arthritis D. absence of necrosis
C. involve one joint or only a few joints E. necrotic muscle in the nodule
D. only A and C
E. all of the above 10. Subcutaneous nodules are associated with
rheumatoid arthritis. In what percentage of patients
3. Common initial sites of involvement in JRA include with classical rheumatoid arthritis do rheumatoid
the A subcutaneous nodules develops? C
A. knees, wrists, ankles, and neck A. 3 to 7%
B. hip, elbows, shoulders and sacroiliac joints B. 10 to 15%
C. hands, feet and temporomandibular joints C. 20 to 25%
D. costovertebral joints and facet joints of spine D. 50 to 60%
E. JRA randomly involves the joints and there E. 85 to 90%
are no most common sites of initial
involvement 11.Nerve compression syndromes may occur in
rheumatoid arthritis. Which is the most common? B
4. Asymptomatic sacro-iliitis may occur as an x-ray A. ulnar nerve compression at Guyon’s canal
finding in about 24% of patients with JRA. The B. carpal tynnel syndrome
presence of sacro-iliitis correlates with E C. tarsal tunnel syndrome
A. disease onset after 10 years of age D. ulnar nerve compression at the elbow
B. hip involvement E. thoracic outlet syndrome
C. presence of rheumatoid factor
D. only A and C 12. A useful laboratory test for following the progress
E. all of the above of a case of rheumatoid arthritis is the A
A. sedimentation rate
5. A possible major complication of JRA that must be B. latex fuxation test
considered in evaluating each patients is A C. serum iron concentration
A. iridocyclitic D. leukocytosis
B. subcutaneous nodules E. none of the above are useful in following the
C. skin rash course of the disease
D. encephalitis
E. peripheral neuropathy 13. A 40-year-old female with rheumatoid arthritis is
able to perform all of her daily activities with the
6. The approximately incidence of positive rheumatoid exception of lifting her heavy bags of groceries. She is
factor detection in JRA is A also unable to continue her golfing and bowli8ng, into
A. 20% which functional class of the ARA (American
B. 40% Rheumatism Association) might this patient fall? B
C. 60% A. I
D. 80% B. II
E. 100% C. III
D. IV
E. None of the above
 20. A patient with osteoarthritis has undergone a total
14. A 53-year-old male with rheumatoid arthritis hip replacement. Which physical modality should not
demonstrates the following findings: (1) osteoporosis be used over the joint implant? D
seen on x-rays: and (2) no joint deformities, but A. short wave diathermy
limitation of mobility in the hand and elbows. Into B. ultrasound
which anatomical stage of the ARA classification does C. microwave
this patient fall? B D. both A and C
A. I early E. all of the above
B. II moderate
C. III severe 21. A patient with arthritis is advised to take regular
D. IV terminal hot tub baths to help diminish stiffness and pain. The
E. None of the above approximate water temperature that should be used is
C
15. The nonmedicinal management of the patient with A. 60F
rheumatoid arthritis which of the following? E B. 80F
A. Systemic rest C. 100F
B. Articular rest D. 120F
C. Physical rest E. 140F
D. Proper nutrition
E. None of the above 22. One of the most useful modalities for treating the
rheumatoid hand involves A
16. In the treatment of rheumatoid arthritis with A. paraffin
salicylates, salicylism is used as a guideline in helping B. hot warm bottles
to individualize the dose. In an adult, the usual first C. ultrasound given under water
manifestation of salicylism is E D. short wave diathermy
A. peptic ulcer E. heating pads
B. anemia
C. centrally induced hyperventilation 23. Which of the below exercises is not indicated for
D. psychosis used in the average arthritic patient? C
E. tinnitus A. passive range motion
B. active range of motion
17. Physical therapy modalities can be useful for the C. rapidly performed coordination
arthritic patient at home. The patient should be D. isometric strengthening
instructed in how to properly use these treatment E. active-assistive
modalities. What is the major and most frequent
hazard encountered in the home treatment program? 24. Which physical heating modality might be of most
D benefit to the arthritic patient with painful degenerative
A. fractures from too vigorous exercise arthritis to the hip? C
B. skin infection from improper use of massage A. short wave diathermy
C. neck dislocation of improper use of traction B. microwave
D. burns from improper use of heat C. ultrasound
E. deformities aggravated by homemade splints D. hot packs
E. ultraviolet
18. What might be a useful treatment for the arthritic
patients to help alleviate morning stiffness? D 25. The common deformities seen in the arthritic knee
A. sleeping on a heating pad include: E
B. taking a hot bath before retiring for bed A. knee flexion contractures
C. sleeping with hot water bottles B. subluxation
D. using an electric blanket C. external rotation
E. none of the above D. both A and C
E. all of the above
19. A patient with osteoarthritis develops a knee
effusion. Which physical therapy modality should not 26. The most common age period for onset of
be used over the knee? D ankylosing spondylitis is C
A. hot packs A. birth to 5 years
B. ice massage B. 5 to 20 years
C. infrared C. 20 to 40 years
D. microwave D. 40 to 60 years
E. ultrasound E. over 60 years

27. The joints which usually first show x-ray

abnormalities in ankylosing spondylitis are the D
 A. vertebral facet joints 34. Approximately what percentage of patients with
B. metacarpophalangeal joints psoriasis develop arthritis? A
C. interphalangeal joints A. 5%
D. sacroiliac joints B. 25%
E. hip joints C. 50%
D. 75%
28. What percentage of cases of ankylosing E. 95%
spondylitis have involvement of the peripheral joints at
some stage in the disease? C 35. The joints most commonly involved in psoriatic
A. 0% arthritis are the D
B. 15% A. hip joints
C. 35% B. knee joints
D. 75% C. sacroiliac joints
E. 100% D. distal interphalangeal joints of the fingers
and toes
29. At times the onset of ankylosing spondylitis is in E. carpormetacarpal joints
the peripheral joints. In what percentage of cases
does this occur? C 36. Which of the following medications is
A. 5% contraindicated in the treatment of psoriatic arthritis?
B. 10% D
C. 20% A. systemic coritcosteriods
D. 50% B. gold
E. less than 1% C. intraarticular corticosteriods
D. antimalarials
30. A patient with ankylosing spondylitis complains of E. methotrexate
pain radiating into the lower extremities. A likely
explanation for this symptoms is B 37. What is the most serious complication of
A. the patient has probably herniated a nucleus rheumatic fever? A
pulposus and has nerve root pain A. carditis
B. the pain is probably originating from the B. arthritis
sacroliac joint. C. chorea
C. A bone spur is probably causing pressure on D. pharyngitis
a nerve root in the back E. pneumonitis
D. Both A and C
E. All of the above 38. How commonly do arthritis and arthralgia occur at
some time in the course of systemic lupus
31. In what percentage of cases of ankylosing erythematosus (SLE)? E
spondylitis is the course of the disease relatively A. in less than 5% of cases
benign over 1—20 year period? C B. in 20% of cases
A. 5% C. in 50% of cases
B. 20% D. in 75% of cases
C. 40% E. in 90% of cases
D. 80%
E. 95% 39. The most frequent cause of death in the patient
with SLE is E
32. In what percentage of patients with ankylosing A. pericarditis
spondylitis is there rapid progression to severe B. stroke
disability? B C. myocardial infraction
A. less than 1% D. malignancy
B. 5% E. nephritis
C. 25%
D. 50% 40. patients with SLE occasionally develop
E. 70% psychoses. In what percentage of cases of SLE would
psychosis at some time be present? D
33. Usually the most appropriate analgesic for use in A. less than 1%
patients with ankylosing spondylitis is A B. 5%
A. salicylates C. 20%
B. indomethacin D. 50%
C. acetaminophen E. 90%
D. codeine
E. meperidine 41. In patients with rheumatoid arthritis, lupus
erythematous (LE) cells may occasionally be
demonstrated. Which of the following statements is D. 85%
true about this group of patients? E E. 100%
A. most go on to develop the typical lupus
nephrtiis 48. Which of the following are features of the
B. many develop the typical lupus vasculitis peripheral neuritis found in polyarteritis? A
C. the lupus dermatitis is common in these 1. paresthesias
patients 2. burning pains
D. all of the above 3. absence of motor weakness
E. these patients do not generally go on to 4. primary involvement of the upper
develop features of SLE extremities
5. asymmetry
42. The prognosis of drug-induced SLE B
A. is the same as for SLE A. only 1,2, and 5
B. is better than that for SLE B. only 3.4 and 5
C. is worse than that for SLE C. only 1,2,3 and 4
D. is quite variable, with the prognosis D. only 4
depending on the severity of the renal E. all are correct
involvement
E. is quite variable depending on the amount of 49. The major cause of death in polyartheritis is D
cardiac disease present A. cardiac disease
B. stroke
43. A patient being treated with procainamide C. pneumonia
develops arthritis and hepatosplenomegaly after six D. renal disease
months of using the drug. A likely explanation is D. E. gastrointestinal bleeding
A. the patient has developed rheumatoid
arthritis 50. The most frequent initial symptom in polymyositis
B. the patient is suffering from a viral arthralgia and dermatomyositis is B
secondary to hepatitis A. skin rash
C. the patient suffers from a drug-induces B. weakness of the legs
psoriatic arthritis C. joint and muscular pain
D. the patient has develop drug-induced SLE D. weakness of the arms
E. none of the above E. dysphagia

