National Physical Therapy Examination (NPTE-PT) — Questions and Answers

Question 1: A PT in private practice fires an employee without documentation after the employee filed an OSHA complaint. This may constitute:

Retaliatory termination, which is illegal under whistleblower protection laws (Correct answer)
Constructive dismissal
At-will employment termination, which is always lawful
A breach of contract only if a written contract exists

Correct answer: Retaliatory termination, which is illegal under whistleblower protection laws

Terminating an employee for filing an OSHA complaint constitutes illegal retaliation, prohibited under federal whistleblower protection provisions.

Question 2: Which special test assesses for meniscal pathology in the knee?

Ober's test
Apley compression test (Correct answer)
Thomas test
Lachman test

Correct answer: Apley compression test

The Apley compression test applies axial load with rotation to stress the menisci, reproducing pain in cases of meniscal tear.

Question 3: Which of the following joints is classified as a condyloid (ellipsoid) joint?

Sternoclavicular joint
Interphalangeal joint
Hip joint
Radiocarpal (wrist) joint (Correct answer)

Correct answer: Radiocarpal (wrist) joint

The radiocarpal (wrist) joint is a condyloid joint, allowing flexion/extension and radial/ulnar deviation but no axial rotation.

Question 4: Idiopathic toe walking in children without neurological cause is typically managed first with:

Immediate surgical intervention
Botulinum toxin injection
No intervention needed
Conservative treatment: stretching, serial casting, and AFOs (Correct answer)

Correct answer: Conservative treatment: stretching, serial casting, and AFOs

Conservative management including gastrocnemius stretching, serial casting, and ankle-foot orthoses (AFOs) is the first-line treatment for idiopathic toe walking.

Question 5: Manual resistance training in PT is characterized by:

Therapist-applied resistance that can be adjusted in real-time based on patient ability (Correct answer)
Using isokinetic dynamometers
Fixed weight resistance only
Resistance applied through pulleys and cables

Correct answer: Therapist-applied resistance that can be adjusted in real-time based on patient ability

Manual resistance allows the therapist to grade and modify resistance interactively throughout the range of motion, accommodating for pain or weakness at different angles.

Question 6: Which grading system is used to classify muscle strains?

ASIA scale
Grade I (mild), Grade II (moderate), Grade III (complete tear) (Correct answer)
Salter-Harris classification
Outerbridge classification

Correct answer: Grade I (mild), Grade II (moderate), Grade III (complete tear)

Muscle strains are graded I (minor fiber disruption, no loss of strength), II (partial tear, significant weakness), and III (complete rupture).

Question 7: External validity in a research study refers to:

Whether the study results can be generalized to other populations and clinical settings (Correct answer)
The reproducibility of measurements across different testing occasions
The degree to which the study design controls for confounding variables
The accuracy of the measurement tool used in the study

Correct answer: Whether the study results can be generalized to other populations and clinical settings

External validity (generalizability or applicability) concerns whether findings from a study sample can be applied meaningfully to broader populations and real-world clinical contexts.

Question 8: A positive apprehension test for the shoulder with the arm at 90 degrees abduction and external rotation indicates:

Superior labrum anterior to posterior (SLAP) tear
Anterior glenohumeral instability (Correct answer)
Rotator cuff tear
Acromioclavicular joint sprain

Correct answer: Anterior glenohumeral instability

The anterior apprehension test reproduces the feeling of the shoulder going out (apprehension) when placed in the position of anterior dislocation (90 degrees abduction plus full external rotation), confirming anterior glenohumeral instability.

Question 9: The carrying angle of the elbow is formed between which two bones?

Humerus and ulna (Correct answer)
Humerus and radius
Radius and ulna
Humerus and both forearm bones equally

Correct answer: Humerus and ulna

The carrying angle is the valgus angle formed between the long axis of the humerus and the long axis of the ulna when the elbow is fully extended and the forearm supinated. Normal values are 5-15 degrees in men and 10-25 degrees in women.

Question 10: Athletic trainers are frequently referred to as "physician extenders" because they are capable of performing many tasks that doctors are only qualified to handle.

True
False (Correct answer)

Correct answer: False

Athletic trainers are highly skilled healthcare professionals who work collaboratively with physicians, but they have a distinct scope of practice focused on injury prevention, assessment, treatment, and rehabilitation. They are not qualified to perform tasks that *only* doctors are licensed to handle, such as prescribing medication or performing surgery. Their role is complementary and supportive, not an extension that replaces a physician's unique responsibilities, making the statement false.

Question 11: At approximately what age do typical children achieve independent walking?

12–15 months (Correct answer)
18–24 months
9–10 months
6–8 months

Correct answer: 12–15 months

Most children begin walking independently between 12 and 15 months, with a normal range of approximately 9–18 months.

Question 12: Which manual therapy technique is classified as a Grade IV oscillation according to Maitland's grading system?

Large-amplitude movement at the beginning of range
High-velocity thrust at end range
Large-amplitude movement through full range
Small-amplitude movement at the end of range (Correct answer)

Correct answer: Small-amplitude movement at the end of range

Maitland Grade IV consists of small-amplitude oscillations performed at the end of the available range of motion.

Question 13: Which outcome measure assesses walking speed and is considered a vital sign of functional mobility?

10-Meter Walk Test (Correct answer)
Mini-BESTest
Functional Independence Measure
Modified Rankin Scale

Correct answer: 10-Meter Walk Test

The 10-Meter Walk Test measures comfortable gait speed and is considered a functional vital sign, with norms predicting community ambulation.

Question 14: Therapeutic ultrasound at 3 MHz is preferred over 1 MHz for treatment of which tissue location?

Superficial tendons and bursae (less than 2 cm depth) (Correct answer)
Spinal cord stimulation
Deep muscles and joints (3-5 cm depth)
Bone fractures

Correct answer: Superficial tendons and bursae (less than 2 cm depth)

3 MHz ultrasound is absorbed in superficial tissues (less than 2 cm) due to higher frequency causing faster energy attenuation, making it ideal for treating superficial structures like tendons and bursae.

Question 15: Open kinetic chain (OKC) knee extension exercises are contraindicated during early ACL reconstruction rehabilitation primarily because:

Terminal knee extension creates anterior shear forces at the tibia, placing high stress on the healing ACL graft (Correct answer)
They cause excessive patellar compression
They cannot be performed with a brace
They are too easy and do not load the graft

Correct answer: Terminal knee extension creates anterior shear forces at the tibia, placing high stress on the healing ACL graft

During terminal OKC knee extension (from approximately 40 degrees to full extension), the quadriceps pull anteriorly on the tibia via the patellar tendon, placing anterior tibial shear forces that stress an ACL graft.

Question 16: The muscle responsible for scapular upward rotation during arm elevation above 90 degrees is:

Levator scapulae
Serratus anterior and lower trapezius force couple (Correct answer)
Rhomboid major
Upper trapezius only

Correct answer: Serratus anterior and lower trapezius force couple

Scapular upward rotation above 90 degrees requires the serratus anterior and lower trapezius force couple, along with the upper trapezius, to efficiently rotate the glenoid upward.

Question 17: A patient with diabetes mellitus presents with decreased vibration sense and absent Achilles tendon reflexes bilaterally. This is most consistent with:

Bilateral plantar fasciitis
Lumbar spinal stenosis
Distal symmetric sensorimotor polyneuropathy (Correct answer)
Multiple sclerosis

Correct answer: Distal symmetric sensorimotor polyneuropathy

Diabetic peripheral neuropathy characteristically presents as a distal symmetric sensorimotor polyneuropathy with length-dependent sensory loss (vibration, proprioception) and diminished distal reflexes.

Question 18: Publication bias in research most commonly refers to:

Journals preferentially publishing studies with positive or statistically significant results (Correct answer)
Researchers only submitting results from large-scale studies
Industry-funded studies being more likely to appear in high-impact journals
Authors selectively reporting only favorable secondary outcome measures

Correct answer: Journals preferentially publishing studies with positive or statistically significant results

Publication bias occurs when studies with positive or significant findings are more likely to be submitted and accepted, causing the literature to overrepresent favorable outcomes.

Question 19: Which classification system is used to grade the completeness of a spinal cord injury?

Fugl-Meyer Scale
Barthel Index
ASIA Impairment Scale (Correct answer)
Ashworth Scale

Correct answer: ASIA Impairment Scale

The ASIA (American Spinal Injury Association) Impairment Scale grades SCI from A (complete) to E (normal) based on motor and sensory function.

Question 20: Which law protects a PT student's academic records from unauthorized disclosure?

FERPA (Correct answer)
FMLA
HIPAA
ADA

Correct answer: FERPA

The Family Educational Rights and Privacy Act (FERPA) protects the privacy of student education records, separate from HIPAA which covers health information.

Question 21: A steppage gait (high stepping) pattern is most commonly caused by:

Hip abductor weakness
Plantar flexor weakness
Dorsiflexor weakness (foot drop) (Correct answer)
Knee extensor weakness

Correct answer: Dorsiflexor weakness (foot drop)

Steppage gait results from dorsiflexor weakness (foot drop), requiring the patient to excessively flex the hip and knee during swing to clear the toes from the ground.

Question 22: The Specific, Measurable, Achievable, Relevant, Time-bound (SMART) goal framework is used in PT to:

Determine medication dosage
Schedule billing and reimbursement
Create clear, trackable functional goals with the patient and care team (Correct answer)
Design exercise intensity only

Correct answer: Create clear, trackable functional goals with the patient and care team

SMART goals in physical therapy provide clear, objective, time-bound targets that guide treatment planning and allow progress measurement.

Question 23: Which prosthetic foot design is best suited for a highly active K4-level transtibial amputee returning to running?

SACH (solid ankle cushion heel) foot
Single-axis foot
Energy-storing and return carbon fiber foot (Correct answer)
Multi-axial foot

Correct answer: Energy-storing and return carbon fiber foot

Carbon fiber energy-storing and return (ESR) feet are best suited for K4-level (high activity, sports) amputees. They store elastic energy during loading and return it during push-off, enabling running.

Question 24: Which scale is used to objectively measure spasticity in clinical practice?

Visual Analog Scale
Functional Independence Measure
Numerical Rating Scale
Modified Ashworth Scale (Correct answer)

Correct answer: Modified Ashworth Scale

The Modified Ashworth Scale grades resistance to passive stretch on a 0–4 scale and is the standard clinical tool for quantifying spasticity.

Question 25: Which cluster of signs is most characteristic of complex regional pain syndrome type I (CRPS-I)?

Joint swelling with morning stiffness and positive rheumatoid factor
Allodynia, autonomic changes (skin temperature and color), edema, and trophic changes in the absence of nerve injury (Correct answer)
Myotomal weakness with absent reflexes and positive Tinel sign
Sharp dermatomal pain with normal skin color and temperature

Correct answer: Allodynia, autonomic changes (skin temperature and color), edema, and trophic changes in the absence of nerve injury

CRPS-I is diagnosed by the Budapest Criteria: allodynia or hyperalgesia, autonomic dysfunction (temperature asymmetry, skin color changes, sweating), edema, and trophic changes (hair, nail, skin), with no definable nerve injury.

Question 26: A patient presents with shoulder pain reproduced by the Hawkins-Kennedy test. This test most specifically assesses for:

Subacromial impingement (supraspinatus or subacromial bursa compression) (Correct answer)
Acromioclavicular joint sprain
Bicipital tendinopathy
Posterior glenohumeral instability

Correct answer: Subacromial impingement (supraspinatus or subacromial bursa compression)

The Hawkins-Kennedy test (shoulder flexion to 90 degrees plus internal rotation) compresses the supraspinatus and subacromial bursa under the coracoacromial arch, reproducing impingement pain.

Question 27: According to the Cyriax model of orthopedic assessment, a capsular pattern of the hip joint presents as:

Equal limitation of all hip movements
Greatest limitation in hip extension with full internal rotation
Greatest limitation in hip flexion, then abduction, then internal rotation
Greatest limitation in hip internal rotation, followed by abduction, then flexion (Correct answer)

Correct answer: Greatest limitation in hip internal rotation, followed by abduction, then flexion

Cyriax capsular pattern for the hip is: most limited in internal rotation, then abduction, then flexion. This pattern indicates intra-articular hip pathology (osteoarthritis, capsular fibrosis).

