Question 1

The angle of Louis is an important landmark for all of the following except,
A)Counting ribs
B)Palpation of trachea
C)Ascending aorta ends at this level
D)Marking the upper limit of the base of the heart

Accepted Answer

The angle of Louis is not an important landmark for palpation of the trachea.
The trachea can be palpated usually at the jugular notch or suprasternal notch, which is the superior border of the manubrium sternum between the two clavicles.
The angle of Louis is also a landmark for the ending of the ascending aorta, the beginning of the arch of aorta, and marks the plane which separates the superior and inferior mediastinum.

Question 2

Which nerve acts as an afferent for the cough reflex?
A)Trigeminal
B)Facial
C)Vagus
D)Glossopharyngeal

Accepted Answer

Vagus nerve acts as an afferent for cough reflex.
The vagus (X) is the tenth cranial nerve. It is both afferent and efferent in nature. It provides sensation for the pharynx region and organs in the chest and abdomen. When there is any chemical or foreign matter irritation, it initiates the cough reflex. Mainly, the vagus nerve carries the afferent impulses to the medulla and thereby initiates the cough reflex.
The other nerves are not involved in the cough reflex.
The facial is the seventh (VII) cranial nerve. It is both afferent and efferent. It innervates the muscles of facial expression.
The glossopharyngeal is the ninth (IX) cranial nerve. It is both afferent and efferent. It provides sensation for the posterior third of the tongue and pharynx area.
The trigeminal nerve is the fifth cranial nerve. It is both afferent and efferent and supplies the muscles of mastication.

Question 3

When a person is exercising, which of the following phases refers to the cardiovascular drift?
A)Preparation of cardiovascular system by neurological, humoral, and mechanical factors
B)Progressively less efficient delivery of oxygen and metabolite needs and increasing demands on the cardiovascular system
C)Rapid adaptation of cardiovascular system
D)Maintenance of equilibrium through cardiovascular adjustments

Accepted Answer

Progressively less efficient delivery of oxygen and metabolite needs and increasing demands on the cardiovascular system is referred to as the cardiovascular drift phase while exercising.
There are four phases of cardiovascular response to exercise. The cardiovascular drift is the final phase. In this phase there is progressively less efficient delivery of oxygen and metabolite needs and increasing demands on the cardiovascular system to dispose of body heat.
The initial phase is the anticipatory phase in which there occurs preparation of the cardiovascular system for exercise by the neurological, humoral and mechanical factors.
The second phase is where there is a rapid adaptation of cardiovascular response to the exercise that is occurring.
The next phase is a steady phase in which the equilibrium is maintained by cardiovascular adjustments.

Question 4

Which of the following structures can be responsible for rapid spread of lung infection?
A)Respiratory bronchiole
B)Pores of Kohn
C)Lambart canals
D)Both B and C
E)All the above

Accepted Answer

Both B and C (the Pores of Kohn and Lambart Canals) can be responsible for the rapid spread of lung infection.
Alveolar walls communicate through the pores of Kohn and the Lambart Canals act as a communication channel between the bronchioles and alveoli. These communications provide collateral ventilation to the alveoli. So they are responsible for the rapid spread of infection within the lung.
Respiratory bronchioles are the branches from the 17th to 19th generation.

Question 5

Which parts /sides of the lung have the maximum perfusion?
A)Bases of the lung in an upright position
B)Apices of the lung in upright position
C)Right side lung in right side lying position
D)Both B and C
E)Both A and C

Accepted Answer

Both A and C (bases of the lung in an upright position and right side lung in right side lying position) will have the maximum perfusion.
Gravity tends to pull blood into the dependent positions of the lung. Therefore, in those areas perfusion is greater than ventilation. The non-dependent areas will have more ventilation. The knowledge of ventilation and perfusion inequalities is important in physical therapy because patients with cardiopulmonary pathology may find it distressful if positioned wrongly during the treatment. Distress caused by a wrong position is due to poor gas exchange in the dependent lung because of ventilation - perfusion inequalities.

