Endothelial cells are classified as ________________.

a. permanent

b. labile*
c. stabile
d. dormant

Chemotaxic factors ______________________.

a. attract leukocytes*
b. promote vasodilation
c. help to promote lymphatic drainage
d. a and b are correct
e. a, b, and c are correct

Of the following, which is/are true regarding collagen?

a. It is formed by the conversion of fibrin to fibrinogen.
b. It is synthesized by fibroblasts.*
c. It is the principal component of ground substance.
d. a and b are correct.
e. a, b, and c are correct.

Vasoconstriction occurs immediately following soft tissue damage. Why?

a. to minimize the loss of red blood cells*
b. to promote the invasion of neutrophils into the damaged tissue
c. to increase the permeability of the capillary membrane
d. a and b are correct
e. a, b, and c are correct

Mast cells synthesize which of the following?

a. leukotrienes
b. prostaglandin E2
c. bradykinin
d. a and b are correct*
e. a, b, and c are correct

Which of the following pairings of tissue type and ability to regenerate is incorrect?

a. cardiac muscle; permanent
b. epidermis; labile
c. bone; stabile
d. ligament; labile*

The prominent phagocyte at the end of acute inflammation is the ________________.

a. macrophage*
b. basophil
c. neutrophil
d. T-lymphocyte

The metabolic activity of the fibroblasts is greatest during which stage of the inflammatory response?

a. acute
b. tissue repair*
c. remodeling
d. recovery

The swelling associated with acute inflammation is primarily the result of ________________.

a. increased capillary hydrostatic pressure
b. increased capillary osmotic pressure
c. increased interstitial osmotic pressure*
d. increased tissue free fluid pressure

All of the following promote vasodilation except ______________.

a. histamine
b. complement cascade
c. prostaglandin E2
d. thromboxane*

Collagen is _________________.

a. synthesized by myofibroblasts
b. synthesized by fibroblasts
c. the principal protein found in scar tissue
d. a and c are correct
e. b and c are correct*

Of the following, which is not a true statement regarding the acute inflammatory response?

a. The presence of histamine is due to mast cell degranulation.
b. Bradykinin is formed by the conversion of fibrinogen.*
c. Late in the acute inflammatory response, the fibrin clots are dissolved by fibrolysin.
d. The loss of plasma proteins out of the capillaries is increased due to increased capillary membrane permeability.
e. It begins within seconds and can last for several days depending on the extent of the damage.

Resolution of swelling following acute tissue injury is primarily due to ________________.

a. absorption of fluid in the postcapillary venule
b. lymphatic drainage*
c. increased capillary membrane permeability
d. decreased capillary hydrostatic pressure

The conversion of prekallikrein to kallikrein ____________________.

a. is necessary for the formation of prostaglandin E2
b. is an example of the conversion of an active plasma protein to its inactive form
c. is stimulated by XII factor*
d. a and b are correct
e. a, b, and c are correct

Neutrophils perpetuate the inflammatory response by releasing _______________ when they die.

a. leukotrienes
b. cationic proteins*
c. histamine
d. a and b are correct
e. a, b, and c are correct

Macrophages _____________________________.

a. are the principal leukocytes in chronic inflammation
b. are attracted by cationic proteins
c. mature from monocytes
d. a and b are correct
e. a, b, and c are correct*

Of the following, which is/are true regarding mast cells?

a. Degranulation results in the release of histamine.*
b. Mast cell activity is greatest during the tissue repair phase of inflammation.
c. Mast cells are responsible for the conversion of fibrinogen to fibrin.
d. a and b are correct.
e. a, b, and c are correct.