Question 28: A patient presents with deep buttock pain that worsens with sitting, tenderness to palpation in the sciatic notch region, and positive FAIR test. This presentation is most consistent with:

Trochanteric bursitis
Piriformis syndrome (Correct answer)
Hamstring origin tendinopathy
L5-S1 disc herniation

Correct answer: Piriformis syndrome

Piriformis syndrome presents with deep buttock pain, sciatic nerve symptoms (from piriformis compressing the sciatic nerve), tenderness at the sciatic notch, and positive FAIR test (Flexion, Adduction, Internal Rotation).

Question 29: Which type of muscle contraction produces the greatest force at the lowest metabolic cost?

Eccentric (Correct answer)
Isometric at mid-range
Isokinetic concentric
Concentric isotonic

Correct answer: Eccentric

Eccentric contractions generate more force than concentric contractions while consuming less ATP, making them the most mechanically efficient type of muscle contraction.

Question 30: A patient presents with foot drop following a common peroneal nerve injury. Which assistive device is MOST appropriate for initial gait training?

Rocker-bottom shoe
Crutches with non-weight-bearing gait
Ankle-foot orthosis (AFO) in slight dorsiflexion (Correct answer)
Knee-ankle-foot orthosis (KAFO)

Correct answer: Ankle-foot orthosis (AFO) in slight dorsiflexion

An AFO set in slight dorsiflexion supports the foot during swing phase, preventing toe drag and compensating for absent dorsiflexor activation.

Question 31: Normal cadence for adults during comfortable walking is approximately:

60-80 steps per minute
80-95 steps per minute
130-150 steps per minute
100-120 steps per minute (Correct answer)

Correct answer: 100-120 steps per minute

Normal adult cadence during comfortable walking is approximately 100-120 steps per minute. Stride length and cadence together determine gait velocity.

Question 32: FEV1/FVC ratio below 0.70 is indicative of which type of pulmonary dysfunction?

Normal lung function
Mixed ventilatory defect
Restrictive lung disease
Obstructive lung disease (Correct answer)

Correct answer: Obstructive lung disease

An FEV1/FVC ratio <0.70 confirms airflow obstruction, as seen in COPD and asthma, where expiration is disproportionately impaired.

Question 33: Plagiocephaly in infants is best treated during which age range for optimal outcome?

Between 4 and 12 months of age (Correct answer)
After 18 months
During school age
Only after cranial suture closure

Correct answer: Between 4 and 12 months of age

Cranial molding helmets and repositioning are most effective between 4–12 months when the skull is most malleable and growing rapidly.

Question 34: Which electrophysiological finding is most characteristic of carpal tunnel syndrome (median nerve compression)?

Decreased sensory nerve conduction velocity across the wrist (Correct answer)
Normal distal motor latency with absent H-reflex
Increased motor conduction velocity of the ulnar nerve
Fibrillation potentials in the APB with normal sensory conduction

Correct answer: Decreased sensory nerve conduction velocity across the wrist

Carpal tunnel syndrome characteristically shows prolonged or slowed sensory nerve conduction velocity (NCV) of the median nerve across the wrist, as sensory fibers are more sensitive to compression than motor fibers.

Question 35: A PT uses ultrasound at 3 MHz frequency. Compared to 1 MHz, which statement is TRUE?

3 MHz produces greater cavitation at depth
3 MHz penetrates deeper and heats deeper tissues more effectively
3 MHz is absorbed more superficially and is best for structures within 1–2 cm (Correct answer)
3 MHz is preferred for treating large muscle groups

Correct answer: 3 MHz is absorbed more superficially and is best for structures within 1–2 cm

Higher frequency (3 MHz) ultrasound is absorbed more rapidly in superficial tissues (within 1–2 cm), while 1 MHz penetrates to 3–5 cm depth.

Question 36: Which of the following is not a passive therapy, exactly?

creating a treatment plan
low-impact aerobic exercise (Correct answer)
false (second class)
parkinson's disease

Correct answer: low-impact aerobic exercise

Passive therapy involves treatments where the patient does not actively participate, such as manual techniques, modalities like heat or cold, or electrical stimulation. Low-impact aerobic exercise, however, requires the patient to actively engage their muscles and cardiovascular system through movement. Therefore, it is an *active* form of therapy, not a passive one.

Question 37: A patient presents with pain at the lateral epicondyle of the elbow that worsens with wrist extension against resistance. What is the most likely diagnosis?

Olecranon bursitis
Lateral epicondylitis (Correct answer)
Cubital tunnel syndrome
Medial epicondylitis

Correct answer: Lateral epicondylitis

Lateral epicondylitis (tennis elbow) involves overuse of the wrist extensor muscles, causing pain at their common origin on the lateral epicondyle.

Question 38: Constraint-induced movement therapy (CIMT) is primarily used to treat:

Upper extremity learned non-use following stroke (Correct answer)
Lower extremity weakness after hip fracture
Peripheral neuropathy pain
Balance disorders in Parkinson's disease

Correct answer: Upper extremity learned non-use following stroke

CIMT constrains the unaffected arm to force intensive use of the impaired arm, overcoming learned non-use after stroke.

Question 39: Which nerve is at risk during a posterior approach to the hip during total hip arthroplasty?

Femoral nerve
Obturator nerve
Superior gluteal nerve
Sciatic nerve (Correct answer)

Correct answer: Sciatic nerve

The sciatic nerve runs posterior to the hip joint and is the structure most at risk of injury during posterior surgical approach for total hip arthroplasty.

Question 40: A patient with a complete C5 spinal cord injury would be expected to have preserved function of which muscle?

Wrist extensors
Biceps brachii and deltoid (Correct answer)
Finger flexors
Triceps brachii

Correct answer: Biceps brachii and deltoid

C5 innervates the biceps brachii and deltoid, so these muscles are preserved in a complete C5 SCI while C6 and below functions are absent.

Question 41: A physical therapist is treating a patient with multiple sclerosis using the Frenkel exercises. What are these exercises designed to address?

Ataxia and coordination deficits (Correct answer)
Spasticity management
Upper extremity strengthening
Respiratory muscle weakness

Correct answer: Ataxia and coordination deficits

Frenkel exercises use slow, controlled, progressive movements to improve coordination and proprioception in patients with ataxia.

Question 42: Exercises that require the patient to actively participate include range-of-motion, strength, and low-impact aerobic activities.

as one team pulls, the other relaxes
low-impact aerobic exercise
active physical therapy (Correct answer)
orthopedics

Correct answer: active physical therapy

Active physical therapy involves exercises where the patient actively participates and performs movements using their own muscle power. Range-of-motion, strength, and low-impact aerobic activities all require the patient's voluntary effort and engagement to execute the movements. This direct involvement distinguishes them from passive therapies, where the therapist performs the movement for the patient.

Question 43: The energy cost of walking increases most dramatically at what level of lower-limb amputation?

Transfemoral amputation (Correct answer)
Transtibial amputation
Toe amputation
Symes amputation

Correct answer: Transfemoral amputation

Transfemoral (above-knee) amputation increases the energy cost of walking by approximately 65-100%, compared to about 25% for transtibial amputation, due to loss of knee joint function and increased prosthetic weight.

Question 44: In Parkinson's disease, physical therapy commonly uses external cues to improve gait because of deficits in which function?

Internal rhythm generation (basal ganglia dysfunction) (Correct answer)
Peripheral proprioception
Visual acuity
Cerebellar coordination

Correct answer: Internal rhythm generation (basal ganglia dysfunction)

Parkinson's disease impairs the basal ganglia's ability to generate internal movement rhythms, so external auditory, visual, or tactile cues help regulate gait.

Question 45: Exertional compartment syndrome is best confirmed by:

Nerve conduction study
MRI of soft tissue
X-ray imaging
Intra-compartmental pressure measurement during and after exercise (Correct answer)

Correct answer: Intra-compartmental pressure measurement during and after exercise

Chronic exertional compartment syndrome is diagnosed by measuring compartment pressures before and after a standardized exercise protocol.

Question 46: Which gait deviation is most commonly associated with weak hip abductors?

Scissor gait
Antalgic gait
Trendelenburg gait (Correct answer)
Steppage gait

Correct answer: Trendelenburg gait

Weakness of the hip abductors (gluteus medius) causes a Trendelenburg gait, where the pelvis drops on the contralateral side during single-leg stance.

Question 47: A patient with a transfemoral (above-knee) amputation displays a lateral trunk lean toward the prosthetic side during stance. The most likely cause is:

Prosthetic socket is in excessive abduction
Prosthetic knee is too stiff
Hip abductor weakness on the residual limb side (Correct answer)
Foot is too wide

Correct answer: Hip abductor weakness on the residual limb side

Lateral trunk lean (Trendelenburg-type gait) toward the prosthetic side indicates hip abductor weakness on the residual limb, causing the trunk to lean over the prosthesis to reduce hip abductor demand.

Question 48: In pediatric PT, the GMFCS (Gross Motor Function Classification System) classifies children with CP into how many levels?

7 levels
3 levels
5 levels (Correct answer)
10 levels

Correct answer: 5 levels

The GMFCS classifies gross motor function in children with CP into 5 levels, from Level I (walks without limitations) to Level V (severely limited self-mobility).

Question 49: A patient is 6 weeks post total knee arthroplasty (TKA). They have full passive knee extension and 95 degrees flexion. The primary rehabilitation goal at this stage is:

Achieving 120 degrees flexion, independent stair climbing, and safe community ambulation (Correct answer)
Return to running
Initiating aquatic therapy only
Discontinuing all strengthening exercises

Correct answer: Achieving 120 degrees flexion, independent stair climbing, and safe community ambulation

At 6 weeks post-TKA, goals include achieving functional ROM (greater than 120 degrees for most ADLs), independence with functional mobility (stairs, transfers), and reducing pain and swelling.

Question 50: Which color of wound tissue indicates healthy granulation tissue and suggests the wound is progressing toward healing?

Green (infected exudate)
Yellow (slough)
Black (eschar)
Red (granulation) (Correct answer)

Correct answer: Red (granulation)

Red, beefy, moist granulation tissue indicates healthy wound healing with good vascularization. It represents new connective tissue and blood vessels filling the wound bed.

Question 51: Sensory integration therapy, developed by A. Jean Ayres, primarily targets children with:

Fractures and orthopedic injuries
Cardiac defects
Visual impairments
Sensory processing disorders affecting functional performance (Correct answer)

Correct answer: Sensory processing disorders affecting functional performance

Sensory integration therapy addresses the neurological processing of sensory information to improve adaptive responses and functional participation.

Question 52: A PT notices a colleague routinely leaving a confused elderly patient unattended on a treatment table, resulting in repeated near-falls. The PT's legal and ethical obligation is to:

Document the incidents in their own personal notes only
Wait until an actual injury occurs before acting
Report the concern through appropriate channels (supervisor, risk management, or state board) to protect patient safety (Correct answer)
Counsel the colleague privately and take no further action

Correct answer: Report the concern through appropriate channels (supervisor, risk management, or state board) to protect patient safety

PTs have both an ethical and legal duty to report unsafe practices that put patients at risk; failure to act can result in liability for known harm that was not addressed.

Question 53: A patient presents with progressive weakness and atrophy of intrinsic hand muscles bilaterally, spastic legs, and hyperreflexia. This clinical picture is most consistent with:

Bilateral carpal tunnel syndrome
Peripheral polyneuropathy
Cervical myelopathy (Correct answer)
Lateral epicondylitis

Correct answer: Cervical myelopathy

Cervical myelopathy presents with upper extremity LMN signs (atrophy, weakness) combined with lower extremity UMN signs (spasticity, hyperreflexia) due to spinal cord compression at the cervical level.

Question 54: The Ottawa Ankle Rules are used to determine the need for X-ray in ankle injuries by assessing:

Bone tenderness at specific locations and ability to weight-bear (Correct answer)
Ligament laxity via stress testing
Swelling and bruising only
Pain with passive range of motion

Correct answer: Bone tenderness at specific locations and ability to weight-bear

The Ottawa Ankle Rules screen for fracture by assessing bone tenderness at the posterior fibula, posterior tibia, navicular, and base of 5th metatarsal, plus ability to bear weight.

Question 55: Which technique involves applying rhythmic compression to the chest wall during exhalation to mobilize secretions?

Positive expiratory pressure (PEP)
Vibration (Correct answer)
Chest percussion
Incentive spirometry

Correct answer: Vibration

Chest vibration applies fine oscillatory force during exhalation to loosen and mobilize bronchial secretions toward larger airways.

Question 56: Which of the following would a sports trainer choose as an illustration of a decision? <br> <br> Answer: A paid internship in a physical therapy program in a hospital or clinic setting.