44. the 10years survival rate after a diagnosis of SLE 51. The most consistently weak muscle in
has been made is approximately D polymyositis are the B
A. less than 10% A. neck flexor
B. 15% B. proximal muscles of the lower extremities
C. 25% C. facial muscles
D. 50% D. hand intrinsic muscles
E. 80% E. extrocular muscles

45. the prevalence of renal disease in polyartheritis is 52. In what percentage of cases of polymyositis and
D dermatomyositis would one expect to see the
A. 5% presence of Raynaud’s phenomenon? C
B. 25% A. 0%-if it occurs, it indicates that the diagnosis
C. 50% was in error
D. 75% B. 5%
E. 100% C. 30%
D. 75%
46. The most frequent area of heart involvement in E. 100% - if it is not present, the diagnosis must
polyartheritis is in the B be reevaluated
A. endocardium
B. myocardium 53. A nearly pathognomonic rash seen in
C. pericardium dermatomyositic is D
D. there is equal involvement of all of the above A. a butterfly rash on the face
E. polyartheritis does not involve the heart B. anerythematous rash on the elbows
C. a scaly rash on the anterior chest wall
47. What percentage of cases of polyartheritis will D. a dusky lilac suffusion on the upper eyelids
develop a peripheral neuritis? C E. a periungual erythematous and scaly rash
A. 5%
B. 25%
C. 50%
54. In a 40 years old male with dermatomyositis what B. renal
is the probability of eventually discrovering a C. rectal
malignant lesion? C D. neurological
A. 100% E. esophageal
B. 75%
C. 50% 62. Osteoarthritis is D
D. 25% A. an inflammatory disease of bone
E. 5% B. a degenerative disease of bone
C. an inflammatory disease of articular cartilage
55. The initial treatment of choice for polymyositis is E D. a degenerative disease of articular cartilage
A. methotrexate E. all of the above
B. salicylates
C. gold 63. On of the least involved portions of the joint in
D. phenylbutazone osteiarthritis is the A
E. croticosteriods A. synovial tissue
B. bone
56. The most common form of onset of sclerodema A C. cartilage
A. Raynaud’s phenomenon or swelling and D. ligaments
thickening of hands and fingers E. tendons
B. Arthralgias
C. Severe muscle weakness 64. The term Heberden’s node refers to the
D. Visceral involvement (dysphagia and osteoarthritic changes occurring at which joint? E
intestinal involvement) A. metacarpophageal
E. Renal disease B. tarsal-metatarsal
C. proximal interphalangeal
57. What is the proper sequence of skin changes in D. carpometacarpal of the thumb
sclerodema (earliest to latest)?C E. distal interphalangeal
A. indurative, atrophic, and edematous
B. atrophic, indurative and edematous 65. Bony enlargement of the proximal interphalangeal
C. edematous, indurative and atrophic joint of finger is prenent in a patient with advanced
D. indurative, edematous, and atrophic osteoarthritis. The name of this enlargement would be
E. edematous, atrophic, and indurative aC
A. Heberden’s node
58. The incidence of Raynaud’s phenomenon on B. Schmori’s node
patient with sclerodema is approximately A C. Bouchard’s node
A. 90% D. Fibro-osseus node of Schmidt
B. 70% E. There is no specific name for the nodular
C. 50% enlargement
D. 30%
E. 10% 66. Degenerative changes in joints become more
frequent with advancing age. Generally at what age
59. The most frequent x-ray feature seen in may degenerative changed first be seen in joints
sclerodema is C autopsy?B
A. narrowing of the intervertebral disc A. first decade of life
B. erosion of the carpal bones B. second decade of life
C. absoption of the tufts of the distal phalanges C. third decade of life
D. spotty osteoporosis underlying areas of skin D. fourth decade of life
changes E. fifth decade of life
E. loss of articular cartilage of involved joints
67. The chief symptom of osteoarthritis is usually D
60. A patient with sclerodema develops proximal A. edema
muscle wekanes. A likely explanation is that the B. fever
patient has developed A C. muscular weakness
A. sclerodematomyositis D. pain
B. limb-girgle muscular dystrophy E. joint deformity
C. duchenne muscular dystrophy
D. viral myositis 68. The pain osteoarthritis is usually B
E. myotonic dystrophy A. a burning sensation
B. aching in character
61. The most common form of visceral involvement in C. a sharo, well localized pain
sclerodema is E D. a sharp, radiating pain
A. cardiac E. a combination of all of the above
 B. measuring serum uric acid levels
69. The most consistency helpful laboratory C. measuring urate excretion in the feces
abnormality in confirming the diagnosis of D. examining the synovial fluid
osteoarthritis is E E. assessing dietary habits
A. an elevated sedimentation arte
B. leukocytosis 77. The synovial fluid a patient with possible acute
C. a normocytic, normochronic anemia gouty arthritis contains no monosodium urate crystals.
D. rheumatoid factor Your next move is to D
E. none of the above A. evaluate the patient for other causes of acute
arthritis
70. X-ray changed seen in osteoarthritis include E B. begin the patient on salicylate therapy
A. joint space narrowing C. reassure the patient and have him return for
B. marginal osteophyte formation a recheck in one week
C. subchondrial bony sclerosis D. aspirate more synovial fluid for examination
D. both A and C E. get anteroposterior and lateral x-rays of the
E. all of the above involved joints.