The prominent phagocyte associated with chronic inflammation, such as that occurring with rheumatoid arthritis, is the ______________________.

a. macrophage*
b. basophil
c. neutrophil
d. eosinophil

Pain during movement, but not at rest, is most associated with ______________.

a. acute inflammation
b. the tissue repair phase of the inflammatory response*
c. the tissue maturation phase of the inflammatory response

Macrophages are attracted into an area of damaged tissue by cationic proteins released from ____________.

a. mast cells
b. neutrophils*
c. fibroblasts
d. a and b are correct
e. a, b, and c are correct

Older individuals are prone to developing swelling in the feet and ankles due to failure of the valves in the veins of the legs. Blood pools in the veins, creating an _______________________________, which limits absorption from the interstitium.

a. increased capillary hydrostatic pressure*
b. increased capillary osmotic pressure
c. increased interstitial osmotic pressure
d. increased tissue free fluid pressure

The length of time required for healing depends on all the following EXCEPT

a. overall health of the patient
b. specific tissue damaged
c. severity of the damage
d. all of the above*

The primary sign and/or symptom resulting from altered capillary filtration pressure balance is

a. pain
b. increased swelling*
c. heat
d. redness
e. all of the above

All of the following are signs of shock EXCEPT

a. cool, clammy skin
b. rapid, weak pulse
c. high blood pressure*
d. rapid, shallow breathing
e. lethargy

The greatest effect of histamine is

a. Increased capillary membrane permeability
b. vasodilation*
c. attraction of neutrophils
d. stimulate clotting

Neutrophil chemotactic factor

a. attracts neutrophils to areas of damaged tissue*
b. increases capillary membrane permeability
c. increases blood flow
d. initiates the inflammatory response

Prostaglandin E2

a. stimulates free nerve endings resulting in pain perception
b. interactes with histamine to increase capillary membrane permeability
c. activates the complement cascade
d. a and b only*
e. all of the above

All of the following are correct regarding oxygen free radicals EXCEPT

a. produced by neutrophils
b. produced by the cyclooxygenase pathway
c. contribute to secondary cell death
d. trigger mast cell degranulation*

All of the following are considered labile cells EXCEPT

a. bone marrow
b. epidermis
c. motor neurons*
d. endothelial cells

All of the following are considered stabile cells EXCEPT

a. endothelial
b. cells of the CNS*
c. chondrocytes
d. osteocytes
e. fibroblasts

All of the following are considered permanent cells EXCEPT

a. liver, kidney, and pancreas*
b. cells of CNS
c. lenses of the eyes
d. cardiac muscle
e. all of the above are permanent

Only damaged vascularized tissues can heal via the inflammatory response, while avascular tissues cannot heal

a. True*
b. False

The acute inflammatory response lasts until damaged tissue has been removed and new capillaries are formed.

a. True*
b. False

The body's own mechanisms cannot control blood loss.

a. True
b. False*

Prostaglandins and leukotrienes are derived from arachidonic acid, which is produced from phospholipids

a. True*
b. False

The protein cascades function with the chemical mediators released from all injured cells.

a. True
b. False*

What type of therapeutic modalities can decrease pain?

a. ultrasound
b. ice
c. electrical stimulation
d. heat
e. all of the above*

All of the following anatomical levels of pain transmission can be affected by therapeutic modalities EXCEPT

a. descending pathway
b. ascending pathway
c. spinal level
d. periphery
e. all of the above can be affected*

Which one of the following are considered first-order neurons?

a. T cell
b. sensory*
c. decussates
d. neospinothalamic
e. none of the above

Which one of the following are considered second-order neurons?

a. T cell*
b. sensory
c. decussates
d. neospinothalamic
e. none of the above

All of the following are sensory receptor classifications EXCEPT

a. deep
b. superficial
c. visceral
d. motor*
e. special

Superficial receptors transmit all of the following sensations EXCEPT

a. tickle and itch
b. warmth and cold
c. deep pressure and kinesthesia*
d. touch and pressure
e. none of the above are correct

Deep receptors transmit all of the following sensations EXCEPT

a. position
b. warmth and cold*
c. deep pressure and kinesthesia
d. muscle and tendon pain
e. none of the above are correct

Sensory nerve fibers can be grouped by each of the following EXCEPT

a. function
b. length of fiber*
c. diameter or width of fiber
d. degree of myelination
e. all of the above are correct

All of the following pertain to C fibers EXCEPT

a. unmyelinated
b. smallest afferent pain fibers
c. slowest sensory nerve fiber
d. requirement of greater stimulation to elicit a response
e. all of the above are correct*

Which of the following can evoke the goal of pain modulation in a descending fashion?