True
False (Correct answer)

Correct answer: False

A sports trainer's role primarily involves preventing, diagnosing, and treating injuries in athletic populations, often working under a physician. A paid internship in a physical therapy program, however, is a step towards becoming a physical therapist, which is a distinct profession with a different scope of practice. Therefore, this decision relates to a different career path than that of a sports trainer, making the statement false.

Question 57: The Romberg test assesses the contribution of which sensory system to balance?

Auditory system
Proprioception (somatosensory system) (Correct answer)
Visual system
Vestibular system

Correct answer: Proprioception (somatosensory system)

The Romberg test reveals proprioceptive deficits: patients maintain balance with eyes open but fall with eyes closed if somatosensory input is compromised.

Question 58: In the spine, which ligament runs within the vertebral canal on the posterior surface of the vertebral bodies?

Posterior longitudinal ligament (Correct answer)
Anterior longitudinal ligament
Interspinous ligament
Ligamentum flavum

Correct answer: Posterior longitudinal ligament

The posterior longitudinal ligament runs along the posterior surface of the vertebral bodies inside the vertebral canal, resisting spinal flexion and posterior disc herniation.

Question 59: The iliotibial band is a thickening of which fascial structure?

Biceps femoris tendon
Fascia lata (Correct answer)
Inguinal ligament
Tensor fasciae latae muscle belly

Correct answer: Fascia lata

The IT band is a lateral thickening of the fascia lata, the deep fascia of the thigh, with contributions from the tensor fasciae latae and gluteus maximus muscles.

Question 60: Which muscle is tested by asking a patient to abduct the arm between 60° and 120° with pain during this arc?

Supraspinatus (Correct answer)
Teres minor
Infraspinatus
Subscapularis

Correct answer: Supraspinatus

A painful arc between 60–120° of shoulder abduction is the hallmark of supraspinatus tendinopathy or impingement syndrome.

Question 61: The International Classification of Functioning (ICF) framework in pediatric PT emphasizes:

Participation, activity, and body structure/function in context (Correct answer)
Pharmacological management
Diagnosis-based treatment protocols only
Medical model focused on impairment alone

Correct answer: Participation, activity, and body structure/function in context

The ICF model addresses body functions/structures, activities, participation, and contextual factors, promoting a holistic child-and-family-centered approach.

Question 62: In the Rancho Los Amigos gait nomenclature, initial contact corresponds to which event in traditional gait terminology?

Foot flat
Toe-off
Heel strike (Correct answer)
Push-off

Correct answer: Heel strike

In the Rancho Los Amigos system, initial contact replaces the traditional term heel strike and describes the moment the foot first contacts the ground, regardless of which part contacts first.

Question 63: Which movement assessment tool screens for fundamental movement pattern asymmetry and dysfunction in athletes?

Berg Balance Scale
SEBT
Y Balance Test
Functional Movement Screen (FMS) (Correct answer)

Correct answer: Functional Movement Screen (FMS)

The Functional Movement Screen (FMS) scores 7 fundamental movement patterns on a 0–3 scale to identify asymmetry and dysfunction that may predispose to injury.

Question 64: Phase II cardiac rehabilitation typically begins:

One year after a cardiac event
Shortly after hospital discharge, as outpatient supervised exercise (Correct answer)
During acute hospitalization (days 1–3 post-MI)
Only after coronary artery bypass surgery

Correct answer: Shortly after hospital discharge, as outpatient supervised exercise

Phase II cardiac rehab is an outpatient, supervised exercise program beginning shortly after hospital discharge following a cardiac event.

Question 65: Which APTA ethical principle requires a PT to provide truthful information to patients so they can make informed decisions?

Justice
Veracity (Correct answer)
Autonomy
Beneficence

Correct answer: Veracity

Veracity is the ethical principle requiring honesty and truthful communication so patients can exercise informed consent and autonomous decision-making.

Question 66: Blood flow restriction (BFR) training is used in sports rehab primarily to:

Improve cardiovascular fitness
Gain muscle hypertrophy and strength at low loads after injury (Correct answer)
Decrease nerve conduction velocity
Reduce post-surgical swelling

Correct answer: Gain muscle hypertrophy and strength at low loads after injury

BFR training restricts venous outflow during low-load exercise (20–30% 1RM), creating metabolic stress that drives muscle hypertrophy without high mechanical loading.

Question 67: A patient with a transtibial amputation complains of skin breakdown on the distal end of the residual limb. The most likely prosthetic cause is:

Excessive dorsiflexion alignment
Socket too tight proximally
Carbon fiber foot too rigid
Piston action (socket too loose with inadequate suspension) (Correct answer)

Correct answer: Piston action (socket too loose with inadequate suspension)

Piston action from a loose socket or inadequate suspension causes the residual limb to move up and down inside the socket, creating shear forces on the distal end and causing skin breakdown.

Question 68: Which principle guides pediatric physical therapy intervention to maximize motor learning in young children?

Play-based, task-oriented, and child-motivated activities (Correct answer)
Massed practice of isolated muscle exercises
Rote repetition of therapist-directed drills only
Passive stretching as the primary modality

Correct answer: Play-based, task-oriented, and child-motivated activities

Children learn motor skills best through play-based, meaningful, and self-motivated task practice, applying principles of neuroplasticity and motor learning.

Question 69: What is 'foot drop' and which nerve is most commonly affected?

Inability to invert; sural nerve
Inability to evert; femoral nerve
Inability to plantar flex; tibial nerve
Inability to dorsiflex; common peroneal nerve (Correct answer)

Correct answer: Inability to dorsiflex; common peroneal nerve

Foot drop is the inability to dorsiflex the foot due to weakness of the tibialis anterior, most commonly caused by common peroneal nerve injury.

Question 70: A transtibial (below-knee) amputee demonstrates excessive knee flexion during stance. The most likely prosthetic cause is:

Foot positioned too far anterior
Excessive plantar flexion of the prosthetic foot (Correct answer)
Socket too large
Foot positioned too far posterior

Correct answer: Excessive plantar flexion of the prosthetic foot

Excessive plantar flexion of the prosthetic foot creates a dorsiflexion moment at the knee during stance, forcing the knee into flexion and producing a flexed knee gait pattern.

Question 71: Duchenne muscular dystrophy (DMD) is caused by a mutation in which gene?

CFTR gene
FMR1 gene
SOD1 gene
Dystrophin gene (Correct answer)

Correct answer: Dystrophin gene

DMD results from mutations in the dystrophin gene on the X chromosome, leading to absent dystrophin protein and progressive muscle degeneration.

Question 72: Which warm-up component has been shown to most effectively reduce hamstring strain risk?

Passive heating of the muscle
Static stretching immediately before sprint activity
Progressive dynamic warm-up with neuromuscular activation (Correct answer)
Ice application before activity

Correct answer: Progressive dynamic warm-up with neuromuscular activation

Progressive dynamic warm-up programs that include neuromuscular activation (e.g., Nordic hamstring curls) have the strongest evidence for reducing hamstring strain incidence.

Question 73: In a forest plot from a meta-analysis, a diamond that crosses the vertical line of no effect indicates:

The pooled treatment effect is not statistically significant (Correct answer)
High statistical heterogeneity among the included studies
The overall sample size across studies was insufficient
There is likely publication bias affecting the analysis

Correct answer: The pooled treatment effect is not statistically significant

The diamond in a forest plot represents the pooled estimate; if it crosses the line of no effect (RR=1 or mean difference=0), the result is not statistically significant.

Question 74: Which type of cerebral palsy is characterized by fluctuating muscle tone with involuntary writhing movements?

Spastic diplegia
Hypotonic CP
Ataxic CP
Athetoid/dyskinetic CP (Correct answer)

Correct answer: Athetoid/dyskinetic CP

Dyskinetic (athetoid) CP involves damage to the basal ganglia, resulting in fluctuating tone, involuntary slow writhing (athetosis) or rapid jerky movements (chorea).

Question 75: The 6-Minute Walk Test (6MWT) is used to assess:

Maximum aerobic capacity (VO2 max)
Cardiac output at rest
Submaximal functional exercise capacity (Correct answer)
Pulmonary function volumes

Correct answer: Submaximal functional exercise capacity

The 6MWT measures the distance walked in 6 minutes, reflecting submaximal functional aerobic capacity relevant to daily activities.

Question 76: The FABER test is used to assess pathology in which region?

Ankle joint
Lumbar spine
Hip joint and sacroiliac joint (Correct answer)
Knee joint

Correct answer: Hip joint and sacroiliac joint

FABER (Flexion, ABduction, External Rotation) stresses the hip and sacroiliac joint to reproduce pain and identify pathology.

Question 77: The Lachman test is preferred over the anterior drawer test for detecting ACL insufficiency because:

It tests the ACL in the functional weight-bearing range
At 20-30 degrees flexion, hamstring guarding and posterior capsule tension are minimized, improving sensitivity (Correct answer)
It can be performed without patient cooperation
It tests the PCL simultaneously

Correct answer: At 20-30 degrees flexion, hamstring guarding and posterior capsule tension are minimized, improving sensitivity

The Lachman test at 20-30 degrees knee flexion has greater sensitivity than the anterior drawer (90 degrees flexion) because the posterior capsule and hamstrings are relaxed, allowing clearer anterior tibial translation.

Question 78: High-volt pulsed current (HVPC) used for wound healing is best described as:

Monophasic twin-peaked pulses with peak voltages greater than 100V and very short pulse durations (Correct answer)
Low-voltage direct current with continuous flow
Biphasic balanced waveform for pain control only
Alternating current with frequency greater than 1000 Hz

Correct answer: Monophasic twin-peaked pulses with peak voltages greater than 100V and very short pulse durations

HVPC delivers monophasic twin-peaked pulses at high peak voltages (greater than 100V) but very short durations and low average current, making it safe for wound care application.

Question 79: Which term describes resistance training in which the muscle lengthens while producing force against an external load?

Isokinetic contraction
Eccentric contraction (Correct answer)
Concentric contraction
Isometric contraction

Correct answer: Eccentric contraction

Eccentric contractions occur when the external load exceeds the muscle force, causing the muscle to lengthen while still producing tension (e.g., lowering a weight, descending stairs).

Question 80: Biofeedback using surface EMG (sEMG) is most appropriate for which clinical condition?

Assessing deep nerve conduction velocity
Staging peripheral neuropathy severity
Measuring intra-compartment pressure in compartment syndrome
Relaxation training for upper trapezius tension headaches or motor re-education after stroke (Correct answer)

Correct answer: Relaxation training for upper trapezius tension headaches or motor re-education after stroke

Surface EMG biofeedback provides visual or auditory feedback of muscle activity, making it effective for both muscle relaxation training (tension headaches, TMJ) and motor re-education (post-stroke, post-surgery).

Question 81: The single-leg squat is used in sports PT as a functional assessment to observe:

Ankle plantarflexion strength
Hip abductor control, knee alignment, and trunk stability during dynamic tasks (Correct answer)
Spinal extension mobility
Quadriceps tendon integrity

Correct answer: Hip abductor control, knee alignment, and trunk stability during dynamic tasks

Single-leg squat assessment reveals hip abductor weakness (contralateral pelvic drop), knee valgus, and trunk lateral sway, all linked to injury risk.

Question 82: Which bedside test is used to screen for benign paroxysmal positional vertigo (BPPV) affecting the posterior semicircular canal?

Dynamic visual acuity test
Romberg test
Dix-Hallpike test (Correct answer)
Head impulse test (HIT)

Correct answer: Dix-Hallpike test

The Dix-Hallpike test is the gold standard for diagnosing posterior canal BPPV. A positive result shows geotropic torsional nystagmus with a latency of seconds and fatigability, reproduced by the provoking head position.

Question 83: Which type of muscle fiber (Type I or Type II) is predominant in postural muscles and most recruited during low-intensity prolonged activities?

Type IIb (fast-twitch, anaerobic)
Type IIx (fast-twitch glycolytic)
Type I (slow-twitch oxidative) (Correct answer)
Type IIa (fast-twitch oxidative glycolytic)

Correct answer: Type I (slow-twitch oxidative)

Type I (slow-twitch oxidative) fibers are fatigue-resistant, highly oxidative, and preferentially recruited for low-intensity, endurance, and postural activities via Henneman size principle.

Question 84: A clinical test has a sensitivity of 90%. This means:

90% of people who test negative actually have the disease
90% of people who have the disease will test positive (Correct answer)
90% of people who test positive actually have the disease
90% of people without the disease will test negative

Correct answer: 90% of people who have the disease will test positive

Sensitivity is the true positive rate — the proportion of people with the condition who correctly test positive; high sensitivity means few false negatives.

Question 85: A patient with COPD shows paradoxical breathing. Which pattern is observed?