71. The acute attack of gouty arthritis is triggered by E 78. Which would probably be the preferred oral
A. a food allergy medication for the treatment of acute gouty arthritis?
B. periarticular vasoscpasm D
C. hyperuricemia A. aspirin
D. a decrease in the blood glucose level B. cochicine
E. sodium urate crystals C. allopurinol
D. phenylbutazone
72. A patient with chronic gouty arthritis develops E. methotrexate
carpal tunnel syndrome. A likely explanation is that B
A. a urate vascular plaque is compressing the 79. The drug allopurinol is used in the treatment of
median nerve hyperuricemia. What is its mechanisms of action? D
B. a tophus is compressing the median nerve A. it increases uric acid excretion in the urine
C. the patient has diabetic neuritis secondary to B. it increases uric acid excretion in the feces
the gout C. it increase the solubility of uric acid in the
D. the patient has satumine gout serum
E. none of the above D. it inhibits xanthine oxidase
E. it inhibits white cells migration to urate
73. The major component of a tophus in gout is A crystals
A. sodium urate crystals
B. lipid 80. A 40 year old male develops dermatomyositis. He
C. collagen should be also closely evaluated for the presence of D
D. calcium monohydrate A. diabetes
E. bile salts B. hyperparathyroidism
C. Addison’s disease
74. A patient being treated for hypertension develops D. Malignant tumor
acute gout. A likely cause is that C E. Hypertriglyceridemia
A. the antihypertensive medication decreased
the uric solubility 81. A patient presents with complaints of stiffness and
B. the patient also had leukemia discomfort in the low back. The patient’s urine has
C. the diuretics used to treat the hypertension been noted to turn black upon standing. Also x-rays of
D. in an attempt to food a low-sodium diet, the the spine show calcification of the intervertebral discs.
patient ate foods with excessive amount of The likely disganosis is E
purines A. ankylosing syndrome
E. none of the above B. Reiter’s syndrome
C. Wilson’s disease
75. the male female ration in primary gout is D. Pseudogout
approximately A E. Ochronosis
A. 9:1
B. 3:1 82. The organism most often found to cause
C. 1:1 infectious pyogenic arthritis in children is A
D. 1:3 A. Staphylococcus aureus
E. 1:9 B. Diplococcus pneumonia
C. Streptococcus pyogenes
76. The best way to diagnose gout is by D D. Neisseria gonorrhea
A. history E. Hemophilus influenzae
 B. if only 1 and 3 are correct
83. The organism most often found to cuse infectious C. if only 2 and 4 are correct
pyogenic arthritis in the adult is D D. if only 4 is correct
A. Staphylococcus aureus E. if all are correct
B. Diplococcus pneumonia
C. Streptococcus pyogenes 89. The treatment program in juvenile rheumatoid
D. Neisseria gonorrhea arthritis includes E
E. Hemophilus influenzae 1. joint rest during acute attacks
2. splints to correct deformities
84. A male develops fever, polyarticular arthritis 3. heart
urethritis and conjunctivitis. A lkely diagnosis would be 4. exercises
C
A. gonococcal arthritis 90. characteristics of the anemia found in rheumatoid
B. rheumatoid arthritis arthritis include C
C. Reiter’s syndrome 1. a good response to the
D. Ankylosing spondylitis administration of vitamin B-12
E. Psoriatic arthritis 2. failure to response to the
administration of iron
85. A knee x-ray is taken several months following 3. association with macrocytic red
acute trauma to the knee. A calcific debsity is noted in blood cells
the area of the medical collateral ligament. A likely 4. association with normochronic red
diagnosis is D blood cells
A. juvenile rheumatoid arthritis
B. ankylosing spondylitis 91. Which statements about the sedimentation rate
C. chrondrocalcinosis are true? A
D. tuberculosis of the spine 1. the sedimentation rate normally
E. the renal disease found in gout rises slightly in the process of aging
2. the sedimentation rate is usually
86. A patient presents with chest pain, tenderness and normal in primary osteoarthrtis
firm swelling in the area of the left third costochrondral 3. the disorder polymyagia rhematica
junction. No history of trauma can be obtained. Deep is distinguished by a moderately to
breathing increases the pain . a likely diagnosis is A markedly elevated sedimentation
A. dermatomyositis rate
B. sclerodema 4. the sedimentation rate is elevated in
C. Chrondrocalcinosis fibrositis
D. Pellegrini-Steieda syndrome
E. Jaccoud’s arthritis 92. The LE phenomenon and antinuclear factors are
characteristics of SLE. Which of the following are
true? C
87. A patient presents with chest pain, tenderness and 1. antinuclear factors and the LE
firm swelling in the area of the left third costochrondral phenomenon are not found in
junction. No history of trauma can be obtained. Deep patients with rheumatoid arthritis
breathing increases the pain. A likely diagnosis is A 2. as a group, rheumatoid arthritis
A. Tietze’s syndrome patient with a positive LE cell test
B. Atypical angina tend to have more pronounced
C. Pneumonitis systemic involvement
D. Rib fracture 3. the LE phenomenon in a patient will
E. Scheuemann’s disease go on to develop features of SLE
4. antinuclear factors have been
88. In acute arthritis of the wrist, what form of reported in various disorders
therapeutic exercise should be utilized? A characterized by chronic
A. passive range of motion inflammation
B. isometric strengthening
C. isotonic strengthening 93. Which statements about the serum complement
D. isokinetic strengthening level are true? E
E. none of the above is indicated in acute 1. it is usually normal or somewhat
arthritis elevated in rheumatoid arthritis
2. it is decreased in patients with
Directions: for each one of the incomplete statements vasculitits
or questions below, ONE or MORE of the numbered 3. it is often elevated early in the
completions is correct. In each case select. course of rheumatic fever
A. if only 1,2 and 3 are correct
 4. it is reduced in most patients with
SLE
94. Which of the following are useful clinical features
in helping to make the diagnosis of rheumatoid
arthritis? A
1. slowly progressive, symmetrical
polyarthritis
2. prolonged early morning stiffness
3. periarticular swelling of soft tissues
4. weakness of the trunk musculature
95. A patient with rheumatoid arthritis develops acute
arthritis of the wrist. Which of the following measures
might be indicated in the treatment? A
1. daily passive range of motion
exercise
2. superficial heat
3. salicylate analgesic
4. articular rest by placing the forearm
and hand in a plaster cast for two
weeks
96. Which of the following statements is true about the
use of gold therapy in rheumatoid arthritis? C
1. gold therapy can occasionally
reverse some of the damage done
by the arthritis
2. gold therapy should not be used in
the patient with SLE
3. the most serious toxic side effect of
gold therapy is dermatitis
4. the best results from gold therapy
occur when the drug is used
relatively early in the course of the
illness
97. Systemic corcosteriods are occasionally useful in
controlling rheumatoid arthritis. Which of the following
statements are true concerning the use of
corticosteriods? B
1. patient who are candidates for
steroids therapy are those with
active disease who are not
responding to the usual measures
of treatments
2. corticosteroids therapy can
occasionally reverse some of the
damage caused by the arthritis
process
3. severe rheumatoid vasculitis and
hypersplenism are relative
indication for the use of systemic
corticosteriods
4. the dosage of corticosteriod used in
rheumatoid arthritis should
generally be rather large.
98. Which of the following are potential side effects to
the use of systemic corticosteriods? E
1. gastrointestinal ulcerations
2. fatty deposition
3. osteoporosis
4. carbohydrate intolerance
99. Intraarticular corticosteroid injection is
occasionally use in treating the patient with
rheumatoid arthritis. Which of the following are
indications for considering the use of intraarticular
corticosteriod injections? C
1. infection in or near the joint
2. inflammation of one or only a few
peripheral joint
3. severe juxtaarticular osteoporosis
4. contraindication of systemic gold,
cortisone, or other therapy
100. The objectives for the use of physical therapy in
arthritis include E
1. helping to relive symptoms
2. shortening the period of disability
from the disease
3. preventing or helping to correct
deformities
4. improving function
101. A patient with rheumatoid arthritis is referred to
the physical therapy department with a prescription,
which reads “physical therapy daily’. What is your
response to his prescription? D
1. the prescription is satisfactory in
that it gives the therapist freedom to
develop the most adequate therapy
program
2. the prescription is inadequate in
that the patient should be treated on
a twice daily basis
3. the prescription is adequate as far
as it goes but occupational therapy
should also be specified.
4. the prescription lacks sufficient
detail to be acceptable
102. Some indication for the use of therapeutic
exercise in arthritis include E
1. preservation or improvement of joint
range of motion
2. preservation or improvement of
muscular strength and endurance
3. maintenance of useful ambulation
for as long as possible
4. maintenance of upper extremity
function
103. In a patient with ankylosing spondylitis, which
exercise are most indicated? C
1. knee-chest exercises
2. back hyperextension exercises
3. hip range of motion exercises
4. deep breathing exercises
104. Some areas in which the occupational therapist
can help the arthritic patient include E
 1. providing appropriate splints for the
upper extremities
2. helping the patient maintain or
regain upper extremity strength and
range of motion
3. helping to evaluate the patient’s
vocational potential
4. helping the patient to achieve
independence in activities of daily
living
105. Which of the following statements about
ankylosing spondylitis are true? D
1. ankylosing spondylitis is most
common in females
2. the eitiology of ankylosing
spondylitis is thought to be
infectious
3. the onset of symptoms is often
abrupt
4. the earliest symptom is usually low
back pain
106. With cervical spine involvement in ankylosing
spondylitis, which of the following are potential
problems? A
1. cervical radiculopathy
2. cervical spine fractures
3. spinal cord injury
4. cauda equina injury
107. Which of the following are typical x-ray changes
seen in akylosing spondylitis
1. slight to moderate narrowing of the
disc spaces
2. squarinf of the vertebral bodies
3. ossification of the connective tissue
around the vertebrae
4. ossification of the nucleus pulposus
108. Sacroiliac x-ray changes are characteristic of
ankylosing spondylitis but can laso seen in other
disorder. Which of the following disorders can
occasionally produce sacroiliac x-ray changes? A
1. psoriasis
2. ulcerative colitis
3. reiter’s disease
4. gout
109. X-ray therapy can provide symptomatic relief in
about 60% of patients with ankylosing spondylitis yet
is rarely used as a dorm of treatment for this disorder.
Why is this? B
1. bone marrow aplasia follows the x-
ray therapy
2. radiation burns are common in
patients treated with the x-ray
therapy
3. there is a higher risk of developing
leukemia following the irradiation
4. while the x-ray therapy may help up
to 60% of patients, it may cause the
disease to flare up to 30% of the
other treated patients.
110. Which of the following statements about psoriatic
arthritis are true? D
1. tests for rheumatoid factor are
usually positive
2. subcutaneous nodules are found in
the majority of cases
3. x-ray features are identical to those
seen with rheumatoid arthritis
4. the spine and sacroiliac joints can
be involved
111. Laboratory test that are commonly found to be
abnormal in psoriatic arthritis include C
1. rheumatoid factor
2. uric acid
3. IgG levels
4. sedimentation rate
112. Which of the following are true about the arthritis
seen in rheumatoid fever? B
1. joint involvement becomes more
common in the older group of
patients with rheumatic fever
2. carditis and chorea parallel the
presence of arthritis
3. the arthritis usually occur early in
the course of the illness
4. the arthritis often results in mild joint
deformities
113. Which of the following can be seen in Sjogren’s
syndrome? A
1. rheumatoid arthritis
2. myopathy
3. the sicca complex
4. predominance of the disease in
males
114. The fibrositis syndrome B
1. is characteristic by areas of
localized point tenderness over
muscles
2. is associated with increased in the
sedimentation rate
3. often presents complaints of pain
and stiffness
4. is a wastebasket term that has little
clinical value.
115. Which of the following are typical of the fibrositis
syndrome? A
1. increase in symptoms in damp and
cool weather
2. complaints of chronic fatigue
3. relief of symptoms with the use of
heat
4. constant level of discomfort
persisting for periods of several
weeks