Question 6

Which option in the below explains the tympanic tone in mediate percussion?
A)Loud amplitude, low pitch, longer duration, heard over air filled organ
B)Low amplitude, medium to high pitch, short duration, heard over solid organs
C)Very low pitch, prolonged duration, heard over tissue with reduced density
D)High pitch, medium duration, heard over hollow structures

Accepted Answer

High pitch, medium duration, heard over hollow structures explains the tympanic tone in mediate percussion.
The tone that has loud amplitude, low pitch, and longer duration, heard over an air-filled organ, such as a lung, is known as resonant.
The tone which has low amplitude, medium to high pitch, short duration, heard over solid organs, such as the liver, is known as dull.
The tone which is very low pitch, prolonged duration, heard over tissue with reduced density, such as emphysema, is known as hyper-resonant.

Question 7

Which part of chest wall excursion is measured if you place the palms distal to the nipple line with the thumbs meeting in the midline, and the fingers lying in the posterior axillary fold?
A)Lingula motion
B)Apical motion
C)Posterior motion
D)Lower lobe motion

Accepted Answer

Lingula motion is measured if you place the palms distal to the nipple line with the thumbs meeting in the midline and the fingers lying in the posterior axillary fold.
The chest wall excursion is most commonly measured by direct hand method. For lingula /middle lobe or anterolateral motion measurement, the hands are placed with the palms distal to the nipple line and the thumbs meeting in the midline. The fingers lie in the posterior axillary fold.
For measuring the apical or upper lobe motion, the hands are placed over the anterior chest. The heels of the hands are about level with the fourth rib and the fingertips reach toward the upper trapezius.
For the posterior / lower lobe motion measurement, the hands are placed flat on the posterior chest wall at the level of the tenth rib. The thumbs meet at the midline. The fingers reach towards the anterior axillary fold.

Question 8

While assessing the voice sounds, which sign is helpful in identifying patchy areas of lung consolidation?
A)Egophony
B)Brochophony
C)Whispered pectoriloquy
D)None of the above

Accepted Answer

Whispered pectoriloquy is helpful in identifying patchy areas of lung consolidation.
Whispered voice sounds produce low-pitched vibrations over the chest which are muffled by normal lung parenchyma. Whispered pectoriloquy is the sign in which the whispered voice sounds are distinct and clear. Patient will be asked to say repeatedly - One, two or 99 to evaluate this sound.
The other two options are also used for identifying lung consolidation. Whereas whispered pectoriloquy is useful in identifying small and patchy consolidations.
Bronchophony occurs in conditions caused by increased lung density. The repeated words are louder and clearer.
Egophony is also present when there is increased density. The patient is asked to say 'eee'. The underlying process distorts the e sound. So 'aaa' sound is heard.

Question 9

According to the Winsor and Hyman functional grading system, what of the following is referred to as Grade III?
A)No functional limitation
B)Ambulatory less than 4 blocks before onset of claudication
C)Ambulatory at least 4 blocks before onset of claudication
D)Non-ambulatory due to ischemic pain at rest

Accepted Answer

According to the Winsor and Hyman functional grading system, Grade III refers to ambulatory less than 4 blocks before onset of claudication.
The Winsor and Hyman functional grading system can be used to grade the functional level of patients with peripheral vascular disorder. It has Grades I to IV.
Grade I - No functional limitation
Grade II - Ambulatory at least 4 blocks before onset of claudication
Grade III - Ambulatory less than 4 blocks before onset of claudication
Grade IV - Non-ambulatory due to ischemic pain at rest

Question 10

Of what use is the Stemmer's sign?
A)To detect deep vein thrombosis
B)To detect arterial insufficiency
C)To determine superficial vein valve competency
D)To clarify the presence of lymphedema

Accepted Answer

Stemmer's sign is used to clarify the presence of lymphedema.
Stemmer's sign is the inability to pick up a fold of skin at the base of second toe of the affected lower limb. This test can be performed to clarify the presence of lymphedema.
The Cuff test is useful to detect deep vein thrombosis.
The Claudication test is useful in detecting arterial involvement.
Percussion tests and Trendelenburg tests are useful to detect valve competency.

Question 11

Where does the maximum range of movement occur during respiration in women?
A)Upper thorax
B)Lower thorax
C)Abdominal
D)Both A and B

Accepted Answer

The maximum range of movement occurs in the upper thorax during respiration in women.
In children, the maximum range of movement occurs in the abdomen.
In men, it occurs in both the upper and lower thoraxes.

