Metabolic Endocrine 2 2010

1 A physical therapist reviews a patient's blood gas analysis. The therapist identifies that
the PaCO2 is elevated and the pH is below the normal level. These findings are MOST
representative of:
a) respiratory acidosis
b) respiratory alkalosis
c) metabolic acidosis
d) metabolic alkalosis

Rationale: Respiratory acidosis is caused by retention of carbon dioxide due to

pulmonary insufficiency. Signs and symptoms include dizziness, tingling, and
syncope.

2 A pregnant female in her third trimester completes a series of exercises in supine. In

order to prevent vena cava compression during the exercise session, what would be
considered the physical therapists next best move ?
a) Place a folded towel under the right side of the patient's pelvis.
b) Place a folded towel under the left side of the patient's pelvis.
c) Complete the exercise inside lying.
d) Elevate the patient's feet 12 inches.

Rationale: Turning the patient slightly to the left by placing a towel under the right
side of the patient's pelvis will tend to lessen the effects of uterine compression on
the abdominal vessels and improve cardiac output.

3 You are moving only the visual reference to test for balance. Which system must
remain intact for this sensory organization test?
a) Endocrine
b) Metabolic
c) Visual
d) Proprioceptive

Rationale: Am J Sports Med. 2005 Aug;33(8):1174-82. Epub 2005 Jul 6. Ankle joint
proprioception and postural control in basketball players with bilateral ankle sprains.
Fu AS, Hui-Chan CW.The Sensory Organization Test was applied with dynamic
posturography to assess postural sway angle under 6 sensory conditions.
Deficiencies in ankle proprioception and standing balance in basketball players with
multiple ankle sprains have been reported in separate studies. Such findings
highlight the need for the rehabilitation of patients with multiple ankle sprains to
include proprioceptive and balance training.

4 You are treating a patient by asking his to reach and touch a pen. The patient often
reaches past the pen. You identify this as:
a) dysmetria
b) dysdiadochokinesia
c) athetosis
d) dysphagia

Rationale: Dysmetria (English: difficult to measure) refers to a lack of coordination of

movement typified by the undershoot or overshoot of intended position with the
 hand, arm, leg, or eye. It is sometimes described as an inability to judge distance or
scale. As dysmetria can refer to more than just a motor problem, an overlying
definition that encompasses all forms of it is “the inability to receive and process
information rapidly, to retrieve the relevant associated constructs, and to produce a
well-modulated and fine-tuned response.” Hypermetria and hypometria refer,
respectively, to overshooting and undershooting the intended position. Ref:
http://en.wikipedia.org/wiki/Dysmetria

5 You are treating a patient s/p rotator cuff repair. He complains of headaches, chest
pain, and pain at the base of the neck. Your next course of action would be:
a) monitor his vital signs
b) notify the primary care physician
c) discontinue treatment
d) proceed with caution

Rationale: Several times daily an individual will come into the office with a left arm
tingling, or pain or tingling in the left chest. Often the patient will be concerned about
the heart. This discomfort is most often due to a " pinched nerve" in the cervical
spine where a disc is bulging onto the nerve root. This can cause acute severe pain,
or a chronic low grade intermittent gnawing pain, worse in the cold weather. The
discomfort can be at the base of the neck, radiating up into the scalp, down the
shoulder to the arm and fingers, into the top of the chest, the pectorals, into the
angle of the shoulderblade, or under the arm and into the lower pectoral muscles.
Some women with this pain become concerned about breast cancer, which
incidentally rarely causes pain, especially in the first few years.

6 You are performing progressive resistive exercises with patient in an exercise mat.
Your patient complains of syncope. The best position would be:
a) sidelying
b) sitting
c) supine
d) Tredelenburg

Rationale: In the Trendelenburg position the body is supine position with the feet
higher than the head, in contrast to the reverse Trendelenburg position, where the
body is tilted in the opposite direction. It was named after the German surgeon
Friedrich Trendelenburg. * Hypotensive patients have historically been placed in the
Trendelenburg position in hopes of increasing their cerebral perfusion pressure (the
blood pressure in the brain). A 2005 literature review found the "Literature on the
position was scarce, lacked strength, and seemed to be guided by 'expert opinion.'"
However, the passive leg raising test is a useful clinical guide to fluid resuscitation
and can be used for effective autotransfusion. * The Trendelenburg position used to
be the standard first aid position for shock * Trendelenburg position is helpful in
surgical reduction of an abdominal hernia.
http://en.wikipedia.org/wiki/Trendelenburg_position