116. Features consistent with the diagnosis of
polymyalgia rheumatica include C
1. patients usually in the 20 to 40
years age group
2. markedly elevated sedimentation
rate
3. pain in the proximal joints
4. relief of symptoms with the use of
systemic corticosteriods
117. Which of the following are consistent with the
diagnosis of polymyalgia rheumatica? B
1. pain on motion
2. muscle weakness
3. abrupt onset
4. usually a normal hemoglobin level
118. Which of the following are features of SLE? A
1. most commonly found in females
2. usually begins in the third to fourth
decades
3. may present with a highly variable
clinical picture
4. follows a stereotyped pattern after
its onset
119. Very common initial manifestation of SLE include
E disease
1. fever
2. fatigue and malaise
3. acute polyarthritis
4. erythematous skin eruption
120. Which of the following are typical of the arthritis
seen in SLE? D
1. absence of morning stiffness
2. ankylosis and contracture
3. absence of subcutaneous nodules
4. frequent involvement of the
proximal interphalangeal and
metacarpophalangeal joints of the
hands
121. Neurologic involvement which can occur in SLE
includes E
1. peripheral neuritis
2. seizures
3. cerebral infraction
4. transverse myelitis
122. Laboratory abnormalities in the patient with
systemic lupus erythematous can include E
1. normochronic normocytic anemia
2. presence of LE cells
3. reduced levels of serum
complement
4. presence of antinuclear antibodies
123. Certain drugs have been implicated as inducing
a clinical picture typical of SLE. Which of the following
drugs can produce a drug-associated SLE? E
1. hydralazine
2. diphenylhydantoin
3. procainamide
4. methyldopa
124. Which o the following statements are true about
polyarteritis? D
1. females comprise the majority of
cases
2. the disease mainly involves large
arteries
3. the disease occurs primarily in the
elderly
4. the disease most frequently
involves the kidneys and heart
125. The initial symptoms of polyarteritis may include
E
1. fever of unknown etiology
2. renal disease
3. cardiac disease
4. peripheral neuritis
126. Which of the following statements are true about
polymyositis and dermatomyositis? E
1. women are involved twice as often
as men
2. may be associated with malignant
3. may occur at almost any age
4. may occur in conjunction with one
of the other connective tissue
diseases
127. Patients with polymyositis occasionally complain
of pain. What are the most common sites of pain? B
1. shoulders
2. calves
3. upper back
4. lower back
128. Which of the following are true about
polymyositis dermatomyositis? D
1. contractures are relatively common
early in the course of the disease
2. severe atrophy of muscles is
common
3. the typical skin rash is present in
5% of cases
4. calsinosis of the muscles occurs
most often in children
129. Features which can occur when dermatomyositis
is associated with malignant tumor included E
1. generally poor therapeutic response
to corticosteriods
2. age of over 40 years for most
patients
3. the muscle disease takes the form
of a florid dermatomyositis
4. the neoplasm is usually a
carcinoma

130. Which of the following statements is true about
scaleroderma? E
1. females are affected two to three
times as often as males
2. it is more common in coal miners
3. it is relatively uncommon in
childhood
4. there are no significant racial
differences in incidence
131. Esophagela abnormalities seen in
cinefluoroscopic examination of the patient with
scleroderma include A
1. decrease or absence of peristaltic
action
2. gastroesophageal reflux
3. dilatation of the lower portion of the
esophagus
4. constriction of the upper portion of
the esophagus
132. What are the major forms of new bone formation
seen in osteoarthritis? C
1. ectopic muscular calcification
2. subchondral eburnation
3. intraarticular ossification
4. marginal osteophytes
133. Subchondral bone ‘cysts” may develop in
osteoarthritis and on x-ray may appear similar to the
lesions seen in C
1. diabetes
2. gout
3. pernicious anemia
4. hemophilia
134. Which statements about osteoarthritis are true?
A is referred for physical therapy. What would be
1. under the age of 45 years, males
are involved more frequently than
females
2. osteoarthritis is related to the
presence of obesity
3. after the age of 55, the hands in
females are more involved than
those in males
4. whites have a higher incidence of
osteoarthritis than black do.
135. systemic findings common in osteoarthritis
include D
1. fever
2. anemia
3. nausea and vomiting
4. none of the above
136. Which of the following statements are true about
Heberden’s nodes? A
1. they may develop gradually with
little or no pain
2. they may develop rather rapidly with
associated redness, swelling
tenderness and aching
3. they are more common in women
4. they are seen in the proximal
interphalangeal joints
137. joints commonly involved in degenerative arthritis
(osteoarthritis include the) C
1. shoulders
2. cervical spine
3. wrists
4. hips
138. Joints frequently involved in degenerative
arthritis (osteoarthritis) include the E
1. elbows
2. wrists
3. shoulders
4. first metacarpophalangeal joints
139. Which of the following are true about
osteoarthritis? A
1. symptoms are uncommon before
the age of 40 years
2. stiffness is usually of short duration
3. bony ankylosing is uncommon
4. joint effusions are relatively
common
140. Which of the following are true about
osteoarthritis? E
1. diet
2. medication
3. physical therapy
4. joint rest
141. A patient with painful osteoarthritis of the right hip
appropriate treatments? A
1. use of ultrasound encouraging the
patient to lose weight if he is overweight
2. encouraging the patient to lose weight
if he is overweight
3. range of motion exercises to the
involved hip
4.using a cane in the right hand to unload
stress from the hip
142. Which of the following is true about the initial attack of
gout? A
1. onset is usually abrupt
2. often involves the great toe
3. may last a few days to a few weeks
4. recovery is seldom complete
143. Common sites for the development of gouty tophi
include the A
1. ear
2. tendons
3. patellar and olecranon bursae
 4. aorta

144. Which of the following is true about the renal disease

associated with gout? E
1. other than arthritis, it is the most
common complication of gout
2. it is usually slowly progressive
3. the incidence of proteinuria varies
from 20 to 40%
4. renal failure is the cause of death in
about one fourth of patients with
gout

145. Secondary forms of gout can occur with E

1. severe alcoholism
2. starvation
3. renal disease
4. leukemia

146. Which of the following drugs can alter the serum

urate levels? A Chapter 9
1. salicylates
2. thiazide diuretics Neurology
3. phenylbutazone
Directions: Each of the questions or incomplete
4. colchicines
statements below is followed by five suggested
answers or completions. Select the single BEST
147. The Charcot neuropathic joint may occur with E answer in each case.

1. diabetes mellitus 1. A hyperactive jaw reflex maybe an indication of

2. syringomyelia bilateral pyramidal tract dysfunction. At which level
3. myelomeningocele of the central nervous system is the jaw jerk
4. tabes dorsalis
mediated? C
148. Characteristic of the Charcot joint include B A. cerebral hemispheres
1. hypermobility of the joint B. cerebellum
2. usually severe pain C. pons
3. possible combinations of D. medulla
destructive and hypertrophic E. upper cervical segments of the spinal cord
changes on x-rays
4. the patients neurological 2. A 47 year old man is being seen for a routine
examination will be normal. physical examination. His neurological examination
appears normal except that no deep tendon reflexes
can be obtained in the upper or lower extremities.
The most likely reason for this is: E
A. generalized peripheral neuropathy
B. myopathy
C. spinal cord lesion
D. this maybe a normal variant
E. this maybe normal variant