Abdomen rises while chest falls during inspiration
Chest rises while abdomen falls during inspiration (Correct answer)
Prolonged expiration with pursed-lip breathing
Both chest and abdomen rise simultaneously during expiration

Correct answer: Chest rises while abdomen falls during inspiration

Paradoxical breathing is characterized by the chest rising while the abdomen falls (or moves inward) during inspiration, opposite to normal diaphragmatic breathing.

Question 86: What is the primary goal of joint mobilization in physical therapy?

Strengthen surrounding muscles
Improve cardiovascular endurance
Increase muscle flexibility only
Restore normal joint arthrokinematics and reduce pain (Correct answer)

Correct answer: Restore normal joint arthrokinematics and reduce pain

Joint mobilization aims to restore normal arthrokinematic motion, reduce pain, and improve joint function.

Question 87: The name of the program providing free medical care to those in need is:

Worker's compensation
AETNA
Medicare
Medicaid (Correct answer)

Correct answer: Medicaid

Medicaid is a joint federal and state program in the United States that provides health coverage to millions of low-income Americans, including eligible adults, children, pregnant women, elderly adults, and people with disabilities. Its primary purpose is to offer free or low-cost medical care to those who meet specific income and eligibility requirements, making it the program for those in need.

Question 88: Which sign, elicited by stroking the plantar surface of the foot, indicates upper motor neuron lesion?

Clonus
Hoffmann sign
Tinel sign
Babinski sign (Correct answer)

Correct answer: Babinski sign

A positive Babinski sign (great toe extension with fanning of other toes) indicates an upper motor neuron lesion in adults.

Question 89: Which intervention is CONTRAINDICATED in a patient with acute deep vein thrombosis (DVT) in the lower extremity?

Vigorous massage and compression of the affected limb (Correct answer)
Upper extremity active exercises
Passive ROM of the uninvolved extremity
Breathing exercises

Correct answer: Vigorous massage and compression of the affected limb

Vigorous massage and compression of a limb with DVT can dislodge the thrombus, causing pulmonary embolism.

Question 90: The close-packed position of the glenohumeral joint is:

Full external rotation with 90 degrees abduction (Correct answer)
90 degrees flexion with neutral rotation
Full internal rotation with extension
Arm at 0 degrees abduction

Correct answer: Full external rotation with 90 degrees abduction

The close-packed position of the glenohumeral joint is full external rotation combined with 90 degrees abduction, where joint surfaces are maximally congruent and ligaments are taut.

Question 91: What is the Thomas test used to assess?

Hip flexor tightness (iliopsoas/rectus femoris) (Correct answer)
Piriformis syndrome
Hip abductor tightness
Gluteus maximus strength

Correct answer: Hip flexor tightness (iliopsoas/rectus femoris)

The Thomas test assesses hip flexor tightness by holding one knee to the chest and observing if the contralateral thigh rises from the table.

Question 92: Which muscle group is primarily responsible for stabilizing the lumbar spine through intra-abdominal pressure?

Gluteus maximus
Erector spinae
Deep core muscles including transverse abdominis and multifidus (Correct answer)
Hip flexors

Correct answer: Deep core muscles including transverse abdominis and multifidus

The transverse abdominis and lumbar multifidus form the deep core stabilization system, generating intra-abdominal pressure to protect the lumbar spine.

Question 93: Spasticity is best defined as:

Velocity-dependent increase in tonic stretch reflex (Correct answer)
Loss of sensation in a limb
Weakness due to upper motor neuron lesion
Involuntary writhing movements

Correct answer: Velocity-dependent increase in tonic stretch reflex

Spasticity is a velocity-dependent increase in the tonic stretch reflex (muscle tone) resulting from upper motor neuron lesions.

Question 94: Which finding on EMG needle examination indicates active denervation (ongoing nerve injury)?

Large amplitude, long duration MUAPs
Polyphasic motor unit action potentials (MUAPs)
Fibrillation potentials and positive sharp waves at rest (Correct answer)
Decreased recruitment with firing rates greater than 20 Hz

Correct answer: Fibrillation potentials and positive sharp waves at rest

Fibrillation potentials and positive sharp waves recorded at rest indicate spontaneous activity of individual denervated muscle fibers, which is pathognomonic of active denervation.

Question 95: Which therapeutic approach for TBI focuses on graded sensory and cognitive stimulation during early recovery?

Constraint-induced therapy
Coma stimulation (sensory regulation) program (Correct answer)
Aquatic therapy
Kinesiotaping

Correct answer: Coma stimulation (sensory regulation) program

Coma stimulation programs use graded multimodal sensory input to promote arousal and early recovery in patients with disorders of consciousness.

Question 96: According to the Wagner classification, a Grade 2 diabetic foot ulcer is defined as:

Full-thickness ulcer with exposed bone and osteomyelitis
Superficial ulcer without subcutaneous involvement
Localized gangrene
Deep ulcer penetrating to tendon, capsule, or bone (Correct answer)

Correct answer: Deep ulcer penetrating to tendon, capsule, or bone

Wagner Grade 2 describes a deep diabetic foot ulcer penetrating to tendon, joint capsule, or bone, without frank infection or osteomyelitis.

Question 97: Which test best assesses single-leg dynamic balance and lower extremity neuromuscular control in athletes?

Star Excursion Balance Test (SEBT) (Correct answer)
Romberg test
Thomas test
Gait analysis

Correct answer: Star Excursion Balance Test (SEBT)

The SEBT measures dynamic single-leg balance by having the athlete reach as far as possible in 8 directions while standing on one leg.

Question 98: A patient with a Stage 4 pressure ulcer over the sacrum has exposed bone. Which debridement method should be AVOIDED?

Sharp or surgical debridement
Enzymatic debridement with collagenase
Autolytic debridement with hydrogel
Wet-to-dry gauze debridement of the exposed bone surface (Correct answer)

Correct answer: Wet-to-dry gauze debridement of the exposed bone surface

Wet-to-dry gauze debridement is non-selective and traumatic; when applied to exposed bone, it can cause direct bone trauma, desiccation, and is contraindicated in wounds with exposed structures.

Question 99: Which measure is the GOLD STANDARD for assessing cardiorespiratory fitness (VO2 max) in a PT research study?

6-Minute Walk Test
Maximal graded exercise test with direct gas analysis (Correct answer)
Step test with heart rate recovery
Bruce Treadmill Protocol with indirect calorimetry

Correct answer: Maximal graded exercise test with direct gas analysis

Direct measurement of expired gases during maximal graded exercise testing (direct calorimetry) is the gold standard for measuring VO2 max.

Question 100: Task-specific training in neurorehabilitation is based on which motor learning principle?

Mental practice is superior to physical practice
Random practice degrades learning
Skills are best learned by practicing the specific task to be relearned (Correct answer)
Blocked practice maximizes retention

Correct answer: Skills are best learned by practicing the specific task to be relearned

Task-specific training applies the specificity of practice principle: motor skills are optimally relearned through repetitive practice of the actual functional task.

Question 101: During a sensory examination, the patient cannot distinguish between a sharp and dull stimulus but accurately identifies light touch. This finding indicates dysfunction of which sensory pathway?

Dorsal spinocerebellar tract
Spinothalamic tract (anterolateral system) (Correct answer)
Corticospinal tract
Dorsal column (posterior funiculus)

Correct answer: Spinothalamic tract (anterolateral system)

Pain and temperature discrimination (and crude touch) are transmitted via the spinothalamic tract. Loss of sharp-dull discrimination with intact light touch indicates anterolateral system dysfunction.

Question 102: Incentive spirometry is primarily used post-operatively to prevent:

Urinary tract infection
Atelectasis and pneumonia (Correct answer)
Wound dehiscence
Deep vein thrombosis

Correct answer: Atelectasis and pneumonia

Incentive spirometry encourages slow maximal inhalation to reinflate collapsed alveoli, preventing post-operative atelectasis and pneumonia.

Question 103: Which exercise intensity corresponds to approximately 40–59% of VO2 reserve and is recommended as a starting point for deconditioned cardiac patients?

Vigorous intensity
Moderate intensity
Very light to light intensity (Correct answer)
Maximal intensity

Correct answer: Very light to light intensity

40–59% VO2 reserve corresponds to moderate intensity, but deconditioned cardiac patients often start at very light to light (30–39% VO2R) intensity per ACSM guidelines.

Question 104: Which type of muscle contraction occurs when the muscle generates force while shortening?

Eccentric contraction
Isometric contraction
Concentric contraction (Correct answer)
Isokinetic contraction

Correct answer: Concentric contraction

A concentric contraction shortens the muscle as it produces force, such as the biceps during the lifting phase of a curl.

Question 105: A patient with a T6 complete spinal cord injury presents with autonomic dysreflexia. Which action is the FIRST priority?

Apply ice to the neck
Administer antihypertensive medication
Contact the physician immediately
Sit the patient upright and identify the noxious stimulus (Correct answer)

Correct answer: Sit the patient upright and identify the noxious stimulus

Sitting the patient upright lowers blood pressure by orthostatic effect while identifying and removing the triggering noxious stimulus is the first-line intervention for autonomic dysreflexia.

Question 106: Which medication class used in COPD management causes bronchodilation by blocking muscarinic receptors?

Beta-2 agonists
Inhaled corticosteroids
Long-acting anticholinergics (LAMA) (Correct answer)
Phosphodiesterase inhibitors

Correct answer: Long-acting anticholinergics (LAMA)

Long-acting muscarinic antagonists (LAMA) such as tiotropium block M3 receptors in bronchial smooth muscle, reducing bronchoconstriction and secretion.

Question 107: The slump test is used to assess neural tension in the spine and lower extremities. Which position maximally sensitizes this test?

Lumbar extension, hip external rotation, and ankle plantarflexion
Cervical extension with thoracic flexion and hip flexion
Cervical flexion, thoracic flexion, knee extension, and ankle dorsiflexion (Correct answer)
Cervical neutral, thoracic extension, and hip flexion

Correct answer: Cervical flexion, thoracic flexion, knee extension, and ankle dorsiflexion

The slump test is maximally sensitized by cervical and thoracic flexion (to tension the dura), combined with knee extension and ankle dorsiflexion (to tension the sciatic nerve).

Question 108: Which law requires that emergency medical treatment be provided regardless of a patient's ability to pay or insurance status, relevant to PTs working in emergency settings?

Stark Law
HIPAA
EMTALA (Emergency Medical Treatment and Labor Act) (Correct answer)
COBRA

Correct answer: EMTALA (Emergency Medical Treatment and Labor Act)

EMTALA requires Medicare-participating hospitals to provide emergency medical screening and stabilization regardless of a patient's ability to pay.

Question 109: Ober test assesses tightness of which structure?

Piriformis muscle
Iliotibial band and tensor fasciae latae (Correct answer)
Lateral knee collateral ligament
Hamstring muscle group

Correct answer: Iliotibial band and tensor fasciae latae

Ober test assesses iliotibial band (ITB) and tensor fasciae latae (TFL) flexibility by testing whether the hip can adduct from a side-lying position with the knee flexed.

Question 110: Which physiological adaptation primarily explains strength gains in the first 4–6 weeks of resistance training in a deconditioned patient?

Increased bone density
Muscle hypertrophy
Connective tissue lengthening
Neural adaptations (motor unit recruitment and synchronization) (Correct answer)

Correct answer: Neural adaptations (motor unit recruitment and synchronization)

Early strength gains are predominantly neural: improved motor unit recruitment, rate coding, and synchronization before significant muscle hypertrophy occurs.

Question 111: The Number Needed to Treat (NNT) is best calculated as:

The ratio of treatment benefit to potential harm
Total participants divided by the number who benefited
The difference in outcome rates between treatment and control groups
The reciprocal of the absolute risk reduction (Correct answer)

Correct answer: The reciprocal of the absolute risk reduction

NNT = 1/Absolute Risk Reduction and represents how many patients must be treated for one additional patient to benefit compared to the control condition.

Question 112: Proprioceptive neuromuscular facilitation (PNF) techniques rely on which neurophysiological mechanism for inhibiting a tight muscle?

Both reciprocal inhibition and autogenic inhibition (Correct answer)
Autogenic inhibition via Golgi tendon organs during muscle contraction
Direct reflex arc inhibition of the motor cortex
Reciprocal inhibition (antagonist contraction inhibits agonist)

Correct answer: Both reciprocal inhibition and autogenic inhibition

PNF stretching uses both autogenic inhibition (GTO activation during contract-relax reduces agonist tension) and reciprocal inhibition (antagonist contraction inhibits agonist) to achieve greater ROM.