7 A 61-year-old woman with metastatic colon cancer presented with complaints of

intractable abdominal pain. Since her initial diagnosis of colon cancer with liver
metastases 14 years earlier, she had undergone multiple surgeries, including sigmoid
colon resection, excision of hepatic metastases (on two separate occasions), and
excision of a pulmonary metastasis. In addition, she had received several courses of
chemotherapy. You are treating this patient with little to no improvement for the past 2
weeks. Which of the following would require a visit to the physician?
a) intractable pain which remains constant
b) poor motivation
c) limited range that did not improve
d) her poor exercise tolerance

Rationale: Despite medical awareness, intractable pain is a serious problem in

cancer and occurs in up to 2% of advanced cancer patients. Intractable pain for 2
weeks warrants medical attention.

8 You have patient who is recently diagnosed with lung cancer. His spouse is in great
distress. The best recommendation for the spouse is:
a) notify the primary care physician
b) join a local support group
c) call the national hotline
d) speak with a pastor

Rationale: Support groups are made up of people with common interests and
experiences. People who have been through, or are going through, a similar
circumstance can do more than sympathize with you — they can relate to what you
are going through and keep you from feeling like you are alone. However, many
people are unaware of the additional benefits of joining a support group — support
groups can be a great place to find practical tips and resources. At many support
groups you can find: * Information about medical treatments, research and strategies
(through brochures, booklets, websites, telephone help lines, and person-to-person
sharing in the group meetings). * Information about public policy, legal resources,
privacy laws, and protection from discrimination. * Links to researchers. * Financial
assistance and scholarships.

9 You are treating an African American patient. He is 20 years old and suffered burns
throughout his right upper arm. You should inform the patient that:
a) he should wear a pressure garment for a year
b) he will develop keloids
c) African Americans are more prone to develop keloids
d) he should massage the area for 15 minutes everyday for 6 months

Rationale: Keloid scars are defined as an abnormal scar that grows beyond the
boundary of the original site of a skin injury. It is a raised and ill defined growth of
skin in the area of damaged skin. Although anyone can form a keloid scar some
ethnic groups are at more risk of developing them.You are 16% more susceptable if
you are African-American or Hispanic. Keloid scars are seen 15 times more in highly
pigmented ethnic groups rather than Caucasians. The fact is that there may be little
you can do if you are unfortunate enough to have the sort of skin that reacts by
forming keloid scarring. You can assist the healing process by keeping any wounds
clean, that may help. If you know you are susceptible because of previous
experience or a family connection then you can avoid taking extra risks. Do not have
piercing or tattoos and make sure you tell your doctor if you are going to have
surgery. There is a high rate of recurrence - up to 50%. Some doctors say that all
highly pigmented people should avoid tattoos and piercing to be on the safe side.
10 What sterilization process is being used to sanitize some medications, plastics or
sutures?
a) Filtration
b) Iodines
c) Ionizing radiation
d) Ultraviolet light

Rationale: Answer: 3. Ionizing radiation Reason: Ionizing radiation: used to sterilize

some medications, plastics or sutures.

11 You are treating a patient who is blaming herself for her motorcycle accident. In what
psychological phase is your patient undergoing?
a) denial
b) anger
c) grief reaction
d) depression

Rationale: Phases of normal grief reaction Phase I Shock and protest – includes
numbness, disbelief and acute dysphoria Phase II Preoccupation – includes
yearning, searching and anger Phase III Disorganization – includes despair and
acceptance of loss Phase IV Resolution

12 Which of the following is not true regarding hepatitis A?

a) It leaves the body in feces
b) It is found in the blood
c) It enters via the mucous membrane
d) It is found in the body fluids

Rationale: HAV infection is primarily transmitted by the fecal-oral route, by either

person-to-person contact or consumption of contaminated food or water. Although
viremia occurs early in infection and can persist for several weeks after onset of
symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally might
be detected in saliva in experimentally infected animals, but transmission by saliva
has not been demonstrated. Ref: Centers for Disease Control www.cdc.gov

13 You are treating a patient whose arterial blood gas has a pH of 7.5, PaCO2 of 25
mmHg. This patient has:
a) alkalosis
b) acidosis
c) normal
d) acute alveolar ventilation