3. Recovery in a middle cerebral artery stroke is

usually most complete in the muscles around the: C
A. hand
B. shoulder
C. hip
D. ankle
E. all of the above recover equally
4. The circle of Willis provides connection between B. deep leg veins
the carotid and vertebral-basilar artery system. C. heart
Anomalies in the circle of Willis may reduce it’s D. lungs
ability to provide needed additional circulation. In the E. lymphatic system
general population, what is the approximate
prevalence of anomalies of the circle of Willis? D 11. Following stroke involving the carotid arterial
A. 1% system, the physical finding which would indicate the
B. 10% poorest prognosis is :D
C. 25% A. hemiparesis
D. 50% B. hemiplegia
E. 75% C. hemianopsia
D. altered consciousness
5. The most common cause of stroke is :D E. expressive aphasia
A. cerebral embolism
B. intracerebral hemorrhage 12. Systemic hypertension is found in approximately
C. subarachnoid hemorrhage what percentage of cases of cerebral hemorrhage?
D. cerebral thrombosis A
E. subdural hematoma A. greater than 90%
B. 75%
6. The clinical findings in the anterior horn cell C. 50%
disease would include all of the following except: C D. 25%
A. fasciculation E. less than 10%
B. loss of reflexes
C. sensory abnormalities 13. The most common symptom in intracranial
D. muscle weakness hemorrhage is :B
E. atrophy A. dizziness
B. headache
7. Following conclusion of the anterior cerebral C. confusion
artery the greatest amount of motor deficit is found in D. vomiting
the :B E. nausea
A. contralateral arm
B. contralateral leg 14. The most common cause of a saccular or “berry”
C. ipsilateral arm aneurysm is :D
D. ipsilateral leg
E. involvement will be equally severe in both A. Hypertension
legs B. connective tissue disease with vasculitis
C. Buerger’s disease
8. Complete occlusion of the basilar artery usually D. Congenital defect of the vessel wall
causes : A E. All of the above are equally commomn
A. death
B. quadriplegia 15. The usual time chosen for performing surgery
C. hemiplegia following suubarachnoid hemorrage is :D
D. a Brown-Sequard syndrome A. As soon as possible
E. no symptoms B. When the neurological lesion progresses to
show corticospinal tract involvement
9. Cerebral embolism accounts for what percentage C. C. when the neurogical lesion progresses to
of all pathologically documented strkes? C show cranial nerve involvement
A. less than 1% D. When patient is clinically stable
B. 10% E. Surgery is never indicated
C. 25%
D. 50% 16. The incidence of mortality following
E. 75% subarachnoid hemorrhage is generally about :C
A. 100%
10. The primary site of origin for cerebral embolism B. 75%
is the :C C. 50%
A. superficial leg veins D. 25%
 E. 0% 23. Chronic subdural hematoma can be characterized
by :E
17 Rupture of a “berry” aneurysm primarily leads to A. recurrent headache
:B B. drowsiness
A. cerebral embolism C. convulsion
B. subarachnoiod hemorrhage D. confusion
C. cerebral thrombosis E. all of the above
D. intracerbral hemorrhage
E. there are usually no clinical findings 24. following a strke, when should the patient begin
rehabilitation :D
18. Findings in adhesive spinal arachnoiditis include A. ater three weeks of bedrest
:D B. after two weeks of bedrest
A. intense, persistent unilateral radicular pain C. after one week of bedrest
which may later become bilateral D. when the patient is medically stable
B. signs of complete spinal cord lesion E. one week after the patient is medically
C. males are more commonly involved than stabled
females and the onset is usually in middle
age 25. Areas of concern for the occupational therapist in
D. only A and C dealing with the stroke patient include :E
E. all of the above A. evaluating and instructing in the activities of
daily living
19. Causes of adhesive spinal arachnoiditis include B. assisting the patient performance of one
:E handed activities
A. trauma to the spine C. assisting in evaluating the need for various
B. spinal anesthesia self-help devices
C. meningitis D. assisting in the perceptual evaluation of the
D. only bA and C patient
E. all of the above E. all of the above

20. Following a head injury, the “posttraumatic 26. Which of the following features should be
syndrome” may develop. Common symptoms include specified in a wheelchair obtained for a stroke patient
:E :E
A. vertigo A. large drive wheel in the front to allow the
B. fatigue and sleeplessness patient to better grasp it
C. headache B. a one-hand drive chair with two concentric
D. both A and C handrims
E. all of the babove C. a full reclining model so that the patient can
lie down and rest
21. Features of acute subarachnoiod hemorrhage D. all of the above features should usually be
include :D specified
A. headache E. none of the above should usually be
B. normal level of awareness specified
C. stiff neck
D. both A and C 27. A patient is brought in for examination by his
E. all of the above family. He is 62 years old and sustained a stroke 4
years ago. He has been unable to walk since the
22. Among features of acute subdural hematoma are stroke. He underwent two months of rehabilitation at
that it :E the time of stroke and has also received other courses
A. Ussually follows severe head injury of physical therapy as an outpatient. The family feels
B. B. Is usually associated with major brain that he is now moving his leg much better and is
injury recovering from the stroke. He recently underwent
C. Is marked loss of consciousness two months of additional physical therapy elsewhere
D. Both A and C but still could not walk in the parallel bars. The
E. All of the above therapy was discontinued and the family complains
that the therapy was stopped just as the patient was
starting to show more improvement. They say that he
moves around much better at home than in the B. ventral roots of the spinal nerves
therapy department. They insist on additional C. anterior horn cells
physical therapy. Your examination reveals poor D. peripheral nerves
standing balance. Would you order additional E. corticospinal tracts
therapy? :E
A. Yes, the patient was probably improving and 32. A patient presents with a unilateral vesicular
should be given additional therapy eruption of the chestwall, which extends around the
B. Yes, although the patient was probably not chest in a narrow band. A sharp pain is also present in
improving, more therapy would be the area corresponding to the rash. A likely diagnosis
psychologically beneficial to the patient would be :B
C. Yes, more therapy would be psychologically A. eczema
beneficial to the family B. herpes zoster
D. No, the patient had recent therapy. A period C. psoriasis
of 4 to 6 months should pass before D. Guillain-Barre syndrome
additional therapy is started E. Protruded thoracic intervertebral disc
E. No, the patient and family should be
counseled with understanding and 33. After a hotn tub bath, a patient with multiple
compassion into beeter adjusting to the sclerosis complains that he is m arkedly fatigued and
stroke and its disability weakened. How would this be explained? :A
A. this is a normal finding in multiple sclerosis
28. A patient has suffered severe stroke, Over what patients
period of time might you expect that improvement in B. heat causes the multiple sclerosis to greatly
muscular control might occur? :C progress
A. in first week only C. the patient should undergo a complete
B. over the first neurological reevaluation as soon as possible
C. over the first year D. the patient should be referred to an internist
D. over three years for complete evaluation
E. some cases may recover upto five years E. this not occur with multiple sclerosis, but
post-stroke even if it did not would not warrant any
further studies.
29. Which of the following is true about the use
of hand splints in hemiplegia? :E 34. The age range in which the onset of multiple
A. they may facilitate return of function in the sclerosis most commonly occurs is :C
hemiplegic hand A. birth to age 3 years
B. dynamic splints are often useful to help B. 5 to 15 years
substitute for paralyzed muscles C. 20 to 30 years
C. all hemiplegic hands should be routinely D. 45 to 60 years
splinted to prevent contractures E. over age 60 years
D. all of the above are correct
E. none of the above is correct 35. In the United States, the approximate number of
patients with multiple sclerosis is :D
30. An elderly female stroke patient has a foot-drop A. 600
but adequate knee stability. The patient is somewhat B. 7,500
concerned about cosmesis. What might be the best C. 50,000
treament? :E D. 150,000
A. surgical fusion of ankle E. 2,000,000
B. long leg brace
C. double upright short leg brace with spring 36. To which category of diseases does multiple
dorsiflexion assist sclerosis belong? :D
D. spring wire short leg brace A. extrapyramidal
E. polypropylene leaf spring ankle-foot B. cerebellar
orthosis C. peripheral neuropathies
D. demyelinating
31. The main site of involvement in poliomyelitis is E. anterior horn cell
in the :C
A. dorsal roots of the spinal nerves
37. Carcinoma, especially of the lung, can produce the chance of this patient developing multiple
remote effects on the neuromuscular system. Of the sclerosis over the next 15 years? :C
following, which could be relaxed to the presence of A. less than 1%
a carcinoma? :E B. 5%
A. Myopathy C. 40%
B. Neuropathy D. 80%
C. Eaton-Lambert syndrome E. 100%
D. Only A and C
E. All of the above 44. Various types of multiple sclerosis based on the
clinical features include :E
38. Which of the following may be etiologic factors A. spinal form
in the production myelitis? :E B. cerebellar form
A. Multiple sclerosis C. cerebral form
B. Infections such as syphilis D. bulbar form
C. Acute disseminated encephalomyelitis E. all of the above
D. Spinal anesthetics
E. All of the above 45. Subacute combined degeneration of the spinal
cord is due to :D
39. After the onset of multiple sclerosis, what is the A. hereditary factors ( autosomal recessive)
usual duration of survival of the average patient? :E B. carcinomatous myelopathy
A. less than one year C. diabetes mellitus
B. 3 to 5 years D. vitamin B12 deficiency
C. 7 to 10 years E. Multiple sclerosis
D. 12 to 18 years
E. 20 years or more 46. Charcot-Marie-Tooth disease is a :A
A. form of progressive polyneuropathy
40. The IgG fraction of the gamma globulins is often B. neurological complication of diabetes
measured in the diagnostic evaluation of a patient mellitus
with suspected multiple sclerosis. In what percentage C. progressive degenerative disease of the
of cases would this parameter be abnormal at some cerebellum
time during the course of the disease? :d D. type of myopathy found in familial patterns
A. less than 5% E. none of the above
B. 20-25%
C. 45-80% 47. Werdnig-Hoffmann disease is a (an) :A
D. 75-80% A. anterior horn cell disease of infants
E. 100% B. metabolic disease resulting in mental
retardation
41. Lhemittes sign can be found in? :E C. form of peripheral neuropathy
A. Pott’s disease D. benign type of hypotonia found in infants
B. Multiple sclerosis E. disease in which the basal ganglia become
C. Cervical tumor calcified
D. Cervical chord trauma
E. All of the above 48. Upon actively flexing the head, a patient
complains of an electric shock sensation radiating
42. The most frequent motor abnormality and often down the spine into the legs. What is the name of the
the earliest manifestation of multiple sclerosis is :C sign? :D
A. isolated peripheral neuropathy A. Spurling’s sign
B. mononeuropathy B. Lasegue’s sign
C. paraplegia C. Parkinson’s sign
D. hemiplegia D. Lhermitte’s sign
E. anterior horn call damage E. Sternberg’s sign