Question 113: The MRC (Medical Research Council) Dyspnea Scale grades breathlessness on a scale of:

0–10
0–4 or 1–5 (modified) (Correct answer)
1–5
6–20

Correct answer: 0–4 or 1–5 (modified)

The MRC Dyspnea Scale uses grades 0–4 (original) or 1–5 (modified) to classify breathlessness from none to breathlessness while dressing.

Question 114: Diaphragmatic breathing exercises are prescribed primarily to:

Increase expiratory reserve volume
Decrease functional residual capacity
Strengthen accessory neck muscles
Improve efficiency of ventilation by maximizing diaphragm use (Correct answer)

Correct answer: Improve efficiency of ventilation by maximizing diaphragm use

Diaphragmatic breathing reduces the use of accessory muscles, improves ventilatory efficiency, and reduces the work of breathing.

Question 115: The Fugl-Meyer Assessment is used to evaluate:

Cognitive function post-TBI
Sensorimotor impairment following stroke (Correct answer)
Balance in vestibular disorders
Peripheral nerve conduction velocity

Correct answer: Sensorimotor impairment following stroke

The Fugl-Meyer Assessment quantifies sensorimotor recovery of upper and lower extremities following stroke.

Question 116: Which sign or symptom requires immediate cessation of exercise during cardiopulmonary rehabilitation?

HR increase of 10 bpm above resting
Mild fatigue rated 13 on Borg scale
Onset of angina, severe dyspnea, or SpO2 drop below 88% (Correct answer)
Blood pressure rise to 145/85 mmHg

Correct answer: Onset of angina, severe dyspnea, or SpO2 drop below 88%

Angina, severe dyspnea, dangerous arrhythmia, or SpO2 below 88% are absolute indications to stop exercise immediately in cardiac/pulmonary rehab.

Question 117: Which of the following describes the concave-convex rule for joint mobilization?

A concave surface glides in the same direction as bone movement; a convex surface glides opposite (Correct answer)
A convex surface glides in the same direction as bone movement; a concave surface glides opposite
Both surfaces always glide in the same direction as bone movement
Glide direction is determined by ligamentous tension alone

Correct answer: A concave surface glides in the same direction as bone movement; a convex surface glides opposite

Per Kaltenborn's concave-convex rule: when a concave surface moves on a convex surface, glide and roll occur in the same direction. When a convex surface moves on a concave surface, glide occurs opposite to roll and bone movement.

Question 118: What is the purpose of the Spurling test in cervical spine assessment?

Assess vertebral artery integrity
Test for thoracic outlet syndrome
Measure cervical rotation range
Reproduce cervical radiculopathy symptoms (Correct answer)

Correct answer: Reproduce cervical radiculopathy symptoms

Spurling's test involves ipsilateral lateral flexion and axial compression to narrow the intervertebral foramen, reproducing radicular symptoms.

Question 119: Which of the following is NOT a required element to prove malpractice (negligence) against a PT?

Causation and damages
Duty owed to the patient
The PT's intent to cause harm (Correct answer)
Breach of the standard of care

Correct answer: The PT's intent to cause harm

Malpractice is a negligence claim and does not require proof of intent to harm — only duty, breach, causation, and damages must be established.

Question 120: Which outcome measure assesses functional mobility in prosthetic users by predicting K-level functional classification?

Berg Balance Scale
Amputee Mobility Predictor (AMP) (Correct answer)
6-Minute Walk Test
Timed Up and Go test

Correct answer: Amputee Mobility Predictor (AMP)

The Amputee Mobility Predictor (AMP) is specifically designed for prosthetic users, assessing balance, transfers, and ambulation across varied surfaces to predict K-level functional classification.

Question 121: A PT is asked to sign a productivity report that understates actual visit times to inflate per-unit billing rates. Signing would make the PT:

A participant in healthcare fraud, regardless of who submitted the billing (Correct answer)
Liable only if the PT personally submitted the claims
Subject only to internal disciplinary action
Protected by the employer's corporate liability shield

Correct answer: A participant in healthcare fraud, regardless of who submitted the billing

Knowingly signing false productivity or billing records makes the PT a participant in healthcare fraud under the False Claims Act, regardless of who submits the final claim.

Question 122: What section of the SOAP format would the physical therapist assistant place the patient's short-term goals?

Objective
Assessment
Subjective
Plan (Correct answer)

Correct answer: Plan

In the SOAP note format, the 'Plan' section (P) outlines the future course of action for the patient's care. This includes specific interventions, referrals, patient education, and both short-term and long-term goals for treatment. The goals are essential for guiding therapy, measuring progress, and ensuring a clear path forward for the patient's recovery.

Question 123: According to the Guide to Physical Therapist Practice, which term describes a specific cluster of signs and symptoms that guides PT intervention?

Preferred practice pattern (Correct answer)
Medical diagnosis
Clinical prediction rule
Practice pattern

Correct answer: Preferred practice pattern

Preferred practice patterns in the Guide to Physical Therapist Practice group patients with similar impairments and functional limitations to guide examination and intervention.

Question 124: The kappa statistic is used to measure:

Agreement between categorical measurements beyond what is expected by chance (Correct answer)
Reliability of continuous outcome measurements
The strength and direction of a treatment effect
Correlation between two continuous variables

Correct answer: Agreement between categorical measurements beyond what is expected by chance

Cohen's kappa measures inter-rater agreement for categorical data, correcting for agreement that would be expected by chance alone.

Question 125: Pursed-lip breathing is used primarily to:

Increase tidal volume immediately
Increase respiratory rate
Slow exhalation and reduce air trapping in COPD (Correct answer)
Strengthen inspiratory muscles

Correct answer: Slow exhalation and reduce air trapping in COPD

Pursed-lip breathing creates back pressure that slows expiratory flow, reduces dynamic airway collapse, and decreases air trapping in COPD.

Question 126: The False Claims Act allows private citizens to file suit on behalf of the government against entities committing fraud. This provision is known as:

Qui tam (Correct answer)
Res judicata
Pro bono
In loco parentis

Correct answer: Qui tam

The qui tam provision of the False Claims Act allows 'relators' (whistleblowers) to file fraud suits on the government's behalf and share in any recovery.

Question 127: A therapist performs a special test and gets a sensitivity of 0.90 and specificity of 0.50. Which interpretation is CORRECT?

The test has equal diagnostic value for positive and negative results
The test has high false-positive rate and is not clinically useful
The test is good at ruling out disease (Correct answer)
The test is good at ruling in disease

Correct answer: The test is good at ruling out disease

High sensitivity (0.90) means few false negatives, so a negative result effectively rules out the condition (SnNout mnemonic).

Question 128: The medial longitudinal arch of the foot is primarily supported by which passive structure?

Tibialis anterior tendon
Peroneus longus tendon
Plantar fascia only
Spring (plantar calcaneonavicular) ligament (Correct answer)

Correct answer: Spring (plantar calcaneonavicular) ligament

The spring ligament (plantar calcaneonavicular ligament) directly supports the head of the talus and is the primary passive stabilizer of the medial longitudinal arch.

Question 129: The SAID principle (Specific Adaptation to Imposed Demands) states that:

Aerobic conditioning automatically improves strength
Exercises must be performed daily to maintain gains
The body adapts specifically to the type, intensity, and mode of training imposed (Correct answer)
Muscles can only strengthen in the plane they are trained

Correct answer: The body adapts specifically to the type, intensity, and mode of training imposed

The SAID principle states that the body makes specific physiological adaptations in response to the specific demands placed on it. Training adaptations are specific to the movement pattern, speed, load, and energy system used.

Question 130: A PT bills Medicare for 60-minute sessions but consistently provides 45-minute sessions. This practice constitutes:

Appropriate billing under incident-to rules
Upcoding, a form of healthcare fraud (Correct answer)
A documentation error only, not fraud
Acceptable billing if outcomes are achieved

Correct answer: Upcoding, a form of healthcare fraud

Billing for more time or services than actually provided is upcoding, which constitutes healthcare fraud under the False Claims Act.

Question 131: Iliotibial band syndrome (ITBS) in runners is associated with pain at which location?

Posterior knee in the popliteal fossa
Lateral knee at the lateral femoral epicondyle (Correct answer)
Medial joint line
Anterior knee over the patella

Correct answer: Lateral knee at the lateral femoral epicondyle

ITBS causes pain at the lateral femoral epicondyle where the ITB impinges during repetitive knee flexion-extension at approximately 30° of flexion.

Question 132: A PT's malpractice insurance policy provides 'claims-made' coverage. The PT retires and cancels the policy. A patient then files a claim for an injury that occurred during active coverage. The PT:

Is protected by HIPAA from lawsuits after retirement
Is covered because the injury occurred during active practice
May not be covered unless tail coverage (extended reporting period) was purchased (Correct answer)
Is always covered by their state licensing board

Correct answer: May not be covered unless tail coverage (extended reporting period) was purchased

Claims-made policies only cover claims filed while the policy is active; tail coverage must be purchased to cover claims filed after policy cancellation for events during active coverage.

Question 133: The family-centered care model in pediatric PT prioritizes:

Partnerships with families as essential decision-makers in the child's care (Correct answer)
Hospital-based intervention over community participation
Therapist-directed goals without family input
Diagnosis and prognosis over family preferences

Correct answer: Partnerships with families as essential decision-makers in the child's care

Family-centered care recognizes parents and caregivers as key partners, incorporating their priorities and strengths into therapy goals and delivery.

Question 134: Under the Anti-Kickback Statute, a PT who accepts payment from a medical equipment company for referring patients to purchase their products may face:

No liability if referrals are documented in the medical record
Only civil fines with no criminal exposure
Liability only if the equipment company is not FDA-approved
Criminal penalties including fines and imprisonment, plus exclusion from federal healthcare programs (Correct answer)

Correct answer: Criminal penalties including fines and imprisonment, plus exclusion from federal healthcare programs

The Anti-Kickback Statute is a criminal law; violations can result in felony charges, substantial fines, imprisonment, and exclusion from Medicare/Medicaid.

Question 135: During normal gait, which phase of the gait cycle requires the greatest quadriceps activity?

Terminal swing
Loading response (early stance) (Correct answer)
Pre-swing
Mid-stance

Correct answer: Loading response (early stance)

The loading response (initial 0-12% of gait cycle) demands peak quadriceps activity to control knee flexion and accept body weight during weight acceptance.

Question 136: In evidence-based practice, which study design provides the highest level of evidence for treatment effectiveness?

Cohort study
Randomized controlled trial (RCT)
Systematic review with meta-analysis of RCTs (Correct answer)
Case-control study

Correct answer: Systematic review with meta-analysis of RCTs

Systematic reviews with meta-analyses pool data from multiple RCTs, providing the highest level of evidence in the hierarchy of study designs.

Question 137: Which special test is used to assess the integrity of the posterior cruciate ligament (PCL)?

Lachman test
Posterior drawer test (Correct answer)
Anterior drawer test
McMurray test

Correct answer: Posterior drawer test

The posterior drawer test assesses PCL integrity by applying a posterior force to the proximal tibia at 90 degrees knee flexion. Excessive posterior tibial translation indicates PCL laxity.

Question 138: Gowers' sign, seen in children with DMD, describes:

Waddling gait pattern
Calf pseudohypertrophy
Using hands to 'walk up' the legs when rising from the floor (Correct answer)
Inability to raise arms above shoulder height

Correct answer: Using hands to 'walk up' the legs when rising from the floor

Gowers' sign is the characteristic maneuver where a child pushes off their own legs with their hands to stand, compensating for weak hip and knee extensors.

Question 139: An employer requires a PT to perform a pre-employment physical that screens out applicants with disabilities unrelated to job performance. Under the ADA, this is:

Permissible only for direct-care positions
Required under OSHA safety standards
Permissible if all applicants are screened equally
Unlawful disability discrimination (Correct answer)

Correct answer: Unlawful disability discrimination

The ADA prohibits using medical examinations to screen out applicants based on disabilities unless the disability directly affects ability to perform essential job functions.

Question 140: The Denver Developmental Screening Test II assesses development in which domains?

Personal-social, fine motor, language, and gross motor (Correct answer)
Sensory processing and feeding
Gross motor and language only
Cognitive and behavioral only

Correct answer: Personal-social, fine motor, language, and gross motor

The Denver II screens children from birth to 6 years across four domains: personal-social, fine motor-adaptive, language, and gross motor development.

Question 141: Which federal law specifically governs the privacy and security of individually identifiable health information held by covered entities and their business associates?