Question 12

Which factor increases the transdiaphragmatic pressure difference?
A)Small radius of diaphragm
B)Reduced intra-abdominal pressure
C)Increased abdominal muscle tension
D)Both A and C
E)All the above

Accepted Answer

Small radius of diaphragm and increased abdominal muscle tension are the factors that increase the transdiaphragmatic pressure.
There is an inverse relationship between the thoracic and abdominal pressures during ventilation, often called transdiaphragmatic pressure, which is explained by the Laplace's Law, i.e., tension = pressure × radius. The smaller the diaphragmatic radius, the higher the transdiaphragmatic pressure. Increasing the abdominal muscle tension just before inspiring could result in stronger contraction of the diaphragm and greater potential for higher transdiaphragmatic pressure differences.

Question 13

Which of the following is the bucket-handle movement?
A)Upward and forward motion of the upper ribs
B)Free motion of ribs 11 and 12
C)Forward and lateral motion of the intermediate ribs
D)Upward and lateral motion of the lower ribs

Accepted Answer

Upward and lateral motion of the lower ribs is known as bucket-handle movement.
The upward and forward motion of the upper ribs is called a pump- handle motion.
Ribs 11 and 12 move in any direction because they articulate only with a single vertebral facet.

Question 14

If a patient describes pain as a burning, pressure-like, stinging, aching, what could possibly be the structure involved?
A)Muscle
B)Vasculature
C)Bone
D)Sympathetic nerve

Accepted Answer

If a patient describes pain as burning, pressure-like, stinging, aching, the structure involved is the sympathetic nerve.
Sympathetic pain is usually described as intense burning pain along with stiffness and swelling.
Muscle pain is usually described as dull and aching. It is hard to localize.
Vasculature pain is usually felt as throbbing and diffused.
Pain in the bone is described as diffuse, aching, and poorly localized.

Question 15

When you are examining an orthopedic injury patient, which one of the following principles is not followed?
A)Do the active movements first, followed by the passive movements
B)Do the resisted isometric movements in resting position
C)The involved side should be tested first
D)During the myotome testing, the contraction should be held for five seconds

Accepted Answer

When you are examining an orthopedic injury patient, testing the involved side first is not a standard principle that needs to be followed.
When doing the examination, the normal side should be tested first. This gives confidence to the patient and thereby reduces the apprehension for testing the injured side. The therapist also becomes more familiar with knowing the normal baseline movement for the joint.
Other options are the basic principles of examining patients.
Myotome weakness takes time to develop, therefore the contraction should be held for five seconds.

Question 16

According to the Seddon classification of nerve injuries, what is the grade of injury if the patient has no pain, presents with muscle wasting, has complete loss of motor, sensory, and sympathetic functions which take months to recover after surgery?
A)Neuropraxia
B)Axonotmesis
C)Neurotmesis
D)Both A and B

Accepted Answer

According to Seddon classification, if the patient has no pain, presents with muscle wasting, has complete loss of motor, sensory, and sympathetic functions which takes months to recover after surgery, itis classified as neurotmesis. In neurotmesis, the structure of the nerve is destroyed by cutting and severe scarring.
Neuropraxia is a minimally severe type of nerve injury. The symptoms and signs include pain, muscle weakness, numbness, and proprioception becomes affected. There will be no muscle wasting. Recovery can be within minutes to sometimes days.
Axonotmesis is the disruption of the nerve cell. Wallerian degeneration can possibly occur distal to the injury site. The symptoms and signs include pain, evident muscle wasting, and complete loss of motor, sensory, and sympathetic functions. Recovery might take months.

Question 17

Which joint has the capsular pattern of lateral rotation, abduction and medial rotation?
A)The humeroulnar joint
B)The hip joint
C)The mid tarsal joint
D)The glenohumeral joint

Accepted Answer

The glenohumeral joint has the capsular pattern of lateral rotation, abduction and medial rotation.
The knowledge about capsular pattern is essential to determine the joint dysfunction because the limitation of joint motion occurs in a specific pattern and each joint has a different capsular pattern.
The humeroulnar joint has the capsular pattern of flexion and extension.
The hip joint has the capsular pattern of flexion, abduction and medial rotation.
The mid tarsal joint has the capsular pattern of dorsiflexion, plantar flexion, adduction, and medial rotation.