43. A patient develops retro bulbar neuritis with 49. The primary site of pathology in Friedreich’s
decreased visual acuity and pain upon movement of ataxia is in the :C
the eye. The patient is currently 25 years old. What is A. cerebellum
B. cerebral hemispheres
 C. spinal cord B. brainstem
D. peripheral nerves C. cerebral hemispheres
E. muscles D. cranial nerves
E. cranial bones
50. The most common age group for the development
of parkinson’s disease is :D
A. 5 to 15 years 57. The most common primary sites of metastatic
B. 25 to 35 years tumors to the brain are the :A
C. 40 to 50 years A. lungs and breast
D. 50 to 60 years B. prostate and stomach
E. over 60 years C. thyroid and kidney
D. uterus and bone
51. The basic mechanism for parkinsonism is :D E. colon and liver
A. calcification of the basal ganglia
B. diffuse cerebellar artery 58. The most frequent type of metastatic lesion in the
C. an abnormality of acetylcholine release in brain is :B
the thalamus A. diffuse microscopic infiltration
D. reduction in dopamine concentration in the B. multiple metastasis
caudate and putamen C. a single large metastatic lesion
E. an autosomal dominant disorder with D. A and C are equally common
delayed clinical manifestations E. A and B are equally common

52. Another name for the disorder “paralysis agitans 59. The differential diagnosis of brain tumor should
is :D include :E
A. Alzheimer’s disease A. cerebrovascular disease
B. Pick’s disease B. subdural hematoma
C. Still’s disease Parkinson’s disease C. brain abscess
D. Chronic alcoholic cerebellar degeneration D. aneurysm
E. all of the above
53. features typical of Parkinson’s disease include :E
A. rigidity of movement 60. The most frequent primary sites of metastatic
B. shuffling gait tumors to spinal cord are the :E
C. immobile face A. lungs and thyroid
D. stooped posture B. kidney and colon
E. all of the above C. uterus and liver
D. stomach and skin
54. The category of the brain tumors known as E. breast and prostate
gliomas can be differentiated into specific types of
gliomas. Which type of glioma is most common? :D 61. The most common intramedullary spinal cord
A. Glioblastoma multiforme tumors are the :C
B. Medulloblastoma A. tuberculomas
C. Epyndymoma B. meningiomas
D. Astrocytoma C. gliomas
E. Spongioblastoma polare D. lipomas
E. metastatic tumors
55. The most common type of brain tumors are
the :E 62. Lead neuritis involves chiefly the :B
A. cerebellepontine andle tumors A. sensory nerve fibers
B. pituitary tumors B. motor nerve fibers
C. metastatic tumors C. autonomic nerve fibers
D. meningiomas D. both A and C
E. gliomas E. both A and B