COBRA
ERISA
EMTALA
HIPAA (Correct answer)

Correct answer: HIPAA

HIPAA (Health Insurance Portability and Accountability Act) establishes the Privacy and Security Rules governing protected health information (PHI).

Question 142: A patient's resting heart rate is 95 bpm and target training zone is 60–80% of heart rate reserve using the Karvonen formula. If their maximum HR is 170 bpm, what is the lower training HR?

120 bpm
150 bpm
132 bpm (Correct answer)
140 bpm

Correct answer: 132 bpm

HRR = 170 − 95 = 75; lower target = 95 + (0.60 × 75) = 95 + 45 = 140 bpm — wait, let me recalculate: 95 + 45 = 140... actually 95 + 0.60×75 = 95+45=140. The correct answer is 140 bpm (option B).

Question 143: Constraint therapy in children with hemiplegic CP has demonstrated improvements in:

Balance in bilateral lower extremity tasks
Language acquisition
Respiratory capacity
Unilateral upper extremity function and motor learning (Correct answer)

Correct answer: Unilateral upper extremity function and motor learning

Pediatric constraint-induced movement therapy (CIMT) improves the quality and quantity of use of the affected upper extremity in hemiplegic CP.

Question 144: Which mobilization technique involves movement of one joint surface on the other in a sliding manner?

Glide (translation) (Correct answer)
Distraction
Traction
Compression

Correct answer: Glide (translation)

A glide or translational mobilization moves one articular surface parallel to the treatment plane of the other surface.

Question 145: Which component of a transfemoral prosthesis controls knee stability during the loading response phase?

Knee extension assist or polycentric mechanism (Correct answer)
Pylon length
Foot dorsiflexion bumper
Socket suspension system

Correct answer: Knee extension assist or polycentric mechanism

Prosthetic knee stability during loading response is primarily controlled by the knee extension assist mechanism or polycentric (4-bar) linkage, which prevents knee buckling at initial contact.

Question 146: A patient post-ACL reconstruction is 4 weeks post-op. Which criterion must be met before initiating running on a treadmill?

Negative Lachman test and full ROM
Quadriceps index ≥90% and pain-free jogging
Full passive knee extension and at least 90° of knee flexion (Correct answer)
Normal knee joint effusion and 120° of flexion

Correct answer: Full passive knee extension and at least 90° of knee flexion

Full passive extension and at least 90° of flexion are the standard ROM criteria to clear a patient for early functional progression after ACL reconstruction before introducing running.

Question 147: Which outcome measure is MOST appropriate to assess balance confidence in community-dwelling older adults?

Activities-specific Balance Confidence Scale (ABC) (Correct answer)
Functional Reach Test
Berg Balance Scale
Timed Up and Go Test

Correct answer: Activities-specific Balance Confidence Scale (ABC)

The ABC Scale directly measures self-perceived confidence in performing daily activities without losing balance, making it the most appropriate for community-dwelling older adults.

Question 148: The purpose of periodization in a rehabilitation exercise program is to:

Train only one body part per session
Focus exclusively on flexibility
Keep training volume constant throughout
Systematically vary training load and intensity to optimize adaptation and prevent plateau (Correct answer)

Correct answer: Systematically vary training load and intensity to optimize adaptation and prevent plateau

Periodization systematically varies training variables across macrocycles, mesocycles, and microcycles to optimize adaptation and prevent overtraining.

Question 149: Pulsed shortwave diathermy (PSWD) is most appropriately used for which clinical application?

Thermal heating of deep joints such as the hip
Acute inflammatory phase wound healing (non-thermal effects) (Correct answer)
Stimulation of superficial sensory nerves for pain
Wound debridement via cavitation

Correct answer: Acute inflammatory phase wound healing (non-thermal effects)

Pulsed (non-thermal) shortwave diathermy is used in the acute inflammatory phase to promote healing through non-thermal electromagnetic field effects, including enhanced cell membrane permeability and edema reduction.

Question 150: Osteokinematics refers to which type of movement?

Gross angular movement of a bone segment (Correct answer)
Movement of one joint surface on another
Nerve conduction along a limb
Muscle fiber recruitment pattern

Correct answer: Gross angular movement of a bone segment

Osteokinematics describes the gross angular motion of a bone, such as flexion, extension, abduction, and rotation, as observed externally.

Question 151: Congenital muscular torticollis involves shortening or fibrosis of which muscle?

Sternocleidomastoid (SCM) (Correct answer)
Levator scapulae
Trapezius
Scalene muscles

Correct answer: Sternocleidomastoid (SCM)

Congenital muscular torticollis is caused by fibrosis or shortening of the sternocleidomastoid, causing head tilt toward and rotation away from the affected side.

Question 152: Which grade of joint mobilization is used primarily for pain relief rather than increasing range of motion?

Grade IV
Grade V
Grade I and II (Correct answer)
Grade III

Correct answer: Grade I and II

Maitland Grades I and II are small-amplitude oscillations within range used primarily for neurophysiological pain relief.

Question 153: Which manual muscle testing grade indicates the patient can move through full ROM against gravity but cannot tolerate any additional resistance?

Grade 5
Grade 3 (Correct answer)
Grade 4
Grade 2

Correct answer: Grade 3

Grade 3 (Fair) indicates the muscle can move the limb through full ROM against gravity only, with no additional external resistance tolerated.

Question 154: A PT provides services to a patient who is enrolled in Medicaid. The PT knowingly submits a claim for a non-covered service by misrepresenting the service code. This is an example of:

Healthcare fraud under the False Claims Act (Correct answer)
Unbundling
Downcoding
Permissible billing variation

Correct answer: Healthcare fraud under the False Claims Act

Misrepresenting services to obtain Medicaid payment constitutes healthcare fraud, prosecutable under the False Claims Act and state Medicaid fraud laws.

Question 155: Which step from the list below does Prochaska's "Readiness to Change" model include?

Voluntary
Contemplation (Correct answer)
Cardiovascular And Pulmonary Rehabilitation
Low-impact aerobic exercise

Correct answer: Contemplation

Prochaska's Transtheoretical Model of Change (TTM) describes the stages individuals go through when modifying a problem behavior. 'Contemplation' is a core stage in this model, where an individual acknowledges a problem and seriously considers making a change within the next six months, weighing the pros and cons. The other options listed are not stages within this psychological model of behavior change.

Question 156: In normal gait, the center of mass reaches its highest point during which phase?

Mid-stance (Correct answer)
Loading response
Pre-swing
Mid-swing

Correct answer: Mid-stance

The center of mass reaches its highest vertical point during mid-stance (single-limb support), when the body vaults over the relatively straight stance limb like an inverted pendulum.

Question 157: Which concept describes the brain's ability to reorganize neural pathways after injury?

Muscle hypertrophy
Descending facilitation
Neuroplasticity (Correct answer)
Reciprocal inhibition

Correct answer: Neuroplasticity

Neuroplasticity is the nervous system's ability to reorganize its structure, function, and connections in response to injury or experience.

Question 158: Active cycle of breathing technique (ACBT) includes which three phases?

Incentive spirometry, percussion, vibration
Breathing control, thoracic expansion exercises, forced expiration technique (Correct answer)
Diaphragmatic breathing, coughing, postural drainage
PEP therapy, pursed-lip breathing, aerobic exercise

Correct answer: Breathing control, thoracic expansion exercises, forced expiration technique

ACBT cycles through breathing control (relaxed breathing), thoracic expansion exercises (deep breaths), and forced expiration (huffing) to clear secretions.

Question 159: Which breath sound indicates secretion accumulation in the larger airways?

Coarse crackles (rhonchi) (Correct answer)
Wheeze
Fine crackles
Stridor

Correct answer: Coarse crackles (rhonchi)

Coarse crackles (rhonchi) are low-pitched, gurgling sounds caused by secretions in the larger central airways and often clear with coughing.

Question 160: The anterior talofibular ligament (ATFL) is most taut and most commonly injured in which ankle position?

Neutral and eversion
Full dorsiflexion and neutral rotation
Plantar flexion and inversion (Correct answer)
Dorsiflexion and eversion

Correct answer: Plantar flexion and inversion

The ATFL is most taut in plantar flexion and is the primary restraint against inversion in this position, making it the most commonly injured ligament in lateral ankle sprains.

Question 161: Autolytic debridement of a wound is achieved by which mechanism?

Application of enzymatic collagenase ointments
Use of maggot therapy (biosurgical debridement)
Maintaining a moist wound environment with occlusive dressings, allowing endogenous enzymes to liquefy necrotic tissue (Correct answer)
Application of sharp instruments to remove necrotic tissue

Correct answer: Maintaining a moist wound environment with occlusive dressings, allowing endogenous enzymes to liquefy necrotic tissue

Autolytic debridement uses the body's own proteolytic enzymes and macrophages, maintained at the wound surface by moisture-retentive dressings, to selectively liquefy and remove necrotic tissue.

Question 162: A pediatric patient demonstrates the inability to walk by 18 months of age. According to developmental milestones, which action is MOST appropriate?

Begin wheelchair assessment
Immediately refer for neurological evaluation and PT assessment (Correct answer)
Initiate strengthening exercises and reassess in 6 months
Reassure the parents that walking by 24 months is normal

Correct answer: Immediately refer for neurological evaluation and PT assessment

Typical independent walking is achieved by 12–15 months; failure to walk by 18 months is a developmental red flag requiring prompt neurological evaluation and physical therapy assessment.

Question 163: A positive Spurling test (foraminal compression test) is most indicative of:

Cervical facet syndrome
Thoracic outlet syndrome
Cervical nerve root compression (Correct answer)
Vertebral artery insufficiency

Correct answer: Cervical nerve root compression

Spurling test (cervical compression with lateral flexion toward the symptomatic side) reproduces radicular arm pain when a cervical nerve root is compressed, indicating cervical radiculopathy.

Question 164: Which dermatome corresponds to the C6 nerve root?

Lateral forearm only
Ring and little finger
Thumb and index finger (Correct answer)
Middle finger

Correct answer: Thumb and index finger

The C6 dermatome covers the lateral forearm, thumb, and index finger, and is tested with light touch or pinprick in those areas.

Question 165: Which scale is commonly used to rate perceived exertion during cardiopulmonary rehabilitation?

DASH Scale
Modified Ashworth Scale
Visual Analog Scale
Borg RPE Scale (Correct answer)

Correct answer: Borg RPE Scale

The Borg Rating of Perceived Exertion (RPE) Scale (6–20) allows patients to self-rate exercise intensity, aiding exercise prescription in cardiac rehab.

Question 166: A PT working in a hospital performs an intervention outside their clinical training, resulting in patient injury. Which legal concept most directly applies?

Practice beyond scope, supporting a negligence claim (Correct answer)
Assumption of risk by the patient
Negligence per se
Strict liability

Correct answer: Practice beyond scope, supporting a negligence claim

Performing interventions outside one's training and scope of practice is a basis for negligence, as it violates the expected standard of care.

Question 167: What is the target oxygen saturation range for most patients during cardiopulmonary physical therapy?

90–95%
85–89%
≥95% (Correct answer)
100%

Correct answer: ≥95%

SpO2 ≥95% is generally the target during exercise in cardiopulmonary PT; exercise is typically stopped if SpO2 drops below 88–90%.

Question 168: For a transfemoral amputee, which of the following socket designs provides the most total surface contact?

Quadrilateral socket
Patellar tendon-bearing socket
Ischial containment (CAT-CAM) socket (Correct answer)
Open-top socket

Correct answer: Ischial containment (CAT-CAM) socket

The ischial containment (CAT-CAM) socket encases the ischial tuberosity and provides total surface contact throughout the socket, improving mediolateral stability and comfort for transfemoral amputees.

Question 169: Which outcome measure is most commonly used to assess functional mobility in stroke patients?

Oswestry Disability Index
DASH questionnaire
Visual Analog Scale
Berg Balance Scale (Correct answer)

Correct answer: Berg Balance Scale

The Berg Balance Scale is a 14-item validated tool widely used to assess static and dynamic balance in stroke and other neurological populations.

Question 170: Which landing mechanics are associated with increased ACL injury risk in female athletes?

Increased knee flexion and hip flexion
Hip external rotation and wide stance
Plantarflexed ankle and reduced knee valgus
Knee valgus, reduced knee flexion, and upright trunk during landing (Correct answer)

Correct answer: Knee valgus, reduced knee flexion, and upright trunk during landing

Knee valgus collapse, minimal knee flexion, and upright trunk during landing increase ACL strain, and these patterns are more prevalent in female athletes.

