Which physical feature acts as a formidable barrier separating China from South Asia and creates the rain shadow effect that forms the Gobi Desert?

What did the 1959 Antarctic Treaty accomplish?

Which mountain range is traditionally considered the eastern boundary of Europe, separating it from Asia?

Why is the “Schengen Agreement” considered a major milestone in European integration?

Which environmental issue currently plagues the Ganges River, despite its deeply sacred status to millions of people?

What geographic phenomenon explains why one side of the Himalaya Mountains receives over 30 feet of rain per year, while the other side is an arid desert?

What environmental phenomenon is currently threatening the Great Barrier Reef as a direct result of rising ocean temperatures?

Which animal is considered a highly destructive invasive species in New Zealand, originally brought by early settlers for fur and meat?

USE THIS CASE INFORMATION ON QUESTIONS 13 – 30! Your patient is a 55-year-old female high school teacher who tripped and fell on her L side eight weeks ago. She sustained a humeral fracture and underwent surgery (Open Reduction Internal Fixation – ORIF) three days after her fall. Recent x-rays demonstrate callus formation at the fracture site, as well as decreased bone density in other parts of the humerus, consistent with osteoporosis. The patient had been cleared to participate in PT with no restrictions. She has been attending PT for the last three weeks at another clinic, but you are now examining her as a new patient. She reports stiffness and weakness in her L upper extremity, with pain up to 4/10 with activities. She finds it difficult to perform daily activities such as dressing,grooming, and cooking. When asked about the fall during which she sustained her fracture, she reports no other recent falls, but says she doesn’t feel as strong or steady as she used to feel. She also states that she has always been active but has never followed a specific training or workout regimen. Previous medical history includes:Moderate osteoporosisAtrial fibrillationMetabolic syndromeUrgency urinary incontinence (Was prescribed meds but stopped after three months due to side effects. Was referred to PT but hasn’t gotten around to going.) Current medications: Warfarin (blood thinner), Acetaminophen (pain), Alendronate (osteoporosis) On physical examination, you noted the following:Increased thoracic kyphosis with forward head postureDecreased flexibility of bilateral pectoralis minor musclesAROM: (L/R)Shoulder F 100 deg/165 degShoulder AB 90 deg/150 degShoulder ER 10 deg/60 degMMT: L/R Shoulder F 4/5/5/5AB 4/5/5/5Shoulder ER 3/5/5/5Scapular musculature grossly 4-/5 5/5 Due to her mechanism of injury (fall) and her subjective report of feeling less strong and more unsteady, you decide to assess her balance and gait. Findings include: Able to maintain double leg stance eyes open and eyes closed, 30 seconds.Single leg stance eyes open limited to 7 seconds both L and R sidesUses hip or stepping strategy to manage very small balance perturbationsDecreased L hip extension during terminal stance

USE THIS CASE INFORMATION FOR THE REMAINING QUESTIONS ON THE EXAM (20) Your patient is a 65-year-old male with a 6-month history of insidious onset and worsening L knee pain. He has noted progressive difficulty with walking around his home (inside and out) and stair negotiation and has had three falls in the last four months. He currently works at the local golf course part-time and is unable to do his job in the pro shop (checking in golfers prior to playing) due to pain with standing. He reports feeling unsteady, especially when walking on uneven surfaces.  He notes his knee pain is 2-3/10 at rest, but will ache at a 6/10 at the end of the day. Previous medical history includes:Type 2 Diabetes with associated peripheral neuropathy.HypertensionHistory of CABG 3 years ago Medications: Metformin (Diabetes), Lisinopril (Hypertension) On examination you noted the following: Gait: Antalgic with shortened stance on L LEAROM L knee: 0-7-110 degAROM R knee: 0 -2-118 degFlexibility of Hamstrings as noted in 90/90 passive hamstrings length test: L = 40 deg; R = 32 deg (decreased flexibility of L compared to R) MMT: L/RQuadriceps 3+/5/4-/5Hamstrings 4/5/4/5Hip abductors 3/5/4-/5Gastrocnemius 4-/5/4/5Hip extensors 4/5/4/5 Balance: L/RSingle leg stance 2 seconds/8 seconds Eyes-open1 second/5 seconds Eyes-closed Unable to maintain tandem stance position without upper extremity support