56. The most common location for a brain tumor in 63. Neuritis may occur following serum injection.
the adult is the :C Which is the most frequent cause of a serum neuritis?
A. posterior fossa :E
 A. diphtheria antitoxin 69. A patient develops Bell’s palsy. What would be
B. scarletb fever antitoxsin the approximate chance of obtaining adequate
C. antimeningococcic serum recovery without resorting to surgery? :D
D. antineumococcic serum A. 5-10%
E. tetanus antitoxin B. 35-40%
C. 55-60%
64. Immediately following a stroke involving the D. 75-80%
cerebral artery distribution, facial weakness is noted E. 95-100%
on the hemiplegic side. A name for this facial palsy is
:E 70. A patient develops herpes zoster around the same
A. Horner’s syndrome side. This would be referred to as :B
B. Bell’s palsy A. Marcus-Gunn syndrome
C. Hunt’s syndrome B. Ramsay-Hunt syndrome
D. Romberg’s sign C. Hassin’s syndrome
E. None of the above D. Klippel-feil syndrome
E. Bell’s palsy
65. Symptoms in the thoracic outlet syndrome can be
due to compression of :D 71. A lesion of the ulnar nerve is suspected. Which of
A. vasculature structures the following movements would be expected to be
B. lymphatic structures weaker than normal? :B
C. neurological structures A. abduction of the thumb
D. both A and C B. abduction of the little finger
E. all of the above C. extension of the metacarpophalngeal joint of
the index finger
66. Following nerve injury in the axilla, which nerve D. both A and C
would generally be expected to demonstrate the most E. all of the above
rapid return of function? :C
A. Ulnar 72. A patient who was sustained a knife wound above
B. Median the elbow is examined and found to be unable to flex
C. Radial the distal interphalangeal joint of the index finger.
D. There would be no difference in recovery What is likely lesion? :C
time A. transection of the tendon of the flexor
E. There is too much variability to be able to digitorum profundus to the index of the
predict finger
B. transection of the tendon of the flexor
67. Following a peripheral nerve in jury, degeneration digitorum sublimes to the index finger
of the axons and myelin occurs but continuity of the C. injury to the median nerve
endoneurial tubes is retained. What would be the D. injury to the ulnar nerve
approximate rate of nerve regeneration for the motor E. injury to the radial nerve
fibers? :C
A. 3mm/month 73. After a prolonged period of sitting within the legs
B. 1mm/week crossed, it is noted that there is a foot drop in one of
C. 1mm/day the legs. A likely diagnosis is :A
D. 1cm/day A. injury to the peroneal nerve
E. 0.5 cm/hr B. injury to tibial nerve
C. injury to sciatic nerve
68. A major complication of Guillain-Barre syndrome D. S1 radiculopathy
is :B E. Anterior compartment syndrome
A. renal failure
B. respiratory paralysis 74. Following severance of the median nerve, there is
C. idiopathic hepatic necrosis noted to be more pink coloration than usual along the
D. cardiac valvular involvement lateral portion of the palm of the hand. Why? :D
E. cerebral nemboli A. the veins which closely accompany the
median were probably also severed, causing
arterial blood to accumulate in the hand.
 B. The arteries which is closely accompany the
median nerve were probably also severed,
causing venous blood to pool
C. The parasympathetic vasoconstrictor fibers
were interrupted
D. The symphathetic vasoconstrictor fibers
were interrupted
E. Edema formation causes the skin to appear
75. What is cause of a Volkman’s contracture? :E
A. Disuse of the affected extremity
B. Spasticity of the muscles in the affected
extremity
C. It is an idiopathic familial disorder
D. It is intrinsic disorder of the dermis
E. It is due to ischemia
76. What is a Dupuytren’s contracture :D
A. contracture of the Achilles tendon
B. contracture of the hip flexors following an
above knee amputation
C. contracture of elbow following a stroke
D. contracture of the palmar fascia
E. contracture of the skin around the neck
following a burn
77. Nerves directly originating from the upper trunk
of the brachial plexus include the :D
A. suprascapular nerve
B. axillary nerve
C. subclavian nerve
D. only A and C
E. all of the above
78. Which of the following muscles differs in its
pattern of innervation from that of the other muscles
listed? :B
A. deltoid
B. rhomboids
C. triceps
D. extensor carpi ulnaris
E. opponens pollicis
79. Which of the following muscles differs in its
pattern of innervation from thet of the other muscles
listed :B
A> biceps brachii
B> triceps
C> supraspinatus
D> infraspinatus
E> brachioradialis
80. With a suprascapular nerve injury, the primary
weakness noted is in :A
A. external rotation of the shoulder
B. forward flexion opf the shoulder
C. extension of the shoulder
D. supination of the forearm
E. pronation of the forearm
81. A patient with a peripheral nerve injury is noted
to have a positive Froment’s sign. What nerve is most
likely injured? :B
A. median
B. ulnar
C. radial
D. musculocutaneous
E. upper trunk of the brachial plexus
82. After sustaining a peripheral nerve injury a
patient is described as having a simian hand. What
nerves was most likely injured? :A
A. median
B. ulnar
C. radial
D. musculocutaneous
E. upper trunk of the brachial plexus
83. A patient sustains a gunshot wound in the
infraclavicular region and later complains of
weakness of the arm. Upon examination the only
weakness that can be detected is in flexion of the
elbow and supination of the forearm. There is noted
to be a strip of hypesthesia along the radial border of
the forearm. What nerve was most likely injured :E
A. axillary
B. ulnar
C. median
D. radial
F. musculocutaneous
84. A patient was diagnosed as having meralgia
paresthetica. The patient wants to know which nerve
is affected. Your answer is the :E
A. obturator nerve
B. sciatic nerve
C. peroneal nerve
D. ilioinguinal nerve
E. lateral femoral cutaneous nerve
85. A patient with a periphral nerve injury is noted to
have a “steppage gait”. There is also noted to be
weakness in the extensor of gtraet toe. Which nerve is
most likely injured? :A
A. peroneal
B. sural
C. tibial
D. femoral
E. lateral plantar
86. A patient with what appears to be a complete
femoral nerve lesion complais of hypesthjesia along
the medial aspect of the leg. What is the reason for
this complaint? :D
A. the medial cutaneous nerve was also injured
B. the sural nerve, which is a branch from the
femoral nerve, supplies this area
C. the superficial peroneal nerve was also
injured
D. the saphenous nerve, which is a branch from
the femoral nerve, supplies this area
E. there is no adequate explanation inthis case.
This appears to be functional rather than an
organic problem
Directions: For each one of the incomplete statements
or questions below, One or more of the numbered
compltions is correct. In each case select:
A. if only 1,2, and 3 are correct
B. if only 1 and 3 are correc
C. if only 2 and 4 are correct
D. if only 4 is correc
E. if all are correct
87. Spasticity is associated with :A
1. an increase in muscle stretch
reflexes
2. pathological reflexes
3. an increased resistance to passive
joint movement
4. an overall decrease in muscle tone
88. Tongue deviation can occur with both peripheral
and central lesions. Which of the following is (are)
correct? :E
1. with left hemiplegia. The toungue
will usually deviate to tye left
2. withperipheral hypoglossal
dysfunction, the toungue will
deviate toward the side of the
lesion
3. with a right cortical lesion. The
toungue will deviate to the left
4. atrophy and fasciculations occur
with peripheral hypoglossal
dysfunction
89. Dysfunction of the Seventh cranial nerve results
in :C
1. weakness of the muscles of
mastication
2. loss of taste on the anterior two
thirds of the toungue
3. sensory deficit on the involved side
of the face
4. weakness of facial expression
90. A Babinski sign is usually an indication of
corticospinal dysfunction. The characteristics of the
Babinski sign include :E
1. extension of the great
toe
2. flexion of the small toes
3. spreading of the small
toes
4. flexion of the leg
91. Major differential factors between cerebral
thrombosis and cerebral embolism would include: E
i. the patient with embolic
disease is usually younger
ii. generalized vascular
changes are more common
with cerebral thrombosis
iii. hypertension and diabetes
are more often associated
with thrombosis
iv. the onset of cerebral
thrombosis is generally
slower than that of
cerebral embolism
92. Common findings in the patient with cerebral
thrombosis include: B
i. hypertension
ii. hyperlipidemia
iii. diabetes
iv. collagen vascular disease
93. Major differential factors between cerebral
thrombosis and hemorrhage would include: A
a. loss of consciousness is more
common with hemorrhage
b. nuchal rigidity is commonly
present with hemorrhage
c. transient ischemic attacks occur
more often before cerebral
thrombosis
d. headache is more common with
cerebral thrombosis
94. Findings in vertebral artery disease may include:
E
a. transirnt attacks of vertigo
b. clinical findings indicating
dysfunction of the lower brain stem
and upper cervical cord
c. production of symptoms by turning
the head sharply
d. impairment of consciousness
95. The differentiation between pseudobulbar palsy
and bulbar palsy includes: A
 a. the usual involvement by
pseudobulbar and corticobulbar
trunks above the midpons
b. the usual involvement by bulbar
palsy of the anterior horn cells
c. pseudobulbar palsy is usually
vascular in origin
d. bulbar palsy is not associated with
muscle atrophy
96. Features commonly associated with thrombosis of
the internal carotid artery include: A
a. transient episodes of contralateral
hemiparesis or hemianesthesia
b. ipsilateral (monocular) blindness
c. mild impairment of consciousness
d. weakness greater in the leg than in
the arm
97. Occlusion of the main trunk of the left middle
cerebral artery usually results in the following
deficits : E
a. hemianesrhesia
b. expressive aphasia
c. receptive aphasia
d. hemiplegia
98. A patient with mild right hemiparesis is having
difficulty ascending and descending stairs and asks
for your advice. You tell him: B
a. in going up the stairs, lead with the
sound leg
b. in going up the srairs, lead with the
involved leg
c. in going down stairs, lead with the
involved leg
d. in going down stairs, lead with the
sound leg
99. Transient cerebral ischemic attacks (TIA): D
1.often last longer than 24 hours
are often of insidious onset
may produce permanent neurologic deficit
increase the risk of cerebral infarction
100. Transient ischemic attacks are often abrupt in
onset and may present with a wide spectrum of
findings. Which of the following could be confused
with a transient ischemic attack? :A
a. multiple sclerosis
b. migraine
c. focal seizures
d. carpal tunnel syndrome
101. Findings are often seen with posterior inferior
cerebellar artery occlusion include: E
a. ipsilateral loss of pain sensation
and normal temperature in the face
b. contralateral loss of pain and
temperature
c. ipsilateral Horner’s syndrome
d. ipsilateral cerebellar incoordiantion
102. Which of the following could be considered
mechanism(s) by which an embolus can pass from
the systematic circulation to the brain :C
a. the embolus can pass through a
patent hepatorenal shunt
b. the embolus can pass through a
patent pulmonary vasculature shunt
c. the embolus can pass through a
peripheral arterio-venous
anastomosis