Question 171: A patient with right-sided hemiplegia requires functional training. Which Bobath/NDT principle should guide facilitation?

Strengthen the unaffected side first to compensate for deficits
Use maximum resistance to rebuild lost motor units
Focus exclusively on splinting to prevent contractures
Inhibit abnormal tone and facilitate normal movement patterns (Correct answer)

Correct answer: Inhibit abnormal tone and facilitate normal movement patterns

Neurodevelopmental Treatment (NDT/Bobath) centers on inhibiting abnormal tone and reflexes while facilitating normal, coordinated movement patterns on the affected side.

Question 172: Which study design is most appropriate for determining the prevalence of low back pain in a population at a single point in time?

Prospective cohort study
Cross-sectional study (Correct answer)
Randomized controlled trial
Case-control study

Correct answer: Cross-sectional study

Cross-sectional studies measure exposure and outcome simultaneously at one time point, making them ideal for estimating disease prevalence in a population.

Question 173: Which parameter of NMES most directly determines the depth of muscle recruitment?

Pulse duration (pulse width)
Intensity (amplitude) (Correct answer)
Frequency (pulse rate)
Waveform shape

Correct answer: Intensity (amplitude)

Intensity (amplitude) most directly determines the depth and breadth of motor unit recruitment. Increasing amplitude depolarizes more deeply located motor nerve fibers, recruiting deeper motor units.

Question 174: Which postural drainage position is used to drain the right middle lobe of the lung?

Sitting upright
Left side-lying with foot of bed elevated 15° (Correct answer)
Prone with head down
Left side-lying with head of bed elevated 15°

Correct answer: Left side-lying with foot of bed elevated 15°

The right middle lobe drains best with the patient in left side-lying with the foot of the bed elevated 15° to use gravity assistance.

Question 175: A physical therapist receives a subpoena for a patient's records in a malpractice lawsuit. What is the most appropriate first action?

Contact the facility's legal counsel before releasing any records (Correct answer)
Notify the patient and obtain written authorization before releasing records
Refuse the subpoena on the basis of HIPAA
Release records immediately to avoid contempt of court

Correct answer: Contact the facility's legal counsel before releasing any records

Upon receiving a subpoena, a PT should first consult legal counsel, as a subpoena alone may not override HIPAA protections without a court order.

Question 176: What does 'end feel' describe in a musculoskeletal assessment?

Joint surface appearance
Quality of resistance felt at the end of passive range of motion (Correct answer)
Patient's pain level at end of range
Muscle strength at end range

Correct answer: Quality of resistance felt at the end of passive range of motion

End feel is the quality of resistance the clinician perceives at the end of passive joint range of motion, which can be normal or pathological.

Question 177: Which type of electrical stimulation is most appropriate for denervated muscle to maintain muscle bulk and prevent atrophy?

Interferential current (IFC)
Russian stimulation (medium frequency AC)
High-volt pulsed current (HVPC)
Low-frequency direct current using long pulse durations (Correct answer)

Correct answer: Low-frequency direct current using long pulse durations

Denervated muscle requires longer pulse durations (greater than 10 ms) and lower frequencies to produce a twitch response, as it lacks functional motor nerve fibers and cannot respond to normal NMES parameters.

Question 178: Which phase of the gait cycle is typically reduced in stride length by a patient with significant hip flexion contracture?

Pre-swing
Terminal stance (Correct answer)
Loading response
Mid-swing

Correct answer: Terminal stance

Hip flexion contracture reduces hip extension in terminal stance, causing the patient to prematurely advance off the stance limb and shorten the step length of the contralateral limb.

Question 179: A state PT practice act establishes that PTs may practice under 'direct access' without a physician referral. A PT practicing in that state without a referral is:

Acting within the law if direct access is permitted by state statute (Correct answer)
Violating federal Medicare regulations in all cases
Practicing outside their scope regardless of state law
Committing insurance fraud

Correct answer: Acting within the law if direct access is permitted by state statute

Direct access is legal when expressly authorized by the state PT practice act, though separate payer requirements (e.g., Medicare referral rules) may still apply for reimbursement.

Question 180: The Alberta Infant Motor Scale (AIMS) is used to assess:

School-age children's athletic performance
Gross motor maturation from birth to independent walking (Correct answer)
Fine motor and hand function
Cognitive development milestones

Correct answer: Gross motor maturation from birth to independent walking

The AIMS is an observational scale assessing gross motor development from birth to 18 months, evaluating weight-bearing, posture, and antigravity movement.

Question 181: Hypotonia in an infant most commonly presents as:

Involuntary spastic movements
Hyperreflexia
Increased resistance to passive movement
Decreased muscle tone ('floppy infant') with poor posture and feeding difficulties (Correct answer)

Correct answer: Decreased muscle tone ('floppy infant') with poor posture and feeding difficulties

Hypotonia presents as low muscle tone, causing a floppy appearance, poor head control, difficulty feeding, and delayed motor milestones.

Question 182: Which special test is used to assess anterior cruciate ligament (ACL) integrity?

Patellar grind test
Lachman test (Correct answer)
Valgus stress test
McMurray test

Correct answer: Lachman test

The Lachman test is the gold-standard clinical test for ACL integrity, performed with the knee at 20–30° of flexion.

Question 183: The screw-home mechanism of the knee occurs during the last degrees of extension and involves which rotation?

Medial rotation of the femur on the tibia
Lateral rotation of the femur on the tibia (Correct answer)
Posterior glide of the tibia
Anterior glide of the tibia

Correct answer: Lateral rotation of the femur on the tibia

The screw-home mechanism involves lateral rotation of the femur (or medial rotation of the tibia in open kinetic chain) during the last 30 degrees of knee extension, locking the knee for weight-bearing.

Question 184: A pressure injury that appears as a full-thickness wound with visible fat but no bone, tendon, or muscle is classified as:

Stage 4
Stage 3 (Correct answer)
Stage 1
Stage 2

Correct answer: Stage 3

Stage 3 pressure injuries involve full-thickness skin loss with visible subcutaneous fat, but bone, tendon, or muscle is not exposed or palpable.

Question 185: The FABER test (Flexion, ABduction, External Rotation) reproduces groin or hip pain. This finding is most suggestive of:

Sacroiliac joint dysfunction or hip joint pathology (Correct answer)
Piriformis syndrome
Patellar tracking dysfunction
Femoral nerve entrapment

Correct answer: Sacroiliac joint dysfunction or hip joint pathology

A positive FABER test (groin pain) suggests hip joint pathology (labral tear, FAI, arthritis) or sacroiliac joint dysfunction, depending on pain location (groin vs. posterior SI region).

Question 186: A PT is documenting under the SOAP format. Where should the patient's self-reported pain level and functional goals be recorded?

Plan
Objective
Subjective (Correct answer)
Assessment

Correct answer: Subjective

The Subjective section contains information reported by the patient, including pain ratings, symptoms, and personal goals.

Question 187: Which psychometric property refers to a test measuring the construct it is actually intended to measure?

Feasibility
Validity (Correct answer)
Responsiveness
Reliability

Correct answer: Validity

Validity is the degree to which an instrument accurately measures the intended construct, encompassing content, criterion, and construct validity subtypes.

Question 188: Which balance training progression is most appropriate for an elderly patient at high fall risk who currently requires bilateral upper extremity support for standing?

Immediately practice tandem walking
Begin with dynamic balance training on foam surfaces
Start with treadmill walking at 2.0 mph
Progress from bilateral UE support to unilateral UE support to fingertip support to no support while standing on a firm surface (Correct answer)

Correct answer: Progress from bilateral UE support to unilateral UE support to fingertip support to no support while standing on a firm surface

Fall prevention balance training follows a systematic progression from maximum support (bilateral UE) to reduced support (unilateral, fingertip), on stable surfaces before progressing to unstable surfaces.

Question 189: The straight leg raise (SLR) test becomes positive (radicular symptoms reproduced) at 30-70 degrees of hip flexion. This finding most specifically indicates:

Piriformis syndrome
Lumbar facet joint irritation
L4-S1 nerve root tension or compression (Correct answer)
SI joint dysfunction

Correct answer: L4-S1 nerve root tension or compression

The SLR test tensions the L4, L5, and S1 nerve roots. Reproduction of radicular pain into the leg between 30-70 degrees indicates nerve root compression or irritation (disc herniation, stenosis) at these levels.

Question 190: A PT treating a minor patient discovers signs consistent with physical abuse. State law mandates reporting. Which of the following is correct?

The PT must report regardless of parental objection, as mandatory reporting supersedes confidentiality (Correct answer)
The PT must obtain parental consent before reporting
The PT should document findings but defer reporting to the physician
Reporting is optional if the parent denies abuse

Correct answer: The PT must report regardless of parental objection, as mandatory reporting supersedes confidentiality

Mandatory reporting laws require PTs to report suspected child abuse regardless of parental consent or confidentiality obligations.

Question 191: Which spirometry measurement represents the maximum volume exhaled forcefully in one second?

FEV1 (Correct answer)
TLC
RV
FVC

Correct answer: FEV1

FEV1 (Forced Expiratory Volume in 1 second) measures how much air can be expelled forcefully in the first second of a maximal exhalation.

Question 192: Functional electrical stimulation (FES) in rehabilitation is used to:

Reduce swelling only
Replace manual therapy
Increase bone density without exercise
Electrically activate paralyzed or weakened muscles to produce functional movement (Correct answer)

Correct answer: Electrically activate paralyzed or weakened muscles to produce functional movement

FES delivers electrical impulses to nerves or muscles to produce coordinated contractions in paralyzed or weak muscles, facilitating functional tasks like grasping or walking.

Question 193: The push-off power generated during terminal stance and pre-swing is primarily produced by which muscle group?

Hip flexors
Quadriceps
Plantar flexors (gastrocnemius and soleus) (Correct answer)
Hamstrings

Correct answer: Plantar flexors (gastrocnemius and soleus)

The plantar flexors (gastrocnemius and soleus) generate the primary propulsive power burst during terminal stance and pre-swing, providing forward propulsion and contributing to swing initiation.

Question 194: The overload principle in therapeutic exercise states that:

Light exercise is always superior to heavy exercise
Patients should exercise to failure at every session
Exercise intensity should remain constant throughout rehab
The body adapts only when subjected to a load greater than it is accustomed to (Correct answer)

Correct answer: The body adapts only when subjected to a load greater than it is accustomed to

The overload principle requires progressively increasing load, volume, or intensity beyond the body's current capacity to stimulate adaptation.

Question 195: A patient refuses a prescribed PT intervention, stating they understand the risks. The PT proceeds anyway. This action violates which legal concept?

Standard of care
Beneficence
Scope of practice
Informed consent and patient autonomy (Correct answer)

Correct answer: Informed consent and patient autonomy

Proceeding with treatment after a patient refuses violates the legal right to informed consent and patient autonomy, potentially constituting battery.

Question 196: During the stance phase of normal gait, the center of mass reaches its HIGHEST vertical position at which point?

Terminal stance
Pre-swing
Initial contact
Mid-stance (Correct answer)

Correct answer: Mid-stance

The center of mass reaches its highest vertical position during mid-stance when the body vaults over the supporting limb.

Question 197: A patient presents with weakness in wrist extension, finger extension, and thumb extension following a humeral shaft fracture. The nerve most likely damaged is:

Axillary nerve
Ulnar nerve
Radial nerve (posterior interosseous branch) (Correct answer)
Median nerve

Correct answer: Radial nerve (posterior interosseous branch)

Radial nerve palsy (at the mid-humerus) produces weakness of wrist, finger, and thumb extension (posterior interosseous nerve distribution), with wrist drop being the classic presentation.

Question 198: Which test is used to assess vertebral artery insufficiency before cervical manipulation?

Sharp-Purser test
Vertebral artery test (sustained end-range extension-rotation) (Correct answer)
Valsalva maneuver
Spurling test

Correct answer: Vertebral artery test (sustained end-range extension-rotation)

The vertebral artery (or VBI) test involves sustained end-range cervical extension-rotation to assess for vertebrobasilar insufficiency symptoms (dizziness, nystagmus, diplopia) indicating vascular compromise.

Question 199: The overload principle in resistance training states that muscle adaptations occur only when:

The same exercise is performed every day without variation
Training load exceeds what the body is currently accustomed to, progressively challenging the neuromuscular system (Correct answer)
Exercise is performed at the same load for extended periods
Exercise is performed to failure on every set

Correct answer: Training load exceeds what the body is currently accustomed to, progressively challenging the neuromuscular system

The overload principle requires that training stimulus progressively exceeds current capacity — muscles adapt to loads greater than habitual, so training intensity, volume, or complexity must be progressively increased.