Rationale: The pH or H+ indicates if a patient is acidotic (pH < 7.35; H+ >45) or

alkalemic (pH > 7.45; H+ < 35). PaCO2 is normal at 35–45 mmHg. The carbon
dioxide partial pressure (PaCO2) indicates a respiratory problem: for a constant
metabolic rate, the PaCO2 is determined entirely by ventilation. A high PaCO2
(respiratory acidosis) indicates underventilation, a low PaCO2 (respiratory alkalosis)
hyper- or overventilation. PaCO2 levels can also become abnormal when the
respiratory system is working to compensate for a metabolic issue so as to normalize
the blood pH. An elevated PaCO2 level is desired in some disorders associated with
respiratory failure; this is known as permissive hypercapnia.
14 You are treating a patient who has Cushing's syndrome. The hematocrit level was
45%. Which of the following is true?
a) The patient is anemic
b) The patient has sickle cell
c) The patient is taking blood thinners
d) The patient has normal hematocrit level

Rationale: The hematocrit (Ht or HCT) or packed cell volume (PCV) or erythrocyte
volume fraction (EVF) is the proportion of blood volume that is occupied by red blood
cells. It is normally about 48% for men and 38% for women. It is considered an
integral part of a person's complete blood count results, along with hemoglobin
concentration, white blood cell count, and platelet count.

15 You are treating a patient who complains of cramping or fatigue in the legs and
buttocks during activity. Such cramping subsides when the person stands still. This is
indicative of:
a) poor wound healing
b) chest pain
c) bipedal edema
d) intermittent claudication

Rationale: Peripheral artery disease (PAD) is a condition similar to coronary artery

disease and carotid artery disease. In PAD, fatty deposits build up in the inner linings
of the artery walls. These blockages restrict blood circulation, mainly in arteries
leading to the kidneys, stomach, arms, legs and feet. In its early stages a common
symptom is cramping or fatigue in the legs and buttocks during activity. Such
cramping subsides when the person stands still. This is called "intermittent
claudication." People with PAD often have fatty buildup in the arteries of the heart
and brain. Because of this association, most people with PAD have a higher risk of
death from heart attack and stroke. Ref:
http://www.americanheart.org/presenter.jhtml?identifier=4692

16 An eleven month old child has cerebral palsy and attempts to maintain quadruped
position. Which reflex would interfere with this activity if it was Not integrated ?
a) Galant reflex.
b) Symmetrical tonic neck reflex.
c) Plantar grasp reflex
d) Positive support reflex

Rationale: Head position is the stimulus for the symmetrical tonic neck reflex. when
the head extends the upper extremities extend and the lower extremities flex. The
reaction of the extremities would not allow the infant to maintain a quadrup position.

17 What is the common terminology for a body system that consists of central immune
structures where immune cells and peripheral immune structures are produced?
a) Lymph system
b) Immune system
c) Reproductive system
d) Renal system
 Rationale: Answer: 2. Immune system Reason: Immune system consists of immune
cells, central immune structures where immune cells are produced as well as
peripheral immune structures.

18 What is the common term for infection control procedure that inhibits or destroys
microorganisms on skin or living tissue?
a) Ammonia
b) Phenols
c) Chlorination
d) Antiseptic

Rationale: Answer: 4. Antiseptic Reason: Antiseptic: procedures that inhibit or

destroy microorganisms on skin or living tissue.

19 What specific sterilization process subjects the bacteria to prolonged exposure to

high heat in oven?
a) Autoclaving
b) Boiling water
c) Dry heat
d) Gaseous

Rationale: Answer: 3. Dry heat Reason: Dry heat: prolonged exposure to high heat
in ovens.

20 Which blood compositions comprise about 45% of the total blood volume and are
produced in the marrow of the long bones and controlled by hormones?
a) Red blood cells
b) White blood cells
c) Serum
d) Phenols

Rationale: Answer: 1. Red blood cells Reason: Red blood cells (RBC) comprise
about 45% of the total blood volume and contain the oxygen-carrying protein
hemoglobin responsible for transporting oxygen.

21 Which composition of blood comprises about 1% of the total blood volume and
circulates through the lymphoid tissues?
a) Erythocytes
b) Leukocytes
c) Agranulocytes
d) Basophils

Rationale: Answer: 2. Leukocytes Reason: Leukocytes or white blood cells (WBC)

comprise about 1% of the total blood volume and circulates through the lymphoid
tissues.

22 The hypothalamus and pituitary gland comprise the central network that exerts
control over many other glands in the body with wide ranging functions. Endocrine
functions are also closely linked with what body system?
a) Nervous system
b) Reproductive system
 c) Digestive system
d) Immune system

Rationale: Answer: 4. Immune system Reason: Endocrine functions are also closely
linked with immune system (including autoimmune conditions, tumors, infections,
vascular disorders, and toxins).