d. the embolus can pass through a
cardiac septal defect
103. Areas of the brain most often involved by
hypertensive cerebral hemorrhage include the: C
a. superficial cortex
b. basal ganglia
c. brain stem
d. internal capsule
104. Clinical findings common with intracerebral
hemorrhage include: E
1. coma
2. nuchal rigidity.
3. Convulsions
4. Hemiplegia
105. The most common location for “berry”
aneurysms is the: A
a. internal carotid artery
b. anterior communicate artery
c. middle cerebral artery
d. basilar artery
106. Hematomyelia is hemorrhage into the spinal
cord. Trauma is the most common cause. Which of
the following are typical of hematomyelia? B
a. most severe involvement by
hemorrhage is in the gray matter
around the central canal
b. slow insidious onset
c. sphincter involvement of a
neurogenic type
d. no motor system involvement
107. Clinical findings associated with anterior spinal
artery occlusion include: A
 a. paraplegia
b. loss of pain and temperature
sensation
c. atrophy of muscles at the level of
the lesion
d. chronic absence of the ankle jerk
reflexes
108. Possible causes of anterior spinal artery
thrombosis include:E
a. syphilis
b. aortic occlusion
c. cervical spondylosis
d. arterities secondary to collagen-
vascular disease
109. A patient awakens in the morning with weakness
in the right arm. Upon examination there is complete
loss of function in the wrist extensors and in the
extensors of the fingers at the metacarpophalangeal
joints. There also appears to be some weakness of the
finger abductors when they are tested in an
unsupported position. What lesions are most likely
present? D
a. median nerve
b. ulnar nerve
c. axillary nerve
d. radial nerve
110. Which statement(s) is (are) true about sweating
following a nerve injury? C
a. when peripheral nerve is totally
severed, over secretion of sweat
occurs in it’s area of distribution
b. an increase tendency to sweat is
frequently seen following partial
nerve injuries
c. the area of sweating abnormality
following nerve section is generally
much smaller than the area of
sensory deficit
d. when a peripheral nerve is
completely sectioned, sweating no
longer occurs in its area of
distribution
111. The axillary nerve in a patient was injured where
it passes posteriorly around the surgical neck of the
humerus. What Muscle (s) would be expected to be
weak? :D
1. triceps
2. teres minor
3. supraspinatus
4. deltoid
112. Following a radial nerve injury in the
midhumeral area, which of the following muscles
would be expected to be weak? :B
1. extensor indicis proprius
2. triceps
3. supinator
4. pronator teres
113. Which of the following can occur with meralgia
paresthetica? :B
1. hypesthesia in the anterior lateral aspect of thigh
2. diminished of the knee-jerk reflex
3. hyperesthesia in the anterior lateral aspect of the
thigh
4. weakness of quadriceps
114. Poliomyelitis should be differentiated from
Guillain- Barre syndrome. Which of the following
might be helpful for this purpose? : A
1. the protein content of the spinal fluid is increased
with Guillain-Barre syndrome
2. an accurate immunization history
3. the cell court in the spinal fluid is usually elevated
with poliomylelitis
4. a flu-like illness occurs before the Guillain-Barre
syndrome only
115. Which of the following are typical of subacute
combined degeneration of the spinal cord? : E
1. paresthesias most commonly around the feet
2. ataxia
3. impairment of the position and vibration sensation
4. spasticity due to pyramidal tract involvement
116. Progressive spinal muscular atrophy
pathologically involves the :D
1. extrapyramidal system
2. corticospinal tract
3. cerebellar tracts
4. anterior horn cells
117. Common symptoms in amyotrophic lateral
sclerosis (ASL) include : A
1. weakness of the hands and arms
2. muscle cramps in the legs
3. difficulty in talking and swallowing
4. numbness of the feet
118. Amyotrophic lateral sclerosis pathologically
involves in :C
1. extrapyramidal system
2. corticospinal tracts
3. cerebellar tracts
4. anterior horn cells
119. Hypertrophic interstitial neuropathy (dejerine
scotts disease) is characterized by :E
1. weakness of the hands and feet with distal atrophy
2. familial inheritance
3. loss of muscle stretch reflexes
4. enlargement of peripheral nerves
120. Findings typical of Charlot –Marie –tooth
disease include :A
1. gradual onset of symptoms
2. atrophy and weakness of leg muscles
3. impaired superficial sensation in the distal portions
of the limbs
4. relatively normal nerve conduction studies
121. The characteristics of progressive bulbar palsy
include :E
1. pathologic involvement of cranial nerve motor
nuclei
2. usually symmetry in its involvement
3. difficulty in articulation is a common early
symptom
4. overall prognosis is poor
122. Kugelberg-Welander disease is a familial
disorder involving anterior horn cells. Which of the
following is (are) characteristic of this disoreder? :B
1. onset between the ages of 2 and 17 years
2. corticospinal tract involvement
3. weakness and atrophy beginning in the proximal
limb muscles
4. relatively rapidly progressive course with death
usually around the age of 30 years
123. characteristics of infantile progressive muscular
atrophy (werdnig-hoffmann disease) include :A
1. usual development of symptoms in the first year of
life
2. flaccid weakness which makes the infant nearly
immobile
3. joint hyperextensibility
4. death usually around the age of 20 years
124. Which of the following is (are) true about
Friedreich’s ataxia? :E
1. initial symptoms generally develop in the 5 to 20
year age group
2. the disorder is hereditary
3. ataxia is usually the first symptom
4. kyphoscoliosis is common
125. Which of the following is (are) true about the
tremor found in parkinson’s disease : C
1. it is accentuated by movement
2. it is diminished with movement
3. it disappear while the patient is at rest
4. it is generally present while the patient is at rest
126. Which of the following is (are) true about
paralysis agitans? :C
1. tremor is often the initial symptom
2. handwriting is characterized by the abnormalities
of macrographia
3. slowness of movement is common
4. the onset is often rather abrupt
127. Which of the following is (are) true about
astroeytomas? :E
1. they are the most benign type of glioma
2. they grow very slowly
3. they occur in both solid and cystic forms
4. the prognosis is better for cerebellar rather than
cerebral astroesytomas
128. Which of the following is (are) true about
glioblastoma multiforme brain tumors? :A
1. they are highly malignant and rapidly growing
2. they usually occur in persons over the age of 35
years
3.the prognosis for survival is generally poor
4. most are located in the cerebellum
129. Which of the following is (are) true about
medulloblastomas? :C
1. they are most common in the cerebral hemisphere
2. headache, vomiting and ocular distrurbances are
common
3. they occur primarily in adults
4. surgical removal and intensive irradiation are the
best forms of treatment
130. Which of the following is (are) true about
meningiomas of the brain? A
1. they are the most benign of all brain tumors
2. they may be multiple
3. they are found chiefly in adults
4. they are best treated with irradiation and
chemotherapy
131. Which of the following is (are) true about spinal
cord tumors? C
1. they are equal in frequency to brain tumors
2. they are most frequently extramedullary rather than
intramedullary
3. they most often occur in children
4. they are most commonly fibroblastomas
132. Which of the following is (are) true about
fibroblastomas type of spinal cord tumor?E
1. most are found in the thoracic portion of the
vertebral column
2. the spinal cord is compressed and pushed to the Directions: the numbered items should be answered
side to the following key:
3. it is extramedullary in location A. if only A is correct
4. pain is common symptom B. if only B is correct
C. if both A & B are correct
133. Which of the following is (are) true about D. if neither A nor B are is correct
syringomyelia? B
1. it is characterized by cavity formation in the spinal Question 139 through 144
cord 139. sudden severe headache :B
2. it generally presents symptomatically over the age 140. loss of consciousness :B
of 50 years 141. hypertension C
3. it most commonly involves the cervical portion of 142. often develops during sleep A
the spinal cord 143. bloody cerebrospinal fluid B
4. it often presents with rapid development of 144. nuchal rigidity B
symptoms A. cerebral thrombosis
B. cerebral hemorrhage
134. Which of the following is (are) true about the C. both A and B
Arnold-Chian malformation? A D. neither A nor B
1. it is congenital malformation involving the
cerebellum and lower brain stem Questions 145 through 151
2. it is commonly presents in children with 145. often related to he presence B
myelomenigolece 146. frequent involvement of the ocular muscles A
3. symptoms of increased intracranial pressure may 147. usually a good response to anticholinesterase
occur medications A
4. it is usually a benign disorder which requires no 148. characterized by muscular weakness and fatigue
treatment C
149. repeated activity results in an increase in
135.Characteristic of alcoholic neuritis include E weakness A
1. its general occurrence in chronic rather than 150. repeated activity results in an increase in
episodic drinker strength B
2. may develop quite acutely 151. may be associated with neoplasm of the thymus
3. pain is prominent A
4. a probably greater relationship to avitaminosis A. myasthenia gravis
than to the alcohol itself B. myasthenia syndrome
C. both A & B
136. characteristics of diabetic neuritis include B D. neither A nor B
1. pain, especially at night
2. symptoms developing Question 152 through 155
3. in younger diabetic patient 152. a fairy common complication is the carpal
4. diminished muscle stretch reflexes tunnel syndrome B
5. severe muscle atrophy 153. a myopathy may be present C
154. a fine rapid tremor is often present A
137. characteristic of arsenic neuritis include :A 155. can be associated with muscle wasting A
1. symmetric polyneuritis A. hyperthyroidism
2. ataxia B. hypothyroidism
3. transverse while lines on the fingernails C. both A & B
4. painless sensory deficit in the feet D. neither A nor B

138. characteristic of the Guillain-Barre syndrome Questions 156 through 160

include :A
1. clinical onset is usually preceded by recent
respiratory or gastrointestinal infection
2. weakness is symmetrical
3. sensory abnormalities are usually minimal
4. pleocytosis is a common spinal fluid finding
156. weakness is on the ipsilateral side of the lesion
A
157. weakness is on the contralateral side of the
lesion B
158. the upper half of the face is involved to a greater
extent than is the lower half D
159. the lower half of the face is involved to a greater
extent than is the upper half B
160. the entire half of the face is involved A
A. peripheral nerve injury to the seventh cranial
nerve
B. alteration of facial function due to a supranuclear
lesion
C. both A & B
D. neither A nor B

Question 161 through 165

161. often gives more difficulty with dressing
activities B
162. often is accompanied with aphasia A
163. visual perpectual problems are relatively
common B
164. usually requires longer rehabilitation programs
before ambulation B
165. rehabilitation programs are often beneficial C
A. right hemiplegia
B. left hemiplegia
C. both A & B
D. neither A nor B