Question 200: A study reports a p-value of 0.03. What does this most accurately indicate?

The effect size is small but meaningful
There is a 3% chance the intervention is clinically effective
The sample size was adequate for the study
There is a 3% probability of obtaining results as extreme as observed if the null hypothesis is true (Correct answer)

Correct answer: There is a 3% probability of obtaining results as extreme as observed if the null hypothesis is true

A p-value represents the probability of observing results as extreme as those obtained assuming the null hypothesis is true, not the probability that the treatment works.

Question 201: A patient cannot perform a heel-to-toe walk without losing balance. Which structure is most likely impaired?

Rotator cuff
Wrist extensors
Hip flexors
Cerebellum or proprioceptive pathways (Correct answer)

Correct answer: Cerebellum or proprioceptive pathways

Tandem gait (heel-to-toe walking) assesses cerebellar function and proprioception; failure suggests compromise of these systems.

Question 202: Straight leg raise (SLR) test positive at less than 60° indicates involvement of which structure?

Sciatic nerve or lumbar nerve roots L4–S1 (Correct answer)
Obturator nerve
Piriformis
Femoral nerve

Correct answer: Sciatic nerve or lumbar nerve roots L4–S1

A positive SLR below 60° indicates tension or irritation of the sciatic nerve or lumbar nerve roots, most commonly from disc herniation.

Question 203: The terrible triad knee injury involves which three structures?

ACL, PCL, and medial meniscus
ACL, LCL, and lateral meniscus
PCL, MCL, and lateral meniscus
ACL, MCL, and medial meniscus (Correct answer)

Correct answer: ACL, MCL, and medial meniscus

The terrible triad (O'Donoghue triad) classically describes combined injury to the ACL, MCL, and medial meniscus, typically from a valgus-external rotation force.

Question 204: Developmental dysplasia of the hip (DDH) is commonly detected in infants using which clinical tests?

Thomas test and Ober's test
Galeazzi sign only
Trendelenburg test and FABER test
Ortolani and Barlow tests (Correct answer)

Correct answer: Ortolani and Barlow tests

The Ortolani test relocates a dislocated hip and the Barlow test provocatively dislocates a lax hip, together screening for DDH in newborns.

Question 205: The H-reflex in electromyographic testing is the electrical analogue of which clinical reflex?

Patellar tendon reflex (L3-L4)
Babinski reflex
Biceps reflex (C5-C6)
Achilles tendon reflex (S1-S2) (Correct answer)

Correct answer: Achilles tendon reflex (S1-S2)

The H-reflex tests the S1 reflex arc (afferent Ia fibers to spinal cord to efferent motor fibers to soleus) and is the electrophysiological equivalent of the clinical Achilles tendon or ankle jerk reflex.

Question 206: Physical therapists should be knowledgeable of the training background, professional standards, and current challenges affecting physical therapist assistants. Which of the following statements is untrue?

It is cost effective to employ physical therapist assistants.
Physical therapist assistants may be affiliate members of the APTA.
Career advancement may be limited in many facilities for the physical therapist assistant.
Physical therapist assistants are regulated in all 50 states. (Correct answer)

Correct answer: Physical therapist assistants are regulated in all 50 states.

While Physical Therapist Assistants (PTAs) are regulated in the vast majority of states, it is not universally true that they are regulated in *all* 50 states. The specific licensure, certification, and supervision requirements for PTAs can vary considerably across different states, with some having unique or less stringent regulations. Therefore, the statement that they are regulated in all 50 states is untrue.

Question 207: Under the Americans with Disabilities Act (ADA), a physical therapy clinic must provide reasonable accommodations. Which scenario best exemplifies an 'undue hardship' exemption?

Installing a ramp in a large hospital system
Widening a doorway to meet ADA standards
Training staff on disability etiquette
Purchasing a Braille-capable communication device for a small solo-practice clinic with limited revenue (Correct answer)

Correct answer: Purchasing a Braille-capable communication device for a small solo-practice clinic with limited revenue

Undue hardship applies when an accommodation imposes significant difficulty or expense relative to the size and financial resources of the organization.

Question 208: Clonus, observed at the ankle, is indicative of:

Peripheral nerve damage
Muscle strain
Ligamentous laxity
Upper motor neuron lesion with hyperreflexia (Correct answer)

Correct answer: Upper motor neuron lesion with hyperreflexia

Clonus is rhythmic involuntary muscle contractions triggered by sustained passive stretch, indicating upper motor neuron hyperexcitability.

Question 209: Aquatic therapy offers which primary physiological advantage for patients with significant joint pain or weight-bearing restrictions?

Buoyancy reduces effective body weight, allowing exercise with decreased joint compression forces (Correct answer)
It provides direct electrical stimulation to weakened muscles
Water resistance is lower than air, reducing muscle demand
It increases cardiovascular load greater than land-based exercise

Correct answer: Buoyancy reduces effective body weight, allowing exercise with decreased joint compression forces

Water buoyancy reduces effective body weight by up to 90% (at neck depth), allowing patients with severe arthritis, post-surgical restrictions, or pain to exercise with dramatically reduced joint loading.

Question 210: Other names for the problem-oriented medical record (POMR) include:

System-related record
Weed system
SOAP system (Correct answer)
Source-related system

Correct answer: SOAP system

The Problem-Oriented Medical Record (POMR) system, developed by Dr. Lawrence Weed, organizes patient information around identified problems. The SOAP note format (Subjective, Objective, Assessment, Plan) is the primary method used within the POMR system to document progress and plans for each specific problem. Consequently, the POMR is often referred to as the SOAP system due to this integral relationship.

Question 211: Which standardized assessment is used to evaluate gross motor function in children with cerebral palsy?

Alberta Infant Motor Scale
Gross Motor Function Measure (GMFM) (Correct answer)
Bayley Scales of Infant Development
Peabody Developmental Motor Scales

Correct answer: Gross Motor Function Measure (GMFM)

The Gross Motor Function Measure (GMFM) is the gold standard for evaluating and tracking gross motor ability in children with cerebral palsy.

Question 212: A physical therapist assistant records that the patient "complained of back pain when sitting" in a problem-focused medical record. Where should this information be inserted in the SOAP note?

Objective
Subjective (Correct answer)
Assessment
Plan

Correct answer: Subjective

The 'Subjective' section (S) of a SOAP note is dedicated to information reported by the patient or their family. This includes their chief complaint, symptoms, relevant history, and how they perceive their condition. A patient's complaint of 'back pain when sitting' is a direct report of their personal experience and symptoms, making it subjective data.

Question 213: A therapist applies moist heat to reduce muscle spasm before exercise. This modality primarily acts via which mechanism?

Increased sympathetic vasoconstriction
Increased nerve conduction velocity
Decreased collagen extensibility
Reduced alpha motor neuron excitability via Golgi tendon organ activation (Correct answer)

Correct answer: Reduced alpha motor neuron excitability via Golgi tendon organ activation

Superficial heat reduces alpha motor neuron excitability partly through stimulation of Golgi tendon organs, decreasing muscle tone and spasm.

Question 214: When a PT student intern performs a treatment under the direct supervision of a licensed PT, who bears primary legal responsibility for the treatment?

The referring physician
The supervising licensed PT (Correct answer)
The student intern alone
The facility administration

Correct answer: The supervising licensed PT

The supervising licensed PT bears primary legal responsibility for treatments performed by students under their direct supervision.

Question 215: Aquatic therapy is advantageous for rehabilitation primarily because water provides:

Only resistance — no unloading effect
Greater gravitational load than land
Buoyancy to reduce weight-bearing and resistance for movement (Correct answer)
Thermal cooling that reduces muscle activity

Correct answer: Buoyancy to reduce weight-bearing and resistance for movement

Water buoyancy reduces effective body weight (up to 90% at neck depth), allowing earlier exercise with reduced joint loading while providing resistance in all directions.

Question 216: Which research design is most appropriate for establishing cause-and-effect relationships between an intervention and an outcome?

Cohort study
Randomized controlled trial (Correct answer)
Case-control study
Cross-sectional study

Correct answer: Randomized controlled trial

Randomized controlled trials are the gold standard for establishing causality because randomization distributes confounders equally and allows direct comparison of treatment effects.

Question 217: The PICO framework used in evidence-based practice stands for:

Patient, Issue, Criteria, Outcome
Problem, Indicator, Clinical, Objective
Population, Interest, Control, Observation
Patient, Intervention, Comparison, Outcome (Correct answer)

Correct answer: Patient, Intervention, Comparison, Outcome

PICO (Patient/Population, Intervention, Comparison, Outcome) provides a structured format for formulating answerable clinical questions to guide efficient literature searches.

Question 218: Internal validity in a research study refers to:

The consistency of measurements across different raters
The degree to which results can be generalized to other populations
The accuracy of the measurement instruments used
The extent to which the study design supports valid conclusions about cause and effect within the study (Correct answer)

Correct answer: The extent to which the study design supports valid conclusions about cause and effect within the study

Internal validity reflects how well the study controls for confounders and biases, allowing valid causal conclusions to be drawn about the relationship studied.

Question 219: The FIFA 11+ warm-up program is designed to prevent injuries in which sport?

Soccer (football) (Correct answer)
Basketball
Rugby
American football

Correct answer: Soccer (football)

FIFA 11+ is a structured 20-minute warm-up program developed for amateur soccer players, shown to reduce injuries by up to 50%.

Question 220: Which federal act prohibits healthcare providers from referring patients to entities with which they have a financial relationship, unless a specific exception applies?

EMTALA
Stark Law (Physician Self-Referral Law) (Correct answer)
HIPAA Privacy Rule
Anti-Kickback Statute

Correct answer: Stark Law (Physician Self-Referral Law)

The Stark Law prohibits physician self-referrals for designated health services (including PT) to entities in which the physician has a financial interest, absent an exception.

Question 221: Plyometric training is most appropriate at which stage of rehabilitation following a lower extremity injury?

When pain is completely absent during all daily activities
Immediately post-surgery to maintain neural drive
When the patient has achieved greater than 90% limb symmetry index on strength tests and passed criteria-based functional tests (Correct answer)
At 6 weeks post-surgery regardless of strength level

Correct answer: When the patient has achieved greater than 90% limb symmetry index on strength tests and passed criteria-based functional tests

Plyometric training should begin when the patient has achieved greater than 90% limb symmetry on strength tests (typically single-leg hop, triple hop), acceptable pain levels, and full functional ROM.

Question 222: In a prospective cohort study, participants are:

Randomly assigned to treatment or control conditions
Matched based on similar demographic and clinical characteristics
Selected because they already have the outcome of interest
Identified by exposure status and followed forward in time to observe outcomes (Correct answer)

Correct answer: Identified by exposure status and followed forward in time to observe outcomes

In prospective cohort studies, participants are enrolled based on exposure status before the outcome occurs and then followed forward in time to observe outcome incidence.

Question 223: The Timed Up and Go (TUG) test measures:

Functional mobility and fall risk (Correct answer)
Grip strength
Upper extremity coordination only
Aerobic capacity

Correct answer: Functional mobility and fall risk

The TUG test times a patient rising from a chair, walking 3 meters, turning, returning, and sitting, providing a measure of functional mobility and fall risk.

Question 224: In the concave-convex rule, when a convex surface moves on a fixed concave surface, the glide occurs in which direction relative to the bone motion?

Opposite direction to the bone motion (Correct answer)
Perpendicular to bone motion
No glide occurs
Same direction as the bone motion

Correct answer: Opposite direction to the bone motion

When a convex surface moves on a concave surface, the joint glide is opposite to the direction of bone movement (Kaltenborn's rule).

Question 225: The single-leg squat test (repetitions to fatigue at 60 degrees of knee flexion) is used to assess which quality in patients with patellofemoral pain?

Ankle dorsiflexion mobility
Star Excursion Balance Test (SEBT) performance
Quadriceps endurance and neuromuscular control (Correct answer)
Hamstring-to-quadriceps ratio

Correct answer: Quadriceps endurance and neuromuscular control

The single-leg squat test (repetitions to fatigue at 60 degrees flexion) is used to assess quadriceps endurance and neuromuscular control as an outcome measure for patellofemoral pain syndrome rehabilitation.

National Physical Therapy Examination (NPTE-PT)

The NPTE-PT is the national licensing exam for physical therapists in the United States, administered by FSBPT. It tests clinical knowledge and decision-making across body systems and non-systems domains required for entry-level PT practice.

225

Questions

300 min

Time Limit

75%

To Pass

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