23 Luteinizing hormone (LH) operates on Leydig cells to produce testosterone. Which

among the glands control the release of androgens or testosterone?
a) Testes
b) Kidneys
c) Liver
d) Ovaries

Rationale: Answer: 1. Testes Reason: Testes control the release of androgens or

testosterone. In men, follicle-stimulating hormone (FSH) performs on Sertoli cells
and is necessary for spermatogenesis.

24 Female 21years old, suffering with bipolar mania . The patient explains to the
physician how she feels : racing thoughts, rapid talk. The physician recommends a mood
stabilizer. Which appropriate medication would be prescribed as an antimanic?
a) Lithium
b) Valium
c) Diazepam
d) Paroxetine

Rationale: Bipolar disorder is a serious diagnosis, but it is important to know that

you are not alone. if you are suffering from mania the doctor will prescribe you with
an anti- psychotic drug , possibly lithium.

25 Female with history of depression arrives at the hospital for her twice weekly session
of ECT ( electroconvulsive therapy ) . The patient is given a brief anaesthetic, how long
does the effect last for ?
a) 3-5 minutes
b) 10-15 minutes
c) 5-10 minutes
d) 5-15 minutes

Rationale: Most people do not like the idea of electroconvulsive therapy ( ECT ) . It
is a treatment that is reserved only for patients who have severe depression , for
which it is highly effective and can works faster than medication. It involves having a
brief anaesthetic that sends a person to sleep for 5-10 minutes. While asleep , a
muscle relaxing drug is given and a small electric current is passed through the brain
for a fraction of as a second.

26 A patient diagnosed with C5 tetraplegia received physical therapy services in a

rehabilitation hospital. The patient has made good progress in therapy. He is scheduled
for discharge in one week. During a treatment session, the patient informs the physical
therapist that one day in the future he will walk again. The Most appropriate response is:
a) Your level of injury makes walking unrealistic.
b) Future Advances in spinal cord research may make your goal a reality.
 c) You can have a rewarding life even if confined to a wheel chair.
d) Completing your exercises will help you walk.

Rationale: The patient is making a general statement about his desire to walk again
in the future. Although ambulation would not be currently realistic due to the level of
injury it would be inappropriate to demiss the further chances of the patient being
able to walk.

27 A 52 year-old, self referred male, over the last three months he has experienced
increased neck stiffness, night pain, and dizziness. The patient has a family history of
cancer, and has smoked two packs of cigarettes a day for twenty years. The date of his
last medical examination was ten years ago. The physical therapist's appropriate action
would be to :
a) Treat the patient conservatively and document may changes in the patient status.
b) Inform the patient that he is not a candidate for physical therapy.
c) Continue the physical therapy protocol
d) Refer the patient to his primary care physician.

Rationale: The self referred patient offers a medical history that represents several
significant issues including episodes of dizziness, neck stiffness with pain at night
and a family history of cancer. Based on the history and date of the last medical
examination the patient should be referred to a physician.

28 AIDS exhibits some of the symptoms of AIDS-related complex (ARC). Which among
the following is not included in these symptoms?
a) Headaches
b) Weight gain
c) Dsyphagia
d) Dementia

Rationale: Answer: 2. Weight gain Reason: Weight gain is not among the symptoms
of ARC. These are: headaches, blurred vision, dyspnea, dry cough, oral or skin
lesions, dysphagia, dementia, seizures, focal neurological signs.

29 Which chemical disinfection is being used in hydrotherapy when filtering system not
possible which provides full bactericidal activity when organic matter is present?
a) Ultrasonic
b) Iodines
c) Phenols
d) Formaldehyde

Rationale: Answer: 2. Iodines Reason: Iodines: used in hydrotherapy when filtering

system not possible and provides full bactericidal activity when organic matter is present.

30 A patient with hemophilia presents the signs and symptoms of acute bleeding. Which
among the following symptoms is not true for hemophilia?
a) Increased ROM
b) Stiffening
c) Pain swelling
d) Prickling or tingling sensation
 Rationale: Answer: 1. Increased ROM Reason: The correct symptom of hemophilia
is decreased ROM together with stiffening, pain swelling, tenderness, heat and
prickling or tingling sensations

31 Which among the following early warnings is not true for cancer disease?
a) Unexplained weight gain
b) Indigestion or difficulty swallowing
c) Change in bladder or bowel habits
d) Unusual bleeding or discharge

Rationale: Answer: 1. Unexplained weight gain Reason: Unexplained weight gain is

not among the symptoms of cancer disease. A patient with this disease usually
shows unexplained weight loss.