a. stress relief
b. medication
c. modalities
d. a and b
e. a, b, and c*

Which of the following brain areas has/have influence on the descending pathway?

a. reticular formation
b. PAG
c. hypothalamus
d. Raphe nucleus
e. all of the above*

All of the following neuroactive peptides are believed to facilitate synaptic transmission in nociceptive pathways EXCEPT

a. substance P
b. dynorphin*
c. glutamate
d. a and c
e. none of the above are correct

All of the following are endogenous opioids that inhibit pain transmission EXCEPT

a. leucine enkephalin
b. dynorphin
c. beta-endorphin
d. methionine enkephalin
e. all of the above are correct*

All of the following apply to endorphins EXCEPT

a. inhibited by exercise*
b. endogenous
c. produced in several locations in the body
d. possibly enhanced by low-frequency, high-intensity electrical stimulation
e. broken down from beta liptropin

Of the following, which would be considered part of the nociceptive pathway "to the brain"?

a. C fibers
b. A-delta fibers
c. A-beta fibers
d. a and b are correct*
e. a, b, and c are correct

According to the gate control theory, the substantia gelatinosa __________________.

a. is caused by input along small- and large-diameter fibers*
b. results in inhibition of synaptic transmission to the T cell
c. will result in a decrease in the sensation of pain
d. a and b are correct
e. a, b, and c are correct

A-beta primary afferent fibers _________________________.

a. are of larger diameter than A-delta fibers
b. are more rapidly conducting than A-delta fibers
c. are unmyelinated
d. a and b are correct*
e. a, b, and c are correct

Nerve fibers in the spinothalamic tract are ___________________.

a. first-order efferent nerves
b. considered interneurons
c. second-order afferent nerves*
d. principally efferent fibers

Depolarization of nociceptive-specific second-order afferents _________________.

a. is facilitated by substance P
b. is inhibited by enkephalin
c. results in the transmission of impulses to the dorsal horn of the spinal cord
d. a and b are correct*
e. a, b, and c are correct

_____________ nerves are most responsible for fast pain "sensation" and are myelinated and larger in diameter

a. A-alpha afferent

b. A-beta afferent*
c. A-delta afferent
d. C fiber afferent

_____________ nerves are most responsible for slower pain "sensation" and are smallest in diameter.

a. A-alpha afferent
b. A-beta afferent
c. A-delta afferent
d. C fiber afferent*

Descending pain modulation uses feedback loops that involve several different nuclei in the brainstem.

a. True*
b. False

The conduction velocity of a nerve fiber is related to the diameter and the degree of myelination.

a. True*
b. False

Pain is difficult to assess because it is a sign rather than a symptom.

a. True
b. False*

The VPL and the VPM nuclei are identified as the most significant for pain transmission and pain modulation.

a. True*
b. False

Serotonergic neurons are presumed to have a direct monosynaptic inhibitory effect on the T cell

a. True*
b. False

Wedenski's inhibition is often seen with high-frequency currents such as Russian stimulation

a. True
b. False*

Kehr's sign, or left shoulder pain due to spleen trauma, is a type of ____________ pain.

referred

What does each letter in the acronym PQRST stand for when one is asking questions of a patient about pain?

P = provocation
Q = quality
R = referral or radiation
S = severity
T = timing

All of the following are used as assessment tools in order to gauge whether a specific treatment has the desired outcome EXCEPT

a. clinician-derived measures of changes in strength
b. clinician-derived measures of changes in ROM
c. patient self-assessments
d. a and b only
e. a, b, and c are correct*

Of the following, which are reasons that a patient might report improvement for reasons other than the treatment given by the ATC?

a. the patient is assured that the injury is not serious
b. natural history of the condition
c. placebo effect
d. all of the above are correct*

All of the following are patient self-report instruments that assist clinicians in deciding if the treatment outcome is desired EXCEPT

a. Short Form-36
b. Short Form-12
c. ATOA
d. Owestry Back Pain Index
e. all of the above*

All of the following are necessary components of a well-designed, randomized, controlled clinical trial EXCEPT

a. blinded subjects
b. control for natural history
c. control for subject and investigator bias
d. short so as to be done quickly*
e. blinded clinicians and evaluators