Question 18

If the synovial fluid appears as a thick exudate and is brownish in color, it indicates the presence of which of the following?
A)Non inflammatory condition
B)Inflammatory arthritis
C)Septic arthritis
D)Tumors

Accepted Answer

If the synovial fluid is a thick exudate and brownish in color, it indicates the presence of septic arthritis.
In the case of a non-inflammatory condition, the synovial fluid will be clear and yellow in color.
In infective arthritis, the synovial fluid will be cloudy.
In tumor conditions, the synovial fluid it will be hemorrhagic in nature.

Question 19

Which is the name of the test performed by tapping the plantar surface of the toes to detect the pyramidal tract lesion?
A)Chaddock's reflex test
B)Schaeffer's reflex test
C)Piotrowski's reflex test
D)Rossolimo's reflex test

Accepted Answer

Rossolimo's reflex test is performed by tapping the plantar surface of the toes to detect pyramidal tract lesions.
A positive sign in Rossolimo's reflex test is plantar flexion of toes which indicates pyramidal tract lesion.
Schaeffer's reflex test is performed by pinching of Achilles tendon in the middle third. A positive sign is flexion of foot and toes. This test is used to detect organic hemiplegia.
Chaddock's reflex test is performed by stroking the lateral side of foot beneath lateral malleolus. A positive sign is by the extension of great toe and fanning of four small toes. This test is also used to detect pyramidal tract lesion.
Piotrowski's reflex test is performed by percussion of the tibialis anterior muscle. Dorsiflexion and supination of the foot indicates a positive sign. It is useful in detecting organic disease of the central nervous system.

Question 20

Which one of the following special tests needs to be performed before doing manipulation of the cervical spine?
A)Lhermitte's sign
B)Bakody's sign
C)Elvey test
D)Sharp - purser test

Accepted Answer

Sharp - purse test needs to be performed before doing manipulation of the cervical spine.
Sharp - purser test is used to determine the subluxation of atlas on the axis. This test should be performed with extreme caution. If there is instability of the spine, mobilization techniques are contraindicated.
Lhermitte's sign is used to determine upper motor neuron lesion and cervical myelopathy.
Bakody's sign is used to detect radicular symptoms in C4 or C5.
Elvey test is to put stress on the neurological structures.

Quiz 1: Data Collection

The angle of Louis is an important landmark for all of the following except,

Which nerve acts as an afferent for the cough reflex?

When a person is exercising, which of the following phases refers to the cardiovascular drift?

Which of the following structures can be responsible for rapid spread of lung infection?

Which parts /sides of the lung have the maximum perfusion?

Which option in the below explains the tympanic tone in mediate percussion?

Which part of chest wall excursion is measured if you place the palms distal to the nipple line with the thumbs meeting in the midline, and the fingers lying in the posterior axillary fold?

While assessing the voice sounds, which sign is helpful in identifying patchy areas of lung consolidation?

According to the Winsor and Hyman functional grading system, what of the following is referred to as Grade III?

Of what use is the Stemmer's sign?

Where does the maximum range of movement occur during respiration in women?

Which factor increases the transdiaphragmatic pressure difference?

Which of the following is the bucket-handle movement?

If a patient describes pain as a burning, pressure-like, stinging, aching, what could possibly be the structure involved?

When you are examining an orthopedic injury patient, which one of the following principles is not followed?

According to the Seddon classification of nerve injuries, what is the grade of injury if the patient has no pain, presents with muscle wasting, has complete loss of motor, sensory, and sympathetic functions which take months to recover after surgery?

Which joint has the capsular pattern of lateral rotation, abduction and medial rotation?

If the synovial fluid appears as a thick exudate and is brownish in color, it indicates the presence of which of the following?

Which is the name of the test performed by tapping the plantar surface of the toes to detect the pyramidal tract lesion?

Which one of the following special tests needs to be performed before doing manipulation of the cervical spine?