32 Some of cancer cells spread via lymphatic system of bloodstream. What is the term
used for movement of cancer cells from one body part to another?
a) Malignant tumor
b) Metastasis
c) Chemotherapy
d) Lymphoma

Rationale: Answer: 2. Metastasis Reason: Metastasis: movement of cancer cells

from one body part to another; spread is via lymphatic system of bloodstream.

33 What kind of syndrome shows signs and symptoms that are produced at a site distant
from the tumor or its metastasized sites, from ectopic hormone production by tumor cells
or metabolic abnormalities from secretion of tumor vasoactive products?
a) Paraneoplastic syndrome
b) Cushing's syndrome
c) Neurological syndrome
d) Psychological syndrome

Rationale: Answer: 1. Paraneoplastic syndrome Reason: Paraneoplastic syndrome:

signs and symptoms are produced at a site distant from the tumor or its
metastasized sites, from ectopic hormone production by tumor cells or metabolic
abnormalities from secretion of tumor vasoactive products.

34 What is a malignant tumor originating in epithelial tissues such as skin, stomach,

colon, breast and rectum?
a) Leukemias
b) Carcinoma
c) Hemarthrosis
d) Lymphoma

Rationale: Answer: 2. Carcinoma Reason: Carcinoma: a malignant tumor originating

in epithelial tissues such as skin, stomach, colon, breast and rectum.

35 Which among the adverse side effects of cancer treatment is secondary to high
doses of steroids in many chemotherapy protocols?
a) ROM deficits
b) Muscle atrophy and weakness
 c) Hematological disruptions
d) Myositis

Rationale: Answer: 2. Muscle atrophy and weakness Reason: Muscle atrophy and
weakness: secondary to high doses of steroids in many chemotherapy protocols.

36 Center for Disease Control provides guidelines for transmission-based precautions.

Which among the following guidelines is not applicable for airborne precautions?
a) Limit movement and transport of patient to essential purpose only.
b) Wear respiratory protection mask when entering room.
c) Wear a gown when entering room if you anticipate your clothing will have
substantial contact with the patient.
d) Respiratory isolation room.

Rationale: Answer: 3. Wear a gown when entering room if you anticipate your
clothing will have substantial contact with the patient. Reason: Wearing a gown is
among the guidelines listed under contact precautions.

37 Hemophilia is a group of hereditary bleeding disorders. Which category of hemophilia

is most common in synovial joints such as knees, ankles, elbows and hips?
a) Hemorrhage
b) Goniometry
c) Hemarthrosis
d) Joint deformities

Rationale: Answer: 3. Hemarthrosis Reason: Hemarthrosis (bleeding into joint

spaces) most common in synovial joints such as knees, ankles, elbows and hips.

38 Tumor or neoplasm is an abnormal growth of new tissue that is non-functional and

competes for vital blood supply and nutrients. Which type of tumor is affecting the
lymphatic system such Hodgkins disease and lymphatic leukemia?
a) Lymphoma
b) Sarcoma
c) Cythokine
d) Carcinoma

Rationale: Answer: 1. Lymphoma Reason: Lymphoma: affecting lymphatic system

such Hodgkin�s disease and lymphatic leukemia.

39 Your patient has diabetes. He was recently diagnosed with diabetic retinopathy. You
should recommend:
a) a cane
b) balance and gait training
c) night lights
d) area rugs

Rationale: Night lights should immediately be placed in strategic areas throughout

the house and they should remain lit continuously.

40 Your patient was diagnosed with complex regional pain syndrome. 2 months after,
you expect her hand to be:
 a) cold and blue
b) warm, dry skin with increased nail growth
c) swollen with signs of osteoporosis
d) severely painful and sensitive

Rationale: At this phase, you would expect causalgia with vasomotor reflex spasm
resulting in warm, dry skin with increased nail growth

41 Your patient has suffered an optic chiasm damage affecting her visual field. The
deficit would be:
a) blindness in one eye
b) bitemporal hemianopsia
c) blindness in two eyes
d) lateral stravismus

Rationale: Damage before the optic chiasm causes loss of vision in the visual field
of the same side only. Damage in the chiasm causes loss of vision laterally in both
visual fields (bitemporal hemianopia). It may occur in large pituitary adenomata.
Damage after the chiasm causes loss of vision on one side but affecting both visual
fields: the visual field affected is located on the opposite side of the lesion.