All of the following are important to consider when assessing the methodological quality of randomized controlled clinical trials EXCEPT

a. randomization allocation was concealed
b. large number of subjects were obtained regardless of inclusion/exclusion criteria*
c. groups were similar at baseline regarding the most important prognostic indicators
d. all subjects were blinded
e. all clinicians administering treatment were blinded

The challenge across health care is to provide the care necessary to optimize treatment outcome in the most efficient manner.

a. True*
b. False

The goal of evidence-based medicine is that, ultimately, the most beneficial treatments will become the standard of care while ineffective treatments will be discontinued.

a. True*
b. False

An ice pack is an example of which form of thermal energy transfer?

a. conduction*

b. convection

c. radiation

d. conversion

 A warm whirlpool is an example of which form of thermal energy transfer?

a. conduction

b. convection*

c. radiation

d. conversion

An infrared heat lamp is an example of which form of thermal energy transfer?

a. conduction

b. convection

c. radiation*

d. conversion

Commercial cold packs

a. do not conform well to the skin

b. can result in frostbite due to colder temperatures

c. do not require a layer between the pack and the skin

d. a and b are correct*

e. all of the above are true

For contrast therapy, all of the following ratios of cooling time to rewarming time are acceptable EXCEPT

a. 1:1

b. 1:2

c. 1:3

d. none of the above

e. all of the above*

All of the following are true about cryokinetics EXCEPT

a. not used on acute injuries

b. can speed functional recovery

c. alternates cold with controlled exercise

d. can break the pain–spasm cycle

e. all of the above are true*

All of the following pertain to Raynaud’s phenomenon EXCEPT

a. vasospastic disorder

b. occurs anywhere in the body*

c. constriction of arteries and arterioles

d. most common in women

e. a and b are correct

All of the following are special precautions to be considered when using cryotherapy EXCEPT

a. individuals suffering from significant medical problems

b. frail individuals

c. slow-healing wounds

d. very young individuals*

e. individuals with diminished circulation or sensation

All of the following are physiological responses in superficial tissues to superficial heat EXCEPT

a. increased viscosity*

b. increased circulation and sweating

c. increased inflammation and metabolic activity

d. increased tissue elasticity

e. all of the above are correct

All of the following are true about the use of counterirritants EXCEPT

a. results in sensation of heating

b. causes no clinically meaningful changes in temperature

c. possibly induces gate control theory of pain modulation

d. can substitute for other modalities especially if time is an issue*

e. all of the above are correct

Of the following, which is/are true regarding cryotherapy?

a. Cold depresses the inflammatory response 

b. A 20-min cold application relieves pain by slowing nerve conduction velocity in nociceptive pathways.

c. Cold alleviates muscle spasm by reducing activity of muscle spindles.

d. a and b are correct.

e. b and c are correct.*

Which alters tissue temperature 2 cm below the skin surface?

a. 20-min application of superficial heat 

b. 20-min application of ice bag*

c. neither a nor b

d. both a and b

Which results in decreased muscle spindle activity?

a. 20-min application of superficial heat 

b. 20-min application of ice bag

c. neither a nor b

d. both a and b*

Of the following, which is/are true regarding cold application?

a. If crushed ice is placed in a plastic bag and applied to the skin, a moist towel should be placed between the bag and skin to prevent frostbite.

b. A 20-min application of cold is effective in reducing swelling because of cold-induced vasodilation.

c. Deep tissue temperature (2-3 cm) will return to baseline within minutes following a 20-min application of crushed ice.

d. None of the statements are true.*

e. a, b, and c are correct.

Of the following, which is a correct statement regarding the response to superficial heat?

a. Heat decreases muscle spasm via a spinal reflex mechanism.8

b. Heat-induced vasodilation occurs in muscle tissue following 20 min of application.

c. The analgesic response to a 20-min superficial heat application is most likely due to a decrease in nerve conduction velocity.

d. Superficial heat stimulates lymphatic drainage, which results in decreases in interstitial edema.