42 Your patient has just undergone a total knee replacement. He was prescribed with
Percocet to manage the pain. When would you schedule your treatment?
a) before the meds is administered
b) immediately after the meds is administered
c) when the meds has reached its peak effect
d) 3 hours after the meds is administered

Rationale: You should schedule the patient when the pain medication has reached
its peak effect.

43 You are treating a hospice patient. Your psychological focus would be:
a) reassure the patient
b) discontine patient
c) keep loved ones informed
d) focus of the therapy treatment plan

Rationale: Your main psychological focus should focus on reassuring the patient.
You should address any feelings of loneliness, abandonment or isolation that the
patient expresses to you.

44 You are treating a 50 year old with 30 pack years of smoking. He complains of
thoracic pain with tingling in his fingers. The first you should do:
a) teach him diaphragmatic breathing
b) assess for thoracic outlet syndrome
c) refer to the physician
d) assess for nerve root impingement

Rationale: You should determine the origin of the dysfunction and refer the patient
to the physician. Tumor as a possible cause of symptoms should be ruled out
because of the patient's history.
45 Which developmental test is best used for motor development testing?
a) APGAR
b) Peabody
c) Denver II
d) Purdue

Rationale: The Peabody Developmental Motor Scales is the best choice to use for
motor development testing would be the Peabody Developmental Motor Scales.

46 You are performing a screening exam for an elderly population who at risk for falls.
Which test would be most difficult?
a) reaching
b) single leg stance
c) stepping backwards
d) tandem Romberg

Rationale: Sharpened Romberg (Tandem) Instructions for the Patient (Eyes Open,
Sharpened Romberg): Stand with one foot directly in front of the other with your eyes
open. Place your arms on your chest crossed with your hands touching your
opposite shoulder. Do this test 3 feet from the wall and focus on a visual target.
Stand with your eyes open for 30 sec. Instructions for the Patient (Eyes Closed,
Sharpened Romberg): Stand with one foot directly in front of the other with your eyes
closed. Place your arms on your chest crossed with your hands touching your
shoulders. Stand with your eyes open for 30 sec. Criteria to stop timing the test: The
feet moved on the floor, the eyes open during the eyes closed test, or the arms
moved from their start position.

47 You are treating a 5 year old diagnosed with Down's Syndrome. You would like to
focus on his hypotonicity. Which intervention would be most appropriate?
a) child seated on gym ball; seated
b) prone lying on gym ball
c) slow stroking on paravertebral muscles
d) supine lying on gym ball

Rationale:

48 You are treating a 2 year old patient. Which developmental milestone should be
achieved?
a) hop on one foot
b) run
c) bike
d) ascend stairs reciprocally

Rationale:

49 You are treating a 3 year old patient at home. She has a ventriculoperitoneal shunt.
While performing active range of motion exercises, the child becomes agitated then
drowsy. The first thing you should do is:
a) notify the physician immediately
b) cancel the session for today
 c) call emergency medical services
d) continue the sesssion.

Rationale:

50 A 29-year-old C-7 SCI patient is sweating, anxious, and reports a headache. The
patient has remarkably high blood pressure with systolic reading over 200 mm. Hg. He
manifests facial erythema, goosebumps, nasal stuffiness, and a "feeling of doom". After
removal of noxious stimuli what should you do?
a) Raise the foot of the bed
b) Give orange juice
c) Lay the patient in supine
d) Sit him upright

Rationale: Proper treatment of autonomic dysreflexia involves administration of anti-

hypertensives along with immediate determination and removal of the triggering
stimuli. Often, sitting the patient up and dangling legs over the bedside can reduce
blood pressures below dangerous levels and provide partial symptom relief. Tight
clothing and stockings should be removed. Catheterization of the bladder, or relief of
a blocked urinary catheter tube may resolve the problem. The rectum should be
cleared of stool impaction, using anaesthetic lubricating jelly. If the noxious
precipitating trigger cannot be identified, drug treatment is needed to decrease
elevating intracranial pressure until further studies can identify the cause. Drug
treatment includes the rapidly acting vasodilators, including sublingual nitrates or oral
clonidine. Topical nitropaste is a convenient and safe treatment—an inch or two can
be applied to the chest wall, and wiped off when blood pressures begin to normalize.
Autonomic dysreflexia is abolished temporarily by spinal or general anaesthesia.
These treatment are used during obstetric delivery of a woman with autonomic
dysreflexia.