An athlete presents five days following a second-degree hamstring strain. The athlete has some pain with activity and demonstrates a loss of hamstring flexibility. The athlete performs an ice massage over the injured hamstring and four long, slow hamstring stretches. The athlete stretches much farther than before applying the ice. What is the best explanation for this observation?

a. Cold-induced vasodilation has increased the connective tissue temperature, making it more elastic.

b. Cold has decreased the muscle spindle hypersensitivity, allowing the muscle to be stretched without a reflexive muscle spasm.*

c. Cold has anesthetized the tissue, preventing the athlete from sensing pain during stretching.

d. Cold has activated the gate control and is blocking the sensation of pain during stretching.

Superficial heat _________________________________________.

a. causes the release of kallikrein from sweat glands

b. promotes vasodilation in cutaneous tissue

c. increases viscosity of synovial fluid

d. a and b are correct*

e. a, b, and c are correct

Warm whirlpools __________________________________.

a. heat tissues via convection

b. permit therapeutic exercise during the heat application

c. pose a risk of contamination and infection if the patient has an open wound

d. a and b are correct

e. a, b, and c are correct*

Paraffin ______________________.

a. consists of wax and mineral oil

b. should be heated to approximately 125° F

c. is contraindicated if the patient has an open wound

d. a and b are correct

e. a, b, and c are correct*

Numbness in the volar aspect of the fourth and fifth fingers following the application of ice to the elbow is consistent with which of the following?

a. cold-induced radial nerve palsy

b. cold-induced ulnar nerve palsy*

c. cold-induced median nerve palsy

d. cold urticaria

Fluidotherapy units __________________________________.

a. heat tissues via convection

b. permit therapeutic exercise during the heat application

c. pose a greater risk of contamination and infection than a whirlpool or paraffin bath if the patient has an open wound

d. a and b are correct*

e. a, b, and c are correct

The height of an infrared heating lamp is lowered from 20 to 10 in. above the skin. At a fixed treatment time, what will be the impact on tissue heating?

a. It will increase 200%.

b. It will decrease 50%.

c. It will increase 400%.*

d. It will decrease 75%.

Which of the following would be the best treatment choice for the following patient problem? The athlete is a 45-year-old tennis player who underwent ORIF for a displaced fracture of the proximal phalanx of the index finger eight weeks ago. The pin fixation was recently removed. The primary complaint is lack of motion in the M-P and PIP joints.

a. hot pack

b. contrast bath

c. paraffin

d. fluidotherapy*

e. cryokinetics

Which of the following would be the best treatment choice for the following patient problem? The athlete is a 20-year-old volleyball player who suffered a first-degree lateral ankle sprain two days ago. The team is participating in the NCAA regional tournament in two days. The team physician will allow the athlete to play, but the athlete limps while walking and has not jogged or jumped since the injury. There is some swelling but it does not limit motion.

a. hot hydrocollator

b. contrast bath

c. paraffin

d. fluidotherapy

e. cryokinetics*

To optimize the heating under an infrared lamp, the cosine law dictates that the lamp be positioned so that the angle between the heated surface and the light is 90°.

a. true*

b. false

Ice massage is an excellent way to reduce pain prior to therapeutic exercise.

a. true*

b. false

Larger temperature decreases are seen in muscles than in joints following cryotherapy

a. true

b. false*

Superficial vasoconstriction occurs primarily through reflex mechanisms while decreased metabolic activity is responsible for decreased blood flow in deeper tissues.

a. true*

b. false

Based on the randomized controlled trials in the literature, cryotherapy has a dramatic effect on expediting the recovery from injury.

a. true

b. false*

Based on the randomized controlled trials in the literature, superficial heat has a dramatic effect on expediting the recovery from injury.

a. true

b. false*

The primary theory supporting the use of contrast therapy is cycles of vasodilation and vasoconstriction that create a pumping action to decrease swelling.

a. true

b. false*

During the acute inflammatory response, use of an ice pack should be combined with __________________.

compression, elevation, protection

_________________are the primary risk of superficial heating.

Burns

The two most common sites of cold-induced nerve palsy resulting in motor loss are the ___________ and ______________ nerves.

ulnar; common peroneal